Using Shock Index as a Predictor of ICU Readmission: A Quality Iimprovement Project

Background: Adverse events will occur in one-third of patients discharged from the intensivecare unit (ICU) and evidence shows that ICU readmissions increase a patient’s length of stay,mortality, hospital costs, and nosocomial infections, as well as decrease long-term survival.Specific predictive factors that will accurately predict which patients are at risk of adverseevents requiring readmission are needed.Aim: The specific aim of this project was to identify if shock index (SI) values higher than 0.7at the time of transfer from the ICU are a useful predictor of ICU readmission.Methods: Using the Plan, Do, Study, Act (PDSA) framework, a retrospective chart review wasperformed using a matched cohort of 34 patients readmitted with 72 hours of discharge from theICU and 34 controls to obtain SI values at admission, transfer from and readmission to the ICU.A second PDSA cycle looked for SI trends within 24 hours prior to discharge from the ICU.Results: An odds ratio calculating the risk of readmission of patients with an elevated SI was2.96 (Confidence Interval (CI) 1.1 to 7.94, p-value=0.03). The odds ratio for an 80% SIelevation over 24 hours prior to discharge was 1.56 (CI 0.36 to 6.76, p-value=0.55).Conclusion and Implications for CNL Practice: Patients with elevated SIs at the time oftransfer are three times more likely to be readmitted to the ICU. Patients with elevations in atleast 80% of the 24 hour pre-discharge SIs showed no significant differences between thecontrol and readmitted cohorts. Implications of these results for the clinical nurse leader will bediscussed

The prevalence of cocaine-associated chest pain in a London hospital

Objectives: To determine the prevalence of cocaine misuse in patients presenting to an Accident and Emergency department with chest pain. 4 of 12 FAEM abstracts www.emjonline.co

Environmental risk assessment in a contaminated estuary: an integrated weight of evidence approach as a decision support tool

Environmental risk assessment of complex ecosystems such as estuaries is a challenge, where innovative and integrated approaches are needed. The present work aimed at developing an innovative integrative methodology to evaluate in an impacted estuary (the Sado, in Portugal, was taken as case study), the adverse effects onto both ecosystem and human health. For the purpose, new standardized lines of evidence based on multiple quantitative data were integrated into a weight of evidence according to a best expert judgment approach. The best professional judgment for a weight of evidence approach in the present study was based on the following lines of evidence: i) human contamination pathways; ii) human health effects: chronic disease; iii) human health effects: reproductive health; iv) human health effects: health care; v) human exposure through consumption of local agriculture produce; vi) exposure to contaminated of water wells and agriculture soils; vii) contamination of the estuarine sedimentary environment (metal and organic contaminants); viii) effects on benthic organisms with commercial value; and ix) genotoxic potential of sediments. Each line of evidence was then ordinally ranked by levels of ecological or human health risk, according to a tabular decision matrix and expert judgment. Fifteen experts scored two fishing areas of the Sado estuary and a control estuarine area, in a scale of increasing environmental risk and management actions to be taken. The integrated assessment allowed concluding that the estuary should not be regarded as impacted by a specific toxicant, such as metals and organic compounds hitherto measured, but by the cumulative risk of a complex mixture of contaminants. The proven adverse effects on species with commercial value may be used to witness the environmental quality of the estuarine ecosystem. This method argues in favor of expert judgment and qualitative assessment as a decision support tool to the integrative management of estuaries. Namely it allows communicating environmental risk and proposing mitigation measures to local authorities and population under a holistic perspective as an alternative to narrow single line of evidence approaches, which is mandatory to understand cause and effect relationships in complex areas like estuaries.info:eu-repo/semantics/publishedVersio

Review on Master Patient Index

In today's health care establishments there is a great diversity of information systems. Each with different specificities and capacities, proprietary communication methods, and hardly allow scalability. This set of characteristics hinders the interoperability of all these systems, in the search for the good of the patient. It is vulgar that, when we look at all the databases of each of these information systems, we come across different registers that refer to the same person; records with insufficient data; records with erroneous data due to errors or misunderstandings when inserting patient data; and records with outdated data. These problems cause duplicity, incoherence, discontinuation and dispersion in patient data. With the intention of minimizing these problems that the concept of a Master Patient Index is necessary. A Master Patient Index proposes a centralized repository, which indexes all patient records of a given set of information systems. Which is composed of a set of demographic data sufficient to unambiguously identify a person and a list of identifiers that identify the various records that the patient has in the repositories of each information system. This solution allows for synchronization between all the actors, minimizing incoherence, out datedness, lack of data, and a decrease in duplicate registrations. The Master Patient Index is an asset to patients, the medical staff and health care providers

Enteral feeding pumps: efficacy, safety, and patient acceptability.

