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Buss A, Areia C, Biggs C, Edmundson H, Young L, Roman C, Santos M, Tarassenko L, Watkinson P, Vollam S. Using a novel ambulatory monitoring system to support patient safety on an acute infectious disease ward during an unfolding pandemic. J Adv Nurs 2024; 80:2452-2461. [PMID: 38054397 DOI: 10.1111/jan.15977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/16/2023] [Accepted: 11/09/2023] [Indexed: 12/07/2023]
Abstract
AIM To gain staff feedback on the implementation and impact of a novel ambulatory monitoring system to support coronavirus patient management on an isolation ward. DESIGN Qualitative service evaluation. METHODS Semi-structured interviews were conducted with 15 multidisciplinary isolation ward staff in the United Kingdom between July 2020 and May 2021. Interviews were audio-recorded, transcribed and analysed using thematic analysis. FINDINGS Adopting Innovation to Assist Patient Safety was identified as the overriding theme. Three interlinked sub-themes represent facets of how the system supported patient safety. Patient Selection was developed throughout the pandemic, as clinical staff became more confident in choosing which patients would benefit most. Trust In the System described how nurses coped with discrepancies between the ambulatory system and ward observation machines. Finally, Resource Management examined how, once trust was built, staff perceived the ambulatory system assisted with caseload management. This supported efficient personal protective equipment resource use by reducing the number of isolation room entries. Despite these reported benefits, face-to-face contact was still highly valued, despite the risk of coronavirus exposure. CONCLUSION Hospital wards should consider using ambulatory monitoring systems to support caseload management and patient safety. Patients in isolation rooms or at high risk of deterioration may particularly benefit from this additional monitoring. However, these systems should be seen as an adjunct to nursing care, not a replacement. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Nurses valued ambulatory monitoring as a means of ensuring the safety of patients at risk of deterioration and prioritizing their workload. IMPACT The findings of this research will be useful to all those developing or considering implementation of ambulatory monitoring systems in hospital wards. REPORTING METHOD This manuscript follows the Consolidated criteria for Reporting Qualitative Research (COREQ) guidelines with inclusion of relevant SQUIRE guidelines for reporting quality improvement. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- Annika Buss
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Allied Health Professions Research & Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carlos Areia
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Christopher Biggs
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Holly Edmundson
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Louise Young
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Cristian Roman
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Mauro Santos
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Lionel Tarassenko
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Peter Watkinson
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sarah Vollam
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- OXinAHR, Oxford Brookes University, Oxford, UK
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Papathanakos G, Blot S, Koulenti D. Should we base our blood culture sampling on early changes in skin surface temperature? Intensive Crit Care Nurs 2024; 83:103712. [PMID: 38678698 DOI: 10.1016/j.iccn.2024.103712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Affiliation(s)
| | - Stijn Blot
- Dept. of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Despoina Koulenti
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Critical Care Department, King's College Hospital NHS Foundation Trust, London, United Kingdom
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Alshehri A, Ince J, Panerai RB, Divall P, Robinson TG, Minhas JS. Physiological Variability during Prehospital Stroke Care: Which Monitoring and Interventions Are Used? Healthcare (Basel) 2024; 12:835. [PMID: 38667597 PMCID: PMC11050416 DOI: 10.3390/healthcare12080835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/24/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Prehospital care is a fundamental component of stroke care that predominantly focuses on shortening the time between diagnosis and reaching definitive stroke management. With growing evidence of the physiological parameters affecting long-term patient outcomes, prehospital clinicians need to consider the balance between rapid transfer and increased physiological-parameter monitoring and intervention. This systematic review explores the existing literature on prehospital physiological monitoring and intervention to modify these parameters in stroke patients. The systematic review was registered on PROSPERO (CRD42022308991) and conducted across four databases with citation cascading. Based on the identified inclusion and exclusion criteria, 19 studies were retained for this review. The studies were classified into two themes: physiological-monitoring intervention and pharmacological-therapy intervention. A total of 14 included studies explored prehospital physiological monitoring. Elevated blood pressure was associated with increased hematoma volume in intracerebral hemorrhage and, in some reports, with increased rates of early neurological deterioration and prehospital neurological deterioration. A reduction in prehospital heart rate variability was associated with unfavorable clinical outcomes. Further, five of the included records investigated the delivery of pharmacological therapy in the prehospital environment for patients presenting with acute stroke. BP-lowering interventions were successfully demonstrated through three trials; however, evidence of their benefit to clinical outcomes is limited. Two studies investigating the use of oxygen and magnesium sulfate as neuroprotective agents did not demonstrate an improvement in patient's outcomes. This systematic review highlights the absence of continuous physiological parameter monitoring, investigates fundamental physiological parameters, and provides recommendations for future work, with the aim of improving stroke patient outcomes.
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Affiliation(s)
- Abdulaziz Alshehri
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.A.); (R.B.P.); (T.G.R.)
- College of Applied Medical Sciences, University of Najran, Najran P.O. Box 1988, Saudi Arabia
| | - Jonathan Ince
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.A.); (R.B.P.); (T.G.R.)
| | - Ronney B. Panerai
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.A.); (R.B.P.); (T.G.R.)
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Pip Divall
- University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK;
| | - Thompson G. Robinson
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.A.); (R.B.P.); (T.G.R.)
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Jatinder S. Minhas
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.A.); (R.B.P.); (T.G.R.)
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester LE3 9QP, UK
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Considine J, Casey P, Omonaiye O, van Gulik N, Allen J, Currey J. Importance of specific vital signs in nurses' recognition and response to deteriorating patients: A scoping review. J Clin Nurs 2024. [PMID: 38454551 DOI: 10.1111/jocn.17099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/11/2023] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
AIM(S) To explore the published research related to nurses' documentation and use of vital signs in recognising and responding to deteriorating patients. DESIGN Scoping review of international, peer-reviewed research studies. DATA SOURCES Cumulative Index to Nursing and Allied Health Literature Complete, Medline Complete, American Psychological Association PsycInfo and Excerpta Medica were searched on 25 July 2023. REPORTING METHOD Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. RESULTS Of 3880 potentially eligible publications, 32 were included. There were 26 studies of nurses' vital sign documentation: 21 adults and five paediatric. The most and least frequently documented vital signs were blood pressure and respiratory rate respectively. Seven studies focused on vital signs and rapid response activation or afferent limb failure. Five studies of vital signs used to trigger the rapid response system showed heart rate was the most frequent and respiratory rate and conscious state were the least frequent. Heart rate was least likely and oxygen saturation was most likely to be associated with afferent limb failure (n = 4 studies). CONCLUSION Despite high reliance on using vital signs to recognise clinical deterioration and activate a response to deteriorating patients in hospital settings, nurses' documentation of vital signs and use of vital signs to activate rapid response systems is poorly understood. There were 21studies of nurses' vital sign documentation in adult patients and five studies related to children. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE A deeper understanding of nurses' decisions to assess (or not assess) specific vital signs, analysis of the value or importance nurses place (or not) on specific vital sign parameters is warranted. The influence of patient characteristics (such as age) or the clinical practice setting, and the impact of nurses' workflows of vital sign assessment warrants further investigation. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- Julie Considine
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research-Eastern Health Partnership, Eastern Health, Box Hill, Victoria, Australia
| | - Penelope Casey
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research-Eastern Health Partnership, Eastern Health, Box Hill, Victoria, Australia
| | - Olumuyiwa Omonaiye
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research-Eastern Health Partnership, Eastern Health, Box Hill, Victoria, Australia
| | - Nantanit van Gulik
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research-Eastern Health Partnership, Eastern Health, Box Hill, Victoria, Australia
| | - Joshua Allen
- Department of Nursing, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Judy Currey
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
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Rayan A, Al-Ghabeesh SH, Fawaz M, Behar A, Toumi A. Experiences, barriers and expectations regarding current patient monitoring systems among ICU nurses in a University Hospital in Lebanon: a qualitative study. Front Digit Health 2024; 6:1259409. [PMID: 38440198 PMCID: PMC10910027 DOI: 10.3389/fdgth.2024.1259409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/01/2024] [Indexed: 03/06/2024] Open
Abstract
Purpose The aim of the study is to assess the experiences, barriers, and expectations regarding current patient monitoring systems among intensive care unit nurses at one university hospital. Methods A qualitative exploratory study approach was adopted to test the research questions. Results Intensive care unit personnel placed a high value on practical criteria such as user friendliness and visualization while assessing the present monitoring system. Poor alarm handling was recognized as possible patient safety hazards. The necessity of high accessibility was highlighted once again for a prospective system; wireless, noninvasive, and interoperability of monitoring devices were requested; and smart phones for distant patient monitoring and alert management improvement were required. Conclusion Core comments from ICU personnel are included in this qualitative research on patient monitoring. All national healthcare involved parties must focus more on user-derived insights to ensure a speedy and effective introduction of digital health technologies in the ICU. The findings from the alarm control or mobile device studies might be utilized to train ICU personnel to use new technology, minimize alarm fatigue, increase medical device accessibility, and develop interoperability standards in critical care practice.
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Affiliation(s)
- Ahmad Rayan
- Faculty of Nursing, Zarqa University, Zarqa, Jordan
- University of Business and Technology (UBT), Jeddah, Saudi Arabia
| | | | - Mirna Fawaz
- Department Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Amal Behar
- Department Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Amina Toumi
- Health Information Management Department, Liwa College of Technology, Abu Dhabi, United Arab Emirates
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Bello C, Luedi MM. Postoperative intrahospital monitoring: Transforming the danger zone. J Clin Anesth 2024; 92:111183. [PMID: 37328311 DOI: 10.1016/j.jclinane.2023.111183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Corina Bello
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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van Noort HHJ, Becking-Verhaar FL, Bahlman-van Ooijen W, Pel M, van Goor H, Huisman-de Waal G. Three Years of Continuous Vital Signs Monitoring on the General Surgical Ward: Is It Sustainable? A Qualitative Study. J Clin Med 2024; 13:439. [PMID: 38256573 PMCID: PMC10816891 DOI: 10.3390/jcm13020439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Continuous monitoring of vital signs using a wireless wearable device was implemented in 2018 at a surgical care unit of an academic hospital. This study aimed at gaining insight into nurses' and patients' perspectives regarding the use and innovation of a continuous vital signs monitoring system, three years after its introduction. This qualitative study was performed in a surgical, non-intensive care unit of an academic hospital in 2021. Key-user nurses (nurses with additional training and expertise with the device) and patients were selected for semi-structured interviews, and nurses from the ward were selected for a focus group interview using a topic list. Transcripts of the audio tapes were deductively analysed using four dimensions for adoptions of information and communication technologies (ICT) devices in healthcare. The device provided feelings of safety for nurses and patients. Nurses and patients had a few issues with the device, including the size and the battery life. Nurses gained knowledge and skills in using the system for measurement and interpretations. They perceived the system as a tool to improve the recognition of clinical decline. The use of the system could be further developed regarding the technical device's characteristics, nurses' interpretation of the data and the of type of alarms, the information needs of patients, and clarification of the definition and standardization of continuous monitoring. Three years after the introduction, wireless continuous vital signs monitoring is the new standard of care according to the end-users at the general surgical ward.
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Affiliation(s)
- Harm H. J. van Noort
- Department of Surgery, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands; (F.L.B.-V.); (W.B.-v.O.); (M.P.); (G.H.-d.W.)
| | | | | | | | - Harry van Goor
- Department of Surgery, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands; (F.L.B.-V.); (W.B.-v.O.); (M.P.); (G.H.-d.W.)
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Posthuma LM, Breteler MJM, Lirk PB, Nieveen van Dijkum EJ, Visscher MJ, Breel JS, Wensing CAGL, Schenk J, Vlaskamp LB, van Rossum MC, Ruurda JP, Dijkgraaf MGW, Hollmann MW, Kalkman CJ, Preckel B. Surveillance of high-risk early postsurgical patients for real-time detection of complications using wireless monitoring (SHEPHERD study): results of a randomized multicenter stepped wedge cluster trial. Front Med (Lausanne) 2024; 10:1295499. [PMID: 38249988 PMCID: PMC10796990 DOI: 10.3389/fmed.2023.1295499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024] Open
Abstract
Background Vital signs measurements on the ward are performed intermittently. This could lead to failure to rapidly detect patients with deteriorating vital signs and worsens long-term outcome. The aim of this study was to test the hypothesis that continuous wireless monitoring of vital signs on the postsurgical ward improves patient outcome. Methods In this prospective, multicenter, stepped-wedge cluster randomized study, patients in the control group received standard monitoring. The intervention group received continuous wireless monitoring of heart rate, respiratory rate and temperature on top of standard care. Automated alerts indicating vital signs deviation from baseline were sent to ward nurses, triggering the calculation of a full early warning score followed. The primary outcome was the occurrence of new disability three months after surgery. Results The study was terminated early (at 57% inclusion) due to COVID-19 restrictions. Therefore, only descriptive statistics are presented. A total of 747 patients were enrolled in this study and eligible for statistical analyses, 517 patients in the control group and 230 patients in the intervention group, the latter only from one hospital. New disability at three months after surgery occurred in 43.7% in the control group and in 39.1% in the intervention group (absolute difference 4.6%). Conclusion This is the largest randomized controlled trial investigating continuous wireless monitoring in postoperative patients. While patients in the intervention group seemed to experience less (new) disability than patients in the control group, results remain inconclusive with regard to postoperative patient outcome due to premature study termination. Clinical trial registration ClinicalTrials.gov, ID: NCT02957825.
