Vital Sign Parameters Research Articles

Design of a multifunctional urine bag

At present, there are many monitoring devices for vital signs parameters for clinical selection, but urine monitoring has not received enough attention. The traditional manual visual measurement, intermittent measurement of urine pH value, and other methods are still in use, so the authors designed a multifunctional urine bag. The urine bag can set up an alarm system per unit time according to patient's age and condition as well as set up urine pH value detection area in hard plastic measuring bottle. This device can not only accurately monitor urine volume per unit time, but also hopefully realize the alarm automation of abnormal urine volume per unit time, as well as real-time dynamic monitoring of urine pH value. It is helpful for medical staff to make accurate judgment on patients' condition changes, to guide the formulation and modification of clinical treatment plans, and to reduce the workload of clinical nursing staff to a certain extent.

Accommodate Data Loss in Monitoring Vital Signs Through Autoregressive Model

In this paper, the measurement of two vital signs including heartbeat and respiratory rate are discussed under two critical scenarios; namely subjection to noise and intermittent observations. Previously adopted scheme for finding the above mentioned vital signs was Fourier Transform which couldn't handle non-stationary process. For a broader perspective, Wavelet Transform is employed in this paper which is equally applicable to stationary and non-stationary processes. In addition, the intermittent observation is a malfunction which may result in severe consequences in measuring vital signs. In past, only noise-free data has been incorporated in tracing vital signs parameters. A Modified Robust Kalman Filter (MRKF) is designed to obtain optimum results in the presence of above two critical scenarios. Simulation results obtained on real data show that the performance of MRKF produces similar vital signs as with clean and undistorted data.

Towards development of alert thresholds for clinical deterioration using continuous predictive analytics monitoring.

Patients who deteriorate while on the acute care ward and are emergently transferred to the Intensive Care Unit (ICU) experience high rates of mortality. To date, risk scores for clinical deterioration applied to the acute care wards rely on static or intermittent inputs of vital sign and assessment parameters. We propose the use of continuous predictive analytics monitoring, or data that relies on real-time physiologic monitoring data captured from ECG, documented vital signs, laboratory results, and other clinical assessments to predict clinical deterioration. A necessary step in translation to practice is understanding how an alert threshold would perform if applied to a continuous predictive analytic that was trained to detect clinical deterioration. The purpose of this study was to evaluate the positive predictive value of 'risk spikes', or large abrupt increases in the output of a statistical model of risk predicting clinical deterioration. We studied 8111 consecutive patient admissions to a cardiovascular medicine and surgery ward with continuous ECG data. We first trained a multivariable logistic regression model for emergent ICU transfer in a test set and tested the characteristics of the model in a validation set of 4059 patient admissions. Then, in a nested analysis we identified large, abrupt spikes in risk (increase by three units over the prior 6h; a unit is the fold-increase in risk of ICU transfer in the next 24h) and reviewed hospital records of 91 patients for clinical events such as emergent ICU transfer. We compared results to 59 control patients at times when they were matched for baseline risk including the National Warning Score (NEWS). There was a 3.4-fold higher event rate for patients with risk spikes (positive predictive value 24% compared to 7%, p = 0.006). If we were to use risk spikes as an alert, they would fire about once per day on a 73-bed acute care ward. Risk spikes that were primarily driven by respiratory changes (ECG-derived respiration (EDR) or charted respiratory rate) had highest PPV (30-35%) while risk spikes driven by heart rate had the lowest (7%). Alert thresholds derived from continuous predictive analytics monitoring are able to be operationalized as a degree of change from the person's own baseline rather than arbitrary threshold cut-points, which can likely better account for the individual's own inherent acuity levels. Point of care clinicians in the acute care ward settings need tailored alert strategies that promote a balance in recognition of clinical deterioration and assessment of the utility of the alert approach.

