Search

Introduction. Сomputed tomography (СТ) and magnetic resonance imaging (MRI) are the main methods of radiological diagnostics, which makes it possible to objectively assess the local advancement of malignant tumors of the hearing organ and decide on the possibility of surgical intervention.The objective of this scientific research – to determine the main indications for surgical intervention, taking into account the radiological criteria for the lesion of the temporal bone (CT, MRI) in locally advanced outer ear skin cancer. Materials and methods. This research work based on a retrospective and prospective analysis case history for patients with locally advanced external ear skin cancer. These are 45 patients, who received treatment in surgical department of head and neck tumors in N. N. Blokhin National Medical Research Center of Oncology between 1994 and 2020. Patient observation time averaged 30.0 ± 32.3 months (from 0.7 to 117.4 months, median – 12.0 months).Results. The prevalence of the tumor process in cancer of the skin of the external auditory canal in accordance with the staging system for lesions of the temporal bone structures (University of Pittsburgh, 1990), which takes into account CT and MRI signs of damage to the temporal bone and adjacent anatomical structures, is a factor that significantly affects the long-term results of treatment (for disease-free survival: hazard ratio (HR) 4.76, 95 % confidence interval (CI) 1.93–11.73, р = 0.00069; for tumor-specific survival: HR 4.25, 95 % CI 1.74–10.39, р = 0.0015; for overall survival: HR 1.96, 95 % CI 1.07–3.58, р = 0.029).Conclusion. CT and MRI are mandatory methods of radiological diagnosis of patients with skin cancer of the external auditory canal.

Aim To analyze the frequency and core elements of nursing work interruptions in Chinese emergency nursing settings. Background Little is known about nursing interruptions, which affect the quality of services in Chinese emergency nursing setting. Method(s) A cross-sectional observational study was conducted in three units of an emergency department in a Chinese tertiary hospital. Participants comprised 60 nurses. Data were collected using a questionnaire developed by the researchers specifically for this study. Results In total, 25,965 minutes of work were observed and 2,333 interruptions were identified. Most interruptions were from patients, their families, and nurses. Therapeutic nursing and patient observation and documentation were the most frequently interrupted procedures. Most interruptions were negative, and a majority of the nurses immediately responded to interruptions. Significant differences existed in the overall distribution of the core elements among the three nursing units. Conclusions The frequency of emergency nursing interruptions were moderate. Most interruptions tend to lead to negative treatment outcomes for patients. Implications for nursing management Emergency nursing managers should recognize the importance of interruptions, understand work situations better, and develop ways to reduce the incidence of interruptions. Thus, nursing risks can be avoided by reducing the adverse outcomes caused by work interruptions.

Many patients are dying day after day due to the hypothetical treatment of brain tumors. Brain tumor detection and location identification are very ticklish and time-consuming task in biomedical image processing due to the complex structure of the brain. It is an important factor for detecting the tumor at the early stage that prevents the death from this epidemic disease. One of the most used and popular for the brain tumor diagnosis system is Magnetic Resonance Imaging (MRI) but it is a manual and time-consuming approach. In this research, an automated system has proposed to detect, locate and observe the tumor area in the patient brain. In the tumor extraction stage, the morphological operation based and marker control watershed segmentation methods used to extract the affected region from brain hemisphere through some additional step like filtrations and noise removal. In the tumor location identification stage, the brain hemisphere divided into four parts and compared among them by counting the pixels value that gave the proper location of the tumor in the hemisphere of the brain. Finally, this research study proposed a patient observation technique that compared the tumor growth of patient in timely.

Background: Nursing care in the recovery room is oriented to take into account the patient’s condition after surgery intervention with its main purpose of providing direct and continuous patient observation in emergence from general or regional anesthesia. In the absence of professional assistance, patients can develop complications that can lead them into shock or death. This study aims to understand the place of nurses in guiding nursing care in recovery room in two hospitals of Gitega Province by assessing the nurse’s knowledge and attitudes for the promotion of quality nursing care for post-operative patients. Methods: A cross sectional study design was used to assess the practice of nurses in managing nursing care in the recovery room in these two hospitals. A purposive sampling method was used to select the 82 nurses working in the recovery room for these two hospitals and Alain Bouchard’s formula was used to calculate the sample size. Data were collected using a self-report method involving questionnaire completion with five components addressing participants identifications, factors related to the work organization, factors related to the work environment, factors related to healthcare system, and nursing interventions in recovery room. Results: Findings revealed a significant lack of knowledge among the participants and their attitudes were slightly poor as for most of the variables of factors related to healthcare system as their score was less than 50% and their knowledge for nursing interventions was also poor as most of variable scores were less than 25%. Conclusions: The study findings were slightly poor as their scores were less than 50% in most of the variables; therefore, it was recommended that in-service training and workshops should be organized by these healthcare facilities for the purpose of empowering the nurse’s knowledge and practice. Moreover, these institutions should provide and encourage nurses to use nursing guidelines and protocols.

Uncooperative elderly patients with cognitive disorder are often confused and/or agitated. Risk of involuntary venous access device dislodgment is high in these patients. This is equally likely with peripherally inserted central catheters and centrally inserted central catheters but less common with femorally inserted central catheters. Solutions to this problem include strict continuous patient observation, using sutures or subcutaneous anchored securement, wrapping the arm to “hide” the line, or using soft mittens to occupy the hands. However, some patients are able to disrupt the dressing, dislodge the catheter, and often pull the catheter out completely. In some cases, the patient may also overcome the resistance offered by the stitches or by the subcutaneous anchored securement device. In a recent paper on the impact of subcutaneously anchored securement in preventing dislodgment, the only demonstrated failures occurred in non-compliant elderly patients. Creation of an alternative exit site is an emerging trend in patients with cognitive impairment at high risk for catheter dislodgement. Subcutaneous tunneling from traditional insertion sites such as the jugular, axillary, or femoral veins allows placement of the exit site in a region inaccessible to the patient. The following two case reports demonstrate the technique for tunneling a femorally inserted central catheter downward to the patellar region and for tunneling a centrally inserted central catheter to the scapular region. Internal review board approval was not deemed necessary as subcutaneous tunneling is not a new technique. In our experience, such maneuvers can be successfully performed at the bedside.

