A Review of Intelligent Sensor-Based Systems for Pressure Ulcer Prevention

Pressure ulcers are a critical issue not only for patients, decreasing their quality of life, but also for healthcare professionals, contributing to burnout from continuous monitoring, with a consequent increase in healthcare costs. Due to the relevance of this problem, many hardware and software approaches have been proposed to ameliorate some aspects of pressure ulcer prevention and monitoring. In this article, we focus on reviewing solutions that use sensor-based data, possibly in combination with other intrinsic or extrinsic information, processed by some form of intelligent algorithm, to provide healthcare professionals with knowledge that improves the decision-making process when dealing with a patient at risk of developing pressure ulcers. We used a systematic approach to select 21 studies that were thoroughly reviewed and summarized, considering which sensors and algorithms were used, the most relevant data features, the recommendations provided, and the results obtained after deployment. This review allowed us not only to describe the state of the art regarding the previous items, but also to identify the three main stages where intelligent algorithms can bring meaningful improvement to pressure ulcer prevention and mitigation. Finally, as a result of this review and following discussion, we drew guidelines for a general architecture of an intelligent pressure ulcer prevention system.

The Identikit of Patient at Risk for Severe COVID-19 and Death: The Dysregulation of Renin-Angiotensin System as the Common Theme

Since the first months of the coronavirus disease 2019 (COVID-19) pandemic, several specific physiologic traits, such as male sex and older age, or health conditions, such as overweight/obesity, arterial hypertension, metabolic syndrome, and type 2 diabetes mellitus, have been found to be highly prevalent and associated with increased risk of adverse outcomes in hospitalized patients. All these cardiovascular morbidities are widespread in the population and often coexist, thus identifying a common patient phenotype, characterized by a hyper-activation of the “classic” renin-angiotensin system (RAS) and mediated by the binding of angiotensin II (Ang II) to the type 1-receptor. At the same time, the RAS imbalance was proved to be crucial in the genesis of lung injury after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, where angiotensin-converting-enzyme-2 (ACE2) is not only the receptor for SARS-CoV-2, but its down-regulation through internalization and shedding, caused by the virus binding, leads to a further dysregulation of RAS by reducing angiotensin 1-7 (Ang 1-7) production. This focused narrative review will discuss the main available evidence on the role played by cardiovascular and metabolic conditions in severe COVID-19, providing a possible pathophysiological link based on the disequilibrium between the two opposite arms of RAS.

Gastric Residual Volumes in the Adult Intensive Care Patient: a Systematic Review

<p>Background: Enteral nutrition is one method of delivering nutrition to intubated patients. There are several issues that prevent optimal delivery of the prescribed enteral nutrition goal rates. The measurement of the patient's gastric residual volume (GRV) may demonstrate tolerability, or intolerability, of enteral nutrition. Identifying a safe GRV, at which to accept and continue enteral nutrition delivery, is essential to ensure the delivery of enteral nutrition adequately achieves the nutritional requirements of patients, and to mitigate the risks associated with the delivery of enteral nutrition. Objectives: This systematic review sought to answer the research question: what is the maximum GRV to accept in order to continue the delivery of enteral nutrition in the Intensive Care Unit (ICU) adult patient? This is specifically related to the primary outcome measures indicative of accepting a specified GRV that is too high or too low. Accepting a GRV that is too high would put the patient at risk of vomiting, regurgitation, aspiration of gastric contents and potentially aspiration pneumonia. Conversely, accepting a GRV that is too low would put the patient at risk of not achieving caloric needs, potentially placing the patient at risk of malnutrition and increased morbidity. Search methods: Databases searched included: CCTR, CLCMR, CLTA, CLEED, OVID MEDLINE (R) (Ovid SP), EMBASE, CINAHL Plus with Full Text (EBSCO host via helicon), AMED, Ovid Nursing Full Text plus, CDSR, ACP Journal Club, DARE, Proquest via helicon (advanced search), Pubmed via helicon (limits "all adult", "humans", "abstract", "title"), all EBM reviews, and the reference lists of articles. Selection criteria: The types of studies eligible for inclusion were published randomised controlled trials, case controlled studies, cohort studies and observational studies. Interventions considered were a comparison of two or more GRV measures. The participants eligible were adult ICU or critical care patients receiving enteral nutrition. The primary outcome measures for study inclusion were caloric requirement met, and specified potential adverse events including vomiting, regurgitation, or aspiration. Data collection and analysis: Data was extracted using a data extraction tool created by the researcher. Risk of bias was assessed by the author using two risk of bias assessment tools. Main results: Three studies met the inclusion criteria for the systematic review (McClave et al., 2005; Metheny, Schallom, Oliver, & Clouse, 2008; Pinilla, Samphire, Arnold, Liu, & Thiessen, 2001). Each of these studies contained methodological risks of bias and limitations related to their study designs. McClave et al.'s study was a prospective study (n = 40), Metheny et al.'s study was a prospective descriptive study (n = 206), and Pinilla et al.'s study was a randomised controlled trial (n = 80). No one study, or a combination of studies, provided conclusive evidence to support the use of one particular GRV over another. Author's conclusion: No recommendation for a definitive GRV was made in this systematic review due to the lack of strong evidentiary support for one GRV over another. There remain opportunities for enhancing practice through developing a consistent, multidisciplinary approach to managing GRVs. There are future research opportunities related to improving the management of GRVs in the enterally fed ICU patient, and achieving optimal volumes of nutrition delivered.</p>

