Vital Sign Measurements Research Articles

PSXV-15 Application of a survey instrument for understanding pain management practices associated with equine assisted activities and therapy horses

Abstract Equine assisted activities and therapy (EAAT) is a popular therapy option for physical, psychological, and cognitive disorders. A critical component of this treatment option is the horse, and while research has reported the benefits for human participants, there is a lack of knowledge concerning the therapy horse due to limited research documenting the impact of these activities. Nevertheless, those that manage these animals understand the demanding activities placed on the therapy horse, and thus, can play a vital role in educating those new to the industry. Therefore, the objective of this study was to utilize a survey instrument to document management activities associated with pain for the therapy horse. An 11 forced-choice question survey was developed and sent out to 97 EAAT programs within the U.S. Participation was available online for a total of four months. Response rate was 31% (n = 30). From the respondents, 50% answered +46 yrs old for age, 70% answered +15 yrs equine experience, and 60% answered +11 yrs working in EAAT. The most popular answer for number of horses in the respondents’ EAAT program was >11 horses (53%), and as to the horses in the program, 50% answered they had >7 geriatric horses. The majority of the respondents answered “definitely yes” to having functionally lame horses used regularly in their programs (53%) and having experience with pain management practices associated with orthopedic (50%) and gastrointestinal (67%) conditions. The majority of the programs used vital sign measurements (67%), facial expressions (73%), and behavioral changes (87%) to detect equine pain. In conclusion, EAAT horses appear to commonly need healthcare practices for pain management suggesting further research is needed in precision medicine and animal welfare. In addition, educational programs covering pain management practices for individuals going into the EAAT industry would assist in ensuring the welfare of these animals.

Impact of inhalation therapy on occurrence of oral manifestations in patients with bronchial asthma, in Jeddah, Saudi Arabia

Background: Inhalation therapy for asthma includes cortisol and bronchodilators. High dosage and long duration of inhalation therapy has been linked with several adverse effects on the oral tissues. Objectives: To explore the oral manifestations associated with the use of inhalation therapy among patients with asthma in Jeddah city. Method: This was a cross sectional study; the non-probability convenient sampling method was used to select 215 subjects (99 with Doctor diagnosed asthma and 116 without asthma), from the outpatient clinics of two private hospitals. Data were collected using interview questionnaire, the standard 5th ed. WHO survey on oral manifestations, measurement of vital signs and anthropometric parameters, as well as clinical oral examination. Data were analyzed using SPSS version 22, and Logistic multinomial regression was used to study the Odds ratio and its 95% confidence interval between the variables. Level of significance for the study was 0.05. Results: The majority of patients with asthma (95%) used inhalation therapy, without use of spacers. Ulceration, pigmentation and candidiasis of the tongue, buccal mucosa and palate weresignificantly more encountered among patients with asthma compared to those without asthma (p < 0.001, 0.002 and 0.046 respectively). Xerostomia and salivary gland affection, also, were significantly more encountered among patients with asthma compared to those without asthma (p < 0.000, and 0.002 respectively). Patients with asthma were 7.7 times more likely to develop tongue disorders (OR: 7.7, p < 0.013), 3 times more likely to develop buccal mucosal disorders (OR: 3, p < 0.039), and 15 times more likely to develop palate disorders (OR: 15, p < 0.004) compared to subjects without bronchial asthma. Conclusion: Use of inhalation therapy in patients with asthma was significantly associated with increased occurrence of oral health problems. Health education programs about proper use of inhalers and oral hygiene should be implemented by primary health care personnel. Key words: Inhalation therapy, Asthma, Oral manifestations, Jeddah.