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Affiliation(s)
- Linda M. Posthuma
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
| | | | - Philipp B. Lirk
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
- Department of Anesthesiologie, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Els J. Nieveen van Dijkum
- Department of Surgery, Amsterdam University Medical Center, Location University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Maarten J. Visscher
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
| | - Jennifer S. Breel
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
| | - Carin A. G. L. Wensing
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
| | - Jimmy Schenk
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
| | - Lyan B. Vlaskamp
- Department of Anesthesiologie, University Medical Center, Utrecht, Netherlands
| | | | - Jelle P. Ruurda
- Department of Gastro-Intestinal and Oncologic Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marcel G. W. Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, Location AMC, Amsterdam, Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, Netherlands
| | - Markus W. Hollmann
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
| | - Cor J. Kalkman
- Department of Anesthesiologie, University Medical Center, Utrecht, Netherlands
| | - Benedikt Preckel
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- Amsterdam Cardiovascular Science, Diabetes and Metabolism, Amsterdam, Netherlands
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Leenen JPL, Ardesch V, Kalkman CJ, Schoonhoven L, Patijn GA. Impact of wearable wireless continuous vital sign monitoring in abdominal surgical patients: before-after study. BJS Open 2024; 8:zrad128. [PMID: 38235573 PMCID: PMC10794900 DOI: 10.1093/bjsopen/zrad128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Technological advances have enabled continuous monitoring of vital signs (CMVS) by wearable, wireless devices on general hospital wards to facilitate early detection of clinical deterioration, which could potentially improve clinical outcomes. However, evidence on the impact of these CMVS systems on patient outcomes is limited. This research aimed to explore the effect of CMVS on the clinical outcomes in major abdominal surgery patients in a general surgery ward. METHODS A single-centre before-after study was conducted from October 2019 to June 2022. Patients in the intervention group received CMVS in addition to conventional intermittent vital sign monitoring (standard care for control group). With CMVS, heart rate and respiratory rate were measured every 5 min by a patch sensor. Proactive vital signs trends assessments and, when necessary, subsequent nursing activities were performed every nursing shift. The primary outcome of interest was the length of hospital stay (LOS); also, 12 patient-related outcomes were analysed. In the CMVS group, follow-up nursing activities of deviating vital signs trends were described and patient acceptability was measured. Post-hoc subgroup analysis was performed for colorectal and hepatopancreatobiliary surgery. RESULTS A total of 908 patients were included (colorectal: n = 650; hepatopancreatobiliary: n = 257). Overall, median LOS was lower in the CMVS group (5.0 versus 5.5 days; P = 0.012), respectively. Post-hoc subgroup analysis showed this reduction in LOS was mostly observed in the colorectal group and not in the hepatopancreatobiliary group. Apart from a decrease in nurse-to-house-officer calls (from 15.3% to 7.7%; P = 0.007), all secondary clinical outcomes were similar in CMVS and control groups. However, a non-significant trend towards less-severe complications and reduced ICU LOS was observed in the CMVS group. In CMVS patients, 109 additional nursing activities were performed and 83% of patients indicated CMVS was acceptable. CONCLUSION CMVS was associated with a significant reduction in LOS, while other clinical outcomes were unchanged. CMVS triggered additional nursing activities such as extra patient assessments and therapeutic interventions.
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Affiliation(s)
- Jobbe P L Leenen
- Department of Surgery, Isala, Zwolle, The Netherlands
- Connected Care Centre, Isala, Zwolle, The Netherlands
- Research Group IT Innovations in Healthcare, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Vera Ardesch
- Flex pool department, Isala, Zwolle, The Netherlands
| | - Cor J Kalkman
- Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lisette Schoonhoven
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Gijs A Patijn
- Department of Surgery, Isala, Zwolle, The Netherlands
- Connected Care Centre, Isala, Zwolle, The Netherlands
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Lee KT, Chen YC, Yang YC, Wang WL. On practicing magicine, from wonder to care: A systematic review of studies that apply magic in healthcare. Soc Sci Med 2024; 341:116541. [PMID: 38176244 DOI: 10.1016/j.socscimed.2023.116541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024]
Abstract
RATIONALE Magic, traditionally perceived as entertainment, has been increasingly employed in healthcare to enhance health and well-being. Despite its potential benefits across various dimensions of health, including biological, psychological, and social, a comprehensive review highlighting its broad applications in healthcare remains unexplored. OBJECTIVE This study aims to explore the diverse uses of magic within healthcare, progressing from entertainment to integral medical care, termed "magicine." METHODS This systematic review adopted a narrative synthesis approach, and an extensive database search was conducted including Embase Classic & Embase, MEDLINE (Ovid), Scopus, the Cochrane Collaboration Central Register of Controlled Clinical Trials, Cochrane Systematic Reviews, and CINAHL (EBSCOhost), from the earliest records to 22 June 2023. Potential applications of magic in healthcare were explored with an unrestricted search strategy. A quality assessment was conducted using the Mixed Methods Appraisal Tool. (Registration: PROSPERO number CRD42023417122.) RESULTS: This review identified 82 journal articles, including 11 randomized controlled trials, four quasi-experimental designs, 10 pre-experimental designs, five qualitative studies, three mixed methods studies, two observational studies, five review articles, and 42 commentaries. The review resulted in the conception of "magicine ennead" - nine diverse areas where magic can be applied in healthcare including physical rehabilitation, cognitive training, psychotherapy, humor therapy, distraction therapy, social skills, health education, doctor-patient relationships, and surgical techniques. These applications demonstrate the potential of magic to enhance health outcomes for the general population and improve the clinical practice of healthcare professionals. CONCLUSIONS Magic in healthcare shows potential for varied applications, and a deeper understanding of these applications could lead to optimized and cost-efficient intervention programs. Given the heterogeneity and varied methodological quality of the current research, future studies necessitate the adoption of rigorous designs with active controls.
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Affiliation(s)
- Kuan-Ting Lee
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan City, 70403, Taiwan
| | - Yen-Chin Chen
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan City, 70403, Taiwan; Department of Nursing, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan City, 701401, Taiwan; School of Medicine, College of Medicine, National Sun Yat-Sen University, No. 70, Lian-Hai Road, Kaohsiung City, 80424, Taiwan
| | - Yi-Ching Yang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan City, 70403, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan City, 701401, Taiwan.
| | - Wei-Li Wang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan City, 70403, Taiwan.
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Hotta S, Ashida K, Tanaka M. Night-time detection and response in relation to deteriorating inpatients: A scoping review. Nurs Crit Care 2024; 29:178-190. [PMID: 37095606 DOI: 10.1111/nicc.12917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Although detection and response to clinical deterioration have been studied, the range and nature of studies focused on night-time clinical setting remain unclear. AIM This study aimed to identify and map existing research and findings concerning night-time detection and response to deteriorating inpatients in usual care or research settings. STUDY DESIGN A scoping review method was used. PubMed, CINAHL, Web of Science, and Ichushi-Web databases were systematically searched. We included studies focusing on night-time detection and response to clinical deterioration. RESULTS Twenty-eight studies were included. These studies were organized into five categories: night-time medical emergency team or rapid response team (MET/RRT) response, night-time observation using the early warning score (EWS), available resources for physicians' practice, continuous monitoring of specific parameters, and screening for night-time clinical deterioration. The first three categories were related to interventional measures in usual care settings, and relevant findings mainly demonstrated the actual situation and challenges of night-time practice. The final two categories were related to the interventions in the research settings and included innovative interventions to identify at-risk or deteriorating patients. CONCLUSIONS Systematic interventional measures, such as MET/RRT and EWS, could have been sub-optimally performed at night. Innovations in monitoring technologies or implementation of predictive models could be helpful in improving the detection of night-time deterioration. RELEVANCE TO CLINICAL PRACTICE This review provides a compilation of current evidence regarding night-time practice concerning patient deterioration. However, a lack of understanding exists on specific and effective practices regarding timely action for deteriorating patients at night.
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Affiliation(s)
- Soichiro Hotta
- Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kaoru Ashida
- Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Makoto Tanaka
- Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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12
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Posthuma LM, Preckel B. Initiatives to detect and prevent death from perioperative deterioration. Curr Opin Anaesthesiol 2023; 36:676-682. [PMID: 37767926 PMCID: PMC10621647 DOI: 10.1097/aco.0000000000001312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
PURPOSE OF REVIEW This study indicates that there are differences between hospitals in detection, as well as in adequate management of postsurgical complications, a phenomenon that is described as 'failure-to-rescue'.In this review, recent initiatives to reduce failure-to-rescue in the perioperative period are described. RECENT FINDINGS Use of cognitive aids, emergency manuals, family participation as well as remote monitoring systems are measures to reduce failure-to-rescue situations. Postoperative visit of an anaesthesiologist on the ward was not shown to improve outcome, but there is still room for improvement of postoperative care. SUMMARY Improving the complete emergency chain, including monitoring, recognition and response in the afferent limb, as well as diagnostic and treatment in the efferent limb, should lead to reduced failure-to-rescue situations in the perioperative period.
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Affiliation(s)
- Linda M. Posthuma
- Department of Anesthesiology and Intensive Care Medicine, Amphia Hospital, Breda
| | - Benedikt Preckel
- Department of Anesthesiology, Amsterdam University Medical Centre, location University of Amsterdam
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam University Medical Centre, Amsterdam, The Netherlands
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13
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Rasmussen SS, Grønbæk KK, Mølgaard J, Haahr-Raunkjær C, Meyhoff CS, Aasvang EK, Sørensen HBD. Quantifying physiological stability in the general ward using continuous vital signs monitoring: the circadian kernel density estimator. J Clin Monit Comput 2023; 37:1607-1617. [PMID: 37266711 PMCID: PMC10651555 DOI: 10.1007/s10877-023-01032-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/07/2023] [Indexed: 06/03/2023]
Abstract
Technological advances seen in recent years have introduced the possibility of changing the way hospitalized patients are monitored by abolishing the traditional track-and-trigger systems and implementing continuous monitoring using wearable biosensors. However, this new monitoring paradigm raise demand for novel ways of analyzing the data streams in real time. The aim of this study was to design a stability index using kernel density estimation (KDE) fitted to observations of physiological stability incorporating the patients' circadian rhythm. Continuous vital sign data was obtained from two observational studies with 491 postoperative patients and 200 patients with acute exacerbation of chronic obstructive pulmonary disease. We defined physiological stability as the last 24 h prior to discharge. We evaluated the model against periods of eight hours prior to events defined either as severe adverse events (SAE) or as a total score in the early warning score (EWS) protocol of ≥ 6, ≥ 8, or ≥ 10. The results found good discriminative properties between stable physiology and EWS-events (area under the receiver operating characteristics curve (AUROC): 0.772-0.993), but lower for the SAEs (AUROC: 0.594-0.611). The time of early warning for the EWS events were 2.8-5.5 h and 2.5 h for the SAEs. The results showed that for severe deviations in the vital signs, the circadian KDE model can alert multiple hours prior to deviations being noticed by the staff. Furthermore, the model shows good generalizability to another cohort and could be a simple way of continuously assessing patient deterioration in the general ward.
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Affiliation(s)
- Søren S Rasmussen
- Biomedical Signal Processing & AI Research Group, Digital Health Section, Department of Health Technology, Technical University of Denmark, Ørsteds Plads, Building 345B, 2800 Kgs, Lyngby, Denmark.
| | - Katja K Grønbæk
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Jesper Mølgaard
- Department of Anaesthesiology, the Center for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Camilla Haahr-Raunkjær
- Department of Anaesthesiology, the Center for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Christian S Meyhoff
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Eske K Aasvang
- Department of Anaesthesiology, the Center for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Helge B D Sørensen
- Biomedical Signal Processing & AI Research Group, Digital Health Section, Department of Health Technology, Technical University of Denmark, Ørsteds Plads, Building 345B, 2800 Kgs, Lyngby, Denmark
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14
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Kjærgaard K, Mølgaard J, Rasmussen SM, Meyhoff CS, Aasvang EK. The effect of technical filtering and clinical criteria on alert rates from continuous vital sign monitoring in the general ward. Hosp Pract (1995) 2023; 51:295-302. [PMID: 38126772 DOI: 10.1080/21548331.2023.2298185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/19/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Continuous vital sign monitoring at the general hospital ward has major potential advantages over intermittent monitoring but generates many alerts with risk of alert fatigue. We hypothesized that the number of alerts would decrease using different filters. METHODS This study was an exploratory analysis of the alert reducing effect from adding two different filters to continuously collected vital sign data (peripheral oxygen saturation, blood pressure, heart rate, and respiratory rate) in patients admitted after major surgery or severe medical disease. Filtered data were compared to data without artifact removal. Filter one consists of artifact removal, filter two consists of artifact removal plus duration criteria adjusted for severity of vital sign deviation. Alert thresholds were based on the National Early Warning Score (NEWS) threshold. RESULTS A population of 716 patients admitted for severe medical disease or major surgery with continuous wireless vital sign monitoring at the general ward with a mean monitoring time of 75.8 h, were included for the analysis. Without artifact removal, we found a median of 137 [IQR: 87-188] alerts per patient/day, artifact removal resulted in a median of 101 [IQR: 56-160] alerts per patient/day and with artifact removal combined with a duration-severity criterion, we found a median of 19 [IQR: 9-34] alerts per patient/day. Reduction of alerts was 86.4% (p < 0.001) for values without artifact removal (137 alerts) vs. the duration criteria and a reduction (19 alerts) of 81.5% (p < 0.001) for the criteria with artifact removal (101 alerts) vs. the duration criteria (19 alerts). CONCLUSION We conclude that a combination of artifact removal and duration-severity criteria approach substantially reduces alerts generated by continuous vital sign monitoring.