Peripheral white blood cell count as a screening tool for ventriculostomy-related infections

One of the most common complications following external ventricular drain (EVD) placement is infection. Routine cultures of cerebrospinal fluid (CSF) are often used to screen for infection, however several days may pass before infection is discovered. In this study, we compared the predictive value of daily recorded vital sign parameters and peripheral white blood count (WBC) in identifying ventriculostomy-related infections. Patients with EVDs who had CSF cultures for microorganisms performed between January 2011 and July 2017 were assigned to either an infected and/or uninfected study group. Clinical parameters were then compared using t-test, chi squared and multiple logistic regression analyses. Patients of any age and gender were included. One hundred seventy uninfected and 10 infected subjects were included in the study. Nine of the 10 infected patients had an elevated WBC (>10.4 × 103/μL), with a significantly greater WBC (15.9 × 103/μL) than the uninfected group (10.4 × 103/μL) (p-value ≤ 0.0001). Using logistic regression, we found no association between patient vital signs and CSF infection except for WBC (p = .003). As a diagnostic marker for CSF infection, the sensitivity and specificity of WBC elevation greater than 15 × 103/μL was 70% (7/10) and 90.2% (147/163), respectively. This study serves as a ‘proof of concept’ that WBC could be useful as potential screening tool for early detection of CSF infection post-EVD placement. Future investigation using a large, multicenter prospective study is needed to further assess the applicability of this parameter.

Hypotension Definition Variability Among Infection Preventionists: An APIC Chapter Survey

BACKGROUND The National Healthcare Safety Network (NHSN) does not provide a specific value for hypotension. The NHSN Safety Protocol directs facilities to “use the vital sign parameter(s) as stated in its policies and procedures for clinical practices.” Variation in defining hypotension criteria affects comparability of data, public reporting, and reimbursement. An Association for Professionals in Infection Control and Epidemiology (APIC) chapter's surveillance special interest group (SIG) posits the definition for hypotension as applied to laboratory-confirmed bloodstream infection (LCBI-2) central line associated bloodstream infection (CLABSI) varies widely among the healthcare facilities within its membership. METHODS The surveillance SIG developed a five-question survey to review facility-defined hypotension utilized in NHSN CLABSI surveillance. Survey questions addressed facility name, type of facility, and hypotension definition. The web-based survey was emailed in March 2018 to chapter members. The infection preventionist (IP) primarily responsible for reporting CLABSI at each facility was asked to complete the survey. The distribution of responses was evaluated. RESULTS Thirty-three IPs from 28 unique facilities responded. Twenty-six of the 28 facilities (93%) were acute care hospitals; two (7%) were long term acute care hospitals. The survey revealed 15 unique definitions for hypotension with both quantitative and qualitative elements. Quantitative results included a single systolic blood pressure CONCLUSIONS Such wide variation in facility-defined hypotension impacts identification and reporting of not just CLABSI, but also the intra-abdominal infection criteria NHSN uses for secondary bloodstream infections and surgical site infections.

Predicting serious bacterial infection in febrile young infants utilizing body temperature.

Febrile young infants have a high risk of serious infection. Although measuring vital sign parameters can serve as a rapid and effective assessment in these patients, their predictive value for serious bacterial infection (SBI) has not been fully investigated. This retrospective observational study enrolled febrile (>38.0°C) infants aged <90days at the time of presentation. Data from the emergency room triage database at Tokyo Metropolitan Children's Medical Center for the period 1 November 2011-30 November 2013, were reviewed. Variables included patient age, gender, and vital sign data, including body temperature, pulse rate, oxygen saturation, definitive diagnosis, and disposition. Two hundred and sixty-nine patients were included, with a mean age of 55days, and 158 (58.7%) were male. Of the total, 43 patients had an SBI. On logistic regression, body temperature ≥38.5°C (OR, 2.80; 95%CI: 1.37-5.74) was a significant predictor of SBI. High-grade fever was found to be a significant predictor of SBI in febrile young infants.

