Vital Sign Parameters Research Articles

P018: Prehospital diversion of mental health patients to a mental health center vs the emergency department: safety and compliance of an EMS direct transport protocol

Introduction: Prehospital transport of patients to an alternative destination (diversion) has been proposed as part of a solution to overcrowding in emergency departments (ED). We evaluated compliance and safety of an EMS protocol allowing paramedics to transport medically stable patients with psychiatric issues directly to an alternate facility [Crisis Intervention (CI)], bypassing the ED. Patients were eligible for diversion if they were ≥18 years old, classified as CTAS III-IV, scored <4 on the Prehospital Early Warning (PHEW) score, and did not have any vital sign parameters in a danger zone (as per PHEW score criteria). Methods: A retrospective analysis was conducted on patients presenting to Sudbury EMS with behavioural or psychiatric issues. Data was abstracted from EMS reports, hospital medical records, and discharge forms from CI. Protocol compliance was measured using missed protocol opportunities (patients eligible for diversion but taken directly to the ED) and protocol noncompliance rates; protocol safety was measured using protocol failure (presentation to ED within 48 hours of appropriate diversion) and patient morbidity rates (hospital admission within 48 hours of diversion). Data was analysed qualitatively and quantitatively using proportions. Results: EMS responded to 695 calls with psychiatric complaints. Of the 650 taken directly to the ED, 18 met diversion criteria; these were missed protocol opportunities (3%). 45 patients were diverted. There was protocol noncompliance in 36 cases (80%), but 34 were due to incomplete recording of vital signs. There were direct protocol violations in only 2 cases (4%). There was protocol failure in 3 cases (33%), and patient morbidity in 8 cases (18%). No patients died within 48 hours of diversion. Conclusion: EMS providers were highly compliant with the protocol when transporting patients directly to the ED. There were high levels of protocol non-compliance in diverting patients to CI, though this is largely attributed to incomplete recording of vital signs; direct protocol violations were low. The protocol provides moderate levels of safety in diverted patients. Broader implementation of a diversion protocol could reduce the volume of mental health patients seen in the ED, and improve quality of care received by this patient population.

Integration of Single-Center Data-Driven Vital Sign Parameters into a Modified Pediatric Early Warning System.

Pediatric early warning systems using expert-derived vital sign parameters demonstrate limited sensitivity and specificity in identifying deterioration. We hypothesized that modified tools using data-driven vital sign parameters would improve the performance of a validated tool. Retrospective case control. Quaternary-care children's hospital. Hospitalized, noncritically ill patients less than 18 years old. Cases were defined as patients who experienced an emergent transfer to an ICU or out-of-ICU cardiac arrest. Controls were patients who never required intensive care. Cases and controls were split into training and testing groups. The Bedside Pediatric Early Warning System was modified by integrating data-driven heart rate and respiratory rate parameters (modified Bedside Pediatric Early Warning System 1 and 2). Modified Bedside Pediatric Early Warning System 1 used the 10th and 90th percentiles as normal parameters, whereas modified Bedside Pediatric Early Warning System 2 used fifth and 95th percentiles. The training set consisted of 358 case events and 1,830 controls; the testing set had 331 case events and 1,215 controls. In the sensitivity analysis, 207 of the 331 testing set cases (62.5%) were predicted by the original tool versus 206 (62.2%; p = 0.54) with modified Bedside Pediatric Early Warning System 1 and 191 (57.7%; p < 0.001) with modified Bedside Pediatric Early Warning System 2. For specificity, 1,005 of the 1,215 testing set control patients (82.7%) were identified by original Bedside Pediatric Early Warning System versus 1,013 (83.1%; p = 0.54) with modified Bedside Pediatric Early Warning System 1 and 1,055 (86.8%; p < 0.001) with modified Bedside Pediatric Early Warning System 2. There was no net gain in sensitivity and specificity using either of the modified Bedside Pediatric Early Warning System tools. Integration of data-driven vital sign parameters into a validated pediatric early warning system did not significantly impact sensitivity or specificity, and all the tools showed lower than desired sensitivity and specificity at a single cutoff point. Future work is needed to develop an objective tool that can more accurately predict pediatric decompensation.

