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1.
Curr Sports Med Rep ; 21(1): 28-33, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-35018896

RESUMO

ABSTRACT: We reviewed charts of 14,446 sports medicine patients, children aged 5 to 18 years, over a 3-year period to determine the discriminant validity of Exercise Vital Sign (EVS) questions. A logistic regression analyzed factors related to any moderate to vigorous physical activity (MVPA). A linear regression analyzed factors related to amount of MVPA for those who participated in any weekly MVPA. Overall, 48% of children reported meeting physical activity guidelines for 420 min·wk-1. Overall, children reported 400.36 ± 280.04 min·wk-1 of MVPA. Those with depression had significantly less MVPA than those without (95% confidence interval [CI], -96.65 to -26.31). Girls had significantly less MVPA than boys (95% CI, -59.15 to -40.31). Overweight and obese children reported less MVPA compared with normal weight children (95% CIs, -42.65 to -17.29 and -91.61 to -65.50, respectively). EVS demonstrates strong discriminant validity to detect differences between groups as a function of sex, body mass index, and depression.


Assuntos
Obesidade Pediátrica , Índice de Massa Corporal , Criança , Exercício Físico , Feminino , Humanos , Masculino , Sobrepeso , Obesidade Pediátrica/diagnóstico , Sinais Vitais
2.
JAMA Netw Open ; 4(12): e2136398, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34913982

RESUMO

Importance: Severity scores are used to improve triage of hospitalized patients in high-income settings, but the scores may not translate well to low- and middle-income settings such as sub-Saharan Africa. Objective: To assess the performance of the Universal Vital Assessment (UVA) score, derived in 2017, compared with other illness severity scores for predicting in-hospital mortality among adults with febrile illness in northern Tanzania. Design, Setting, and Participants: This prognostic study used clinical data collected for the duration of hospitalization among patients with febrile illness admitted to Kilimanjaro Christian Medical Centre or Mawenzi Regional Referral Hospital in Moshi, Tanzania, from September 2016 through May 2019. All adult and pediatric patients with a history of fever within 72 hours or a tympanic temperature of 38.0 °C or higher at screening were eligible for enrollment. Of 3761 eligible participants, 1132 (30.1%) were enrolled in the parent study; of those, 597 adults 18 years or older were included in this analysis. Data were analyzed from December 2019 to September 2021. Exposures: Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), quick Sequential Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SIRS) assessment, and UVA. Main Outcomes and Measures: The main outcome was in-hospital mortality during the same hospitalization as the participant's enrollment. Crude risk ratios and 95% CIs for in-hospital death were calculated using log-binomial risk regression for proposed score cutoffs for each of the illness severity scores. The area under the receiver operating characteristic curve (AUROC) for estimating the risk of in-hospital death was calculated for each score. Results: Among 597 participants, the median age was 43 years (IQR, 31-56 years); 300 participants (50.3%) were female, 198 (33.2%) were HIV-infected, and in-hospital death occurred in 55 (9.2%). By higher risk score strata for each score, compared with lower risk strata, risk ratios for in-hospital death were 3.7 (95% CI, 2.2-6.2) for a MEWS of 5 or higher; 2.7 (95% CI, 0.9-7.8) for a NEWS of 5 or 6; 9.6 (95% CI, 4.2-22.2) for a NEWS of 7 or higher; 4.8 (95% CI, 1.2-20.2) for a qSOFA score of 1; 15.4 (95% CI, 3.8-63.1) for a qSOFA score of 2 or higher; 2.5 (95% CI, 1.2-5.2) for a SIRS score of 2 or higher; 9.1 (95% CI, 2.7-30.3) for a UVA score of 2 to 4; and 30.6 (95% CI, 9.6-97.8) for a UVA score of 5 or higher. The AUROCs, using all ordinal values, were 0.85 (95% CI, 0.80-0.90) for the UVA score, 0.81 (95% CI, 0.75-0.87) for the NEWS, 0.75 (95% CI, 0.69-0.82) for the MEWS, 0.73 (95% CI, 0.67-0.79) for the qSOFA score, and 0.63 (95% CI, 0.56-0.71) for the SIRS score. The AUROC for the UVA score was significantly greater than that for all other scores (P < .05 for all comparisons) except for NEWS (P = .08). Conclusions and Relevance: This prognostic study found that the NEWS and the UVA score performed favorably compared with other illness severity scores in predicting in-hospital mortality among a hospitalized cohort of adults with febrile illness in northern Tanzania. Given its reliance on readily available clinical data, the UVA score may have utility in the triage and prognostication of patients admitted to the hospital with febrile illness in low- to middle-income settings such as sub-Saharan Africa.


