A comparison between infrared tympanic thermometry, oral and axilla with rectal thermometry in neutropenic adults

Time of Day Effects on Anaerobic Performance Using a Nonmotorized Treadmill

ABSTRACT

Renziehausen, JM, Bergquist, AM, Park, J-H, Hill, EC, Wells, AJ, Stout, JR, and Fukuda, DH. Time of day effects on anaerobic performance using a nonmotorized treadmill. J Strength Cond Res 37(10): 2002-2007, 2023-The purpose of this study was to determine the effects of time of day on performance during a maximal effort sprinting assessment (30nmt) and determine potential differences based on chronotype and sex. Twenty-six recreationally active men (n = 12) and women (n = 14) between the ages of 18 and 35 years old (21.5 ± 2.4 years) completed the 30nmt at 9:00 am, 2:00 pm, and 7:00 pm in a randomized order over a 24-hour period. Resting heart rate and temperature assessments were taken at each visit. A dietary recall and the Morningness-Eveningness Questionnaire were used to assess kilocalories (kcals) and chronotype, respectively. Two-way (time x sex) repeated measures analyses of variance were conducted to determine differences in peak/mean power, peak/mean velocity, distance, resting heart rate, temperature, and kcals at each time point. Paired sample t tests were used to assess peak and nadir of each performance variable. A significance level was set at p < 0.05. There was a significant main effect for temperature (p < 0.001), resting heart rate (p = 0.007), and pre-exercise caloric intake (p = 0.021) throughout the day. No significant main effects for time were found for peak power (p = 0.766), mean power (p = 0.094), peak velocity (p = 0.497), mean velocity (p = 0.193), or distance (p = 0.262). There were no significant time × sex interactions for any dependent performance variables (p > 0.05). Significant differences were shown between the peak and nadir of each performance variable (p < 0.001). There were no significant differences in performance during maximal effort anaerobic assessments shown throughout the day; however, peak/nadir of performance times may be individualized and differ between morning types and intermediate types.

Comparison of the acute effects of ankle bathing versus moderate-intensity aerobic exercise on vascular function in young adults

We examined the efficacy of ankle bathing versus aerobic exercise to improve vascular function in young adults who were randomized to aerobic exercise (AE) (n = 13, 40%-60% of heart rate reserve), ankle bathing (AB) (n = 15, 43 °C), or a control condition (CON) (n = 14, ankle bathing, 36 °C) for 40 min. Conduit vessel function [brachial artery flow-mediated dilation (FMD)], carotid and femoral artery blood flow and shear rate (SR), and arterial stiffness [carotid-to-femoral pulse wave velocity (cf-PWV), augmentation index (AIx@75), β-stiffness index, and arterial compliance] were evaluated. Compared with CON, AE and AB increased FMD at 30 min and 90 min (interaction: p < 0.05); AB decreased carotid artery blood flow and SR at 30 min, while both AE and AB increased femoral artery blood flow and SR at 30 min and 90 min (interaction: p < 0.05); AE and AB decreased cf-PWV and AIx@75 at 30 min and 90 min (interaction: p < 0.05); and AE improved both carotid and femoral β-stiffness index and arterial compliance, while AB reduced β-stiffness index and increased arterial compliance only in the femoral artery (interaction: p < 0.05). These findings suggest that ankle bathing may serve as an alternative strategy for enhancing vascular function. Novelty: We observed similar improvements in conduit vessel function, femoral artery blood flow and shear rate, and arterial stiffness following ankle bathing and acute aerobic exercise in young adults. These findings have identified ankle bathing as a potential therapeutic strategy for enhancing vascular function, which may be particularly relevant for those with limited ability to engage in regular aerobic exercise.

SARS-CoV-2 (Covid-19) workplace temperature screening: Seasonal concerns for thermal detection in northern regions

Workplace temperature screening has become standard practice during the SARS-CoV-2 pandemic. The objective was to determine the consistency of four temperature devices during exposure to simulated and actual environmental conditions reflective of a workplace. An infrared (IR) digital thermometer (accuracy(A)±0.2), IR laser thermometer (A±1), and thermal imaging camera (A±0.3) were used to measure forehead and tympanic (digital only) temperatures. The first experiment was conducted in a controlled simulated environment (-20 to 20 °C) with three participants (32-YOF, 27-YOM, 20-YOF). The second experiment used actual outdoor conditions (-0.48 to 45.6 °C) with two participants (32-YOF, 27-YOM). The tympanic measurement was the least impacted by environmental temperature (mean(±SD)): simulated (36.8(±0.18) °C) and actual (36.9(±0.16) °C). The thermal imaging camera had the lowest RMSE values (0.81-0.97 °C), with outdoor temperatures ranging from 0 to 45 °C. Environmental temperature influenced forehead temperature readings and required a resting period in a thermoneutral environment (5-9 min (-20 to -10 °C) to immediate (15-20 °C)).

