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Early AND warning AND score

Candice Downey, Rebecca Randell, Julia Brown, David G Jayne
BACKGROUND: Vital signs monitoring is a universal tool for the detection of postoperative complications; however, unwell patients can be missed between traditional observation rounds. New remote monitoring technologies promise to convey the benefits of continuous monitoring to patients in general wards. OBJECTIVE: The aim of this pilot study was to evaluate whether continuous remote vital signs monitoring is a practical and acceptable way of monitoring surgical patients and to optimize the delivery of a definitive trial...
December 11, 2018: Journal of Medical Internet Research
Jais Emmanuel, Adalberto Torres
Purpose To assess the impact of the automated surveillance of the electronic medical record process on clinical interventions among hospitalized children at a tertiary care pediatric center. Methods A retrospective chart review of the alerts triggered for central line-associated blood stream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), neonatal sepsis, or clinical deterioration through elevated pediatric early warning scores (PEWS) by automated electronic surveillance of the hospital electronic medical record (EMR) over a five-month period among hospitalized children...
October 1, 2018: Curēus
Muhammad Faisal, Andrew J Scally, Natalie Jackson, Donald Richardson, Kevin Beatson, Robin Howes, Kevin Speed, Madhav Menon, Jeremey Daws, Judith Dyson, Claire Marsh, Mohammed A Mohammed
OBJECTIVES: There are no established mortality risk equations specifically for emergency medical patients who are admitted to a general hospital ward. Such risk equations may be useful in supporting the clinical decision-making process. We aim to develop and externally validate a computer-aided risk of mortality (CARM) score by combining the first electronically recorded vital signs and blood test results for emergency medical admissions. DESIGN: Logistic regression model development and external validation study...
December 6, 2018: BMJ Open
Martin Spångfors, Gitte Bunkenborg, Mats Molt, Karin Samuelson
AIMS AND OBJECTIVES: To evaluate if the scale used for assessment of hospital ward patients could predict in-hospital and 30-day mortality amongst those with deviating vital signs i.e. that patients classified as medium or high-risk would have increased risk of in-hospital and 30-day mortality compared to patients with low-risk. BACKGROUND: The National Early Warning Score (NEWS) is a widely-adopted scale for assessing deviating vital signs. A clinical risk-scale that comes with the NEWS divides the risk for critical illness into three risk-categories, low, medium and high...
December 5, 2018: Journal of Clinical Nursing
Rebecca Wallihan, Keely G Smith, Mark D Hormann, Rajesh R Donthi, Kimberly Boland, John D Mahan
BACKGROUND: Traditionally, quizzes have been applied as a tool for summative assessment, though literature suggests their use as a formative assessment can improve motivation and content retention. With this premise, we implemented a series of intermittent, online quizzes known as the Board Examination Simulation Exercise (BESE). We sought to demonstrate an association between BESE participation and scores and performance on the American Board of Pediatrics (ABP) Certifying Examination (CE)...
December 4, 2018: BMC Medical Education
Dan-Dan Zhang, Gan Lu, Xuan-Feng Zhu, Ling-Ling Zhang, Jia Gao, Li-Cheng Shi, Jian-Hua Gu, Jian-Nan Liu
Background: Neural respiratory drive (NRD) using diaphragm electromyography through an invasive transesophageal multi-electrode catheter can be used as a feasible clinical physiological parameter in patients with chronic obstructive pulmonary disease (COPD) to provide useful information on the treatment response. However, it remains unknown whether the surface diaphragm electromyogram (EMGdi) could be used to identify the deterioration of clinical symptoms and to predict the necessity of hospitalization in acute exacerbation of COPD (AECOPD) patients...
December 5, 2018: Chinese Medical Journal
Aleksandra Trajkovska, Munawar Farooq, Drew Richardson
OBJECTIVE: To assess utility and accuracy of general observation modified early warning score charts; and compare sensitivity and specificity of single- and multiple-parameter-based trigger scores on patient outcomes in the ED. METHODS: Retrospective cohort clinical audit of all adult Modified Early Warning Score charts in the ED of a mixed tertiary hospital over 4 weeks. Data extracted included recorded parameters required to calculate Modified Early Warning Score and evidence of response...
