Failure to detect ward hypoxaemia and hypotension: contributions of insufficient assessment frequency and patient arousal during nursing assessments

Author(s):  
Remie Saab ◽  
Bernie P. Wu ◽  
Eva Rivas ◽  
Andrew Chiu ◽  
Sofia Lozovoskiy ◽  
...  
Keyword(s):  
Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Katja Bryant ◽  
Kim Anda ◽  
Leslie Busby ◽  
Deborah Camp ◽  
Kerrin Connely ◽  
...  

The current clinical practice guidelines (CPG) based on the NINDS trial from 1995 recommend that vital signs and neuro checks are completed Q15 min x 2 hrs., Q 30 min x 6 hrs., Q 1 hour x 16 hrs. post administration of IV t-PA. The half-life (t ½α ) of Alteplase is <5 min, therefore the current vigilance of neurological assessments may not be necessary. The purpose of this study was to evaluate the timing of when a symptomatic intracranial hemorrhage (sICH) occured in relation to the administration of IV t-PA. Results: A total of 569 patients who received IV t-PA were reviewed. Nine patients, with a mean age of 70 ± 17 years and mean NIHSS of 11, were diagnosed with a sICH within 36 hrs. post IV t-PA administration. The mean time of detecting sICH post IV t-PA administration was 294 minutes. The shortest time was 77 min and the longest time was 814 min (13 hrs and 34 min). The vast majority (77%) of the sICH complications were diagnosed in less than 6 hrs. Conclusions: This analysis suggests that sICH occurs early in the course after administration of IV t-PA. Future guidelines may consider reducing the neurological assessment frequency after 12 hours from IV t-PA administration. Prospective controlled studies are required to validate these results.


2001 ◽  
Vol 25 (6) ◽  
pp. 844-846 ◽  
Author(s):  
Michael A. Sayette ◽  
Christopher S. Martin ◽  
Michael A. Perrott

2019 ◽  
Vol 11 ◽  
pp. 117957351989708
Author(s):  
Jannik Stokholm ◽  
Janni Vagner Steenholt ◽  
Claudio Csilag ◽  
Troels Wesenberg Kjær ◽  
Thomas Christensen

Purpose: The purpose of this systematic literature review was to examine whether different assessment methods contribute to the variance in delirium incidence detected in populations of patients with acute stroke. Specifically, the aim was to address the influence of (1) choice of assessment tool, (2) frequency of assessment, and (3) type of health professional doing the assessment. Methods: We searched MEDLINE, EMBASE, and PsycINFO and included pro- and retrospective cohort studies assessing delirium during hospitalization of adult acute stroke patients. Results: In 30 articles, 24 unique populations were identified and included in the review. Delirium incidence ranged from 1.4% to 75.6% in total and a chi-square test showed a significant heterogeneity across studies (χ2 = 536.5, df = 23, P < .0001). No studies had an assessment for delirium before a patient entered the study. No specific patterns regarding the influence of tool, assessment frequency or health professional were discernible. Discussion: Subgroups analyses were not conducted due to the heterogeneity across studies. Studies comparing delirium assessment tools directly with each other are needed. Conclusions: Delirium is a common complication in acute stroke. No firm conclusions about a possible correlation of choice of tool, assessment frequency, and delirium incidence could be made due to the great heterogeneity of the study populations. Only 1 study compared 2 tools directly with each other. Further studies comparing delirium assessment tools directly with each other are needed.


2020 ◽  
Vol 103 (1) ◽  
pp. 638-648 ◽  
Author(s):  
Hanna K. Eriksson ◽  
Ruan R. Daros ◽  
Marina A.G. von Keyserlingk ◽  
Daniel M. Weary

Author(s):  
Sergey Yu. Perov ◽  
Olga V. Belaya ◽  
Quirino Balzano ◽  
Nina B. Rubtsova

New and necessary improvements of electromagnetic exposure assessment principles and methods are considered and presented. The electromagnetic field exposure assessment is the physical basis for hygienic and biological research and needs s to consider the new technological features of emerging 5G mobile systems in addition to existing 2-4G systems. The new generation of telecommunication networks will cause significantly novel electromagnetic field exposure, in particular for time-frequency and spatial parameters. A complex exposure assessment based on refined broadband measurements seems to be the proper and necessary approach to the enhancement of Russian EMF assessment guidelines. Simple broadband EMF measurements are the common approach for present exposure assessment and cannot be used any longer as the only measure for multiple 5G sources exposure evaluation. Then again broadband measurements are the simple and practical approach for mm wave in-situ exposure assessment. Frequency-selective and code-selective measurements provide detailed EMF level distribution in separate frequency channels, telecommunication services or sources and are a promising approach for objective exposure assessment.


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