Measurement Of Vital Parameters Research Articles

Underwater temperature and pressure monitoring for deep-sea SCUBA divers using optical techniques

The safety of SCUBA divers remains at high risk in deep-sea owing to multiple factors such as dangerous surrounding, rely upon technical equipment necessary for life support, decreased underwater navigation, and communication infrastructure. Gradual decrease and increase in water temperature and pressure corresponding to depth are among the most common problems that cause most of the fatalities in deep-sea diving. Therefore, different gadgets for accurate measurement of vital parameters, reliable navigation, and seamless communication are of prime importance. In this paper, we propose an all-optical technique for local and remote monitoring of underwater temperature and pressure for deep-sea SCUBA divers based on fiber Bragg grating (FBG) sensors and underwater optical communication-single mode fiber (UWOC-SMF) integrated transmission system. The proposed technique is implemented using two FBG temperature and pressure sensors fixed over diver’s suit and UWOC-SMF integrated transmission system for simultaneous local and remote monitoring of underwater temperature and pressure. Remote monitoring of underwater temperature and pressure is achieved at ship station through a remotely operated underwater vehicle (ROV) and UWOC-SMF integrated transmission system by means of shifts in the original Bragg wavelengths of sensors due to temperature and pressure variations. The performance of the sensors is analyzed for pressure and temperature in the range of 0 to 6.4 MPa (≈0 to 655 mH2O) and 40 to −2°C, respectively corresponding to different depths. The results show that the proposed technique can work well in the deep ocean over a range of pressures and temperatures of 0–7 MPa and 40 to −2°C while achieving a temperature sensitivity of 4.3 p.m./°C and a pressure sensitivity of 30.5 p.m./MPa. Clear spectra of reflected signals from FBG sensors at ship station are achieved after signal transmission over UWOC-SMF hybrid link.

Vital signs estimation in elderly using camera-based photoplethysmography

In the context of Ambient Assisted Living, the demand for healthcare technologies development has been increased in the last two years by the current global health situation. The contagious nature of COVID-19 warrants inevitability to the thought of easing a continuous measurement of vital signs such as Heart Rate, Breath Rate, and SpO2 in a non-invasive manner, contributing of fundamental importance in the assessment of health status especially among frail and/or elderly individuals. A widely diffused method for contactless vital signs monitoring is remote photoplethysmography from facial video streams that, contrary to traditional contact measurement techniques, allows the measurement of vital parameters without the need for wearable sensors (generally considered uncomfortable, especially by the elderly), even with commercial and low-cost digital cameras. This paper proposes the design and implementation of a new pipeline for estimating Heart Rate, Breath Rate, and SpO2 values, and its integration on Raspberry Pi 4 as an elaboration unit. The pipeline provides specific algorithmic blocks to improve vital signs estimation in elderly subjects as it is made more difficult by the skin tone and the presence on the face of wrinkles, folds, and moles. Quantitative evaluations on our dataset containing the acquisition of only elderly older than 65 years of age demonstrate the validity of the proposed pipeline. For validation against the state of the art, tests were also conducted on three standard benchmark datasets containing video with subjects of varying ages. Again, the pipeline proved to be robust concerning the estimation of vital signs considered in the present work.

