Brain Vital Signs M-Score: Point-of-care Monitoring for Motor Recovery After Stroke

2019 ◽  
Author(s):  
Keyword(s):  
Point Of Care ◽  
Vital Signs ◽  
Motor Recovery ◽  
Score Point

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 High burden of cryptococcal antigenemia and meningitis among patients presenting at an emergency department in Maputo, Mozambique

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250195
Author(s):  
Robert Deiss ◽  
Carolina V. Loreti ◽  
Ana G. Gutierrez ◽  
Eudoxia Filipe ◽  
Milton Tatia ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cryptococcal Meningitis ◽  
Screening Program ◽  
Point Of Care ◽  
Rapid Assessment ◽  
Vital Signs ◽  
Cd4 Count ◽  
Sub Saharan Africa ◽  
Induction Treatment ◽  
Cryptococcal Antigen

Background Cryptococcal meningitis is a leading cause of HIV-related mortality in sub-Saharan Africa, however, screening for cryptococcal antigenemia has not been universally implemented. As a result, data concerning cryptococcal meningitis and antigenemia are sparse, and in Mozambique, the prevalence of both are unknown. Methods We performed a retrospective analysis of routinely collected data from a point-of-care cryptococcal antigen screening program at a public hospital in Maputo, Mozambique. HIV-positive patients admitted to the emergency department underwent CD4 count testing; those with pre-defined abnormal vital signs or CD4 count ≤ 200 cells/μL received cryptococcal antigen testing and lumbar punctures if indicated. Patients with CM were admitted to the hospital and treated with liposomal amphotericin B and flucytosine; their 12-week outcomes were ascertained through review of medical records or telephone contact by program staff made in the routine course of service delivery. Results Among 1,795 patients screened for cryptococcal antigenemia between March 2018—March 2019, 134 (7.5%) were positive. Of patients with cryptococcal antigenemia, 96 (71.6%) were diagnosed with CM, representing 5.4% of all screened patients. Treatment outcomes were available for 87 CM patients: 24 patients (27.6%) died during induction treatment and 63 (72.4%) survived until discharge; of these, 38 (60.3%) remained in care, 9 (14.3%) died, and 16 (25.3%) were lost-to follow-up at 12 weeks. Conclusions We found a high prevalence of cryptococcal antigenemia and meningitis among patients screened at an emergency department in Maputo, Mozambique. High mortality during and after induction therapy demonstrate missed opportunities for earlier detection of cryptococcal antigenemia, even as point-of-care screening and rapid assessment in an emergency room offer potential to improve outcomes.

scholarly journals Pre-hospital suPAR, lactate and CRP measurements for decision-making: a prospective, observational study of patients presenting non-specific complaints

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Milla Jousi ◽  
Marja Mäkinen ◽  
Johanna Kaartinen ◽  
Leena Meriläinen ◽  
Maaret Castrén
Keyword(s):  
Decision Making ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Point Of Care ◽  
Vital Signs ◽  
Hospital Setting ◽  
Medical Systems ◽  
Urokinase Plasminogen Activator Receptor ◽  
Support Tool ◽  
Chief Complaints

Abstract Background In the pre-hospital setting, non-urgent patients with non-specific chief complaints pose assessment challenges for the emergency medical systems (EMS). Severely ill patients should be identified among these patients, and unnecessary transport to the emergency department (ED) should be avoided. Unnecessary admissions burden EDs, deplete EMS resources and can even be harmful to patients, especially elderly patients. Therefore, tools for facilitating pre-hospital decision-making are needed. They could be based on vital signs or point-of-care laboratory biomarkers. In this study, we examined whether the biomarker soluble urokinase plasminogen activator receptor (suPAR), either alone or combined with C-reactive protein (CRP) and/or lactate, could predict discharge from the ED and act as a pre-hospital support tool for non-conveyance decision-making. Methods This was a prospective, observational study of adult patients with normal or near-normal vital signs transported by an EMS to an ED with a code referring to deteriorated general condition. The levels of suPAR, CRP and lactate in the patients’ pre-hospital blood samples were analysed. The values of hospitalized patients were compared to those of discharged patients to determine whether these biomarkers could predict direct discharge from the ED. Results A total of 109 patients (median age: 81 years) were included in the study. Of those, 52% were hospitalized and 48% were discharged from the ED. No statistically significant association was found between suPAR and the ED discharge vs hospitalization outcome (OR: 1.04, 95% CI 0.97–1.13, AUROC: 0.58, 95% CI 0.47–0.69). Adding CRP (AUROC: 0.64, 95% CI 0.54–0.75) or lactate (AUROC: 0.60, 95% CI 0.49–0.71) to the regression models did not improve their diagnostic accuracy. None of the patients with a suPAR value of less than 2 ng/ml were admitted to hospital, while 64% of the patients with a suPAR value of more than 6 ng/ml were hospitalized. Conclusion Pre-hospital suPAR measurements alone or combined with CRP and/or lactate measurements could not predict the ED discharge or hospital admission of 109 non-urgent EMS patients with non-specific chief complaints and normal or near-normal vital signs.

