Patient Vital Signs Research Articles

Effects of Virtual Reality on Pain, Anxiety, Patient Satisfaction in Coronary Angiography: A Randomized Trial

BackgroundSince patients are conscious during the coronary angiography procedure, they may experience pain and anxiety regarding possible complications and an uncertain outcome. AimThis study was conducted to determine the effects of virtual reality application on pain severity, anxiety level, and patient satisfaction in patients who undergo coronary angiography. MethodThis randomized controlled study was conducted with a total of 70 patients, including 35 patients in the intervention and 35 patients in the control group. Apart from their routine treatment, virtual reality glasses application was used in the intervention group patients during the procedure. The patients in the control group were given only routine treatment. Data were collected by using “Descriptive Information Form”, “Visual Analogue Scale (VAS)”, Anxiety Assessment Scale (AAS), “Physiological Symptoms of Anxiety Follow-up Form”, and “Virtual Reality Glass Application Satisfaction Form”. ResultsMean post-intervention scores of VAS, AAS, heart rate, diastolic and systolic blood pressure, respiratory rate of the intervention group decreased significantly compared with the control group, while O2 saturation value was found to increase significantly. ConclusionsIn this study, it was found that virtual reality application was effective in reducing pain and anxiety, increasing patient satisfaction, and normative regulation of vital signs in patients who undergo coronary angiography.

Promoting physical activity in clinical practice through wearable technology.

The negative health consequences of physical inactivity continue to be a global problem that must be addressed from the highest levels of government down to local primary care providers. Physical activity has been identified as a useful patient vital sign in health care. Advanced practice nurses should aggressively prescribe physical activity as an evidence-based intervention to help mitigate the increased mortality and morbidity associated with a sedentary lifestyle. A focused literature review was conducted using PubMed, CINAHL, and the Cochrane online databases. Fitness wearables and mobile health trackers are a catalyst for lifestyle behavior change and cultivate a health care partnership between the patient and their provider. The evolution of fitness wearables into mainstream health care hinges on the ability of devices to integrate into electronic health records, uniformity of manufacturer standards, intuitiveness, and the assurance of user privacy and security. It is incumbent on nurse practitioners to educate themselves about the reliability and practicality of fitness trackers for their patient population. Future research should focus on adopting quality standards for all consumer devices, the seamless integration of device data into electronic health records and ensuring personal privacy and security.

Combination of Remimazolam, Remifentanil Anesthesia, and Enteral Nutrition Support Restores Vital Signs and Nutritional Status of Patients Undergoing Intravascular Interventional Therapy for Intracranial Aneurysms

Ninety-eight patients from our hospital were included in the study from March 2022 to March 2023. The patients were divided into two groups: 49 patients received propofol + remifentanil in the control group and 49 patients received remimazolam + remifentanil in the observation group. Postoperatively, the control group accepted parenteral nutrition support, while the observation group accepted enteral nutrition support. The observation group experienced a longer duration of consciousness loss but shorter times for consciousness recovery and trachea extubation than the control group. Although both groups experienced elevated mean blood pressure, heart rate, norepinephrine, angiotensin II, and plasma cortisol levels during tracheal intubation and extraction, the observation group showed differences compared to the control group. No statistical significance was discovered in the incidence of postoperative adverse reactions between the two groups (P = 0.29). Furthermore, tumor necrosis factor-α and interleukin-6 levels were lower in the observation group than in the control group, while total protein, albumin, and hemoglobin levels were higher. Overall, remimazolam combined with remifentanil demonstrated superiority over propofol combined with remifentanil in the perioperative period for patients undergoing intravascular interventional therapy for intracranial aneurysms.

Non-Invasive Wearable Devices for Monitoring Vital Signs in Patients with Type 2 Diabetes Mellitus: A Systematic Review.

