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Tanii R, Hayashi K, Naito T, Shui-Yee Wong Z, Yoshida T, Hayashi K, Fujitani S. Impact of dynamic parameter of trends in vital signs on the prediction of serious events in hospitalized patients -a retrospective observational study. Resusc Plus 2024; 18:100628. [PMID: 38617440 PMCID: PMC11015492 DOI: 10.1016/j.resplu.2024.100628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/16/2024] Open
Abstract
Aim Although early detection of patients' deterioration may improve outcomes, most of the detection criteria use on-the-spot values of vital signs. We investigated whether adding trend values over time enhanced the ability to predict adverse events among hospitalized patients. Methods Patients who experienced adverse events, such as unexpected cardiac arrest or unplanned ICU admission were enrolled in this retrospective study. The association between the events and the combination of vital signs was evaluated at the time of the worst vital signs 0-8 hours before events (near the event) and at 24-48 hours before events (baseline). Multivariable logistic analysis was performed, and the area under the receiver operating characteristic curve (AUC) was used to assess the prediction power for adverse events among various combinations of vital sign parameters. Results Among 24,509 in-patients, 54 patients experienced adverse events(cases) and 3,116 control patients eligible for data analysis were included. At the timepoint near the event, systolic blood pressure (SBP) was lower, heart rate (HR) and respiratory rate (RR) were higher in the case group, and this tendency was also observed at baseline. The AUC for event occurrence with reference to SBP, HR, and RR was lower when evaluated at baseline than at the timepoint near the event (0.85 [95%CI: 0.79-0.92] vs. 0.93 [0.88-0.97]). When the trend in RR was added to the formula constructed of baseline values of SBP, HR, and RR, the AUC increased to 0.92 [0.87-0.97]. Conclusion Trends in RR may enhance the accuracy of predicting adverse events in hospitalized patients.
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Affiliation(s)
- Rimi Tanii
- Department of Emergency and Critical Care Medicine, St Marianna University Yokohama Seibu Hospital, 1197-1 Yasushi-cho, Asahi-ku, Yokohama, Kanagawa, Japan
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Kuniyoshi Hayashi
- Faculty of Data Science, Kyoto Women’s University, 35 Kitahiyoshi-cho, Imakumano, Higashiyama-ku, Kyoto, Japan
| | - Takaki Naito
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Zoie Shui-Yee Wong
- Graduate School of Public Health, St. Luke’s International University Omura Susumu & Mieko Memorial St.Luke’s Center for Clinical Academia, 5th floor, 3-6-2 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Toru Yoshida
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Koichi Hayashi
- Department of Emergency and Critical Care Medicine, St Marianna University Yokohama Seibu Hospital, 1197-1 Yasushi-cho, Asahi-ku, Yokohama, Kanagawa, Japan
| | - Shigeki Fujitani
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
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Peng P, Manini AF. Diagnostic utility of capnography in emergency department triage for screening acidemia: a pilot study. Int J Emerg Med 2024; 17:57. [PMID: 38649817 PMCID: PMC11036727 DOI: 10.1186/s12245-024-00631-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Capnography is a quantitative and reliable method of determining the ventilatory status of patients. We describe the test characteristics of capnography obtained during Emergency Department triage for screening acidemia. RESULTS We performed an observational, pilot study of adult patients presenting to Emergency Department (ED) triage. The primary outcome was acidemia, as determined by the basic metabolic panel and/or blood gas during the ED visit. Secondary outcomes include comparison of estimated and measured respiratory rates (RR), relationships between end-tidal CO2 (EtCO2) and venous partial pressure of CO2, admission disposition, in-hospital mortality during admission, and capnogram waveform analysis. A total of 100 adult ED encounters were included in the study and acidemia ([Formula: see text] or [Formula: see text]) was identified in 28 patients. The measured respiratory rate (20.3 ± 6.4 breaths/min) was significantly different from the estimated rate (18.4 ± 1.6 breaths/min), and its area under the receiver operating curve (c-statistic) to predict acidemia was only 0.60 (95% CI 0.51-0.75, p = 0.03). A low end-tidal CO2 (EtCO2 < 32 mmHg) had positive (LR+) and negative (LR-) likelihood ratios of 4.68 (95% CI 2.59-8.45) and 0.34 (95% CI 0.19-0.61) for acidemia, respectively-corresponding to sensitivity 71.4% (95% CI 51.3-86.8) and specificity 84.7% (95% CI 74.3-92.1). The c-statistic for EtCO2 was 0.849 (95% CI 0.76-0.94, p = 0.00). Waveform analysis further revealed characteristically abnormal capnograms that were associated with underlying pathophysiology. CONCLUSIONS Capnography is a quantitative method of screening acidemia in patients and can be implemented feasibly in Emergency Department triage as an adjunct to vital signs. While it was shown to have only modest ability to predict acidemia, triage capnography has wide generalizability to screen other life-threatening disease processes such as sepsis or can serve as an early indicator of clinical deterioration.
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Affiliation(s)
- Paul Peng
- Department of Emergency Medicine, The State University of New Jersey, 08901, Rutgers, New Brunswick, NJ, United States of America.
| | - Alex F Manini
- Division of Medical Toxicology, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 10029, New York, NY, United States of America
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Gu Q, Wei J, Yoon CH, Yuan K, Jones N, Brent A, Llewelyn M, Peto TEA, Pouwels KB, Eyre DW, Walker AS. Distinct patterns of vital sign and inflammatory marker responses in adults with suspected bloodstream infection. J Infect 2024; 88:106156. [PMID: 38599549 DOI: 10.1016/j.jinf.2024.106156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/01/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVES To identify patterns in inflammatory marker and vital sign responses in adult with suspected bloodstream infection (BSI) and define expected trends in normal recovery. METHODS We included patients ≥16 y from Oxford University Hospitals with a blood culture taken between 1-January-2016 and 28-June-2021. We used linear and latent class mixed models to estimate trajectories in C-reactive protein (CRP), white blood count, heart rate, respiratory rate and temperature and identify CRP response subgroups. Centile charts for expected CRP responses were constructed via the lambda-mu-sigma method. RESULTS In 88,348 suspected BSI episodes; 6908 (7.8%) were culture-positive with a probable pathogen, 4309 (4.9%) contained potential contaminants, and 77,131(87.3%) were culture-negative. CRP levels generally peaked 1-2 days after blood culture collection, with varying responses for different pathogens and infection sources (p < 0.0001). We identified five CRP trajectory subgroups: peak on day 1 (36,091; 46.3%) or 2 (4529; 5.8%), slow recovery (10,666; 13.7%), peak on day 6 (743; 1.0%), and low response (25,928; 33.3%). Centile reference charts tracking normal responses were constructed from those peaking on day 1/2. CONCLUSIONS CRP and other infection response markers rise and recover differently depending on clinical syndrome and pathogen involved. However, centile reference charts, that account for these differences, can be used to track if patients are recovering line as expected and to help personalise infection.
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Affiliation(s)
- Qingze Gu
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jia Wei
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Chang Ho Yoon
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kevin Yuan
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nicola Jones
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrew Brent
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Tim E A Peto
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
| | - Koen B Pouwels
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
| | - David W Eyre
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
| | - A Sarah Walker
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK.
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Ramgopal S, Sepanski RJ, Gorski JK, Chaudhari PP, Spurrier RG, Horvat CM, Macy ML, Cash R, Martin-Gill C. Centiles for the shock index among injured children in the prehospital setting. Am J Emerg Med 2024; 80:149-155. [PMID: 38608467 DOI: 10.1016/j.ajem.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVE The shock index (SI), the ratio of heart rate to systolic blood pressure, is a clinical tool for assessing injury severity. Age-adjusted SI models may improve predictive value for injured children in the out-of-hospital setting. We sought to characterize the proportion of children in the prehospital setting with an abnormal SI using established criteria, describe the age-based distribution of SI among injured children, and determine prehospital interventions by SI. METHODS We performed a multi-agency retrospective cross-sectional study of children (<18 years) in the prehospital setting with a scene encounter for suspected trauma and transported to the hospital between 2018 and 2022 using the National Emergency Medical Services (EMS) Information System datasets. Our exposure of interest was the first calculated SI. We identified the proportion of children with an abnormal SI when using the SI, pediatric age-adjusted (SIPA); and the pediatric SI (PSI) criteria. We developed and internally validated an age-based distributional model for the SI using generalized additive models for location, scale, and shape to describe the age-based distribution of the SI as a centile or Z-score. We evaluated EMS interventions (basic airway interventions, advanced airway interventions, cardiac interventions, vascular access, intravenous fluids, and vasopressor use) in relation to both the SIPA, PSI, and distributional SI values. RESULTS We analyzed 1,007,863 pediatric EMS trauma encounters (55.0% male, median age 13 years [IQR, 8-16 years]). The most common dispatch complaint was for traffic/transport related injury (32.9%). When using the PSI and SIPA, 13.1% and 16.3% were classified as having an abnormal SI, respectively. There were broad differences in the percentage of encounters classified as having an abnormal SI across the age range, varying from 5.1 to 22.8% for SIPA and 3.7-20.1% for PSI. The SIPA values ranged from the 75th to 95th centiles, while the PSI corresponded to an SI greater than the 90th centile, except in older children. The centile distribution for SI declined during early childhood and stabilized during adolescence and demonstrated a difference of <0.1% at cutoff values. An abnormal PSI, SIPA and higher SI centiles (>90th centile and >95th centiles) were associated with interventions related to basic and advanced airway management, cardiac procedures, vascular access, and provision of intravenous fluids occurred with greater frequency at higher SI centiles. Some procedures, including airway management and vascular access, had a smaller peak at lower (<10th) centiles. DISCUSSION We describe the empiric distribution of the pediatric SI across the age range, which may overcome limitations of extant criteria in identifying patients with shock in the prehospital setting. Both high and low SI values were associated with important, potentially lifesaving EMS interventions. Future work may allow for more precise identification of children with significant injury using cutpoint analysis paired to outcome-based criteria. These may additionally be combined with other physiologic and mechanistic criteria to assist in triage decisions.
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Affiliation(s)
- Sriram Ramgopal
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Robert J Sepanski
- Department of Quality and Safety, Children's Hospital of The King's Daughters, Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Jillian K Gorski
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Pradip P Chaudhari
- Division of Emergency and Transport Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Ryan G Spurrier
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California Los Angeles, Los Angeles, CA, USA
| | - Christopher M Horvat
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michelle L Macy
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rebecca Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christian Martin-Gill
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Wu F, Wu C, Wu Q, Yan F, Xiao Y, Du C. Prediction of Death in Intracerebral Hemorrhage Patients After Minimally Invasive Surgery by Vital Signs and Blood Glucose. World Neurosurg 2024; 184:e84-e94. [PMID: 38244679 DOI: 10.1016/j.wneu.2024.01.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE This study examined the impact of vital signs and blood glucose levels on the long-term prognosis of intracerebral hemorrhage (ICH) patients treated with minimally invasive surgery (MIS). METHODS The patients diagnosed with ICH and treated with MIS within 24 hours of admission at the ∗∗ Hospital between January 2020 and October 2021 were included. The relationship between a range of indicators, including vital signs, blood glucose levels, and patient mortality at discharge and 3 or 12 months postdischarge were analyzed. RESULTS A total of 195 consecutive patients were included, of which 16 patients passed away during hospitalization, 29 and 34 within 3 and 12 months postdischarge, respectively. The multivariate analysis revealed that hospital death positively correlated with age ≥66.50 years, fasting blood glucose ≥8.25 mmol/L on the third day after MIS, systolic blood pressure ≥166.00 mmHg on the third day, and heart rate ≥89.50 beats/min at discharge (area under the curve [AUC] = 0.927). Death at 3 months positively correlated with male sex, blood glucose before dinner ≥8.15 mmol/L on the second day after MIS, body temperature ≥36.95°C at discharge, and heart rate ≥89.50 beats/minute at discharge (AUC = 0.810). Death at 12 months positively correlated with age ≥61.50 years, body temperature ≥36.95°C at discharge, and heart rate ≥92.50 beats/min on the third day after MIS (AUC = 0.824). CONCLUSIONS The prognosis of ICH patients after MIS is closely related to their vital signs and blood glucose levels at various stages of hospitalization.
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Affiliation(s)
- Fang Wu
- Department of Neurology, Chongqing University Three Gorges Hospital, Wanzhou, Chongqing, China; School of Medicine, Chongqing University, Chongqing, China
| | - Chuyue Wu
- Department of Neurology, Chongqing University Three Gorges Hospital, Wanzhou, Chongqing, China; School of Medicine, Chongqing University, Chongqing, China; Chongqing Municipality Clinical Research Center for Geriatric Diseases, Chongqing University Three Gorges Hospital, Wanzhou, Chongqing, China; NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qingyuan Wu
- Department of Neurology, Chongqing University Three Gorges Hospital, Wanzhou, Chongqing, China; School of Medicine, Chongqing University, Chongqing, China; Chongqing Municipality Clinical Research Center for Geriatric Diseases, Chongqing University Three Gorges Hospital, Wanzhou, Chongqing, China; NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fei Yan
- School of Medicine, Chongqing University, Chongqing, China; Chongqing Municipality Clinical Research Center for Geriatric Diseases, Chongqing University Three Gorges Hospital, Wanzhou, Chongqing, China
| | - Yaping Xiao
- School of Medicine, Chongqing University, Chongqing, China; Department of Pharmacy, Chongqing University Three Gorges Hospital, Wanzhou, Chongqing, China
| | - Cuiping Du
- Department of Neurology, Chongqing University Three Gorges Hospital, Wanzhou, Chongqing, China; School of Medicine, Chongqing University, Chongqing, China.
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Funabiki S, Yamamoto R, Homma K, Yoshizawa J, Jia S, Takanashi Y, Kahara R, Sasaki J. Delta Shock Index and higher incidence of emergency surgery in older adults with blunt trauma. Eur J Trauma Emerg Surg 2024; 50:561-566. [PMID: 38285212 DOI: 10.1007/s00068-023-02438-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE Vital signs are important for predicting clinical outcomes in patients with trauma. However, their accuracy can be affected in older adults because hemodynamic changes are less obvious. This study aimed to examine the usefulness of changes in vital signs during transportation in predicting the need for hemostatic treatments in older patients with trauma. METHODS This retrospective cohort study was conducted using data from the Japan Trauma Data Bank (2004-2019). Patients aged ≥ 65 years who were hemodynamically stable at the scene were included in this study. The incidence of emergency surgery within 12 h after hospital arrival was compared between patients with delta Shock Index (dSI) > 0.1 and those with dSI ≤ 0.1. Predicting ability was examined after adjusting for patient demographics, comorbidities, vital signs at the scene and on hospital arrival, Injury Severity Score, and abbreviated injury scale in each region. RESULTS Among the 139,242 patients eligible for the study, 3,701 underwent urgent hemostatic surgery within 12 h. Patients with dSI > 0.1 showed a significantly higher incidence of emergency surgery than those with dSI ≤ 0.1 (871/16,549 [5.3%] vs. 2,830/84,250 [3.4%]; odds ratio (OR), 1.60 [1.48-1.73]; adjusted OR, 1.22 [1.08-1.38]; p = 0.001). The relationship between high dSI and a higher incidence of intervention was observed in patients with hypertension and those with decreased consciousness on arrival. CONCLUSION High dSI > 0.1 was significantly associated with a higher incidence of urgent hemostatic surgery in older patients.
