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1.
Hu Li Za Zhi ; 67(1): 4-5, 2020 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-31960390

RESUMO

Disease progression often differs among patients. According to study findings, changes in vital signs, blood oxygen saturation, and consciousness are each related closely to acute deterioration in disease status (Sutherasan et al., 2018). The early warning system (EWS) is a predictive approach to detecting deterioration in disease condition based on the observation of slight variations in patient vital signs and clinical symptoms (Smith et al., 2014). Most patients experience changes in specific physiological variables before experiencing a cardiac arrest. The implementation of a comprehensive EWS facilitates the early identification and prevention of serious adverse events such as unexpected cardiac arrest and death, and may help reduce the risk of other unexpected events as well (Gerry et al., 2017). For medical team members, the use of EWS not only permits the detection of changes in patient condition at an early stage but also allows healthcare workers to respond more proactively and effectively. Moreover, EWS has been shown to improve communication, increase cooperation, and strengthen personal responsibility among healthcare workers (Burns et al., 2018). In summary, implementing EWS allows the prompt initiation of appropriate patient treatment and helps improve patient-care outcomes. While recognizing the importance of incorporating EWS into patient care in clinical and home-based institutions as an important strategy to protecting the lives of patients, appropriate standardized warning systems must be tailored to address different disease characteristics. Changes in patient condition are traditionally addressed through nursing assessment followed by physician notification and response. However, this process may be affected by factors such as assessment accuracy, cultural differences, confidence, and past experiences that may result in decision-making errors (Wood, Chaboyer, & Carr, 2019). The integration of EWS and medical informatics technology is expected to reduce the risks of human-interpretation-related omissions and errors (Downey, Tahir, Randell, Brown, & Jayne, 2017). Although the use of medical informatics technology to enhance EWS remains in its infancy, this will certainly be one of the future trends in patient care. The articles in this issue, in addition to introducing EWS, elucidate the current application of EWS in clinical critical conditions and introduce how informatics technology is being combined in home EWS applications. These articles comprise a rich body of information on EWS that may referenced in clinical nursing care, home care, education, and research.


Assuntos
Deterioração Clínica , Diagnóstico Precoce , Parada Cardíaca/prevenção & controle , Humanos , Sinais Vitais
2.
Arch Dis Child Fetal Neonatal Ed ; 105(1): 87-93, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31123057

RESUMO

OBJECTIVE: High-flow nasal cannula (HFNC) therapy is increasingly used in preterm infants despite a paucity of physiological studies. We aimed to investigate the effects of HFNC on respiratory physiology. STUDY DESIGN: A prospective randomised crossover study was performed enrolling clinically stable preterm infants receiving either HFNC or nasal continuous positive airway pressure (nCPAP). Infants in three current weight groups were studied: <1000 g, 1000-1500 g and >1500 g. Infants were randomised to either first receive HFNC flows 8-2 L/min and then nCPAP 6 cm H2O or nCPAP first and then HFNC flows 8-2 L/min. Nasopharyngeal end-expiratory airway pressure (pEEP), tidal volume, dead space washout by nasopharyngeal end-expiratory CO2 (pEECO2), oxygen saturation and vital signs were measured. RESULTS: A total of 44 preterm infants, birth weights 500-1900 g, were studied. Increasing flows from 2 to 8 L/min significantly increased pEEP (mean 2.3-6.1 cm H2O) and reduced pEECO2 (mean 2.3%-0.9%). Tidal volume and transcutaneous CO2 were unchanged. Significant differences were seen between pEEP generated in open and closed mouth states across all HFNC flows (difference 0.6-2.3 cm H2O). Infants weighing <1000 g received higher pEEP at the same HFNC flow than infants weighing >1000 g. Variability of pEEP generated at HFNC flows of 6-8 L/min was greater than nCPAP (2.4-13.5 vs 3.5-9.9 cm H2O). CONCLUSIONS: HFNC therapy produces clinically significant pEEP with large variability at higher flow rates. Highest pressures were observed in infants weighing <1000 g. Flow, weight and mouth position are all important determinants of pressures generated. Reductions in pEECO2 support HFNC's role in dead space washout.