Type 2 diabetes mellitus (T2D) poses a significant global health challenge and demands effective self-management strategies, including continuous blood glucose monitoring (CGM) and lifestyle adaptations. While CGM offers real-time glucose level assessment, the quest for minimizing trauma and enhancing convenience has spurred the need to explore non-invasive alternatives for monitoring vital signs in patients with T2D. Objective: This systematic review is the first that explores the current literature and critically evaluates the use and reporting of non-invasive wearable devices for monitoring vital signs in patients with T2D. Methods: Employing the PRISMA and PICOS guidelines, we conducted a comprehensive search to incorporate evidence from relevant studies, focusing on randomized controlled trials (RCTs), systematic reviews, and meta-analyses published since 2017. Of the 437 publications identified, seven were selected based on predetermined criteria. Results: The seven studies included in this review used various sensing technologies, such as heart rate monitors, accelerometers, and other wearable devices. Primary health outcomes included blood pressure measurements, heart rate, body fat percentage, and cardiorespiratory endurance. Non-invasive wearable devices demonstrated potential for aiding T2D management, albeit with variations in efficacy across studies. Conclusions: Based on the low number of studies with higher evidence levels (i.e., RCTs) that we were able to find and the significant differences in design between these studies, we conclude that further evidence is required to validate the application, efficacy, and real-world impact of these wearable devices. Emphasizing transparency in bias reporting and conducting in-depth research is crucial for fully understanding the implications and benefits of wearable devices in T2D management.

Delay Between Actual Occurrence of Patient Vital Sign and the Nominal Appearance in the Electronic Health Record: Single-Center, Retrospective Study of PICU Data, 2014-2018.

Patient vital sign data charted in the electronic health record (EHR) are used for time-sensitive decisions, yet little is known about when these data become nominally available compared with when the vital sign was actually measured. The objective of this study was to determine the magnitude of any delay between when a vital sign was actually measured in a patient and when it nominally appears in the EHR. We performed a single-center retrospective cohort study. Tertiary academic children's hospital. A total of 5,458 patients were admitted to a PICU from January 2014 to December 2018. None. We analyzed entry and display times of all vital signs entered in the EHR. The primary outcome measurement was time between vital sign occurrence and nominal timing of the vital sign in the EHR. An additional outcome measurement was the frequency of batch charting. A total of 9,818,901 vital sign recordings occurred during the study period. Across the entire cohort the median (interquartile range [IQR]) difference between time of occurrence and nominal time in the EHR was in hours:minutes:seconds, 00:41:58 (IQR 00:13:42-01:44:10). Lag in the first 24 hours of PICU admission was 00:47:34 (IQR 00:15:23-02:19:00), lag in the last 24 hours was 00:38:49 (IQR 00:13:09-01:29:22; p < 0.001). There were 1,892,143 occurrences of batch charting. This retrospective study shows a lag between vital sign occurrence and its appearance in the EHR, as well as a frequent practice of batch charting. The magnitude of the delay-median ~40 minutes-suggests that vital signs available in the EHR for clinical review and incorporation into clinical alerts may be outdated by the time they are available.

Prone Positioning of Ventilated Patients During Air Medical Evacuation: A Case Series

ObjectiveThe purpose of this study was to investigate patient safety implications of transporting prone-positioned mechanically ventilated patients in the air medical environment (AME). MethodsA retrospective health record review of patient encounters from 2019 to 2021 was conducted using British Columbia Emergency Health Services air medical electronic patient care reports. ResultsA total of 633 patients were identified as intubated, mechanically ventilated, and transported by British Columbia Emergency Health Services air medical teams. Ten patients were identified as having been transported in the prone position. Oxygen saturation, arterial blood oxygen levels, and carbon dioxide measurements from 8 cases indicated that patients remained stable or improved during transport. Cardiovascular episodes including hypotension and tachycardia were observed. In 2 patients, a mean 17.5% decline in oxygen saturation was identified. It could not be determined if this was a result of prone positioning during AME or due to a deteriorating physiological condition related to the patient's underlying disease. There were no identified tube dislodgments during AME transport. ConclusionAlthough proning did not compromise patient safety with respect to tube or line displacement in our study, we cannot draw definitive conclusions regarding the safety implications of proning on patient vital signs during transport.

