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1.
Reprod Health ; 20(1): 6, 2023 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-36609353

RESUMO

BACKGROUND: The CRADLE (Community blood pressure monitoring in Rural Africa: Detection of underLying pre-Eclampsia) Vital Signs Alert device-designed specifically to improve maternity care in low resource settings-had varying impact when trialled in different countries. To better understand the contextual factors that may contribute to this variation, this study retrospectively evaluated the adoption of CRADLE, during scale-up in Sierra Leone. METHODS: This was a mixed methods study. A quantitative indicator of adoption (the proportion of facilities trained per district) was calculated from existing training records, then focus groups were held with 'CRADLE Champions' in each district (n = 32), to explore adoption qualitatively. Template Analysis was used to deductively interpret qualitative data, guided by the NASSS (non-adoption, abandonment, scale-up, spread, sustainability) Framework. FINDINGS: Substantial but non-significant variation was found in the proportion of facilities trained in each district (range 59-90%) [X2 (7, N = 8) = 10.419, p = 0.166]. Qualitative data identified complexity in two NASSS domains that may have contributed to this variation: 'the technology' (for example, charging issues, difficulty interpreting device output and concerns about ongoing procurement) and 'the organisation' (for example, logistical barriers to implementing training, infighting and high staff turnover). Key strategies mentioned to mitigate against these issues included: transparent communication at all levels; encouraging localised adaptations during implementation (including the involvement of community leaders); and selecting Champions with strong soft skills (particularly conflict resolution and problem solving). CONCLUSIONS: Complexity related to the technology and the organisational context were found to influence the adoption of CRADLE in Sierra Leone, with substantial inter-district variation. These findings emphasise the importance of gaining an in-depth understanding of the specific system and context in which a new healthcare technology is being implemented. This study has implications for the ongoing scale-up of CRADLE, and for those implementing or evaluating other health technologies in similar contexts.


Many women die during pregnancy and childbirth from causes that could be prevented, and the vast majority of these deaths occur in low-resource settings. The 'CRADLE Vital Signs Alert' is a medical device that helps identify problems during pregnancy­designed specifically for healthcare professionals in low-resource settings. However, for unknown reasons, the device appears to have varying impact according to the country or setting in which it is used. This study aimed to explore in depth whether, and why, healthcare professionals in Sierra Leone adopted the device and engaged in training (or not). Between March 2020 and January 2021, the CRADLE device and training package was disseminated across 8 districts in Sierra Leone. This relied on a few healthcare workers (nominated 'CRADLE Champions') to voluntarily distribute the devices and training in their local areas. Group discussions were held with CRADLE Champions in each district after the rollout to gather their feedback. In addition, the proportion of facilities trained in each district was recorded. The study found differences in how well the device and training was adopted in each district. Common challenges reported across districts related to technological difficulties (such as issues charging the devices) and organisational barriers (such as high levels of staff turnover at facilities). These findings will help to inform future rollout of the CRADLE device and training in Sierra Leone and highlight factors that may need to be considered by those implementing other health technologies in similar settings.


Assuntos
Serviços de Saúde Materna , Humanos , Feminino , Gravidez , Serra Leoa , Estudos Retrospectivos , África , Sinais Vitais
2.
Sci Rep ; 13(1): 954, 2023 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-36653386

RESUMO

Cognitive buildings use data on how occupants respond to the built environment to proactively make occupant-centric adjustments to lighting, temperature, ventilation, and other environmental parameters. However, sensors that unobtrusively and ubiquitously measure occupant responses are lacking. Here we show that Doppler-radar based sensors, which can sense small physiological motions, provide accurate occupancy detection and estimation of vital signs in challenging, realistic circumstances. Occupancy was differentiated from an empty room over 93% of the time in a 3.4 m × 8.5 m conference room with a single sensor in both wall and ceiling-mounted configurations. Occupancy was successfully detected while an occupant was under the table, visibly blocked from the sensor, a scenario where infrared, ultrasound, and video-based occupancy sensors would fail. Heart and respiratory rates were detected in all seats in the conference room with a single ceiling-mounted sensor. The occupancy sensor can be used to control HVAC and lighting with a short, 1-2 min delay and to provide information for space utilization optimization. Heart and respiratory rate sensing could provide additional feedback to future human-building interactive systems that use vital signs to determine how occupant comfort and wellness is changing with time.


