Electronic Monitoring Data Research Articles

Large-Scale Analysis of Hand Hygiene Frequency Across Healthcare Facilities Varying in Key Hospital Characteristics

Background: Hand hygiene by healthcare personnel is a critical infection prevention intervention. Direct observation, the most widely utilized method to observe hand hygiene practices, often provides an incomplete picture due to small sample size and altered behavior in the presence of observers. A growing number of healthcare facilities are employing electronic hand hygiene monitoring systems to capture overall compliance rates. These electronic systems can provide a wealth of data on hand hygiene practices within and across healthcare facilities. Objective: We used high-accuracy electronic monitoring data to perform a detailed analysis of hand hygiene practices across numerous facilities that varied in key hospital characteristics. Methods: In total, 11 tertiary-care facilities were equipped with an electronic hand hygiene monitoring system. Hospitals varied in size, region, area classification (urban vs rural), acuity level, and teaching status. The electronic monitoring system was composed of uniquely assigned employee badges and electronically monitored dispensers. Every recorded dispensing event was time stamped and associated with a specific healthcare worker, the location of the dispenser, and the specific product being dispensed (ie, alcohol-based hand rub [ABHR] or hand soap). The total number of dispensing events for each product type and the total number of hours worked were calculated for each healthcare worker and were used to determine hand hygiene frequency. Hospital attributes, such as size and area classification, were obtained from publicly available sources including but not limited to facility-owned websites and CMS data. Results: More than 15.7 million hand hygiene events, performed by nearly 11,000 healthcare workers, were captured by the electronic monitoring system and were included in the analysis. Overall, median hand hygiene frequency was 4.1 events per hour and ranged from 2.0 events per hour to 5.6 events per hour, depending on the facility. ABHR use (median, 3.6 events per hour) was more frequent than handwashing (median, 0.4 events per hour). Hospitals included in the analysis ranged from small (<20 beds) rural facilities to large (>600 beds) academic hospitals and provided a variety of services from general medical-surgical treatment to intensive care. Interfacility differences in observed hand hygiene frequency were analyzed. Conclusions: The current analysis reinforces and builds upon previous work that examined a smaller subset of 5 hospitals located in a single geographic region. Combined, these datasets represent >20 million hand hygiene events among ∼15,000 healthcare workers from 16 unique healthcare facilities. This analysis provides detailed information about hand hygiene practices across a diverse set of healthcare facilities.Funding: Ecolab, Inc, provided support for this study.Disclosures: Jessica Carol Albright and Cheryl A Littau report salary from Ecolab.

Effect of individualized learning plans on nurse learning outcomes and risk mitigation.

A "Primary Learner Assessment" (PLA) was created to provide an individualized learning plan, offering education as part of a 4-step computer-based process. The PLA is intended to improve learner's knowledge, skills, and patient safety perceptions, regarding interpretation of electronic fetal monitoring (EFM) data and administration of appropriate interventions in a timely fashion to mitigate fetal and maternal risks. Research was conducted to determine if learner knowledge, skills, and patient safety perceptions improved after completion of a 4-step computer-based, individualized adaptive-learning process. Participants were registered nurses (RNs) responsible for administering and interpreting EFM, from three U.S. hospitals with labor and delivery units. This mixed method pilot study was determined to be exempt by the institutional review board; all participants provided consent. The process included four steps. In step one, RNs completed the baseline PLA. Based on incorrect quantitative and EFM interpretation responses, computer-based EFM education courses were recommended (step two). After completion of recommended courses weeks or greater of practice (step three), the RNs completed a follow-up PLA (step four). Of the 55 RN participants, most (85.5%) were clinical nurses, had a bachelor degree in nursing or higher (80.0%), and 11.2 average years of labor and delivery experience. There was a statistically significant improvement (P < .0001) in overall average percentage of correct PLA scores from baseline (76.7, SD = 9.1) to follow-up (82.5, SD = 6.9). Practice-related perceptions showed increased ranking of familiarity with the National Institute of Child Health and Human Development (NICHD) 2008 EFM terminology and guidelines from baseline of 49.0% to follow-up of 87.4% and of impact to which the participants integrated EFM administration and interpretation of NICHD EFM terminology and guidelines into practice from 52.8% at baseline to 94.5% at follow-up. In addition, RNs perceived improvement in their oxygen therapy competence and accuracy in interpreting EFM data with implementation of appropriate interventions. These pilot study findings support a 4-step, computer-based individualized adaptive-learning process as RNs responsible for EFM to potentially mitigate fetal and maternal risk had improved knowledge and skills. Research is warranted in larger samples.