Enteral feeding is a long established practice across pediatric and adult populations, to enhance nutritional intake and prevent malnutrition. Despite recognition of the importance of nutrition within the modern health agenda, evaluation of the efficacy of how such feeds are delivered is more limited. The accuracy, safety, and consistency with which enteral feed pump systems dispense nutritional formulae are important determinants of their use and acceptability. Enteral feed pump safety has received increased interest in recent years as enteral pumps are used across hospital and home settings. Four areas of enteral feed pump safety have emerged: the consistent and accurate delivery of formula; the minimization of errors associated with tube misconnection; the impact of continuous feed delivery itself (via an enteral feed pump); and the chemical composition of the casing used in enteral feed pump manufacture. The daily use of pumps in delivery of enteral feeds in a home setting predominantly falls to the hands of parents and caregivers. Their understanding of the use and function of their pump is necessary to ensure appropriate, safe, and accurate delivery of enteral nutrition; their experience with this is important in informing clinicians and manufacturers of the emerging needs and requirements of this diverse patient population. The review highlights current practice and areas of concern and establishes our current knowledge in this field

Aerospace Medicine and Biology: A continuing bibliography, supplement 191

A bibliographical list of 182 reports, articles, and other documents introduced into the NASA scientific and technical information system in February 1979 is presented

Early indication of decompensated heart failure in patients on home-telemonitoring: a comparison of prediction algorithms based on daily weight and noninvasive transthoracic bio-impedance

Background: Heart Failure (HF) is a common reason for hospitalization. Admissions might be prevented by early detection of and intervention for decompensation. Conventionally, changes in weight, a possible measure of fluid accumulation, have been used to detect deterioration. Transthoracic impedance may be a more sensitive and accurate measure of fluid accumulation. Objective: In this study, we review previously proposed predictive algorithms using body weight and noninvasive transthoracic bio-impedance (NITTI) to predict HF decompensations. Methods: We monitored 91 patients with chronic HF for an average of 10 months using a weight scale and a wearable bio-impedance vest. Three algorithms were tested using either simple rule-of-thumb differences (RoT), moving averages (MACD), or cumulative sums (CUSUM). Results: Algorithms using NITTI in the 2 weeks preceding decompensation predicted events (P<.001); however, using weight alone did not. Cross-validation showed that NITTI improved sensitivity of all algorithms tested and that trend algorithms provided the best performance for either measurement (Weight-MACD: 33%, NITTI-CUSUM: 60%) in contrast to the simpler rules-of-thumb (Weight-RoT: 20%, NITTI-RoT: 33%) as proposed in HF guidelines. Conclusions: NITTI measurements decrease before decompensations, and combined with trend algorithms, improve the detection of HF decompensation over current guideline rules; however, many alerts are not associated with clinically overt decompensation

Analysis of CDC social control measures using an agent-based simulation of an influenza epidemic in a city

Background: the transmission of infectious disease amongst the human population is a complex process which requires advanced, often individual-based, models to capture the space-time details observed in reality.Methods: an Individual Space-Time Activity-based Model (ISTAM) was applied to simulate the effectiveness of non-pharmaceutical control measures including: (1) refraining from social activities, (2) school closure and (3) household quarantine, for a hypothetical influenza outbreak in an urban area.Results: amongst the set of control measures tested, refraining from social activities with various compliance levels was relatively ineffective. Household quarantine was very effective, especially for the peak number of cases and total number of cases, with large differences between compliance levels. Household quarantine resulted in a decrease in the peak number of cases from more than 300 to around 158 for a 100% compliance level, a decrease of about 48.7%. The delay in the outbreak peak was about 3 to 17 days. The total number of cases decreased to a range of 3635-5403, that is, 63.7%-94.7% of the baseline value.When coupling control measures, household quarantine together with school closure was the most effective strategy. The resulting space-time distribution of infection in different classes of activity bundles (AB) suggests that the epidemic outbreak is strengthened amongst children and then spread to adults. By sensitivity analysis, this study demonstrated that earlier implementation of control measures leads to greater efficacy. Also, for infectious diseases with larger basic reproduction number, the effectiveness of non-pharmaceutical measures was shown to be limited.Conclusions: simulated results showed that household quarantine was the most effective control measure, while school closure and household quarantine implemented together achieved the greatest benefit. Agent-based models should be applied in the future to evaluate the efficacy of control measures for a range of disease outbreaks in a range of settings given sufficient information about the given case and knowledge about the transmission processes at a fine scal

Precise Proximal Femur Fracture Classification for Interactive Training and Surgical Planning

We demonstrate the feasibility of a fully automatic computer-aided diagnosis (CAD) tool, based on deep learning, that localizes and classifies proximal femur fractures on X-ray images according to the AO classification. The proposed framework aims to improve patient treatment planning and provide support for the training of trauma surgeon residents. A database of 1347 clinical radiographic studies was collected. Radiologists and trauma surgeons annotated all fractures with bounding boxes, and provided a classification according to the AO standard. The proposed CAD tool for the classification of radiographs into types "A", "B" and "not-fractured", reaches a F1-score of 87% and AUC of 0.95, when classifying fractures versus not-fractured cases it improves up to 94% and 0.98. Prior localization of the fracture results in an improvement with respect to full image classification. 100% of the predicted centers of the region of interest are contained in the manually provided bounding boxes. The system retrieves on average 9 relevant images (from the same class) out of 10 cases. Our CAD scheme localizes, detects and further classifies proximal femur fractures achieving results comparable to expert-level and state-of-the-art performance. Our auxiliary localization model was highly accurate predicting the region of interest in the radiograph. We further investigated several strategies of verification for its adoption into the daily clinical routine. A sensitivity analysis of the size of the ROI and image retrieval as a clinical use case were presented.Comment: Accepted at IPCAI 2020 and IJCAR