Assuntos
Taxa Respiratória , Sinais Vitais , Humanos , Ventilação , Temperatura , Ultrassonografia Doppler
3.
Sensors (Basel) ; 23(2)2023 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-36679435

RESUMO

With advances in the Internet of Things, patients in intensive care units are constantly monitored to expedite emergencies. Due to the COVID-19 pandemic, non-face-to-face monitoring has been required for the safety of patients and medical staff. A control center monitors the vital signs of patients in ICUs. However, some medical devices, such as ventilators and infusion pumps, operate in a standalone fashion without communication capabilities, requiring medical staff to check them manually. One promising solution is to use a robotic system with a camera. We propose a real-time optical digit recognition embedded system called ROMI. ROMI is a mobile robot that monitors patients by recognizing digits displayed on LCD screens of medical devices in real time. ROMI consists of three main functions for recognizing digits: digit localization, digit classification, and digit annotation. We developed ROMI by using Matlab Simulink, and the maximum digit recognition performance was 0.989 mAP on alexnet. The developed system was deployed on NVIDIA GPU embedded platforms: Jetson Nano, Jetson Xavier NX, and Jetson AGX Xavier. We also created a benchmark by evaluating the runtime performance by considering ten pre-trained CNN models and three NVIDIA GPU platforms. We expect that ROMI will support medical staff with non-face-to-face monitoring in ICUs, enabling more effective and prompt patient care.


Assuntos
COVID-19 , Humanos , COVID-19/diagnóstico , Pandemias , Monitorização Fisiológica , Unidades de Terapia Intensiva , Sinais Vitais
4.
Sensors (Basel) ; 23(2)2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36679548

RESUMO

The combination of advanced radar sensor technology and smart grid has broad prospects. It is meaningful to monitor the respiration and heartbeat of grid employees under resting state through radar sensors to ensure that they are in a healthy working state. Ultra-wideband (UWB) radar sensor is suitable for this application because of its strong penetration ability, high range resolution and low average power consumption. However, due to weak heartbeat amplitude and measurement noise, the accurate measurement of the target heart rate is a challenge. In this paper, singular spectrum analysis (SSA) is proposed to reconstruct the eigenvalues of noisy vital signs to eliminate noise peaks around the heartbeat rate; combined with the variational modal decomposition (VMD), the target vital signs can be extracted with high accuracy. The experiment confirmed that the target vital sign information can be extracted with high accuracy from ten subjects at different distances, which can play an important role in short distance human detection and vital sign monitoring.


Assuntos
Radar , Processamento de Sinais Assistido por Computador , Humanos , Sinais Vitais/fisiologia , Frequência Cardíaca/fisiologia , Respiração , Algoritmos , Monitorização Fisiológica
5.
Sensors (Basel) ; 23(2)2023 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-36679598

RESUMO

Vital signs estimation provides valuable information about an individual's overall health status. Gathering such information usually requires wearable devices or privacy-invasive settings. In this work, we propose a radar-based user-adaptable solution for respiratory signal prediction while sitting at an office desk. Such an approach leads to a contact-free, privacy-friendly, and easily adaptable system with little reference training data. Data from 24 subjects are preprocessed to extract respiration information using a 60 GHz frequency-modulated continuous wave radar. With few training examples, episodic optimization-based learning allows for generalization to new individuals. Episodically, a convolutional variational autoencoder learns how to map the processed radar data to a reference signal, generating a constrained latent space to the central respiration frequency. Moreover, autocorrelation over recorded radar data time assesses the information corruption due to subject motions. The model learning procedure and breathing prediction are adjusted by exploiting the motion corruption level. Thanks to the episodic acquired knowledge, the model requires an adaptation time of less than one and two seconds for one to five training examples, respectively. The suggested approach represents a novel, quickly adaptable, non-contact alternative for office settings with little user motion.


