Improving communications in PPE: a solution for 'landline' telephone communication.

BACKGROUND: Emergency care staff wearing elastomeric respiratory personal protective equipment (PPE) report difficulties in communicating by telephone. We developed and tested an affordable technological solution aimed at improving telephone call intelligibility for staff wearing PPE. METHODS: A novel headset was created to enable a throat microphone and bone conduction headset to be used in combination with a standard hospital 'emergency alert' telephone system. Speech intelligibility of an ED staff member wearing PPE was compared between the proposed headset and current practice by simultaneously recording a version of the Modified Rhyme Test and a Key Sentences Test. Recordings were played back to a group of blinded ED staff listening to pairs of recordings under identical conditions. The proportion of correctly identified words was compared using a paired t-test. RESULTS: Fifteen ED staff correctly identified a mean of 73% (SD 9%) words for speech communicated via the throat microphone system, compared with only 43% (SD 11%) of words for standard practice (paired t-test, p<0.001). CONCLUSIONS: Introduction of a suitable headset could significantly improve speech intelligibility during 'emergency alert' telephone calls.

Feasibility of fully automated closed-loop glucose control using continuous subcutaneous glucose measurements in critical illness: a randomized controlled trial.

INTRODUCTION: Closed-loop (CL) systems modulate insulin delivery according to glucose levels without nurse input. In a prospective randomized controlled trial, we evaluated the feasibility of an automated closed-loop approach based on subcutaneous glucose measurements in comparison with a local sliding-scale insulin-therapy protocol. METHODS: Twenty-four critically ill adults (predominantly trauma and neuroscience patients) with hyperglycemia (glucose, ≥10 mM) or already receiving insulin therapy, were randomized to receive either fully automated closed-loop therapy (model predictive control algorithm directing insulin and 20% dextrose infusion based on FreeStyle Navigator continuous subcutaneous glucose values, n = 12) or a local protocol (n = 12) with intravenous sliding-scale insulin, over a 48-hour period. The primary end point was percentage of time when arterial blood glucose was between 6.0 and 8.0 mM. RESULTS: The time when glucose was in the target range was significantly increased during closed-loop therapy (54.3% (44.1 to 72.8) versus 18.5% (0.1 to 39.9), P = 0.001; median (interquartile range)), and so was time in wider targets, 5.6 to 10.0 mM and 4.0 to 10.0 mM (P ≤ 0.002), reflecting a reduced glucose exposure >8 and >10 mM (P ≤ 0.002). Mean glucose was significantly lower during CL (7.8 (7.4 to 8.2) versus 9.1 (8.3 to 13.0] mM; P = 0.001) without hypoglycemia (<4 mM) during either therapy. CONCLUSIONS: Fully automated closed-loop control based on subcutaneous glucose measurements is feasible and may provide efficacious and hypoglycemia-free glucose control in critically ill adults. TRIAL REGISTRATION: ClinicalTrials.gov Identifier, NCT01440842.

Automated overnight closed-loop glucose control in young children with type 1 diabetes.

BACKGROUND: We evaluated the effectiveness of automated overnight closed-loop (AOCL) insulin delivery and the influence of timing of initiation on glucose control overnight in young children with type 1 diabetes (T1D). METHODS: Eight children with T1D (four boys, four girls) (mean ± SD: 9.4 ± 2.7 years old; body mass index, 18.3 ± 2.3 kg/m(2); duration of diabetes, 3.9 ± 2.5 years; total daily insulin dose, 0.7 ± 0.1 U/kg/day; glycosylated hemoglobin, 7.9 ± 0.9%) were studied in a clinical research facility on two separate occasions. Subjects had a meal at 18:00 (77 ± 8 g of carbohydrate [CHO]) and snack at 21:00 (21 ± 6 g of CHO), both accompanied by a prandial insulin bolus. In random order, AOCL was started at 18:00 or 21:00 h and ran until 08:00 h the next day. Subcutaneous continuous glucose monitoring data were fed automatically into the model predictive control algorithm. Calculated subcutaneous insulin infusion rates were sent wirelessly to an insulin pump. Plasma glucose was measured to assess closed-loop performance. RESULTS: No rescue CHOs were administered. Time spent with plasma glucose in the target range from 3.9 to 8.0 mmol/L was 50.7% (29.0%, 72.2%), and it did not differ on the two occasions: median (interquartile range), 42% (18%, 64%) versus 58% (32%, 79%) (P = 0.161). Time when plasma glucose was above 8.0 mmol/L (42% [25%, 82%] vs. 29% [14%, 64%], P = 0.093), time below 3.9 mmol/L (0% [0%, 11%] vs. 8% [0%, 17%], P = 0.500), low blood glucose index (0.1 [0.0, 2.5] vs. 1.7 [0.4, 3.3], P = 0.380), plasma glucose at the start of AOCL (12.5 ± 2.7 vs. 11.6 ± 4.2 mmol/L, P = 0.562), and mean overnight plasma glucose (8.3 ± 2.1 vs. 7.5 ± 2.2 mmol/L, P = 0.246) were also similar. CONCLUSIONS: AOCL is feasible in young children with T1D. Comparable results were obtained when closed-loop was initiated at 18:00 or 21:00 h.

A comparison of technologies used for estimation of body temperature.

Body temperature measurement is an important clinical parameter. The performance of a number of non-invasive thermometers was measured by comparing intra- and inter-operator variability (n = 100) and clinical accuracy (n = 61). Variability was elevated in febrile compared to normothermic subjects for axillary and oral electronic contact thermometer measures and a temporal artery thermometer (p < 0.001 for both). Temporal artery thermometry and one mode of an infrared tympanic thermometer demonstrated significant clinical inaccuracy (p < 0.001 for both). Electronic contact thermometer repeatability and reproducibility are highly variable in febrile adults both in the axilla and oral cavity. Infrared thermometry of the skin over the superficial temporal artery is unreliable for measuring core body temperature, particularly in febrile subjects and patients in theatre. The infrared tympanic thermometers tested are acceptable for clinical practice; however, care should be exercised with the different modes of operation offered.