Background Approximately 5-10% of patients with asthma have severe disease. High-quality real-world studies are needed to identify areas for improved management. Objective Aligned with the International Severe Asthma Registry, the CHRONICLE study (ClinicalTrials.gov: NCT03373045) was developed to address this need in the US. Study design Learnings from prior studies were applied to develop a real-world, prospective, noninterventional study of US patients with confirmed severe asthma who are treated by subspecialist physicians and require biologic or maintenance systemic immunosuppressant therapy or who are uncontrolled by high-dosage inhaled corticosteroids and additional controllers. Target enrollment is 4000 patients, with patient observation for ≥3 years. A geographically diverse sample of allergist/immunologist and pulmonologist sites approach all eligible patients under their care and report patient characteristics, treatment, and health outcomes every 6 months. Patients complete online surveys every 1-6 months. Initial results From February 2018 to February 2019, 102 sites screened 1428 eligible patients; 936 patients enrolled. Study sites (40% allergist/immunologist, 42% pulmonologist, 18% both) were similar to other US asthma subspecialist samples. Enrolled patients were 67% female with median ages at enrollment and diagnosis of 55 (range: 18-89) and 26 (0-80) years, respectively. Median body mass index was 31 kg/m2; 3% and 29% were current or former smokers, respectively, and >60% reported ≥1 exacerbation in the prior year and suboptimal symptom control. Conclusion CHRONICLE will provide high-quality provider- and patient-reported data from a large, real-world cohort of US adults with subspecialist-treated severe asthma.

This essay is “an account […] of an honest and patient observation” (p. 6) of an ethnic group left nameless in history, and which Tournon renamed the Canayens [kana’jɛ˜ ] after the popular pronunci...

A clinical picture of bipolar affective disorders in children and adolescents is variable and dependent on the specificity of developmental age. From diagnostic and therapeutic point, especially difficult are cases with the pre-pubertal onset. In the article, a case report of 18-year observation of male patient with the onset of bipolar affective disorder at 11 years of age is presented. This very early pre-pubertal onset of the illness was manifested with rapid cycling, depressive episode with psychotic symptoms and the classic symptoms of mania. The use of lithium carbonate appeared effective and safe. Lithium was used for two years in combination with valproates, and in following years as monotherapy. In recent two years, due to depressive episodes of moderate intensity, the patients also received fluoxetine on periodic basis. No adverse effects of the treatment were observed.

The aim of this study was to describe nurses’ opinions regarding assessments of oxygen requirements and which modes of cognition they used about oxygen treatment in ventilated children aged 0–3 years. The method was survey design with descriptive statistics. The sample included 90 nurses from intensive care units within all university hospitals in Norway. The questionnaire covered use of physiological, clinical, and technical observations in assessments, and the Nursing Decision-Making Instrument was used to map the mode of cognition. Respondents perceived they used many of the physiological criteria except for the haemoglobin–oxygen dissociation curve, pulse and blood pressure. Most respondents used clinical and technical criteria to assess oxygen needs, but more than half would exceed 10% oxygen at each regulation. They considered written guidelines to be necessary. A majority demonstrated a flexible use of analytical and intuitive modes of cognition in the decision-making processes. The results indicate that assessment of children’s need for oxygen may be based on insufficient information, and written guidelines should be developed.

Purpose: analysis of various clinical results in patients registered in the liver transplantation waiting list (LTWL).Materials and methods: the study was carried at the Center of Surgery and Donor Coordination of the Rostov Regional Clinical Hospital using clinical, laboratory and instrumental data of 198 patients from the LTWL. 99 men and 99 women were enrolled into this study. The men age ranged from 21 to 70 years (47.8 ± 10.4 years), women age - from 18 to 66 years (49.2 ± 10.9 years). At the time of analysis of the LTWL, the average follow-up period was 14.8 ± 11.2 months. All patients were examined according to the list required for inclusion in the LTWL.Results: depending on the outcome, 198 patients from TLWL were grouped into 4 groups. The first group (delisting group) — 19 patients (9.6 %) with clinical and laboratory indicators that allowed them to be excluded from WL. The second group — 67 patients (33.8 %) who had positive clinical dynamics following therapy. The third group — 39 patients (19.7 %) who underwent liver transplantation. The fourth group — 73 patients (36.9 %) who had negative dynamics following therapy, including patients with a fatal outcome. While keeping LTWL for 4 years, 61 (30.81 %) of 198 listed patients died. The majority (40 patients) died of bleeding from varicose veins and OPPN, 17 patients died of hepatic coma and SPB. Each group represents the distribution of patients according to the MELD-Na scale, the severity of portal hypertension and hepatic encephalopathy.Conclusion: the following factors are indispensable for successful work of the transplant center: systematic work with the territories in order to expand the donor base; defining the patient priority criteria in the LTWL in order to reduce the death rate in the list; detailed examination of the patient before entering the list; forming the observation base; systematic patient observation during the pre- and postoperative period, at the rehabilitation stage, as well as at long-term periods in order to develop an effective algorithm of management of the recipient of a solid organ.

As vantagens da telemedicina incluem observação, diagnóstico, tratamento e monitorização do utente à distância. Devido à pandemia por COVID-19, o recurso à teleconsulta aumentou, pretendendo evitar deslocações desnecessárias e contágios. Com este trabalho, procurou-se avaliar a evidência existente sobre teleconsulta em outcomes de saúde na população seguida nos Cuidados de Saúde Primários e/ou que os procura para resolução de doença aguda, através de uma pesquisa sistemática nas bases de dados de medicina baseada na evidência de estudos que analisem a teleconsulta nos Cuidados de Saúde Primários. Foram incluídas duas revisões sistemáticas. A primeira demonstrou que as consultas telefónicas são uma opção apropriada em determinadas situações, reduzindo a carga de trabalho na prática clínica. A segunda revelou que as intervenções de telemedicina são eficazes e custo-efetivas. Tendo em consideração o limitado número de estudos sobre o tema e o facto de apresentarem limitações, atribuiu-se uma força de recomendação SORT B.

