Monitoring Of Vital Parameters Research Articles

Palliative sedation : Development and consensus of aGerman language documentation template

Palliative sedation (PS) serves as atherapeutic option in cases of otherwise intractable suffering. As the use of sedative and hypnotic medication in many diverse situations is acore competency of anesthesiology, anesthesiologists are confronted with questions of sedative therapy at the end of life in institutions for specialized palliative care, in intensive care units and intermediate care wards. In recent years anumber of guidelines have been published internationally but so far no official guidelines exist in Germany. The most recognized document is the European Association for Palliative Care (EAPC) framework on PS. This project aims to develop aGerman language template for the preparation, application, documentation and evaluation of PS according to the current frameworks, especially the EAPC framework on PS. Afirst draft of the template was generated by the project team using the EAPC framework and individual templates of various institutions, which had been collected during aprevious project. Professionals (n = 136) from inpatient and outpatient specialist palliative and hospice care were invited to assess all items of the draft regarding "relevance", "wording" and "feasibility" in an online Delphi survey (Unipark®, Questback, Cologne, Germany). After the second Delphi round an expert panel was asked to reflect the results and generate afinal draft. Approval was granted if acceptance exceeded 75% of participants. The 3rounds of the Delphi process were completed by 64, 46 and 41participants, respectively. The Delphi process as well as the expert panel led to significant changes of the template. The indications for PS had to be clarified. The significance of documentation of vital parameters, such as oxygen saturation, blood pressure or respiratory rate during PS was intensively discussed. In many teams, predominantly hospice or outpatient palliative care teams, it seems to be difficult to measure these parameters or it is regarded as inappropriate in apalliative care setting. In contrast, the EAPC framework recommends monitoring of vital parameters in cases of intermittent or respite sedation. Finally, asolution was found to support documentation of additional data without the explicit mentioning of specific parameters. After the third Delphi round, all 16items of the documentation template reached consensus with respect to relevance (82.9-100%), clarity of wording (80.5-100%), and feasibility in practice (78-100%). This article provides an empirically based, multiprofessional consented documentation template for PS. Core elements of the documentation of PS are the indications and the decision process towards PS. During the treatment, at least the level of sedation and the symptom burden have to be recorded. The documentation of vital signs during PS remains ahighly disputed topic. The presented data suggest that especially in outpatient settings and in hospices measuring and documentation of vital parameters is uncommon and therefore is often regarded as not feasible. This template can help to support the medically and ethically sound use of PS and facilitate research. The template can be accessed at http://www.palliativmedizin.uk-erlangen.de/forschung/downloads/ .

Smartphones Democratize Advanced Biomedical Instruments and Foster Innovation.

From microscopy to diagnostics and monitoring of vital parameters, scientists, engineers, and educators have been making use of smartphones and smartphone components in various innovative ways, helping to democratize advanced measurement instruments used in research and education.

Moving towards novel multidisciplinary approaches for improving elderly quality of life: The emerging role of telemedicine in Sicily

Introduction Elderly care is a worldwide social and economic challenge for the public health system, and it requires the development of new management strategies. Telemedicine provides an innovative approach towards elderly care, especially for those with chronic diseases. In this study, we aimed to evaluate the potential role of a multidisciplinary telemedicine approach for improving elderly quality of life. Methods Twenty-two participants received weekly vital parameter monitoring and nutritional counselling, biweekly psychological counselling and a monthly consultation with a neurologist. The neuropsychological assessment included the Mini Mental State Examination, the Activities of Daily Living, the Instrumental Activities of Daily Living, the Geriatric Depression Scale and the Short-Form Health Survey, and was administered at enrolment (T0) and at the end of the study (T3). The nutritional evaluation included haematochemical examinations of glycaemia, total cholesterol, and triglycerides at baseline (T0) and every four months (T1, T2, T3). Results Significant differences in Activities of Daily Living, Geriatric Depression Scale and all domains of the Short-Form Health Survey were observed between baseline and the end of the study. The haematochemical parameters showed obvious changes over time, especially in cholesterol values, and the patients with hypercholesterolaemia and hypertriglyceridaemia showed a reduction in body mass index. Moreover, we found that the haematochemical values were moderately correlated with the Activities of Daily Living, Geriatric Depression Scale and Short-Form Health Survey scores. Conclusion Telemedicine can be a suitable tool for caring for elderly people more efficiently by promoting the remission of depressive symptoms and improving social functioning, cognitive levels and nutritional habits to prevent vascular diseases and exacerbations of pre-existing chronic illness.