The effect of intrapartum oxygen supplementation on category II fetal monitoring

Maternal oxygen administration is a widely used intrauterine resuscitation technique for fetuses with category II electronic fetal monitoring patterns, despite a paucity of evidence on its ability to improve electronic fetal monitoring patterns. This study investigated the effect of intrapartum oxygen administration on Category II electronic fetal monitoring patterns. This is a secondary analysis of a randomized trial conducted in 2016-2017, in which patients with fetuses at ≥37 weeks' gestation in active labor with category II electronic fetal monitoring patterns were assigned to 10 L/min of oxygen by face mask or room air until delivery. Trained obstetrical research nurses blinded to allocation extracted electronic fetal monitoring data. The primary outcome was a composite of high-risk category II features including recurrent variable decelerations, recurrent late decelerations, prolonged decelerations, tachycardia, or minimal variability 60 minutes after randomization to room air or oxygen. Secondary outcomes included individual components of the composite high-risk category II features, resolution of recurrent decelerations within 60 minutes of randomization, and total deceleration area. The outcomes between the room air and oxygen groups were compared using univariable statistics. Time-to-event analysis was used to compare time to resolution of recurrent decelerations between the groups. Paired analysis was used to compare the pre- and postrandomization outcomes within each group. All 114 randomized patients (57 room air and 57 oxygen) were included in this analysis. There was no difference in resolution of recurrent decelerations within 60 minutes between the oxygen and room air groups (75.4% vs 86.0%; P=.15). The room air and oxygen groups had similar rates of composite high-risk category II features including recurrent variable decelerations, recurrent late decelerations, prolonged decelerations, tachycardia, and minimal variability 60 minutes after randomization. Time to resolution of recurrent decelerations and total deceleration area were similar between the room air and oxygen groups. Among patients who received oxygen, there was no difference in the electronic fetal monitoring patterns pre- and postrandomization. Similar findings were observed in the electronic fetal monitoring patterns pre- and postrandomization in room air patients. Intrapartum maternal oxygen administration for category II electronic fetal monitoring patterns did not resolve high-risk category II features or hasten the resolution of recurrent decelerations. These results suggest that oxygen administration has no impact on improving category II electronic fetal monitoring patterns.

Fisheye Lens: Data Stewardship and Privacy Rights Under the Northeast Multispecies Fishery Management Plan's Amendment 23's Proposed Electronic Monitoring

