Using Telehealth to Improve the Accuracy of Delirium Screening by Bedside Critical Care Nurses

Background Delirium affects up to 80% of patients in the intensive care unit (ICU) but is missed in up to 75% of cases. Telehealth in the ICU (tele-ICU) has become the standard for providing timely, expert care to remotely located ICUs. Objectives This pilot study assessed the feasibility and acceptability of using tele-ICU to increase the accuracy of delirium screening and recognition by ICU nurses. Methods The pilot sites included 4 ICUs across 3 hospitals. A geriatrician with delirium expertise remotely observed 13 bedside ICU nurses administering the Confusion Assessment Method for the ICU (CAM-ICU) to patients in real time via the tele-ICU platform and subsequently provided training on CAM-ICU performance and delirium management. Training evaluation consisted of a validated spot check form, a 2-item satisfaction/change-of-practice survey, and a qualitative question on acceptability. Results Thirteen ICU nurses were observed performing 26 bedside delirium assessments. The top observed barriers to accurate delirium screening were CAM-ICU knowledge deficits, establishment of baseline cognition, and inappropriate use of the “unable to assess” designation. The mean percentage of correct observations improved from 40% (first observation) to 90% (second observation) (P < .001). All 13 nurses strongly agreed that the training was beneficial and practice changing. Conclusions The use of tele-ICU to improve the accuracy of delirium screening by ICU nurses appears to be feasible and efficient for leveraging delirium expertise across multiple ICUs. Future studies should evaluate the effects of tele-ICU delirium training on patient-centered outcomes.

Progressive evaluation in spectroscopic sensors for non-invasive blood haemoglobin analysis - a review

Frequent monitoring of haemoglobin concentration is highly recommended by physicians to diagnose anaemia and polycythemia Vera. Moreover, Some other conditions also demand assessment of haemoglobin, and these conditions are blood loss, before blood donation, during pregnancy, preoperative, perioperative and postoperative conditions. Cyanmethaemoglobin/haemiglobincyanide method, portable haemoglobinometers and haematology analyzers are few standard methods to diagnose mentioned ailments. However, discomfort, delay and risk of infection are typical limitations of traditional measuring solutions. These limitations create the necessity to develop a non-invasive haemoglobin monitoring technique for a better lifestyle. Various methods and products are already developed and popular due to their non-invasiveness; however, invasive solutions are still considered as the reference standard method. Therefore, this review summarizes the attributes of existing non-invasive solutions. These attributes are finalized as brief details, accuracy, optimal benefits, and research challenges for exploring potential gaps, advancements and possibilities to consider as futuristic alternative methodologies. Non-invasive total haemoglobin assessing techniques are mainly based on optical spectroscopy (reflectance/transmittance) or digital photography or spectroscopic imaging in spot check/continuous monitoring mode. In all these techniques, we have noticed that there is a need to consider different light conditions, motion artefacts, melanocytes, other blood constituents, smoking and precise fixing of the sensor from the sensing spot for exact formulation. Moreover, based on careful and critical analysis of outcomes, none of these techniques or products is used independently or intended to replace invasive laboratory testing. Therefore there is a requirement for a more accurate technique that can eliminate the requirement of blood samples and likely end up as a reference standard method.

Brain thermal kinetics at brain-eyelid thermal tunnels overcoming COVID-19 thermometry limitations for automated asymptomatic infection detection in concert with physical and biological principles

For centuries, temperature measurement deficiencies attributable to biological barriers and low thermo-conductivity (k) have precluded accurate surface-based fever assessment. At this stage of the pandemic, infection detection in children (who due to immature immune system may not effectively respond to vaccines) is critical because children can be readily infected and also become a large mutation reservoir. We reveal hitherto-unrecognized worldwide body temperature measurements (T°), in children and adults, over tissue typified by low-k similar to wood that may reach 6.8°C in thermal variability, hampering thereby COVID-19 control. Brain-eyelid thermal tunnels’ (BTT) integration of low-k and high-k regions creating a thermal pathway for undisturbed heat transmission from hypothalamus to high-k skin eliminates current shortcomings and makes the brain indispensable for defeating COVID-19 given that brain thermoregulatory signals are not limited by mutations. Anatomo-histologic, emissive, physiologic, and thermometric bench-to-bedside studies characterized and overcome biophysical limitations of thermometry through high-k eyelid-enabled brain temperature measurements in children and adults. BTT eyelid features fat-free skin (~900 µm) and unique light emission through a blood/fat configuration in the underlying tunnel. Contrarily, forehead features variable and thick dermis (2000–2500 µm) and variable fat layers (1100–2800 µm) resulting in variable low-k as well as temperatures 1.97 °C lower than BTT temperature (BTT°). Highest emission present in only ~3.1% of forehead averaged 1.08±0.49 °C (mean±SD) less than BTT° (p=0.008). Environmental and biological impacts during fanning revealed thermal imaging limitations for COVID-19 screening. Comparison of paired measurements for 100 pediatric patients showed that in the children subgroup above 37°C, BTT° exceeded body core temperature (Core°) in 60/72 patients; the average difference in the 72 patients was 0.62±0.7°C (p<0.001 by unpaired t-test); and in the subgroup beyond 37.5°C, BTT° exceeded Core° in 30/32 patients. Delineating hypothalamic activity in children facilitates early infection detection, which is essential because children’s immunogenicity prevents effective vaccination and causes accelerated viral evolution. Capturing hypothalamic thermal signals from BTT was further supported by brain thermal kinetics via BTT using wearables during anesthesia, sedation, sleep, brain injury, exercise, and asymptomatic infection, which revealed brain/core discordance and enabled automated noninvasive afebrile infection detection for interrupting asymptomatic human-to-human transmission. BTT-based spot-check thermometry can be harmlessly implemented for children worldwide without undue burden and costs; meanwhile, continuous brain-eyelid T° in concert with biological and physical principles affords a new dimension for combating pandemics. The “detection–vaccination” pair solution presented is required to mitigate COVID-19 from spreading indefinitely through mutations and vaccine evasion while opening a viable path for eradicating COVID-19.

