Post-operative vital signs: How often is too often?

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 210-210
Author(s):  
Kristen Filson ◽  
Colleen Atherholt ◽  
Meredith Simoes ◽  
Michael DiPalma ◽  
Susheela John ◽  
...  
Keyword(s):  
Vital Sign ◽  
Best Practice ◽  
Vital Signs ◽  
Time Frame ◽  
Evidence Based ◽  
Background Current ◽  
Safe Patient Care ◽  
Published Evidence ◽  
Blood Pressures ◽  
Operative Monitoring

210 Background: Current protocol for post-operative patients admitted to medical-surgical/telemetry units from post anesthesia care units states vital signs are taken every 15 minutes for 1 hour, every 30 minutes for 2 hours and then, every 4 hours for 24 hours. To date, published evidence-based research regarding the frequency and duration of vital signs to safely monitor post-operative patients is limited. The goal is to determine best practice in post-operative vital sign monitoring to ensure safe patient care. The purpose of this review is to determine what frequency and duration of vital signs is required to identify a deviation greater than 20% of patient baseline to ensure safe post-operative monitoring of patients. Methods: A total of 742 post-operative patients’ charts were evaluated. A time frame in which vital signs deviated greater than 20% from patient baseline was established from the data collected. A chart was created depicting these results; listing the total deviations by individual vital sign and time frame. Results: Results show blood pressure and heart rate are the vital signs that have the greatest deviation from baseline followed by pulse-oximetry. Temperature deviations are widespread, while changes in respiratory rate are seen within the first hour. When looking at specific percentages, it was noted that 65% of the total patients reviewed had a 20% deviation from their baseline vital signs. Blood pressures made up 50% of those deviations, while heart rates made up 45%. A total of 27% of the deviations occurred 4-8 hours after admission, 13% of deviations occurred 8-12 hours after admission, 9% of deviations occurred 1.5 hours after admission, and 7% of deviations occurred 12-16 hours after admission. Conclusions: Based on these results, the best times to take post-operative vitals to ensure deviations are detected are: every 15 minutes for 30 minutes upon admission, 1.5 hours after admission, 4 hours after admission, and then every 4 hours for 20 hours. Findings indicate vital signs can safely be taken less frequently in post-operative patients admitted to medical-surgical/telemetry units.

scholarly journals Vestibular Physical Therapy Treatment of Individuals Exposed to Directed Energy

2021 ◽  
Author(s):  
Carrie W Hoppes ◽  
Karen H Lambert ◽  
Brooke N Klatt ◽  
Orlando D Harvard ◽  
Susan L Whitney
Keyword(s):  
Physical Therapy ◽  
Treatment Program ◽  
Best Practice ◽  
Physical Therapist ◽  
Health Condition ◽  
Evidence Based ◽  
Joint Force ◽  
Therapy Regimen ◽  
Published Evidence ◽  
Directed Energy

ABSTRACT Introduction Following suspected sonic attacks on U.S. Embassies, a subset of individuals presented with a unique cluster of symptoms believed to have resulted from exposure to directed energy. Directed energy has been described as exposure to a unique sound/pressure phenomenon such as infrasonic or ultrasonic acoustic or electromagnetic energy. The Joint Force does not have an established protocol to guide vestibular physical therapy for individuals exposed to directed energy. Therefore, we have provided evidence-based guidance for the treatment of oculomotor- and vestibular-related impairments from similar populations. Materials and Methods Published evidence was used to inform suggestions for clinical best practice. We offer resources for the management of non-oculomotor- and non-vestibular-related impairments, before discussing physical therapy interventions for dizziness and imbalance. Results The physical therapist should design a treatment program that addresses the individual’s health condition(s), body structure and function impairments, activity limitations, and participation restrictions after suspected directed energy exposure. This treatment program may include static standing, compliant surface standing, weight shifting, modified center of gravity, gait, and gaze stabilization or vestibular-ocular reflex training. Habituation may also be prescribed. Interventions were selected that require little to no specialized equipment, as such equipment may not be available in all settings (i.e., operational environments). Conclusions Evidence-based guidance for prescribing a comprehensive vestibular physical therapy regimen for individuals exposed to directed energy may aid in their rehabilitation and return to duty. This standardized approach can help physical therapists to treat complaints that do not match any previously known medical conditions but resemble brain injury or vestibular pathology.