Comparison and applicability study of blood volume pulse extraction based on facial video

Blind source separation technique based on independent component analysis (ICA) can separate blood volume pulse (BVP) from the facial video and then realize the telemetry of heart rate, blood oxygen saturation, respiratory rate and other vital signs parameters. However, the superiority of ICA in BVP extraction has not been demonstrated in the existing researches. Some researchers suggested using traditional G-channel method for BVP extraction (G-BVP) instead of ICA method (ICA-BVP). This study investigated the applicability of ICA-BVP comparatively. To solve the inherent permutation problem of ICA, a spectral kurtosis-based method was proposed for BVP identification. The experimental results based on the facial video datasets from 9 subjects shows that ICA-BVP method has apparent advantages in motion artifacts attenuation and ambient light changes elimination. The kurtosis-based method achieved a good performance in BVP identification and dynamic heart rate (HR) estimation. In practical application, the proposed ICA-BVP method could present a better stability and accuracy in vital signs parameters extraction.

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.

Frequency-Tracking CW Doppler Radar Solving Small-Angle Approximation and Null Point Issues in Non-Contact Vital Signs Monitoring.

A Doppler radar operating as a Phase-Locked-Loop (PLL) in frequency demodulator configuration is presented and discussed. The proposed radar presents a unique architecture, using a single channel mixer, and allows to detect contactless vital signs parameters while solving the null point issue and without requiring the small angle approximation condition. Spectral analysis, simulations, and experimental results are presented and detailed to demonstrate the feasibility and the operational principle of the proposed radar architecture.

Emergency nurses' decisions regarding frequency and nature of vital sign assessment.

To explore the factors emergency nurses use to inform their decisions regarding frequency and nature of vital sign assessment. Research related to clinical deterioration and vital sign assessment in the emergency department is in its infancy. Studies to date have explored the frequency of vital sign assessment in the emergency department; however, there are no published studies that have examined factors that emergency nurses use to inform their decisions regarding frequency and nature of ongoing vital sign assessment. A prospective exploratory design was used. Data were collected using a survey consisting of eight patient vignettes. The study was conducted in one emergency department in metropolitan Melbourne. Participants were emergency nurses permanently employed at the study site. A 96% response rate was achieved (n=47/49). The most common frequency of patient reassessment nominated by participants was 15 or 30 minutely, with an equal number of participants choosing these frequency intervals. Abnormality in initial vital sign parameters was the most common factor identified for choosing either a 15- or 30-minute assessment interval. Frequency of assessment decisions was influenced by years of emergency nursing experience in one vignette and level of postgraduate qualification in three vignettes. Heart rate, respiratory rate and blood pressure were all nominated by over 80% of participants as vital signs that participants considered important for reassessment. The frequency and nature of vital signs selected varied according to vignette content. There were significant negative correlations between assessment of conscious state and years of nursing experience and assessment of respiratory rate and years of emergency nursing experience. Level of postgraduate qualification did not influence selection of parameters for reassessment. Emergency nurses are tailoring vital sign assessment to patients' clinical status, and nurses are integrating known vital sign data into vital sign decision-making. Accurate assessment and interpretation of vital sign data is fundamental to patient safety. Emergency nurses are responsible for the initial and ongoing assessment of undiagnosed or undifferentiated patients. Prior to medical assessment, emergency nurses are solely responsible for patient assessment, escalation of care and implementation of interventions within nursing scope of practice.