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Affiliation(s)
- Karoline Kjærgaard
- Department of Anesthesiology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jesper Mølgaard
- Department of Anesthesiology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Søren M Rasmussen
- Digital Health Section, Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Christian Sylvest Meyhoff
- Department of Anesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Eske Kvanner Aasvang
- Department of Anesthesiology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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15
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Piet A, Jablonski L, Daniel Onwuchekwa JI, Unkel S, Weber C, Grzegorzek M, Ehlers JP, Gaus O, Neumann T. Non-Invasive Wearable Devices for Monitoring Vital Signs in Patients with Type 2 Diabetes Mellitus: A Systematic Review. Bioengineering (Basel) 2023; 10:1321. [PMID: 38002444 PMCID: PMC10669651 DOI: 10.3390/bioengineering10111321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Type 2 diabetes mellitus (T2D) poses a significant global health challenge and demands effective self-management strategies, including continuous blood glucose monitoring (CGM) and lifestyle adaptations. While CGM offers real-time glucose level assessment, the quest for minimizing trauma and enhancing convenience has spurred the need to explore non-invasive alternatives for monitoring vital signs in patients with T2D. Objective: This systematic review is the first that explores the current literature and critically evaluates the use and reporting of non-invasive wearable devices for monitoring vital signs in patients with T2D. Methods: Employing the PRISMA and PICOS guidelines, we conducted a comprehensive search to incorporate evidence from relevant studies, focusing on randomized controlled trials (RCTs), systematic reviews, and meta-analyses published since 2017. Of the 437 publications identified, seven were selected based on predetermined criteria. Results: The seven studies included in this review used various sensing technologies, such as heart rate monitors, accelerometers, and other wearable devices. Primary health outcomes included blood pressure measurements, heart rate, body fat percentage, and cardiorespiratory endurance. Non-invasive wearable devices demonstrated potential for aiding T2D management, albeit with variations in efficacy across studies. Conclusions: Based on the low number of studies with higher evidence levels (i.e., RCTs) that we were able to find and the significant differences in design between these studies, we conclude that further evidence is required to validate the application, efficacy, and real-world impact of these wearable devices. Emphasizing transparency in bias reporting and conducting in-depth research is crucial for fully understanding the implications and benefits of wearable devices in T2D management.
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Affiliation(s)
- Artur Piet
- Institute of Medical Informatics, University of Lübeck, 23562 Lübeck, Germany
| | - Lennart Jablonski
- Institute of Medical Informatics, University of Lübeck, 23562 Lübeck, Germany
| | | | - Steffen Unkel
- Department of Digital Health Sciences and Biomedicine, University of Siegen, 57076 Siegen, Germany
- Department of Medical Statistics, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Christian Weber
- Department of Digital Health Sciences and Biomedicine, University of Siegen, 57076 Siegen, Germany
| | - Marcin Grzegorzek
- Institute of Medical Informatics, University of Lübeck, 23562 Lübeck, Germany
- Department of Knowledge Engineering, University of Economics in Katowice, 40-287 Katowice, Poland
| | - Jan P. Ehlers
- Department of Didactics and Educational Research in Health Science, Witten/Herdecke University, 58455 Witten, Germany
| | - Olaf Gaus
- Department of Digital Health Sciences and Biomedicine, University of Siegen, 57076 Siegen, Germany
| | - Thomas Neumann
- Department of Digital Health Sciences and Biomedicine, University of Siegen, 57076 Siegen, Germany
- Faculty of Economics and Management, Otto von Guericke University Magdeburg, 39106 Magdeburg, Germany
- University Department of Neurology, Otto von Guericke University Magdeburg, 39106 Magdeburg, Germany
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16
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Aggarwal R, Gunaseelan V, Manual D, Sanker M, Prabaaker S. Clinical Evaluation of a Wireless Device for Monitoring Vitals in Newborn Babies. Indian J Pediatr 2023; 90:1110-1115. [PMID: 36809506 DOI: 10.1007/s12098-022-04459-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/13/2022] [Indexed: 02/23/2023]
Abstract
OBJECTIVES To evaluate the ability of the Nemocare Raksha (NR), an internet of things (IoT)-enabled device, to continuously monitor vitals for 6 h and its safety in newborns. The accuracy of the device was also compared with the readings from the standard device used in the pediatric ward. METHOD Forty neonates (either gender) weighing ≥ 1.5 kg were included in the study. Heart rate, respiratory rate, body temperature, and oxygen saturation was measured using the NR and compared with standard care devices. Safety was assessed by monitoring for skin changes and local rise in temperature. The neonatal infant pain scale (NIPS) was used to assess pain and discomfort. RESULT A total of 227 h of observations (5.67 h per baby) were obtained. No discomfort or device-related adverse events were noted during the study period. The mean difference between the NR and the standard monitoring was 0.66 (0.42 to 0.90) for temperature (°C); -6.57 (-8.66 to -4.47) for heart rate (bpm); 7.60 (6.52 to 8.68) for respiratory rate (breaths per minute); -0.79 (-1.10 to -0.48) for oxygen saturation (%). The level of agreement analyzed using the intraclass correlation coefficient (ICC) was good for heart rate [ICC 0.77 (0.72 to 0.82); p value < 0.001] and oxygen saturation [ICC 0.80 (0.75 to 0.84); p value < 0.001]; moderate for body temperature [ICC 0.54 (0.36 to 0.60); p value < 0.001] and poor for respiratory rate [ICC 0.30 (0.10 to 0.44); p value 0.002]. CONCLUSION The NR was able to seamlessly monitor vital parameters in neonates without any safety concern. The device showed a good level of agreement for heart rate and oxygen saturation among the four parameters measured.
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Affiliation(s)
- Rajiv Aggarwal
- Department of Pediatrics, Narayana Hrudayalaya, Bangalore, Karnataka, India
| | | | - Delitia Manual
- Department of Clinical Research, Narayana Hrudayalaya, Bangalore, Karnataka, India
| | - Manoj Sanker
- Nemocare Wellness Pvt. Ltd., Hyderabad, Telangana, India
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17
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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] [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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18
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van Rossum MC, Bekhuis REM, Wang Y, Hegeman JH, Folbert EC, Vollenbroek-Hutten MMR, Kalkman CJ, Kouwenhoven EA, Hermens HJ. Early Warning Scores to Support Continuous Wireless Vital Sign Monitoring for Complication Prediction in Patients on Surgical Wards: Retrospective Observational Study. JMIR Perioper Med 2023; 6:e44483. [PMID: 37647104 PMCID: PMC10500362 DOI: 10.2196/44483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 06/16/2023] [Accepted: 07/07/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Wireless vital sign sensors are increasingly being used to monitor patients on surgical wards. Although early warning scores (EWSs) are the current standard for the identification of patient deterioration in a ward setting, their usefulness for continuous monitoring is unknown. OBJECTIVE This study aimed to explore the usability and predictive value of high-rate EWSs obtained from continuous vital sign recordings for early identification of postoperative complications and compares the performance of a sensor-based EWS alarm system with manual intermittent EWS measurements and threshold alarms applied to individual vital sign recordings (single-parameter alarms). METHODS Continuous vital sign measurements (heart rate, respiratory rate, blood oxygen saturation, and axillary temperature) collected with wireless sensors in patients on surgical wards were used for retrospective simulation of EWSs (sensor EWSs) for different time windows (1-240 min), adopting criteria similar to EWSs based on manual vital signs measurements (nurse EWSs). Hourly sensor EWS measurements were compared between patients with (event group: 14/46, 30%) and without (control group: 32/46, 70%) postoperative complications. In addition, alarms were simulated for the sensor EWSs using a range of alarm thresholds (1-9) and compared with alarms based on nurse EWSs and single-parameter alarms. Alarm performance was evaluated using the sensitivity to predict complications within 24 hours, daily alarm rate, and false discovery rate (FDR). RESULTS The hourly sensor EWSs of the event group (median 3.4, IQR 3.1-4.1) was significantly higher (P<.004) compared with the control group (median 2.8, IQR 2.4-3.2). The alarm sensitivity of the hourly sensor EWSs was the highest (80%-67%) for thresholds of 3 to 5, which was associated with alarm rates of 2 (FDR=85%) to 1.2 (FDR=83%) alarms per patient per day respectively. The sensitivity of sensor EWS-based alarms was higher than that of nurse EWS-based alarms (maximum=40%) but lower than that of single-parameter alarms (87%) for all thresholds. In contrast, the (false) alarm rates of sensor EWS-based alarms were higher than that of nurse EWS-based alarms (maximum=0.6 alarm/patient/d; FDR=80%) but lower than that of single-parameter alarms (2 alarms/patient/d; FDR=84%) for most thresholds. Alarm rates for sensor EWSs increased for shorter time windows, reaching 70 alarms per patient per day when calculated every minute. CONCLUSIONS EWSs obtained using wireless vital sign sensors may contribute to the early recognition of postoperative complications in a ward setting, with higher alarm sensitivity compared with manual EWS measurements. Although hourly sensor EWSs provide fewer alarms compared with single-parameter alarms, high false alarm rates can be expected when calculated over shorter time spans. Further studies are recommended to optimize care escalation criteria for continuous monitoring of vital signs in a ward setting and to evaluate the effects on patient outcomes.
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Affiliation(s)
- Mathilde C van Rossum
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
- Department of Cardiovascular and Respiratory Physiology, University of Twente, Enschede, Netherlands
| | - Robin E M Bekhuis
- Department of Surgery, Hospital Group Twente, Almelo, Netherlands
- Hospital Group Twente Academy, Hospital Group Twente, Almelo, Netherlands
| | - Ying Wang
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
- Hospital Group Twente Academy, Hospital Group Twente, Almelo, Netherlands
| | | | - Ellis C Folbert
- Department of Surgery, Hospital Group Twente, Almelo, Netherlands
| | | | - Cornelis J Kalkman
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Hermie J Hermens
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
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van Melzen R, Haveman ME, Schuurmann RCL, Struys MMRF, de Vries JPPM. Implementing Wearable Sensors for Clinical Application at a Surgical Ward: Points to Consider before Starting. SENSORS (BASEL, SWITZERLAND) 2023; 23:6736. [PMID: 37571519 PMCID: PMC10422413 DOI: 10.3390/s23156736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023]
Abstract
Incorporating technology into healthcare processes is necessary to ensure the availability of high-quality care in the future. Wearable sensors are an example of such technology that could decrease workload, enable early detection of patient deterioration, and support clinical decision making by healthcare professionals. These sensors unlock continuous monitoring of vital signs, such as heart rate, respiration rate, blood oxygen saturation, temperature, and physical activity. However, broad and successful application of wearable sensors on the surgical ward is currently lacking. This may be related to the complexity, especially when it comes to replacing manual measurements by healthcare professionals. This report provides practical guidance to support peers before starting with the clinical application of wearable sensors in the surgical ward. For this purpose, the Non-Adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of technology adoption and innovations in healthcare organizations is used, combining existing literature and our own experience in this field over the past years. Specifically, the relevant topics are discussed per domain, and key lessons are subsequently summarized.
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Affiliation(s)
- Rianne van Melzen
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (R.C.L.S.); (J.-P.P.M.d.V.)
| | - Marjolein E. Haveman
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.E.H.); (M.M.R.F.S.)
| | - Richte C. L. Schuurmann
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (R.C.L.S.); (J.-P.P.M.d.V.)
| | - Michel M. R. F. Struys
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.E.H.); (M.M.R.F.S.)
| | - Jean-Paul P. M. de Vries
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (R.C.L.S.); (J.-P.P.M.d.V.)
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20
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Garssen SH, Kant N, Vernooij CA, Mauritz GJ, Koning MV, Bosch FH, Doggen CJM. Continuous monitoring of patients in and after the acute admission ward to improve clinical pathways: study protocol for a randomized controlled trial (Optimal-AAW). Trials 2023; 24:405. [PMID: 37316919 DOI: 10.1186/s13063-023-07416-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/26/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Because of high demand on hospital beds, hospitals seek to reduce patients' length of stay (LOS) while preserving the quality of care. In addition to usual intermittent vital sign monitoring, continuous monitoring might help to assess the patient's risk of deterioration, in order to improve the discharge process and reduce LOS. The primary aim of this monocenter randomized controlled trial is to assess the effect of continuous monitoring in an acute admission ward (AAW) on the percentage of patients who are discharged safely. METHODS A total of 800 patients admitted to the AAW, for whom it is equivocal whether they can be discharged directly after their AAW stay, will be randomized to either receive usual care without (control group) or with additional continuous monitoring of heart rate, respiratory rate, posture, and activity, using a wearable sensor (sensor group). Continuous monitoring data are provided to healthcare professionals and used in the discharge decision. The wearable sensor keeps collecting data for 14 days. After 14 days, all patients fill in a questionnaire to assess healthcare use after discharge and, if applicable, their experience with the wearable sensor. The primary outcome is the difference in the percentage of patients who are safely discharged home directly from the AAW between the control and sensor group. Secondary outcomes include hospital LOS, AAW LOS, intensive care unit (ICU) admissions, Rapid Response Team calls, and unplanned readmissions within 30 days. Furthermore, facilitators and barriers for implementing continuous monitoring in the AAW and at home will be investigated. DISCUSSION Clinical effects of continuous monitoring have already been investigated in specific patient populations for multiple purposes, e.g., in reducing the number of ICU admissions. However, to our knowledge, this is the first Randomized Controlled Trial to investigate effects of continuous monitoring in a broad patient population in the AAW. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT05181111 . Registered on 6 January 2022. Start of recruitment: 7 December 2021.
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Affiliation(s)
- Sjoerd H Garssen
- Clinical Research Center, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Patient Care and Monitoring, Philips Research, Eindhoven, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - Niels Kant
- Clinical Research Center, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Enschede, The Netherlands
- Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Carlijn A Vernooij
- Department of Patient Care and Monitoring, Philips Research, Eindhoven, The Netherlands
| | - Gert-Jan Mauritz
- Department of Emergency Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Mark V Koning
- Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Frank H Bosch
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Internal Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Carine J M Doggen
- Clinical Research Center, Rijnstate Hospital, Arnhem, The Netherlands.
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Enschede, The Netherlands.
