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Arntsberg L, Fernberg S, Berger AS, Hedin K, Moberg A. Management and documentation of pneumonia - a comparison of patients consulting primary care and emergency care. Scand J Prim Health Care 2024; 42:338-346. [PMID: 38459974 PMCID: PMC11003321 DOI: 10.1080/02813432.2024.2326469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 02/27/2024] [Indexed: 03/11/2024] Open
Abstract
OBJECTIVE To compare management and documentation of vital signs, symptoms and infection severity in pneumonia patients seeking primary care and emergency care without referral. DESIGN Medical record review of vital signs, examination findings and severity of pneumonia. SETTING Primary and emergency care. SUBJECTS Two hundred and forty patients diagnosed with pneumonia. MAIN OUTCOME MEASURES Vital signs, examination findings and severity of pneumonia. Assessments of pneumonia severity according to the reviewers, the traffic light score and CRB-65. RESULTS Respiratory rate, blood pressure, heart rate and oxygen saturation were less often documented in primary care (p < .001). Chest X-ray was performed in 5% of primary care patients vs. 88% of emergency care patients (p < .01). Primary care patients had longer symptom duration, higher oxygen saturation and lower respiratory rate. In total, the reviewers assessed 63% of all pneumonias as mild and 9% as severe. The traffic light scoring model identified 11 patients (9%) in primary care and 53 patients (44%) in emergency care at high risk of severe infection. CONCLUSIONS Vital signs were documented less often in primary care than in emergency care. Patients in primary care appear to have a less severe pneumonia, indicating attendance to the correct care level. The traffic light scoring model identified more patients at risk of severe infection than CRB-65, where the parameters were documented to a limited extent.
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Affiliation(s)
| | | | | | - Katarina Hedin
- Futurum, Jönköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden
| | - Anna Moberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Kärna Primary Health Care Centre, Linköping, Sweden
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Rocha VAD, Cruz-Machado SDS, Silva IA, Fernandes PACM, Markus RP, Bueno M. Identification of Inflammatory Mediators in Saliva Samples From Hospitalized Newborns: Potential Biomarkers? Clin Nurs Res 2024; 33:207-219. [PMID: 38506123 DOI: 10.1177/10547738241238249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Saliva measurements serve as a noninvasive tool for clinically monitoring newborns (NB) and children, a vulnerable population with promising potential for both research and clinical practice. Saliva acts as a repository for various inflammatory biomarkers involved in diverse biological functions. Particularly for children, it offers numerous advantages when compared to plasma and urine sampling. Nevertheless, there is a significant knowledge gap regarding detectable levels of cytokines in the saliva of newborns and children, as well as studies aiming to assess the relationship of this content with physiological and pathological processes. OBJECTIVES To characterize the levels of 11 inflammatory mediators (IFNg, IL1b, IL2, IL4, IL6, IL8, IL10, IL12, IL17, TNF, and VEGF) in saliva samples from NB on the first and second day of hospitalization in the Neonatal Intensive Care Unit (NICU). METHOD Exploratory study, descriptive, nested within a primary clinical, observational, and prospective study, conducted in the NICU of a public hospital in São Paulo, Brazil. Demographic data and vital signs were recorded in the clinical records of 90 NB, and five saliva samples from 5 NB were collected between the first and second day of life (D1-D2) at approximately 8-hr intervals (8-9 am, 4-5 pm, and 11-12 pm). Saliva samples were used for the measurement of 11 cytokines (IFNg, IL1b, IL2, IL4, IL6, IL8, IL10, IL12, IL17, TNF, and VEGF). RESULTS Five NBs participated in this exploratory study, and the vital signs showed variability from the first (D1) to the second day (D2) of hospitalization, variability similar to that of the total population of the primary study. The presence and levels of the 11 cytokines were detected in the saliva samples, as well as a statistical correlation between 10 cytokines (IFNg, IL1b, IL2, IL4, IL6, IL10, IL12, IL17, TNF, and VEGF) and vital signs. CONCLUSIONS The novelty of measuring inflammatory mediators in saliva samples from hospitalized NBs in the NICU is highlighted, providing support and new perspectives for the development of clinical and experimental research and an opportunity for developing and implementing new salivary biomarkers in different population segments.
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Affiliation(s)
- Vanderlei Amadeu da Rocha
- Universidade de São Paulo, Hospital Universitário, Unidade de Terapia Intensiva Pediátrica e Neonatal, São Paulo, SP, Brasil
| | | | - Isília Aparecida Silva
- Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Psiquiatrica, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Regina Pekelmann Markus
- Universidade de São Paulo, Instituto de Biociências, Laboratório de Cronofarmacologia, São Paulo, SP, Brasil
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Mehrjouseresht P, Hail RE, Karsmakers P, Schreurs DMMP. Respiration and Heart Rate Monitoring in Smart Homes: An Angular-Free Approach with an FMCW Radar. Sensors (Basel) 2024; 24:2448. [PMID: 38676065 PMCID: PMC11054141 DOI: 10.3390/s24082448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/28/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024]
Abstract
This paper proposes a new approach for wide angle monitoring of vital signs in smart home applications. The person is tracked using an indoor radar. Upon detecting the person to be static, the radar automatically focuses its beam on that location, and subsequently breathing and heart rates are extracted from the reflected signals using continuous wavelet transform (CWT) analysis. In this way, leveraging the radar's on-chip processor enables real-time monitoring of vital signs across varying angles. In our experiment, we employ a commercial multi-input multi-output (MIMO) millimeter-wave FMCW radar to monitor vital signs within a range of 1.15 to 2.3 m and an angular span of -44.8 to +44.8 deg. In the Bland-Altman plot, the measured results indicate the average difference of -1.5 and 0.06 beats per minute (BPM) relative to the reference for heart rate and breathing rate, respectively.
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Affiliation(s)
- Pouya Mehrjouseresht
- Waves: Core Research and Engineering (WaveCoRE), Department of Electrical Engineering (ESAT), KU Leuven, B-3001 Leuven, Belgium;
| | - Reda El Hail
- Division of Declarative Languages and Artificial Intelligence (DTAI), Leuven.AI, Department of Computer Science, KU Leuven, B-2440 Geel, Belgium; (R.E.H.); (P.K.)
- Flanders Make, MPRO, B-3000 Leuven, Belgium
| | - Peter Karsmakers
- Division of Declarative Languages and Artificial Intelligence (DTAI), Leuven.AI, Department of Computer Science, KU Leuven, B-2440 Geel, Belgium; (R.E.H.); (P.K.)
- Flanders Make, MPRO, B-3000 Leuven, Belgium
| | - Dominique M. M.-P. Schreurs
- Waves: Core Research and Engineering (WaveCoRE), Department of Electrical Engineering (ESAT), KU Leuven, B-3001 Leuven, Belgium;
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Bultmann CR, Qiu J, Belmonte B, Fairchild KD, Sullivan BA. Heart rate and oxygen saturation patterns in very low birth weight infants with early onset sepsis and histologic chorioamnionitis. J Neonatal Perinatal Med 2024:NPM230093. [PMID: 38578905 DOI: 10.3233/npm-230093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
BACKGROUND Chorioamnionitis and early onset sepsis (EOS) in very low birth weight (VLBW,< 1500 g) infants may cause a systemic inflammatory response reflected in patterns of heart rate (HR) and oxygenation measured by pulse oximetry (SpO2). Identification of these patterns might inform decisions about duration of antibiotic therapy after birth. OBJECTIVE Compare early HR and SpO2 patterns in VLBW infants with or without early onset sepsis (EOS) or histologic chorioamnionitis (HC). STUDY DESIGN Retrospective study of placental pathology and HR and SpO2 in the first 72 h from birth in relation to EOS status for inborn VLBW NICU patients 2012-2019. RESULT Among 362 VLBW infants with HR and SpO2 data available, clinical, or culture-positive EOS occurred in 91/362 (25%) and HC in 81/355 (22%). In univariate analysis, EOS was associated with higher mean HR, lower mean SpO2, and less negative skewness of HR in the first 3 days after birth. HC was associated with higher standard deviation and skewness of HR but no difference in SpO2. In multivariable modeling, significant risk factors for EOS were mean HR, gestational age, HC, mean SpO2, and skewness of SpO2. CONCLUSION HR and SpO2 patterns differ shortly after birth in VLBW infants exposed to HC or with EOS, likely reflecting a systemic inflammatory response.
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Affiliation(s)
| | - Jiaxang Qiu
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Briana Belmonte
- Department of Pediatrics, University of Texas Southwestern, Dallas, TX, USA
| | - Karen D Fairchild
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Brynne A Sullivan
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
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Elliott M, Foo PL. Is vital signs assessment important in the acute mental health setting? A review of fundamental nursing textbooks. Int J Ment Health Nurs 2024; 33:473-479. [PMID: 37957819 DOI: 10.1111/inm.13252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Affiliation(s)
- Malcolm Elliott
- Nursing & Midwifery, Monash University, Clayton, Victoria, Australia
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April MD, Fisher AD, Rizzo JA, Wright FL, Winkle JM, Schauer SG. Early Vital Sign Thresholds Associated with 24-Hour Mortality among Trauma Patients: A Trauma Quality Improvement Program (TQIP) Study. Prehosp Disaster Med 2024; 39:151-155. [PMID: 38563282 DOI: 10.1017/s1049023x24000207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Identifying patients at imminent risk of death is critical in the management of trauma patients. This study measures the vital sign thresholds associated with death among trauma patients. METHODS This study included data from patients ≥15 years of age in the American College of Surgeons Trauma Quality Improvement Program (TQIP) database. Patients with vital signs of zero were excluded. Documented prehospital and emergency department (ED) vital signs included systolic pressure, heart rate, respiratory rate, and calculated shock index (SI). The area under the receiver operator curves (AUROC) was used to assess the accuracy of these variables for predicting 24-hour survival. Optimal thresholds to predict mortality were identified using Youden's Index, 90% specificity, and 90% sensitivity. Additional analyses examined patients 70+ years of age. RESULTS There were 1,439,221 subjects in the 2019-2020 datasets that met inclusion for this analysis with <0.1% (10,270) who died within 24 hours. The optimal threshold for prehospital systolic pressure was 110, pulse rate was 110, SI was 0.9, and respiratory rate was 15. The optimal threshold for the ED systolic was 112, pulse rate was 107, SI was 0.9, and respiratory rate was 21. Among the elderly sub-analysis, the optimal threshold for prehospital systolic was 116, pulse rate was 100, SI was 0.8, and respiratory rate was 21. The optimal threshold for ED systolic was 121, pulse rate was 95, SI was 0.8, and respiratory rate was 0.8. CONCLUSIONS Systolic blood pressure (SBP) and SI offered the best predictor of mortality among trauma patients. The SBP values predictive of mortality were significantly higher than the traditional 90mmHg threshold. This dataset highlights the need for better methods to guide resuscitation as initial vital signs have limited accuracy in predicting subsequent mortality.
