Vital Signs Research Articles

Effect of traditional Chinese Yijinjing exercise on hand dysfunction in rheumatoid arthritis patients: a randomized controlled trial

IntroductionRheumatoid arthritis (RA) patients often experience significant hand dysfunction. Yijinjing, a traditional Chinese exercise, has been recognized for its benefits to mind–body health. This study aimed to evaluate the efficacy and safety of Yijinjing in improving hand dysfunction among individuals with RA.MethodsThis research was conducted as a single-center, outcome-blinded, randomized controlled trial. A total of 66 eligible RA participants were randomly assigned in a 1:1 ratio to either the Yijinjing exercise group (YJJG) with sessions conducted three times per week over a 12-week period or the control group (CG), which maintained ordinary activities. Various outcomes were assessed, including the Michigan Hand Outcomes Questionnaire (MHQ), handgrip strength, active range of motion (AROM), RA disease activity, the Health Assessment Questionnaire Disability Index (HAQ-DI), levels of anxiety and depression, and wrist ultrasound, all of which were collected at baseline and the week 12.ResultsAt the end of the 12 weeks, the YJJG demonstrated significant improvements in MHQ scores compared to the CG (p < 0.05), alongside enhancements in handgrip strength and AROM, specifically in wrist extension, radial deviation, and metacarpophalangeal flexion (p < 0.05). Wrist ultrasound scores did not exhibit a significant increase in the YJJG, meaning no inflammation aggravation (p > 0.05). Additionally, morning stiffness duration, Disease Activity Score 28-ESR (DAS28-ESR), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels showed significant improvement in the YJJG (p < 0.05). Both groups reported enhancements in quality of life, as well as reductions in anxiety and depression scores, with the YJJG displaying greater improvements overall (p < 0.05). Importantly, no adverse events or significant abnormalities in vital signs were observed in either group.ConclusionYijinjing exercise may effectively enhance hand function, handgrip strength, and flexibility in RA patients with low disease activity. Furthermore, it appears to improve quality of life and reduce anxiety and depression without exacerbating joint inflammation.Clinical trial registrationhttps://clinicaltrials.gov/study/NCT05527158, Identifier NCT05527158.

Repetitive Transcranial Magnetic Stimulation for Auditory Verbal Hallucinations in Schizophrenia

ImportanceAuditory verbal hallucinations (AVH) are a common symptom of schizophrenia, increasing the patient’s risks of suicide and violence. Repetitive transcranial magnetic stimulation (rTMS) is a potential treatment for AVH.ObjectiveTo investigate the effect of imaging-navigated rTMS on AVH in patients with schizophrenia.Design, Setting, and ParticipantsThis 6-week, double-blind, sham-controlled, randomized clinical trial was performed at the Anhui Mental Health Center, Hefei, China, from September 1, 2016, to August 31, 2021. Participants included 66 patients with AVH and schizophrenia. Data were analyzed from May 1, 2022, to March 31, 2023.InterventionsParticipants were randomly assigned 1:1 to either imaging-navigated active or sham rTMS over the left temporoparietal junction for 2 weeks.Main Outcomes and MeasuresThe primary outcome measured improvements in AVH from baseline to week 2 and week 6 using the Auditory Hallucination Rating Scale (AHRS) scores. In addition, the TMS-induced electric field strength was used to estimate improvements in AVH as a secondary outcome.ResultsA total of 62 participants (33 women [53%]; mean [SD] age, 27.4 [9.2] years) completed the 2-week treatments. Of these, 32 were randomized to the active rTMS group (18 women [56%]; mean [SD] age, 26.9 [9.2] years) and 30 to the sham treatment group (15 women [50%]; mean [SD] age, 27.8 [9.4] years). In the intention-to-treat analyses, patients receiving active rTMS showed a significantly greater reduction in AHRS scores compared with those receiving sham treatment at week 2 (difference, 5.96 [95% CI, 3.42-8.50]; t = 4.61; P < .001; Cohen d, 1.17 [95% CI, 0.62-1.71]). These clinical effects were sustained at week 6. Additionally, a stronger TMS-induced electric field within a predefined AVH brain network was associated with greater reductions in AHRS scores (B = 3.12; t = 3.58; P = .002). No serious adverse event was observed.Conclusions and RelevanceThe findings of this randomized clinical trial suggest that imaging-navigated rTMS may effectively and safely alleviate AVH in patients with schizophrenia. Findings also suggest that the electric field strength in the individualized AVH network is a vital parameter for optimizing the efficacy of the rTMS protocol.Trial RegistrationClinicalTrials.gov Identifier: NCT02863094