Case Report: Early signs of tamponade may be detected by cardiac point-of-care ultrasound

POCUS Journal ◽  
2017 ◽  
Vol 2 (3) ◽  
pp. 24-25 ◽  
Author(s):  
Michael Cenkowski, MD ◽  
Amer M. Johri, MD ◽  
Raveen Pal, MD ◽  
Jennifer Hutchison, RDCS
Keyword(s):  
Blood Pressure ◽  
End Stage Renal Disease ◽  
Point Of Care ◽  
Vital Signs ◽  
Point Of Care Ultrasound ◽  
Past Medical History ◽  
Pleuritic Chest Pain ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage

A 35-year-old male with a past medical history of end stage renal disease on hemodialysis and a chronic pericardial effusion secondary to dialysis presented to the Emergency Room (ER) with a 2-week history of a flu-like illness and pleuritic chest pain. He was compliant with dialysis three times per week. His blood pressure was 150/85 mmHg with a heart rate of 85 beats per minute and the remainder of his vital signs were stable. Pulsus paradoxus was not present.

How to integrate vital interdisciplinary information in a non-closed-loop system?

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 314-314
Author(s):  
Jack Toshimine Seki ◽  
Dominic Tsang ◽  
Diana Incekol ◽  
Ian Brandle ◽  
Emma Paisley ◽  
...  
Keyword(s):  
Closed Loop ◽  
Electronic Patient Record ◽  
Point Of Care ◽  
Vital Signs ◽  
Loop System ◽  
Patient Record ◽  
Electronic Prescribing ◽  
Closed Loop System ◽  
Ensure Patient Safety ◽  
Paper Record

314 Background: History of hypersensitivity reactions (HSR) must be readily accessible to ensure patient safety while receiving chemotherapy. While documentation of HSR is a routine process, gaps are found in maintaining vital information amongst various stand-alone systems (SAS). Centralized documentation (CD) by frontline nursing staff in the Electronic Patient Record is key to reduce risk. Pharmacists refer to CD for HSR information when processing chemotherapy. We developed and evaluated a technology-based workaround approach as a possible solution to a non-closed-loop system. Methods: An e-clinical point of care documentation tool was designed and built for nursing data collection of HSR details within the Electronic Patient Record. Vital parameters necessary for “complete” HSR documentation were outlined in a cue card, including time of reaction, reaction drug, volume and rate of infusion, management, vital signs and objective symptoms, re-challenge or discontinuation, and patient outcome. This cue card standardizes e-documentation. Pre- and post-system rollout survey was used to gauge effectiveness of CD by nursing and pharmacists. Results: Over a 6-month period, there were 173 HSRs in 11,754 patient visits (1.5%), with variability in collection of vital documentation in relation to roll out of the e-tool. In the pre-CD rollout phase (May 25 to September 12, 2011) 108 HSRs were identified that were documented in multiple locations including an electronic prescribing SAS (86%) and the chemotherapy nursing paper record (77%). In the post-CD phase (April 23 to June 23, 2012) 65 HSRs were identified, 46% of which were documented in CD, 72% in the electronic prescribing SAS, and 85% in paper record. Six of 7 pharmacists (85%) and 7 of 10 nurses (70%) who were surveyed indicated that the new CD documentation process was “effective” or “significantly effective”. Conclusions: As non-fully integrated systems exist in current environments, technology workarounds should be used to “close the loop”. E-Clinical documentation is an upcoming centralized technology solution, which we have used with promising initial adoption results. Formal e-documentation tools can lead to more detailed documentation than current processes.