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Affiliation(s)
- Michael D April
- Uniformed Services University of the Health Sciences, Bethesda, MarylandUSA
- 14th Field Hospital, Fort Stewart, GeorgiaUSA
| | - Andrew D Fisher
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New MexicoUSA
| | - Julie A Rizzo
- Uniformed Services University of the Health Sciences, Bethesda, MarylandUSA
- Brooke Army Medical Center, JBSA Fort Sam Houston, TexasUSA
| | - Franklin L Wright
- University of Colorado School of Medicine, Department of Surgery, Aurora, ColoradoUSA
| | - Julie M Winkle
- University of Colorado School of Medicine, Departments of Anesthesia and Emergency Medicine, Aurora, ColoradoUSA
| | - Steven G Schauer
- Uniformed Services University of the Health Sciences, Bethesda, MarylandUSA
- University of Colorado School of Medicine, Departments of Anesthesia and Emergency Medicine, Aurora, ColoradoUSA
- University of Colorado School of Medicine Center for Combat and Battlefield (COMBAT) Research, Aurora, ColoradoUSA
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Bahcecioglu Turan G, Gürcan F, Özer Z. The effects of eye masks and earplugs on sleep quality, anxiety, fear, and vital signs in patients in an intensive care unit: A randomised controlled study. J Sleep Res 2024; 33:e14044. [PMID: 37723617 DOI: 10.1111/jsr.14044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/26/2023] [Accepted: 08/29/2023] [Indexed: 09/20/2023]
Abstract
In intensive care units, environmental factors like loud noises and bright lights can cause fear, anxiety, changes in vital signs, and sleep disturbances. The aim of this study was to find out how using earplugs and eye masks during the night affected sleep quality, anxiety, fear, and vital signs of patients in an intensive care unit. A total of 70 patients, 35 in the intervention and 35 in the control group, were included in this randomised controlled study. While the patients in the intervention group were provided with earplugs and eye masks for 3 nights in addition to their routine care, only routine care was given to the patients in the control group. The 'Introductory Information Form', 'Visual Analogue Scale-Fear (VAS-F)', 'Visual Analogue Scale-Anxiety (VAS-A)', 'Vital Signs Monitoring Form', and 'Richards-Campbell Sleep Questionnaire' were used for data collection. It was found that the mean scores of VAS-F, VAS-A, heart rate, diastolic and systolic blood pressure of the intervention group decreased significantly after the intervention, while their sleep quality increased significantly. In this study, it was found that using earplugs and eye masks for patients in an intensive care unit during the night was effective in improving patients' sleep quality and reducing fear, anxiety, and problems in vital signs.
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Affiliation(s)
| | - Fatma Gürcan
- Department of Internal Medicine Nursing, FIrat University Institute of Health Sciences, Elazig, Turkey
| | - Zülfünaz Özer
- Department of Nursing, Faculty of Health Sciences, Istanbul Sabahattin Zaim University, Istanbul, Turkey
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bhavani SV, Robichaux C, Verhoef PA, Churpek MM, Coopersmith CM. Using Trajectories of Bedside Vital Signs to Identify COVID-19 Subphenotypes. Chest 2024; 165:529-539. [PMID: 37748574 PMCID: PMC10925543 DOI: 10.1016/j.chest.2023.09.020] [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: 05/09/2023] [Revised: 08/23/2023] [Accepted: 09/18/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Trajectories of bedside vital signs have been used to identify sepsis subphenotypes with distinct outcomes and treatment responses. The objective of this study was to validate the vitals trajectory model in a multicenter cohort of patients hospitalized with COVID-19 and to evaluate the clinical characteristics and outcomes of the resulting subphenotypes. RESEARCH QUESTION Can the trajectory of routine bedside vital signs identify COVID-19 subphenotypes with distinct clinical characteristics and outcomes? STUDY DESIGN AND METHODS The study included adult patients admitted with COVID-19 to four academic hospitals in the Emory Healthcare system between March 1, 2020, and May 31, 2022. Using a validated group-based trajectory model, we classified patients into previously defined vital sign trajectories using oral temperature, heart rate, respiratory rate, and systolic and diastolic BP measured in the first 8 h of hospitalization. Clinical characteristics, biomarkers, and outcomes were compared between subphenotypes. Heterogeneity of treatment effect to tocilizumab was evaluated. RESULTS The 7,065 patients with hospitalized COVID-19 were classified into four subphenotypes: group A (n = 1,429, 20%)-high temperature, heart rate, respiratory rate, and hypotensive; group B (1,454, 21%)-high temperature, heart rate, respiratory rate, and hypertensive; group C (2,996, 42%)-low temperature, heart rate, respiratory rate, and normotensive; and group D (1,186, 17%)-low temperature, heart rate, respiratory rate, and hypotensive. Groups A and D had higher ORs of mechanical ventilation, vasopressors, and 30-day inpatient mortality (P < .001). On comparing patients receiving tocilizumab (n = 55) with those who met criteria for tocilizumab but were admitted before its use (n = 461), there was significant heterogeneity of treatment effect across subphenotypes in the association of tocilizumab with 30-day mortality (P = .001). INTERPRETATION By using bedside vital signs available in even low-resource settings, we found novel subphenotypes associated with distinct manifestations of COVID-19, which could lead to preemptive and targeted treatments.
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Affiliation(s)
| | - Chad Robichaux
- Department of Biomedical Informatics, Emory University, Atlanta, GA
| | - Philip A Verhoef
- Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, HI; Hawaii Permanente Medical Group, Honolulu, HI
| | | | - Craig M Coopersmith
- Emory Critical Care Center, Atlanta, GA; Department of Surgery, Emory University, Atlanta, GA
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Rowland BA, Motamedi V, Michard F, Saha AK, Khanna AK. Impact of continuous and wireless monitoring of vital signs on clinical outcomes: a propensity-matched observational study of surgical ward patients. Br J Anaesth 2024; 132:519-527. [PMID: 38135523 DOI: 10.1016/j.bja.2023.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Continuous and wireless vital sign monitoring is superior to intermittent monitoring in detecting vital sign abnormalities; however, the impact on clinical outcomes has not been established. METHODS We performed a propensity-matched analysis of data describing patients admitted to general surgical wards between January 2018 and December 2019 at a single, tertiary medical centre in the USA. The primary outcome was a composite of in-hospital mortality or ICU transfer during hospitalisation. Secondary outcomes were the odds of individual components of the primary outcome, and heart failure, myocardial infarction, acute kidney injury, and rapid response team activations. Data are presented as odds ratios (ORs) with 95% confidence intervals (CIs) and n (%). RESULTS We initially screened a population of 34,636 patients (mean age 58.3 (Range 18-101) yr, 16,456 (47.5%) women. After propensity matching, intermittent monitoring (n=12 345) was associated with increased risk of a composite of mortality or ICU admission (OR 3.42, 95% CI 3.19-3.67; P<0.001), and heart failure (OR 1.48, 95% CI 1.21-1.81; P<0.001), myocardial infarction (OR 3.87, 95% CI 2.71-5.71; P<0.001), and acute kidney injury (OR 1.32, 95% CI 1.09-1.57; P<0.001) compared with continuous wireless monitoring (n=7955). The odds of rapid response team intervention were similar in both groups (OR 0.86, 95% CI 0.79-1.06; P=0.726). CONCLUSIONS Patients who received continuous ward monitoring were less likely to die or be admitted to ICU than those who received intermittent monitoring. These findings should be confirmed in prospective randomised trials.
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Affiliation(s)
- Bradley A Rowland
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Vida Motamedi
- Wake Forest University School of Medicine, Winston-Salem, NC, USA; Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Department of Anesthesiology, Vanderbilt School of Medicine, Nashville, TN, USA
| | | | - Amit K Saha
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA; Outcomes Research Consortium, Cleveland, OH, USA
| | - Ashish K Khanna
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA; Outcomes Research Consortium, Cleveland, OH, USA.
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Hidayat AI, Purnawan I, Mulyaningrat W, Saryono S, Siwi AS, Rias YA, Efendi F. Effect of Combining Dhikr and Prayer Therapy on Pain and Vital Signs in Appendectomy Patients: A Quasi-Experimental Study. J Holist Nurs 2024; 42:6-14. [PMID: 37277995 DOI: 10.1177/08980101231180051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Purpose: Dhikr and prayer reduce pain and improve a patient's vital signs. However, the interactions among these require further clarification in patients undergoing appendectomy. This study aimed to assess the effects of the combination of dhikr and prayer on pain, pulse rate, respiratory rate, and oxygen saturation. Study design: Quasi-experimental design. Method: Pain, pulse, respiratory rate, and oxygen saturation were measured via clinical examination immediately after leaving the recovery room at 1 and 2 hr after surgery in both the experimental and control groups. In total, 88 eligible participants were allocated to two groups: participants who received both dhikr and prayer (n = 44), and those who received routine care without analgesic therapy (n = 44). The chi-square test, independent t test, and general equation model were employed. Results: Respondents showed a significant interaction between group and time to decrease in pain, pulse, respiratory rate, and improved oxygen saturation, except for pain within 1 hr. The differences in all outcome scores between the groups after 1 and 2 hr were statistically significant, except for oxygen saturation after 1 hr. Conclusion: The combination of dhikr and prayer effectively decreased pain and improved vital signs. This helped nurses implement this procedure by promoting an essential culture of spiritual care for appendectomy patients.
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Affiliation(s)
| | - Iwan Purnawan
- Universitas Jenderal Soedirman, Purwokerto, Indonesia
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Braem CIR, Yavuz US, Hermens HJ, Veltink PH. Missing Data Statistics Provide Causal Insights into Data Loss in Diabetes Health Monitoring by Wearable Sensors. Sensors (Basel) 2024; 24:1526. [PMID: 38475061 DOI: 10.3390/s24051526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/14/2024] [Accepted: 02/25/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Data loss in wearable sensors is an inevitable problem that leads to misrepresentation during diabetes health monitoring. We systematically investigated missing wearable sensors data to get causal insight into the mechanisms leading to missing data. METHODS Two-week-long data from a continuous glucose monitor and a Fitbit activity tracker recording heart rate (HR) and step count in free-living patients with type 2 diabetes mellitus were used. The gap size distribution was fitted with a Planck distribution to test for missing not at random (MNAR) and a difference between distributions was tested with a Chi-squared test. Significant missing data dispersion over time was tested with the Kruskal-Wallis test and Dunn post hoc analysis. RESULTS Data from 77 subjects resulted in 73 cleaned glucose, 70 HR and 68 step count recordings. The glucose gap sizes followed a Planck distribution. HR and step count gap frequency differed significantly (p < 0.001), and the missing data were therefore MNAR. In glucose, more missing data were found in the night (23:00-01:00), and in step count, more at measurement days 6 and 7 (p < 0.001). In both cases, missing data were caused by insufficient frequency of data synchronization. CONCLUSIONS Our novel approach of investigating missing data statistics revealed the mechanisms for missing data in Fitbit and CGM data.
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Affiliation(s)
- Carlijn I R Braem
- Department of Biomedical Signals and Systems, University of Twente, 7522 NB Enschede, The Netherlands
| | - Utku S Yavuz
- Department of Biomedical Signals and Systems, University of Twente, 7522 NB Enschede, The Netherlands
| | - Hermie J Hermens
- Department of Biomedical Signals and Systems, University of Twente, 7522 NB Enschede, The Netherlands
| | - Peter H Veltink
- Department of Biomedical Signals and Systems, University of Twente, 7522 NB Enschede, The Netherlands
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Gouveia C, Soares B, Albuquerque D, Barros F, Soares SC, Pinho P, Vieira J, Brás S. Remote Emotion Recognition Using Continuous-Wave Bio-Radar System. Sensors (Basel) 2024; 24:1420. [PMID: 38474953 DOI: 10.3390/s24051420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024]
Abstract
The Bio-Radar is herein presented as a non-contact radar system able to capture vital signs remotely without requiring any physical contact with the subject. In this work, the ability to use the proposed system for emotion recognition is verified by comparing its performance on identifying fear, happiness and a neutral condition, with certified measuring equipment. For this purpose, machine learning algorithms were applied to the respiratory and cardiac signals captured simultaneously by the radar and the referenced contact-based system. Following a multiclass identification strategy, one could conclude that both systems present a comparable performance, where the radar might even outperform under specific conditions. Emotion recognition is possible using a radar system, with an accuracy equal to 99.7% and an F1-score of 99.9%. Thus, we demonstrated that it is perfectly possible to use the Bio-Radar system for this purpose, which is able to be operated remotely, avoiding the subject awareness of being monitored and thus providing more authentic reactions.
