scholarly journals Longitudinal remotely mentored self-performed lung ultrasound surveillance of paucisymptomatic Covid-19 patients at risk of disease progression

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Andrew W. Kirkpatrick ◽  
Jessica L. McKee ◽  
John M. Conly
Keyword(s):  
At Risk ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Human Life ◽  
Vital Signs ◽  
Home Monitoring ◽  
Cost Effective ◽  
Care Providers ◽  
Vital Signs Monitoring ◽  
Ultrasound Probes

AbstractCOVID-19 has impacted human life globally and threatens to overwhelm health-care resources. Infection rates are rapidly rising almost everywhere, and new approaches are required to both prevent transmission, but to also monitor and rescue infected and at-risk patients from severe complications. Point-of-care lung ultrasound has received intense attention as a cost-effective technology that can aid early diagnosis, triage, and longitudinal follow-up of lung health. Detecting pleural abnormalities in previously healthy lungs reveal the beginning of lung inflammation eventually requiring mechanical ventilation with sensitivities superior to chest radiographs or oxygen saturation monitoring. Using a paradigm first developed for space-medicine known as Remotely Telementored Self-Performed Ultrasound (RTSPUS), motivated patients with portable smartphone support ultrasound probes can be guided completely remotely by a remote lung imaging expert to longitudinally follow the health of their own lungs. Ultrasound probes can be couriered or even delivered by drone and can be easily sterilized or dedicated to one or a commonly exposed cohort of individuals. Using medical outreach supported by remote vital signs monitoring and lung ultrasound health surveillance would allow clinicians to follow and virtually lay hands upon many at-risk paucisymptomatic patients. Our initial experiences with such patients are presented, and we believe present a paradigm for an evolution in rich home-monitoring of the many patients expected to become infected and who threaten to overwhelm resources if they must all be assessed in person by at-risk care providers.

scholarly journals Implementation of Clinical Algorithms for Take-Home Naloxone and Buprenorphine/ Naloxone in Emergency Rooms: SuboxED Project Evaluation

2020 ◽  
Vol 5 (10) ◽  
Keyword(s):  
At Risk ◽  
Health Care Providers ◽  
Point Of Care ◽  
Free Access ◽  
Opioid Overdose ◽  
Care Providers ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Eligibility Criteria ◽  
Clinical Algorithm

Introduction: Emergency departments (EDs) are often the first point of care for people at risk of opioid-related overdose, an issue on the rise in Canada. Dispensing take-home naloxone (THN) and/or initiating opioid agonist treatment (OAT) in the ED can help prevent overdose. Methods: The SuboxED (CC-BY-NC-SA) project evaluated the implementation of a clinical algorithm for dispensing THN and prescribing buprenorphine/naloxone (B/n) in three EDs in the province of Québec. We performed a retrospective review of ED electronic medical records flagged as “at risk of opioid overdose (ROO).” This study included an implementation process from April 1, 2018 to April 30, 2019, and an evaluation of the project implementation for eligible patients from May 1 to December 31, 2019. We also administered satisfaction surveys to medical teams and patients. Results: A total of 877 (36.2%) patient records were included in the analysis. Of these, 62% had a confirmed diagnostic of opioid use disorder (OUD) and 70.8% met eligibility criteria for naloxone prescription. However, only 7.7 % were given a prescription or take-home naloxone in the ED, and 12.4 % were initiated on B/n in the ED or in the community after the ED visit. Seven patients and 125 health care providers from EDs, clinics, and retail pharmacies completed the survey. Conclusion: The SuboxED project demonstrated the feasibility of implementing a clinical algorithm for dispensing THN and initiating B/n in the ED, and of evaluating its efficacy in the 6 months following implantation. In addition to advocating for free access to THN in EDs, scaling up the uptake of the algorithm in EDs is the next challenge.