An effect of physical exercise-induced fatigue on the vital sign parameters: A preliminary study

Vital sign monitoring is an important body measurement to identify health condition and diagnose any disease and illness. In sports, physical exercise will contribute to the changes of the physiological systems, specifically for the vital signs. Therefore, the objective of this study was to determine the effect of physical fatigue exercise on the vital sign parameters. This is significant for the fitness identification and prediction of each individual when performing an exercise. Five male subjects with no history of injuries and random BMI were selected from students of biomedical engineering, Universiti Teknologi Malaysia. Based on the relationship between physical movement and physiology, the parameters considered were heart rate, blood pressure, and body temperature. Subjects were required to run on the treadmill at an initial speed of 4 km/h with an increase of 1 km/h at every 2 minutes interval. The effect of exercise was marked according to the fatigue protocol where the subject was induced to the maximum condition of performance. All parameters were measured twice, for pre and post exercise-induced protocol. The analysis of relationship of each parameter between pre and post fatigue was p&lt;0.05. The results revealed that the heart rate and gap between blood pressure’s systolic and diastolic were greater for all categories except underweight, where the systolic blood pressure dropped to below 100mmHg at the end of exercise. Also, the body temperature was slightly declined to balance the thermoregulatory system with sweating. Hence, the vigorous physical movement could contribute to the active physiological system based on body metabolism. Heart rate and blood pressure presented significant effects from the fatiguing exercise whereas the body temperature did not indicate any distinguishable impact. The results presented might act as the basis of reference for physical exercise by monitoring the vital sign parameters.

Edge computing in multi-scope service-oriented mobile healthcare systems

IoT based e-Health solutions is an upcoming trend which will revolutionize the healthcare in the near future. IoT has evolved from micro-electro-mechanical systems (MEMS), wireless technologies and Internet which together offer connectivity of systems, microelectronic devices, and medical services and allow data processing at the edge. That at the same time allows to save computational resources and avoid unnecessary point of failure, such as centralized synchronization point. Monitoring of patients’ vital signs parameters (measured at home) is achieved by using modern Internet of Things technology which provides networkable connections between portable diagnostic sensors, their cell phones, cloud data storage with patients’ Personal Health Records and professional health providers. This paper explores possibilities of using fog computing approach to shift data processing and computations from cloud to the edge and to build a multi-scope infrastructure for mHealth and citizen-observation system, based on SOA approach.

Comparison of performance of shock index and conventional vital sign parameters for prediction of adverse maternal outcomes following major postpartum hemorrhage in Abakaliki, Southeast Nigeria

Background: Despite advances in care, postpartum hemorrhage has continued to contribute disproportionately to maternal morbidity and mortality in developing countries due to delayed and/or substandard care in the diagnosis and management of hypovolemic shock. Aim: To compare the performance of the shock index with conventional vital signs for prediction of maternal outcome following postpartum hemorrhage and to establish alert thresholds for use in low-resource settings. Materials and Method: This is a 7-year retrospective cohort study of 289 women treated for primary postpartum hemorrhage at the Alex Ekwueme Federal University Teaching Hospital, Abakaliki. The data for systolic and diastolic blood pressure, mean arterial pressure, pulse pressure, heart rate, and shock index measured at the time of diagnosis of postpartum hemorrhage were analyzed. Adverse maternal outcomes such as intensive care unit admission, blood transfusion ≥5 units, hemoglobin level <7 g/dL, surgical interventions, end-organ failure, and death were reviewed. The area under the receiver operating characteristic curve (AUROC) for each vital sign was used to predict adverse maternal outcomes. Sensitivity, specificity, and negative and positive predictive values were calculated to determine the thresholds of the best predictor. Results: Shock index had the highest AUROC to predict invasive surgical procedures (0.70 for SI [95% CI 0.66–0.80] compared with 0.69 [95% CI 0.61–0.76] for pulse rate). Shock index was a consistent superior predictor for other outcomes. Shock index (SI) ≥0.9 had 100% sensitivity (95% CI 74.6–100) and 46.7% specificity (95% CI 34.9–56.5) for prediction of intensive care admission, and SI ≥1.7 had 46.9% sensitivity (95% CI 19.8–62.8) and 98.9% specificity (CI 91.1–100) for prediction of maternal death. Conclusion: Shock index is a consistent superior predictor of adverse maternal outcomes following postpartum hemorrhage when compared with conventional vital signs. SI <0.9 provides reassurance, whereas SI ≥1.7 indicates a need for urgent intervention to prevent maternal mortality.

