Assessment Of Vital Signs Research Articles

Screening for Atrial Fibrillation in Older Adults at Primary Care Visits: VITAL-AF Randomized Controlled Trial.

Undiagnosed atrial fibrillation (AF) may cause preventable strokes. Guidelines differ regarding AF screening recommendations. We tested whether point-of-care screening with a handheld single-lead ECG at primary care practice visits increases diagnoses of AF. We randomized 16 primary care clinics 1:1 to AF screening using a handheld single-lead ECG (AliveCor KardiaMobile) during vital sign assessments, or usual care. Patients included were ages ≥65 years. Screening results were provided to primary care clinicians at the encounter. All confirmatory diagnostic testing and treatment decisions were made by the primary care clinician. New AF diagnoses during the 1-year follow-up were ascertained electronically and manually adjudicated. Proportions and incidence rates were calculated. Effect heterogeneity was assessed. Of 30 715 patients without prevalent AF (n=15 393 screening [91% screened], n=15 322 control), 1.72% of individuals in the screening group had new AF diagnosed at 1 year versus 1.59% in the control group (risk difference, 0.13% [95% CI, -0.16 to 0.42]; P=0.38). In prespecified subgroup analyses, new AF diagnoses in the screening and control groups were greater among those aged ≥85 years (5.56% versus 3.76%, respectively; risk difference, 1.80% [95% CI, 0.18 to 3.30]). The difference in newly diagnosed AF between the screening period and the previous year was marginally greater in the screening versus control group (0.32% versus -0.12%; risk difference, 0.43% [95% CI, -0.01 to 0.84]). The proportion of individuals with newly diagnosed AF who were initiated on oral anticoagulants was not different in the screening (n=194, 73.5%) and control (n=172, 70.8%) arms (risk difference, 2.7% [95% CI, -5.5 to 10.4]). Screening for AF using a single-lead ECG at primary care visits did not affect new AF diagnoses among all individuals aged 65 years or older compared with usual care. URL: https://www. gov; Unique identifier: NCT03515057.

Acute Tolerability of Methylphenidate in Treatment-Naïve Children with ADHD: An Analysis of Naturalistically Collected Data from Clinical Practice.

ObjectivesThe acute tolerability of methylphenidate (MPH) in children with attention-deficit/hyperactivity disorder (ADHD) has been studied mainly in research samples. Taking advantage of the mandatory test-dose procedure required for starting MPH in Italy, this study aimed to assess the incidence of intolerable adverse events after initial exposure to MPH in routine clinical practice.MethodsThe medical records of 480 consecutively treated, previously drug-naïve children and adolescents with ADHD (90% male, mean age 10.6 ± 3.0 years) were retrospectively analyzed. All children received an initial single dose of MPH immediate release (5 or 10 mg) followed by a 4-hour direct medical observation. Heart rate and blood pressure were measured at dosing and 1, 2, and 3 hours afterwards. If the first dose was well tolerated, the child continued treatment with MPH 5–20 mg daily, and was reassessed a week later.ResultsEleven patients (2.3%, 95% CI 1.1–4.1) interrupted treatment within a week of initiation because of the following adverse events: irritability (n = 3), tics worsening (n = 3), reduced appetite (n = 1), enuresis (n = 1), hallucinations (n = 1), hyperfocus (n = 1), and ‘rebound’ behavioral worsening (n = 1). The most common adverse events were reduced appetite (20%), irritability (14.2%), headache (10.6%), sleep problems (9.4%), stomachache (9.4%), and tics (5%). Intellectual disability increased the risk of any adverse event in general and of irritability in particular. No cardiovascular symptom was clinically reported. However, routine assessments of vital signs during the first 3 hours after the first dose of MPH showed that 9% of the children had a 20% increase in heart rate, 8.8% had a 20% increase in diastolic blood pressure and 4.5% had a 20% increase in systolic blood pressure. Of these, 25.2% still had an elevated heart rate 1 week later.ConclusionsAmong stimulant-naïve children in clinical practice, the incidence of acute MPH intolerance can be estimated to be between 1.2 and 4.1%. An asymptomatic elevation in cardiovascular parameters can be observed in about 1 out of 10 children and warrants monitoring during ongoing treatment.