The reliability and validity of a novel clinical tool for distributing rehabilitation patients: a multicenter cross-sectional study in China

This study aimed to assess the reliability and validity of a novel clinical tool for distributing rehabilitation patients (DRP) for measuring a population of rehabilitation patients based on first-hand data from the field survey in China. A multi-stage sampling scheme was used to select 2512 rehabilitation outpatients from 21 medical institutions in seven cities in China. The evaluation indicators of the DRP tool consisted of five clinical indexes on multiple dysfunctions, self-care ability, vital signs, disease status, and disease course. The evaluation of rehabilitation ways of the DRP tool mainly included outpatient rehabilitation treatment, admission to primary healthcare, admission to secondary hospitals, and admission to tertiary hospitals. The mean age of participants was 54.22 years (SD:17.91), and nearly half (48.68%) were male. The majority (70.15%) were diagnosed with orthopaedic disorders. The Cronbach’s alpha (0.66), the Kendall test (Kendall coefficient = 0.86; P < 0.001), and the Kappa test (Kappa = 0.83; Agreement: 90.48%; P < 0.001) reflected acceptable consistency reliability for the indexes on multiple dysfunctions, self-care ability, vital signs, disease status, and disease course in DRP tool. The modified confirmatory factor analysis (CFA) showed the indexes of multiple dysfunctions (β = 0.31; 95%CI = 0.20–0.43), self-care ability (β = 0.99; 95%CI = 0.65–1.33), disease status (β = 0.11; 95%CI = 0.06–0.16), disease course (β = 0.15; 95%CI = 0.09–0.21), and vital signs (β = 0.15; 95%CI = 0.08–0.21) had significantly factor loadings on the rehabilitation ways. The modified CFA exhibited a satisfactory model fit (RMSEA = 0.03; CFI = 0.99; TLI = 0.95; SRMR = 0.01; AIC = 8268.51; BIC = 8373.43). This is the first study to develop a DRP tool using a relatively large sample from seven cities in China. The DRP tool had acceptable reliability and validity in measuring the rehabilitation ways of patients. Our findings provide a starting point for developing a practical tool in rehabilitation clinical practices and could provide advice on building more effective strategies and tools for other low-and middle-income countries that struggle with integrated healthcare.

A new domestic self-expanding nitinol stent: in vivo preclinical study

Objective. To evaluate the results of implantation of a new domestic self-expanding nitinol stent in experimental animals. Materials and methods. Experimental implantations of a self-expanding nitinol stent were performed in the common iliac artery of three Vietnamese Pot-bellied pigs. In the postoperative period, all animals received dual antiplatelet therapy for 3 months. Vital signs were also assessed throughout the observation period. After 3 months, the animals underwent control angiography and ultrasound examination of the iliofemoral segment, followed by withdrawal from the experiment by euthanasia. The next step was a macroscopic and histological analysis of the stented areas of the vessels. Results. The observation period of the animals was 3 months. Throughout the entire observation period, vital signs in all animals remained within normal values. The results of control angiography and ultrasound examination after 3 months demonstrated patency, as well as the absence of significant in-stent stenoses in two pigs. One animal showed signs of in-stent restenosis. The results of macroscopic and histological analysis showed signs of damage to the subendothelial layer, as well as myointimal hyperplasia. These changes were especially pronounced in the animal with restenosis. Our analysis showed that the presented results were due to excessive oversizing of the implanted stents (20–30 %). Conclusion. Our proposed self-expanding nitinol stent, in general, showed satisfactory results in the in vivo experiment. Nevertheless, it should be borne in mind that severe stent oversizing can cause excessive neointimal proliferation, which, in turn, will lead to the development of restenosis in the long-term postoperative period. In this regard, it is necessary to carry out an additional series of implantation of the presented stent to the experimental animals with less oversizing in order to determine its optimal values for this particular stent model.