Simultaneous monitoring of motion ECG of two subjects using Bluetooth Piconet and baseline drift.

Uninterrupted monitoring of multiple subjects is required for mass causality events, in hospital environment or for sports by medical technicians or physicians. Movement of subjects under monitoring requires such system to be wireless, sometimes demands multiple transmitters and a receiver as a base station and monitored parameter must not be corrupted by any noise before further diagnosis. A Bluetooth Piconet network is visualized, where each subject carries a Bluetooth transmitter module that acquires vital sign continuously and relays to Bluetooth enabled device where, further signal processing is done. In this paper, a wireless network is realized to capture ECG of two subjects performing different activities like cycling, jogging, staircase climbing at 100Hz frequency using prototyped Bluetooth module. The paper demonstrates removal of baseline drift using Fast Fourier Transform and Inverse Fast Fourier Transform and removal of high frequency noise using moving average and S-Golay algorithm. Experimental results highlight the efficacy of the proposed work to monitor any vital sign parameters of multiple subjects simultaneously. The importance of removing baseline drift before high frequency noise removal is shown using experimental results. It is possible to use Bluetooth Piconet frame work to capture ECG simultaneously for more than two subjects. For the applications where there will be larger body movement, baseline drift removal is a major concern and hence along with wireless transmission issues, baseline drift removal before high frequency noise removal is necessary for further feature extraction.

Clinical Variables Associated With Adverse Maternal Outcomes in Puerperal Group A Streptococci Infection.

To identify clinical variables associated with increased risk of composite adverse outcome in a cohort of women with puerperal group A streptococci infection. Our prospective case registry enrolled patients between 1991 and 2017. Chart abstraction was conducted for admission demographic and clinical data in patients with culture-proven puerperal group A streptococci infection. We created a composite variable of signs of capillary leakage including pulmonary edema, pleural effusion, ascites, and abdominal distention. The composite adverse outcome included death, hysterectomy, intensive care unit admission, mechanical ventilation, and blood transfusion. Clinical characteristics were compared between those with a composite adverse outcome and those without. We fit unadjusted log-linear models with robust error variance to measure the relative risk of a composite adverse outcome associated with clinical and demographic variables among patients with group A streptococci. Thirty-five of 71 (49%) patients had an adverse outcome. Women who had adverse outcomes had higher admission heart rates (126±19 vs 112±22 beats per minute, P=.008) and respiratory rates (26±10 vs 20±5 breaths per minute, P=.01), lower systolic blood pressure (98±24 vs 114±19 mm Hg, P=.004), and were more likely to have signs of capillary leakage (77% vs 20%, P<.001) and symptoms of capillary leakage (dyspnea, cough, shoulder pain, abdominal bloating, and chest pain) (40% vs 17%, P=.03) compared with those without adverse outcomes. Log-linear models indicated that these clinical variables were individually associated with increased risk of a composite adverse outcome. The relative risk of an adverse outcome was 3.5 times higher among women with signs of capillary leakage (relative risk 3.67, 95% CI 1.94-6.94, P<.001). Vital sign parameters consistent with severe infection correlate with adverse outcomes in women with puerperal group A streptococci infection. Signs of capillary leakage are most strongly associated with a composite adverse outcome. These clinical characteristics, particularly signs of capillary leakage, are potentially useful to guide clinical care.

The Safety and Efficacy of Propranolol in Reducing the Hypermetabolic Response in the Pediatric Burn Population.

