Improving an Electrocardiogram Competency Assessment Tool for Registered Nurses

Abstract Problem: Rapid and accurate interpretation of an EKG rhythm is an advanced-level competency required for all acute care nurses working in a cardiac monitored/telemetry unit. Observational data collected over a 4-month period by the facility clinical nurse educators identified that less than half of the nurses required to take the EKG exam passed on the first attempt. Context: The education department at the facility onboards approximately 550-600 nurses annually for the 241-bed community hospital in the San Francisco Bay Area of Northern California, part of a larger healthcare organization. Interventions: A total of 19 nurses from various departments across the facility were recruited to evaluate the current EKG assessment tool. Participants ranked the EKG exam questions on a 1-3 Likert scale based on their perceived level of difficulty. The information was collated and used to create an addendum to the study guide. Measures: Improve first-time pass rates for the EKG exam in newly-hired nurses at the time of onboarding by 25%. Results: The study guide was revised with implementation beginning the week of October 23, 2021. Of the 15 new nurses onboarded since implementation, first-time pass rate improvement was not demonstrated. Conclusions: As educators, there is a need to build competencies within a framework that recognizes the continuum of knowledge ranging from novice to expert and what the appropriate minimum competency is for nurses to practice safely and within their scope and at every level. Keywords: EKG, competence, competency assessment, telemetry, onboardin

Detection of Drug Interactions via Android Smartphone: Design and Implementation

Despite the morbidity and cases of widespread drug poisoning, clinical guidelines are largely written by taking into account only one treatment at a time. The cumulative impact of multiple treatments is rarely considered. Drug treatment for people with several diseases produces a complex regimen called “polypharmacy” with a potential combination of harmful and even lethal drugs that can be prevented. This polypharmacy causes in many cases the death of some people due to drug interactions. The vast majority of these deaths can be prevented by detecting interactions before taking these medications. But the problem is that such information exists in a state that is difficult to access for the general public, much less for people with little knowledge in the field. Although the pharmacist is unmistakable and most viable source to avoid such a problem, he cannot know what the patient does not mention because he is not aware of what may affect his treatment. To remedy this, we aim in this paper to develop an ergonomic Android application that will inform the patient about the potential risks of such drug interactions. The application is optimized to handle various databases and operate automation of QR code

Extraction of respiratory signals from the electrocardiogram and photoplethysmogram: technical and physiological determinants.

OBJECTIVE: Breathing rate (BR) can be estimated by extracting respiratory signals from the electrocardiogram (ECG) or photoplethysmogram (PPG). The extracted respiratory signals may be influenced by several technical and physiological factors. In this study, our aim was to determine how technical and physiological factors influence the quality of respiratory signals. APPROACH: Using a variety of techniques 15 respiratory signals were extracted from the ECG, and 11 from PPG signals collected from 57 healthy subjects. The quality of each respiratory signal was assessed by calculating its correlation with a reference oral-nasal pressure respiratory signal using Pearson's correlation coefficient. MAIN RESULTS: Relevant results informing device design and clinical application were obtained. The results informing device design were: (i) seven out of 11 respiratory signals were of higher quality when extracted from finger PPG compared to ear PPG; (ii) laboratory equipment did not provide higher quality of respiratory signals than a clinical monitor; (iii) the ECG provided higher quality respiratory signals than the PPG; (iv) during downsampling of the ECG and PPG significant reductions in quality were first observed at sampling frequencies of  <250 Hz and  <16 Hz respectively. The results informing clinical application were: (i) frequency modulation-based respiratory signals were generally of lower quality in elderly subjects compared to young subjects; (ii) the qualities of 23 out of 26 respiratory signals were reduced at elevated BRs; (iii) there were no differences associated with gender. SIGNIFICANCE: Recommendations based on the results are provided regarding device designs for BR estimation, and clinical applications. The dataset and code used in this study are publicly available

Neuroautonomic evaluation of patients with unexplained syncope: Incidence of complex neurally mediated diagnoses in the elderly

BACKGROUND: The incidence of syncope increases in individuals over the age of 70 years, but data about this condition in the elderly are limited. Little is known about tilt testing (TT), carotid sinus massage (CSM), or supine and upright blood pressure measurement related to age or about patients with complex diagnoses, for example, those with a double diagnosis, ie, positivity in two of these three tests. METHODS: A total of 873 consecutive patients of mean age 66.5±18 years underwent TT, CSM, and blood pressure measurement in the supine and upright positions according to the European Society of Cardiology guidelines on syncope.1 Neuroautonomic evaluation was performed if the first-line evaluation (clinical history, physical examination, electrocardiogram) was suggestive of neurally mediated syncope, or if the first-line evaluation was suggestive of cardiac syncope but this diagnosis was excluded after specific diagnostic tests according to European Society of Cardiology guidelines on syncope, or if certain or suspected diagnostic criteria were not present after the first-line evaluation. RESULTS: A diagnosis was reached in 64.3% of cases. TT was diagnostic in 50.4% of cases, CSM was diagnostic in 11.8% of cases, and orthostatic hypotension was present in 19.9% of cases. Predictors of a positive tilt test were prodromal symptoms and typical situational syncope. Increased age and a pathologic electrocardiogram were predictors of carotid sinus syndrome. Varicose veins and alpha-receptor blockers, nitrates, and benzodiazepines were associated with orthostatic hypotension. Twenty-three percent of the patients had a complex diagnosis. The most frequent association was between vasovagal syncope and orthostatic hypotension (15.8%); 42.9% of patients aged 80 years or older had a complex diagnosis, for which age was the strongest predictor. CONCLUSION: Neuroautonomic evaluation is useful in older patients with unexplained syncope after the initial evaluation. A complex neurally mediated diagnosis is frequent in older people. Our results suggest that complete neuroautonomic evaluation should be done particularly in older patients