Silent Devastation: Acute Marchiafava-Bignami Disease Unmasked by Chronic Alcoholism in a 24-Year-Old Male: A Case Report

Marchiafava-Bignami disease (MBD) is an uncommon condition that is mainly linked to prolonged alcoholism and nutritional deficits. It is characterised by necrosis and demyelination of the corpus callosum. Due to its rarity and vague clinical signs, this disorder can frequently be misdiagnosed. It manifests as a range of neurological symptoms, from altered awareness to motor impairments. We present a 24-year-old man in this case report who has a history of intravenous drug use, chronic alcohol intake, and recent binge drinking.He presented with a 10-day history of constipation, vomiting, and a high-grade continuous fever. Over two days, the patient’s condition deteriorated into a drowsy state with abdominal pain.On examination, the patient was drowsy but arousable, with stable vital signs except for hypertension. Neurological findings indicated reduced deep tendon reflexes, hypotonia, and neck stiffness. A systemic workup revealed normal brain CT findings, however, diffusion limitation was seen in the corpus callosum's splenium on MRI, along with mild oedema and T2/FLAIR hyperintensity. The lumbar puncture showed lymphocytic predominance, low CSF glucose, and elevated protein levels suggestive of a possible CNS infection. The differential diagnosis included Marchiafava-Bignami disease (MBD) and cytotoxic lesions of the corpus callosum (CLOCCs).The patient was managed with intravenous steroids, empirical antitubercular therapy (ATT), broad-spectrum antibiotics, and supportive care, including airway protection via intubation. Despite the late diagnosis, the clinical history of chronic alcoholism, recent binge, and imaging findings confirmed MBD. Early recognition and treatment of this disorder can improve neurological outcomes. The present study emphasises how crucial it is to take MBD into account when making a differential diagnosis for alcohol-related encephalopathies, especially in individuals who have neurological decline and prolonged alcohol consumption.

An Explainable Deep Learning-Enhanced IoMT Model for Effective Monitoring and Reduction of Maternal Mortality Risks

Maternal mortality (MM) is considered one of the major worldwide concerns. Despite the advances of artificial intelligence (AI) in healthcare, the lack of transparency in AI models leads to reluctance to adopt them. Employing explainable artificial intelligence (XAI) thus helps improve the transparency and effectiveness of AI-driven healthcare solutions. Accordingly, this article proposes a complete framework integrating an Internet of Medical Things (IoMT) architecture with an XAI-based deep learning model. The IoMT system continuously monitors pregnant women’s vital signs, while the XAI model analyzes the collected data to identify risk factors and generate actionable insights. Additionally, an efficient IoMT transmission model is developed to ensure reliable data transfer with the best-required system quality of service (QoS). Further analytics are performed on the data collected from different regions in a country to address high-risk cities. The experiments demonstrate the effectiveness of the proposed framework by achieving an accuracy of 80% for patients and 92.6% for regional risk prediction and providing interpretable explanations. The XAI-generated insights empower healthcare providers to make informed decisions and implement timely interventions. Furthermore, the IoMT transmission model ensures efficient and secure data transfer.

Effective blind bilateral superficial cervical plexus block for tracheostomy tube insertion in a geriatric patient with Ludwig angina with hypertension in resource constrained area: a case report