Introduction For patients with dementia, behaviour and reactions to stimuli can change and an X-ray examination in the hospital can have be a frightening experience. The aim of this study was to identify the experiences and perspectives of patients with dementia and their caregivers on receiving a mobile x-ray examination in nursing homes. Methods This study was designed as a qualitative study using patient observation and semi structured interviews, with a phenomenology-hermeneutic approach. In total, 23 patients were observed during X-ray examinations in nursing homes, and six semi structured interviews were conducted with the caregivers who participated in the examination. Results The observations and interviews indicated that a known environment, a recognizable framework and calmness were central for a patient with dementia. The patients appeared calm and relaxed during the examination in their usual environment (nursing homes) where there are less stimuli and impressions based of the observations. Conclusion Mobile X-ray examinations for patients with dementia living in nursing homes had a positive impact on patients' reactions towards the X-ray examination. The examinations were performed in the patients' usual and safe environments, where impressions and stimuli were less disturbing for patients with dementia. Implications for practice The mobile x-ray unit can be of benefit for patients suffering from dementia and result in less impact. The patients living in nursing homes have the opportunity to be examined in their familiar environment, because of the mobile x-ray unit.

Stress, anxiety and depressive disorders are often characterized by the activation of the stress axis, which results in similar symptoms at some point in these disorders. These disorders are closely related to each other—they occur simultaneously or follow one another. The diagnosis of stress, anxiety and depression is not a perfect procedure currently—it is based on patient observation and an interview with the patient and their family. There are no laboratory tests that would dispel the doubts of the doctor making the diagnosis and allow the appropriate treatment to be implemented as soon as possible. Therefore, this study will review the components of saliva that could be helpful in the quick diagnosis of stress, anxiety and/or depression. Such potential salivary biomarkers could also be useful in monitoring the effectiveness of pharmacological treatment prescribed by a psychiatrist. The following are promising salivary biomarkers of stress, anxiety or depression: cortisol, immunoglobulin A (sIgA), lysozyme, melatonin, α-amylase (sAA), chromogranin A (CgA) and fibroblast growth factor 2 (FGF-2). To the best valuable potential salivary markers of stress, we can include cortisol, lysozyme, sAA and CgA. To differentiate depression from stress, salivary cortisol and melatonin can be helpful. Fluctuations in the concentrations of the above-mentioned substances in saliva indicate a particularly strong relationship with typical human psychological problems, such as stress, depression or anxiety.

Epilepsy, a neurological disease, affects quite sixty-five million individuals all over the world. Epilepsy, a brain disorder, is characterized by intermittent seizures which are caused by disturbances in the electrical activity of the brain. These seizures will last from seconds to minutes and vary from an impaired consciousness up to severe convulsions of the whole human body. To reduce morbidity and mortality caused by epilepsy, real-time patient observation is essential to alert caretakers and to look after the emergency medications and give assistance. A wrist band monitors real-time biological parameters in cloud server whereas Myoware muscle sensor senses muscle contraction and SpO2 sensor measures pulse rate and oxygen level in the body. Databases are collected in the cloud server which helps doctor and caretakers to monitor patient’s health regularly. An Android app is used to alert caretakers and alarm is used to alert the surroundings for emergency help and medication.

Poisoning with household substances is responsible for a significant morbidity in children. The objective of this study is to specify the epidemiological characteristics of accidental and voluntary poisoning with these products at pediatric age. Research Design and Method.The study was observational, retrospective and included acute intoxication by ingestion of household substances in children aged 0-18 years hospitalized in The Regional Toxicology Center of the Emergency Hospital for Children "St. Maria “Iasi. Results.The study group included 230 children admitted in the last 6 years with this diagnosis. Data were obtained from patient observation sheets, centralized and subsequently processed statistically. Conclusion.Knowing the epidemiological aspects of these poisonings can contribute to the elaboration and application of appropriate prevention strategies

BackgroundRapid discharge strategies for patients with low-risk chest pain using high-sensitivity troponin assays have been extensively evaluated. The adherence to, and acceptability of such strategies, has largely been explored using quantitative data. The aims of this integrated qualitative study were to explore the acceptability of the limit of detection and ECG discharge strategy (LoDED) to patients and health professionals, and to refine a discharge information leaflet for patients with low-risk chest pain.MethodsPatients with low-risk chest pain who consented to a semi-structured interview were purposively sampled for maximum variation from four of the participating National Health Service sites between October 2018 and May 2019. Two focus groups with ED health professionals at two of the participating sites were completed in April and June 2019.ResultsA discharge strategy based on a single undetectable hs-cTn test (LoDED) was acceptable to patients. They trusted the health professionals who were treating them and felt reassured by other tests, (ECG) alongside blood test(s), even when the clinical assessment did not provide a firm diagnosis. In contrast, health professionals had reservations about the LoDED strategy, including concern about identifying low-risk patients and a shortened patient observation period. Findings from 11 patient interviews and 2 staff focus groups (with 20 clinicians) centred around three overarching themes: acceptability of the LoDED strategy, perceptions of symptom severity and uncertainty, and patient discharge information.ConclusionRapid discharge for low-risk chest pain is acceptable to patients, but clinicians reported some reticence in implementing the LoDED strategy. Further work is required to optimise discharge discussions and information provision for patients.

