Improve Patient Monitoring Research Articles

Anesthesia considerations for patients with epilepsy: Findings of a qualitative study in the Palestinian practice

ObjectiveThis qualitative exploratory study was conducted to explore how anesthesiologists in Palestine provide perioperative care for patients with epilepsy and how they account for the unique challenges relevant to epilepsy while planning perioperative care for patients with epilepsy. MethodsThis study was conducted in an explorative qualitative design. Purposive and snowball sampling approaches were used to recruit the study participants. Qualitative semi-structured in-depth interviews were conducted with anesthesiologists (n = 10) and a neurologist (n = 1). The qualitative data collected in this study were thematically analyzed using the interpretive description methodology to generate themes, subthemes, and patterns. ResultsThree major themes emerged from the collected qualitative data with a total of 18 subthemes. The 3 themes were: 1) considerations/challenges while assessing patients, 2) anesthetic considerations, and 3) recovery considerations. Lack of epilepsy-specific assessment and anesthesia protocols, underuse of neurology referral services, and lack of neuromonitoring were identified. ConclusionFindings of this study highlighted the need to develop specific anesthesia protocols for patients with epilepsy. Anesthesiologists and planners of perioperative care should improve collection of patient information and assessment methods, ensure control over seizures, reduce triggers of seizures, and improve patient monitoring approaches. Findings of this study might be used to inform anesthesiologists and decision makers in professional groups, patient advocacy groups, and healthcare authorities to benchmark and improve anesthesia care and services offered to patients with epilepsy. More studies are still needed to quantitatively assess the quality of anesthesia care and services provided to patients with epilepsy.

A Nested Eight-Channel Transmit Array With Open-Face Concept for Human Brain Imaging at 7 Tesla

Purpose: Parallel transmit technology for MRI at 7 tesla will significantly benefit from high performance transmit arrays that offer high transmit efficiency and low mutual coupling between the individual array elements. A novel dual-mode transmit array with nested array elements has been developed to support imaging the human brain in both the single-channel (sTx) and parallel-transmit (pTx) excitation modes of a 7 tesla MRI scanner. In this work, the design, implementation, validation, specific absorption rate (SAR) management, and performance of the head coil is presented.Methods: The transmit array consisted of a nested arrangement to improve decoupling between the second-neighboring elements. Two large cut-outs were introduced in the RF shield for an open-face design to reduce claustrophobia and to allow patient monitoring. A hardware interface allows the coil to be used in both the sTx and pTx modes. SAR monitoring is done with virtual observation points (VOP) derived from human body models. The transmit efficiency and coverage is compared with the commercial single-channel and parallel-transmit head coils.Results: Decoupling inductors between the second-neighboring coil elements reduced the coupling to less than −20 dB. Local SAR estimates from the electromagnetic (EM) simulations were always less than the EM-based VOPs, which in turn were always less than scanner predictions and measurements for static and dynamic pTx waveforms. In sTx mode, we demonstrate improved coverage of the brain compared to the commercial sTx coil. The transmit efficiency is within 10% of the commercial pTx coil despite the two large cut-outs in the RF shield. In pTx mode, improved signal homogeneity was shown when the Universal Pulse was used for acquisition in vivo.Conclusion: A novel head coil which includes a nested eight-channel transmit array has been presented. The large cut-outs improve patient monitoring and reduce claustrophobia. For pTx mode, the EM simulation and VOP-based SAR management provided greater flexibility to apply pTx methods without the limitations of SAR constraints. For scanning in vivo, the coil was shown to provide an improved coverage in sTx mode compared to a standard commercial head coil.

Could 5G Technology Be the Cause of COVID-19?

