Search

Technological advances seen in recent years have introduced the possibility of changing the way hospitalized patients are monitored by abolishing the traditional track-and-trigger systems and implementing continuous monitoring using wearable biosensors. However, this new monitoring paradigm raise demand for novel ways of analyzing the data streams in real time. The aim of this study was to design a stability index using kernel density estimation (KDE) fitted to observations of physiological stability incorporating the patients' circadian rhythm. Continuous vital sign data was obtained from two observational studies with 491 postoperative patients and 200 patients with acute exacerbation of chronic obstructive pulmonary disease. We defined physiological stability as the last 24 h prior to discharge. We evaluated the model against periods of eight hours prior to events defined either as severe adverse events (SAE) or as a total score in the early warning score (EWS) protocol of ≥ 6, ≥ 8, or ≥ 10. The results found good discriminative properties between stable physiology and EWS-events (area under the receiver operating characteristics curve (AUROC): 0.772–0.993), but lower for the SAEs (AUROC: 0.594–0.611). The time of early warning for the EWS events were 2.8–5.5 h and 2.5 h for the SAEs. The results showed that for severe deviations in the vital signs, the circadian KDE model can alert multiple hours prior to deviations being noticed by the staff. Furthermore, the model shows good generalizability to another cohort and could be a simple way of continuously assessing patient deterioration in the general ward. [ABSTRACT FROM AUTHOR]

Objective: We evaluated the impact of medical emergency simulation training on self-reported attitudes, confidence level and knowledge amongst psychiatric doctors and mental health nurses. Methods: Before and following Essential Life Support (ELS) simulation training for medical emergencies, pre and post-questionnaires were employed. Paired t-tests were used to analyse change in self-reported attitudes, confidence in self and the team, and theoretical knowledge. Results: In 37 participants we found significant improvement in doctors and nurses attitudes (t = 2.168 p <.05 and 2.651 p <.05) and doctor's confidence t = 3.711 p <.001) following training. Knowledge increased for all participants and was significant for doctors (t = 2.112, p <.041). Comments supported training. Conclusion: Many doctors and nurses in mental health feel inadequately prepared and lack confidence in themselves and their colleagues to respond to medical emergencies. A structured simulation course was useful to change attitudes and increase confidence and knowledge which could benefit the team and patients. [ABSTRACT FROM AUTHOR]

Aim: To evaluate whether a two‐part culture improvement programme aimed at nurses in clinical and managerial positions in an inpatient mental health service was associated with culture change, and safety‐related behaviour and knowledge improvements. Background: Due to serious failings in the delivery of physiological care to mentally disordered inpatients, it was deemed important that interventions be applied to improve service culture. Methods: A pre‐test and post‐test study was conducted to evaluate change associated with a mandated intervention aimed at culture change. Nurses in clinical and managerial positions at all levels attended relevant sessions. All were invited to participate in evaluation measures. Results: N = 241 nurses participated in the evaluation (n = 137 and n = 104, pre‐test and post‐test, respectively). There was a small but significant change in organisational culture indicating greater adhocracy and less clan culture in the second survey period and a small decline in reported safety behaviour. Measures of safety culture, knowledge and emergency‐related educational satisfaction were unchanged. Conclusion: Only a small change in measured culture was associated with the programme. Implications for Nursing Management: Attempts to evaluate culture change need to align anticipated outcomes with appropriate outcome measures. A mandated programme of culture change had little tangible effect on the outcomes measured. [ABSTRACT FROM AUTHOR]

In this paper, we investigate the impact of data uncertainty on the prediction of a vital sign of abnormalities. We analyze the evolution of mean arterial blood pressure (MAP) and heart rate (HR) vital signs time series over a given forecasting window, whose values are classified according to a model of normality that models patient's physiological deterioration. To this end, we developed a generic prediction framework that enables the deployment of different methods for data preparation, training, prediction, and classification so as to perform a set of experiments. To address our purpose, we selected a general regression neural network model (to predict vital sign trends) and a support vector machine (to recognize abnormalities) as the appropriate methods for a baseline analysis. However, other algorithm choices could be tailored in the defined prediction framework. We extract from the multiparameter intelligent monitoring in intensive care II waveform database a set of 302, 940 vital sign samples (organized as 459 records) to define training and testing data sets. From our experiments, we obtained evidence demonstrating the incidence of null values in the MAP/HR input time series on forecasting tasks. This was performed under different conditions in terms of null values in the observation window, and varying other factors like labeling methods and forecast window sizes. In our experiments, we concentrate on analyzing the extent of prediction performance under such conditions and identify that a tolerable level of null values is around 25% where it is possible to still derive forecast windows with an accuracy target ≥ 0.9 for both MAP and HR vital signs. The presented evaluation contributes to acknowledge the importance of uncertainty conditions on the prediction performance of vital signs and paves the way for future extensions involving other prediction approaches.