Miniaturization of Microwave Biosensor for Non-invasive Measurements of Materials and Biological Tissues

Non-invasive planar complementary split ring resonators (CSRRs) coupled to microstrip line for measuring the dielectric properties of materials and biological tissues are presented in this paper. The expectations of health professionals are increasingly turning to less invasive surgical procedures and treatments. In particular, the monitoring of vital parameters (sweat, water in the lungs, etc.) or the evolution of certain pathologies, such as cancer cells, could be observed regularly if suitable devices were developed and could especially replace traditional invasive method. Appropriate miniaturized RF or microwave devices could be an alternative for some medical diagnostic applications. These devices would make it possible to determine the dielectric characteristics of biological tissues, which represent their real pathological states. It would thus be possible, by means of dielectric contrast measurements, to follow the evolution of pathology as well as the vital parameters of a patient. The objective of this research is to produce a prototype biosensor that is suitable for measurements on biological tissues and that can be miniaturized to enhance its spatial sensitivity. This work focuses on the design, electromagnetic simulations and characterization of a new miniaturized biosensors operating between 1 and 10 GHz. The ex-vivo experimental results will be shown by measuring the S-parameters of various materials and animal biological tissues. The extraction of the dielectric parameters of these samples is obtained by the measurements of materials

Energy Efficient Raptor Codes for Error Control in Wireless Body Area Networks

WBAN consists of several tiny sensors that are located inside and outside human body for continuous monitoring of vital parameters of patients suffering from chronic diseases. The wearable sensor unit consists of transmitter, receiver and central process unit (gateway). The gateway is used to connect wearable sensors on human body to the internet. To increase the lifetime of such networks, the energy spent by the sensors has to be minimized. In this work we analyzed the feasibility and performance of fountain code based raptor code for error correction to overcome the energy and reliability issues. Versatility of raptor code in terms of code rate and coding gain is advantageous to increase the energy efficiency of WBAN network. Simulation results considering different fading channels show that the raptor coded packet transmission is more energy efficient than that of LT code, traditional BCH code and ARQ error control technique.

Da li je potreban fibrinolitik u prehospitalnim uslovima?

Introduction: Acute coronary syndrome represents a group of several different clinical conditions, all caused by acute myocardial ischemia and/or necrosis. It includes: unstable angina pectoris, non ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI). Being a part of the 'Vojvodina STEMI network' since 2014. Emergency Medical Service of Sombor provides early pre-hospital diagnostic, initial therapy and transport of STEMI patients (with constant monitoring of vital parameters) to the Institute of Cardiovascular Diseases of Vojvodina in Sremska Kamenica for primary percutaneous coronary intervention (pPCI). Object: The object of this paper is to analyze the possibility of providing prehospital thrombolytic therapy for STEMI patients transported to the ICVDV Sremska Kamenica, within current standard protocol. Methodology: For the purpose of this research, a retrospective analysis of the registry 'Time management protocol for STEMI patients' was made from January 1st, 2014 to December 31st, 2017. These time frames were examined: duration from the onset of pain to the established diagnosis, duration of transport to the Institute and overall duration time from the onset of pain to pPCI. Furthermore, patients were divided into four groups according to the time duration from the onset of pain to the established diagnosis: less than 1 hour, less than 2 hours, less than 3 hours and more than 3 hours. Results: 34, 18% of the analyzed patients were diagnosed as STEMI patients within one hour from the onset of pain, 36.71% within two hours, 10.13% within three hours and 18.99% needed more than three hours. For all of those that got their STEMI diagnosis within one, two and three hours, the average time was 71.47 minutes (1 hour and 11 minutes) and for those who got diagnosed after three hours that time was 318.13 minutes (5 hours and 18 minutes). Summarized average time from the onset of pain to the establishing of STEMI diagnosis was 194.80 minutes (3 hours and 14 minutes) for both groups. The average transportation time was 71.32 minutes (1 hour and 11 minutes), shortest being 47 minutes and the longest 88 minutes. For all those in the group that needed less than three hours for STEMI diagnosis, the average time from the onset of pain to the ICVDV was 158.08 minutes (2 hours and 38 minutes), and for those who needed more than 3 hours to get diagnosed the average time from the onset of pain to the ICVDV was 416.57minutes (6 hours and 56 minutes). The overall average time for all analyzed patients, from the onset of pain to the catheterization lab of the ICVDV was 295.13 minutes (4 hours and 55 minutes). Conclusion: Taking into account these results, it becomes reasonable to apply fibrinolytic therapy before transporting, keeping in mind at all times current standard protocols and safety precautions for possible fibrinolytic therapy contraindications. If transport of a STEMI patient to the PCI lab is not likely to happen within the first 120 min, because of some kind of technical disability or catheterization lab overload, and that patient is presented to the EMS within the first three hours from the beginning of pain, fibrinolytic therapy should be used in order to establish reperfusion and to buy some time until transport to the pPCI.