Pediatric burn patients often have hypertension and tachycardia for several years post-injury. Propranolol has shown to be effective in treating the hypermetabolic state secondary to a major burn injury. This study was conducted to document a safe and effective dosing regimen for three different age groups. One hundred four burn-injured children with a 30% to 92% total body surface area burn were treated for 1 to 2 years with propranolol in the outpatient setting. Guardians of the patients were instructed on how to take and monitor the systolic blood pressure and heart rate, and document their vital signs several times a day. The documentation was reviewed with the guardian and patient, and based on age-specific vital sign parameters, propranolol dosing adjustment was done to measure at least 15% to 20% reduction in admission heart rate. Mean doses for the age groups were as follows: 0 to 3 years 5.2 ± 2.8 mg/kg/day, 4 to 10 years 4.2 ± 1.8 mg/kg/day, and 11 to 18 years 2.9 ± 1.4 mg/kg/day. The propranolol dose decreased as time post-burn increased. On selected patients, propranolol was stopped due to changes in the heart rate, but at all times, it was safe and effective. No adverse effects were noted. The dosing regimen was not affected by burn size or gender. Propranolol can be safely stopped abruptly with no rebound hypertension. Individuals older than 10 years required a lower dose per kilogram following the burn injury than prepubertal burn survivors. Propranolol proved to be both safe and effective in the management of cardiovascular changes occurring in the hypermetabolic state.

A Phase 3, Double-Blind, Randomized, Placebo-Controlled Study of Vilazodone in Adolescents with Major Depressive Disorder

BackgroundMajor depressive disorder (MDD) is a serious illness in children and adolescents. Vilazodone is a selective serotonin reuptake inhibitor approved for MDD in adults. This study evaluated the efficacy, safety, and tolerability of vilazodone in adolescent patients, ages 12–17 years, with MDD (NCT01878292).MethodsThis double-blind, randomized, placebo-controlled, parallel-group, fixed-dose study was conducted at 56 study centers in the United States and was 10 weeks in duration (a 1-week screening period, an 8-week double-blind treatment period, and a 1-week double-blind down-taper period). Outpatients with an MDD diagnosis based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria were included in the study. Clinical inclusion criteria required a Children’s Depression Rating Scale–Revised (CDRS-R) total score of ≥ 40 and Clinical Global Impressions–Severity (CGI-S) score of ≥ 4. Patients were randomized 1:1:1 to 8 weeks of double-blind treatment with placebo (n = 174), vilazodone 15 mg/day (n = 175), or vilazodone 30 mg/day (n = 180). The primary and secondary efficacy parameters were change from baseline to week 8 in CDRS-R total score and CGI-S score, respectively. Safety parameters included adverse events (AEs); clinical laboratory, vital sign, and electrocardiogram parameters; and the Columbia-Suicide Severity Rating Scale.ResultsApproximately 86% of patients completed double-blind treatment. There was no statistically significant difference between vilazodone 15 mg/day or 30 mg/day and placebo in change from baseline in CDRS-R score. Change in CGI-S score was not significant after adjustment for multiple comparisons. The most common treatment-emergent AEs were nausea, upper abdominal pain, vomiting, diarrhea, nasopharyngitis, headache, and dizziness. Reports of suicidal ideation (placebo, 33.3%; vilazodone 15 mg/day, 36.0%; vilazodone 30 mg/day, 31.1%) and suicidal behavior (placebo, 1.8%; vilazodone 15 mg/day, 1.1%; vilazodone 30 mg/day, 1.1%) were similar between treatment groups. There were no deaths in the study.ConclusionsThe efficacy of vilazodone for the treatment of MDD in adolescent patients could not be confirmed in this study. Vilazodone was generally safe and well tolerated, with treatment-emergent AEs similar to those in adult patients.Clinical Trial RegistrationNCT01878292.Electronic supplementary materialThe online version of this article (10.1007/s40272-018-0290-4) contains supplementary material, which is available to authorized users.

