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https://www.readbyqxmd.com/read/27832561/improved-hospital-mortality-with-a-low-met-dose-the-importance-of-a-modified-early-warning-score-and-communication-tool
#1
D V Mullany, M Ziegenfuss, M A Goleby, H E Ward
Rapid response systems have been mandated for the recognition and management of the deteriorating patient. Increasing medical emergency team (MET) dose may be associated with improved outcomes. Large numbers of MET calls may divert resources from the program providing the service unless additional personnel are provided. To describe the implementation and outcomes of a multifaceted rapid response system (RRS) in a teaching hospital, we conducted an observational study. The RRS consisted of the introduction of a MET together with 1) redesign of the ward observation chart with the vital sign variables colour-coded to identify variation from normal; 2) mandated minimum frequency of vital sign measurement; 3) three formal levels of escalation based on the degree of physiological instability as measured by a modified early warning score (MEWS); 4) COMPASS© education and e-learning package with a two-hour face-to-face small group tutorial; 5) practise in escalation and communication using the ISBAR (Identify, Situation, Background, Assessment, Response/Recommendation) communication tool...
November 2016: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/27811448/the-comparison-of-modified-early-warning-score-and-glasgow-coma-scale-age-systolic-blood-pressure-scores-in-the-assessment-of-nontraumatic-critical-patients-in-emergency-department
#2
Ö Köksal, G Torun, E Ahun, D Sığırlı, S B Güney, M O Aydın
INTRODUCTION: The purpose of this study is to assess and compare the discriminatory ability of the Glasgow coma scale (GCS)-age-systolic blood pressure (GAP) score and modified early warning scoring system (mEWS) score for 4-week mortality, for the patients being in the triage category 1 and 2 who refer to Emergency Department (ED). METHODS: Five hundred and two nontraumatic cases being in the triage category 1 and 2 who were ≥18-year-old and who referred to ED were assessed prospectively...
November 2016: Nigerian Journal of Clinical Practice
https://www.readbyqxmd.com/read/27783733/modified-early-warning-score-evaluation-of-trauma-patients
#3
Thaís Flôr da Rocha, Juliana Gibbon Neves, Karin Viegas
Objective: to identify the severity of patients admitted to an emergency trauma. Method: A cross-sectional and retrospective study with 115 trauma patients classified as orange (Manchester System), from June 2013 to July 2014. The data were presented as mean and standard deviation, in addition to the Pearson Chi-square test, One-Way ANOVA and Tukey tests. Results: from the sample, 81.7% were male with mean age of 39.46±19.71 years. Higher incidence of major trauma (48...
September 2016: Revista Brasileira de Enfermagem
https://www.readbyqxmd.com/read/27766526/implementation-of-a-novel-postoperative-monitoring-system-using-automated-modified-early-warning-scores-mews-incorporating-end-tidal-capnography
#4
Joseph M Blankush, Robbie Freeman, Joy McIlvaine, Trung Tran, Stephen Nassani, I Michael Leitman
Modified Early Warning Scores (MEWS) provide real-time vital sign (VS) trending and reduce ICU admissions in post-operative patients. These early warning calculations classically incorporate oxygen saturation, heart rate, respiratory rate, systolic blood pressure, and temperature but have not previously included end-tidal CO2 (EtCO2), more recently identified as an independent predictor of critical illness. These systems may be subject to failure when physiologic data is incorrectly measured, leading to false alarms and increased workload...
October 20, 2016: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/27697395/correlation-of-the-predictive-ability-of-early-warning-metrics-and-mortality-for-cardiac-arrest-patients-receiving-in-hospital-advanced-cardiovascular-life-support
#5
Barbara DeVoe, Anita Roth, Gregory Maurer, Michal Tamuz, Martin Lesser, Renee Pekmezaris, Amgad N Makaryus, Alan Hartman, Paola DiMarzio
BACKGROUND: The Modified Early Warning Score (MEWS) helps identify patients experiencing a decline in physiological parameters that indicate risk for cardiac arrest (CA). OBJECTIVES: To assess the association between MEWS values and patient survival following in-hospital CA. METHODS: Retrospective cohort study of patients who experienced in-hospital CA. The relationship between CA survival and MEWS values as well as other risk factors such as age, gender and type of electrographic cardiac rhythms was analyzed using logistic regression...
