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Banerjee A, Narasimhulu CA, Singla DK. Immune interactions in pembrolizumab (PD-1 inhibitor) cancer therapy and cardiovascular complications. Am J Physiol Heart Circ Physiol 2023; 325:H751-H767. [PMID: 37594487 PMCID: PMC10659324 DOI: 10.1152/ajpheart.00378.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 08/19/2023]
Abstract
The use of immunotherapies like pembrolizumab (PEM) is increasingly common for the management of numerous cancer types. The use of PEM to bolster T-cell response against tumor growth is well documented. However, the interactions PEM has on other immune cells to facilitate tumor regression and clearance is unknown and warrants further investigation. In this review, we present literature findings that have reported the interactions of PEM in stimulating innate and adaptive immune cells, which enhance cytotoxic phenotypes. This triggers secretion of cytokines and chemokines, which have both beneficial and detrimental effects. We also describe how this leads to the development of rare but underreported occurrence of PEM-induced immune-related cardiovascular complications that arise suddenly and progress rapidly to debilitating and fatal consequences. This review encourages further research and investigation of PEM-induced cardiovascular complications and other immune cell interactions in patients with cancer. As PEM therapy in treating cancer types is expanding, we expect that this review will inform health care professionals of diverse specializations of medicine like dermatology (melanoma skin cancers), ophthalmology (eye cancers), and pathology (hematological malignancies) about PEM-induced cardiac complications.
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Affiliation(s)
- Abha Banerjee
- Division of Metabolic and Cardiovascular Sciences, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, United States
| | - Chandrakala Aluganti Narasimhulu
- Division of Metabolic and Cardiovascular Sciences, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, United States
| | - Dinender K Singla
- Division of Metabolic and Cardiovascular Sciences, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, United States
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2
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Vomer RP, Boggess S, Boggess B. Ultrasound Evaluation of Knee Osteoarthritis. Cureus 2023; 15:e39188. [PMID: 37378133 PMCID: PMC10292167 DOI: 10.7759/cureus.39188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/29/2023] Open
Abstract
While radiographs and magnetic resonance imaging (MRI) have long been used in the assessment of osteoarthritis (OA), ultrasound imaging has been rapidly accepted by musculoskeletal providers in both the assessment and treatment of OA. A limiting factor in the use of ultrasound is the proper training required by the user for results to be reliable and reproducible. A standardized ultrasound protocol can potentially address this limiting factor. The critical information to consider in a standardized protocol include proper patient positioning, probe alignment, probe orientation, and identification of the appropriate anatomic landmarks. The outlined protocol considers these factors with the purpose of providing a step-by-step method to assess and monitor knee OA.
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Affiliation(s)
- Rock P Vomer
- Department of Family and Community Health/Department of Orthopedics, Division of Sports Medicine, Duke University, Durham, USA
- Family Medicine, Mayo Clinic Jacksonville Campus, Jacksonville, USA
| | - Samuel Boggess
- Department of Osteopathic Medicine, Philadelphia College of Osteopathic Medicine-Georgia, Suwanee, USA
| | - Blake Boggess
- Department of Orthopedics, Division of Sports Medicine, Duke University, Durham, USA
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3
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Moreau T. [Multiple sclerosis treatments]. Soins 2023; 68:23-27. [PMID: 37037639 DOI: 10.1016/j.soin.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
The last thirty years have led to the introduction of treatments that reduce the frequency of relapses and slow the progression of multiple sclerosis. They must be prescribed early, chosen according to the form of the disease and actively monitored. Symptomatic treatments complete the treatment.
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Affiliation(s)
- Thibault Moreau
- Service de neurologie, Centre hospitalier universitaire François-Mitterrand Dijon Bourgogne, 2B boulevard Maréchal-de-Lattre-de-Tassigny, 21000 Dijon, France; Centre de ressources et de compétences sclérose en plaques Bourgogne-Franche-Comté, Centre hospitalier universitaire François-Mitterrand Dijon Bourgogne, 2B boulevard Maréchal-de-Lattre-de-Tassigny, 21000 Dijon, France.
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4
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Graber J, Juarez-Colunga E, Thigpen C, Waugh D, Bade M, Stevens-Lapsley J, Kittelson A. Development of reference charts for monitoring quadriceps strength with handheld dynamometry after total knee arthroplasty. Disabil Rehabil 2022; 44:7535-7542. [PMID: 34751608 PMCID: PMC9306324 DOI: 10.1080/09638288.2021.1995054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/25/2021] [Accepted: 10/13/2021] [Indexed: 01/18/2023]
Abstract
Purpose: To develop reference charts that describe normative quadriceps strength recovery after total knee arthroplasty (TKA) as measured by handheld dynamometry (HHD).Materials and Methods: We conducted a retrospective analysis of post-TKA quadriceps strength recovery in a longitudinal dataset consisting of both clinical and research HHD data. We created sex-specific models for recovery using Generalized Additive Models for Location, Scale, and Shape. We created reference charts from the models to display the recovery of population centiles over the first six postoperative months.Results: A total of 588 patient records with 1176 observations were analyzed. Reference charts for both sexes demonstrated a rapid increase in quadriceps strength over the first 60 postoperative days followed by a more gradual increase over the next 120 days. Males appeared to demonstrate faster recovery and greater strength on average compared to females. The quadriceps strength recovery of three female patient records was plotted on the reference chart to illustrate the charts' potential clinical utility.Conclusions: These reference charts provide normative data for quadriceps strength recovery after TKA as assessed by HHD. The reference charts may augment clinicians' ability to monitor and intervene upon quadriceps weakness-a pronounced and debilitating post-TKA impairment-throughout rehabilitation.Implications for RehabilitationHandheld dynamometry (HHD) is an objective and clinically feasible method for assessing muscle strength, but normative HHD values are lacking for quadriceps strength recovery after total knee arthroplasty (TKA).We created sex-specific reference charts which provide normative quadriceps strength HHD values for the first 180 days after TKA.These reference charts may improve clinicians' ability to monitor and intervene upon post-TKA quadriceps strength deficits.