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Choi A, Choi SY, Chung K, Chung HS, Song T, Choi B, Kim JH. Development of a machine learning-based clinical decision support system to predict clinical deterioration in patients visiting the emergency department. Sci Rep 2023; 13:8561. [PMID: 37237057 DOI: 10.1038/s41598-023-35617-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 05/21/2023] [Indexed: 05/28/2023] Open
Abstract
This study aimed to develop a machine learning-based clinical decision support system for emergency departments based on the decision-making framework of physicians. We extracted 27 fixed and 93 observation features using data on vital signs, mental status, laboratory results, and electrocardiograms during emergency department stay. Outcomes included intubation, admission to the intensive care unit, inotrope or vasopressor administration, and in-hospital cardiac arrest. eXtreme gradient boosting algorithm was used to learn and predict each outcome. Specificity, sensitivity, precision, F1 score, area under the receiver operating characteristic curve (AUROC), and area under the precision-recall curve were assessed. We analyzed 303,345 patients with 4,787,121 input data, resampled into 24,148,958 1 h-units. The models displayed a discriminative ability to predict outcomes (AUROC > 0.9), and the model with lagging 6 and leading 0 displayed the highest value. The AUROC curve of in-hospital cardiac arrest had the smallest change, with increased lagging for all outcomes. With inotropic use, intubation, and intensive care unit admission, the range of AUROC curve change with the leading 6 was the highest according to different amounts of previous information (lagging). In this study, a human-centered approach to emulate the clinical decision-making process of emergency physicians has been adopted to enhance the use of the system. Machine learning-based clinical decision support systems customized according to clinical situations can help improve the quality of care.
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Affiliation(s)
- Arom Choi
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - So Yeon Choi
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyungsoo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyun Soo Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Taeyoung Song
- LG Electronics, 128 Yeoui-daero, Yeongdeungpo-gu, Seoul, 07336, Republic of Korea
| | - Byunghun Choi
- LG Electronics, 128 Yeoui-daero, Yeongdeungpo-gu, Seoul, 07336, Republic of Korea
| | - Ji Hoon Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
- Institute for Innovation in Digital Healthcare, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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van Goor HMR, Breteler MJM, Schoonhoven L, Kalkman CJ, van Loon K, Kaasjager KAH. Interpretation of continuously measured vital signs data of COVID-19 patients by nurses and physicians at the general ward: A mixed methods study. PLoS One 2023; 18:e0286080. [PMID: 37228047 DOI: 10.1371/journal.pone.0286080] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Continuous monitoring of vital signs is introduced at general hospital wards to detect patient deterioration. Interpretation and response currently rely on experience and expert opinion. This study aims to determine whether consensus exist among hospital professionals regarding the interpretation of vital signs of COVID-19 patients. In addition, we assessed the ability to recognise respiratory insufficiency and evaluated the interpretation process. METHODS We performed a mixed methods study including 24 hospital professionals (6 nurses, 6 junior physicians, 6 internal medicine specialists, 6 ICU nurses). Each participant was presented with 20 cases of COVID-19 patients, including 4 or 8 hours of continuously measured vital signs data. Participants estimated the patient's situation ('improving', 'stable', or 'deteriorating') and the possibility of developing respiratory insufficiency. Subsequently, a semi-structured interview was held focussing on the interpretation process. Consensus was assessed using Krippendorff's alpha. For the estimation of respiratory insufficiency, we calculated the mean positive/negative predictive value. Interviews were analysed using inductive thematic analysis. RESULTS We found no consensus regarding the patient's situation (α 0.41, 95%CI 0.29-0.52). The mean positive predictive value for respiratory insufficiency was high (0.91, 95%CI 0.86-0.97), but the negative predictive value was 0.66 (95%CI 0.44-0.88). In the interviews, two themes regarding the interpretation process emerged. "Interpretation of deviations" included the strategies participants use to determine stability, focused on finding deviations in data. "Inability to see the patient" entailed the need of hospital professionals to perform a patient evaluation when estimating a patient's situation. CONCLUSION The interpretation of continuously measured vital signs by hospital professionals, and recognition of respiratory insufficiency using these data, is variable, which might be the result of different interpretation strategies, uncertainty regarding deviations, and not being able to see the patient. Protocols and training could help to uniform interpretation, but decision support systems might be necessary to find signs of deterioration that might otherwise go unnoticed.
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Affiliation(s)
- Harriët M R van Goor
- Department of Acute Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martine J M Breteler
- Department of Acute Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Digital Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lisette Schoonhoven
- Department of Public Health, Healthcare Innovation & Evaluation and Medical Humanities, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cor J Kalkman
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kim van Loon
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karin A H Kaasjager
- Department of Acute Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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23
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Becking-Verhaar FL, Verweij RPH, de Vries M, Vermeulen H, van Goor H, Huisman-de Waal GJ. Continuous Vital Signs Monitoring with a Wireless Device on a General Ward: A Survey to Explore Nurses' Experiences in a Post-Implementation Period. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105794. [PMID: 37239523 DOI: 10.3390/ijerph20105794] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/10/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Nurse engagement, perceived need and usefulness affect healthcare technology use, acceptance and improvements in quality, safety and accessibility of healthcare. Nurses' opinions regarding continuous monitoring appear to be positive. However, facilitators and barriers were little studied. This study explored nurses' post-implementation experiences of the facilitators and barriers to continuously monitoring patients' vital signs using a wireless device on general hospital wards. METHODS This study employed a cross-sectional survey. Vocational and registered nurses from three general wards in a Dutch tertiary university hospital participated in a survey comprising open and closed questions. The data were analysed using thematic analysis and descriptive statistics. RESULTS Fifty-eight nurses (51.3%) completed the survey. Barriers and facilitators were identified under four key themes: (1) timely signalling and early action, (2) time savings and time consumption, (3) patient comfort and satisfaction and (4) preconditions. CONCLUSIONS According to nurses, early detection and intervention for deteriorating patients facilitate the use and acceptance of continuously monitoring vital signs. Barriers primarily concern difficulties connecting patients correctly to the devices and system.
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Affiliation(s)
- Femke L Becking-Verhaar
- Department of Surgery, Radboud University Medical Centre, Huispost 751, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Robin P H Verweij
- Department of Surgery, Radboud University Medical Centre, Huispost 751, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Marjan de Vries
- Department of Surgery, Radboud University Medical Centre, Huispost 751, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Hester Vermeulen
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Huispost 160, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Centre, Huispost 751, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Getty J Huisman-de Waal
- Department of Surgery, Radboud University Medical Centre, Huispost 751, Postbus 9101, 6500 HB Nijmegen, The Netherlands
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Huispost 160, Postbus 9101, 6500 HB Nijmegen, The Netherlands
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24
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Peelen RV, Eddahchouri Y, Koeneman M, Melis R, van Goor H, Bredie SJH. Comparing Continuous with Periodic Vital Sign Scoring for Clinical Deterioration Using a Patient Data Model. J Med Syst 2023; 47:60. [PMID: 37154986 PMCID: PMC10167173 DOI: 10.1007/s10916-023-01954-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/18/2023] [Indexed: 05/10/2023]
Abstract
To evaluate a minute-by-minute monitoring algorithm against a periodic early warning score (EWS) in detecting clinical deterioration and workload. Periodic EWSs suffer from large measurement intervals, causing late detection of deterioration. This might be prevented by continuous vital sign monitoring with a real-time algorithm such as the Visensia Safety Index (VSI). This prospective comparative data modeling cohort study (NCT04189653) compares continuous algorithmic alerts against periodic EWS in continuous monitored medical and surgical inpatients. We evaluated sensitivity, frequency, number of warnings needed to evaluate (NNE) and time of initial alert till escalation of care (EOC): Rapid Response Team activation, unplanned ICU admission, emergency surgery, or death. Also, the percentage of VSI alerting minutes was compared between patients with or without EOC. In 1529 admissions continuous VSI warned for 55% of EOC (95% CI: 45-64%) versus 51% (95% CI: 41-61%) by periodic EWS. NNE for VSI was 152 alerts per detected EOC (95% CI: 114-190) compared to 21 (95% CI: 17-28). It generated 0.99 warnings per day per patient compared to 0.13. Time from detection score till escalation was 8.3 hours (IQR: 2.6-24.8) with VSI versus 5.2 (IQR: 2.7-12.3) hours with EWS (P=0.074). The percentage of warning VSI minutes was higher in patients with EOC than in stable patients (2.36% vs 0.81%, P<0.001). Although sensitivity of detection was not significantly improved continuous vital sign monitoring shows potential for earlier alerts for deterioration compared to periodic EWS. A higher percentage of alerting minutes may indicate risk for deterioration.
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Affiliation(s)
- Roel V Peelen
- Department of Internal Medicine, Radboud University Medical Center, Geert Grooteplein 8, 6525 GA, Nijmegen, The Netherlands.
| | - Yassin Eddahchouri
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein 8, 6525 GA, Nijmegen, The Netherlands
| | - Mats Koeneman
- Health Innovation Lab, Radboud University Medical Center, Geert Grooteplein 8, 6525 GA, Nijmegen, The Netherlands
| | - René Melis
- Department of Geriatrics, Radboud University Medical Center, Geert Grooteplein 8, 6525 GA, Nijmegen, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein 8, 6525 GA, Nijmegen, The Netherlands
| | - Sebastian J H Bredie
- Department of Internal Medicine, Radboud University Medical Center, Geert Grooteplein 8, 6525 GA, Nijmegen, The Netherlands
- Health Innovation Lab, Radboud University Medical Center, Geert Grooteplein 8, 6525 GA, Nijmegen, The Netherlands
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25
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Leenen JPL, Ardesch V, Patijn G. Remote Home Monitoring of Continuous Vital Sign Measurements by Wearables in Patients Discharged After Colorectal Surgery: Observational Feasibility Study. JMIR Perioper Med 2023; 6:e45113. [PMID: 37145849 DOI: 10.2196/45113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/01/2023] [Accepted: 03/31/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Hospital stays after colorectal surgery are increasingly being reduced by enhanced recovery and early discharge protocols. As a result, postoperative complications may frequently manifest after discharge in the home setting, potentially leading to emergency room presentations and readmissions. Virtual care interventions after hospital discharge may capture clinical deterioration at an early stage and hold promise for the prevention of readmissions and overall better outcomes. Recent technological advances have enabled continuous vital sign monitoring by wearable wireless sensor devices. However, the potential of these devices for virtual care interventions for patients discharged after colorectal surgery is currently unknown. OBJECTIVE We aimed to determine the feasibility of a virtual care intervention consisting of continuous vital sign monitoring with wearable wireless sensors and teleconsultations for patients discharged after colorectal surgery. METHODS In a single-center observational cohort study, patients were monitored at home for 5 consecutive days after discharge. Daily vital sign trend assessments and telephone consultations were performed by a remote patient-monitoring department. Intervention performance was evaluated by analyzing vital sign trend assessments and telephone consultation reports. Outcomes were categorized as "no concern," "slight concern," or "serious concern." Serious concern prompted contact with the surgeon on call. In addition, the quality of the vital sign data was determined, and the patient experience was evaluated. RESULTS Among 21 patients who participated in this study, 104 of 105 (99%) measurements of vital sign trends were successful. Of these 104 vital sign trend assessments, 68% (n=71) did not raise any concern, 16% (n=17) were unable to be assessed because of data loss, and none led to contacting the surgeon. Of 62 of 63 (98%) successfully performed telephone consultations, 53 (86%) did not raise any concerns and only 1 resulted in contacting the surgeon. A 68% agreement was found between vital sign trend assessments and telephone consultations. Overall completeness of the 2347 hours of vital sign trend data was 46.3% (range 5%-100%). Patient satisfaction score was 8 (IQR 7-9) of 10. CONCLUSIONS A home monitoring intervention of patients discharged after colorectal surgery was found to be feasible, given its high performance and high patient acceptability. However, the intervention design needs further optimization before the true value of remote monitoring for early discharge protocols, prevention of readmissions, and overall patient outcomes can be adequately determined.
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Affiliation(s)
- Jobbe P L Leenen
- Connected Care Center, Isala, Zwolle, Netherlands
- Department of Surgery, Isala, Zwolle, Netherlands
- Isala Academy, Isala, Zwolle, Netherlands
| | - Vera Ardesch
- Connected Care Center, Isala, Zwolle, Netherlands
- Flexpool General Wards, Department of Care Support, Isala, Zwolle, Netherlands
| | - Gijsbert Patijn
- Connected Care Center, Isala, Zwolle, Netherlands
- Department of Surgery, Isala, Zwolle, Netherlands
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26
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Leenen JPL, Rasing HJM, Kalkman CJ, Schoonhoven L, Patijn GA. Process Evaluation of a Wireless Wearable Continuous Vital Signs Monitoring Intervention in 2 General Hospital Wards: Mixed Methods Study. JMIR Nurs 2023; 6:e44061. [PMID: 37140977 DOI: 10.2196/44061] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/25/2023] [Accepted: 03/27/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Continuous monitoring of vital signs (CMVS) using wearable wireless sensors is increasingly available to patients in general wards and can improve outcomes and reduce nurse workload. To assess the potential impact of such systems, successful implementation is important. We developed a CMVS intervention and implementation strategy and evaluated its success in 2 general wards. OBJECTIVE We aimed to assess and compare intervention fidelity in 2 wards (internal medicine and general surgery) of a large teaching hospital. METHODS A mixed methods sequential explanatory design was used. After thorough training and preparation, CMVS was implemented-in parallel with the standard intermittent manual measurements-and executed for 6 months in each ward. Heart rate and respiratory rate were measured using a chest-worn wearable sensor, and vital sign trends were visualized on a digital platform. Trends were routinely assessed and reported each nursing shift without automated alarms. The primary outcome was intervention fidelity, defined as the proportion of written reports and related nurse activities in case of deviating trends comparing early (months 1-2), mid- (months 3-4), and late (months 5-6) implementation periods. Explanatory interviews with nurses were conducted. RESULTS The implementation strategy was executed as planned. A total of 358 patients were included, resulting in 45,113 monitored hours during 6142 nurse shifts. In total, 10.3% (37/358) of the sensors were replaced prematurely because of technical failure. Mean intervention fidelity was 70.7% (SD 20.4%) and higher in the surgical ward (73.6%, SD 18.1% vs 64.1%, SD 23.7%; P<.001). Fidelity decreased over the implementation period in the internal medicine ward (76%, 57%, and 48% at early, mid-, and late implementation, respectively; P<.001) but not significantly in the surgical ward (76% at early implementation vs 74% at midimplementation [P=.56] vs 70.7% at late implementation [P=.07]). No nursing activities were needed based on vital sign trends for 68.7% (246/358) of the patients. In 174 reports of 31.3% (112/358) of the patients, observed deviating trends led to 101 additional bedside assessments of patients and 73 consultations by physicians. The main themes that emerged during interviews (n=21) included the relative priority of CMVS in nurse work, the importance of nursing assessment, the relatively limited perceived benefits for patient care, and experienced mediocre usability of the technology. CONCLUSIONS We successfully implemented a system for CMVS at scale in 2 hospital wards, but our results show that intervention fidelity decreased over time, more in the internal medicine ward than in the surgical ward. This decrease appeared to depend on multiple ward-specific factors. Nurses' perceptions regarding the value and benefits of the intervention varied. Implications for optimal implementation of CMVS include engaging nurses early, seamless integration into electronic health records, and sophisticated decision support tools for vital sign trend interpretation.