Simple artificial training device for respiratory muscle strength and lung volumes in healthy young male and female subjects: A pilot study

ObjectiveThe aim of this study was to evaluate the efficiency of a simple artificial device for respiratory muscle strength training and lung volumes using either combined or non-combined exercise with elastic bands in healthy young participants. MethodsForty healthy young participants (20 male and 20 female) aged 19–24 years old were randomized into two main experiments with four sub-groups; (1) artificial device (n = 10) & standard device (n = 10) training, and (2) artificial device training combined with elastic band (EB) exercise (n = 10) & standard device training combined with EB (n = 10) exercise. Respiratory muscle strength with maximal peak inspiratory pressure (PImax), and lung volumes; tidal volume (TV), inspiratory reserve volume (IRV), expiratory reserve volume (ERV) and vital capacity (VC) were evaluated before and after training once daily for 3 weeks. Moreover, the peak dyspnea score and vital sign parameters were compared between the experimental groups after final training. ResultsAll parameters had no statistical differences (p > 0.5) between the training devices alone and those combined with EB exercise prior to any experiments. Results from the first experiment showed that training with an artificial device increased all parameters (PImax, VC, IRV, ERV) significantly (p < 0.05), except for TV, when compared to pre training results, which were the same as those in the standard device training group. No statistical difference was shown between these groups after the training period had been performed. Furthermore, results of applying artificial device training combined with EB exercise showed a significant increase in all parameters, except for TV, and they were the same as the increased results in training with the standard device combined with EB exercise. There was no significant difference of data between these groups after the training period. Finally, the results of peak dyspnea score and all vital sign parameters from using the artificial device, with or without EB exercise, showed no statistical difference when compared to use of the standard device. ConclusionThis study proposed that a simple artificial device can be used to train the respiratory muscle with or without elastic band exercise in healthy young subjects.

A Secure Smartcard-Based Anonymous User Authentication Scheme for Healthcare Applications Using Wireless Medical Sensor Networks

A wireless medical sensor network (WMSN ) is a professional application of the traditional wireless body area sensor networks in medicine. Using WMSNs, the parameters of patients' vital signs can be gathered from the sensor nodes deployed on the body of the patients and accessed by the healthcare professionals by using a mobile device. Due to wireless communication, securing communication becomes a vital issue in WMSNs. Since the vital signs parameters are sensitive to the patients' health status and these information must not be revealed to the others except the healthcare professionals, the protection of patients' privacy becomes another key issue for WMSNs applications. Thus, user authentication with anonymity property is the most basic and commonly used method in order to resolve the security and privacy issues of WMSNs. He et al. presented a user authentication protocol for healthcare applications using WMSNs to protect the security and privacy problems. However, Li et al. showed that their scheme is incorrect in authentication and session key agreement phase, has no wrong password detection mechanism and is vulnerable to denial of service caused by password change with wrong password. In this paper, we review Li et al.'s scheme and show that their scheme is still vulnerable to privileged-insider attack, sensor node capture attack and fails to provide user anonymity property. Moreover, we find that He et al.'s scheme is still vulnerable to the same attacks as we find out in Li et al.'s scheme. In order to remedy the security weaknesses found in both He et al.'s scheme and Li et al.'s scheme, we present a secure biometrics-based user authentication scheme in WMSNs using smart card. Through the rigorous formal and informal security analysis, we show that our scheme is secure against possible known attacks. In addition, we simulate our scheme using the most-widely accepted and used Automated Validation of Internet Security Protocols and Applications tool and the simulation results reveal that our scheme is secure. Our scheme is also efficient in computation and communication as compared to He et al.'s scheme, Li et al.'s scheme and other related schemes.

Implementation of an Early Warning Scoring System to Identify Patients With Cancer at Risk for Deterioration.

Early warning scoring systems are tools for nurses to help monitor their patients and improve how quickly a patient experiencing a sudden decline receives clinical care. Nurse leaders and frontline staff at a major academic medical center implemented a new early warning system that gives clear guidelines to nurses, nursing assistants, and other clinicians about vital-sign parameters and changes in patients' mental status. .

