Arterial blood pressure, with special reference to renal disease

The clinical aspects of arterial blood pressure must be studied from a practical standpoint and in a thorough and systematic way, if, in the treatment of diseases, we are to derive any real benefit from such study. We must study arterial pressure not merely by digital estimation, but also by such an apparatus as will indicate the smallest variations in blood pressure to a nicety and with certain reliance. Such an apparatus we now fortunately possess in the Sphygmometer, of which there are several varieties on the market. Of these undoubtedly the most reliable, as well as the most convenient, is Dr. C. J. Martin's modification of the Riva-Rocci Sphygometer. This instrument is quite simple and accurate

The electronic patient record: a linguistic ethnographic study in general practice

PhDElectronic Patient Records (EPRs) are in widespread use in UK general practice. Although often taken-for-granted by clinicians, managers, administrators and patients, there is limited understanding of how EPRs shape care processes and healthcare interactions in this setting. The EPR is ubiquitous in practice, but its social impact remains under-researched. In this thesis I present a novel approach to examining the role of the EPR, which draws on ethnography and discourse analysis. My work is based on eight months of ethnographic observation in clinical and administrative areas of two general practices. This included observation of clinical consultations, with videorecording of the interpersonal interaction and contemporaneous screen capture of the EPR. This opens up the ‘EPR-in-use’ to detailed scrutiny. In my analysis, which draws particularly on the theoretical work of Goffman and Bakhtin, I pay close attention to the detail of local action and interaction, whilst maintaining sensitivity to the wider context of the general practice organisation. This makes an original contribution to the emerging field of linguistic ethnography. My analysis shows that the EPR contributes to shaping and regimenting interactions and care practices in profound ways, both within the consultation and more widely in general practice organisations. It creates new opportunities, but also creates new demands and tensions. In particular, it sharpens the tension between different ways of framing the patient – the patient as ‘individual’ and the patient as ‘one of a population’ – the latter a more institutional version of the patient. This creates what I have called a ‘dilemma of attention’ for clinicians engaged in patient care. I show ways in which the EPR contributes to the bureaucratisation of care, the construction and circulation of authority within and beyond the consultation, and the production of new notions of patienthood and professional habitus in contemporary general practice

A clinical patient vital signs parameter measurement, processing and predictive algorithm using ECG

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.In the modern clinical and healthcare setting, the electronic collection and analysis of patient related vital signs and parameters are a fundamental part of the relevant treatment plan and positive patient response. Modern analytical techniques combined with readily available computer software today allow for the near real time analysis of digitally acquired measurements. In the clinical context, this can directly relate to patient survival rates and treatment success. The processing of clinical parameters, especially the Electrocardiogram (ECG) in the critical care setting has changed little in recent years and the analytical processes have mostly been managed by highly trained and experienced cardiac specialists. Warning, detection and measurement techniques are focused on the post processing of events relying heavily on averaging and analogue filtering to accurately capture waveform morphologies and deviations. This Ph.D. research investigates an alternative and the possibility to analyse, in the digital domain, bio signals with a focus on the ECG to determine if the feasibility of bit by bit or near real time analysis is indeed possible but more so if the data captured has any significance in the analysis and presentation of the wave patterns in a patient monitoring environment. The research and experiments have shown the potential for the development of logical models that address both the detection and short term predication of possible follow-on events with a focus on Myocardial Ischemic (MI) and Infraction based deviations. The research has shown that real time waveform processing compared to traditional graph based analysis, is both accurate and has the potential to be of benefit to the clinician by detecting deviations and morphologies in a real time domain. This is a significant step forward and has the potential to embed years of clinical experience into the measurement processes of clinical devices, in real terms. Also, providing expert analytical and identification input electronically at the patient bedside. The global human population is testing the healthcare systems and care capabilities with the shortage of clinical and healthcare providers in ever decreasing coverage of treatment that can be provided. The research is a moderate step in further realizing this and aiding the caregiver by providing true and relevant information and data, which assists in the clinical decision process and ultimately improving the required standard of patient care

The Cowl - v.83 - n.8 - Nov 1, 2018

The Cowl - student newspaper of Providence College. Vol 83 - No. 8 - November 1, 2018. 24 pages