The Atlantic Cod, Gadus morhua, once held a prime ecological and economic presence in the North Atlantic Ocean, and European colonizers capitalized on this resource by establishing a cod fishery in Newfoundland as far back as 1517. In 1992, Newfoundland’s fishery nearly eliminated its cod stocks, and the Gulf of Maine’s stocks were dying three times as fast as managers predicted. The fishery became one of the world’s most concrete examples of the tragedy of the commons, where harvesters exhaust an open-access resource. Guiding the New England Fisheries Management Council (NEFMC) cod fishery rebuilding effort is a tremendous amount of fisheries modeling aimed at estimating a requisite fishery’s stock size, using landings, discards, and survey data. The Northeast Fisheries Science Center (NEFSC) sources and verifies data partly through the Northeast Fisheries Observer Program (NEFOP). Among the observers’ duties is physically boarding industry vessels to record data. The observers’ physical bias, however, could produce inaccurate data, leading the NEFMC to make inaccurate decisions and hinder the northeastern U.S. cod fishery’s recovery. Inaccurate data would thus hinder managers’ ability to rebuild this historically profitable fishery and the lack of cod would continue to deprive the Northeast’s ecosystem of a key predator. In response to the concern over bias, the NEFMC is currently considering several alternatives to the traditional human observer program in Amendment 23 to the Northeast Multispecies Fisheries Management Plan. One such alternative is electronic monitoring (EM). EM is a system of cameras that captures video of fishing activities onboard vessels, a crucial tool to produce high-quality and low-cost fisheries data to better inform management decisions. However, Northeast fishers have several concerns about EM. EM is a seemingly simple solution to human observers but produces highly detailed video and image data instead of pure numbers, which could identify private individuals, business, or their trade secrets. EM thus presents uncertainty in fishers’ private information, leading to apprehension of EM systems. The opportunity to design a program that is amenable to fishers could speed up implementing EM and its benefits to the northeast’s ecological and economic marine communities. Amending the Magnuson Stevens Act, promulgating strong privacy regulations and internal rules, and ensuring privacy guarantees in third-party contracts would best protect fishers’ privacy, which the National Oceanic and Atmospheric Administration should consider in light of their broad authority to collect EM data. Strong fisheries management requires strong cooperation and mutual respect; guaranteeing strong privacy rights for EM data furthers everyone’s interests. The goal of this Note is to provide a framework to promote the recovery of New England’s marine environment through coastal stakeholder and federal management cooperation.

Prevalence and adherence trends of inhaled corticosteroid/long-acting bronchodilator (ICS/LABA) and ICS monotherapy by age group using electronic medication monitoring (EMM) data from 2017-2019

Prevalence and adherence trends of inhaled corticosteroid/long-acting bronchodilator (ICS/LABA) and ICS monotherapy by age group using electronic medication monitoring (EMM) data from 2017-2019

Telehealth delivery of adherence and medication management system improves outcomes in inner-city children with asthma.

Healthcare disparities exist in pediatric asthma in the United States. Children from minority, low‐income families in inner‐city areas encounter barriers to healthcare, leading to greater rates of poorly controlled asthma and healthcare utilization. Finding an effective way to deliver high‐quality healthcare to this underserved population to improve outcomes, reduce morbidity and mortality, and reduce healthcare utilization is of the utmost importance. The purpose of this study was to assess the feasibility and efficacy of a novel school‐based care delivery model that incorporates video‐based telehealth (VBT) medical and self‐management visits with electronic inhaler monitoring to improve asthma outcomes. Over a 6‐month period, children from inner‐city, low‐income schools with uncontrolled asthma completed seven scheduled medical visits with an asthma specialist and five self‐management visits with an adherence psychologist at school using VBT. Composite Asthma Severity Index (CASI) scores and electronic inhaler monitor data were recorded and analyzed. A total of 21 patients were enrolled in the study. Study subjects with higher baseline severity (CASI ≥ 4 at visit 1) demonstrated a greater reduction in their score than those with lower baseline severity (CASI < 4 at visit 1). The CASI domains showed improvement in daytime symptoms, nighttime symptoms, and exacerbations. Adherence results demonstrated a significant improvement in adherence from baseline to postintervention. Study retention was 100%. This study demonstrates that a multicomponent medical and behavioral interventional program delivered by VBT to a school‐based setting is feasible and can significantly improve asthma outcomes and care in a challenging population.

A Proposed Waterpipe Emissions Topography Protocol Reflecting Natural Environment User Behaviour.

Usage of waterpipes is growing in popularity around the world. Limited waterpipe natural environment topography data reduces the ability of the research community to accurately assess emissions and user exposure to toxicants. A portable ergonomic waterpipe monitor was provided to study participants to use every time they smoked their own waterpipe during a one-week monitoring period in conjunction with their own choice shisha tobacco. Users provided demographic information and logged their product use to supplement electronic monitor data. A total of 44 prospective study participants were invited to an intake appointment following an on-line pre-screening survey. Of these, 34 individuals were invited to participate in the study and data for 24 individuals who completed all aspects of the 1-week monitoring protocol is presented. 7493 puffs were observed during 74 waterpipe sessions accumulating over 48 h of waterpipe usage. The 95% CI on mean puff flow rate, duration, volume and interval are presented, yielding grand means of 243 [mL/s], 3.5 [s], 850 [mL], and 28 [s] respectively. The middle 95% of puff flow rates ranged between 62 to 408 [mL/s], durations from 0.8 to 6.8 [s], and puff volumes from 87 to 1762 [mL]. A waterpipe emissions topography protocol consisting of 13 flow conditions is proposed to reflect 93% of the observed range of puff flow rate, puff duration and puff volume with representative inter-puff interval, cumulative session time and aerosol volumes.