Pengembangan Modul Materi Virus Terintegrasi Nilai-Nilai Islam Berbasis E-Learning dan QR Code

Pengembangan modul ini didasarkan pada pentingnya penggunaan modul bagi siswa dalam proses pembelajaran secara mandiri dan adaptasi dari proses pembelajaran saat ini yang menuntut penggunaan platform online dalam pembelajaran secara optimal. Tujuan dari penelitian ini adalah menghasilkan produk berupa pengembangan modul materi virus terintegrasi berbasis nilai-nilai Islami dalam E-Learning dan QR Code untuk SMA Kelas X yang layak digunakan oleh siswa. Dan untuk mengatasi masalah pembelajaran dengan mengembangkan bahan ajar yang lengkap dan sistematis untuk memfasilitasi pembelajaran baik secara tatap muka maupun online. Penelitian ini menggunakan model pengembangan yang dikemukakan oleh Thiagarajan pada tahun 1974 yaitu define, design, develop dan disseminate. Berdasarkan hasil analisis, persentase hasil validasi yang diperoleh dari ahli materi dan evaluasi adalah 83%, ahli desain 78%, ahli bahasa 75%, dan ahli integrasi nilai-nilai islami 79% dan uji coba kelompok kecil dengan hasil analisis 86 %. Berdasarkan analisis yang telah dilakukan, modul materi virus terintegrasi nilai karakter yang bersumber dari nilai keislaman berbasis E-Learning dan QR Code untuk SMA kelas X cocok untuk siswa

Coherence and Coupling Functions Reveal Microvascular Impairment in Treated Hypertension

The complex interactions that give rise to heart rate variability (HRV) involve coupled physiological oscillators operating over a wide range of different frequencies and length-scales. Based on the premise that interactions are key to the functioning of complex systems, the time-dependent deterministic coupling parameters underlying cardiac, respiratory and vascular regulation have been investigated at both the central and microvascular levels. Hypertension was considered as an example of a globally altered state of the complex dynamics of the cardiovascular system. Its effects were established through analysis of simultaneous recordings of the electrocardiogram (ECG), respiratory effort, and microvascular blood flow [by laser Doppler flowmetry (LDF)]. The signals were analyzed by methods developed to capture time-dependent dynamics, including the wavelet transform, wavelet-based phase coherence, non-linear mode decomposition, and dynamical Bayesian inference, all of which can encompass the inherent frequency and coupling variability of living systems. Phases of oscillatory modes corresponding to the cardiac (around 1.0 Hz), respiratory (around 0.25 Hz), and vascular myogenic activities (around 0.1 Hz) were extracted and combined into two coupled networks describing the central and peripheral systems, respectively. The corresponding spectral powers and coupling functions were computed. The same measurements and analyses were performed for three groups of subjects: healthy young (Y group, 24.4 ± 3.4 y), healthy aged (A group, 71.1 ± 6.6 y), and aged treated hypertensive patients (ATH group, 70.3 ± 6.7 y). It was established that the degree of coherence between low-frequency oscillations near 0.1 Hz in blood flow and in HRV time series differs markedly between the groups, declining with age and nearly disappearing in treated hypertension. Comparing the two healthy groups it was found that the couplings to the cardiac rhythm from both respiration and vascular myogenic activity decrease significantly in aging. Comparing the data from A and ATH groups it was found that the coupling from the vascular myogenic activity is significantly weaker in treated hypertension subjects, implying that the mechanisms of microcirculation are not completely restored by current anti-hypertension medications

Cardiac Autonomic Neuropathy in Diabetes: A Predictor of Cardiometabolic Events

Autonomic nervous system (ANS) imbalance manifesting as cardiac autonomic neuropathy in the diabetic population is an important predictor of cardiovascular events. Symptoms and signs of ANS dysfunction, such as resting heart rate elevations, diminished blood pressure responses to standing, and altered time and frequency domain measures of heart rate variability in response to deep breathing, standing, and the Valsalva maneuver, should be elicited from all patients with diabetes and prediabetes. With the recognition of the presence of ANS imbalance or for its prevention, a rigorous regime should be implemented with lifestyle modification, physical activity, and cautious use of medications that lower blood glucose. Rather than intensifying diabetes control, a regimen tailored to the individual risk of autonomic imbalance should be implemented. New agents that may improve autonomic function, such as SGLT2 inhibitors, should be considered and the use of incretins monitored. One of the central mechanisms of dysfunction is disturbance of the hypothalamic cardiac clock, a consequence of dopamine deficiency that leads to sympathetic dominance, insulin resistance, and features of the metabolic syndrome. An improvement in ANS balance may be critical to reducing cardiovascular events, cardiac failure, and early mortality in the diabetic population

NASA contributions to - Cardiovascular monitoring

NASA contributions to cardiovasular monitorin