IntroductionLudwig angina is a rare, rapidly spreading submaxillary, submandibular, and sublingual necrotizing life-threatening widespread cellulitis of the soft tissue on the floor of the mouth that can cause fatal complications because of airway obstruction. Currently, there are few published studies assessing the efficacy of superficial cervical plexus block for airway surgery and there is no agreement in the literature about airway management. The published recommendations differ and are based on the authors’ own experiences and available resources. This report aimed to provide insight into critical patient management by performing regional anesthesia with fewer complications to the cardiovascular and respiratory systems.Case presentationWe report the case of a 70 year-old hypertensive Black Ethiopian woman with American Society of Anesthesiologist–Physical Status class III and hypertension, who was admitted to the hospital for treatment by her surgeon. The surgeon diagnosed her with Ludwig angina. After adequate physical examination and laboratory investigation, she arrived at the operation room for exploration and drainage of the abscess with a superficial cervical plexus block. She arrived safely at the adult intensive care unit for frequent suctioning. The block was effective until 6 h after the procedure with visual analogue scale (2/10), her vital signs remained stable throughout the postoperative period, and then the tracheostomy tube was removed by the surgeon after 10 days. The patient’s hemodynamic status and breathing effort were satisfactory, and she was discharged 15 days later.Clinical discussionProper airway management is critical for the survival of patients diagnosed with Ludwig angina. According to recent studies, an increasing number of patients with Ludwig angina require intensive care unit admission for tracheal intubation and mechanical breathing. However, it is uncertain whether intensive care reduces the death rate in patients with Ludwig angina. Finally, it is suggested that studies with large sample sizes and strong levels of evidence be conducted to conclude the effectiveness of superficial cervical plexus block for airway emergency surgeries.ConclusionManagement of the airway in patients with Ludwig angina is challenging. Clinicians must take precautions and make sharp decisions on the basis of a variety of circumstances, including the availability of equipment at medical facilities, such as fiberoptic intubation equipment; the anesthetist’s level of experience, such as performing superficial regional block and good mask ventilation; and the patient’s medical status at the time of presentation. As a result, intervention needs to be quick so as to avoid airway obstruction and further complications.

Acute change in resting energy expenditure and vital signs in response to white tea consumption in females: a pilot study

BackgroundWhite tea, derived from the Camellia sinensis plant like other teas, uses tender buds and young leaves and undergoes minimal processing. This results in higher levels of antioxidants and bioactive substances, which may enhance thermogenesis more effectively than other teas. This first human study aimed to investigate the acute effects of white tea consumption on resting energy expenditure (REE) and some vital signs, including blood pressure (BP), heart rate (HR), and body temperature (BT).MethodsThirty-two healthy female volunteers with normal initial BP and whose caffeine intakes were < 300 mg/d were enrolled in the study. The caffeine and total phenolic content of white tea samples were determined by the high-performance liquid chromatography method and the Folin-Ciocalteu colorimetric method, respectively. After baseline measurements, participants consumed white tea containing 6 mg of caffeine per kilogram of lean body mass, and the white tea was prepared with bottled drinking water at 80 °C and brewed for 3 min. REE, BP, and BT were assessed at various intervals (baseline, 30 min, 120 min, and 180 min) post-consumption of the white tea.ResultsThe results revealed a significant increase in REE by 8.7% at 180 min after the consumption. In particular, there was a substantial difference in both values between the intervals of 30 min to 180 min and baseline to 180 min for REE (p < 0.05). Maximal oxygen consumption and BT also increased significantly over time (p < 0.05) and the observed increment in BT suggests a thermogenic effect associated with white tea consumption. However, systolic BP, diastolic BP, and heart rate showed no significant difference.ConclusionsThese findings suggest white tea consumption may acutely enhance REE and maximal oxygen consumption, so the results are promising for body weight management. This study is the first human study in the literature about the effects of white tea on energy expenditure and vital signs.

The Effectiveness of Herbal Inhaler Products, Suan Sunandha Palace Recipe

This research purpose for Study the effectiveness of the herbal inhalant product, Wang Suan Sunandha recipe. This is quasi-experimental research with a single group pretest-posttest design. The experimental group is Suan Sunandha Rajabhat University students aged 18-25 years. Be healthy and have no chronic diseases. Consented to be research volunteers, totaling 50 people (25 males, 25 females). The research instrument is 1 questionnaire, divided into 4 parts, consisting of questionnaires and personal information of the sample group. Vital signs recording form Emotion and Feeling Assessment and Satisfaction Questionnaire An experiment was conducted where a sample of 50 people had their vital signs measured. and record the emotions before and after inhaling the herbal inhaler aroma Suan Sunandha Palace recipe, about 10 minutes. and after the end of the sample group, they self-assessed their satisfaction. The data was analyzed using descriptive statistics, finding frequency, percentage, mean, and standard deviation. and the use of paired t-test statistics. The results of the research found that after inhaling the scent of herbal inhalers, Suan Sunandha Palace Recipe It was found that vital signs (blood pressure and heart rate). The emotions and feelings of the sample group were different from before inhaling the herbal inhalant scent. Suan Sunandha Palace Recipe Statistically significant at the.05 level. But the breathing rate before and after inhaling the herbal inhaler odor Suan Sunandha Palace Recipe was no different, and the average satisfaction score of the sample was at the highest level.