Effects of Intravenous Lipid Emulsion Administration in Acute Tramadol Poisoning: A Randomized Controlled Trial

BackgroundAs the prevalence of tramadol toxicity is increasing, managing these patients with the aim of treatment and complete recovery has become a major challenge for health care professionals. ObjectiveThis study evaluated the short-term effects of IV lipid emulsion (ILE) administration in cases of tramadol poisoning. MethodsIn this double-blind, randomized controlled trial, 120 patients with pure tramadol poisoning and a Glasgow Coma (GCS) score ≤ 12 referred to a poisoning center in Tehran, Iran were selected and randomly assigned 1:1 to receive ILE 20% (intervention) or 0.9% saline (control) after admission and primary stabilization. The patient's vital signs, GCS score, hospitalization duration, and rate of seizure occurrence were recorded and compared between the two groups. ResultsMean (SD) age of participants was 25.3 (5.4) years and 84 (70%) were male. Mean (SD) ingested dose of tramadol was 3118 (244) mg, which was not different between the groups. Compared with controls, the ILE group had a higher level of consciousness after treatment (median [interquartile range] GCS score 12 [10–13] vs. 10 [8–12]; p = 0.03). In addition, length of hospitalization (median [interquartile range] (2 [1–3] days vs. 4 [4–6] days; p < 0.01) and rate of seizure occurrence were lower in the intervention group (16/60 vs. 30/60; p < 0.01). ConclusionsIn the setting of tramadol poisoning with a decreased level of consciousness and based on our study's findings, administration of ILE is suggested to help manage patients in hospital emergency departments. However, larger trials might be needed to confirm these findings before entering the guidelines.

Early and Consistent CRS Detection Using Wearable Device for Remote Patient Monitoring Following CAR-T Therapy in Relapsed/Refractory Multiple Myeloma (RRMM): Early Results of an Investigator-Initiated Trial

The administration of Chimeric Antigen Receptor T-cell (CAR-T) therapy for relapsed refractory multiple myeloma (RRMM) predominantly takes place in the inpatient setting to monitor for adverse effects like cytokine release syndrome (CRS) and neurotoxicity leading to increased healthcare utilization, infection risk and patient discomfort. Shifting the administration model to the outpatient setting may improve patient experience, optimize hospital bed utilization and decrease costs, but requires an objective and reliable method for CRS detection to monitor patients remotely and safely. The feasibility of using a wearable device for detecting CRS following CAR-T therapy in RRMM was compared to standard of care (SoC) nursing-recorded vital signs in this investigator initiated clinical trial (IIT). Patients wore a wearable device that collected continuous measures of temperature, pulse, respiratory rate, and O2 saturation in addition to SoC while receiving CAR-T therapy from the day infusion to discharge. Changes in vital signs captured by the device were analyzed based on 2 thresholds: (i) CRS timestamps were tagged in wearable data when pt's temperature breached a fixed threshold of 38 0C ( Tf) defined as fever by the American Society of Transplantation and Cellular Therapy (ASTCT), and (ii) when pt's temperature breached an individualized threshold of 2 standard deviations above their baseline temperature ( Ti) [see Figure 1]. Outcomes were time to first detection of CRS in wearable data vs. SoC. Wearable adherence was the duration pts wore the device over the total monitoring period. To date, 34 pts were screened, 28 enrolled (82.3% uptake), 1 was excluded from the dataset because of concurrent COVID-19, and 2 pts with CRS were excluded from time to detection comparison because of wearable adherence &amp;lt;50% during high-risk windows (defined as the time period where CRS is expected per known data for the CAR-T product). Max CRS grades were 1 (17 pts), 2 (1 pt), 3 (2 pts), and 4 (1 pt); 5 pts did not have clinical CRS. Patients wore the device for a median of 13 (12-15) days out of a median of 15.5 (14-17) days of inpatient admission for CAR-T infusion. Median individualized temperature threshold was 37.4 (37-37.6) C. Wearable adherence was 64 (51 - 77) % and 72 (57 - 87) % for the overall monitoring and high-risk periods, respectively. The wearable detected the initial CRS events at a median of 22 (-43 - 113.5) min earlier than SoC with Tf and a median of 184 (53 - 312) mins earlier than SoC with Ti method. In the no CRS subgroup, false CRS detection occurred in 1 pt with the Tf and 2 pts with the Ti method. Preliminary results suggest that time to CRS detection by the wearable device preceded SoC detection by a median of 103 minutes corroborated by both threshold methods. Temperature thresholds calibrated to the baseline temperature of individual patients facilitate earlier detection of CRS than fixed thresholds per clinical/ASTCT criteria. While the low false detection rate in is encouraging, these may also potentially be attributed to subclinical events. Both pts who had “false positive” triggers breached their individualized temperature thresholds via device readings while only recording low-grade temperatures that did not meet clinical CRS criteria per ASTCT, indicating possible capture of subclinical events. The study showcases the utility of continuous remote patient vital signs monitoring by wearable devices in efficiently capturing CRS, including subclinical events, earlier than SoC. Objective and reliable CRS monitoring may help safely transition workflows to outpatient CAR-T administration models. Analysis of trends in cytokine biomarkers for early CRS detection signal(s) is currently underway. Cytokine signals, alone and in combination with device data, are planned to be incorporated into machine learning models to build a CRS prediction index in future analyses. Figure 1: Snapshot in time of the continuous temperature data generated by the wearable device after CAR-T infusion showing capture of cytokine release syndrome. – Ti (solid line) represents the median baseline temperature of the patient over the entire duration of the data capture by the wearable device – Tf (dotted line) represents the temperature threshold of 38 0C, the clinical definition of fever as per ASTCT – Black diamond: clinical CRS event, when temperature &amp;gt;38 0C as recorded by nursing