Respiratory Distress in the Newborn: An Approach for the Emergency Care Provider

The emergency care provider has a crucial role in the evaluation and management of respiratory distress in the newborn and can see infants presenting at time of birth to many months old. Respiratory distress in the newborn is important to recognize as it can present anywhere along a spectrum of severity from tachypnea to respiratory failure. In addition, it may represent a primary respiratory disease or be the harbinger of a systemic illness or problem in another organ system. Timely assessment, recognition of signs of newborn respiratory distress, and proper newborn airway management and assisted ventilation are the key initial steps in treatment. Once the infant is stabilized, being familiar with the normal newborn physical examination and vital sign parameters as well as the pertinent historical questions to ask can help rule in or out different causes of respiratory distress and help guide definitive treatment.

Separation algorithm of vital sign signal in complex environments based on time-frequency filtering

Life detection radar that combines radar technology with biomedical engineering detects human physiological signals (respiration, heartbeat, body movement, etc.) from a long distance with non-contact method. In this field, vital sign detection and parameter extraction are hot issues in current researches, and the acquisition of vital sign signal of human target with radar may very helpful. In this paper, a separation method for vital sign signals based on time-frequency filtering (TFF) is proposed, which mainly predicts the instantaneous frequency (IF) by combining the Viterbi algorithm (VA) with strong noise immunity and taking advantage of the high-resolution time-frequency transformation method with good cross-term inhibitory effect in B distribution (BD), so as to extract the weak vital sign signals in the radar echo effectively. According to the simulation result, this algorithm has good resolution precision and anti-noise performance, and it is applicable for the extraction of vital sign signals in low signal-to-noise ratio, which may provide basis for the further launch of parameter extraction of the vital sign signals.

An Android based Application for Determine a Specialized Hospital Nearest to Patient&amp;apos;s Location

and Communication Technologies (ICTs) are commonly using in healthcare organizations worldwide. The android operating system (AOS) based electronic devices such as Smartphones and computer tablets are extensively used for many purposes like instant messaging, gaming, word processing, Internet and download number of applications online. A rapid growth of android phones has enabled to replace PC's software and other licensed software development technologies. There are different kinds of healthcare applications developed in android Smartphones which help patients and their caregivers to reduce time and cost efficiency. In this research work, an application is developed that locates the nearest hospital about five km radius with the desired medical specialist. The nearest position of hospitals is calculated with a built-in feature of Global Positioning System (GPS) in Smartphones and finds the route from their current location through Google Map application Program Interfaces (API). An informative survey of different hospitals in Karachi is conducted to obtain an accurate list of doctors available in each hospital. With the help of this application, a patient can find the nearest hospital according to specialized consultant availability. A comprehensive profile of doctor and hospital is available in the application including the website, mailing addresses and contact numbers. thousands of new apps are uploaded in their online database. A number of applications related to healthcare are available in the medical category which is helpful in the diagnosis of vital sign parameters, vaccinations schedule, medicine reminder etc (2). These kinds of applications are lies in mobile-health (m- health) technology. Some applications determine the location of health clinics, healthcare centers and city hospitals. Search the nearest hospital with the specialty in the city of Karachi is the unique idea of this application. Authentic and up-to-date information are available about each hospital and doctor. Below is the background information about choosing the AOS platform for this application.

Community-acquired pneumonia as medical emergency: predictors of early deterioration

BackgroundEarly organ dysfunction determines the prognosis of community-acquired pneumonia (CAP), and recognition of CAP as a medical emergency has been advocated.ObjectiveTo characterise patients with ‘emergency CAP’ and evaluate predictors for...

A new authentication protocol for healthcare applications using wireless medical sensor networks with user anonymity