The burning of 5G sites across the UK in April 2020 has shocked the scientific and industrial society in the UK. The UK's mobile networks have reported 20 cases of masts being targeted in suspected arson attacks over the Easter weekend [1]. The attacks have been driven by conspiracy theories, which claim that the deployment of 5G networks has caused or helped accelerating the spread of COVID-19. But scientists say the connection between COVID-19 and 5G is a "complete nonsense" and biologically impossible. This article discusses the claims about 5G technology and its link to COVID-19 and will make a conclusion whether conspiracy theories have any ground. Our fact checking investigation lead to the conclusion that any claims connecting this technology to the pandemic are false. Inversely, the huge capabilities offered by 5G especially with IoT and AI that could be used to revolutionize the healthcare sector by providing better assistance to the frontline staff, and facilitating improved virus tracking, patient monitoring, data collection, and analysis.

A prospective interventional study evaluating seizure activity during a radiotherapy course for high-grade gliomas (SURF-ROGG)

BackgroundGliomas are often associated with symptoms including seizures. Most patients with high-grade gliomas are treated with radiotherapy or radio-chemotherapy. Since irradiation causes inflammation, it may initially aggravate symptoms. Studies focusing on seizure activity during radiotherapy for gliomas are not available. Such knowledge may improve patient monitoring and anti-epileptic treatment. This study evaluates seizure activity during radiotherapy for high-grade gliomas.MethodsThe primary objective this prospective interventional study is the evaluation of seizure activity during a course of radiotherapy for high-grade gliomas. Progression of seizure activity is defined as increased frequency of seizures by > 50%, increased severity of seizures, or initiation/increase by ≥25% of anti-epileptic medication. Seizure frequency up to 6 weeks following radiotherapy and electroencephalography activity typical for epilepsy will also be evaluated. Patients keep a seizure diary during and up to 6 weeks following radiotherapy. Every day, they will document number (and type) of seizures and anti-epileptic medication. Once a week, the findings of the diary are checked and discussed with a neurologist to initiate or adjust anti-epileptic medication, if necessary. Patients complete a questionnaire regarding their satisfaction with the seizure diary. If the dissatisfaction rate is > 40%, the seizure diary will be considered not suitable for the investigated indication. Thirty-five patients (32 patients plus drop-outs) should be enrolled. With this sample size, a one-sample binomial test with a one-sided significance level of 2.5% has a power of 80% to yield statistical significance, if the rate of patients with progression of seizure activity is 30% (rate under the alternative hypothesis), assuming a ‘natural’ background progression-rate of 10% without radiotherapy (null hypothesis).DiscussionIf an increase in seizure activity during a course of radiotherapy for high-grade glioma occurs, the findings of this study may pave the way for a larger prospective trial and will likely lead to closer patient monitoring and better anti-epileptic treatment.Trial registrationclinicaltrials.gov (NCT04552756); registered on 16th of September, 2020.

Motion sensor-acquired reachable workspace correlates with patient-reported upper extremity activities of daily living (ADL) function in facioscapulohumeral dystrophy.

This study examines the correlation, and clinical meaningfulness, between reachable workspace outcome and reported activities of daily living (ADL) function of individuals with facioscapulohumeral dystrophy (FSHD). Twenty-one FSHD subjects with various disease severity (clinical severity scores 1-4) underwent reachable workspace evaluation and completed the Quality of Life in Neurological Disorders (NeuroQoL) upper extremity questionnaire. Spearman and receiver operator curve analyses were performed. Moderate correlation was found between NeuroQoL scores and total (ρ = 0.7609; P < .01), and upper-quadrants relative surface areas (RSAs) (ρ = 0.6969; P < .01). Five specific items (ie, shirt on, shirt off, use spoon, pull on pants, pick-up clothes) demonstrated even higher correlations with total (ρ = 0.8397; P < .01) and above shoulder (ρ = 0.8082; P < .01) RSAs. A total RSA cuffoff value of 0.70 would achieve 100% sensitivity and 94% specificity (area under the curve = 0.975). Reachable workspace values identify when individuals have difficulties performing ADLs at home. This information improves patient monitoring, and clinical decision making by enabling more timely recommendations for medications, assistive devices, or considerations for clinical trial enrollments.

