scholarly journals A Prospective Case Control Study To Evaluate The CRADLE Vital Signs Alert Device For Detection Of Patients With Clinically Important Malaria In Refugee Settings

2020 ◽  
Author(s):  
Katy Kuhrt ◽  
Paul T Seed ◽  
Andrew H Shennan

Abstract Background: Malaria is a significant threat to refugee populations. Bidibidi Refugee Settlement, Northern Uganda hosts 223 000 of Uganda’s 1.4 million refugees, vulnerable to malaria due to crowded conditions and limited access to preventative measures and health care. Early detection and referral of suspected malaria cases is key to reducing associated morbidity and mortality. We therefore aimed to evaluate shock index (heart rate/ systolic blood pressure), calculated by the CRADLE Vital Signs Alert (VSA) device, an easy-to-use blood pressure and heart rate monitor, for detection of malaria as grounds for whether the device could be used for low cost identification and referral of patients by non-medically trained Village Health Team workers (VHTs).Methods: CRADLE VSA devices and related training were delivered to all health facilities and VHTs in Bidibidi Refugee Settlement from April to August 2018. CRADLE VSA readings was performed as part of routine patient assessment. CRADLE VSA data (blood pressure, heart rate) and assigned diagnoses were collected from health facility data record books and shock index calculated for each case. Cases were grouped into predefined disease categories, including malaria and severe malaria. A control group consisted of refugees undergoing asymptomatic screening using the CRADLE VSA. Average shock index was calculated for cases and controls and prespecified disease categories, and predictive statistics to evaluate shock index for prediction of malaria and severe malaria.Results: Five hundred and eighty-seven CRADLE VSA devices were delivered. Malaria accounted for 26% (915/3577) of cases and had the highest shock index compared to other disease categories. Positive likelihood ratios for shock index using a threshold of greater than or equal to 0.9 were 5 and 11 for malaria and severe malaria respectively.Conclusion: Malaria accounted for over a quarter of cases. Positive likelihood ratios indicated that patients with shock index greater than or equal to 0.9 were 5 and 11 times more likely to be suffering from malaria and severe malaria respectively, indicating that the CRADLE VSA could be used by non-medically trained VHTs to identify patients likely to have malaria, and those most at risk of severe disease needing urgent referral. Trial Registration: This is an observational study and therefore does not have or require a trial registration. Appropriate permissions were granted by UN Refugee Council, Ministry of Health and Office of the Prime Minister.

2021 ◽  
Author(s):  
Katy Kuhrt ◽  
Paul T Seed ◽  
Andrew H Shennan

Abstract BackgroundMalaria is a significant threat to refugee populations. Bidibidi Refugee Settlement, Northern Uganda hosts 223 000 of Uganda’s 1.4 million refugees, vulnerable to malaria due to crowded conditions and limited access to preventative measures and health care. Early detection and referral of suspected malaria cases is key to reducing associated morbidity and mortality. We therefore aimed to evaluate shock index (heart rate/ systolic blood pressure), calculated by the CRADLE Vital Signs Alert (VSA) device, an easy-to-use blood pressure and heart rate monitor, for detection of malaria as grounds for whether the device could be used for low cost identification and referral of patients by non-medically trained Village Health Team workers (VHTs).Methods CRADLE VSA devices and related training were delivered to all health facilities and VHTs in Bidibidi Refugee Settlement from April to August 2018. CRADLE VSA readings was performed as part of routine patient assessment. CRADLE VSA data (blood pressure, heart rate) and assigned diagnoses were collected from health facility data record books and shock index calculated for each case. Cases were grouped into predefined disease categories, including malaria and severe malaria. A control group consisted of refugees undergoing asymptomatic screening using the CRADLE VSA. Average shock index was calculated for cases and controls and prespecified disease categories, and predictive statistics to evaluate shock index for prediction of malaria and severe malaria.ResultsFive hundred and eighty-seven CRADLE VSA devices were delivered. Malaria accounted for 26% (915/3577) of cases and had the highest shock index compared to other disease categories. Positive likelihood ratios for shock index using a threshold of greater than or equal to 0.9 were 5 and 11 for malaria and severe malaria respectively.ConclusionMalaria accounted for over a quarter of cases. Positive likelihood ratios indicated that patients with shock index greater than or equal to 0.9 were 5 and 11 times more likely to be suffering from malaria and severe malaria respectively, indicating that the CRADLE VSA could be used by non-medically trained VHTs to identify patients likely to have malaria, and those most at risk of severe disease needing urgent referral. Trial RegistrationThis is an observational study and therefore does not have or require a trial registration. Appropriate permissions were granted by UN Refugee Council, Ministry of Health and Office of the Prime Minister.