ABSTRACTWith the development and maturation of the wireless communication technologies, the wireless sensor networks have been widely applied in different environments to acquire specific information. The wireless medical sensor networks (WMSNs), as a professional application of the wireless sensor networks in medicine, have attracted more and more attention because of its potential in improving the quality of healthcare services. Through the WMSNs, the parameters of patients' vital signs can be gathered from the sensor nodes equipped on the body of the patients and then can be accessed by the healthcare professionals by using a mobile device. By reason of the open feature of wireless communication, how to guarantee secure communication becomes an important issue. On the other hand, because the vital signs parameters are sensitive to the patients' health status and no one wants to reveal it to the others except the healthcare professionals, the protection of patients' privacy becomes another key issue for WMSNs applications. User authentication protocol with anonymity is the most basic and commonly used method to resolve the security and privacy issues of WMSNs. Recently, He et al. proposed an enhanced authentication protocol for healthcare applications using WMSNs to protect the security and privacy problems. However, we find that their scheme is incorrect in authentication and session key agreement phase. Besides, their scheme has no wrong password detection mechanism, which will not only waste the unnecessary computation and communication costs, but also may deduce the denial of service problem. In this paper, the biometric is introduced as the third authentication factor, and a new user anonymous authentication protocol based on WMSNs is designed so as to remove the drawbacks of the protocol of He et al. Compared with previous protocols, the new presented protocol enhances the security and also keeps the computation efficiency. Copyright © 2015 John Wiley &amp; Sons, Ltd.

A randomized, crossover study to investigate the pharmacokinetics and safety of inhaled fluticasone furoate and umeclidinium, administered separately and in combination via dry powder inhaler in healthy adult volunteers.

A combination of fluticasone furoate (FF) and umeclidinium (UMEC) has been considered for development for the treatment of asthma. The primary objectives were to investigate the plasma and urine pharmacokinetics (PK) of FF/UMEC in combination compared with FF and UMEC monotherapies. This randomized, double-blind, three-period crossover, single-center study in healthy volunteers assessed the PK of FF 400 mcg and UMEC 500 mcg administered separately and in combination (four inhalations of FF/UMEC 100/125 mcg, FF 100 mcg, or UMEC 125 mcg) via dual-strip dry powder inhaler. Subjects were randomized based on codes generated using a validated computerized system (Randall, GlaxoSmithKline). Eighteen subjects were enrolled; 17 received all three scheduled doses of study medication. Plasma FF and UMEC concentrations peaked at 0.5 and 0.08 h post-dose, respectively, for FF/UMEC and the monotherapies. FF and UMEC co-administration resulted in slightly lower or similar systemic exposure for both drugs versus the monotherapies. In post hoc sensitivity analyses (performed because two subjects administered inhalations incorrectly), the ratio of adjusted geometric means (maximum plasma concentration and area under the curve) was closer to unity than in the planned analyses. Cumulative urinary UMEC excretion (Ae) was similar for FF/UMEC and UMEC. Post hoc sensitivity analyses on Ae(0-24) suggested a small carryover effect but results were similar to those of the population as a whole. Urinary UMEC excretion following FF/UMEC was low (~1.5% over 24 h) and unlikely to have impacted upon PK comparisons. Three adverse events were reported; none were severe or led to withdrawal. There were no clinically significant effects on electrocardiogram, vital sign, or laboratory parameters. Fluticasone furoate and umeclidinium co-administration was well tolerated and was not associated with meaningful changes in systemic or urinary PK versus the monotherapies. GlaxoSmithKline.