40 Trajectories of Vital Signs and Risk of Cardiac Arrest in the Emergency Department

Early recognition and prevention have been added as the first link in the Chain of Survival for in-hospital cardiac arrest (IHCA). However, little is known about the trajectories of vital signs prior to IHCA, which could inform the heterogeneous processes preceding this devastating event. Therefore, using group- based trajectories modeling of longitudinal vital sign data in the emergency department (ED), we aimed to identify clinically relevant subphenotypes at high risk of IHCA in the ED. This retrospective cohort study used electronic clinical warehouse data from a tertiary medical center with approximately 100, 000 ED visits per year. We retrieved data from 733, 398 ED visits over a 7-year period. We selected one ED visit per person and excluded out-of-hospital cardiac arrest, patients aged less than 18 years, or those who had less than three vital-sign measurements. Patient demographics, triage data, vital signs (systolic blood pressure [SBP], heart rate [HR], body temperature, respiratory rate, oxygen saturation), selected laboratory test results, and IHCA status were also retrieved. Group-based trajectory modeling was performed to identify vital-sign trajectory groups, and patient characteristics and IHCA status were compared between the groups. A total of 37, 697 adult ED patients were included. Of them, 145 (0.4%) developed IHCA. Three to four trajectory groups per vital sign were identified, and the following five trajectory groups were associated with a higher rate of IHCA: low and fluctuating SBP, high and fluctuating HR, persistent hypothermia, initially resolving but recurring tachypnea, and low and fluctuating oxygen saturation. Except for the persistent hypothermia group, the other four trajectory groups were more likely to have fever and higher levels of lactic acid, C-reactive protein, and D-dimer. Within each vital sign, the IHCA-prone trajectory group was associated with a higher triage level and a higher mortality rate, compared to other trajectory groups. We identified five novel subphenotypes associated with a higher likelihood of IHCA, with some distinct patterns in clinical course and laboratory test results. A better understanding of the pre-IHCA vital sign trajectories may potentially reverse clinical deterioration and reduce IHCA in the ED.

A Smart, Low Cost, Wearable Technology for Remote Patient Monitoring

Accurate measurement and timely communication of vital signs is critical to determine health status of patients in the hospital. Absence of reliable vital signs values or delay in their communication leads to medical errors which often result in life threatening situation. This is caused mainly by the manual nature of current monitoring practices and large patient to nurse ratio in under-resourced clinical settings. The neonatology department faces major issues in this regard as ill and/or premature new-born infants require constant monitoring to avoid any subsequent adverse event. To address this issue, an affordable and automated system to continuously measure three important vital signs; temperature, pulse rate, and pulse oxygen concentration using microelectronics and Internet of things is presented here. The system measures the vital signs using wearable sensors and communicates the data wirelessly with maximum error of 0.1 °C temperature, 0.6 % oxygen saturation, and 0.8 beats per minute(BPM) in pulse rate. It also automatically alarms to indicate life-threatening conditions based upon the values of these vital signs. The overall system costs only 7000 PKR (45 USD) and it can be reused across patients due to its wearable nature. It is a compact, smart and easy to handle system having approximate weight and dimensions of 50g and <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$190\times 85\times20$ </tex-math></inline-formula> mm respectively. The results presented here will enable widespread adoption of the system

The feasibility of home self-assessment of vital signs and symptoms: A new key to telehealth for individuals?

ObjectiveDuring the COVID-19 pandemic, social distancing and self-isolation called for innovative, readily implementable, and effective short-term health solutions. The objective of this study was to assess the feasibility of self-assessment of vital signs and symptoms with electronic transmission of results, by self-isolating individuals with positive SARS-CoV-2 polymerase chain reaction (PCR) test. The secondary objective was to describe the association between the presence of abnormal vital signs and severe symptoms as well as their evolution over time. MethodParticipants with positive SARS-CoV-2 PCR test were asked to perform twice daily standardized vital signs measurements and self-assessment of symptoms for 14 consecutive days. All data were transmitted electronically through a mobile application and a web-based platform. Participants were provided with decision support tools based on the severity of their condition and a weekly nurse practitioner telephone follow-up. Abnormal values for vital signs and severe symptoms were determined. Per participant and per days, proportions of abnormal vital signs and severe symptoms were calculated. ResultsData from 46 participants (mean age 54.1 ± 6.9 years, 54% male) were available for analysis. On average, participants performed the standardized self-assessment for 12.3 ± 3.4 days (89% performed at least 7 measurement days and 61% completed all 14 days). The highest proportions abnormal values for vital signs were for oximetry (20.1%) and respiratory rate (12.1%). The highest proportions of severe symptoms were for fatigue (16.9%) and myalgia. (10.2%). The combined proportion of abnormal vital signs and severe symptoms was maximal on day 1 with 20.3% of total measurements, with a linear decrease to 3.5% on day 14. ConclusionRemote initiation of home measurements of vital signs and symptoms, self-management of these measures, accompanied by a decision support tool and supported by preplanned nurse follow-up are feasible. This could allow to opening up new insight for the care of sick individuals.

