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1.
Adv Exp Med Biol ; 1232: 291-297, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893423

RESUMO

We present an IoT-based monitoring system for healthcare that allows for long-term measurements of blood pressure (BP), heart rate (HR), and body weight (BW), as well as near-infrared spectroscopy (NIRS) for measurement of prefrontal cortex (PFC) activity. To verify the applicability of the system, it was set up in a local fitness gym for a preliminary study. A total of 39 subjects, selected from members of the gym, participated in the study. We analyzed the BP, HR, and BW data, collected from the subjects over one half-year. In addition, to assess the degree of mental stress of the subjects, we analysed left-right asymmetry of the PFC activity using the laterality index at rest (LIR) of the NIRS parameter. Results show that the subjects were able to measure their physiological data by themselves when they visited the gym, after being instructed how to perform the measurements. Furthermore, the results also indicate that ordinary people can continuously monitor physiological functions such as brain function in a non-medical facility, such as a fitness gym.


Assuntos
Monitorização Fisiológica , Córtex Pré-Frontal , Espectroscopia de Luz Próxima ao Infravermelho , Idoso , Feminino , Lateralidade Funcional , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Autoexame/normas , Estresse Psicológico
2.
Adv Exp Med Biol ; 1232: 315-322, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893426

RESUMO

We present an unobtrusive cuff-less sphygmomanometer based on contact-type and optical pulse sensors for continuous and minimally invasive monitoring of blood pressure (BP). We developed a cuff-less sphygmomanometer that utilizes the pulse arrival time (PAT) to estimate continuous BP. To assess its accuracy, we recruited 10 healthy subjects in whom we carried out BP studies using the cuff-less sphygmomanometer compared with a standard cuff-type device in a stationary sitting patient. Preliminary results showed that the mean difference (MD) of estimated systolic blood pressure and diastolic blood pressure were 0.96 ± 9.6 (mean ± SD) mmHg and 1.14 ± 7.5 mmHg, respectively, compared to the control. The corresponding correlation between the estimated BP values and controls were 0.78 for systolic blood pressure (p < 0.01) and 0.69 for diastolic blood pressure (p < 0.01); thus, there were significant correlations. These results suggest that the developed cuff-less sphygmomanometer has the potential for continuous BP monitoring. Finally, we conducted a preliminary study of simultaneous monitoring of cuff-less BP and near-infrared spectroscopy to evaluate the potential for assessment of autonomic nervous system functions during mental stress tasks.


Assuntos
Determinação da Pressão Arterial , Esfigmomanômetros , Adulto , Sistema Nervoso Autônomo/fisiologia , Pressão Sanguínea , Determinação da Pressão Arterial/instrumentação , Eletrocardiografia , Frequência Cardíaca , Humanos , Masculino , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/normas , Esfigmomanômetros/normas , Adulto Jovem
3.
Adv Exp Med Biol ; 1232: 323-329, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893427

RESUMO

Recent guidelines on cardiopulmonary resuscitation (CPR) have stressed the necessity to improve the quality of CPR. Our previous studies demonstrated the usefulness of monitoring cerebral blood oxygenation (CBO) during CPR by near-infrared spectroscopy (NIRS). The present study evaluates whether the NIRO-CCR1, a new NIRS device, is as useful in the clinical setting as the NIRO-200NX. We monitored CBO in 20 patients with cardiac arrest by NIRS. On the arrival of patients at the emergency department, the attending physician immediately assessed whether the patient was eligible for this study after conventional advanced life support and, if eligible, measured CBO in the frontal lobe by NIRS. We found that in all patients, the cerebral blood flow waveform was in synchrony with the chest compressions. Moreover, the tissue oxygenation index increased following cardiopulmonary bypass (CPB) in patients undergoing CPB, including one patient in whom CBO was monitored using the NIRO-CCR1. In addition, although the NIRO-CCR1 could display the pulse rate (Tempo) in real time, Tempo was not always detected, despite detection of the cerebral blood flow waveform. This suggested that chest compressions may not have been effective, indicating that the NIRO-CCR1 also seems useful to assess the quality of CPR. This study suggests that the NIRO-CCR1 can measure CBO during CPR in patients with cardiac arrest as effectively as the NIRO-200NX; in addition, the new NIRO-CCR1 may be even more useful, especially in prehospital fields (e.g. in an ambulance), since it is easy to carry.