Assuntos
Radar , Processamento de Sinais Assistido por Computador , Humanos , Monitorização Fisiológica/métodos , Sinais Vitais , Taxa Respiratória , Respiração , Algoritmos , Frequência Cardíaca
6.
Sensors (Basel) ; 23(2)2023 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-36679632

RESUMO

The human radial artery pulse carries a rich array of biomedical information. Accurate detection of pulse signal waveform and the identification of the corresponding pulse condition are helpful in understanding the health status of the human body. In the process of pulse detection, there are some problems, such as inaccurate location of radial artery key points, poor signal noise reduction effect and low accuracy of pulse recognition. In this system, the pulse signal waveform is collected by the main control circuit and the new piezoelectric sensor array combined with the wearable wristband, creating the hardware circuit. The key points of radial artery are located by an adaptive pulse finding algorithm. The pulse signal is denoised by wavelet transform, iterative sliding window and prediction reconstruction algorithm. The slippery pulse and the normal pulse are recognized by feature extraction and classification algorithm, so as to analyze the health status of the human body. The system has accurate pulse positioning, good noise reduction effect, and the accuracy of intelligent analysis is up to 98.4%, which can meet the needs of family health care.


Assuntos
Dispositivos Eletrônicos Vestíveis , Punho , Humanos , Frequência Cardíaca , Artéria Radial , Sinais Vitais , Pulso Arterial
7.
Int J Med Inform ; 170: 104970, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36603390

RESUMO

BACKGROUND: Even low-acuity patients suffer from disrupted sleep in the hospital in part due to routine overnight vital sign (VS) checks. When invasive monitoring is not needed, vital sign monitoring devices (VSMDs) similar to consumer-grade health monitors may play a role in promoting sleep, which can aid healing and recovery. METHODS: We provided one VSMD to neuroscience ward patients during their hospital stays and used surveys to assess patient and nurse attitudes toward the device and the impact of the device on patient comfort. We also compared VSMD-streamed vS data to nurse-recorded vS data in the chart to evaluate the consistency of data streaming and data concordance between the device and nurse-collected vital sign values. FINDINGS: 21 patients and 15 nurses enrolled. Overall, patients and nurses responded positively to the device and patients preferred wearing the device to receiving manual vital checks overnight. The most common device-related cause of sleep disruption per patients was device weight (29%). Device vS were concordant with nurse vS on average but there was significant variance in agreement between nurse and device values. INTERPRETATION: Patients and nurses feel positively about the use of VSMDs and their use in the hospital. The device we tested may be limited in its sleep promotion by its weight and patient comfort assessment. Further research is needed to assess the precision of the device in measuring vital signs when used in a clinical setting. Future studies should compare VSMD models and assess their impacts on patient sleep in the absence of manual vS checks overnight. FUNDING: Funding provided by the Sara & Evan Williams Foundation Endowed Neurohospitalist Chair at UCSF.


Assuntos
Sono , Sinais Vitais , Humanos , Estudos de Viabilidade , Monitorização Fisiológica , Hospitais
8.
Am J Emerg Med ; 64: 96-100, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36502653

