Abstract TP396: Improving Documentation of Blood Pressure and Neurological Assessments in Post Alteplase Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Katie BROADWAY ◽  
Danielle Butler Winey ◽  
Jodie Garcia
Keyword(s):  
Blood Pressure ◽  
Real Time ◽  
Hemorrhagic Stroke ◽  
Vital Signs ◽  
Critical Care Nursing ◽  
Missed Opportunities ◽  
Clinical Nurse ◽  
Emergency Department Nurse ◽  
Chart Audits ◽  
Care Nursing

Introduction: Patients who receive alteplase for acute ischemic strokes are at a high risk for conversion to a hemorrhagic stroke and must be monitored closely through frequent vital signs and neurological checks. Documentation of these measures was found to have a low compliance due to various factors such as a new electronic medical record (EMR) and lack of knowledge related to required documentation. Methods: A team was created to address this issue which included the Emergency Department Nurse Manager, a Clinical Nurse Expert, and the Stroke Program Director. Inservices were provided to the ED and Critical Care nursing staff. Daily review of all alteplase patients and chart audits were performed and real-time feedback was given to the staff and leadership caring for the patients. This real-time feedback allowed for corrections to be made if necessary and served as both an educational and accountability opportunity. The feedback was not limited to just missed opportunities but was also used to praise staff for complete documentation. Results: Concurrent monitoring of blood pressure and neurological checks was completed from September 2018 to June 2019 on all alteplase patients. The overall compliance of documentation for blood pressure checks improved from 88% to 93.1% and the compliance for the neurological checks improved from 81.5% to 85.7%. Conclusions: Providing real time feedback is an effective way to notify staff of both missed opportunities and successes. Overall, when the staff has a better understanding of what is required, the patients are given more comprehensive care.

scholarly journals Prediction of Blood Pressure after Induction of Anesthesia Using Deep Learning: A Feasibility Study

2019 ◽  
Vol 9 (23) ◽  
pp. 5135 ◽  
Author(s):  
Young-Seob Jeong ◽  
Ah Reum Kang ◽  
Woohyun Jung ◽  
So Jeong Lee ◽  
Seunghyeon Lee ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Real Time ◽  
Anesthetic Management ◽  
Vital Signs ◽  
Anesthesia Induction ◽  
Induction Phase ◽  
Time Model ◽  
Related Data ◽  
Unseen Data ◽  
Blood Pressure Fluctuation

Anesthesia induction is associated with frequent blood pressure fluctuation such as hypotension and hypertension. If it is possible to precisely predict blood pressure a few minutes ahead, anesthesiologists can proactively give anesthetic management before patients develop hemodynamic problem. The objective of this study is to develop a real-time model for predicting 3-min-ahead blood pressure from the start of anesthesia induction to surgical incision. We used only vital signs and anesthesia-related data obtained during anesthesia-induction phase and designed a bidirectional recurrent neural network followed by fully connected layers. We conducted experiments on our collected data of 102 patients, and obtained mean absolute errors between 8.2 mmHg and 11.1 mmHg and standard deviation between 8.7 mmHg and 12.7 mmHg. The average elapsed time for prediction of a batch of 100 unseen data was about 26.56 milliseconds. We believe that this study shows feasibility of real-time prediction of future blood pressures, and the performance will be improved by collecting more data and finding better model structures.

scholarly journals Prospective Pilot Study of Telehealth As Domiciliary Follow-up after Hematopoietic Cell Transplantation during the COVID19 Pandemic

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 35-36
Author(s):  
Alberto Mussetti ◽  
Maria Queralt Salas Gay ◽  
Maria Condom ◽  
Maite Antonio ◽  
Cristian Ochoa ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Oxygen Saturation ◽  
Real Time ◽  
Emotional Distress ◽  
Patient Monitoring ◽  
Clinical Symptoms ◽  
Vital Signs ◽  
Clinical Information ◽  
Patient Monitoring System