Assuntos
Febre/mortalidade , Mortalidade Hospitalar , Pacientes Internados/estatística & dados numéricos , Índice de Gravidade de Doença , Adulto , Área Sob a Curva , Criança , Escore de Alerta Precoce , Feminino , Febre/diagnóstico , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Fatores de Risco , Síndrome de Resposta Inflamatória Sistêmica , Tanzânia , Sinais Vitais
3.
Expert Rev Med Devices ; 18(sup1): 145-152, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34937478

RESUMO

BACKGROUND: Wearable sensors enable continuous vital sign monitoring, although information about their performance on nursing wards is scarce. Vital signs measured by telemonitoring and nurse measurements on a surgical ward were compared to assess validity and reliability. METHODS: In a prospective observational study, surgical patients wore a wearable sensor (Everion, Biovotion AG, Zürich, Switzerland) that continuously measured heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), and temperature during their admittance on the ward. Validity was evaluated using repeated-measures correlation and reliability using Bland-Altman plots, mean difference, and 95% limits of agreement (LoA). RESULTS: Validity analyses of 19 patients (median age, 68; interquartile range, 62.5-72.5 years) showed a moderate relationship between telemonitoring and nurse measurements for HR (r = 0.53; 95% confidence interval, 0.44-0.61) and a poor relationship for RR, SpO2, and temperature. Reliability analyses showed that Everion measured HR close to nurse measurements (mean difference, 1 bpm; LoA, -16.7 to 18.7 bpm). Everion overestimated RR at higher values, whereas SpO2 and temperature were underestimated. CONCLUSIONS: A moderate relationship was determined between Everion and nurse measurements at a surgical ward in this study. Validity and reliability of telemonitoring should also be assessed with gold standard devices in future clinical trials.


Assuntos
Técnicas Biossensoriais , Monitorização Fisiológica , Telemetria , Sinais Vitais , Idoso , Temperatura Corporal , Frequência Cardíaca , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Taxa Respiratória
4.
Rev Bras Enferm ; 75Suppl 1(Suppl 1): e20200704, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34816965

RESUMO

OBJECTIVE: to identify the main nursing care procedures for performing bed bath in patients with COVID-19. METHOD: an integrative literature review. Five stages were followed for this research: research question elaboration (identification of the problem), search of studies in literature, study assessment, data analysis, and presentation of review. To search for primary studies, the VHL and SciELO databases were selected. RESULTS: initially, 55 publications were found. After reading and analyzing the abstracts, the sample consisted of 15 studies. CONCLUSION: patients with the new coronavirus have specific care to perform a bed bath, oral, intimate and skin hygiene. It is important that professionals use adequate personal protective equipment, perform humanized care, continuously observing patients' vital signs to avoid occurrence of adverse events, promoting patient safety.


Assuntos
COVID-19 , Cuidados de Enfermagem , Humanos , Segurança do Paciente , SARS-CoV-2 , Sinais Vitais
5.
Comput Inform Nurs ; 39(11): 793-803, 2021 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-34747895

RESUMO

Documentation and review of patient heart rate are a fundamental process across a myriad of clinical settings. While historically recorded manually, bedside monitors now provide for the automated collection of such data. Despite the availability of continuous streaming data, patients' charts continue to reflect only a subset of this information as snapshots recorded throughout a hospitalization. Over the past decade, prominent works have explored the implications of such practices and established fundamental differences in the alignment of discrete charted vitals and steaming data captured by monitoring systems. Limited work has examined the temporal properties of these differences, how they manifest, and their relation to clinical applications. The work presented in this article addresses this disparity, providing evidence that differences between charting techniques extend to measures of variability. Our results demonstrate how variability manifests with respect to temporal elements of charting timing and how it can facilitate personalized care by contextualizing deviations in magnitude. This work also highlights the utility of variability metrics with relation to clinical measures including associations to severity scores and a case study utilizing complex variability metrics derived from the complete set of monitor data.


