Vital Sign Measurements Research Articles

Checklist-based training for essential clinical skills in 3 term MBBS students

Background: Undergraduate students find the correct sequence & method of eliciting clinical signs is ambiguous, leading to confusion & reluctance to demonstrate. The 3-term posting is the introduction to clinical skills & it is essential that bedside teaching is organized & delivered well. Studies have shown that a structured clinical training improves students' examination skills. This study aimed to estimate the difference in competence in basic physical examination in students taught by checklist-based training and those taught by standard clinical teaching. Materials and Methods: This was a randomized crossover trial conducted on 3 term MBBS students posted to medicine. Checklists for general physical examination (GPE) and vital sign examination were framed, piloted. Students were divided in to control & test groups by simple randomization. In phase 1, the control group learnt measurement of vital signs by standard clinical teaching in the units. The test group learned using checklist-based demonstration. In phase 2, the groups were interchanged and GPE was taught by checklist method in the test group. Skills were assessed by OSCE after each training. OSCE scores between control & test groups were compared and analysed. Results: Students showed significantly higher scores when GPE was taught by checklist-based method (Test 1.49, control 0.6. P – 0.000). There was no significant difference in OSCE scores in vital sign examination (Test – 1.15, Control 1.19 P – 0.378). Students found the checklist-based method systematic and easy to remember Conclusion: Checklist-based training improves student clinical learning in GPE, though not in vital sign examination. The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice-based learning and improvement.

Exploring omissions in nursing care using retrospective chart review: An observational study

BackgroundOmissions in nursing care can compromise patient safety. To date, this phenomenon has been investigated almost exclusively via nurse surveys. However, such surveys restrict the range of activities which can be assessed for omissions, and patient level analysis. As an alternative, retrospective chart review methodology has been used successfully in other research fields, but not yet for omitted nursing care. ObjectivesTo describe characteristics and frequency of omitted nursing care using a retrospective chart review methodology. Design, setting and participantsObservational single center study in two German neurological inpatient units. A random sample of 100 patient admissions was used. MethodsA structured chart review protocol to detect nursing omissions was developed and applied. The full range of expected nursing care activities were assessed regarding the importance of documenting them and whether they had been fully or partially omitted. Vital sign measurements were assessed regarding both the measurement target number and the number of measurements recorded. ResultsIn total, 1885 activities—a mean of 19 per patient—were identified. Of the reviewed activities, 52% (n = 971) were fully or partially omitted. Patients experienced between one and 22 omitted nursing care activities during their hospital stay (8–84% of expected care activities). Ranging from 6% to 100% some activities were more commonly omitted than others during admission. The most frequently omitted nursing activity was giving emotional care (88%, n = 66); the least frequently omitted was teaching (10%, n = 29). Vital signs were recorded only 50% (n = 141) of the targeted number of times. ConclusionsUsing a retrospective chart review protocol to identify omissions in nursing care allows the assessment of a broad range of nursing activities. Additionally, this is the first-time patient-level data on a broad range of activities have been analyzed. The newly developed chart review methodology can complement established survey methods and provide a new perspective on the phenomenon of omitted nursing care.

Activity-Aware Vital SignMonitoring Based on a Multi-Agent Architecture.

Vital sign monitoring outside the clinical environment based on wearable sensors ensures better support in assessing a patient’s health condition, and in case of health deterioration, automatic alerts can be sent to the care providers. In everyday life, the users can perform different physical activities, and considering that vital sign measurements depend on the intensity of the activity, we proposed an architecture based on the multi-agent paradigm to handle this issue dynamically. Different types of agents were proposed that processed different sensor signals and recognized simple activities of daily living. The system was validated using a real-life dataset where subjects wore accelerometer sensors on the chest, wrist, and ankle. The system relied on ontology-based models to address the data heterogeneity and combined different wearable sensor sources in order to achieve better performance. The results showed an accuracy of 95.25% on intersubject activity classification. Moreover, the proposed method, which automatically extracted vital sign threshold ranges for each physical activity recognized by the system, showed promising results for remote health status evaluation.