scholarly journals Transcription Errors of Blood Glucose Values and Insulin Errors in an Intensive Care Unit: Secondary Data Analysis Toward Electronic Medical Record-Glucometer Interoperability (Preprint)

2018 ◽  
Author(s):  
Azizeh Khaled Sowan ◽  
Ana Vera ◽  
Ashwin Malshe ◽  
Charles Reed
Keyword(s):  
Intensive Care ◽  
Blood Glucose ◽  
Medical Record ◽  
Intensive Care Units ◽  
Electronic Medical Record ◽  
Point Of Care ◽  
Vital Signs ◽  
Secondary Data ◽  
Flow Sheet ◽  
Glucose Testing

BACKGROUND Critically ill patients require constant point-of-care blood glucose testing to guide insulin-related decisions. Transcribing these values from glucometers into a paper log and the electronic medical record is very common yet error-prone in intensive care units, given the lack of connectivity between glucometers and the electronic medical record in many US hospitals. OBJECTIVE We examined (1) transcription errors of glucometer blood glucose values documented in the paper log and in the electronic medical record vital signs flow sheet in a surgical trauma intensive care unit, (2) insulin errors resulting from transcription errors, (3) lack of documenting these values in the paper log and the electronic medical record vital signs flow sheet, and (4) average time for docking the glucometer. METHODS This secondary data analysis examined 5049 point-of-care blood glucose tests. We obtained values of blood glucose tests from bidirectional interface software that transfers the meters’ data to the electronic medical record, the paper log, and the vital signs flow sheet. We obtained patient demographic and clinical-related information from the electronic medical record. RESULTS Of the 5049 blood glucose tests, which were pertinent to 234 patients, the total numbers of undocumented or untranscribed tests were 608 (12.04%) in the paper log, 2064 (40.88%) in the flow sheet, and 239 (4.73%) in both. The numbers of transcription errors for the documented tests were 98 (2.21% of 4441 documented tests) in the paper log, 242 (8.11% of 2985 tests) in the flow sheet, and 43 (1.64% of 2616 tests) in both. The numbers of transcription errors per patient were 0.4 (98 errors/234 patients) in the paper log, 1 (242 errors/234 patients) in the flow sheet, and 0.2 in both (43 errors/234 patients). Transcription errors in the paper log, the flow sheet, and in both resulted in 8, 24, and 2 insulin errors, respectively. As a consequence, patients were given a lower or higher insulin dose than the dose they should have received had there been no errors. Discrepancies in insulin doses were 2 to 8 U lower doses in paper log transcription errors, 10 U lower to 3 U higher doses in flow sheet transcription errors, and 2 U lower in transcription errors in both. Overall, 30 unique insulin errors affected 25 of 234 patients (10.7%). The average time from point-of-care testing to meter docking was 8 hours (median 5.5 hours), with some taking 56 hours (2.3 days) to be uploaded. CONCLUSIONS Given the high dependence on glucometers for point-of-care blood glucose testing in intensive care units, full electronic medical record-glucometer interoperability is required for complete, accurate, and timely documentation of blood glucose values and elimination of transcription errors and the subsequent insulin-related errors in intensive care units.