scholarly journals Effect of Alemtuzumab Infusions on Vital Signs

2020 ◽  
Vol 22 (2) ◽  
pp. 53-59 ◽  
Author(s):  
Angel Chinea ◽  
William David Honeycutt ◽  
Tamara Miller ◽  
Donna Graves ◽  
Alan Jacobs ◽  
...  
Keyword(s):  
Vital Sign ◽  
Vital Signs ◽  
Serious Adverse Events ◽  
Point Change ◽  
Relapsing Remitting ◽  
Blood Pressures ◽  
Clinically Significant ◽  
Relapsing Remitting Multiple Sclerosis ◽  
Potentially Clinically Significant ◽  
Infusion Duration

Abstract Background: Alemtuzumab efficacy and safety were established in phase 3 randomized trials. We characterize vital signs during and after the first alemtuzumab infusion course. Methods: Patients with relapsing-remitting multiple sclerosis commercially prescribed alemtuzumab 12 mg/day on 5 consecutive days (initial course) were enrolled in this prospective, observational study. Preinfusion medications included methylprednisolone, antihistamine, and antipyretics. Primary end point: change from precourse baseline in vital signs during and 2 hours after each alemtuzumab infusion. Secondary end points: infusion duration and serious adverse events (AEs) starting within 24 hours and within 7 days after infusion (AEs collected up to 15 days after treatment). Potentially clinically significant vital sign abnormalities were based on predefined thresholds from literature review. Results: In the 304 patients treated, minimal increases in mean systolic (≤8 mm Hg) and diastolic (≤3 mm Hg) blood pressures from precourse baseline were observed on infusion days 3 to 5. An increase in mean heart rate (20 beats per minute) during the first infusion day normalized by day 2, and smaller increases (5 beats per minute) occurred during subsequent infusions. Serious AEs occurred in two patients (0.7%) during or within 24 hours after infusion and in three patients (1.0%) within 7 days. Mean/median infusion duration was 4 hours. Vital sign abnormalities with potential clinical significance occurred in 62.5% of patients. Conclusions: Although most patients had potentially clinically significant vital sign abnormalities, mean changes from baseline during and after infusion of the first alemtuzumab course were clinically insignificant. No new safety signals were detected.

Limitations in the evidence for safe and effective medications for older people

2017 ◽  
pp. 189-194
Author(s):  
Antonio Cherubini ◽  
Graziano Onder
Keyword(s):  
Clinical Trials ◽  
Cognitive Impairment ◽  
Clinical Practice ◽  
Older Patients ◽  
Best Practice ◽  
Randomized Clinical Trials ◽  
Evidence Based ◽  
Geriatric Syndromes ◽  
Published Evidence ◽  
Based Medicine

In the last decades, evidence-based medicine has emerged as the approach to promote the best clinical practice for health problems. It collates the best published evidence, preferentially based on randomized clinical trials, to guide clinical practice. However, the growing older population challenges the evidence underpinning ‘best practice’. Many older patients are characterized by multimorbidity and polypharmacotherapy, present various degrees of functional and cognitive impairment, and are at risk of developing geriatric syndromes. For these reasons they have been almost systematically excluded from clinical trials. In addition, the results of clinical trials are difficult to apply to patients with these characteristics, given the high risk of drug–drug and drug–disease interactions. An effort to promote a greater involvement of older patients in clinical research is needed, using specific measures to facilitate the participation of complex older patients, who are representative of those treated in clinical practice.

Meeting the Best Practice for Hearing Aid Verification in Children: Challenges and Future Directions

2019 ◽  
Vol 28 (4) ◽  
pp. 877-894
Author(s):  
Nur Azyani Amri ◽  
Tian Kar Quar ◽  
Foong Yen Chong
Keyword(s):  
Clinical Practice ◽  
Hearing Aids ◽  
Best Practice ◽  
Hearing Aid ◽  
Evidence Based ◽  
Future Directions ◽  
Major Barrier ◽  
Klang Valley ◽  
Age Range ◽  
Fitting Hearing Aids

Purpose This study examined the current pediatric amplification practice with an emphasis on hearing aid verification using probe microphone measurement (PMM), among audiologists in Klang Valley, Malaysia. Frequency of practice, access to PMM system, practiced protocols, barriers, and perception toward the benefits of PMM were identified through a survey. Method A questionnaire was distributed to and filled in by the audiologists who provided pediatric amplification service in Klang Valley, Malaysia. One hundred eight ( N = 108) audiologists, composed of 90.3% women and 9.7% men (age range: 23–48 years), participated in the survey. Results PMM was not a clinical routine practiced by a majority of the audiologists, despite its recognition as the best clinical practice that should be incorporated into protocols for fitting hearing aids in children. Variations in practice existed warranting further steps to improve the current practice for children with hearing impairment. The lack of access to PMM equipment was 1 major barrier for the audiologists to practice real-ear verification. Practitioners' characteristics such as time constraints, low confidence, and knowledge levels were also identified as barriers that impede the uptake of the evidence-based practice. Conclusions The implementation of PMM in clinical practice remains a challenge to the audiology profession. A knowledge-transfer approach that takes into consideration the barriers and involves effective collaboration or engagement between the knowledge providers and potential stakeholders is required to promote the clinical application of evidence-based best practice.