FPGA Implementation of an Efficient FFT Processor for FMCW Radar Signal Processing

This paper presents the design and implementation results of an efficient fast Fourier transform (FFT) processor for frequency-modulated continuous wave (FMCW) radar signal processing. The proposed FFT processor is designed with a memory-based FFT architecture and supports variable lengths from 64 to 4096. Moreover, it is designed with a floating-point operator to prevent the performance degradation of fixed-point operators. FMCW radar signal processing requires windowing operations to increase the target detection rate by reducing clutter side lobes, magnitude calculation operations based on the FFT results to detect the target, and accumulation operations to improve the detection performance of the target. In addition, in some applications such as the measurement of vital signs, the phase of the FFT result has to be calculated. In general, only the FFT is implemented in the hardware, and the other FMCW radar signal processing is performed in the software. The proposed FFT processor implements not only the FFT, but also windowing, accumulation, and magnitude/phase calculations in the hardware. Therefore, compared with a processor implementing only the FFT, the proposed FFT processor uses 1.69 times the hardware resources but achieves an execution time 7.32 times shorter.

Clinical Implications of Mask Wearing for Special Populations in an Inpatient Rehabilitation Setting during COVID-19 Global Pandemic

Research ObjectivesTo describe the clinical implications of wearing a mask among special populations in inpatient rehabilitation.DesignNarrative Review.SettingInpatient rehabilitation.ParticipantsPatients undergoing acute inpatient rehabilitation.InterventionsMask wearing.Main Outcome MeasuresEffect of mask wearing on exercise outcomes, including perceived exertion, shortness of breath, and patient perception; clinical implications for the interdisciplinary team.ResultsFive trials which observed exercise outcomes after mask wearing were identified and summarized. Findings for the effect of face masks on exercise and vital signs varied due to heterogeneity of exercise protocols and outcome measures. Relevant findings show that patients who wore masks had higher ratings of perceived exertion, increased shortness of breath, and feelings of claustrophobia while wearing a face mask during exercise. Wearing masks affected physical and mental outcomes despite exercise intensity (low, moderate, or high).ConclusionsModerate-to-high intensity exercise is needed for neuroplasticity. This type of exercise may not be possible in neurological populations, who do not have normal oxygen consumption at rest or with exercise, and may be further affected by wearing masks. Clinicians should their patients' mask wearing into consideration, and change the frequency, intensity, timing and types of exercises when patients are wearing a face mask. Frequent measurement of vital signs and fatigue symptoms are critical to maintain patient safety, and adjustments should be made as necessary. Other neurological challenges to monitor include impaired cognitive function, limited communication, reduced mood, and interactions with medications. These can affect the patients' ability to accurately determine and state their perceived effort or may hinder physiological and autonomic responses. Lastly, interdisciplinary teams should communicate patient findings related to mask wearing at team conferences, huddles and include discussion for ways to increase patients' participation and how to optimize health outcomes.Author(s) DisclosuresNone.

Effects of Progressive Relaxation Exercises on Vital Signs and Fatigue in Liver Transplant Patients: A Randomized Controlled Trial.

This randomized controlled study was conducted to evaluate the effects of progressive relaxation exercises on vital signs and fatigue level. Ninety patients with liver transplantation (experimental group = 45, control group = 45) were included in the study. The patients in the experimental group performed progressive relaxation exercises for 25 to 30 minutes every day for 4 weeks. Before the progressive relaxation exercises, the vital signs and fatigue level of the patients were recorded. Vital signs were recorded again immediately after the progressive relaxation exercises and at the end of the second week. At the end of the fourth week, the final measurement of vital signs was performed along with the second fatigue level assessment. In the experimental group, pulse and respiratory rates, systolic and diastolic blood pressure values, and fatigue severity mean scores were found to be lower and oxygen saturation level was higher than those of the control group. The improvement in vital signs in the experimental group was evident at week 3 (p < .05).