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Affiliation(s)
- Shoma Funabiki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, 160-8582, Shinjuku, Tokyo, Japan
| | - Ryo Yamamoto
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, 160-8582, Shinjuku, Tokyo, Japan.
| | - Koichiro Homma
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, 160-8582, Shinjuku, Tokyo, Japan
| | - Jo Yoshizawa
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, 160-8582, Shinjuku, Tokyo, Japan
| | - Siqi Jia
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, 160-8582, Shinjuku, Tokyo, Japan
| | - Yukako Takanashi
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, 160-8582, Shinjuku, Tokyo, Japan
| | - Reo Kahara
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, 160-8582, Shinjuku, Tokyo, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, 160-8582, Shinjuku, Tokyo, Japan
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Chang P, Li H, Quan SF, Lu S, Wung SF, Roveda J, Li A. A transformer-based diffusion probabilistic model for heart rate and blood pressure forecasting in Intensive Care Unit. Comput Methods Programs Biomed 2024; 246:108060. [PMID: 38350189 PMCID: PMC10940190 DOI: 10.1016/j.cmpb.2024.108060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 12/21/2023] [Accepted: 01/12/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND AND OBJECTIVE Vital sign monitoring in the Intensive Care Unit (ICU) is crucial for enabling prompt interventions for patients. This underscores the need for an accurate predictive system. Therefore, this study proposes a novel deep learning approach for forecasting Heart Rate (HR), Systolic Blood Pressure (SBP), and Diastolic Blood Pressure (DBP) in the ICU. METHODS We extracted 24,886 ICU stays from the MIMIC-III database which contains data from over 46 thousand patients, to train and test the model. The model proposed in this study, Transformer-based Diffusion Probabilistic Model for Sparse Time Series Forecasting (TDSTF), merges Transformer and diffusion models to forecast vital signs. The TDSTF model showed state-of-the-art performance in predicting vital signs in the ICU, outperforming other models' ability to predict distributions of vital signs and being more computationally efficient. The code is available at https://github.com/PingChang818/TDSTF. RESULTS The results of the study showed that TDSTF achieved a Standardized Average Continuous Ranked Probability Score (SACRPS) of 0.4438 and a Mean Squared Error (MSE) of 0.4168, an improvement of 18.9% and 34.3% over the best baseline model, respectively. The inference speed of TDSTF is more than 17 times faster than the best baseline model. CONCLUSION TDSTF is an effective and efficient solution for forecasting vital signs in the ICU, and it shows a significant improvement compared to other models in the field.
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Affiliation(s)
- Ping Chang
- Department of Electrical & Computer Engineering, The University of Arizona, Tucson, AZ, USA
| | - Huayu Li
- Department of Electrical & Computer Engineering, The University of Arizona, Tucson, AZ, USA
| | - Stuart F Quan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Asthma and Airway Disease Research Center, College of Medicine, The University of Arizona, Tucson, AZ, USA
| | - Shuyang Lu
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, PR China; The Shanghai Institute of Cardiovascular Diseases, Shanghai, PR China
| | - Shu-Fen Wung
- Bio5 Institute, The University of Arizona, Tucson, AZ, USA; College of Nursing, The University of Arizona, Tucson, AZ, USA
| | - Janet Roveda
- Department of Electrical & Computer Engineering, The University of Arizona, Tucson, AZ, USA; Bio5 Institute, The University of Arizona, Tucson, AZ, USA; Department of Biomedical Engineering, The University of Arizona, Tucson, AZ, USA
| | - Ao Li
- Department of Electrical & Computer Engineering, The University of Arizona, Tucson, AZ, USA; Bio5 Institute, The University of Arizona, Tucson, AZ, USA.
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Mbuthia N, Kagwanja N, Ngari M, Boga M. General ward nurses detection and response to clinical deterioration in three hospitals at the Kenyan coast: a convergent parallel mixed methods study. BMC Nurs 2024; 23:143. [PMID: 38429750 PMCID: PMC10905788 DOI: 10.1186/s12912-024-01822-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 02/22/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND In low and middle-income countries like Kenya, critical care facilities are limited, meaning acutely ill patients are managed in the general wards. Nurses in these wards are expected to detect and respond to patient deterioration to prevent cardiac arrest or death. This study examined nurses' vital signs documentation practices during clinical deterioration and explored factors influencing their ability to detect and respond to deterioration. METHODS This convergent parallel mixed methods study was conducted in the general medical and surgical wards of three hospitals in Kenya's coastal region. Quantitative data on the extent to which the nurses monitored and documented the vital signs 24 h before a cardiac arrest (death) occurred was retrieved from patients' medical records. In-depth, semi-structured interviews were conducted with twenty-four purposefully drawn registered nurses working in the three hospitals' adult medical and surgical wards. RESULTS This study reviewed 405 patient records and found most of the documentation of the vital signs was done in the nursing notes and not the vital signs observation chart. During the 24 h prior to death, respiratory rate was documented the least in only 1.2% of the records. Only a very small percentage of patients had any vital event documented for all six-time points, i.e. four hourly. Thematic analysis of the interview data identified five broad themes related to detecting and responding promptly to deterioration. These were insufficient monitoring of vital signs linked to limited availability of equipment and supplies, staffing conditions and workload, lack of training and guidelines, and communication and teamwork constraints among healthcare workers. CONCLUSION The study showed that nurses did not consistently monitor and record vital signs in the general wards. They also worked in suboptimal ward environments that do not support their ability to promptly detect and respond to clinical deterioration. The findings illustrate the importance of implementation of standardised systems for patient assessment and alert mechanisms for deterioration response. Furthermore, creating a supportive work environment is imperative in empowering nurses to identify and respond to patient deterioration. Addressing these issues is not only beneficial for the nurses but, more importantly, for the well-being of the patients they serve.
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Affiliation(s)
- Nickcy Mbuthia
- Department of Medical Surgical Nursing, School of Health Sciences, Kenyatta University, Nairobi, Kenya.
| | - Nancy Kagwanja
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya
| | - Moses Ngari
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya
| | - Mwanamvua Boga
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya
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Gielen AHC, Schoenmakers M, Breukink SO, Winkens B, van der Horst J, Wevers KP, Melenhorst J. The value of C-reactive protein, leucocytes and vital signs in detecting major complications after oncological colorectal surgery. Langenbecks Arch Surg 2024; 409:76. [PMID: 38409295 PMCID: PMC10896856 DOI: 10.1007/s00423-024-03266-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/19/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE To assess the association of postoperative C-reactive protein (CRP), leucocytes and vital signs in the first three postoperative days (PODs) with major complications after oncological colorectal resections in a tertiary referral centre for colorectal cancer in The Netherlands. METHODS A retrospective cohort study, including 594 consecutive patients who underwent an oncological colorectal resection at Maastricht University Medical Centre between January 2016 and December 2020. Descriptive analyses of patient characteristics were performed. Logistic regression models were used to assess associations of leucocytes, CRP and Modified Early Warning Score (MEWS) at PODs 1-3 with major complications. Receiver operating characteristic curve analyses were used to establish cut-off values for CRP. RESULTS A total of 364 (61.3%) patients have recovered without any postoperative complications, 134 (22.6%) patients have encountered minor complications and 96 (16.2%) developed major complications. CRP levels reached their peak on POD 2, with a mean value of 155 mg/L. This peak was significantly higher in patients with more advanced stages of disease and patients undergoing open procedures, regardless of complications. A cut-off value of 170 mg/L was established for CRP on POD 2 and 152 mg/L on POD 3. Leucocytes and MEWS also demonstrated a peak on POD 2 for patients with major complications. CONCLUSIONS Statistically significant associations were found for CRP, Δ CRP, Δ leucocytes and MEWS with major complications on POD 2. Patients with CRP levels ≥ 170 mg/L on POD 2 should be carefully evaluated, as this may indicate an increased risk of developing major complications.
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Affiliation(s)
- Anke H C Gielen
- Department of Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.
| | - Maud Schoenmakers
- Department of Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Stephanie O Breukink
- Department of Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jischmaël van der Horst
- Department of Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Kevin P Wevers
- Department of Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Jarno Melenhorst
- Department of Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
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Akgül EA, Yanar N. The effectiveness of the therapeutic toys on the comfort level and vital signs of the neonates during intravenous cannula insertion (Comfiestudy): A randomized controlled trial. J Pediatr Nurs 2024:S0882-5963(24)00015-0. [PMID: 38267276 DOI: 10.1016/j.pedn.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE This study was planned to determine the effect of the therapeutic toy used during IV cannula insertion on the comfort level, crying time and vital signs of neonates. METHODS The sample (n = 38) was randomized to the Control and the Comfie Groups. Vital signs were measured before, during, and after the IV cannula insertion. Comfort levels and the duration of crying were measured during the insertion. RESULTS Neonates in the Comfie Group had lower pulse and higher saturation levels during the insertion, and they had lower respiration rates and pulse but higher oxygen saturation levels at the post 1st-5th minute. They were more comfortable than the neonates in the control group. DISCUSSION The result of this research reveals that therapeutic toys applied during the IV cannula insertion in neonates increase the comfort level and stabilize the vital signs. APPLICATION TO PRACTICE The use of toys during IV cannula insertion could be an effective nonpharmacological method to improve outcomes.
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Affiliation(s)
- Esra Ardahan Akgül
- İzmir Kâtip Çelebi University, Faculty of Health Sciences, Department of Pediatric Nursing, İzmir, Turkey.
| | - Nisa Yanar
- Izmir Can Hospital, Neonatal Intensive Care Unit, İzmir, Turkey
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11
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Nazari-Ostad Z, Namazinia M, Hajiabadi F, Aghebati N, Esmaily H, Peivandi Yazdi A. Effect of protocol-based family visitation on physiological indicators in ICU patients: a randomized controlled trial. BMC Anesthesiol 2024; 24:18. [PMID: 38195443 PMCID: PMC10775482 DOI: 10.1186/s12871-023-02396-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/25/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Intensive care unit (ICU) patients often experience significant physiological stress. This study evaluated the effect of a defined family visitation protocol on physiological responses in the ICU. METHODS A randomized, block-randomized clinical trial was conducted on 78 ICU patients at Imam Reza Hospital between February 8, 2017, and August 8, 2017. The intervention group received protocol-based visits, and the control group continued with standard visitation. Block randomization was utilized for group assignments. The primary outcome was the measurement of physiological signs using designated monitoring devices. Data were analyzed using SPSS version 22, employing independent t-tests, Mann-Whitney U test, repeated measures analysis, and Friedman's test. RESULTS The results showed no significant differences in systolic blood pressure, diastolic blood pressure, mean arterial pressure, respiratory rate, and arterial blood oxygen levels between the two groups. However, heart rate in the intervention group was significantly lower in three stages before, during, and after the meaningful visiting (P = 0.008). CONCLUSION Protocol-based scheduled family visits in the ICU may reduce physiological stress, as evidenced by a decrease in patients' heart rate. Implementing tailored visitation protocols sensitive to patient preferences and clinical contexts is advisable, suggesting the integration of family visits into standard care practices for enhanced patient outcomes. TRIAL REGISTRATION IRCT20161229031654N2; 25/01/2018; Iranian Registry of Clinical Trials ( https://en.irct.ir ).
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Affiliation(s)
- Zahra Nazari-Ostad
- Department of Medical- Surgical Nursing (MSC Student), School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Namazinia
- Department of Nursing, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Fatemeh Hajiabadi
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Nahid Aghebati
- Department of Medical- Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Habibollah Esmaily
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Arash Peivandi Yazdi
- Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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12
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Bal SK, Gun M. The effects of acupressure on pain, anxiety and vital signs in patients undergoing coronary angiography: A randomized and sham-controlled trial. Explore (NY) 2024; 20:101-109. [PMID: 37429762 DOI: 10.1016/j.explore.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 07/12/2023]
Abstract
AIM This randomised sham-controlled trial aimed to analyse the effects of acupressure on pain, anxiety, and vital signs in patients who underwent coronary angiography. MATERIALS AND METHODS After undergoing coronary angiography, 105 patients were randomised into acupressure (n = 35), sham acupressure (n = 35), and control groups (n = 35). Patients in the acupressure group received acupressure on the heart meridian 7 (HT7), large intestine meridian 4 (LI4), and pericardium meridian (PC6) acupoints 30 min after admission to the clinic, for a period of 16 min, whereas those in the sham group received acupressure on locations 1-1.5 cm away from these points. The control group received standard treatment. The patient information form, Spielberger's state anxiety inventory, visual analogue scale, and vital signs follow-up form were used for data collection. FINDINGS Consecutive measurements revealed that anxiety levels in the acupressure group were lower than that in the sham and control groups (p < 0.05). In addition, compared to the sham and control groups, the pain scores in the acupressure group decreased significantly after acupressure (p < 0.01). Although there was no significant difference between the pain scores of the sham group before and after acupressure intervention (p > 0.05), the scores of the control group increased significantly over time (p < 0.01). Finally, the vital signs decreased significantly in the acupressure and sham groups after intervention (p < 0.01), but increased significantly in the control group (p < 0.01). CONCLUSION The findings of this trial indicated that acupressure is an effective method for reducing anxiety, pain, and vital signs.
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Affiliation(s)
- Selda Kartal Bal
- Department of Nursing, Faculty of Health Sciences, Eastern Mediterranean University, via Mersin 10, Famagusta, North Cyprus, Turkey.
| | - Meral Gun
- Department of Internal Medicine Nursing, Mersin University Faculty of Nursing, Mersin, Turkey
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Burgos LM, Ballari F, Massa M, Talavera ML, Benzadón M, Díez M. Evaluation of vital signs through a mobile application in patients with heart failure: a opportunity for remote titration? Arch Cardiol Mex 2024; 94:86-94. [PMID: 38507315 DOI: 10.24875/acm.22000221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 06/01/2023] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Virtual consultations have increased exponentially, but a limitation is the inability to assess vital signs (VS). This is particularly useful in patients with heart failure (HF) for titrating prognosis-modifying medication. This issue could potentially be addressed by a tool capable of measuring blood pressure (BP) and heart rate (HR) accurately, remotely, and conveniently. Mobile phones equipped with transdermal optical imaging technology could meet these requirements. OBJECTIVE To evaluate the accuracy of a transdermal optical imaging-based app for estimating VS compared to clinical assessment in patients with HF. METHODS A prospective cohort study included patients evaluated in an HF outpatient unit between February and April 2022. BP and HR were simultaneously assessed using the app and clinical examination (BP with an automated sphygmomanometer and HR by brachial palpation). Three measurements were taken by both the app and clinic for each patient, by two independent blinded physicians. RESULTS Thirty patients were included, with 540 measurements of BP and HR. The mean age was 66 (± 13) years, 53.3% were male. The mean left ventricular ejection fraction was 37 ± 15, with 63.3% having previous hospitalizations for HF, and 63.4% in NYHA class II-III. The mean difference between the app measurement and its clinical reference measurement was 3.6 ± 0.5 mmHg for systolic BP (SBP), 0.9 ± -0.2 mmHg for diastolic BP (DBP), and 0.2 ± 0.4 bpm for HR. When averaging the paired mean differences for each patient, the mean across the 30 patients was 2 ± 6 mmHg for SBP, -0.14 ± 4.6 mmHg for DBP, and 0.23 ± 4 bpm for HR. CONCLUSION The estimation of BP and HR by an app with transdermal optical imaging technology was comparable to non-invasive measurement in patients with HF and met the precision criteria for BP measurement in this preliminary study. The use of this new transdermal optical imaging technology provides promising data, which should be corroborated in larger cohorts.