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Affiliation(s)
- Jeremy Graber
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Elizabeth Juarez-Colunga
- Department of Biostatistics and Informatics, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric, Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO
| | | | - Dawn Waugh
- ATI Physical Therapy, Greenville, SC, USA
| | - Michael Bade
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric, Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO
| | - Jennifer Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric, Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO
| | - Andrew Kittelson
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT
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5
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Litvinova O, Klager E, Tzvetkov NT, Kimberger O, Kletecka-Pulker M, Willschke H, Atanasov AG. Digital Pills with Ingestible Sensors: Patent Landscape Analysis. Pharmaceuticals (Basel) 2022; 15:ph15081025. [PMID: 36015173 PMCID: PMC9415622 DOI: 10.3390/ph15081025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
The modern healthcare system is directly related to the development of digital health tools and solutions. Pills with digital sensors represent a highly innovative class of new pharmaceuticals. The aim of this work was to analyze the patent landscape and to systematize the main trends in patent protection of digital pills with ingestible sensors worldwide; accordingly, to identify the patenting leaders as well as the main prevailing areas of therapy for patent protection, and the future perspectives in the field. In July 2022, a search was conducted using Internet databases, such as the EPO, USPTO, FDA and the Lens database. The patent landscape analysis shows an increase in the number of patents related to digital pills with ingestible sensors for mobile clinical monitoring, smart drug delivery, and endoscopy diagnostics. The leaders in the number of patents issued are the United States, the European Patent Office, Canada, Australia, and China. The following main areas of patenting digital pills with ingestible sensors were identified: treatment in the field of mental health; HIV/AIDS; pain control; cardiovascular diseases; diabetes; gastroenterology (including hepatitis C); oncology; tuberculosis; and transplantology. The development of scientific and practical approaches towards the implementation of effective and safe digital pills will improve treatment outcomes, increase compliance, reduce hospital stays, provide mobile clinical monitoring, have a positive impact on treatment costs and will contribute to increased patient safety.
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Affiliation(s)
- Olena Litvinova
- Department of Management, Economy and Quality Assurance in Pharmacy, National University of Pharmacy, The Ministry of Health of Ukraine, 61002 Kharkiv, Ukraine
- Correspondence: (O.L.); (A.G.A.); Tel.: +380-67-300-78-49 (O.L.); +43-1401-6036-250 (A.G.A.)
| | - Elisabeth Klager
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, 1180 Vienna, Austria
| | - Nikolay T. Tzvetkov
- Institute of Molecular Biology “Roumen Tsanev”, Department of Biochemical Pharmacology and Drug Design, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria
| | - Oliver Kimberger
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, 1180 Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Maria Kletecka-Pulker
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, 1180 Vienna, Austria
- Institute for Ethics and Law in Medicine, University of Vienna, 1090 Vienna, Austria
| | - Harald Willschke
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, 1180 Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Atanas G. Atanasov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, 1180 Vienna, Austria
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, 05-552 Jastrzebiec, Poland
- Correspondence: (O.L.); (A.G.A.); Tel.: +380-67-300-78-49 (O.L.); +43-1401-6036-250 (A.G.A.)
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6
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Chan PY, Ryan NP, Chen D, McNeil J, Hopper I. Novel wearable and contactless heart rate, respiratory rate, and oxygen saturation monitoring devices: a systematic review and meta-analysis. Anaesthesia 2022; 77:1268-1280. [PMID: 35947876 DOI: 10.1111/anae.15834] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 11/28/2022]
Abstract
We performed a systematic review and meta-analysis to identify, classify and evaluate the body of evidence on novel wearable and contactless devices that measure heart rate, respiratory rate and oxygen saturations in the clinical setting. We included any studies of hospital inpatients, including sleep study clinics. Eighty-four studies were included in the final review. There were 56 studies of wearable devices and 29 of contactless devices. One study assessed both types of device. A high risk of patient selection and rater bias was present in proportionally more studies assessing contactless devices compared with studies assessing wearable devices (p = 0.023 and p < 0.0001, respectively). There was high but equivalent likelihood of blinding bias between the two types of studies (p = 0.076). Wearable device studies were commercially available devices validated in acute clinical settings by clinical staff and had more real-time data analysis (p = 0.04). Contactless devices were more experimental, and data were analysed post-hoc. Pooled estimates of mean (95%CI) heart rate and respiratory rate bias in wearable devices were 1.25 (-0.31-2.82) beats.min-1 (pooled 95% limits of agreement -9.36-10.08) and 0.68 (0.05-1.32) breaths.min-1 (pooled 95% limits of agreement -5.65-6.85). The pooled estimate for mean (95%CI) heart rate and respiratory rate bias in contactless devices was 2.18 (3.31-7.66) beats.min-1 (pooled limits of agreement -6.71-10.88) and 0.30 (-0.26-0.87) breaths.min-1 (pooled 95% limits of agreement -3.94-4.29). Only two studies of wearable devices measured Sp O2 ; these reported mean measurement biases of 3.54% (limits of agreement -5.65-11.45%) and 2.9% (-7.4-1.7%). Heterogeneity was observed across studies, but absent when devices were grouped by measurement modality and reference standard. We conclude that, while studies of wearable devices were of slightly better quality than contactless devices, in general all studies of novel devices were of low quality, with small (< 100) patient datasets, typically not blinded and often using inappropriate statistical techniques. Both types of devices were statistically equivalent in accuracy and precision, but wearable devices demonstrated less measurement bias and more precision at extreme vital signs. The statistical variability in precision and accuracy between studies is partially explained by differences in reference standards.