Implementation of the Fetal Monitor Safety Nurse Role: Lessons Learned.

The fetal monitor safety nurse role was created as a supplemental support for nurses assessing fetal heart rate tracings in response to an adverse event. An experienced labor and delivery nurse without a patient care assignment was designated to continuously assess all active fetal monitoring tracings, via an electronic display away from the main nurses' station, as an adjunct to the care and assessment of the nurse with primary responsibility for the patient. The purpose of this project was to evaluate the views of nurses who served as fetal monitor safety nurses about various aspects of the role. Nurses who served as fetal monitor safety nurses were invited to attend a small group session where they completed a survey about the role and then received information on the importance of fetal monitoring safety. Two weeks later, they were asked to take the survey again to evaluate potential changes in viewpoints. Thirty nurses attended small group sessions and completed the survey. Of those, 22 nurses completed the post survey 2 weeks later. There was minimal change in nurses' views of the fetal monitor safety nurse role after attending the small group sessions. Nurses expressed comfort in notifying peers about concerns related to the fetal heart rate tracing and perceived overall safety benefits; however, they felt that safe staffing measures were not in place to support the role. Concerns were expressed about a nurse being in a nondirect patient care position during times of high census and acuity. The fetal monitoring safety nurse may be an innovative potential solution to minimize risk of adverse events during labor that are related to accurate assessment of electronic fetal monitoring data and timely and appropriate interventions. More data are needed on improvements in fetal outcomes and adverse events potentially related to the fetal monitor safety nurse role. Budgetary support and adequate nurse staffing are required to make the role operationally feasible and safe. Valuing and seeking nurses' input as bedside experts about perinatal safety initiatives should be a part of implementing new practices.

Discontinuation of angiotensin-converting enzyme inhibitors or beta-blockers and the impact on heart failure hospitalization rates.

Adherence to evidence-based therapy is essential for optimal management of heart failure. Yet, medication adherence is poor in heart failure patients. The Ascertaining Barriers to Compliance Project decomposed the medication adherence process into initiation, implementation, and discontinuation stages, but electronic monitoring-based adherence analyses usually do not consider this process. The aim of this study was to describe individual-patient patterns of medication adherence from electronic monitoring data among adults with chronic heart failure, adherence types, and risk factors for increased all-cause hospitalization including measures of poor adherence such as discontinuation. Data from two prospective studies of adherence measured with electronic monitoring for heart failure patients were combined and restricted to monitoring of angiotensin-converting enzyme inhibitors and beta-blockers over an initial three-month period. Hospitalizations were recorded for this period as well as for a three-month follow-up period. Analyses were conducted using adaptive modeling methods to identify individual-patient adherence patterns, adherence types, and risk factors for an increased hospitalization rate. Using electronic monitoring data for 254 heart failure patients, four adherence types were identified: highly consistent, consistent but variable, moderately consistent, and poorly consistent. Sixteen individually significant risk factors for increased hospitalization rates were identified and used to generate a multiple risk factors model. Medication discontinuation was the most important individual risk factor and most important in the multiple risk factors model. Discontinuation of angiotensin-converting enzyme inhibitors or beta-blockers increases hospitalization rates for heart failure patients. Interventions that effectively address this problem are urgently needed.

Identifying Patients Experiencing Opioid-Induced Respiratory Depression During Recovery From Anesthesia: The Application of Electronic Monitoring Devices.

