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1.
Med Sci Monit ; 30: e944913, 2024 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-38961611

RESUMO

Vital signs are crucial for monitoring changes in patient health status. This review compared the performance of noncontact sensors with traditional methods for measuring vital signs and investigated the clinical feasibility of noncontact sensors for medical use. We searched the Medical Literature Analysis and Retrieval System Online (MEDLINE) database for articles published through September 30, 2023, and used the key search terms "vital sign," "monitoring," and "sensor" to identify relevant articles. We included studies that measured vital signs using traditional methods and noncontact sensors and excluded articles not written in English, case reports, reviews, and conference presentations. In total, 129 studies were identified, and eligible articles were selected based on their titles, abstracts, and full texts. Three articles were finally included in the review, and the types of noncontact sensors used in each selected study were an impulse radio ultrawideband radar, a microbend fiber-optic sensor, and a mat-type air pressure sensor. Participants included neonates in the neonatal intensive care unit, patients with sleep apnea, and patients with coronavirus disease. Their heart rate, respiratory rate, blood pressure, body temperature, and arterial oxygen saturation were measured. Studies have demonstrated that the performance of noncontact sensors is comparable to that of traditional methods of vital signs measurement. Noncontact sensors have the potential to alleviate concerns related to skin disorders associated with traditional skin-contact vital signs measurement methods, reduce the workload for healthcare providers, and enhance patient comfort. This article reviews the medical use of noncontact sensors for measuring vital signs and aimed to determine their potential clinical applicability.


Assuntos
COVID-19 , Sinais Vitais , Humanos , Sinais Vitais/fisiologia , Monitorização Fisiológica/métodos , Monitorização Fisiológica/instrumentação , COVID-19/diagnóstico , SARS-CoV-2 , Frequência Cardíaca/fisiologia , Pressão Sanguínea/fisiologia
2.
Sensors (Basel) ; 24(13)2024 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-39000917

RESUMO

This study explores the feasibility of a wearable system to monitor vital signs during sleep. The system incorporates five inertial measurement units (IMUs) located on the waist, the arms, and the legs. To evaluate the performance of a novel framework, twenty-three participants underwent a sleep study, and vital signs, including respiratory rate (RR) and heart rate (HR), were monitored via polysomnography (PSG). The dataset comprises individuals with varying severity of sleep-disordered breathing (SDB). Using a single IMU sensor positioned at the waist, strong correlations of more than 0.95 with the PSG-derived vital signs were obtained. Low inter-participant mean absolute errors of about 0.66 breaths/min and 1.32 beats/min were achieved, for RR and HR, respectively. The percentage of data available for analysis, representing the time coverage, was 98.3% for RR estimation and 78.3% for HR estimation. Nevertheless, the fusion of data from IMUs positioned at the arms and legs enhanced the inter-participant time coverage of HR estimation by over 15%. These findings imply that the proposed methodology can be used for vital sign monitoring during sleep, paving the way for a comprehensive understanding of sleep quality in individuals with SDB.


Assuntos
Frequência Cardíaca , Polissonografia , Sono , Sinais Vitais , Dispositivos Eletrônicos Vestíveis , Humanos , Masculino , Feminino , Frequência Cardíaca/fisiologia , Polissonografia/instrumentação , Polissonografia/métodos , Sinais Vitais/fisiologia , Adulto , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Sono/fisiologia , Taxa Respiratória/fisiologia , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/fisiopatologia , Pessoa de Meia-Idade , Adulto Jovem
3.
BMJ Open ; 14(7): e081645, 2024 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-38964797