Assuntos
Oxigenoterapia/métodos , Respiração com Pressão Positiva , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Peso Corporal , Dióxido de Carbono/sangue , Pressão Positiva Contínua nas Vias Aéreas , Estudos Cross-Over , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Oxigênio/sangue , Estudos Prospectivos , Volume de Ventilação Pulmonar , Sinais Vitais
3.
J Glob Health ; 9(2): 020432, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31788230

RESUMO

Background: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide, but it mainly affects women from low- and middle-income countries. Despite being a treatable condition, the high number of maternal deaths resulting from PPH is outstanding for at least 25 years. Late diagnosis and difficulties in identifying women who will develop severe postpartum bleeding can, in part, explain the high incidence of PPH. Over the past few years, researchers have focused on identifying a simple, accessible and low-cost diagnostic tool that could be applied to avoid maternal deaths. In particular, it has been suggested that vital signs and shock index (SI) could be useful. The objective of this study was to evaluate whether vital signs are correlated with the percentage of body blood volume (BBVp) lost after vaginal delivery. Methods: A prospective cohort study was performed at the Women's Hospital of UNICAMP, Brazil. The inclusion criteria were women delivering vaginally who did not suffer from hypertension, hyper- or hypothyroidism, cardiac disease, infections or coagulopathy. Blood loss was measured over 24 hours using a calibrated drape and by weighing compresses, gauzes and pads. Vital signs were measured up to 24 hours after delivery. We evaluated the BBVp lost, and generated a Receiver operating characteristics (ROC) curve with area under the curve (AUC) analysis to determine the cut-off values for vital signs to determine the likelihood of postpartum bleeding above the 90th percentile within 24 hours of delivery. Results: A total of 270 women were included. The mean blood loss within 24 hours of vaginal delivery was 570.66 ± 360.04 mL. In the first 40 minutes, 73% of the total blood loss over the 24-hour period had occurred, and within 2 hours, 91% of women had bled 90% of the total blood loss. Changes in SI and heart rate (HR) were statistically significant in predicting postpartum bleeding (P ≤ 0.05). Higher values for likelihood ratio (LR) to identify BBVp loss above the 90th percentile within 2 hours were a SI above 1.04 at 41-60 minutes after birth (LR = +11.84) and a HR above 105.2 bpm at 21-40 minutes after birth (LR = +4.96). Both measures showed high specificity but low sensitivity. Conclusion: Values of SI and HR are statistically significant in predicting postpartum bleeding with high specificity but low sensitivity. The cut-off points were 1.04 for SI and 105 bpm for HR.


Assuntos
Perda Sanguínea Cirúrgica/fisiopatologia , Parto Obstétrico/efeitos adversos , Frequência Cardíaca/fisiologia , Hemorragia Pós-Parto/epidemiologia , Índices de Gravidade do Trauma , Adulto , Volume Sanguíneo , Brasil/epidemiologia , Feminino , Humanos , Incidência , Mortalidade Materna , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Índice de Gravidade de Doença , Sinais Vitais
4.
Prensa méd. argent ; 105(11): 783-785, dic2019. fig
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1049774

RESUMO

Background: It is widely established that the extraction of impaled objects should be carried out under direct vision. In the case of stable patients, endoscopic vision can be used as an alternative. Clinical Case: A 70-year-old male is admitted for a 5-hour impaled precordial stab wound. Evolution valued according to ATLS standards. Clinically and hemodynamically compensated patient. On physical examination: left pulmonary hypoventilation, subcutaneous emphysema, no jugular engorgement. Control of vital signs: TA: 110 / 70mmHg, FC: 70min, FR: 20min, Sat02: 97%. Complementary studies: ECO FAST: no pericardial fluid. Rx thorax: mild left pneumothorax heme. Chest CT: Puncture object of 18 cm in the left lung of AP and medial to the lateral path, hematoma of the angle, and hemopneumothorax grade I. Surgery: Patient in dorsal recumbency, under ARM with selective intubation. An incision in 5th left intercostal space, middle axillary line. 10mm trocar placement, 30 ° optics introduction. After discarding the commitment of the pericardium, active bleeding, and observing that the end of the weapon was going through the end of the angle, the weapon is removed under endoscopic vision. Clot washing/aspiration. Verification of hemostasis, absence of air leakage and pulmonary expansion. Drainage with 28 French tubes. Evolution: Derived from UTI extubated. CT scan thorax 72 h post: small intraparenchymal hematoma left, expanded lung. Minimum serohematic debit. Pleural tube and definitive discharge are removed on the 4th post-surgical day. Discussion: The literature suggests in the urgency, the removal of impaled objects under direct vision of the compromised structures. However, in stable patients, the previous study with CT should be unavoidable. Video-thoracoscopy in these wounded can avoid open surgery, but the procedure must be performed in trauma reference centers, with the appropriate means and by a trained surgical team willing to perform an emergency thoracotomy