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Affiliation(s)
- Carolina Gouveia
- Instituto de Engenharia Electrónica e Telemática de Aveiro, Departamento de Electrónica, Telecomunicações e Informática, Intelligent Systems Associate Laboratory, University of Aveiro, 3810-193 Aveiro, Portugal
- Colab Almascience, Madan Parque, 2829-516 Caparica, Portugal
| | - Beatriz Soares
- Instituto de Telecomunicações, 3810-193 Aveiro, Portugal
- Departamento de Electrónica, Telecomunicações e Informática, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Daniel Albuquerque
- Instituto de Engenharia Electrónica e Telemática de Aveiro, Departamento de Electrónica, Telecomunicações e Informática, Intelligent Systems Associate Laboratory, University of Aveiro, 3810-193 Aveiro, Portugal
- Instituto de Telecomunicações, 3810-193 Aveiro, Portugal
- Escola Superior de Tecnologia e Gestão de Águeda, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Filipa Barros
- Center for Health Technology and Services Research, Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal
- William James Center for Research, Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Sandra C Soares
- William James Center for Research, Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Pedro Pinho
- Instituto de Telecomunicações, 3810-193 Aveiro, Portugal
- Departamento de Electrónica, Telecomunicações e Informática, University of Aveiro, 3810-193 Aveiro, Portugal
| | - José Vieira
- Instituto de Engenharia Electrónica e Telemática de Aveiro, Departamento de Electrónica, Telecomunicações e Informática, Intelligent Systems Associate Laboratory, University of Aveiro, 3810-193 Aveiro, Portugal
- Instituto de Telecomunicações, 3810-193 Aveiro, Portugal
| | - Susana Brás
- Instituto de Engenharia Electrónica e Telemática de Aveiro, Departamento de Electrónica, Telecomunicações e Informática, Intelligent Systems Associate Laboratory, University of Aveiro, 3810-193 Aveiro, Portugal
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14
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Goldfine CE, Oshim MFT, Chapman BP, Ganesan D, Rahman T, Carreiro SP. Contactless Monitoring System Versus Gold Standard for Respiratory Rate Monitoring in Emergency Department Patients: Pilot Comparison Study. JMIR Form Res 2024; 8:e44717. [PMID: 38363588 PMCID: PMC10907933 DOI: 10.2196/44717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Respiratory rate is a crucial indicator of disease severity yet is the most neglected vital sign. Subtle changes in respiratory rate may be the first sign of clinical deterioration in a variety of disease states. Current methods of respiratory rate monitoring are labor-intensive and sensitive to motion artifacts, which often leads to inaccurate readings or underreporting; therefore, new methods of respiratory monitoring are needed. The PulsON 440 (P440; TSDR Ultra Wideband Radios and Radars) radar module is a contactless sensor that uses an ultrawideband impulse radar to detect respiratory rate. It has previously demonstrated accuracy in a laboratory setting and may be a useful alternative for contactless respiratory monitoring in clinical settings; however, it has not yet been validated in a clinical setting. OBJECTIVE The goal of this study was to (1) compare the P440 radar module to gold standard manual respiratory rate monitoring and standard of care telemetry respiratory monitoring through transthoracic impedance plethysmography and (2) compare the P440 radar to gold standard measurements of respiratory rate in subgroups based on sex and disease state. METHODS This was a pilot study of adults aged 18 years or older being monitored in the emergency department. Participants were monitored with the P440 radar module for 2 hours and had gold standard (manual respiratory counting) and standard of care (telemetry) respiratory rates recorded at 15-minute intervals during that time. Respiratory rates between the P440, gold standard, and standard telemetry were compared using Bland-Altman plots and intraclass correlation coefficients. RESULTS A total of 14 participants were enrolled in the study. The P440 and gold standard Bland-Altman analysis showed a bias of -0.76 (-11.16 to 9.65) and an intraclass correlation coefficient of 0.38 (95% CI 0.06-0.60). The P440 and gold standard had the best agreement at normal physiologic respiratory rates. There was no change in agreement between the P440 and the gold standard when grouped by admitting diagnosis or sex. CONCLUSIONS Although the P440 did not have statistically significant agreement with gold standard respiratory rate monitoring, it did show a trend of increased agreement in the normal physiologic range, overestimating at low respiratory rates, and underestimating at high respiratory rates. This trend is important for adjusting future models to be able to accurately detect respiratory rates. Once validated, the contactless respiratory monitor provides a unique solution for monitoring patients in a variety of settings.
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Affiliation(s)
- Charlotte E Goldfine
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Md Farhan Tasnim Oshim
- Manning College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | - Brittany P Chapman
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Deepak Ganesan
- Manning College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | - Tauhidur Rahman
- Halıcıoğlu Data Science Institute, University of California San Diego, San Diego, CA, United States
| | - Stephanie P Carreiro
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
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15
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Helwan A, Azar D, Ma'aitah MKS. Conventional and deep learning methods in heart rate estimation from RGB face videos. Physiol Meas 2024; 45:02TR01. [PMID: 38081130 DOI: 10.1088/1361-6579/ad1458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 12/11/2023] [Indexed: 02/10/2024]
Abstract
Contactless vital signs monitoring is a fast-advancing scientific field that aims to employ monitoring methods that do not necessitate the use of leads or physical attachments to the patient in order to overcome the shortcomings and limits of traditional monitoring systems. Several traditional methods have been applied to extract the heart rate (HR) signal from the face. Moreover, machine learning has recently contributed majorly to the development of such a field in which deep networks and other deep learning methods are employed to extract the HR signal from RGB face videos. In this paper, we evaluate the state-of-the-art conventional and deep learning methods for HR estimates, focusing on the limits of deep learning methods and the availability of less-controlled face video datasets. We aim to present an extensive review that helps the various approaches of remote photoplethysmography extraction and HR estimation to be understood, in addition to their drawbacks and benefits.
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Affiliation(s)
| | | | - Mohamad Khaleel Sallam Ma'aitah
- Department of Robotics and Artificial Intelligence Engineering, Faculty of Engineering & Technology, Applied Science Private University, Amman, Jordan
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16
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Elliott M, Williamson R, Endacott R. Patient mortality and the neglect of vital signs' assessment: An audit of a national coronial database. Nurs Crit Care 2024. [PMID: 38328857 DOI: 10.1111/nicc.13037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Vital signs assessment is critical for patient surveillance and safety. Research has found, however, that this assessment is often neglected in clinical practice. The reasons for this are unclear as few studies have explored this issue. Those studies that have are small, single site studies and found that culture and poor understanding are contributing factors. AIM The aim was to explore the link between the clinical neglect of vital signs assessment and patient mortality and provide a better understanding of factors influencing vital signs assessment in the context of acute patient care. Coroners' reports represent an untapped source of information regarding shortfalls in vital signs assessment. Using a framework analysis, an audit was conducted of the Australian National Coronial Information System for cases where vital signs' assessment was mentioned in coronial reports. RESULTS Fifty-eight cases met the eligibility criteria, with deceased patients aged from 7 days to 93 years. Key themes related to absence of reassessment of vital signs, inappropriate delegation, passing responsibility to another staff member and not following policy. CONCLUSIONS The findings reflect a combination of individual and institutional failings and suggest that vital signs assessment was not considered a priority aspect of care. RELEVANCE TO CLINICAL PRACTICE Vital signs assessment must be considered an essential aspect of clinical care in all patients. This important aspect of care should be emphasized across all domains of patient care.
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Affiliation(s)
- Malcolm Elliott
- Nursing & Midwifery, Monash University, Clayton, Victoria, Australia
| | - Roz Williamson
- Nursing & Midwifery, Monash University, Clayton, Victoria, Australia
| | - Ruth Endacott
- National Institute for Health and Care Research, London, UK
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17
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Karaman F, Genc A, Yerebakan Sen AN, Rashidi M, Yildirim G, Unsal Jafarov G, Acar R, Saygin Sahin B. Effects of love glove application on vital signs for COVID-19 patients in the intensive care unit. Nurs Open 2024; 11:e2106. [PMID: 38391100 PMCID: PMC10847619 DOI: 10.1002/nop2.2106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 03/11/2023] [Accepted: 01/11/2024] [Indexed: 02/24/2024] Open
Abstract
AIM To evaluate the effects of love glove application on vital signs for COVID-19 patients in the intensive care unit. DESIGN A single-group pretest-posttest quasi-experimental design was used. TREND Statement Checklist was followed during the present study. METHODS The study was conducted on 30 intubated/extubated adult patients. The gloves were filled with warm water and air to prevent pressure injuries. Then they were tied together and applied to both hands of the patient for 30 min. The patient's vital signs were recorded before and after the application. A Wilcoxon signed-rank test was performed. RESULTS It was determined that respiratory rate, systolic blood pressure, diastolic blood pressure and oxygen saturation were significantly affected after the application of the love glove. The application of love gloves is a cheap and non-pharmacological method with no side effects. PATIENT OR PUBLIC CONTRIBUTION Patients were involved in the design and conduct of this study.
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Affiliation(s)
- Funda Karaman
- Department of Nursing, Faculty of Health SciencesBiruni UniversityIstanbulTurkey
| | - Asli Genc
- Department of Nursing, School of NursingUfuk UniversityAnkaraTurkey
| | - Ayse Nur Yerebakan Sen
- Department of Surgical Nursing, Institute of Graduate StudiesIstanbul University‐CerrahpasaIstanbulTurkey
| | - Mahruk Rashidi
- Department of Nursing, Faculty of Health SciencesIstanbul Gelisim UniversityIstanbulTurkey
| | - Gulay Yildirim
- Department of Nursing, Kesan Hakki Yoruk School of HealthTrakya UniversityEdirneTurkey
| | | | | | - Buse Saygin Sahin
- Department of Mental Health and Diseases Nursing, Institute of Graduate StudiesIstanbul University‐CerrahpasaIstanbulTurkey
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18
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Sigvardt E, Grønbaek KK, Jepsen ML, Søgaard M, Haahr L, Inácio A, Aasvang EK, Meyhoff CS. Workload associated with manual assessment of vital signs as compared with continuous wireless monitoring. Acta Anaesthesiol Scand 2024; 68:274-279. [PMID: 37735843 DOI: 10.1111/aas.14333] [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: 05/17/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Vital sign monitoring is considered an essential aspect of clinical care in hospitals. In general wards, this relies on intermittent manual assessments performed by clinical staff at intervals of up to 12 h. In recent years, continuous monitoring of vital signs has been introduced to the clinic, with improved patient outcomes being one of several potential benefits. The aim of this study was to determine the workload difference between continuous monitoring and manual monitoring of vital signs as part of the National Early Warning Score (NEWS). METHODS Three wireless sensors continuously monitored blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation in 20 patients admitted to the general hospital ward. The duration needed for equipment set-up and maintenance for continuous monitoring in a 24-h period was recorded and compared with the time spent on manual assessments and documentation of vital signs performed by clinical staff according to the NEWS. RESULTS The time used for continuous monitoring was 6.0 (IQR 3.2; 7.2) min per patient per day vs. 14 (9.7; 32) min per patient per day for the NEWS. Median difference in duration for monitoring of vital signs was 9.9 (95% CI 5.6; 21) min per patient per day between NEWS and continuous monitoring (p < .001). Time used for continuous monitoring in isolated patients was 6.6 (4.6; 12) min per patient per day as compared with 22 (9.7; 94) min per patient per day for NEWS. CONCLUSION The use of continuous monitoring was associated with a significant reduction in workload in terms of time for monitoring as compared with manual assessment of vital signs.