The Effect of Reiki and Aromatherapy on Vital Signs, Oxygen Saturation, and Anxiety Level in Patients Undergoing Upper Gastrointestinal Endoscopy: A Randomized Controlled Study.

This randomized controlled study aimed to determine the effect of Reiki and aromatherapy on vital signs, oxygen saturation, and anxiety level in patients undergoing upper gastrointestinal endoscopy. The sample consisted of 100 patients divided into Reiki (n = 34), aromatherapy (n = 33), and control (n = 33) groups. Data were collected 3 times (before, during, and after the procedure) using a descriptive characteristics questionnaire, a follow-up form, and the State Anxiety Subscale. The Reiki group had a mean State Anxiety Subscale score of 53.59 ± 2.98 and 43.94 ± 4.31 before and after the procedure, respectively. The aromatherapy group had a mean State Anxiety Subscale score of 54.03 ± 4.03 and 43.85 ± 3.91 before and after the procedure, respectively. The control group had a mean State Anxiety Subscale score of 38.79 ± 4.68 and 53.30 ± 7.26 before and after the procedure, respectively (P < .05). The results showed that the Reiki and aromatherapy groups had significantly lower State Anxiety Subscale scores than the control group after the procedure, indicating that Reiki and aromatherapy help reduce anxiety levels. There was a significant difference in the mean respiratory rates and oxygen saturation levels between the groups (P < .05). In conclusion, patients who do Reiki or undergo aromatherapy are less likely to experience anxiety before upper gastrointestinal endoscopy.

The effect of ınformation about the operating room environment with virtual reality glasses on the anxiety level and vital findings of the patients: a randomized controlled study protocol

Background: This article summarizes the study protocol currently used to evaluate the effect of informing about the operating room environment with virtual reality (VR) glasses on patients' anxiety level and vital signs. Methods: This study was designed as a non-drug clinical, randomized controlled trial. Eligible patients will be randomly assigned to one of two groups. The population of the study will consist of 80 patients who will undergo planned abdominal surgery in the operating room unit of a state hospital affiliated to the TRNC ministry of health. Before surgery, the first group (n=40) will be informed through VR glasses, while the second group (n=40) will receive standard care. Conclusions: The outcome is anxiety level before surgery and the state of vital signs during surgery. Trial registration: International standard randomized controlled trial number NCT05899790.