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Affiliation(s)
- P Y Chan
- Department of Intensive Care Medicine, Eastern Health, Melbourne, Vic., Australia
| | - N P Ryan
- Department of Intensive Care Medicine, Eastern Health, Melbourne, Vic., Australia
| | - D Chen
- Department of Intensive Care Medicine, Eastern Health, Melbourne, Vic., Australia
| | - J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - I Hopper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
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7
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Plou J, Valera PS, García I, de Albuquerque CDL, Carracedo A, Liz-Marzán LM. Prospects of Surface-Enhanced Raman Spectroscopy for Biomarker Monitoring toward Precision Medicine. ACS Photonics 2022; 9:333-350. [PMID: 35211644 PMCID: PMC8855429 DOI: 10.1021/acsphotonics.1c01934] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 05/14/2023]
Abstract
Future precision medicine will be undoubtedly sustained by the detection of validated biomarkers that enable a precise classification of patients based on their predicted disease risk, prognosis, and response to a specific treatment. Up to now, genomics, transcriptomics, and immunohistochemistry have been the main clinically amenable tools at hand for identifying key diagnostic, prognostic, and predictive biomarkers. However, other molecular strategies, including metabolomics, are still in their infancy and require the development of new biomarker detection technologies, toward routine implementation into clinical diagnosis. In this context, surface-enhanced Raman scattering (SERS) spectroscopy has been recognized as a promising technology for clinical monitoring thanks to its high sensitivity and label-free operation, which should help accelerate the discovery of biomarkers and their corresponding screening in a simpler, faster, and less-expensive manner. Many studies have demonstrated the excellent performance of SERS in biomedical applications. However, such studies have also revealed several variables that should be considered for accurate SERS monitoring, in particular, when the signal is collected from biological sources (tissues, cells or biofluids). This Perspective is aimed at piecing together the puzzle of SERS in biomarker monitoring, with a view on future challenges and implications. We address the most relevant requirements of plasmonic substrates for biomedical applications, as well as the implementation of tools from artificial intelligence or biotechnology to guide the development of highly versatile sensors.
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Affiliation(s)
- Javier Plou
- CIC
biomaGUNE, Basque Research
and Technology Alliance (BRTA), 20014 Donostia-San Sebastián, Spain
- Biomedical
Research Networking Center in Bioengineering, Biomaterials, and Nanomedicine
(CIBER-BBN), 20014 Donostia-San Sebastián, Spain
- CIC
bioGUNE, Basque Research and Technology
Alliance (BRTA), 48160 Derio, Spain
| | - Pablo S. Valera
- CIC
biomaGUNE, Basque Research
and Technology Alliance (BRTA), 20014 Donostia-San Sebastián, Spain
- CIC
bioGUNE, Basque Research and Technology
Alliance (BRTA), 48160 Derio, Spain
| | - Isabel García
- CIC
biomaGUNE, Basque Research
and Technology Alliance (BRTA), 20014 Donostia-San Sebastián, Spain
- Biomedical
Research Networking Center in Bioengineering, Biomaterials, and Nanomedicine
(CIBER-BBN), 20014 Donostia-San Sebastián, Spain
| | | | - Arkaitz Carracedo
- CIC
bioGUNE, Basque Research and Technology
Alliance (BRTA), 48160 Derio, Spain
- Biomedical
Research Networking Center in Cancer (CIBERONC), 48160, Derio, Spain
- Ikerbasque,
Basque Foundation for Science, 48009 Bilbao, Spain
- Translational
Prostate Cancer Research Lab, CIC bioGUNE-Basurto, Biocruces Bizkaia Health Research Institute, 48160 Derio, Spain
| | - Luis M. Liz-Marzán
- CIC
biomaGUNE, Basque Research
and Technology Alliance (BRTA), 20014 Donostia-San Sebastián, Spain
- Biomedical
Research Networking Center in Bioengineering, Biomaterials, and Nanomedicine
(CIBER-BBN), 20014 Donostia-San Sebastián, Spain
- Ikerbasque,
Basque Foundation for Science, 48009 Bilbao, Spain
- E-mail:
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8
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Milazzo M, Spezzaneve A, Astrea G, Giorgolo F, Tonacci A, Sansone F, Calderisi M, Conte R, Santorelli FM, Roccella S. AUTOMA: a wearable device to assess the upper limb muscular activity in patients with neuromuscular disorders. Acta Myol 2021; 40:143-151. [PMID: 35047754 PMCID: PMC8744014 DOI: 10.36185/2532-1900-057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/12/2021] [Indexed: 11/03/2022]
Abstract
Inherited muscular dystrophies and congenital myopathies present in early childhood with progressive muscle weakness, determining severe motor limitations. Active surveillance and management of associated complications have improved ambulation, function, quality of life and life expectancy. The need for repeatable, objective and quantitative measures to monitor the clinical course of the disease is a current issue, particularly in the new era where new flows of therapies are proposed to the patients. In this scenario, we designed and tested a wearable device termed AUTOMA that is able to provide quantification of the muscular impairment in the upper limb upon isokinetic tests through the integration of a force sensor and an electric goniometer. This allows qualitatively estimating the muscular functions with a systematic procedure. We carried out a preliminary pilot study on 9 patients that revealed the suitability of AUTOMA as an objective measurement tool for diagnosing and monitoring neuromuscular disorders, and opens to a more extensive clinical study in which to test and validate our platform intensively.
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Affiliation(s)
- Mario Milazzo
- The BioRobotics Institute, Scuola Superiore Sant’Anna, Pontedera (PI), Italy,Correspondence Mario Milazzo The BioRobotics Institute, Scuola Superiore Sant’Anna, Viale Rinaldo Piaggio 34, 56025 Pontedera (PI), Italy E-mail:
| | - Andrea Spezzaneve
- The BioRobotics Institute, Scuola Superiore Sant’Anna, Pontedera (PI), Italy
| | - Guja Astrea
- IRCCS Fondazione Stella Maris, Calambrone (PI), Italy
| | | | - Alessandro Tonacci
- Institute of Clinical Physiology, National Research Council of Italy (CNR), Pisa, Italy
| | - Francesco Sansone
- Institute of Clinical Physiology, National Research Council of Italy (CNR), Pisa, Italy
| | | | | | - Raffaele Conte
- Institute of Clinical Physiology, National Research Council of Italy (CNR), Pisa, Italy
| | | | - Stefano Roccella
- The BioRobotics Institute, Scuola Superiore Sant’Anna, Pontedera (PI), Italy
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9
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Agerskov M, Thusholdt ANW, Holm-Sørensen H, Wiberg S, Meyhoff CS, Højlund J, Secher NH, Foss NB. Association of the intraoperative peripheral perfusion index with postoperative morbidity and mortality in acute surgical patients: a retrospective observational multicentre cohort study. Br J Anaesth 2021; 127:396-404. [PMID: 34226038 PMCID: PMC8451236 DOI: 10.1016/j.bja.2021.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/02/2021] [Indexed: 12/02/2022] Open
Abstract
Background We hypothesised that in acute high-risk surgical patients, a lower intraoperative peripheral perfusion index (PPI) would indicate a higher risk of postoperative complications and mortality. Methods This retrospective observational study included 1338 acute high-risk surgical patients from November 2017 until October 2018 at two University Hospitals in Denmark. Intraoperative PPI was the primary exposure variable and the primary outcome was severe postoperative complications defined as a Clavien–Dindo Class ≥III or death, within 30 days. Results intraoperative PPI was associated with severe postoperative complications or death: odds ratio (OR) 1.12 (95% confidence interval [CI] 1.05–1.19; P<0.001), with an association of intraoperative mean PPI ≤0.5 and PPI ≤1.5 with the primary outcome: OR 1.79 (95% CI 1.09–2.91; P=0.02) and OR 1.65 (95% CI 1.20–2.27; P=0.002), respectively. Each 15-min increase in intraoperative time spend with low PPI was associated with the primary outcome (per 15 min with PPI ≤0.5: OR 1.11 (95% CI 1.05–1.17; P<0.001) and with PPI ≤1.5: OR 1.06 (95% CI 1.02–1.09; P=0.002)). Thirty-day mortality in patients with PPI ≤0.5 was 19% vs 10% for PPI >0.5, P=0.003. If PPI was ≤1.5, 30-day mortality was 16% vs 8% in patients with a PPI >1.5 (P<0.001). In contrast, intraoperative mean MAP ≤65 mm Hg was not significantly associated with severe postoperative complications or death (OR 1.21 [95% CI 0.92–1.58; P=0.2]). Conclusions Low intraoperative PPI was associated with severe postoperative complications or death in acute high-risk surgical patients. To guide intraoperative haemodynamic management, the PPI should be further investigated.