Comparison of body temperature and heart rate in sea turtles from Baja California Sur, Mexico

Sea turtles depend on ambient temperature to carry out their main activities, so changes in water temperature can affect the function of their immune system and represent different threats. To assess vital signs in black sea turtles (Chelonia mydas) in the Ojo de Liebre lagoon complex, Mexico, 600 turtles were examined. Carapace, plastron, and left inguinal area temperatures were measured with a digital infrared thermometer gun. Cloacal temperature was measured with an electronic thermometer. Heart rate was recorded using a stethoscope. Statistical analyses found no significant variation between inguinal area and cloacal temperatures. Vital sign measurements were compared with previous reports in the region, and there were differences in body temperatures, which were attributed to the characteristics of the water masses inhabited by the turtles. There was no significant difference between heart rate data for black sea turtles in this study and previously reported data for healthy sea turtles in the region, indicating that these data are likely an accurate representation for the species. All values fell within the reference intervals for healthy sea turtles. This minimally invasive diagnostic approach using vital signs allowed us to evaluate and infer core organ functions and to rule out health threats such as cold-stunning, resulting in a useful preliminary systemic assessment of free-ranging sea turtles.

Radar Life Signal Processing Algorithm Based on Improved EEMD

Non-contact measurement of human vital signs is of great significance to the construction of smart homes and hospitals. The vital signal extracted from the FMCW radar contains a lot of noise. In order to reduce the noise impact and improve the life signal detection results accuracy, Ensemble Empirical Mode Decomposition (EEMD) algorithm is studied, and a new method based on the combination of EEMD and Translation Invariant Wavelet Transform (TIWT) is proposed. This method firstly decomposes the original signal using EEMD to obtain several Intrinsic Mode Function (IMF) components, and then changes the arrangement order of IMF by Translation Invariant Wavelet Transform to change the position of the singularity in the whole signal to reduce or eliminate the oscillations. Finally, signal screening is completed and life signals are reconstructed. Experiments show that, the proposed method has better detection accuracy in detecting vital signs collected by radar.

Psychiatric staff training in managing medical emergencies: re-audit

AimsIn the UK, people with severe mental illness at a greater risk of poor physical health and have higher premature mortality than the general population, highlighting the importance of responding to physical health problems among patients suffering from psychiatric conditions. However, training for staff on inpatient psychiatric units to meet patients’ physical health needs is sometimes overlooked and has not always been effective.According to NICE Clinical Guideline 25 (2005) and NPSA Rapid Response Report (2008/RRR010), staff on any psychiatric inpatient setting must be capable of monitoring, measurement, and interpretation of vital signs. They must have both adequate information and skills to identify signs indicating worsening of patients’ health and respond effectively to severely ill patients.Hence, we aim to re-audit the results of a similar audit carried out in 2016 to review the level of medical emergency training (in terms of life support training) of clinical staff across the inpatient psychiatric wards at our local hospital - Stepping Hill Hospital- in Stockport.Our hypothesis is that there will be a gap in meeting the required standards for training.MethodA questionnaire including 6 questions (role of the staff member, level of their life support training, when was their training last updated, whether they know the location of the crash trolley, whether they know the local hospital emergency number and whether they should resuscitate the patient if their training is out of date) was given to staff on acute inpatient psychiatric units in Stepping Hill Hospital.ResultThe sample included 49 staff members from all the 3 wards included in the audit. The level of training of nursing staff on the 3 wards was meeting standards except for nursing staff who were new to the wards or coming back to work from prolonged leaves. There was also a gap identified in the level of training of other staff members on the ward as well as on the remaining standards measured by the audit.ConclusionA gap was identified in meeting the required standards of training on the inpatient psychiatric units. Reasons identified for this gap are mainly due to the fact that new or bank staff are asked to cover the wards without providing them with appropriate training and without orientating them about the location of different equipments and policies on the ward.

Effect of National Early Warning Scoring System Implementation on Cardiopulmonary Arrest, Unplanned ICU Admission, Emergency Surgery, and Acute Kidney Injury in an Emergency Hospital, Egypt.