Fresh-cut lettuce, stored in modified atmosphere packaging (MAP), is a frequent component of bagged salads. However, even in MAP, fresh-cut lettuce is highly perishable due to non-microbial deterioration manifested by tissue liquefaction. The present study investigated the effects of plant physiology, lettuce processing, storage conditions, and exogenous stimuli on the deterioration of fresh-cut lettuce stored in MAP. Tests were performed on genotypes with a known rate of deterioration after processing. Leaf maturity of slowly deteriorating cultivars was generally negatively correlated with the shelf life, i.e., younger leaves deteriorated more slowly than older leaves. Leaf maturity of rapidly deteriorating cultivars was positively correlated with the shelf life, i.e., younger leaves deteriorated more rapidly than older leaves. The deterioration rate increased with temperature. Larger salad pieces deteriorated slower than smaller pieces and pieces that had additional wounding. Packaged samples of smaller size (less tissue per MAP bag with a constant volume) usually had a slower deterioration rate than larger samples. Reduced humidity in MAP slowed the rate of deterioration, particularly for rapidly deteriorating cultivars. Ethanol and hexanal accelerated the deterioration process of all cultivars in a dose-dependent manner. Sanitization of lettuce with chlorine, or treatments with abscisic acid, methyl jasmonate, salicylic acid, melatonin, or calcium lactate, had no obvious effect on the deterioration rate at the tested concentrations. This work provides insights into factors that need to be optimized to slow the rate of physiological deterioration of fresh-cut salad and identifies the most suitable conditions to reveal genotypic differences among lettuces. [ABSTRACT FROM AUTHOR]

Aims and objective: To capture the experiences of nurses in relation to the acutely physiologically deteriorating consumer. Background: Improving the physical health care of consumers with mental illness has been widely adopted as a priority for mental health nursing. Much of the effort thus far has focused on routine screening, prevention and treatment of common comorbidities including cardiovascular disease, diabetes mellitus and cancer. There has been less focus on the acutely physiologically deteriorating consumer in the mental health setting. Further study is warranted since this issue poses a set of highly complex challenges for nurses within the inpatient setting. Method: An exploratory, descriptive study was employed using focus groups to gather narrative data, which was then subject to qualitative analysis. Eleven mental health inpatient wards within a local health district in Sydney, Australia, were studied, comprising ward‐based nurses (n = 64) and nurse unit managers (n = 8). This paper follows the COREQ guidelines for reporting qualitative health research. Results: Qualitative data analysis revealed three themes central to the nurses' experience: (a) lack of clarity (subthemes: procedures and leadership accountability); (b) confidence in the workforce (subthemes: knowledge and skills, training needs, relevant experience, collaboration with emergency and medical teams, stigmatising attitudes); and (c) complexity (subthemes: complexity as the new norm and suitability of the mental health environment). Conclusion: The themes found in this study can be used to guide and inform healthcare policy, protocols, education and processes around building a more confident nurse workforce for the acutely physiologically deteriorating consumer. Relevance to clinical practice: Findings provide a rich data set for the generation of measurement tools and protocols to guide physical health care and evaluate performance. [ABSTRACT FROM AUTHOR]