Introduction In a hospital, a patient may traditionally have observations and personal data displayed on a paper clipboard next to their bed. Not only does this raise privacy concerns, as data can be viewed by anyone approaching the bed, but it also needs to be manually updated when there is a change. A handheld mobile Augmented Reality (AR) application allows the clinician to view data as superimposed on a real-life clipboard, fetching and updating this information in real time. The AR application draws the clinician away from the screen and back into the ‘real world’, human interaction with the patient, providing a seamless, unobtrusive way for them to interact with patient data. Method As part of a collaboration between GOSH and UCL computer science through the industry exchange network (IXN), we developed a prototype mobile AR application for viewing patient data on an AR clipboard. The application was developed using Unity game engine and the AR foundation package for cross platform development with iOS and Android. The application pulled synthetic patient data for display, in the FHIR standard format, from the FHIR API. Results The mobile AR application responds to a trigger image on a clipboard and displays patient information in real time, tracking the clipboard in space, so the information appears superimposed onto the object. The application offers the option to search and display patient data by patient ID number. Further search functions are proposed, such as searching and displaying by name or hospital number. Conclusion A proof of principle system for an AR patient data clipboard was developed to connect with the FHIR database and fetch patient information for use by clinicians in a hospital environment. Further work on this system could enable the application to connect with IoT medical devices to pull patient observations in real time.

The literature shows that respiratory complications are common with sedation. Given the inherent risk, capnography monitoring is recommended whenever sedation is administered. We aimed to explore sedation practitioners’ behavior patterns and perceptions regarding capnography monitoring during endoscopy sedation and examine how capnography influenced clinical decision making when assessing respiration. We conducted a focused ethnography with triangulated observations and semi-structured interviews, and we purposively sampled and recruited five sedation practitioners as participants at a hospital in Saudi Arabia. Through data analysis, we identified representative themes and found cultural differences between anesthesia practitioners and nurses when using capnography during sedation. Anesthesia practitioners linked safety and the use of capnography to maintain adequate respiration, while nurses believed capnography was a secondary supportive monitor to patient observation and assessment. Findings also captured the unique cultures and values of each professional group to be associated with the varying perceptions. We also identified several factors facilitating and barring adequate utilization of capnography. In conclusion, professional culture, hospital policy, knowledge and previous experience with capnography guided the monitoring practice of endoscopy practitioners when assessing respiration during sedation.

Brain Computer Interface (BCI) offers direct communication and controlling channel between the human brain and various physical devices. This paper introduces a mind controlled device that enables monitoring of the patient and indoor location using Capsule Network (CapsNet) Algorithm. This system offers huge benefits to patients who are restrained to wheelchairs and ventilators but have their cognitive ability intact. The electroencephalogram (EEG) signals are extracted and processed using Arduino Uno Microcontroller and classified with deep learning techniques. Comparison of the EEG signals is done using capsule network algorithm for feature extraction and to predict the brain attention and meditation state. The proposed architecture based on CapsNet outperforms the existing ANN approaches.

Is to evaluate the advantage of Contractubex gel with regards to influence on vascularisation, pigmentation, thickness, surface size, configuration, and elisticity of postsurgical scars of children (after cheilorinoplasty) in comparison to absence of systematized topical treatment.Into the prospective, non-interventional, observational, multi-centered, in parallel groups, open, controlled study were included 60 patients aged 2,5 months and older with postsurgical scars after first cheilorinoplasty after 7-14 day after operation. Patients were randomized into 2 groups of 30 patients in each. I group - patients get applications of Contractubex gel 3 times a day (in the morning, in the afternoon, in the evening) in accordance with patient information leaflet. II group - control group with no regular therapy of of postsurgical scars (without treatment or without application of oils and gels with anticsarring action). The period of medicine usage - 9 months and more for each patient, the each patient observation duration is 18 months.After analysis of the primary as well as secondary efficacy criteria (total grade based on POSAS scale, reported by investigator/parent) after 3, 6, 12, 18 months of observation in both groups a positive statistically significant dynamics was registered. At the same time in the Contractubex group results were statistically significantly better than in the control group. Positive dynamics was achieved quickier in the main group than in the contol group and was to observe already after 3 months of therapy, during the whole treatment and observation phase, and after 18 months of therapy. Additionally conducted photodocumentation of postsurgical scar development dynamics in terms of the study confirms positive effect of surgery and absence of visual data regarding keloids or hyperthrophic scars formation in patients in both groups. Adverse events, i. a. pain, itch, burning, long-run hyperemia were not registered during the whole period os study.The conducted study has shown high efficacy and safety of Contractubex usage for the treatment of postsurgical scars of children with with congenital cleft lip and palate (from 2,5 months old). The statistically significant advantage of the therapy with Contractubex was demonstrated in comparison with the control group (with no regular topical treatment). The obtained results allow to recommend Contractubex gel as an effective and safe medicine for the treatment of scarring after surgeries for kids directly after sutures removal.Оценить преимущество геля Контрактубекс по влиянию на васкуляризацию, пигментацию, толщину, площадь поверхности, рельеф и эластичность послеоперационных рубцов у детей (после хейлоринопластики) в сравнении с отсутствием систематизированного местного лечения.Обследованы 60 детей в возрасте 2,5 мес и старше с послеоперационными рубцами после впервые проведенной хейлоринопластики через 7—14 сут после операции, которые были рандомизированы в 2 группы по 30 пациентов в каждой. Пациентам 1-й группы на область рубца наносился гель Контрактубекс 3 раза в день (утром, днем, вечером), во 2-й группе (контроль) местная терапия послеоперационных рубцов на регулярной основе не проводилась. Длительность применения препарата составила 9 мес и более, длительность наблюдения — 18 мес. Для оценки эффектив ности препарата применяли шкалу POSAS. Осуществляли фотодокументировние динамики развития послеоперационного рубца.При анализе критериев эффективности (общий балл по POSAS, выставленный исследователем / родителем пациента) через 3, 6, 12, 18 мес наблюдения в обеих группах отмечалась статистически значимая положительная дина-мика, однако у детей 1-й группы она была более выраженной, чем в контроле, и имела более быстрое развитие. Результаты фотодокументирования свидетельствовали о положительном эффекте оперативного вмешательства и об отсутствии визуальных данных о формировании келоидов и гипертрофических рубцов у пациентов обеих групп. Нежелательных явленийпри применении препарата, в том числе боли, зуда, жжения, длительной гиперемии, зарегистрировано не было.