Intoxicação espontânea e experimental por Myrocarpus frondosus em bovinos

ABSTRACT: An outbreak of photosensitization in Holstein and Jersey cattle occurred after the passage of an extratropical cyclone in Southern Brazil. On that occasion, several trees fell, including some of the species Myrocarpus frondosus (Fabaceae family) popularly known as “gabreúva”, “cabriúna” or “gabriúna”. Five heifers consumed the leaves of this plant, and all of them became ill. The main clinical signs were decreased appetite, permanence in the water, decreased ruminal movements, dry stools, congested and icteric sclera and conjunctivae, dark urine and restlessness when exposed to the sun. One heifer showed circling, incoordination, restlessness and death six days after the onset of clinical signs. From the seventh day, three heifers showed improvement; one remained apathetic, with jaundiced mucous membranes, ulceration, and scaling on the tongue, increased respiratory rate, and fever, and died 18 days after ingestion of the plant. At necropsy, photosensitivity lesions were observed on the depigmented skin, snout, teats, and ear tip, characterized by discontinuity of the skin with the formation of crusts, inflammatory exudate associated with redness of the skin, in addition to ulceration in the mouth, snout and ventral portion of the tongue and jaundice and edema in the submandibular region. The liver was enlarged, with an orange color, full gallbladder, and wall edema. Through microscopy, liver lesions were characterized by moderate and diffuse necrosis of hepatocytes, vacuolar and centrilobular degeneration, bilirubin retention and proliferation of biliary epithelium. The literature shows no reports of M. frondosus toxicity in cattle. Experiments were carried out in cattle to clarify the possible clinical-pathological picture produced by this plant. A survey of the epidemiological data of the diagnosed spontaneous outbreak was carried out, and subsequently, three cattle received the plant’s green leaves, and a fourth received the dried leaves. After administering the plant, blood samples were collected daily for blood count, measurement of liver enzymes (gamma glutamyl transferase, alkaline phosphatase, alanine aminotransferase, aspartate transferase), bilirubin, measurement of vital parameters and liver biopsy from the onset of signs. In case of death, a necropsy was performed with collection of viscera samples for macro and microscopic evaluation. The experimental part was developed at the Laboratory of Animal Pathology, CAV-UDESC. The single dose of 33g/kg of green leaves caused severe clinical signs, while the administration of 22g/kg and 11g/kg caused mild to moderate signs of the disease. The supply of desiccated leaves in a single dose did not cause clinical manifestations. M. frondosus can be blamed as a cause of spontaneous hepatogenous photosensitization in cattle. Experimentally, the ingestion of green leaves of this plant, in doses greater than 11g/kg can lead to clinical changes, with subsequent recovery, or progress to death with severe liver damage.

Towards ultrasound wearable technology for cardiovascular monitoring: from device development to clinical validation.

The advent of flexible, compact, energy-efficient, robust, and user-friendly wearables has significantly impacted the market growth, with an estimated value of 61.30billion USD in 2022. Wearable sensors have revolutionized in-home health monitoring by warranting continuous measurements of vital parameters. Ultrasound is used to non-invasively, safely, and continuously record vital parameters. The next generation of smart ultrasonic devices for healthcare integrates microelectronics with flexible, stretchable patches and body-conformable devices. They offer not only wearability, and user comfort, but also higher tracking accuracy of immediate changes of cardiovascular parameters. Moreover, due to the fixed adhesion to the skin, errors derived from probe placement or patient movement are mitigated, even though placement at the correct anatomical location is still critical and requires a user's skill and knowledge. In this review, the steps required to bring wearable ultrasonic systems into the medical market (technologies, device development, signal-processing, in-lab validation, and, finally, clinical validation) are discussed. The next generation of vascular ultrasound and its future research directions offer many possibilities for modernizing vascular health assessment and the quality of personalized care for home and clinical monitoring.

BCG-VARS: BallistoCardioGraphy vital algorithms for real-time systems

Disorders with a transient signature (e.g., obstructive sleep apnea, drowsy driving, or atrial fibrillation) are difficult to predict. In addition, the aging population is moving towards dependency and medical structures lack caregivers. This paper introduces an innovative and generic vitals monitoring software. This real-time and embedded software, called BCG-VARS, uses ballistocardiography to perform contactless measurements of vital parameters on various types of equipment (e.g. medical bed, car seat, wheelchair). The software consists in two algorithms and was designed to extract three different vital parameters: actigraphy, Breath-to-Breath Interval (BBI), and heart Inter-Beats Interval (IBI). The algorithms were designed to analyze ballistocardiography signals but can be reused for other pseudo-periodic signals. BCG-VARS shows state-of-the-art high performances, even when sensors are deeply integrated in a medical bed. Absolute mean errors of 1.59 beats per minute for IBIs and 1.03 cycles per minute for BBIs were obtained in the deep integration configuration. In addition, all the subjects presences and movements (lie down, roll over or leave) were detected by the algorithms. Thanks to parameter tuning and interval prediction, the system is accurate, reliable in multiple applications and adapts to every new individual.