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Affiliation(s)
- Emilie Sigvardt
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Katja Kjaer Grønbaek
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mia Lind Jepsen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Marlene Søgaard
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Louise Haahr
- Department of Anesthesiology, Center of Organ and Cancer Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ana Inácio
- University of Porto, Faculty of Medicine, Porto, Portugal
| | - Eske Kvanner Aasvang
- Department of Anesthesiology, Center of Organ and Cancer Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Sylvest Meyhoff
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Othman W, Kashevnik A, Ali A, Shilov N, Ryumin D. Remote Heart Rate Estimation Based on Transformer with Multi-Skip Connection Decoder: Method and Evaluation in the Wild. Sensors (Basel) 2024; 24:775. [PMID: 38339492 PMCID: PMC10857270 DOI: 10.3390/s24030775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
Heart rate is an essential vital sign to evaluate human health. Remote heart monitoring using cheaply available devices has become a necessity in the twenty-first century to prevent any unfortunate situation caused by the hectic pace of life. In this paper, we propose a new method based on the transformer architecture with a multi-skip connection biLSTM decoder to estimate heart rate remotely from videos. Our method is based on the skin color variation caused by the change in blood volume in its surface. The presented heart rate estimation framework consists of three main steps: (1) the segmentation of the facial region of interest (ROI) based on the landmarks obtained by 3DDFA; (2) the extraction of the spatial and global features; and (3) the estimation of the heart rate value from the obtained features based on the proposed method. This paper investigates which feature extractor performs better by captioning the change in skin color related to the heart rate as well as the optimal number of frames needed to achieve better accuracy. Experiments were conducted using two publicly available datasets (LGI-PPGI and Vision for Vitals) and our own in-the-wild dataset (12 videos collected by four drivers). The experiments showed that our approach achieved better results than the previously published methods, making it the new state of the art on these datasets.
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Affiliation(s)
- Walaa Othman
- St. Petersburg Federal Research Center of the Russian Academy of Sciences (SPC RAS), 199178 St. Petersburg, Russia; (W.O.); (N.S.); (D.R.)
| | - Alexey Kashevnik
- St. Petersburg Federal Research Center of the Russian Academy of Sciences (SPC RAS), 199178 St. Petersburg, Russia; (W.O.); (N.S.); (D.R.)
| | - Ammar Ali
- Information Technology and Programming Faculty, ITMO University, 191002 St. Petersburg, Russia;
| | - Nikolay Shilov
- St. Petersburg Federal Research Center of the Russian Academy of Sciences (SPC RAS), 199178 St. Petersburg, Russia; (W.O.); (N.S.); (D.R.)
| | - Dmitry Ryumin
- St. Petersburg Federal Research Center of the Russian Academy of Sciences (SPC RAS), 199178 St. Petersburg, Russia; (W.O.); (N.S.); (D.R.)
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Luu AP, Nguyen TT, Cao VTC, Ha THD, Chung LTT, Truong TN, Nguyen Le Nhu T, Dao KB, Nguyen HV, Khanh PNQ, Le KTT, Tran LHB, Nhat PTH, Tran DM, Lam YM, Thwaites CL, Mcknight J, Vinh Chau NV, Van Nuil JI. Acceptance and User Experiences of a Wearable Device for the Management of Hospitalized Patients in COVID-19-Designated Wards in Ho Chi Minh City, Vietnam: Action Learning Project. JMIR Hum Factors 2024; 11:e44619. [PMID: 38180799 PMCID: PMC10773555 DOI: 10.2196/44619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/15/2023] [Accepted: 11/20/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Wearable devices have been used extensively both inside and outside of the hospital setting. During the COVID-19 pandemic, in some contexts, there was an increased need to remotely monitor pulse and saturated oxygen for patients due to the lack of staff and bedside monitors. OBJECTIVE A prototype of a remote monitoring system using wearable pulse oximeter devices was implemented at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam, from August to December 2021. The aim of this work was to support the ongoing implementation of the remote monitoring system. METHODS We used an action learning approach with rapid pragmatic methods, including informal discussions and observations as well as a feedback survey form designed based on the technology acceptance model to assess the use and acceptability of the system. Based on these results, we facilitated a meeting using user-centered design principles to explore user needs and ideas about its development in more detail. RESULTS In total, 21 users filled in the feedback form. The mean technology acceptance model scores ranged from 3.5 (for perceived ease of use) to 4.4 (for attitude) with behavioral intention (3.8) and perceived usefulness (4.2) scoring in between. Those working as nurses scored higher on perceived usefulness, attitude, and behavioral intention than did physicians. Based on informal discussions, we realized there was a mismatch between how we (ie, the research team) and the ward teams perceived the use and wider purpose of the technology. CONCLUSIONS Designing and implementing the devices to be more nurse-centric from their introduction could have helped to increase their efficiency and use during the complex pandemic period.
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Affiliation(s)
- An Phuoc Luu
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | | | | | | | | | - Khoa Bach Dao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Hao Van Nguyen
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | | | | | | | - Duc Minh Tran
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Yen Minh Lam
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Catherine Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffleld Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jacob Mcknight
- Centre for Tropical Medicine and Global Health, Nuffleld Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nguyen Van Vinh Chau
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Jennifer Ilo Van Nuil
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffleld Department of Medicine, University of Oxford, Oxford, United Kingdom
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Yang S, Galvagno S, Badjatia N, Stein D, Teeter W, Scalea T, Shackelford S, Fang R, Miller C, Hu P. A Novel Continuous Real-Time Vital Signs Viewer for Intensive Care Units: Design and Evaluation Study. JMIR Hum Factors 2024; 11:e46030. [PMID: 38180791 PMCID: PMC10799282 DOI: 10.2196/46030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 11/03/2023] [Accepted: 11/20/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Clinicians working in intensive care units (ICUs) are immersed in a cacophony of alarms and a relentless onslaught of data. Within this frenetic environment, clinicians make high-stakes decisions using many data sources and are often oversaturated with information of varying quality. Traditional bedside monitors only depict static vital signs data, and these data are not easily viewable remotely. Clinicians must rely on separate nursing charts-handwritten or electric-to review physiological patterns, including signs of potential clinical deterioration. An automated physiological data viewer has been developed to provide at-a-glance summaries and to assist with prioritizing care for multiple patients who are critically ill. OBJECTIVE This study aims to evaluate a novel vital signs viewer system in a level 1 trauma center by subjectively assessing the viewer's utility in a high-volume ICU setting. METHODS ICU attendings were surveyed during morning rounds. Physicians were asked to conduct rounds normally, using data reported from nurse charts and briefs from fellows to inform their clinical decisions. After the physician finished their assessment and plan for the patient, they were asked to complete a questionnaire. Following completion of the questionnaire, the viewer was presented to ICU physicians on a tablet personal computer that displayed the patient's physiologic data (ie, shock index, blood pressure, heart rate, temperature, respiratory rate, and pulse oximetry), summarized for up to 72 hours. After examining the viewer, ICU physicians completed a postview questionnaire. In both questionnaires, the physicians were asked questions regarding the patient's stability, status, and need for a higher or lower level of care. A hierarchical clustering analysis was used to group participating ICU physicians and assess their general reception of the viewer. RESULTS A total of 908 anonymous surveys were collected from 28 ICU physicians from February 2015 to June 2017. Regarding physicians' perception of whether the viewer enhanced the ability to assess multiple patients in the ICU, 5% (45/908) strongly agreed, 56.6% (514/908) agreed, 35.3% (321/908) were neutral, 2.9% (26/908) disagreed, and 0.2% (2/908) strongly disagreed. CONCLUSIONS Morning rounds in a trauma center ICU are conducted in a busy environment with many data sources. This study demonstrates that organized physiologic data and visual assessment can improve situation awareness, assist clinicians with recognizing changes in patient status, and prioritize care.
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Affiliation(s)
- Shiming Yang
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Samuel Galvagno
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Neeraj Badjatia
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Deborah Stein
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - William Teeter
- Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Thomas Scalea
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Stacy Shackelford
- United States Air Force Academy, Colorado Springs, CO, United States
| | - Raymond Fang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Catriona Miller
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Peter Hu
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, United States
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Carter C, Notter J. Undertaking a neurological assessment. Nurs Stand 2024; 39:45-50. [PMID: 37927224 DOI: 10.7748/ns.2023.e12173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 11/07/2023]
Abstract
Neurological observations are an essential aspect of assessment in patients with altered mental status and require the nurse to collect and analyse information using a validated assessment tool. Assessing a patient's pupil size and response is also an important element of a neurological assessment. This article summarises the pathophysiology of raised intracranial pressure and lists some of the conditions that may contribute to an alteration in a patient's mental status. The article details the use of two commonly used neurological assessment tools and the assessment of a patient's pupil size and response. The author also considers the challenges related to accurate recording of neurological observations.
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Affiliation(s)
- Chris Carter
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, England
| | - Joy Notter
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, England
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24
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Bello KO, Irekhore OT, Adeitan OO, Yusuf AO, Bada BS. Physiological Response, Haematology and Stress Condition of Scavenging Chickens in Cement Production Areas. J APPL ANIM WELF SCI 2024; 27:21-32. [PMID: 35034535 DOI: 10.1080/10888705.2021.2021531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study investigated the physiological and stress indices of scavenging chickens in LAFARGE and Dangote cement factories located at Ewekoro and Ibese, respectively and respective adjourning communities of Ogun State, Nigeria. One hundred adult scavenging chickens comprising of 25 from each location were used. The birds were caught at night on their perch and kept in furnished cages till the next morning. Data were collected on their rectal temperature, pulse rate, and respiratory rate . Also 5 mL blood was collected through the wing vein of each chicken. Highest (p < 0.05) pulse rate (215.64 beat/minute) and respiratory rate (19.90 breath/minute) were recorded among the chickens at LAFARGE area. Highest (p < 0.05) packed cell volume (28.06%), hemoglobin (4.01 g/dL), monocyte (4.28%) and glucose (256.53 g/dL) were recorded among ones at Ibese (Dangote). White blood cell (6488.89 × 103µL) was highest (p < 0.05) in chickens at Ewekoro (LAFARGE). The study concluded that cement factories infringe on health status of scavenging chickens in the domains. Effective environmental mitigation programme should be put in place for enhanced welfare of the birds.
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Affiliation(s)
- Kazeem O Bello
- Institute of Food Security, Environmental Resources and Agricultural Research, Federal University of Agriculture Abeokuta, Abeokuta, Nigeria
| | - Oluwakemi T Irekhore
- Agricultural Media and Extension Centre, Federal University of Agriculture Abeokuta, Abeokuta, Nigeria
| | - Onaopepo O Adeitan
- Department of Animal Production and Health, Federal University of Agriculture Abeokuta, Abeokuta, Nigeria
| | - Azeez O Yusuf
- Department of Animal Production and Health, Federal University of Agriculture Abeokuta, Abeokuta, Nigeria
| | - Babatunde S Bada
- Department of Environmental Management and Toxicology, Federal University of Agriculture Abeokuta, Abeokuta, Nigeria
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Schlosser Metitiri KR, Perotte A. Delay Between Actual Occurrence of Patient Vital Sign and the Nominal Appearance in the Electronic Health Record: Single-Center, Retrospective Study of PICU Data, 2014-2018. Pediatr Crit Care Med 2024; 25:54-61. [PMID: 37966346 PMCID: PMC10842173 DOI: 10.1097/pcc.0000000000003398] [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] [Indexed: 11/16/2023]
Abstract
OBJECTIVES Patient vital sign data charted in the electronic health record (EHR) are used for time-sensitive decisions, yet little is known about when these data become nominally available compared with when the vital sign was actually measured. The objective of this study was to determine the magnitude of any delay between when a vital sign was actually measured in a patient and when it nominally appears in the EHR. DESIGN We performed a single-center retrospective cohort study. SETTING Tertiary academic children's hospital. PATIENTS A total of 5,458 patients were admitted to a PICU from January 2014 to December 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We analyzed entry and display times of all vital signs entered in the EHR. The primary outcome measurement was time between vital sign occurrence and nominal timing of the vital sign in the EHR. An additional outcome measurement was the frequency of batch charting. A total of 9,818,901 vital sign recordings occurred during the study period. Across the entire cohort the median (interquartile range [IQR]) difference between time of occurrence and nominal time in the EHR was in hours:minutes:seconds, 00:41:58 (IQR 00:13:42-01:44:10). Lag in the first 24 hours of PICU admission was 00:47:34 (IQR 00:15:23-02:19:00), lag in the last 24 hours was 00:38:49 (IQR 00:13:09-01:29:22; p < 0.001). There were 1,892,143 occurrences of batch charting. CONCLUSIONS This retrospective study shows a lag between vital sign occurrence and its appearance in the EHR, as well as a frequent practice of batch charting. The magnitude of the delay-median ~40 minutes-suggests that vital signs available in the EHR for clinical review and incorporation into clinical alerts may be outdated by the time they are available.
