Wearable continuous vital sign monitoring for deterioration detection and clinical outcomes in hospitalised patients

 Current practice uses physiological early warning scoring (EWS) systems to monitor “standard” vital signs, including heart rate (HR), respiratory rate (RR), blood pressure (BP), oxygen saturations (SpO2) and temperature, coupled with a graded response such as referral for a senior review or increasing monitoring frequency. Early detection of the deteriorating patient is a known challenge within hospital environments, as EWS is dependent on correct frequency of physiological observations tailored to specific patient needs, that can be time consuming for healthcare professionals, resulting in missed or incomplete observations. Wearable monitoring systems (WMS) may bring the potential to fill the gap in vital sign monitoring between traditional intermittent manual measurements and continuous automatic monitoring. However, evidence on the feasibility and impact of WMS implementation remains scarce. The virtual High Dependency Unit (vHDU) project was designed to develop and test the feasibility of deploying a WMS system in the hospital ward environment. This doctoral work aims to critically analyse the roadmap work of the vHDU project, containing ten publications distributed throughout 7 chapters. Chapter 1 (with 3 publications) includes a systematic review and meta-analysis identifying the lack of statistical evidence of the impact of WMS in early deterioration detection and associated clinical outcomes, highlighting the need for high-quality randomised controlled trials (RCTs). It also supports the use of WMS as a complement, and not a substitute, for standard and direct care. Chapter 2 explores clinical staff and patient perceptions of current vital sign monitoring practices, as well as their early thoughts on the use of WMS in the hospital environment through a qualitative interview study. WMS were seen positively by both clinical and patient groups as a potential tool to bridge the gap between manual observations and the traditional wired continuous automatic systems, as long as it does not add more noise to the wards nor replaces direct contact from the clinical staff. In chapter 3, the wearability of 7 commercially available wearables (monitoring HR, RR and SpO2) was assessed, advocating for the use of pulse oximeters without a fingertip probe and a small chest patch to improve worn times from the patients. Out of these, five devices were submitted to measurement accuracy testing (chapter 4, with 3 publications) under movement and controlled hypoxaemia, resulting in the validation of a chest patch (monitoring HR and RR) and proving the diagnostic accuracy of 3 pulse oximeters (monitoring pulse rate, PR and SpO2) under test. These results were timely for the final selection of the devices to be integrated in our WMS, namely vHDU system, explored in chapter 5, outlining the process for its development and rapid deployment in COVID-19 isolation wards in our local hospital during the pandemic. This work is now converging in the design of a feasibility RCT to test the impact of the vHDU system (now augmented with blood pressure and temperature monitoring, completing all 5 vital signs) versus standard care in an unbiased environment (chapter 6). This will also ascertain the feasibility for a multicentre RCT, that may in the future, contribute with the much-needed statistical evidence to my systematic review and meta-analysis research question, highlighted in chapter 1. Finally, chapter 7 includes a critical reflection of the vHDU project and overall doctoral work, as well as its contributions to the field of wearable monitoring.<p class="MsoNormal"/

Longitudinal Analysis for macthed series osf studies

In the first phase of the STATIS methodology the information is contained in a series of studies is first condensed into a symmetric matrix. Models based in the spectral analysis of their mean matrices were developped,see Areia et al.(2008). When their first engenvalue is dominant a further condensation of the information into a structure vector, with the eigenvector associated to and a sum of square of residues is carried out. This enables the joint analysis of matched series of studies associated to the treatments of a base design. Then in the longitudinal analysis of such families of series we study the action of the factors in the base design (contrasts)taken for the components of the structure vectors. An application to elections in Portugal is presented