Assuntos
Reanimação Cardiopulmonar , Circulação Cerebrovascular , Parada Cardíaca , Monitorização Fisiológica , Oximetria , Espectroscopia de Luz Próxima ao Infravermelho , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/normas , Oximetria/instrumentação , Oximetria/normas , Projetos Piloto , Espectroscopia de Luz Próxima ao Infravermelho/instrumentação , Espectroscopia de Luz Próxima ao Infravermelho/normas
4.
Hosp Pract (1995) ; 47(4): 177-180, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31594430

RESUMO

Objective: We sought to determine a benchmark for our blood glucose monitoring and compare our data to published data.Methods: Natividad Medical Center is a 172-bed rural hospital located in Salinas, California.Point of care blood glucose (POC-BG) data was extracted from our EMR for all ICU patients greater than 18 years of age between January 2014 and May 2018. Patient day-weighted mean POC-BGs were calculated for each patient by calculating the average POC-BG per day for each patient. Proportion measurements for each of our measurements groups were recorded (>180 mg/dL, <70 mg/dL, >250 mg/dL and <50 mg/dL). Monthly averages were plotted for visual comparison. Benchmarks were calculated by using 2x Standard Deviation for each measurement group.Results: A total of 3164 patients were found with 21,006 POC-BG measurements. The average POC-BG was 136 mg/dL and median 119 mg/dL. Proportion measurements of monthly day-weighted mean POC-BGs ranged from 0-1.2%, 5.3-44.8%, 0-0.3% and 0.6-16.5%, respectively for less than 70 mg/dL, greater than 180 mg/dL, less than 50 mg/dL and greater than 250 mg/dL. A 2x Standard Deviation was used to calculate our benchmark cut offs which provides a 95% confidence interval and includes 97.5% when neglecting the lower range. Our calculated benchmark values are 1.2, 38.2, 0.19, and 13.1% respectively for measurement groups less than 70 mg/dL, greater than 180 mg/dL, less than 50 mg/dL and greater than 250 mg/dL.Conclusion: Here we present data from a small rural hospital in the Western United States. We calculated benchmarks that could be used to track our ongoing hyper/hypoglycemia improvement projects. We found that when compared to published data, our hyper/hypoglycemia data was comparable to national data.


Assuntos
Glicemia , Hospitais Rurais/organização & administração , Unidades de Terapia Intensiva/organização & administração , Monitorização Fisiológica/normas , Sistemas Automatizados de Assistência Junto ao Leito/normas , Hospitais Rurais/normas , Humanos , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Unidades de Terapia Intensiva/normas , Padrões de Referência , Índice de Gravidade de Doença
5.
Gut ; 68(10): 1731-1750, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31366456

RESUMO

These guidelines on oesophageal manometry and gastro-oesophageal reflux monitoring supersede those produced in 2006. Since 2006 there have been significant technological advances, in particular, the development of high resolution manometry (HRM) and oesophageal impedance monitoring. The guidelines were developed by a guideline development group of patients and representatives of all the relevant professional groups using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. A systematic literature search was performed and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) tool was used to evaluate the quality of evidence and decide on the strength of the recommendations made. Key strong recommendations are made regarding the benefit of: (i) HRM over standard manometry in the investigation of dysphagia and, in particular, in characterising achalasia, (ii) adjunctive testing with larger volumes of water or solids during HRM, (iii) oesophageal manometry prior to antireflux surgery, (iv) pH/impedance monitoring in patients with reflux symptoms not responding to high dose proton pump inhibitors and (v) pH monitoring in all patients with reflux symptoms responsive to proton pump inhibitors in whom surgery is planned, but combined pH/impedance monitoring in those not responsive to proton pump inhibitors in whom surgery is planned. This work has been endorsed by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG) under the auspices of the oesophageal section of the BSG.