Continuous visualization and validation of pain in critically ill patients using artificial intelligence: a retrospective observational study

Machine learning tools have demonstrated viability in visualizing pain accurately using vital sign data; however, it remains uncertain whether incorporating individual patient baselines could enhance accuracy. This study aimed to investigate improving the accuracy by incorporating deviations from baseline patient vital signs and the concurrence of the predicted artificial intelligence values with the probability of critical care pain observation tool (CPOT) ≥ 3 after fentanyl administration. The study included adult patients in intensive care who underwent multiple pain-related assessments. We employed a random forest model, utilizing arterial pressure, heart rate, respiratory rate, gender, age, and Richmond Agitation–Sedation Scale score as explanatory variables. Pain was measured as the probability of CPOT scores of ≥ 3, and subsequently adjusted based on each patient's baseline. The study included 10,299 patients with 117,190 CPOT assessments. Of these, 3.3% had CPOT scores of ≥ 3. The random forest model demonstrated strong accuracy with an area under the receiver operating characteristic curve of 0.903. Patients treated with fentanyl were grouped based on CPOT score improvement. Those with ≥ 1-h of improvement after fentanyl administration had a significantly lower pain index (P = 0.020). Therefore, incorporating deviations from baseline patient vital signs improved the accuracy of pain visualization using machine learning techniques.

FRI082 Impact Of Setmelanotide On Metabolic Parameters And Vital Signs In Patients With Hypothalamic Obesity

Abstract Disclosure: M.J. Abuzzahab: Advisory Board Member; Self; Pfizer, Inc., Endo Pharmaceuticals, Rhythm Pharmaceuticals, Inc., Consynance. Consulting Fee; Self; Pfizer, Inc., Endo Pharmaceuticals, Consynance, Rhythm Pharmaceuticals, Inc. A. Shoemaker: Advisory Board Member; Self; Rhythm Pharmaceuticals, Saniona. M. Gottschalk: Advisory Board Member; Self; Rhythm Pharmaceuticals, Inc. Consulting Fee; Self; Rhythm Pharmaceuticals, Inc. J. Miller: Other; Self; Study funding from Rhythm Pharmaceuticals, Inc. G. Yuan: Employee; Self; Rhythm Pharmaceuticals, Inc. Stock Owner; Self; Rhythm Pharmaceuticals, Inc. S. Malhotra: Employee; Self; Rhythm Pharmaceuticals, Inc. Stock Owner; Self; Rhythm Pharmaceuticals, Inc. C. Scimia: Employee; Self; Rhythm Pharmaceuticals, Inc. Stock Owner; Self; Rhythm Pharmaceuticals, Inc. C.L. Roth: Other; Self; Study funding from Rhythm Pharmaceuticals, Inc. Background: Hypothalamic obesity (HO) is a severe form of obesity that results from insult to the hypothalamus, primarily from tumors, tumor resections, and radiotherapy treatment, which can impair melanocortin-4 receptor (MC4R) pathway signaling. Treatment with setmelanotide, an MC4R agonist, resulted in weight loss and hunger reduction in a Phase 2 trial of patients with HO. This analysis evaluated the impact of 16 weeks of setmelanotide on metabolic parameters and vital signs in patients with HO. Methods: A Phase 2 open-label trial of setmelanotide enrolled patients aged ≥6 to ≤40 years with obesity resulting from hypothalamic injury who completed tumor-related treatment ≥6 months before enrollment (NCT04725240). The primary endpoint was the proportion of patients with ≥5% reduction in baseline body mass index (BMI) after 16 weeks of setmelanotide. Exploratory endpoints of change from baseline in waist circumference and metabolic parameters, including fasting glucose and glycated hemoglobin, were evaluated. Vital signs, including heart rate and blood pressure, were also assessed. Descriptive statistics including changes at Week 16 from baseline are reported. Results: Eighteen patients were included in the study. At Week 16, most patients met the primary endpoint (88.9% [n/N=16/18]; P&amp;lt;0.0001), and 13 of 18 patients who completed treatment had ≥10% BMI reduction (mean [standard deviation (SD)] percent change, −14.5% [9.5%]). Across all patients, body weight was reduced by a mean (SD) of 12.6% (9.1%), and change in BMI Z score in patients aged ≥6 to &amp;lt;18 years was −1.3 (1.0). Overall, waist circumference was reduced by a mean (SD) of 12.0 (5.8) cm, which was a 10.4% (5.2%) reduction. Weight loss was predominately due to reduction in total fat mass rather than loss of lean mass. Most mean metabolic and vital sign values were within normal ranges at baseline, and given the short duration of the study, no changes in metabolic parameters were noted. Vital signs continued to remain normal during the 16-week study duration. Treatment-related adverse events occurred in all patients. The most frequent adverse events included nausea (61.1%; n=11), vomiting (33.3%; n=6), skin hyperpigmentation (33.3%; n=6), and diarrhea (22.2%; n=4). Conclusions: In a heterogeneous population of patients with HO secondary to treatment of hypothalamic tumors, setmelanotide led to weight loss and reduction in BMI and a favorable change in body composition. Efficacy and safety of setmelanotide will continue to be evaluated in a larger Phase 3 clinical trial. Presentation: Friday, June 16, 2023