RESUMO

OBJECTIVE: Skin and soft tissue infections (SSTI) are commonly diagnosed in the emergency department (ED). While most SSTI are diagnosed with patient history and physical exam alone, ED clinicians may order CT imaging when they suspect more serious or complicated infections. Patients who inject drugs are thought to be at higher risk for complications from SSTI and may undergo CT imaging more frequently. The objective of this study is to characterize CT utilization when evaluating for SSTI in ED patients particularly in patients with intravenous drug use (IVDU), the frequency of significant and actionable findings from CT imaging, and its impact on subsequent management and ED operations. METHODS: We performed a retrospective analysis of encounters involving a diagnosis of SSTI in seven EDs across an integrated health system between October 2019 and October 2021. Descriptive statistics were used to assess overall trends, compare CT utilization frequencies, actionable imaging findings, and surgical intervention between patients who inject drugs and those who do not. Multivariable logistic regression was used to analyze patient factors associated with higher likelihood of CT imaging. RESULTS: There were 4833 ED encounters with an ICD-10 diagnosis of SSTI during the study period, of which 6% involved a documented history of IVDU and 30% resulted in admission. 7% (315/4833) of patients received CT imaging, and 22% (70/315) of CTs demonstrated evidence of possible deep space or necrotizing infections. Patients with history of IVDU were more likely than patients without IVDU to receive a CT scan (18% vs 6%), have a CT scan with findings suspicious for deep-space or necrotizing infection (4% vs 1%), and undergo surgical drainage in the operating room within 48 h of arrival (5% vs 2%). Male sex, abnormal vital signs, and history of IVDU were each associated with higher likelihood of CT utilization. Encounters involving CT scans had longer median times to ED disposition than those without CT scans, regardless of whether these encounters resulted in admission (9.0 vs 5.5 h), ED observation (5.5 vs 4.1 h), or discharge (6.8 vs 2.9 h). DISCUSSION: ED clinicians ordered CT scans in 7% of encounters when evaluating for SSTI, most frequently in patients with abnormal vital signs or a history of IV drug use. Patients with a history of IVDU had higher rates of CT findings suspicious for deep space infections or necrotizing infections and higher rates of incision and drainage procedures in the OR. While CT scans significantly extended time spent in the ED for patients, this appeared justified by the high rate of actionable findings found on imaging, particularly for patients with a history of IVDU.


Assuntos
Infecções dos Tecidos Moles , Abuso de Substâncias por Via Intravenosa , Humanos , Masculino , Infecções dos Tecidos Moles/diagnóstico por imagem , Infecções dos Tecidos Moles/tratamento farmacológico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Serviço Hospitalar de Emergência , Sinais Vitais , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/epidemiologia
9.
Technol Health Care ; 31(1): 327-337, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36530105

RESUMO

BACKGROUND: Patient monitors are medical devices used to monitor vital parameters such as heart rate, respiratory rate, blood pressure, blood oxygen saturation, and body temperature during inpatient treatment. As such, patient monitors provide physicians with information necessary to adjust the treatment as well as evaluate the overall status and recovery of the patient. Measurements made by intrinsic sensors of patient monitors must be compliant and provide reliable readings in order to ensure safety and optimal quality of care to the patients. OBJECTIVE: This paper proposes a novel method for conformity assessment testing of patient monitors in healthcare institutions for post-market surveillance purposes. METHOD: The method was developed on the basis of metrology characteristics of sensors used to monitor vital parameters observed by patient monitors and evaluation of their vital safety and performance parameters. In addition to the evaluation of essential safety and visual integrity of patient monitors, their performance in terms of accuracy of the readings is evaluated. RESULTS: The developed method was validated between 2018 and 2021 in healthcare institutions of all levels. The results obtained during validation suggest that conformity assessment testing of patient monitors as a method used during PMS contributes to significant improvement in devices' accuracy and reliability. CONCLUSION: A standardized approach in conformity assessment testing of patient monitors during PMS, besides increasing reliability of the devices, is the first step in digital transformation of management of these devices in healthcare institutions opening possibility for use of artificial intelligence.


Assuntos
Inteligência Artificial , Sinais Vitais , Humanos , Reprodutibilidade dos Testes , Pressão Sanguínea/fisiologia , Frequência Cardíaca
10.
J Phys Act Health ; 20(1): 28-34, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-36493760

RESUMO

BACKGROUND: Physical inactivity is a risk factor for many chronic conditions. This retrospective cohort study examined associations between physical activity (PA) with health care utilization (HU). METHODS: A PA vital sign was recorded in clinics from January 2018 to December 2020. Patients were categorized as inactive, insufficiently active, or sufficiently active by US PA aerobic guidelines. Associations between PA vital sign and visits (inpatient admissions, emergency department, urgent care, and primary care) were estimated using population average regression by visit type. RESULTS: 23,721 patients had at least one PA vital sign recorded, with a mean age of 47.3 years and mean body mass index (BMI) of 28; 52% were female and 63% were White. Sufficiently active patients were younger, male, White, and had lower BMI than insufficiently active patients. Achieving 150 minutes per week of moderate to vigorous PA per 1000 patient years was associated with 34 fewer emergency department visits (P < .001), 19 fewer inpatient admissions (P < .001), and 38 fewer primary care visits (P < .001) compared with inactive patients. Stronger associations between lower PA and higher HU were present among those who were older or had a higher comorbidity. BMI, sex, ethnicity, and race did not modify the association between PA and HU. CONCLUSIONS: Meeting aerobic guidelines was associated with reduced HU for inpatient, primary care, and emergency department visits.