Postsurgical patients experiencing opioid-related adverse drug events have 55% longer hospital stays, 47% higher costs associated with their care, 36% increased risk of 30-day readmission, and 3.4 times higher risk of inpatient mortality compared to those with no opioid-related adverse drug events. Most of the adverse events are preventable. This study explored three types of electronic monitoring devices (pulse oximetry, capnography, and minute ventilation [MV]) to determine which were more effective at identifying the patient experiencing respiratory compromise and, further, to determine whether algorithms could be developed from the electronic monitoring data to aid in earlier detection of respiratory depression. A study was performed in the postanesthesia care unit (PACU) in an inner city. Sixty patients were recruited in the preoperative admissions department on the day of their surgery. Forty-eight of the 60 patients wore three types of electronic monitoring devices while they were recovering from back, neck, hip, or knee surgery. Machine learning models were used for the analysis. Twenty-four of the 48 patients exhibited sustained signs of opioid-induced respiratory depression (OIRD). Although the SpO2 values did not change, end-tidal CO2 levels increased, and MV decreased, representing hypoventilation. A machine learning model was able to predict an OIRD event 10min before the actual event occurred with 80% accuracy. Electronic monitoring devices are currently used as a tool to assess respiratory status using thresholds to distinguish when respiratory depression has occurred. This study introduces a potential paradigm shift from a reactive approach to a proactive approach that would identify a patient at high risk for OIRD. Capnography and MV were found to be effective tools in detecting respiratory compromise in the PACU.

Tenofovir-Diphosphate as a Marker of HIV Pre-exposure Prophylaxis Use Among East African Men and Women.

Background: Controlled pharmacokinetic (PK) studies in United States populations have defined categories of tenofovir-diphosphate (TFV-DP) in dried blood spots (DBS) for various pre-exposure prophylaxis (PrEP) adherence targets. It is unknown how these categories perform in other populations. Therefore, we evaluated the sensitivity and specificity of these PK-derived categories compared to daily medication electronic adherence monitoring (MEMS) data among East African men and women using daily PrEP.Methods: Participants were enrolled as members of HIV serodiscordant couples as part of an open-label PrEP study in Kenya and Uganda. Blood samples were taken at quarterly visits and stored as DBS, which were analyzed for TFV-DP concentrations.Results: Among 150 samples from 103 participants, MEMs data indicated that 87 (58%) took ≥4 doses and 62 (41%) took ≥6 per week consistently over the 4 weeks prior to sample collection. Sensitivities of DBS TFV-DP levels were 62% for the ≥4 doses/week category (≥700 fmol/punch TFV-DP) and 44% for the ≥6 doses/week category (≥1050 fmol/punch TFV-DP); specificities were 86 and 94%, respectively. There were no statistically significant differences in these sensitivities and specificities by gender.Conclusion: In this sample of East African PrEP users, categories of TFV-DP concentrations developed from directly observed PrEP use among United States populations had high specificity but lower than expected sensitivity. Sensitivity was lowest when MEMS data indicated high adherence (i.e., ≥6 doses/week). PrEP studies and implementation programs should carefully consider the sensitivity and specificity of the TFV-DP levels used for adherence feedback.

More data for the money: Improvements in design and cost efficiency of electronic monitoring in the Danish cod catch quota management trial

Electronic Monitoring (EM) with video is a tool often mentioned to ensure compliance with fishing regulations while vessels are at sea. Since 2008, several trials have been conducted in the European Union on the use of EM. One of the largest and longest running European trials was the 2010–2016 Cod Catch Quota Management trial (CCQM) in Denmark. This paper reviews the methods and experiences gained from this trial, with focus on the last two years where criteria for video audits were expanded and major technical developments took place. The cost-effectiveness and potential of EM for compliance, management and scientific purposes is discussed. The present study demonstrates that EM is capable of high precision detection of non-compliance with a discard ban and that developments in the transmission of EM data allowed for a smoother and more reliable Monitoring, Control and Surveillance (MCS) system. Although further developments are needed, especially within the field of automated image analysis, we conclude that EM is one of the few feasible tools where fisheries information and compliance can be ensured under a Landing Obligation.

Measuring Antiretroviral Adherence Among Young People Living with HIV: Observations from a Real-Time Monitoring Device Versus Self-report.