MODELLING THE COMPROMISE MATRIX IN STATIS

STATIS methodology has three phases: Inter-structure, Compromise, and Intra-structure. In order to be able to carry out inference and simultaneously study several matched series of studies models were introduced for the first place, e. g. Areia et al. 2008 and Oliveira and Mexia 2007. In this poster we extend the models to the Compromise. We apply our approach to the results of local elections in Mainland Portugal. In the last few decades, many authors have studied a series of double-entry tables, thus originating the Join Analysis of Tables (ACT). We can considerer the STATIS methodology as na ACT method that uses Euclidian distances between configurations observed in k situations. The STATIS method was introduced by Hermier des Plantes (1976) and developed by several authors, in particular by Lavit (1988) to analyse data organized in series of studies. A study consiste of a matrix triplet (Xi, Dni, Dpi),i=1,…,k, being a data array and Dni and Dpi being two weight matrices for objects and variables. To obtain a geometrical representation of the studies, Escoufier (1976), developed the operators The compromise matrix M with diagonal matrices Dn and Dp being two weight matrices for objects and variables

RELATÓRIO DE ESTÁGIO

ENQUADRAMENTO: Em Enfermagem de Saúde Familiar, a translação da teoria para a prática é considerada essencial para o desenvolvimento de competências de enfermagem. Em particular, o envolvimento da família nos cuidados de enfermagem é cada vez mais defendido por peritos da academia e praxis clínica. Todavia, os enfermeiros mantêm diversas atitudes quanto ao envolvimento das famílias. Apesar de a investigação identificar vários preditores destas atitudes, a evidência ainda é escassa e dispersa na literatura científica. OBJETIVOS: analisar as competências desenvolvidas no estágio do curso de mestreado em Enfermagem Comunitária na área da Enfermagem de Saúde Familiar e identificar preditores das atitudes dos enfermeiros quanto à importância da família nos cuidados de enfermagem. METODOLOGIA: Efetuou-se uma análise crítica sobre as competências desenvolvidas em estágio e uma revisão sistemática da literatura. A revisão incluiu estudos analíticos publicados entre outubro de 2016 e setembro de 2021, que identificaram preditores das atitudes dos enfermeiros, recorrendo à escala Families’ Importance in Nursing Care – Nurses’ Attitudes e a análises de regressão. A pesquisa foi efetuada através dos motores de busca da B-ON e EBSCOHost, sendo os estudos triados de acordo com o Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 Statement. A qualidade metodológica foi aferida com a checklist de avaliação crítica para estudos transversais do Joanna Briggs Institute e os dados foram extraídos e resumidos em tabelas e na forma de síntese narrativa. RESULTADOS: O estágio permitiu desenvolver as competências do enfermeiro especialista em Enfermagem de Saúde Familiar. O acervo da revisão inclui 4 estudos, abrangendo um total de 1894 enfermeiros. Estes estudos apresentam uma considerável diversidade metodológica entre si. Os preditores mais consensuais foram o contexto de trabalho, as políticas centradas na família e a zona geográfica. CONCLUSÃO: As atitudes dos enfermeiros parecem variar com a zona geográfica, contexto de trabalho e políticas centradas na família. Contudo, a diversidade metodológica e a disparidade de resultados realçam a necessidade de mais investigação para fundamentar a prática clínica em enfermagem de saúde familiar e promover o desenvolvimento de competências específicas, particularmente o envolvimento das famílias nos cuidados de enfermagem