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Affiliation(s)
- Katherine R. Schlosser Metitiri
- Division of Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children’s Hospital
| | - Adler Perotte
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
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Gupta K, Sinhal R, Badhiye SS. Remote photoplethysmography-based human vital sign prediction using cyclical algorithm. J Biophotonics 2024; 17:e202300286. [PMID: 37614208 DOI: 10.1002/jbio.202300286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023]
Abstract
This article aims to predict vital signs like heart rate (HR), respiration rate, and arterial oxygen saturation using ambient light video, eliminating chronic distortions through improved frame quality with BER estimation. The study employs the cascade residual CNN-FPNR technique for preprocessing and SNR enhancement using energy variance maximization. The image cascade network (ICNet) facilitates segmentation, achieving strong segmentation in low-light ambient videos. Remote photoplethysmography (iPPG) enables noncontact vital sign monitoring, predicting HR and respiratory rate (RR). An innovative noninvasive temperature and cyclical algorithm, incorporating principal component analysis and fast Fourier transform, evaluate patient HR and RR. To address challenges related to involuntary movements, a dynamic time-warping-based optimization method is used for precise region selection. The study introduces an intensity variance-based threshold analysis for arterial oxygen saturation level determination. Ultimately, the support vector machine (SVM) classification technique evaluates the ground truth, showcasing the system's promising potential for remote and accurate vital sign assessment.
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Affiliation(s)
- Kapil Gupta
- Department of Computer Engineering, St. Vincent Pallotti College of Engineering and Technology, Nagpur, India
| | - Ruchika Sinhal
- Reporting Engineer, Kagool Data Pvt. Ltd, Hyderabad, India
| | - Sagarkumar S Badhiye
- Symbiosis Institute of Technology, Nagpur Campus, Symbiosis International (Deemed University), Pune, Maharashtra, India
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Francoeur C, Silva A, Hornby L, Wollny K, Lee LA, Pomeroy A, Cayouette F, Scales N, Weiss MJ, Dhanani S. Pediatric Death After Withdrawal of Life-Sustaining Therapies: A Scoping Review. Pediatr Crit Care Med 2024; 25:e12-e19. [PMID: 37678383 PMCID: PMC10756696 DOI: 10.1097/pcc.0000000000003358] [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] [Indexed: 09/09/2023]
Abstract
OBJECTIVES Evaluate literature on the dying process in children after withdrawal of life sustaining measures (WLSM) in the PICU. We focused on the physiology of dying, prediction of time to death, impact of time to death, and uncertainty of the dying process on families, healthcare workers, and organ donation. DATA SOURCES MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL, and Web of Science. STUDY SELECTION We included studies that discussed the dying process after WLSM in the PICU, with no date or study type restrictions. We excluded studies focused exclusively on adult or neonatal populations, children outside the PICU, or on organ donation or adult/pediatric studies where pediatric data could not be isolated. DATA EXTRACTION Inductive qualitative content analysis was performed. DATA SYNTHESIS Six thousand two hundred twenty-five studies were screened and 24 included. Results were grouped into four categories: dying process, perspectives of healthcare professionals and family, WLSM and organ donation, and recommendations for future research. Few tools exist to predict time to death after WLSM in children. Most deaths after WLSM occur within 1 hour and during this process, healthcare providers must offer support to families regarding logistics, medications, and expectations. Providers describe the unpredictability of the dying process as emotionally challenging and stressful for family members and staff; however, no reports of families discussing the impact of time to death prediction were found. The unpredictability of death after WLSM makes families less likely to pursue donation. Future research priorities include developing death prediction tools of tools, provider and parental decision-making, and interventions to improve end-of-life care. CONCLUSIONS The dying process in children is poorly understood and understudied. This knowledge gap leaves families in a vulnerable position and the clinical team without the necessary tools to support patients, families, or themselves. Improving time to death prediction after WLSM may improve care provision and enable identification of potential organ donors.
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Affiliation(s)
- Conall Francoeur
- Division of Pediatric Critical Care, Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Amina Silva
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Laura Hornby
- Consultant, Canadian Blood Services, Hamilton, ON, Canada
| | - Krista Wollny
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Laurie A Lee
- Division of Pediatric Critical Care, Department of Pediatrics, McGill University, Montreal, QC, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Consultant, Canadian Blood Services, Hamilton, ON, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- School of Nursing, Queen's University, Kingston, ON, Canada
- Department of Pediatrics, CHU de Quebec - University of Laval, Montreal, QC, Canada
- Dynamical Analysis Lab, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Transplant Québec, Montréal, QC, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | | | - Florence Cayouette
- Department of Pediatrics, CHU de Quebec - University of Laval, Montreal, QC, Canada
| | - Nathan Scales
- Dynamical Analysis Lab, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Matthew J Weiss
- Department of Pediatrics, CHU de Quebec - University of Laval, Montreal, QC, Canada
- Transplant Québec, Montréal, QC, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Sonny Dhanani
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
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Fu S, Ling M, Li Z, Pan L. A new method for vital sign detection using FMCW radar based on random body motion cancellation. BIOMED ENG-BIOMED TE 2023; 68:617-632. [PMID: 37289651 DOI: 10.1515/bmt-2023-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/15/2023] [Indexed: 06/10/2023]
Abstract
In this study, we present a new method for acquiring human vital signs using a Range-Doppler matrix (RDM) of FMCW radar data and a Gaussian interpolation algorithm (GIA). First, the RDM is derived by applying a two-dimensional fast Fourier transform (2D-FFT) to the radar data, and the GIA is applied in the Doppler dimension to estimate the target velocity signal. Subsequently, a robust enhanced trend filtering (RETF) algorithm is used to eliminate the large-scale body motion from the vital signs. Finally, the time-varying filter-based empirical mode decomposition (TVF-EMD) algorithm is employed to extract the respiratory and heartbeat intrinsic mode functions (IMFs), which are filtered according to their respective spectral power to obtain the respiratory and heartbeat frequencies. The proposed method was evaluated using vital signs data collected from seven volunteers (4 males and 3 females) with Texas Instrument's AWR1642, and the results were compared with data from a reference monitor. The experiments showed that the method had an accuracy of 93 % for respiration and 95 % for heart rate in the presence of random body movements. Unlike traditional radar-based vital signs detection methods, this approach does not rely on range bin selection of the range profile matrix (RPM), thereby avoiding phase wrap problems and producing more accurate results. Currently, research in this field is limited.
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Affiliation(s)
- Shuai Fu
- School of Electronic and Electrical Engineering, Shanghai University of Engineering Science, ShangHai, China
| | - Ming Ling
- School of Electronic and Electrical Engineering, Shanghai University of Engineering Science, ShangHai, China
| | - Zhenhua Li
- Shanghai Baolong Automotive Corporation, ShangHai, China
| | - Long Pan
- Shanghai Baolong Automotive Corporation, ShangHai, China
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29
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Özden G, Parlar Kılıç S. Breathing better: A tech-monitored study of positive expiratory pressure and reading aloud for chronic obstructive pulmonary disease. Int J Nurs Pract 2023; 29:e13198. [PMID: 37653574 DOI: 10.1111/ijn.13198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/23/2023] [Accepted: 08/20/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Breathing exercises, such as diaphragmatic breathing and positive expiratory pressure (PEP), relieve breathlessness in people with chronic obstructive pulmonary disease (COPD). AIM This study aimed to investigate the effects of breathing exercises with PEP and reading aloud on vital signs, fatigue level, severity of dyspnoea and respiratory function parameters in patients with COPD. DESIGN The study followed a randomized controlled trial of COPD patients from a single hospital in eastern Turkey. METHODS The study included 103 patients who were randomly assigned to receive pre-reading exercises, breathing exercises with a PEP device or no intervention for 8 weeks. RESULTS The use of a PEP device improved oxygen saturation, forced expiratory volume in 1 s (FEV1 ) and FEV1 /forced vital capacity (FVC) values and reduced fatigue and dyspnoea severity. Reading aloud lowered the mean arterial pressure and reduced fatigue and dyspnoea severity. CONCLUSION The study concludes that PEP devices and reading aloud can improve respiratory function in patients with COPD. Additionally, reading aloud is an accessible, easy-to-implement and economically feasible method for treating COPD symptoms.
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Affiliation(s)
- Gürkan Özden
- Faculty of Nursing, Department of Internal Medicine Nursing, İnönü University, Malatya, Turkey
| | - Serap Parlar Kılıç
- Faculty of Nursing, Department of Internal Medicine Nursing, İnönü University, Malatya, Turkey
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30
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [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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31
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Tang H, Xu J, She R, Ning D, Gong Y, Li Y, Wei L. [Development of Human Vital Signs and Body Posture Monitoring and Positioning Alarm Systems]. Zhongguo Yi Liao Qi Xie Za Zhi 2023; 47:617-623. [PMID: 38086717 DOI: 10.3969/j.issn.1671-7104.2023.06.006] [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] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
In view of the high incidence of malignant diseases such as malignant arrhythmias in the elderly population, accidental injuries such as falls, and the problem of no witnesses when danger occurs, the study developed a human vital signs and body posture monitoring and positioning alarm system. Through the collection and analysis of electrocardiogram (ECG), respiration (RESP) and acceleration (ACC) signals, the system monitors human vital signs and body posture in real time, automatically judges critical states such as malignant arrhythmias and accidental falls on the local device side, and then issues alarm information, opens the positioning function, and uploads physiological information and patient location information through 4G communication. Experiments have shown that the system can accurately determine the occurrence of ventricular fibrillation and falls, and issue position and alarm information.
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Affiliation(s)
- Haoxiang Tang
- Basic Medical College, Army Medical University, Chongqing, 400038
| | - Jia Xu
- Basic Medical College, Army Medical University, Chongqing, 400038
| | - Ruijing She
- Basic Medical College, Army Medical University, Chongqing, 400038
| | - Dongni Ning
- Basic Medical College, Army Medical University, Chongqing, 400038
| | - Yushun Gong
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing, 400038
| | - Yongqin Li
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing, 400038
| | - Liang Wei
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing, 400038
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32
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El Abbaoui A, Sodoyer D, Elbahhar F. Contactless Heart and Respiration Rates Estimation and Classification of Driver Physiological States Using CW Radar and Temporal Neural Networks. Sensors (Basel) 2023; 23:9457. [PMID: 38067830 PMCID: PMC10708560 DOI: 10.3390/s23239457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 12/18/2023]
Abstract
The measurement and analysis of vital signs are a subject of significant research interest, particularly for monitoring the driver's physiological state, which is of crucial importance for road safety. Various approaches have been proposed using contact techniques to measure vital signs. However, all of these methods are invasive and cumbersome for the driver. This paper proposes using a non-contact sensor based on continuous wave (CW) radar at 24 GHz to measure vital signs. We associate these measurements with distinct temporal neural networks to analyze the signals to detect and extract heart and respiration rates as well as classify the physiological state of the driver. This approach offers robust performance in estimating the exact values of heart and respiration rates and in classifying the driver's physiological state. It is non-invasive and requires no physical contact with the driver, making it particularly practical and safe. The results presented in this paper, derived from the use of a 1D Convolutional Neural Network (1D-CNN), a Temporal Convolutional Network (TCN), a Recurrent Neural Network particularly the Bidirectional Long Short-Term Memory (Bi-LSTM), and a Convolutional Recurrent Neural Network (CRNN). Among these, the CRNN emerged as the most effective Deep Learning approach for vital signal analysis.