RESUMO

OBJECTIVE: To describe the associations between patient-to-nurse staffing ratios and rates of mortality, process of care events and vital sign documentation. DESIGN: Secondary analysis of data from the evaluating processes of care and outcomes of children in hospital (EPOCH) cluster-randomised trial. SETTING: 22 hospitals caring for children in Canada, Europe and New Zealand. PARTICIPANTS: Eligible hospitalised patients were aged>37 weeks and <18 years. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was all-cause hospital mortality. Secondary outcomes included five events reflecting the process of care, collected for all EPOCH patients; the frequency of documentation for each of eight vital signs on a random sample of patients; four measures describing nursing perceptions of care. RESULTS: A total of 217 714 patient admissions accounting for 849 798 patient days over the course of the study were analysed. The overall mortality rate was 1.65/1000 patient discharges. The median (IQR) number of patients cared for by an individual nurse was 3.0 (2.8-3.6). Univariate Bayesian models estimating the rate ratio (RR) for the patient-to-nurse ratio and the probability that the RR was less than one found that a higher patient-to-nurse ratio was associated with fewer clinical deterioration events (RR=0.88, 95% credible interval (CrI) 0.77-1.03; P (RR<1)=95%) and late intensive care unit admissions (RR=0.76, 95% CrI 0.53-1.06; P (RR<1)=95%). In adjusted models, a higher patient-to-nurse ratio was associated with lower hospital mortality (OR=0.77, 95% CrI=0.57-1.00; P (OR<1)=98%). Nurses from hospitals with a higher patient-to-nurse ratio had lower ratings for their ability to influence care and reduced documentation of most individual vital signs and of the complete set of vital signs. CONCLUSIONS: The data from this study challenge the assumption that lower patient-to-nurse ratios will improve the safety of paediatric care in contexts where ratios are low. The mechanism of these effects warrants further evaluation including factors, such as nursing skill mix, experience, education, work environment and physician staffing ratios. TRIAL REGISTRATION NUMBER: EPOCH clinical trial registered on clinical trial.gov NCT01260831; post-results.


Assuntos
Documentação , Mortalidade Hospitalar , Sinais Vitais , Humanos , Criança , Feminino , Masculino , Pré-Escolar , Lactente , Adolescente , Canadá/epidemiologia , Documentação/estatística & dados numéricos , Documentação/normas , Recursos Humanos de Enfermagem Hospitalar , Nova Zelândia , Teorema de Bayes , Hospitais Pediátricos/estatística & dados numéricos
5.
BMC Infect Dis ; 24(1): 573, 2024 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-38853273

RESUMO

PURPOSE: Frailty is a vulnerable state to stressors due to the loss of physiological reserve as a result of multisystem dysfunction. The physiological and laboratory-based frailty index (FI-Lab), depending on laboratory values and vital signs, is a powerful tool to capture frailty status. The aim of this study was to assess the relationship between FI-Lab and in-hospital mortality in patients with septic shock. METHODS: Baseline data for patients with sepsis in the intensive care unit were retrieved from the Critical Care Medicine Database (MIMIC-IV, v2.2). The primary outcome was mortality during hospitalization. The propensity score matching (PSM) method was used to analyze the basic conditions during hospitalization between groups.The FI-Lab was analysed for its relationship with in-hospital mortality using logistic regression according to continuous and categorical variables, respectively, and described using the restricted cubic spline (RCS). Survival was compared between groups using Kaplan-Meier (KM) curves. Subgroup analyses were used to improve the stability of the results. RESULTS: A total of 9219 patients were included. A cohort score of 1803 matched patients was generated after PSM. The analyses showed that non-surviving patients with septic shock in the ICU had a high FI-Lab index (P<0.001). FI-Lab, whether used as a continuous or categorical variable, increased with increasing FI-Lab and increased in-hospital mortality (P<0.001).Subgroup analyses showed similar results. RCS depicts this non-linear relationship. KM analysis shows the cumulative survival time during hospitalisation was significantly lower as FI-Lab increased (log-rank test, P<0.001). CONCLUSION: Elevated FI-Lab is associated with increased in-hospital mortality in patients with septic shock.