Assuntos
Gastroenterologia , Refluxo Gastroesofágico/diagnóstico , Manometria/normas , Monitorização Fisiológica/métodos , Sociedades Médicas , Humanos , Monitorização Fisiológica/normas , Reino Unido
6.
Sensors (Basel) ; 19(14)2019 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-31337067

RESUMO

Mobile gait analysis systems using wearable sensors have the potential to analyze and monitor pathological gait in a finer scale than ever before. A closer look at gait in Parkinson's disease (PD) reveals that turning has its own characteristics and requires its own analysis. The goal of this paper is to present a system with on-shoe wearable sensors in order to analyze the abnormalities of turning in a standardized gait test for PD. We investigated turning abnormalities in a large cohort of 108 PD patients and 42 age-matched controls. We quantified turning through several spatio-temporal parameters. Analysis of turn-derived parameters revealed differences of turn-related gait impairment in relation to different disease stages and motor impairment. Our findings confirm and extend the results from previous studies and show the applicability of our system in turning analysis. Our system can provide insight into the turning in PD and be used as a complement for physicians' gait assessment and to monitor patients in their daily environment.


Assuntos
Algoritmos , Monitorização Fisiológica/instrumentação , Doença de Parkinson/fisiopatologia , Sapatos , Dispositivos Eletrônicos Vestíveis , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Desenho de Equipamento , Feminino , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Reprodutibilidade dos Testes , Análise Espaço-Temporal
7.
Handb Clin Neurol ; 160: 67-81, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31277877

RESUMO

Since the purpose of clinical neurophysiology testing is to record the electrical activity of the nervous system, and often to electrically stimulate the peripheral or central nervous system (for evoked potentials, nerve conduction studies, etc.), these tests by their very nature demand an excellent electrical connection to the patient. This direct electrical connection by definition puts the patient at increased risk of electrical shock. When patients suffer from other nonneurological disorders that also require equipment to be attached to or inserted into their body, the additional and more direct electrical pathways to the heart make them even more vulnerable, especially when undergoing monitoring in the operating room or intensive care unit. Although we depend on the hospital's construction and utilities to follow appropriate regulations (the National Electrical Code in the United States) and on the vendors to sell only safe equipment (approved by the Food and Drug Administration in the United States), there may exist combinations of equipment and connections that put the patient at risk of injurious or fatal electrical shock. Regular testing and safe practices, informed by a scientific understanding of the risks, are the responsibilities of the healthcare providers in order to protect the patient from harm from electricity.


Assuntos
Traumatismos por Eletricidade/prevenção & controle , Terapia por Estimulação Elétrica/efeitos adversos , Monitorização Fisiológica/efeitos adversos , Segurança do Paciente , Traumatismos por Eletricidade/etiologia , Terapia por Estimulação Elétrica/normas , Eletricidade/efeitos adversos , Eletrodos Implantados/efeitos adversos , Humanos , Monitorização Fisiológica/normas , Condução Nervosa/fisiologia , Segurança do Paciente/normas
8.
Rev Bras Enferm ; 72(3): 609-616, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269123

RESUMO

OBJECTIVE: To measure the magnitude of the effect of an individualized parameterization protocol for hemodynamic alarms in patients with acute myocardial infarction. METHOD: Pragmatic clinical trial, open label and single arm, whose intervention was performed through a protocol validated and tested in 32 patients using multiparametric monitors. The heart rate, blood pressure, respiratory rate, oxygen saturation and ST segment-monitoring were measured and classified for clinical consistency one hour before and after the intervention, for 64 hours. RESULTS: The protocol obtained Content Validity Index of 0.92. Of the 460 registered alarms, 261 were considered inconsistent before the intervention and 47 after it. The Relative Risk of inconsistent alarms after the protocol was 0.32 (95% CI 0.23-0.43, p <0.0001). CONCLUSION: The protocol proved to be a protective factor to the appearance of inconsistent clinical alarms of multiparametric monitors.