4,4,16-Trifluoropalmitate: Design, Synthesis, Tritiation, Radiofluorination and Preclinical PET Imaging Studies on Myocardial Fatty Acid Oxidation.

Fatty acid oxidation (FAO) produces most of the ATP used to sustain the cardiac contractile work, although glycolysis is a secondary source of ATP under normal physiological conditions. FAO impairment has been reported in the advanced stages of heart failure (HF) and is strongly linked to disease progression and severity. Thus, from a clinical perspective, FAO dysregulation provides prognostic value for HF progression, the assessment of which could be used to improve patient monitoring and the effectiveness of therapy. Positron emission tomography (PET) imaging represents a powerful tool for the assessment and quantification of metabolic pathways in vivo. Several FAO PET tracers have been reported in the literature, but none of them is in routine clinical use yet. Metabolically trapped tracers are particularly interesting because they undergo FAO to generate a radioactive metabolite that is subsequently trapped in the mitochondria, thus providing a quantitative means of measuring FAO in vivo. Herein, we describe the design, synthesis, tritium labelling and radiofluorination of 4,4,16-trifluoro-palmitate (1) as a novel potential metabolically trapped FAO tracer. Preliminary PET-CT studies on [18 F]1 in rats showed rapid blood clearance, good metabolic stability - confirmed by using [3 H]1 in vitro - and resistance towards defluorination. However, cardiac uptake in rats was modest (0.24±0.04 % ID/g), and kinetic analysis showed reversible uptake, thus indicating that [18 F]1 is not irreversibly trapped.

The natural history of weight and swallowing outcomes in oropharyngeal cancer patients following radiation or concurrent chemoradiation therapy.

Patients treated for oropharyngeal cancer (OPC) are at increased risk for functional decline due to cancer-related impairments and treatment toxicities, often leading to recommendations for enteral nutritional support. This study investigated the natural history of weight and swallowing outcomes in patients with and without feeding tube (FT) placement. Data were collected from electronic medical records of OPC patients treated with (chemo)radiotherapy at a single regional cancer center between January 2013 and December 2015. Weight measurements, Functional Oral Intake Scale (FOIS) scores, Performance Status Scale for Head and Neck Cancer (PSS-HN) normalcy of diet scores, and M.D. Anderson Dysphagia Inventory (MDADI) composite scores were gathered at baseline and at 3-, 6-, and 12-months post-treatment. Patients were grouped based on FT placement and change over time was assessed using linear mixed effects analysis. Of 122 eligible patients, 38 (31.1%) received a FT (FT group). Compared with baseline, weight decreased significantly at 3 and 6months in both groups and at 12months for patients without a FT (NFT group). Swallowing-related quality of life (QoL) decreased significantly at 3 and 6months only in the NFT group. OPC patients experience clinically relevant decreases in weight and swallowing-related QoL in the first-year post-treatment irrespective of FT placement. These findings will contribute to improved patient monitoring and communication within the clinical setting which may ultimately lead to better outcomes for those with OPC.

Evaluating standards of care in psoriatic arthritis of the QUANTUM project (qualitative initiative to improve outcomes): results of an accreditation project in Spain

In Spain, the QUANTUM project has been promoted to reduce variability in clinical practice and improve the care and quality of life of people with psoriatic arthritis (PsA) by accrediting PsA units throughout the Spanish national health system. To present the results of this approach which sought to ensure an optimum level of quality for patients with PsA. Descriptive analysis of the self-assessments that the PsA units have carried out assessing their degree of compliance with the quality standards established in the QUANTUM project grouped into four blocks: shortening time to diagnosis; optimizing disease management; improving multidisciplinary collaboration; and improving patient monitoring. A total of 41 PsA units were self-evaluated. They met 64.1% of the defined quality standards. Optimize disease management obtained a higher level of standards compliance (72%) and improve multidisciplinary collaboration the lesser (63.9%). Accessibility to the treatments available for PsA in all hospitals was guaranteed (100%). Appropriate diagnostic equipment is available (97.6%). Compliance with specific quality standards leads to detect actions that should be implemented: quality of life assessment (9.8%), locomotor system assessment (12.2%), physical examination data record (14.6%), periodic cardiovascular risk assessment (17.1%). The QUANTUM project results make it possible to visualise how to care for patients with PsA is being developed in Spain. Problems identified in recent multinational reports are also identified in Spain.