Performance of Risk Models for Antimicrobial Resistance in Adult Patients With Sepsis

ImportanceThe results of prediction models that stratify patients with sepsis and risk of resistant gram-negative bacilli (GNB) infections inform treatment guidelines. However, these models do not extrapolate well across hospitals.ObjectiveTo assess whether patient case mix and local prevalence rates of resistance contributed to the variable performance of a general risk stratification GNB sepsis model for community-onset and hospital-onset sepsis across hospitals.Design, Setting, and ParticipantsThis was a retrospective cohort study conducted from January 2016 and October 2021. Adult patients with sepsis at 10 acute-care hospitals in rural and urban areas across Missouri and Illinois were included. Inclusion criteria were blood cultures indicating sepsis, having received 4 days of antibiotic treatment, and having organ dysfunction (vasopressor use, mechanical ventilation, increased creatinine or bilirubin levels, and thrombocytopenia). Analyses were completed in April 2024.ExposureThe model included demographic characteristics, comorbidities, vital signs, laboratory values, procedures, and medications administered.Main Outcomes and MeasuresCulture results were stratified for ceftriaxone-susceptible GNB (SS), ceftriaxone-resistant but cefepime-susceptible GNB (RS), and ceftriaxone- and cefepime-resistant GNB (RR). Negative cultures and other pathogens were labeled SS. Deep learning models were developed separately for community-onset (patient presented with sepsis) and hospital-onset (sepsis developed ≥48 hours after admission) sepsis. The models were tested across hospitals and patient subgroups. Models were assessed using area under the receiver operating characteristic curve (AUROC) and area under precision recall curve (AUPRC).ResultsA total of 39 893 patients with 85 238 sepsis episodes (43 207 [50.7%] community onset; 42 031 [48.3%] hospital onset) were included. Median (IQR) age was 65 (54-74) years, 21 241 patients (53.2%) were male, and 18 830 (47.2%) had a previous episode of sepsis. RS contributed to 3.9% (1667 episodes) and 5.7% (2389 episodes) of community-onset and hospital-onset sepsis episodes, respectively, and RR contributed to 1.8% (796 episodes) and 3.9% (1626 episodes), respectively. Previous infections and exposure to antibiotics were associated with the risk of resistant GNB. For example, in community-onset sepsis, 375 RR episodes (47.1%), 420 RS episodes (25.2%) and 3483 of 40 744 (8.5%) SS episodes were among patients with resistance to antimicrobial drugs (P &amp;amp;lt; .001). The AUROC and AUPRC results varied across hospitals and patient subgroups for both community-onset and hospital-onset sepsis. AUPRC values correlated with the prevalence rates of resistant GNB (R = 0.79; P = .001).Conclusions and RelevanceIn this cohort study of 39 893 patients with sepsis, variable model performance was associated with prevalence rates of antimicrobial resistance rather than patient case mix. This variability suggests caution is needed when using generalized models for predicting resistant GNB etiologies in sepsis.

The MangLE score: A novel simple tool to identify patients who are unlikely to require amputation following severe lower extremity injury