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Affiliation(s)
- Lucrecia M Burgos
- Servicio de Insuficiencia Cardiaca, Hipertensión Pulmonar y Trasplante Cardiaco
| | | | | | - María L Talavera
- Servicio de Insuficiencia Cardiaca, Hipertensión Pulmonar y Trasplante Cardiaco
| | - Mariano Benzadón
- Departamento de Innovación. Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Mirta Díez
- Servicio de Insuficiencia Cardiaca, Hipertensión Pulmonar y Trasplante Cardiaco
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Marco CA, Sandelich S, Nelson E, Hu E, Locke D, Boehmer S. Vital signs among emergency department trauma patients in the setting of alcohol or drug use. Injury 2024; 55:111024. [PMID: 37709640 DOI: 10.1016/j.injury.2023.111024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/12/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION The incidence of alcohol use among trauma patients has been estimated at 19-55%. This study was undertaken to identify any relationship between vital signs and alcohol and drug use among Emergency Department (ED) patients with trauma. METHODS In this retrospective case control study, eligible subjects included trauma patients ages 18 and over, with trauma and drug or alcohol use, between 2018 and 2022. The control group was comprised of trauma patients ages 18 and over, with trauma and no drug or alcohol use, who were matched by Injury Severity Score (ISS). Vital signs on ED arrival were compared among patients with and without alcohol use, and with and without recreational drug use. RESULTS Among 16,159 eligible trauma subjects, 5,323 had tests available for drugs and alcohol of whom 2,750 had complete ISS and vital signs data. 684 subjects were identified with alcohol intoxication, 707 subjects were identified with recreational drug use. Patients with alcohol use had lower mean systolic blood pressure (Mean=133, SD=26.7), compared to patients without alcohol use (Mean=143, SD=29.4) (p < 0.001). Patients with alcohol use had higher mean heart rate (Mean=93, SD=19.9) compared to patients without alcohol use (Mean=91, SD=19.7) (p = 0.01). Patients with recreational drug use had lower mean systolic blood pressure (Mean=137, SD=28.5) compared to patients without drug use (Mean=143, SD=29.6) (p < 0.001). Patients with drug use had higher mean heart rate (Mean=94, SD=22.8), compared to patients without drug use (Mean=91, SD=20.0) (p = 0.002). Cannabinoids were associated with lower SBP (Case Mean=136 (25.4) vs. Control Mean=141 (31.0), p = 0.009). Opioids were associated with lower SBP (Case Mean=138 (28.0) vs. Control Mean=145 (29.4), p = 0.01). Benzodiazepines were associated with increased HR and decreased SBP and RR. CONCLUSIONS There appear to be no clinically relevant differences in vital signs among trauma patients with drug use and/or alcohol use, compared to patients without drug or alcohol use. Abnormal vital signs should not be prematurely attributed solely to acute substance intoxication before fully evaluating for associated traumatic injuries.
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Affiliation(s)
- Catherine A Marco
- Department of Emergency Medicine, Penn State Health - Milton S. Hershey Medical Center, United States.
| | - Stephen Sandelich
- Department of Emergency Medicine, Penn State Health - Milton S. Hershey Medical Center, United States
| | - Evan Nelson
- Penn State College of Medicine, United States
| | - Eric Hu
- Penn State College of Medicine, United States
| | - David Locke
- Department of Emergency Medicine, Penn State Health - Milton S. Hershey Medical Center, United States
| | - Susan Boehmer
- Department of Emergency Medicine, Penn State Health - Milton S. Hershey Medical Center, United States; Penn State College of Medicine, United States
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15
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Öner U, Cengiz Z. The effects of aromatherapy with thyme oil on disease symptoms, vital findings, and hemodynamic parameters in COVID-19 patients. Explore (NY) 2023:S1550-8307(23)00275-6. [PMID: 38129231 DOI: 10.1016/j.explore.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To determine the effect of aromatherapy with thyme oil on disease symptoms, vital signs, and hemodynamic parameters in COVID-19 patients. METHODS We conducted the randomized controlled trial with 140 (experimental group=70, control group=70) COVID-19 patients. Patients admitted to the COVID-19 service of the Batman Training and Research Hospital were included in the sample between 31.01 - 31.08 2022. Patients in the experimental group inhaled thyme oil 3 times a day during 5 days. At the end of day 5, symptoms and hemodynamic parameters were measured as posttest. Vital signs were measured 3 times a day during 5 days. The control group only received routine treatment. RESULTS Thyme oil was found to be effective in relieving symptoms of shortness of breath, dizziness, secretion, diarrhea, weakness, loss of appetite, cough, headache and muscle joint pain. Although there was improvement in the symptoms of nausea-vomiting, runny nose and loss of taste-smell, the effect was not statistically significant. Thyme oil significantly decreased body temperature, pulse rate and respiratory rate (p<0.05), increased SPO 2 (p<0.05), and did not affect systolic and diastolic blood pressure (p>0.05). It had a significant effect on the regulation of pH, decreased CO2 and increased O2 significantly (p<0.05). CONCLUSION Thyme oil aromatherapy was effective in reducing symptoms, regulating vital signs and hemodynamic parameters. Accordingly, thyme oil is recommended as non-pharmacological treatment method in COVID-19 patients.
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Affiliation(s)
- Uğur Öner
- Department of Fundamentals of Nursing, Batman University, Faculty of Health Sciences, Main Campus 72060, Batman, Turkey
| | - Zeliha Cengiz
- Department of Fundamentals of Nursing, Inonu University, Nursing Faculty, Malatya, Turkey.
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Eren C, Karamzadeh S, Kartal M. Radar human breathing dataset for applications of ambient assisted living and search and rescue operations. Data Brief 2023; 51:109757. [PMID: 38053604 PMCID: PMC10694063 DOI: 10.1016/j.dib.2023.109757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/09/2023] [Accepted: 10/30/2023] [Indexed: 12/07/2023] Open
Abstract
This dataset consists of signatures of human vital signs that are recorded by ultrawideband radar and lidar sensors. The data acquisition scene considers the human posture models(supine/lateral/facedown), different radar antenna angles towards the human, various set of distances and operational radar characteristics (bandwidth selection/mean power). The raw data files of lidar&radar and processed data files are presented separately in the data repository. The lidar sensor is chosen as a reference sensor. There are 432 data records, and each data scene's trial number is eight. There is a homogeneous wooden table to mimic clutter while forming a dataset. Thus, this dataset covers applications of search and rescue operations, sleep monitoring, and ambient assisted living (AAL) applications.
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Affiliation(s)
- Cansu Eren
- Satellite Communication and Remote Sensing, Department of Communication Systems, Informatics Institute, Istanbul Technical University, Istanbul, Türkiye
| | - Saeid Karamzadeh
- Millimeter Wave Technologies, Intelligent Wireless System, Silicon Austria Labs (SAL), 4040 Linz, Austria. Electrical and Electronics Engineering Department, Faculty of Engineering and Natural Sciences, Bahçeşehir University, 34349 Istanbul, Türkiye
| | - Mesut Kartal
- Department of Electronics and Communication Engineering, Istanbul Technical University, Istanbul, Türkiye
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Wang Y, Yu H, Tang H, Zhu R, Shi Y, Xu C, Li Y, Wang H, Chen Y, Shen P, Xu J, Wang C, Liu Z. Characterization of dynamical changes in vital signs during allogeneic human umbilical cord-derived mesenchymal stem cells infusion. Regen Ther 2023; 24:282-287. [PMID: 37559872 PMCID: PMC10407816 DOI: 10.1016/j.reth.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/15/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023] Open
Abstract
Human umbilical cord-derived mesenchymal stem cells (hUC-MSCs), a kind of adult stem cell, were studied for clinical applications in regenerative medicine. To date, the safety evaluations of intravenous infusion of allogeneic hUC-MSCs were focused on fever, infection, malignancy, and death. However, the characteristics of dynamical changes in vital signs during hUC-MSCs infusion are largely unknown. In this study, twenty participants with allogeneic hUC-MSCs transplanted (MSC group) and twenty sex- and age-matched individuals with cardiovascular disease who treated with the equal volume of 0.9% normal saline were recruited (NS group). Heart rate, respiratory rate, oxygen saturation, systolic and diastolic blood pressure, and temperature were monitored at intervals of 15 min during infusion. Adverse events were recorded during infusion and within seven days after infusion. No adverse events were observed during and after infusion in both groups. Compared with the baseline, the mean systolic blood pressure (SBP) levels were significantly decreased at 15 min, 30 min, 45 min and 60 min in the MSC group (all P < 0.05) during infusion. In addition, SBP changed significantly from baseline during hUC-MSCs infusion when compared with that of NS group (P < 0.05). Repeated measures analysis of variance confirmed difference over time on the SBP levels (P < 0.05). Our results showed that the process of allogeneic hUC-MSCs intravenous infusion was safe and the vital signs were stable, whereas a slight decrease in SBP was observed.
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Affiliation(s)
- Yue Wang
- Clinical Research Center for Cell Therapy, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
| | - Haiping Yu
- Nursing Department, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
| | - Hongming Tang
- Clinical Research Center for Cell Therapy, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
- Translational Medical Center for Stem Cell Therapy, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
| | - Rong Zhu
- Clinical Research Center for Cell Therapy, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
| | - Yiqi Shi
- Clinical Research Center for Cell Therapy, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
| | - Changqin Xu
- Clinical Research Center for Cell Therapy, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
| | - Yan Li
- Clinical Research Center for Cell Therapy, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
| | - Hua Wang
- Catheterization Room, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai 200137, China
| | - Yuanyuan Chen
- Translational Medical Center for Stem Cell Therapy, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
| | - Peichen Shen
- Department of Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
| | - Jinfang Xu
- Department of Health Statistics, Second Military Medical University, Shanghai 200433, China
| | - Congrong Wang
- Department of Endocrinology & Metabolism, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, China
| | - Zhongmin Liu
- Clinical Research Center for Cell Therapy, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
- Translational Medical Center for Stem Cell Therapy, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
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Johansen AO, Mølgaard J, Rasmussen SS, Gu Y, Grønbæk KK, Sørensen HBD, Aasvang EK, Meyhoff CS. Deviations in continuously monitored electrodermal activity before severe clinical complications: a clinical prospective observational explorative cohort study. J Clin Monit Comput 2023; 37:1573-1584. [PMID: 37195623 PMCID: PMC10651525 DOI: 10.1007/s10877-023-01030-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/03/2023] [Indexed: 05/18/2023]
Abstract
Monitoring of high-risk patients in hospital wards is crucial in identifying and preventing clinical deterioration. Sympathetic nervous system activity measured continuously and non-invasively by Electrodermal activity (EDA) may relate to complications, but the clinical use remains untested. The aim of this study was to explore associations between deviations of EDA and subsequent serious adverse events (SAE). Patients admitted to general wards after major abdominal cancer surgery or with acute exacerbation of chronic obstructive pulmonary disease were continuously EDA-monitored for up to 5 days. We used time-perspectives consisting of 1, 3, 6, and 12 h of data prior to first SAE or from start of monitoring. We constructed 648 different EDA-derived features to assess EDA. The primary outcome was any SAE and secondary outcomes were respiratory, infectious, and cardiovascular SAEs. Associations were evaluated using logistic regressions with adjustment for relevant confounders. We included 714 patients and found a total of 192 statistically significant associations between EDA-derived features and clinical outcomes. 79% of these associations were EDA-derived features of absolute and relative increases in EDA and 14% were EDA-derived features with normalized EDA above a threshold. The highest F1-scores for primary outcome with the four time-perspectives were 20.7-32.8%, with precision ranging 34.9-38.6%, recall 14.7-29.4%, and specificity 83.1-91.4%. We identified statistically significant associations between specific deviations of EDA and subsequent SAE, and patterns of EDA may be developed to be considered indicators of upcoming clinical deterioration in high-risk patients.
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Affiliation(s)
- Andreas Ohrt Johansen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark.
| | - Jesper Mølgaard
- Department of Anaesthesiology, Centre for Cancer and Organ Dysfunction, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | | | - Ying Gu
- Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Katja Kjær Grønbæk
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Helge B D Sørensen
- Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Eske Kvanner Aasvang
- Department of Anaesthesiology, Centre for Cancer and Organ Dysfunction, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Sylvest Meyhoff
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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刘 雨, 梁 诗, 范 美, 龚 仁, 李 卡. [Correlation Between 6 Characteristics of Perioperative Hypothermia and Allogeneic Red Blood Cell Transfusion in Abdominal Surgery Patients]. Sichuan Da Xue Xue Bao Yi Xue Ban 2023; 54:1256-1262. [PMID: 38162052 PMCID: PMC10752764 DOI: 10.12182/20230960507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Indexed: 01/03/2024]
Abstract
Objective To explore the correlation between six characteristics of perioperative hypothermia and allogeneic red blood cell (RBC) transfusions in patients who underwent abdominal surgeries. Methods Patients who underwent abdominal surgeries at West China Hospital, Sichuan University between October 2019 and July 2021 were retrospectively enrolled. A wearable wireless temperature sensor was used to continuously monitor the core body temperature of patients throughout the perioperative period. The perioperative temperature nadir, maximum temperature loss, percentage of time with hypothermia, time-weighted average temperature, area under the curve (AUC) at 36 ℃, and AUC at 37 ℃ were calculated for the period from entering the operation room to 24 hours after the end of anesthesia. The restricted cubic spline (RCS) and multiple logistic regression models were used to explore the correlation between these temperature characteristics and perioperative allogeneic RBC transfusions. Results A total of 3119 patients were included in the study, with an allogeneic RBC transfusion rate of 2.8%. The RCS model showed that allogeneic RBC transfusion was associated with the perioperative temperature nadir (Poverall=0.048) and AUC at 36 ℃ (Poverall=0.026) and no statistical significance was found in the nonlinear test. The association between allogeneic RBC transfusions and other temperature characteristics was not statistically significant. According to the RCS model results, cut-off points were taken to form groups based on the body temperature characteristics. Multivariate logistic regression showed that the perioperative temperature nadir<35.5 ℃ (odds ratio [OR]=2.47, 95% confidence interval [CI]: 1.21-5.03) and AUC at 36 ℃≥100 ℃·min (OR=2.24, 95% CI:1.09-4.58) were associated with increased demand for allogeneic RBC transfusion. Conclusion Hypothermia is associated with an increased need for perioperative allogeneic RBC transfusions and has a cumulative effect over time. For patients at high risk of bleeding, attention should be paid to the prevention of perioperative hypothermia and reduction in the cumulative exposure to hypothermia, thereby reducing the need for blood transfusion.
