Automatic pre-hospital vital signs waveform and trend data capture fills quality management, triage and outcome prediction gaps. (1/69)

Trauma Triage errors are frequent and costly. What happens in pre-hospital care remains anecdotal because of the dual responsibility of treatment (resuscitation and stabilization) and documentation in a time-critical environment. Continuous pre-hospital vital signs waveforms and numerical trends were automatically collected in our study. Abnormalities of pulse oximeter oxygen saturation (< 95%) and validated heart rate (> 100/min) showed better prediction of injury severity, need for immediate blood transfusion, intra-abdominal surgery, tracheal intubation and chest tube insertion than Trauma Registry data or Pre-hospital provider estimations. Automated means of data collection introduced the potential for more accurate and objective reporting of patient vital signs helping in evaluating quality of care and establishing performance indicators and benchmarks. Addition of novel and existing non-invasive monitors and waveform analyses could make the pulse oximeter the decision aid of choice to improve trauma patient triage.  (+info)

Diagnostic considerations regarding pediatric delirium: a review and a proposal for an algorithm for pediatric intensive care units. (2/69)

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Efficacy and safety of placing nasoenteral feeding tube with transnasal ultrathin endoscope in critically ill patients. (3/69)

BACKGROUND: The placement of an enteral feeding tube is the foundation for providing enteral nutrition. But due to the anatomic complexity of the stomach and the duodenum, to a certain degree, there are some technical difficulties in the placement of postpyloric feeding tube, especially in critically ill patients. This study aimed to evaluate the efficacy and safety of placing nasoenteral feeding tube with a transnasal ultrathin endoscope. METHODS: Totally 49 patients, involving 46 (93.9%) being American Society of Anesthesiologists Physical Status (ASA-PS) grade III (n = 3) and grade IV (n = 43), in whom a nasoenteral feeding tube was placed with a transnasal ultrathin endoscope by using over-the-wire technique. The related clinic information during the procedure including success rate, time required, complications and monitoring results of vital signs was analyzed. RESULTS: The tube was placed at or beyond the Treitz's ligament in all of the 49 cases and the total tube-placement success rate was 100% including the one-time tube-placement success rate 95.9%. The tube placement was successful in 46 (93.9%) cases by transnasal method and 3 (6.1%) cases by transoral method. In the 47 cases whose one-time tube-placement success was obtained, the average procedure time was (6.2 +/- 5.6) minutes. For the 3 patients the endoscope inserted transorally due to the failure of transnasal insertion, the total procedure time was (12.3 +/- 2.1) minutes. In the period of nasoenteral tube placement, the average systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and average pulse oxygen saturation (SpO(2)) did not show any significant change. Apart from 3 patients in whom nausea occurred in the procedure and 2 nasal bleeding, no any other acute complications arose. CONCLUSION: The method of placing nasoenteral feeding tube with the transnasal ultrathin endoscope is not only efficient, time-saving, technically simple, and painless to patients, but also safe especially in critically ill patients.  (+info)

Redesign and evaluation of a patient assessment course. (4/69)

OBJECTIVES: To redesign a patient assessment course using a structured instructional design process and evaluate student learning. DESIGN: Course coordinators collaborated with an instructional design and development expert to incorporate new pedagogical approaches (eg, Web-based self-tests), create new learning activities (eg, peer collaboration on worksheets, SOAP note writing), and develop grading rubrics. ASSESSMENT: Formative and summative surveys were administered for student self-assessment and course evaluation. Seventy-six students (78%) completed the summative survey. The mean course grade was 91.8% + or - 3.6%, with more than 75% of students reporting achievement of primary course learning objectives. All of the additional learning activities helped students meet the learning objectives with the exception of the written drug information response. CONCLUSION: The use of a structured instructional design process to redesign a patient assessment course was successful in creating a curriculum that succeeded in teaching students the specified learning objectives. Other colleges and schools are encouraged to collaborate with an instructional design and development expert to improve the pharmacy curriculum.  (+info)

An automated sleep-analysis system operated through a standard hospital monitor. (5/69)

STUDY OBJECTIVES: Sleep disordered breathing (SDB), a cause of clinically important cardiovascular comorbidity, is often not recognized and diagnosed. An automated system that detects SDB using signals from a standard hospital monitor might provide useful information about the presence and severity of SDB without the need to evaluate the patient in a sleep laboratory and without additional hardware. The aim of this study was to examine the feasibility and accuracy of routine overnight sleep testing for SDB detection by an automated analysis system that operates by analyzing signals derived from standard hospital monitors. METHODS: Comparison of SDB detection by simultaneous "gold-standard" polysomnography and by Morpheus Hx (WideMed, Ltd., Herzliya, Israel), a bedside computerized analysis system (CAS) connected to a standard hospital monitor (ECG, respiratory impedance, end-tidal carbon dioxide (ETCO2), and SpO2). A total of 53 subjects were examined, 36 men and 17 women, all with suspected SDB. Each subject underwent an overnight sleep study, scored both by polysomnography and by CAS. The study was conducted in Brigham and Women's Hospital, Newton Center, MA. RESULTS: CAS-derived values for apnea-hypopnea index and total sleep time, were each found to be highly correlated with the corresponding polysomnography results, with linear regression values of r = 0.96 and r = 0.82, respectively. Mean apnea-hypopnea index values were also quite similar (CAS of 15.5 +/- 20.0 vs polysomnography of 15.4 +/- 24.0). CONCLUSIONS: An automated sleep-analysis system utilizing signals derived from a standard hospital monitor can be considered as a feasible and accurate method to detect and quantify SDB.  (+info)

Impact of vital signs screening & clinician prompting on alcohol and tobacco screening and intervention rates: a pre-post intervention comparison. (6/69)

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Novel representation of physiologic states during critical illness and recovery. (7/69)

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Pitfalls in haemodynamic monitoring based on the arterial pressure waveform. (8/69)

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