Predicting deterioration of patients with early sepsis at the emergency department using continuous heart rate variability analysis: a model-based approach

BackgroundSepsis is a life-threatening disease with an in-hospital mortality rate of approximately 20%. Physicians at the emergency department (ED) have to estimate the risk of deterioration in the coming hours or days and decide whether the patient should be admitted to the general ward, ICU or can be discharged. Current risk stratification tools are based on measurements of vital parameters at a single timepoint. Here, we performed a time, frequency, and trend analysis on continuous electrocardiograms (ECG) at the ED to try and predict deterioration of septic patients.MethodsPatients were connected to a mobile bedside monitor that continuously recorded ECG waveforms from triage at the ED up to 48 h. Patients were post-hoc stratified into three groups depending on the development of organ dysfunction: no organ dysfunction, stable organ dysfunction or progressive organ dysfunction (i.e., deterioration). Patients with de novo organ dysfunction and those admitted to the ICU or died were also stratified to the group of progressive organ dysfunction. Heart rate variability (HRV) features over time were compared between the three groups.ResultsIn total 171 unique ED visits with suspected sepsis were included between January 2017 and December 2018. HRV features were calculated over 5-min time windows and summarized into 3-h intervals for analysis. For each interval, the mean and slope of each feature was calculated. Of all analyzed features, the average of the NN-interval, ultra-low frequency, very low frequency, low frequency and total power were different between the groups at multiple points in time.ConclusionsWe showed that continuous ECG recordings can be automatically analyzed and used to extract HRV features associated with clinical deterioration in sepsis. The predictive accuracy of our current model based on HRV features derived from the ECG only shows the potential of HRV measurements at the ED. Unlike other risk stratification tools employing multiple vital parameters this does not require manual calculation of the score and can be used on continuous data over time.Trial registration The protocol of this study is published by Quinten et al., 2017.

The Accuracy of Wrist-Worn Photoplethysmogram-Measured Heart and Respiratory Rates in Abdominal Surgery Patients: Observational Prospective Clinical Validation Study.

Postoperative deterioration is often preceded by abnormal vital parameters. Therefore, vital parameters of postoperative patients are routinely measured by nursing staff. Wrist-worn sensors could potentially provide an alternative tool for the measurement of vital parameters in low-acuity settings. These devices would allow more frequent or even continuous measurements of vital parameters without relying on time-consuming manual measurements, provided their accuracy in this clinical population is established. This study aimed to assess the accuracy of heart rate (HR) and respiratory rate (RR) measures obtained via a wearable photoplethysmography (PPG) wristband in a cohort of postoperative patients. The accuracy of the wrist-worn PPG sensor was assessed in 62 post-abdominal surgery patients (mean age 55, SD 15 years; median BMI 34, IQR 25-40 kg/m2). The wearable obtained HR and RR measurements were compared to those of the reference monitor in the postanesthesia or intensive care unit. Bland-Altman and Clarke error grid analyses were performed to determine agreement and clinical accuracy. Data were collected for a median of 1.2 hours per patient. With a coverage of 94% for HR and 34% for RR, the device was able to provide accurate measurements for the large majority of the measurements as 98% and 93% of the measurements were within 5 bpm or 3 rpm of the reference signal. Additionally, 100% of the HR and 98% of the RR measurements were clinically acceptable on Clarke error grid analysis. The wrist-worn PPG device is able to provide measurements of HR and RR that can be seen as sufficiently accurate for clinical applications. Considering the coverage, the device was able to continuously monitor HR and report RR when measurements of sufficient quality were obtained. ClinicalTrials.gov NCT03923127; https://www.clinicaltrials.gov/ct2/show/NCT03923127.