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Affiliation(s)
- Amal El Abbaoui
- COSYS-LEOST, University Gustave Eiffel, F-59650 Villeneuve d’Ascq, France;
| | | | - Fouzia Elbahhar
- COSYS-LEOST, University Gustave Eiffel, F-59650 Villeneuve d’Ascq, France;
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abdou A, Krishnan S, Mistry N. Evaluating a Novel Infant Heart Rate Detector for Neonatal Resuscitation Efforts: Protocol for a Proof-of-Concept Study. JMIR Res Protoc 2023; 12:e45512. [PMID: 37782528 PMCID: PMC10580137 DOI: 10.2196/45512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Over 10 million newborns worldwide undergo resuscitation at birth each year. Pediatricians may use electrocardiogram (ECG), pulse oximetry (PO), and stethoscope in determining heart rate (HR), as HR guides the need for and steps of resuscitation. HR must be obtained quickly and accurately. Unfortunately, the current diagnostic modalities are either too slow, obtaining HR in more than a minute, or inaccurate. With time constraints, a reliable robust heart rate detector (HRD) modality is required. This paper discusses a protocol for conducting a methods-based comparison study to determine the HR accuracy of a novel real-time HRD based on 3D-printed dry-electrode single-lead ECG signals for cost-effective and quick HR determination. The HRD's HR results are compared to either clinical-grade ECG or PO monitors to ensure robustness and accuracy. OBJECTIVE The purpose of this study is to design and examine the feasibility of a proof-of-concept HRD that quickly obtains HR using biocompatible 3D-printed dry electrodes for single-lead neonatal ECG acquisition. This study uses a novel HRD and compares it to the gold-standard 3-lead clinical ECG or PO in a hospital setting. METHODS A cross-sectional study is planned to be conducted in the neonatal intensive care unit or postpartum unit of a large community teaching hospital in Toronto, Canada, from June 2023 to June 2024. In total, 50 newborns will be recruited for this study. The HRD and an ECG or PO monitor will be video recorded using a digital camera concurrently for 3 minutes for each newborn. Hardware-based signal processing and patent-pending embedded algorithm-based HR estimation techniques are applied directly to the raw collected single-lead ECG and displayed on the HRD in real time during video recordings. These data will be annotated and compared to the ECG or PO readings at the same points in time. Accuracy, F1-score, and other statistical metrics will be produced to determine the HRD's feasibility in providing reliable HR. RESULTS The study is ongoing. The projected end date for data collection is around July 2024. CONCLUSIONS The study will compare the novel patent-pending 3D-printed dry electrode-based HRD's real-time HR estimation techniques with the state-of-the-art clinical-grade ECG or PO monitors for HR accuracy and examines how fast the HRD provides reliable HR. The study will further provide recommendations and important improvements that can be made to implement the HRD for clinical applications, especially in neonatal resuscitation efforts. This work can be seen as a stepping stone in the development of robust dry-electrode single-lead ECG devices for HR estimations in the pediatric population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45512.
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Affiliation(s)
- Abdelrahman Abdou
- Department of Electrical, Computer and Biomedical Engineering, Toronto Metropolitan University, Toronto, ON, Canada
| | - Sridhar Krishnan
- Department of Electrical, Computer and Biomedical Engineering, Toronto Metropolitan University, Toronto, ON, Canada
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Vicente‐Perez S, Robleda G, Gich I, Nolla T, Ponce‐Taylor J, Verd S, Ginovart G. Physiological responses and behavioural organization of very low birth weight infants during swaddled versus traditional weighing. Nurs Open 2023; 10:6896-6902. [PMID: 37458256 PMCID: PMC10495735 DOI: 10.1002/nop2.1943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/20/2023] [Accepted: 07/07/2023] [Indexed: 09/13/2023] Open
Abstract
AIM Despite the consequences of neonatal distress and agitation, preterm infants undergo stress owing to weighing procedures. The objective of this study was to enable very low birth weight infants to maintain adequate self-regulation during weighing. DESIGN This prospective crossover study utilizes a within-subjects design, where intervention days were compared to control days. METHOD Infants were exposed to both swaddled and unswaddled weighing in an intensive care nursery setting. Nineteen very low birth weight infants were weighed on two consecutive days. Variables of heart rate, respiratory rate and ALPS-Neo score were recorded. RESULTS Stress score decreased significantly from 1.65 (pre-weight) to 0.23 (weight measurement) in swaddled-intervention periods; conversely, it increased significantly from 1.26 (pre-weight) to 4.97 (weight measurement) in control periods. During weight measurement, heart and respiratory rate were significantly lower for swaddled-intervention days when compared to control days. Given the significant impact of swaddled weighing in reducing stress, this method can be used as an appropriate weighing procedure in intensive care. This research has no patient or public contribution.
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Affiliation(s)
| | - Gemma Robleda
- Campus docent Sant Joan de DéuBarcelona UniversityBarcelonaSpain
- Iberoamerican Cochrane CentreHospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Ignasi Gich
- Clinical Epidemiology UnitHospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Tania Nolla
- Orthopedic & Neuroscience UnitsHospital de la Santa Creu i Sant PauBarcelonaSpain
| | | | - Sergio Verd
- Department of Primary CareBalearic Health Authority, La Vileta surgeryMajorcaSpain
| | - Gemma Ginovart
- Neonatal Intensive Care UnitHospital Germans TriasBarcelonaSpain
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Considine J, Hutchinson AM, Mitchell I, Bohingamu Mudiyanselage S, Mohebbi M, Watts JJ, Bucknall T. Vital sign assessment and nursing interventions in medical and surgical patients with rapid response system triggers. J Clin Nurs 2023; 32:7310-7320. [PMID: 37365897 PMCID: PMC10946594 DOI: 10.1111/jocn.16810] [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: 01/10/2023] [Revised: 05/01/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023]
Abstract
AIM(S) To explore vital sign assessment (both complete and incomplete sets of vital signs), and escalation of care per policy and nursing interventions in response to clinical deterioration. DESIGN This cohort study is a secondary analysis of data from the Prioritising Responses of Nurses To deteriorating patient Observations cluster randomised controlled trial of a facilitation intervention on nurses' vital sign measurement and escalation of care for deteriorating patients. METHODS The study was conducted in 36 wards at four metropolitan hospitals in Victoria, Australia. Medical records of all included patients from the study wards during three randomly selected 24-h periods within the same week were audited at three time points: pre-intervention (June 2016), and at 6 (December 2016) and 12 months (June 1017) post-intervention. Descriptive statistics were used to summarise the study data, and relationships between variables were examined using chi-square test. RESULTS A total of 10,383 audits were conducted. At least one vital sign measurement was documented every 8 h in 91.6% of audits, and a complete set of vital signs was documented every 8 h in 83.1% of audits. There were pre-Medical Emergency Team, Medical Emergency Team or Cardiac Arrest Team triggers in 25.8% of audits. When triggers were present, a rapid response system call occurred in 26.8% of audits. There were 1350 documented nursing interventions in audits with pre-Medical Emergency Team (n = 2403) or Medical Emergency Team triggers (n = 273). One or more nursing interventions were documented in 29.5% of audits with pre-Medical Emergency Team triggers and 63.7% of audits with Medical Emergency Team triggers. CONCLUSION When rapid response system triggers were documented, there were gaps in escalation of care per policy; however, nurses undertook a range of interventions within their scope of practice in response to clinical deterioration. RELEVANCE TO CLINICAL PRACTICE Medical and surgical ward nurses in acute care wards frequently engage in vital sign assessment. Interventions by medical and nurgical nurses may occur prior to, or in parallel with calling the rapid response system. Nursing interventions are a key but under-recognised element of the organisational response to deteriorating patients. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Nurses engage in a range of nursing interventions to manage deteriorating patients, (aside from rapid response system activation) that are not well understood, nor well described in the literature to date. IMPACT This study addresses the gap in the literature regarding nurses' management of deteriorating patients within their scope of practice (aside from RRS activation) in real world settings. When rapid response system triggers were documented, there were gaps in escalation of care per policy; however, nurses undertook a range of interventions within their scope of practice in response to clinical deterioration. The results of this research are relevant to nurses working on medical and surgical wards. REPORTING METHOD The trial was reported according to the Consolidated Standards of Reporting Trials extension for Cluster Trials recommendations, and this paper is reported according to the Strengthening the Reporting of Observational Studies in Epidemiology Statement. 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 TransformationDeakin UniversityGeelongAustralia
- Centre for Quality and Patient Safety Research – Eastern Health PartnershipBox HillAustralia
| | - Alison M. Hutchinson
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health TransformationDeakin UniversityGeelongAustralia
- Centre for Quality and Patient Safety Research – Barwon Health PartnershipGeelongAustralia
| | - Imogen Mitchell
- Research and Academic PartnershipsCanberra Health ServicesCanberraAustralian Capital TerritoryAustralia
- Australian National University College of Health and MedicineCanberraAustralian Capital TerritoryAustralia
| | - Shalika Bohingamu Mudiyanselage
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Faculty of HealthDeakin UniversityGeelongAustralia
| | | | - Jennifer J. Watts
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Faculty of HealthDeakin UniversityGeelongAustralia
| | - Tracey Bucknall
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health TransformationDeakin UniversityGeelongAustralia
- Centre for Quality and Patient Safety Research – Alfred Health PartnershipMelbourneAustralia
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Kovoor JG, Bacchi S, Stretton B, Gupta AK, Lam L, Jiang M, Lee S, To MS, Ovenden CD, Hewitt JN, Goh R, Gluck S, Reid JL, Hugh TJ, Dobbins C, Padbury RT, Hewett PJ, Trochsler MI, Flabouris A, Maddern GJ. Vital signs and medical emergency response (MER) activation predict in-hospital mortality in general surgery patients: a study of 15 969 admissions. ANZ J Surg 2023; 93:2426-2432. [PMID: 37574649 DOI: 10.1111/ans.18648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/28/2023] [Accepted: 07/21/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The applicability of the vital signs prompting medical emergency response (MER) activation has not previously been examined specifically in a large general surgical cohort. This study aimed to characterize the distribution, and predictive performance, of four vital signs selected based on Australian guidelines (oxygen saturation, respiratory rate, systolic blood pressure and heart rate); with those of the MER activation criteria. METHODS A retrospective cohort study was conducted including patients admitted under general surgical services of two hospitals in South Australia over 2 years. Likelihood ratios for patients meeting MER activation criteria, or a vital sign in the most extreme 1% for general surgery inpatients (<0.5th percentile or > 99.5th percentile), were calculated to predict in-hospital mortality. RESULTS 15 969 inpatient admissions were included comprising 2 254 617 total vital sign observations. The 0.5th and 99.5th centile for heart rate was 48 and 133, systolic blood pressure 85 and 184, respiratory rate 10 and 31, and oxygen saturations 89% and 100%, respectively. MER activation criteria with the highest positive likelihood ratio for in-hospital mortality were heart rate ≤ 39 (37.65, 95% CI 27.71-49.51), respiratory rate ≥ 31 (15.79, 95% CI 12.82-19.07), and respiratory rate ≤ 7 (10.53, 95% CI 6.79-14.84). These MER activation criteria likelihood ratios were similar to those derived when applying a threshold of the most extreme 1% of vital signs. CONCLUSIONS This study demonstrated that vital signs within Australian guidelines, and escalation to MER activation, appropriately predict in-hospital mortality in a large cohort of patients admitted to general surgical services in South Australia.