Introduction: Patients with cancer often experience mild to severe pain. Therefore, effective pain assessment and management is paramount to this patient sub-population. This study sought to assess the knowledge, attitude, and practices associated with pain assessment among nurses at Uganda Cancer Institute (UCI), Mulago National Referral Hospital, Kampala, Uganda. Methods: This descriptive cross-sectional study was conducted at UCI among 67 randomly selected nurses. Statistical analysis was performed using SPSS software. Results: The mean age of the respondents was 26 years with the standard deviation (SD) of 2.46. The average knowledge scale score was 12 (range: 0-16), indicating good knowledge of pain assessment. Nurses’ average attitude scale score was 9 out of a total score of 12, indicating a positive attitude towards pain assessment. Practices included use of standardized pain assessment tools (61.2%), patient observation (41.8%), documentation (94.0%), and administration of analgesics (56.7%). Most common assessment tool used was the verbal rating scale (32.8%). Pain assessment findings were rarely discussed (52.2%) during nurses’ reports. Conclusion: Nurses’ knowledge, attitude, and practices of pain assessment and intervention are essential components in promoting patient comfort; continuous professional development and research in this area is needed.

Continuous monitoring of the electrocardiogram (ECG) is a common intervention in people admitted to hospital, especially when the cause of admission has a cardiovascular origin. Although widely considered a simple, routine procedure, ECG monitoring requires expert knowledge and sound clinical judgement for it to be used safely. Incorrect use of monitoring equipment can result in sub-optimal care, and adverse patient outcomes, including death. Patient selection, correct setup of equipment, and careful alarm management are all important in ensuring that monitoring is conducted safely. In this first article in a two-part series, the indications for monitoring are discussed and evaluated. For most patients, this will be arrhythmia monitoring; however, some will have an additional requirement for ischaemia or QT interval monitoring. The practical aspects of ECG monitoring will be addressed in the second article of this short series.

Background : Both the high frequency of recurrence of large or giant paraclinoid aneurysms (PA) of the internal carotid artery and the occurrence of intra- and postoperative complications, leading to unsatisfactory results of surgical treatment of this group of patients, make the stated problem urgent. Flow-diverter embolization devices are actively used in many large international neurosurgical centers for the treatment of cerebral aneurysms of different morphology, size, and localization. Currently, there are very few reports on the effectiveness of the use of flow diverting stents in the surgical treatment of large and giant PA of the internal carotid artery. The results of these studies are controversial and largely contradictory. Aim : Outcome analysis of the use of Pipeline embolization device (PED) for the surgical treatment of large and giant carotid PA. Methods : The study enrolled 37 patients (25 women, 12 men; mean age 51.7±10.7 years) who were divided into those treated with the PED alone versus those treated with the PED and concurrent coil embolization. The average follow-up period was 19.7±3.8 months. Results : In 56.7% of cases, PA caused the development of an insignificant neurological deficit (Modified Rankin Scale 1−2). In 18.9% of patients, PA provoked a gross neurologic deficit (MRS 3−5). 24.3% of patients with PA did not have any clinical-neurological manifestations. After the surgery, neurologic status improved in 32.4% of patients, remained the same — in 45.9% of cases, and the degree of neurologic deficit increased in 21.6%. PED procedure was performed in 70.2% of patients. In 29.7% of cases, the dislocation of large or giant PA of the internal carotid artery from the systemic blood stream was performed using PED and concurrent coil embolization. At the indicated period of patient observation, complete occlusion of large and giant carotid PA was achieved in 75.6% of cases, almost complete and partial occlusion — in 24.3%. The incidence of thromboembolic and hemorrhagic complications was 10.8% and 8.1%, respectively. Mortality rate among patients was 2.7%. Conclusions : The use of PED is an effective method for occluding large or giant PA of the internal carotid artery. Nevertheless, this method of endovascular treatment of PA is associated with a high complication incidence.

Intestinal stoma creation is one of the most common surgical procedures. The most common long-term complication following stoma creation is parastomal hernia, which according to some authors is practically unavoidable. Statistical differences of its occurrence are mainly due to patient observation time and evaluation criteria. Consequently, primary prevention methods such as placement of prosthetic mesh and newly developed minimally invasive methods of stoma creation are used. It seems that in the light of evidence-based medicine, the best way to treat parastomal hernia is the one that the surgeon undertaking therapy is the most experienced in and is suited to the individuality of each patient, his condition and comorbidities. As a general rule, reinforcing the abdominal wall with a prosthetic mesh is the treatment of choice, with a low rate of complications and relapses over a long period of time. The current trend is to use lightweight, large pore meshes.

Objectives The aim of this study was to provide a comprehensive description of multiple skills in patient observation in critical care nursing. Research methodology Data from semi-structured interviews were analysed using thematic analysis. Setting Experienced critical care nurses (n = 20) from three intensive care units in two university hospitals in Finland. Findings Patient observation skills consist of: information gaining skills, information processing skills, decision-making skills and co-operation skills. The first three skills are integrated in the patient observation process, in which gaining information is a prerequisite for processing information that precedes making decisions. Co-operation has a special role as it occurs throughout the process. Conclusion This study provided a comprehensive description of patient observation skills related to the three-phased patient observation process. The findings contribute to clarifying this part of the competence. The description of patient observation skills may be applied in both clinical practice and education as it may serve as a framework for orientation, ensuring clinical skills and designing learning environments. Based on this study, patient observation skills can be recommended to be included in critical care nursing education, orientation and as a part of critical care nurses’ competence evaluation.