Assuntos
Uso Significativo , Sinais Vitais , Documentação , Frequência Cardíaca , Humanos , Monitorização Fisiológica
6.
J Healthc Eng ; 2021: 2621655, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34760140

RESUMO

Cardiovascular and chronic respiratory diseases are global threats to public health and cause approximately 19 million deaths worldwide annually. This high mortality rate can be reduced with the use of technological advancements in medical science that can facilitate continuous monitoring of physiological parameters-blood pressure, cholesterol levels, blood glucose, etc. The futuristic values of these critical physiological or vital sign parameters not only enable in-time assistance from medical experts and caregivers but also help patients manage their health status by receiving relevant regular alerts/advice from healthcare practitioners. In this study, we propose a machine-learning-based prediction and classification system to determine futuristic values of related vital signs for both cardiovascular and chronic respiratory diseases. Based on the prediction of futuristic values, the proposed system can classify patients' health status to alarm the caregivers and medical experts. In this machine-learning-based prediction and classification model, we have used a real vital sign dataset. To predict the next 1-3 minutes of vital sign values, several regression techniques (i.e., linear regression and polynomial regression of degrees 2, 3, and 4) have been tested. For caregivers, a 60-second prediction and to facilitate emergency medical assistance, a 3-minute prediction of vital signs is used. Based on the predicted vital signs values, the patient's overall health is assessed using three machine learning classifiers, i.e., Support Vector Machine (SVM), Naive Bayes, and Decision Tree. Our results show that the Decision Tree can correctly classify a patient's health status based on abnormal vital sign values and is helpful in timely medical care to the patients.


Assuntos
Aprendizado de Máquina , Sinais Vitais , Algoritmos , Teorema de Bayes , Humanos , Máquina de Vetores de Suporte
7.
F1000Res ; 10: 622, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34754421

RESUMO

Background: Postoperative hypotension associated with postoperative morbidity and early mortality has been studied previously. Hypertension and other hemodynamic, respiratory, and temperature abnormalities have comparatively understudied during the first postoperative days. Methods: This bi-centre observational cohort study will include 114 adult patients undergoing non-cardiac surgery hospitalized on an unmonitored general care floor and wearing a multi-signal wearable sensor, allowing remote monitoring ( Biobeat Technologies Ltd, Petah Tikva, Israel). The study will cover the first 72 hours after discharge of the patient from the post-anaesthesia care unit. Several thresholds will be used for each variable (arterial pressure, heart rate, respiratory rate, oxygen saturation, and skin temperature). Data obtained using the sensor will be compared to data obtained during the routine nurse follow-up. The primary outcome is hemodynamic abnormality. The secondary outcomes are postoperative respiratory and temperature abnormalities, artefacts and blank/null outputs from the wearable device, postoperative complications, and finally, the ease of use of the device. We hypothesize that remote monitoring will detect abnormalities in vital signs more often or more quickly than the detection by nurses' routine surveillance. Discussion: A demonstration of the ability of wireless sensors to outperform standard monitoring techniques paves the way for the creation of a loop which includes this monitoring mode, the automated creation of alerts, and the sending of these alerts to caregivers. Trial registration: ClinicalTrials.gov, NCT04585178. Registered on October 14, 2020.


Assuntos
Sinais Vitais , Dispositivos Eletrônicos Vestíveis , Adulto , Estudos de Coortes , Hemodinâmica , Humanos , Estudos Observacionais como Assunto , Taxa Respiratória
8.
Br J Hosp Med (Lond) ; 82(10): 1-7, 2021 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-34726933

RESUMO

Falls are one of the most common reasons for patients to present to the emergency department. Syncope is a common cause of falls, which disproportionately affects older people. In most cases, syncope can be confirmed with a detailed history and simple bedside tests, but tilt table testing remains an invaluable diagnostic adjunct in more complex cases. Often misunderstood, the tilt table test is a useful way to reproduce a patient's symptoms in a safe and controlled environment. The tilt table test is considered positive if the patient experiences symptoms associated with a drop in blood pressure or postural tachycardia. The test can support a diagnosis and can direct therapeutic interventions.