Introduction An increased risk of mortality has been documented in transplanted patients affected by Coronavirus Disease 2019 (COVID19) with an estimated mortality rate between 20-40%. Multiple efforts are ongoing to control COVID19 pandemic, and clinical practice is being adapted at the same time as the pandemic progresses around the world. To reduce unnecessary in-person appointments has become crucial to minimize hospital exposition. Digital technologies allow us to perform real-time monitoring of patients' clinical status. A real-time patient monitoring system through the use of a smartphone application and wearable devices was implemented at our Center during the COVID19 pandemic. Methods Since March 2020, a real time patient monitoring system was implemented at our HCT program. All consecutive adults patients transplanted between April 2020 and July 2020 were considered for the study. Vital signs and relevant clinical information were reported during 14 consecutive days after being discharged, through the online platform provided by Trilema Fundation (saludencasa.trilema.org, Fundación Trilema, Valencia, Spain). Vital signs (cardiac frequency, blood pressure, oxygen saturation) were measured with validated oxymeters (Onyx II®, Nonin Inc, Plymouth MN USA) and blood pressure monitors (iHealth Track®, Mountain View, CA USA). Temperature was measured through domiciliary thermometers. Patients were educated to measure their respiratory frequency. A checklist of clinical symptoms was filled daily. An analogue visual scale (0-10) to detect potential cases of anxiety or depressive disorders was reported daily. Scores of >6 were evaluated by a psycho-oncologist through videoconference. All the data were reported to the online platform using a smartphone app compatible with iPhone and Android systems. A direct chat between patients and physician was available through the app. Clinical information was daily supervised by an experienced HCT hematologist. Clinical interventions were arranged if significant clinical abnormalities were documented. A hematologist with experience in HCT patients revised all the patients' data daily. Programmed alarms were set in case of any of the following situations: fever >38 oC; oxygen saturation <92%; tachicardia >125/bpm, hypotension (sytolic<90 mmHg, diastolic > 60 mmHg; altered mental status; persistent emesis or diarrhea). Patient´s satisfaction questionnaires were evaluated individually after finalizing the 14-days clinical monitoring. Results During the study period, 21 adults underwent HCT and 16 were s were eligible to be recruited into the study (80% feasibility) with team effort and without additional costs. Reasons for not being enrolled were: language incompatibility (1 patient), no consent (1 patient), not compatible smartphone (3 patients). Of the 16 enrolled patients, median age was 50 (range 22-70 years), 37% were female and 94% had lymphoid diseases. Thirty-eight percent of HCTs were autologous and 62% allogeneic. Of the 16 enrolled patients, 25% were not able to adequately use the app due to inability in using smartphone applications. Of the remaining 12 patients, adherence in reporting study data (number of days reported of the planned 14 days study period) was as follows (average): temperature 89%, oxygen saturation 90%, respiratory frequency 70%, cardiac frequency 85%, blood pressure 89%, symptoms reporting 65%, emotional distress 71%. Automatic alarms were activated only 3 times: twice for the presence of clinical symptoms and once, for emotional distress. A videoconference with the psycho-oncologist was requested by one patient only. The chat service to communicate with hospital personnel was used in 4 patients. Data collected with the digital system helped the clinician to early recognize arterial hypertension (1 patient) and acute cutaneous GVHD grade 1 (1 patient). Only two patients of the whole cohort were readmitted within 14 days from discharge due to grade 4 odynophagia due to HSV1/2 reactivation. Patients´ experiences with telehealth systems are reported in table 1. Conclusion Telehealth monitoring can potentially improve patient's follow-up in terms of both physical and psychological outcomes. Technological problems still represent a barrier to a wider application of telehealth monitoring systems in the medical setting. Disclosures Mussetti: Novartis, Gilead: Honoraria, Research Funding. Sureda Balari:Incyte: Consultancy; Janssen: Consultancy, Honoraria; Celgene/Bristol-Myers Squibb: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; BMS: Speakers Bureau; Roche: Honoraria; Takeda: Consultancy, Honoraria, Speakers Bureau; Sanofi: Consultancy, Honoraria; Gilead/Kite: Consultancy, Honoraria; Merck Sharpe and Dohme: Consultancy, Honoraria, Speakers Bureau.

scholarly journals Implementation of MEMS Capacitive Pressure Sensor Design using COMSOL Software

2019 ◽  
Vol 8 (2S8) ◽  
pp. 967-972 ◽  
Keyword(s):  
Blood Pressure ◽  
Blood Vessel ◽  
Blood Vessels ◽  
Real Time ◽  
Pressure Sensor ◽  
Vital Signs ◽  
Capacitive Pressure Sensor ◽  
Sensor Design

This paper is based on the research of emerging implantable medical instrumentations. An implantable Blood Pressure (BP) monitoring Microsystems is very essential to monitor patient’s BP continuously and gives warning when they are extreme and interim levels. The instrument should be accurately measure the both systolic and diastolic values. Based on the readings the BP is categorized in to four (Ideal BP: diastolic=120 and systolic=80, low BP 90 and 60, Pre-hyper values are 140 and 90 and hyper tension values are 190 and 100). BP consists one of the principle vital signs referring to the force entered by circulating blood on the walls of blood vessels. The system consists of instrumented elastic cuff, wrapped around a blood vessel, to sense real time blood pressure. In this paper, a MEMS based capacitor pressure sensor is to be designed with less than the dimensions of 0.4x0.5x0.4mm 3 , and with the approximate capacitance of less than 2pF and 1fF per mmHg.