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Affiliation(s)
- Joshua G Kovoor
- University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Brandon Stretton
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Lydia Lam
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Melinda Jiang
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Shane Lee
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Minh-Son To
- Health and Information, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joseph N Hewitt
- University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rudy Goh
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Samuel Gluck
- University of Adelaide, Adelaide, South Australia, Australia
| | - Jessica L Reid
- University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Thomas J Hugh
- University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Christopher Dobbins
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Peter J Hewett
- University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Markus I Trochsler
- University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Arthas Flabouris
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Guy J Maddern
- University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
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Santiago González N, García-Hernández MDL, Cruz-Bello P, Chaparro-Díaz L, Rico-González MDL, Hernández-Ortega Y. Modified Early Warning Score: Clinical Deterioration of Mexican Patients Hospitalized with COVID-19 and Chronic Disease. Healthcare (Basel) 2023; 11:2654. [PMID: 37830691 PMCID: PMC10572652 DOI: 10.3390/healthcare11192654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023] Open
Abstract
The objective was to evaluate the Modified Early Warning Score in patients hospitalized for COVID-19 plus chronic disease. METHODS Retrospective observational study, 430 hospitalized patients with COVID-19 and chronic disease. Instrument, Modified Early Warning Score (MEWS). Data analysis, with Cox and logistic regression, to predict survival and risk. RESULTS Of 430 patients, 58.6% survived, and 41.4% did not. The risk was: low 53.5%, medium 23.7%, and high 22.8%. The MEWS score was similar between survivors 3.02, p 0.373 (95% CI: -0.225-0.597) and non-survivors 3.20 (95% CI: -0.224-0.597). There is a linear relationship between MEWS and mortality risk R 0.920, ANOVA 0.000, constant 4.713, and coefficient 4.406. The Cox Regression p 0.011, with a risk of deterioration of 0.325, with a positive coefficient, the higher the risk, the higher the mortality, while the invasive mechanical ventilation coefficient was negative -0.757. By providing oxygen and ventilation, mortality is lower. CONCLUSIONS The predictive value of the modified early warning score in patients hospitalized for COVID-19 and chronic disease is not predictive with the MEWS scale. Additional assessment is required to prevent complications, especially when patients are assessed as low-risk.
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Affiliation(s)
- Nicolás Santiago González
- Hospital Regional de Alta Especialidad Ixtapaluca (HRAEI), Universidad Autónoma del Estado de México (UAEMex), Ixtapaluca 56530, Mexico;
| | - María de Lourdes García-Hernández
- Facultad de Enfermería y Obstetricia, Universidad Autónoma del Estado de México (UAEMéx), Toluca 50000, Mexico; (P.C.-B.); (M.d.L.R.-G.); (Y.H.-O.)
| | - Patricia Cruz-Bello
- Facultad de Enfermería y Obstetricia, Universidad Autónoma del Estado de México (UAEMéx), Toluca 50000, Mexico; (P.C.-B.); (M.d.L.R.-G.); (Y.H.-O.)
| | - Lorena Chaparro-Díaz
- Nursing Department, Faculty of Nursing, Universidad Nacional de Colombia, Sede Bogotá, Bogotá 111321, Colombia;
| | - María de Lourdes Rico-González
- Facultad de Enfermería y Obstetricia, Universidad Autónoma del Estado de México (UAEMéx), Toluca 50000, Mexico; (P.C.-B.); (M.d.L.R.-G.); (Y.H.-O.)
| | - Yolanda Hernández-Ortega
- Facultad de Enfermería y Obstetricia, Universidad Autónoma del Estado de México (UAEMéx), Toluca 50000, Mexico; (P.C.-B.); (M.d.L.R.-G.); (Y.H.-O.)
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Power J, Gouldthorpe C, Davies A. Vital Signs in Palliative Care: A Scoping Review. Cancers (Basel) 2023; 15:4641. [PMID: 37760611 PMCID: PMC10527359 DOI: 10.3390/cancers15184641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Vital signs are routinely measured in secondary healthcare settings and can be used to detect clinical problems, guide treatment, and monitor response to treatment. Vital signs are less frequently measured in palliative care settings. Reasons for this are unclear. This scoping review aimed to assess the generic use of vital signs in palliative care, and its role in prognostication for adult patients with cancer receiving palliative care. Medline, Embase, and CINAHL were searched for articles involving adult patients with advanced cancer receiving palliative care who had their vital signs measured. Twenty-six articles were identified in which one or a combination of vital signs, with or without other clinical parameters, was used to prognosticate for patients. An additional three articles investigated the generic use of vital signs in patients with advanced cancer. There was significant heterogeneity between identified studies, with some indication that changes in vital signs may indicate that a patient is close to death. However, other studies suggested that patients may maintain normal vital signs until the time of death. Further studies are needed to explore whether abnormal vital signs may be used as a prognostic indicator for patients with cancer receiving palliative care.
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Affiliation(s)
- Jenny Power
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
- Our Lady’s Hospice & Care Services, D6W RY72 Dublin, Ireland
| | - Craig Gouldthorpe
- Our Lady’s Hospice & Care Services, D6W RY72 Dublin, Ireland
- School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Andrew Davies
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
- Our Lady’s Hospice & Care Services, D6W RY72 Dublin, Ireland
- School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Othman W, Hamoud B, Kashevnik A, Shilov N, Ali A. A Machine Learning-Based Correlation Analysis between Driver Behaviour and Vital Signs: Approach and Case Study. Sensors (Basel) 2023; 23:7387. [PMID: 37687842 PMCID: PMC10490726 DOI: 10.3390/s23177387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/11/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023]
Abstract
Driving behaviour analysis has drawn much attention in recent years due to the dramatic increase in the number of traffic accidents and casualties, and based on many studies, there is a relationship between the driving environment or behaviour and the driver's state. To the best of our knowledge, these studies mostly investigate relationships between one vital sign and the driving circumstances either inside or outside the cabin. Hence, our paper provides an analysis of the correlation between the driver state (vital signs, eye state, and head pose) and both the vehicle maneuver actions (caused by the driver) and external events (carried out by other vehicles or pedestrians), including the proximity to other vehicles. Our methodology employs several models developed in our previous work to estimate respiratory rate, heart rate, blood pressure, oxygen saturation, head pose, eye state from in-cabin videos, and the distance to the nearest vehicle from out-cabin videos. Additionally, new models have been developed using Convolutional Neural Network (CNN) and Bidirectional Long Short-Term Memory (BiLSTM) to classify the external events from out-cabin videos, as well as a Decision Tree classifier to detect the driver's maneuver using accelerometer and gyroscope sensor data. The dataset used includes synchronized in-cabin/out-cabin videos and sensor data, allowing for the estimation of the driver state, proximity to other vehicles and detection of external events, and driver maneuvers. Therefore, the correlation matrix was calculated between all variables to be analysed. The results indicate that there is a weak correlation connecting both the maneuver action and the overtaking external event on one side and the heart rate and the blood pressure (systolic and diastolic) on the other side. In addition, the findings suggest a correlation between the yaw angle of the head and the overtaking event and a negative correlation between the systolic blood pressure and the distance to the nearest vehicle. Our findings align with our initial hypotheses, particularly concerning the impact of performing a maneuver or experiencing a cautious event, such as overtaking, on heart rate and blood pressure due to the agitation and tension resulting from such events. These results can be the key to implementing a sophisticated safety system aimed at maintaining the driver's stable state when aggressive external events or maneuvers occur.
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Affiliation(s)
- Walaa Othman
- Saint Petersburg Federal Research Center of the Russian Academy of Sciences (SPC RAS), 199178 St. Petersburg, Russia; (W.O.); (B.H.); (N.S.)
| | - Batol Hamoud
- Saint Petersburg Federal Research Center of the Russian Academy of Sciences (SPC RAS), 199178 St. Petersburg, Russia; (W.O.); (B.H.); (N.S.)
| | - Alexey Kashevnik
- Saint Petersburg Federal Research Center of the Russian Academy of Sciences (SPC RAS), 199178 St. Petersburg, Russia; (W.O.); (B.H.); (N.S.)
- Institute of Mathematics and Information Technologies, Perozavodsk State University (PetrSU), 185035 Petrozavodsk, Russia
| | - Nikolay Shilov
- Saint Petersburg Federal Research Center of the Russian Academy of Sciences (SPC RAS), 199178 St. Petersburg, Russia; (W.O.); (B.H.); (N.S.)
| | - Ammar Ali
- Information Technology and Programming Faculty, ITMO University, 191002 St. Petersburg, Russia;
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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) 2023; 23:6736. [PMID: 37571519 PMCID: PMC10422413 DOI: 10.3390/s23156736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [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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Çetin K, Ekici B. The Effect of Incubator Cover on Newborn Vital Signs: The Design of Repeated Measurements in Two Separate Groups with No Control Group. Children (Basel) 2023; 10:1224. [PMID: 37508721 PMCID: PMC10378478 DOI: 10.3390/children10071224] [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] [Received: 06/16/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023]
Abstract
(1) Background: During their stays in neonatal intensive care units (NICU), newborns are exposed to many stimuli that disrupt their physiological indicators. The aim of this study was to investigate the impact of the light-dark cycle created with and without an incubator cover on the vital signs of term and preterm newborns. (2) Methods: A repeated measures design was used in the study utilizing two separate groups, without a control group. The study included 91 neonates hospitalized in a NICU (44 term and 47 preterm). With and without an incubator cover, the newborns' vital signs (heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), and body temperature (BT)) were measured. Three separate measurements were taken. (3) Results: The mean age of the newborns was 37.0 weeks. There was no significant difference between the HR and RR medians of the term and preterms in the incubator undraped and clad measurements (p > 0.05). At the first measurement, the SpO2 medians of the incubator-covered term and preterms were significantly higher than those of the incubator-covered term and preterms (p = 0.001). (4) Conclusions: The vital signs of the neonates demonstrated variable responses in the measurements when their incubators were covered vs. when they were not covered. However, more research on the effect of the light-dark cycle on their vital signs is required.