Polygeline in patients with hypovolemia caused by accidental trauma: a prospective, multicentric, safety study

Background: Objective of present study was to evaluate the safety of polygeline (Haemaccel®) and its effect on vital sign parameters in patients with hypovolemia caused by accidental trauma.Methods: Adverse drug reactions (ADRs) of polygeline within 6 hours after administration, and the effect of polygeline infusion on vital sign parameters, in trauma patients hospitalized at the emergency department, were evaluated in this prospective, multicentric, post-marketing observational study.Results: One hundred forty patients (men: 81.4%; women: 18.6%), with a mean (±standard deviation) age of 33.7±10.6 years, were enrolled. At the time of admission, mean blood volume loss was 1400.1±558.8ml, with 86.4% patients reporting blood volume loss of &gt;15%; 49.3% patients presented with class-II hypovolemia. No ADRs or any unusual clinically significant changes were reported within 6 hours of polygeline administration. All vital parameters (blood pressure and pulse rate) significantly improved at 1 hour of polygeline administration; this trend was sustained until 6 hours (p&lt;0.001). Reduction in respiratory rate was significant at 1 and 6 hours versus baseline (p&lt;0.001). Urine output and central venous oxygen saturation also showed significant improvement at 1 and 6 hours after treatment initiation (p&lt;0.001). Arterial pH and mean blood lactate levels also showed a significant change from the baseline (p&lt;0.05) at both 1 and 6 hours.Conclusions: Polygeline was found to be safe and effective in improving hemodynamic stability in patients with hypovolemia due to accidental trauma.

Significant Correlation between Regional Tissue Oxygen Saturation and Vital Signs of Critically Ill Infants.

Near-infrared spectroscopy (NIRS) has been used to non-invasively measure specific tissue oxygen saturation (StO2) continuously. Cerebral autoregulation status can be derived from NIRS and arterial blood pressure. The relationship of both cerebral and somatic StO2, fractional tissue oxygen extraction (FTOE), and cerebro-splanchnic oxygenation ratio (CSOR) with measured vital sign parameters for Neonatal Intensive Care Unit (NICU) patients has not been well studied. The aims of this study are to determine if significant relationships of brain and somatic StO2, brain and somatic FTOE, and CSOR parameters with vital signs for neonates exist and assess relationship between pressure passivity index, cerebral autoregulation, and mean blood pressure (MBP). Neonates weighing < 5 kg, preferentially with an arterial catheter, were enrolled in the study. FORE-SIGHT Elite (CASMedical Systems, Inc., Branford, CT, USA) cerebral and somatic NIRS sensors were placed over the abdominal right upper quadrant and right frontal-temporal area of the forehead for 24 h. Vital signs including arterial MBP were recorded simultaneously from the patients' bedside monitor. Data were averaged into 60 s windows and analyzed using linear regression. Results were stratified by gestational age (GA), birth weight (BW), and presence of brain abnormality. Data were obtained from 27 subjects (GA 22.2-42 weeks). Two subjects did not have an arterial line, thus they were not included in the MBP measurements. There were ~28,000-31,000 paired data points per comparison. Significant positive and negative correlations (p value < 0.0001) were noted between NIRS parameters and vital signs. When stratified by BW, there was a positive correlation between brain StO2 (StO2B) and MBP in the <1,500 g BW group (r = 0.193) and a negative correlation in >1,500 g group (r = 0.057). Brain and somatic FTOE in <1,500 g BW revealed a negative correlation with MBP (r = 0.172 and r = 0.086, respectively). In patients with an abnormal brain scan, a positive correlation was noted between StO2B and MBP (r = 0.354), and a negative correlation was noted between FTOE-B and MBP (r = 0.305). Generated pressure passive index plots suggested good cerebral autoregulation at low normal MBP ranges for lower weight and GA subjects. There is a significant correlation between cerebral and somatic StO2 and FTOE with measured vital sign parameters in NICU patients.