Reevaluation of risk factors for aneurysmal subarachnoid hemorrhage associated epilepsy

BackgroundSymptomatic epilepsy is a common complication of aneurysmal subarachnoid hemorrhage (aSAH) associated with poor outcome. We sought to analyze the risk factors leading to post-SAH epilepsy. MethodsAll consecutive aSAH cases treated between 01/2003 and 06/2016 were retrospectively included. Post-aSAH period was followed up to 03/2020 for the occurrence of epilepsy. Demographic characteristics and previous medical history of the patients, parameters of initial severity, performed treatments, certain early and late complications of aSAH, as well as routine laboratory and vital parameter measurements were collected. Functional outcome was assessed at discharge and 6 months after aSAH using the modified Rankin scale (mRS). ResultsDuring the post-aSAH follow-up (median: 8.93 months/patient), 85 of 948 individuals (9%) in the final analysis developed symptomatic epilepsy (median: 3.43 months). In the majority of cases, epilepsy was diagnosed >3 weeks after aSAH (n = 67, 78.8%) and in survivors with poor outcome at discharge (mRS = 4–5, 15.8% vs. 5.3%, p < 0.0001). Of over 150 analyzed potential risk factors, the following parameters were independently associated with the risk of symptomatic epilepsy after aSAH: thyroid dysfunction (aHR = 1.81, p = 0.029), need for decompressive craniectomy (aHR = 2.32, p = 0.011) and shunt placement (aHR = 1.94, p = 0.022), prolonged tachycardia (≥4 days, aHR = 2.06, p = 0.025), as well as anemia signs (mean red blood cell count <3.6 × 1012 /L [aHR = 2.4, p = 0.015] and mean hematocrit <31% [aHR = 2.13, p = 0.044]) during first 2 weeks after aSAH. ConclusionSymptomatic epilepsy occurs predominantly in individuals with poor outcome at discharge and after the acute phase of aSAH. Knowledge of risk factors associated with aSAH-related epilepsy might help in early identification and treatment of compromised individuals, and therefore, help to improve their outcome.

Patient care after heart transplantation - a case study

Heart transplantation is a recognized and effective method of treating end-stage heart failure. Complicated heart transplant surgery carries a high surgical risk as well as complications that are dangerous to life and health. Transplantation is a life-saving opportunity for patients who have run out of alternative treatments. Patients with heart transplants face many physical and psychological problems every day.&#x0D; The aim of the work was to discuss the care problems of a patient 3.5 years after the heart transplantation procedure.&#x0D; Material and methods: The study used a research method - an individual case study, in which the interview technique, observation, analysis of medical documentation and measurement of vital parameters were used.&#x0D; Results: After the interview, observation and analysis of medical records and as a result of the measurements made, the patient was diagnosed with nursing problems, including such as: increased susceptibility to infections that may pose a serious threat to the life and health of the patient caused by the weakening of the immune system by immunosuppression, anxiety and fear related to the risk of rejection of a transplanted organ and mood instability resulting from uncertain health situation and the effects of immunosuppressive drugs, physical limitations related to with previous operations.&#x0D; Conclusions: Despite the passage of time, the patient after heart transplantation still feels the fear of a sudden deterioration of his health, the occurrence of side effects of the implemented treatment, and to the greatest extent his organism rejects the transplanted organ. Educating the patient, caring for it and keeping track of his health condition makes him feel more confident and at ease. The quality of life of the patient after transplantation can be significantly improved thanks to discipline and properly conducted self-care and self-care.

Protocol Adherence for Adult Sickle Cell Patients Presenting with Vaso-Occlusive Crises on a Tertiary Teaching Hospital Emergency Department