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Affiliation(s)
- Marianne Agerskov
- Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Anna N W Thusholdt
- Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Holm-Sørensen
- Department of Integrative Physiology, NEXS, University of Copenhagen, Copenhagen, Denmark
| | - Sebastian Wiberg
- Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christian S Meyhoff
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Højlund
- Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Niels H Secher
- Department of Anaesthesiology, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai B Foss
- Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
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10
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Elvekjaer M, Carlsson CJ, Rasmussen SM, Porsbjerg CM, Grønbæk KK, Haahr-Raunkjær C, Sørensen HBD, Aasvang EK, Meyhoff CS. Agreement between wireless and standard measurements of vital signs in acute exacerbation of chronic obstructive pulmonary disease: a clinical validation study. Physiol Meas 2021; 42. [PMID: 33984846 DOI: 10.1088/1361-6579/ac010c] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/13/2021] [Indexed: 11/11/2022]
Abstract
Objective.Wireless sensors for continuous monitoring of vital signs have potential to improve patient care by earlier detection of deterioration in general ward patients. We aimed to assess agreement between wireless and standard (wired) monitoring devices in patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Approach.Paired measurements of vital signs were recorded with 15 min intervals for two hours. The primary outcome was agreement between wireless and standard monitor measurements using the Bland and Altman method to calculate bias with 95% limits of agreement (LoA). We considered LoA of less than ±5 beats min-1(bpm) acceptable for heart rate (HR), whereas agreement of peripheral oxygen saturation (SpO2), respiratory rate (RR), and blood pressure (BP) were acceptable if within ±3%-points, ±3 breaths min-1(brpm), and ±10 mmHg, respectively.Main results.180 sample-pairs of vital signs from 20 with AECOPD patients were recorded for comparison. The wireless versus standard monitor bias was 0.03 (LoA -3.2 to 3.3) bpm for HR measurements, 1.4% (LoA -0.7% to 3.6%) for SpO2, -7.8 (LoA -22.3 to 6.8) mmHg for systolic BP and -6.2 (LoA -16.8 to 4.5) mmHg for diastolic BP. The wireless versus standard monitor bias for RR measurements was 0.75 (LoA -6.1 to 7.6) brpm.Significance.Commercially available wireless monitors could accurately measure HR in patients admitted with AECOPD compared to standard wired monitoring. Agreement for SpO2were borderline acceptable while agreement for RR and BP should be interpreted with caution.
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Affiliation(s)
- Mikkel Elvekjaer
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.,Department of Anaesthesiology, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Denmark
| | - Christian Jakob Carlsson
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.,Department of Anaesthesiology, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Denmark
| | - Søren Møller Rasmussen
- Biomedical Engineering, Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Celeste M Porsbjerg
- Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.,Respiratory Research Unit, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Katja Kjær Grønbæk
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.,Department of Anaesthesiology, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Denmark
| | - Camilla Haahr-Raunkjær
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.,Department of Anaesthesiology, Centre for Cancer and Organ Diseases, Rigshospitalet, University of 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 Diseases, Rigshospitalet, University of Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Christian S Meyhoff
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
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11
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Wang W, Li H, Zhang L, Jiang W, Shen L, Fan G. Clinical applications of monitoring immune status with 90 immune cell subsets in human whole blood by 10-color flow cytometry. Int J Lab Hematol 2021; 43:1132-1144. [PMID: 33870648 DOI: 10.1111/ijlh.13541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/19/2021] [Accepted: 03/26/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The immune system may involve and predict the different prognosis and therapy consequences. So, it's important to monitor and evaluate the immune status before and after treatments. METHODS Flow cytometry is the best technology to perform immune monitoring, because it can detect immune cells using small amount of sample in a short time. The whole blood is the ideal sample for immune status monitoring, since it includes almost all the immune cells and it's relatively easy to obtain and less invasive than bone marrow or lymph node. RESULTS Here we developed and validated a 10-color panel with only four tubes containing 29 antibodies to monitor 90 immune cell subsets in 2 ml whole blood samples. The major immune cell populations detected by our panel included T cell subsets (CD3+ total T, Th, Tc, Treg, CD8hi , CD8low , αβTCR, γδTCR, naïve, and memory T), T cell activation markers (CD25, CD69, and HLA-DR) and one immune checkpoint PD1, B cell subsets (B1, switched memory, non-switched, naïve B, and CD27- IgD- B cells), neutrophils, basophils, four monocytic cell subsets, dendritic cells (pDCs and mDCs), and four NK cell subsets. These panels of antibodies had been applied to monitor immune status (percentage and absolute number) in total 303 cases with various diseases, such as leukemia (AML, CML, MM, and ALL), lymphoma (B cells and NK/T cells), cancers (colon, lung, prostate, and breast), immune deficiencies, and autoimmune diseases. CONCLUSION We provided proof of feasibility for clinical monitoring immune status and guiding immunotherapy by multicolor flow cytometry testing.