2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Lili Zhou ◽  
Guoen Cai ◽  
Zhihui Xu ◽  
Qinyong Weng ◽  
Qinyong Ye ◽  
...  

Abstract Background To study the effects of different positive end expiratory pressure (PEEP) on blood pressure and heart function in elderly patients with hypertension. Methods Forty elderly patients above 65 years of age treated with mechanical ventilation were divided into two groups: a control group of non-hypertensive subjects (n = 18) and a hypertension group (n = 22) patients with essential hypertension. Changes in blood pressure, central venous pressure (CVP), central venous oxygen saturation (ScvO2), heart rate, and airway pressure were determined in response to different selected PEEP levels of 0, 2, 4, 6, 8, 10 and 12 cm H2O under SIMV(PC) + PSV mode throughout the study. Results In both groups, the increase in PEEP led to an increase in CVP and airway pressure. When PEEP was above 4 cm H2O in the hypertension group, a decrease in blood pressure and ScvO2, and an increase of heart rate were observed. These results indicated that cardiac output significantly decreased. Conclusion High levels of PEEP can significantly influence changes in blood pressure and heart function in elderly patients with hypertension. Trial registration This trial was retrospectively registered, The Chinese trial registration number is ChiCTR-ROC-17012873. The date of registration is 10-2-2017.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nora K. Schaal ◽  
Johanna Brückner ◽  
Oliver T. Wolf ◽  
Eugen Ruckhäberle ◽  
Tanja Fehm ◽  
...  

AbstractStudies have shown that perioperative music interventions can reduce patients’ anxiety levels. However, in small operations like port catheter surgery evidence is sparse. The present single-blinded, randomised controlled two-armed study included 84 female patients undergoing port catheter placement who were randomly assigned to either listening to music during surgery vs. no music intervention. The medical staff was blind to group allocation. On the day of the surgery anxiety and stress levels were evaluated using subjective (STAI questionnaire, visual analogue scales) and objective (vital parameters, salivary cortisol) parameters at different time points (before the surgery, at the end of the surgery and 1 h post-surgery). The music group showed significant reductions of systolic blood pressure (from 136.5 mmHg ± 26.1 to 123.3 mmHg ± 22.0, p = .002) and heart rate (from 75.6 bpm ± 12.3 to 73.1 bpm ± 12.2, p = .035) from beginning of the surgery to skin suture, whereas the control group did not. No significant effects of the music intervention on subjective anxiety measures or salivary cortisol were revealed. In sum, the study demonstrates that a music intervention during port catheter placement positively influences physiological anxiety levels, whereas no effects were revealed for subjective anxiety and salivary cortisol. Thus, music can be considered as a low cost addition in clinical routine in order to reduce patients’ heart rate and blood pressure. Future studies are encouraged to further explore the differential effects of intraoperative music interventions on physiological, endocrinological and subjective anxiety levels.


2021 ◽  
Author(s):  
Lucie Giblin ◽  
Nicola Vousden ◽  
Hannah Nathan ◽  
Muchabayiwa Francis Gidiri ◽  
Shivaprasad Goudar ◽  
...  