Additively Manufactured Pneumatically Driven Skin Electrodes.

Telemedicine focuses on improving the quality of health care, particularly in out-of-hospital settings. One of the most important applications is the continuous remote monitoring of vital parameters. Long-term monitoring of biopotentials requires skin-electrodes. State-of-the-art electrodes such as Ag/AgCl wet electrodes lead, especially during long-term application, to complications, e.g., skin irritations. This paper presents a low-cost, on-demand electrode approach for future long-term applications. The fully printed module comprises a polymeric substrate with electrodes on a flexible membrane, which establishes skin contact only for short time in case of measurement. The membranes that produce airtight seals for pressure chambers can be pneumatically dilated and pressed onto the skin to ensure good contact, and subsequently retracted. The dilatation depends on the pressure and membrane thickness, which has been tested up to 150 kPa. The electrodes were fabricated in screen and inkjet printing technology, and compared during exemplary electrodermal activity measurement (EDA). The results show less amplitude compared to conventional EDA electrodes but similar behavior. Because of the manufacturing process the module enables high individuality for future applications.

Palliative care for end-of-life patients in a basic emergency service.

This research sought to describe the care provided by the nursing staff of the Western Department of the Basic Emergency Service for end-of-life patients. This was a retrospective, quantitative, exploratory and descriptive (level I) study, which sought to research the nursing records of 83 patients from admission to death. Patients who met the following inclusion criteria were considered eligible: adults; had an oncological or nononcological, advanced and irreversible chronic disease; and died in the Basic Emergency Service in the period from January 2011 to December 2012. An instrument was created for data collection, the content, relevance and adequacy of which was validated by a panel of experts in the area of palliative care. The study protocol was approved by the Institutional Ethics Committee. The main results indicate that the majority of patients died in the Observation Room in a period between the first two and twenty-four hours. Nursing interventions favoured technical-instrumental care related to medical prescriptions and service routines such as venous punctures, catheterisations, taking blood samples for analysis, aspiration of secretions, intravenous administration of fluids and drugs for symptomatic control, and monitoring of vital parameters and the state of consciousness. With the proximity of death, the nurses favoured the registration of cardiorespiratory arrest, cardiopulmonary resuscitation manoeuvres and aspiration of secretions. In the recognition of predictive factors of imminent death, the nurses favoured the patient's entry into a comatose state and aggravation of asthenia. In most patients, the entry into agony phase was not diagnosed.

Wireless alerting system using vibration for vehicles dashboard

This paper aims at improving the engine life of any vehicle through a continuous measurement and monitoring of vital engine operational parameters and providing an effective alerting to drivers for any abnormality. Vehicles currently are using audio and visible alerting signals through alarms and light as a warning to the driver but these are not effective in noisy environments and during daylight. Through the use of the sense of feeling a driver can be alerted effectively. The need to no other vehicle parameter needs to be aided through the mobile display (phone).Thus a system is designed and implements to measure engine temperature, RPM, Oil level and Coolant level using appropriate sensors and a wireless communication (Bluetooth) is established to actuate a portable vibration control device and to read the different vehicle sensor readings through an android application for display and diagnosis.