Background Patients with Sickle cell disease (SCD) suffer from frequent vaso-occlusive crises (VOC) that heavily contribute to morbidity and mortality. VOC's constitute the principal cause of emergency department (ED) presentation and hospital admission and the ED visit serves to diagnose underlying disorders, VOC complications and to institute pain relieve most often requiring intravenous opioids. The need for prompt and adequate treatment and pain relieve is reflected by standardized protocols for acute care in SCD. Adherence to these protocols has been shown to increase the quality of care, while improving overall patient pain control, decreasing frequency of ED visits and ED patient crowding and decreasing total hospital days. Several studies have demonstrated that negative health care provider attitudes interfere significantly with adequate assessment of pain and in turn may lead to insufficient treatment. We recently (October 2019) introduced novel protocols for management of SCD patients presenting with VOC's at the ED, but local the actual protocol adherence has not been evaluated. Aim Retrospective analysis of adherence to ED protocols for management of SCD patients on the ED. Methods We included all patients with SCD presenting at the ED between March 2021 and March 2022. Children and patients that presented for alternative causes than a VOC were excluded from analysis. The SCD protocol contained a circumscriptive manual with indicated timing of interventions that could be analysed for adherence. Interventions were divided into three groups: diagnostics, supportive care and analgesics. Diagnostics contained physician consultation within 60 minutes of arrival, measurement of vital parameters (SpO2, respiratory frequency, heart rate, blood pressure and body temperature), and extensive laboratory testing. In patients with chest pain it prescribed chest imaging and arterial blood gas analysis. Supportive measures included oxygen supplementation in hypoxic patients and administration of intravenous hyper hydration in absence of contraindications such as a history of fluid overload. Analgesia included treatment using a predefined personalized pain plan (PPP) if available. In all other patients, treatment consisted of acetaminophen, NSAIDs and opioids until the NRS pain score was 6 or lower or pain was deemed acceptable by the patient. Opioid treatment consisted of IV fentanyl in a maximal cumulative dose of 2 mcg/kg within the first hour followed by opioid escalation with intravenous (IV) morphine in a maximal cumulative dose of 50mg. In patients with renal failure (eGFR<30 ml/min), buprenorphine was advised instead of morphine. When analgesic treatment remained insufficient after 15 minutes the protocol prescribed consultation of the pain specialist for administration of clonidine or esketamine. Results We analyzed data from a total of 109 ED visits of 70 unique patients (median age: 31,1 years (IQR 14,0), 49.5% male) between March 2021 and March 2022 in a tertiary teaching hospital in The Netherlands. Results of protocol adherence are shown in table 1. Adherence to the complete protocol was extremely low (0.9%). For most individual components of the protocol adherence was above 50%. For fluid administration, timing of initial fentanyl and morphine escalation, adherence was 39.4%, 19.3% and 11.9%, respectively. Conclusion In patients with sickle cell disease, protocols aim to increase accuracy and speed of diagnostics and analgesia which is related to outcomes such as overall patient pain control, frequency of ED visits and total hospital days. This study evaluates protocol adherence in a large tertiary university hospital. Whereas adherence to individual components of the SCD is above 50%, total patients in which complete protocol adherence is observed is extremely low. We identify fluid administration and opioid administration as protocol components to which adherence is most insufficient. Further research on the reasons for these impaired adherence together with training of medical and nursing staff is required to improve the quality of healthcare for this patient group. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Non-Contact Heart Rate Measurement From Facial Video Data Using a 2D-VMD Scheme

Non-contact human body vital parameter measurements are getting more attention and have been extensively studied in a short span of time. One of such techniques is the heart rate (HR) estimation based on video recording of human face known as remote photoplethysmogram (rPPG). Usually, the recorded video gets contaminated due to illumination variation of ambient light, motion artifacts, and other environmental factors. Thus, extracting a reliable rPPG signal is a challenging task. In this paper, a novel spatial-temporal filtering method is proposed that utilizes 2D variational mode decomposition (2D-VMD) along with azimuthally averaged power spectrum density (AAPSD) and multimode kurtosis to extract a reliable rPPG signal. The robustness of the proposed algorithm is tested and validated using our own database and the publicly available standard dataset. The obtained experimental results are compared with the reference PPG signal measurements. Also, the proposed method is compared with the well-established independent component analysis (ICA)-based method. The performance results show that the non-contact HR estimated by the proposed method dramatically reduces the error and it proves our method to be superior than the existing method.

The Contribution of Galenics to Patients' Sensory Perception of Nasal Sprays After Nasal Surgery: Data from a Prospective Randomised, Controlled, Double-Blind, Crossover, Multicentre Study.