Assuntos
Cuidados Críticos , Fragilidade , Mortalidade Hospitalar , Unidades de Terapia Intensiva , Choque Séptico , Sinais Vitais , Humanos , Choque Séptico/mortalidade , Feminino , Masculino , Idoso , Fragilidade/mortalidade , Estudos Retrospectivos , Pessoa de Meia-Idade , Unidades de Terapia Intensiva/estatística & dados numéricos , Bases de Dados Factuais , Idoso de 80 Anos ou mais
6.
Sensors (Basel) ; 24(11)2024 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-38894339

RESUMO

Vital sign monitoring is dominated by precise but costly contact-based sensors. Contactless devices such as radars provide a promising alternative. In this article, the effects of lateral radar positions on breathing and heartbeat extraction are evaluated based on a sleep study. A lateral radar position is a radar placement from which multiple human body zones are mapped onto different radar range sections. These body zones can be used to extract breathing and heartbeat motions independently from one another via these different range sections. Radars were positioned above the bed as a conventional approach and on a bedside table as well as at the foot end of the bed as lateral positions. These positions were evaluated based on six nights of sleep collected from healthy volunteers with polysomnography (PSG) as a reference system. For breathing extraction, comparable results were observed for all three radar positions. For heartbeat extraction, a higher level of agreement between the radar foot end position and the PSG was found. An example of the distinction between thoracic and abdominal breathing using a lateral radar position is shown. Lateral radar positions could lead to a more detailed analysis of movements along the body, with the potential for diagnostic applications.


Assuntos
Frequência Cardíaca , Radar , Respiração , Sinais Vitais , Humanos , Sinais Vitais/fisiologia , Monitorização Fisiológica/métodos , Monitorização Fisiológica/instrumentação , Frequência Cardíaca/fisiologia , Adulto , Masculino , Polissonografia/métodos , Feminino
7.
Hosp Pediatr ; 14(7)2024 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-38910528

RESUMO

OBJECTIVES: Vital sign measurement and interpretation are essential components of assessment in the emergency department. We sought to assess the completeness of vital signs documentation (defined as a temperature, heart rate, respiratory rate, blood pressure, and oxygen saturation) in a nationally representative sample of children presenting to the emergency department, characterize abnormal vital signs using pediatric advanced life support (PALS) criteria, and evaluate their association with hospitalization or transfer. METHODS: We conducted a retrospective, cross-sectional study using the 2016-2021 National Hospital Ambulatory Medical Care Survey. We evaluated the proportion of children (aged ≤15 years) with complete vital signs and identified characteristics associated with complete vital signs documentation. We assessed the proportion of children having abnormal vital signs when using PALS criteria. RESULTS: We included 162.7 million survey-weighted pediatric encounters. Complete vital signs documentation was present in 50.8% of encounters. Older age and patient acuity were associated with vital signs documentation. Abnormal vital signs were documented in 73.0% of encounters with complete vital signs and were associated with younger age and hospitalization or transfer. Abnormal vital signs were associated with increased odds of hospitalization or transfer (odds ratio 1.51, 95% confidence interval 1.11-2.04). Elevated heart rate and respiratory rate were associated with hospitalization or transfer. CONCLUSIONS: A low proportion of children have documentation of complete vital signs, highlighting areas in need of improvement to better align with pediatric readiness quality initiatives. A high proportion of children had abnormal vital signs using PALS criteria. Few abnormalities were associated with hospitalization or transfer.


Assuntos
Documentação , Serviço Hospitalar de Emergência , Sinais Vitais , Humanos , Estudos Transversais , Criança , Serviço Hospitalar de Emergência/estatística & dados numéricos , Estudos Retrospectivos , Pré-Escolar , Adolescente , Feminino , Estados Unidos/epidemiologia , Masculino , Lactente , Documentação/estatística & dados numéricos , Documentação/normas , Documentação/métodos , Hospitalização/estatística & dados numéricos , Recém-Nascido , Pesquisas sobre Atenção à Saúde
8.
J Med Internet Res ; 26: e46691, 2024 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-38900529