Characteristics Analysis of Battery Used in Equipment for Monitoring and Remote Transmission of Vital Human Parameters

AbstractNowadays, the use of remote monitoring and transmission of vital parameters became extremely common, because these systems reduce the degree of risk among ill people and provide an additional time necessary for the intervention teams - in case of emergency action. Generally, these devices monitor and transmit data as values of blood pressure and the heart rate. This equipment permanently worn by the ill people have as sources of electric energy supply batteries or accumulators. The behavior of batteries and the parameters measurement for different operating states are defined as particularly important analyses, especially in terms of voltage and time. In this article we have analyzed two types of batteries (Lithium-Ion and Nickel-Metal Hydride) with different characteristics, using a monitoring device that measures the depth of discharge (DOD) while under load in our biomedical system. The battery characterizations were made while the system was operating measuring the body signs and transmitting the data.

Changing Trends in Clinical Presentation and Biochemical Spectrum of Dengue Fever: An Observation of a Tertiary Care Centre

Objectives: Cases of dengue are on the rise and India experienced its worst epidemic during 2015. There was almost a 2 times rise in the number of cases. This study was done to understand the varied presentation and manifestation of dengue at a tertiary care centre of Haryana, India. Methods: This was an observational cross sectional study undertaken at PGIMS Rohtak, Haryana, India. One hundred and one patients aged ≥ 14 years, who had positive test results for dengue, as NS1/IgM, were included in the study. Clinical presentations, haematological, and biochemical markers were studied and analyzed. Results: Out of 101 patients, 63.3% were males. Overall, 95% had fever followed by headache (62.3%), rash (53.4%), retrorbital pain (43.5%), and abdomenal pain (43.5%). Furthermore, 31.8% of patients had bleeding manifestation, of which the commonest was petechiae (12.8%) followed by malena (7.9%) and bleeding gum (6.9%). All patients had raised liver enzymes. Platelet count of < 50,000/mm3 was present in 79.2%. Leucopenia was found in 43.5% of patients. Ultrasonography suggestive of free fluid was found in 44.5%. Hypokalemia was seen in 21.7% of patients. Complications, such as acute respiratory distress syndrome (ARDS) and DIC, were seen in 2.9% and 5.9% cases. Overall mortality rate was 2.97%. Conclusions: Dengue could have varied presentations ranging from a simple febrile illness to fatal multiorgan failure. It is crucial to understand the features, which predict the progress of dengue fever (DF) to dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). Considering that the treatment of dengue is relatively simple, early institution of appropriate therapy with close monitoring of vital signs and laboratory parameters could help prevent morbidity and mortality related to dengue.

ANMCO/AIIC/SIT Consensus Information Document: definition, precision, and suitability of electrocardiographic signals of electrocardiographs, ergometry, Holter electrocardiogram, telemetry, and bedside monitoring systems.

The electrocardiogram (ECG) signal can be derived from different sources. These include systems for surface ECG, Holter monitoring, ergometric stress tests, and telemetry systems and bedside monitoring of vital parameters, which are useful for rhythm and ST-segment analysis and ECG screening of electrical sudden cardiac death predictors. A precise ECG diagnosis is based upon correct recording, elaboration, and presentation of the signal. Several sources of artefacts and potential external causes may influence the quality of the original ECG waveforms. Other factors that may affect the quality of the information presented depend upon the technical solutions employed to improve the signal. The choice of the instrumentations and solutions used to offer a high-quality ECG signal are, therefore, of paramount importance. Some requirements are reported in detail in scientific statements and recommendations. The aim of this consensus document is to give scientific reference for the choice of systems able to offer high quality ECG signal acquisition, processing, and presentation suitable for clinical use.