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Affiliation(s)
- Weiwei Wang
- Department of Clinical laboratory, Xinhua hospital, Shanghai Jiaotong University of Medicine School, Shanghai, China
| | - Haibo Li
- Department of Pathology, Oregon Health and Science University, Portland, OR, USA
| | - Lihua Zhang
- Department of Clinical laboratory, Xinhua hospital, Shanghai Jiaotong University of Medicine School, Shanghai, China
| | - Wenli Jiang
- Department of Clinical laboratory, Xinhua hospital, Shanghai Jiaotong University of Medicine School, Shanghai, China
| | - Lisong Shen
- Department of Clinical laboratory, Xinhua hospital, Shanghai Jiaotong University of Medicine School, Shanghai, China
| | - Guang Fan
- Department of Pathology, Oregon Health and Science University, Portland, OR, USA
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12
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Wadhwa M, Bird C, Atkinson E, Cludts I, Rigsby P. The First WHO International Standard for Adalimumab: Dual Role in Bioactivity and Therapeutic Drug Monitoring. Front Immunol 2021; 12:636420. [PMID: 33936049 PMCID: PMC8082443 DOI: 10.3389/fimmu.2021.636420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/19/2021] [Indexed: 12/17/2022] Open
Abstract
The expanded availability of adalimumab products continues to widen patient access and reduce costs with substantial benefit to healthcare systems. However, the long-term success of these medicines is highly dependent on maintaining consistency in quality, safety and efficacy while minimizing any risk of divergence during life-cycle management. In recognition of this need and demand from global manufacturers, the World Health Organization (WHO) Expert Committee on Biological standardization established the WHO 1st International standard (IS) for Adalimumab (coded 17/236) in October 2019 with a defined unitage ascribed to each of the individual bioactivities evaluated in the study namely, TNF-α binding, TNF-α neutralization, complement dependent cytotoxicity and antibody-dependent cellular cytotoxicity. For development of the IS, two candidate standards were manufactured as per WHO recommendations. Analysis of extensive datasets generated by testing of a common set of samples including the candidate standards by multiple stakeholders including regulatory agencies using their own qualified assays in a large international collaborative study showed comparable biological activity for the tested candidates for the different activities. Use of a common standard significantly decreased the variability of bioassays and improved agreement in potency estimates. Data from this study clearly supports the utility of the IS as an important tool for assuring analytical assay performance, for bioassay calibration and validation, for identifying and controlling changes in bioactivity during life-cycle management and for global harmonization of adalimumab products. In addition, in a separate multi-center study which included involvement of hospital and clinical diagnostic laboratories, the suitability of the adalimumab IS for therapeutic drug monitoring assays was examined by analysis of data from testing of a common blind coded panel of adalimumab spiked serum samples representative of the clinical scenario along with the IS and in-house standards in diverse immunoassays/platforms. Both commercially available and in-house assays that are routinely used for assessing adalimumab trough levels were included. Excellent agreement in estimates for adalimumab content in the spiked samples was observed regardless of the standard or the method with inter-laboratory variability also similar regardless of the standard employed. This data, for the first time, provides support for the extended applicability of the IS in assays in use for therapeutic drug monitoring based on the mass content of the IS. The adalimumab IS, in fulfilling clinical demand, can help toward standardizing and harmonizing clinical monitoring assays for informed clinical decisions and/or personalized treatment strategies for better patient outcomes. Collectively, a significant role for the adalimumab IS in assuring the quality, safety and efficacy of adalimumab products globally is envisaged.
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Affiliation(s)
- Meenu Wadhwa
- Biotherapeutics Division, National Institute for Biological Standards and Control, Medicines and Healthcare Products Regulatory Agency, Potters Bar, United Kingdom
| | - Chris Bird
- Biotherapeutics Division, National Institute for Biological Standards and Control, Medicines and Healthcare Products Regulatory Agency, Potters Bar, United Kingdom
| | - Eleanor Atkinson
- Analytical and Biological Sciences Division, National Institute for Biological Standards and Control, Medicines and Healthcare Products Regulatory Agency, Potters Bar, United Kingdom
| | - Isabelle Cludts
- Biotherapeutics Division, National Institute for Biological Standards and Control, Medicines and Healthcare Products Regulatory Agency, Potters Bar, United Kingdom
| | - Peter Rigsby
- Analytical and Biological Sciences Division, National Institute for Biological Standards and Control, Medicines and Healthcare Products Regulatory Agency, Potters Bar, United Kingdom
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13
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Gómez-Pulido JA, Gómez-Pulido JM, Rodríguez-Puyol D, Polo-Luque ML, Vargas-Lombardo M. Predicting the Appearance of Hypotension During Hemodialysis Sessions Using Machine Learning Classifiers. Int J Environ Res Public Health 2021; 18:2364. [PMID: 33671029 DOI: 10.3390/ijerph18052364] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 01/01/2023]
Abstract
A patient suffering from advanced chronic renal disease undergoes several dialysis sessions on different dates. Several clinical parameters are monitored during the different hours of any of these sessions. These parameters, together with the information provided by other parameters of analytical nature, can be very useful to determine the probability that a patient may suffer from hypotension during the session, which should be specially watched since it represents a proven factor of possible mortality. However, the analytical information is not always available to the healthcare personnel, or it is far in time, so the clinical parameters monitored during the session become key to the prevention of hypotension. This article presents an investigation to predict the appearance of hypotension during a dialysis session, using predictive models trained from a large dialysis database, which contains the clinical information of 98,015 sessions corresponding to 758 patients. The prediction model takes into account up to 22 clinical parameters measured five times during the session, as well as the gender and age of the patient. This model was trained by means of machine learning classifiers, providing a success in the prediction higher than 80%.