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Affiliation(s)
- Jobbe P L Leenen
- Connected Care Center, Isala, Zwolle, Netherlands
- Isala Academy, Isala, Zwolle, Netherlands
- Department of Surgery, Isala, Zwolle, Netherlands
| | | | - Cor J Kalkman
- Department of Anaesthesiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Lisette Schoonhoven
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, Netherlands
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Gijsbert A Patijn
- Connected Care Center, Isala, Zwolle, Netherlands
- Department of Surgery, Isala, Zwolle, Netherlands
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Gangl C, Krychtiuk K. Digital health-high tech or high touch? Wien Med Wochenschr 2023; 173:115-124. [PMID: 36602630 PMCID: PMC9813878 DOI: 10.1007/s10354-022-00991-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/07/2022] [Indexed: 01/06/2023]
Abstract
Digital transformation in medicine refers to the implementation of information technology-driven developments in the healthcare system and their impact on the way we teach, share, and practice medicine. We would like to provide an overview of current developments and opportunities but also of the risks of digital transformation in medicine. Therefore, we examine the possibilities wearables and digital biomarkers provide for early detection and monitoring of diseases and discuss the potential of artificial intelligence applications in medicine. Furthermore, we outline new opportunities offered by telemedicine applications and digital therapeutics, discuss the aspects of social media in healthcare, and provide an outlook on "Health 4.0."
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Affiliation(s)
- Clemens Gangl
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
| | - Konstantin Krychtiuk
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
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Holland M, Kellett J. The United Kingdom's National Early Warning Score: should everyone use it? A narrative review. Intern Emerg Med 2023; 18:573-583. [PMID: 36602553 PMCID: PMC9813902 DOI: 10.1007/s11739-022-03189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 12/24/2022] [Indexed: 01/06/2023]
Abstract
This review critiques the benefits and drawbacks of the United Kingdom's National Early Warning Score (NEWS). Potential developments for the future are considered, as well as the role for NEWS in an emergency department (ED). The ability of NEWS to predict death within 24 h has been well validated in multiple clinical settings. It provides a common language for the assessment of clinical severity and can be used to trigger clinical interventions. However, it should not be used as the only metric for risk stratification as its ability to predict mortality beyond 24 h is not reliable and greatly influenced by other factors. The main drawbacks of NEWS are that measuring it requires trained professionals, it is time consuming and prone to calculation error. NEWS is recommended for use in acute UK hospitals, where it is linked to an escalation policy that reflects postgraduate experience; patients with lower NEWS are first assessed by a junior clinician and those with higher scores by more senior staff. This policy was based on expert opinion that did not consider workload implications. Nevertheless, its implementation has been shown to improve the efficient recording of vital signs. How and who should respond to different NEWS levels is uncertain and may vary according to the clinical setting and resources available. In the ED, simple triage scores which are quicker and easier to use may be more appropriate determinants of acuity. However, any alternative to NEWS should be easier and cheaper to use and provide evidence of outcome improvement.
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Affiliation(s)
- Mark Holland
- School of Clinical and Biomedical Sciences, Faculty of Health and Wellbeing, University of Bolton, A676 Deane Road, Bolton, BL3 5AB UK
| | - John Kellett
- Department of Emergency Medicine, University Hospital, Odense, Denmark
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29
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Eysenbach G, Oke J, Kardos A. ChroniSense National Early Warning Score Study: Comparison Study of a Wearable Wrist Device to Measure Vital Signs in Patients Who Are Hospitalized. J Med Internet Res 2023; 25:e40226. [PMID: 36745491 PMCID: PMC9941897 DOI: 10.2196/40226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/28/2022] [Accepted: 12/24/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Wearable devices could be used to continuously monitor vital signs in patients who are hospitalized, but they require validation. OBJECTIVE This study aimed to evaluate the clinical validity of the prototype of a semiautomated wearable wrist device (ChroniSense Polso) to measure vital signs and provide National Early Warning Scores (NEWSs). METHODS Vital signs and NEWSs measured using the wearable device were compared with standard, nurse-lead manual measurements. We enrolled adult patients (aged ≥18 years) who required vital sign measurements at least every 6 hours in a UK teaching district general hospital. Wearable device measurements were not used for clinical decision-making. The primary outcome was the agreement on the individual National Early Warning parameter scores and vital sign measurements: respiratory rate, oxygen saturation, body temperature, systolic blood pressure, and heart rate. Secondary outcomes were the agreement on the total NEWS, incidence of adverse events, and user acceptance. To compare the wearable device measurements with the standard measurements, we analyzed vital sign measurements by limits of agreement (Bland-Altman analysis) and conducted κ agreement analyses for NEWSs. A user experience survey was conducted with questions about comfort of the wrist device, safety, preference, and use. RESULTS We included 132 participants in the study, with a mean age of 62 (SD 15.81) years; most of them were men (102/132, 77.3%). The highest weighted κ values were found for heart rate (0.69, 95% CI 0.57-0.81 for all 385 measurements) and systolic blood pressure (0.39, 95% CI 0.30-0.47 for all 339 measurements). Weighted κ values were low for respiration rate (0.03, 95% CI -0.001 to 0.05 for all 445 measurements), temperature (0, 95% CI 0-0 for all 231 measurements), and oxygen saturation (-0.11, 95% CI -0.20 to -0.02 for all 187 measurements). Weighted κ using Cicchetti-Allison weights showed κ of 0.20 (95% CI 0.03-0.38) when using all 56 total NEWSs. The user acceptance survey found that approximately half (45/91, 49%) of the participants found it comfortable to wear the device and liked its appearance. Most (85/92, 92%) of them said that they would wear the device during their next hospital visit, and many (74/92, 80%) said that they would recommend it to others. CONCLUSIONS This study shows the promising use of a prototype wearable device to measure vital signs in a hospital setting. Agreement between the standard measurements and wearable device measurements was acceptable for systolic blood pressure and heart rate, but needed to be improved for respiration rate, temperature, and oxygen saturation. Future studies need to improve the clinical validity of this wearable device. Large studies are required to assess clinical outcomes and cost-effectiveness of wearable devices for vital sign measurement. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2018-028219.
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Affiliation(s)
| | - Jason Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Attila Kardos
- Department of Cardiology, Translational Cardiovascular Research Group, Milton Keynes University Hospital, Milton Keynes, United Kingdom
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30
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Vroman H, Mosch D, Eijkenaar F, Naujokat E, Mohr B, Medic G, Swijnenburg M, Tesselaar E, Franken M. Continuous vital sign monitoring in patients after elective abdominal surgery: a retrospective study on clinical outcomes and costs. J Comp Eff Res 2023; 12:e220176. [PMID: 36645412 PMCID: PMC10288965 DOI: 10.2217/cer-2022-0176] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/10/2022] [Indexed: 01/17/2023] Open
Abstract
Aim: To assess changes in outcomes and costs upon implementation of continuous vital sign monitoring in postsurgical patients. Materials & methods: Retrospective analysis of clinical outcomes and in-hospital costs compared with a control period. Results: During the intervention period patients were less frequently admitted to the intensive care unit (ICU) (p = 0.004), had shorter length of stay (p < 0.001) and lower costs (p < 0.001). The intervention was associated with a lower odds of ICU admission (odds ratio: 0.422; p = 0.007) and ICU related costs (odds ratio: -662.4; p = 0.083). Conclusion: Continuous vital sign monitoring may have contributed to fewer ICU admissions and lower ICU costs in postsurgical patients.
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Affiliation(s)
- Heleen Vroman
- Department of Science, Bravis Hospital, Roosendaal, The Netherlands
| | - Diederik Mosch
- Department of Medical Physics, Bravis Hospital, Roosendaal, The Netherlands
| | - Frank Eijkenaar
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands
| | - Elke Naujokat
- Philips Medizin Systeme Boeblingen GmbH, Hewlett-Packard-Str. 2,71034 Boeblingen, Germany
| | - Belinda Mohr
- Philips, 222 Jacobs Street, Cambridge, MA 02141, USA
| | - Goran Medic
- Philips Healthcare, High Tech Campus 52, 5656 AG Eindhoven, The Netherlands
- Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | | | - Eric Tesselaar
- Department of Medical Physics, Bravis Hospital, Roosendaal, The Netherlands
- Department of Medical & Health Sciences, Medical Radiation Physics, Linköping University, Sweden
| | - Martijn Franken
- Department of Medical Physics, Bravis Hospital, Roosendaal, The Netherlands
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Félix J, Moreira J, Santos R, Kontio E, Pinheiro AR, Sousa ASP. Health-Related Telemonitoring Parameters/Signals of Older Adults: An Umbrella Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:796. [PMID: 36679588 PMCID: PMC9862356 DOI: 10.3390/s23020796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 06/17/2023]
Abstract
Aging is one of the greatest challenges in modern society. The development of wearable solutions for telemonitoring biological signals has been viewed as a strategy to enhance older adults' healthcare sustainability. This study aims to review the biological signals remotely monitored by technologies in older adults. PubMed, the Cochrane Database of Systematic Reviews, the Web of Science, and the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports were systematically searched in December 2021. Only systematic reviews and meta-analyses of remote health-related biological and environmental monitoring signals in older adults were considered, with publication dates between 2016 and 2022, written in English, Portuguese, or Spanish. Studies referring to conference proceedings or articles with abstract access only were excluded. The data were extracted independently by two reviewers, using a predefined table form, consulting a third reviewer in case of doubts or concerns. Eighteen studies were included, fourteen systematic reviews and four meta-analyses. Nine of the reviews included older adults from the community, whereas the others also included institutionalized participants. Heart and respiratory rate, physical activity, electrocardiography, body temperature, blood pressure, glucose, and heart rate were the most frequently measured biological variables, with physical activity and heart rate foremost. These were obtained through wearables, with the waist, wrist, and ankle being the most mentioned body regions for the device's placement. Six of the reviews presented the psychometric properties of the systems, most of which were valid and accurate. In relation to environmental signals, only two articles presented data on this topic. Luminosity, temperature, and movement were the most mentioned variables. The need for large-scale long-term health-related telemonitoring implementation of studies with larger sample sizes was pointed out by several reviews in order to define the feasibility levels of wearable devices.
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Affiliation(s)
- José Félix
- Department of Physics, School of Health, Polytechnic Institute of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
- Center for Rehabilitation Research (CIR), School of Health, Polytechnic Institute of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
- Department of Medical Sciences, University of Aveiro, Agras do Crasto, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
| | - Juliana Moreira
- Center for Rehabilitation Research (CIR), School of Health, Polytechnic Institute of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
- Department of Physiotherapy, School of Health, Polytechnic Institute of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
| | - Rubim Santos
- Department of Physics, School of Health, Polytechnic Institute of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
- Center for Rehabilitation Research (CIR), School of Health, Polytechnic Institute of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
| | - Elina Kontio
- Faculty of Engineering and Business, Turku University of Applied Sciences, Joukahaisenkatu 3, 20520 Turku, Finland
| | - Ana Rita Pinheiro
- School of Health Sciences (ESSUA), University of Aveiro, Agras do Crasto, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
- Institute of Biomedicine (iBiMED), University of Aveiro, Agras do Crasto, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
| | - Andreia S. P. Sousa
- Center for Rehabilitation Research (CIR), School of Health, Polytechnic Institute of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
- Department of Physiotherapy, School of Health, Polytechnic Institute of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
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van der Stam JA, Mestrom EHJ, Nienhuijs SW, de Hingh IHJT, Boer AK, van Riel NAW, de Groot KTJ, Verhaegh W, Scharnhorst V, Bouwman RA. A wearable patch based remote early warning score (REWS) in major abdominal cancer surgery patients. Eur J Surg Oncol 2023; 49:278-284. [PMID: 36085116 DOI: 10.1016/j.ejso.2022.08.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/30/2022] [Accepted: 08/26/2022] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION The shift toward remote patient monitoring methods to detect clinical deterioration requires testing of wearable devices in real-life clinical settings. This study aimed to develop a remote early warning scoring (REWS) system based on continuous measurements using a wearable device, and compare its diagnostic performance for the detection of deterioration to the diagnostic performance of the conventional modified early warning score (MEWS). MATERIALS AND METHODS The study population of this prospective, single center trial consisted of patients who underwent major abdominal cancer surgery and were monitored using routine in-hospital spotcheck measurements of the vital parameters. Heart and respiratory rates were measured continuously using a wireless accelerometer patch (HealthDot). The prediction by MEWS of deterioration toward a complication graded Clavien-Dindo of 2 or higher was compared to the REWS derived from continuous measurements by the wearable patch. MAIN RESULTS A total of 103 patients and 1909 spot-check measurements were included in the analysis. Postoperative deterioration was observed in 29 patients. For both EWS systems, the sensitivity (MEWS: 0.20 95% CI: [0.13-0.29], REWS: 0.20 95% CI: [0.13-0.29]) and specificity (MEWS: 0.96 95% CI: [0.95-0.97], REWS: 0.96 95% CI: [0.95-0.97]) were assessed. CONCLUSIONS The diagnostic value of the REWS method, based on continuous measurements of the heart and respiratory rates, is comparable to that of the MEWS in patients following major abdominal cancer surgery. The wearable patch could detect the same amount of deteriorations, without requiring manual spot check measurements.