Clinical Relevance of Home Monitoring of Vital Signs and Blood Glucose Levels: A Narrative Review

2019 ◽  
Vol 35 (4) ◽  
pp. 334-339
Author(s):  
Jessica P. Lee ◽  
Georgina Freeman ◽  
Michelle Cheng ◽  
Lauren Brown ◽  
Hector De la Hoz Siegler ◽  
...  
Keyword(s):  
Statistical Methods ◽  
Vital Signs ◽  
Home Monitoring ◽  
Reporting Quality ◽  
Narrative Review ◽  
Medical Decision ◽  
Health Practitioner ◽  
Quality Reporting ◽  
Vital Signs Monitoring ◽  
Monitoring Technologies

AbstractObjectivesWe sought to assess the presence and reporting quality of peer-reviewed literature concerning the accuracy, precision, and reliability of home monitoring technologies for vital signs and glucose determinations in older adult populations.MethodsA narrative literature review was undertaken searching the databases Medline, Embase, and Compendex. Peer-reviewed publications with keywords related to vital signs, monitoring devices and technologies, independent living, and older adults were searched. Publications between the years 2012 and 2018 were included. Two reviewers independently conducted title and abstract screening, and four reviewers independently undertook full-text screening and data extraction with all disagreements resolved through discussion and consensus.ResultsTwo hundred nine articles were included. Our review showed limited assessment and low-quality reporting of evidence concerning the accuracy, precision, and reliability of home monitoring technologies. Of 209 articles describing a relevant device, only 45 percent (n = 95) provided a citation or some evidence to support their validation claim. Of forty-eight articles that described the use of a comparator device, 65 percent (n = 31) used low-quality statistical methods, 23 percent (n = 11) used moderate-quality statistical methods, and only 12 percent (n = 6) used high-quality statistical methods.ConclusionsOur review found that current validity claims were based on low-quality assessments that do not provide the necessary confidence needed by clinicians for medical decision-making purposes. This narrative review highlights the need for standardized health technology reporting to increase health practitioner confidence in these devices, support the appropriate adoption of such devices within the healthcare system, and improve health outcomes.

scholarly journals Potential Use of Remote Telesonography as a Transformational Technology in Underresourced and/or Remote Settings

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Linping Pian ◽  
Lawrence M. Gillman ◽  
Paul B. McBeth ◽  
Zhengwen Xiao ◽  
Chad G. Ball ◽  
...  
Keyword(s):  
Urban Areas ◽  
Point Of Care ◽  
Traumatic Injury ◽  
Trauma System ◽  
Cost Effective ◽  
Point Of Care Ultrasound ◽  
Care Providers ◽  
Mortality And Morbidity ◽  
Medical Centers ◽  
Human Exploration

Mortality and morbidity from traumatic injury are twofold higher in rural compared to urban areas. Furthermore, the greater the distance a patient resides from an organized trauma system, the greater the likelihood of an adverse outcome. Delay in timely diagnosis and treatment contributes to this penalty, regardless of whether the inherent barriers are geographic, cultural, or socioeconomic. Since ultrasound is noninvasive, cost-effective, and portable, it is becoming increasingly useful for remote/underresourced (R/UR) settings to avoid lengthy patient travel to relatively inaccessible medical centers. Ultrasonography is a user-dependent, technical skill, and many, if not most, front-line care providers will not have this advanced training. This is particularly true if care is being provided by out-of-hospital, “nontraditional” providers. The human exploration of space has forced the utilization of information technology (IT) to allow remote experts to guide distant untrained care providers in point-of-care ultrasound to diagnose and manage both acute and chronic illness or injuries. This paradigm potentially brings advanced diagnostic imaging to any medical interaction in a setting with internet connectivity. This paper summarizes the current literature surrounding the development of teleultrasound as a transformational technology and its application to underresourced settings.

scholarly journals Reversing the Stop Signs to Proactive Nursing Care in DNR Patients

2015 ◽  
Author(s):  
Natalie Volpe
Keyword(s):  
Critical Care ◽  
Interpersonal Relationships ◽  
Health Care Providers ◽  
Nursing Care ◽  
Vital Signs ◽  
Care Providers ◽  
Do Not Resuscitate ◽  
Structured Interviews ◽  
Code Status ◽  
Vital Signs Monitoring