Clinical accuracy and agreement between tympanic and forehead body temperature measurements for screening of patients with COVID-19

AIM

To investigate the accuracy, reliability and agreement between infrared forehead thermometers versus infrared tympanic thermometers temperature, a cross-sectional study was conducted in April 2020.

METHODS

The forehead and tympanic temperatures of 615 subjects were measured simultaneously in three exposed SARS-COV-2 groups at one hospital in Iran, during April 2020. These comparisons were evaluated by Bland-Altman Plot, repeatability, Passing-Bablok regression and Lin's concordance correlation coefficient. The receiver operating characteristic (ROC) analysis was done to describe the discrimination accuracy of a diagnostic test. The study adhered to STROBE checklist for cross-sectional studies.

RESULTS

A Bland-Altman plot indicated that the limits of agreement between the forehead and tympanic temperature were -0.259 to +0.19°C. Passing-Bablok regression analysis illustrated that the infrared forehead was not linearly related to tympanic temperatures (reference method), with a slope estimate that was significantly different from 1.00. The infrared forehead thermometer showed poor precision and lower accuracy than the tympanic. The forehead temperature readings had 60.0% sensitivity and 44.4% specificity (p > .05) to predict disease.

CONCLUSION

According to the results of study, there is no evidence that the assessment of temperature by infrared forehead thermometer could discriminate between the two groups (positive and negative).

Diagnostic accuracy of oral thermometry for fever detection in adult patients: literature review and meta-analysis

AIMS AND OBJECTIVES

To synthesise the evidence on the accuracy and precision of oral thermometry in adult patients, as well as on its sensitivity and specificity for fever detection.

BACKGROUND

Oral thermometry has long been used in various clinical settings thanks to its rapid, safe and convenient measurements, which are easy to obtain and minimally prone to operator errors.

DESIGN

Literature review and meta-analysis that adhered to the PRISMA statement.

METHODS

By using key terms, literature searches were conducted in CINAHL, PubMed, Web of Science, Scopus and Cochrane Library. Method-comparison studies, which were published from January 1990 to December 2020 in English-language, peer-reviewed journals, compared oral temperature measurements with invasive thermometry ones, and were conducted on patients ≥18 years, were included. Methodological quality of selected studies was evaluated with QUADAS-2.

RESULTS

Sixteen articles were selected for inclusion. Risk of bias was assessed as low in most of them. Quantitative synthesis indicated that pooled mean oral temperature was lower than core temperature by .07℃, with 95% limits of agreement ranging between -.22℃ and .08℃. Pooled sensitivity and specificity for fever detection (defined as core temperature ≥38℃ in most studies) were .53 (95% confidence interval, .39-.66) and .98 (95% confidence interval, .97-.99), respectively. Sensitivity analysis indicated larger temperature underestimation in case rectal temperature was used as reference standard.

CONCLUSION

Despite its satisfactory accuracy, precision and specificity, oral thermometry has low sensitivity for fever detection, which entails a high number of false-negative readings and uncertainty for excluding fever in patients found to be non-febrile.

RELEVANCE TO CLINICAL PRACTICE

Oral thermometry cannot be recommended for replacing invasive thermometry methods in hospitalised adult patients, considering the high incidence of fever in them and possible negative effects of missing fever for patient diagnosis and outcomes.