RESUMO

BACKGROUND: Early warning scores (EWS) are routinely used in hospitals to assess a patient's risk of deterioration. EWS are traditionally recorded on paper observation charts but are increasingly recorded digitally. In either case, evidence for the clinical effectiveness of such scores is mixed, and previous studies have not considered whether EWS leads to changes in how deteriorating patients are managed. OBJECTIVE: This study aims to examine whether the introduction of a digital EWS system was associated with more frequent observation of patients with abnormal vital signs, a precursor to earlier clinical intervention. METHODS: We conducted a 2-armed stepped-wedge study from February 2015 to December 2016, over 4 hospitals in 1 UK hospital trust. In the control arm, vital signs were recorded using paper observation charts. In the intervention arm, a digital EWS system was used. The primary outcome measure was time to next observation (TTNO), defined as the time between a patient's first elevated EWS (EWS ≥3) and subsequent observations set. Secondary outcomes were time to death in the hospital, length of stay, and time to unplanned intensive care unit admission. Differences between the 2 arms were analyzed using a mixed-effects Cox model. The usability of the system was assessed using the system usability score survey. RESULTS: We included 12,802 admissions, 1084 in the paper (control) arm and 11,718 in the digital EWS (intervention) arm. The system usability score was 77.6, indicating good usability. The median TTNO in the control and intervention arms were 128 (IQR 73-218) minutes and 131 (IQR 73-223) minutes, respectively. The corresponding hazard ratio for TTNO was 0.99 (95% CI 0.91-1.07; P=.73). CONCLUSIONS: We demonstrated strong clinical engagement with the system. We found no difference in any of the predefined patient outcomes, suggesting that the introduction of a highly usable electronic system can be achieved without impacting clinical care. Our findings contrast with previous claims that digital EWS systems are associated with improvement in clinical outcomes. Future research should investigate how digital EWS systems can be integrated with new clinical pathways adjusting staff behaviors to improve patient outcomes.


Assuntos
Escore de Alerta Precoce , Sinais Vitais , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Reino Unido , Hospitais , Unidades de Terapia Intensiva
9.
Sensors (Basel) ; 24(12)2024 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-38931747

RESUMO

The development of non-contact techniques for monitoring human vital signs has significant potential to improve patient care in diverse settings. By facilitating easier and more convenient monitoring, these techniques can prevent serious health issues and improve patient outcomes, especially for those unable or unwilling to travel to traditional healthcare environments. This systematic review examines recent advancements in non-contact vital sign monitoring techniques, evaluating publicly available datasets and signal preprocessing methods. Additionally, we identified potential future research directions in this rapidly evolving field.


Assuntos
Sinais Vitais , Humanos , Sinais Vitais/fisiologia , Monitorização Fisiológica/métodos , Processamento de Sinais Assistido por Computador
10.
Sci Rep ; 14(1): 13863, 2024 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-38879652

RESUMO

Heart rate (HR) and respiration rate (RR) play an important role in the study of complex behaviors and their physiological correlations in non-human primates (NHPs). However, collecting HR and RR information is often challenging, involving either invasive implants or tedious behavioral training, and there are currently few established simple and non-invasive techniques for HR and RR measurement in NHPs owing to their stress response or indocility. In this study, we employed a frequency-modulated continuous wave (FMCW) radar to design a novel contactless HR and RR monitoring system. The designed system can estimate HR and RR in real time by placing the FMCW radar on the cage and facing the chest of both awake and anesthetized macaques, the NHP investigated in this study. Experimental results show that the proposed method outperforms existing methods, with averaged absolute errors between the reference monitor and radar estimates of 0.77 beats per minute (bpm) and 1.29 respirations per minute (rpm) for HR and RR, respectively. In summary, we believe that the proposed non-invasive and contactless estimation method could be generalized as a HR and RR monitoring tool for NHPs. Furthermore, after modifying the radar signal-processing algorithms, it also shows promise for applications in other experimental animals for animal welfare, behavioral, neurological, and ethological research.