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Affiliation(s)
- 雨薇 刘
- 四川大学华西医院普通外科/四川大学华西护理学院 (成都 610041)Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
- 护理学四川省重点实验室 (成都 610041)Sichuan Provincial Key Laboratory of Nursing, Chengdu 610041, China
| | - 诗琪 梁
- 四川大学华西医院普通外科/四川大学华西护理学院 (成都 610041)Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - 美龄 范
- 四川大学华西医院普通外科/四川大学华西护理学院 (成都 610041)Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - 仁蓉 龚
- 四川大学华西医院普通外科/四川大学华西护理学院 (成都 610041)Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
- 护理学四川省重点实验室 (成都 610041)Sichuan Provincial Key Laboratory of Nursing, Chengdu 610041, China
| | - 卡 李
- 四川大学华西医院普通外科/四川大学华西护理学院 (成都 610041)Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
- 护理学四川省重点实验室 (成都 610041)Sichuan Provincial Key Laboratory of Nursing, Chengdu 610041, China
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Bitterfeld L, Mathias J, Waldron BP, Kranz C. Understanding the effects of overnight vital signs monitoring on sleep duration and disruptions in hospitalized children: A scoping review. J Pediatr Nurs 2023; 73:e10-e18. [PMID: 37442685 DOI: 10.1016/j.pedn.2023.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/03/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023]
Abstract
PROBLEM Overnight vital signs are typically taken every four hours on pediatric acute care units, despite limited evidence supporting the efficacy of this practice. Vital signs are often ordered and collected without considering the patient's clinical status or potential impact that they may have on sleep. We sought to understand the impact that overnight vital sign monitoring has on sleep duration and disruptions among hospitalized children in an acute care setting. ELIGIBILITY CRITERIA We conducted a scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols extension for scoping reviews (PRISMA-ScR). Studies were included if they addressed the relationship between vital signs monitoring and sleep among children hospitalized in an acute care unit. SAMPLE Eleven studies from 2012 to 2022 were included in the final review. RESULTS Vital signs monitoring is the most common sleep disruptor among hospitalized children in acute care units and early evidence suggests that minimizing overnight vital signs may be a safe intervention for clinically stable children. Methods for measuring sleep duration and disruptions are heterogenous and validated tools are not often used. Finally, nurses report comfort with forgoing overnight vital signs when their patient's clinical status is stable. CONCLUSION Despite a lack of evidence regarding the efficacy of every 4 h vital signs, overnight vital signs monitoring is consistently the greatest disruptor to sleep for hospitalized children. IMPLICATIONS Nurses should play a central role in guiding vital signs monitoring that maintains safety and improves sleep in hospitalized children.
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Affiliation(s)
- Leandra Bitterfeld
- Intermountain Primary Children's Hospital, 100 Mario Capecchi Dr, Salt Lake City, UT 84113, United States of America.
| | - Julianne Mathias
- Intermountain Primary Children's Hospital, 100 Mario Capecchi Dr, Salt Lake City, UT 84113, United States of America.
| | - Brianna Peterson Waldron
- Intermountain Primary Children's Hospital, 100 Mario Capecchi Dr, Salt Lake City, UT 84113, United States of America.
| | - Clare Kranz
- Intermountain Primary Children's Hospital, 100 Mario Capecchi Dr, Salt Lake City, UT 84113, United States of America.
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21
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Lysaught S, Erickson L, Marshall J, Feldman K. SSSH: Responsive soothing bassinet feasibility study for infants with congenital heart disease after cardiac surgery. J Pediatr Nurs 2023; 73:e125-e133. [PMID: 37598095 DOI: 10.1016/j.pedn.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE For infants with congenital heart disease (CHD) requiring surgery, prolonged hospital stays, intermittent caregiver visitation, and constrained unit staffing ratios present barriers to adequately address post-operative stressors and associated need to retain cognitive and physiological reserves. Similar patients requiring high-engagement interventions, such as hospitalized infants with neonatal abstinence syndrome, have found success in utilizing responsive bassinets to soothe infants and save floor nurses' time. However, it remains unclear if such technology can be leveraged in the CHD population given their complex hemodynamics, feeding intolerance, and monitoring requirements. METHODS This multidisciplinary feasibility study evaluated responsive bassinet use in a cohort of infants with CHD <6 months of age in a medical-surgical unit at a midwestern children's hospital. Specifically assessing 1) implementation requirements, challenges, and potential of utilizing the device, together with 2) ability to perform bedside monitoring (monitoring) and 3) measuring physiologic trends during use. RESULTS Between 11/2020-1/2022, nine infants utilized a responsive bassinet over 599 h (mean 13, range 4-26 days per infant). No increase in monitoring alarms and accurate vital signs monitoring during bassinet activity were noted with appropriate physiologic responses for infants with single ventricle and biventricular surgeries. CONCLUSIONS Feasibility of introducing new technology into care, and successful use of its functionality for soothing was found to be plausible for infants with CHD. PRACTICE IMPLICATIONS After cardiac surgery, infants with CHD have need for interventions to reduce stress. Use of a soothing bassinet has the potential to aid in doing so without interference with monitoring requirements.
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Affiliation(s)
- Shannon Lysaught
- Children's Mercy Hospital, Department of Nursing, Kansas City, MO 64108, USA.
| | - Lori Erickson
- Children's Mercy Hospital, Department of Strategy, Innovation, and Partnerships, Kansas City, MO 64108, USA.
| | - Jennifer Marshall
- Children's Mercy Hospital, Department of Strategy, Innovation, and Partnerships, Kansas City, MO 64108, USA.
| | - Keith Feldman
- Children's Mercy Kansas City, Division of Health Services and Outcomes Research, Kansas City, MO 64108, USA; University of Missouri-Kansas City School of Medicine, Department of Pediatrics, Kansas City, MO 64108, USA.
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O'Connell A, Flabouris A, Edwards S, Tang D, Lavrencic K, Brook E, Shih-Teng Kao S, Thompson C. Predictive value of a tiered escalation response system: A case control study. Aust Crit Care 2023; 36:1067-1073. [PMID: 37028974 DOI: 10.1016/j.aucc.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/29/2023] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVE Rapid response systems designed to detect and respond to clinical deterioration often incorporate a multitiered, escalation response. We sought to determine the 'predictive strength' of commonly used triggers, and tiers of escalation, for predicting a rapid response team (RRT) call, unanticipated intensive care unit admission, or cardiac arrest (events). DESIGN This was a nested, matched case-control study. SETTING The study setting involved a tertiary referral hospital. PARTICIPANTS Cases experienced an event, and controls were matched patients without an event. OUTCOME MEASURES Sensitivity and specificity and area under the receiver operating characteristic curve (AUC) were measured. Logistic regression determined the set of triggers with the highest AUC. RESULTS There were 321 cases and 321 controls. Nurse triggers occurred in 62%, medical review triggers in 34%, and RRT triggers 20%. Positive predictive value of nurse triggers was 59%, that of medical review triggers was 75%, and that of RRT triggers was 88%. These values were no different when modifications to triggers were considered. The AUC was 0.61 for nurses, 0.67 for medical review, and 0.65 for RRT triggers. With modelling, the AUC was 0.63 for the lowest tier, 0.71 for next highest, and 0.73 for the highest tier. CONCLUSION For a three-tiered system, at the lowest tier, specificity of triggers decreases, sensitivity increases, but the discriminatory power is poor. Thus, there is little to be gained by using a rapid response system with more than two tiers. Modifications to triggers reduced the potential number of escalations and did not affect tier discriminatory value.
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Affiliation(s)
- Alice O'Connell
- Royal Adelaide Hospital, Port Road, Adelaide, South Australia, Australia; Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia. Alice.O'
| | - Arthas Flabouris
- Royal Adelaide Hospital, Port Road, Adelaide, South Australia, Australia; Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Suzanne Edwards
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Doris Tang
- Royal Adelaide Hospital, Port Road, Adelaide, South Australia, Australia
| | | | - Emma Brook
- Central Adelaide Palliative Care, Adelaide, South Australia, Australia
| | | | - Campbell Thompson
- Royal Adelaide Hospital, Port Road, Adelaide, South Australia, Australia; Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Thekkan KR, Genna C, Ferro F, Cecchetti C, Dall'Oglio I, Tiozzo E, Raponi M, Gawronski O. Pediatric vital signs monitoring in hospital wards: Recognition systems and factors influencing nurses' attitudes and practices. J Pediatr Nurs 2023; 73:e602-e611. [PMID: 37977971 DOI: 10.1016/j.pedn.2023.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
AIMS To describe: 1) systems in place for recognition and response to deteriorating children in Italy, 2) attitudes and practices of registered nurses (RN) towards vital signs (VS) monitoring in pediatric wards, 3) the associations of nurses attitudes and pratices with nurses' and organizational characteristics. DESIGN AND METHODS A multicentre cross-sectional correlational study. Data were collected between January-May 2020 using: an adapted version of the 'Survey on Recognition and Response Systems in Australia', and the 'Ped-V Scale'. Descriptive and adjusted linear regression analysis was performed, accounting for clustering. RESULTS Ten Italian hospitals participated, 432 RNs responded to the Ped-V scale (response rate = 52%). Five (50%) hospitals had a VS policy in place, three hospitals (30%) had a Pediatric Early Warning System (PEWS), almost all hospitals had a system in place to respond to deteriorating children. Following multivariate regression analysis, having a PEWS was significantly associated with Ped-V scale 'Workload', 'Clinical competence', 'Standardization' dimensions; gender was associated with 'key indicators' and pediatric surgical ward with 'Clinical competence'. CONCLUSIONS The use of VS policies and PEWS was not consistent across hospitals caring for children in Italy. Nurses' attitudes and practices (i.e., perception of workload, and clinical competence) were significantly lower in hospitals with increased complexity of care/PEWS. Gender was significantly associated with knowledge scores. PRACTICE IMPLICATIONS System strategies to improve nurses' attitudes and practices towards VS monitoring and education are warranted to support effective behaviors towards VS monitoring, their interpretation, and appropriate communication to activate the efferent limb of the rapid response system.
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Affiliation(s)
- Kiara Ros Thekkan
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Catia Genna
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Federico Ferro
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Corrado Cecchetti
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
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Udagawa K, Yamamoto R, Shimatani N, Nishida Y, Ono S, Niki Y, Sasaki J. Simple parameters to identify patients treatable with early definitive fixation: A nationwide study. Injury 2023:111117. [PMID: 37872009 DOI: 10.1016/j.injury.2023.111117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
INTRODUCTION Early appropriate care (EAC) is widely accepted as a safe strategy to perform early definitive fracture fixation, and good clinical outcomes have been reported in selected, multiply injured patients, although the optimal candidate for early definitive fixation (EDF) has not been validated. The aim of this study was to identify simple clinical parameters to help select patients who could undergo EDF. METHODS Patients with extremity injuries who underwent open reduction and internal fixation were retrospectively identified, using data from the Japan Trauma Data Bank (JTDB). Age, vital signs on hospital presentation, and the injury severity score (ISS) were examined by transforming these variables to binary categories. Patients were divided into categories based on these variables, and in-hospital mortality was compared between patients treated with EDF (EDF group) and those treated without EDF (non-EDF group) in each category. RESULTS Of the 12,735 patients who were eligible for the analyses, 3706 (29.1 %) were managed with EDF. In-hospital mortality was significantly higher in the EDF group than in the non-EDF group among patients with a low Glasgow Coma Scale (GCS) score (<13), low systolic blood pressure (sBP) (<90 mmHg), and ISS≥15, whereas in-hospital mortality was comparable between the EDF and non-EDF groups among patients with GCS scores ≥13, sBP ≥90 mmHg, and ISS <15. DISCUSSION In this large nationwide database of trauma patients, EDF was performed without affecting mortality in patients with GCS scores ≥13 and sBP ≥90 mmHg on hospital presentation, as well as ISS <15. These parameters might be useful as screening tools to select the candidates who could be treated with EDF safely.
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Affiliation(s)
- Kazuhiko Udagawa
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan; Department of Orthopedic Surgery, Keio University School of Medicine, Japan.
| | - Ryo Yamamoto
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Naotaka Shimatani
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Yusho Nishida
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Soichiro Ono
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Yasuo Niki
- Department of Orthopedic Surgery, Keio University School of Medicine, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
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Khanna AK, O'Connell NS, Ahuja S, Saha AK, Harris L, Cusson BD, Faris A, Huffman CS, Vallabhajosyula S, Clark CJ, Segal S, Wells BJ, Kirkendall ES, Sessler DI. Incidence, severity and detection of blood pressure and heart rate perturbations in postoperative ward patients after noncardiac surgery. J Clin Anesth 2023; 89:111159. [PMID: 37295123 DOI: 10.1016/j.jclinane.2023.111159] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/22/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023]
Abstract
STUDY OBJECTIVE We sought to determine changes in continuous mean and systolic blood pressure and heart rate in a cohort of non-cardiac surgical patients recovering on the postoperative ward. Furthermore, we estimated the proportion of vital signs changes that would remain undetected with intermittent vital signs checks. DESIGN Retrospective cohort. SETTING Post-operative general ward. PATIENTS 14,623 adults recovering from non-cardiac surgical procedures. INTERVENTIONS & MEASUREMENTS Using a wireless, noninvasive monitor, we recorded postoperative blood pressure and heart rate at 15-s intervals and encouraged nursing intervention as clinically indicated. MAIN RESULTS 7% of our cohort of 14,623 patients spent >15 sustained minutes with a MAP <65 mmHg, and 23% had MAP <75 mmHg for 15 sustained minutes. Hypertension was more common, with 67% of patients spending at least 60 sustained minutes with MAP >110 mmHg. Systolic pressures <90 mmHg were present for 15 sustained minutes in about a fifth of all patients, and 40% of patients had pressures >160 mmHg sustained for 30 min. 40% of patients were tachycardic with heart rates >100 beats/min for at least continuous 15 min and 15% of patients were bradycardic at a threshold of <50 beats/min for 5 sustained minutes. Conventional vital sign assessments at 4-h intervals would have missed 54% of mean pressure episodes <65 mmHg sustained >15 min, 20% of episodes of mean pressures >130 mmHg sustained >30 min, 36% of episodes of heart rate > 120 beats/min sustained <10 min, and 68% of episodes of heart rate sustained <40 beats per minute for >3 min. CONCLUSIONS Substantial hemodynamic disturbances persisted despite implementing continuous portable ward monitoring coupled with nursing alarms and interventions. A significant proportion of these changes would have gone undetected using traditional intermittent monitoring. Better understanding of effective responses to alarms and appropriate interventions on hospital wards remains necessary.