October 1, 2016: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/27694098/prediction-of-sepsis-in-the-intensive-care-unit-with-minimal-electronic-health-record-data-a-machine-learning-approach
#6
Thomas Desautels, Jacob Calvert, Jana Hoffman, Melissa Jay, Yaniv Kerem, Lisa Shieh, David Shimabukuro, Uli Chettipally, Mitchell D Feldman, Chris Barton, David J Wales, Ritankar Das
BACKGROUND: Sepsis is one of the leading causes of mortality in hospitalized patients. Despite this fact, a reliable means of predicting sepsis onset remains elusive. Early and accurate sepsis onset predictions could allow more aggressive and targeted therapy while maintaining antimicrobial stewardship. Existing detection methods suffer from low performance and often require time-consuming laboratory test results. OBJECTIVE: To study and validate a sepsis prediction method, InSight, for the new Sepsis-3 definitions in retrospective data, make predictions using a minimal set of variables from within the electronic health record data, compare the performance of this approach with existing scoring systems, and investigate the effects of data sparsity on InSight performance...
September 30, 2016: JMIR Medical Informatics
https://www.readbyqxmd.com/read/27666624/single-source-dual-energy-computed-tomography-in-the-diagnosis-of-gout-diagnostic-reliability-in-comparison-to-digital-radiography-and-conventional-computed-tomography-of-the-feet
#7
Tobias Kiefer, Torsten Diekhoff, Sandra Hermann, Andrea Stroux, Jürgen Mews, Jörg Blobel, Bernd Hamm, Kay-Geert A Hermann
OBJECTIVES: To investigate the diagnostic value of single-source dual-energy computed tomography (SDECT) in gouty arthritis and to compare its capability to detect urate depositions with digital radiography (DR) and conventional computed tomography (CT). METHODS: Forty-four patients who underwent SDECT volume scans of the feet for suspected gouty arthritis were retrospectively analyzed. SDECT, CT (both n=44) and DR (n=36) were scored by three blinded readers for presence of osteoarthritis, erosions, and tophi...
October 2016: European Journal of Radiology
https://www.readbyqxmd.com/read/27649072/qsofa-sirs-and-early-warning-scores-for-detecting-clinical-deterioration-in-infected-patients-outside-the-icu
#8
Matthew M Churpek, Ashley Snyder, Xuan Han, Sarah Sokol, Natasha Pettit, Michael D Howell, Dana P Edelson
RATIONALE: The 2016 definitions of sepsis included the quick Sepsis-related Organ Failure Assessment (qSOFA) score to identify high-risk patients outside the intensive care unit (ICU). OBJECTIVE: We sought to compare qSOFA to other commonly used early warning scores. METHODS: All admitted patients first meeting criteria for suspicion of infection in the emergency department (ED) or hospital wards from November 2008 until January 2016 were included...
September 20, 2016: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27626832/clinical-study-of-a-new-modified-early-warning-system-scoring-system-for-rapidly-evaluating-shock-in-adults
#9
Qin Qin, Yiqin Xia, Yu Cao
OBJECTIVE: Shock, the most common severe emergency syndrome, has a complicated etiopathogenesis, is difficult to identify, progresses quickly, and is dangerous. Early identification and intervention play determining roles in the final outcomes of shock patients, but no specific scoring system for shock has been established to date. METHODS: We collected 292 shock patients and analyzed the correlation between 28-day prognosis and the Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II), Modified Early Warning System (MEWS), and Sequential Organ Failure Assessment scoring systems...
September 2, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27596721/clinical-frailty-adds-to-acute-illness-severity-in-predicting-mortality-in-hospitalized-older-adults-an-observational-study
#10
Roman Romero-Ortuno, Stephen Wallis, Richard Biram, Victoria Keevil
AIM: Frail individuals may be at higher risk of death from a given acute illness severity (AIS), but this relationship has not been studied in an English National Health Service (NHS) acute hospital setting. METHODS: This was a retrospective observational study in a large university NHS hospital in England. We analyzed all first non-elective inpatient episodes of people aged ≥75years (all specialties) between October 2014 and October 2015. Pre-admission frailty was assessed with the Clinical Frailty Scale (CFS) of the Canadian Study on Health & Aging, and AIS in the Emergency Department was measured with a Modified Early Warning Score (ED-MEWS<4 was considered as low acuity, and ED-MEWS≥4 as high acuity)...
November 2016: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/27537689/delayed-recognition-of-deterioration-of-patients-in-general-wards-is-mostly-caused-by-human-related-monitoring-failures-a-root-cause-analysis-of-unplanned-icu-admissions
#11
Louise S van Galen, Patricia W Struik, Babiche E J M Driesen, Hanneke Merten, Jeroen Ludikhuize, Johannes I van der Spoel, Mark H H Kramer, Prabath W B Nanayakkara
BACKGROUND: An unplanned ICU admission of an inpatient is a serious adverse event (SAE). So far, no in depth-study has been performed to systematically analyse the root causes of unplanned ICU-admissions. The primary aim of this study was to identify the healthcare worker-, organisational-, technical,- disease- and patient- related causes that contribute to acute unplanned ICU admissions from general wards using a Root-Cause Analysis Tool called PRISMA-medical. Although a Track and Trigger System (MEWS) was introduced in our hospital a few years ago, it was implemented without a clear protocol...