Abstract Background Obstetric haemorrhage is the leading cause of maternal death worldwide, 99% of which occur in low and middle income countries. The majority of deaths and adverse events are associated with delays in identifying compromise and escalating care. Management of severely compromised pregnant women may require transfer to tertiary centres for specialised treatment, therefore early recognition is vital for efficient management. The CRADLE vital signs alert device accurately measures blood pressure and heart rate, calculates the shock index (heart rate divided by systolic blood pressure) and alerts the user to compromise through a traffic light system reflecting previously validated shock index thresholds. Methods This is a planned secondary analysis of data from the CRADLE-3 trial from ten clusters across Africa, India and Haiti where the device and training package were randomly introduced. Referral data were prospectively collected for a 4-week period before, and a 4-week period 3 months after implementation. Referrals from primary or secondary care facilities to higher level care for any cause were recorded. The denominator was the number of women seen for maternity care in these facilities. Results Between April 1 2016 and Nov 30th, 2017 536 223 women attended maternity care facilities. We reviewed a total of 144 cases that were referred, 119 cases 3.84% pre-implementation and 4.48% post-implementation were referred to higher-level facilities. Overall referrals did not significantly reduce (OR 0.89 (0.39- 2.05)) but there was a significant reduction in referrals for bleeding (OR 0.5 (0.39-0.65) following introduction of the device, with homogeneity (I-squared 10.4) between sites. There was no increase in any bleeding-related morbidity.Conclusions Referrals for obstetric haemorrhage reduced following implementation of the CRADLE Vital Signs Alert Device, occurring without an increase in maternal death or emergency hysterectomy. This demonstrates the potential benefit of Shock Index in management pathways for obstetric haemorrhage and targeting limited resources in low- middle- income settings. Trial Registration This study is registered with the ISRCTN registry, number ISRCTN41244132 (02/02/2016)


Micromachines ◽  
2021 ◽  
Vol 12 (8) ◽  
pp. 918
Author(s):  
Siraporn Sakphrom ◽  
Thunyawat Limpiti ◽  
Krit Funsian ◽  
Srawouth Chandhaket ◽  
Rina Haiges ◽  
...  

This article presents the design of a low-cost Wireless Body Sensor Network (WBSN) for monitoring vital signs including a low-cost smart wristwatch that contains an ESP-32 microcontroller and three sensors: heart rate (HR), blood pressure (BP) and body temperature (BT), and an Internet of Things (IoT) platform. The vital signs data are processed and displayed on an OLED screen of the patient’s wristwatch and sent the data over a wireless connection (Wi-Fi) and a Cloud Thing Board system, to store and manage the data in a data center. The data can be analyzed and notified to medical staff when abnormal signals are received from the sensors based on a set parameters from specialists. The proposed low-cost system can be used in a wide range of applications including field hospitals for asymptotic or mild-condition COVID-19 patients as the system can be used to screen those patients out of symptomatic patients who require more costly facilities in a hospital with considerably low expense and installation time, also suitable for bedridden patients, palliative care patients, etc. Testing experiments of a 60-person sample size showed an acceptable accuracy level compared with standard devices when testing with 60 patient-samples with the mean errors heart rate of 1.22%, systolic blood pressure of 1.39%, diastolic blood pressure of 1.01%, and body temperature of 0.13%. According to testing results with 10 smart devices connected with the platform, the time delay caused by the distance between smart devices and the router is 10 s each round with the longest outdoor distance of 200 m. As there is a short-time delay, it does not affect the working ability of the smart system. It is still making the proposed system be able to show patient’s status and function in emergency cases.


2021 ◽  
Vol 4 (2) ◽  
pp. 625-633
Author(s):  
Irman Irman ◽  
Dhea Natashia ◽  
Dewi Gayatri

This study aims to determine the effect of auditory stimulus therapy using murotal on changes in vital signs in acute phase stroke patients. This research is a Randomized Controlled Trial (RCT) with the single-blind method and parallel design without matching. The results of statistical tests using the T-test to determine the difference in the mean decrease in the five vital signs showed that there was a decrease in the average pain scale, blood pressure, and heart rate in the intervention group, which was more significant than the control group (p-value < 0,05). In conclusion, auditory stimulation therapy using murotal significantly reduces pain scale, blood pressure, and heart rate in acute phase stroke patients.   Keywords: Murotal, Auditory Stimulation, Acute Phase Stroke, TTV


2001 ◽  
Vol 6 (1) ◽  
pp. 15-25 ◽  
Author(s):  
Harald Walach ◽  
Stefan Schmidt ◽  
Yvonne-Michelle Bihr ◽  
Susanne Wiesch