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Affiliation(s)
- Ashish K Khanna
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA; Outcomes Research Consortium, Cleveland, OH, USA.
| | - Nathaniel S O'Connell
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Sanchit Ahuja
- Outcomes Research Consortium, Cleveland, OH, USA; Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH and Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
| | - Amit K Saha
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA.
| | - Lynnette Harris
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA.
| | - Bruce D Cusson
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Ann Faris
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA; Center for Nursing Research, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA.
| | - Carolyn S Huffman
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA; Center for Nursing Research, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA.
| | - Saraschandra Vallabhajosyula
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA; Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Clancy J Clark
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Scott Segal
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA.
| | - Brian J Wells
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Center for Biomedical Informatics, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Eric S Kirkendall
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
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Durmaz A, Sezici E, Akkaya DD. The effect of kangaroo mother care or skin-to-skin contact on infant vital signs: A systematic review and meta-analysis. Midwifery 2023; 125:103771. [PMID: 37454580 DOI: 10.1016/j.midw.2023.103771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 06/22/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND It has been reported that kangaroo mother care/skin-to-skin contact immediately after birth facilitates the newborn's physiological and psychological adaptation to extrauterine life. OBJECTIVE To examine the effect of kangaroo mother care/skin-to-skin contact on infants' body temperature, oxygen saturation, respiratory rate and heart rate. DESIGN Systematic review and meta-analysis. METHODS PubMed, ScienceDirect, SpringerLink, Wiley Online Library and Taylor & Francis Online were searched for the period 1 January 2015 to 30 November 2021 for studies published in the English language. The methodological quality of articles was assessed using the modified Jadad scale and the Newcastle-Ottawa scale. Effect size calculations were made using the fixed effects and random effects models. FINDINGS This meta-analysis included 13 studies, with a total of 891 infants. Kangaroo mother care/skin-to-skin contact was effective for maintaining infants' body temperature (p = 0.000). Infants' heart rate decreased (p = 0.015) and oxygen saturation was higher (p = 0.040) following kangaroo mother care/skin-to-skin contact. Kangaroo mother care/skin-to-skin contact did not affect infants' respiratory rate (p = 0.896), but infants' respiratory rate decreased after kangaroo mother care/skin-to-skin contact (p = 0.047). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Kangaroo mother care/skin-to-skin contact is effective for improving the vital signs of newborns. Kangaroo mother care/skin-to-skin contact is recommended for all neonates, and standardization of this approach would be beneficial.
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Affiliation(s)
- Aysegul Durmaz
- Department of Midwifery, Faculty of Health Sciences, Kutahya Health Sciences University, Kutahya, Türkiye.
| | - Emel Sezici
- Department of Pediatric Nursing, Faculty of Health Sciences, Kutahya Health Sciences University, Kutahya, Türkiye
| | - Deniz Done Akkaya
- Department of Pediatric Nursing, Faculty of Health Sciences, Kutahya Health Sciences University, Kutahya, Türkiye
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van Rossum MC, da Silva PMA, Wang Y, Kouwenhoven EA, Hermens HJ. Missing data imputation techniques for wireless continuous vital signs monitoring. J Clin Monit Comput 2023; 37:1387-1400. [PMID: 36729298 PMCID: PMC9893204 DOI: 10.1007/s10877-023-00975-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 01/16/2023] [Indexed: 02/03/2023]
Abstract
Wireless vital signs sensors are increasingly used for remote patient monitoring, but data analysis is often challenged by missing data periods. This study explored the performance of various imputation techniques for continuous vital signs measurements. Wireless vital signs measurements (heart rate, respiratory rate, blood oxygen saturation, axillary temperature) from surgical ward patients were used for repeated random simulation of missing data periods (gaps) of 5-60 min in two-hour windows. Gaps were imputed using linear interpolation, spline interpolation, last observation- and mean carried forwards technique, and cluster-based prognosis. Imputation performance was evaluated using the mean absolute error (MAE) between original and imputed gap samples. Besides, effects on signal features (window's slope, mean) and early warning scores (EWS) were explored. Gaps were simulated in 1743 data windows, obtained from 52 patients. Although MAE ranges overlapped, median MAE was structurally lowest for linear interpolation (heart rate: 0.9-2.6 beats/min, respiratory rate: 0.8-1.8 breaths/min, temperature: 0.04-0.17 °C, oxygen saturation: 0.3-0.7% for 5-60 min gaps) but up to twice as high for other techniques. Three techniques resulted in larger ranges of signal feature bias compared to no imputation. Imputation led to EWS misclassification in 1-8% of all simulations. Imputation error ranges vary between imputation techniques and increase with gap length. Imputation may result in larger signal feature bias compared to performing no imputation, and can affect patient risk assessment as illustrated by the EWS. Accordingly, careful implementation and selection of imputation techniques is warranted.
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Affiliation(s)
- Mathilde C van Rossum
- Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands.
- Cardiovascular and Respiratory Physiology, University of Twente, Postbox 217, 7500 AE, Enschede, The Netherlands.
- Department of Surgery, Hospital Group Twente, Almelo, The Netherlands.
| | - Pedro M Alves da Silva
- Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
- NOVA School of Science and Technology, NOVA University of Lisbon, Lisbon, Portugal
| | - Ying Wang
- Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
- ZGT Academy, Hospital group Twente, Almelo, The Netherlands
| | | | - Hermie J Hermens
- Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
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Udompongpaiboon P, Reangvilaikul T, Vattanavanit V. Predicting mortality among patients with severe COVID-19 pneumonia based on admission vital sign indices: a retrospective cohort study. BMC Pulm Med 2023; 23:342. [PMID: 37700259 PMCID: PMC10496301 DOI: 10.1186/s12890-023-02643-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/07/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pneumonia remains a major public health concern. Vital sign indices-shock index (SI; heart rate [HR]/systolic blood pressure [SBP]), shock index age (SIA, SI × age), MinPulse (MP; maximum HR-HR), Pulse max index (PMI; HR/maximum HR), and blood pressure-age index (BPAI; SBP/age)-are better predictors of mortality in patients with trauma compared to traditional vital signs. We hypothesized that these vital sign indices may serve as predictors of mortality in patients with severe COVID-19 pneumonia. This study aimed to describe the association between vital sign indices at admission and COVID-19 pneumonia mortality and to modify the CURB-65 with the best performing vital sign index to establish a new mortality prediction tool. METHODS This retrospective study was conducted at a tertiary care center in southern Thailand. Adult patients diagnosed with COVID-19 pneumonia were enrolled in this study between January 2020 and July 2022. Patient demographic and clinical data on admission were collected from an electronic database. The area under the receiver operating characteristic (AUC) curve analysis was used to assess the predictive power of the resultant multivariable logistic regression model after univariate and multivariate analyses of variables with identified associations with in-hospital mortality. RESULTS In total, 251 patients with COVID-19 pneumonia were enrolled in this study. The in-hospital mortality rate was 27.9%. Non-survivors had significantly higher HR, respiratory rate, SIA, and PMI and lower MP and BPAI than survivors. A cutoff value of 51 for SIA (AUC, 0.663; specificity, 80%) was used to predict mortality. When SIA was introduced as a modifier for the CURB-65 score, the new score (the CURSIA score) showed a higher AUC than the Acute Physiology and Chronic Health Evaluation II and CURB-65 scores (AUCs: 0.785, 0.780, and 0.774, respectively) without statistical significance. CONCLUSIONS SIA and CURSIA scores were significantly associated with COVID-19 pneumonia mortality. These scores may contribute to better patient triage than traditional vital signs.
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Affiliation(s)
- Piyaphat Udompongpaiboon
- Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
| | - Teeraphat Reangvilaikul
- Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
| | - Veerapong Vattanavanit
- Critical Care Medicine Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla, 90110, Thailand.
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Songthawornpong N, Elvekjaer M, Mølgaard J, Rasmussen SM, Meyhoff CS, Aasvang EK, Eriksen VR. Deviating vital signs in continuous monitoring prior to discharge and risk of readmission: an observational study. Intern Emerg Med 2023; 18:1453-1461. [PMID: 37326796 DOI: 10.1007/s11739-023-03318-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/17/2023] [Indexed: 06/17/2023]
Abstract
Premature discharge may result in readmission while longer hospitalization may increase risk of complications such as immobilization and reduce hospital capacity. Continuous monitoring detects more deviating vital signs than intermittent measurements and may help identify patients at risk of deterioration after discharge. We aimed to investigate the association between deviating vital signs detected by continuous monitoring prior to discharge and risk of readmission within 30 days. Patients undergoing elective major abdominal surgery or admitted with acute exacerbation of chronic obstructive pulmonary disease were included in this study. Eligible patients had vital signs monitored continuously within the last 24 h prior to discharge. The association between sustained deviated vital signs and readmission risk was analyzed by using Mann-Whitney's U test and Chi-square test. A total of 51 out of 265 patients (19%) were readmitted within 30 days. Deviated respiratory vital signs occurred frequently in both groups: desaturation < 88% for at least ten minutes was seen in 66% of patients who were readmitted and in 62% of those who were not (p = 0.62) while desaturation < 85% for at least five minutes was seen in 58% of readmitted and 52% of non-readmitted patients (p = 0.5). At least one sustained deviated vital sign was detected in 90% and 85% of readmitted patients and non-readmitted patients, respectively (p = 0.2). Deviating vital signs prior to hospital discharge were frequent but not associated with increased risk of readmission within 30 days. Further exploration of deviating vital signs using continuous monitoring is needed.
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Affiliation(s)
- Nicharatch Songthawornpong
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg, Bakke 23, 2400, Copenhagen, NV, Denmark.
- Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
| | - Mikkel Elvekjaer
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg, Bakke 23, 2400, Copenhagen, NV, Denmark
- Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Jesper Mølgaard
- Department of Anaesthesiology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Søren M Rasmussen
- Biomedical Engineering, Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Christian S Meyhoff
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg, Bakke 23, 2400, Copenhagen, NV, Denmark
- Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Eske K Aasvang
- Department of Anaesthesiology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke R Eriksen
- Department of Anaesthesiology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Kayser SA, Williamson R, Siefert G, Roberts D, Murray A. Respiratory rate monitoring and early detection of deterioration practices. Br J Nurs 2023; 32:620-627. [PMID: 37410682 DOI: 10.12968/bjon.2023.32.13.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
BACKGROUND Growing evidence points to respiratory rate (RR) being the most important vital sign for early detection of patient deterioration. However, RR is the vital sign most likely to be inaccurate or missed. AIMS To measure prevalence of early detection of deterioration protocols, examine whether RR was perceived as the leading indicator of deterioration, and understand RR monitoring practices used by nurses around the world. METHODS A double-blinded survey of nurses in Asia Pacific, Middle East, and Western Europe. FINDINGS 161 nurses responded. Most (80%) reported having an initiative for early detection of patient deterioration; 12% indicated RR was the most important indicator of deterioration, 27% captured RR for all medical/surgical patients, and 56% take 60 seconds or longer to measure RR. CONCLUSION Nurses across all regions generally underestimated the importance of capturing an accurate RR for all patients' multiple times per day. This study reinforces the need to enhance international nursing education regarding the importance of RR.
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Affiliation(s)
- Susan A Kayser
- Health Economist, Baxter International, Batesville, Indiana, USA
| | - Rachel Williamson
- Director, Global Strategic Marketing, Baxter International, Batesville, Indiana, USA
| | - Gabriela Siefert
- Associate Director of Strategy, Baxter International, Omaha, Nebraska, USA
| | - Dan Roberts
- Health Economist, Baxter International, Scottsville, Virginia, USA
| | - Angela Murray
- Senior Director of Health Economics, Baxter International, Chicago, Illinois, USA
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31
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Alić B, Zauber T, Wiede C, Seidl K. Current methods for contactless optical patient diagnosis: a systematic review. Biomed Eng Online 2023; 22:61. [PMID: 37330551 DOI: 10.1186/s12938-023-01125-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/08/2023] [Indexed: 06/19/2023] Open
Abstract
Many countries around the world face a shortage of medical personnel, leading to work overload or even burnout. This calls for political and scientific solutions to relieve the medical personnel. The measurement of vital signs in hospitals is still predominately carried out manually with traditional contact-based methods, taking over a substantial share of the medical personnel's workload. The introduction of contactless methods for vital sign monitoring (e.g., with a camera) has great potential to relieve the medical personnel. This systematic review's objective is to analyze the state of the art in the field of contactless optical patient diagnosis. This review distinguishes itself from already existing reviews by considering studies that do not only propose the contactless measurement of vital signs but also include an automatic diagnosis of the patient's condition. This means that the included studies incorporate the physician's reasoning and evaluation of vital signs into their algorithms, allowing an automated patient diagnosis. The literature screening of two independent reviewers resulted in a total of five eligible studies. The highest number of studies (three) introduce methods for the risk assessment of infectious diseases, one study introduces a method for the risk assessment of cardiovascular diseases, and one study introduces a method for the diagnosis of obstructive sleep apnea. Overall, high heterogeneity in relevant study parameters is reported among the included studies. The low number of included studies indicates a large research gap and emphasizes the demand for further research on this emerging topic.
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Affiliation(s)
- Belmin Alić
- Department of Electrical Engineering and Information Technology, University of Duisburg-Essen, Bismarckstr. 81, 47057, Duisburg, Germany.
| | - Tim Zauber
- Department of Electrical Engineering and Information Technology, University of Duisburg-Essen, Bismarckstr. 81, 47057, Duisburg, Germany
| | - Christian Wiede
- Department of Embedded Software and Embedded AI, Fraunhofer Institute for Microelectronic Circuits and Systems, Finkenstr. 61, 47057, Duisburg, Germany
| | - Karsten Seidl
- Department of Electrical Engineering and Information Technology, University of Duisburg-Essen, Bismarckstr. 81, 47057, Duisburg, Germany
- Business Unit Health, Fraunhofer Institute for Microelectronic Circuits and Systems, Finkenstr. 61, 47057, Duisburg, Germany
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Li JQ, Yuan H, Wang XQ, Yang M. Dexmedetomidine-induced anesthesia in elderly patients undergoing hip replacement surgery. World J Clin Cases 2023; 11:3756-3764. [PMID: 37383121 PMCID: PMC10294164 DOI: 10.12998/wjcc.v11.i16.3756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/13/2023] [Accepted: 04/24/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND A femoral neck fracture is a common and frequently reported issue in orthopedics, with a greater rate of incidence among the elderly. Due to their advanced age and the presence of some primary diseases, both anesthesia and surgery are increasingly difficult in elderly patients with a femoral neck fractures. In fact, general anesthesia can easily induce complications such as cognitive dysfunction, which is not conducive to postoperative recovery.