PurposeTo evaluate the effect of national early warning scoring system (NEWS) implementation in identifying patients at risk of clinical deterioration at an emergency hospital.BackgroundEarly warning score has been developed to facilitate early detection of deterioration by categorizing a patients’ severity of illness and prompting nursing staff to request a medical review at specific trigger points.Patients and MethodsA prospective, control/intervention groups’, quasi-experimental design was utilized. A sample of 364 adult patients were admitted to the inpatient unit at an emergency hospital for six months. The patients were divided into a study group (174 patients) and a control group (190 patients). All study patients were followed up to either death or hospital discharge before and after implementing a new observation chart. The patients’ outcomes were compared and analyzed between both groups.ResultsIn the intervention period, compared to the control period, a significant reduction was seen in the number of cardiopulmonary arrest (4.7% vs 1.1%, p = 0.046), unplanned ICU admission (5.3% vs 1.7%, p = 0.049), emergency surgery (6.3% vs 0%, p = 0.001), acute kidney injury (6.8% vs 1.1%, p = 0.006). As well, there was a significant increase in the number of patients receiving medical reviews following clinical deterioration in terms of escalation plan (3.2% vs 26.4%, p = <0.001).ConclusionThe implementation of NEWS was associated with a significant improvement in patients’ outcomes in hospital wards, increases in the frequency of vital signs measurements, and an increase in the number of medical reviews following clinical instability.

Wearable sensors enable personalized predictions of clinical laboratory measurements.

Vital signs, including heart rate and body temperature, are useful in detecting or monitoring medical conditions, but are typically measured in the clinic and require follow-up laboratory testing for more definitive diagnoses. Here we examined whether vital signs as measured by consumer wearable devices (that is, continuously monitored heart rate, body temperature, electrodermal activity and movement) can predict clinical laboratory test results using machine learning models, including random forest and Lasso models. Our results demonstrate that vital sign data collected from wearables give a more consistent and precise depiction of resting heart rate than do measurements taken in the clinic. Vital sign data collected from wearables can also predict several clinical laboratory measurements with lower prediction error than predictions made using clinically obtained vital sign measurements. The length of time over which vital signs are monitored and the proximity of the monitoring period to the date of prediction play a critical role in the performance of the machine learning models. These results demonstrate the value of commercial wearable devices for continuous and longitudinal assessment of physiological measurements that today can be measured only with clinical laboratory tests.

Validation of telemedicine-based self-assessment of vital signs for patients with COVID-19: A pilot study

Introduction In the ongoing COVID-19 pandemic, the development of a system that would prevent the infection of healthcare providers is in urgent demand. We sought to investigate the feasibility and validity of a telemedicine-based system in which healthcare providers remotely check the vital signs measured by patients with COVID-19. Methods Patients hospitalized with confirmed or suspected COVID-19 measured and uploaded their vital signs to secure cloud storage. Additionally, the respiratory rates were monitored using a mat-type sensor placed under the bed. We assessed the time until the values became available on the Cloud and the agreements between the patient-measured vital signs and simultaneous healthcare provider measurements. Results Between 26 May–23 September 2020, 3835 vital signs were measured and uploaded to the cloud storage by the patients (n=16, median 72 years old, 31% women). All patients successfully learned how to use these devices with a 10-minute lecture. The median time until the measurements were available on the cloud system was only 0.35 min, and 95.2% of the vital signs were available within 5 min of the measurement. The agreement between the patients’ and healthcare providers’ measurements was excellent for all parameters. Interclass coefficient correlations were as follows: systolic (0.92, p<0.001), diastolic blood pressure (0.86, p<0.001), heart rate (0.89, p<0.001), peripheral oxygen saturation (0.92, p<0.001), body temperature (0.83, p<0.001), and respiratory rates (0.90, p<0.001). Conclusions Telemedicine-based self-assessment of vital signs in patients with COVID-19 was feasible and reliable. The system will be a useful alternative to traditional vital sign measurements by healthcare providers during the COVID-19 pandemic.