This report compares self-report (SR) antiretroviral (ARV) adherence data to adherence data collected via Wisepill, a real-time electronic monitoring (EM) device, among young people living with HIV (YPLH) in the southern United States. Participants (n = 66; ages 16 to 26) were followed for 14weeks. Descriptive analyses were used to compare SR to EM data. Correlations and a linear regression were conducted to explore factors possibly associated with SR-EM discrepancies. We also examined associations between various levels of SR and EM adherence and viral suppression/non-suppression at 14weeks. Rates of SR adherence were maintained between 87% and 92% while rates of EM adherence declined from 64% to 34%. YPLH who were ARV-experienced, had lower treatment motivation, and reported more frequent recent marijuana use, had a greater discrepancy between their SR and EM adherence levels compared to other YPLH. Higher rates of SR and EM adherence were independently associated with a decline in viral load. A sensitivity analysis also revealed that SR adherence was a better predictor of viral non-suppression, whereas EM adherence was a better predictor of viral suppression. These measurement approaches are discussed in the context of providing clinical care to YPLH.

Measuring congruence between electronic monitoring and logbook data in Australian Commonwealth longline and gillnet fisheries

Electronic monitoring (EM) has the capacity to collect fisheries-dependent data to support fisheries management decision-making. Following successful pilot studies, EM was introduced into several Australian Commonwealth fisheries in 2015, including the Eastern Tuna and Billfish Fishery (ETBF) and the Gillnet, Hook and Trap (GHAT) sector of the Southern and Eastern Scalefish and Shark Fishery (SESSF). We compared two years of EM analyst and fisher-reported logbook data from the ETBF and GHAT sector to examine the level of congruence in reporting of both retained and discarded catch and protected species interactions. In general, congruence between EM analyst and fisher-reported logbook data in both the ETBF and GHAT sector was higher for retained than for discarded catch, and the ETBF had a higher level of data equivalency than the GHAT sector. Fishery-wide estimates of congruence, however, concealed a large amount of variation among individual and groups of species. EM analyst and fisher-reported logbook data were highly congruent for some species (e.g. tunas, swordfish and gummy shark), but for others there were clear taxonomic (e.g. escolar and rudderfish), identification (e.g. sharks, marlins) and reporting (e.g. draughtboard shark and elephantfish) issues, which reduced overall congruence. There was evidence of increased congruence through time, particularly for discarded bycatch species in the GHAT sector, due presumably to increased manager feedback and communication with fishers on their logbook reporting. While EM analyst and fisher-reported logbook interactions with protected species in the GHAT sector were equivalent, this was not the case for species other than seabirds in the ETBF. In the ETBF, a greater number of interactions were reported by fishers in their logbooks, suggesting a need to modify existing or install additional EM technology to improve on-board vision for the EM analyst. It is important to review the performance of any integrated EM system through time to ensure it is fulfilling the data requirements for the fishery and meeting the overall objectives of the program.

Desarrollo de un sistema de monitoreo para acuaponía en hogares basado en IOT

&lt;p&gt;La metodología de producir alimentos de forma local es una de las herramientas&lt;br /&gt;más importante en la teoría de la soberanía y seguridad alimentaria, y en este perfil productivo el tener proteína animal se convierte en un reto importante a considerar, por diferentes razones de espacio, logística, generación de olores, etc. Así, los cultivos hidropónicos se convierten en una solución, máxime cuando este sistema se transfiere incluyendo el cultivo de peces en estanques que se benefician de la hidroponía. Es así como este tipo de sistema, en donde a la metodología de hidroponía se le agregan peces, se convierte en acuapónico, metodología que requería ser valorada, y así se hizo, usando herramientas agrónicas para su automatización, midiendo variables de temperatura, humedad y pH para controlar la circulación y la temperatura, con la producción de hortalizas y peces en una misma estructura, para comprobar el funcionamiento del modelo, bajo el monitoreo electrónico y la toma remota de datos con actuadores y comunicación inalámbrica a una plataforma web. El resultado fue la construcción de un prototipo que permite la integración de peces con cultivo de hortalizas, bajo un monitoreo remoto con sensores, y la transmisión de datos a una plataforma web. En las conclusiones se hace referencia a las condiciones mínimas de uso de esta metodología con resultados productivos positivos, y las condiciones de manejos para un buen uso del prototipo, de hasta un 90 % de resultados positivos en la producción, el uso eficiente de recursos, y los sistemas remotos de control; esto como una alternativa&lt;br /&gt;para la producción integrada de peces y hortalizas en espacios urbanos.&lt;/p&gt;