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14
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Andersen KK, Kvarstein G. Postoperative opioids and risk of respiratory depression - A cross-sectional evaluation of routines for administration and monitoring in a tertiary hospital. Scand J Pain 2021; 21:203-207. [PMID: 33108339 DOI: 10.1515/sjpain-2020-0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/17/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Opioids are the most potent analgesics in the treatment of postoperative pain. Respiratory depression is, however, a serious side effect. The aims of this study were to evaluate current practice and routines for post-operative administration of opioids in a Norwegian university hospital and to evaluate whether the clinical safeguards adequately protected patients' safety regarding risk of respiratory depression. METHODS The study had a retrospective cross-sectional design and included 200 patients, treated with opioids postoperatively. The patients were treated in a post-anesthesia care unit (PACU) before transferal to a surgical ward. Relevant data such as opioid dosages, routes of administration, sedation and respiratory function, routines for patient monitoring, and numbers of patients with opioid induced respiratory depression was collected. RESULTS Two patients (1%) developed respiratory depression that needed naloxone to reverse the effect, and 32 patients (16%) had a respiratory rate (RR) <10/min, which may have been caused by opioids. In the PACU, the patient's RR was evaluated on a routine base, but after transferal to a surgical ward RR documented in only 7% of the patients. CONCLUSIONS The lack of routines for patient monitoring, especially RR, represented a risk of not detecting opioid induced respiratory depression.
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Affiliation(s)
| | - Gunnvald Kvarstein
- Department of Clinical Medicine, UIT, The Arctic University of Norway, Tromsø, Norway.,Department of Anesthesiology, University Hospital of North Norway (UNN), Tromsø, Norway
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15
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Auepanwiriyakul C, Waibel S, Songa J, Bentley P, Faisal AA. Accuracy and Acceptability of Wearable Motion Tracking for Inpatient Monitoring Using Smartwatches. Sensors (Basel) 2020; 20:s20247313. [PMID: 33352717 PMCID: PMC7766923 DOI: 10.3390/s20247313] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 11/16/2022]
Abstract
Inertial Measurement Units (IMUs) within an everyday consumer smartwatch offer a convenient and low-cost method to monitor the natural behaviour of hospital patients. However, their accuracy at quantifying limb motion, and clinical acceptability, have not yet been demonstrated. To this end we conducted a two-stage study: First, we compared the inertial accuracy of wrist-worn IMUs, both research-grade (Xsens MTw Awinda, and Axivity AX3) and consumer-grade (Apple Watch Series 3 and 5), and optical motion tracking (OptiTrack). Given the moderate to strong performance of the consumer-grade sensors, we then evaluated this sensor and surveyed the experiences and attitudes of hospital patients (N = 44) and staff (N = 15) following a clinical test in which patients wore smartwatches for 1.5–24 h in the second study. Results indicate that for acceleration, Xsens is more accurate than the Apple Series 5 and 3 smartwatches and Axivity AX3 (RMSE 1.66 ± 0.12 m·s−2; R2 0.78 ± 0.02; RMSE 2.29 ± 0.09 m·s−2; R2 0.56 ± 0.01; RMSE 2.14 ± 0.09 m·s−2; R2 0.49 ± 0.02; RMSE 4.12 ± 0.18 m·s−2; R2 0.34 ± 0.01 respectively). For angular velocity, Series 5 and 3 smartwatches achieved similar performances against Xsens with RMSE 0.22 ± 0.02 rad·s−1; R2 0.99 ± 0.00; and RMSE 0.18 ± 0.01 rad·s−1; R2 1.00± SE 0.00, respectively. Surveys indicated that in-patients and healthcare professionals strongly agreed that wearable motion sensors are easy to use, comfortable, unobtrusive, suitable for long-term use, and do not cause anxiety or limit daily activities. Our results suggest that consumer smartwatches achieved moderate to strong levels of accuracy compared to laboratory gold-standard and are acceptable for pervasive monitoring of motion/behaviour within hospital settings.
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Affiliation(s)
- Chaiyawan Auepanwiriyakul
- Brain & Behaviour Lab, Department of Computing, Imperial College London, London SW7 2AZ, UK; (C.A.); (S.W.)
- Behaviour Analytics Lab, Data Science Institute, London SW7 2AZ, UK
| | - Sigourney Waibel
- Brain & Behaviour Lab, Department of Computing, Imperial College London, London SW7 2AZ, UK; (C.A.); (S.W.)
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK;
| | - Joanna Songa
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK;
| | - Paul Bentley
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK;
- Correspondence: (P.B.); (A.A.F.)
| | - A. Aldo Faisal
- Brain & Behaviour Lab, Department of Computing, Imperial College London, London SW7 2AZ, UK; (C.A.); (S.W.)
- Behaviour Analytics Lab, Data Science Institute, London SW7 2AZ, UK
- UKRI CDT in AI for Healthcare, Imperial College London, London SW7 2AZ, UK
- MRC London Institute of Medical Sciences, London W12 0NN, UK
- Correspondence: (P.B.); (A.A.F.)
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16
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Bichet DG, Aerts JM, Auray-Blais C, Maruyama H, Mehta AB, Skuban N, Krusinska E, Schiffmann R. Assessment of plasma lyso-Gb 3 for clinical monitoring of treatment response in migalastat-treated patients with Fabry disease. Genet Med 2021; 23:192-201. [PMID: 32994552 DOI: 10.1038/s41436-020-00968-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To assess the utility of globotriaosylsphingosine (lyso-Gb3) for clinical monitoring of treatment response in patients with Fabry disease receiving migalastat. METHODS A post hoc analysis evaluated data from 97 treatment-naive and enzyme replacement therapy (ERT)-experienced patients with migalastat-amenable GLA variants from FACETS (NCT00925301) and ATTRACT (NCT01218659) and subsequent open-label extension studies. The relationship between plasma lyso-Gb3 and measures of Fabry disease progression (left ventricular mass index [LVMi], estimated glomerular filtration rate [eGFR], and pain) and the relationship between lyso-Gb3 and incidence of Fabry-associated clinical events (FACEs) were assessed in both groups. The relationship between changes in lyso-Gb3 and kidney interstitial capillary (KIC) globotriaosylceramide (Gb3) inclusions was assessed in treatment-naive patients. RESULTS No significant correlations were identified between changes in lyso-Gb3 and changes in LVMi, eGFR, or pain. Neither baseline lyso-Gb3 levels nor the rate of change in lyso-Gb3 levels during treatment predicted FACE occurrences in all patients or those receiving migalastat for ≥24 months. Changes in lyso-Gb3 correlated with changes in KIC Gb3 inclusions in treatment-naive patients. CONCLUSIONS Although used as a pharmacodynamic biomarker in research and clinical studies, plasma lyso-Gb3 may not be a suitable biomarker for monitoring treatment response in migalastat-treated patients.