Evaluation of commercial, wireless dermal thermometers for surrogate measurements of core temperature

Extensive research has been devoted to developing methods for assessing core body temperature, and to determine which method is most accurate. A number of wireless dermal thermometers for home use are presently available, but their relation to core body temperature and suitability for use in clinical research has hitherto not been assessed. The current study aimed to evaluate such thermometers by comparing them to the results of a rectal thermometer. Four wireless dermal thermometers for home use (FeverSmart, iThermonitor, Quest Temp Sitter, and Thermochron iButton) were applied to 15 patients during 24 h, and rectal temperature was measured at four occasions. Pearson correlation revealed moderate correlation for the Feversmart (r = 0.75), iThermonitor (r = 0.79), and Thermochron iButton (r = 0.71) systems. The Quest Temp Sitter system malfunctioned repeatedly, and the correlation (r = 0.29) for this method should therefore be assessed with caution. All dermal thermometers rendered lower average temperatures than Terumo c405 (Feversmart -0.70 ± 0.65 °C; iThermonitor -0.77 ± 0.53 °C, Quest Temp Sitter -1.18 ± 0.66 °C, and Thermochron iButton -0.87 ± 0.65 °C). Sensitivity of the dermal thermometers for detecting core temperatures ≥38.0 °C was low, ranging from 0.33 to 0.6, but improved to 0.60 to 0.80 after adjusting temperatures by the methods' average deviation from rectal temperature. The results from the dermal thermometers tested here showed an insufficient correlation to core temperature to be used for core temperature monitoring in clinical research and practice. Unfortunately, other options for non-invasive temperature measurements are few. The two thermometers with the least unsatisfactory performance profile in our evaluations were the Feversmart and iThermonitor systems.

Impacts of cooling intervention on the heat strain attenuation of construction workers

This study aimed to evaluate the effectiveness and practicality of a cooling intervention with a newly designed cooling vest on heat strain attenuation in the construction industry. Fourteen construction workers volunteered to participate in the field study. Each participant took part in two trials, i.e., cooling and control. Construction work included morning and afternoon sessions. Cooling intervention was implemented for 15 and 30 min during the morning and afternoon rest periods, respectively, between repeated bouts of work. Micrometeorological (wet-bulb globe temperature [WBGT]), physiological (tympanic temperature and heart rate), and perceptual (ratings of perceived exertion [RPE] and thermal sensation) measurements were taken during the test. Heat strain indices, including physiological strain index (PSI_HR) and perceptual strain index (PeSI), were estimated accordingly. During the study, construction workers were exposed to a hot environment with a mean WBGT of 31.56 ± 1.87 °C. Compared with the control, physiological and perceptual strain were significantly reduced in the cooling condition during rest and subsequent work periods (p < 0.05; d = 0.24-1.07, small to large cooling effect). Cooling intervention significantly alleviates heat strain in the construction industry. The effectiveness and practicality of a proposed cooling intervention were tested in a field study. Results provide a reference for setting guidelines and promoting application on a range of construction sites.

Accuracy and precision of four common peripheral temperature measurement methods in intensive care patients

INTRODUCTION

An accurate determination of body temperature in critically ill patients is a fundamental requirement for initiating the proper process of diagnosis, and also therapeutic actions; therefore, the aim of the study was to assess the accuracy and precision of four noninvasive peripheral methods of temperature measurement compared to the central nasopharyngeal measurement.

METHODS

In this observational prospective study, 237 patients were recruited from the intensive care unit of Imam Ali Hospital of Kermanshah. The patients' body temperatures were measured by four peripheral methods; oral, axillary, tympanic, and forehead along with a standard central nasopharyngeal measurement. After data collection, the results were analyzed by paired t-test, kappa coefficient, receiver operating characteristic curve, and using Statistical Package for the Social Sciences, version 19, software.

RESULTS

There was a significant meaningful correlation between all the peripheral methods when compared with the central measurement (P<0.001). Kappa coefficients showed good agreement between the temperatures of right and left tympanic membranes and the standard central nasopharyngeal measurement (88%). Paired t-test demonstrated an acceptable precision with forehead (P=0.132), left (P=0.18) and right (P=0.318) tympanic membranes, oral (P=1.00), and axillary (P=1.00) methods. Sensitivity and specificity of both the left and right tympanic membranes were more than for other methods.

CONCLUSION

The tympanic and forehead methods had the highest and lowest accuracy for measuring body temperature, respectively. It is recommended to use the tympanic method (right and left) for assessing a patient's body temperature in the intensive care units because of high accuracy and acceptable precision.