Design of the ACcomplisH Trial: A Phase 2, Multicenter, Placebo-Controlled, Dose Escalation Trial Evaluating Safety, Efficacy, and Pharmacokinetics of Weekly TransCon CNP in Children With Achondroplasia

Abstract Background: Achondroplasia (ACH) is the most common skeletal dysplasia and the most frequent form of dwarfism. ACH is caused by a gain-of-function mutation in the fibroblast growth factor receptor 3 (FGFR3) gene and results in impairment of the endochondral ossification processes. C-type natriuretic peptide (CNP) promotes chondrocyte development through inhibition of the FGFR3 pathway, specifically through activation of NPRB. CNP is a desirable target as it is known to increase chondrocyte development without off-target effects (Bocciardi, 2007). TransCon CNP is a long-acting prodrug of CNP designed to optimize safety and efficacy with a once-weekly dose. The Phase 1 clinical trial with TransCon CNP demonstrated that doses up to 150 μg CNP/kg were well-tolerated in healthy adult male volunteers, with no clinically significant trends observed in clinical laboratory assessments, vital sign measurements, ECG parameters, or physical examination findings. Methods: The phase 2 ACcomplisH trial will be conducted at over 35 sites worldwide. The primary objective of the trial will be to evaluate the safety and efficacy of once-weekly TransCon CNP compared to placebo at 12 months in prepubertal children, aged 2-10 years old, with ACH. Approximately 60 subjects will be randomized 3:1 to receive either weekly TransCon CNP or placebo. Following screening and verification of clinical ACH with genetic confirmation, subjects will remain within the dose cohort for 52 weeks of treatment. TransCon CNP will be dosed 6 to 100 μg CNP/kg/week across 4 cohorts, with an optional 5th cohort at up to 200 μg CNP/kg/week. An independent Data Monitoring Committee will review safety data prior to initiation of a higher dose cohort. The primary endpoint will evaluate annualized height velocity at 52 weeks of TransCon CNP or placebo. Key secondary endpoints will examine change in upper to lower body segment ratio at week 52, safety, pharmacokinetics (PK), and quality of life associated with weekly TransCon CNP. Conclusion: CNP is targeted specifically to the underlying pathology of ACH through inhibition FGFR3. No effective medicinal product is currently available for the treatment of ACH. TransCon CNP is designed to provide sustained exposure of CNP. This ongoing Phase 2 ACcomplisH trial is designed to assess the efficacy, safety, and PK of TransCon CNP by weekly administration compared to placebo.

Agreement between wireless and standard measurements of vital signs in acute exacerbation of chronic obstructive pulmonary disease: a clinical validation study

Objective. Wireless sensors for continuous monitoring of vital signs have potential to improve patient care by earlier detection of deterioration in general ward patients. We aimed to assess agreement between wireless and standard (wired) monitoring devices in patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Approach. Paired measurements of vital signs were recorded with 15 min intervals for two hours. The primary outcome was agreement between wireless and standard monitor measurements using the Bland and Altman method to calculate bias with 95% limits of agreement (LoA). We considered LoA of less than ±5 beats min−1 (bpm) acceptable for heart rate (HR), whereas agreement of peripheral oxygen saturation (SpO2), respiratory rate (RR), and blood pressure (BP) were acceptable if within ±3%-points, ±3 breaths min−1 (brpm), and ±10 mmHg, respectively. Main results. 180 sample-pairs of vital signs from 20 with AECOPD patients were recorded for comparison. The wireless versus standard monitor bias was 0.03 (LoA −3.2 to 3.3) bpm for HR measurements, 1.4% (LoA −0.7% to 3.6%) for SpO2, −7.8 (LoA −22.3 to 6.8) mmHg for systolic BP and −6.2 (LoA −16.8 to 4.5) mmHg for diastolic BP. The wireless versus standard monitor bias for RR measurements was 0.75 (LoA −6.1 to 7.6) brpm. Significance. Commercially available wireless monitors could accurately measure HR in patients admitted with AECOPD compared to standard wired monitoring. Agreement for SpO2 were borderline acceptable while agreement for RR and BP should be interpreted with caution.

User Engagement Using an Etextbook: A Descriptive Study.

Engagement is an integral pedagogical component underpinning effective educational activities and is of importance for educators using online platforms. Carefully designed, technology-enabled learning resources can increase student engagement. We developed an open educational resource etextbook on vital sign measurement using an interactive and multimodal platform to facilitate student learning. The etextbook design was informed by experiential teaching-learning theory. Students progressed through the etextbook at their own pace, following pedagogy informed by the iterative process of read, observe, practice, and test, commonly used in nursing education. The etextbook was introduced as a required reading in a first-year health assessment course at one university and two colleges. In this project, we explored the level of engagement experienced by users of the etextbook. We conducted a descriptive study using the User Engagement Scale to measure students' degree of engagement using the etextbook. Results from participants (N = 455) who used the etextbook in the study indicated a high level of engagement. The responses to an open-ended item on the survey provided context to the results and shed light on effective design practices. Several recommendations for best practices in developing etextbooks are identified for educators to consider.

