scholarly journals Monitor-Watcher Use, Nurses’ Knowledge of Electrocardiographic Monitoring, and Arrhythmia Detection

2021 ◽  
Vol 30 (1) ◽  
pp. 38-44
Author(s):  
Marjorie Funk ◽  
Kristopher P. Fennie ◽  
Krista A. Knudson ◽  
Halley Ruppel
Keyword(s):  
Intensive Care Unit ◽  
Closed Loop ◽  
Test Accuracy ◽  
Ecg Monitoring ◽  
Knowledge Test ◽  
Arrhythmia Detection ◽  
Electrocardiographic Monitoring ◽  
Online Test ◽  
The Impact ◽  
Nurses Knowledge

Background Electrocardiographic telemetry monitors are ubiquitous in hospitals. Dedicated monitor watchers, either on the unit or in a centralized location, are often responsible for observing telemetry monitors and responding to their alarms. The impact of use of monitor watchers is not known. Objectives To evaluate the association of monitor-watcher use with (1) nurses’ knowledge of electrocardiographic (ECG) monitoring and (2) accuracy of arrhythmia detection. Methods Baseline data from 37 non–intensive care unit cardiac patient care areas in 17 hospitals in the Practical Use of the Latest Standards for Electrocardiography trial were analyzed. Nurses’ knowledge (n = 1136 nurses) was measured using a validated, 20-item online test. Accuracy of arrhythmia detection (n = 1189 patients) was assessed for 5 consecutive days by comparing arrhythmias stored in the monitor with nurses’ documentation. Multiple regression was used to evaluate the association of use of monitor watchers with scores on the ECG-monitoring knowledge test. The association of monitor-watcher use with accuracy of arrhythmia detection was examined by χ2 analysis. Results Of the 37 units, 13 (35%) had monitor watchers. Use of monitor watchers was not independently associated with ECG-monitoring knowledge (P = .08). The presence of monitor watchers also was not significantly associated with the accuracy of arrhythmia detection (P = .94). Conclusion Although the use of monitor watchers was not associated with diminished nurses’ knowledge of ECG monitoring, it also was not associated with more accurate arrhythmia detection. If implementing a monitor-watcher program, critical safety points, such as ensuring closed-loop communication, must be considered.

The Impact of Visual Feedback Type on the Mastery of Visuo-Motor Transformations

2012 ◽  
Vol 220 (1) ◽  
pp. 3-9 ◽  
Author(s):  
Sandra Sülzenbrück
Keyword(s):  
Empirical Research ◽  
Visual Feedback ◽  
Closed Loop ◽  
Motor Planning ◽  
Visual Input ◽  
Closed Loop Control ◽  
Loop Control ◽  
Feedback Type ◽  
Effective Use ◽  
The Impact

For the effective use of modern tools, the inherent visuo-motor transformation needs to be mastered. The successful adjustment to and learning of these transformations crucially depends on practice conditions, particularly on the type of visual feedback during practice. Here, a review about empirical research exploring the influence of continuous and terminal visual feedback during practice on the mastery of visuo-motor transformations is provided. Two studies investigating the impact of the type of visual feedback on either direction-dependent visuo-motor gains or the complex visuo-motor transformation of a virtual two-sided lever are presented in more detail. The findings of these studies indicate that the continuous availability of visual feedback supports performance when closed-loop control is possible, but impairs performance when visual input is no longer available. Different approaches to explain these performance differences due to the type of visual feedback during practice are considered. For example, these differences could reflect a process of re-optimization of motor planning in a novel environment or represent effects of the specificity of practice. Furthermore, differences in the allocation of attention during movements with terminal and continuous visual feedback could account for the observed differences.