Evaluation of Physiologic Alterations during Prehospital Paramedic-Performed Rapid Sequence Intubation

Objective: Physiologic alterations during rapid sequence intubation (RSI) have been studied in several emergency airway management settings, but few data exist to describe physiologic alterations during prehospital RSI performed by ground-based paramedics. To address this evidence gap and provide guidance for future quality improvement initiatives in our EMS system, we collected electronic monitoring data to evaluate peri-intubation vital signs changes occurring during prehospital RSI. Methods: Electronic patient monitor data files from cases in which paramedic RSI was attempted were prospectively collected over a 15-month study period to supplement the standard EMS patient care documentation. Cases were analyzed to identify peri-intubation changes in oxygen saturation, heart rate, and blood pressure. Results: Data from 134 RSI cases were available for analysis. Paramedic-assigned prehospital diagnostic impression categories included neurologic (42%), respiratory (26%), toxicologic (22%), trauma (9%), and cardiac (1%). The overall intubation success rate (95%) and first-attempt success rate (82%) did not differ across diagnostic impression categories. Peri-intubation desaturation (SpO2 decrease to below 90%) occurred in 43% of cases, and 70% of desaturation episodes occurred on first-attempt success. The incidence of desaturation varied among patient categories, with a respiratory diagnostic impression associated with more frequent, more severe, and more prolonged desaturations, as well as a higher incidence of accompanying cardiovascular instability. Bradycardia (HR decrease to below 60 bpm) occurred in 13% of cases, and 60% of bradycardia episodes occurred on first-attempt success. Hypotension (systolic blood pressure decrease to below 90 mmHg) occurred in 7% of cases, and 63% of hypotension episodes occurred on first-attempt success. Peri-intubation cardiac arrest occurred in 2 cases, one of which was on first-attempt success. Only 11% of desaturations and no instances of bradycardia were reflected in the standard EMS patient care documentation. Conclusions: In this study, the majority of peri-intubation physiologic alterations occurred on first-attempt success, highlighting that first-attempt success is an incomplete and potentially deceptive measure of intubation quality. Supplementing the standard patient care documentation with electronic monitoring data can identify unrecognized physiologic instability during prehospital RSI and provide valuable guidance for quality improvement interventions.

The need for data-informed clinical supervision in substance use disorder treatment

ABSTRACTEffective clinical supervision is necessary for high-quality care in community-based substance use disorder treatment settings, yet little is known about current supervision practices. Some evidence suggests that supervisors and counselors differ in their experiences of clinical supervision; however, the impact of this misalignment on supervision quality is unclear. Clinical information monitoring systems may support supervision in substance use disorder treatment, but the potential use of these tools must first be explored. First, the current study examines the extent to which misaligned supervisor–counselor perceptions impact supervision satisfaction and emphasis on evidence-based treatments. This study also reports on formative work to develop a supervision-based clinical dashboard, an electronic information monitoring system and data visualization tool providing real-time clinical information to engage supervisors and counselors in a coordinated and data-informed manner, help align supervisor–counselor perceptions about supervision, and improve supervision effectiveness. Clinical supervisors and frontline counselors (N = 165) from five Midwestern agencies providing substance abuse services completed an online survey using Research Electronic Data Capture software, yielding a 75% response rate. Valid quantitative measures of supervision effectiveness were administered, along with qualitative perceptions of a supervision-based clinical dashboard. Through within-dyad analyses, misalignment between supervisor and counselor perceptions of supervision practices was negatively associated with satisfaction of supervision and reported frequency of discussing several important clinical supervision topics, including evidence-based treatments and client rapport. Participants indicated the most useful clinical dashboard functions and reported important benefits and challenges to using the proposed tool. Clinical supervision tends to be largely an informal and unstructured process in substance abuse treatment, which may compromise the quality of care. Clinical dashboards may be a well-targeted approach to facilitate data-informed clinical supervision in community-based treatment agencies.