Reliability and Validity Study of a Simple Assessment Tool for Early Detection of Perioperative Stroke

Background: Stroke is a feared postoperative complication. The diagnosis is usually delayed resulting in a reduced possibility for therapeutic intervention. Objective: To assess the reliability and validity of a simple assessment tool for early detection of perioperative stroke. Materials and Methods: The authors set up a short course and workshop for all service nurses in neurological screening method for the assessment tool for early detection of perioperative stroke including observing eye deviation or extraocular muscle limitation, asymmetrical limb weakness, and conscious changes in 24 surgical wards in Siriraj Hospital. The protocol was applied during routine postoperative vital sign measurement to evaluate new neurological deficits within 14 days after surgery. The postoperative patients were selected under the permission. The authors used content validity, sensitivity, specificity, and analysis to measure content and criterion validity, respectively. The authors also tested inter-rater reliability by using Kappa and Fleiss’s Kappa statistics. Results: Four hundred twenty-five postoperative patients between June and December 2018 were assessed by the protocol. The sensitivity was 85.71% and specificity was 98.02%. Positive predictive value (PPV) and Negative predictive value (NPV) was 69.23% and 99.25%, respectively. The accuracy of the tool was 97.41%. The interrater reliability was substantial agreement. Conclusion: This simple assessment tool is a valid and reliable clinical tool used for perioperative stroke screening. The tool is simple and quick to perform among nurses and physicians. The tool was designed to detect only moderate to severe stroke that required treatment intervention due to postoperative treatment limitation. Keywords: Diagnosis, Screening, Perioperative, Postoperative, In-hospital, Tool, Stroke

Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients

ObjectivesTo compare hospitalisation rates, intensive care unit (ICU) admissions and mortality for patients with COVID-19 who were consistently inactive, doing some activity or consistently meeting physical activity guidelines.MethodsWe identified 48...

Cocreating Programmable Diagnostic Simulation: Devices to Enhance Reality in Vital Sign Measurement.

Providing authentic educational experiences in clinical teaching laboratories or health care simulation environments is fundamental to producing optimum learning. However, some simulated diagnostic devices are price prohibitive or yet to be developed. This article explores a collaborative effort between health academics and engineering interns to develop cost-effective, authentic devices that overcome limitations of those currently available. Simulated patient tympanic thermometer and pulse oximetry devices were developed for use in clinical teaching laboratories and health care simulation environments. The tympanic thermometers and pulse oximetry probes provide programmable temperature, pulse, and oxygen saturation for use with any commercially available manikins or standardized patients. Authentic simulated diagnostic devices can enhance reality and foster immersion in clinical simulation scenarios. Sharing cost-effective innovations designed to address the simulation-specific limitations of commercially available diagnostic devices provides health care educators with solutions that can enhance the authenticity of clinical teaching experiences for participants. [J Nurs Educ. 2021;60(4):235-239.].