IntroductionPostoperative care after nasal surgery is commonly achieved with nasal sprays. The current study compared two decongesting, wound-healing nasal sprays in patients after nasal surgery in order to investigate their sensory perception. One of the sprays was a new galenic formulation (nasic® neo, Cassella-med GmbH & Co. KG).MethodsAccording to the crossover design, patients who had undergone nasal surgery applied two different nasal sprays during two treatment periods of 4 days each, interrupted by a 3-day washout period. Sensory perception of the nasal sprays was assessed with the nasal spray sensoric scale. Throughout the study, nasal obstruction was evaluated by patients, and physical examinations, measurements of vital parameters and rhinoscopic examinations were carried out by investigators. Adverse events were documented during the entire study, and following treatment, patients judged the overall preference, efficacy and tolerability of both products.ResultsOverall, no significant differences in sum scores of the assessments of the nasal spray sensoric scale were observed between treatments. A significant period effect observed during the crossover study limited the overall analysis. Nevertheless, significantly more patients preferred the new galenics nasal spray compared to the comparator spray (57.1% vs. 34.7%; p = 0.031). Further, 10% more patients rated the efficacy of the new galenics as ‘good’ to ‘very good’ compared to the comparator. Importantly, a subgroup population of patients with more pronounced signs of inflammation present at screening evaluated the sensory perception of the new galenics as significantly better (p = 0.033) compared to the comparator. Within this subgroup, no period effect was observed. The application of both nasal sprays was shown to be safe and well-tolerated.ConclusionThe overall sensory perception of both nasal sprays was evaluated comparably well in patients after nasal surgery and overall the application of the new galenics nasal spray was preferred by significantly more patients compared to the comparator nasal spray. Patients with marked nasal abnormalities may have a greater benefit from the contribution of galenics as significant differences in the sensory evaluation by the nasal spray sensoric scale in favour of the new galenics product were shown for this subgroup.Trial RegistrationThe current study was registered in the EU Clinical Trials Register with the EudraCT No. 2019-004936-52.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-021-01937-x.

Remote patient monitoring after cardiac surgery: The utility of a novel telemedicine system.

ObjectiveWe examined cardiac surgery patients who underwent monitoring of postoperative vital parameters using medical monitoring devices which transferred data to a mobile application and a web‐based software.MethodsFrom November 2017 to November 2020, a total of 2340 patients were enrolled in the remote patient monitoring system after undergoing cardiac surgery. The medical devices recorded vital parameters, such as blood pressure, pulse rate, saturation, body temperature, blood glucose, and electrocardiography were measured via the Health Monitor DakikApp and Holter ECG DakikApp devices which reported data to web‐based software and a mobile application (DakikApp Mobile Systems, Remscheid, Germany). During the follow‐up period, patients were contacted daily through text and voice messages, and video conferences. Remote Medical Evaluations (RMEs) concerning patients' medical states were performed. Medication reminders, daily treatment were communicated to the patients with the DakikApp Mobile Systems Software.ResultsDuring a mean follow‐up period of 78.9 ± 107.1 (10–395) days, a total of 135,786 patient contacts were recorded (782 video conferences, 2805 voice messaging, and 132,199 text correspondence). The number of RMEs handled by the Telemedicine Team was 79,560. A total of 105,335 vital parameter measurements were performed and 5024 hospital application requests (6.3% per RME) were addressed successfully and hospitalization was avoided. A total of 144 (6.1%) potentially life‐threatening complications were found to have been diagnosed early using the Telemedicine System.ConclusionRemote Patient Monitoring Systems combined with professional medical devices are feasible, effective, and safe for the purpose of improving postoperative outcomes.