While physiological warning signs prior to deterioration events during hospitalization have been widely studied, evaluating clinical interventions, such as rapid response team (RRT) activations, based on scoring systems remains an understudied area. Simulation of physiological deterioration patterns represented by scoring systems can facilitate testing different RRT policies without disturbing care processes. Christiana Care Early Warning System (CEWS) is a scoring system developed at the study hospital to detect the physiological warning signs and inform RRT activations. The objective of this study is to evaluate CEWS-triggered RRT policies based on patient demographics and policy structures. Using retrospective data derived from a subset of electronic health records between December 2015 and December 2016 (6000 patients), we developed a microsimulation model with integrated regression analysis to compare RRT policies on subpopulations defined by age, gender, and comorbidities to find score thresholds that result in the lowest percent of time spent above critical CEWS values. Policies that rely on average scores were more sensitive to threshold changes compared to policies that rely on current value and change in the CEWS. Policy using score threshold 10 provided the lowest percentage of time under the critical condition for majority of subpopulations. The proposed model is a novel framework to simulate individual deterioration patterns and systematically evaluate RRT policies based on their impact on health conditions. Our work highlights the importance of integration of data-driven models into personalized care and represents a significant opportunity to inform biomedical and health informatics research on designing and evaluating EWS-based clinical interventions. [ABSTRACT FROM AUTHOR]

Background: A significant body of evidence now demonstrates that early warning, recognition and response systems can help to prevent harm associated with in-hospital clinical deterioration. Systems for early recognition of, and response to, pregnant or recently pregnant (<42 days) women whose conditions are acutely deteriorating in hospital maternity settings have been recommended in other countries as a useful way of supporting rapid intervention and treatment, but it was not known what systems were in place in New Zealand (NZ) hospitals. The Maternal Morbidity Working Group (MMWG), within the Perinatal and Maternal Mortality Review Committee, has recommended the development of a national approach to detecting and responding to acute deterioration in inpatient pregnant women to align with the national patient deterioration programme currently in implementation. Aim: The aim of this project was to investigate current practice nationally and internationally, by identifying the evidence related to early warning systems and tools, and investigating current models in place at NZ district health boards (DHBs) that support the early identification and treatment of an inpatient pregnant woman’s deteriorating condition. Method: We performed a literature search and environmental scan. The search strategy incorporated both academic and grey literature databases using the same search terms. The environmental scan involved contact with all NZ DHB midwifery leaders to request information on early warning systems and tools currently in use. Findings: Sixteen papers met the inclusion criteria for the literature scan. The majority of evidence about the role of maternal early warning systems in preventing morbidity comes from retrospective case reviews, retrospective cohort studies, cross-sectional surveys, and validation studies, with some prospective evidence where early warning systems were evaluated after implementation. There were some indications that early warning systems can contribute to earlier identification of deterioration and cost-effectively reduce harm, although there is wide variation in the parameters used. The environmental scan found that 15 of the 17 DHB maternity services who responded (from 20 total services) have introduced, or are in the process of introducing, modified obstetric early warning systems. There is wide variation in the designs, parameters and thresholds of these scores, as well as the recognition and response systems in use. Conclusion: A substantial proportion of DHBs are developing and implementing tools and early warning systems for maternity care. There is significant variation in the tools and approaches in current use. The MMWG and the Health Quality & Safety Commission have recommended development of a nationally standardised recognition and response system for use in NZ hospitals for pregnant or recently pregnant (<42 days) women to align with the national patient deterioration programme. [ABSTRACT FROM AUTHOR]

[Display omitted] • 72 Cassava landraces root metabolomes established with HPLC & GC–MS. • Tryptophan present in all landraces with max. of 2,242.09 µg/100 g DM. • Neighbour joining & PCA analyses revealed four distinct chemotypes. • Scopoletin, DMC, sugars analyzed in 174 acc. and compared with PPD at different ages. • PPD is positively correlated with DMC and negatively correlated with scopoletin. Cassava landraces are impacted by post-harvest physiological deterioration (PPD). 34 primary/secondary metabolites (carotenes, flavonols, indols, phenolic, hydroxycinnamic, and organic acids) were analysed using HPLC/GC–MS in 72 landraces harvested 8 months after planting (MAP) to clarify whether these compounds may play a role in PPD tolerance. Cluster analysis differentiated a first group with high organic acids contents, citric acid being dominant, a second group with landraces high in tryptophan, a third group including landraces with high phenolic and hydroxycinnamic acids content, and a fourth group characterised by 8 carotenoids. PPD tolerant and susceptible landraces were present in each group. To determine if PPD is related to age of harvest, 174 landraces were harvested at 6, 8, 10 and 12 MAP. Scopoletin, sucrose and glucose were analysed. PPD was positively correlated with DMC and negatively correlated with scopoletin at all ages of harvest. Scopoletin is a useful biomarker to characterize landraces. [ABSTRACT FROM AUTHOR]