Online-Based Healthcare Program for the Elderly: A Pilot Program

During the pandemic, health programs for the elderly in the community have been limited to prevent the transmission of COVID-19. However, health services still need to be provided for the elderly to maintain their health. This paper aimed to explain the health problems of the elderly and the participation of elders, the family, and community health workers in the revitalization of strategies for integrated health service activities for the elderly during the pandemic. The Community as Partner model was used in this study. A one-group pre-test/post-test pilot study was conducted. The activities included health assessments via telemedicine (video call), drive-through services for vital signs assessment and simple lab checks, home visits, and education via WhatsApp as needed. We also provided training to community health workers and nursing students. The pilot project ran from June 2020 to May 2021 with 184 community-dwelling elderly in Central Java. The evaluation included participant questionnaires and measurements before and after the program. Change in outcomes was assessed using Wilcoxon signed-rank tests. The study found health problems of the elderly included depression, hypertension, and joint stiffness. 100 elderly people participated in the online exercise activities accompanied by their families and felt a decrease in complaints of joint stiffness, and 84 others participated in health education and exercise activities in open areas, adhering to strict health protocols. Most of the participants said they were satisfied with the activities. The online health education and exercise activities were successfully adapted to be effective interventions.
 Keywords: elderly, empowerment, health services

Abstract WP31: Really, Did A Code Stroke Simulation Improve Compliance In Patient Care Requirements?

Purpose: Enhance the care of ischemic stroke patients by improving compliance with implementation of appropriate order sets, following protocols addressing assessment of vital signs, neuro checks, and lowering door to needle times. Method: ED nurses were required to attend one of five simulation skills fair offered over a nine month period. A stroke simulation scenario was provided in the simulation lab. Groups of nurses performed each step in the care of a code stroke patient. An ED nurse facilitated each step to assure the staff had an understanding of time related events such as calling code stroke, identifying the exact time of last seen well, obtaining CT, vital signs, labs, neuro checks, scoring the patient, and administration of Alteplace, if applicable. Results/Outcomes: Metrics for fiscal year were compared to the statistics collected for the last quarter of fiscal year. Implementation of the stroke order set rose 56.4%, from 43.6% to 100%. Compliance with the protocol, neuro checks improved 40% to 90% and documentation of vital signs per protocol rose from 90% to 97%. Door to needle time improved by 11 minutes. Implications: The simulation educational intervention proved to show a significant improvement in compliance in performing vital signs, neuro checks, using stroke order sets and especially door to needle times. The ED leadership team has recognized the significant impact to our patient care outcomes and compliance resulting from providing this simulation education. The simulation also identified that the majority of the staff did not understand how to correctly perform neuro checks and were not placing the correct code stroke order sets that included the orders to do vital signs and neuro checks per protocol.

Effectiveness of scheduled vital signs assessment during infliximab infusions in detecting infusion reactions: a multi-centre retrospective data review.

To determine if scheduled vital signs monitoring is useful in the detection of infusion reactions to infliximab (IFX). The infusion records of 35,988 IFX infusions completed in 2017 were reviewed for infusion reactions that occurred during the infusion, which were then examined further to determine how those infusion reactions were detected. Of the 90 complete infusion reaction records reviewed, no infusion reactions (0) were detected by scheduled vital signs assessment. According to the infusion reaction data reviewed, scheduled vital sign assessment did not detect any infusion reactions and may not be necessary for the purpose of monitoring patients during infusions for early detection of infusion reactions. Previous research into IFX infusion reactions reviewed also concluded that scheduled vital signs assessment may not be helpful in the detection of infusion reactions and, in many cases, vital signs did not vary significantly enough from baseline to signal an infusion reaction.