Akut Üst Gastrointestinal Kanama İle Başvuran Hastaların Endoskopi Yapılma Zamanının Hastaların Mortalitesine Etkileri

Background: Endoscopy is recommended in acute upper gastrointestinal bleeding (AUGIB) to detect the bleeding source and stop the bleeding. The optimal timing of endoscopy in AUGIB is controversial. We aimed to investigate the time of endoscopy and the factors affecting it.&#x0D; Materials and methods: Retrospective, single-center study. The patients were divided into four groups: endoscopy after discharge, 0-12 hours endoscopy, 12-24 hours endoscopy and 24 hours later. Age, sex, vital signs, laboratory findings were recorded. Glasgow-Blatchford Score (GBS) and Charlson comorbidity index (CCI) were calculated. The obtained data were compared between these four groups. All-cause mortality for 30 days was recorded.&#x0D; Results: A total of 318 patients were included. In the comparison of endoscopy times, the parameters found to be statistically significant between the four groups are Hb, BUN, and INR levels, GBS and CCI. As a result of CHAID analysis, the most crucial variable affecting the timing of endoscopy was found to be the Hb value of the patients (χ2=66.528; adjusted p=0.000). Mortality occurred in 10.69% of the patients. The timing of endoscopy did not affect mortality. In binary logistic regression analysis, low systolic BP (0.967 times increase), high CCI (86,402 times increase) were found to affect mortality.&#x0D; Conclusion: The factors affecting the timing of endoscopy are the signs of bleeding. A thorough follow-up of vital signs in patients presenting to the emergency department with acute gastrointestinal bleeding, particularly an evaluation of systolic blood pressure and detailed questioning of additional comorbid conditions, is critical to reduce mortality.

Adapting remote photoplethysmography for Indonesian subjects: an examination of diverse rPPG techniques

Vital sign measurements are essential in intensive care patients, such as in the ICU or emergency department, and also for newborns or prenatal babies. The duty nurse usually monitors these vital signs by manually writing down the patient's condition on a large piece of paper in front of the patient's room. The lack of nurses can hinder the process of monitoring patient vital signs. However, since the COVID-19 pandemic, people have limited contact with their surroundings, making measuring vital signs with contact uncomfortable and unhygienic. The typical non-contact method for measuring heart rate is the remote photoplethysmography (rPPG) technique. In this study, we proposed to assess the performance of various rPPG algorithms on the Indonesian subjects dataset. The algorithms used are CHROM, GREEN, ICA, LGI, PBV, PCA, and POS on 70 pieces of data. Based on the test results with three types of evaluation metrics, namely MAE (Mean Absolute Error), RMSE (Root Mean Square Error), and Bland Altman, it is found that the measurement results with the best performance POS algorithm with a low prediction error rate with the resulting MAE value of 2.59 and RMSE of 4.65.