Assuntos
Monitorização Fisiológica/enfermagem , Infarto do Miocárdio/enfermagem , Idoso , Pressão Sanguínea/fisiologia , Alarmes Clínicos , Eletrocardiografia/enfermagem , Eletrocardiografia/normas , Feminino , Frequência Cardíaca/fisiologia , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/normas
9.
Curr Opin Anaesthesiol ; 32(4): 453-456, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31169549

RESUMO

PURPOSE OF REVIEW: Capnography is an excellent tool for early detection of hypoxemia and apnea in patients undergoing sedation for gastrointestinal endoscopy. The current American Society of Anesthesiology (ASA) guidelines recommend the use of capnography in any patient undergoing moderate sedation. The purpose of this review was to compile the most recent data available on capnography use in gastrointestinal endoscopy with the focus primarily on the use of capnography in moderate sedation cases. RECENT FINDINGS: Recent high-quality studies have evaluated the utility of capnography in low risk patients undergoing moderate sedation and have found no benefit with addition of capnography. SUMMARY: Capnography is beneficial when used for patients who are at a higher risk for sedation-related complications. There is no benefit when capnography is used in low risk patients undergoing routine upper endoscopy and colonoscopy under moderate sedation but there is benefit when used in advanced endoscopic procedures that require deeper sedation and have longer procedure times.


Assuntos
Capnografia/normas , Sedação Consciente/efeitos adversos , Sedação Profunda/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Monitorização Fisiológica/normas , Dor Processual/prevenção & controle , Apneia/diagnóstico , Apneia/etiologia , Humanos , Hipóxia/diagnóstico , Hipóxia/etiologia , Monitorização Fisiológica/métodos , Dor Processual/etiologia , Guias de Prática Clínica como Assunto , Fatores de Risco , Fatores de Tempo
10.
Int J Med Inform ; 128: 18-23, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31160007

RESUMO

BACKGROUND: Almost two thirds of patients diagnosed with cancer are age 65 years or older. In order to follow up on older patients with cancer receiving chemotherapy at home, we implemented remote phone monitoring conducted by skilled oncology nurses. However, given the rising number of patients assessed and the limited time that hospital professionals can spend on their patients after discharge, we needed to modernize this program. In this paper we present the preliminary results and the ongoing evaluation. METHOD: We implemented a semi-automated messaging application to upgrade the current follow-up procedures. The primary aim is to collect patient's key data over time and to free up nurses' time so that during phone calls they can focus on education and support. The Chatbot feasibility was assessed in a sub-sample of unselected patients before its wider dissemination and pragmatic evaluation. MAIN RESULTS: During the first deployment period, 9 unselected patients benefited from the Chatbot (mean 83 y.o.) with a total of 52 completed remote evaluations. Each participant answered 6 questionnaires over 7 weeks with an 86% compliance rate. The average completion time for the questionnaires was 3.5 min and the answer rate was 100%. The 'free text' field was used in 58% of the questionnaires. The Chatbot solution is currently proposed to all eligible patients thanks to the regional cancer network support. We are measuring acceptability, health outcomes and health network impact. DISCUSSION AND CONCLUSION: The results of this first phase are encouraging. The integration of the solution into the health care organization was feasible and acceptable. Moreover, the answers revealed serious health (e.g. fever) or adherence (e.g. blood test) issues that require timely interventions. The major strength of this solution is to rely on end-users' current knowledge of technologies (text-messaging), which allows a seamless integration into a complex clinical network.