Validation of an iCare Health Monitor smartphone application in the assessment of vital signs among stroke survivors in a poor-resource country.

Frequent and accurate monitoring of blood pressure (BP) is a vital part of stroke management. There is therefore the need for availability of simple, portable and accurate devices for monitoring BP at any point in time. To determine the validity and reliability of the iCare Health Monitor (iCHM) smartphone application in the measurement of BP, heart rate (HR) and respiratory rate (RR) amongst stroke survivors in Anambra State. This was a cross-sectional survey involving 86 stroke survivors (64.0% males; mean age = 65.23 ± 12.10 years) consecutively recruited from three conveniently selected centres in Anambra State. BP, PR and RR were assessed using both the standardised methods and iCHM. The parameters were reassessed with the iCHM after few minutes. Convergent validity and test-retest reliability of the iCHM were determined using Pearson product moment correlation and intra-class correlation coefficient respectively at an alpha level of 0.05. The convergent validity of the iCHM was excellent in measuring systolic BP (SBP) (r = 0.96; p < 0.01), diastolic BP (DBP) (r = 0.93; p < 0.01), HR (r = 0.96; p < 0.01) but moderate in measuring RR (r = 0.74; p < 0.01). The test-retest reliability of the iCHM was excellent in assessing SBP (ICC = 0.95; p < 0.01), DBP (ICC = 0.94; p < 0.01) and HR (ICC = 0.92; p < 0.01) but poor in assessing RR (ICC = 0.35; p = 0.03). Also, the iCHM displayed clinically insignificant bias. The iCHM is a valid and reliable tool for assessing BP and HR (but not RR) among stroke survivors. Its use is therefore recommended especially in poor-resource countries where gadgets for assessing BP and PR might not easily be affordable and available.

Modernization of acute toxicity testing with integrated assessment of multiple vital signs as endpoints

Modernization of acute toxicity testing with integrated assessment of multiple vital signs as endpoints

Clinical Judgment Development: Six Steps to Establish Professional Identity and Role-Specific Competencies in Caring for a Sexual Assault Survivor

Background: Clinical judgment is a specific role that establishes a professional identity. The purpose of this paper is to prepare nursing students to make better judgments in the clinical setting and realign learning and teaching. Methods: We used six steps to arrive at a competent clinical judgment suggested by the National Council State Board of Nursing (NSCBN) as a clinical judgment model 1) recognizing cues, 2) analyzing cues, 3) prioritizing hypotheses, 4) generating solutions, 5) taking an action, and 6) evaluating outcomes during the head-to-toe examination of the patient. Results: The primary outcomes are stabilization of the hemodynamics of the patient and prevention of further blood loss. Fluids are being given to help keep the vascular volume from being depleted, but they cannot solve the underlying problem. Continued assessment, intervention, and monitoring of vital signs through the course of the hospital stay ending with the patient’s discharge. Discussion: Survivors of sexual assault are unique for a nurse to provide care. The nurse needs to assess, intervene, monitor, and pay attention to detail of the 6 steps to clinical judgment, resulting in positive outcomes for their patient. Conclusions: Forensic nursing is a field of nursing that focuses on sexual assault survivor care and works to make the aftermath of their tragic situation easier to cope with. Strengthening clinical judgment skills could remedy significant mistakes made by novice forensic nurses. Critical thinking and clinical ethical reasoning are the building blocks of clinical judgment.