Pediatric Rapid Response Team: Vital Sign-Based System vs. Pediatric Early Warning Score System

Background: Pediatric cardiopulmonary arrests that occur outside the ICU are associated with increased mortality. Pediatric rapid response teams (PRRT) are effective in preventing codes and improving mortality. Our institution previously established a PRRT system modeled after the adult RRT system that was triggered by one abnormal vital sign (VS) parameter. This system resulted in many triggered PRRTs due to pediatric physiology that easily prompts vital sign changes in the setting of anxiety, fever, or medication delivery. The Pediatric Early Warning Score (PEWS) system is an evidence-based tool …

A randomized, double-blind, placebo-controlled, dose-ranging study of lisdexamfetamine dimesylate augmentation for major depressive disorder in adults with inadequate response to antidepressant therapy

Background:This randomized, double-blind, placebo-controlled study evaluated dose-response relationships of lisdexamfetamine dimesylate when used as augmentation for major depressive disorder in individuals exhibiting inadequate responses to antidepressant monotherapy.Methods:Eligible adults (18–65 years) were assigned to antidepressant monotherapy (escitalopram or venlafaxine extended-release) plus lisdexamfetamine dimesylate-matching placebo during an eight-week single-blind lead-in phase. Participants meeting randomization criteria were randomized (1:1:1:1:1) to eight weeks of lisdexamfetamine dimesylate (10, 30, 50, or 70 mg) or placebo while maintaining antidepressant therapy. Dose-responses for changes from augmentation baseline to week 16/early termination for Montgomery-Åsberg Depression Rating Scale total score (primary efficacy endpoint) and vital signs (systolic and diastolic blood pressure and pulse) were assessed using multiple comparisons procedures with modeling.Results:For Montgomery-Åsberg Depression Rating Scale total score change, no significant dose-responses were observed for any candidate dose-response curve (all p>0.10). In the dose-response evaluable population, least squares mean (90% confidence interval) treatment differences versus placebo for Montgomery-Åsberg Depression Rating Scale total score change at week 16 were −1.4 (−3.9, 1.2), 0.1 (−2.5, 2.7), −0.7 (−3.4, 2.0), and −0.9 (−3.5, 1.6) with 10, 30, 50, and 70 mg lisdexamfetamine dimesylate, respectively. For all vital sign parameters, lisdexamfetamine dimesylate exhibited significant dose-responses for all candidate dose-response curves (all p<0.10), with increases observed as lisdexamfetamine dimesylate dose increased; a linear relationship provided the best fit. Mean±standard deviation changes from augmentation baseline for systolic and diastolic blood pressure and pulse at week 16/early termination were −0.7±9.90 and −0.3±7.24 mm Hg and 0.2±10.57 bpm with placebo and were 1.9±9.47 and 0.8±7.40 mm Hg and 3.6±9.74 bpm with lisdexamfetamine dimesylate (all doses combined). The safety and tolerability profile of lisdexamfetamine dimesylate was consistent with previous studies.Conclusions:Lisdexamfetamine dimesylate augmentation did not provide benefit over placebo in adults with inadequate responses to antidepressant monotherapy based on the assessed efficacy measures.

An Efficient Network Coding-Based Fault-Tolerant Mechanism in WBAN for Smart Healthcare Monitoring Systems

As a key technology in smart healthcare monitoring systems, wireless body area networks (WBANs) can pre-embed sensors and sinks on body surface or inside bodies for collecting different vital signs parameters, such as human Electrocardiograph (ECG), Electroencephalograph (EEG), Electromyogram (EMG), body temperature, blood pressure, blood sugar, blood oxygen, etc. Using real-time online healthcare, patients can be tracked and monitored in normal or emergency conditions at their homes, hospital rooms, and in Intensive Care Units (ICUs). In particular, the reliability and effectiveness of the packets transmission will be directly related to the timely rescue of critically ill patients with life-threatening injuries. However, traditional fault-tolerant schemes either have the deficiency of underutilised resources or react too slowly to failures. In future healthcare systems, the medical Internet of Things (IoT) for real-time monitoring can integrate sensor networks, cloud computing, and big data techniques to address these problems. It can collect and send patient’s vital parameter signal and safety monitoring information to intelligent terminals and enhance transmission reliability and efficiency. Therefore, this paper presents a design in healthcare monitoring systems for a proactive reliable data transmission mechanism with resilience requirements in a many-to-one stream model. This Network Coding-based Fault-tolerant Mechanism (NCFM) first proposes a greedy grouping algorithm to divide the topology into small logical units; it then constructs a spanning tree based on random linear network coding to generate linearly independent coding combinations. Numerical results indicate that this transmission scheme works better than traditional methods in reducing the probability of packet loss, the resource redundant rate, and average delay, and can increase the effective throughput rate.