Assuntos
Masculino , Idoso , Ferimentos Perfurantes/cirurgia , Dor no Peito/cirurgia , Toracotomia , Laparoscopia , Cirurgia Torácica Vídeoassistida , Sinais Vitais
5.
Scand J Trauma Resusc Emerg Med ; 27(1): 111, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842961

RESUMO

BACKGROUND: The national early warning score (NEWS) enables early detection of in-hospital patient deterioration and timely activation of hospital's rapid response team (RRT). NEWS was updated in 2017 to include a separate SpO2 scale for those patients with type II respiratory failure (T2RF). In this study we investigated whether NEWS with and without the new SpO2 scale for the T2RF patients is associated with immediate and in-hospital patient outcomes among the patients actually attended by the RRT. METHODS: We conducted a two-year prospective observational study including all adult RRT patients without limitations of medical treatment (LOMT) in a large Finnish university associated tertiary level hospital. According to the first vital signs measured by the RRT, we calculated NEWSs for the RRT patients and further utilized the new SpO2 scale for the patients with confirmed T2RF. We used multivariate logistic regression and area under the receiver operating characteristic analyses to test NEWS's accuracy to predict two distinct outcomes: RRT patient's I) immediate need for intensive care and/or new LOMT and 2) in-hospital death or discharge with cerebral performance category >2 and/or LOMT. RESULTS: The final cohort consisted of 886 RRT patients attended for the first time during their hospitalization. Most common reasons for RRT activation were respiratory (343, 39%) and circulatory (226, 26%) problems. Cohort's median (Q1, Q3) NEWS at RRT arrival was 8 (5, 10) and remained unchanged if the new SpO2 scale was applied for the 104 patients with confirmed T2RF. Higher NEWS was independently associated with both immediate (OR 1.28; 95% CI 1.22-1.35) and in-hospital (1.15; 1.10-1.21) adverse outcomes. Further, NEWS had fair discrimination for both the immediate (AUROC 0.73; 0.69-0.77) and in-hospital (0.68; 0.64-0.72) outcomes. Utilizing the new SpO2 scale for the patients with confirmed T2RF did not improve the discrimination capability (0.73; 0.69-0.76 and 0.68; 0.64-0.71) for these outcomes, respectively. CONCLUSIONS: We found that in patients attended by a RRT, the NEWS predicts patient's hospital outcome with moderate accuracy. We did not find any improvement using the new SpO2 scale in T2RF patients.


Assuntos
Equipe de Respostas Rápidas de Hospitais/normas , Insuficiência Respiratória/terapia , Adulto , Idoso , Estudos de Coortes , Cuidados Críticos , Diagnóstico Precoce , Estudos de Avaliação como Assunto , Feminino , Finlândia , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Estudos Prospectivos , Curva ROC , Insuficiência Respiratória/fisiopatologia , Sinais Vitais
6.
Br J Nurs ; 28(19): 1256-1259, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31680572

RESUMO

Clinical surveillance provides essential data on changes in a patient's condition. The common method for performing this surveillance is the assessment of vital signs. Despite the importance of these signs, research has found that vital signs are not rigorously assessed in clinical practice. Respiratory rate, arguably the most important vital sign, is the most neglected. Poor understanding might contribute to nurses incorrectly valuing oxygen saturation more than respiratory rate. Nurses need to understand the importance of respiratory rate assessment as a vital sign and the benefits and limitations of pulse oximetry as a clinical tool. By better understanding pulse oximetry and respiratory rate assessment, nurses might be more inclined to conduct rigorous vital signs' assessment. Research is needed to understand why many nurses do not appreciate the importance of vital signs' monitoring.