scholarly journals Early prediction of hemodynamic interventions in the intensive care unit using machine learning

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Asif Rahman ◽  
Yale Chang ◽  
Junzi Dong ◽  
Bryan Conroy ◽  
Annamalai Natarajan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Real Time ◽  
Situational Awareness ◽  
Vital Signs ◽  
Stability Index ◽  
Hemodynamic Instability ◽  
Data Availability ◽  
Prediction Confidence ◽  
Physiologic Parameters

Abstract Background Timely recognition of hemodynamic instability in critically ill patients enables increased vigilance and early treatment opportunities. We develop the Hemodynamic Stability Index (HSI), which highlights situational awareness of possible hemodynamic instability occurring at the bedside and to prompt assessment for potential hemodynamic interventions. Methods We used an ensemble of decision trees to obtain a real-time risk score that predicts the initiation of hemodynamic interventions an hour into the future. We developed the model using the eICU Research Institute (eRI) database, based on adult ICU admissions from 2012 to 2016. A total of 208,375 ICU stays met the inclusion criteria, with 32,896 patients (prevalence = 18%) experiencing at least one instability event where they received one of the interventions during their stay. Predictors included vital signs, laboratory measurements, and ventilation settings. Results HSI showed significantly better performance compared to single parameters like systolic blood pressure and shock index (heart rate/systolic blood pressure) and showed good generalization across patient subgroups. HSI AUC was 0.82 and predicted 52% of all hemodynamic interventions with a lead time of 1-h with a specificity of 92%. In addition to predicting future hemodynamic interventions, our model provides confidence intervals and a ranked list of clinical features that contribute to each prediction. Importantly, HSI can use a sparse set of physiologic variables and abstains from making a prediction when the confidence is below an acceptable threshold. Conclusions The HSI algorithm provides a single score that summarizes hemodynamic status in real time using multiple physiologic parameters in patient monitors and electronic medical records (EMR). Importantly, HSI is designed for real-world deployment, demonstrating generalizability, strong performance under different data availability conditions, and providing model explanation in the form of feature importance and prediction confidence.

scholarly journals FRI0618-HPR EFFECTS OF MUSIC THERAPY ON PAIN, ANXIETY, AND VITAL SIGNS IN CHRONIC INFLAMMATORY RHEUMATIC DISEASES PATIENTS DURING BIOLOGICAL DRUGS INFUSION

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 914.2-914
Author(s):  
S. Boussaid ◽  
M. Ben Majdouba ◽  
S. Jriri ◽  
M. Abbes ◽  
S. Jammali ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Music Therapy ◽  
Systolic Blood Pressure ◽  
Respiratory Rate ◽  
Vital Signs ◽  
Biological Therapies ◽  
Biological Drugs ◽  
Pain Anxiety ◽  
The Mean