Abstract A36: Impact of feeding tube use on swallowing-related quality of life and weight in oropharyngeal cancer

Abstract Purpose: This study investigated differences in swallowing-related quality of life (QoL) and weight outcomes in patients treated for oropharyngeal cancer (OPC) based on feeding tube (FT) use. Methods: A retrospective chart review of OPC patients treated with definitive radiotherapy (± chemotherapy) was performed. Swallowing QoL and weight outcomes were collected from electronic medical records for patients seen at a single regional cancer center between January 2013 and December 2015. M.D. Anderson Dysphagia Inventory (MDADI) composite scores, Performance Status Scale for Head and Neck Cancer (PSS-HN) Normalcy of Diet scores, and weight measurements were gathered at baseline and at 3, 6, and 12 months post-treatment. Patients were grouped based on FT use. Bivariate associations were evaluated using the chi-square test and change over time was analyzed by group using a linear mixed effects analysis. The proportion of patients with clinically meaningful change was also determined. Results: Of 126 eligible patients, 46 (36.5%) received a reactive gastrostomy or gastro-jejunostomy FT (FT group). Compared to baseline, MDADI composite scores were significantly lower at 3 and 6 months (p &amp;lt; .001) for those who did not receive a FT (NFT group), while no significant change occurred in the FT group over time. No significant change was noted in PSS-HN scores for either group. Significant decreases in weight occurred in both groups at 3 and 6 months, and at 12 months for the NFT group alone (p &amp;lt; .001). Clinically meaningful decreases in MDADI composite scores at 3, 6, and 12 months were observed in 53%, 43%, and 29% of FT patients and 45%, 44%, and 33% of NFT patients, respectively. Clinically meaningful decreases in weight were observed at 3, 6, and 12 months in 30%, 23%, and 13% of FT patients and for 50%, 44%, and 40% of NFT patients, respectively. There was no significant association between FT use and clinically meaningful decreases in either MDADI composite scores or weight. Conclusions: Despite selective use of enteral feeding for nutritional support in patients at risk, the impact of FT utilization on functional outcomes is not well understood. Statistically significant decreases in short-term swallowing-related QoL were noted preferentially in patients without FTs, and there was a concerning trend for NFT patients to not return to baseline weight by 12 months post-treatment. However, this study also identified that patients in both groups experienced clinically meaningful decreases in swallowing-related QoL and weight in the first year post-treatment irrespective of FT use. Based on this evidence, it is prudent to monitor weight change closely, particularly in patients who do not meet initial risk criteria for reactive FT placement. Understanding the potential for clinically meaningful change in swallowing QOL and weight will contribute to improved patient monitoring and intervention, and may ultimately lead to better outcomes for those with OPC. Citation Format: Nedeljko Jovanovic, Colleen Dreyer, Sarah Hawkins, Kendra Thouless, David Palma, Philip C. Doyle, Julie A. Theurer. Impact of feeding tube use on swallowing-related quality of life and weight in oropharyngeal cancer [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr A36.