Febrile infants risk score at triage (FIRST) for the early identification of serious bacterial infections

We aimed to derive the Febrile Infants Risk Score at Triage (FIRST) to quantify risk for serious bacterial infections (SBIs), defined as bacteremia, meningitis and urinary tract infections. We performed a prospective observational study on febrile infants < 3 months old at a tertiary hospital in Singapore between 2018 and 2021. We utilized machine learning and logistic regression to derive 2 models: FIRST, based on patient demographics, vital signs and history, and FIRST + , adding laboratory results to the same variables. SBIs were diagnosed in 224/1002 (22.4%) infants. Among 994 children with complete data, age (adjusted odds ratio [aOR] 1.01 95%CI 1.01–1.02, p < 0.001), high temperature (aOR 2.22 95%CI 1.69–2.91, p < 0.001), male sex (aOR 2.62 95%CI 1.86–3.70, p < 0.001) and fever of ≥ 2 days (aOR 1.79 95%CI 1.18–2.74, p = 0.007) were independently associated with SBIs. For FIRST + , abnormal urine leukocyte esterase (aOR 16.46 95%CI 10.00–27.11, p < 0.001) and procalcitonin (aOR 1.05 95%CI 1.01–1.09, p = 0.009) were further identified. A FIRST + threshold of ≥ 15% predicted risk had a sensitivity of 81.8% (95%CI 70.5–91.0%) and specificity of 65.6% (95%CI 57.8–72.7%). In the testing dataset, FIRST + had an area under receiver operating characteristic curve of 0.87 (95%CI 0.81–0.94). These scores can potentially guide triage and prioritization of febrile infants.

Vital Signs in Palliative Care: A Scoping Review.

Vital signs are routinely measured in secondary healthcare settings and can be used to detect clinical problems, guide treatment, and monitor response to treatment. Vital signs are less frequently measured in palliative care settings. Reasons for this are unclear. This scoping review aimed to assess the generic use of vital signs in palliative care, and its role in prognostication for adult patients with cancer receiving palliative care. Medline, Embase, and CINAHL were searched for articles involving adult patients with advanced cancer receiving palliative care who had their vital signs measured. Twenty-six articles were identified in which one or a combination of vital signs, with or without other clinical parameters, was used to prognosticate for patients. An additional three articles investigated the generic use of vital signs in patients with advanced cancer. There was significant heterogeneity between identified studies, with some indication that changes in vital signs may indicate that a patient is close to death. However, other studies suggested that patients may maintain normal vital signs until the time of death. Further studies are needed to explore whether abnormal vital signs may be used as a prognostic indicator for patients with cancer receiving palliative care.

A Review of Federal and Statewide Guidelines and Their Effects on Orthopedics.

In the past three decades, the use of opioids has risen tremendously. Pain was named the "fifth patient vital sign" in the 1990s, and from that point, opioid usage has continued to grow throughout the 2010s leading to its recognition as a crisis.The United States is responsible for 80% of the global opioid usage while only accounting for less than 5% of the global population. Previously opioids were mostly used to treat acute pain, however, opioids have been most recently used to manage chronic pain as well.The opioid crisis has presented new challenges in treating pain while preventing the abuse of these medications in a system that lacks standardization of treatment guidelines across the United States. Therefore, the authors of this review examine the current national recommendations to help manage the ongoing opioid crisis and explore how they may impact orthopedic patient care.

A Descriptive Study ofCasualties Evacuated Out ofAfghanistan by Critical Care Air Transport Teams During the Withdrawal ofU.S. Troops.