Associations Between Personality Traits and Adherence to Antidepressants Assessed Through Self-Report, Electronic Monitoring, and Pharmacy Dispensing Data: A Pilot Study.

Treatment with antidepressants is often compromised by substantial nonadherence. To understand nonadherence, specific medication-related behaviors and beliefs have been studied, but less is known about broader and temporally stable personality "traits." Furthermore, adherence has often been assessed by a single method. Hence, we investigated associations between the Big Five personality traits and adherence assessed by self-report, electronic drug use monitoring, and dispensing data. Using the Big Five Inventory, we assessed the personality traits "openness," "conscientiousness," "extraversion," "agreeableness," and "neuroticism" of patients treated with antidepressants who were invited through community pharmacies. Self-reported adherence was assessed with the Medication Adherence Rating Scale (score >24), electronic monitoring with medication event monitoring system (MEMS) devices (therapy days missed ≤ 10% and < 4 consecutive days missed), and dispensing data (medication possession ratio ≥ 80%). One hundred four women and 33 men participated (mean age, 51; standard deviation, 14). Paroxetine was most frequently prescribed (N = 53, 38%). Logistic regression analysis revealed that of the personality traits, the third and fourth quartiles of "conscientiousness" were associated with better self-reported adherence (odds ratio, 3.63; 95% confidence interval, 1.34-9.86 and odds ratio, 2.97; 95% confidence interval, 1.09-8.08; P ≤ 0.05). No relationships were found between personality traits and adherence assessed through electronic drug use monitoring or dispensing data. We therefore conclude that adherence to antidepressant therapy seems to be largely unrelated to personality traits.

Identification of high-risk areas for harbour porpoise Phocoena phocoena bycatch using remote electronic monitoring and satellite telemetry data

Identification of high-risk areas for harbour porpoise Phocoena phocoena bycatch using remote electronic monitoring and satellite telemetry data

Development of an algorithm for analysing the electronic measurement of medication adherence in routine HIV care.

Background Medication adherence is crucial for successful treatment. Various methods exist for measuring adherence, including electronic drug monitoring, pharmacy refills, pill count, and interviews. These methods are not equivalent, and no method can be considered as the gold standard. A combination of methods is therefore recommended. Objective To develop an algorithm for the management of routinely collected adherence data and to compare persistence and implementation curves using post-algorithm data (reconciled data) versus raw electronic drug monitoring data. Setting A community pharmacy located within a university medical outpatient clinic in Lausanne, Switzerland. Methods The algorithm was developed to take advantage of the strengths of each available adherence measurement method, with electronic drug monitoring as a cornerstone to capture the dynamics of patient behaviour, pill count as a complementary objective method to detect any discrepancy between the number of openings measured by electronic monitoring and the number of pills ingested per opening, and annotated interviews to interpret the discrepancy. The algorithm was tested using data from patients taking lopinavir/r and having participated in an adherence-enhancing programme for more than 3months. Main outcome measure Adherence was calculated as the percentage of persistent patients (persistence) and the proportion of days with correct dosing over time (implementation) from inclusion to the end of the median follow-up period. Results A 10-step algorithm was established. Among 2041 analysed inter-visit periods, 496 (24%) were classified as inaccurate, among which 372 (75%) could be reconciled. The average implementation values were 85% (raw data) and 91% (reconciled data) (p<0.0001). At day 544, persistence values were 68% (raw) and 82% (reconciled) (p=0.11), and adherence values were 74% (raw) and 82% (reconciled) (p<0.0001). Conclusion Combining electronic drug monitoring, pill count and patient interviews is possible within the setting of a medication adherence clinic. Electronic drug monitoring underestimates medication adherence, affecting subsequent analysis of routinely collected adherence data. To ensure a set of reliable electronic drug monitoring data, structured and timely electronic drug monitoring management should be reinforced.