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17
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Weatherall A, Poynter E, Garner A, Lee A. Near-infrared spectroscopy monitoring in a pre-hospital trauma patient cohort: An analysis of successful signal collection. Acta Anaesthesiol Scand 2020; 64:117-123. [PMID: 31287156 DOI: 10.1111/aas.13444] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/16/2019] [Accepted: 06/18/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Noninvasive monitoring of cerebral physiology could potentially guide pre-hospital management of patients with traumatic injuries. Near-infrared spectroscopy (NIRS) is one such modality but the consistency of monitoring performance remains unclear. This study assessed the proportion of successful signal collection during pre-hospital care. METHODS As part of a prospective observational study, an independent study observer placed three sensors for a Nonin 7610 NIRS device; two on the forehead and one on the forearm. NIRS records were analysed for time of adequate monitoring signal in each sensor (>70% of total pre-hospital time). We also compared pre-hospital scene and transport times for patients with or without NIRS monitoring. RESULTS Sixty-three patients with monitoring sensors applied were compared to 255 patients where no study observer was on board and 97 without NIRS monitoring for various reasons within the same time period. The proportion of pre-hospital time with successful monitoring (>70%) was 71.4% (45 of 63) for all three sensors, with at least two sensors functional in 90.4% (57 of 63). The median (interquartile range) scene time was 19 (11-23) minutes in patients with NIRS monitoring compared to 18 (11-27) minutes without NIRS monitoring (P = .570). There was no difference in the median (interquartile range) total pre-hospital time between patients with or without monitoring sensors (72 [59-89] versus 72 [59-80] minutes; P = .605). CONCLUSIONS In this pre-hospital observational feasibility study with dedicated personnel an acceptable proportion of measurement time was achieved in over 90% of monitored subjects. Addition of NIRS monitoring did not alter pre-hospital scene or transport times in this research setting.
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Affiliation(s)
- Andrew Weatherall
- CareFlight Northmead New South Wales Australia
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | | | - Alan Garner
- CareFlight Northmead New South Wales Australia
| | - Anna Lee
- Department of Anaesthesia and Intensive Care The Chinese University of Hong Kong Sha Tin Hong Kong
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18
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Li T, Divatia S, McKittrick J, Moss J, Hijnen NM, Becker LB. A pilot study of respiratory rate derived from a wearable biosensor compared with capnography in emergency department patients. Open Access Emerg Med 2019; 11:103-108. [PMID: 31123424 PMCID: PMC6511238 DOI: 10.2147/oaem.s198842] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/21/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose: Respiratory rate is assessed less frequently than other vital signs, and documented respiratory rates are often erroneous. This pilot study compared respiratory rates derived from a wearable biosensor to those derived from capnography. Methods: Emergency department patients with respiratory complaints were enrolled and had capnography via nasal cannula and a wireless, wearable biosensor from Philips applied for approximately one hour. Respiratory rates were obtained from both of these methods. We determined the difference between median respiratory rates obtained from the biosensor and capnography and the proportion of biosensor-derived respiratory rates that were within three breaths/minute of the capnography-derived respiratory rates for each patient. A Spearman correlation coefficient was calculated to assess the strength of the correlation between mean respiratory rates derived from both methods. Plots of minute-by-minute respiratory rates, per patient, for each monitoring method were shown to two physicians. The physicians identified time periods in which the respiratory rates appeared invalid. The proportion of time with invalid respiratory rates for each patient, for each method, was calculated and averaged. Results: We analyzed data for 17 patients. Median biosensor-derived respiratory rate was 20 breaths/minute (range: 7-40 breaths/minute) and median capnography-derived respiratory rate was 25 breaths/minute (range: 0-58 breaths/minute). Overall, 72.8% of biosensor-derived respiratory rates were within three breaths per minute of the capnography-derived respiratory rates. Overall mean difference was 3.5 breaths/minute (±5.2 breaths/minute). Respiratory rates appeared invalid 0.7% of the time for the biosensor and 5.0% of the time for capnography. Conclusion: Our pilot study suggests that the Philips wearable biosensor can continuously obtain respiratory rates that are comparable to capnography-derived respiratory rates among emergency department patients with respiratory complaints.
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Affiliation(s)
- Timmy Li
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, USA
| | - Shreya Divatia
- Department of Connected Sensing, Philips North America Corporation, Cambridge, MA 02171, USA
| | - Justine McKittrick
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY 11030, USA
| | - Jeena Moss
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY 11030, USA
| | - Nicole M Hijnen
- Department of Connected Sensing, Philips North America Corporation, Cambridge, MA 02171, USA
| | - Lance B Becker
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, USA
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Souliotis K, Golna C, Mantzana V, Papaspyropoulos S, Koutsovasilis A, Sotiropoulos A. Clinical audit as a tool to optimize contracted private healthcare provision: Testing the waters in resource-deprived Greece. SAGE Open Med 2019; 7:2050312119838736. [PMID: 30911389 PMCID: PMC6425533 DOI: 10.1177/2050312119838736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 02/27/2019] [Indexed: 11/29/2022] Open
Abstract
Background and Aims: Clinical audit is applied to optimize clinical practice and quality of healthcare services while controlling for money spent, critically in resource-deprived settings. This case study reports on the outcomes of a retrospective clinical audit on private hospitalizations, for which reimbursement had been pending by the Health Care Organization for Public Servants (OPAD) in Greece. This case study is the first effort by a social insurance organization in Greece to employ external clinical audit before settling contracted private healthcare charges. Methods: One thousand two hundred hospitalization records were reviewed retrospectively and a fully anonymized clinical audit summary report created for each one of them by a team of clinical audit experts, proposing evidence-based cuts in pending charges where medical services were deemed clinically unnecessary. These audit reports were then collated and analysed to test trends in overcharges among hospitalized insureds per reason for hospitalization. Results: The clinical audit report concluded that 17.4% of a total reimbursement claim of €12,387,702.18 should not be reimbursed, as it corresponded to unnecessary or not fully justifiable according to evidence-based, best practice, medical service provision. The majority of proposed cuts were related to charges for medical devices, which are borne directly by social insurance with no patient or private insurance co-payment. Conclusion: Clinical audit of hospital practice may be a key tool to optimize care provision, address supplier-induced demand and effectively manage costs for national health insurance, especially in circumstances of budgetary constraints, such as in austerity-stricken settings or developing national healthcare systems.
