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1.
Fisioterapia (Madr., Ed. impr.) ; 42(4): 170-176, jul.-ago. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193504

RESUMO

INTRODUCCIÓN: Las tecnologías para la rehabilitación son instrumentos, equipos, sistemas o dispositivos, que aportan a los procesos de recuperación de las capacidades humanas. La 4.ª revolución industrial ha hecho que se utilice la realidad virtual en procesos de rehabilitación, por lo cual es necesario conocer sus efectos fisiológicos en las personas. OBJETIVO: Determinar el efecto de la exposición a la RV sobre los signos vitales en 7 adultos mayores aparentemente sanos. MÉTODO: Se presenta un estudio epidemiológico descriptivo de una serie de 7 casos que permitió evaluar el comportamiento de los signos vitales. Los participantes fueron adultos mayores con edades entre 50 a 75 años, sin ningún tipo de patología osteomuscular y neuromuscular que impidan la ejecución de programa. Se contó con 4 tipos de ambientes virtuales programados progresivamente desde un ambiente de adaptación hasta el ambiente virtual de demandas reales. RESULTADOS: En la recolección de los signos vitales se evidenció un aumento significativo en FC, FR, TAM y SaO2 (P < 0,05), no se encontraron diferencias significativas de los signos vitales tomados previos a la exposición y 10 minutos posterior (P < 0,05). CONCLUSIÓN: Los cambios hemodinámicos antes de la exposición a RV no son permanentes en el tiempo. Los signos vitales 10 minutos posterior a la exposición regresan a los valores iniciales; lo cual permite aplicar la RV en personas mayores aparentemente sanas como estrategia terapéutica sin riesgo de presentar cambios fisiológicos concurrentes y nocivos, de acuerdo a la muestra de este estudio


INTRODUCTION: The technologies for rehabilitation are instruments, equipment, systems or devices, which contribute to the processes of recovery of human capabilities. The 4.th industrial revolution has brought about the use of virtual reality in rehabilitation processes, and therefore it is necessary to be aware of its physiological effects on people. OBJECTIVE: To determine the effect of VR exposure on vital signs in 7 apparently healthy older adults. METHOD: We present a descriptive epidemiological study of a series of 7 cases that allowed us to evaluate the behaviour of vital signs. The participants were older adults aged between 50 and 75 years, without any musculoskeletal or neuromuscular pathology to prevent them undertaking the programme. There were 4 types of virtual environments programmed progressively from an adaptation environment to the virtual environment of real demands. RESULTS: In the collection of vital signs, a significant increase in HR, FR, TAM and SaO2 (P < .05) was evidenced, no significant differences were found in the vital signs taken before and 10minutes after exposure (P < .05). CONCLUSION: Haemodynamic changes before exposure to RV are not permanent over time. Vital signs 10minutes after exposure return to initial values, which allows the application of RV in apparently healthy older people as a therapeutic strategy without risk of presenting concurrent and harmful physiological changes, according to the sample of this study


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Realidade Virtual , Sinais Vitais/fisiologia , Terapia por Exercício , 24960 , Hemodinâmica , Técnicas de Exercício e de Movimento/instrumentação , Eletrocardiografia/métodos , Arritmias Cardíacas/diagnóstico por imagem
2.
Pediatr Cardiol ; 41(6): 1190-1198, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32474738

RESUMO

Patients with congenital heart disease (CHD) who undergo cardiac procedures may become hemodynamically unstable. Predictive algorithms that utilize dense physiologic data may be useful. The compensatory reserve index (CRI) trends beat-to-beat progression from normovolemia (CRI = 1) to decompensation (CRI = 0) in hemorrhagic shock by continuously analyzing unique sets of features in the changing pulse photoplethysmogram (PPG) waveform. We sought to understand if the CRI accurately reflects changing hemodynamics during and after a cardiac procedure for patients with CHD. A transcatheter pulmonary valve replacement (TcPVR) model was used because left ventricular stroke volume decreases upon sizing balloon occlusion of the right ventricular outflow tract (RVOT) and increases after successful valve placement. A single-center, prospective cohort study was performed. The CRI was continuously measured to determine the change in CRI before and after RVOT occlusion and successful TcPVR. Twenty-six subjects were enrolled with a median age of 19 (interquartile range (IQR) 13-29) years. The mean (± standard deviation) CRI decreased from 0.66 ± 0.15 1-min before balloon inflation to 0.53 ± 0.16 (p = 0.03) 1-min after balloon deflation. The mean CRI increased from a pre-valve mean CRI of 0.63 [95% confidence interval (CI) 0.56-0.70] to 0.77 (95% CI 0.71-0.83) after successful TcPVR. In this study, the CRI accurately reflected acute hemodynamic changes associated with TcPVR. Further research is justified to determine if the CRI can be useful as an early warning tool in patients with CHD at risk for decompensation during and after cardiac procedures.