Assuntos
Avaliação Geriátrica/métodos , Monitorização Fisiológica/normas , Neoplasias/tratamento farmacológico , Smartphone/estatística & dados numéricos , Mensagem de Texto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Cooperação do Paciente , Inquéritos e Questionários
11.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31248940

RESUMO

Ventilatory support may affect the short- and long-term neurologic and respiratory morbidities of preterm infants. Ongoing monitoring of oxygenation and ventilation and control of adequate levels of oxygen, pressures, and volumes can decrease the incidence of such adverse outcomes. Use of pulse oximetry became a standard of care for titrating oxygen delivery, but continuous noninvasive monitoring of carbon dioxide (CO2) is not routinely used in NICUs. Continuous monitoring of CO2 level may be crucial because hypocarbia and hypercarbia in extremely preterm infants are associated with lung and brain morbidities, specifically bronchopulmonary dysplasia, intraventricular hemorrhage, and cystic periventricular leukomalacia. It is shown that continuous monitoring of CO2 levels helps in maintaining stable CO2 values within an accepted target range. Continuous monitoring of CO2 levels can be used in the delivery room, during transport, and in infants receiving invasive or noninvasive respiratory support in the NICU. It is logical to hypothesize that this will result in better outcome for extremely preterm infants. In this article, we review the different noninvasive CO2 monitoring alternatives and devices, their advantages and disadvantages, and the available clinical data supporting or negating their use as a standard of care in NICUs.


Assuntos
Dióxido de Carbono/sangue , Terapia Intensiva Neonatal/métodos , Monitorização Fisiológica/métodos , Biomarcadores/sangue , Gasometria/instrumentação , Gasometria/métodos , Gasometria/normas , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal/normas , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/normas , Respiração Artificial , Padrão de Cuidado
12.
Implement Sci ; 14(1): 65, 2019 06 19.
Artigo em Inglês | MEDLINE | ID: mdl-31217028

RESUMO

BACKGROUND: Each year, 2.2 million intrapartum-related deaths (intrapartum stillbirths and first day neonatal deaths) occur worldwide with 99% of them taking place in low- and middle-income countries. Despite the accelerated increase in the proportion of deliveries taking place in health facilities in these settings, the stillborn and neonatal mortality rates have not reduced proportionately. Poor quality of care in health facilities is attributed to two-thirds of these deaths. Improving quality of care during the intrapartum period needs investments in evidence-based interventions. We aim to evaluate the quality improvement package-Scaling Up Safer Bundle Through Quality Improvement in Nepal (SUSTAIN)-on intrapartum care and intrapartum-related mortality in public hospitals of Nepal. METHODS: We will conduct a stepped wedge cluster randomized controlled trial in eight public hospitals with each having least 3000 deliveries a year. Each hospital will represent a cluster with an intervention transition period of 2 months in each. With a level of significance of 95%, the statistical power of 90% and an intra-cluster correlation of 0.00015, a study period of 19 months should detect at least a 15% change in intrapartum-related mortality. Quality improvement training, mentoring, systematic feedback, and a continuous improvement cycle will be instituted based on bottleneck analyses in each hospital. All concerned health workers will be trained on standard basic neonatal resuscitation and essential newborn care. Portable fetal heart monitors (Moyo®) and neonatal heart rate monitors (Neobeat®) will be introduced in the hospitals to identify fetal distress during labor and to improve neonatal resuscitation. Independent research teams will collect data in each hospital on intervention inputs, processes, and outcomes by reviewing records and carrying out observations and interviews. The dose-response effect will be evaluated through process evaluations. DISCUSSION: With the global momentum to improve quality of intrapartum care, better understanding of QI package within a health facility context is important. The proposed package is based on experiences from a similar previous scale-up trial carried out in Nepal. The proposed evaluation will provide evidence on QI package and technology for implementation and scale up in similar settings. TRIAL REGISTRATION NUMBER: ISRCTN16741720 . Registered on 2 March 2019.