Inpatient-Derived Vital Sign Parameters Implementation: An Initiative to Decrease Alarm Burden.

To implement data-driven vital sign parameters to reduce bedside monitor alarm burden. Single-center, quality-improvement initiative with historical controls assessing the impact of age-based, inpatient-derived heart rate (HR) and respiratory rate (RR) parameters on a 20-bed acute care ward that serves primarily pediatric cardiology patients. The primary outcome was the number of alarms per monitored bed day (MBD) with the aim to decrease the alarms per MBD. Balancing measures included the frequency of missed rapid response team activations, acute respiratory code events, and cardiorespiratory arrest events in the unit with the new vital sign parameters. The median number of all cardiorespiratory monitor alarms per MBD decreased by 21% from 52 (baseline period) to 41 (postintervention period) (P < .001). This included a 17% decrease in the median HR alarms (9-7.5 per MBD) and a 53% drop in RR alarms (16.8-8.0 per MBD). There were 57 rapid response team activations, 8 acute respiratory code events, and no cardiorespiratory arrest events after the implementation of the new parameters. An evaluation of HRs and RRs recorded at the time of the event revealed that all patients with HRs and/or RRs out of range per former default parameters would also be out of range with the new parameters. Implementation of data-driven HR and iteratively derived RR parameters safely decreased the total alarm frequency by 21% in a pediatric acute care unit.

P019: Prehospital diversion of intoxicated patients to a detoxification facility vs the emergency department: safety and compliance of an EMS direct transport protocol

Introduction: Prehospital transport of patients to an alternative destination (diversion) has been proposed as part of a solution to overcrowding in emergency departments (ED). We evaluated compliance and safety of an EMS bypass protocol allowing paramedics to transport intoxicated patients directly to an alternate facility [Withdrawal Management Services (WMS)], bypassing the ED. Patients were eligible for diversion if they were ≥18 years old, classified as CTAS level III-IV, scored &amp;lt;4 on the Prehospital Early Warning (PHEW) score, and did not have any vital sign parameters in a danger zone (as per PHEW score criteria). Methods: A retrospective analysis was conducted on intoxicated patients presenting to Sudbury EMS. Data was abstracted from EMS reports, hospital medical records, and discharge forms from WMS. Protocol compliance was measured using missed protocol opportunities (patients eligible for diversion but taken directly to the ED) and protocol noncompliance rates; protocol safety was measured using protocol failure (presentation to ED within 48 hours of appropriate diversion) and patient morbidity rates (hospital admission within 48 hours of diversion). Data was analysed qualitatively and quantitatively using proportions. Results: EMS responded to 681 calls for intoxication. Of the 568 taken directly to the ED, 65 met diversion criteria; these were missed protocol opportunities (11%). 113 patients were diverted. There was protocol noncompliance in 41 cases (36%), but 35 were due to incomplete recording of vital signs. There were direct protocol violations in only 6 cases (5%). There was protocol failure in 16 cases (22%), and patient morbidity in 1 case (1%). No patients died within 48 hours of diversion. Conclusion: EMS providers were fairly compliant with the protocol when transporting patients directly to the ED. There was some protocol non-compliance with patients diverted to WMS, though this is largely attributed to incomplete recording of vital signs; direct protocol violations were low. The protocol provides high levels of safety for patients diverted to WMS. Broader implementation of the protocol could reduce the volume of intoxicated patients seen in the ED, and improve quality of care received by this population.