Assuntos
Cardiopatias Congênitas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Hemodinâmica , Adolescente , Adulto , Algoritmos , Cateterismo Cardíaco , Feminino , Humanos , Masculino , Fotopletismografia , Estudo de Prova de Conceito , Estudos Prospectivos , Valva Pulmonar/cirurgia , Volume Sistólico , Resultado do Tratamento , Sinais Vitais/fisiologia , Adulto Jovem
4.
Holist Nurs Pract ; 34(4): 244-251, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32404727

RESUMO

To determine the impact of Healing Touch on vital signs, adult intensive care unit patients were recruited from multiple hospital sites. Both pain and agitation improved and there was a significant change in hemodynamics that reflected a calming effect. Healing Touch may be considered a respected addition to symptom management.


Assuntos
Cuidados Críticos/normas , Toque Terapêutico/normas , Sinais Vitais/fisiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Cuidados Críticos/métodos , Cuidados Críticos/psicologia , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Toque Terapêutico/métodos , Toque Terapêutico/estatística & dados numéricos
5.
Sci Rep ; 10(1): 416, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31942021

RESUMO

The monitoring of vital signs plays a key role in the diagnosis of several diseases. Piezoelectric sensors have been utilized to collect a corresponding representative signal from the chest surface. The subject typically needs to hold his or her breath to eliminate the respiration effect. This work further contributes to the extraction of the corresponding representative vital signs directly from the measured respiration signal. The contraction and expansion of the heart muscles, as well as the respiration activities, will induce a mechanical vibration across the chest wall. The induced vibration is then captured by the piezoelectric sensor placed at the chest surface, which produces an electrical output voltage signal conformally mapped with the respiration-cardiac activities. During breathing, the measured voltage signal is composed of the cardiac cycle activities modulated along with the respiratory cycle activity. A representative model that incorporates the cardiac and respiratory activities is developed and adopted. The piezoelectric and the convolution theories along with Fourier transformation are applied to extract the corresponding cardiac activity signal from the respiration signal. All the results were validated step by step by a conventional apparatus, with good agreement observed.


Assuntos
Técnicas Biossensoriais/métodos , Técnicas Eletroquímicas/métodos , Coração/fisiologia , Monitorização Fisiológica , Músculos/fisiologia , Respiração , Sinais Vitais/fisiologia , Humanos , Taxa Respiratória
6.
Am J Emerg Med ; 38(6): 1129-1133, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31405725

RESUMO

BACKGROUND: Trauma level designation and verification are examples of healthcare regionalization aiming at improving patient outcomes. This study examines impact of Trauma Levels on survival of patients arriving with "no signs of life" to US trauma centers. METHODS: This retrospective study used the US National Trauma Data Bank (NTDB) 2015 dataset. A descriptive followed by a bivariate analysis was done comparing variables by the trauma designation levels. A multivariate analysis assessed the effect of the trauma designation on survival to hospital discharge after controlling for potential confounding factors. RESULTS: 6160 patients without signs of life were included. The average age was 40.66 years (±19.96) with male predominance (77.3%). Most patients were transported using ground ambulance (83.5%) and were taken to Level I (57%) and Level II (32.4%) centers. Blunt injuries were the most common (56.9%). Motor Vehicle Collision (MVC) (38.5%) and firearm (33.8%) were the most common mechanisms of injury. Survival to hospital discharge among patients with no signs of life ranged from 13.7% at Level I to 27.9% at Level III. After adjusting for confounders, including Injury Severity Score (ISS), higher survival was noted at Level II trauma centers compared to Level I. CONCLUSIONS: Patients presenting without signs of life to Level II trauma centers had higher survival to hospital discharge compared to Level I and Level III centers. These findings can guide future prehospital triage criteria of trauma patients in organized Emergency Medical Services (EMS) systems and highlight the need for more outcome research on trauma systems.