Background:Music therapy is based on ancient cross-cultural beliefs that music can have a “healing” effect on mind and body. Research determined that listening to music can increase comfort and relaxation, relieve pain, lower distress, reduce anxiety, improve positive emotions and mood, and decrease psychological symptoms. Music therapy has been used greatly in various medical procedures to reduce associated anxiety and pain. Patients have a high level of anxiety when they are in the hospital, this is the case of patients with rheumatic diseases who consult regularly to have intravenous infusion of biological therapies.Objectives:The purpose of this study was to examine the effectiveness of music therapy on pain, anxiety, and vital signs among patients with chronic inflammatory rheumatic diseases during intravenous infusion of biological drugs.Methods:Fifty patients were divided into two groups: The experimental group G1 (n=25) received drug infusion while lestening to soft music (30 minutes); and the control group G2 (n=25) received only drug infusion. Measures include pain, anxiety, vital signs (blood pressure, heart rate and respiratory rate). The pain was measured using visual analogic scale (VAS). The state-trait anxiety inventory (STAI) was used for measuring anxiety, low anxiety ranges from 20 to 39, the moderate anxiety ranges from 40 to 59, and high anxiety ranges from 60 to 80. Vital signs (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], and respiratory rate [RR]) were measured before, during and immediately after the infusion.Statistical package for social sciences (SPSS) was used for analysis.Results:The mean age in G1 was 44.45 years (26-72) with a sex ratio (M/F) of 0.8. Including the 25 patients, 12 had rheumatoid arthritis, 10 had ankylosing spondylitis and 3 had psoriatic arthritis. The mean disease duration was 8 years. In G2, the mean age was 46 years (25-70) with a sex ratio (M/F) of 0.75, 12 had rheumatoid arthritis, 11 had ankylosing spondylitis and 2 had psoriatic arthritis. The mean disease duration was 7.5 years. The biological drugs used were: Infliximab in 30 cases, Tocilizumab in 12 cases and Rituximab in 8 cases.Before the infusion, the patients of experimental group had a mean VAS of 5/10±3, a mean STAI of 50.62±6.01, a mean SBP of 13.6 cmHg±1.4, a mean DBP of 8.6 cmHg±1, a mean HR of 85±10 and a mean RR of 18±3. While in control group the mean VAS was 5.5±2, the mean STAI was 50.89±5.5, the mean SBP was 13.4±1.2, the mean DBP was 8.8±1.1, the mean HR was 82±8 and the mean RR was 19±2.During the infusion and after music intervention in G1, the mean STAI became 38.35±5 in G1 versus 46.7±5.2 in G2 (p value=0.022), the mean SBP became 12.1±0.5 in G1 versus 13±1 in G2 (p=0.035), the mean DBP became 8.1±0.8 in G1 versus 8.4±0.9 in G2 (p=0.4), the mean HR became 76±9 in G1 versus 78±7 in G2 (p=0.04) and the mean RR became 17.3±2.1 in G1 versus 18.2±1.7 in G2 (p=0.39).This study found a statistically significant decrease in anxiety, systolic blood pressure and heart rate in patients receiving music interventions during biological therapies infusion, but no significant difference were identified in diastolic blood pressure and respiratory rate.Conclusion:The findings provide further evidence to support the use of music therapy to reduce anxiety, and lower systolic blood pressure and heart rate in patients with rheumatic disease during biological therapies infusion.References:[1] Lin, C., Hwang, S., Jiang, P., & Hsiung, N. (2019).Effect of Music Therapy on Pain After Orthopedic Surgery -A Systematic review and Meta-Analysis. Pain Practice.Disclosure of Interests:None declared

Critical Care Nursing in the Philippines

2021 ◽  
Vol 33 (1) ◽  
pp. 75-87
Author(s):  
Rudolf Cymorr Kirby P. Martinez ◽  
Maria Isabelita C. Rogado ◽  
Diana Jean F. Serondo ◽  
Gil P. Soriano ◽  
Karen Czarina S. Ilano
Keyword(s):  
Critical Care ◽  
The Philippines ◽  
Critical Care Nursing ◽  
Care Nursing

scholarly journals Prehospital triage of patients with acute cardiac complaints: study protocol of HART-c, a multicentre prospective study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041553
Author(s):  
Enrico de Koning ◽  
Tom E Biersteker ◽  
Saskia Beeres ◽  
Jan Bosch ◽  
Barbra E Backus ◽  
...  
Keyword(s):  
Real Time ◽  
Patient Outcomes ◽  
Medical Records ◽  
Vital Signs ◽  
Hospital Data ◽  
Ed Overcrowding ◽  
Prehospital Triage ◽  
Ed Visits ◽  
Multicentre Prospective Study ◽  
At Home

IntroductionEmergency department (ED) overcrowding is a major healthcare problem associated with worse patient outcomes and increased costs. Attempts to reduce ED overcrowding of patients with cardiac complaints have so far focused on in-hospital triage and rapid risk stratification of patients with chest pain at the ED. The Hollands-Midden Acute Regional Triage—Cardiology (HART-c) study aimed to assess the amount of patients left at home in usual ambulance care as compared with the new prehospital triage method. This method combines paramedic assessment and expert cardiologist consultation using live monitoring, hospital data and real-time admission capacity.Methods and analysisPatients visited by the emergency medical services (EMS) for cardiac complaints are included. EMS consultation consists of medical history, physical examination and vital signs, and ECG measurements. All data are transferred to a newly developed platform for the triage cardiologist. Prehospital data, in-hospital medical records and real-time admission capacity are evaluated. Then a shared decision is made whether admission is necessary and, if so, which hospital is most appropriate. To evaluate safety, all patients left at home and their general practitioners (GPs) are contacted for 30-day adverse events.Ethics and disseminationThe study is approved by the LUMC’s Medical Ethics Committee. Patients are asked for consent for contacting their GPs. The main results of this trial will be disseminated in one paper.DiscussionThe HART-c study evaluates the efficacy and feasibility of a prehospital triage method that combines prehospital patient assessment and direct consultation of a cardiologist who has access to live-monitored data, hospital data and real-time hospital admission capacity. We expect this triage method to substantially reduce unnecessary ED visits.

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