Implementing an Intelligent Alarm System in Intensive Care Units

Today’s intensive care units monitor patients through the use of various medical devices, which generate a high ratio of false positive alarms due to a low alarm specificity. The false alarms have resulted in a stressful working environment for healthcare professionals that are getting more desensitized to triggered alarms and causing alarm fatigue. The patient safety is also compromised by having high noise levels in the patient room, which disturbs their sleep. This thesis has developed an intelligent alarm system with an improved alarm management and the use of 23 intelligent algorithms to minimize the number of false positive alarms. The suggested system is capable of improving the alarm situation and increasing the patient safety in critical care. The algorithms were modeled with fuzzy logics consisting of delays and multi parameter validation. The results were iteratively developed by having focus groups with various experts

Patient evaluation of Dr. Cecilia with recommended future implementations

Idag är unga kvinnor den grupp som utgör majoriteten av ätstörningsdrabbade, där anorexia nervosa, bulimia nervosa och EDNOS (eating disorder not otherwise specified) är de vanligast förekommande diagnoserna. Mando Group AB behandlar patienter med ätstörningar och har till patienternas hjälp utformat datorprogrammet Doktor Cecilia som är en virtuell behandlare till vilken patienterna kan ställa frågor. Användandet ligger enligt Mando Group AB inte på önskvärda nivåer och programmet har inte heller tidigare genomgått en utvärdering. Syftet med detta arbete var att ta fram potentiella förbättringar av programmet och att av patienterna få dessa tillsammans med programmet utvärderade. Vidare utfördes en enkätundersökning på två Mandometerkliniker för att kartlägga patienternas åsikter om programmet och de framtagna potentiella förbättringarna. Resultatet visade att patienterna var positivt inställda till implementerandet av bland annat röstsvar, tvåvägskommunikation och möjlighet till att se till programmet vanligt ställda frågor. Detta resultat användes sedan för att framställa rekommenderade implementationer som skulle kunna förbättra programmet och på sikt kunna öka dess användning.Today, adolescent females represent the majority of people suffering from eating disorders with anorexia nervosa, bulimia nervosa and EDNOS (eating disorder not otherwise specified) being the most common diagnoses. Mando Group AB treats patients with eating disorders and has for the sake of the patients developed the computer software ‘Doctor Cecilia’ which is a virtual caretaker to whom patients may direct their queries. Mando Group AB has stated that the usage of the software has not reached the desirable level amongst their patients. Moreover, the software has not been subject to an evaluation. The purpose of this thesis has been to produce suggestions of potential improvements for ‘Doctor Cecilia’ by consulting patients in order to evaluate these improvements as well as the software in general. As such, an investigation was conducted at two Mandometer-clinics in order to clarify the opinions of the patients regarding the software itself and the potential improvements which are presented by this thesis. The results showed that the patients were in favor of the implementation of for instance voice response, two-way communication and the opportunity to see frequently asked questions. The results of this thesis have been used to produce recommended implementations that could improve the software and eventually increase its usage

Association between endometriosis and increased arterial stiffness

Background: Endometriosis is a common gynecologic disease associated with systemic inflammation and atherogenic risk factors. Therefore, women with endometriosis may have increased cardiovascular risk. Aims: We aimed to evaluate arterial stiffness using cardio–ankle vascular index (CAVI) in women with and without endometriosis. Methods: We enrolled 44 patients with endometriosis and 76 age‑matched controls without endometriosis.Endometriosis was diagnosed based on histopathologic examination or magnetic resonance imaging. Arterial stiffness was evaluated using CAVI in all study participants. Results: No differences were observed between patients and controls in terms of age (median [interquartile range, IQR], 30 [24.25–5] years and 26 years [24–35] years, respectively), body mass index (median [IQR], 23.31 [20.82–24.98] kg/m2 and 23.74 [21.13–26.78] kg/m2, respectively), or waist circumference (median [IQR], 69 [64–75] cm and 72 [65–81.25] cm, respectively). C‑reactive protein levels were higher in women with endometriosis than in controls (median [IQR], 0.27 [0.14–0.68] mg/dl vs 0.12 [0.06–0.24] mg/dl; P < 0.001). Left ventricular ejection fraction, left ventricular mass index (LVMI), relative wall thickness, as well as systolic and diastolic blood pressures were similar in both groups. Women with endometriosis had higher CAVI than controls (mean [SD], 5.961 [0.644] vs 5.554 [0.654]; P = 0.001). Elevated arterial stiffness was observed in the endometriosis group also after adjustment for age and LVMI. Conclusions: Our results indicate increased arterial stiffness measured by CAVI in women with endometriosis. Therefore,clinicians should be aware that these patients may be at increased cardiovascular risk