Assuntos
Serviços Médicos de Emergência , Centros de Traumatologia , Triagem/métodos , Sinais Vitais/fisiologia , Ferimentos e Lesões/diagnóstico , Adulto , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Índices de Gravidade do Trauma , Estados Unidos/epidemiologia , Ferimentos e Lesões/epidemiologia
7.
J Clin Neurophysiol ; 37(1): 74-78, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31261350

RESUMO

INTRODUCTION: Epilepsy is a common disorder. Psychogenic nonepileptic attack (PNEA) is one of the epilepsy mimics. Video EEG is still the gold standard tool that differentiates between epileptic seizures (ES) and PNEA. Oxygen saturation (SaO2) and ictal vital signs, including heart rate (HR), respiration rate (RR), body temperature, systolic blood pressure (SBP), and diastolic blood pressure show crucial changes during ES and PNEA. PURPOSE: To analyze, compare, and find relationships of changes in ictal vital sign during ES and PNEA. METHODS: Ninety-four adults had video EEG monitoring. SaO2, HR, RR, body temperature, SBP, and diastolic blood pressure were obtained at baseline and during the attacks. RESULTS: The 49 patients with ES and 45 patients with PNEA had nearly similar baseline vital sign. Epileptic seizures yielded a higher ictal HR (p = 0.003) and lower ictal SaO2 (p = 0.04) than PNEA. Ictal RR and ictal SBP of patients with PNEA were higher than those of patients with ES (p = 0.02 and P = 0.04, respectively). For ES, ictal HR inversely correlated with ictal SaO2 (P = 0.003). In PNEA, ictal HR directly correlated with ictal SBP (P = <0.005). CONCLUSIONS: There are statistically significant differences between pre-ictal and ictal SaO2, HR, SBP, and diastolic blood pressure in both ES and PNEA groups. The inverse relationship between ictal SaO2 and ictal HR in ES suggests severe cardiorespiratory dysfunction. The significantly elevated ictal HR, ictal RR, and ictal SBP during PNEA demonstrates the risk of those attacks if not stopped.


Assuntos
Eletroencefalografia/métodos , Convulsões/diagnóstico , Convulsões/fisiopatologia , Sinais Vitais/fisiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravação em Vídeo
8.
J Healthc Eng ; 2019: 5930379, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31885832

RESUMO

Objective: Achieving accurate prediction of sepsis detection moment based on bedside monitor data in the intensive care unit (ICU). A good clinical outcome is more probable when onset is suspected and treated on time, thus early insight of sepsis onset may save lives and reduce costs. Methodology: We present a novel approach for feature extraction, which focuses on the hypothesis that unstable patients are more prone to develop sepsis during ICU stay. These features are used in machine learning algorithms to provide a prediction of a patient's likelihood to develop sepsis during ICU stay, hours before it is diagnosed. Results: Five machine learning algorithms were implemented using R software packages. The algorithms were trained and tested with a set of 4 features which represent the variability in vital signs. These algorithms aimed to calculate a patient's probability to become septic within the next 4 hours, based on recordings from the last 8 hours. The best area under the curve (AUC) was achieved with Support Vector Machine (SVM) with radial basis function, which was 88.38%. Conclusions: The high level of predictive accuracy along with the simplicity and availability of input variables present great potential if applied in ICUs. Variability of a patient's vital signs proves to be a good indicator of one's chance to become septic during ICU stay.