Assuntos
Monitorização Fisiológica/enfermagem , Avaliação em Enfermagem/estatística & dados numéricos , Oximetria/enfermagem , Taxa Respiratória , Humanos , Monitorização Fisiológica/métodos , Sinais Vitais
7.
Best Pract Res Clin Anaesthesiol ; 33(2): 229-245, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31582102

RESUMO

The postoperative ward is considered an ideal nursing environment for stable patients transitioning out of the hospital. However, approximately half of all in-hospital cardiorespiratory arrests occur here and are associated with poor outcomes. Current monitoring practices on the hospital ward mandate intermittent vital sign checks. Subtle changes in vital signs often occur at least 8-12 h before an acute event, and continuous monitoring of vital signs would allow for effective therapeutic interventions and potentially avoid an imminent cardiorespiratory arrest event. It seems tempting to apply continuous monitoring to every patient on the ward, but inherent challenges such as artifacts and alarm fatigue need to be considered. This review looks to the future where a continuous, smarter, and portable platform for monitoring of vital signs on the hospital ward will be accompanied with a central monitoring platform and machine learning-based pattern detection solutions to improve safety for hospitalized patients.


Assuntos
Hospitalização/tendências , Monitorização Fisiológica/tendências , Cuidados Pós-Operatórios/tendências , Complicações Pós-Operatórias/prevenção & controle , Sinais Vitais/fisiologia , Inteligência Artificial/tendências , Parada Cardíaca/diagnóstico , Parada Cardíaca/fisiopatologia , Parada Cardíaca/prevenção & controle , Humanos , Monitorização Fisiológica/métodos , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia
8.
Br J Nurs ; 28(19): 1156-1159, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31647734

RESUMO

Clinical surveillance provides essential data on changes in a patient's condition. The common method for performing this surveillance is the assessment of vital signs. Despite the importance of these signs, research has found that vital signs are not rigorously assessed in clinical practice. Respiratory rate, arguably the most important vital sign, is the most neglected. Poor understanding might contribute to nurses incorrectly valuing oxygen saturation more than respiratory rate. Nurses need to understand the importance of respiratory rate assessment as a vital sign and the benefits and limitations of pulse oximetry as a clinical tool. By better understanding pulse oximetry and respiratory rate assessment, nurses might be more inclined to conduct rigorous vital signs' assessment. Research is needed to understand why many nurses do not appreciate the importance of vital signs' monitoring.


Assuntos
Monitorização Fisiológica/enfermagem , Avaliação em Enfermagem/estatística & dados numéricos , Oximetria/enfermagem , Taxa Respiratória , Humanos , Monitorização Fisiológica/métodos , Sinais Vitais
9.
Sensors (Basel) ; 19(20)2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31615095

RESUMO

Elderly fall detection systems based on wireless body area sensor networks (WBSNs) have increased significantly in medical contexts. The power consumption of such systems is a critical issue influencing the overall practicality of the WBSN. Reducing the power consumption of these networks while maintaining acceptable performance poses a challenge. Several power reduction techniques can be employed to tackle this issue. A human vital signs monitoring system (HVSMS) has been proposed here to measure vital parameters of the elderly, including heart rate and fall detection based on heartbeat and accelerometer sensors, respectively. In addition, the location of elderly people can be determined based on Global Positioning System (GPS) and transmitted with their vital parameters to emergency medical centers (EMCs) via the Global System for Mobile Communications (GSM) network. In this paper, the power consumption of the proposed HVSMS was minimized by merging a data-event (DE) algorithm and an energy-harvesting-technique-based wireless power transfer (WPT). The DE algorithm improved HVSMS power consumption, utilizing the duty cycle of the sleep/wake mode. The WPT successfully charged the HVSMS battery. The results demonstrated that the proposed DE algorithm reduced the current consumption of the HVSMS to 9.35 mA compared to traditional operation at 85.85 mA. Thus, an 89% power saving was achieved based on the DE algorithm and the battery life was extended to 30 days instead of 3 days (traditional operation). In addition, the WPT was able to charge the HVSMS batteries once every 30 days for 10 h, thus eliminating existing restrictions involving the use of wire charging methods. The results indicate that the HVSMS current consumption outperformed existing solutions from previous studies.