Assuntos
Frequência Cardíaca , Radar , Taxa Respiratória , Animais , Frequência Cardíaca/fisiologia , Taxa Respiratória/fisiologia , Monitorização Fisiológica/métodos , Macaca , Sinais Vitais , Masculino
12.
ACS Appl Mater Interfaces ; 16(24): 31807-31816, 2024 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-38847366

RESUMO

Wearable smart textile sensors for monitoring vital signs are fast, noninvasive, and highly desirable for personalized health management to diagnose health anomalies such as cardiovascular diseases and respiratory dysfunction. Traditional biosignal sensors, with power consumption issues, constrain the use of wearable medical devices. This study introduces an autonomous triboelectric smart textile sensor (AUTS) made of reduced graphene oxide/manganese dioxide/polydimethylsiloxane (RGO-M-PDMS) and polytetrafluoroethylene (TEFLON)-knitted silver electrode, offering promise for vital sign monitoring with self-powering, flexibility, and wearability. The sensor exhibits impressive output performance, with a sensitivity of 7.8 nA/kPa, response time of ≈40 ms, good stability of >15,000 cycles, stretchability of up to 40%, and machine washability of >20 washes. The AUTS has been integrated to the TriBreath respiratory belt for monitoring respiratory signals and pulse strap for pulse signals concurrently at different body pulse points. These sensors wirelessly transmitted the acquired biosignals to a smartphone, demonstrating the potential of a self-powered and real-time vital sign monitoring system.


Assuntos
Sinais Vitais , Têxteis , Dispositivos Eletrônicos Vestíveis , Nanotecnologia , Respiração , Fatores de Tempo
14.
BMC Oral Health ; 24(1): 632, 2024 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-38811912

RESUMO

BACKGROUND: Anxiety is common preceding tooth extraction; hence, it is crucial to identify patients with dental anxiety (DA) and to manage DA. This study assessed the level of DA and influencing factors in tooth extraction patients in a dental hospital in China and changes in their blood pressure (BP) and heart rate (HR) during the tooth-extraction procedure. METHODS: The study was a cohort study. The Dental Anxiety Scale (DAS) was used to assess the level of DA of 120 patients before tooth extraction. A Demographics and Oral Health Self-Assessment Form was used to assess factors influencing DA. The correlations of DAS scores with HR and BP were measured. The effects of local anesthesia and general anesthesia on HR and BP were also compared using a Datex-Ohmeda anesthesia monitor to detect HR and BP continuously before and after anesthesia. Independent sample t-tests, OLS multiple regression model and one-way analysis of variance were applied to analysis the results. RESULTS: Based on the DAS score, 12.5% of the participants were identified as suffering from DA. DA was related to age, gender, and the self-assessment of oral health. The DAS score was correlated with increased BP (P < 0.05). BP showed an overall upward trend after local anesthesia, while it was generally stable after general anesthesia. The systolic BP at 4 and 5 min and the HR at 2 and 4 min increased remarkably (P < 0.05) after local anesthesia compared with those before anesthesia. The HR and BP of patients under local anesthesia were generally higher than those of patients under general anesthesia were during the operation. CONCLUSIONS: The prevalence of DA in adults was 12.5% in this study population. DA was related to gender, age, and the self-assessment of oral health. The score of DAS was correlated with BP. Compare to local anesthesia, general anesthesia can make the vital signs of tooth extraction patients more stable.