Standardization of caregiver and nursing perioperative care on gynecologic oncology wards in a resource-limited setting

IntroductionIn Kampala, Uganda, there is a strong cultural practice for patients to have designated caregivers for the duration of hospitalization. At the same time, nursing support is limited. This quality improvement project aimed to standardize caregiver and nursing perioperative care on the gynecologic oncology wards at the Uganda Cancer Institute and Mulago Specialised Women and Neonatal Hospital. MethodsWe developed, implemented, and evaluated a multidisciplinary intervention involving standardization of nursing care, patient education, and family member integration from October 2019 – July 2020. Data were abstracted from medical records and patient interviews pertaining to the following outcomes: 1) pain control; 2) post-operative surgical site infections, urinary tract infections, and pneumonia; 3) nursing documentation of medication administration, pain quality, and vital sign assessments, and 4) patient and caregiver education. Descriptive statistics, Fisher’s exact test, and independent samples t-test were applied. ResultsData were collected from 25 patients undergoing major gynecologic procedures. Pre- (N = 14) and post- (N = 11) intervention comparison demonstrated significant increases in preoperative patient education (0% to 80%, p = 0.001) and utilization of a comprehensive postoperative order form (0% to 45.5%, p = 0.009). Increased frequency in nursing documentation of patient checks (3 to 8, p = 0.266) and intraoperative antibiotic administration (9 to 10, p = 0.180) in patient charts did not reach significance. There was no change in infection rate, pain score utilization, caregiver documentation, or preoperative medication acquisition. ConclusionOur findings suggest that patient- and family-centered perioperative care can be improved through standardization of nursing care, improved education, and integration of caregivers in a nursing-limited setting.

A Study to Assess Perception of Nursing Students about the Effectiveness of Objective Structured Clinical Examination (OSCE) during Perineal Care Procedure in the selected College of Metropolitan City

Aim: 1. To conduct OSCE 2. To assess the perception of nursing students about OSCE 3. To compare the perception of nursing students between traditional evaluation (TE) and Objective Structured Clinical Examination (OSCE). Material and methods: The research approach and design were Qualitative Descriptive. The subjects were 30 students of 4th year Basic BSc Nursing. OSCE conducted under 4 stations namely Hygiene, Execution, Interaction, and Feedback. Data was collected using Demographic data profile; Clinical checklist for hand washing, perineal care SOP; related viva and opinionnaire. Data were analyzed using descriptive and inferential statistics. Results: Hygiene- 16.69% (5) had excellent, 66.6% (19) had Very good, 19.98% (6) had Good score &amp; none of them had an Average or poor score in hand washing. Execution- 73.26% (22) had excellent, 16% (5) had Very good, 9.99% (3) had Good score &amp; none of them had an Average or poor score in vital signs assessment. Interaction- 56.61% (17) had excellent, 43.29% (13) had Very good score &amp;none of them had a Good, Average or poor score in viva. Feedback- 10 Opinionnaire on personal perception about OSCE administered to participants. 100% (30) of them had positively responded. Conclusion: OSCE proved to be an excellent method of clinical evaluation than traditional evaluation.

Assessment and measurement of vital signs of human beings using IoT architecture

Assessment and measurement of vital signs of human beings using IoT architecture

Comparison of biochemical and safety parameters of regular kratom (Mitragyna speciosa Korth.) users at two different time periods

ABSTRACT Introduction Kratom is a medicinal plant native to Southeast Asia. This present study was primarily undertaken to investigate changes in the vital signs, hematological, and biochemical parameters of regular kratom users. Method Five male regular kratom users were recruited for this longitudinal study. Subjects volunteered to undergo two sessions of blood tests and vital signs assessments after a 3-month interval (baseline: T1; after 3 months: T2). Result There were no significant alterations found in the hematological and biochemical of kratom users, except for a decrease in white cell count after a 3-month interval. In general, the kidney, liver function tests, thyroid, and glucose parameters were not significantly affected. Calcium, total protein, and globulin levels were significantly increased at T2 compared to T1, but all these parameters were within the normal reference range. There were alterations in the lipid profile, where total cholesterol and LDL cholesterol parameters were elevated at both T1 and T2, while significant increase in HDL cholesterol, and decrease in triglycerides levels were observed at T2 compared to T1. Conclusion Our results indicated that continuous consumption of kratom decoction at a daily mitragynine dose of 76.3–114.8 mg did not appear to alter the safety hematological and biochemical parameters of kratom users.