Introduction Early warning systems (EWS) were developed as a means of alerting medical staff to patient clinical decline. Since 85% of severe adverse events are preceded by abnormal physiological signs, the patient bed-side vital signs observation chart has emerged as an EWS tool to help staff identify and quantify deteriorating patients. There are three broad categories of patient observation chart EWS: single or multiple parameter systems; aggregated weighted scoring systems; or combinations of single or multiple parameter and aggregated weighted scoring systems. Objective This scoping review is an overview of quantitative studies and systematic reviews examining the efficiency of the adult EWS charts in the recognition of in-hospital patient deterioration. Method A broad search was undertaken of peer-reviewed publications, official government websites and databases housing research theses, using combinations of keywords and phrases. Data sources CINAHL with full text; MedLine, PsycINFO, MasterFILE Premier, GreenFILE and ScienceDirect. Also, the Cochrane Library database, Department of Health government websites and Ethos, ProQuest and Trove databases were searched. Exclusions Paediatric, obstetric and intensive care studies, studies undertaken at the point of hospital admission or pre-admission, non-English publications and editorials. Results Five hundred and sixty five publications, government documents, reports and theses were located of which 91 were considered and 21 were included in the scoping review. Of the 21 publications eight studies compared the efficacy of various EWS and 13 publications validated specific EWS. Conclusions There is low level quantitative evidence that EWS improve patient outcomes and strong anecdotal evidence that they augment the ability of the clinical staff to recognise and respond to patient decline, thus reducing the incidence of severe adverse events. Although aggregated weighted scoring systems are most frequently used, the efficiency of the specific EWS appears to be dependent on the patient cohort, facilities available and staff training and attitude. While the review demonstrates support for EWS, researchers caution that given the contribution of human factors to the EWS decision-making process, patient EWS charts alone cannot replace good clinical judgment.

Early eighteenth-century Edinburgh provided a unique learning environment for aspiring practitioners: one in which the unity of medicine and surgery was appreciated and clinical observations and a reasoning practitioner became the well spring of proper patient care. John Rutherford, a surgical apprentice in this environment, student on the wards of London hospitals and under Boerhaave at Leiden, became one of the original medical professors at the University of Edinburgh medical school in 1726. Rutherford taught the popular, theory-based Practice of Medicine for twenty-two years. Then at the end of 1748 he convinced Royal Infirmary of Edinburgh managers to allow him to begin a new lecture series, entitled Clinical Lectures, conducted at the patient's bedside. Pedagogically, the new lecture series integrated medical theory and its application on the ward. Pragmatically, Rutherford used the Clinical Lectures to transition students into practitioners. He oriented the student to the medical profession at large and placed him simultaneously at the patient-disease-physician interface. He taught that systematic patient observation and examination, when combined with experience and reasoning, were essential to accurate diagnoses and proper therapeutic interventions. Importantly too, Rutherford prepared his students for failure through humility, introspection, and the speculative nature of medical practice.

Background Enrolled Nurses (ENs) and Enrolled Nursing Auxiliaries (ENAs) are responsible for the monitoring of vital signs as an essential indicator of patients’ physiological deterioration. Monitoring are essential for early recognition of and responding to signs of deterioration as delayed responses could severely affect patient safety. Objectives This research study, (1) describe the accuracy of recording and the ability of ENs and ENAs (2) interpret the data presented during the assessment of vital signs at a selected private hospital in KwaZulu-Natal. Design and sample A quantitative, descriptive design was used. Methods The population (N = 89) consisted of permanent ENs (n = 27) and ENAs (n = 47). Part-time nurses working for an agency were also invited. A sample total of 64 respondents, comprising 20 ENs and 44 ENAs, participated in the study. Ethical permission Ethical clearance and permission from the organization head office was obtained. Results The data, reveals a young workforce, with 55% of respondents being between 26 and 35 years of age. Results from the questionnaire indicate that the nurses with more nursing experience and permanently employed achieved a higher score in the knowledge component. Analysis of the documentation, showed that the implementation record was not always correctly identified and that 29.6% of the ENs and ENAs did not enter the vital signs data correctly on the implementation record or rapport abnormalities to the professional nurse in charge. Conclusion The gaps identified during the assessment of vital signs while working at a private hospital put patients at risk and severely affect quality care.

In Healthcare 4.0, Remote patient monitoring (RPM) becomes a more powerful and flexible patient observation through wearable sensors at any time and anywhere. The most focused application area of RPM which allows doctors to get real-time information of their patient remotely with the help of wireless communication system. Thus, RPM reduces the time and cost of the patient. It also provides the quality care to the patient. To enhance the security and privacy of the patient data, in this paper, we have presented a Permissioned blockchain-based healthcare architecture. We have also discussed the challenges and their solutions. We have described the applications of blockchain. We also have given the usage of Machine learning with blockchain technology which can impact the healthcare industry.

The facial allotransplantation technique was first introduced to the general public in 2005. The definition of the face as a complex system of organs that perform social functions made possible the adaptation of this operation into clinical practice. The year 2010 was the starting point for initial research in the Russian Federation. Based on previous achievements and existing world experience in this field, facial allotransplantation was used for the first time in 2015 in St. Petersburg. The goal of this operation was to reconstruct a soldier’s central facial area after an electric burn; he was injured in the military line of duty. This article describes complications faced regarding the preparation for this operation, the issues encountered for facial tissue removal, as well as donor selection criteria. Each stage of the composite facial allotransplantation, complications that can occur during operation, milestone results, as well as the subsequent rehabilitation and immunosuppressive therapy during the 4-year patient observation period following surgery, including the description of a single episode of cell-humoral rejection of transplanted tissue, are described in detail. The experience gained from the first facial allotransplantation performed in Russia shows the possibility of using a new composite allograft to correct deformities in the central area of the face with the achievement of a successfully functioning and aesthetically pleasing result after the operation. After 4 years of dynamic observation and individual rehabilitation programs, the main goal of the facial transplantation, that is, social re-adaptation of the patient, was achieved.