A Chest Patch for Continuous Vital Sign Monitoring: Clinical Validation Study During Movement and Controlled Hypoxia.

BackgroundThe standard of care in general wards includes periodic manual measurements, with the data entered into track-and-trigger charts, either on paper or electronically. Wearable devices may support health care staff, improve patient safety, and promote early deterioration detection in the interval between periodic measurements. However, regulatory standards for ambulatory cardiac monitors estimating heart rate (HR) and respiratory rate (RR) do not specify performance criteria during patient movement or clinical conditions in which the patient’s oxygen saturation varies. Therefore, further validation is required before clinical implementation and deployment of any wearable system that provides continuous vital sign measurements.ObjectiveThe objective of this study is to determine the agreement between a chest-worn patch (VitalPatch) and a gold standard reference device for HR and RR measurements during movement and gradual desaturation (modeling a hypoxic episode) in a controlled environment.MethodsAfter the VitalPatch and gold standard devices (Philips MX450) were applied, participants performed different movements in seven consecutive stages: at rest, sit-to-stand, tapping, rubbing, drinking, turning pages, and using a tablet. Hypoxia was then induced, and the participants’ oxygen saturation gradually reduced to 80% in a controlled environment. The primary outcome measure was accuracy, defined as the mean absolute error (MAE) of the VitalPatch estimates when compared with HR and RR gold standards (3-lead electrocardiography and capnography, respectively). We defined these as clinically acceptable if the rates were within 5 beats per minute for HR and 3 respirations per minute (rpm) for RR.ResultsComplete data sets were acquired for 29 participants. In the movement phase, the HR estimates were within prespecified limits for all movements. For RR, estimates were also within the acceptable range, with the exception of the sit-to-stand and turning page movements, showing an MAE of 3.05 (95% CI 2.48-3.58) rpm and 3.45 (95% CI 2.71-4.11) rpm, respectively. For the hypoxia phase, both HR and RR estimates were within limits, with an overall MAE of 0.72 (95% CI 0.66-0.78) beats per minute and 1.89 (95% CI 1.75-2.03) rpm, respectively. There were no significant differences in the accuracy of HR and RR estimations between normoxia (≥90%), mild (89.9%-85%), and severe hypoxia (<85%).ConclusionsThe VitalPatch was highly accurate throughout both the movement and hypoxia phases of the study, except for RR estimation during the two types of movements. This study demonstrated that VitalPatch can be safely tested in clinical environments to support earlier detection of cardiorespiratory deterioration.Trial RegistrationISRCTN Registry ISRCTN61535692; https://www.isrctn.com/ISRCTN61535692

Using vital signs measurements to identify patients with COVID-19 who require early continuous positive airway pressure.

The coronavirus disease 2019 (COVID-19) can result in severe pneumonia, leading to acute respiratory distress syndrome, which are treated using continuous positive airway pressure (CPAP). Patients must be evaluated quickly to commence early CPAP if required. To identify patients with COVID-19 in the emergency department (ED) who require early CPAP, using vital signs measurements during triage. This was a retrospective, observational, single-centre cohort study of patients with COVID-19 admitted to the ED of a university hospital in Lombardy, Italy, between 21 February 2020 and 30 April 2020. These patients were divided into two groups: those who required CPAP and those did not require CPAP. Recordings of their vital signs were retrieved from triage medical records. The vital signs values recorded in the two groups on their arrival at the ED were compared. Of 601 patients, 120 (20%) required CPAP. It was identified that the typical characteristics of patients requiring early CPAP were: male (P=.013) with a median age of 68 years (P=.000), oxygen saturation of 92% (P=.000), temperature ≥38°C (P=.008), respiratory rate of 26 breaths per minute (P=.000) and had received pre-hospital oxygen therapy before arriving at the ED (P=.000). The CPAP group was divided into two subgroups: patients who had received pre-hospital oxygen therapy and those who had not. The median respiratory rate values between the two subgroups presented a statistically significant difference (P=.004). This study identified the characteristics of a typical patient with COVID-19 who requires early CPAP. Based on the results, the authors have devised a triage flow chart that uses selected vital signs measurements (oxygen saturation, respiratory rate and receipt of pre-hospital oxygen therapy) to identify patients requiring early CPAP. This flow chart should be trialled in a prospective study before it is used to inform clinical decision-making.