Assuntos
Aprendizado de Máquina , Sepse/diagnóstico , Sinais Vitais , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Análise de Variância , Área Sob a Curva , Estudos de Casos e Controles , Diagnóstico por Computador , Diagnóstico Precoce , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Sepse/fisiopatologia , Software , Máquina de Vetores de Suporte , Sinais Vitais/fisiologia , Adulto Jovem
9.
IEEE Trans Biomed Circuits Syst ; 13(6): 1690-1699, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31670678

RESUMO

This work presents a mixed-signal physical-compu-tation-electronics for monitoring three vital signs; namely heart rate, blood pressure, and blood oxygen saturation; from electrocardiography, arterial blood pressure, and photoplethysmography signals in real-time. The computational circuits are implemented on a reconfigurable and programmable signal-processing platform, namely field-programmable analog array (FPAA). The design leverages the core enabling technology of FPAA, namely floating-gate CMOS devices, and an on-chip low-power microcontroller to achieve energy-efficiency while not compromising accuracy. The custom physical-computation-electronics operating in CMOS subthreshold region, performs low-level (i.e., physiologically-relevant feature extraction) and high-level (i.e., detecting arrhythmia) signal processing in an energy-efficient manner. The on-chip microcontroller is used (1) in the programming mode for controlling the charge storage at the analog-memory elements to introduce patient-dependency into the system and (2) in the run mode to quantify the vital signs. The system has been validated against digital computation results from MATLAB using datasets collected from three healthy subjects and datasets from the MIT/BIH open source database. Based on all recordings in the MIT/BIH database, ECG R-peak detection sensitivity is 94.2%. The processor detects arrhythmia in three MIT/BIH recordings with an average sensitivity of 96.2%. The cardiac processor achieves an average percentage mean error bounded by 3.75%, 6.27%, and 7.3% for R-R duration, systolic blood pressure, and oxygen saturation level calculations; respectively. The power consumption of the ECG, blood-pressure and photo-plethysmography processing circuitry are 126 nW, 251 nW and 1.44 µW respectively in a 350 nm process. Overall, the cardiac processor consumes 1.82 µW.


Assuntos
Determinação da Pressão Arterial/instrumentação , Eletrocardiografia/instrumentação , Fotopletismografia/instrumentação , Sinais Vitais/fisiologia , Sistemas Computacionais , Diagnóstico Precoce , Voluntários Saudáveis , Humanos , Dispositivos Lab-On-A-Chip , Semicondutores , Processamento de Sinais Assistido por Computador/instrumentação , Dispositivos Eletrônicos Vestíveis
10.
Anesth Analg ; 129(6): 1621-1626, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31743183

RESUMO

BACKGROUND: Many cases of maternal mortality and morbidity are preventable. A delayed response to clinical warning signs contributes to preventability. Therefore, the National Partnership for Maternal Safety devised maternal early warning criteria (MEWC), composed of abnormal vital signs that trigger bedside evaluation by a provider with the capacity to escalate care. The relationship of the MEWC to maternal morbidity has not been studied. We evaluated the correlation between the MEWC and maternal morbidity. METHODS: We retrospectively reviewed the first 400 deliveries at the University of Chicago in 2016. We analyzed the electronic medical record to determine whether vital signs triggered the MEWC during the admission to labor and delivery and whether patients experienced morbidity during their delivery hospitalization. The association between MEWC and morbidity was tested using χ analysis. We calculated the sensitivity, specificity, and positive and negative predictive values of the MEWC. RESULTS: Two hundred eighty-one (70%) of 400 patients triggered the MEWC at least once, and 198 (50%) of 400 patients had multiple or recurrent triggers. Ninety-nine (25%) of 400 patients experienced morbidity. The most common causes of morbidity were hemorrhage, suspected infection, and preeclampsia with severe features. The relative risk of maternal morbidity with at least a single trigger was 13.55 (95% confidence interval [CI], 4.38-41.91) and with recurrent or multiple triggers was 5.29 (95% CI, 3.22-8.71). The sensitivity of the MEWC in predicting morbidity was 0.97 (95% CI, 0.92-0.99) and the specificity was 0.39 (95% CI, 0.33-0.44) when patients with at least a single trigger were included. When including only patients with multiple or recurrent triggers, the sensitivity was 0.84 (95% CI, 0.75-0.90) and the specificity was 0.62 (95% CI, 0.56-0.67). The positive predictive value of the MEWC in our population was 0.34 (95% CI, 0.29-0.40), and the negative predictive value was 0.97 (95% CI, 0.93-0.99). When considering only patients with multiple or recurrent triggers, the positive predictive value was 0.42 (95% CI, 0.38-0.46) and the negative predictive value was 0.92 (95% CI, 0.88-0.95). CONCLUSIONS: The MEWC are associated with maternal morbidity. As a screening tool, they appropriately prioritize sensitivity and have an excellent negative predictive value. The criteria demonstrate low specificity, which is slightly improved by considering only patients with recurrent or multiple triggers. Additional efforts to improve the specificity of MEWC, with a focus on identifying sustained or recurrent patterns of abnormal vital signs, may be necessary before their widespread implementation.