Predictors of the chest CT score in COVID-19 patients: a cross-sectional study

BackgroundSince the COVID-19 outbreak, pulmonary involvement was one of the most significant concerns in assessing patients. In the current study, we evaluated patient’s signs, symptoms, and laboratory data on the first visit to predict the severity of pulmonary involvement and their outcome regarding their initial findings.MethodsAll referred patients to the COVID-19 clinic of a tertiary referral university hospital were evaluated from April to August 2020. Four hundred seventy-eight COVID-19 patients with positive real-time reverse-transcriptase-polymerase chain reaction (RT-PCR) or highly suggestive symptoms with computed tomography (CT) imaging results with typical findings of COVID-19 were enrolled in the study. The clinical features, initial laboratory, CT findings, and short-term outcomes (ICU admission, mortality, length of hospitalization, and recovery time) were recorded. In addition, the severity of pulmonary involvement was assessed using a semi-quantitative scoring system (0–25).ResultsAmong 478 participants in this study, 353 (73.6%) were admitted to the hospital, and 42 (8.7%) patients were admitted to the ICU. Myalgia (60.4%), fever (59.4%), and dyspnea (57.9%) were the most common symptoms of participants at the first visit. A review of chest CT scans showed that Ground Glass Opacity (GGO) (58.5%) and consolidation (20.7%) were the most patterns of lung lesions. Among initial clinical and laboratory findings, anosmia (P = 0.01), respiratory rate (RR) with a cut point of 25 (P = 0.001), C-reactive protein (CRP) with a cut point of 90 (P = 0.002), white Blood Cell (WBC) with a cut point of 10,000 (P = 0.009), and SpO2 with a cut point of 93 (P = 0.04) was associated with higher chest CT score. Lung involvement and consolidation lesions on chest CT scans were also associated with a more extended hospitalization and recovery period.ConclusionsInitial assessment of COVID-19 patients, including symptoms, vital signs, and routine laboratory tests, can predict the severity of lung involvement and unfavorable outcomes.

Long-Term Safety and Tolerability of Fremanezumab for Migraine Preventive Treatment in Japanese Outpatients: A Multicenter, Randomized, Open-Label Study.

IntroductionEarly discontinuation and poor adherence are common limitations of conventional preventive migraine medications that limit their long-term efficacy. Therefore, a migraine preventive medication with favorable long-term safety is warranted.ObjectiveThis study aimed to evaluate the long-term safety and tolerability of fremanezumab for the preventive treatment of chronic or episodic migraine in Japanese patients.MethodsIn this 52-week, randomized, open-label, parallel-group study, fremanezumab monthly or quarterly was administered in newly enrolled Japanese patients with chronic migraine or episodic migraine. Safety was assessed by monitoring of treatment-emergent adverse events, including injection-site reactions, laboratory and vital sign assessments. Newly enrolled patients and rollover patients from previous phase IIb/III trials who did not receive fremanezumab in this study were included in the immunogenicity testing cohort (n = 587). Efficacy outcomes included changes from baseline in the average monthly migraine days and headache days of at least moderate severity. Other efficacy outcomes included changes in disability scores.ResultsA total of 50 patients were enrolled with chronic migraine (monthly, n = 17; quarterly, n = 17) or episodic migraine (monthly, n = 8; quarterly, n = 8). The most commonly reported treatment-emergent adverse events were nasopharyngitis (64.0%) and injection-site reactions (erythema, 24.0%; induration, 10.0%; pain, 8.0%; pruritus, 6.0%). The discontinuation rate was low (4.0% from adverse events, 2.0% from a lack of efficacy) and no deaths were reported. The incidence of anti-drug antibody development was low (2.4%). Fremanezumab reduced monthly migraine days and headache days of at least moderate severity from 1 month after initial administration, and this effect was maintained with no worsening throughout 12 months. Fremanezumab also led to sustained reductions in any acute headache medication use and headache-related disability at 12 months.ConclusionsFremanezumab administered monthly and quarterly was well tolerated in patients with chronic migraine and episodic migraine and led to sustained improvements in monthly migraine days and headache days of at least moderate severity throughout 12 months.Clinical Trial RegistrationClinicalTrials.gov Identifier: NCT03303105.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40264-021-01119-2.