Assuntos
Síncope , Teste da Mesa Inclinada , Idoso , Pressão Sanguínea , Serviço Hospitalar de Emergência , Humanos , Síncope/diagnóstico , Síncope/etiologia , Sinais Vitais
9.
Dimens Crit Care Nurs ; 40(6): 328-332, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34606223

RESUMO

OBJECTIVE: Documenting vital signs and National Institutes of Health Stroke Scale (NIHSS) once every 15 minutes after intravenous thrombolytic therapy for acute ischemic stroke is often used as a metric to assess the quality of care. This study explores the association between "once every 15 minutes" documentation and stroke outcomes. METHODS: This is a retrospective study of the first 2 hours of vital signs and NIHSS documentation after thrombolytic stroke therapy. Sociodemographic and clinical data, including NIHSS, temperature, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, and respiratory rate, were abstracted from the medical record. Missing documentation was examined for association with modified Rankin Scale (mRS) scores and neurologic changes. RESULT: Among 84 patients with a mean age of 68.8 years, there were 2276 documented assessments from an expected 3780. There were 104 clinically significant changes in 1 or more index variables. The most commonly missed documentation occurred during interventional radiology. After controlling for admission NIHSS, there was no significant relationship between the completeness of documentation and discharge mRS score (r2 = 0.047, P = .0561), nor between vital sign documentation and discharge mRS (r2 = 0.003, P = .6338). CONCLUSION: Frequency of documentation does not reflect the quality of care during the early phase of acute stroke treatment.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Idoso , Isquemia Encefálica/tratamento farmacológico , Documentação , Humanos , Estudos Retrospectivos , Índice de Gravidade de Doença , Ativador de Plasminogênio Tecidual , Resultado do Tratamento , Sinais Vitais
10.
Int J Med Inform ; 155: 104602, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34601238

RESUMO

OBJECTIVE: During the COVID-19 pandemic, social distancing and self-isolation called for innovative, readily implementable, and effective short-term health solutions. The objective of this study was to assess the feasibility of self-assessment of vital signs and symptoms with electronic transmission of results, by self-isolating individuals with positive SARS-CoV-2 polymerase chain reaction (PCR) test. The secondary objective was to describe the association between the presence of abnormal vital signs and severe symptoms as well as their evolution over time. METHOD: Participants with positive SARS-CoV-2 PCR test were asked to perform twice daily standardized vital signs measurements and self-assessment of symptoms for 14 consecutive days. All data were transmitted electronically through a mobile application and a web-based platform. Participants were provided with decision support tools based on the severity of their condition and a weekly nurse practitioner telephone follow-up. Abnormal values for vital signs and severe symptoms were determined. Per participant and per days, proportions of abnormal vital signs and severe symptoms were calculated. RESULTS: Data from 46 participants (mean age 54.1 ± 6.9 years, 54% male) were available for analysis. On average, participants performed the standardized self-assessment for 12.3 ± 3.4 days (89% performed at least 7 measurement days and 61% completed all 14 days). The highest proportions abnormal values for vital signs were for oximetry (20.1%) and respiratory rate (12.1%). The highest proportions of severe symptoms were for fatigue (16.9%) and myalgia. (10.2%). The combined proportion of abnormal vital signs and severe symptoms was maximal on day 1 with 20.3% of total measurements, with a linear decrease to 3.5% on day 14. CONCLUSION: Remote initiation of home measurements of vital signs and symptoms, self-management of these measures, accompanied by a decision support tool and supported by preplanned nurse follow-up are feasible. This could allow to opening up new insight for the care of sick individuals.


Assuntos
COVID-19 , Telemedicina , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Autoavaliação (Psicologia) , Sinais Vitais
11.
Curr Cardiol Rep ; 23(11): 172, 2021 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-34647161

RESUMO

PURPOSE OF REVIEW: Current risk prediction tools do not include physical activity (PA) or cardiorespiratory fitness (CRF), despite their robust association with adverse cardiovascular disease (CVD) events and their potential as targets for preventive interventions. RECENT FINDINGS: PA and CRF are each associated with cardiovascular (CV) morbidity and mortality, independent of traditional risk factors. Improvement in CRF is associated with reduced risk of atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF). Risk prediction tools have been developed for ASCVD, and more recently for HF, to refine CVD risk assessment and inform CVD prevention strategies. Attempts have been made to incorporate PA and CRF into available CVD risk prediction models. Inclusion of PA and CRF into established CVD risk assessment models improves CVD risk prediction incremental to established CVD risk prediction tools, suggesting PA and CRF are markers of CVD risk and targets for CVD prevention.