Assuntos
Trabalho de Parto/fisiologia , Mortalidade Materna/tendências , Guias de Prática Clínica como Assunto/normas , Sinais Vitais/fisiologia , Adulto , Bases de Dados Factuais/tendências , Feminino , Humanos , Morbidade/tendências , Gravidez , Estudos Retrospectivos , Adulto Jovem
11.
Intensive Crit Care Nurs ; 55: 102743, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31677850

RESUMO

OBJECTIVES: To evaluate the use of vital signs for pain detection in brain-injured patients in the intensive care unit. DESIGN: A repeated-measures descriptive-correlational study. SETTING: Two neurological intensive care units in Montréal, Canada. A total of 101 brain-injured patients were included. MAIN OUTCOME MEASURES: This study examined the fluctuations in systolic and diastolic blood pressure, heart and respiratory rates, and oxygen saturation in brain-injured critically ill patients before, during, and 15 minutes after turning and soft touch using a data collection computer. When possible, patients' pain self-reports were obtained using a 0-10 Faces Pain Thermometer. RESULTS: The heart and respiratory rates were higher during turning than soft touch and higher during the procedure compared to prior (p < 0.05), but their fluctuation was modest. The systolic blood pressure increased during both turning and soft touch by 2 mmHg, but was 26.6 mmHg higher for those who reported pain versus no pain (Mann-Whitney = 25.00, p = 0.008, n = 28). A moderate correlation was observed between the systolic blood pressure (Spearman's rho = 0.617, p = 0.004, n = 24) and self-reported pain intensity during turning. No significant effects were observed for diastolic blood pressure and oxygen saturation. CONCLUSION: Only increases in systolic blood pressure were positively associated with pain in this sample and replication studies with larger samples is needed.


Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Dor/etiologia , Sinais Vitais/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Temperatura Corporal/fisiologia , Lesões Encefálicas Traumáticas/complicações , Correlação de Dados , Estado Terminal , Feminino , Frequência Cardíaca/fisiologia , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Dor/fisiopatologia , Medição da Dor/métodos , Quebeque , Autorrelato
12.
Physiol Meas ; 40(11): 115001, 2019 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-31661680

RESUMO

Non-contact vital sign monitoring enables the estimation of vital signs, such as heart rate, respiratory rate and oxygen saturation (SpO2), by measuring subtle color changes on the skin surface using a video camera. For patients in a hospital ward, the main challenges in the development of continuous and robust non-contact monitoring techniques are the identification of time periods and the segmentation of skin regions of interest (ROIs) from which vital signs can be estimated. We propose a deep learning framework to tackle these challenges. APPROACH: This paper presents two convolutional neural network (CNN) models. The first network was designed for detecting the presence of a patient and segmenting the patient's skin area. The second network combined the output from the first network with optical flow for identifying time periods of clinical intervention so that these periods can be excluded from the estimation of vital signs. Both networks were trained using video recordings from a clinical study involving 15 pre-term infants conducted in the high dependency area of the neonatal intensive care unit (NICU) of the John Radcliffe Hospital in Oxford, UK. MAIN RESULTS: Our proposed methods achieved an accuracy of 98.8% for patient detection, a mean intersection-over-union (IOU) score of 88.6% for skin segmentation and an accuracy of 94.5% for clinical intervention detection using two-fold cross validation. Our deep learning models produced accurate results and were robust to different skin tones, changes in light conditions, pose variations and different clinical interventions by medical staff and family visitors. SIGNIFICANCE: Our approach allows cardio-respiratory signals to be continuously derived from the patient's skin during which the patient is present and no clinical intervention is undertaken.