Telemonitoring in Heart Failure Rehabilitation

2011 ◽  
Vol 7 (1) ◽  
pp. 66 ◽  
Author(s):  
Ewa Piotrowicz ◽  
Ryszard Piotrowicz ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Cardiac Rehabilitation ◽  
Ecg Monitoring ◽  
Heart Rate Monitoring ◽  
Electrocardiographic Monitoring ◽  
Number Of Patients ◽  
Patients With Heart Failure ◽  
Related Quality ◽  
Health Related

Exercise training (ET) is now recommended as an important component of a comprehensive approach to patients with heart failure (HF). Despite the existence of proven benefits of ET, many HF patients remain physically inactive. Introducing telerehabilitation (TR) may eliminate most of the factors that result in the currently low number of patients undergoing outpatient-based rehabilitation programmes and thus increase the percentage of those who will undergo cardiac rehabilitation. Despite the fact that TR is highly applicable and effective, there are few papers dedicated to the study of TR in HF patients. Until recently, only a couple of home rehabilitation-monitoring models have been presented, from the simplest, i.e. heart rate monitoring and transtelephonic electrocardiographic monitoring, through to the more advanced tele-electocardiogram (tele-ECG) monitoring (via a remote device) and realtime electrocardiographic and voice transtelephonic monitoring. It seems the last two are the most useful and reliable. Based on published studies, TR in HF patients could be equally effective as and provide similar improvements in health-related quality of life to standard outpatient cardiac rehabilitation. In addition, adherence to cardiac rehabilitation seems to be better during TR. Due to disease-related limitations, TR seems to be a viable alternative for comprehensive cardiac rehabilitation in HF patients. Further studies are needed to confirm the utility of this type of rehabilitation in routine clinical practice, including its cost-effectiveness. Because of the diversity of technological systems, it is necessary to create a platform to ensure compatibility between the devices used in telemedicine.

scholarly journals Research on Closed-Loop Supply Chain Decision-Making in Different Cooperation Modes with Government’s Reward-Penalty Mechanism

2021 ◽  
Vol 13 (11) ◽  
pp. 6425
Author(s):  
Quanxi Li ◽  
Haowei Zhang ◽  
Kailing Liu
Keyword(s):  
Supply Chain ◽  
Closed Loop ◽  
Stackelberg Game ◽  
Recycling Rate ◽  
Transfer Payment ◽  
Closed Loop Supply Chain ◽  
Asymmetry Of Information ◽  
Optimal Decisions ◽  
The Government ◽  
The Impact

In closed-loop supply chains (CLSC), manufacturers, retailers, and recyclers perform their duties. Due to the asymmetry of information among enterprises, it is difficult for them to maximize efficiency and profits. To maximize the efficiency and profit of the CLSC, this study establishes five cooperation models of CLSC under the government‘s reward–penalty mechanism. We make decisions on wholesale prices, retail prices, transfer payment prices, and recovery rates relying on the Stackelberg game method and compare the optimal decisions. This paper analyzes the impact of the government reward-penalty mechanism on optimal decisions and how members in CLSC choose partners. We find that the government’s reward-penalty mechanism can effectively increase the recycling rate of used products and the total profit of the closed-loop supply chain. According to the calculation results of the models, under the government’s reward-penalty mechanism, the cooperation can improve the CLSC’s used products recycling capacity and profitability. In a supply chain, the more members participate in the cooperation, the higher profit the CLSC obtain. However, the cooperation mode of all members may lead to monopoly, which is not approved by government and customers.

Differential impact of on-site or telepharmacy in the intensive care unit: a controlled before–after study

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Joao Gabriel Rosa Ramos ◽  
Sandra Cristina Hernandes ◽  
Talita Teles Teixeira Pereira ◽  
Shana Oliveira ◽  
Denis de Melo Soares ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Phase 1 ◽  
Phase 2 ◽  
Differential Impact ◽  
Scarce Resources ◽  
Clinical Pharmacists ◽  
Versus Phase ◽  
Quasi Experimental ◽  
The Impact