Associations between obesity and the radiographic phenotype in knee osteoarthritis

Background/aim: Investigation of the association between obesity and the distinction of radiographic patterns in knee osteoarthritis. Materials and methods: Seven hundred and thirty-four women underwent weight-bearing antero-posterior knee radiography. Osteophytes and joint space narrowing (JSN) were graded according to the OARSI atlas. Each subject was assigned to one of the following groups with respect to the maximum score: osteophyte-dominant, indeterminate, JSN-dominant, and radiographically normal. Results: Obese patients had a significantly more frequent osteophyte-dominant pattern compared to nonobese subjects (74.5\% and 38\%, respectively, P < 0.001). Logistic regression analysis demonstrated that obesity had a stronger association with an osteophyte-dominant pattern compared to a JSN-dominant pattern (OR and 95\% CI = 7.16 (3.15-16.26) and 1.63 (0.96-2.78), respectively). Age had a very weak effect on the distinction to an osteophyte-dominant pattern and no effect on JSN dominance (OR and 95\% CI = 1.1 (1.06-1.15) and 1.02 (0.99-1.05), respectively). Conclusion: There might be an association between obesity and the radiographic phenotype in patients with knee osteoarthritis. The findings suggest that the association between obesity and the osteophyte formation is stronger than that of JSN

Adherence to the European Society of Cardiology/European Society of Anaesthesiology recommendations on preoperative cardiac testing and association with positive results and cardiac events: a cohort study

European Society of Cardiology/European Society of Anaesthesiology (ESC/ESA) guidelines inform cardiac workup before noncardiac surgery based on an algorithm. Our primary hypotheses were that there would be associations between (i) the groups stratified according to the algorithms and major adverse cardiac events (MACE), and (ii) over- and underuse of cardiac testing and MACE.; This is a secondary analysis of a multicentre prospective cohort. Major adverse cardiac events were a composite of cardiac death, myocardial infarction, acute heart failure, and life-threatening arrhythmia at 30 days. For each cardiac test, pathological findings were defined a priori. We used multivariable logistic regression to measure associations.; We registered 359 MACE at 30 days amongst 6976 patients; classification in a higher-risk group using the ESC/ESA algorithm was associated with 30-day MACE; however, discrimination of the ESC/ESA algorithms for 30-day MACE was modest; area under the curve 0.64 (95% confidence interval: 0.61-0.67). After adjustment for sex, age, and ASA physical status, discrimination was 0.72 (0.70-0.75). Overuse or underuse of cardiac tests were not consistently associated with MACE. There was no independent association between test recommendation class and pathological findings (P=0.14 for stress imaging; P=0.35 for transthoracic echocardiography; P=0.52 for coronary angiography).; Discrimination for MACE using the ESC/ESA guidelines algorithms was limited. Overuse or underuse of cardiac tests was not consistently associated with cardiovascular events. The recommendation class of preoperative cardiac tests did not influence their yield.; NCT02573532

Geographical barriers to timely diagnosis of cystic fibrosis and anxiety level of parents during newborn screening in Turkey

