scholarly journals P007: A comparative analysis of qSOFA, SIRS and Early Warning Scores Criteria to identify sepsis in the prehospital setting

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S79-S80 ◽  
Author(s):  
S. AlQahtani ◽  
P. Menzies ◽  
B. Bigham ◽  
M. Welsford
Keyword(s):  
Severe Sepsis ◽  
Screening Tool ◽  
Early Recognition ◽  
Capture Rate ◽  
Data Capture ◽  
Prehospital Setting ◽  
Life Saving ◽  
Data Points ◽  
And Performance ◽  
Definition Of

Introduction: Early recognition of sepsis is key in delivering timely life-saving interventions. The role of paramedics in recognition of these patients is understudied. It is not known if the usual prehospital information gathered is sufficient for severe sepsis recognition. We sought to: 1) evaluate the paramedic medical records (PMRs) of severe sepsis patients to describe epidemiologic characteristics; 2) determine which severe sepsis recognition and prediction scores are routinely captured by paramedics; and 3) determine how these scores perform in the prehospital setting. Methods: We performed a retrospective review of patients ≥18 years who met the definition of severe sepsis in one of two urban Emergency Departments (ED) and had arrived by ambulance over an eighteen-month period. PMRs were evaluated for demographic, physiologic and clinical variables. The information was entered into a database, which auto-filled a tool that determined SIRS criteria, shock index, prehospital critical illness score, NEWS, MEWS, HEWS, MEDS and qSOFA. Descriptive statistics were calculated. Results: We enrolled 298 eligible sepsis patients: male 50.3%, mean age 73 years, and mean prehospital transportation time 30 minutes. Hospital mortality was 37.5%. PMRs captured initial: respiratory rate 88.6%, heart rate 90%, systolic blood pressure 83.2%, oxygen saturation 59%, temperature 18.7%, and Glasgow Coma Scale 89%. Although complete MEWS and HEWS data capture rate was <17%, 98% and 68% patients met the cut-point defining “critically-unwell” (MEWS ≥3) and “trigger score” (HEWS ≥5), respectively. The qSOFA criteria were completely captured in 82% of patients; however, it was positive in only 36%. It performed similarly to SIRS, which was positive in only 34% of patients. The other scores were interim in having complete data captured and performance for sepsis recognition. Conclusion: Patients transported by ambulance with severe sepsis have high mortality. Despite the variable rate of data capture, PMRs include sufficient data points to recognize prehospital severe sepsis. A validated screening tool that can be applied by paramedics is still lacking. qSOFA does not appear to be sensitive enough to be used as a prehospital screening tool for deadly sepsis, however, MEWS or HEWS may be appropriate to evaluate in a large prospective study.

Classification of sepsis, severe sepsis and septic shock: the impact of minor variations in data capture and definition of SIRS criteria

2012 ◽  
Vol 38 (5) ◽  
pp. 811-819 ◽  
Author(s):  
Peter M. C. Klein Klouwenberg ◽  
David S. Y. Ong ◽  
Marc J. M. Bonten ◽  
Olaf L. Cremer
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Data Capture ◽  
Definition Of ◽  
Sepsis And Septic Shock ◽  
The Impact ◽  
Sirs Criteria

Картофелекопатель с ротационной сепарирующей поверхностью

2018 ◽  
Author(s):  
V.M. Alakin ◽  
G.S. Nikitin
Keyword(s):  
Performance Data ◽  
Pilot Studies ◽  
Research Results ◽  
Operating Modes ◽  
Analysis Of Results ◽  
Design Characteristics ◽  
And Performance ◽  
Definition Of

Приведены результаты исследований экспериментального картофелекопателя с ротационной сепарирующей поверхностью. Особое внимание уделяется обоснованию конструктивных параметров и определению рабочих характеристик нового сепарирующего устройства. На основе анализа результатов экспериментальных исследований определены наиболее оптимальные режимы работы экспериментального картофелекопателя.Research results of an experimental potato digger with rotational separating web are published in this article. Special attention is paid to definition of design characteristics and performance data of the new separating device. Admissible operating modes are defined on the basis of the analysis of results of pilot studies of the experimental potato digger.