<p>Research has supported that patients with a do-not-resuscitate (DNR) code status receive less aggressive treatment and have higher mortality rates compared to those without DNR orders, after adjusting for confounding factors (Cohn, Fritz, Frankau, Laroche, & Fuld, 2012). Health care providers erroneously understand DNR status to imply that a patient is dying and should not undergo other life-saving interventions (Hewitt & Marco, 2004). Surveyed critical care nurses revealed that they believed that interventions such as complete history and physicals, checking vital signs, monitoring neuro status, and ICU admission should not be performed as regular interventions on patients with a DNR status (Sherman & Branum, 1995). The purpose of this paper was to explore the factors that contribute to less aggressive nursing care in DNR patients that are not actively dying from a terminal illness. This study employed a<strong> </strong>qualitative approach using semi-structured interviews. The sample consisted of five critical care registered nurses. Three common themes were revealed: the definition of DNR code status; interpersonal relationships between nurse/patient; and personal views and feelings directing nursing care. Recommendations and implications for practice are discussed.</p>

scholarly journals Point of care lung ultrasound is useful when screening for CoVid-19 in Emergency Department patients.

2020 ◽  
Author(s):  
Andrea Hankins ◽  
Heejung Bang ◽  
Paul Walsh
Keyword(s):  
Emergency Department ◽  
Null Hypothesis ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Vital Signs ◽  
P Value ◽  
Inclusion Criteria ◽  
Upper Respiratory Infection ◽  
Life Threatening ◽  
Emergency Department Patients

Background CoVid-19 can be a life-threatening lung disease or a trivial upper respiratory infection depending on whether the alveoli are involved. Emergency department (ED) screening in symptomatic patients with normal vital signs is frequently limited to oro-nasopharyngeal swabs. We tested the null hypothesis that patients being screened for CoVid-19 in the ED with normal vital signs and without hypoxia would have a point-of-care lung ultrasound (LUS) consistent with CoVid-19 less than 2% of the time. Methods Subjects Subjects were identified from ED ultrasound logs. Inclusion criteria Age 14 years or older with symptoms prompting ED screening for CoVid-19. Exclusion criteria Known congestive heart failure or other chronic lung condition likely to cause excessive B lines on LUS. Intervention Structured blinded ultrasound review and chart review Analysis We used an exact hypothesis tests for binomial random variables. We also measured LUS diagnostic performance using computed tomography as the gold standard. Results We reviewed 77 charts; 62 met inclusion criteria. Vital signs were normal in 31 patients; 10 (32%) of these patients had LUS consistent with CoVid-19. We rejected the null hypothesis (p-value for bitest <0.001). The treating physicians' interpretation of their own point of care lung ultrasounds had a sensitivity of 100% (95% CI 75%, 100%) and specificity of 80% (95% CI 68%, 89%). Conclusion LUS has a meaningful detection rate for CoVid-19 in symptomatic emergency department patients with normal vital signs. We recommend at least LUS be used in addition to PCR testing when screening symptomatic ED patients for CoVid-19.

scholarly journals Protocol on a multicentre statistical and economic modelling study of risk-based stratified and personalised screening for diabetes and its complications in India (SMART India)

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e039657
Author(s):  
Sobha Sivaprasad ◽  
Rajiv Raman ◽  
Ramachandran Rajalakshmi ◽  
Viswanathan Mohan ◽  
Mohan Deepa ◽  
...  
Keyword(s):  
At Risk ◽  
Diagnostic Accuracy ◽  
Low Income ◽  
Point Of Care ◽  
Cost Effective ◽  
Glycated Haemoglobin ◽  
Economic Modelling ◽  
Community Screening ◽  
Study Results ◽  
Modelling Study