529 Acute Colonic Pseudo-Obstruction: A Critical Complication in Burn Patients

Abstract Introduction Acute Colonic Pseudo-Obstruction (ACPO) is a rare clinical condition characterized by gross dilation of the large bowel in the absence of an obstruction. It presents a particularly complex challenge in diagnosis and management in the context of burn trauma. We followed five burn patients who developed ACPO that did not respond to conservative treatments. These patients ultimately required surgical intervention to resolve their ACPO. Through our study, we propose that traditional management may not be successful in fully treating ACPO in burn patients without recurrence and that complete resolution necessitates a more aggressive management course, often in the form of surgical intervention. Methods We studied the clinical course of all burn patients who developed ACPO in the past 2 years at our burn center. Using Electronic Health Records, we collected patient demographic data, percent total burn surface area (%TBSA), hospital length of stay, cecal diameter, bowel regimen for catharsis, and vital sign measurements. Abdominal CT scans and X-rays were used to monitor the progression of cecal diameter. Results We have noted that burn patients who are at a high risk of developing ACPO tend to either be obese, have large TBSA burns (&amp;gt;20%), or have a combination of both. Furthermore, patients who had a greater percentage of 3rd degree burns had worse outcomes. All patients received acetylcholinesterase inhibitors (AChEi’s), but ultimately underwent some manner of further intervention for complete resolution of ACPO. Two patients were treated solely with decompression: one via NGT suction, the other via colonoscope. Three patients received surgical intervention through hemicolectomy, subtotal colectomy, and cecostomy. The former two subsequently expired, one due to direct ACPO complications; the latter three survived and remain well today. Conclusions ACPO is a rare but serious complication in burn patients that may easily be missed by the diagnosing clinician. In the treatment of ACPO in burn patients, one should consider a more aggressive approach, as traditional medical therapy may not be enough to resolve the original distention or prevent a recurrence. In our review of five burn patients that subsequently developed ACPO, surgical intervention was universally the mechanism by which definitive resolution of the condition was achieved.

CARDIOVASCULAR PROFILE OF CROATIAN MILITARY VETERANS WITH HISTORY OF PTSD

Abstract Objective: The purpose of this analysis was to evaluate cardiovascular profile of military veterans with confirmed diagnosis of PTSD Design and method: We evaluated cardiovascular risk of military veterans in relation to their history of combat exposure and targeted a specific group of veterans with confirmed diagnosis of PTSD. All subjects underwent physical examination which included measurement of vital signs. Blood pressure was measured using Omron M6 device, central BP and PWV were determined by MobiloGraph. CV risk was calculated using Heart Score chart for high-risk countries. Results: Mean age was 53,40 ± 6,95. 90,0% were active or former tobacco users, while 20,0% drank alcohol. Mean cholesterol level was 5,89 ± 1,36; mean levels of LDL and triglycerides were 3,65 ± 1,35 and 1,81 ± 0,75 respectively. Body mass index mean was 28,25 ± 4,02. 10,0% of all subjects had left ventricular hypertrophy. Mean value for Pulse Wave Velocity was 8,90 ± 1,03. Average value measured in estimated glomerular filtration rate (eGFR) was 98,20 ± 11,73. 30,0% had diabetes; 10,0% had coronary heart disease; 10,0% had previous myocardial infarction. Analysis showed 40,0% of PTSD veterans had hypertension, 20,0% had well controlled hypertension with pharmacotherapy while10% had uncontrolled but treated hypertension. 60,0% of PTSD military veterans had resting heart rate below 80/min, 10,0% had heart rate between 80 and 84/min and 30,0% had heart rate equal or higher than 85/min. Conclusions: There is limited data regarding cardiovascular risk in veterans with history of PTSD. A possible explanation for insufficient data is veterans’ avoidance of Croatian healthcare system due to social stigma associated with PTSD. Veterans prefer to obtain support and assistance through various veterans’ associations and religious organizations. Eliminating stigma around PTSD, its’ early detection and appropriate treatment could improve registration of veterans with Croatian healthcare system and allow better understanding of their cardiovascular profile while ensuring optimal management of their cardiovascular risks.

Remote Home Monitoring of Patients With Cancer During the COVID Pandemic: A Pilot Study.

PURPOSE:The COVID-19 pandemic has posed significant challenges in the care of patients with cancer, including how to manage outpatients who are COVID-positive but do not require hospitalization. We explored the use of a remote patient monitoring (RPM) program to care for such outpatients.METHODS:Consecutive patients who were tested for COVID-19 because of symptom onset but were clinically stable were offered enrollment into a pilot RPM program. Patients were provided equipment for vital sign measurements and a computer tablet to enter results three times per day. The results were monitored centrally by clinical staff. The goal was to closely monitor patients and escalate care as warranted.RESULTS:Between March and June of 2020, 29 patients were approached and 26 were enrolled. The mean age was 57 years old (range, 30-88), 14 were women, and patients remained in the program for an average of 16 days (range, 2-63). Twenty-four patients (83%) were on active anticancer therapy. During that time period, only one patient was admitted to the hospital for worsening respiratory symptoms. The percentage of days during which at least one set of data and all three sets of data were entered was 97.2% and 65.7%, respectively. There was no association between the demographic factors of age, sex, or the reason for being monitored with the level of engagement (P > .05).CONCLUSION:In this pilot study, patients with cancer were readily enrolled in a remote home monitoring program. Monitoring was feasible, and there was a high rate of engagement with the program. The role of RPM should be further tested as the COVID pandemic continues.

