Clinical applications of contactless photoplethysmography for vital signs monitoring in pediatrics: A systematic review and meta-analysis

Abstract Background: Contactless photoplethysmography (PPG) potentially affords the ability to obtain vital signs in pediatric populations without disturbing the child. Most validity studies have been conducted in laboratory settings or with healthy adult volunteers. This review aims to evaluate the current literature on contactless vital signs monitoring in pediatric populations and within a clinical setting. Methods: OVID, Webofscience, Cochrane library, and clinicaltrials.org were systematically searched by two authors for research studies which used contactless PPG to assess vital signs in children and within a clinical setting. Results: Fifteen studies were included with a total of 170 individuals. Ten studies were included in a meta-analysis for neonatal heart rate (HR), which demonstrated a pooled mean bias of −0.25 (95% limits of agreement (LOA), −1.83 to 1.32). Four studies assessed respiratory rate (RR) in neonates, and meta-analysis demonstrated a pooled mean bias of 0.65 (95% LOA, −3.08 to 4.37). All studies were small, and there were variations in the methods used and risk of bias. Conclusion: Contactless PPG is a promising tool for vital signs monitoring in children and accurately measures neonatal HR and RR. Further research is needed to assess children of different age groups, the effects of skin type variation, and the addition of other vital signs

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Continuous versus intermittent vital signs monitoring in surgical patients

Despite medical advances, major surgery remains high risk. Up to 44% of patients experience post-operative complications, which can have huge impacts for patients and the healthcare system. Early recognition of postoperative complications is crucial in reducing morbidity and preventing long term disability. The current standard of care is intermittent manual vital signs monitoring, but new wearable remote monitors offer the benefits of continuous vital signs monitoring without limiting the patient’s mobility. The aim of this thesis was to evaluate the feasibility, acceptability and clinical impacts of CRM in a surgical population. Two randomised controlled trials, qualitative studies involving the nursing staff and surgical patients, and an early health economic analysis provide a compelling case for the evaluation of continuous remote vital signs monitoring in a high-risk surgical population. By combining all known literature in the field with a comprehensive range of mixed methodologies, it can be concluded that a future definitive trial should be large, ideally multi-centred, with individual randomisation and clinically relevant outcomes, such as length of hospital stay. A simultaneous economic evaluation is necessary to inform decision-makers after the study is complete, and will provide an opportunity to address the gaps in the literature surrounding postoperative complications. This work has also identified a number of theories regarding the design and implementation of such an evaluation. These theories can now be used to inform future studies, in which the theories themselves can be tested on a wider population of staff, and to optimise any subsequent widespread adoption of such technologies

Reliability of a wearable wireless patch for continuous remote monitoring of vital signs in patients recovering from major surgery: a clinical validation study from the TRaCINg trial

Objective: To validate whether a wearable remote vital signs monitor could accurately measure heart rate (HR), respiratory rate (RR) and temperature in a postsurgical patient population at high risk of complications. Design: Manually recorded vital signs data were paired with vital signs data derived from the remote monitor set in patients participating in the Trial of Remote versus Continuous INtermittent monitoring (TRaCINg) study: a trial of continuous remote vital signs monitoring. Setting: St James’s University Hospital, UK. Participants: 51 patients who had undergone major elective general surgery. Interventions: The intervention was the SensiumVitals monitoring system. This is a wireless patch worn on the patient’s chest that measures HR, RR and temperature continuously. The reference standard was nurse-measured manually recorded vital signs. Primary and secondary outcome measures: The primary outcomes were the 95% limits of agreement between manually recorded and wearable patch vital sign recordings of HR, RR and temperature. The secondary outcomes were the percentage completeness of vital sign patch data for each vital sign. Results: 1135 nurse observations were available for analysis. There was no clinically meaningful bias in HR (1.85 bpm), but precision was poor (95% limits of agreement −23.92 to 20.22 bpm). Agreement was poor for RR (bias 2.93 breaths per minute, 95% limits of agreement −8.19 to 14.05 breaths per minute) and temperature (bias 0.82°C, 95% limits of agreement −1.13°C to 2.78°C). Vital sign patch data completeness was 72.8% for temperature, 59.2% for HR and 34.1% for RR. Distributions of RR in manually recorded measurements were clinically implausible. Conclusions: The continuous monitoring system did not reliably provide HR consistent with nurse measurements. The accuracy of RR and temperature was outside of acceptable limits. Limitations of the system could potentially be overcome through better signal processing. While acknowledging the time pressures placed on nursing staff, inaccuracies in the manually recorded data present an opportunity to increase awareness about the importance of manual observations, particularly with regard to methods of manual HR and RR measurements

Identifying Vulnerable Marine Ecosystems: An image-based vulnerability index for the Southern Ocean seafloor

A significant proportion of Southern Ocean seafloor biodiversity is thought to be associated with fragile, slow growing, long-lived, and habitat-forming taxa. Minimizing adverse impact to these so-called vulnerable marine ecosystems (VMEs) is a conservation priority that is often managed by relying on fisheries bycatch data, combined with threshold-based conservation rules in which all “indicator” taxa are considered equal. However, VME indicator taxa have different vulnerabilities to fishing disturbance and more consideration needs to be given to how these taxa may combine to form components of ecosystems with high conservation value. Here, we propose a multi-criteria approach to VME identification that explicitly considers multiple taxa identified from imagery as VME indicator morpho-taxa. Each VME indicator morpho-taxon is weighted differently, based on its vulnerability to fishing. Using the “Antarctic Seafloor Annotated Imagery Database”, where 53 VME indicator morpho-taxa were manually annotated generating >40000 annotations, we computed an index of cumulative abundance and overall richness and assigned it to spatial grid cells. Our analysis quantifies the assemblage-level vulnerability to fishing, and allows assemblages to be characterized, e.g. as highly diverse or highly abundant. The implementation of this quantitative method is intended to enhance VME identification and contextualize the bycatch events