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Affiliation(s)
- Jonna A van der Stam
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Clinical Laboratory, Catharina Hospital, Eindhoven, the Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands.
| | - Eveline H J Mestrom
- Department of Anesthesiology, Intensive Care & Pain Medicine, Catharina Hospital, Eindhoven, the Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Ignace H J T de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Arjen-Kars Boer
- Clinical Laboratory, Catharina Hospital, Eindhoven, the Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands
| | - Natal A W van Riel
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands; Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Koen T J de Groot
- Department of AI, Data Science & Digital Twin, Philips Research, Eindhoven, the Netherlands
| | - Wim Verhaegh
- Department of AI, Data Science & Digital Twin, Philips Research, Eindhoven, the Netherlands
| | - Volkher Scharnhorst
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Clinical Laboratory, Catharina Hospital, Eindhoven, the Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands
| | - R Arthur Bouwman
- Department of Anesthesiology, Intensive Care & Pain Medicine, Catharina Hospital, Eindhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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van Ede ES, Scheerhoorn J, Buise MP, Bouwman RA, Nienhuijs SW. Telemonitoring for perioperative care of outpatient bariatric surgery: Preference-based randomized clinical trial. PLoS One 2023; 18:e0281992. [PMID: 36812167 PMCID: PMC9946229 DOI: 10.1371/journal.pone.0281992] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 01/24/2023] [Indexed: 02/24/2023] Open
Abstract
IMPORTANCE Implementation of bariatric surgery on an outpatient basis is hampered by concerns about timely detection of postoperative complications. Telemonitoring could enhance detection and support transition to an outpatient recovery pathway. OBJECTIVE This study aimed to evaluate non-inferiority and feasibility of an outpatient recovery pathway after bariatric surgery, supported by remote monitoring compared to standard care. DESIGN Preference-based non-inferiority randomized trial. SETTING Center for obesity and metabolic surgery, Catharina hospital Eindhoven, the Netherlands. PARTICIPANTS Adult patients scheduled for primary gastric bypass or sleeve gastrectomy. INTERVENTIONS Same-day discharge with one week ongoing Remote Monitoring (RM) of vital parameters or Standard Care (SC) with discharge on postoperative day one. MAIN OUTCOMES Primary outcome was a thirty-day composite Textbook Outcome score encompassing mortality, mild and severe complications, readmission and prolonged length-of-stay. Non-inferiority of same-day discharge and remote monitoring was accepted below the selected margin of 7% upper limit of confidence interval. Secondary outcomes included admission duration, post-discharge opioid use and patients' satisfaction. RESULTS Textbook Outcome was achieved in 94% (n = 102) in RM versus 98% (n = 100) in SC (RR 2.9; 95% CI, 0.60-14.23, p = 0.22). The non-inferiority margin was exceeded which is a statistically inconclusive result. Both Textbook Outcome measures were above Dutch average (5% RM and 9% SC). Same-day discharge reduced hospitalization days by 61% (p<0.001) and by 58% with re-admission days included (p<0.001). Post-discharge opioid use and satisfaction scores were equal (p = 0.82 and p = 0.86). CONCLUSION In conclusion, outpatient bariatric surgery supported with telemonitoring is clinically comparable to standard overnight bariatrics in terms of textbook-outcome. Both approaches reached primary endpoint results above Dutch average. However, statistically the outpatient surgery protocol was neither inferior, nor non-inferior to the standard pathway. Additionally, offering same-day discharge reduces the total hospitalization days while maintaining patient satisfaction and safety.
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Affiliation(s)
- E. S. van Ede
- Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
- Department of Electrical Engineering, Signal Processing Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
- * E-mail:
| | - J. Scheerhoorn
- Department of Surgery, Catharina hospital Eindhoven, Eindhoven, The Netherlands
| | - M. P. Buise
- Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - R. A. Bouwman
- Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
- Department of Electrical Engineering, Signal Processing Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - S. W. Nienhuijs
- Department of Surgery, Catharina hospital Eindhoven, Eindhoven, The Netherlands
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Zahradka N, Geoghan S, Watson H, Goldberg E, Wolfberg A, Wilkes M. Assessment of Remote Vital Sign Monitoring and Alarms in a Real-World Healthcare at Home Dataset. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 10:bioengineering10010037. [PMID: 36671610 PMCID: PMC9854741 DOI: 10.3390/bioengineering10010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/10/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
The importance of vital sign monitoring to detect deterioration increases during healthcare at home. Continuous monitoring with wearables increases assessment frequency but may create information overload for clinicians. The goal of this work was to demonstrate the impact of vital sign observation frequency and alarm settings on alarms in a real-world dataset. Vital signs were collected from 76 patients admitted to healthcare at home programs using the Current Health (CH) platform; its wearable continuously measured respiratory rate (RR), pulse rate (PR), and oxygen saturation (SpO2). Total alarms, alarm rate, patient rate, and detection time were calculated for three alarm rulesets to detect changes in SpO2, PR, and RR under four vital sign observation frequencies and four window sizes for the alarm algorithms' median filter. Total alarms ranged from 65 to 3113. The alarm rate and early detection increased with the observation frequency for all alarm rulesets. Median filter windows reduced alarms triggered by normal fluctuations in vital signs without compromising the granularity of time between assessments. Frequent assessments enabled with continuous monitoring support early intervention but need to pair with settings that balance sensitivity, specificity, clinical risk, and provider capacity to respond when a patient is home to minimize clinician burden.
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Haahr-Raunkjaer C, Skovbye M, Rasmussen SM, Elvekjaer M, Sørensen HBD, Meyhoff CS, Aasvang EK. Agreement between standard and continuous wireless vital sign measurements after major abdominal surgery: a clinical comparison study. Physiol Meas 2022; 43. [PMID: 36322987 DOI: 10.1088/1361-6579/ac9fa3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/02/2022] [Indexed: 11/27/2022]
Abstract
Objective. Continuous wireless monitoring outside the post-anesthesia or intensive care units may enable early detection of patient deterioration, but good accuracy of measurements is required. We aimed to assess the agreement between vital signs recorded by standard and novel wireless devices in postoperative patients.Approach. In 20 patients admitted to the post-anesthesia care unit, we compared heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO2), and systolic and diastolic blood pressure (SBP and DBP) as paired data. The primary outcome measure was the agreement between standard wired and wireless monitoring, assessed by mean bias and 95% limits of agreement (LoA). LoA was considered acceptable for HR and PR, if within ±5 beats min-1(bpm), while RR, SpO2, and BP were deemed acceptable if within ±3 breaths min-1(brpm), ±3%-points, and ±10 mmHg, respectively.Main results.The mean bias between standard versus wireless monitoring was -0.85 bpm (LoA -6.2 to 4.5 bpm) for HR, -1.3 mmHg (LoA -19 to 17 mmHg) for standard versus wireless SBP, 2.9 mmHg (LoA -17 to 22) for standard versus wireless DBP, and 1.7% (LoA -1.4 mmHg to 4.8 mmHg) for SpO2, comparing standard versus wireless monitoring. The mean bias of arterial blood gas analysis versus wireless SpO2measurements was 0.02% (LoA -0.02% to 0.06%), while the mean bias of direct observation of RR compared to wireless measurements was 0.0 brpm (LoA -2.6 brpm to 2.6 brpm). 80% of all values compared were within predefined clinical limits.Significance.The agreement between wired and wireless HR, RR, and PR recordings in postoperative patients was acceptable, whereas the agreement for SpO2recordings (standard versus wireless) was borderline. Standard wired and wireless BP measurements may be used interchangeably in the clinical setting.
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Affiliation(s)
- Camilla Haahr-Raunkjaer
- Department of Anesthesiology, Center for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Anesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Magnus Skovbye
- Department of Anesthesiology, Center for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Søren M Rasmussen
- Biomedical Signal Processing, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Mikkel Elvekjaer
- Department of Anesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Helge B D Sørensen
- Biomedical Signal Processing, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Christian S Meyhoff
- Department of Anesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Eske K Aasvang
- Department of Anesthesiology, Center for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Xu S, Kim J, Walter JR, Ghaffari R, Rogers JA. Translational gaps and opportunities for medical wearables in digital health. Sci Transl Med 2022; 14:eabn6036. [PMID: 36223451 DOI: 10.1126/scitranslmed.abn6036] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
A confluence of advances in biosensor technologies, enhancements in health care delivery mechanisms, and improvements in machine learning, together with an increased awareness of remote patient monitoring, has accelerated the impact of digital health across nearly every medical discipline. Medical grade wearables-noninvasive, on-body sensors operating with clinical accuracy-will play an increasingly central role in medicine by providing continuous, cost-effective measurement and interpretation of physiological data relevant to patient status and disease trajectory, both inside and outside of established health care settings. Here, we review current digital health technologies and highlight critical gaps to clinical translation and adoption.
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Affiliation(s)
- Shuai Xu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60611, USA.,Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA.,Sibel Health, Niles, IL 60714, USA
| | - Joohee Kim
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60611, USA
| | - Jessica R Walter
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60611, USA.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Roozbeh Ghaffari
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60611, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA.,Epicore Biosystems Inc., Cambridge, MA 02139, USA
| | - John A Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60611, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Tam W, Alajlani M, Abd-alrazaq A. An Exploration of Wearable Device Features Used in UK Hospital Parkinson Disease Care: Scoping Review (Preprint).. [DOI: 10.2196/preprints.42950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND
The prevalence of Parkinson disease (PD) is becoming an increasing concern owing to the aging population in the United Kingdom. Wearable devices have the potential to improve the clinical care of patients with PD while reducing health care costs. Consequently, exploring the features of these wearable devices is important to identify the limitations and further areas of investigation of how wearable devices are currently used in clinical care in the United Kingdom.
OBJECTIVE
In this scoping review, we aimed to explore the features of wearable devices used for PD in hospitals in the United Kingdom.
METHODS
A scoping review of the current research was undertaken and reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The literature search was undertaken on June 6, 2022, and publications were obtained from MEDLINE or PubMed, Embase, and the Cochrane Library. Eligible publications were initially screened by their titles and abstracts. Publications that passed the initial screening underwent a full review. The study characteristics were extracted from the final publications, and the evidence was synthesized using a narrative approach. Any queries were reviewed by the first and second authors.
RESULTS
Of the 4543 publications identified, 39 (0.86%) publications underwent a full review, and 20 (0.44%) publications were included in the scoping review. Most studies (11/20, 55%) were conducted at the Newcastle upon Tyne Hospitals NHS Foundation Trust, with sample sizes ranging from 10 to 418. Most study participants were male individuals with a mean age ranging from 57.7 to 78.0 years. The AX3 was the most popular device brand used, and it was commercially manufactured by Axivity. Common wearable device types included body-worn sensors, inertial measurement units, and smartwatches that used accelerometers and gyroscopes to measure the clinical features of PD. Most wearable device primary measures involved the measured gait, bradykinesia, and dyskinesia. The most common wearable device placements were the lumbar region, head, and wrist. Furthermore, 65% (13/20) of the studies used artificial intelligence or machine learning to support PD data analysis.
CONCLUSIONS
This study demonstrated that wearable devices could help provide a more detailed analysis of PD symptoms during the assessment phase and personalize treatment. Using machine learning, wearable devices could differentiate PD from other neurodegenerative diseases. The identified evidence gaps include the lack of analysis of wearable device cybersecurity and data management. The lack of cost-effectiveness analysis and large-scale participation in studies resulted in uncertainty regarding the feasibility of the widespread use of wearable devices. The uncertainty around the identified research gaps was further exacerbated by the lack of medical regulation of wearable devices for PD, particularly in the United Kingdom where regulations were changing due to the political landscape.
CLINICALTRIAL
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Do W, Russell R, Wheeler C, Lockwood M, De Vos M, Pavord I, Bafadhel M. Performance of Contactless Respiratory Rate Monitoring by Albus Home TM, an Automated System for Nocturnal Monitoring at Home: A Validation Study. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22197142. [PMID: 36236241 PMCID: PMC9573065 DOI: 10.3390/s22197142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/01/2022] [Accepted: 09/16/2022] [Indexed: 06/12/2023]
Abstract
Respiratory rate (RR) is a clinically important predictor of cardio-respiratory deteriorations. The mainstay of clinical measurement comprises the manual counting of chest movements, which is variable between clinicians and limited to sporadic readings. Emerging solutions are limited by poor adherence and acceptability or are not clinically validated. Albus HomeTM is a contactless and automated bedside system for nocturnal respiratory monitoring that overcomes these limitations. This study aimed to validate the accuracy of Albus Home compared to gold standards in real-world sleeping environments. Participants undertook overnight monitoring simultaneously using Albus Home and gold-standard polygraphy with thoraco-abdominal respiratory effort belts (SomnomedicsEU). Reference RR readings were obtained by clinician-count of polygraphy data. For both the Albus system and reference, RRs were measured in 30-s segments, reported as breaths/minute, and compared. Accuracy was defined as the percentage of RRs from the Albus system within ±2 breaths/minute of reference counts. Across a diverse validation set of 32 participants, the mean accuracy exceeded 98% and was maintained across different participant characteristics. In a Bland-Altman analysis, Albus RRs had strong agreement with reference mean differences and the limits of agreement of -0.4 and ±1.2 breaths/minute, respectively. Albus Home is a contactless yet accurate system for automated respiratory monitoring. Validated against gold -standard methods, it enables long-term, reliable nocturnal monitoring without patient burden.