A LABORATORY MODEL OF ORGAN DONOR CIRCULATORY DEATH WITH DIRECT MEASUREMENT OF CARDIAC GRAFT FUNCTION

At present, the only clinical pathway for cardiac transplantation involves the use of an organ donor who meets criteria for neurologic death. Unfortunately, there is a consistent shortage of donor hearts despite a growing number of potential transplant recipients. This supply-demand mismatch is associated with significant waitlist mortality. An alternative to neurologic death, referred to as organ donation after circulatory death (DCD), is currently in use for lung, liver and kidney transplantation. The DCD clinical pathway, however, is associated with a variable and unpredictable duration of donor hypoxia and hypotension, culminating in 5 minutes of total circulatory standstill. As a result of the heart’s unique susceptibility to injury under these conditions, cardiac grafts from DCD donors are currently wasted. Sprague-Dawley rats are deeply anesthetized, tracheotomized and mechanically ventilated. Rats are systemically anticoagulated with unfractionated heparin. Control subjects receive a median sternotomy. The heart is harvested and flushed with ice-cold cardioplegic solution prior to functional assessment. DCD subjects receive invasive blood pressure monitoring via the left femoral artery. Subsequently, a median sternotomy is performed and both pleural spaces are opened. The DCD pathway is initiated by discontinuing mechanical ventilation. Vital sign parameters are monitored regularly until the graft is harvested. When asystole is achieved, 5 minutes of circulatory standstill is observed (to mimic the clinical requirement) prior to harvesting and flushing the cardiac graft. Cardiac grafts are reperfused on a Langendorff rig. After 10 minutes of reperfusion, the rig is switched into a working-heart mode. The left ventricle is catheterized with a calibrated pressure-volume conductance catheter to generate baseline and preload occlusion data. We have established a clinically relevant rodent model of donor circulatory death. Furthermore, we have coupled our DCD protocol with direct phyiosologic assessment of cardiac function, demonstrating a significant difference between control and DCD subjects. Vital sign parameters recorded during the DCD protocol have enabled us to crudely correlate the extent and duration of donor instability with cardiac graft function. Our model of DCD with direct measurement of cardiac graft function is important and clinically relevant. It will be valuable in determining the limits of cardiac viability in the DCD setting, and also in assessing the ability of pre- and post-DCD treatment strategies to salvage cardiac function.

Effect of foot massage on postoperative pain and vital signs in breast cancer patient

Background : Pain is a common sequela of surgery and foot massage has been advocated as an effective and easy technique that can be applied independently by nurses to patients in postoperative period to relive pain intensity. It involves a simple technique, costs little and requires no special equipment. The aim of this study is to evaluate the effect of foot massage on postoperative pain and vital sign parameters in postoperative breast cancer patients. Methods: A quasiexperimental design was used to investigate any causality between foot massage and postoperative pain with a total of 60 breast cancer patients (n = 30 in the control group who received only analgesic treatment and n = 30 in the experimental group who received analgesic treatment plus foot massage). A structured questionnaire was developed by the researcher to collect data related to participants’ characteristics such as age, level of education, type of surgery and usage of Non-steroidal Anti Inflammatory Drugs [NSAIDs]. Following an initial complaint from patients that they were experiencing post-operative pain the pain intensity level was assessed by a Visual Analogue Scale [VAS] as a baseline and after 60 minutes and 120 minutes following foot massage. Vital signs were assessed using the same time intervals. Findings: When analyzing pain levels over time a significant difference was found between both groups with the mean pain level of the experimental group who had experienced foot massage as an adjunct to analgesia being noted to be lower than that of the control group. A statistically significant reduction of systolic and diastolic blood pressure in both groups was also observed but a higher reduction was observed in the experimental group ( P &lt; .001) whilst the respiratory rate remained unchanged in both groups. Conclusion : Foot massage is an effective modality in helping to relieve postoperative pain among women who have been treated with surgery for breast surgery. To promote and improve the quality of foot massage in clinical settings, regular meeting should be held by health team members to discuss the potential positive clinical outcomes, patient benefits and methods of implementation and audit of this technique. Consideration should be given by schools of nursing to include this technique within their nursing curriculum, through the integration of the complementary therapy foot massage technique as part of the considerations on the fundamentals of surgical nursing theory and practice.

Macitentan, a dual endothelin receptor antagonist for the treatment of pulmonary arterial hypertension, does not affect cardiac repolarization in healthy subjects

