Low-Invasive CO2-Based Visual Alerting Systems to Manage Natural Ventilation and Improve IAQ in Historic School Buildings

Children spend a large part of their growing years in schools, and as they are more sensitive to some pollutants than adults, it is essential to monitor and maximize the indoor air quality (IAQ) in classrooms. Many schools are located in historic and heritage buildings, and improving the IAQ, preserving the architectural features, poses a great challenge. The aim of the study is to evaluate the effectiveness of a low-invasiveness, low-cost, smart CO2-based visual alerting systems to manage natural ventilation and improve IAQ in historic school buildings. Indoor and outdoor parameters were monitored for three weeks in four schools with different levels of education (two classrooms per school; device installed in one only). Based on indoor CO2 concentration, air temperature and relative humidity, the device suggests when windows should be opened to ventilate. The comparison between the two classrooms show that the effectiveness of the device is highly dependent on the occupants: (i) reduction in the average CO2 concentrations of up to 42% in classrooms with frontal lesson and full occupancy, (ii) the device is not the most ideal solution for kindergarten due to the young age of the pupils, and (iii) it is more used during mild outdoor temperatures.

Pharmacogenomic alerts: developing guidance for use by healthcare professionals

Background: For diseases with a genetic cause genomics can deliver improved diagnostics and facilitate access to targeted treatments. Drug pharmacodynamics and pharmacokinetics are often dependent on genetic variation underlying these processes. As pharmacogenomics comes of age it may be the first way in which genomics is utilised at a population level. Still required is guidance and standards of how genomic information can be communicated within the health record, and how clinicians should be alerted to variation impacting the use of medicines. Methods: The Professional Record Standards Body commissioned by National Health Service England developed guidance on using pharmacogenomics information in clinical practice. We conducted research with those implementing pharmacogenomics in England and internationally to produce guidance and recommendations for a systems-based approach. Results: A consensus viewpoint is that systems need to be in place to ensure the safe provision of pharmacogenomics information that is curated, actionable and up-to-date. Standards should be established with respect to notification and information exchange, which could impact new or existing prescribing and these must be in keeping with routine practice. Alerting systems should contribute to safer practices. Conclusion: Ensuring pharmacogenetics information is available to make use of medicines safer will require major effort of which this guidance is a beginning. Standards are required to ensure useful genomic information within the health record can be communicated to clinicians in the right format and times to be actioned successfully. A multidisciplinary group of stakeholders must be engaged in developing pharmacogenomic standards to support the most appropriate prescribing.

Comparison of the validity, perceived usefulness and usability of I-MeDeSA and TEMAS, two tools to evaluate alert system usability: a study protocol

IntroductionResearch has shown that improvements to the usability of medication alert systems are needed. For designers and decisions-makers to assess usability of their alert systems, two paper-based tools are currently available: the instrument for evaluating human-factors principles in medication-related decision support alerts (I-MeDeSA) and the tool for evaluating medication alerting systems (TEMAS). This study aims to compare the validity, usability and usefulness of both tools to identify their strengths and limitations and assist designers and decision-makers in making an informed decision about which tool is most suitable for assessing their current or prospective system.Methods and analysisFirst, TEMAS and I-MeDeSA will be translated into French. This translation will be validated by three experts in human factors. Then, in 12 French hospitals with a medication alert system in place, staff with expertise in the system will evaluate their alert system using the two tools successively. After the use of each tool, participants will be asked to fill in the System Usability Scale (SUS) and complete a survey on the understandability and perceived usefulness of each tool. Following the completion of both assessments, participants will be asked to nominate their preferred tool and relay their opinions on the tools. The design philosophy of TEMAS and I-MeDeSA differs on the calculation of a score, impacting the way the comparison between the tools can be performed. Convergent validity will be evaluated by matching the items of the two tools with respect to the usability dimensions they assess. SUS scores and answers to the survey will be statistically compared for I-MeDeSA and TEMAS to identify differences. Free-text responses in surveys will be analysed using an inductive approach.Ethics and disseminationEthical approval is not required in France for a study of this nature. The results will be published in a peer-reviewed journal.

Smartphone Based Alerting of First Responders During the COVID-19 Pandemic

Background: Smartphone Alerting Systems (SAS) for first responders potentially shorten the resuscitation-free interval of patients with acute cardiac arrest. During the COVID-19 pandemic, many systems were suspended due to potential risks for the responders. Therefore, a COVID-19 concept for the SAS in Freiburg/Germany was established and evaluated. Methods: Due to the pandemic, SAS was stopped in March 2020. A concept for a safe restart was elaborated with provision of a set with ventilation bag/mask, airway filter and personal protective equipment (PPE) for every volunteer. A standard operating procedure followed the COVID-19 guidelines of the European Resuscitation Council (ERC). Willingness of the participants to respond alarms during the pandemic was investigated using an online survey. Results: The system was restarted in May 2020. The willingness to respond to alarms was lower during the pandemic without PPE. It remained lower than before the pandemic when the volunteers had been equipped with PPE, but the alarm response rate remained at approximately 50% during the ongoing pandemic. Conclusions: When volunteers are equipped with PPE, the operation of a SAS does not need to be paused, and the willingness to respond remains high among first responders.