Advanced Maternal Age: Adverse Outcomes of Pregnancy, A Meta-Analysis

INTRODUCTION: The risks of pregnancy in women of advanced maternal age are not consensual amongst studies. The aim of this metaanalysis was to determine whether women of advanced maternal age (≥ 35 years old) had worse obstetrical and perinatal outcomes than non- advanced maternal age women (20 - 34 years old) in singleton, naturally-conceived pregnancies. MATERIAL AND METHODS: We searched PubMed/ MEDLINE, IndexRMP and the Cochrane Database of Systematic Reviews. Ten studies were included according to the following criteria: population of > 1000 nulliparous and/or multiparous women with singleton gestations who did not undergo any type of infertility treatment. Using Review Manager v. 5.3, two meta-analysis were performed: one comparing the outcomes of 20 - 34-year-old vs 35 - 40-year-old women, and another comparing the outcomes of 35 - 40-year-old women vs > 40-year-old women. RESULTS: Women aged 35 - 40 years old were more likely to have > 12 years of education than 20 - 34 years old and > 40 years old women. Advanced maternal age women (35 - 40 and > 40 years old) were more likely to be overweight and having gestational diabetes and gestational hypertension. They were also more likely to undergo induced labour and elective caesarean deliveries. Furthermore, they had worse perinatal outcomes such as preterm delivery, low birthweight babies, higher rates of Neonatal Intensive Care Unit admission and worse Apgar scores. Advanced maternal age women had higher rates of perinatal mortality and stillbirth. DISCUSSION: Most authors present similar results to our study. Although the majority of adverse outcomes can be explained through the physio-pathological changes regarding the female reproductive apparatus that come with aging and its inherent comorbidities, according to the existing literature advanced maternal age can be an independent risk factor per se. In older pregnant women without comorbidities such as gestational hypertension or diabetes there are still worse obstetric and perinatal outcomes, which indicate that advanced maternal age is an independent strong risk factor alone. CONCLUSION: Advanced maternal age women are at a higher risk of adverse obstetrical and perinatal outcomes. In both comparisons, worse outcomes were more prevalent in the older group, suggesting that poorer outcomes are more prevalent with increasing age.info:eu-repo/semantics/publishedVersio

Paraovarian tumor of borderline malignancy: a case report

A case of a 23-year-old woman with a paraovarian tumor is presented. The patient complained of pelvic pain and abdominal swelling. Cystectomy was the initial surgical treatment, but after the histological diagnosis, a staging surgery was carried out. The clinical aspects and subsequent management of related cases are discussed, and a literature review is made

Adaptações neuromusculares em futebolistas com história de lesão dos isquiotibiais