A validity study of the rapid emergency Triage and treatment system for children

BackgroundThe Scandinavian Rapid Emergency Triage and Treatment System-pediatric (RETTS-p) is a reliable triage system that includes both assessment of vital parameters and a systematic approach to history and symptoms. In Scandinavia, the system is used in most pediatric emergency departments (PED). We aimed to study the validity of RETTS-p.MethodsWe conducted a study based on triage priority ratings from all children assessed in 2013 and 2014 to the PED at St. Olavs University Hospital Trondheim, Norway. Patients were assigned one of four priority ratings, based on the RETTS-p systematic evaluation of individual disease manifestations and vital parameter measurements. In the absence of a gold-standard for true disease severity, we assessed whether priority ratings were associated with 3 proxy variables: 1) hospitalization to the wards (yes vs. no), 2) length of hospital stay (≤ mean vs. > mean, and 3) referral to pediatric intensive care (yes vs. no). We further compared priority ratings with selected diagnoses and procedure codes at discharge.ResultsSix thousand three hundred sixty-eight children were included in the study. All analyses were performed in the entire population and separately in pediatric sub-disciplines, medicine (n = 4741) and surgery (general and neurosurgery) (n = 1306). In the entire population and the sub-disciplines, a high priority rate was significantly associated with hospitalization to wards, a longer hospital stay and referral to the pediatric intensive care unit compared to patients with low priority. We observed a dose-response relationship between increased triage code level and indicators of more severe disease (p-trend < 0.001). For the same three proxy variables, the sensitivity was 54, 61 and 83%, respectively, and the specificity 66, 62 and 57%, respectively. Subgroup analyzes within the most common complaints, demonstrated that more severe conditions were higher prioritized than less severe conditions for both medical and surgical patients. Overall, children with surgical diagnoses attained lower priority ratings than children with medical diagnoses.ConclusionsRETTS-p priority ratings varies among a broad spectrum of pediatric conditions and mirror medical urgency in both medical and surgical disciplines. RETTS-p is a valid triage system for children as used in a university hospital setting.

Prevalence of asymptomatic SARS-CoV-2-positive individuals in the general population of northern Italy and evaluation of a diagnostic serological ELISA test: a cross-sectional study protocol

IntroductionAs of 30 April 2020, the novel betacoronavirus SARS-CoV-2 had infected more than 3 172 000 individuals, killing over 224 000 people and spreading to more than 200 countries. Italy...

The reliability and accuracy of operational system data in a nationwide helicopter emergency medical services mission database

AimThe aim of this study was to evaluate the reliability and accuracy of documentation in FinnHEMS database, which is a nationwide helicopter emergency service (HEMS) clinical quality registry.MethodsThis is a nationwide study based on written fictional clinical scenarios. Study subjects were HEMS physicians and paramedics, who filled in the clinical quality registry based on the clinical scenarios. The inter-rater -reliability of the collected data was analyzed with percent agreement and free-marginal multi-rater kappa.ResultsDispatch coding had a percent agreement of 91% and free-marginal multi-rater kappa value of 0.83. Coding for transportation or mission cancellation resulted in an agreement of 84% and free-marginal kappa value of 0.68. An agreement of 82% and a kappa value of 0.73 for dispatcher coding was found. Mission end, arrival at hospital and HEMS unit dispatch -times had agreements from 80 to 85% and kappa values from 0.61 to 0.73. The emergency call to dispatch centre time had an agreement of 71% and kappa value of 0.56. The documentation of pain had an agreement of 73% on both the first and second measurements. All other vital parameters had less than 70% agreement and 0.40 kappa value in the first measurement. The documentation of secondary vital parameter measurements resulted in agreements from 72 to 91% and kappa values from 0.43 to 0.64.ConclusionData from HEMS operations can be gathered reliably in a national clinical quality registry. This study revealed some inaccuracies in data registration and data quality, which are important to detect to improve the overall reliability and validity of the HEMS clinical quality register.

A Novel Approach for Non-Contact Heart Rate Measurement

This paper provides an insight into the non-contact vital parameter measurements, especially the heart rate of a person from a short distance. The increasing demand to new developments in healthcare technologies poses inevitability to the thought of easing the patient monitoring in a non-invasive and unobtrusive manner. Patients, who are in need of regular checkups, find the existing modes of electrode-based and probe-based monitoring, a discomfort. To make the monitoring environment comfortable for the patients and to take the results in a continuous and rapid manner, the non-contact heart rate measurement comes as a boon to the healthcare sector. This paper deals with miniaturized radar-based non-contact heart rate measurement using hand gestures in a precise manner. Though there were lots of methods proposed for contactless measurements, this approach comes with better accuracy and ease of handling.