Incorporating systematic financial screening into the electronic health record.

184 Background: Routine screening for financial hardship may identify patients at risk of financial crisis (bankruptcy or inability to afford food or medication). Identifying financial hardship risk is a critical step toward mitigating financial toxicity, associated with earlier mortality and poorer quality of life. We are studying the implementation of systematic financial hardship screening using the electronic health record (EHR) in a large, urban, outpatient cancer center. Methods: Guided by the Consolidated Framework for Implementation Research, we met with key stakeholders, including providers, medical assistants (MA’s), administrative staff, and patient advocates to develop a process to systematically screen all cancer patients for financial hardship risk using 2 items (Q1 and Q3) from the Comprehensive Score for Financial Toxicity (COST). We initiated the process in the breast oncology clinic and partnered with EPIC to integrate the items in the EHR and patient portal. In March 2021, we implemented systematic screening, with automatic prompts to reassess monthly. Results: The workflow includes two mechanisms for patients to complete the 2 items: through the online patient portal during appointment check-in; or through a paper form in English or Spanish, distributed to patients during check-in. An EHR flag was created to notify staff if the patient is due to complete the questions during check-in. During vital signs assessment, the MA collects the form and enters the responses into the EHR. Two important factors were identified to improve the implementation: 1) Patient support to facilitate EHR portal use to reduce clinic workflow congestion; and 2) printed resources for patients who express financial concern. Ongoing discussions reveal that certain clinic days are busier, during which staff find it difficult to review EHR flag, provide and collect paper forms. To date, of 1,358 patients seen in the breast oncology clinic, 526 (39%) have responded to the question, “I know that I have enough money in savings, retirement, or assets to cover the costs of my treatment,” and of those, 278 (53%) responded “not at all” or “a little bit.” Of the 532 patients (39%) who responded to the question, “I worry about the financial problems I will have in the future as a result of my illness or treatment,” 215 (40%) responded “quite a bit” or “very much.” Conclusions: Preliminary analysis highlights the complexities of initiating systematic financial screening in oncology clinics. However, interim results suggest financial hardship is prevalent. Next steps include: expanding to pediatric and gynecologic oncology; building a dashboard to inform financial referrals; comparison of the 2-item screener to the COST survey in a subset of patients; qualitative interviews and focus groups with patients and staff to improve current procedures and optimize the use of dashboards and alerts to focus interventions and referrals on patients most in need.

The global elements of vital signs' assessment: a guide for clinical practice.

The assessment of vital signs is critical for safe, high-quality care. Vital signs' data provide valuable insight into the patient's condition, including how they are responding to medical treatment and, importantly, whether the patient is deteriorating. Although abnormal vital signs have been associated with poor clinical outcomes, research has consistently found that vital signs' assessment is often neglected in clinical practice. Factors contributing to this include nurses' knowledge, clinical judgement, culture, tradition and workloads. To emphasise the importance of vital signs' assessment, global elements of vital signs' assessment are proposed. The elements reflect key principles underpinning vital signs' assessment and are informed by evidence-based literature.

Cardiopulmonary response to high-altitude mountaineering in lung transplant recipients-The Jebel Toubkal experience.