Positive Workplaces

2009 ◽  
pp. 578-588
Author(s):  
Fred Luthans ◽  
Carolyn M. Youssef
Keyword(s):  
Organizational Behavior ◽  
Psychological Capital ◽  
Future Research ◽  
Positive Organizational Behavior ◽  
Performance Impact ◽  
Research Directions ◽  
Future Research Directions ◽  
And Performance ◽  
Definition Of ◽  
Psychological Capacities

Over the years, both management practitioners and academics have generally assumed that positive workplaces lead to desired outcomes. Unlike psychology, considerable attention has also been devoted to the study of positive topics such as job satisfaction and organizational commitment. However, to place a scientifically based focus on the role that positivity may play in the development and performance of human resources, and largely stimulated by the positive psychology initiative, positive organizational behavior (POB) and psychological capital (PsyCap) have recently been introduced into the management literature. This chapter first provides an overview of both the historical and contemporary positive approaches to the workplace. Then, more specific attention is given to the meaning and domain of POB and PsyCap. Our definition of POB includes positive psychological capacities or resources that can be validly measured, developed, and have performance impact. The constructs that have been determined so far to best meet these criteria are efficacy, hope, optimism, and resiliency. When combined, they have been demonstrated to form the core construct of what we term psychological capital (PsyCap). A measure of PsyCap is being validated and this chapter references the increasing number of studies indicating that PsyCap can be developed and have performance impact. The chapter concludes with important future research directions that can help better understand and build positive workplaces to meet current and looming challenges.

scholarly journals Cerebral Perfusion in Hemodialysis Patients: A Feasibility Study

2021 ◽  
Vol 8 ◽  
pp. 205435812110106
Author(s):  
Jessica Anne Vanderlinden ◽  
Rachel Mary Holden ◽  
Stephen Harold Scott ◽  
John Gordon Boyd
Keyword(s):  
Cerebral Oxygenation ◽  
Capture Rate ◽  
Data Capture ◽  
Dialysis Initiation ◽  
Trial Registration ◽  
Neuropsychological Battery ◽  
Consent Rate ◽  
Dialysis Unit ◽  
Individual Level ◽  
High Data

Background: Patients on hemodialysis (HD) are known to exhibit low values of regional cerebral oxygenation (rSO2) and impaired cognitive functioning. The etiology of both is currently unknown. Objective: To determine the feasibility of serially monitoring rSO2 in patients initiating HD. In addition, we sought to investigate how rSO2 is related to hemodynamic and dialysis parameters. Design: Prospective observational study. Setting: Single-center tertiary academic teaching hospital in Ontario, Canada. Participants: Six patients initiating HD were enrolled in the study. Methods: Feasibility was defined as successful study enrollment (>1 patient/month), successful consent rate (>70%), high data capture rates (>90%), and assessment tolerability. Regional cerebral oxygenation monitoring was performed 1 time/wk for the first year of dialysis. A neuropsychological battery was performed 3 times during the study: before dialysis initiation, 3 months, and 1 year after dialysis initiation. The neuropsychological battery included a traditional screening tool: the Repeatable Battery for the Assessment of Neuropsychological Status, and a robot-based assessment: Kinarm. Results: Our overall consent rate was 33%, and our enrollment rate was 0.4 patients/mo. In total 243 rSO2 sessions were recorded, with a data capture rate of 91.4% (222/243) across the 6 patients. Throughout the study, no adverse interactions were reported. Correlations between rSO2 with hemodynamic and dialysis parameters showed individual patient variability. However, at the individual level, all patients demonstrated positive correlations between mean arterial pressure and rSO2. Patients who had more than 3 liters of fluid showed significant negative correlations with rSO2. Less cognitive impairment was detected after initiating dialysis. Limitation: This small cohort limits conclusions that can be made between rSO2 and hemodynamic and dialysis parameters. Conclusions: Prospectively monitoring rSO2 in patients was unfeasible in a single dialysis unit, due to low consent and enrollment rates. However, rSO2 monitoring may provide unique insights into the effects of HD on cerebral oxygenation that should be further investigated. Trial Registration: Due to the feasibility nature of this study, no trial registration was performed.

Recent Advances in the Management of Cardiogenic Shock

2021 ◽  
Author(s):  
Christine M. Gasperetti
Keyword(s):  
Mortality Rate ◽  
Cardiogenic Shock ◽  
Case Studies ◽  
Mechanical Circulatory Support ◽  
Early Recognition ◽  
Dynamic State ◽  
Circulatory Support ◽  
Mechanical Support ◽  
Recent Advances ◽  
Definition Of

For decades, the cardiogenic shock has remained one of the cardiac illnesses with the highest mortality, as high as 50%. Recent advances have lowered this mortality rate by use of early recognition of shock as well as an increased understanding of both advanced mechanical support and the hemodynamics of myocardial support. Included are the new definition of shock, results of a study of inotropic medications in shock, description, and case studies of mechanical circulatory support, all providing a framework for the overall goal in the management of cardiogenic shock as one to recognize shock, follow its dynamic state, and maximize support to patients toward recovery.