Assuntos
Acidentes por Quedas , Fontes de Energia Elétrica , Tecnologia sem Fio , Idoso , Algoritmos , Eletricidade , Humanos , Monitorização Fisiológica , Sinais Vitais
10.
J Coll Physicians Surg Pak ; 29(10): 954-957, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31564269

RESUMO

OBJECTIVE: To find out the effectiveness of the deep breathing exercises and incentive spirometryon arterial blood gases in second degree inhalation burn patients. STUDY DESIGN: Randomised control trial. PLACE AND DURATION OF STUDY: The study was conducted in the Burns Unit of PIMS Hospital, Islamabad from September 2017 to March 2018. METHODOLOGY: The data was collected on structured questionnaire using respiratory distress scoring and objective tools including arterial blood gases (ABGs) and vital signs with signed consent. There was random allocation of patients in the control and experimental groups. Baseline data was collected on day 00 and after completion of 14 sessions, it was recollected on day 07, and was assessed by using independent t-test and paired t-test. Both groups were given standard medical and nursing care. The experimental group was given single treatment regimen i.e. deep breathing exercises (given twice daily with 5-10 repetitions of each DBE possible onto patient for a period of 15-30 minutes). ISM was being performed on control group patients with 10-15 cycles along with steam inhalation and nebulization with beta 2 agonist for a period of 15-20 minutes for 35-45 minutes twice daily for a period of 07 days. RESULTS: The male to female ratio was 7:8 in control group and 8:7 in the experimental group. The mean age was 29.6 ±6.66 years in the control group, and 38.4 ±4.91 years in the experimental group. The pH in arterial blood gas analysis of the experimental group was 7.33 (p=0.002) > pO2 was was 90.53 (p<0.001) and pCO2 was 41.61 (p=0.626). For control group, the pH in ABGs was 7.36 (p=0.268), pO2 was 88.06 (p=0.739) and pCO2 was 38.86 (p<0.001). CONCLUSION: Deep breathing exercises are significant in improving pulmonary complications in patients of second degree inhalation burns.


Assuntos
Gasometria , Exercícios Respiratórios , Queimaduras por Inalação/reabilitação , Espirometria , Adulto , Feminino , Humanos , Concentração de Íons de Hidrogênio , Masculino , Paquistão , Inquéritos e Questionários , Sinais Vitais
11.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 11(5): 1307-1311, out.-dez. 2019. ilus
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1022248

RESUMO

Objective: The study's goal has been to describe the antecedent signs and symptoms of sepsis in patients hospitalized in the Medical Clinic of a Federal Hospital in Rio de Janeiro city, which are identified by a Registered Nurse; to analyze how the Nurse correlates the signs and symptoms with Sepsis-1, Sepsis-2 and Sepsis-3. Methods: It is a descriptive study with a quantitative approach; the population were 10 Registered Nurses who worked daytime shifts in the nursing ward. Data collection was performed through a structured questionnaire, addressing the identification of signs and symptoms that precede sepsis, including the characteristics and peculiarities of sepsis. Results: The Nurses have adequate understanding regarding the concept of sepsis, although they have showed difficulties in correlating some of the signs and symptoms. Conclusion: The Nurses are aware that sepsis is a health problem and that they provide direct care to the patient, therefore, it is important to identify the signs and symptoms that precede it in order to offer quality assistance and to help reducing new cases


Objetivo: Descrever os sinais e sintomas que antecedem a sepse em pacientes internados na Clínica Médica de um Hospital Federal no Rio de Janeiro identificados pelo Enfermeiro; analisar como o Enfermeiro correlaciona os sinais e sintomas com a Sepsis-1, Sepsis-2 e Sepsis-3. Métodos: Estudo descritivo com abordagem quantitativa, a população foram 10 Enfermeiros em plantões diurnos na enfermaria da Clínica. A coleta de dados foi um questionário estruturado, abordando identificação dos sinais e sintomas que antecedem a sepse, englobando as características e particularidades da sepse. Resultados: Evidenciou-se que possuem entendimento sobre o conceito de sepse, entretanto apresentaram dificuldades em correlacionar alguns dos sinais e sintomas dos tipos de sepse. Conclusão: Ciente que a sepse é um problema de saúde e o Enfermeiro presta cuidado direto ao paciente, percebe-se a importância na identificação dos sinais e sintomas que a antecedem para oferecer assistência de qualidade e auxiliar na redução dos casos


Objetivo: Describe los síntomas y antecedentes de la sepsis en pacientes internados en la Clínica Médica de un Hospital Federal en Río de Janeiro por el enfermero; analizar cómo el enfermero correlaciona los signos y síntomas con Sepsis-1, Sepsis-2 y Sepsis-3. Métodos: Estudio descriptivo con abordaje cuantitativo, la población fue 10 enfermeros en turnos diurnos en la enfermería de la Clínica. La recolección de datos fue un cuestionario estructurado, abordando identificación de los signos y síntomas que anteceden a la sepsis, englobando las características y particularidades de la sepsis. Resultados: Tienen un entendimiento adecuado sobre el concepto de sepsis, sin embargo, presentan dificultades en correlacionar algunos de los signos y síntomas. Conclusión: Es consciente de que la sepsis es un problema de salud y el enfermero presta atención directa al paciente, se percibe la importancia en la identificación de los signos y síntomas que la anteceden para ofrecer asistencia de calidad y auxiliar en la reducción de los casos