AIM To analyze the efficacy of dexmedetomidine in inducing anesthesia for elderly patients undergoing hip replacement surgery.
METHODS A total of 98 elderly patients undergoing hip replacement in our hospital from June 2020 to June 2021 were randomly divided into control group (49 cases) and observation group (49 cases). The control group was given general anesthesia, and the observation group was combined with dexmedetomidine for anesthesia on the basis of the control group. Both groups were observed until the patients were discharged. The vital signs, serum inflammatory factors and renal function indexes of the two groups were compared before, during and 6 h after operation. The postoperative recovery and adverse events of the two groups were statistically analyzed.
RESULTS Compared with the mean arterial pressure of the two groups, the intraoperative and postoperative 6 h was higher than that before the operation, the intraoperative was lower than the postoperative 6 h (P < 0.05); the blood oxygen saturation of the two groups was higher than that before operation and 6 h after operation, and the observation group was higher than the control group 6 h after operation (P < 0.05). The heart rate of the two groups was lower during and 6 h after operation than that before operation, and higher at 6 h after operation than that during operation (P < 0.05). The levels of serum C-reactive protein, tumor necrosis factor-α, interleukin-1β and kidney injury molecule-1 in the two groups were higher during operation and 6 h after operation than those before operation (P < 0.05). The level of serum urea nitrogen in the two groups was higher than that before operation, and that in the observation group was lower than that in the control group (P < 0.05). During hospitalization, the first time of getting out of bed, recovery time of grade II muscle strength, recovery time of grade III muscle strength and hospitalization time in the observation group were shorter than those in the control group (P < 0.05).
CONCLUSION Dexmedetomidine can effectively improve the vital signs of elderly patients undergoing hip replacement surgery, reduce the body's inflammatory response and renal function damage, and promote postoperative recovery. Meanwhile, dexmedetomidine showcased a good safety profile and a good anesthetic outcome.
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Affiliation(s)
- Jun-Qing Li
- Department of Anesthesiology, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang 236000, Anhui Province, China
| | - Hao Yuan
- Department of Anesthesiology, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang 236000, Anhui Province, China
| | - Xiao-Qiang Wang
- Department of Anesthesiology, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang 236000, Anhui Province, China
| | - Meng Yang
- Department of Anesthesiology, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang 236000, Anhui Province, China
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Hakim A, Kaldozkhi SSH, Tashakori A, Ghanbari S. The effect of non-verbal music on anxiety in hospitalized children. BMC Pediatr 2023; 23:279. [PMID: 37277730 DOI: 10.1186/s12887-023-04101-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/30/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND In recent years, the positive effect of non-pharmacological methods such as listening to music in reducing the level of anxiety of hospitalized patients has been reported. This study aimed to determine the effect of non-verbal music on anxiety in hospitalized children. METHODS In this study, 52 hospitalized children aged 6 to 12 years were randomly divided into Test and control groups. Research data collection tools included the Spielberger questionnaire to assess the level of anxiety in children. Statistical analysis of data was performed using Chi-square and t-tests by SPSS 23 software. RESULTS Daily listening to non-verbal music for 20 minutes after the second and third days significantly reduced the anxiety score and the number of breaths per minute of hospitalized children (P ≤ 0.01). The trend of changes in anxiety score was measured for three consecutive days and vital signs except body temperature decreased significantly in the test group (P ≤ 0.01). CONCLUSION According to the results of this study, listening to non-verbal music by hospitalized children can be used as an effective practical method to reduce the level of anxiety and subsequently reduce vital signs.
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Affiliation(s)
- Ashrafalsadat Hakim
- Nursing Care Research Center in Chronic Diseases, Department of Nursing, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | | | - Ashraf Tashakori
- Department of Psychiatry, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Ghanbari
- Department of Health and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Santos RL, Cruz-Correia R. Improving Healthcare Quality with an LHS. Stud Health Technol Inform 2023; 302:145-146. [PMID: 37203633 DOI: 10.3233/shti230088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The Learning Health System (LHS) is an important tool to help healthcare professionals solve problems by collecting, analyzing, interpreting and comparing health data, with the objective of helping patients make the best decision based on their own data, given the best evidence available. [1]. We believe partial oxygen saturation of arterial blood (SpO2) and related measurements and calculations can also be candidates for predictions and analysis of health conditions. We intend to build a Personal Health Record (PHR) that can exchange data with Electronic Health Records (EHRs) from hospitals, propose enhanced self-care, seek a support network, or look for healthcare assistance, (primary care or emergency service).
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Affiliation(s)
- Ricardo L Santos
- PhD Student Health Data Science Faculty of Medicine University of Porto, Portugal
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Demir Kösem D, Bektaş M, Gawronski O. Psychometric properties of the Turkish version of the vital signs monitoring on pediatric wards scale (Ped-V scale). J Pediatr Nurs 2023:S0882-5963(23)00102-1. [PMID: 37142493 DOI: 10.1016/j.pedn.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE The aim of this study should be to adopt the Turkish version of the vital signs monitoring on pediatric wards scale (Ped-V scale). DESIGN AND METHOD This methodological study was carried out with 331 pediatric nurses aged 18-65 between September 2022 and November 2022. The data were collected using an online questionnaire including a Descriptive Information Form and the Ped-V scale. Before starting the implementation of the study, the language adaptation of the scale was made, then expert opinion was taken and a pilot application was made. Then the main sampling was applied and evaluated. Explanatory and confirmatory factor analysis, Cronbach's alpha, and item-total score analysis were used for data analysis. RESULTS It was determined that the scale consisted of 30 items and four sub-dimensions and that four sub-dimensions explained 42.91% of the total variance. Both exploratory and confirmatory factor analyses indicated that all factor loads were >0.30. According to the confirmatory factor analysis, all of the fit indices were >0.80, and the RMSEA was <0.080. Cronbach's alpha was determined as 0.88 for the total scale and >0.60 for all sub-dimensions. CONCLUSION As a result of the analyses, it was determined that the Ped-V scale was a valid and reliable measurement tool for the Turkish sample. PRACTICE IMPLICATIONS Using the Ped-V scale, it can help to determine the attitudes of nurses working in pediatric clinics toward monitoring vital signs and to plan in-service training if there is a problem.
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Affiliation(s)
- Dilek Demir Kösem
- Hakkari University Faculty of Health Sciences, Department of Nursing, Hakkari, Turkey.
| | - Murat Bektaş
- Dokuz Eylul University Faculty of Nursing, Inciraltı, Izmir, Turkey.
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
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Munday J, Delaforce A, Heidke P, Rademakers S, Sturgess D, Williams J, Douglas C. Perioperative temperature monitoring for patient safety: A period prevalence study of five hospitals. Int J Nurs Stud 2023; 143:104508. [PMID: 37209531 DOI: 10.1016/j.ijnurstu.2023.104508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Monitoring body temperature is essential for safe perioperative care. Without patient monitoring during each surgical phase, alterations in core body temperature will not be recognised, prevented, or treated. Safe use of warming interventions also depends on monitoring. Yet there has been limited evaluation of temperature monitoring practices as the primary endpoint. OBJECTIVE To investigate temperature monitoring practices during all stages of perioperative care. We examined what patient characteristics are associated with the rate of temperature monitoring, along with clinical variables such as warming intervention or exposure to hypothermia. DESIGN An observational period-prevalence study over seven days across five Australian hospitals. SETTINGS Four metropolitan, tertiary hospitals and one regional hospital. PARTICIPANTS We selected all adult patients (N = 1690) undergoing any surgical procedure and any mode of anaesthesia during the study period. METHODS Patient characteristics, perioperative temperature data, warming interventions and exposure to hypothermia were retrospectively collected from patient charts. We describe the frequencies and distribution of temperature data at each perioperative stage, including adherence to minimum temperature monitoring based on clinical guidelines. To examine associations with clinical variables, we also modelled the rate of temperature monitoring using each patient's count of recorded temperature measurements within their calculated time interval from anaesthetic induction to postanaesthetic care unit discharge. All analyses adjusted 95% confidence intervals (CI) for patient clustering by hospital. RESULTS There were low levels of temperature monitoring, with most temperature data clustered around admission to postanaesthetic care. Over half of patients (51.8%) had two or less temperatures recorded during perioperative care and one-third (32.7%) had no temperature data at all prior to admission to postanaesthetic care. Of all patients that received active warming intervention during surgery, over two-thirds (68.5%) had no temperature monitoring recorded. In our adjusted model, associations between clinical variables and the rate of temperature monitoring often did not reflect clinical risk or need: rates were decreased for those with greatest operative risk (American Society of Anesthesiologists Classification IV: rate ratio (RR) 0.78, 95% CI 0.68-0.89; emergency surgery: RR 0.89, 0.80-0.98), and neither warming interventions (intraoperative warming: RR 1.01, 0.93-1.10; postanaesthetic care unit warming: RR 1.02, 0.98-1.07) nor hypothermia at postanaesthetic care unit admission (RR 1.12, 0.98-1.28) were associated with monitoring rate. CONCLUSIONS Our findings point to the need for systems-level change to enable proactive temperature monitoring over all phases of perioperative care to enhance patient safety outcomes. REGISTRATION Not a clinical trial.
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Affiliation(s)
- Judy Munday
- School of Nursing & Centre for Healthcare Transformation, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059, Australia; Royal Brisbane and Women's Hospital, Herston, Queensland 4029, Australia; Faculty of Health and Nursing Science, University of Agder, Norway.
| | - Alana Delaforce
- School of Nursing & Centre for Healthcare Transformation, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059, Australia; Mater Health Services, South Brisbane, Queensland 4101, Australia; CSIRO Australian e-Health Research Centre, Brisbane, QLD 4029, Australia
| | - Penny Heidke
- School of Nursing & Centre for Healthcare Transformation, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059, Australia; Central Queensland University, Brisbane, Queensland 4000, Australia
| | - Sasha Rademakers
- School of Nursing & Centre for Healthcare Transformation, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059, Australia; Department of Health Western Australia, Perth 6000, Western Australia, Australia
| | - David Sturgess
- University of Queensland, St Lucia 4072, Queensland, Australia
| | | | - Clint Douglas
- School of Nursing & Centre for Healthcare Transformation, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059, Australia; Metro North Hospital and Health Service, Herston, Queensland 4029, Australia
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Dargahiyan Z, Ghasemi F, Karami K, Valizadeh F, Mohammadi R. A comparative study of the effects of Kangaroo care by mothers and maternal grandmothers on the vital signs of hospitalized preterm newborns: a randomized controlled clinical trial study. Trials 2023; 24:275. [PMID: 37059994 PMCID: PMC10104429 DOI: 10.1186/s13063-023-07288-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 03/31/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Kangaroo care (KC) is an effective technique to prevent injury in newborns due to prematurity and hospitalization. Mothers of preterm newborns experience their own set of physical and mental problems. Such circumstances call for another family member to take care of the newborn. This study compared the effect of KC by mothers and maternal grandmothers on the vital signs of preterm newborns. METHODS This parallel randomized controlled trial was done at the neonatal and NICU departments of the hospital in Kuhdasht in Iran. Eighty preterm neonates were selected through convenience sampling according to the eligibility criteria, then by stratified block randomization allocated to two groups. The control group received KC from the mother, and the intervention group received KC from the maternal grandmothers on the vital signs of preterm newborns. Vital signs were assessed 15 min before, during, and after the KC as the primary outcome. The data collection tools included a demographic questionnaire and a form to record the vital signs. Vital signs were measured by a pulse oximeter, an electronic thermometer, and observation. Data were analyzed by the chi-square test, the independent t-test, and the repeated measures ANOVA. RESULTS The vital signs of newborns in each group showed a significant difference before, during, and after receiving KC (P < 0.05). Nevertheless, the vital signs of the newborns did not differ significantly between the mother and the maternal grandmother KC groups (P > 0.05). CONCLUSION KC by maternal grandmother may stabilize the vital signs of preterm newborns as much as when this type of care is provided by the mother. We, therefore, recommend the provision of KC by the maternal grandmother, as a support and substitute for the mother whenever she is incapable of being at the hospital and to enable the mother to rest. TRIAL REGISTRATION Iranian Registry of Clinical Trials IRCT20211225053516N1, March 31, 2022.
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Affiliation(s)
- Zahra Dargahiyan
- School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Fatemeh Ghasemi
- Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Kimia Karami
- Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Fatemeh Valizadeh
- Department of Pediatrics Nursing, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramad, Iran
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
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Park SN, Hwang HY, Koo HY. Development of a virtual reality program in South Korea for the measurement of vital signs in children: a methodological study. Child Health Nurs Res 2023; 29:137-148. [PMID: 37170492 PMCID: PMC10183758 DOI: 10.4094/chnr.2023.29.2.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/20/2023] [Indexed: 05/13/2023] Open
Abstract
PURPOSE We developed a virtual reality (VR) program for use in pediatric nursing practicums to help nursing students learn to measure vital signs in children. METHODS The analysis, design, development, implementation, and evaluation model was employed between July 2021 and December 2021 at a university in South Korea. In the analysis phase, in-depth interviews were conducted with four nursing students, two nursing school graduates, and four experts. The topic and contents of the VR program were settled in the design phase. The VR program was developed and subsequently used and evaluated by 20 nursing students and four experts. RESULTS The contents of the VR program for pediatric nursing practicums included the measurement of vital signs in a newborn baby and a young child, as well as an evaluation system. The mean score for the nursing students' satisfaction with practice was 4.02 out of 5 points. The mean scores for overall satisfaction with the VR program were 4.15 and 4.79 out of 5 points for nursing students and experts, respectively. CONCLUSION The VR program developed in this study allows nursing students to practice measuring vital signs in children, thus improving the students' clinical performance in pediatric nursing.