Assuntos
Hospitais Públicos/organização & administração , Pacotes de Assistência ao Paciente , Assistência Perinatal/normas , Melhoria de Qualidade , Países em Desenvolvimento , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Mortalidade Materna , Monitorização Fisiológica/normas , Nepal , Gravidez , Ressuscitação/normas
13.
Crit Rev Oncol Hematol ; 141: 73-81, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31252322

RESUMO

This study aimed to assess the false-positive proportion of follow-up 18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in lymphoma patients who initially achieved an end-of-treatment complete remission, using biopsy as reference standard. Medline was searched for original studies, studies were methodologically evaluated and results were meta-analytically summarized. Proportion of false-positive results ranged between 9.5%-90.0%, with a weighted summary proportion (random effects) of 42.9% (95% confidence interval [CI]: 29.0%-58.0%). A separate subgroup analysis in symptomatic patients only again revealed a relatively high summary proportion of false-positive follow-up FDG-PET of 37.5% (random effects). In conclusion, the false-positive proportion of follow-up FDG-PET in lymphoma patients who initially achieved an end-of-treatment complete remission is high and remains high when a combination of clinical symptoms and follow-up FDG-PET is used. Therefore, biopsy remains compulsory and follow-up FDG-PET alone may be regarded as unreliable to define progression-free survival.


Assuntos
Fluordesoxiglucose F18 , Linfoma/diagnóstico , Monitorização Fisiológica , Tomografia por Emissão de Pósitrons/métodos , Tomografia por Emissão de Pósitrons/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Criança , Pré-Escolar , Reações Falso-Positivas , Feminino , Fluordesoxiglucose F18/farmacocinética , Seguimentos , Humanos , Linfoma/epidemiologia , Linfoma/metabolismo , Linfoma/patologia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Monitorização Fisiológica/estatística & dados numéricos , Tomografia por Emissão de Pósitrons/normas , Indução de Remissão , Adulto Jovem
14.
BMJ ; 365: l1516, 2019 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036557

RESUMO

OBJECTIVE: To investigate associations between pre-eclampsia and later risk of kidney disease. DESIGN: Nationwide register based cohort study. SETTING: Denmark. POPULATION: All women with at least one pregnancy lasting at least 20 weeks between 1978 and 2015. MAIN OUTCOME MEASURE: Hazard ratios comparing rates of kidney disease between women with and without a history of pre-eclampsia, stratified by gestational age at delivery and estimated using Cox regression. RESULTS: The cohort consisted of 1 072 330 women followed for 19 994 470 person years (average 18.6 years/woman). Compared with women with no previous pre-eclampsia, those with a history of pre-eclampsia were more likely to develop chronic renal conditions: hazard ratio 3.93 (95% confidence interval 2.90 to 5.33, for early preterm pre-eclampsia (delivery <34 weeks); 2.81 (2.13 to 3.71) for late preterm pre-eclampsia (delivery 34-36 weeks); 2.27 (2.02 to 2.55) for term pre-eclampsia (delivery ≥37 weeks). In particular, strong associations were observed for chronic kidney disease, hypertensive kidney disease, and glomerular/proteinuric disease. Adjustment for cardiovascular disease and hypertension only partially attenuated the observed associations. Stratifying the analyses on time since pregnancy showed that associations between pre-eclampsia and chronic kidney disease and glomerular/proteinuric disease were much stronger within five years of the latest pregnancy (hazard ratio 6.11 (3.84 to 9.72) and 4.77 (3.88 to 5.86), respectively) than five years or longer after the latest pregnancy (2.06 (1.69 to 2.50) and 1.50 (1.19 to 1.88). By contrast, associations between pre-eclampsia and acute renal conditions were modest. CONCLUSION: s Pre-eclampsia, particularly early preterm pre-eclampsia, was strongly associated with several chronic renal disorders later in life. More research is needed to determine which women are most likely to develop kidney disease after pre-eclampsia, what mechanisms underlie the association, and what clinical follow-up and interventions (and in what timeframe post-pregnancy) would be most appropriate and effective.