Assuntos
Humanos , Masculino , Feminino , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Sepse/enfermagem , Sepse/prevenção & controle , Diagnóstico , Sinais Vitais
12.
Stud Health Technol Inform ; 267: 28-36, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31483251

RESUMO

The alpine space is challenging for mobile care organizations as rural homes of patients are often characterized through long way distances or might be sometimes even isolated due to weather conditions. Real-time monitoring features for supporting mobile care require the easy conduction of self-measurements on vital signs for patients. Therefore, a vital sign telemonitoring system got conceptualized, utilizing the potential of Information and Communication Technology (ICT). The aim of this work was to gather technical and user-related requirements for a patient-centered telemonitoring system. Therefore, a mixed approach was followed comprising a comprehensive technical review, a literature review and interviews with stakeholders. Suitable use cases were derived from the gathered technical and user-related requirements. The results yielded to a concept for a seamless integrated, unobtrusive home monitoring system for elderly people with real-time data synchronization and communication features to support the mobile nurse organization, which got implemented and evaluated in the field. The concept overcomes known barriers of usability on telemonitoring systems like complex interaction which might lead to more efficiency and effectiveness in mobile nursing. The developed concept got further implemented as a prototype and validated within a 3-month test period.


Assuntos
Telemedicina , Eletrocardiografia , Humanos , Monitorização Fisiológica , Sinais Vitais
13.
J Altern Complement Med ; 25(12): 1215-1224, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31553228

RESUMO

Objective: Toutongning (TTN) capsule, a Chinese patent medicine, is used as a prophylactic treatment for migraine. The present study was conducted as a postmarketing evaluation of the efficacy and safety of TTN capsule. Design: A randomized, double-blind, placebo-controlled trial. Location: Patients recruited from 14 medical centers in China from May 2014 to August 2015. Subjects: Patients between 18 and 65 years of age with a diagnosis of migraine. Interventions: The patients were randomly assigned to receive either TTN (1200 mg, three times daily) or a matched placebo (1:1) for 4 weeks. Outcome measures: The primary outcome measured was a minimum 50% reduction in the frequency of headaches from the 4-week baseline period to the last 4 weeks of the 12-week trial. Secondary outcomes included duration, days, and visual analog score of headache attack, interval between headache attacks, usage of acute analgesics, and score on the Headache Impact Test-6. In addition, all patients were evaluated for adverse events (AEs). Results: This study initially enrolled 400 patients; a total of 378 participants completed the experiment while fulfilling all study requirements. TTN had a superior effect compared with the placebo on both the primary and secondary outcome measures without any serious AEs or unexpected side effects. Conclusion: TTN can effectively prevent the occurrence of migraine headaches and is well-tolerated and safe. TTN may exhibit a persistent therapeutic effect even after cessation of use. Trial Registration number: ChiCTR-IPR-15007058.


Assuntos
Medicamentos de Ervas Chinesas/efeitos adversos , Medicamentos de Ervas Chinesas/uso terapêutico , Transtornos de Enxaqueca/tratamento farmacológico , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/epidemiologia , Resultado do Tratamento , Sinais Vitais
14.
Comput Methods Programs Biomed ; 178: 47-58, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31416562