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Affiliation(s)
- Sun Nam Park
- Professor, Department of Nursing, Seoul Women's College of Nursing, Seoul, Korea
| | - Hye Young Hwang
- Assistant Professor, Department of Nursing, Seoul Women's College of Nursing, Seoul, Korea
| | - Hyun Young Koo
- Professor, College of Nursing · Research Institute of Nursing Science, Daegu Catholic University, Daegu, Korea
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Tatliparmak AC, Yilmaz S. Impact of rigid cervical collars on the vital signs and cervical vasculature: Should we be on the alert for anything? Am J Emerg Med 2023; 66:31-35. [PMID: 36669441 DOI: 10.1016/j.ajem.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/10/2022] [Accepted: 01/07/2023] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE In this study, it was aimed to reveal the effect of RCC application on vital signs and physiology of the neck vascular structures. METHODS The study was designed as a prospective interventional study on 11 volunteers. The factors that would affect the hemodynamics of the volunteers were standardized before the measurements. The vital signs before and after RCC were measured and under the guidance of ultrasonography (USG), internal jugular vein cross-sectional area (CSA), diameter of the common carotid artery (CCAD), peak systolic velocity (PSV). end-diastolic velocity (EDV), time-averaged maximum velocity (TAMAX), Pulsatility Index, Resistivity Index, time averaged mean velocity (TAMEAN), Volume Flow (FV) measurements were made and compared with each other. RESULTS Among 11 volunteers, the study included 5 women (45.5%). 10 min of RCC application was associated with a reduction of the heart rate by 7.9 bpm (95% CI 4.84-10.98) (pre-collar 74.73 + -8.84, post-collar 66.82 + -9.05, p < 0.001). A corresponding 7.18 mmHg (95% CI 2.11-12.25) decrease in systolic blood pressure (pre-collar mean 115.82 mmHg + -12.55, post-collar mean 108.64 mmHg + -11.46, p = 0.01) and 108.55 mL/min reduction of mean common carotid artery blood volume (95% CI 22.28-194.82) (pre-collar 590.14 mL/min + -194.63, post-collar 481.59 mL/min + -279.36, p = 0.019) were noted. Internal jugular vein CSA has decreased for 0.17 cm2 (95% CI 0.05-0.29) (pre-collar CSA 0.53 + -0.29, post-collar CSA 0.36 + -0.17, p = 0.012). CONCLUSION In healthy volunteers, RCC application lasting for ten minutes may reduce systolic blood pressure and heart rate, while decreasing blood volume in both the common carotid artery and the internal jugular vein. It has also been noted that the collapse is larger in the internal jugular vein than in the common carotid artery following the pressure applied by RCC.
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Affiliation(s)
| | - Sarper Yilmaz
- University of Health Sciences, Dept. of Emergency Medicine, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey.
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Eddahchouri Y, Peelen RV, Koeneman M, van Veenendaal A, van Goor H, Bredie SJH, Touw H. The Effect of Continuous Versus Periodic Vital Sign Monitoring on Disease Severity of Patients with an Unplanned ICU Transfer. J Med Syst 2023; 47:43. [PMID: 37000306 PMCID: PMC10066074 DOI: 10.1007/s10916-023-01934-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 03/02/2023] [Indexed: 04/01/2023]
Abstract
Continuous vital sign monitoring (CM) may detect ward patient's deterioration earlier than periodic monitoring. This could result in timely ICU transfers or in a transfer delay due to misperceived higher level of care on the ward. The primary objective of this study was to compare patient's disease severity upon unplanned ICU transfer, before and after CM implementation. We included a one-year period before and after CM implementation between August 1, 2017 - July 31, 2019. Before implementation, surgical and internal medicine patients' vital signs were periodically monitored, compared to continuous monitoring with wireless linkage to hospital systems after implementation. In both periods the same early warning score (EWS) protocol was in place. Primary outcome was disease severity scores upon ICU transfer. Secondary outcomes were ICU and hospital length of stay, incidence of mechanical ventilation and ICU mortality. In the two one-year periods 93 and 59 unplanned ICU transfer episodes were included, respectively. Median SOFA (3 (2-6) vs 4 (2-7), p = .574), APACHE II (17 (14-20) vs 16 (14-21), p = .824) and APACHE IV (59 (46-67) vs 50 (36-65), p = .187) were comparable between both periods, as were the median ICU LOS (3.0 (1.7-5.8) vs 3.1 (1.6-6.1), p.962), hospital LOS (23.6 (11.5-38.0) vs 19 (13.9-39.2), p = .880), incidence of mechanical ventilation (28 (47%) vs 22 (54%), p.490), and ICU mortality (11 (13%) vs 10 (19%), p.420). This study shows no difference in disease severity upon unplanned ICU transfer after CM implementation for patients who have deteriorated on the ward.
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Affiliation(s)
- Yassin Eddahchouri
- Department of Surgery, Radboud university medical center, PO Box 9101, 618, Nijmegen, 6500 HB, The Netherlands.
| | - Roel V Peelen
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Mats Koeneman
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Alec van Veenendaal
- Department of Intensive Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud university medical center, PO Box 9101, 618, Nijmegen, 6500 HB, The Netherlands
| | - Sebastian J H Bredie
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Hugo Touw
- Department of Intensive Care, Radboud university medical center, Nijmegen, The Netherlands
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Wittmann S, Jorgensen R, Oostenbrink R, Moll H, Herberg J, Levin M, Maconochie I, Nijman R. Heart rate and respiratory rate in predicting risk of serious bacterial infection in febrile children given antipyretics: prospective observational study. Eur J Pediatr 2023; 182:2205-2214. [PMID: 36867236 PMCID: PMC10175419 DOI: 10.1007/s00431-023-04884-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/09/2023] [Accepted: 02/16/2023] [Indexed: 03/04/2023]
Abstract
Clinical algorithms used in the assessment of febrile children in the Paediatric Emergency Departments are commonly based on threshold values for vital signs, which in children with fever are often outside the normal range. Our aim was to assess the diagnostic value of heart and respiratory rate for serious bacterial infection (SBI) in children after temperature lowering following administration of antipyretics. A prospective cohort of children presenting with fever between June 2014 and March 2015 at the Paediatric Emergency Department of a large teaching hospital in London, UK, was performed. Seven hundred forty children aged 1 month-16 years presenting with a fever and ≥ 1 warning signs of SBI given antipyretics were included. Tachycardia or tachypnoea were defined by different threshold values: (a) APLS threshold values, (b) age-specific and temperature-adjusted centiles charts and (c) relative difference in z-score. SBI was defined by a composite reference standard (cultures from a sterile site, microbiology and virology results, radiological abnormalities, expert panel). Persistent tachypnoea after body temperature lowering was an important predictor of SBI (OR 1.92, 95% CI 1.15, 3.30). This effect was only observed for pneumonia but not other SBIs. Threshold values for tachypnoea > 97th centile at repeat measurement achieved high specificity (0.95 (0.93, 0.96)) and positive likelihood ratios (LR + 3.25 (1.73, 6.11)) and may be useful for ruling in SBI, specifically pneumonia. Persistent tachycardia was not an independent predictor of SBI and had limited value as a diagnostic test. Conclusion: Among children given antipyretics, tachypnoea at repeat measurement had some value in predicting SBI and was useful to rule in pneumonia. The diagnostic value of tachycardia was poor. Overreliance on heart rate as a diagnostic feature following body temperature lowering may not be justified to facilitate safe discharge. What is Known: • Abnormal vital signs at triage have limited value as a diagnostic test to identify children with SBI, and fever alters the specificity of commonly used threshold values for vital signs. • The observed temperature response after antipyretics is not a clinically useful indicator to differentiate the cause of febrile illness. What is New: • Persistent tachycardia following reduction in body temperature was not associated with an increased risk of SBI and of poor value as a diagnostic test, whilst persistent tachypnoea may indicate the presence of pneumonia.
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Affiliation(s)
- Stefanie Wittmann
- Department of Paediatric Emergency Medicine, Division of Medicine, St. Mary's Hospital-Imperial College NHS Healthcare Trust, London, UK
| | - Rikke Jorgensen
- Department of Paediatric Emergency Medicine, Division of Medicine, St. Mary's Hospital-Imperial College NHS Healthcare Trust, London, UK
| | - Rianne Oostenbrink
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Henriette Moll
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jethro Herberg
- Faculty of Medicine, Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London, UK.,Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Mike Levin
- Faculty of Medicine, Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London, UK.,Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Ian Maconochie
- Department of Paediatric Emergency Medicine, Division of Medicine, St. Mary's Hospital-Imperial College NHS Healthcare Trust, London, UK
| | - Ruud Nijman
- Department of Paediatric Emergency Medicine, Division of Medicine, St. Mary's Hospital-Imperial College NHS Healthcare Trust, London, UK. .,Faculty of Medicine, Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London, UK. .,Centre for Paediatrics and Child Health, Imperial College London, London, UK.
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Sullivan TM, Milestone ZP, Colson CD, Tempel PE, Gestrich-Thompson WV, Burd RS. Evaluation of Missing Prehospital Physiological Values in Injured Children and Adolescents. J Surg Res 2023; 283:305-312. [PMID: 36423480 PMCID: PMC9990680 DOI: 10.1016/j.jss.2022.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/11/2022] [Accepted: 10/16/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Prehospital vital signs and the Glasgow Coma Scale score are often missing in clinical practice and not recorded in trauma databases. Our study aimed to identify factors associated with missing prehospital physiological values, including systolic blood pressure, heart rate, respiratory rate, peripheral oxygen saturation, and Glasgow Coma Scale. METHODS We used our hospital trauma registry to obtain patient, injury, resuscitation, and transportation characteristics for injured children and adolescents (age <15 y). We evaluated the association of missing documentation of prehospital values with other patient, injury, transportation, and resuscitation characteristics using multivariable regression. We standardized vital sign values using age-adjusted z-scores. RESULTS The odds of a missing physiological value decreased with age (odds ratio [OR] = 0.9, 95% confidence interval [CI] = 0.9, 0.9) and were higher when prehospital cardiopulmonary resuscitation was required (OR = 3.3, 95% CI = 1.9, 5.7). Among the physiological values considered, we observed the highest odds of missingness of systolic blood pressure, respiratory rate, and oxygen saturation. The odds of observing normal emergency department physiological values were lower when prehospital physiological values were missing (OR = 0.9, 95% CI = 0.9, 1.0; P = 0.04). CONCLUSIONS Missing prehospital physiological values were associated with younger age and cardiopulmonary resuscitation among the injured children treated at our hospital. Measurement and documentation of physiological variables of patients with these characteristics should be targeted.
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Affiliation(s)
- Travis M Sullivan
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
| | - Zachary P Milestone
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
| | - Cindy D Colson
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
| | - Peyton E Tempel
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
| | | | - Randall S Burd
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia.
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O'Connell A, Flabouris A, Edwards S, Thompson CH. Tiered escalation response systems in practice: A post hoc analysis examining the workload implications. CRIT CARE RESUSC 2023; 25:47-52. [PMID: 37876991 PMCID: PMC10581276 DOI: 10.1016/j.ccrj.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Objective Many rapid response systems now have multiple tiers of escalation in addition to the traditional single tier of a medical emergency team. Given that the benefit to patient outcomes of this change is unclear, we sought to investigate the workload implications of a multitiered system, including the impact of trigger modification. Design The study design incorporated a post hoc analysis using a matched case-control dataset. Setting The study setting was an acute, adult tertiary referral hospital. Participants Cases that had an adverse event (cardiac arrest or unanticipated intensive care unit admission) or a rapid response team (RRT) call participated in the study. Controls were matched by age, gender, ward and time of year, and no adverse event or RRT call. Participants were admitted between May 2014 and April 2015. Main outcome measures The main outcome measure were the number of reviews, triggers, and modifications across three tiers of escalation; a nurse review, a multidisciplinary review (MDT-admitting medical team review), and an RRT call. Results There were 321 cases and 321 controls. Overall, there were 1948 nurse triggers, of which 1431 (73.5%) were in cases and 517 (26.5%) in controls, 798 MDT triggers (660 [82.7%] in cases and 138 [17.3%] in controls), and 379 RRT triggers (351 [92.6%] in cases and 28 [7.4%] in controls). Per patient per 24 h, there were 3.03 nurse, 1.24 MDT, and 0.59 RRT triggers. Accounting for modifications, this reduced to 2.17, 0.88, and 0.42, respectively. The proportion of triggers that were modified, so as not to trigger a review, was similar across all the tiers, being 28.6% of nurse, 29.6% of MDT, and 28.2% of RRT triggers. Per patient per 24 h, there were 0.61 nurse reviews, 0.52 MDT reviews, and 0.08 RRT reviews. Conclusions Lower-tier triggers were more prevalent, and modifications were common. Modifications significantly mitigated the escalation workload across all tiers of a multitiered system.
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Affiliation(s)
- Alice O'Connell
- Consultant, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Arthas Flabouris
- Consultant, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Suzanne Edwards
- Statistician, Adelaide Health Technology Assessment, School of Public Health, The University of Adelaide, South Australia, Australia
| | - Campbell H. Thompson
- Consultant, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Shahiri T S, Gélinas C. The Validity of Vital Signs for Pain Assessment in critically Ill Adults: A Narrative Review. Pain Manag Nurs 2023; 24:318-328. [PMID: 36781330 DOI: 10.1016/j.pmn.2023.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/30/2022] [Accepted: 01/20/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVES Pain assessment in the intensive care unit (ICU) is challenging because many patients are unable to self-report or exhibit pain-related behaviors. In such situations, vital signs (VS) through continuous monitoring are alternative cues for pain assessment. This review aimed to describe the reliability and validity of VS for ICU pain assessment. DESIGN Narrative review of the literature. DATA SOURCES Medline, Embase, CINAHL, Cochrane. REVIEW/ANALYSIS METHODS A narrative review was conducted with a comprehensive search in four databases. Search terms included VS, pain assessment, and ICU. RESULTS Out of 1,359 results, 30 studies from 17 countries were included. Heart rate, blood pressure, and respiratory rate were most used for ICU pain assessment. Assessments were performed at rest before procedures, during nociceptive and non-nociceptive procedures, and after procedures. Increases in respiratory rate were clinically significant by more than 25% during nociceptive procedures (e.g., endotracheal suctioning, turning) compared with rest/pre-procedures in five studies. Correlations of VS with self-reported pain (reference standard measure) and behavioral pain scores (alternative measure) were absent or weak. CONCLUSIONS VS are not valid indicators for ICU pain assessment. Increases of respiratory rate may be a cue for the detection of pain. However, fluctuations in respiratory rate can be influenced by opioids or controlled ventilation mode. Our results dissuade the use of VS for pain assessment because of the lack of association with ICU pain reference standards. Other physiologic measures of pain in critically ill adults should be explored.