Assuntos
Exercício Físico , Aceitação pelo Paciente de Cuidados de Saúde , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Massa Corporal , Sinais Vitais
11.
Biosensors (Basel) ; 12(12)2022 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-36551036

RESUMO

The popularity of health concepts and the wave of digitalization have driven the innovation of sensors in the medical field. Such continual development has made sensors progress in the direction of safety, flexibility, and intelligence for continuous monitoring of vital signs, which holds considerable promise for changing the way humans live and even treat diseases. To this end, flexible wearable devices with high performance, such as high sensitivity, high stability, and excellent biodegradability, have attracted strong interest from scientists. Herein, a review of flexible wearable sensors for temperature, heart rate, human motion, respiratory rate, glucose, and pH is highlighted. In addition, engineering issues are also presented, focusing on material selection, sensor fabrication, and power supply. Finally, potential challenges facing current technology and future directions of wearable sensors are also discussed.


Assuntos
Dispositivos Eletrônicos Vestíveis , Humanos , Sinais Vitais , Frequência Cardíaca , Temperatura , Fontes de Energia Elétrica , Monitorização Fisiológica
12.
Biosensors (Basel) ; 12(12)2022 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-36551134

RESUMO

Hemorrhage is the leading cause of preventable death from trauma. Accurate monitoring of hemorrhage and resuscitation can significantly reduce mortality and morbidity but remains a challenge due to the low sensitivity of traditional vital signs in detecting blood loss and possible hemorrhagic shock. Vital signs are not reliable early indicators because of physiological mechanisms that compensate for blood loss and thus do not provide an accurate assessment of volume status. As an alternative, machine learning (ML) algorithms that operate on an arterial blood pressure (ABP) waveform have been shown to provide an effective early indicator. However, these ML approaches lack physiological interpretability. In this paper, we evaluate and compare the performance of ML models trained on nine ABP-derived features that provide physiological insight, using a database of 13 human subjects from a lower-body negative pressure (LBNP) model of progressive central hypovolemia and subsequent progressive restoration to normovolemia (i.e., simulated hemorrhage and whole blood resuscitation). Data were acquired at multiple repressurization rates for each subject to simulate varying resuscitation rates, resulting in 52 total LBNP collections. This work is the first to use a single ABP-based algorithm to monitor both simulated hemorrhage and resuscitation. A gradient-boosted regression tree model trained on only the half-rise to dicrotic notch (HRDN) feature achieved a root-mean-square error (RMSE) of 13%, an R2 of 0.82, and area under the receiver operating characteristic curve of 0.97 for detecting decompensation. This single-feature model's performance compares favorably to previously reported results from more-complex black box machine learning models. This model further provides physiological insight because HRDN represents an approximate measure of the delay between the ABP ejected and reflected wave and therefore is an indication of cardiac and peripheral vascular mechanisms that contribute to the compensatory response to blood loss and replacement.


Assuntos
Volume Sanguíneo , Hemorragia , Humanos , Pressão Sanguínea/fisiologia , Volume Sanguíneo/fisiologia , Hemorragia/complicações , Hemorragia/diagnóstico , Hipovolemia/diagnóstico , Hipovolemia/etiologia , Sinais Vitais
13.
Sensors (Basel) ; 22(24)2022 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-36560066