Gastric Residual Volumes in the Adult Intensive Care Patient: a Systematic Review

<p>Background: Enteral nutrition is one method of delivering nutrition to intubated patients. There are several issues that prevent optimal delivery of the prescribed enteral nutrition goal rates. The measurement of the patient's gastric residual volume (GRV) may demonstrate tolerability, or intolerability, of enteral nutrition. Identifying a safe GRV, at which to accept and continue enteral nutrition delivery, is essential to ensure the delivery of enteral nutrition adequately achieves the nutritional requirements of patients, and to mitigate the risks associated with the delivery of enteral nutrition. Objectives: This systematic review sought to answer the research question: what is the maximum GRV to accept in order to continue the delivery of enteral nutrition in the Intensive Care Unit (ICU) adult patient? This is specifically related to the primary outcome measures indicative of accepting a specified GRV that is too high or too low. Accepting a GRV that is too high would put the patient at risk of vomiting, regurgitation, aspiration of gastric contents and potentially aspiration pneumonia. Conversely, accepting a GRV that is too low would put the patient at risk of not achieving caloric needs, potentially placing the patient at risk of malnutrition and increased morbidity. Search methods: Databases searched included: CCTR, CLCMR, CLTA, CLEED, OVID MEDLINE (R) (Ovid SP), EMBASE, CINAHL Plus with Full Text (EBSCO host via helicon), AMED, Ovid Nursing Full Text plus, CDSR, ACP Journal Club, DARE, Proquest via helicon (advanced search), Pubmed via helicon (limits "all adult", "humans", "abstract", "title"), all EBM reviews, and the reference lists of articles. Selection criteria: The types of studies eligible for inclusion were published randomised controlled trials, case controlled studies, cohort studies and observational studies. Interventions considered were a comparison of two or more GRV measures. The participants eligible were adult ICU or critical care patients receiving enteral nutrition. The primary outcome measures for study inclusion were caloric requirement met, and specified potential adverse events including vomiting, regurgitation, or aspiration. Data collection and analysis: Data was extracted using a data extraction tool created by the researcher. Risk of bias was assessed by the author using two risk of bias assessment tools. Main results: Three studies met the inclusion criteria for the systematic review (McClave et al., 2005; Metheny, Schallom, Oliver, & Clouse, 2008; Pinilla, Samphire, Arnold, Liu, & Thiessen, 2001). Each of these studies contained methodological risks of bias and limitations related to their study designs. McClave et al.'s study was a prospective study (n = 40), Metheny et al.'s study was a prospective descriptive study (n = 206), and Pinilla et al.'s study was a randomised controlled trial (n = 80). No one study, or a combination of studies, provided conclusive evidence to support the use of one particular GRV over another. Author's conclusion: No recommendation for a definitive GRV was made in this systematic review due to the lack of strong evidentiary support for one GRV over another. There remain opportunities for enhancing practice through developing a consistent, multidisciplinary approach to managing GRVs. There are future research opportunities related to improving the management of GRVs in the enterally fed ICU patient, and achieving optimal volumes of nutrition delivered.</p>

Quality Improvement in Clinical Research: ESA Utilization to improve Patient Safety Monitoring, time management, and Research Compliance.

We analyzed the capabilities of Electronic Signature Administrators (ESA) in reporting adverse and serious adverse events (AE/SAE) in clinical trials to improve Principal Investigator (PI) oversight. The current and most conventional way to sing on AE/SAE reports, by wet ink paper signatures, faces long report completion times, miscommunications, and a high rate of error that can put the study and the patient at risk. We demonstrate here that ESAs can easily take over this task, speeding up the process and enhancing patient's safety and research compliance. Our results show that the average of 31 days to obtain wet-signatures on AE/SAE reports is reduced to merely 3 days after the implementation of ESA. We also found that research professionals spend more than half an hour in commuting each time they need to get PI signatures, while this time is zero if ESAs are used. Finally, an anonymous survey distributed to coordinators shows that ESAs can be well received when implemented since 86% have used an ESA and are satisfied with it or are interested in using it, while only 14% of the participants are either not interested or not satisfied.