A new reinforced MAC protocol for lifetime prolongation of reliable Wireless Body Area Network

Recent development of sensors and sensor networks has allowed the creation of new emerging systems which is used as promising solutions in several types of applications. Among which, wireless body area networks (WBANs) is an example that enable continuous monitoring of patients vital signs parameters in everyday life situations. Reliability and energy optimization are considered amongst the important and challenging issues in WBANs. The standard IEEE 802.15.4 is of paramount importance MAC (Media Access Control) protocol for medical sensor body area networks, owing to its low-power, low data rate and low-cost features. In this paper, we propose a reinforcement optimized MAC protocol based on IEEE 802.15.4 dubbed RMAC. The proposed protocol aims to enhance the reliability and to extend the network life time, by reducing energy consumption. NS2 simulator is used for the implementation of the protocol and for the performance evaluation in comparison with the Standard IEEE 802.15.4. The simulation results show that our protocol outperforms the Standard in terms of reliability and network lifetime.

ECG derived respiration: comparison of time-domain approaches and application to altered breathing patterns of patients with schizophrenia

In life-threatening diseases and in several clinical interventions, monitoring of vital parameters is essential to guarantee the safety of patients. Besides monitoring the electrocardiogram (ECG), it is helpful to assess respiratory activity. If the respiration signal itself is not recorded, it can be extracted from the ECG (i.e. ECG derived respiration, EDR).In the present paper, we compared six EDR approaches, namely RS-decline quantified by central moments, respiratory sinus arrhythmia (RSA), R-wave amplitude, QRS area, RS-distance and maximum RS-slope. In order to evaluate the performance of each approach, we applied each method to a database of ECGs and reference respiration signals of 41 healthy subjects. All considered methods revealed relatively small absolute mean errors of the breathing rate (BR) at rest (0.75–1.3 Bpm). The method based on higher order central moments revealed a minimum mean absolute error of 0.75 Bpm (4.40%) and a maximum correlation and concordance with the reference BR (rp = 0.97, rc = 0.97). Using this technique, we analyzed changes of respiration in patients suffering from acute schizophrenia. An increased respiration rate of about 4 Bpm was found. Additionally, alteration of respiratory ratio and reduced respiratory sinus arrhythmia was demonstrated. We conclude that a precise dynamic monitoring of breathing and the investigation of changes in breathing patterns is possible without recording respiration per se.

Noncontact Heart Activity Measurement System Based on Video Imaging Analysis

Vital parameter monitoring systems based on video camera imagery is a growing interest field in clinical and biomedical applications. Heart rate (HR) is one of the most important vital parameters of interest in a clinical diagnostic and monitoring system. This study proposed a noncontact HR and beat length measurement system based on both motion magnification and motion detection at four different regions of interest (ROIs) (wrist, arm, neck and leg). A motion magnification based on a Chebyshev filter was utilized in order to magnify heart pulses in different ROIs that are difficult to see with the naked eye. A new measuring system based on motion detection was used to measure HR and beat length by detecting rapid motion areas in the video frame sequences that represent the heart pulses and converting video frames into a corresponding logical matrix. Video quality metrics were also used to compare our magnification system with standard Eulerian video magnification to select which one has better magnification results and gives better results for the heart pulse. The 99.3% limits of agreement between the proposed system and reference measurement fall within[Formula: see text] beats/min based on Bland and Altman test. The proposed system is expected to produce new options for further noncontact information extraction.

Anästhesiologisches Vorgehen und invasive Gefäßzugänge bei der klinischen Erstversorgung von schwer verletzten Patienten in Deutschland

The continuous monitoring of vital parameters and subsequent therapy belong to the core duties of anaesthetists during acute trauma resuscitation in the trauma room. Important procedures may include placement of arterial lines and central venous catheters (CVCs). Knowledge of indication, performance and localization of invasive catheterisation of trauma care in Germany is scarce. After approval of the German Society of Anaesthesiology and Intensive Care Medicine we conducted an online survey about arterial and central venous catheterisation of severely injured patients with consideration of common practice used by anaesthetists in German trauma rooms. Data are presented in adescriptive manner. Of 843 hospitals invited for the survey, 72(8.5%) had complete and valid data and were thus included in the analysis. Of these, 47% were supra-regional (level1) trauma centres, 38% regional trauma centres and 15% local trauma centres. The annual mean injury severity score (ISS) of admitted patients to these hospitals was 21± 10. In the trauma room, the responding hospitals place CVCs (49%) and arterial lines (59%) only in haemodynamically unstable patients, whereas 24% (CVC) and 39% (arterial line) do when pathological laboratory tests were confirmed. Standard operating procedures (SOPs) merely exist for placement of either arterial lines (25%) or CVCs (22%) in multiple trauma resuscitation. The decision to perform CVC or arterial line placement is usually (79%) at the discretion of the attending anaesthetist. The preferred anatomical access site for CVCs is the right internal jugular vein (46%) and for arterial lines the radial artery (without side preference) (57%), respectively. Of the responding hospitals, 49% prefer landmark-guided CVC-puncture (91% of arterial lines) instead of 43% using sonographic guidance (9% of arterial lines). Intravascular electrocardiography monitoring for CVC tip detection is used by 36%. In Germany, medical indication and schedule of invasive vascular catheterisation of severely injured patients in the trauma room is rarely regulated by SOPs and often performed at the discretion of the attending trauma team. Sonographic assistance during vascular puncture and electrocardiography for CVC tip detection is not as common as in non-emergency anaesthesia. Further studies are required to explore the real necessity and safety of invasive vascular catheterisation in multiple trauma patients in order to improve trauma care.