Abstract WMP62: Achieving Ultra-Fast Door-to-Needle Times With a “Treat-in-CT” Acute Stroke Protocol

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Andria L Ford ◽  
Jennifer A Williams ◽  
Brian Hoff ◽  
David Curfman ◽  
Rebecca Wiesehan ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Lean Manufacturing ◽  
Treatment Time ◽  
Point Of Care ◽  
Patient Flow ◽  
Vital Signs ◽  
Ct Scanner ◽  
Rapid Improvement ◽  
Ct Protocol ◽  
Before And After

Background: Ultra-early thrombolysis [onset-to-treatment time (OTT) < 90 min], leads to better clinical outcomes. We utilized lean manufacturing principles to re-choreograph patient flow such that tPA was delivered in the CT scanner rather than moving the patient to a separate treatment room. We tested the efficiency and safety of a “Treat-in-CT” protocol comparing metrics and outcomes before and after implementation. Methods: In July 2014, a LEAN rapid improvement event was conducted to design a “Treat-in-CT” stroke protocol. Several changes included: (1) Vital signs monitors and point of care glucose and INR were placed near the scanner. (2) Computer monitors were placed in the scanner to allow for rapid charting and order entry. (3) Local EMS crews, physicians, nursing staff, and CT technicians were trained on parallel work-flow in the scanner. The “Treat-in-CT” protocol went live 10/1/2014. We directly compared the “Pre” and “Post” Treat-in-CT epochs (1/2013-9/2014 and 10/2014-8/2015, respectively) with regard to baseline variables, metrics, and outcomes. Non-parametric statistics were used with p<0.05 required for significance. Results: In the Pre- and Post-Treat-in-CT epochs, 139 and 74 patients were treated with IV tPA, respectively. Baseline variables were similar between the two epochs. Median door-to-needle time was lower in the Post-Treat-in-CT epoch: 38 min pre vs. 29 min post (p=0.002) with a trend towards lower OTT: 131 min pre vs. 100 min post (p=0.07). To ensure that efficiency did not impact safety, favorable discharge location (87% pre vs. 81% post, p=0.3), symptomatic hemorrhage rate (2.9% pre vs. 1.5% post, p=1.0), stroke mimic rate, and 90 day mRS were compared and did not differ. Conclusions: The AHA Target: Stroke-Phase II guidelines recommend administration of tPA bolus while in the CT scanner. A “Treat-in-CT” acute stroke protocol using efficient choreography and parallel processing expedited tPA delivery without compromising safety.

Point-of-care lactate measurement for suspected sepsis in the prehospital environment: are we missing the point at the sharp end?

2020 ◽  
Vol 26 (4) ◽  
pp. 1-9
Author(s):  
Bryan Lightowler
Keyword(s):  
Point Of Care ◽  
Vital Signs ◽  
Screening Tools ◽  
Handheld Devices ◽  
Services Research ◽  
Suspected Sepsis ◽  
Lactate Measurement ◽  
Life Threatening ◽  
Lactate Levels ◽  
Sepsis Screening

Expecting ambulance clinicians to dependably differentiate the life-threatening organ dysfunction caused by sepsis from an inflammatory response to a non-infectious aetiology, relying upon vital signs and a physical examination of the patient alone, must be considered unrealistic. Although lactate measurement has been integrated into numerous prehospital sepsis screening tools, it is not yet measured routinely within UK ambulance services. Research has generally focused on whether handheld point-of-care lactate measurement devices are as accurate as laboratory analysis of venous or arterial samples. The weight of literature has concluded negatively in relation to this. However, there is potential for handheld devices to be used independently to monitor trends in lactate elimination or accumulation to inform decisions on the efficacy of prehospital interventions, or simply to report categorical data in terms of whether lactate levels are elevated or not. This offers UK paramedics the opportunity to improve sepsis care through the enhanced assessment of risk and acuity, the identification of patients with cryptic shock, more aggressive fluid resuscitation and advanced notification to receiving units.

scholarly journals Real-world evaluation of AI driven COVID-19 triage for emergency admissions: External validation & operational assessment of lab-free and high-throughput screening solutions

2021 ◽  
Author(s):  
Andrew AS Soltan ◽  
Jenny Yang ◽  
Ravi Pattanshetty ◽  
Alex Novak ◽  
Omid Rohanian ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Throughput ◽  
Clinical Pathway ◽  
High Throughput Screening ◽  
Standard Care ◽  
Point Of Care ◽  
Vital Signs ◽  
Routine Care ◽  
Service Improvement ◽  
University Hospitals