Abstract Background Clinical pharmacists have an important role in the intensive care unit (ICU) team but are scarce resources. Our aim was to evaluate the impact of on-site pharmacists on medical prescriptions in the ICU. Methods This is a retrospective, quasi-experimental, controlled before-after study in two ICUs. Interventions by pharmacists were evaluated in phase 1 (February to November 2016) and phase 2 (February to May 2017) in ICU A (intervention) and ICU B (control). In phase 1, both ICUs had a telepharmacy service in which medical prescriptions were evaluated and interventions were made remotely. In phase 2, an on-site pharmacist was implemented in ICU A, but not in ICU B. We compared the number of interventions that were accepted in phase 1 versus phase 2. Results During the study period, 8797/9603 (91.6%) prescriptions were evaluated, and 935 (10.6%) needed intervention. In phase 2, there was an increase in the proportion of interventions that were accepted by the physician in comparison to phase 1 (93.9% versus 76.8%, P < 0.001) in ICU A, but there was no change in ICU B (75.2% versus 73.9%, P = 0.845). Conclusion An on-site pharmacist in the ICU was associated with an increase in the proportion of interventions that were accepted by physicians.

scholarly journals SARS-CoV-2 and Cytomegalovirus Co-Infections—A Case Series of Critically Ill Patients

2021 ◽  
Vol 10 (13) ◽  
pp. 2792
Author(s):  
Patrícia Moniz ◽  
Sérgio Brito ◽  
Pedro Póvoa
Keyword(s):  
Intensive Care Unit ◽  
Critically Ill ◽  
Immune Suppression ◽  
Clinical Course ◽  
Health Care Systems ◽  
Case Series ◽  
Confounding Factors ◽  
Care Systems ◽  
The Impact ◽  
Cmv Reactivation

The SARS-CoV-2 pandemic has placed great strain on the most developed of health care systems, especially in the context of critical care. Although co-infections with cytomegalovirus (CMV) are frequent in the critically ill due to underlying immune suppression of multiple causes, the impact on COVID-19 patients remains unclear. Furthermore, severe COVID-19 has recently been associated with significant immune suppression, and this may in turn impact CMV reactivation, possibly contributing to clinical course. Nevertheless, multiple confounding factors in these patients will certainly challenge upcoming research. The authors present a case series of five patients admitted to the intensive care unit (ICU) in the context of respiratory failure due to severe COVID-19. All patients evolved with CMV reactivation during ICU stay.

The presence of liver cirrhosis is a strong negative predictor of survival for patients admitted to the intensive care unit – Cirrhosis in intensive care patients

2021 ◽  
Author(s):  
Jörg Bojunga ◽  
Mireen Friedrich-Rust ◽  
Alica Kubesch ◽  
Kai Henrik Peiffer ◽  
Hannes Abramowski ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Liver Cirrhosis ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Intensive Care Treatment ◽  
Matched Cohort ◽  
Care Treatment ◽  
Cirrhotic Patients ◽  
The Impact ◽  
Cirrhotic Group

Abstract Background and Aims Liver cirrhosis is a systemic disease that substantially impacts the body’s physiology, especially in advanced stages. Accordingly, the outcome of patients with cirrhosis requiring intensive care treatment is poor. We aimed to analyze the impact of cirrhosis on mortality of intensive care unit (ICU) patients compared to other frequent chronic diseases and conditions. Methods In this retrospective study, patients admitted over three years to the ICU of the Department of Medicine of the University Hospital Frankfurt were included. Patients were matched for age, gender, pre-existing conditions, simplified acute physiology score (SAPS II), and therapeutic intervention scoring system (TISS). Results A total of 567 patients admitted to the ICU were included in the study; 99 (17.5 %) patients had liver cirrhosis. A total of 129 patients were included in the matched cohort for the sensitivity analysis. In-hospital mortality was higher in cirrhotic patients than non-cirrhotic patients (p < 0.0001) in the entire and matched cohort. Liver cirrhosis remained one of the strongest independent predictors of in-hospital mortality (entire cohort p = 0.001; matched cohort p = 0.03) along with dialysis and need for transfusion in the multivariate logistic regression analysis. Furthermore, in the cirrhotic group, the need for kidney replacement therapy (p < 0.001) and blood transfusion (p < 0.001) was significantly higher than in the non-cirrhotic group.  Conclusions In the presented study, liver cirrhosis was one of the strongest predictors of in-hospital mortality in patients needing intensive care treatment along with dialysis and the need for ventilation. Therefore, concerted efforts are needed to improve cirrhotic patients’ outcomes, prevent disease progression, and avoid complications with the need for ICU treatment in the early stages of the disease.