Assuntos
Aprendizado Profundo , Coração/fisiologia , Monitorização Fisiológica , Respiração , Processamento de Sinais Assistido por Computador , Gravação em Vídeo , Sinais Vitais/fisiologia , Automação , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Redes Neurais de Computação , Pele
14.
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
15.
Curr Opin Crit Care ; 25(6): 653-660, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31524718

RESUMO

PURPOSE OF REVIEW: To summarize the differential diagnosis and diagnostic approach of sudden unresponsiveness with normal vital signs in various settings, including the ICU. RECENT FINDINGS: Sudden unresponsiveness may be either transient or persistent, and may result from primary brain diseases or nonstructural systemic conditions. Life-threatening causes should always be discriminated from those more benign. Regional epidemiology, for example regarding intoxications, and evolving therapeutic management, for example for ischemic stroke, should always be taken into account for optimal opportunity for rapid diagnosis and best management. SUMMARY: Sudden unresponsiveness with normal vital signs should trigger immediate and focused diagnostic evaluation to find or exclude those conditions requiring urgent, and possibly life-saving, management.


Assuntos
Cuidados Críticos , Sinais Vitais/fisiologia , Diagnóstico Diferencial , Humanos , Acidente Vascular Cerebral/diagnóstico
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.
Am Surg ; 85(7): 725-729, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405416

RESUMO

Prior studies have used vital signs and laboratory measurements with conventional modeling techniques to predict acute kidney injury (AKI). The purpose of this study was to use the trend in vital signs and laboratory measurements with machine learning algorithms for predicting AKI in ICU patients. The eICU Collaborative Research Database was queried for five consecutive days of laboratory measurements per patient. Patients with AKI were identified and trends in vital signs and laboratory values were determined by calculating the slope of the least-squares-fit linear equation using three days for each value. Different machine learning classifiers (gradient boosted trees [GBT], logistic regression, and deep learning) were trained to predict AKI using the laboratory values, vital signs, and slopes. There were 151,098 ICU stays identified and the rate of AKI was 5.6 per cent. The best performing algorithm was GBT with an AUC of 0.834 ± 0.006 and an F-measure of 42.96 per cent ± 1.26 per cent. Logistic regression performed with an AUC of 0.827 ± 0.004 and an F-measure of 28.29 per cent ± 1.01 per cent. Deep learning performed with an AUC of 0.817 ± 0.005 and an F-measure of 42.89 per cent ± 0.91 per cent. The most important variable for GBT was the slope of the minimum creatinine (30.32%). This study identifies the best performing machine learning algorithms for predicting AKI using trends in laboratory values in ICU patients. Early identification of these patients using readily available data indicates that incorporating machine learning predictive models into electronic medical record systems is an inevitable requisite for improving patient outcomes.


Assuntos
Lesão Renal Aguda/diagnóstico , Aprendizado de Máquina , Adulto , Análise de Variância , Creatinina/análise , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Sinais Vitais/fisiologia
18.
BMJ Open Qual ; 8(1): e000503, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31206042

RESUMO

Early warning scores are points-based or colour-coded systems used to detect changes in physiological parameters and prompt earlier recognition and management of deteriorating patients. Vital signs recorded within a coloured zone corresponding to degree of derangement ('trigger') should prompt an action. The report of the UK Confidential Enquiry into Maternal and Child Health recommends the use of modified versions in the obstetric population. Currently, there is limited research into the effects of early warning scores in low-resource settings where maternal mortality remains high, and there is a need for low-cost, simple methods to reduce this. A modified obstetric early warning system (MOEWS) was introduced for parturients who had undergone surgical intervention at Felege Hiwot Referral Hospital, a tertiary centre in Bahir Dar, Ethiopia. A guideline was developed to accompany the MOEWS, together with training of healthcare workers. Prior to introduction, the quality of postoperative monitoring was assessed through retrospective case note review. This was reassessed at 8 months and 11 months postimplementation, with assessment of response to 'triggers'. A questionnaire and qualitative interviews were undertaken to establish views of healthcare workers on its acceptability and usability. Recording of postoperative vital signs improved with the implementation of the MOEWS and was sustained at both monitoring periods. The number of patients with vital signs within the coloured zones ('trigger') was reduced, although documented action to these remained low. Staff were positive towards the MOEWS, its impact on patient care and felt confident using the system. The introduction of a MOEWS in an Ethiopian referral hospital in this study appeared to improve the monitoring of postoperative patients. With modifications to suit the setting and senior clinician involvement, coupled with regular training, the early warning score is a feasible and acceptable tool to cope with the unique demands faced in this low-resource setting.