Characterization of Immune Phenotypes in Peripheral Blood of Adult Renal Transplant Recipients using Mass Cytometry (CyTOF)

Abstract Background Chronic immunosuppressive therapy in transplant patients can be associated with opportunistic infections and risks of cancer development. There is an important need to better measure the immune status of patients in a transplant setting to improve patient monitoring and guide development of appropriate immunosuppressive agents and regimen. Results In this study, CyTOF was performed to comprehensively characterize the immune differences between 10 renal transplant recipients and 11 age-matched healthy donors, longitudinally over 6 months. Overall, the immune cells of transplant patients showed signs of increased CD8+ T cell activation/differentiation. Higher levels of CD57 on CD8+ T cells were observed. CD8+ T cells and their memory subsets also showed increased production of MIP-1β and IFNγ. Further, CD107a and Granzyme B expression were also increased in CD8+ T cells and CD56hi NK cells, while Tregs had decreased IL-10 production. These changes are consistent with a more stimulated immune system, despite the administration of immune suppressants to the patients. However, there were also some signs of immune suppression in the transplant patients consistent with the treatment regimen. γδT cells showed decreased TNFα and IFNγ expression, while MIP-1β expression was reduced in NKT, CD56hi NK and γδT cells. CD8+ T memory cell subsets also showed decreased expression of IL-2, IL-17 and GM-CSF. Conclusions This mosaic pattern of functional changes highlights the importance of comprehensive immune monitoring of these patients. Such information will aid in optimizing individual treatment strategies and development of improved immunosuppressants that specifically target overly activated populations.

Rapid response team, is it still helpful?

For the last three decades, efforts at improving the survival rate for patients post-cardiopulmonary arrest has remained unattainable. Confronting such challenge has opened the door to devise new strategies to improve patient outcomes at the onset of subtle deterioration, rather than at the point of cardiac arrest.1 In 2006, the Institute for Healthcare Improvement (IHI) introduced the Rapid Response Team (RRT) concept, also known as the Medical Emergency Team (MET), as one of the six preventative steps needed to save the lives of patients who might otherwise die unnecessarily.2 These six recommended interventions were included in a campaign by the IHI called the 100,000 Lives Campaign. A review of the literature was conducted to assess the certainty of clinical outcomes following the implementation of an RRT service within healthcare facilities. The main clinical outcome measures found included reduction of the:– Incidence of cardiac arrests that occurred outside the intensive care unit (ICU),– Total ICU admissions,– Unplanned ICU admissions, and– Total hospital mortality rate per 1000 discharge.3 Despite the increasing utilization of RRTs worldwide, their effectiveness in reducing hospital mortality has been debated.4 However, the purpose of an RRT service is not to improve cardiac arrest management and outcomes. The primary focus of this concept is to identify patients before they deteriorate through improving patient monitoring on general wards (the afferent component) and improving the reliability of the response to deterioration by a dedicated Critical Care Outreach Team, Rapid Response Team, or Medical Emergency Team (the efferent component).4 The reliability of such systems depends on the faultless functioning of a “chain of survival” consisting of:– Timely recording of vital signs,– Improved education and mindset of staff at the bedside to recognize pathological patterns,– Reporting of abnormalities to the efferent team,– Timely and appropriate response by the latter,– Repeating feedback loops. Metrics to estimate failure rescue rates have been developed and are widely used as indicators of hospital quality. The Agency for Healthcare Research and Quality has developed a measure of failure to rescue intended to address concerns about variation in documentation among reporting institutions and the fact that other metrics of patient safety, such as mortality and complication rates, may be more a measure of patient-related factors than quality of care. Those metrics are limited to some degree in their usefulness because some patients with advanced illness simply do not want life-prolonging interventions, and some adverse occurrences are not preventable. Nevertheless, recognition of failure to rescue as a significant issue and an important quality indicator has prompted numerous studies of the underlying causes and the development of systematic approaches to address them. It is time to stop asking whether RRT “works.” Overall, the balance of evidence indicates that RRTs are effective at reducing cardiorespiratory arrest and mortality. The focus should now be more on how to improve detection of patient deterioration and promote a culture of safety.5