November 28, 2018: Emergency Medicine Australasia: EMA
M Vasco, S Pandya, D Van Dyk, D G Bishop, R Wise, R A Dyer
Maternal critical care reflects interdisciplinary care in any hospital area according to the severity of illness of the pregnant woman. The admission rate to intensive care units is below 1% (0.08-0.76%) of deliveries in high-income countries, and ranges from 0.13% to 4.6% in low middle-income countries. Mortality in these patients is high and varies from 0% to 4.9% of admissions in high-income countries, and from 2% to 43.6% in low middle-income countries. Obstetric haemorrhage, sepsis, preeclampsia, human immunodeficiency virus complications and tropical diseases are the main reasons for intensive care unit admission in low middle-income countries...
September 29, 2018: International Journal of Obstetric Anesthesia
M Schmedding, B R Adegbite, S Gould, J O Beyeme, A A Adegnika, M P Grobusch, M A M Huson
The quick sequential organ failure assessment (qSOFA) score has been proposed for risk stratification of emergency room patients with suspected infection. Its use of simple bedside observations makes qSOFA an attractive option for resource-limited regions. We prospectively assessed the predictive ability of qSOFA compared with systemic inflammatory response syndrome (SIRS), universal vital assessment (UVA), and modified early warning score (MEWS) in a resource-limited setting in Lambaréné, Gabon. In addition, we evaluated different adaptations of qSOFA and UVA in this cohort and an external validation cohort from Malawi...
November 26, 2018: American Journal of Tropical Medicine and Hygiene
Clare Warnock, Peter Totterdell, Angela Mary Tod, Rachel Mead, Jamie-Lee Gynn, Barry Hancock
PURPOSE: The primary aim of this study was to examine the value of temperature as a diagnostic and prognostic indicator of infection and sepsis in neutropenic patients. A secondary aim was to gain insight into the presenting symptoms reported by these patients at home or on their initial admission assessment. METHODS: A cohort study was carried out using a case note review of 220 emergency admissions to a regional cancer centre. All participants were neutropenic and were diagnosed with infection on admission...
December 2018: European Journal of Oncology Nursing: the Official Journal of European Oncology Nursing Society
Omar A Usman, Asad A Usman, Michael A Ward
OBJECTIVES: The increasing use of sepsis screening in the Emergency Department (ED) and the Sepsis-3 recommendation to use the quick Sepsis-related Organ Failure Assessment (qSOFA) necessitates validation. We compared Systemic Inflammatory Response Syndrome (SIRS), qSOFA, and the National Early Warning Score (NEWS) for the identification of severe sepsis and septic shock (SS/SS) during ED triage. METHODS: This was a retrospective analysis from an urban, tertiary-care academic center that included 130,595 adult visits to the ED, excluding dispositions lacking adequate clinical evaluation (n = 14,861, 11...
November 7, 2018: American Journal of Emergency Medicine
Katherine M Steffen, Corina Noje, Philomena M Costabile, Eric Henderson, Elizabeth A Hunt, Bruce L Klein, Kristen Nelson McMillan
OBJECTIVES: We developed a Pediatric Transport Triage Tool (PT3) to objectively guide selection of team composition and transport mode, thereby standardizing transport planning. Previously, modified Pediatric Early Warning Score for transport has been used to assess illness severity but not to guide transport decision making. METHODS: The PT3 was created for pediatric transport by combining objective evaluations of neurologic, cardiovascular, and respiratory systems with a systems-based medical condition list to identify diagnoses requiring expedited transport and/or advanced team composition not captured by neurologic, cardiovascular, and respiratory systems alone...
November 19, 2018: Pediatric Emergency Care
(no author information available yet)
BACKGROUND: Epistaxis is a common emergency presentation to ENT. The 'Epistaxis 2016: national audit of management' collected prospective data over a 30-day audit window in 113 centres. A 30-day all-cause mortality rate of 3.4 per cent was identified. This study examines in more detail the subgroup of patients who died during the audit period. METHODS: There were 985 eligible patients identified. Of these, 33 patients died within the audit period. World Health Organization bleeding score, Modified Early Warning System score, haemostasis time, source of referral, co-morbidities and cause of death were investigated from the dataset...