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Affiliation(s)
- Kenan Çetin
- Neonatal Intensive Care Unit, Siverek State Hospital, Şanlıurfa 63600, Türkiye
| | - Behice Ekici
- School of Nursing, Maltepe University, Istanbul 34857, Türkiye
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Zaman S, Padayachee Y, Shah M, Samways J, Auton A, Quaife NM, Sweeney M, Howard JP, Tenorio I, Bachtiger P, Kamalati T, Pabari PA, Linton NWF, Mayet J, Peters NS, Barton C, Cole GD, Plymen CM. Smartphone-Based Remote Monitoring in Heart Failure With Reduced Ejection Fraction: Retrospective Cohort Study of Secondary Care Use and Costs. JMIR Cardio 2023; 7:e45611. [PMID: 37351921 PMCID: PMC10334716 DOI: 10.2196/45611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Despite effective therapies, the economic burden of heart failure with reduced ejection fraction (HFrEF) is driven by frequent hospitalizations. Treatment optimization and admission avoidance rely on frequent symptom reviews and monitoring of vital signs. Remote monitoring (RM) aims to prevent admissions by facilitating early intervention, but the impact of noninvasive, smartphone-based RM of vital signs on secondary health care use and costs in the months after a new diagnosis of HFrEF is unknown. OBJECTIVE The purpose of this study is to conduct a secondary care health use and health-economic evaluation for patients with HFrEF using smartphone-based noninvasive RM and compare it with matched controls receiving usual care without RM. METHODS We conducted a retrospective study of 2 cohorts of newly diagnosed HFrEF patients, matched 1:1 for demographics, socioeconomic status, comorbidities, and HFrEF severity. They are (1) the RM group, with patients using the RM platform for >3 months and (2) the control group, with patients referred before RM was available who received usual heart failure care without RM. Emergency department (ED) attendance, hospital admissions, outpatient use, and the associated costs of this secondary care activity were extracted from the Discover data set for a 3-month period after diagnosis. Platform costs were added for the RM group. Secondary health care use and costs were analyzed using Kaplan-Meier event analysis and Cox proportional hazards modeling. RESULTS A total of 146 patients (mean age 63 years; 42/146, 29% female) were included (73 in each group). The groups were well-matched for all baseline characteristics except hypertension (P=.03). RM was associated with a lower hazard of ED attendance (hazard ratio [HR] 0.43; P=.02) and unplanned admissions (HR 0.26; P=.02). There were no differences in elective admissions (HR 1.03, P=.96) or outpatient use (HR 1.40; P=.18) between the 2 groups. These differences were sustained by a univariate model controlling for hypertension. Over a 3-month period, secondary health care costs were approximately 4-fold lower in the RM group than the control group, despite the additional cost of RM itself (mean cost per patient GBP £465, US $581 vs GBP £1850, US $2313, respectively; P=.04). CONCLUSIONS This retrospective cohort study shows that smartphone-based RM of vital signs is feasible for HFrEF. This type of RM was associated with an approximately 2-fold reduction in ED attendance and a 4-fold reduction in emergency admissions over just 3 months after a new diagnosis with HFrEF. Costs were significantly lower in the RM group without increasing outpatient demand. This type of RM could be adjunctive to standard care to reduce admissions, enabling other resources to help patients unable to use RM.
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Affiliation(s)
| | - Yorissa Padayachee
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Moulesh Shah
- Imperial College Health Partners, London, United Kingdom
| | - Jack Samways
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Alice Auton
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Nicholas M Quaife
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | | | | | - Indira Tenorio
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | | | | | - Punam A Pabari
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | | | - Jamil Mayet
- Imperial College London, London, United Kingdom
| | | | - Carys Barton
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | | | - Carla M Plymen
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
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Lee SS, El Ters N, Vesoulis ZA, Zempel JM, Mathur AM. Variable Association of Physiologic Changes With Electrographic Seizure-Like Events in Infants Born Preterm. J Pediatr 2023; 257:113348. [PMID: 36801212 PMCID: PMC10575679 DOI: 10.1016/j.jpeds.2022.12.044] [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: 04/26/2022] [Revised: 11/22/2022] [Accepted: 12/20/2022] [Indexed: 02/17/2023]
Abstract
OBJECTIVES To determine the incidence of seizure-like events in a cohort of infants born preterm as well as the prevalence of associated vital sign changes (heart rate [HR], respiratory rate, and pulse oximetry [SpO2]). STUDY DESIGN We performed prospective conventional video electroencephalogram monitoring on infants born at 23-30 weeks of gestational age during the first 4 postnatal days. For detected seizure-like events, simultaneously captured vital sign data were analyzed during the pre-event baseline and during the event. Significant vital sign changes were defined as HR or respiratory rate >±2 SD from the infant's own baseline physiologic mean, derived from a 10-minute interval before the seizure-like event. Significant change in SpO2 was defined as oxygen desaturation during the event with a mean SpO2 <88%. RESULTS Our sample included 48 infants with median gestational age of 28 weeks (IQR 26-29) and birth weight of 1125 g (IQR 963-1265). Twelve (25%) infants had seizure-like discharges with a total of 201 events; 83% (10/12) of infants had vital sign changes during these events, and 50% (6/12) had significant vital sign changes during the majority of the seizure-like events. Concurrent HR changes occurred the most frequently. CONCLUSIONS Individual infant variability was observed in the prevalence of concurrent vital sign changes with electroencephalographic seizure-like events. Physiologic changes associated with preterm electrographic seizure-like events should be investigated further as a potential biomarker to assess the clinical significance of such events in the preterm population.
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Affiliation(s)
- Stephanie S Lee
- Division of Neonatology, Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA
| | - Nathalie El Ters
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, MO.
| | - Zachary A Vesoulis
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, MO
| | - John M Zempel
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Amit M Mathur
- Saint Louis University School of Medicine, St Louis, MO
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Beard JW, Sethi A, Jiao W, Hyatt HW, Yapici HO, Erslon M, Overdyk FJ. Cost savings through continuous vital sign monitoring in the medical-surgical unit. J Med Econ 2023:1-27. [PMID: 37249124 DOI: 10.1080/13696998.2023.2219156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
ABSTRACTObjective- This study aimed to determine the potential cost-savings for implementing continuous vital sign monitoring in a hospital's medical-surgical units.Methods- A cost-savings analysis was designed to calculate potential cost-savings for an average-sized U.S. community hospital (153 total beds) over a one-year time horizon. Analysis parameters were extracted from national databases and previous studies that compared outcomes for patients receiving continuous vital sign monitoring (SpO2, HR, and RR) or standard of care (intermittent vital sign measurements) in medical-surgical units based on a targeted literature review. Clinical parameters and associated costs served as analysis inputs. The analysis outputs were costs and potential cost-savings using a 50% and 100% adoption rate of continuous monitoring technologies across the medical-surgical unit.Results- Potential annual cost-savings for in-hospital medical-surgical stays were estimated at $3,414,709 (2022 USD) and $6,829,418 for a 50% and 100% adoption rate, respectively. The cost-savings for an adoption rate of 100% equated to a ∼14% reduction in the overall annual cost of medical-surgical unit stays for an average-sized hospital. The largest contribution to potential cost-savings came from patients that avoided serious adverse events that require transfer to the intensive care unit; this resulted in annual cost-savings from reduced average length of stay between $1,756,613 and $3,513,226 (50% and 100% adoption rate, respectively). Additional cost-savings can be attained from reductions in in-hospital cardiac arrest-associated hospitalizations and decreased rapid response team activation.Conclusions- Our findings demonstrate that there is the potential for cost-savings of over $6.8 million dollars per year in an average-sized US community hospital by improving patient outcomes through implementation of continuous monitoring technologies in medical-surgical units. Continuous vital sign monitoring technologies that increase patient mobility and facilitate recovery may further contribute to cost-savings and should be considered for economic analyses. Future research is needed to explore these health-related outcomes.
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Affiliation(s)
- John W Beard
- Patient Care Solutions, GE HealthCare, Milwaukee, Wisconsin, USA
| | - Antra Sethi
- Patient Care Solutions, GE HealthCare, Milwaukee, Wisconsin, USA
| | - Weiqi Jiao
- Department of Health Economics and Outcomes Research, Boston Strategic Partners Inc., Boston, MA, USA
| | - Hayden W Hyatt
- Department of Health Economics and Outcomes Research, Boston Strategic Partners Inc., Boston, MA, USA
| | - Halit O Yapici
- Department of Health Economics and Outcomes Research, Boston Strategic Partners Inc., Boston, MA, USA
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Bhavani SV, Xiong L, Pius A, Semler M, Qian ET, Verhoef PA, Robichaux C, Coopersmith CM, Churpek MM. Comparison of time series clustering methods for identifying novel subphenotypes of patients with infection. J Am Med Inform Assoc 2023; 30:1158-1166. [PMID: 37043759 PMCID: PMC10198539 DOI: 10.1093/jamia/ocad063] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/06/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVE Severe infection can lead to organ dysfunction and sepsis. Identifying subphenotypes of infected patients is essential for personalized management. It is unknown how different time series clustering algorithms compare in identifying these subphenotypes. MATERIALS AND METHODS Patients with suspected infection admitted between 2014 and 2019 to 4 hospitals in Emory healthcare were included, split into separate training and validation cohorts. Dynamic time warping (DTW) was applied to vital signs from the first 8 h of hospitalization, and hierarchical clustering (DTW-HC) and partition around medoids (DTW-PAM) were used to cluster patients into subphenotypes. DTW-HC, DTW-PAM, and a previously published group-based trajectory model (GBTM) were evaluated for agreement in subphenotype clusters, trajectory patterns, and subphenotype associations with clinical outcomes and treatment responses. RESULTS There were 12 473 patients in training and 8256 patients in validation cohorts. DTW-HC, DTW-PAM, and GBTM models resulted in 4 consistent vitals trajectory patterns with significant agreement in clustering (71-80% agreement, P < .001): group A was hyperthermic, tachycardic, tachypneic, and hypotensive. Group B was hyperthermic, tachycardic, tachypneic, and hypertensive. Groups C and D had lower temperatures, heart rates, and respiratory rates, with group C normotensive and group D hypotensive. Group A had higher odds ratio of 30-day inpatient mortality (P < .01) and group D had significant mortality benefit from balanced crystalloids compared to saline (P < .01) in all 3 models. DISCUSSION DTW- and GBTM-based clustering algorithms applied to vital signs in infected patients identified consistent subphenotypes with distinct clinical outcomes and treatment responses. CONCLUSION Time series clustering with distinct computational approaches demonstrate similar performance and significant agreement in the resulting subphenotypes.
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Affiliation(s)
- Sivasubramanium V Bhavani
- Department of Medicine, Emory University, Atlanta, Georgia, USA
- Emory Critical Care Center, Atlanta, Georgia, USA
| | - Li Xiong
- Department of Computer Science, Emory University, Atlanta, Georgia, USA
| | - Abish Pius
- Department of Computational & Systems Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Matthew Semler
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Edward T Qian
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Philip A Verhoef
- Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, USA
- Hawaii Permanente Medical Group, Honolulu, Hawaii, USA
| | - Chad Robichaux
- Department of Biomedical Informatics, Emory University, Atlanta, Georgia, USA
| | - Craig M Coopersmith
- Emory Critical Care Center, Atlanta, Georgia, USA
- Department of Surgery, Emory University, Atlanta, Georgia, USA
| | - Matthew M Churpek
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin, USA
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Bautista MJ, Kowal M, Cave DGW, Downey C, Jayne DG. Clinical applications of contactless photoplethysmography for monitoring in adults: A systematic review and meta-analysis. J Clin Transl Sci 2023; 7:e129. [PMID: 37313385 PMCID: PMC10260340 DOI: 10.1017/cts.2023.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/24/2023] [Accepted: 05/05/2023] [Indexed: 06/15/2023] Open
Abstract
Contactless photoplethysmography (cPPG) is a method of physiological monitoring. It differs from conventional monitoring methods (e.g., saturation probe) by ensuring no contact with the subject by use of a camera. The majority of research on cPPG is conducted in a laboratory setting or in healthy populations. This review aims to evaluate the current literature on monitoring using cPPG in adults within a clinical setting. Adhering to the Preferred Items for Systematic Reviews and Meta-analysis (PRISMA, 2020) guidelines, OVID, Webofscience, Cochrane library, and clinicaltrials.org were systematically searched by two researchers. Research articles using cPPG for monitoring purposes in adults within a clinical setting were selected. Twelve studies with a total of 654 individuals were included. Heart rate (HR) was the most investigated vital sign (n = 8) followed by respiratory rate ((n = 2), Sp02 (n = 2), and HR variability (n = 2). Four studies were included in a meta-analysis of HR compared to ECG data which demonstrated a mean bias of -0.13 (95% CI, -1.22-0.96). This study demonstrates cPPG can be a useful tool in the remote monitoring of patients and has demonstrated accuracy for HR. However, further research is needed into the clinical applications of this method.
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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. Int J Environ Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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