El ultrasonido, de la cabecera del paciente al aula

In recent years, ultrasound at the patient’s bedside has exponentially grown. Its application has been observed in the operating room, intensive care units, emergency rooms, first-level care and even in field work. It is so versatile that it facilitates diagnosis, improves patient monitoring and supports invasive procedures, all in a safe and effective manner. It has been used as a didactic tool in medical education that helps create a link between basic sciences and clinical application. Ultrasound is one of the most versatile instruments in contemporary medicine, hence, more training and research in the subject is a must and a priority. Key words: Point-of-care ultrasonography; insonation; medical education; anatomy; physiology

Neurogenic bladder monitoring using the cystomanometer and cystoelastometer

Patients with neurogenic bladder (NGB) require periodic urodynamics (UDS) to evaluate bladder function, which in turn helps guide management. At times, bladder decompensation or hydronephrosis may develop in patients between urodynamic testing intervals. Increased surveillance has improved outcomes in other chronic conditions (e.g., diabetes). Two novel devices, the cystomanometer (CM) and cystoelastometer (CEM), have been developed at the authors' institution to allow for home bladder pressure monitoring. The handheld CM can be attached to the end of any catheter and records the opening bladder pressure along with a time stamp. In addition, the CEM actively evacuates urine via a pump and records the urine volume evacuated. For safety, the pump slows and stops as it detects increasing resistance. Data are stored and transmitted wirelessly from both devices to a smartphone. A novel phone application stores, displays, and transmits data to a secure hospital server. This aim of this study was to validate the function of the CM and CEM and their accuracy relative to UDS. Institutional review board approval was obtained. All patients with NGB managed with intermittent catheterization undergoing routine UDS were eligible for study inclusion. At the completion of UDS, the instillation port of the 6-French dual-lumen UDS catheter was connected to the CM or CEM. Bladder parameters were simultaneously recorded using the device and UDS during bladder emptying. Correlative statistics were calculated. A total of 36 patients (30 children/6 adults; age range from 1.2 to 38 years [median: 7.5 years]) underwent CM testing. Strong pressure correlation with UDS was identified (R2=0.89). A total of 42 patients (30 children/12 adults; age range of 2.9-85.2 years [median: 12.2 years]) underwent CEM testing. Again, strong pressure correlation was found (R2=0.77). Cystoelastometer volume measurements were highly correlated with measured volumes (Fig.4, R2=0.98). Both the CM and CEM functioned well and transmitted the data wirelessly to a smartphone. The data from these devices were strongly correlated with simultaneous data from the UDS. A limitation is that these devices were used by healthcare providers, and therefore, use by patients or their parents/caregivers at home has not been demonstrated. The CM and CEM devices provide accurate bladder pressure and volume measurements. The potential for improved patient monitoring and care is promising. Reliability testing and the effects of such monitoring on patient outcomes remain to be determined.

Video directly observed therapy for supporting and monitoring adherence to tuberculosis treatment in Uganda: a pilot cohort study.

IntroductionNonadherence to treatment remains an obstacle to tuberculosis (TB) control worldwide. The aim of this study was to evaluate the feasibility of using video directly observed therapy (VDOT) for supporting TB treatment adherence in Uganda.MethodsFrom May to December 2018, we conducted a pilot cohort study at a TB clinic in Kampala City. We enrolled patients aged 18–65 years with ≥3 months remaining of their TB treatment. Participants were trained to use a smartphone app to record videos of medication intake and submit them to a secured system. Trained health workers logged into the system to watch the submitted videos. The primary outcome was adherence measured as the fraction of expected doses observed (FEDO). In a secondary analysis, we examined differences in FEDO by sex, age, phone ownership, duration of follow-up, reasons for missed videos and patients' satisfaction at study exit.ResultsOf 52 patients enrolled, 50 were analysed. 28 (56%) were male, the mean age was 31 years (range 19–50 years) and 35 (70%) owned smartphones. Of the 5150 videos expected, 4231 (82.2%) were received. The median FEDO was 85% (interquartile range 66%–94%) and this significantly differed by follow-up duration. Phone malfunction, uncharged battery and VDOT app malfunctions were the commonest reasons for missed videos. 92% of patients reported being very satisfied with using VDOT.ConclusionVDOT was feasible and acceptable for monitoring and supporting TB treatment. It resulted in high levels of adherence, suggesting that digital technology holds promise in improving patient monitoring in Uganda.