Assuntos
Hipertensão Renal/epidemiologia , Nefropatias/diagnóstico , Nefropatias/etiologia , Pré-Eclâmpsia/diagnóstico , Adulto , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Dinamarca/epidemiologia , Feminino , Idade Gestacional , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Hipertensão Renal/complicações , Nefropatias/epidemiologia , Monitorização Fisiológica/normas , Período Pós-Parto , Pré-Eclâmpsia/epidemiologia , Gravidez , Fatores de Risco , Adulto Jovem
15.
J Wound Ostomy Continence Nurs ; 46(3): 207-213, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31083063

RESUMO

PURPOSE: We examined the usability, user perceptions, and nursing occupational subculture associated with introduction of a patient monitoring system to facilitate nursing staff implementation of standard care for pressure ulcer/injury prevention in the nursing home setting. DESIGN: Mixed methods, pre-/posttest design. SUBJECTS AND SETTING: Resident (n = 44) and staff (n = 38) participants were recruited from a 120-bed nursing home in the Southeast United States. METHODS: Digital data on frequency and position of residents were transmitted wirelessly from sensors worn on each resident's anterior chest to estimate nursing staff compliance with repositioning standard of care before and after visual monitors were activated to cue staff. The validated Nursing Culture Assessment Tool was used to determine changes in nursing culture. Benefits and challenges of implementation were assessed by 2 focus groups composed of 8 and 5 female members of the nursing staff (RN, LPN, CNA), respectively, and led by the three authors. Descriptive statistics were used for all quantitative variables, and inferential statistics were applied to categorical variables (χ test or Fisher exact test) and continuous variables (analyses of variance or equivalent nonparametric tests), respectively, where a 2-sided P value of <.05 was considered statistically significant. RESULTS: System use significantly (P = .0003) improved compliance with every 2-hour repositioning standards. The nursing culture normative ranking percentage increased from 30.9% to 58.2%; this difference was not statistically significant. Focus groups expressed satisfaction with the monitoring system and recommended improvements to support adaptation and use of technology. CONCLUSIONS: Study findings support the usability of the patient monitoring system to facilitate repositioning. Implementation of multiple strategies for training, supplies, and communication may enhance uptake and effectiveness.


Assuntos
Monitorização Fisiológica/métodos , Casas de Saúde/estatística & dados numéricos , Lesão por Pressão/complicações , Lesão por Pressão/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Feminino , Grupos Focais/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/normas , Casas de Saúde/organização & administração , Postura , Lesão por Pressão/epidemiologia , Pesquisa Qualitativa , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Sudeste dos Estados Unidos/epidemiologia
19.
JMIR Mhealth Uhealth ; 7(3): e11516, 2019 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-30907741

RESUMO

BACKGROUND: Remote monitoring technologies are positioned to mitigate the problem of a dwindling care workforce and disparities in access to care for the growing older immigrant population in the United States. To achieve these ends, designers and providers need to understand how these supports can be best provided in the context of various sociocultural environments that shape older adults' expectations and care relationships, yet few studies have examined how the same remote monitoring technologies may produce different effects and uses depending on what population is using them in a particular context. OBJECTIVE: This study aimed to examine the experiences and insights of low-income, immigrant senior residents, family contacts, and staff of housing that offered a sensor-based passive monitoring system designed to track changes in movement around the home and trigger alerts for caregivers. The senior housing organization had been offering the QuietCare sensor system to its residents for 6 years at the time of the study. We are interested in adoption and discontinuation decisions and use over time, rather than projected acceptance. Our research question is how do cultural differences influence use and experiences with this remote monitoring technology? The study does not draw generalizable conclusions about how cultural groups interact with a given technology, but rather, it examines how values are made visible in elder care technology interactions. METHODS: A total of 41 participants (residents, family, and staff) from 6 large senior housing independent living apartment buildings were interviewed. Interviews were conducted in English and Korean with these participants who collectively had immigrated to the United States from 10 countries. RESULTS: The reactions of immigrant older adults to the passive monitoring system reveal that this tool offered to them was often mismatched with their values, needs, and expectations. Asian elders accepted the intervention social workers offered largely to appease them, but unlike their US-born counterparts, they adopted reluctantly without hope that it would ameliorate their situation. Asian immigrants discontinued use at the highest rate of all residents, and intergenerational family cultural conflict contributed to this termination. Social workers reported that none of the large population of Russian-speaking residents agreed to use QuietCare. Bilingual and bicultural social workers played significant roles as cultural navigators in the promotion of QuietCare to residents. CONCLUSIONS: This research into the interactions of culturally diverse people with the same monitoring technology reveals the significant role that social values and context play in shaping how people and families interact with and experience elder care interventions. If technology-based care services are to reach their full potential, it will be important to identify the ways in which cultural values produce different uses and responses to technologies intended to help older adults live independently.