Assuntos
Deterioração Clínica , Cuidados Críticos/normas , Pessoal de Saúde/educação , Monitorização Fisiológica/normas , Obstetrícia , Sinais Vitais/fisiologia , Países em Desenvolvimento , Etiópia , Estudos de Viabilidade , Feminino , Hospitais , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos
19.
J Adv Nurs ; 75(9): 2024-2035, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31115082

RESUMO

AIM: To develop a theory-based complex intervention (targeting nursing staff), to enhance enablers and overcome barriers to enact expected behaviour when monitoring patients and responding to abnormal vital signs that signal deterioration. DESIGN: A mixed method design including structured observations on hospital wards, field notes, brief, unrecorded interviews and semi-structured interviews to inform the development of an intervention to enhance practice. METHODS: Semi-structured interviews will be conducted with nursing staff using a topic guide informed by the Theoretical Domains Framework. Semi-structured interviews will be transcribed verbatim and coded deductively into the 14 Theoretical Domains Framework domains and then inductively into "belief statements". Priority domains will be identified and mapped to appropriate behaviour change techniques. Intervention content and mode of delivery (how behaviour change techniques are operationalized) will be developed using nominal groups, during which participants (clinicians) will rank behaviour change techniques/mode of delivery combinations according to acceptability and feasibility. Findings will be synthesised to develop an intervention manual. DISCUSSION: Despite being a priority for clinicians, researchers and policymakers for two decades, "sub-optimal care" of the deteriorating ward patient persists. Existing interventions have been largely educational (i.e. targeting assumed knowledge deficits) with limited evidence that they change staff behaviour. Staff behaviour when monitoring and responding to abnormal vital signs is likely influenced by a range of mediators that includes barriers and enablers. IMPACT: Systematically applying theory and evidence-based methods, will result in the specification of an intervention which is more likely to result in behaviour change and can be tested empirically in future research.


Assuntos
Deterioração Clínica , Escore de Alerta Precoce , Equipe de Respostas Rápidas de Hospitais , Monitorização Fisiológica/métodos , Cuidados de Enfermagem/métodos , Recursos Humanos de Enfermagem no Hospital/psicologia , Sinais Vitais/fisiologia , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Desenvolvimento de Programas
20.
Intensive Crit Care Nurs ; 53: 100-108, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31076253

RESUMO

AIM: This study aims to understand the concerns of nurses when making MET calls which did not fulfil the vital sign criteria, and the MET nurses subsequent responses to these calls. METHODS: This was a retrospective report-based study. Research material included nursing reports and MET forms related to MET calls made due to nurses' concern. Inductive content analysis was used to identify observations, which were then quantified based on the research material. FINDINGS: From a total of 546 MET calls, 39 visits (7%) were due to nurses' concern. In these 39 visits, the vital sign criteria did not reach the alert threshold, but nurses made the call due to subjective worry. In 13% of visits, the alert concern was inadequate contact with the doctor. MET nurses responded to the alert by providing clinical and indirect nursing; more specifically, they performed examinations and nursing interventions and collaborated with other professionals. CONCLUSION: A nurse's worry is influenced by subjective changes in the patient's condition or an inadequate doctor's response rather than objective physiological measurements. A MET nurse's ability to assess patient condition, respond to nurses' calls, and acknowledge justified alerts help MET nurses support concerned nurses and encourage them to contact the MET if necessary.


Assuntos
Diagnóstico Precoce , Serviços Médicos de Emergência/normas , Equipe de Respostas Rápidas de Hospitais/normas , Relações Interprofissionais , Recursos Humanos de Enfermagem no Hospital/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Estudos de Coortes , Continuidade da Assistência ao Paciente , Serviços Médicos de Emergência/métodos , Feminino , Finlândia , Equipe de Respostas Rápidas de Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Quartos de Pacientes/organização & administração , Quartos de Pacientes/estatística & dados numéricos , Estudos Retrospectivos , Sinais Vitais/fisiologia , Local de Trabalho/psicologia , Local de Trabalho/normas
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