We studied the effect of experimenter expectations and different instructions in a balanced placebo design. 157 subjects were randomized into a 2 × 4 factorial design. Two experimenters were led to expect placebos either to produce physiological effects or not (pro- vs. antiplacebo). All subjects except a control group received a caffeine placebo. They were either made to expect coffee, no coffee, or were in a double-blind condition. Dependent measures were blood pressure, heart rate, well-being, and a cognitive task. There was one main effect on the instruction factor (p = 0.03) with the group “told no caffeine” reporting significantly better well-being. There was one main effect on the experimenter factor with subjects instructed by experimenter “proplacebo” having higher systolic blood pressure (p = 0.008). There was one interaction with subjects instructed by experimenter “proplacebo” to receive coffee doing worse in the cognitive task than the rest. Subjects instructed by experimenter “antiplacebo” were significantly less likely to believe the experimental instruction, and that mostly if they had been instructed to receive coffee. Contrary to the literature we could not show an effect of instruction, but there was an effect of experimenters. It is likely, however, that these experimenter effects were not due to experimental manipulations, but to the difference in personalities.


2019 ◽  
Vol 70 (5) ◽  
pp. 1754-1757
Author(s):  
Marius Toma Papacocea ◽  
Ioana Anca Badarau ◽  
Mugurel Radoi ◽  
Ioana Raluca Papacocea

Traumatic brain injuries (TBI) represent a high impact public health problem due to a high rate of death , long term disability and occurrence especially in young adults. Despite several promising animal studies, several parameters were proposed as biological markers and were assessed for this aim. Our study proposes the study of the early biochemical changes in association to hematological parameters for severe TBI patients prognosis. 43 patients with acute TBI were included in study based on clinical, laboratory and imagistic findings. The severity of the TBI was established by Glasgow Coma Scale GCS 3-8. In all patients were evaluated hematologic parameters (Red blood cell count - RBC, Hematocrit, blood Hemoglobin, White blood cell - WBC, Platelet count and biochemical parameters (glucose, urea, creatinine, electrolytes). Outcome was expressed as Glasgow Outcome Scale (GOS), between 1-5. Values were compared to control group -15 cases. Significant early differences in body temperature, heart rate, and systolic blood pressure were observed in TBI group versus control (p[0.05). After correlation, laboratory findings significantly associated to severe outcome - GOS = 1, 2 - (p[0.05) were plasma Na decrease and significant glucose increase. An early increase of temperature and decrease of Na may predict a severe outcome in patients with acute TBI; association with shifts in heart rate and blood pressure, imposes aggressive treatment measures.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 914.2-914
Author(s):  
S. Boussaid ◽  
M. Ben Majdouba ◽  
S. Jriri ◽  
M. Abbes ◽  
S. Jammali ◽  
...  