Assuntos
Monitorização Fisiológica/métodos , Pobreza/psicologia , Telemedicina/normas , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/normas , Pobreza/estatística & dados numéricos , Pesquisa Qualitativa , Telemedicina/instrumentação , Telemedicina/métodos , Estados Unidos
20.
JMIR Mhealth Uhealth ; 7(3): e13137, 2019 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-30888331

RESUMO

BACKGROUND: High blood pressure is one of the most common reasons why patients seek assistance in daily clinical practice. Screening for hypertension is fundamental and, because hypertension is identified only when blood pressure is measured, accurate measurements are key to the diagnosis and management of this disease. The European Society of Hypertension International Protocol revision 2010 (ESH-IP2) was developed to assess the validity of automatic blood pressure measuring devices that are increasingly being used to replace mercury sphygmomanometers. OBJECTIVE: We sought to determine whether the iHealth Track blood pressure monitor meets ESH-IP2 requirements for self-measurement of blood pressure and heart rate at the brachial level and is appropriate for use in the general population. METHODS: This study was a descriptive investigation. ESH-IP2 requires a total number of 33 participants. For each measure, the difference between observer and device blood pressure and heart rate values is calculated. In all, 99 pairs of blood pressure differences are classified into 3 categories (≤5, ≤10, and ≤15 mm Hg), and 99 pairs of heart rate differences are classified into 3 categories (≤3, ≤5, and ≤8 beats/min). We followed these protocol procedures in a convenience sample of 33 participants. RESULTS: iHealth Track fulfilled ESH-IP2 requirements and passed the validation process successfully. We observed an absolute difference within 5 mm Hg in 75 of 99 comparisons for systolic blood pressure, 78 of 99 comparisons for diastolic blood pressure, and 89 of 99 comparisons for heart rate. The mean differences between the test and standard readings were 4.19 (SD 4.48) mm Hg for systolic blood pressure, 3.74 (SD 4.55) mm Hg for diastolic blood pressure, and 1.95 (SD 3.27) beats/min for heart rate. With regard to part 2 of ESH-IP2, we observed a minimum of 2 of 3 measurements within a 5-mm Hg difference in 29 of 33 participants for systolic blood pressure and 26 of 33 for diastolic blood pressure, and a minimum of 2 of 3 measurements within a 3-beat/min difference in 30 of 33 participants for heart rate. CONCLUSIONS: iHealth Track readings differed from the standard by less than 5, 10, and 15 mm Hg, fulfilling ESH-IP2 requirements. Consequently, this device is suitable for use in the general population.


Assuntos
Determinação da Pressão Arterial/normas , Pressão Sanguínea , Hipertensão/terapia , Aplicativos Móveis/normas , Monitorização Fisiológica/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Determinação da Pressão Arterial/instrumentação , Determinação da Pressão Arterial/estatística & dados numéricos , Desenho de Equipamento/normas , Desenho de Equipamento/estatística & dados numéricos , Feminino , Humanos , Hipertensão/psicologia , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis/estatística & dados numéricos , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Autogestão/métodos , Estatísticas não Paramétricas , Avaliação da Tecnologia Biomédica/métodos
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