Macitentan is an orally active dual endothelin receptor antagonist, which demonstrated a reduction of the risk of morbidity/mortality events in pulmonary arterial hypertension patients. This double-blind, randomized, placebo- and positive-controlled, four-way crossover thorough QTc study was designed to investigate the effects of therapeutic and supratherapeutic doses of macitentan on cardiac repolarization in healthy male and female subjects. Each subject received the following treatments: moxifloxacin 400 mg, macitentan 10 mg, macitentan 30 mg, and placebo. Each treatment period lasted 9 days and was followed by at least 10 days of washout. The primary endpoint of this study was the baseline-adjusted, placebo-corrected QT interval corrected using the Fridericia method (ΔΔQTcF). Pharmacokinetic (PK), safety, and tolerability assessments were performed during each treatment.A total of 64 subjects were randomized. The upper bound of the 2-sided 90% confidence interval for ΔΔQTcF following macitentan was <10 ms at all time points and no correlation was observed between ΔΔQTcF and PK parameters. Findings in the analysis of the morphological patterns of the ECGs were randomly distributed across all treatments and did not indicate an association with macitentan. Macitentan was well tolerated in this study. Headache and nasopharyngitis were the most frequently reported adverse events. No effects on clinical laboratory and vital signs parameters were observed.In summary, repeated doses of macitentan 10 mg and 30 mg did not indicate any pro-arrhythmic potential.

ABSTRACT 516

Background and aims: Continuous CO monitoring has an important role in the management of acute circulatory failure (ACF) in PICU. In this way CO can be measured continuously with a very simple and totally noninvasive process with esCCO by introducing volumetric information to all care levels. This new noninvasive technology using Pulse Wave Transit Time (PWTT), it’s obtained by familiar vital signs parameters of ECG and pulse oximetry. Aims: This study aim to compare CO obtained by esCCO™ to CO obtained by transthoracic echocardiography (TTE) in the management of patients with ACF. Methods: In this prospective study, the assessment CO was obtained by Schimadzu SD 2200 Pro echocardiograph and esCCO™ by a Nihon Kohden, BSM-3763, for each patient had tachycardia, hypotension, oliguria, delayed capillary refilling. Results: Between January and December 2013, 16 ventilated children with ACF, 32 paired CO measurements were obtained: The overall correlation between the CO obtained by esCCO™ and the CO obtained by TTE was r = 0,150. In 09 children less than 3 years and less than15 kg, the correlation was r = 0.0209. In 07 children older than 3 years and older than15kg, the correlation was r = 0.560. Conclusions: esCCO™ is no appropriated method to measure the CO by introducing volumetric information to all care levels. However, this technique remains reliable and reproducible with external calibration of the CO with TTE.

Efficacy and safety of vortioxetine (Lu AA21004), 15 and 20 mg/day: a randomized, double-blind, placebo-controlled, duloxetine-referenced study in the acute treatment of adult patients with major depressive disorder.

This study assessed the efficacy, tolerability and safety of vortioxetine versus placebo in adults with recurrent major depressive disorder. This double-blind, randomized, placebo-controlled study included 608 patients [Montgomery–Åsberg Depression Rating Scale (MADRS) total score≥26 and Clinical Global Impression – Severity score≥4]. Patients were randomly assigned (1 : 1 : 1 : 1) to vortioxetine 15 mg/day, vortioxetine 20 mg/day, duloxetine 60 mg/day or placebo. The primary efficacy endpoint was change from baseline in MADRS total score at week 8 (mixed model for repeated measurements). Key secondary endpoints were: MADRS responders; Clinical Global Impression – Improvement scale score; MADRS total score in patients with baseline Hamilton Anxiety Rating Scale ≥20; remission (MADRS≤10); and Sheehan Disability Scale total score at week 8. On the primary efficacy endpoint, both vortioxetine doses were statistically significantly superior to placebo, with a mean difference to placebo (n=158) of −5.5 (vortioxetine 15 mg, P<0.0001, n=149) and −7.1 MADRS points (vortioxetine 20 mg, P<0.0001, n=151). Duloxetine (n=146) separated from placebo, thus validating the study. In all key secondary analyses, both vortioxetine doses were statistically significantly superior to placebo. Vortioxetine treatment was well tolerated; common adverse events (incidence≥5%) were nausea, headache, diarrhea, dry mouth and dizziness. No clinically relevant changes were seen in clinical safety laboratory values, weight, ECG or vital signs parameters. Vortioxetine was efficacious and well tolerated in the treatment of patients with major depressive disorder.