This article, product of a research project, shows the results of the evaluation of the influence of the time between harvest and the application of a natural wax in the deterioration of cassava roots; this time was called time of application. Tao chemistry Ltda. wax TAO FRESH ROOT was used in the development of this work. Three factors were considered for the evaluation:the quality of cassava roots, such as: physiological deterioration, loss of weight and dry matter content. They were evaluated in two varieties of cassava,five moments of application (1, 3, 6, 12 and 24 h) for a period of 21 days. The moment of application at 6 h presented the lowest averages of physiological deterioration and weight loss.This article is presented to establish the potential ofnatural waxes as a technique for the preservation of cassavaroots, highlighting the moment of application as an influential factor in the extension of the life of this product.

Objectives Clinical deterioration and death among patients with acute stroke are often preceded by detrimental changes in physiological parameters. Systematic and effective tools to identify patients at risk of deterioration early enough to intervene are therefore needed. The aim of the study was to investigate whether the aggregate weighted track and trigger system early warning score ( EWS) can be used as a simple observational tool to identify patients at risk and predict mortality in a population of patients with acute stroke. Materials and methods Patients admitted with acute stroke at the Copenhagen University Hospital, Nordsjællands Hospital, Denmark, from May to September 2012 were enrolled in a retrospective cohort study (n = 274). Vital signs were measured immediately after admission and consistently during the hospitalization period. Based on the vital signs, a single composite EWS was calculated. Death within 30 days was used as outcome. Area under the receiver operating characteristics curve ( AUROC) and a Kaplan-Meier curve were computed to examine the prognostic validity of EWS. Results A total of 24 patients (8.8%) died within 30 days. The prognostic performance was high for both the EWS at admission ( AUROC 0.856; 95% CI 0.760-0.951; P-value < 0.001) and the maximal EWS measured ( AUROC 0.949; 95% CI 0.919-0.980; P-value < 0.001). Mortality rates were lowest for admission EWS 0-1 (2%) and highest for admission EWS ≥ 5 (63%). Conclusions Early warning score is a simple and valid tool for identifying patients at risk of dying after acute stroke. Readily available physiological parameters are converted to a single score, which can guide both nurses and physicians in clinical decision making and resource allocation. [ABSTRACT FROM AUTHOR]

Background High profile safety failures have demonstrated that recognising early warning signs of clinical and physiological deterioration can prevent or reduce harm resulting from serious adverse events. Early warning scoring systems are now routinely used in many places to detect and escalate deteriorating patients. Timely and accurate vital signs monitoring are critical for ensuring patient safety through providing data for early warning scoring systems, but little is known about current monitoring practices. Objective To establish a profile of nurses’ vital signs monitoring practices, related dialogue, and adherence to health service protocol in New South Wales, Australia. Methods Direct observations of nurses’ working practices were conducted in two wards. The observations focused on times of the day when vital signs were generally measured. Patient interactions were recorded if occurring any time during the observation periods. Participants ( n = 42) included nursing staff on one chronic disease medical and one acute surgical ward in a large urban teaching hospital in New South Wales. Results We observed 441 patient interactions. Measurement of vital signs occurred in 52% of interactions. The minimum five vital signs measures required by New South Wales Health policy were taken in only 6–21% of instances of vital signs monitoring. Vital signs were documented immediately on 93% of vitals-taking occasions and documented according to the policy in the patient's chart on 89% of these occasions. Nurse–patient interactions were initiated for the purpose of taking vital signs in 49% of interactions, with nurse–patient discourse observed during 88% of all interactions. Nurse–patient dialogue led to additional care being provided to patients in 12% of interactions. Conclusion The selection of appropriate vital signs measured and responses to these appears to rely on nurses’ clinical judgement or time availability rather than on policy-mandated frequency. The prevalence of incomplete sets of vital signs may limit identification of deteriorating patients. The findings from this study present an important baseline profile against which to evaluate the impact of introducing continuous monitoring approaches on current hospital practice. [ABSTRACT FROM AUTHOR]