Sustained Inflation Versus Intermittent Positive Pressure Ventilation for Preterm Infants at Birth: Respiratory Function and Vital Sign Measurements

To characterize respiratory function monitor (RFM) measurements of sustained inflations and intermittent positive pressure ventilation (IPPV) delivered noninvasively to infants in the Sustained Aeration of Infant Lungs (SAIL) trial and to compare vital sign measurements between treatment arms. We analyzed RFM data from SAIL participants at 5 trial sites. We assessed tidal volumes, rates of airway obstruction, and mask leak among infants allocated to sustained inflations and IPPV, and we compared pulse rate and oxygen saturation measurements between treatment groups. Among 70 SAIL participants (36 sustained inflations, 34 IPPV) with RFM measurements, 40 (57%) were spontaneously breathing prior to the randomized intervention. The median expiratory tidal volume of sustained inflations administered was 5.3mL/kg (IQR 1.1-9.2). Significant mask leak occurred in 15% and airway obstruction occurred during 17% of sustained inflations. Among 34 control infants, the median expiratory tidal volume of IPPV inflations was 4.3mL/kg (IQR 1.3-6.6). Mask leak was present in 3%, and airway obstruction was present in 17% of IPPV inflations. There were no significant differences in pulse rate or oxygen saturation measurements between groups at any point during resuscitation. Expiratory tidal volumes of sustained inflations and IPPV inflations administered in the SAIL trial were highly variable in both treatment arms. Vital sign values were similar between groups throughout resuscitation. Sustained inflation as operationalized in the SAIL trial was not superior to IPPV to promote lung aeration after birth in this study subgroup. Clinicaltrials.gov: NCT02139800.

Frequency-Modulated Continuous Wave Radar Respiratory Pattern Detection Technology Based on Multifeature.

Respiratory diseases including apnea are often accompanied by abnormal respiratory depth, frequency, and rhythm. If different abnormal respiratory patterns can be detected and recorded, with their depth, frequency, and rhythm analyzed, the detection and diagnosis of respiratory diseases can be achieved. High-frequency millimeter-wave radar (76–81 GHz) has low environmental impact, high accuracy, and small volume, which is more suitable for respiratory signal detection and recognition compared with other contact equipment. In this paper, the experimental platform of frequency-modulated continuous wave (FMCW) radar was built at first, realizing the noncontact measurement of vital signs. Secondly, the energy intensity and threshold of respiration signal during each period were calculated by using the rectangular window, and the accurate judgment of apnea was realized via numerical comparison. Thirdly, the features of respiratory and heart rate signals, the number of peaks and valleys, the difference between peaks and valleys, the average and the standard deviation of normalized short-term energy, and the average and the standard deviation and the minimum of instantaneous frequency, were extracted and analyzed. Finally, support vector machine (SVM) and K-nearest neighbor (KNN) were used to classify the extracted features, and the accuracy was 98.25% and 88.75%, respectively. The classification and recognition of respiratory patterns have been successfully realized.

Sex differences in the acute pharmacological and subjective effects of smoked cannabis combined with alcohol in young adults.