Only a small proportion of lung transplant recipients achieve a physical status comparable to healthy individuals in the long term. It is reasonable to hypothesize that the necessary cardiopulmonary adaptation required for strenuous physical exercise may be impaired. Exposure to high altitude provides an optimal platform to study the physiological cardiopulmonary adaptation in lung transplant recipients under aerobic conditions. To gain a deeper understanding, 14healthy lung transplant recipients and healthcare professionals climbed the highest peak in North Africa (Mount Jebel Toubkal; 4167m) in September 2019. Monitoring included daily assessment of vital signs, repeated transthoracic echocardiography, pulmonary function tests, and capillary blood sampling throughout the expedition. Eleven out of fourteen lung transplant recipients reached the summit. All recipients showed a stable lung function and vital parameters and physiological adaptation of blood gases. Similar results were found in healthy controls. Lung transplant recipients showed worse results in the 6-minute walk test at low and high altitude compared to controls (day 1: 662m vs. 725m, p<0.001, day 5: 656m vs. 700m, p=0.033) and a lack of contractile adaptation of right ventricular function with increasing altitude as measured by tricuspid plane systolic excursion on echocardiography (day 2: 22mm vs. 24mm, p=0.202, day 5: 23mm vs. 26mm, p=0.035). Strenuous exercise in healthy lung transplant recipients is safe. However, the poorer cardiopulmonary performance in the 6-minute walk test and the lack of right ventricular cardiac adaptation may indicate underlying autonomic dysregulation.

Failure to detect ward hypoxaemia and hypotension: contributions of insufficient assessment frequency and patient arousal during nursing assessments

BackgroundPostoperative hypotension and hypoxaemia are common and often unrecognised. With intermittent nursing vital signs, hypotensive or hypoxaemic episodes might be missed because they occur between scheduled measurements, or because the process of taking vital signs arouses patients and temporarily improves arterial blood pressure and ventilation. We therefore estimated the fraction of desaturation and hypotension episodes that did not overlap nursing assessments and would therefore usually be missed. We also evaluated the effect of taking vital signs on blood pressure and oxygen saturation. MethodsWe estimated the fraction of desaturated episodes (arterial oxygen saturation <90% for at least 90% of the time within 30 continuous minutes) and hypotensive episodes (MAP <70 mm Hg for 15 continuous minutes) that did not overlap nursing assessments in patients recovering from noncardiac surgery. We also evaluated changes over time before and after nursing visits. ResultsAmong 782 patients, we identified 878 hypotensive episodes and 2893 desaturation episodes, of which 79% of the hypotensive episodes and 82% of the desaturation episodes did not occur within 10 min of a nursing assessment and would therefore usually be missed. Mean BP and oxygen saturation did not improve by clinically meaningful amounts during nursing vital sign assessments. ConclusionsHypotensive and desaturation episodes are mostly missed because vital sign assessments on surgical wards are sparse, rather than being falsely negative because the assessment process itself increases blood pressure and oxygen saturation. Continuous vital sign monitoring will detect more disturbances, potentially giving clinicians time to intervene before critical events occur.

Efficacy and safety of ciprofol for the sedation/anesthesia in patients undergoing colonoscopy: Phase IIa and IIb multi-center clinical trials