Techniques of Recording Photoplethysmographic Signals

The photoplethysmography optically measures blood volume changes within micro vascular tissue. Furthermore, photoplethysmographic signals are used within pulse oximeters in order to calculate the oxygen saturation of the blood. This standard measurement technique is performed as a non-invasive spot check method for human health conditions in hospitals or other health care facilities. Usually at least two light sources are used alternating in order to measure photoplethysmograms at different wavelengths. In this paper we will investigate different methods of optically recording photoplethysmographic signals.

SprayNPray: user-friendly taxonomic profiling of genome and metagenome contigs

Shotgun sequencing of cultured microbial isolates/individual eukaryotes (whole-genome sequencing) and microbial communities (metagenomics) has become commonplace in biology. Very often, sequenced samples encompass organisms spanning multiple domains of life, necessitating increasingly elaborate software for accurate taxonomic classification of assembled sequences. While many software tools for taxonomic classification exist, SprayNPray offers a quick and user-friendly, semi- automated approach, allowing users to separate contigs by taxonomy (and other metrics) of interest. Easy installation, usage, and intuitive output, which is amenable to visual inspection and/or further computational parsing, will reduce barriers for biologists beginning to analyze genomes and metagenomes. This approach can be used for broad-level overviews, preliminary analyses, or as a supplement to other taxonomic classification or binning software. SprayNPray profiles contigs using multiple metrics, including closest homologs from a user-specified reference database, gene density, read coverage, GC content, tetranucleotide frequency, and codon-usage bias. The output from this software is designed to allow users to spot-check metagenome-assembled genomes, identify, and remove contigs from putative contaminants in isolate assemblies, identify bacteria in eukaryotic assemblies (and vice-versa), and identify possible horizontal gene transfer events.

Undersampling bankruptcy prediction: Taiwan bankruptcy data

Machine learning models have increasingly been used in bankruptcy prediction. However, the observed historical data of bankrupt companies are often affected by data imbalance, which causes incorrect prediction, resulting in substantial economic losses. Many studies have proposed the insolvency imbalance problem, but little attention has been paid to the effect of the undersampling technology. Therefore, a framework is used to spot-check algorithms quickly and combine which undersampling method and classification model performs best. The results show that Naive Bayes (NB) after Edited Nearest Neighbors (ENN) has the best performance, with an F2-measure of 0.423. In addition, by changing the undersampling rate of the cluster centroid-based method, we find that the performance of the Linear Discriminant Analysis (LDA) and Naive Bayes (NB) are affected by the undersampling rate. Neither of them is uniformly declining, and LDA has higher performance when the undersampling rate is 30%. This study accordingly provides another perspective and a guide for future design.

123 Quality Improvement Project on Completion of Respect Form in the Community At Jean Bishop Integrated Care Centre (ICC)

Background ReSPECT (Recommendation Summary Plan for Emergency Care and Treatment) form was designed to communicate a personalized set of recommendations for a patient’s clinical care in an emergency situation and priorities over other aspects of future care. AIMS & OBJECTIVE 1)To measure ReSPECT Form completion rates at ICC and proportion of forms uploaded on the system and this compared with the published data 2 to improve performance where possible through QI process 3) Re-auditing after interventions. Methods All patients who attended the ICC from 1st October 2019 to 21st October 2019 were audited. Altogether 80 patients’ notes on system 1 and Lorenzo were reviewed. After initial results, interventions such as displaying the poster of salient results and recommendations in ICC clinic rooms, giving feedback to key team members were performed by the audit team. Results 9 patients already had ReSPECT forms. From the remaining 71 patients, 57 discussions (80%) were taken place and 29 forms (41%) were completed while 28 were not for definite reasons. ReSPECT discussion was not initiated for recorded reasons in 9 cases and without reason in 5 cases. Out of 29 completed forms, 24(82%) were uploaded on the system. After the interventions, the re-audit cycle with 16 cases in which 13(94%) had ReSPECT discussions and 6 forms were completed. Discussion In comparison with NHS forth valley ReSPECT report, we had a better figure in completion forms (41% Vs 39%) and the number uploaded on system (82% vs 79%). After interventions, 81% had either ReSPECT forms completed or discussion which is much improved. Conclusion From this study, the overall improvement in performance was seen with simple interventions but further spot check QIPs and regular training sessions to team member will be essential for sustainability.