Assuntos
Anestesia Dentária , Anestesia Geral , Pressão Sanguínea , Ansiedade ao Tratamento Odontológico , Frequência Cardíaca , Extração Dentária , Humanos , Feminino , Masculino , Frequência Cardíaca/fisiologia , Anestesia Dentária/métodos , Adulto , Pressão Sanguínea/fisiologia , Pessoa de Meia-Idade , Anestesia Local , Estudos de Coortes , Fatores Sexuais , Fatores Etários , Adulto Jovem , Sinais Vitais , Idoso
15.
Sensors (Basel) ; 24(9)2024 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-38732777

RESUMO

Optical fiber sensors are extensively employed for their unique merits, such as small size, being lightweight, and having strong robustness to electronic interference. The above-mentioned sensors apply to more applications, especially the detection and monitoring of vital signs in medical or clinical. However, it is inconvenient for daily long-term human vital sign monitoring with conventional monitoring methods under the uncomfortable feelings generated since the skin and devices come into direct contact. This study introduces a non-invasive surveillance system that employs an optical fiber sensor and advanced deep-learning methodologies for precise vital sign readings. This system integrates a monitor based on the MZI (Mach-Zehnder interferometer) with LSTM networks, surpassing conventional approaches and providing potential uses in medical diagnostics. This could be potentially utilized in non-invasive health surveillance, evaluation, and intelligent health care.


Assuntos
Aprendizado Profundo , Fibras Ópticas , Sinais Vitais , Humanos , Sinais Vitais/fisiologia , Monitorização Fisiológica/métodos , Monitorização Fisiológica/instrumentação , Redes Neurais de Computação
16.
JAMA Netw Open ; 7(5): e2412778, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38809558
17.
Crit Care Clin ; 40(3): 561-581, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38796228

RESUMO

Early warning systems (EWSs) are designed and deployed to create a rapid assessment and response for patients with clinical deterioration outside the intensive care unit (ICU). These models incorporate patient-level data such as vital signs and laboratory values to detect or prevent adverse clinical events, such as vital signs and laboratories to allow detection and prevention of adverse clinical events such as cardiac arrest, intensive care transfer, or sepsis. The applicability, development, clinical utility, and general perception of EWS in clinical practice vary widely. Here, we review the field as it has grown from early vital sign-based scoring systems to contemporary multidimensional algorithms and predictive technologies for clinical decompensation outside the ICU.


Assuntos
Estado Terminal , Escore de Alerta Precoce , Humanos , Estado Terminal/terapia , Sinais Vitais , Unidades de Terapia Intensiva , Deterioração Clínica , Cuidados Críticos/métodos , Cuidados Críticos/normas , Algoritmos , Monitorização Fisiológica/métodos
18.
Curr Opin Crit Care ; 30(3): 275-282, 2024 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-38690957

RESUMO

PURPOSE OF REVIEW: Wearable wireless sensors for continuous vital signs monitoring (CVSM) offer the potential for early identification of patient deterioration, especially in low-intensity care settings like general wards. This study aims to review advances in wearable CVSM - with a focus on the general ward - highlighting the technological characteristics of CVSM systems, user perspectives and impact on patient outcomes by exploring recent evidence. RECENT FINDINGS: The accuracy of wearable sensors measuring vital signs exhibits variability, especially notable in ambulatory patients within hospital settings, and standard validation protocols are lacking. Usability of CMVS systems is critical for nurses and patients, highlighting the need for easy-to-use wearable sensors, and expansion of the number of measured vital signs. Current software systems lack integration with hospital IT infrastructures and workflow automation. Imperative enhancements involve nurse-friendly, less intrusive alarm strategies, and advanced decision support systems. Despite observed reductions in ICU admissions and Rapid Response Team calls, the impact on patient outcomes lacks robust statistical significance. SUMMARY: Widespread implementation of CVSM systems on the general ward and potentially outside the hospital seems inevitable. Despite the theoretical benefits of CVSM systems in improving clinical outcomes, and supporting nursing care by optimizing clinical workflow efficiency, the demonstrated effects in clinical practice are mixed. This review highlights the existing challenges related to data quality, usability, implementation, integration, interpretation, and user perspectives, as well as the need for robust evidence to support their impact on patient outcomes, workflow and cost-effectiveness.