Objective: The prevalence of co-use of alcohol and cannabis is increasing, particularly among young adults. Sex differences in the effects of alcohol alone and cannabis alone have been observed in animals and humans. However, sex differences in the acute pharmacological effects of cannabis combined with alcohol have not yet been studied. In young adults, aged 19-29 years, we aimed to examine sex differences following an intoxicating dose of alcohol (target 0.08% breath alcohol content) combined with a moderate dose of cannabis (12.5% Δ⁹-tetrahydrocannabinol; THC) using an ad libitum smoking procedure. Method: Using a within-subjects design, 28 regular cannabis users (16 males; 12 females) received in random order: (a) placebo alcohol and placebo cannabis, (b) active alcohol and placebo cannabis, (c) placebo alcohol and active cannabis, and (d) active alcohol and active cannabis. Blood samples for THC were collected and measures of vital signs, subjective drug effects, and cognition were collected. Results: In the alcohol-cannabis combined condition, females smoked significantly less of the cannabis cigarette compared to males (p < .001), although both sexes smoked similar amounts in the other conditions. There was minimal evidence that females and males differed in THC blood concentrations, vitals, subjective effects, or cognitive measures. Conclusions: In the alcohol-cannabis combined condition, females experienced the same acute pharmacological and subjective effects of alcohol and cannabis as males, after smoking less cannabis, which has potential implications for informing education and policy. Further research is warranted on sex differences in cannabis pharmacology, as well as the combined effects of alcohol and cannabis. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Effect of Multimodal Intervention on Nursing Students' Adherence to Hand Hygiene: An Experimental Study.

Hand hygiene adherence is highly important in clinical practice and is influenced by various factors. This study investigated the effect of multimodal intervention on nursing students' adherence to hand hygiene in clinical practice. Internship nursing students were randomized into control (n = 20) and intervention (n = 26) groups. Adherence to hand hygiene was measured by self-report questionnaire and by observation. The intervention group received multimodal interventions for 1 week. Results showed significant effects of multimodal intervention on adherence to hand hygiene in "before contact with the patient," "before and after contact with the patient" situations, and at the beginning of medication administration, catheterization, vital sign measurement, and blood sugar testing. The multimodal intervention improved adherence to hand hygiene in the intervention group. Given the importance of hand hygiene adherence by nursing students in all situations, designing and implementing context-based multimodal interventions are recommended as part of nursing students' educational programs.

A Multi-functional Pressure Sheet Sensor for Vital Signs and Body Posture Measurements

A Multi-functional Pressure Sheet Sensor for Vital Signs and Body Posture Measurements

A role for music in cataract surgery: a systematic review.

There have been several studies that explore the anxiolytic effects of music during cataract surgery. This is the first systematic review of literature highlighting the effects of music on patients undergoing cataract surgery without pharmacological anxiolytics. A systematic review of literature using PRISMA methodology identified randomized controlled trials involving patients undergoing cataract surgery with music as anintervention duringthe procedure with outcomes measured using at least one assessment of anxiety level, pain score, satisfaction, or vital sign measurements. Studies using pharmacologicalanxiolytics or additional pain-relieving medications besides local anesthetic were excluded. Three studies, involving 523 patients, were included with patients undergoing cataract surgery with music intervention. Music intervention during cataract surgery has demonstrated use in reducing perceived pain, reducing anxiety, and improving vitals with increased benefit of reduced heart rate and blood pressures with binaural beat embedded music. The clinical implications of this review identify non-traditional approaches to reducing anxiety intraoperatively for cataract surgeries, offering clinicians alternatives to minimizing benzodiazepine and medication use risks.

The Effect of An Aqueous Electricidal Solution on General Well Being

Solution4USA’s dietary supplement, referred to here as “ELECTROCIDE™,” is a new type of aqueous nutraceutical which is antipathogenic in nature due to pathogen specific electrical charge properties. Thousands of people have been treated with this product when delivered through an existing network of medical professionals validating its efficacy and safety. Using FDA guidelines, “ELECTROCIDE™” was evaluated for wellness benefits as a potential investigational drug under medical supervision using 52 volunteers (Group1: 15 and Group2: 37) in an institutional setting (The Lovelady Center (TLC) in Birmingham, Alabama) using quantitative measurements of vital signs along with two qualitative self-reported questionnaires. The results indicate a highly significant improvement in vital signs and a significant reduction in various physiological and emotional conditions.

Utilizing timestamps of longitudinal electronic health record data to classify clinical deterioration events.