Introduction While considerations of the human rights and efforts to secure safety in medical care are being reinforced, nursing students without nurse licenses are facing a limit in acquiring practical nursing skills during students’ days. In order to fill the gap with the basic skills required in clinical settings after graduation, simulation-based nursing education is conducted by reproducing scenes that can occur in actual clinical settings and using simulator. In this study, we tried whether the simulator as the teaching materials was useful. And we used the instruction designs devised for the simulation-based educational purpose. Methods Subjects: 40 nursing students who already ended the clinical training for 1,260 hours Study period: From November 2009 to March 2014 [Ethical considerations] The open recruitment was carried out for a study cooperator. We obtained a written consent. The study was conducted by ethics review board. The Simulation Design Scale were translated into Japanese and used in the study with the approval of the author. Instruction System Design Set study goals. Create a patient scenario according to the study goal using a Simulation Design Template. Select equipment required to execute the simulation according to the scenario. The setting time is 15 minutes. Assess the conditions of each patient and report to the person playing the role of leader using SBAR. Debriefing: 30 minutes Results The study goal was set as ‘patient‘s condition after operation can be assessed and reported.’ We created a scenario to observe and report conditions of a patient at 30 minutes after returning to a ward after operating surgery. It took 13 minutes on average from assessment of the patient‘s condition until reporting to the person playing the role of nurse leader using SBAR. The debriefing was conducted for the methods and contents of patient observation and reporting. They felt confused as SBAR is not normally R(recommended). The SDS was 4.2/5 on average. Discussion The issue is how to utilize it to achieve the best possible educational effect. We designed simulation-based learning using ISD. It was suggested that the simulator was utilized well as an educational material. It also suggested that video debriefing allows us to subjectively look back on our actions based on certain standards and shows the significance of those actions. Conclusion This study suggested that instruction design need to simulation-based nursing education. Reference Dowie, I., amp;Phillips, C. Supporting the lecturer to deliver high-fidelity simulation. Nursing Standard. Orii Y. Developing post-operative assessment skills in Japanese undergraduate nursing students using high-fidelity simulator (Sim Man) – A pilot study. International Journal of PBL. Cheju Halla University PBL Center, Korea, 2013.

This study evaluated the effect of pranayama on asthma control, pulmonary function, and quality of life in people with asthma.Pranayama was applied to the pranayama group for 20 min once daily for 1 month, and relaxation was applied to the relaxation group similarly in addition to the standard treatment. The outcome measurement tools used were the Asthma Control Test (ACT), Asthma Quality of Life Questionnaire (AQLQ), pulmonary function test (PFT), and patient observation chart.The pranayama group had significantly higher ACT score, overall AQLQ score, and subscale scores than the relaxation group (p 0.05). However, there was no significant difference between the groups in terms of PFT parameters and peak expiratory flow values (p 0.05).Pranayama improved asthma control and asthma-related quality of life in people with asthma, but it did not show a significant difference in PFT values.

Rationale, aims, and objectives Pressure ulcers (PUs), which are preventable complications, increase the cost of health care and the risk of prolonged hospital stay, as well as morbidity and mortality. In this study, we aimed to describe the prevalence, clinical features, and risk factors for PUs among hospitalized patients. Method This study was cross-sectional and conducted over a single day in all the care units. Data were recorded on a patient observation form that included demographic data, diagnosis of admission to the hospital or intensive care unit (ICU), comorbidity and chronic diseases, location, stage of PU, and Braden Scale score. Acute physiology and chronic health evaluation (APACHE) II score, Glasgow coma score (GCS), PaO2 /FiO2 ratio, and albumin level were recorded for ICU patients. Results A total of 1548 adult patients participated in the study. Of these patients, 177 (11.43%) had PU. The patients with PU had more advanced age, lower body mass index (BMI), and longer duration of hospital and ICU stay (for all P = .001). Evaluation of PU in the first 24 hours after hospital admission and the last PU evaluation time also showed a significant effect (both P = .001). Braden Scale score less than or equal to 13 in the first evaluation after hospital admission increased the risk of PU. Albumin was 2.78 ± 0.57 gm/dL in ICU patients, and albumin level was significantly lower in patients with PU (P = .001). PUs were located mainly in the sacrum (47.59%) and were classified as stage II (42.76%) for all patients. Conclusions The prevalence of PU is related to the age and severity of patient clinical status, as predicted by the Braden Scale score and APACHE II score, and length of hospital and ICU stay. Low albumin level is also related to development of PUs in ICU patients.

Background Physiotherapy of carpal tunnel syndrome (CTS) involves manual therapy based on neurodynamic techniques. Until now, two randomized controlled trials have shown that immediately after therapy, CTS patients who received neurodynamic techniques had significant improvement in nerve conduction, pain, symptom severity (SSS), functional state (FSS), muscle strength (MS) and two-point discrimination (2PD). However, long-term effects seem to be more important, as they are the only ones that can significantly improve the patient’s health and influence economic and social costs. Thus, the objective of this study was to evaluate the long-term (six months) effects of neurodynamic techniques in the conservative treatment of CTS patients. Methods Carpal tunnel syndrome patients (107) from two previously published randomised clinical trials were observed for six months after the treatment based on neurodynamic techniques. Results The sensory conduction velocity, motor conduction velocity, and motor latency were not subject to statistically significant changes within six months after therapy (p > 0.05). In both groups, there was further pain reduction (p p p > 0.05). In both groups, there was muscle strength improvement (p Conclusion The use of manual therapy based on neurodynamic techniques maintains the beneficial effects 6 months after therapy in CTS patients.

Objective To evaluate the tolerability and safety of Octagam® 5% and 10% across all indications, ages, and treatment regimens, using data from four non-interventional post-authorization safety studies (PASS); this analysis was performed following changes in the preparation of raw material used to manufacture Octagam. Methods All four studies included in- and out-patients prescribed Octagam for treatment of their medical condition. Physicians used case report forms to document baseline demographics, Octagam treatment details, and data on the efficacy of Octagam, and recorded all adverse drug reactions (ADRs) and other safety data. Results Altogether 21,780 infusions of Octagam in 2,397 patients were included in our analysis. The most frequent indication for Octagam was secondary immunodeficiencies (SID; n = 1,368, 11,348 infusions), followed by primary immunodeficiencies (PID; n = 363; 3,923 infusions). During the individual patient observation, 83% of SID and 67% of PID patients were free of any infection. In up to 85% of all investigator assessments, Octagam was rated to have a favorable effect. In autoimmune diseases, investigators assessed Octagam as being beneficial in 70% (immune thrombocytopenia) up to 100% (Guillain-Barre syndrome), depending on the indication. The majority of patients (92%) tolerated Octagam treatment without any ADR. The overall incidence of reported ADRs was 1.0% for all infusions. The majority of ADRs were considered non-serious (93%) and mild or moderate (87%) in severity. No unexpected ADR signal was detected. Conclusions This analysis demonstrates that the changes in the preparation of raw material used to manufacture Octagam did not affect the safety profile of Octagam® 5% and 10%. *At the time of study realization.