Assuntos
Sinais Vitais , Dispositivos Eletrônicos Vestíveis , Humanos , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Tecnologia sem Fio/instrumentação
19.
BMC Pediatr ; 24(1): 326, 2024 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-38734617

RESUMO

Preterm birth (< 37 weeks gestation) complications are the leading cause of neonatal mortality. Early-warning scores (EWS) are charts where vital signs (e.g., temperature, heart rate, respiratory rate) are recorded, triggering action. To evaluate whether a neonatal EWS improves clinical outcomes in low-middle income countries, a randomised trial is needed. Determining whether the use of a neonatal EWS is feasible and acceptable in newborn units, is a prerequisite to conducting a trial. We implemented a neonatal EWS in three newborn units in Kenya. Staff were asked to record infants' vital signs on the EWS during the study, triggering additional interventions as per existing local guidelines. No other aspects of care were altered. Feasibility criteria were pre-specified. We also interviewed health professionals (n = 28) and parents/family members (n = 42) to hear their opinions of the EWS. Data were collected on 465 preterm and/or low birthweight (< 2.5 kg) infants. In addition to qualitative study participants, 45 health professionals in participating hospitals also completed an online survey to share their views on the EWS. 94% of infants had the EWS completed at least once during their newborn unit admission. EWS completion was highest on the day of admission (93%). Completion rates were similar across shifts. 15% of vital signs triggered escalation to a more senior member of staff. Health professionals reported liking the EWS, though recognised the biggest barrier to implementation was poor staffing. Newborn unit infant to staff ratios varied between 10 and 53 staff per 1 infant, depending upon time of shift and staff type. A randomised trial of neonatal EWS in Kenya is possible and acceptable, though adaptations are required to the form before implementation.


Assuntos
Escore de Alerta Precoce , Estudos de Viabilidade , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Humanos , Quênia , Recém-Nascido , Feminino , Masculino , Sinais Vitais , Atitude do Pessoal de Saúde , Recém-Nascido de Baixo Peso
20.
Emerg Med J ; 41(6): 363-367, 2024 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-38670792

RESUMO

INTRODUCTION: The Modified Early Warning Score (MEWS) is an effective tool to identify patients in the acute care chain who are likely to deteriorate. Although it is increasingly being implemented in the ED, the optimal moment to use the MEWS is unknown. This study aimed to determine at what moment in the acute care chain MEWS has the highest accuracy in predicting critical illness. METHODS: Adult patients brought by ambulance to the ED at both locations of the Amsterdam UMC, a level 1 trauma centre, were prospectively included between 11 March and 28 October 2021. MEWS was calculated using vital parameters measured prehospital, at ED presentation, 1 hour and 3 hours thereafter, imputing for missing temperature and/or consciousness, as these values were expected not to deviate. Critical illness was defined as requiring intensive care unit admission, myocardial infarction or death within 72 hours after ED presentation. Accuracy in predicting critical illness was assessed using the area under the receiver operating characteristics curve (AUROC). RESULTS: Of the 790 included patients, critical illness occurred in 90 (11.4%). MEWS based on vital parameters at ED presentation had the highest performance in predicting critical illness with an AUROC of 0.73 (95% CI 0.67 to 0.79) but did not significantly differ compared with other moments. Patients with an increasing MEWS over time are significantly more likely to become critical ill compared with patients with an improving MEWS. CONCLUSION: The performance of MEWS is moderate in predicting critical illness using vital parameters measured surrounding ED admission. However, an increase of MEWS during ED admission is correlated with the development of critical illness. Therefore, early recognition of deteriorating patients at the ED may be achieved by frequent MEWS calculation. Further studies should investigate the effect of continuous monitoring of these patients at the ED.


Assuntos
Estado Terminal , Escore de Alerta Precoce , Humanos , Estudos Prospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Países Baixos , Serviço Hospitalar de Emergência/organização & administração , Fatores de Tempo , Sinais Vitais , Adulto , Curva ROC , Valor Preditivo dos Testes
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