Smartphone Based Alerting of First Responders During the COVID-19 Pandemic

Background Smartphone Alerting Systems (SAS) for first responders potentially shorten the resuscitation-free interval of patients with acute cardiac arrest. During the COVID-19 pandemic, many systems were suspended due to potential risks for the responders. Therefore, a COVID-19 concept for the SAS in Freiburg/Germany was established and evaluated. Methods Due to the pandemic, SAS was stopped in March 2020. A concept for a safe restart was elaborated with provision of a set with ventilation bag/mask, airway filter and personal protective equipment (PPE) for every volunteer. A standard operating procedure followed the COVID-19 guidelines of the European Resuscitation Council (ERC). Willingness of the participants to respond alarms during the pandemic was investigated using an online survey. Results The system was restarted in May 2020. The willingness to respond to alarms was lower during the pandemic without PPE. It remained lower than before the pandemic when the volunteers had been equipped with PPE, but the alarm response rate remained at approximately 50% during the ongoing pandemic. Conclusions When volunteers are equipped with PPE, the operation of a SAS does not need to be paused, and the willingness to respond remains high among first responders.

Clinical outcomes of digital sensor alerting systems in remote monitoring: a systematic review and meta-analysis

Advances in digital technologies have allowed remote monitoring and digital alerting systems to gain popularity. Despite this, limited evidence exists to substantiate claims that digital alerting can improve clinical outcomes. The aim of this study was to appraise the evidence on the clinical outcomes of digital alerting systems in remote monitoring through a systematic review and meta-analysis. A systematic literature search, with no language restrictions, was performed to identify studies evaluating healthcare outcomes of digital sensor alerting systems used in remote monitoring across all (medical and surgical) cohorts. The primary outcome was hospitalisation; secondary outcomes included hospital length of stay (LOS), mortality, emergency department and outpatient visits. Standard, pooled hazard ratio and proportion of means meta-analyses were performed. A total of 33 studies met the eligibility criteria; of which, 23 allowed for a meta-analysis. A 9.6% mean decrease in hospitalisation favouring digital alerting systems from a pooled random effects analysis was noted. However, pooled weighted mean differences and hazard ratios did not reproduce this finding. Digital alerting reduced hospital LOS by a mean difference of 1.043 days. A 3% mean decrease in all-cause mortality from digital alerting systems was noted. There was no benefit of digital alerting with respect to emergency department or outpatient visits. Digital alerts can considerably reduce hospitalisation and length of stay for certain cohorts in remote monitoring. Further research is required to confirm these findings and trial different alerting protocols to understand optimal alerting to guide future widespread implementation.

Designing and evaluating contextualized drug–drug interaction algorithms

Objective Alert fatigue is a common issue with off-the-shelf clinical decision support. Most warnings for drug–drug interactions (DDIs) are overridden or ignored, likely because they lack relevance to the patient’s clinical situation. Existing alerting systems for DDIs are often simplistic in nature or do not take the specific patient context into consideration, leading to overly sensitive alerts. The objective of this study is to develop, validate, and test DDI alert algorithms that take advantage of patient context available in electronic health records (EHRs) data. Methods Data on the rate at which DDI alerts were triggered but for which no action was taken over a 3-month period (override rates) from a single tertiary care facility were used to identify DDIs that were considered a high-priority for contextualized alerting. A panel of DDI experts developed algorithms that incorporate drug and patient characteristics that affect the relevance of such warnings. The algorithms were then implemented as computable artifacts, validated using a synthetic health records data, and tested over retrospective data from a single urban hospital. Results Algorithms and computable knowledge artifacts were developed and validated for a total of 8 high priority DDIs. Testing on retrospective real-world data showed the potential for the algorithms to reduce alerts that interrupt clinician workflow by more than 50%. Two algorithms (citalopram/QT interval prolonging agents, and fluconazole/opioid) showed potential to filter nearly all interruptive alerts for these combinations. Conclusion The 8 DDI algorithms are a step toward addressing a critical need for DDI alerts that are more specific to patient context than current commercial alerting systems. Data commonly available in EHRs can improve DDI alert specificity.

Improving service-level agreements for critical systems using big data monitoring techniques

The proliferation of big data in virtually every branch of society and industry comes with the need to adapt and develop monitoring and alerting systems in such a way that the system can cope with any kind of data stream, whilst also ensuring rapid response times. This paper presents a framework based on modern open-source technologies that can be used to improve the quality and reliability of a connected system (such as an industrial control system), through effective monitoring and alerting. Service level agreements are crucial in our modern society, where failures need to be detected quickly and effectively, especially when one is providing a service and every moment of downtime means a large quantity of lost money and potential customers, thus monitoring is essential. Benefits in terms of responsiveness and lower downtime are also discussed, with an emphasis on a prototype implementation for a major non-profit organization.