Background:Music therapy is based on ancient cross-cultural beliefs that music can have a “healing” effect on mind and body. Research determined that listening to music can increase comfort and relaxation, relieve pain, lower distress, reduce anxiety, improve positive emotions and mood, and decrease psychological symptoms. Music therapy has been used greatly in various medical procedures to reduce associated anxiety and pain. Patients have a high level of anxiety when they are in the hospital, this is the case of patients with rheumatic diseases who consult regularly to have intravenous infusion of biological therapies.Objectives:The purpose of this study was to examine the effectiveness of music therapy on pain, anxiety, and vital signs among patients with chronic inflammatory rheumatic diseases during intravenous infusion of biological drugs.Methods:Fifty patients were divided into two groups: The experimental group G1 (n=25) received drug infusion while lestening to soft music (30 minutes); and the control group G2 (n=25) received only drug infusion. Measures include pain, anxiety, vital signs (blood pressure, heart rate and respiratory rate). The pain was measured using visual analogic scale (VAS). The state-trait anxiety inventory (STAI) was used for measuring anxiety, low anxiety ranges from 20 to 39, the moderate anxiety ranges from 40 to 59, and high anxiety ranges from 60 to 80. Vital signs (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], and respiratory rate [RR]) were measured before, during and immediately after the infusion.Statistical package for social sciences (SPSS) was used for analysis.Results:The mean age in G1 was 44.45 years (26-72) with a sex ratio (M/F) of 0.8. Including the 25 patients, 12 had rheumatoid arthritis, 10 had ankylosing spondylitis and 3 had psoriatic arthritis. The mean disease duration was 8 years. In G2, the mean age was 46 years (25-70) with a sex ratio (M/F) of 0.75, 12 had rheumatoid arthritis, 11 had ankylosing spondylitis and 2 had psoriatic arthritis. The mean disease duration was 7.5 years. The biological drugs used were: Infliximab in 30 cases, Tocilizumab in 12 cases and Rituximab in 8 cases.Before the infusion, the patients of experimental group had a mean VAS of 5/10±3, a mean STAI of 50.62±6.01, a mean SBP of 13.6 cmHg±1.4, a mean DBP of 8.6 cmHg±1, a mean HR of 85±10 and a mean RR of 18±3. While in control group the mean VAS was 5.5±2, the mean STAI was 50.89±5.5, the mean SBP was 13.4±1.2, the mean DBP was 8.8±1.1, the mean HR was 82±8 and the mean RR was 19±2.During the infusion and after music intervention in G1, the mean STAI became 38.35±5 in G1 versus 46.7±5.2 in G2 (p value=0.022), the mean SBP became 12.1±0.5 in G1 versus 13±1 in G2 (p=0.035), the mean DBP became 8.1±0.8 in G1 versus 8.4±0.9 in G2 (p=0.4), the mean HR became 76±9 in G1 versus 78±7 in G2 (p=0.04) and the mean RR became 17.3±2.1 in G1 versus 18.2±1.7 in G2 (p=0.39).This study found a statistically significant decrease in anxiety, systolic blood pressure and heart rate in patients receiving music interventions during biological therapies infusion, but no significant difference were identified in diastolic blood pressure and respiratory rate.Conclusion:The findings provide further evidence to support the use of music therapy to reduce anxiety, and lower systolic blood pressure and heart rate in patients with rheumatic disease during biological therapies infusion.References:[1] Lin, C., Hwang, S., Jiang, P., & Hsiung, N. (2019).Effect of Music Therapy on Pain After Orthopedic Surgery -A Systematic review and Meta-Analysis. Pain Practice.Disclosure of Interests:None declared


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Menglu Jiang ◽  
Jiawei Ji ◽  
Xin Li ◽  
Zhenqing Liu

Abstract Background Endotracheal intubation and extubation may cause undesirable hemodynamic changes. Intravenous oxycodone has recently been introduced and used for relieving hemodynamic alterations in response to intubation, but there is insufficient information regarding its application in stabilizing hemodynamics during extubation in the patients emerging from general anesthesia. Methods One hundred patients, who had undergone assorted laparoscopic surgeries under general anesthesia, were randomly assigned to Control group (saline injection, 50 cases) and Study group (intravenous injection of 0.08 mg/kg oxycodone immediately after completion of the surgical procedure, 50 cases). Blood pressure, heart rate, blood oxygen saturation (SpO2) as well as blood concentrations of epinephrine, norepinephrine, and cortisol were recorded or measured immediately before extubation (T0), during extubation (T1), as well as one minute (T2), 5 min (T3), and 10 min after extubation (T4). In addition, coughing and restlessness, time of eye-opening, and duration from completing surgery to extubation as well as Ramsay Sedation Scale were analyzed. Results Blood pressure and heart rate as well as blood concentrations of epinephrine, norepinephrine, and cortisol were significantly higher in the Control group compared with the Study group at the time of extubation as well as 1, 5, and 10 min after extubation (P < 0.05). When the patients emerged from general anesthesia, 70 % of the Control group had cough, which was significantly higher than that of Study group (40 %, P < 0.05). Significantly higher number of patients manifested restlessness in the Control group before (40 %) and after extubation (20 %) compared with that in the Study group (20 and 2 %, respectively, P < 0.05). In addition, patients of Control group had lower Ramsay score at extubation (1.7 ± 0.7) as well as 30 min after extubation (2.4 ± 0.9) compared to that of the patients of Study group (2.2 ± 0.9, and 3.0 ± 0.8, respectively, P = 0.003 and 0.001). Conclusions Intravenous oxycodone attenuated alterations of hemodynamics and blood hormones associated with extubation during emergence from general anesthesia. Trial registration Chinese Clinical Trial Registry: ChiCTR2000040370 (registration date: 11-28-2020) “‘retrospectively registered”.


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