Approach to fever assessment in ambulatory cancer patients receiving chemotherapy: a clinical practice guideline

BACKGROUND

This guideline was prepared by the Fever Assessment Guideline Development Group, a group organized by the Program in Evidence-Based Care at the request of the Cancer Care Ontario Systemic Treatment Program. The mandate was to develop a standardized approach (in terms of definitions, information, and education) for the assessment of fever in cancer patients receiving chemotherapy.

METHODS

The guideline development methods included a search for existing guidelines, literature searches in medline and embase for systematic reviews and primary studies, internal review by content and methodology experts, and external review by targeted experts and intended users.

RESULTS

The search identified eight guidelines that had partial relevance to the topic of the present guideline and thirty-eight primary studies. The studies were mostly noncomparative prospective or retrospective studies. Few studies directly addressed the topic of fever except as one among many symptoms or adverse effects associated with chemotherapy. The recommendations concerning fever definition are supported mainly by other existing guidelines. No evidence was found that directly pertained to the assessment of fever before a diagnosis of febrile neutropenia was made. However, some studies evaluated approaches to symptom management that included fever among the symptoms. Few studies directly addressed information needs and resources for managing fever in cancer patients.

CONCLUSIONS

Fever in patients with cancer who are receiving systemic therapy is a common and potentially serious symptom that requires prompt assessment, but currently, evidence to inform best practices concerning when, where, and by whom that assessment is done is very limited.

Climatic and psychosocial risks of heat illness incidents on construction site

The study presented in this paper aims to identify prominent risks leading to heat illness in summer among construction workers that can be prioritised for developing effective interventions. Samples are 216 construction workers' cases at the individual level and 26 construction projects cases at the organisation level. A grounded theory is generated to define the climatic heat and psychosocial risks and the relationships between risks, timing and effectiveness of interventions. The theoretical framework is then used to guide content analysis of 36 individual onsite heat illness cases to identify prominent risks. The results suggest that heat stress risks on construction site are socially constructed and can be effectively managed through elimination at supply chain level, effective engineering control, proactive control of the risks through individual interventions and reactive control through mindful recognition and response to early symptoms. The role of management infrastructure as a base for effective interventions is discussed.

Tympanic ear thermometer assessment of body temperature among patients with cognitive disturbances. An acceptable and ethically desirable alternative?

AIM

Investigation of a possible relation between body temperature measurements by the current generation of tympanic ear and rectal thermometers.

BACKGROUND

In Denmark, a national guideline recommends the rectal measurement. Subsequently, the rectal thermometers and tympanic ear devices are the most frequently used and first choice in Danish hospital wards. Cognitive changes constitute challenges with cooperating in rectal temperature assessments. With regard to diagnosing, ethics, safety and the patients' dignity, the tympanic ear thermometer might comprise a desirable alternative to rectal noninvasive measurement of body temperature during in-hospital-based neurorehabilitation.

DESIGN

A prospective, descriptive cohort study. Consecutive inclusion of 27 patients. Linear regression models were used to analyse 284 simultaneous temperature measurements.

ETHICS

Ethical approval for this study was granted by the Danish Data Protection Agency, and the study was completed in accordance with the Helsinki Declaration 2008.

RESULTS

About 284 simultaneous rectal and ear temperature measurements on 27 patients were analysed. The patient-wise variability of measured temperatures was significantly higher for the ear measurements. Patient-wise linear regressions for the 25 patients with at least three pairs of simultaneous ear and rectal temperature measurements showed large interpatient variability of the association.

CONCLUSION

A linear relationship between the rectal body temperature assessment and the temperature assessment employing the tympanic thermometer is weak. Both measuring methods reflect variance in temperature, but ear measurements showed larger variation.

Application of the predicted heat strain model in development of localized, threshold-based heat stress management guidelines for the construction industry

Existing heat stress risk management guidelines recommended by international standards are not practical for the construction industry which needs site supervision staff to make instant managerial decisions to mitigate heat risks. The ability of the predicted heat strain (PHS) model [ISO 7933 (2004). Ergonomics of the thermal environment analytical determination and interpretation of heat stress using calculation of the predicted heat strain. Geneva: International Standard Organisation] to predict maximum allowable exposure time (D lim) has now enabled development of localized, action-triggering and threshold-based guidelines for implementation by lay frontline staff on construction sites. This article presents a protocol for development of two heat stress management tools by applying the PHS model to its full potential. One of the tools is developed to facilitate managerial decisions on an optimized work-rest regimen for paced work. The other tool is developed to enable workers' self-regulation during self-paced work.