Assuntos
Aptidão Cardiorrespiratória , Doenças Cardiovasculares , Doenças Cardiovasculares/prevenção & controle , Exercício Físico , Fatores de Risco de Doenças Cardíacas , Humanos , Medição de Risco , Fatores de Risco , Sinais Vitais
12.
Sensors (Basel) ; 21(17)2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34502626

RESUMO

Microwave sensors have recently been introduced as high-temporal resolution sensors, which could be used in the contactless monitoring of artery pulsation and breathing. However, accurate and efficient signal processing methods are still required. In this paper, the matrix pencil method (MPM), as an efficient method with good frequency resolution, is applied to back-reflected microwave signals to extract vital signs. It is shown that decomposing of the signal to its damping exponentials fulfilled by MPM gives the opportunity to separate signals, e.g., breathing and heartbeat, with high precision. A publicly online dataset (GUARDIAN), obtained by a continuous wave microwave sensor, is applied to evaluate the performance of MPM. Two methods of bandpass filtering (BPF) and variational mode decomposition (VMD) are also implemented. In addition to the GUARDIAN dataset, these methods are also applied to signals acquired by an ultra-wideband (UWB) sensor. It is concluded that when the vital sign is sufficiently strong and pure, all methods, e.g., MPM, VMD, and BPF, are appropriate for vital sign monitoring. However, in noisy cases, MPM has better performance. Therefore, for non-contact microwave vital sign monitoring, which is usually subject to noisy situations, MPM is a powerful method.


Assuntos
Micro-Ondas , Radar , Algoritmos , Processamento de Sinais Assistido por Computador , Sinais Vitais
13.
Nurse Educ Today ; 107: 105154, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34583238

RESUMO

BACKGROUND: The utilization of smartphone applications in educational settings, specifically in the field of nursing, has grown increasingly popular. To date, there have been few, if any, smartphone applications dedicated specifically to the teaching of vital signs. The Clinic Vitals app was designed to be an acceptable substitute for in-person vital signs instruction. OBJECTIVES: The objective of this study was to show the utility of the Clinic Vitals app as a pedagogical tool in comparison to in-person nursing educational instruction. DESIGN: A crossover design was employed within collegiate nursing educational sessions to determine if Clinic Vitals was an equivalent alternative to traditional vital sign teaching methods. PARTICIPANTS: Participants were first-year nursing students from six different lab sessions within the same undergraduate university. METHODS: Students with little to no vital sign experience were given instruction via the Clinic Vitals mobile application or traditional learning. After the learning session, students were given skills assessments. After one week, students were given the opposite method of instruction followed by skills assessments. RESULTS: Results showed that no significant difference was found between the two groups based on skills assessments. Mobile application and in-person instruction teaching methods produced a similar level of competency in students learning to take vital signs. CONCLUSIONS: The utility of being able to access the application's videos and instructional articles at any time and anywhere that there is an internet connection would make the app particularly useful. The present study provides evidence that the Clinic Vitals mobile application can be a reliable substitute for in-person vital signs instruction. Recent educational advances have demonstrated that online videos, simulations, and mobile applications can be effective resources for nursing educators. There is potential for further study of the uses of educational mobile applications, including Clinic Vitals, for nursing education.


Assuntos
Educação em Enfermagem , Aplicativos Móveis , Estudantes de Enfermagem , Estudos Cross-Over , Humanos , Aprendizagem , Sinais Vitais
14.
J Med Internet Res ; 23(9): e27547, 2021 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-34524087