Validity of the Exercise Vital Sign Tool to Assess Physical Activity

Assessment and counseling by healthcare providers can successfully increase physical activity; however, a valid instrument to effectively measure physical activity is needed. This study examines the validity of the Exercise Vital Sign tool by comparing Exercise Vital Sign data collected at Kaiser Permanente Northwest with accelerometry data. Participants (n=521) completed accelerometer monitoring and had ≥1 Exercise Vital Sign measurement in their electronic medical record. Using accelerometry as the gold standard, the association between moderate-to-vigorous physical activity minutes per week estimated through Exercise Vital Sign and that estimated through accelerometry was examined using the Spearman correlation coefficient. Comparability of moderate-to-vigorous physical activity categories (inactive, lowly active, moderately active, sufficiently active) was assessed using simple and weighted κ statistics. Sensitivity, specificity, and positive and negative predictive values were calculated. The study was conducted in 2012-2015, with analysis in 2019-2020. Average accelerometry-based moderate-to-vigorous physical activity was 212 minutes per week, and 57% of the participants were considered sufficiently active. Exercise Vital Sign‒based moderate-to-vigorous physical activity averaged 170 minutes per week, and 53% of the participants were active. There was a positive correlation between the moderate-to-vigorous physical activity minutes per week reported through Exercise Vital Sign and that reported through accelerometry (r =0.38, p<0.0001). A fair agreement was observed between Exercise Vital Sign‒ and accelerometry-based moderate-to-vigorous physical activity categories (weighted κ=0.29), with the highest agreement occurring for those with physical activity level ≥150 minutes per week. The positive correlation increased when moderate-to-vigorous physical activity was examined dichotomously (<150 or ≥150 minutes per week, κ=0.34). The sensitivity, specificity, positive predictive value, and negative predictive value for Exercise Vital Sign (when compared with those of accelerometry) were 67%, 68%, 61%, and 73%, respectively. The Exercise Vital Sign is a useful physical activity assessment tool that correctly identifies the majority of adults who do and do not meet physical activity guidelines.

A pilot study to assess the safety, efficacy and ease of use of a novel hearing protection device for hospitalized neonates

BackgroundLoud noises in the neonatal intensive care unit (NICU) exacerbate patient cardiac and respiratory activity, disrupt sleep, and may contribute to hearing deficits, speech and language disorders, and neurodevelopmental delays among NICU graduates. AimsThis study evaluated infant-patient tolerance and nurse ease of use of a novel frequency-selective hearing protection device, DREAMIES (NEATCap Medical, LLC). Study design and subjectsFifty neonates receiving care in a Level III NICU participated in a 2-phase prospective study. In Phase 1, 25 infants (mean 36.6 wks GA) wore DREAMIES for two consecutive 30-min periods. In Phase 2, 25 infants (mean 34.8 wks GA) wore DREAMIES between care and feeding times during an 8-h Device-On period followed by an 8-h Device-Off period for three consecutive days. Outcome measuresSubject tolerance was defined by device-related skin irritation, vital sign measurements, and behavioral state. Device fit and ease of use were also evaluated by NICU nurses. ResultsNo skin breakdown was reported in any infant in either phase. Only transient skin erythema was observed. Periods when infants wore DREAMIES resulted in lower heart and respiratory rates and increased sleep (P < 0.001). Nurses reported little to no difficulty in applying or removing the device. ConclusionFindings suggest DREAMIES are a safe, easy to use, and effective device that reduces exposure to NICU noise, and may improve cardio-respiratory activity and promote sleep among neonatal patients. Further studies are warranted to examine longer term use and potential benefits of DREAMIES for improving outcomes in infants receiving NICU care.This trial is registered on clinicaltrials.govNCT02744066.