Reduced level of arousal and increased mortality in adult acute medical admissions: a systematic review and meta-analysis

Abstract Background Reduced level of arousal is commonly observed in medical admissions and may predict in-hospital mortality. Delirium and reduced level of arousal are closely related. We systematically reviewed and conducted a meta-analysis of studies in adult acute medical patients of the relationship between reduced level of arousal on admission and in-hospital mortality. Methods We conducted a systematic review (PROSPERO: CRD42016022048), searching MEDLINE and EMBASE. We included studies of adult patients admitted with acute medical illness with level of arousal assessed on admission and mortality rates reported. We performed meta-analysis using a random effects model. Results From 23,941 studies we included 21 with 14 included in the meta-analysis. Mean age range was 33.4 - 83.8 years. Studies considered unselected general medical admissions (8 studies, n=13,039) or specific medical conditions (13 studies, n=38,882). Methods of evaluating level of arousal varied. The prevalence of reduced level of arousal was 3.1%-76.9% (median 13.5%). Mortality rates were 1.7%-58% (median 15.9%). Reduced level of arousal was associated with higher in-hospital mortality (pooled OR 5.71; 95% CI 4.21-7.74; low quality evidence: high risk of bias, clinical heterogeneity and possible publication bias). Conclusions Reduced level of arousal on hospital admission may be a strong predictor of in-hospital mortality. Most evidence was of low quality. Reduced level of arousal is highly specific to delirium, better formal detection of hypoactive delirium and implementation of care pathways may improve outcomes. Future studies to assess the impact of interventions on in-hospital mortality should use validated assessments of both level of arousal and delirium

Characterising the nature of primary care patient safety incident reports in the England and Wales National Reporting and Learning System: a mixed-methods agenda-setting study for general practice

Background There is an emerging interest in the inadvertent harm caused to patients by the provision of primary health-care services. To date (up to 2015), there has been limited research interest and few policy directives focused on patient safety in primary care. In 2003, a major investment was made in the National Reporting and Learning System to better understand patient safety incidents occurring in England and Wales. This is now the largest repository of patient safety incidents in the world. Over 40,000 safety incident reports have arisen from general practice. These have never been systematically analysed, and a key challenge to exploiting these data has been the largely unstructured, free-text data. Aims To characterise the nature and range of incidents reported from general practice in England and Wales (2005–13) in order to identify the most frequent and most harmful patient safety incidents, and relevant contributory issues, to inform recommendations for improving the safety of primary care provision in key strategic areas. Methods We undertook a cross-sectional mixed-methods evaluation of general practice patient safety incident reports. We developed our own classification (coding) system using an iterative approach to describe the incident, contributory factors and incident outcomes. Exploratory data analysis methods with subsequent thematic analysis was undertaken to identify the most harmful and most frequent incident types, and the underlying contributory themes. The study team discussed quantitative and qualitative analyses, and vignette examples, to propose recommendations for practice. Main findings We have identified considerable variation in reporting culture across England and Wales between organisations. Two-thirds of all reports did not describe explicit reasons about why an incident occurred. Diagnosis- and assessment-related incidents described the highest proportion of harm to patients; over three-quarters of these reports (79%) described a harmful outcome, and half of the total reports described serious harm or death (n = 366, 50%). Nine hundred and ninety-six reports described serious harm or death of a patient. Four main contributory themes underpinned serious harm- and death-related incidents: (1) communication errors in the referral and discharge of patients; (2) physician decision-making; (3) unfamiliar symptom presentation and inadequate administration delaying cancer diagnoses; and (4) delayed management or mismanagement following failures to recognise signs of clinical (medical, surgical and mental health) deterioration. Conclusions Although there are recognised limitations of safety-reporting system data, this study has generated hypotheses, through an inductive process, that now require development and testing through future research and improvement efforts in clinical practice. Cross-cutting priority recommendations include maximising opportunities to learn from patient safety incidents; building information technology infrastructure to enable details of all health-care encounters to be recorded in one system; developing and testing methods to identify and manage vulnerable patients at risk of deterioration, unscheduled hospital admission or readmission following discharge from hospital; and identifying ways patients, parents and carers can help prevent safety incidents. Further work must now involve a wider characterisation of reports contributed by the rest of the primary care disciplines (pharmacy, midwifery, health visiting, nursing and dentistry), include scoping reviews to identify interventions and improvement initiatives that address priority recommendations, and continue to advance the methods used to generate learning from safety reports