RESUMO

BACKGROUND: The standard of care in general wards includes periodic manual measurements, with the data entered into track-and-trigger charts, either on paper or electronically. Wearable devices may support health care staff, improve patient safety, and promote early deterioration detection in the interval between periodic measurements. However, regulatory standards for ambulatory cardiac monitors estimating heart rate (HR) and respiratory rate (RR) do not specify performance criteria during patient movement or clinical conditions in which the patient's oxygen saturation varies. Therefore, further validation is required before clinical implementation and deployment of any wearable system that provides continuous vital sign measurements. OBJECTIVE: The objective of this study is to determine the agreement between a chest-worn patch (VitalPatch) and a gold standard reference device for HR and RR measurements during movement and gradual desaturation (modeling a hypoxic episode) in a controlled environment. METHODS: After the VitalPatch and gold standard devices (Philips MX450) were applied, participants performed different movements in seven consecutive stages: at rest, sit-to-stand, tapping, rubbing, drinking, turning pages, and using a tablet. Hypoxia was then induced, and the participants' oxygen saturation gradually reduced to 80% in a controlled environment. The primary outcome measure was accuracy, defined as the mean absolute error (MAE) of the VitalPatch estimates when compared with HR and RR gold standards (3-lead electrocardiography and capnography, respectively). We defined these as clinically acceptable if the rates were within 5 beats per minute for HR and 3 respirations per minute (rpm) for RR. RESULTS: Complete data sets were acquired for 29 participants. In the movement phase, the HR estimates were within prespecified limits for all movements. For RR, estimates were also within the acceptable range, with the exception of the sit-to-stand and turning page movements, showing an MAE of 3.05 (95% CI 2.48-3.58) rpm and 3.45 (95% CI 2.71-4.11) rpm, respectively. For the hypoxia phase, both HR and RR estimates were within limits, with an overall MAE of 0.72 (95% CI 0.66-0.78) beats per minute and 1.89 (95% CI 1.75-2.03) rpm, respectively. There were no significant differences in the accuracy of HR and RR estimations between normoxia (≥90%), mild (89.9%-85%), and severe hypoxia (<85%). CONCLUSIONS: The VitalPatch was highly accurate throughout both the movement and hypoxia phases of the study, except for RR estimation during the two types of movements. This study demonstrated that VitalPatch can be safely tested in clinical environments to support earlier detection of cardiorespiratory deterioration. TRIAL REGISTRATION: ISRCTN Registry ISRCTN61535692; https://www.isrctn.com/ISRCTN61535692.


Assuntos
Sinais Vitais , Dispositivos Eletrônicos Vestíveis , Humanos , Hipóxia/diagnóstico , Monitorização Fisiológica , Taxa Respiratória
16.
Hematology ; 26(1): 637-647, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34474663

RESUMO

OBJECTIVES: The objective of the current study was to investigate the relationship between changes in vital signs and intensive care unit (ICU) admission. Windsor Regional Hospital treats 15-20 new patients a year with acute leukemia. These patients are at increased risk of neutropenic fevers and admission to the ICU following induction chemotherapy. METHODS: Retrospective review examined the correlation between acute leukemia patient vitals and ICU admission. The analysis included 37 patients: 7 ICU versus 30 controls. Changes were compared to baseline over 24 hours prior to ICU admission or 5 days after the initiation of induction chemotherapy in the following vital signs: heart rate (HR), mean arterial pressure (MAP), temperature (T), respiratory rate (RR), and fraction of inspired oxygen (FiO2) required to maintain a stable oxygen saturation. RESULTS: RR and FiO2 demonstrated significant change over baseline leading up to ICU admission within the ICU group. T, HR and MAP did not demonstrate significant changes over time in either group. RR, FiO2 and HR were significantly higher in the ICU group at time zero compared with the control group. RR was recorded least frequently in the 24 hours leading up to ICU admission. DISCUSSION: Changes in RR and FiO2 predicted clinical deterioration requiring ICU admission in acute leukemia patients. This is consistent with the predominant reason for ICU admission which was respiratory failure. CONCLUSION: We present preliminary evidence to support enhanced monitoring of RR and FiO2 in acute leukemia patients following induction chemotherapy with early intervention if identified.


Assuntos
Unidades de Terapia Intensiva , Leucemia , Admissão do Paciente , Sinais Vitais , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Leucemia/metabolismo , Leucemia/fisiopatologia , Leucemia/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
17.
Br J Nurs ; 30(16): 956-962, 2021 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-34514822

RESUMO

The assessment of vital signs is critical for safe, high-quality care. Vital signs' data provide valuable insight into the patient's condition, including how they are responding to medical treatment and, importantly, whether the patient is deteriorating. Although abnormal vital signs have been associated with poor clinical outcomes, research has consistently found that vital signs' assessment is often neglected in clinical practice. Factors contributing to this include nurses' knowledge, clinical judgement, culture, tradition and workloads. To emphasise the importance of vital signs' assessment, global elements of vital signs' assessment are proposed. The elements reflect key principles underpinning vital signs' assessment and are informed by evidence-based literature.