The War in Afghanistan ended in August 2021. Evacuation from the country was a large effort during the last days of the conflict. During evacuation efforts at Kabul Hamid Karzai International Airport, a suicide bombing occurred necessitating emergent medical care for many injured troops and civilians. The U.S. Air Force Critical Care Air Transport Teams (CCATTs) played a role in the medical care provided during the operations in Afghanistan. We report on in-flight events and interventions that took place during the final days of the Afghanistan withdrawal. We performed a retrospective chart review of patients requiring aeromedical evacuation from the Afghanistan theater of operations by CCATT from July 1 to August 30, 2021. From the CCATT patient care record, data abstractors collected patient characteristics, flight information, vital signs, laboratory values, in-flight interventions, and in-flight events in a study-specific electronic database. We performed descriptive analyses of patient characteristics and in-flight interventions. This study was approved by the San Antonio Institutional Review Board. Nine patients were included in this analysis. Seven out of nine patients were foreign nationals; the remaining two were U.S. Marines. Five patients suffered penetrating injuries from gunshot wounds and four suffered blast injuries. Six received intravenous narcotic analgesia. Four received intravenous sedatives, and four received antibiotics in flight. Two patients required chest tube management. One patient received blood. Three patients were in acute respiratory distress. Severe injuries were sustained during the withdrawal efforts at the end of the War in Afghanistan. Critical Care Air Transport Teams played a role in the care and evacuation of patients out of theater during this unique and unprecedented time. Even given the limitations associated with retrospective studies and a small sample size, information reported in this study can help inform future decisions, and aid in preparatory efforts for future operations, that may require medical care by CCATT.

Intervensi Kombinasi Deep Breathing Exercise dan Murottal terhadap Perubahan Nyeri dan Tanda-Tanda Vital Pasien Pasca Bedah Jantung Terbuka

This study aims to analyze the effect of a combination of deep breathing exercises and murottal on changes in pain and vital signs in patients after open heart surgery in intensive care. This research method uses a quasi-experimental design pre-post test. The results showed that the difference test between the treatment and control groups, there was a significant difference. value= 0.001, SpO2 with p value=0.000 and MAP with p value=0.000. The statistical tests used are the Independent t-test, Paired t-test, and Manova, with a significance level of α= 0.05. In conclusion, combining deep breathing exercises and murottal is a relaxation technique that can affect changes in pain and vital signs (pulse, RR, SpOâ and MAP) in patients after open heart surgery.&#x0D; Keywords: Deep Breathing, Post-Cardiac Surgery, Vital Signs, Pain Level

The value of the INFECTIONS scoring system in identifying bacterial infections among patients presenting at the emergency department of a middle-income country: A pilot study

PurposeTo investigate which scoring system is the most accurate tool in predicting mortality among the infected patients who present to the emergency department in a middle-income country, and to validate a new scoring system to predict bacterial infections. MethodsThis was a retrospective, single-center study among patients who were admitted via the emergency department of a public hospital. All patients who were started on antibiotics were included in the study, while patients aged < 18 years were excluded. Data collected includeding patients' demographics, vital signs and basic laboratory parameters like white blood cell count and creatinine. The sensitivity and specificity of different scoring systems were calculated as well as their negative and positive predictive values. Logistic regression was used to derive a novel early warning system for bacterial infections. The area under the receiver operating characteristic (AUROC) was computed for each scoring model. ResultsIn total, 109 patients were included in this study. The quick sequential organ failure assessment (qSOFA), search out severity and rapid acute physiology score had the highest AUROC (≥ 0.89) for predicting mortality, while qSOFA and universal vital assessment were the simplest scoring systems with an AUROC > 0.85; however, these scoring systems failed to predict whether patients were truly infected. The INFECTIONS (short for impaired mental status, not conscious, fast heart rate, elevated creatinine, high temperature, on inotrope, low oxygen, high neutrophils and high sugar) model reached an AUROC of 0.88 to more accurately predict the infectious state of a patient. ConclusionsMiddle-income countries should use the qSOFA or universal vital assessment score to identify the sickest patients in emergency department. The INFECTIONS score may help recognize patients with bacterial infections, but it should be further validated in multiple countries prior to widely use.