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Affiliation(s)
- Kyriakos Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece.,Health Policy Institute, Athens, Greece
| | | | - Vasiliki Mantzana
- Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece
| | | | | | - Alexios Sotiropoulos
- 3rd Internal Medicine Department & Diabetes Center, General Hospital of Nikaia, Athens, Greece
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Abstract
Nontuberculous mycobacteria (NTM) are environmental organisms that are rapidly emerging as pathogens in the transplant population. The prevalence of infection in transplant recipients remains unknown. While guidelines exist for treatment of NTM, neither the American Thoracic Society, the Infectious Diseases Society of America, nor the British Thoracic Society guidelines dictate the approach needed for transplant recipients. Here, we summarize risk factors, important diagnostic and treatment facts, and preventive measures to be taken to help improve outcomes of those infected with NTM infections.
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Affiliation(s)
- Shweta Anjan
- Department of Medicine, Jackson Memorial Hospital, Miami, FL, 33136, USA.,Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Michele I Morris
- Department of Medicine, Jackson Memorial Hospital, Miami, FL, 33136, USA.,Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
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21
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Loeffert ST, Melloul E, Dananché C, Hénaff L, Bénet T, Cassier P, Dupont D, Guillot J, Botterel F, Wallon M, Gustin MP, Vanhems P. Monitoring of clinical strains and environmental fungal aerocontamination to prevent invasive aspergillosis infections in hospital during large deconstruction work: a protocol study. BMJ Open 2017; 7:e018109. [PMID: 29175886 PMCID: PMC5719317 DOI: 10.1136/bmjopen-2017-018109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Monitoring fungal aerocontamination is an essential measure to prevent severe invasive aspergillosis (IA) infections in hospitals. One central block among 32 blocks of Edouard Herriot Hospital (EHH) was entirely demolished in 2015, while care activities continued in surrounding blocks. The main objective was to undertake broad environmental monitoring and clinical surveillance of IA cases to document fungal dispersion during major deconstruction work and to assess clinical risk. METHODS AND ANALYSIS A daily environmental survey of fungal loads was conducted in eight wards located near the demolition site. Air was collected inside and outside selected wards by agar impact samplers. Daily spore concentrations were monitored continuously by volumetric samplers at a flow rate of 10 L.min-1. Daily temperature, wind direction and speed as well as relative humidity were recorded by the French meteorological station Meteociel. Aspergillus fumigatus strains stored will be genotyped by multiple-locus, variable-number, tandem-repeat analysis. Antifungal susceptibility will be assessed by E-test strips on Roswell Park Memorial Institute medium supplemented with agar. Ascertaining the adequacy of current environmental monitoring techniques in hospital is of growing importance, considering the rising impact of fungal infections and of curative antifungal costs. The present study could improve the daily management of IA risk during major deconstruction work and generate new data to ameliorate and redefine current guidelines. ETHICS AND DISSEMINATION This study was approved by the clinical research and ethics committees of EHH.
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Affiliation(s)
- Sophie Tiphaine Loeffert
- Laboratoire des Pathogènes Emergents-Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Lyon, France
| | - Elise Melloul
- EA 7380 Dynamyc, EnvA, UPEC, Université Paris Est, Créteil, France
| | - Cédric Dananché
- Laboratoire des Pathogènes Emergents-Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Lyon, France
- Unité d'hygiène, épidémiologie et prévention, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
| | - Laetitia Hénaff
- Laboratoire des Pathogènes Emergents-Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Lyon, France
| | - Thomas Bénet
- Laboratoire des Pathogènes Emergents-Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Lyon, France
- Unité d'hygiène, épidémiologie et prévention, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
| | - Pierre Cassier
- Laboratoire de Biologie Sécurité Environnement, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
| | - Damien Dupont
- Institut de Parasitologie et de Mycologie Médicale, Hôpital de la Croix Rousse, Lyon, France
| | - Jacques Guillot
- EA 7380 Dynamyc, EnvA, UPEC, Université Paris Est, Créteil, France
| | | | - Martine Wallon
- Institut de Parasitologie et de Mycologie Médicale, Hôpital de la Croix Rousse, Lyon, France
| | - Marie-Paule Gustin
- Laboratoire des Pathogènes Emergents-Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Lyon, France
- Département de santé Publique, Institut des Sciences Pharmaceutiques et Biologiques (ISPB)-Faculté de Pharmacie, Université de Lyon, Lyon, France
| | - Philippe Vanhems
- Laboratoire des Pathogènes Emergents-Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Lyon, France
- Unité d'hygiène, épidémiologie et prévention, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
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Alian AA, Shelley KH. Respiratory physiology and the impact of different modes of ventilation on the photoplethysmographic waveform. Sensors (Basel) 2012; 12:2236-54. [PMID: 22438762 PMCID: PMC3304164 DOI: 10.3390/s120202236] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 02/07/2012] [Accepted: 02/08/2012] [Indexed: 01/20/2023]
Abstract
The photoplethysmographic waveform sits at the core of the most used, and arguably the most important, clinical monitor, the pulse oximeter. Interestingly, the pulse oximeter was discovered while examining an artifact during the development of a noninvasive cardiac output monitor. This article will explore the response of the pulse oximeter waveform to various modes of ventilation. Modern digital signal processing is allowing for a re-examination of this ubiquitous signal. The effect of ventilation on the photoplethysmographic waveform has long been thought of as a source of artifact. The primary goal of this article is to improve the understanding of the underlying physiology responsible for the observed phenomena, thereby encouraging the utilization of this understanding to develop new methods of patient monitoring. The reader will be presented with a review of respiratory physiology followed by numerous examples of the impact of ventilation on the photoplethysmographic waveform.
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Affiliation(s)
- Aymen A Alian
- Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, P.O. Box 208051, New Haven, CT 06520, USA.
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