Mestrado em FisioterapiaBackground: Hamstring strain injuries (HSI) are one of the most common injuries in a wide variety of running-sports, resulting in a considerable loss of competition and training time. One of the most problematic consequences regarding HSI is the recurrence rate and its non-decrease over the past decades, despite increasing evidence. Recent studies also found several maladaptations post-HSI probably due to neuromuscular inhibition and it has been proposed that these adaptations post-injury may contribute as risk factors for the injury-reinjury cycle and high recurrence rates. Furthermore it has been recently proposed not to disregard the inter-relationship between these adaptations and risk-factors post-injury in order to better understand the mechanisms of this complex injury. Objective: To determine, analyze and correlate neuromuscular adaptations in amateur football players with prior history of HSI per comparison to uninjured athletes in similar conditions. Methodology: Every participant was subjected to isokinetic concentric (60 and 240deg.sec) and eccentric (30 and 120deg.sec¯¹) testing, and peak torque, angle of peak torque and hamstrings to quadriceps (H:Q) conventional ratios were measured, myoelectrical activity of Bicep Femoris (BF) and Medial Hamstrings (MH) were also measured during isokinetic eccentric testing at both velocities and muscle activation percentages were calculated at 30, 50 and 100ms after onset of contraction. Furthermore active and passive knee extension, knee joint position sense (JPS) test, triple-hop distance (THD) test and core stability (flexors and extensors endurance, right and left side bridge test) were used and correlated. Results: Seventeen players have participated in this study: 10 athletes with prior history of HSI, composing the Hamstring injury group (HG) and 7 athletes without prior severe injuries as control group (CG). We found statistical significant differences between HG injured and uninjured sides in the BF myoelectrical activity at almost all times in both velocities and between HG injured and CG non-dominant sides at 100ms in eccentric 120deg.sec¯¹ velocity (p<.05). We found no differences in MH activity. Regarding proprioception we found differences between the HG injured and uninjured sides (p=.027). We found no differences in the rest of used tests. However, significant correlation between myoelectrical activation at 100ms in 120deg.sec¯¹ testing and JPS with initial position at 90º (r-.372; p=0.031) was found, as well as between isokinetic H:Q ratio at 240deg.sec and THD score (r=-.345; p=.045). Conclusion: We found significant differences that support previous research regarding neuromuscular adaptations and BF inhibition post-HSI. Moreover, to our knowledge, this was the first study that found correlation between these adaptations, and may open a door to new perspectives and future studies.Enquadramento: As lesões dos isquiotibiais são bastante comuns numa grande variedade de desportos que envolvem corrida, resultando num grande período de abstinência desportiva e competitiva. Uma das consequências mais problemáticas desta lesão é a sua alta taxa de recorrência que, embora tenha sido alvo de bastantes estudos, não tem diminuído nas últimas décadas. Estudos recentes encontraram também várias maladaptações em atletas com história desta lesão, provavelmente devido a inibição neuromuscular, sendo proposto que estas adaptações pós-lesão possam contribuir como factores de risco no ciclo de lesão-recorrência, e para a elevada taxa desta. Pelo que recentemente estudos sugerem considerar a interacção destas adaptações e factores de risco, de modo a aprofundar o nosso conhecimento dos mecanismos desta complexa lesão. Objectivo: Determinar, analisar e correlacionar adaptações neuromusculares em futebolistas amadores com história de lesão dos isquiotibiais em comparação com atletas sem história de lesões, em condições semelhantes. Metodologia: Todos os participantes foram sujeitos a testes isocinéticos em modo concêntrico (60 e 240º.sec) e excêntricos (30 e 120º.seg¯¹) em ambos os membros, com análise do pico de torque, ângulo de pico de torque e rácio convencional isquiotibial:quadriceps (H:Q), também foi medida a actividade mioeléctrica do Bicípite Femoral (BF) e dos isquiotibiais mediais (MH) durante a avaliação isocinética excêntrica em ambas as velocidades e a percentagem de activação muscular foi calculada a 30, 50 e 100ms após início da contracção. Além destes, foram medidos e correlacionados os testes de extensão do joelho activa e passiva, teste de sensação de posição do joelho (JPS), triple-hop distance (THD) e testes de estabilidade do core (endurance dos flexores e extensores, side bridge para o lado direito e esquerdo). Resultados: Dezassete jogadores participaram neste estudo: 10 atletas com história de lesão dos isquiotibiais (HG) e 7 atletas sem história de lesões graves (CG). Foram encontradas diferenças significativas entre o lado lesado e não lesado do HG na actividade mioeléctrica do BF em quase todos os tempos em ambas as velocidades, e entre o lado lesado do HG e lado não dominante do CG aos 100ms durante o teste excêntrico á velocidade de 120º.seg¯¹ (p<.05). Não foram encontradas diferenças significativas na actividade dos MH. Quanto ao teste proprioceptivo foram encontradas diferenças no HG entre o membro lesado e não lesado no JPS quando a posição inicial era a extensão completa do joelho (p=.027). Não foram encontradas alterações nos outros testes. No entanto houve correlação significativa entre a actividade mioeléctrica do BF aos 100ms a 120º.seg¯¹ e os resultados do JPS com a 90º de flexão do joelho (r-.372; p=0.031) como posição inicial, assim como entre o rácio H:Q no teste isocinético concêntrico a 240graus.sec e o score to THD (r=-345.; p=.045). Conclusão: Neste estudo foram encontradas diferenças significativas que suporta literatura anterior no que toda a existência de adaptações neuromusculares e inibição do BF após lesão dos isquiotibiais. Além disso, no nosso conhecimento, este foi o primeiro estudo a encontrar correlação significativa entre estas adaptações, pelo que pode abrir uma porta a novas perspectivas e estudos futuros

"Downhill" varices. A rare cause of esophageal hemorrhage

"Downhill" varices or upper esophageal varices are a rare cause of proximal digestive tract hemorrhage with only 16 cases described in the literature. In our series, hemorrhage due to "downhill" varices represents 0.1% of all acute esophageal variceal bleeding. Their etiology differs from that of the usual "uphill" varices secondary to portal hypertension, and the clinical management should be directed to vascular obstruction if present. We report a case of an 89-year-old male with hemorrhagic "downhill" varices not associated, as usually, with superior vena cava obstruction or compression, but with severe pulmonary hypertension and drug-related hemorrhagic risk factors, whose removal proved sufficient to prevent rebleeding