ObjectiveCiprofol is a new intravenous anesthetic agent similar to propofol that has the pharmacodynamic characteristics of a rapid rate of onset and recovery in pre-clinical experiments. The aims of the present clinical trials were to compare the efficacy and safety of ciprofol emulsion for sedation or general anesthesia during colonoscopy and to define optimal doses for a subsequent phase III clinical trial. MethodsA phase IIa multi-center, open-label, non-randomized, positive control, dose-escalating study was performed to determine a recommended phase IIb dose (RP2D) of ciprofol to induce sedation or anesthesia in patients undergoing colonoscopy. Phase IIb was also a multi-center clinical trial, but the patients were randomized into 3 groups at a ratio of 1:1:1. It was a double-blinded, propofol controlled study that administered ciprofol 0.4 mg/kg (n = 31) and 0.5 mg/kg (n = 32) or propofol at 2.0 mg/kg (n = 31), with the aim of establishing the optimal dose of ciprofol. The primary endpoint was the colonoscopy success rate. Secondary endpoints were the duration of colonoscope insertion, recovery time, number of top-up doses needed, and the total dose of ciprofol or propofol required to maintain adequate sedation or anesthesia. In addition, we evaluated the satisfaction of sedation/anesthesia from the endoscopists, anesthetists and patients’ points of view. Safety was assessed according to the incidence of AEs including serious AEs and drug related AEs and the assessment of vital signs, a 12-lead ECG and laboratory tests. ResultsIn the phase IIa trial, the colonoscopy success rates in the 0.2–0.5 mg/kg ciprofol and propofol 2.0 mg/kg groups were 100% and all doses were safe and well tolerated. Ciprofol doses of 0.4 mg/kg and 0.5 mg/kg are recommended for subsequent IIb phases. In the phase IIb trial, a 100% success rate was reconfirmed in all the dosage groups. The mean time of colonoscope insertion in the ciprofol 0.4 mg/kg, ciprofol 0.5 mg/kg and propofol 2.0 mg/kg groups were 1.9, 1.5 and 1.5 min, the mean recovery times from colonoscope withdrawal were 6.1, 5.1, and 4.3 min, and the times to discharge were 11.8, 11.2 and 10.6 min, respectively. The satisfaction ratings of anesthetists in the ciprofol 0.5 mg/kg group (9.5 ± 0.8) were higher than in the ciprofol 0.4 mg/kg (9.2 ± 1.0) and propofol 2.0 mg/kg (9.2 ± 0.9) groups. The incidence of sedation and anesthesia-related AEs was highest in the propofol 2.0 mg/kg group (25.8%), followed by the ciprofol 0.5 mg/kg group (21.9%), and was least in the ciprofol 0.4 mg/kg group (16.1%) (P = 0.750). ConclusionsCiprofol was safe and well tolerated at doses ranging from 0.1 mg/kg to 0.5 mg/kg. Ciprofol 0.4-0.5 mg/kg induced equivalent sedation/anesthesia and had a similar safety profile to propofol 2.0 mg/kg during colonoscopy without producing serious AEs.

Students and teachers' satisfaction and perspectives on high-fidelity simulation for learning fundamental nursing procedures: A mixed-method study

BackgroundHigh-fidelity clinical simulation enables skills to be acquired safely and securely by bridging the gap between theory and clinical practice. This method has traditionally been used to address complex clinical scenarios. Students often report high levels of satisfaction and self-confidence, as this method allows them to put techniques and procedures into practice in a safe environment. Most studies assess simulation solely from the students' perspective, disregarding the opinions of teaching staff. ObjectivesTo assess the implementation of high-fidelity simulation as a teaching tool for fundamental nursing procedures from the perspectives of students and teachers. DesignA two-phase mixed-methods study. SettingA simulation centre environment at the University of the Balearic Islands (Spain) during the 2018 academic year. ParticipantsSecond-year nursing students and staff teaching practical classes on basic patient assessment and monitoring of vital signs. MethodsSatisfaction with clinical experience simulation scale, including an open-ended question for students, was used. A focus group session was also held with teachers. ResultsA total of 91 students completed the scale, yielding an overall satisfaction score of 9.3 out of 10. The practical dimension attained the highest scores. Motivation to attend class was the lowest-rated aspect of this dimension, although students' expectations and satisfaction increased during the class. In the open-ended question and the debriefing session, students described the simulation as a playful learning method allowing them to put their theoretical knowledge into practice and helping them to manage their fears before coming into contact with real care settings. In the focus group session, teachers analysed their own experiences and described how they perceived students' satisfaction and practical skills. ConclusionsHigh-fidelity simulation produces good academic outcomes and is highly satisfying for students and teachers.