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Affiliation(s)
- Shiva Shahiri T
- Ingram School of Nursing, McGill University, Montreal, Canada; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital - CIUSSS West-Central-Montreal, Montreal, Canada.
| | - Céline Gélinas
- Ingram School of Nursing, McGill University, Montreal, Canada; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital - CIUSSS West-Central-Montreal, Montreal, Canada
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Takayama A, Yoshioka T, Nagamine T. Impact of beta blockers on resting respiratory rate in older adults: A cross-sectional study. Pulm Pharmacol Ther 2023; 78:102186. [PMID: 36603740 DOI: 10.1016/j.pupt.2022.102186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 12/09/2022] [Accepted: 12/31/2022] [Indexed: 01/03/2023]
Abstract
[Purpose] Beta blockers, commonly prescribed for older adults, affect heart rates and blood pressure and may reduce respiratory rates, which are used to evaluate patient status and predict outcomes. However, limited clinical evidence is available on the impact of beta blockers on respiratory rates. This study aimed to investigate the impact of beta blockers on respiratory rates in older adults. [Methods] This cross-sectional study included patients aged ≥60 years who underwent an annual checkup. Patients were excluded if they had a diagnosis of severe heart failure, chronic obstructive pulmonary disease, interstitial pneumonitis, severe anemia, or neurodegenerative disease. Doubly robust estimation with inverse probability weighting was applied to estimate the mean differences between beta blocker users and non-users. The dose-response relationship between the administered beta blockers and respiratory rates was examined using multivariable regression models. [Results] Of 637 participants, 108 had received beta blockers regularly. The adjusted mean differences (95% confidence interval, CI) in respiratory rates, pulse rates, systolic blood pressure, and diastolic blood pressure between beta blocker users and non-users were 0.35 (-0.68 to 1.37), -3.56 (-6.34 to -0.78), -5.53 (-8.53 to -2.52), and -4.70 (-8.27 to -1.14), respectively. The adjusted mean differences (95% CI) in respiratory rates per 1 mg of a carvedilol equivalent dose in all beta blocker users, liposoluble beta blocker users, and carvedilol users were -0.10 (-0.18 to -0.02), -0.35 (-0.59 to -0.11), and -0.29 (-0.54 to -0.06), respectively. [Conclusions] Beta blockers may dose-dependently reduce the respiratory rates of older adults. However, in clinical settings, the impact of beta-blocker use or non-use on the respiratory rate may not occur at a clinically important level. Clinicians should note the potentially suppressive impact of beta blockers on respiratory rates according to the situation.
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Affiliation(s)
- Atsushi Takayama
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Hikarigaoka 1, Fukushima City, Fukushima, 960-1295, Japan; Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoecho, Sakyoku, Kyoto, 606-8501, Japan.
| | - Takashi Yoshioka
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Hikarigaoka 1, Fukushima City, Fukushima, 960-1295, Japan; Department of Preventive Medicine and Public Health, School of Medicine, Keio University, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takahiko Nagamine
- Department of Psychiatric Internal Medicine, Sunlight Brain Research Center, Hofu, Japan
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Beaman H, Douglas VC, Patel K, John Boscardin W, Youn J, LaHue SC. Potential for remote vital sign monitoring to improve hospital patient sleep: A feasibility study. Int J Med Inform 2023; 170:104970. [PMID: 36603390 DOI: 10.1016/j.ijmedinf.2022.104970] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/20/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Even low-acuity patients suffer from disrupted sleep in the hospital in part due to routine overnight vital sign (VS) checks. When invasive monitoring is not needed, vital sign monitoring devices (VSMDs) similar to consumer-grade health monitors may play a role in promoting sleep, which can aid healing and recovery. METHODS We provided one VSMD to neuroscience ward patients during their hospital stays and used surveys to assess patient and nurse attitudes toward the device and the impact of the device on patient comfort. We also compared VSMD-streamed vS data to nurse-recorded vS data in the chart to evaluate the consistency of data streaming and data concordance between the device and nurse-collected vital sign values. FINDINGS 21 patients and 15 nurses enrolled. Overall, patients and nurses responded positively to the device and patients preferred wearing the device to receiving manual vital checks overnight. The most common device-related cause of sleep disruption per patients was device weight (29%). Device vS were concordant with nurse vS on average but there was significant variance in agreement between nurse and device values. INTERPRETATION Patients and nurses feel positively about the use of VSMDs and their use in the hospital. The device we tested may be limited in its sleep promotion by its weight and patient comfort assessment. Further research is needed to assess the precision of the device in measuring vital signs when used in a clinical setting. Future studies should compare VSMD models and assess their impacts on patient sleep in the absence of manual vS checks overnight. FUNDING Funding provided by the Sara & Evan Williams Foundation Endowed Neurohospitalist Chair at UCSF.
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Affiliation(s)
- Hannah Beaman
- School of Medicine, University of California, San Francisco, CA, USA.
| | - Vanja C Douglas
- Department of Neurology, School of Medicine, University of California, San Francisco, CA, USA; Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Kanan Patel
- Division of Geriatrics, Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA
| | - W John Boscardin
- Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, CA, USA
| | - Joy Youn
- Department of Neurology, School of Medicine, University of California, San Francisco, CA, USA
| | - Sara C LaHue
- Department of Neurology, School of Medicine, University of California, San Francisco, CA, USA; Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
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Totuk A, Bayramoglu B, Tayfur I. Reliability of smartphone measurements of peripheral oxygen saturation and heart rate in hypotensive patients measurement of vital signs with smartphones. Heliyon 2023; 9:e13145. [PMID: 36814605 PMCID: PMC9939538 DOI: 10.1016/j.heliyon.2023.e13145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 01/27/2023] Open
Abstract
Objective With the increasing use of wearable technologies (smartphones and smartwatches), it has become possible to measure vital signs outside healthcare institutions without the need for an additional medical device. With the advancement in technologies, the accuracy of vital signs measured by smartphones and smartwatches has also increased. In this study, the accuracy of smart devices in the measurement of heart rate and saturation, which are two vital signs that are difficult to detect in conditions such as hypotension were investigated. Materials and methods The study was prospectively conducted in a tertiary healthcare center. In hypotensive patients who presented to the emergency department (ED) and required an arterial blood gas evaluation, oxygen saturation and heart rate values measured by a smartphone, those measured with a vital signs monitor (VSM) at the time of admission to the ED and oxygen saturation values measured by a blood gas analyzer (BGA) were compared. Results A total of 200 patients, 117 women and 83 men, were included in the study. It was determined that the correlation coefficients of the heart rate values measured by the vital signs monitor and smartphone were in a high statistical agreement. When the saturation values measured by the vital signs monitor, smartphone, and blood gas analyzer were compared, it was found that the intra-class correlation coefficients of the saturation values measured by the smartphone with reference to the blood gas analyzer and vital signs monitor were 0.957 and 0.949, respectively, indicating an excellent agreement. Conclusion Smartphones have as high efficiency as reference devices in measuring heart rate and saturation in hypotensive patients. In this way, hypotensive patients who need medical help can also have the opportunity to measure their vital parameters with their smartphones, without the need for any other medical device, before applying to the hospital or emergency health system. This may contribute to the improvement of the quality of life of the patients and the early and accurate information of the health care providers about the patient's health parameters.
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Affiliation(s)
- Arman Totuk
- Simav Doc. Dr. Ismail Karakuyu State Hospital, Kütahya, Turkey
| | - Burcu Bayramoglu
- University of Health Sciences, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Ismail Tayfur
- University of Health Sciences, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
- Corresponding author.
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Dong Y, Zhang L, Chen LW, Luo ZR. Music therapy for pain and anxiety in patients after cardiac valve replacement: a randomized controlled clinical trial. BMC Cardiovasc Disord 2023; 23:32. [PMID: 36650441 PMCID: PMC9845817 DOI: 10.1186/s12872-023-03058-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE This study aimed to assess how listening to music after cardiac valve replacements affected patients' pain, anxiety, and vital signs. METHOD In Fuzhou, China's Fujian Medical University Union Hospital, the cardiac surgery division conducted a randomized controlled clinical experiment. 86 patients were enrolled, and 43 were assigned randomly to each group (control and experimental group). The standard treatment was given to the control group, while the experimental group was given standard treatment + a 15-min music intervention 3 times. Indicators include pain, anxiety and vital signs (respiratory rate, heart rate, and blood pressure). RESULTS In comparison to the control group, the experimental group, over time, demonstrated a statistically substantial decrease in pain, anxiety, systolic blood pressure, heart rate and respiratory rate (all P < 0.001), yet, there were no discernible variations (P > 0.05) in diastolic blood pressure. CONCLUSIONS In conclusion, these results provide additional proof for using music therapy to minimize cardiac postoperative pain and anxiety, as well as systolic blood pressure, heart rate and respiratory rate. Moreover, it should be regarded as a supplementary treatment for pain and anxiety after cardiac valve replacement and other medical procedures with comparable postoperative pain.
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Affiliation(s)
- Yi Dong
- grid.256112.30000 0004 1797 9307Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001 People’s Republic of China ,grid.256112.30000 0004 1797 9307Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People’s Republic of China
| | - Lin Zhang
- grid.256112.30000 0004 1797 9307Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001 People’s Republic of China ,grid.256112.30000 0004 1797 9307Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People’s Republic of China
| | - Liang-Wan Chen
- grid.256112.30000 0004 1797 9307Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001 People’s Republic of China ,grid.256112.30000 0004 1797 9307Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People’s Republic of China
| | - Zeng-Rong Luo
- grid.256112.30000 0004 1797 9307Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001 People’s Republic of China ,grid.256112.30000 0004 1797 9307Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People’s Republic of China
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Nielsen VML, Søvsø MB, Kløjgård TA, Skals RG, Corfield AR, Bender L, Lossius HM, Mikkelsen S, Christensen EF. Prehospital vital sign monitoring in paediatric patients: an interregional study of educational interventions. Scand J Trauma Resusc Emerg Med 2023; 31:4. [PMID: 36639802 PMCID: PMC9839956 DOI: 10.1186/s13049-023-01067-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Prehospital vital sign documentation in paediatric patients is incomplete, especially in patients ≤ 2 years. The aim of the study was to increase vital sign registration in paediatric patients through specific educational initiatives. METHODS Prospective quasi-experimental study with interrupted time-series design in the North Denmark and South Denmark regions. The study consecutively included all children aged < 18 years attended by the emergency medical service (EMS) from 1 July 2019 to 31 December 2021. Specific educational initiatives were conducted only in the North Denmark EMS and included video learning and classroom training based on the European Paediatric Advanced Life Support principles. The primary outcome was the proportion of patients who had their respiratory rate, peripheral capillary oxygen saturation, heart rate and level of consciousness recorded at least twice. We used a binomial regression model stratified by age groups to compare proportions of the primary outcome in the pre- and post-intervention periods in each region. RESULTS In North Denmark, 7551 patients were included, while 15,585 patients from South Denmark were used as a reference. Virtually all of the North Denmark EMS providers completed the video learning (98.7%). The total study population involved patients aged ≤ 2 months (5.5%), 3-11 months (7.4%), 1-2 years (18.8%), 3-7 years (16.2%) and ≥ 8 years (52.1%). In the intervention region, the primary outcome increased from the pre- to the post-intervention period from 35.3% to 40.5% [95% CI for difference 3.0;7.4]. There were large variations in between age groups with increases from 18.8% to 27.4% [95% CI for difference 5.3;12.0] among patients aged ≤ 2 years, from 33.5% to 43.7% [95% CI for difference 4.9;15.5] among patients aged 3-7 years and an insignificant increase among patients aged ≥ 8 years (from 46.4% to 47.9% [95% CI for difference - 1.7;4.7]). In the region without the specific educational interventions, proportions were steady for all age groups throughout the entire study period. CONCLUSIONS Mandatory educational initiatives for EMS providers were associated with an increase in the extent of vital sign registration in paediatric patients ≤ 7 years. Incomplete vital registration was associated with, but not limited to non-urgent cases.
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Affiliation(s)
- Vibe Maria Laden Nielsen
- grid.5117.20000 0001 0742 471XCentre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Morten Breinholt Søvsø
- grid.5117.20000 0001 0742 471XCentre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University Hospital, Aalborg University, Aalborg, Denmark ,grid.425870.cPrehospital Emergency Services, Aalborg, North Denmark Region Denmark
| | - Torben Anders Kløjgård
- grid.5117.20000 0001 0742 471XCentre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Regitze Gyldenholm Skals
- grid.27530.330000 0004 0646 7349Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Alasdair Ross Corfield
- grid.8756.c0000 0001 2193 314XNational Health Service Greater Glasgow and Clyde, University of Glasgow, Glasgow, UK
| | - Lars Bender
- grid.27530.330000 0004 0646 7349Paediatric Department, Aalborg University Hospital, Aalborg, Denmark
| | - Hans Morten Lossius
- grid.18883.3a0000 0001 2299 9255Norwegian Air Ambulance Foundation, University of Stavanger, Stavanger, Norway
| | - Søren Mikkelsen
- grid.7143.10000 0004 0512 5013The Prehospital Research Unit, Odense University Hospital, Odense, Region of Southern Denmark Denmark
| | - Erika Frischknecht Christensen
- grid.5117.20000 0001 0742 471XCentre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University Hospital, Aalborg University, Aalborg, Denmark ,grid.425870.cPrehospital Emergency Services, Aalborg, North Denmark Region Denmark
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Ozturk O, Golparvar A, Acar G, Guler S, Yapici MK. Single-arm diagnostic electrocardiography with printed graphene on wearable textiles. Sens Actuators A Phys 2023; 349:114058. [PMID: 36447633 PMCID: PMC9686048 DOI: 10.1016/j.sna.2022.114058] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/04/2022] [Accepted: 11/23/2022] [Indexed: 06/16/2023]
Abstract
Stimulated by the COVID-19 outbreak, the global healthcare industry better acknowledges the necessity of innovating novel methods for remote healthcare monitoring and treating patients outside clinics. Here we report the development of two different types of graphene textile electrodes differentiated by the employed fabrication techniques (i.e., dip-coating and spray printing) and successful demonstration of ergonomic and truly wearable, single-arm diagnostic electrocardiography (SADE) using only 3 electrodes positioned on only 1 arm. The performance of the printed graphene e-textile wearable systems were benchmarked against the "gold standard" silver/silver chloride (Ag/AgCl) "wet" electrodes; achieving excellent correlation up to ∼ 96% and ∼ 98% in ECG recordings (15 s duration) acquired with graphene textiles fabricated by dip-coating and spray printing techniques, respectively. In addition, we successfully implemented automatic detection of heartrate of 8 volunteers (mean value: 74.4 bpm) during 5 min of static and dynamic daily activities and benchmarked their recordings with a standard fingertip photoplethysmography (PPG) device. Heart rate variability (HRV) was calculated, and the root means successive square difference (rMMSD) metric was 30 ms during 5 min of recording. Other cardiac parameters such as R-R interval, QRS complex duration, S-T segment duration, and T-wave duration were also detected and compared to typical chest ECG values.
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Affiliation(s)
- Ozberk Ozturk
- Faculty of Engineering and Natural Sciences, Sabanci University, 34956 Istanbul, Turkey
| | - Ata Golparvar
- Faculty of Engineering and Natural Sciences, Sabanci University, 34956 Istanbul, Turkey
- Integrated Circuit Laboratory, École Polytechnique Fédérale de Lausanne (EPFL), 2002 Neuchâtel, Switzerland
| | - Gizem Acar
- Faculty of Engineering and Natural Sciences, Sabanci University, 34956 Istanbul, Turkey
| | - Saygun Guler
- Faculty of Engineering and Natural Sciences, Sabanci University, 34956 Istanbul, Turkey
| | - Murat Kaya Yapici
- Faculty of Engineering and Natural Sciences, Sabanci University, 34956 Istanbul, Turkey
- Department of Electrical Engineering, University of Washington, 98195 Seattle, USA
- Sabanci University SUNUM Nanotechnology Research Center, 34956 Istanbul, Turkey
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