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Affiliation(s)
| | - Richard Russell
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | | | | | - Maarten De Vos
- Department of Electrical Engineering and Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Ian Pavord
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | - Mona Bafadhel
- King’s Centre for Lung Health, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE1 1UL, UK
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Choi A, Chung K, Chung SP, Lee K, Hyun H, Kim JH. Advantage of Vital Sign Monitoring Using a Wireless Wearable Device for Predicting Septic Shock in Febrile Patients in the Emergency Department: A Machine Learning-Based Analysis. SENSORS (BASEL, SWITZERLAND) 2022; 22:7054. [PMID: 36146403 PMCID: PMC9504566 DOI: 10.3390/s22187054] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
Intermittent manual measurement of vital signs may not rapidly predict sepsis development in febrile patients admitted to the emergency department (ED). We aimed to evaluate the predictive performance of a wireless monitoring device that continuously measures heart rate (HR) and respiratory rate (RR) and a machine learning analysis in febrile but stable patients in the ED. We analysed 468 patients (age, ≥18 years; training set, n = 277; validation set, n = 93; test set, n = 98) having fever (temperature >38 °C) and admitted to the isolation care unit of the ED. The AUROC of the fragmented model with device data was 0.858 (95% confidence interval [CI], 0.809−0.908), and that with manual data was 0.841 (95% CI, 0.789−0.893). The AUROC of the accumulated model with device data was 0.861 (95% CI, 0.811−0.910), and that with manual data was 0.853 (95% CI, 0.803−0.903). Fragmented and accumulated models with device data detected clinical deterioration in febrile patients at risk of septic shock 9 h and 5 h 30 min earlier, respectively, than those with manual data. Continuous vital sign monitoring using a wearable device could accurately predict clinical deterioration and reduce the time to recognise potential clinical deterioration in stable ED patients with fever.
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Affiliation(s)
- Arom Choi
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Kyungsoo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Kwanhyung Lee
- AITRICS, 28 Hyoryeong-ro 77-gil, Seocho-gu, Seoul 06627, Korea
| | - Heejung Hyun
- AITRICS, 28 Hyoryeong-ro 77-gil, Seocho-gu, Seoul 06627, Korea
| | - Ji Hoon Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
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Mulder ST, Omidvari AH, Rueten-Budde AJ, Huang PH, Kim KH, Bais B, Rousian M, Hai R, Akgun C, van Lennep JR, Willemsen S, Rijnbeek PR, Tax DM, Reinders M, Boersma E, Rizopoulos D, Visch V, Steegers-Theunissen R. Dynamic Digital Twin: Diagnosis, Treatment, Prediction, and Prevention of Disease During the Life Course. J Med Internet Res 2022; 24:e35675. [PMID: 36103220 PMCID: PMC9520391 DOI: 10.2196/35675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/31/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
A digital twin (DT), originally defined as a virtual representation of a physical asset, system, or process, is a new concept in health care. A DT in health care is not a single technology but a domain-adapted multimodal modeling approach incorporating the acquisition, management, analysis, prediction, and interpretation of data, aiming to improve medical decision-making. However, there are many challenges and barriers that must be overcome before a DT can be used in health care. In this viewpoint paper, we build on the current literature, address these challenges, and describe a dynamic DT in health care for optimizing individual patient health care journeys, specifically for women at risk for cardiovascular complications in the preconception and pregnancy periods and across the life course. We describe how we can commit multiple domains to developing this DT. With our cross-domain definition of the DT, we aim to define future goals, trade-offs, and methods that will guide the development of the dynamic DT and implementation strategies in health care.
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Affiliation(s)
- Skander Tahar Mulder
- Pattern Recognition Lab, Mathematics and Computer Science, Technical University Delft, Delft, Netherlands
| | - Amir-Houshang Omidvari
- Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Pei-Hua Huang
- Department of Medical Ethics and Philosophy, Erasmus Medical Center, Rotterdam, Netherlands
| | - Ki-Hun Kim
- Department of Industrial Engineering, Pusan National University, Busan, Republic of Korea
| | - Babette Bais
- Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Melek Rousian
- Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Rihan Hai
- Web Information Systems Group, Mathematics and Computer Science, Technical University of Delft, Delft, Netherlands
| | - Can Akgun
- Web Information Systems Group, Mathematics and Computer Science, Technical University of Delft, Delft, Netherlands
- Bioelectronics Section, Department of Microelectronics, Faculty of Electrical Engineering, Technical University Delft, Delft, Netherlands
| | | | - Sten Willemsen
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, Netherlands
| | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, Netherlands
| | - David Mj Tax
- Pattern Recognition Lab, Mathematics and Computer Science, Technical University Delft, Delft, Netherlands
| | - Marcel Reinders
- Pattern Recognition Lab, Mathematics and Computer Science, Technical University Delft, Delft, Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Valentijn Visch
- Industrial Design, Mathematics and Computer Science, Technical University Delft, Delft, Netherlands
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Elvekjaer M, Rasmussen SM, Grønbæk KK, Porsbjerg CM, Jensen JU, Haahr-Raunkjær C, Mølgaard J, Søgaard M, Sørensen HBD, Aasvang EK, Meyhoff CS. Clinical impact of vital sign abnormalities in patients admitted with acute exacerbation of chronic obstructive pulmonary disease: an observational study using continuous wireless monitoring. Intern Emerg Med 2022; 17:1689-1698. [PMID: 35593967 DOI: 10.1007/s11739-022-02988-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/08/2022] [Indexed: 11/27/2022]
Abstract
Early detection of abnormal vital signs is critical for timely management of acute hospitalised patients and continuous monitoring may improve this. We aimed to assess the association between preceding vital sign abnormalities and serious adverse events (SAE) in patients hospitalised with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Two hundred patients' vital signs were wirelessly and continuously monitored with peripheral oxygen saturation, heart rate, and respiratory rate during the first 4 days after admission for AECOPD. Non-invasive blood pressure was also measured every 30-60 min. The primary outcome was occurrence of SAE according to international definitions within 30 days and physiological data were analysed for preceding vital sign abnormalities. Data were presented as the mean cumulative duration of vital sign abnormalities per 24 h and analysed using Wilcoxon rank sum test. SAE during ongoing continuous monitoring occurred in 50 patients (25%). Patients suffering SAE during the monitoring period had on average 455 min (SD 413) per 24 h of any preceding vital sign abnormality versus 292 min (SD 246) in patients without SAE, p = 0.08, mean difference 163 min [95% CI 61-265]. Mean duration of bradypnea (respiratory rate < 11 min-1) was 48 min (SD 173) compared with 30 min (SD 84) in patients without SAE, p = 0.01. In conclusion, the duration of physiological abnormalities was substantial in patients with AECOPD. There were no statistically significant differences between patients with and without SAE in the overall duration of preceding physiological abnormalities.Study registration: http://ClinicalTrials.gov (NCT03660501). Date of registration: Sept 6 2018.
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Affiliation(s)
- Mikkel Elvekjaer
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark.
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg, Copenhagen University Hospital, Copenhagen, Denmark.
- Department of Anaesthesiology, Centre for Cancer and Organ Dysfunction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Søren M Rasmussen
- Biomedical Engineering, Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Katja K Grønbæk
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Anaesthesiology, Centre for Cancer and Organ Dysfunction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Celeste M Porsbjerg
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg, Copenhagen University Hospital, Copenhagen, Denmark
- Respiratory Research Unit, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jens-Ulrik Jensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, CHIP and PERSIMUNE, Rigshospitalet, Copenhagen, Denmark
| | - Camilla Haahr-Raunkjær
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
- Department of Anaesthesiology, Centre for Cancer and Organ Dysfunction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Mølgaard
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
- Department of Anaesthesiology, Centre for Cancer and Organ Dysfunction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Marlene Søgaard
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg, Copenhagen University Hospital, Copenhagen, Denmark
| | - Helge B D Sørensen
- Biomedical Engineering, Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Eske K Aasvang
- Department of Anaesthesiology, Centre for Cancer and Organ Dysfunction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian S Meyhoff
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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42
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Giordano NA, Kane A, Rodriguez R, Papay D, Canales B, Kirk KF, Buckenmaier CC, Highland KB. Changes in actigraphy metrics associated with PROMIS measures after orthopaedic surgery. Int J Nurs Pract 2022; 28:e13089. [PMID: 35983591 DOI: 10.1111/ijn.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/22/2022] [Accepted: 07/21/2022] [Indexed: 11/30/2022]
Abstract
AIM This study examined the feasibility of integrating actigraphy devices into orthopaedic surgical settings to assess the concurrent validity between objective actigraphy data and PROMIS measures. Additionally, the association between changes in actigraphy data and longitudinal changes in PROMIS measures was examined. METHODS Data were collected from 17 participants using actigraphy devices the week prior to and after orthopaedic surgery from 02/2019 to 03/2020. Participants completed PROMIS measures (Physical Function, Sleep Disturbance, Pain Interference) preoperatively and up to 6 months postoperatively. Nonparametric correlations (rs ) assessed for concurrent validity. Linear mixed-effects models examined the association between changes in actigraphy data and PROMIS measures. RESULTS Prolonged wake after sleep onset was associated with increased sleep disturbances (rs = 0.49; p = 0.045) and pain interference (rs = 0.51; p = 0.04). Changes in pain interference were correlated with increased awakenings (rs = 0.54; p = 0.03). Increased wake after sleep onset was associated with worsening sleep disturbance (β = 0.12; p = 0.01) and pain interference scores over the postoperative period (β = 0.12; p = 0.02). CONCLUSIONS This study is among the first to examine changes in objective actigraphy data and longitudinal PROMIS measures following orthopaedic surgery and illustrates the feasibility of incorporating actigraphy into surgical settings to evaluate postoperative recovery.
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Affiliation(s)
- Nicholas A Giordano
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Alexandra Kane
- Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, Rockville, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Rockville, Maryland, USA
| | - Ramiro Rodriguez
- F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Diane Papay
- Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, Rockville, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Rockville, Maryland, USA
| | - Bryanna Canales
- Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, Rockville, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Rockville, Maryland, USA
| | - Keri F Kirk
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Chester C Buckenmaier
- Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, Rockville, Maryland, USA
| | - Krista B Highland
- Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, Rockville, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Rockville, Maryland, USA
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43
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Haveman ME, van Melzen R, Schuurmann RCL, Hermens HJ, Tabak M, de Vries JPPM. Feasibility and patient's experiences of perioperative telemonitoring in major abdominal surgery: an observational pilot study. Expert Rev Med Devices 2022; 19:515-523. [PMID: 35975601 DOI: 10.1080/17434440.2022.2108703] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Telemonitoring during the perioperative trajectory may improve patient outcomes and self-management. The aim of this study is to assess the feasibility of and patient's experiences with telemonitoring before and after major abdominal surgery to inform future study design. METHODS Patients planned for elective major abdominal surgery wore a sensor and answered well-being questions on a tablet daily for at least 2 weeks preoperatively up to 30-days postoperatively. Feasibility was assessed by participation and completion rate, compliance per day, weekly satisfaction scores, and reasons for nonscheduled contact. RESULTS Twenty-three patients were included (participation rate of 54.5%) with a completion rate of 69.6%. Median compliance with the wearable sensor and well-being questions was respectively: 94.7% and 83.3% preoperatively at home; 100% and 66.7% postoperatively in-hospital; and 95.4% and 85.8% postoperatively at home. Median weekly satisfaction scores for both wearing the sensor and well-being questions were 5 (IQR, 4-5). Contact moments were related to absence of sensor data and technological issues (76.0%) or patient discomfort and insecurity (24.0%). CONCLUSIONS In this study, telemonitoring showed high satisfaction and compliance during the perioperative trajectory. Future trial design regarding the effectiveness of telemonitoring requires embedding in clinical practice and support for patients, relatives, and healthcare personnel.
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Affiliation(s)
- Marjolein E Haveman
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rianne van Melzen
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Richte C L Schuurmann
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hermie J Hermens
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands.,eHealth Group, Roessingh Research and Development, Enschede, The Netherlands
| | - Monique Tabak
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands.,eHealth Group, Roessingh Research and Development, Enschede, The Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Tang A, Woldemariam S, Roger J, Sirota M. Translational Bioinformatics to Enable Precision Medicine for All: Elevating Equity across Molecular, Clinical, and Digital Realms. Yearb Med Inform 2022; 31:106-115. [PMID: 36463867 PMCID: PMC9719766 DOI: 10.1055/s-0042-1742513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
OBJECTIVES Over the past few years, challenges from the pandemic have led to an explosion of data sharing and algorithmic development efforts in the areas of molecular measurements, clinical data, and digital health. We aim to characterize and describe recent advanced computational approaches in translational bioinformatics across these domains in the context of issues or progress related to equity and inclusion. METHODS We conducted a literature assessment of the trends and approaches in translational bioinformatics in the past few years. RESULTS We present a review of recent computational approaches across molecular, clinical, and digital realms. We discuss applications of phenotyping, disease subtype characterization, predictive modeling, biomarker discovery, and treatment selection. We consider these methods and applications through the lens of equity and inclusion in biomedicine. CONCLUSION Equity and inclusion should be incorporated at every step of translational bioinformatics projects, including project design, data collection, model creation, and clinical implementation. These considerations, coupled with the exciting breakthroughs in big data and machine learning, are pivotal to reach the goals of precision medicine for all.
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Affiliation(s)
- Alice Tang
- Bakar Computational Health Sciences Institute, UCSF, San Francisco, CA, USA
- Graduate Program in Bioengineering, UCSF, San Francisco, CA, USA
- School of Medicine, UCSF, San Francisco, CA, USA
| | - Sarah Woldemariam
- Bakar Computational Health Sciences Institute, UCSF, San Francisco, CA, USA
- School of Medicine, UCSF, San Francisco, CA, USA
| | - Jacquelyn Roger
- Bakar Computational Health Sciences Institute, UCSF, San Francisco, CA, USA
- Graduate Program in Biological and Medical Informatics, UCSF, San Francisco, CA, USA
| | - Marina Sirota
- Bakar Computational Health Sciences Institute, UCSF, San Francisco, CA, USA
- Department of Pediatrics, UCSF, San Francisco, CA, USA
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Circadian patterns of heart rate, respiratory rate and skin temperature in hospitalized COVID-19 patients. PLoS One 2022; 17:e0268065. [PMID: 35797369 PMCID: PMC9262173 DOI: 10.1371/journal.pone.0268065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/22/2022] [Indexed: 12/15/2022] Open
Abstract
Rationale
Vital signs follow circadian patterns in both healthy volunteers and critically ill patients, which seem to be influenced by disease severity in the latter. In this study we explored the existence of circadian patterns in heart rate, respiratory rate and skin temperature of hospitalized COVID-19 patients, and aimed to explore differences in circadian rhythm amplitude during patient deterioration.