Combining the advantages of multilevel and orthogonal partial least squares data analysis for longitudinal metabolomics: Application to kidney transplantation

Kidney transplantation is one of the renal replacement options in patients suffering from end-stage renal disease (ESRD). After a transplant, patient follow-up is essential and is mostly based on immunosuppressive drug levels control, creatinine measurement and kidney biopsy in case of a rejection suspicion. The extensive analysis of metabolite levels offered by metabolomics might improve patient monitoring, help in the surveillance of the restoration of a “normal” renal function and possibly also predict rejection. The longitudinal follow-up of those patients with repeated measurements is useful to understand changes and decide whether an intervention is necessary.The time modality, therefore, constitutes a specific dimension in the data structure, requiring dedicated consideration for proper statistical analysis. The handling of specific data structures in metabolomics has received strong interest in recent years. In this work, we demonstrated the recently developed ANOVA multiblock OPLS (AMOPLS) to efficiently analyse longitudinal metabolomic data by considering the intrinsic experimental design. Indeed, AMOPLS combines the advantages of multilevel approaches and OPLS by separating between and within individual variations using dedicated predictive components, while removing most uncorrelated variations in the orthogonal component(s), thus facilitating interpretation. This modelling approach was applied to a clinical cohort study aiming to evaluate the impact of kidney transplantation over time on the plasma metabolic profile of graft patients and donor volunteers. A dataset of 266 plasma metabolites was identified using an LC-MS multiplatform analytical setup. Two separate AMOPLS models were computed: one for the recipient group and one for the donor group. The results highlighted the benefits of transplantation for recipients and the relatively low impacts on blood metabolites of donor volunteers.

Reducing Patient Falls on an Acute Inpatient Brain Injury Rehabilitation Unit Through Improved Patient Monitoring

Reducing Patient Falls on an Acute Inpatient Brain Injury Rehabilitation Unit Through Improved Patient Monitoring

Towards the Design of a Smart Glasses Application for MICU Decision-Support: Assessing the Human Factors Impact of Data Portability &amp; Accessibility

The focus of this research is to develop and test a new smart glasses application for use in the medical intensive care unit (MICU) to support workflow, patient care, and overall clinical decision-making. The application prototype, mCARE glass, provides clinicians mobility, portability, and hands-free access to real-time patient electronic medical records and bedside data on demand. Five MICU physician volunteers participated in a study consisting of two parts: 1) a usability test with two tasks, and 2) an interview. Part one included usability testing with the use of the tracking pad, followed by the NASA Task Load Index Test and System Usability Scale test. Our findings suggest that mCARE glass has the potential to enhance clinical workflow in the ICU, and that besides providing easy access to patient data, it would improve patient monitoring and surveillance. Participants concurred that for mCARE glass to optimize clinical workflow, it must be well-integrated into one’s daily work as part of decision-making and observation.