Abstract 3468: Correlation of the Miami Emergency Neurologic Deficit (MEND) Exam Performed in the Field by Paramedics with an Abnormal NIHSS and Final Diagnosis of Stroke for Patients Airlifted from the Scene.

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Angel A Brotons ◽  
Ivette Motola ◽  
Hector F Rivera ◽  
Robert E Soto ◽  
Sandra Schwemmer ◽  
...  
Keyword(s):  
Life Support ◽  
Early Recognition ◽  
Hypertensive Crisis ◽  
Visual Fields ◽  
Healthcare Providers ◽  
Final Diagnosis ◽  
Neurologic Deficit ◽  
Prehospital Setting ◽  
Stroke Patients ◽  
Nihss Score

Introduction Early recognition and rapid transport to a stroke center by prehospital providers is essential in the care of stroke patients. In this study, prehospital providers were trained to perform the Miami Emergency Neurologic Deficit (MEND) exam as part of an 8-hour comprehensive course, Advanced Stroke Life Support (ASLS ® ). The MEND exam was devised to facilitate communication between healthcare providers throughout the continuum of care for stroke patients. It can provide a baseline exam in the prehospital setting, and then be used by nurses for initial evaluation and subsequent exams in the ED, ICU or hospital floor. The MEND exam incorporates all three components of the Cincinnati Prehospital Stroke Scale (CPSS) and six additional components from the NIHSS (level of consciousness, orientation, commands, visual fields, gaze, leg motor, limb ataxia, sensation). The exam takes less than 2 minutes and requires no tools, making it ideal for the Prehospital environment. Purpose Determine the correlation of the MEND exam completed by a prehospital provider on scene to the initial NIHSS performed by the neurologist at the receiving facility, and the final diagnosis. Methods All prehospital providers from three Fire Rescue agencies participated in the training (96 EMT-P, 68 EMT, 5 RN). The Prehospital providers conducted the CPSS, and if abnormal, placed the helicopter team on standby. They then completed the MEND exam and communicated their findings to a receiving hospital stroke neurologist. We retrospectively reviewed the MEND exam performed by the prehospital providers to determine the correlation with the same components of the initial NIHSS at the hospital. While the NIHSS assigned a numerical value to those specific components, the MEND exam did not. Additionally, we examined the final discharge diagnosis to determine how many patients had a stroke or transient ischemic attack (TIA). Results From Sept. 2008 to June 2011, 51 patients met the criteria of having both a MEND exam and NIHSS completed. There were 32 males (63%) and 19 females (37%) with a median age of 67 years (44-98 years). The average NIHSS score was 9 (range 0-30). 90.2% (46 of 51) of patients had an NIHSS that correlated to the findings on the MEND (95% C.I. 90.1-90.3). Of the 5 remaining patients, 1 completely recovered on the flight (diagnosed with a TIA), and 3 had a NIHSS score of 0 and were diagnosed with other conditions. Stroke or TIA was diagnosed in 40 patients (78.4%). Of 37 strokes, 32 were ischemic (86.5%) and 5 hemorrhagic (13.5%). The 11 patients not diagnosed with a stroke had several other pathologies (e.g. seizure, hypertensive crisis, viral encephalitis, complex migraine). Conclusion The MEND exam completed in the Prehospital setting correlated well with the initial NIHSS performed at the receiving facility. The MEND exam is a valuable tool when assessing stroke patients and determining need for air transport.

Cerebral arteriopathy in ACTA2 mutations: a spectrum of disease highlighted by a case of variable penetrance in two siblings

2021 ◽  
pp. 1-6
Author(s):  
Christine Tschoe ◽  
Teddy E. Kim ◽  
Kyle M. Fargen ◽  
Stacey Q. Wolfe
Keyword(s):  
Moyamoya Disease ◽  
De Novo ◽  
Early Recognition ◽  
Smooth Muscle Actin ◽  
Amino Acid Replacement ◽  
Single Mutation ◽  
Cerebral Arteriopathy ◽  
And Performance ◽  
Actin Protein ◽  
Revascularization Procedures

Until recently, cerebral arteriopathy due to heterozygous mutations of the ACTA2 gene was considered a variant of moyamoya disease. However, radiographic analysis of patients with these mutations reveals a distinctive angiographic appearance from that seen in moyamoya disease. Several heterozygous missense ACTA2 mutations have been implicated in the development of this distinct cerebrovascular entity; however, the penetrance and systemic manifestations of these mutations vary based on the location of the amino acid replacement within the α–smooth muscle actin protein. The severity of the phenotype may also differ among patients within a single mutation type. There is limited literature on the safety and efficacy of revascularization procedures for ACTA2 arteriopathy, which have been limited to those patients with known Arg179His mutations. The authors provide a review of the breadth of mutations within the ACTA2 literature and report a case of two siblings with de novo ACTA2 Arg258Cys mutations with differing clinical courses, highlighting the utility of indirect revascularization with 8-year follow-up data. This case highlights the importance of early recognition of the angiographic appearance of ACTA2 cerebral arteriopathy and performance of genetic testing, as the location of the mutation impacts clinical presentation and outcomes.