The use of the objective structured clinical examination (OSCE) in a practice-based health discipline: Academic and student experience in paramedicine

2020 ◽  
Vol 3 (2) ◽  
Author(s):  
Andy Bell ◽  
Jennifer Kelly ◽  
Peter Lewis
Keyword(s):  
Clinical Examination ◽  
Best Practice ◽  
Assessment Tool ◽  
Clinical Performance ◽  
Reliability And Validity ◽  
Specific Area ◽  
Training Model ◽  
Objective Structured Clinical Examination ◽  
Evidence Based ◽  
Effective Measure

Abstract:Purpose:Over the past two decades, the discipline of Paramedicine has seen expediential growth as it moved from a work-based training model to that of an autonomous profession grounded in academia.  With limited evidence-based literature examining assessment in paramedicine, this paper aims to describe student and academic views on the preference for OSCE as an assessment modality, the sufficiency of pre-OSCE instruction, and whether or not OSCE performance is a perceived indicator of clinical performance.Design/Methods:A voluntary, anonymous survey was conducted to examine the perception of the reliability and validity of the Objective Structured Clinical Examination (OSCE) as an assessment tool by students sitting the examination and the academics that facilitate the assessment. Findings:The results of this study revealed that the more confident the students are in the reliability and validity of the assessment, the more likely they are to perceive the assessment as an effective measure of their clinical performance.  The perception of reliability and validity differs when acted upon by additional variables, with the level of anxiety associated with the assessment and the adequacy of feedback of performance cited as major influencers. Research Implications:The findings from this study indicate the need for further paramedicine discipline specific research into assessment methodologies to determine best practice models for high quality assessment.Practical Implications:The development of evidence based best practice guidelines for the assessment of student paramedics should be of the upmost importance to a young, developing profession such as paramedicine.Originality/Value: There is very little research in the discipline specific area of assessment for paramedicine and discipline specific education research is essential for professional growth.Limitations:The principal researcher was a faculty member of one of the institutions surveyed.  However, all data was non identifiable at time of data collection.  Key WordsParamedic; paramedicine; objective structured clinical examinations; OSCE; education; assessment.

American Academy of Otolaryngology–Head and Neck Surgery/Foundation Reg-ent Registry: Purpose, Properties, and Priorities

2021 ◽  
pp. 019459982098413
Author(s):  
Cecelia E. Schmalbach ◽  
Jean Brereton ◽  
Cathlin Bowman ◽  
James C. Denneny
Keyword(s):  
American Academy ◽  
Head And Neck ◽  
Best Practice ◽  
Medical Center ◽  
Quality Care ◽  
Academic Medical Center ◽  
Neck Surgery ◽  
Performance Measure ◽  
Head And Neck Surgery ◽  
Evidence Based

Objective (1) To describe the patient and membership cohort captured by the otolaryngology-based specialty-specific Reg-ent registry. (2) To outline the capabilities of the Reg-ent registry, including the process by which members can access evidence-based data to address knowledge gaps identified by the American Academy of Otolaryngology–Head and Neck Surgery/Foundation and ultimately define “quality” for our field of otolaryngology–head and neck surgery. Methods Data analytics was performed on Reg-ent (2015-2020) Results A total of 1629 participants from 239 practices were enrolled in Reg-ent, and 42 health care specialties were represented. Reg-ent encompassed 6,496,477 unique patients and 24,296,713 encounters/visits: the 45- to 64-year age group had the highest representation (n = 1,597,618, 28.1%); 3,867,835 (60.3%) patients identified as Caucasian; and “private” was the most common insurance (33%), followed by Blue Cross/Blue Shield (22%). Allergic rhinitis–unspecified and sensorineural hearing loss–bilateral were the top 2 diagnoses (9% each). Overall, 302 research gaps were identified from 17 clinical practice guidelines. Discussion Reg-ent benefits are vast—from monitoring one’s practice to defining otolaryngology–head and neck surgery quality, participating in advocacy, and conducting research. Reg-ent provides mechanisms for benchmarking, quality assessment, and performance measure development, with the objective of defining and guiding best practice in otolaryngology–head and neck surgery. To be successful, patient diversity must be achieved to include ethnicity and socioeconomic status. Increasing academic medical center membership will assist in achieving diversity so that the quality domain of equitable care is achieved. Implications for Practice Reg-ent provides the first ever registry that is specific to otolaryngology–head and neck surgery and compliant with HIPAA (Health Insurance Portability and Accountability Act) to collect patient outcomes and define evidence-based quality care.