RESUMO

BACKGROUND: Sepsis-associated cardiac arrest is a common issue with the low survival rate. Early prediction of cardiac arrest can provide the time required for intervening and preventing its onset in order to reduce mortality. Several studies have been conducted to predict cardiac arrest using machine learning. However, no previous research has used machine learning for predicting cardiac arrest in adult sepsis patients. Moreover, the potential of some techniques, including ensemble algorithms, has not yet been addressed in improving the prediction outcomes. It is required to find methods for generating high-performance predictions with sufficient time lapse before the arrest. In this regard, various variables and parameters should also been examined. OBJECTIVE: The aim was to use machine learning in order to propose a cardiac arrest prediction model for adult patients with sepsis. It is required to predict the arrest several hours before the incidence with high efficiency. The other goal was to investigate the effect of the time series dynamics of vital signs on the prediction of cardiac arrest. METHOD: 30 h clinical data of every sepsis patients were extracted from Mimic III database (79 cases, 4532 controls). Three datasets (multivariate, time series and combined) were created. Various machine learning models for six time groups were trained on these datasets. The models included classical techniques (SVM, decision tree, logistic regression, KNN, GaussianNB) and ensemble methods (gradient Boosting, XGBoost, random forest, balanced bagging classifier and stacking). Proper solutions were proposed to address the challenges of missing values, imbalanced classes of data and irregularity of time series. RESULTS: The best results were obtained using a stacking algorithm and multivariate dataset (accuracy = 0.76, precision = 0.19, sensitivity = 0.77, f1-score = 0.31, AUC= 0.82). The proposed model predicts the arrest incidence of up to six hours earlier with the accuracy and sensitivity over 70%. CONCLUSION: We illustrated that machine learning techniques, especially ensemble algorithms have high potentials to be used in prognostic systems for sepsis patients. The proposed model, in comparison with the exiting warning systems including APACHE II and MEWS, significantly improved the evaluation criteria. According to the results, the time series dynamics of vital signs are of great importance in the prediction of cardiac arrest incidence in sepsis patients.


Assuntos
Parada Cardíaca/complicações , Parada Cardíaca/diagnóstico , Aprendizado de Máquina , Monitorização Ambulatorial/métodos , Sepse/complicações , APACHE , Adolescente , Adulto , Algoritmos , Estudos de Casos e Controles , Árvores de Decisões , Registros Eletrônicos de Saúde , Feminino , Parada Cardíaca/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Distribuição Normal , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Sepse/fisiopatologia , Índice de Gravidade de Doença , Sinais Vitais , Adulto Jovem
15.
Pediatrics ; 144(3)2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31416826

RESUMO

BACKGROUND AND OBJECTIVES: Vital signs are important data elements in the pediatric emergency department (PED). The presence of unexplained tachycardia at discharge has been associated with patient return to the PED and subsequent admission. Our aim for this study was to increase the percentage of patients discharged with a complete set of vital signs, when indicated, from 22% to 95% by June 30, 2018. METHODS: A multidisciplinary team developed key drivers, and data were collected by using a retrospective chart review. Outcome measures were the percentage of patients with discharge vital signs and 72-hour returns to the PED. Balancing measures included PED length of stay (LOS) and hospital admissions. Data were compiled from a chart review 7 times monthly; all charts were of patients presenting to the PED during the days being reviewed. An annotated p-chart was used to analyze the data. RESULTS: Data were collected for 18 months, including baseline data from July to September 2017, during which time 22% of patients had discharge vital signs. Targeted quality improvement methodology initially improved discharge vital signs to 41%, and then to 85%, which has been sustained for 7 months. There was no change in 72-hour return PED visits or LOS. Although absolute hospitalizations remained stable, the percentage of patients admitted increased. CONCLUSIONS: Targeted quality improvement methodology is associated with sustained improvement of indicated discharge vital signs for patients discharged from the PED. This improvement was not associated with reduced return PED visits, prolonged LOS, or increased hospitalization.


Assuntos
Documentação , Serviço Hospitalar de Emergência/normas , Hospitais Pediátricos/normas , Alta do Paciente , Sinais Vitais , Criança , Registros Eletrônicos de Saúde/normas , Humanos , Tempo de Internação , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Melhoria de Qualidade , Estudos Retrospectivos
16.
Holist Nurs Pract ; 33(5): 295-302, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31415009

RESUMO

The purpose of the study is to determine the effects of music on the life signs of patients in the postanesthesia care unit after laparoscopic surgery. The study was carried out as a quasi-experimental model with pretest-posttest and control group in the postanesthesia care unit of a training and education hospital from March 2017 to May 2018. The sample consisted of 148 patients (74 experiment and 74 control) who were selected by the method of nonprobability sampling determined on the basis of power analysis who met the inclusion criteria. When the change in the life signs between the groups was examined, after music treatment (second measurement), there was a significant difference only in the respiratory rates (P < .05). There was a significant difference in terms of diastolic blood pressures and respiratory rates in the first admission to the clinic from the postanesthesia care unit (third measurement) (P < .05).