IntroductionThe aim of this study is to develop practical and affordable models to (a) diagnose people with diabetes and prediabetes and (b) identify those at risk of diabetes complications so that these models can be applied to the population in low-income and middle-income countries (LMIC) where laboratory tests are unaffordable.Methods and analysisThis statistical and economic modelling study will be done on at least 48 000 prospectively recruited participants aged 40 years or above through community screening across 20 predefined regions in India. Each participant will be tested for capillary random blood glucose (RBG) and complete a detailed health-related questionnaire. People with known diabetes and all participants with predefined levels of RBG will undergo further tests, including point-of-care (POC) glycated haemoglobin (HbA1c), POC lipid profile and POC urine test for microalbuminuria, retinal photography using non-mydriatic hand-held retinal camera, visual acuity assessment in both eyes and complete quality of life questionnaires. The primary aim of the study is to develop a model and assess its diagnostic performance to predict HbA1c diagnosed diabetes from simple tests that can be applied in resource-limited settings; secondary outcomes include RBG cut-off for definition of prediabetes, diagnostic accuracy of cost-effective risk stratification models for diabetic retinopathy and models for identifying those at risk of complications of diabetes. Diagnostic accuracy inter-tests agreement, statistical and economic modelling will be performed, accounting for clustering effects.Ethics and disseminationThe Indian Council of Medical Research/Health Ministry Screening Committee (HMSC/2018–0494 dated 17 December 2018 and institutional ethics committees of all the participating institutions approved the study. Results will be published in peer-reviewed journals and will be presented at national and international conferences.Trial registration numberISRCTN57962668 V1.0 24/09/2018.

Abstract TP374: Risk Assessment Scale for the Consideration of Long-Term Alternate Means of Nutrition

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Michael Omoniyi Ayanbadejo ◽  
Melissa Hogan ◽  
Wendy Giglio ◽  
Lee Guterman
Keyword(s):  
At Risk ◽  
Neurological Disease ◽  
Vital Signs ◽  
Cost Effective ◽  
Barium Swallow ◽  
Number Of Patients ◽  
Nutritional Needs ◽  
Peg Tube ◽  
Risk Of Aspiration

Objectives: The decision to utilize percutaneous enteral feeding for hospital patients after stroke or as a result neurological disease is based on qualitative measures. There is no defined protocol for the evaluation of patients who may require alternative means of feeding such as a PEG tube. We developed a quantitative scale HOGLIO scale.We developed a quantitative scale to determine which patients with neurologic disease/deficits will require Percutaneous Enteral Gastrostomy. The scale identifies patients at risk for aspiration by applying a score based on patient’s (a) level of arousal as measure by the Observational Scale Level of Arousal (OSLA),(b)respiratory status as measured by peripheral capillary oxygen saturation (c)aspiration risk as measured by formal bedside swallow evaluation/instrumental assessment (d)Long term nutritional needs as measured by patient’s ability to meet nutritional needs orally. Methods: We conducted a prospective registry review of patients with consultation for speech and swallow on the stroke ward at our comprehensive stroke Center, between June-July 2019. The following variables were collected for each patients; Age ,NIH score, OSLA score, HOGLIO score, vital signs ,medication list and per oral diet status. Result: The patients ranged in age from 21-85 years with mean age of 63.6 years. Patients with H score > 10 need PEG. We found that the strongest correlation between the need for PEG and H score was in the level of consciousness .Our preliminary data indicate that score greater than 10 is a good indicator for PEG.A high score on the Level of Arousal testing appears to be indicative of a need for PEG, as is a failed barium swallow, and a failed bedside swallowing test. Conclusion: Historically patients with neurological disease are at risk of aspiration. The PEG tube can be used to improve nutrition and meet metabolic needs of patients at higher risk of aspiration. It is cost effective and associated with lower complications compared to parenteral nutrition. The pilot study may suggest a relationship between HOGLIO score, risk of aspiration and need for an alternative route of nutrition such as PEG. We propose to carry out our study on a larger number of patients to further understand the relationships.

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