Evaluation of the Implementation of the Prevention of Patients at Risk of a Fall in the General Hospital Melati Perbaungan

The risk of falling is an increased chance of falling which can later lead to physical injury. The risk of falling is every patient who is at risk for falling which is generally caused by environmental and physiological factors. The purpose of this study was to evaluate the implementation of prevention of patients at risk of falling at RSU Melati Perbaungan. This type of research used in this research is a type of qualitative research with a phenomenological approach. Data obtained by using in-depth interview guidelines (depth interview) to the respondents. The population is all nurses in the inpatient room of RSU Melati Perbaungan. The sample used non probability sampling with purposive sampling technique of 10 nurses. From the results, it can be concluded that the nurse understands the assessment of the risk patient, the nurse understands the initial assessment of the patient at risk of falling, the nurse understands the reassessment of the patient at risk of falling, the nurse understands the inhibiting factors (patient, family, and nurse factors), the nurse understands the supporting factors (factors motivation and infrastructure factors). The recommendations obtained based on the author's analysis are the need to conduct education and training for the nurse administrators, increase the number of human resources and education for the patient's family regarding the prevention of falling risk patients. Keywords: Melati Perbaungan General Hospital, Patient at Risk of Falling, In-depth Interview, Hospitalization.

Application of Gadamerian Hermeneutics in Medicine based on the Meaning of Mulla Sadra's Truth

Hermeneutics has been introduced as a science of Tafsīrand Ta’wīland this science emphasizes human understanding. Various fields related to the fields of human life and human civilization are the fields of study of this science. the different realms of hermeneutics in the field of medical science requires special delicacy and precision; because any inconsistency of the doctor's understanding with the truth of the disease puts the patient at risk of death. The present article, by descriptive and analytical methods, has applied Gadamerian hermeneutics based on Mulla Sadra's explanation of the truth with the topics of medical hermeneutics. Gadamerian method of medical hermeneutics has paid special attention to understanding the disease due to the importance of human life, and according to this method, both the physician and the patient participate in achieving the nature of the disease according to a dialogical and two-way model. Understanding the truth of the disease follows understanding the truth of the human body; and since the truth of the body, according to Mulla Sadra, depends on the truth of the soul and it also depends on the origin of the universe, which has infinite perfections, then the truth of the human body is unlimited. In short, the physician and the patient proceed through a dialogical relationship to a layer-by-layer understanding of the truth of the disease.

Quello strano dolore toracico

Myocarditis is a rare pathologic condition in paediatric age. It occurs above all in childhood and adolescence. Generally, it is brought about by a typical association with viral infections that cause a massive activation of the inflammatory cascade accountable for the damage in the myocardial tissue. Onset symptoms are not specific and do not often appear to be of cardiac origin, mostly in the youngest children. On the contrary, during adolescence, thoracic pain is likely to be present in the clinical scenario as in the reported case. Laboratory tests, electrocardiography and transthoracic echocardiography can help focus the clinical picture and especially cardiac magnetic resonance imaging is becoming a useful non-invasive investigative method. In contrast endomyocardial biopsy along with histoimmunological analysis is less used given its invasiveness and possible complications. The role of paediatricians is to recognize the patient at risk and promptly address them to the most appropriate diagnostic-therapeutic pathway.

Recent Advances in the Management of Patients with Non-Muscle-Invasive Bladder Cancer Using a Multidisciplinary Approach: Practical Recommendations from the Spanish Oncology Genitourinary (SOGUG) Working Group

On the basis of the discussion of the current state of research on relevant topics of non-muscle-invasive bladder cancer (NMIBC) among a group of experts of the Spanish Oncology Genitourinary (SOGUG) Working Group, recommendations were proposed to overcome the challenges posed by the management of NMIBC in clinical practice. A unified definition of the term ‘microhematuria’ and the profile of the patient at risk are needed. Establishing a ‘hematuria clinic’ would contribute to a centralized and more efficient evaluation of patients with this clinical sign. Second or repeated transurethral resection (re-TUR) needs to be defined, including the time window after the first procedure within which re-TUR should be performed. Complete tumor resection is mandatory when feasible, with specification of the presence or absence of muscle. Budding should be used as a classification system, and stratification of T1 tumors especially in extensive and deep tumors, is advisable. The percentage of the high-grade component should always be reported, and, in multiple tumors, grades should be reported separately. Luminal and basal subtypes can be identified because of possibly different clinical outcomes. Molecular subtypes and immunotherapy are incorporated in the management of muscle-invasive bladder cancer but data on NMIBC are still preliminary.