Academic Planning Board Committee on Computer Requirements

In preparing this report the Committee received support and cooperation from many organizations and individuals. Several computer companies, i,e, IBM, On-Line and ICL, provided useful technical information and participated in the Seminar on 'Computers and Their Applications', The Penang Port Commission and the Muda Agricultural Development Authority also participated in the Seminar. Eighteen government agencies and fifteen private firms responded to the mail questionnaire. Finally the Deans",the Registrar, the Bursar and the Librarian provided valuable information and criticism. To all these organizations and individuals the Committee would like to extend its sincere thanks

Hardware Accelerated Data Analysis

Franzmeier M, Pohl C, Porrmann M, Rückert U. Hardware Accelerated Data Analysis. In: IEEE Computer Society. Technical Committee on Parallel Processing, Technische Universität Dresden. Technical Committee on Parallel Processing, eds. Parallel Computing in Electrical Engineering, 2004. PARELEC 2004. International Conference on. Los Alamitos, Calif. : IEEE Comput. Soc; 2004: 309-314.In this paper we present a massively parallel hardware accelerator for neural network based data mining applications. We use Self-Organizing Maps (SOM) for the analysis of very large datasets. One example is the analysis of semiconductor fabrication process data, which demands very high performance in order to achieve acceptable simulation times. Our system consists of Processing Elements (PEs) working completely in parallel on the task of SOM simulation. We will show the scalability of the system concerning precision and number of PEs, as well as the flexibility of the system regarding size and shape of the simulated maps. The possibility of emulating virtual maps (one PE emulates more than one neuron) enables the computation of maps with more neurons than PEs. Benchmarking results of our FPGA (Field Programmable Gate Array) based implementation of the system show the high performance of our accelerator

Dynamic Reconfiguration of Real-Time Network Interfaces

Vonnahme E, Griese G, Porrmann M, Rückert U. Dynamic Reconfiguration of Real-Time Network Interfaces. In: IEEE Computer Society. Technical Committee on Parallel Processing, Technische Universität Dresden. Technical Committee on Parallel Processing, eds. Parallel Computing in Electrical Engineering, 2004. PARELEC 2004. International Conference on. Los Alamitos, Calif. : IEEE Comput. Soc; 2004: 376-379.The programmable resources of reconfigurable computing architectures are commonly used to support application specific processing. Dynamic reconfiguration enables hardware adaptation even during run-time. This paper concentrates on extending the application of dynamically reconfigurable logic to the area of network interface logic. The benefits and consequences of implementing even low-level networking functions in programmable hardware over fixed realizations are explained, and the possibilities arising from reconfigurable network interfaces are shown. Concerning reconfiguration of the network interface subsystem at run-time, maintaining connections, preventing packet loss, and guaranteeing response times during reconfiguration is crucial. Methods for dynamically replacing network interface hardware are described, and the current prototype is shown

SelfS – A Real-Time Protocol for Virtual Ring Topologies

Griese B, Brinkmann A, Porrmann M. SelfS – A Real-Time Protocol for Virtual Ring Topologies. In: IEEE Computer Society. Technical Committee on Parallel Processing, Institute of Electrical and Electronics Engineers. Technical Committee on Parallel Processing, eds. Proceedings of the 16th International Workshop on Parallel and Distributed Real-Time Systems (WPDRTS '08), on CD. Piscataway, NJ: IEEE; 2008.Real-time automation systems have evolved from centrally controlled sensor-actor systems to complex distributed computing systems. Therefore, the communication system becomes a crucial component that strongly influences performance. In this paper we present a simple distributed communication protocol that meets hard real-time constraints without requiring complex synchronization mechanisms. An advantage of the distributed protocol is that network planning can be reduced to a minimum. The protocol is based on virtual rings and can be easily embedded into arbitrary network topologies. Besides a detailed evaluation and analysis of the protocol, the paper includes lower bounds on jitter and performance for arbitrary communication patterns

A design-oriented computer engineering program

© 1974 Authors. Two national committees issued definitive computer curricula in the 1960s, Since then digital technology has changed, high school graduates have different preparation, computer science and computer engineering curricula have proliferated, and design has become more important. This paper proposes a computer engineering program that will respond to these changes. The program is a spiral one, based on an introductory computer engineering program, and emphasizing design through each of a number of streams that can reflect local interests and resources. This paper discusses the main courses of a stream and the basic introductory course