November 20, 2018: Journal of Laryngology and Otology
Daniël J van Hoving, Luke D Hunter, Rachel Elre J Gerber, Hendrick J Lategan, Carine J Marks
Introduction: Intentional self-poisoning is a significant part of the toxicological burden experienced by emergency centres. The aim of this study was to describe all adults presenting with intentional self-poisoning over a six-month period to the resuscitation unit of Khayelitsha Hospital, Cape Town. Methods: Adult patients with a diagnosis of intentional self-poisoning between 1 November 2014 and 30 April 2015 were retrospectively analysed after eligible patients were obtained from the Khayelitsha Hospital Emergency Centre database...
September 2018: African Journal of Emergency Medicine Revue Africaine de la Médecine D'urgence
Brian M Keuski
This report summarizes some of the most relevant studies during the 2017-2018 academic year of scientific literature for diving medicine. The article selection is the result of a PubMed search for "diving," as well as a manual review of the journals Undersea and Hyperbaric Medicine and Diving and Hyperbaric Medicine. Four articles were published reporting on new advances in decompression modeling. New consensus guidelines in the prehospital treatment of decompression sickness were published as well as a retrospective review of the efficacy of the U...
September 2018: Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc
Claire Foley, Maura Dowling
AIMS AND OBJECTIVES: This study aimed to describe how nurses use the Early Warning Score (EWS) in an acute medical ward, their compliance with the EWS and explore their views and experiences of the EWS. BACKGROUND: EWS systems have been implemented in response to upward trends in mortality rates. Nurses play a central role in the use of EWS systems. However, barriers to their use have been identified and include behavioural, cultural and organisational approaches to adherence...
November 14, 2018: Journal of Clinical Nursing
Yuda Sutherasan, Pongdhep Theerawit, Alongkot Suporn, Arkom Nongnuch, Pariya Phanachet, Chomsri Kositchaiwat
Purpose: The aim of this study was to evaluate the impact of a hospital protocol in response to patient deterioration in general wards, stratified using the national early warning score (NEWS), on primary patient outcomes of in-hospital mortality and percentage of patients transferred to the intensive care unit (ICU). Patients and methods: We conducted a prospective observational cohort study among adult medical patients admitted to a university hospital in Bangkok...
2018: Therapeutics and Clinical Risk Management
Kyi Lai Ye Lynn, Josh Hanson, Nan Cho Nwe Mon, Kyi Nyein Yin, Myo Lwin Nyein, Kyaw Zin Thant, Mar Mar Kyi, Thin Zar Cho Oo, Ne Myo Aung
Background: The clinical characteristics and course of patients hospitalised with sepsis in Myanmar and the responsible pathogens remain poorly defined. Methods: We performed an observational study of adults admitted from the community to a tertiary referral hospital in Yangon with fever and dysfunction of at least two organ systems. Results: The 120 patients had a median age of 47 y (interquartile range 28-63); 11 (9%) were human immunodeficiency virus positive...
November 9, 2018: Transactions of the Royal Society of Tropical Medicine and Hygiene
Nicola Credland, Judith Dyson, Miriam J Johnson
BACKGROUND: Early Warning Scores were introduced into acute hospitals in 2000. 99% of acute hospitals employ a EWS to monitor deteriorating patients with 97.9% of these linked to a referral protocol. Despite this high level of adoption, there has been little improvement in the recognition and response to deteriorating patients over the last decade. OBJECTIVE: To explore the patterns of compliance with Early Warning Track and Trigger Tools. DESIGN: A narrative review...
December 2018: Applied Nursing Research: ANR
David Cw Wong, Julia Knight, Jacqueline Birks, Lionel Tarassenko, Peter J Watkinson
BACKGROUND: Electronic recording of vital sign observations (e-Obs) has become increasingly prevalent in hospital care. The evidence of clinical impact for these systems is mixed. OBJECTIVE: The objective of our study was to assess the effect of e-Obs versus paper documentation (paper) on length of stay (time between trauma unit admission and "fit to discharge") for trauma patients. METHODS: A single-center, randomized stepped-wedge study of e-Obs against paper was conducted in two 26-bed trauma wards at a medium-sized UK teaching hospital...
October 31, 2018: JMIR Medical Informatics
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