To propose an algorithm that utilizes only timestamps of longitudinal electronic health record data to classify clinical deterioration events. This retrospective study explores the efficacy of machine learning algorithms in classifying clinical deterioration events among patients in intensive care units using sequences of timestamps of vital sign measurements, flowsheets comments, order entries, and nursing notes. We design a data pipeline to partition events into discrete, regular time bins that we refer to as timesteps. Logistic regressions, random forest classifiers, and recurrent neural networks are trained on datasets of different length of timesteps, respectively, against a composite outcome of death, cardiac arrest, and Rapid Response Team calls. Then these models are validated on a holdout dataset. A total of 6720 intensive care unit encounters meet the criteria and the final dataset includes 830 578 timestamps. The gated recurrent unit model utilizes timestamps of vital signs, order entries, flowsheet comments, and nursing notes to achieve the best performance on the time-to-outcome dataset, with an area under the precision-recall curve of 0.101 (0.06, 0.137), a sensitivity of 0.443, and a positive predictive value of 0. 092 at the threshold of 0.6. This study demonstrates that our recurrent neural network models using only timestamps of longitudinal electronic health record data that reflect healthcare processes achieve well-performing discriminative power.

Aligning Patient Acuity With Resource Intensity After Major Surgery: A Scoping Review.

Develop unifying definitions and paradigms for data-driven methods to augment postoperative resource intensity decisions. Postoperative level-of-care assignments and frequency of vital sign and laboratory measurements (ie, resource intensity) should align with patient acuity. Effective, data-driven decision-support platforms could improve value of care for millions of patients annually, but their development is hindered by the lack of salient definitions and paradigms. Embase, PubMed, and Web of Science were searched for articles describing patient acuity and resource intensity after inpatient surgery. Study quality was assessed using validated tools. Thirty-five studies were included and assimilated according to PRISMA guidelines. Perioperative patient acuity is accurately represented by combinations of demographic, physiologic, and hospital-system variables as input features in models that capture complex, non-linear relationships. Intraoperative physiologic data enriche these representations. Triaging high-acuity patients to low-intensity care is associated with increased risk for mortality; triaging low-acuity patients to intensive care units (ICUs) has low value and imparts harm when other, valid requests for ICU admission are denied due to resource limitations, increasing their risk for unrecognized decompensation and failure-to-rescue. Providing high-intensity care for low-acuity patients may also confer harm through unnecessary testing and subsequent treatment of incidental findings, but there is insufficient evidence to evaluate this hypothesis. Compared with data-driven models, clinicians exhibit volatile performance in predicting complications and making postoperative resource intensity decisions. To optimize value, postoperative resource intensity decisions should align with precise, data-driven patient acuity assessments augmented by models that accurately represent complex, non-linear relationships among risk factors.

Classification of COPD patients and compliance to recommended treatment in Greece according to GOLD 2017 report: the RELICO study

BackgroundChronic obstructive pulmonary disease (COPD) is a multifactorial clinical condition, characterized by chronic progressive (or worsening) respiratory symptoms, structural pulmonary abnormalities, and impaired lung function, and is often accompanied by multiple, clinically significant comorbid disorders. In 2017, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) issued a new report on COPD prevention, diagnosis and management, aiming at personalizing the maintenance therapeutic approach of the stable disease, based on the patients’ symptoms and history of exacerbations (ABCD assessment approach). Our objective was to evaluate the implementation of GOLD suggestions in everyday clinical practice in Greece.MethodsThis was a cross-sectional observational study. Sixty-five different variables (demographics, vital sign measurements, COPD-related medical history parameters, comorbidities, vaccination data, COPD severity based on spirometry measurements, COPD stage based on the ABCD assessment approach, COPD treatments) were collected from 3615 nation-wide COPD patients (Greece).ResultsThe mean age at the time of initial COPD diagnosis was 63.8 (± 10.2). Almost 60% of the subjects were classified into group B, while the remaining patients were falling into groups A (18%) and D (21%), and only a small minority of patients belonged to Group C, according to the ABCD assessment approach. The compliance of respiratory physicians to the GOLD 2017 therapeutic suggestions is problematic, especially when it comes to COPD patients belonging to Group A.ConclusionOur data provide valuable information regarding the demographic and medical profile of COPD patients in Greece, the domains which the revised ABCD assessment approach may show some clinical significance on, and the necessity for medical practitioners dealing with COPD patients to adhere closer to international recommendations for the proper management of the disease.