Methods
We performed a retrospective study of COVID-19 patients admitted to the general ward of a tertiary hospital between April 2020 and March 2021. Patients were continuously monitored using a wireless sensor and fingertip pulse oximeter. Data was divided into three cohorts: patients who recovered, patients who developed respiratory insufficiency and patients who died. For each cohort, a population mean cosinor model was fitted to detect rhythmicity. To assess changes in amplitude, a mixed-effect cosinor model was fitted.
Results
A total of 429 patients were monitored. Rhythmicity was observed in heartrate for the recovery cohort (p<0.001), respiratory insufficiency cohort (p<0.001 and mortality cohort (p = 0.002). Respiratory rate showed rhythmicity in the recovery cohort (p<0.001), but not in the other cohorts (p = 0.18 and p = 0.51). Skin temperature also showed rhythmicity in the recovery cohort (p<0.001), but not in the other cohorts (p = 0.22 and p = 0.12). For respiratory insufficiency, only the amplitude of heart rate circadian pattern increased slightly the day before (1.2 (99%CI 0.16–2.2, p = 0.002)). In the mortality cohort, the amplitude of heart rate decreased (-1.5 (99%CI -2.6- -0.42, p<0.001)) and respiratory rate amplitude increased (0.72 (99%CI 0.27–1.3, p = 0.002) the days before death.
Conclusion
A circadian rhythm is present in heart rate of COVID-19 patients admitted to the general ward. For respiratory rate and skin temperature, rhythmicity was only found in patients who recover, but not in patients developing respiratory insufficiency or death. We found no consistent changes in circadian rhythm amplitude accompanying patient deterioration.
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Iqbal FM, Joshi M, Fox R, Koutsoukou T, Sharma A, Wright M, Khan S, Ashrafian H, Darzi A. Outcomes of Vital Sign Monitoring of an Acute Surgical Cohort With Wearable Sensors and Digital Alerting Systems: A Pragmatically Designed Cohort Study and Propensity-Matched Analysis. Front Bioeng Biotechnol 2022; 10:895973. [PMID: 35832414 PMCID: PMC9271673 DOI: 10.3389/fbioe.2022.895973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/06/2022] [Indexed: 11/15/2022] Open
Abstract
Background: The implementation and efficacy of wearable sensors and alerting systems in acute secondary care have been poorly described. Objectives: to pragmatically test one such system and its influence on clinical outcomes in an acute surgical cohort. Methods: In this pragmatically designed, pre-post implementation trial, participants admitted to the acute surgical unit at our institution were recruited. In the pre-implementation phase (September 2017 to May 2019), the SensiumVitals™ monitoring system, which continuously measures temperature, heart, and respiratory rates, was used for monitoring alongside usual care (intermittent monitoring in accordance with the National Early Warning Score 2 [NEWS 2] protocol) without alerts being generated. In the post-implementation phase (May 2019 to March 2020), alerts were generated when pre-established thresholds for vital parameters were breached, requiring acknowledgement from healthcare staff on provided mobile devices. Hospital length of stay, intensive care use, and 28-days mortality were measured. Balanced cohorts were created with 1:1 ‘optimal’ propensity score logistic regression models. Results: The 1:1 matching method matched the post-implementation group (n = 141) with the same number of subjects from the pre-implementation group (n = 141). The median age of the entire cohort was 52 (range: 18–95) years and the median duration of wearing the sensor was 1.3 (interquartile range: 0.7–2.0) days. The median alert acknowledgement time was 111 (range: 1–2,146) minutes. There were no significant differences in critical care admission (planned or unplanned), hospital length of stay, or mortality. Conclusion: This study offered insight into the implementation of digital health technologies within our institution. Further work is required for optimisation of digital workflows, particularly given their more favourable acceptability in the post pandemic era. Clinical trials registration information: ClinicalTrials.gov Identifier: NCT04638738.
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Affiliation(s)
- Fahad Mujtaba Iqbal
- Division of Surgery & Cancer, London, United Kingdom
- *Correspondence: Fahad Mujtaba Iqbal,
| | - Meera Joshi
- Division of Surgery & Cancer, London, United Kingdom
| | - Rosanna Fox
- Department of Cardiology, West Middlesex University Hospital, Isleworth, United Kindom
| | - Tonia Koutsoukou
- Department of Cardiology, West Middlesex University Hospital, Isleworth, United Kindom
| | - Arti Sharma
- Department of Cardiology, West Middlesex University Hospital, Isleworth, United Kindom
| | - Mike Wright
- Innovation Business Partner, Chelsea and Westminster Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sadia Khan
- Department of Cardiology, West Middlesex University Hospital, Isleworth, United Kindom
| | | | - Ara Darzi
- Division of Surgery & Cancer, London, United Kingdom
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van Goor HMR, Vernooij LM, Breteler MJM, Kalkman CJ, Kaasjager KAH, van Loon K. Continuously Measured Vital Signs and their Association with Respiratory Insufficiency in Hospitalised COVID-19 Patients: a Retrospective Cohort study (Preprint). Interact J Med Res 2022; 11:e40289. [DOI: 10.2196/40289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/06/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022] Open
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Wang J, Zang Y, Wu Q, She Y, Xu H, Zhang J, Cai S, Li Y, Zhang Z. Predicting Adverse Events During Six-Minute Walk Test Using Continuous Physiological Signals. Front Physiol 2022; 13:887954. [PMID: 35734001 PMCID: PMC9207457 DOI: 10.3389/fphys.2022.887954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/16/2022] [Indexed: 11/15/2022] Open
Abstract
Background and Objective: The 6-min walk test (6MWT) is a common functional assessment test, but adverse events during the test can be potentially dangerous and can lead to serious consequences and low quality of life. This study aimed to predict the occurrence of adverse events during 6MWT, using continuous physiological parameters combined with demographic variables. Methods: 578 patients with respiratory disease who had performed standardized 6MWT with wearable devices from three hospitals were included in this study. Adverse events occurred in 73 patients (12.6%). ECG, respiratory signal, tri-axial acceleration signals, oxygen saturation, demographic variables and scales assessment were obtained. Feature extraction and selection of physiological signals were performed during 2-min resting and 1-min movement phases. 5-fold cross-validation was used to assess the machine learning models. The predictive ability of different models and scales was compared. Results: Of the 16 features selected by the recursive feature elimination method, those related to blood oxygen were the most important and those related to heart rate were the most numerous. Light Gradient Boosting Machine (LightGBM) had the highest AUC of 0.874 ± 0.063 and the AUC of Logistic Regression was AUC of 0.869 ± 0.067. The mMRC (Modified Medical Research Council) scale and Borg scale had the lowest performance, with an AUC of 0.733 and 0.656 respectively. Conclusion: It is feasible to predict the occurrence of adverse event during 6MWT using continuous physiological parameters combined with demographic variables. Wearable sensors/systems can be used for continuous physiological monitoring and provide additional tools for patient safety during 6MWT.
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Affiliation(s)
| | - Yaning Zang
- Department of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Qian Wu
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Yingjia She
- Department of Pulmonary and Critical Care Medicine, Hainan Hospital of PLA General Hospital, Sanya, China
| | - Haoran Xu
- Medical School of Chinese PLA, Beijing, China
| | - Jian Zhang
- Medical School of Chinese PLA, Beijing, China
| | - Shan Cai
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuzhu Li
- Department of Pulmonary and Critical Care Medicine, Hainan Hospital of PLA General Hospital, Sanya, China
- *Correspondence: Yuzhu Li, ; Zhengbo Zhang,
| | - Zhengbo Zhang
- Center for Artificial Intelligence in Medicine, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Yuzhu Li, ; Zhengbo Zhang,
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49
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Paganelli AI, Velmovitsky PE, Miranda P, Branco A, Alencar P, Cowan D, Endler M, Morita PP. A conceptual IoT-based early-warning architecture for remote monitoring of COVID-19 patients in wards and at home. INTERNET OF THINGS (AMSTERDAM, NETHERLANDS) 2022; 18:100399. [PMID: 38620637 PMCID: PMC8023791 DOI: 10.1016/j.iot.2021.100399] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 05/31/2023]
Abstract
Due to the COVID-19 pandemic, health services around the globe are struggling. An effective system for monitoring patients can improve healthcare delivery by avoiding in-person contacts, enabling early-detection of severe cases, and remotely assessing patients' status. Internet of Things (IoT) technologies have been used for monitoring patients' health with wireless wearable sensors in different scenarios and medical conditions, such as noncommunicable and infectious diseases. Combining IoT-related technologies with early-warning scores (EWS) commonly utilized in infirmaries has the potential to enhance health services delivery significantly. Specifically, the NEWS-2 has been showing remarkable results in detecting the health deterioration of COVID-19 patients. Although the literature presents several approaches for remote monitoring, none of these studies proposes a customized, complete, and integrated architecture that uses an effective early-detection mechanism for COVID-19 and that is flexible enough to be used in hospital wards and at home. Therefore, this article's objective is to present a comprehensive IoT-based conceptual architecture that addresses the key requirements of scalability, interoperability, network dynamics, context discovery, reliability, and privacy in the context of remote health monitoring of COVID-19 patients in hospitals and at home. Since remote monitoring of patients at home (essential during a pandemic) can engender trust issues regarding secure and ethical data collection, a consent management module was incorporated into our architecture to provide transparency and ensure data privacy. Further, the article details mechanisms for supporting a configurable and adaptable scoring system embedded in wearable devices to increase usefulness and flexibility for health care professions working with EWS.
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Affiliation(s)
- Antonio Iyda Paganelli
- Informatics Departament, Pontifical Catholic University, Rua Marquês de São Vicente 225-Gávea, Rio de Janeiro 22541-041, Brazil
| | - Pedro Elkind Velmovitsky
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Pedro Miranda
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Adriano Branco
- Informatics Departament, Pontifical Catholic University, Rua Marquês de São Vicente 225-Gávea, Rio de Janeiro 22541-041, Brazil
| | - Paulo Alencar
- David R. Cheriton School of Computer Science, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Donald Cowan
- David R. Cheriton School of Computer Science, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Markus Endler
- Informatics Departament, Pontifical Catholic University, Rua Marquês de São Vicente 225-Gávea, Rio de Janeiro 22541-041, Brazil
| | - Plinio Pelegrini Morita
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
- Research Institute for Aging, University of Waterloo, 250 Laurelwood Drive, Waterloo, ON N2J 0E2, Canada
- Department of Systems Design Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
- eHealth Innovation, Techna Institute, University Health Network, R. Fraser Elliott Building, 4th Floor, 190 Elizabeth St, Toronto, ON M5G 2C4, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building 155 College Street, 6th floor, Toronto, ON M5T 3M7, Canada
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50
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Leenen JPL, Dijkman EM, van Hout A, Kalkman CJ, Schoonhoven L, Patijn GA. Nurses' experiences with continuous vital sign monitoring on the general surgical ward: a qualitative study based on the Behaviour Change Wheel. BMC Nurs 2022; 21:60. [PMID: 35287678 PMCID: PMC8919550 DOI: 10.1186/s12912-022-00837-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 03/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background To support early recognition of clinical deterioration on a general ward continuous vital signs monitoring (CMVS) systems using wearable devices are increasingly being investigated. Although nurses play a crucial role in successful implementation, reported nurse adoption and acceptance scores vary significantly. In-depth insight into the perspectives of nurses regarding CMVS is lacking. To this end, we applied a theoretical approach for behaviour change derived from the Behaviour Change Wheel (BCW). Aim To provide insight in the capability, opportunity and motivation of nurses working with CMVS, in order to inform future implementation efforts. Methods A qualitative study was conducted, including twelve nurses of a surgical ward in a tertiary teaching hospital with previous experience of working with CMVS. Semi-structured interviews were audiotaped, transcribed verbatim, and analysed using thematic analysis. The results were mapped onto the Capability, Opportunity, Motivation – Behaviour (COM-B) model of the BCW. Results Five key themes emerged. The theme ‘Learning and coaching on the job’ linked to Capability. Nurses favoured learning about CVSM by dealing with it in daily practice. Receiving bedside guidance and coaching was perceived as important. The theme ‘interpretation of vital sign trends’ also linked to Capability. Nurses mentioned the novelty of monitoring vital sign trends of patients on wards. The theme ‘Management of alarms’ linked to Opportunity. Nurses perceived the (false) alarms generated by the system as excessive resulting in feelings of irritation and uncertainty. The theme ‘Integration and compatibility with clinical workflow’ linked to Opportunity. CVSM was experienced as helpful and easy to use, although integration in mobile devices and the EMR was highly favoured and the management of clinical workflows would need improvement. The theme ‘Added value for nursing care’ linked to Motivation. All nurses recognized the potential added value of CVSM for postoperative care. Conclusion Our findings suggest all parts of the COM-B model should be considered when implementing CVSM on general wards. When the themes in Capability and Opportunity are not properly addressed by selecting interventions and policy categories, this may negatively influence the Motivation and may compromise successful implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-00837-x.
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Affiliation(s)
- J P L Leenen
- Department of Surgery, Isala, Dr. van Heesweg 2, 8025 AB, Zwolle, The Netherlands. .,Connected Care Centre, Isala, Dr. van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
| | - E M Dijkman
- Department of Surgery, Isala, Dr. van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - A van Hout
- Research Group IT Innovations in Health Care, Windesheim University of Applied Sciences, Campus 2-6, Zwolle, 8017CA, The Netherlands
| | - C J Kalkman
- Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - L Schoonhoven
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Rd, Southampton, SO17 1BJ, UK
| | - G A Patijn
- Department of Surgery, Isala, Dr. van Heesweg 2, 8025 AB, Zwolle, The Netherlands.,Connected Care Centre, Isala, Dr. van Heesweg 2, 8025 AB, Zwolle, The Netherlands
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