RESUMO

Frequency-modulated continuous wave (FMCW) radars are currently being investigated for remote vital signs monitoring (measure of respiration and heart rates) as an innovative wireless solution for healthcare and ambient assisted living. However, static reflectors (furniture, objects, stationary body parts, etc.) within the range or range angular bin where the subject is present contribute in the Doppler signal to a direct current (DC) offset. The latter is added to the person's information, containing also a useful DC component, causing signal distortion and hence reducing the accuracy in measuring the vital sign parameters. Removing the sole contribution of the unwanted DC offset is fundamental to perform proper phase demodulation, so that accurate vital signs monitoring can be achieved. In this work, we analyzed different DC offset calibration methods to determine which one achieves the highest accuracy in measuring the physiological parameters as the transmitting frequency varies. More precisely, by using two FMCW radars, operating below 10 GHz and at millimeter wave (mmWave), we applied four DC offset calibration methods to the baseband radar signals originated by the cardiopulmonary activities. We experimentally determined the accuracy of the methods by measuring the respiration and the heart rates of different subjects in an office setting. It was found that the linear demodulation outperforms the other methods if operating below 10 GHz while the geometric fitting provides the best results at mmWave.


Assuntos
Radar , Processamento de Sinais Assistido por Computador , Humanos , Monitorização Fisiológica/métodos , Sinais Vitais , Respiração , Frequência Cardíaca/fisiologia , Algoritmos
14.
PLoS One ; 17(12): e0279269, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36538515

RESUMO

BACKGROUND: Vasoactive drugs are one of the most common patient-related barriers to early mobilization. Little is known about the hemodynamic effects of early mobilization on patients receiving vasoactive drugs. This study aims to observe and describe the impact of mobilization on the vital signs of critical patients receiving vasoactive drugs as well as the occurrence of adverse events. METHODS: This is a cohort study performed in an Intensive Care Unit with patients receiving vasoactive drugs. All patients, either mobilized or non-mobilized, had their clinical data such as vital signs [heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and oxygen saturation], type and dosage of the vasoactive drug, and respiratory support collected at rest. For mobilized patients, the vital signs were also collected after mobilization, and so was the highest level of mobility achieved and the occurrence of adverse events. The criteria involved in the decision of mobilizing the patients were registered. RESULTS: 53 patients were included in this study and 222 physiotherapy sessions were monitored. In most of the sessions (n = 150, 67.6%), patients were mobilized despite the use of vasoactive drugs. There was a statistically significant increase in heart rate and respiratory rate after mobilization when compared to rest (p<0.05). Only two (1.3%) out of 150 mobilizations presented an adverse event. Most of the time, non-mobilizations were justified by the existence of a clinical contraindication (n = 61, 84.7%). CONCLUSIONS: The alterations observed in the vital signs of mobilized patients may have reflected physiological adjustments of patients' cardiovascular and respiratory systems to the increase in physical demand imposed by the early mobilization. The adverse events were rare, not serious, and reversed through actions such as a minimal increase of the vasoactive drug dosage.


Assuntos
Deambulação Precoce , Hemodinâmica , Humanos , Estudos de Coortes , Estudos Prospectivos , Hemodinâmica/fisiologia , Sinais Vitais
15.
Air Med J ; 41(6): 542-548, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36494170

RESUMO

OBJECTIVE: The aim of this study was to characterize vital sign abnormalities, trajectories, and related risk factors during neonatal transport. METHODS: We performed a retrospective analysis of neonates transported within a US regional care network in 2020 to 2021. Demographic and clinical data were collected from electronic records. Group-based trajectory modeling was applied to identify groups of neonates who followed distinct vital sign trajectories during transport. Patients with conditions likely to impact the assessed vital were excluded. Risk factors for trajectories were examined using modified Poisson regression models. RESULTS: Of the 620 neonates in the study, 92% had one abnormal systolic blood pressure (SBP) measure, approximately half had an abnormal heart rate (47%) or temperature (56%), and 28% had an abnormal oxygen saturation measure during transport. Over half (53%) were in a low and decreasing SBP trajectory, and 36% were in a high and increasing heart rate trajectory. Most infants ≤ 28 weeks postmenstrual age had 2 or more concerning vital sign trajectories during transport. CONCLUSION: Abnormal vital signs were common during neonatal transport, and potentially negative trajectories in heart rate and SBP were more common than temperature or oxygen saturation. Transport teams should be trained and equipped to detect concerning trends and respond appropriately while en route.