scholarly journals 375. COVID 19 infection in a Massachusetts community hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S257-S258
Author(s):  
Raul Davaro ◽  
alwyn rapose
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Essential Hypertension ◽  
Severe Acute Respiratory Syndrome ◽  
High Mortality ◽  
Case Series ◽  
World Health ◽  
Minimal Risk ◽  
The Impact

Abstract Background The ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has led to 105690 cases and 7647 deaths in Massachusetts as of June 16. Methods The study was conducted at Saint Vincent Hospital, an academic health medical center in Worcester, Massachusetts. The institutional review board approved this case series as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent. All consecutive patients who were sufficiently medically ill to require hospital admission with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample were included. Results A total of 109 consecutive patients with COVID 19 were admitted between March 15 and May 31. Sixty one percent were men, the mean age of the cohort was 67. Forty one patients (37%) were transferred from nursing homes. Twenty seven patients died (24%) and the majority of the dead patients were men (62%). Fifty one patients (46%) required admission to the medical intensive care unit and 34 necessitated mechanical ventilation, twenty two patients on mechanical ventilation died (63%). The most common co-morbidities were essential hypertension (65%), obesity (60%), diabetes (33%), chronic kidney disease (22%), morbid obesity (11%), congestive heart failure (16%) and COPD (14%). Five patients required hemodialysis. Fifty five patients received hydroxychloroquine, 24 received tocilizumab, 20 received convalescent plasma and 16 received remdesivir. COVID 19 appeared in China in late 2019 and was declared a pandemic by the World Health Organization on March 11, 2020. Our study showed a high mortality in patients requiring mechanical ventilation (43%) as opposed to those who did not (5.7%). Hypertension, diabetes and obesity were highly prevalent in this aging population. Our cohort was too small to explore the impact of treatment with remdesivir, tocilizumab or convalescent plasma. Conclusion In this cohort obesity, diabetes and essential hypertension are risk factors associated with high mortality. Patients admitted to the intensive care unit who need mechanical ventilation have a mortality approaching 50 %. Disclosures All Authors: No reported disclosures

scholarly journals Classification of multiwavelength transients with Machine Learning

2020 ◽  
Author(s):  
K Sooknunan ◽  
M Lochner ◽  
Bruce A Bassett ◽  
H V Peiris ◽  
R Fender ◽  
...  
Keyword(s):  
Machine Learning ◽  
Small Sample ◽  
Light Curves ◽  
Machine Learning Techniques ◽  
Optical Data ◽  
Test Time ◽  
Test Accuracy ◽  
Training Set ◽  
The Impact

Abstract With the advent of powerful telescopes such as the Square Kilometer Array and the Vera C. Rubin Observatory, we are entering an era of multiwavelength transient astronomy that will lead to a dramatic increase in data volume. Machine learning techniques are well suited to address this data challenge and rapidly classify newly detected transients. We present a multiwavelength classification algorithm consisting of three steps: (1) interpolation and augmentation of the data using Gaussian processes; (2) feature extraction using wavelets; (3) classification with random forests. Augmentation provides improved performance at test time by balancing the classes and adding diversity into the training set. In the first application of machine learning to the classification of real radio transient data, we apply our technique to the Green Bank Interferometer and other radio light curves. We find we are able to accurately classify most of the eleven classes of radio variables and transients after just eight hours of observations, achieving an overall test accuracy of 78%. We fully investigate the impact of the small sample size of 82 publicly available light curves and use data augmentation techniques to mitigate the effect. We also show that on a significantly larger simulated representative training set that the algorithm achieves an overall accuracy of 97%, illustrating that the method is likely to provide excellent performance on future surveys. Finally, we demonstrate the effectiveness of simultaneous multiwavelength observations by showing how incorporating just one optical data point into the analysis improves the accuracy of the worst performing class by 19%.

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