BACKGROUND There are no validated and sensitive models that can guide the decision regarding amputation in patients with mangled lower extremities. We sought to describe a simple scoring model, the Mangled Lower Extremity (MangLE) score, which can predict those who are highly unlikely to need an amputation as a means to direct resources to this cohort. METHODS This is a retrospective study using the 2013–2021 American College of Surgeons Trauma Quality Improvement Program data set. Adult patients with a mangled lower extremity, defined as a crush injury or a fracture of the femur or tibia combined with severe soft tissue injury, arterial injury, or nerve injury, were included. Patients who suffered a traumatic lower extremity amputation, underwent amputation within 24 hours of admission, or who died within 24 hours of admission were excluded. Patients were divided into those who did/did not undergo amputation during their hospital stay. Demographics, injury mechanism, Injury Severity Score, and Abbreviated Injury Scale score, initial vital signs, and comorbid conditions were abstracted. A logistic regression model was constructed and the top five most important variables were used to create the score. RESULTS The study includes 107,620 patients, of whom 2,711 (2.5%) underwent amputation. The five variables with the highest predictive value for amputation were arterial injury, lower-extremity Abbreviated Injury Scale score of ≥3, crush injury, blunt mechanism, and shock index. The lowest possible MangLE score was 0, and the highest was 15. The model demonstrated an excellent predictive ability for lower extremity amputation in both the development and validation data set with an area under the receiver operating characteristic curve of 0.81 (95% confidence interval, 0.80–0.82) and 0.82 (95% confidence interval, 0.81–0.84), respectively. The negative predictive value for a score of &lt;8 is 99%. CONCLUSION The MangLE score is able to identify patients who are unlikely to require amputation. Resources for limb salvage can be directed to this cohort. LEVEL OF EVIDENCE Prospective and Epidemiologic; Level IV.

Effect of Lidocaine on Ciprofol Dosage and Efficacy in Patients Who Underwent Gastroscopy Sedation.

BACKGROUND Intravenous ciprofol is a short-acting sedative with minimal respiratory and circulatory suppression and limited analgesia. Intravenous lidocaine provides analgesia during surgical procedures. This study included 70 patients who underwent gastroscopy with analgesia and aimed to evaluate the effects of intravenous lidocaine on the dose of ciprofol required to produce 50% of the maximal effect (ED50). MATERIAL AND METHODS Seventy patients scheduled for elective painless gastroscopy were randomly assigned into 2 groups: group L (n=35, received ciprofol and 1.5 mg/kg lidocaine) and group S (n=35, received ciprofol and normal saline). The primary outcomes measured were the ED50 and the 95% effective dose (ED95) of ciprofol, determined using the modified up-down sequential method and Probit analysis. Secondary outcomes included induction, operation, and recovery times; monitoring of vital signs such as mean arterial pressure, heart rate, and oxygen saturation; and evaluation of postoperative adverse reactions, including sore throat, nausea, vomiting, abdominal pain, and satisfaction scores from endoscopists and anesthesiologists. RESULTS The ED50 of ciprofol in group L was 0.315 mg/kg (95% CI, 0.291-0.342 mg/kg), which was significantly lower than that in group S, 0.42 mg/kg (95% CI, 0.371-0.491 mg/kg). Additionally, group L exhibited shorter induction and recovery times, a lower incidence of postoperative sore throat, and a temporary drop in blood pressure following induction. CONCLUSIONS Intravenous lidocaine during painless gastroscopy reduces the required ciprofol dose, shortens induction and recovery times, and lowers the incidence of postoperative complications, such as sore throat. These findings support its effective role in improving sedation quality and patient outcomes during gastroscopy.

Combining quality improvement and critical care training: Evaluating an ICU CPR training programme quality improvement initiative at the National Hospital in Tanzania

BackgroundThe United Republic of Tanzania has had a 41.4% mortality rate in the intensive care unit. In Tanzania, the Ministry of Health and Social Welfare has implemented quality improvement (QI),...

Agreement and comparative accuracy of instability criteria at discharge for predicting adverse events in patients with community-acquired pneumonia

ObjectiveFive definitions of clinical instability have been published to assess the appropriateness and safety of discharging patients hospitalised for pneumonia. This study aimed to quantify the level of agreement between...

Developing a clinical decision support framework for integrating predictive models into routine nursing practices in home health care for patients with heart failure