Assuntos
Sinais Vitais , Recém-Nascido , Lactente , Humanos , Estudos Retrospectivos , Fatores de Risco , Frequência Cardíaca
16.
J Emerg Med ; 63(3): 460-466, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36376006

RESUMO

BACKGROUND: Much controversy surrounds the use of orthostatic vital signs (OVS), including their indications, performance, and interpretation. This can lead to conflict between nurses, physicians, and consultants. This article summarizes the evidence for OVS in selected emergency department (ED) indications and the basis for a rapid measurement protocol. OBJECTIVE: This narrative review is intended to clarify indications for OVS measurement, their performance, and interpretation. DISCUSSION: Phlebotomy studies indicate that OVS are more discriminating than supine vital signs in hypovolemia, but many findings, even some considered "positive," do not provide compelling evidence in favor of or against disease. Evaluated as a diagnostic test, they have a low yield and controversial criteria for a positive test, but as vital signs, they are useful for selected patients with frequent ED presentations-blood loss, dehydration, dizziness, weakness, and falls. Available evidence supports a rapid measurement protocol, including a 1-min interval after standing. CONCLUSION: OVS are useful in selected patients, in a variety of frequent presentations, but their indications and implications for a patient's care are subject to physician interpretation. Given their ease of measurement and effect on decision-making, physicians may consider measuring them early in the evaluation of selected patients.


Assuntos
Hipotensão Ortostática , Humanos , Hipotensão Ortostática/diagnóstico , Sinais Vitais , Tontura/diagnóstico , Tontura/etiologia , Serviço Hospitalar de Emergência , Hipovolemia/diagnóstico
17.
BMC Emerg Med ; 22(1): 180, 2022 11 14.
Artigo em Inglês | MEDLINE | ID: mdl-36376795

RESUMO

BACKGROUND: Massive hemorrhage is the main cause of preventable death after trauma. This study aimed to establish prediction models for early diagnosis of massive hemorrhage in trauma. METHODS: Using the trauma database of Chinese PLA General Hospital, two logistic regression (LR) models were fit to predict the risk of massive hemorrhage in trauma. Sixty-two potential predictive variables, including clinical symptoms, vital signs, laboratory tests, and imaging results, were included in this study. Variable selection was done using the least absolute shrinkage and selection operator (LASSO) method. The first model was constructed based on LASSO feature selection results. The second model was constructed based on the first vital sign recordings of trauma patients after admission. Finally, a web calculator was developed for clinical use. RESULTS: A total of 2353 patients were included in this study. There were 377 (16.02%) patients with massive hemorrhage. The selected predictive variables were heart rate (OR: 1.01; 95% CI: 1.01-1.02; P<0.001), pulse pressure (OR: 0.99; 95% CI: 0.98-0.99; P = 0.004), base excess (OR: 0.90; 95% CI: 0.87-0.93; P<0.001), hemoglobin (OR: 0.95; 95% CI: 0.95-0.96; P<0.001), displaced pelvic fracture (OR: 2.13; 95% CI: 1.48-3.06; P<0.001), and a positive computed tomography scan or positive focused assessment with sonography for trauma (OR: 1.62; 95% CI: 1.21-2.18; P = 0.001). Model 1, which was developed based on LASSO feature selection results and LR, displayed excellent discrimination (AUC: 0.894; 95% CI: 0.875-0.912), good calibration (P = 0.405), and clinical utility. In addition, the predictive power of model 1 was better than that of model 2 (AUC: 0.718; 95% CI: 0.679-0.757). Model 1 was deployed as a public web tool ( http://82.156.217.249:8080/ ). CONCLUSIONS: Our study developed and validated prediction models to assist medical staff in the early diagnosis of massive hemorrhage in trauma. An open web calculator was developed to facilitate the practical application of the research results.