Purpose To compare the instillation of eyedrops with and without Xal-Ease® delivery device in inexperienced patients based on patient observation and answers to a questionnaire. Methods This prospective study included consecutive patients considered inexperienced in instilling eyedrops. After a short explanation about the methods, drop instillation technique was evaluated with and without the device. Subjects also completed a survey regarding drop administration and satisfaction. Successful instillation was defined as instilling a single drop in the eye without touching the eye with the bottle tip on the first attempt. Results The overall rate of successful instillation (43%) was the same for both techniques (with or without the device). Without the device, the bottle tip touched the eye or periocular tissues in 8 eyes (35%) compared with 0 (0%) with the Xal-Ease® (pConclusions Xal-Ease® successfully decreased mechanical contact of the tip of the bottle. However, Xal-Ease® failed to help inexperienced subjects dispense fewer drops, or improve accuracy, suggesting that more training might be needed to achieve a good eyedrop administration technique with the device.

In many prospective clinical and biomedical studies, longitudinal biomarkers are repeatedly measured as health indicators to evaluate disease progression when patients are followed up over a period of time. Patient visiting times can be referred to as informative observation times if they are assumed to carry information in addition to that of the longitudinal biomarker measures alone. Irregular visiting times may reflect compliance with physician instruction, disease progression and symptom severity. When the follow-up time may be stopped by competing terminal events, it is possible that patient observation times may correlate with the competing terminal events themselves, thus making the observation times difficult to assess. To explicitly account for the impact of competing terminal events and dependent observation times on the longitudinal data analysis in the context of such complex data, we propose a joint model using latent random effects to describe the association among them. A likelihood...

Background Diurnal variation in the performance of rapid response systems has not been fully elucidated. Afferent limb failure (ALF) is a significant problem and is an important measure of performance of rapid response systems. Objective To determine the diurnal variation in the detection and response to acute patient deterioration as measured by ALF, completeness of patient observations (Respiratory rate (RR); Pulse rate (PR) and Systolic blood pressure (SBP), and to explore the diurnal variation in the consequences of ALF in unanticipated admissions to the Intensive care unit (ICU) from the ward. Design, setting and participants Point Prevalence study conducted on two days in 2012 in 41 ICUs in Australia and New Zealand, examining emergency (unanticipated) admissions to the ICU from the ward. Results 51 patients from the ward were admitted as an emergency to the ICU following a rapid response team call, of whom 48 patients had complete datasets and were enrolled; 32 (67%) were men. The prevalence of ALF was 37.5% (18/48). Median age was 62.5 (IQR 51.5–74.0), Median APACHE II score was 21.0 (IQR 17–26). There was no diurnal variation in the prevalence of ALF (day 28% versus night 28%; p = 0.92), patient observations documented over time ( p = 0.78 for RR, p = 0.95 for PR and p = 0.74 for SBP) or 28-day mortality ( p = 0.24). There was a significant diurnal variation between the least recorded observation (SBP) and the most recorded observation (PR) ( p p Conclusion The prevalence of ALF amongst patients admitted to the ICU from the ward is high. SBP is the least recorded patient observation. This study was unable to identify a diurnal variation in the prevalence of ALF, its consequences (i.e. mortality) and the completeness of patient observations. Observational studies with a larger sample are required to explore this important problem.

This chapter focuses on largely unknown and unpublished albums from the Musee Charcot’s collection that replicate the museum’s methodology in miniature. Most of the drawings in the Musee Charcot albums are unsigned, and a wide variety of styles and hands is evident. The scientific riches offered by the live patient complemented the museum’s human remains, wax casts, and artistic renderings. Charcot’s focused attention while staring at the patient’s body was similar to the close looking required by the artist sketching a model or by the connoisseur studying a work of art. The albums in the Musee Charcot showcase the evident pleasure in the collecting, categorizing, observing, rendering, and illustrating of illness, which was only made possible by the patients who modeled, willingly or not, at the Salpetriere. The patient models not only for a savant-artiste, but also for the medical community at the Salpetriere who would study Mme Beau’s image for signs of pathology in one of the museum’s albums.

Background Across the UK Healthcare Support Workers (HCSWs) makeup 40% of the healthcare workforce, provide 60% of patient care and receive less than 5% of the training budget. The expectation of this workforce is that they will deliver high-quality care that is compassionate and clinically sound. Hierarchy is a recognised barrier to the escalation of deterioration; combined with critically ill patients, a challenging context is created in which to escalate concerns. Methods A one-day blended programme was developed for HCSWs to provide an overview of clinical systems and escalation: focussing on ‘taking obs’ and effective escalation of concerns. The clinical assessment process was broken down and taught through didactic sessions, following the A (airway) to E (exposure) assessment structure. Escalation was explored in a workshop lead by a middle-grade medical trainee. Candidates participated in simulated scenarios as the first responder. Each candidate was required to undertake a full A to E assessment, accurately identify abnormalities and escalate concerns to a senior nurse and middle-grade doctor. Results Qualitative data was collected via a formal candidate survey. The day rated 5/5 for usefulness, however, through comparative analysis of candidate performance against intended learning outcomes, we have identified that escalation across the hierarchy gradient was not the greatest challenge for HCSWs. The difficulty in application of a structured approach to assessment was the prominent barrier to recognition and consequently prompt escalation. Conclusion The course demonstrated that fundamental principles behind patient observation to be understood and applied in a structured manner before challenges in escalation can be addressed. Moving forward, we will provide more time for candidates to practice structured assessment on a manikin prior to applying this within simulated patient scenarios. Only once this is achieved, can we expect to address escalation over the hierarchy gradient.