Vital signs monitoring is an important nursing assessment. Yet, nurses seem to be doing it as part of a routine and often overlooking their significance in detecting patient deterioration. An integrative literature review was conducted to explore factors surrounding ward nursing practice of vital signs monitoring in detecting and reporting deterioration. Twenty papers were included. The structural component of a Nursing Role Effectiveness Model framework, which comprises of patient, nurse and organizational variables, was used to synthesize the review. Patient variables include signs of deterioration displayed by patients which include physical cues and abnormal vital signs. Nursing variables include clinical knowledge, roles and responsibilities, and reporting of deteriorating vital signs. Organizational variables include heavy workload, technology, and observation chart design. This review has highlighted current nursing practice in vital signs monitoring. A myriad of factors were found to surround ward practice of vital signs monitoring in detecting and reporting deterioration. [ABSTRACT FROM AUTHOR]

Modified early warning scoring (MEWS) uses abnormalities in routine observations to identify patients at risk of critical illness. Nurses recorded scores at or above the medical response score of 3 on a hospital clinical information system during the first year of introducing MEWS to 10 wards in a university hospital. A total of 619 triggers were recorded in 365 patients. Fifty-nine required intensive care unit (ICU)/high dependency unit (HDU) care; 71 died. Survival was significantly worse for initial scores > 4 (35/104 patients died) than for scores 3–4 (P < 0.004). Multivariant analysis showed age (P < 0.001) and trigger score (P < 0.001) but not ward specialty (P = 0.1) predicted death. Mean ages of survivors and non-survivors were 64 years (SD 18) and 74 years (SD 17), respectively. Addition of a score for age did not significantly increase the area under a receiver operator characteristic curve for the predictive value of MEWS scores. The study shows that increasing MEWS score is associated with worse outcome across a range of specialties and that nursing staff will use a patient information system to audit MEWS scores. [ABSTRACT FROM AUTHOR]

The present study investigated the effects of heat stress on oxidative stress status and physiological changes using female New Zealand White rabbits. 24 sexually mature female rabbits weighing 1953.1–2375.4 g were divided into 4 groups of 6 animals each and subjected to ambient temperature (T0: 19–26 °C), 27–28 °C for T1, 31–32 °C for T2 and 35–36 °C for T3 using electrical heaters from 8:00 a.m. to 4:00 p.m. daily for 30 days. Feed intake and body weight gain were recorded daily. Behavioral alterations of anxiety, dizziness, aggression, withdrawal, impaired feed intake were observed. At the end of experimental period animals were sacrificed, blood samples and vital organs such as liver, kidney, heart, ovaries, uterus collected for appropriate analysis. Results revealed that animals of T2 and T3 had an 11% decrease in the final body weights and 62% body weight gain but increase in feed conversion ratio by 64.81%, 24.19% water intake, 3.64% in rectal and 2.42% in skin temperature compared to the control. Dizziness, withdrawal to a corner of the cage and reduced feed intake were observed. The live weight of lungs and kidneys increased by 37.71% and 33.78% while that of ovaries and uterus decreased in the same animals of T2 and T3. Animals from T2 and T3 showed significant decrease (p < 0.05) by 23.64% in hemoglobin concentration, 12.73% in red blood cells, 11.93% in packed cell volume, 12.02% in total protein while mean corpuscular volume, white blood cells, lymphocytes, creatinine, urea and aspartate transaminase increased respectively by 10.73%, 42.37%, 15.53%, 28.98%, 53.2% and 23.31% compared to the control. The kidney level of malondialdehyde was significantly increased in T2 and T3 animals by 74.29%, whereas protein, catalase, superoxide dismutase and glutathione peroxidase activity were significantly lower (p < 0.05) compared with control. It was concluded that long-term exposure of female rabbits to elevated ambient temperatures induces heat stress and accompanying oxidative stress that consequently impairs physiological function. • Exposition to high temperature impair animal's productive and reproductive performances. • High temperature negatively affects growth performances of exposed rabbit does. • High temperature exposition impaired most of rabbit does hematobiochemical parameters. • Exposure of rabbit does to hot temperature damaged their oxidative stress control. [ABSTRACT FROM AUTHOR]