Alarm Management: Electrocardiographic Lead Management

Abstract Alarm Management: Electrocardiographic Lead Management Quality improvement and safety that incorporates the Clinical Nurse Leader (CNL) competency of putting in place quality improvements plans that are bases on evidence, analysis, and risk anticipation is the thesis for this project. The associated problem is the myriads of electrocardiographic (ECG) alarms that alert staff to patient issues each day. Of those alerts, 88% to 90% are false or do not require immediate attention (Sendelbach & Jepsen, 2013). The high numbers of false alerts cause staff to become desensitized to the sound. This desensitization may cause staff not to respond to a critical patient need in a timely manner. Objective: The primary objective of the project is to increase patient safety by decreasing the number of alarms alerts. This decrease will lessen the amount of alarm fatigue in the ICU staff. An additional objective includes the increase in staff\u27s efficiency, as less time will be spent addressing inappropriate alarms that will improve both patient and staff satisfaction. Population: The project\u27s populations are the registered nurses and patients in a 20 bed Medical Surgical Intensive Care Unit (ICU). Method: Methods used for the project included a) a survey/pre-test to assess that staff\u27s knowledge of alarm fatigue, b) a learning module that included a quiz that provided staff with information about the project and its processes, and c) the evaluation of staff\u27s compliance to the project\u27s processes and the assessment of the number of alarm alerts compared to baseline data. Results: The project produced a six percent decrease in bed alarms and a 3.2 percent decrease in yellow (moderate) alerts. The total number of alerts decreased by 4.6% but did not meet the project\u27s goal of a 5% reduction in alarm alerts. It is predicted that a greater number of alerts will decrease in the next phase of the alarm management project. This phase will include ECG alarm customization. Reference Sendelbach, S., & Jepsen, S. (2013, May). AACN practice alert: Alarm. American Association of Critical Care Nurses. Retrieved from http://www.aacn.org/wd/practice/docs/practicealerts/alarm-management-practice-alert.pd

Snapping Triceps Syndrome: A Rare Cause of Medial Elbow Pain

PURPOSE: Snapping medial triceps is a relatively rare cause of medial elbow pain that occurs when the tricep tendon dislocates over the medial or lateral epicondyle. Physical exams usually demonstrate intermittent medial elbow pain with extreme elbow flexion or extension, however dynamic diagnostic studies allow for direct visualization of the dislocating tricep. This case report adds to the sparse literature on snapping medial triceps. METHODS: We report a rare occurrence of snapping medial triceps in a young female who initially presented with pain at the posteromedial right elbow with extreme flexion and extension. Intermittent snapping of the medial elbow was noted on physical exam. Ultrasound confirmed snapping of the medial triceps head over osteophytes of the posteromedial olecranon. The patient agreed to surgical right medial triceps release with excision of elbow osteophytes. RESULTS: As demonstrated with our case, static diagnostic imaging such as radiographs and MRI may not adequately characterize snapping triceps syndrome. It is crucial for providers to be aware of subtle differences between dynamic and static diagnostics imaging for snapping medial tricep syndrome. Another important diagnostic tools are electrodiagnostic studies, however as displayed with our patient there may be absence of any ulnar neuropathy at the level of the elbow, which could hinder providers from concerning snapping medial tricep syndrome. CONCLUSION: It is important to consider a broad differential that includes snapping triceps syndrome in a patient presenting with medial elbow pain. EMG and ultrasonography can be useful in differentiating snapping medial triceps from ulnar nerve instability. Treatment can include activity modification, elbow splinting, or surgical release of the snapping part of the triceps

A procedure for the change point problem in parametric models based on phi-divergence test-statistics

This paper studies the change point problem for a general parametric, univariate or multivariate family of distributions. An information theoretic procedure is developed which is based on general divergence measures for testing the hypothesis of the existence of a change. For comparing the accuracy of the new test-statistic a simulation study is performed for the special case of a univariate discrete model. Finally, the procedure proposed in this paper is illustrated through a classical change-point example

How market standards affect building design: the case of low energy design in commercial offices

This paper develops existing work on building design through a focus on one important yet understudied form of regulation: market standards. Market standards are agreed upon definitions of ‘necessary’ provision in buildings and are fundamental in ‘formatting’ markets and determining the value of a building in the market. The paper presents a case study of the design of ten commercial offices in London, UK, the effects of market standards on the designs and on the potential for the development of lower energy buildings. Theoretically, the paper integrates literatures on standards, institutions and markets to argue that market standards do important ‘work’ in design processes that requires closer scrutiny. In particular, we show that market standards: are an important form of normative and cultural regulation in the field of commercial office design; format and act as calculative devices in property markets; and result in forms of knowledge diminution that break the relationship between building design and occupiers’ practices. Together, these effects result in particular designs being legitimised and valued, and lower energy designs being delegitimised, devalued and pushed to the periphery of the attention of commercial office designers

XM02 is superior to placebo and equivalent to Neupogen™ in reducing the duration of severe neutropenia and the incidence of febrile neutropenia in cycle 1 in breast cancer patients receiving docetaxel/doxorubicin chemotherapy

Abstract Background Recombinant granulocyte colony-stimulating factors (G-CSFs) such as Filgrastim are used to treat chemotherapy-induced neutropenia. We investigated a new G-CSF, XM02, and compared it to Neupogen™ after myelotoxic chemotherapy in breast cancer (BC) patients. Methods A total of 348 patients with BC receiving docetaxel/doxorubicin chemotherapy were randomised to treatment with daily injections (subcutaneous 5 μg/kg/day) for at least 5 days and a maximum of 14 days in each cycle of XM02 (n = 140), Neupogen™ (n = 136) or placebo (n = 72). The primary endpoint was the duration of severe neutropenia (DSN) in cycle 1. Results The mean DSN in cycle 1 was 1.1, 1.1, and 3.9 days in the XM02, Neupogen™, and placebo group, respectively. Superiority of XM02 over placebo and equivalence of XM02 with Neupogen™ could be demonstrated. Toxicities were similar between XM02 and Neupogen™. Conclusion XM02 was superior to placebo and equivalent to Neupogen™ in reducing DSN after myelotoxic chemotherapy. Trial Registration Current Controlled Trials ISRCTN02270769</p

Divergent Cortical Generators of MEG and EEG during Human Sleep Spindles Suggested by Distributed Source Modeling

Background: Sleep spindles are,1-second bursts of 10–15 Hz activity, occurring during normal stage 2 sleep. In animals, sleep spindles can be synchronous across multiple cortical and thalamic locations, suggesting a distributed stable phaselocked generating system. The high synchrony of spindles across scalp EEG sites suggests that this may also be true in humans. However, prior MEG studies suggest multiple and varying generators. Methodology/Principal Findings: We recorded 306 channels of MEG simultaneously with 60 channels of EEG during naturally occurring spindles of stage 2 sleep in 7 healthy subjects. High-resolution structural MRI was obtained in each subject, to define the shells for a boundary element forward solution and to reconstruct the cortex providing the solution space for a noise-normalized minimum norm source estimation procedure. Integrated across the entire duration of all spindles, sources estimated from EEG and MEG are similar, diffuse and widespread, including all lobes from both hemispheres. However, the locations, phase and amplitude of sources simultaneously estimated from MEG versus EEG are highly distinct during the same spindles. Specifically, the sources estimated from EEG are highly synchronous across the cortex, whereas those from MEG rapidly shift in phase, hemisphere, and the location within the hemisphere. Conclusions/Significance: The heterogeneity of MEG sources implies that multiple generators are active during huma