When a Baby Is Sent Away: Evidence to Support Best Practice After Neonatal Transport

2018 ◽  
Vol 37 (3) ◽  
pp. 178-181
Author(s):  
Sabrina Schwartz ◽  
Deborah A. Raines
Keyword(s):  
Best Practice ◽  
Care Center ◽  
Bonding Process ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Neonatal Transport ◽  
Child Relationship ◽  
The Hours ◽  
Mother Child Relationship

Every day neonates are transported from the birth hospital to a tertiary neonatal care center. Separation of mother and neonate in the hours immediately following birth interrupts the bonding process and can have long-term implications for the mother–child relationship. This article synthesizes the literature focused on mothers’ experiences with a neonate being transported to a tertiary NICU and identifies evidence-based practices specific to these situations.

scholarly journals Multi-Parameter Vital Sign Telemedicine System Using Web Socket for COVID-19 Pandemics

Healthcare ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 285
Author(s):  
Chuchart Pintavirooj ◽  
Tanapon Keatsamarn ◽  
Treesukon Treebupachatsakul
Keyword(s):  
Real Time ◽  
Vital Sign ◽  
Vital Signs ◽  
Mobile Network ◽  
Cloud Platform ◽  
Telemedicine System ◽  
Web Based ◽  
The Real ◽  
Real Time Application ◽  
Commercial Platform

Telemedicine has become an increasingly important part of the modern healthcare infrastructure, especially in the present situation with the COVID-19 pandemics. Many cloud platforms have been used intensively for Telemedicine. The most popular ones include PubNub, Amazon Web Service, Google Cloud Platform and Microsoft Azure. One of the crucial challenges of telemedicine is the real-time application monitoring for the vital sign. The commercial platform is, by far, not suitable for real-time applications. The alternative is to design a web-based application exploiting Web Socket. This research paper concerns the real-time six-parameter vital-sign monitoring using a web-based application. The six vital-sign parameters are electrocardiogram, temperature, plethysmogram, percent saturation oxygen, blood pressure and heart rate. The six vital-sign parameters were encoded in a web server site and sent to a client site upon logging on. The encoded parameters were then decoded into six vital sign signals. Our proposed multi-parameter vital-sign telemedicine system using Web Socket has successfully remotely monitored the six-parameter vital signs on 4G mobile network with a latency of less than 5 milliseconds.

RF Vital Sign Sensing under Free Body Movement

2021 ◽  
Vol 5 (3) ◽  
pp. 1-22
Author(s):  
Jian Gong ◽  
Xinyu Zhang ◽  
Kaixin Lin ◽  
Ju Ren ◽  
Yaoxue Zhang ◽  
...  
Keyword(s):  
Vital Sign ◽  
Estimation Error ◽  
Body Movement ◽  
Vital Signs ◽  
Motion Artifacts ◽  
Body Parts ◽  
Training Scheme ◽  
Pattern Movement ◽  
Free Body ◽  
Average Estimation Error

Radio frequency (RF) sensors such as radar are instrumental for continuous, contactless sensing of vital signs, especially heart rate (HR) and respiration rate (RR). However, decades of related research mainly focused on static subjects, because the motion artifacts from other body parts may easily overwhelm the weak reflections from vital signs. This paper marks a first step in enabling RF vital sign sensing under ambulant daily living conditions. Our solution is inspired by existing physiological research that revealed the correlation between vital signs and body movement. Specifically, we propose to combine direct RF sensing for static instances and indirect vital sign prediction based on movement power estimation. We design customized machine learning models to capture the sophisticated correlation between RF signal pattern, movement power, and vital signs. We further design an instant calibration and adaptive training scheme to enable cross-subjects generalization, without any explicit data labeling from unknown subjects. We prototype and evaluate the framework using a commodity radar sensor. Under a variety of moving conditions, our solution demonstrates an average estimation error of 5.57 bpm for HR and 3.32 bpm for RR across multiple subjects, which largely outperforms state-of-the-art systems.

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