AbstractBackgroundThe healthcare industry increasingly values high‐quality and personalized care. Patients with heart failure (HF) receiving home health care (HHC) often experience hospitalizations due to worsening symptoms and comorbidities. Therefore, close symptom monitoring and timely intervention based on risk prediction could help HHC clinicians prevent emergency department (ED) visits and hospitalizations. This study aims to (1) describe important variables associated with a higher risk of ED visits and hospitalizations in HF patients receiving HHC; (2) map data requirements of a clinical decision support (CDS) tool to the exchangeable data standard for integrating a CDS tool into the care of patients with HF; (3) outline a pipeline for developing a real‐time artificial intelligence (AI)‐based CDS tool.MethodsWe used patient data from a large HHC organization in the Northeastern US to determine the factors that can predict ED visits and hospitalizations among patients with HF in HHC (9362 patients in 12,223 care episodes). We examined vital signs, HHC visit details (e.g., the purpose of the visit), and clinical note–derived variables. The study identified critical factors that can predict ED visits and hospitalizations and used these findings to suggest a practical CDS tool for nurses. The tool's proposed design includes a system that can analyze data quickly to offer timely advice to healthcare clinicians.ResultsOur research showed that the length of time since a patient was admitted to HHC and how recently they have shown symptoms of HF were significant factors predicting an adverse event. Additionally, we found this information from the last few HHC visits before the occurrence of an ED visit or hospitalization were particularly important in the prediction. One hundred percent of clinical demographic profiles from the Outcome and Assessment Information Set variables were mapped to the exchangeable data standard, while natural language processing–driven variables couldn't be mapped due to their nature, as they are generated from unstructured data. The suggested CDS tool alerts nurses about newly emerging or rising risks, helping them make informed decisions.ConclusionsThis study discusses the creation of a time‐series risk prediction model and its potential CDS applications within HHC, aiming to enhance patient outcomes, streamline resource utilization, and improve the quality of care for individuals with HF.Clinical RelevanceThis study provides a detailed plan for a CDS tool that uses the latest AI technology designed to aid nurses in their day‐to‐day HHC service. Our proposed CDS tool includes an alert system that serves as a guard rail to prevent ED visits and hospitalizations. This tool can potentially improve how nurses make decisions and improve patient outcomes by providing early warnings about ED visits and hospitalizations.

Radar-based contactless heart beat detection with a modified Pan–Tompkins algorithm

Background.Using radar for non-contact measuring human vital signs has garnered significant attention due to its undeniable benefits. However, achieving reasonably good accuracy in contactless measurement senarios is still a technical challenge.Materials and methods.The proposed method includes two stages. The first stage involves the process of datasegmentation and signal channel selection. In the next phase, the raw radar signal from the chosen channel is subjected to modified Pan-Tompkins.Results.The experimental findings from twelve individuals demonstrated a strong agreement between the contactless radar and contact electrocardiography (ECG) devices for heart rate measurement, with correlation coefficient of 98.74 percentage; and the 95% limits of agreement obtained by radar and those obtained by ECG were 2.4 beats per minute.Conclusion.The results showed high agreement between heart rate calculated by radar signals and heart rate by electrocardiograph. This research paves the way for future applications using non-contact sensors to support and potentially replace contact sensors in healthcare.

Factors Associated with Complications of Snakebite Envenomation in Health Facilities in the Cascades Region of Burkina Faso from 2016 to 2021

Snakebite envenomation remains a major cause of morbidity and mortality in rural populations. This study identified factors associated with the complications of snakebite envenomation reported in the Cascades region of Burkina Faso. This cross-sectional study used the routine data of patients admitted for snakebite envenomation at five health facilities between 1 January 2016 and 31 December 2021. Data were collected on sociodemographic, clinical, and therapeutic characteristics of patients with signs of envenomation. Bivariate and multivariate analyses were conducted to identify factors associated with complications. Among the 846 patients with envenomation, 355 (42%) experienced complications. Local complications (23.2%, 196/846) included wounds and skin necrosis, whereas systemic complications (34.3%, 290/846) included hemorrhage, shock, and coma. Of all complicated cases, 7.6% (27/355) died. Factors associated with complications were rural residence (AOR: 4.80; 95% CI: 2.21–11.4), incision at the bite site (AOR: 4.31; 95% CI: 2.51–7.52), tourniquet application (AOR: 5.52; 95% CI: 1.42–30.8), bleeding (AOR: 14.2; 95% CI: 8.80–23.4), abnormal vital signs (AOR: 14.3; 95% CI: 9.22–22.7), and lack of antivenom administration (AOR: 2.92; 95% CI: 1.8–4.8). These findings highlight the importance of antivenom availability and public awareness for reducing the incidence of complications of snakebite envenomation.