Design and evaluation of an electronic triage system for prehospital monitoring of patients

Prehospital emergency triage involves prioritising patients and deciding who are in the most urgent need of treatment and medical intervention. Currently used triage methods do not support simple sharing of patient-related information, making it challenging for emergency personnel to monitor the number, location and medical status of patients involved in an incident. We present the design and evaluation of an electronic system that facilitates patient tracking and monitoring of vital parameters from the incident scene to place of treatment. The system comprises a patient electronic triage bracelet, which communicates with software applications for patient monitoring. We tested the system in two situations: real-life, daily operations involving real patients over 1 month and in a 1-day, large-scale, mass casualty exercise. Results are presented, along with lessons learned and suggestions for future research.

Design and evaluation of an electronic triage system for prehospital monitoring of patients

Prehospital emergency triage involves prioritising patients and deciding who are in the most urgent need of treatment and medical intervention. Currently used triage methods do not support simple sharing of patient-related information, making it challenging for emergency personnel to monitor the number, location and medical status of patients involved in an incident. We present the design and evaluation of an electronic system that facilitates patient tracking and monitoring of vital parameters from the incident scene to place of treatment. The system comprises a patient electronic triage bracelet, which communicates with software applications for patient monitoring. We tested the system in two situations: real-life, daily operations involving real patients over 1 month and in a 1-day, large-scale, mass casualty exercise. Results are presented, along with lessons learned and suggestions for future research.

System for Mobile Monitoring of Vital Functions and Environmental Context

The use of ICT in the health care system is aimed to increase efficacy and decrease costs. We have designed a system and services for mobile monitoring of vital physiological parameters and environmental context. The system is based on a small multi-functional wireless body sensor for simultaneous measurement of ECG, temperature, heart rate, respiration rate, and movement. The sensor is wirelessly connected through Bluetooth Smart to a Smartphone. When necessary, the measurements are transferred to a server and can be accessed by authorized personnel. The contribution of the system to improved quality and efficiency of medical care is validated and estimated through several pilot studies.

IoT Based Low Cost Single Sensor Node Remote Health Monitoring System

In developing countries, population increase is not sufficiently matched by increase in available health care resources. Inspite of technology advances, proper medical facility and resources are still not available to a large percentage of population, especially those having low income and living in rural or remote areas. There is an urgent need for development of a low cost and highly reliable technology for monitoring healthcare for those living in such areas that provides rapid monitoring of basic vital health parameters for large numbers of people, and making this data readily available to doctor present anywhere in the world. A novel and an efficient biomedical device has been designed which can quickly monitor the vital signs of large number of people simultaneously and transmit that information wirelessly to the doctor or medical facility present anywhere in the world. The instrument is represented by a hub and spoke model with the spokes being the sensor nodes consisting of a microcontroller MSP430G2553 and a wireless transceiver nRF24L01 (IEEE 802.15.4). The hub consists of a Raspberry Pi 3 with the same transceiver. The data received at the hub can be transmitted to the doctor through the inbuilt IEEE 802.11 (Wi-Fi protocol) of Raspberry Pi 3. All that the instrument needs to work is a Wi-Fi or an Ethernet connection and all the sensor nodes can be powered from the coin cell batteries.