Comparison of three different thermometers in evaluating the body temperature of healthy young adult individuals

The aim of this study was to compare the measurement values obtained with a non-contact infrared thermometer, a tympanic thermometer and a chemical dot thermometer. The research population was composed of students studying in two departments of a university in Ankara. A total of 452 students who fit the inclusion criteria of the study and volunteered to participate were included in the sample. Body temperature measurements with different thermometers were performed by the same researcher at the same room temperature. Data were analyzed in a computerized environment by SPSS 15.0 statistical program pack and Bland-Altman graph. Mean age of healthy young adults participating in the study was 19.66 ± 0.94, and 55.1% of them were female. The agreement limits for non-contact infrared and chemical dot was between -1.30 and 0.32°C; for non-contact infrared and tympanic was between -1.26 and 0.13°C; and for chemical dot and tympanic -0.89 and 0.74°C. It was determined that, although the measurement values of the tympanic membrane and chemical dot thermometers conformed with each other, the conformity of the non-contact infrared thermometer was weak.

Infection in neutropenic patients with cancer

Neutropenic fever sepsis syndromes are common among patients with cancer who are receiving intensive cytotoxic systemic therapy. Recognition of the syndromes and timely initial antibacterial therapy is critical for survival and treatment success. Outcomes are linked to myeloid reconstitution and recovery from neutropenia, control of active comorbidities, and appropriate treatment of the infections that underlie the sepsis syndrome. Hematologists and oncologists must be clear about the prognosis and treatment goals to work effectively with critical care physicians toward the best outcomes for patients with cancer who develop neutropenic sepsis syndromes.

Evidence-based guidelines for empirical therapy of neutropenic fever in Korea

Neutrophils play an important role in immunological function. Neutropenic patients are vulnerable to infection, and except fever is present, inflammatory reactions are scarce in many cases. Additionally, because infections can worsen rapidly, early evaluation and treatments are especially important in febrile neutropenic patients. In cases in which febrile neutropenia is anticipated due to anticancer chemotherapy, antibiotic prophylaxis can be used, based on the risk of infection. Antifungal prophylaxis may also be considered if long-term neutropenia or mucosal damage is expected. When fever is observed in patients suspected to have neutropenia, an adequate physical examination and blood and sputum cultures should be performed. Initial antibiotics should be chosen by considering the risk of complications following the infection; if the risk is low, oral antibiotics can be used. For initial intravenous antibiotics, monotherapy with a broad-spectrum antibiotic or combination therapy with two antibiotics is recommended. At 3-5 days after beginning the initial antibiotic therapy, the condition of the patient is assessed again to determine whether the fever has subsided or symptoms have worsened. If the patient's condition has improved, intravenous antibiotics can be replaced with oral antibiotics; if the condition has deteriorated, a change of antibiotics or addition of antifungal agents should be considered. If the causative microorganism is identified, initial antimicrobial or antifungal agents should be changed accordingly. When the cause is not detected, the initial agents should continue to be used until the neutrophil count recovers.

Effects of whole-body cryotherapy (-110 °C) on proprioception and indices of muscle damage

The purpose of this study was to investigate the effects of whole-body cryotherapy (WBC) on proprioceptive function, muscle force recovery following eccentric muscle contractions and tympanic temperature (T(TY) ). Thirty-six subjects were randomly assigned to a group receiving two 3-min treatments of -110 ± 3 °C or 15 ± 3 °C. Knee joint position sense (JPS), maximal voluntary isometric contraction (MVIC) of the knee extensors, force proprioception and T(TY) were recorded before, immediately after the exposure and again 15 min later. A convenience sample of 18 subjects also underwent an eccentric exercise protocol on their contralateral left leg 24 h before exposure. MVIC (left knee), peak power output (PPO) during a repeated sprint on a cycle ergometer and muscles soreness were measured pre-, 24, 48 and 72h post-treatment. WBC reduced T(TY) , by 0.3 °C, when compared with the control group (P<0.001). However, JPS, MVIC or force proprioception was not affected. Similarly, WBC did not effect MVIC, PPO or muscle soreness following eccentric exercise. WBC, administered 24 h after eccentric exercise, is ineffective in alleviating muscle soreness or enhancing muscle force recovery. The results of this study also indicate no increased risk of proprioceptive-related injury following WBC.