Assuntos
Competência Clínica , Enfermeiras e Enfermeiros , Humanos , Sinais Vitais , Carga de Trabalho
19.
Glob Heart ; 16(1): 47, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34381669

RESUMO

Background: The implications of city lockdown on vital signs during the COVID-19 outbreak are unknown. Objective: We longitudinally tracked vital signs using data from wearable sensors and determined associations with anxiety and depression. Methods: We selected all participants in the HUAWEI Heart Study from Wuhan and four nearby large provincial capital cities (Guangzhou, Chongqing, Hangzhou, Zhengzhou) and extracted all data from 26 December 2019 (one month before city lockdown) to 21 February 2020. Sleep duration and quality, daily steps, oxygen saturation and heart rate were collected on a daily basis. We compared the vital signs before and after the lockdown using segmented regression analysis of the interrupted time series. The depression and anxiety cases were defined as scores ≥8 on the Hospital Anxiety and Depression Scale depression and anxiety subscales [HADS-D and HADS-A] in 727 participants who finished the survey. Results: We included 19,960 participants (mean age 36 yrs, 90% men). Compared with pre-lockdown, resting heart rate dropped immediately by 1.1 bpm after city lockdown (95% confidence interval [CI]: -1.8, -0.4). Sleep duration increased by 0.5 hour (95% CI: 0.3, 0.8) but deep sleep ratio decreased by 0.9% (95% CI: -1.2, -0.6). Daily steps decreased by 3352 steps (95% CI: -4333, -2370). Anxiety and depression existed in 26% and 17% among 727 available participants, respectively, and associated with longer sleep duration (0.2 and 0.1 hour, both p < 0.001). Conclusions: Lockdown of Wuhan in China was associated with an adverse vital signs profile (reduced physical activity, heart rate, and sleep quality, but increased sleep duration). Wearable devices in combination with mobile-based apps may be useful to monitor both physical and mental health. Clinical trial registration: The trial is registered at Chinese Clinical Trial Registry (ChiCTR) website (ChiCTR-OOC-17014138).


Assuntos
COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Exercício Físico , Frequência Cardíaca , Oxigênio/metabolismo , Política Pública , Sono , Adulto , Ansiedade/psicologia , China/epidemiologia , Cidades/epidemiologia , Depressão/psicologia , Feminino , Humanos , Análise de Séries Temporais Interrompida , Masculino , Pessoa de Meia-Idade , Oximetria , Estudos Retrospectivos , SARS-CoV-2 , Sinais Vitais , Dispositivos Eletrônicos Vestíveis , Adulto Jovem
20.
Artif Intell Med ; 118: 102133, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34412849

RESUMO

Obstructive Sleep Apnea Syndrome (OSAS) is the most common sleep-related breathing disorder. It is caused by an increased upper airway resistance during sleep, which determines episodes of partial or complete interruption of airflow. The detection and treatment of OSAS is particularly important in patients who suffered a stroke, because the presence of severe OSAS is associated with higher mortality, worse neurological deficits, worse functional outcome after rehabilitation, and a higher likelihood of uncontrolled hypertension. The gold standard test for diagnosing OSAS is polysomnography (PSG). Unfortunately, performing a PSG in an electrically hostile environment, like a stroke unit, on neurologically impaired patients is a difficult task; moreover, the number of strokes per day vastly outnumbers the availability of polysomnographs and dedicated healthcare professionals. Hence, a simple and automated recognition system to identify OSAS cases among acute stroke patients, relying on routinely recorded vital signs, is highly desirable. The vast majority of the work done so far focuses on data recorded in ideal conditions and highly selected patients, and thus it is hardly exploitable in real-life circumstances, where it would be of actual use. In this paper, we propose a novel convolutional deep learning architecture able to effectively reduce the temporal resolution of raw waveform data, like physiological signals, extracting key features that can be used for further processing. We exploit models based on such an architecture to detect OSAS events in stroke unit recordings obtained from the monitoring of unselected patients. Unlike existing approaches, annotations are performed at one-second granularity, allowing physicians to better interpret the model outcome. Results are considered to be satisfactory by the domain experts. Moreover, through tests run on a widely-used public OSAS dataset, we show that the proposed approach outperforms current state-of-the-art solutions.


Assuntos
Aprendizado Profundo , Apneia Obstrutiva do Sono , Humanos , Polissonografia , Sono , Apneia Obstrutiva do Sono/diagnóstico , Sinais Vitais
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