Background Uncertainty in patients' COVID-19 status contributes to treatment delays, nosocomial transmission, and operational pressures in hospitals. However, typical turnaround times for batch-processed laboratory PCR tests remain 12-24h. Although rapid antigen lateral flow testing (LFD) has been widely adopted in UK emergency care settings, sensitivity is limited. We recently demonstrated that AI-driven triage (CURIAL-1.0) allows high-throughput COVID-19 screening using clinical data routinely available within 1h of arrival to hospital. Here we aimed to determine operational and safety improvements over standard-care, performing external/prospective evaluation across four NHS trusts with updated algorithms optimised for generalisability and speed, and deploying a novel lab-free screening pathway in a UK emergency department. Methods We rationalised predictors in CURIAL-1.0 to optimise separately for generalisability and speed, developing CURIAL-Lab with vital signs and routine laboratory blood predictors (FBC, U&E, LFT, CRP) and CURIAL-Rapide with vital signs and FBC alone. Models were calibrated during training to 90% sensitivity and validated externally for unscheduled admissions to Portsmouth University Hospitals, University Hospitals Birmingham and Bedfordshire Hospitals NHS trusts, and prospectively during the second-wave of the UK COVID-19 epidemic at Oxford University Hospitals (OUH). Predictions were generated using first-performed blood tests and vital signs and compared against confirmatory viral nucleic acid testing. Next, we retrospectively evaluated a novel clinical pathway triaging patients to COVID-19-suspected clinical areas where either model prediction or LFD results were positive, comparing sensitivity and NPV with LFD results alone. Lastly, we deployed CURIAL-Rapide alongside an approved point-of-care FBC analyser (OLO; SightDiagnostics, Israel) to provide lab-free COVID-19 screening in the John Radcliffe Hospital's Emergency Department (Oxford, UK), as trust-approved service improvement. Our primary improvement outcome was time-to-result availability; secondary outcomes were sensitivity, specificity, PPV, and NPV assessed against a PCR reference standard. We compared CURIAL-Rapide's performance with clinician triage and LFD results within standard-care. Results 72,223 patients met eligibility criteria across external and prospective validation sites. Model performance was consistent across trusts (CURIAL-Lab: AUROCs range 0.858-0.881; CURIAL-Rapide 0.836-0.854), with highest sensitivity achieved at Portsmouth University Hospitals (CURIAL-Lab:84.1% [95% Wilson's score CIs 82.5-85.7]; CURIAL-Rapide:83.5% [81.8 - 85.1]) at specificities of 71.3% (95% Wilson's score CIs: 70.9 - 71.8) and 63.6% (63.1 - 64.1). For 3,207 patients receiving LFD-triage within routine care for OUH admissions between December 23, 2021 and March 6, 2021, a combined clinical pathway increased sensitivity from 56.9% for LFDs alone (95% CI 51.7-62.0) to 88.2% with CURIAL-Rapide (84.4-91.1; AUROC 0.919) and 85.6% with CURIAL-Lab (81.6-88.9; AUROC 0.925). 520 patients were prospectively enrolled for point-of-care FBC analysis between February 18, 2021 and May 10, 2021, of whom 436 received confirmatory PCR testing within routine care and 10 (2.3%) tested positive. Median time from patient arrival to availability of CURIAL-Rapide result was 45:00 min (32-64), 16 minutes (26.3%) sooner than LFD results (61:00 min, 37-99; log-rank p<0.0001), and 6:52 h (90.2%) sooner than PCR results (7:37 h, 6:05-15:39; p<0.0001). Sensitivity and specificity of CURIAL-Rapide were 87.5% (52.9-97.8) and 85.4% (81.3-88.7), therefore achieving high NPV (99.7%, 98.2-99.9). CURIAL-Rapide correctly excluded COVID-19 for 58.5% of negative patients who were triaged by a clinician to COVID-19-suspected (amber) areas. Impact CURIAL-Lab & CURIAL-Rapide are generalisable, high-throughput screening tests for COVID-19, rapidly excluding the illness with higher NPV than LFDs. CURIAL-Rapide can be used in combination with near-patient FBC analysis for rapid, lab-free screening, and may reduce the number of COVID-19-negative patients triaged to enhanced precautions (amber) clinical areas.

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.

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