Simulation of spatially varying non-stationary seismic waves using random frequencies and non-uniform fast fourier transform

The simulation of spatially varying non-stationary seismic waves is a crucial consideration for the seismic analysis of engineering structures. The traditional approach often incurs substantial computational expenses and suffers from low efficiency due to the extensive implementation of large-scale matrix factorizations at numerous sampling points in both time and frequency domains. In this study, an enhanced approach is developed for the efficient simulation of non-stationary seismic waves. The core of this approach lies in the utilization of random frequency sampling coupled with time-domain interpolation to reduce matrix factorizations, and non-uniform fast Fourier transform for expediting the summation of trigonometric functions. A parametric analysis is conducted to investigate the effect of vital parameters, including the decoupling strategy of time-frequency spectrum, the number of random frequencies, and the number of interpolation knots over time, on both the efficiency and accuracy of the enhanced approach. Consequently, the preferred values for these parameters are determined. By considering the simulation of seismic waves acting on a group of bridges, the enhanced approach is validated in the view of correlation functions. The results demonstrate a high level of fidelity of the simulated seismic waves and proves the effectiveness of the enhanced approach in the efficient simulation of spatially varying non-stationary earthquake ground motions. The developed approach can be used for the simulation of non-stationary seismic waves for a wide range of engineering structures.

Prediction of Severe Acute Pancreatitis at a Very Early Stage of the Disease Using Artificial Intelligence Techniques, Without Laboratory Data or Imaging Tests: The PANCREATIA Study.

To evaluate machine learning models' performance in predicting acute pancreatitis severity using early-stage variables while excluding laboratory and imaging tests. Severe acute pancreatitis (SAP) affects approximately 20% of acute pancreatitis (AP) patients and is associated with high mortality rates. Accurate early prediction of SAP and in-hospital mortality is crucial for effective management. Traditional scores such as APACHE-II and BISAP are complex and require laboratory tests, while early predictive models are lacking. Machine learning (ML) has shown promising results in predictive modelling, potentially outperforming traditional methods. We analysed data from a prospective database of AP patients admitted to Vall d'Hebron Hospital from November 2015 to January 2022. Inclusion criteria were adults diagnosed with AP according to the 2012 Atlanta classification. Data included basal characteristics, current medication, and vital signs. We developed machine learning models to predict SAP, in-hospital mortality, and intensive care unit (ICU) admission. The modelling process included two stages: Stage 0, which used basal characteristics and medication, and Stage 1, which included data from Stage 0 and vital signs. Out of 634 cases, 594 were analysed. The Stage 0 model showed AUC values of 0.698 for mortality, 0.721 for ICU admission, and 0.707 for persistent organ failure. The Stage 1 model improved performance with AUC values of 0.849 for mortality, 0.786 for ICU admission, and 0.783 for persistent organ failure. The models demonstrated comparable or superior performance to APACHE-II and BISAP scores. The ML models showed good predictive capacity for SAP, ICU admission, and mortality using early-stage data without laboratory or imaging tests. This approach could revolutionise AP patients' initial triage and management, providing a personalised prediction method based on early clinical data.

Rationale and development of a prehospital goal-directed bundle of care to prevent rearrest after return of spontaneous circulation.

In patients with out-of-hospital cardiac arrest (OHCA) who attain return of spontaneous circulation (ROSC), rearrest while in the prehospital setting represents a significant barrier to survival. To date, there are limited data to guide prehospital emergency medical services (EMS) management immediately following successful resuscitation resulting in ROSC and prior to handoff in the emergency department. Post-ROSC care encompasses a multifaceted approach including hemodynamic optimization, airway management, oxygenation, and ventilation. We sought to develop an evidenced-based, goal-directed bundle of care targeting specified vital parameters in the immediate post-ROSC period, with the goal of decreasing the incidence of rearrest and improving survival outcomes. Here, we describe the rationale and development of this goal-directed bundle of care, which will be adopted by several EMS agencies within California. We convened a group of EMS experts, including EMS Medical Directors, quality improvement officers, data managers, educators, EMS clinicians, emergency medicine clinicians, and resuscitation researchers to develop a goal-directed bundle of care to be applied in the field during the period immediately following ROSC. This care bundle includes guidance for prehospital personnel on recognition of impending rearrest, hemodynamic optimization, ventilatory strategies, airway management, and diagnosis of underlying causes prior to the initiation of transport.