Reliability of smartphone measurements of vital parameters: A prospective study using a reference method

ObjectiveIn this study, we aimed to evaluate the accuracy of HR and SaO2 data obtained using a smartphone compared with the measurements of a vital signs monitor (VSM) and an arterial blood gas (ABG) device, respectively. Material and methodsIn this single-center prospective study, the HR and SaO2 measurements were performed using the built-in sensor and light source of a Samsung Galaxy S8 smartphone and compared to the results of VSM and ABG device. The Bland-Altman analysis was used to evaluate and visualize the agreement between the methods. ResultsThe data of 101 patients were analyzed. There was a high correlation between HR measured by smartphone and HR measured by VSM [P < 0.0001; 0.9918 (95% CI = 0.987–0.994)]. In addition, the SaO2 values obtained by smartphone were highly correlated with those by ABG (P < 0.0001; 0.968 (95% CI = 0.952–0.978)). ConclusionThe HR and SaO2 values obtained by smartphone were found to be consistent with the measurements of the reference devices. With the growing use of smartphone technology in the health field, we foresee that patients will be able to make their own triage assessment before presenting to the hospital.

Development of an IoT system for students' stress management

This paper shows the development of an IoT system for students' stress management. The IoT system is developed in an open architecture and is an integral part of the educational ecosystem. The system is composed of two elements: the one that enables measurement of vital parameters for identifying stress in students, and the other for stress control. The system for stress control consists of a mobile health application featuring relaxation content. Such system should minimize the excitement and have an impact on reducing future stress. The IoT system for stress management was evaluated in a real environment, during students? thesis defense on Faculty of Organizational Sciences, University of Belgrade. The results show that time spent using mobile health application with relaxing content can reduce students? physiological arousal and excitement during thesis defense.

Electrical impedance tomography for predicting failure of spontaneous breathing trials in patients with prolonged weaning

BackgroundSpontaneous breathing trials (SBTs) on a T-piece can be difficult in patients with prolonged weaning because of remaining de-recruitment phenomena and/or insufficient ventilation. There is no clinically established method existent other than experience for estimating whether an SBT is most probably beneficial. Electrical impedance tomography (EIT) is a clinical useful online monitoring technique during mechanical ventilation, particularly because it enables analysis of effects of regional ventilation distribution. The aim of our observational study was to examine if EIT can predict whether patients with prolonged weaning will benefit from a planned SBT.MethodsThirty-one patients were examined. Blood gas analysis, vital parameter measurements, and EIT recordings were performed at three time points: (1) baseline with pressure support ventilation (PSV) (t0), (2) during a T-piece trial (t1), and (3) after resumption of PSV (t2). Calculation of EIT parameters was performed, including the impedance ratio (IR), the tidal variation of impedance (TIV), the changes in end-expiratory lung impedance (ΔEELI), the global inhomogeneity index (GI), and the regional ventilation delay (RVD) index with use of different thresholds of the percentage inspiration time (RVD40, RVD60, RVD80). The predictive power of the baseline GI with regard to clinical impairment of an SBT was analyzed by means of ROC curves. Clinical deterioration was assumed when tidal volume was decreased by at least 20 ml after the T-piece trial, measured at t2.ResultsPartial pressure of arterial oxygen significantly decreased at t1 (71 ± 15 mmHg) compared with t0 (85 ± 17 mmHg, p < 0.05) and t2 (82 ± 18 mmHg, p < 0.05). The IR trended toward higher values during t1. At t1, TIV and ΔEELI significantly decreased. The GI was significantly increased at t1 (t0 59.3 ± 46.1 vs t1 81.5 ± 62.5, p = 0.001), as were all RVD indexes. Assuming a GI cutoff value of >40, sensitivity of 85% and specificity of 50% were reached for predicting an increased future tidal volume.ConclusionsEIT enables monitoring of regional ventilation distribution during SBTs and is suitable to estimate whether an SBT probably will be beneficial for an individual patient. Therefore, the application of EIT can support clinical decisions regarding patients in the phase of prolonged weaning.