Assuntos
Musicoterapia/normas , Manejo da Dor/normas , Sinais Vitais/fisiologia , Adolescente , Adulto , Colecistectomia Laparoscópica/métodos , Colecistectomia Laparoscópica/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Musicoterapia/métodos , Musicoterapia/tendências , Manejo da Dor/métodos , Medição da Dor/métodos , Sala de Recuperação/organização & administração , Sala de Recuperação/estatística & dados numéricos
17.
Int J Med Inform ; 129: 69-74, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31445291

RESUMO

BACKGROUND: Pain gained recognition as a vital sign in the early 2000s, underscoring the importance of accurate documentation, characterization, and treatment of pain. No prior studies have demonstrated the utility of the 0-10 pain scale with respect to discharge opioid prescriptions, nor characterized the most influential factors in discharge prescriptions. METHODS: Inpatient and emergency department(ED) encounters from July 1, 2012 to April 1, 2018 resulting in a discharge prescription for tablet opioid medications were identified. The primary outcome was to determine if pain levels in 24 h prior to discharge correlated with opioids (in milligrams of morphine equivalents (MME)) prescribed. Secondary outcomes included the impact of patient and prescriber demographics, demographics. A generalized linear model was created to investigate factors affecting the quantity of prescribed opioids. RESULTS: n = 78,691 patient encounters. Overall mean adjusted MME for non-ED visits was 378 versus 197 for ED visits. Whites received the highest quantities; those identifying as non-white and non-black received the lowest. Women received significantly fewer discharge MMEs in both the ED and inpatient cohorts. Provider prescribing patterns exhibited the most profound effect on discharge MMEs. The most prolific (≥300 prescriptions over the study period) writing the largest amount. In the ED, there was a significant negative correlation between documented pain levels and discharge MMEs(ρ = 0.074,p < 0.001). CONCLUSIONS: Pain scale was significantly negatively correlated with discharge MMEs in the ED and positively correlated in the inpatient population. Individual prescriber characteristics were the more influential variable, with prolific high prescribers writing for the largest MME amounts. The inverse association of pain and MMEs at discharge in the ED, and the large effect pre-existing prescriber patterns exhibited, both improved methodology for assessing and appropriately treating pain, and effective prescriber-targeted interventions, must be a priority.


Assuntos
Analgésicos Opioides/uso terapêutico , Medição da Dor , Dor/diagnóstico , Alta do Paciente , Sinais Vitais , Adulto , Idoso , Idoso de 80 Anos ou mais , Erros de Diagnóstico , Prescrições de Medicamentos , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
18.
Stud Health Technol Inform ; 264: 1456-1457, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438179

RESUMO

Social and behavioral factors influence health but are infrequently recorded in electronic health records (EHRs). Here, we demonstrate that psychosocial vital signs can be extracted from EHR data. We processed structured and unstructured EHR data using expert-driven queries and Natural Language Processing (NLP), validating results through structured annotation. We found that although these vital signs are present in EHRs, with 681 structured entries identified for psychosocial concepts, NLP identified a nearly 90-fold increase in patients.


Assuntos
Processamento de Linguagem Natural , Determinantes Sociais da Saúde , Registros Eletrônicos de Saúde , Humanos , Registros , Sinais Vitais
19.
Stud Health Technol Inform ; 264: 1641-1642, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438270

RESUMO

Recent statistics have demonstrated that Emergency Departments (EDs) in Greece lack in organization and service. In most cases, patient prioritization is not automatically implemented. The main objective of this paper is to present IntelTriage, a smart triage system, that dynamically assigns priorities to patients in an ED and monitors their vital signs and location during their stay in the clinic through wearable biosensors. Initital scenarios and functional requirements are presented as preliminary results.


Assuntos
Serviço Hospitalar de Emergência , Triagem , Eletrocardiografia , Grécia , Humanos , Sinais Vitais
20.
Stud Health Technol Inform ; 264: 1980-1981, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438438

RESUMO

Vital Sign Data Quality is essential for successful implementation of clinical decision support systems in emergency care. Studies have shown that data quality is inadequate and needs improvement. This study shows that data quality is dependent on both technical and human factors and provides a conceptual model of data quality governance and improvement in the emergency department.


Assuntos
Confiabilidade dos Dados , Sinais Vitais , Serviço Hospitalar de Emergência , Teoria Fundamentada , Humanos , Suécia
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