Trained Helping Behaviors and Group Performance

1991 ◽  
Vol 68 (3_suppl) ◽  
pp. 1291-1298
Author(s):  
Nancy J. Stone ◽  
Molly E. O'Gorman
Keyword(s):  
Group Performance ◽  
Group Members ◽  
Helping Behaviors ◽  
And Performance ◽  
Definition Of ◽  
Crossword Puzzles

96 students assigned to 32 groups were trained in seeking information to judge whether particular helping behaviors would increase application of the behavior found positively correlated with performance. Three-person groups worked crossword puzzles which decreased in difficulty over two trials. Training significantly increased seeking behaviors and performance (reduced errors). Helping behaviors were also more useful when the task was difficult and not helpful when the task was easy, which supports the notion that helping behaviors may even be debilitating under certain circumstances. More research is needed to establish a functional definition of helping behaviors and to investigate the use of helping behaviors on tasks requiring interdependence among group members.

scholarly journals Open-book accounting and trust: influence on buyer-supplier relationship

2018 ◽  
Vol 53 (4) ◽  
pp. 597-621 ◽  
Author(s):  
Lara Cristina Francisco de Almeida Fehr ◽  
Welington Rocha
Keyword(s):  
Data Gathering ◽  
Structured Interview ◽  
Information Value ◽  
Open Book ◽  
Information Process ◽  
Content Type ◽  
And Performance ◽  
Definition Of ◽  
New Research ◽  
Supplier Relationship

PurposeThis paper aims to discuss the role of open-book accounting (OBA) and trust on buyer–supplier relationship satisfaction. The objective of this paper is to analyze how OBA and trust influence satisfaction on the relationship between suppliers and buyers in the Brazilian automotive sector’s supply chain.Design/methodology/approachThe research has been developed based on a qualitative strategy, characterized as explanatory. Data gathering has been conducted through document analysis and semi-structured interview, and content analysis has been used for discourse analysis.FindingsResults show that OBA is unilateral, imposed by the auto manufacturer, representing a selective information process, as suppliers try to protect their information value as far as possible. Trust is partial and cooperation is not spontaneous, both driven by the search for benefits. OBA may yield a positive or a negative outcome with regard to the social and the economic overall satisfaction of suppliers, depending on how the information is used by auto manufacturer.Originality/valueThe main contribution of this article is to provide an understanding of the difficulties of applying the OBA in companies and of the factors that may influence its operation and performance, impacting on satisfaction and continuity of relationships. The paper also contributes with the proposal of a clearer and more objective definition of OBA. Being the intention that new research in this area can be developed from a delimited, clear and objective definition of OBA, allowing better understanding on the subject and comparison among research studies.

New Nonlinear Adaptive Filters with Applications to Chaos

1997 ◽  
Vol 07 (08) ◽  
pp. 1791-1809 ◽  
Author(s):  
Fawad Rauf ◽  
Hassan M. Ahmed
Keyword(s):  
Adaptive Filters ◽  
Broad Class ◽  
Chaotic Map ◽  
New Class ◽  
Chaotic Signals ◽  
Data Points ◽  
Modeling Prediction ◽  
Polynomial Filters ◽  
And Performance ◽  
Nonlinear Adaptive Filtering

We present a new approach to nonlinear adaptive filtering based on Successive Linearization. Our approach provides a simple, modular and unified implementation for a broad class of polynomial filters. We refer to this implementation as the layered structure and note that it offers substantial computational efficiency over previous methods. A new class of Polynomial Autoregressive filters is introduced which can model limit cycle and chaotic dynamics. Existing geometric methods for modeling and characterizing chaotic processes suffer from several drawbacks. They require a huge number of data points to reconstruct the attractor geometry and performance is severely limited by noisy experimental measurements. We present a new method for processing chaotic signals using nonlinear adaptive filters. We demonstrate the modeling, prediction and filtering of these signals. We also show how the prediction error growth rate can be used to estimate the effective Lyapunov exponent of the chaotic map. Our approach requires orders of magnitude fewer data points and is robust to noise in the experimental data. Although reconstruction of the attractor geometry is unnecessary, the adaptive filter contains most of the geometric information.

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