Assuntos
Hemorragia , Sinais Vitais , Humanos , Valor Preditivo dos Testes , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Estudos Retrospectivos , Modelos Logísticos
18.
PLoS One ; 17(11): e0277992, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36413553

RESUMO

BACKGROUND: Rapid Response Teams were developed to provide interventions for deteriorating patients. Their activation depends on timely detection of deterioration. Automated calculation of warning scores may lead to early recognition, and improvement of RRT effectiveness. METHOD: This was a "Before" and "After" study, in the "Before" period ward nurses activated RRT after manually recording vital signs and calculating warning scores. In the "After" period, vital signs and warning calculations were automatically relayed to RRT through a wireless monitoring network. RESULTS: When compared to the before group, the after group had significantly lower incidence and rate of cardiopulmonary resuscitation (CPR) (2.3 / 1000 inpatient days versus 3.8 / 1000 inpatient days respectively, p = 0.01), significantly shorter length of hospital stay and lower hospital mortality, but significantly higher number of RRT activations. In multivariable logistic regression model, being in the "After" group decreases odds of CPR by 33% (OR = 0.67 [95% CI: 0.46-0.99]; p = 0.04). There was no difference between groups in ICU admission. CONCLUSION: Automated activation of the RRT significantly reduced CPR events and rates, improved CPR success rate, reduced hospital length of stay and mortality, but increased the number of RRT activations. There were no differences in unplanned ICU admission or readmission.


Assuntos
Equipe de Respostas Rápidas de Hospitais , Humanos , Estudos de Coortes , Segurança do Paciente , Mortalidade Hospitalar , Sinais Vitais
19.
Sensors (Basel) ; 22(21)2022 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-36365862

RESUMO

Respiration and heartrates are important information for surgery. When the vital signs of the patient lying prone are monitored using radar installed on the back of the surgical bed, the surgeon's movements reduce the accuracy of these monitored vital signs. This study proposes a method for enhancing the monitored vital sign accuracies of a patient lying on a surgical bed using a 60 GHz frequency modulated continuous wave (FMCW) radar system with beamforming. The vital sign accuracies were enhanced by applying a fast Fourier transform (FFT) for range and beamforming which suppress the noise generated at different ranges and angles from the patient's position. The experiment was performed for a patient lying on a surgical bed with or without surgeon. Comparing a continuous-wave (CW) Doppler radar, the FMCW radar with beamforming improved almost 22 dB of signal-to-interference and noise ratio (SINR) for vital signals. More than 90% accuracy of monitoring respiration and heartrates was achieved even though the surgeon was located next to the patient as an interferer. It was analyzed using a proposed vital signal model included in the radar IF equation.


Assuntos
Radar , Processamento de Sinais Assistido por Computador , Humanos , Sinais Vitais , Monitorização Fisiológica/métodos , Respiração , Frequência Cardíaca , Algoritmos
20.
Sensors (Basel) ; 22(21)2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36366187

RESUMO

Quantitative indoor monitoring, in a low-invasive and accurate way, is still an unmet need in clinical practice. Indoor environments are more challenging than outdoor environments, and are where patients experience difficulty in performing activities of daily living (ADLs). In line with the recent trends of telemedicine, there is an ongoing positive impulse in moving medical assistance and management from hospitals to home settings. Different technologies have been proposed for indoor monitoring over the past decades, with different degrees of invasiveness, complexity, and capabilities in full-body monitoring. The major classes of devices proposed are inertial-based sensors (IMU), vision-based devices, and geomagnetic and radiofrequency (RF) based sensors. In recent years, among all available technologies, there has been an increasing interest in using RF-based technology because it can provide a more accurate and reliable method of tracking patients' movements compared to other methods, such as camera-based systems or wearable sensors. Indeed, RF technology compared to the other two techniques has higher compliance, low energy consumption, does not need to be worn, is less susceptible to noise, is not affected by lighting or other physical obstacles, has a high temporal resolution without a limited angle of view, and fewer privacy issues. The aim of the present narrative review was to describe the potential applications of RF-based indoor monitoring techniques and highlight their differences compared to other monitoring technologies.


Assuntos
Análise da Marcha , Telemedicina , Humanos , Tremor , Atividades Cotidianas , Polissonografia , Sinais Vitais
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