Risk assessment and prediction of TD incidence in psychiatric patients taking concomitant antipsychotics: a retrospective data analysis

BackgroundTardive dyskinesia (TD) is a serious, often irreversible movement disorder caused by prolonged exposure to antipsychotics; identifying patients at risk for TD is critical to preventing it. Predictive models for the occurrence of TD can improve patient monitoring and inform implementation of counteractive interventions. This study aims to identify risk factors associated with TD and to develop a model using a retrospective data analysis to predict the incidence of TD among patients taking antipsychotic medications.MethodsAdult patients with schizophrenia, major depressive disorder, or bipolar disorder taking oral antipsychotics were identified in a Medicaid claims database (covering six US states from 1997 to 2016) and divided into cohorts based on whether they developed TD within 1 year after the first observed claim for antipsychotics. Patient characteristics between cohorts were compared, and univariate Cox analyses were used to identify potential TD risk factors. A cross-validated version of the least absolute shrinkage and selection operator regression method was used to develop a parsimonious multivariable Cox proportional hazards model to predict diagnosis of TD.ResultsA total of 189,415 eligible patients were identified. Potential TD risk factors were identified based on the cohort analysis within a sample of 151,280 patients with at least 1 year of continuous eligibility. The prediction model had a clinically meaningful concordance of 70% and was well calibrated (P = 0.32 for Hosmer–Lemeshow goodness-of-fit test). Age (hazard ratio [HR] = 1.04, P < 0.001), diagnosis of schizophrenia (HR = 1.99, P < 0.001), antipsychotic dosage (up to 100 mg/day chlorpromazine equivalent; HR = 1.65, P < 0.01), and comorbid bipolar and related disorders (HR = 1.39, P < 0.01) were significantly associated with an increased risk of TD. Other potential risk factors included history of extrapyramidal symptoms (HR = 1.35), other movement disorders (parkinsonism, HR = 1.43; bradykinesia, HR = 1.44; tremors, HR = 2.12, and myoclonus, HR = 2.33), and diabetes (HR = 1.13). A modest reduction in the risk of TD was associated with the use of second-generation antipsychotics (HR = 0.85) versus first-generation drugs.ConclusionsThis study identified factors associated with development of TD among patients taking antipsychotics. The prediction model described herein can enable physicians to better monitor patients at high risk for TD and recommend appropriate treatment plans to help maintain quality of life.

Haemostatic Changes in Five Patients Infected with Ebola Virus.

Knowledge on haemostatic changes in humans infected with Ebola virus is limited due to safety concerns and access to patient samples. Ethical approval was obtained to collect plasma samples from patients in Sierra Leone infected with Ebola virus over time and samples were analysed for clotting time, fibrinogen, and D-dimer levels. Plasma from healthy volunteers was also collected by two methods to determine effect of centrifugation on test results as blood collected in Sierra Leone was not centrifuged. Collecting plasma without centrifugation only affected D-dimer values. Patients with Ebola virus disease had higher PT and APTT and D-dimer values than healthy humans with plasma collected in the same manner. Fibrinogen levels in patients with Ebola virus disease were normal or lower than values measured in healthy people. Clotting times and D-dimer levels were elevated during infection with Ebola virus but return to normal over time in patients that survived and therefore could be considered prognostic. Informative data can be obtained from plasma collected without centrifugation which could improve patient monitoring in hazardous environments.

Extending Patient-Chatbot Experience with Internet-of-Things and Background Knowledge: Case Studies with Healthcare Applications.

Presents case studies in the healthcare industry that focus on the use of Chatbots to improve patient monitoring and medical services. The transition towards personalized health management requires public awareness about management strategies of self-monitoring, self-appraisal, and self-management, eventually paving a way to more timely interventions and higher quality patient–clinician interactions. A key enabler is patient generated health data, fueled in good part by the growth in wearable devices including smart watches and other Internet-of- Things (IoT) for health-tracking. These tracking devices provide “low-level” monitoring signals indicating health conditions such as sleep apnea and heart rhythm disorder. However, to make more sense of IoT data, it is imperative that we develop cognitive approaches where they mine, interlink, and abstract diverse IoT data. These cognitive approaches often needs to keep the user closely engaged to acquire more information, to obtain feedback, to collect verbal health conditions, and to provide intervention and management actions. The chatbot technology was initially introduced as an artificial conversational agent to simulate conversations with a user using voice or text interactions.