Background Despite the availability of cystic fibrosis (CF) screening countrywide, diagnostic delay is still a crucial issue. The objectives of this study were to explore the stages of the NBS process, determine the risk factors associated with diagnostic delay and evaluate parent anxiety and experience throughout the process. Methods This is a multicenter cross-sectional study. A questionnaire was completed by parents of newborns diagnosed with CF via NBS in 17 centers. Socio-demographic characteristics, parent knowledge and experiences related to NBS, sweat test availability in the region of residence, and time to the definitive CF diagnosis were assessed through this questionnaire. Parents' anxiety levels were evaluated through the State-Trait Anxiety Inventory scales 1 and 2. Delayed diagnosis (DD) was defined as a definite CF diagnosis beyond the 8th week of life. Predictors of delayed CF diagnosis were evaluated by univariate and multivariate analysis. Results A total of 220 CF patients diagnosed via NBS were enrolled; 82 (37.3%) babies had DD. Multivariable analysis indicated that residence in the Southeast Anatolia region of Turkey (OR = 10.79, 95% CI = 2.37-49.2) was associated with a higher incidence of DD compared with other regions in Turkey. Of the total, 216 (98.1%) of the caregivers regarded the NBS program as useful and 180 (82%) reported high anxiety levels. Conclusion The organization of newborn screening should take into account regional and socio-cultural characteristics to improve the early diagnosis of CF and also reduce the anxiety level of parents

Clinical findings of patients with cystic fibrosis according to newborn screening results.

Background Cystic fibrosis (CF) is a lethal recessive genetic disease caused by loss of function associated with mutations in the CF trans-membrane conductance regulator. It is highly prevalent (approximately 1 in 3,500) in Caucasians. The aim of this study was to compare demographic and clinical features, diagnostic tests, treatments, and complications of patients with CF whose newborn screening (NBS) with twice-repeated immune reactive trypsinogen testing was positive, normal, and not performed. Methods In this study, 359 of all 1,488 CF patients recorded in the CF Registry of Turkey in 2018, who had been born through the process of NBS, were evaluated. Demographic and clinical features were compared in patients diagnosed with positive NBS (Group 1), normal (Group 2), or without NBS (Group 3). Results In Group 1, there were 299 patients, in Group 2, there were 40 patients, and in Group 3, there were 20 patients. Among all patients, the median age at diagnosis was 0.17 years. The median age at diagnosis was higher in Groups 2 and 3 than in Group 1 (P = 0.001). Fecal elastase results were higher in Group 2 (P = 0.033). The weight z-score was lower and chronic Staphylococcus aureus infection was more common in Group 3 (P = 0.017, P = 0.004, respectively). Conclusions Frequency of growth retardation and chronic S. aureus infection can be reduced with an early diagnosis using NBS. In the presence of clinical suspicion in patients with normal NBS, further analyses such as genetic testing should be performed, especially to prevent missing patients with severe mutations

Cystic fibrosis in Turkey: First data from the national registry.

Background Cystic fibrosis (CF) care has been implemented in Turkey for a long time; however, there had been no patient registry. For this purpose, the Turkish National CF Registry was established. We present the first results of registry using data collected in 2017. Methods The data were collected using a data-entry software system, which was accessed from the internet. Demographic and annually recorded data consisted of 15 and 79 variables, respectively. Results There were 1170 patients registered from 23 centers; the estimated coverage rate was 30%. The median age at diagnosis was 1.7 years (median current age: 7.3 years); 51 (4.6%) patients were aged over 18 years. Among 293 patients who were under 3 years of age, 240 patients (81.9%) were diagnosed through newborn screening. Meconium ileus was detected in 65 (5.5%) patients. Genotyping was performed in 978 (87.4%) patients and 246 (25.2%) patients' mutations were unidentified. The most common mutation was deltaF508 with an allelic frequency of 28%, followed by N1303K (4.9%). The median FEV1% predicted was 86. Chronic colonization with Pseudomonas aeruginosa was seen in 245 patients. The most common complication was pseudo-Bartter syndrome in 120 patients. The median age of death was 13.5 years in a total of 15 patients. Conclusions Low coverage rate, lack of genotyping, unidentified mutations, and missing data of lung functions are some of our greatest challenges. Including data of all centers and reducing missing data will provide more accurate data and help to improve the CF care in Turkey in the future