2016: PloS One
https://www.readbyqxmd.com/read/27494719/a-protocolised-once-a-day-modified-early-warning-score-mews-measurement-is-an-appropriate-screening-tool-for-major-adverse-events-in-a-general-hospital-population
#12
Louise S van Galen, Casper C Dijkstra, Jeroen Ludikhuize, Mark H H Kramer, Prabath W B Nanayakkara
BACKGROUND: The Modified Early Warning Score (MEWS) was developed to timely recognise clinically deteriorating hospitalised patients. However, the ability of the MEWS in predicting serious adverse events (SAEs) in a general hospital population has not been examined prospectively. The aims were to (1) analyse protocol adherence to a MEWS protocol in a real-life setting and (2) to determine the predictive value of protocolised daily MEWS measurement on SAEs: death, cardiac arrests, ICU-admissions and readmissions...
2016: PloS One
https://www.readbyqxmd.com/read/27489621/high-performance-detection-and-early-prediction-of-septic-shock-for-alcohol-use-disorder-patients
#13
Jacob Calvert, Thomas Desautels, Uli Chettipally, Christopher Barton, Jana Hoffman, Melissa Jay, Qingqing Mao, Hamid Mohamadlou, Ritankar Das
BACKGROUND: The presence of Alcohol Use Disorder (AUD) complicates the medical conditions of patients and increases the difficulty of detecting and predicting the onset of septic shock for patients in the ICU. METHODS: We have developed a high-performance sepsis prediction algorithm, InSight, which outperforms existing methods for AUD patient populations. InSight analyses a combination of singlets, doublets, and triplets of clinical measurements over time to generate a septic shock risk score...
June 2016: Annals of Medicine and Surgery
https://www.readbyqxmd.com/read/27418264/remote-triage-support-algorithm-based-on-fuzzy-logic
#14
Jugoslav Achkoski, S Koceski, D Bogatinov, B Temelkovski, G Stevanovski, I Kocev
OBJECTIVES: This paper presents a remote triage support algorithm as a part of a complex military telemedicine system which provides continuous monitoring of soldiers' vital sign data gathered on-site using unobtrusive set of sensors. METHODS: The proposed fuzzy logic-based algorithm takes physiological data and classifies the casualties according to their health risk level, calculated following the Modified Early Warning Score (MEWS) methodology. RESULTS: To verify the algorithm, eight different evaluation scenarios using random vital sign data have been created...
July 14, 2016: Journal of the Royal Army Medical Corps
https://www.readbyqxmd.com/read/27160454/the-role-of-planned-and-on-demand-relaparotomy-in-the-developing-world
#15
M F Scriba, G L Laing, J L Bruce, B Sartorius, D L Clarke
INTRODUCTION/BACKGROUND: This study compares planned repeat laparotomy (PR) with on-demand repeat laparotomy (OD) in a developing world setting. MATERIALS AND METHODS: This study was conducted over a 30-month study period (December 2012-May 2015) at Greys Hospital, Pietermaritzburg, South Africa. All trauma and general surgery adult patients requiring a single relaparotomy were included in this study. Prospectively gathered data entered into an established electronic registry were retrospectively analysed...
July 2016: World Journal of Surgery
https://www.readbyqxmd.com/read/27132775/two-year-outcomes-after-arthroscopic-lateral-meniscus-centralization
#16
Hideyuki Koga, Takeshi Muneta, Toshifumi Watanabe, Tomoyuki Mochizuki, Masafumi Horie, Tomomasa Nakamura, Koji Otabe, Yusuke Nakagawa, Ichiro Sekiya
PURPOSE: To evaluate clinical and radiographic outcomes of arthroscopic centralization for lateral meniscal extrusion. METHODS: Twenty-one patients who underwent arthroscopic centralization of the lateral meniscus were included. In cases with an extruded lateral meniscus (9 patients) or discoid meniscus (12 patients), the capsule at the margin between the midbody of the lateral meniscus and the capsule was sutured to the lateral edge of the lateral tibial plateau and centralized using suture anchors to reduce or prevent meniscal extrusion...
April 29, 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/27124174/emergency-department-modified-early-warning-score-association-with-admission-admission-disposition-mortality-and-length-of-stay
#17
Juan J Delgado-Hurtado, Andrea Berger, Amit B Bansal
BACKGROUND: Geisinger Health System implemented the Modified Early Warning Score (MEWS) in 2011 and is fully integrated to the Electronic Medical Record (EMR). Our objective was to assess whether the emergency department (ED) MEWS (auto-calculated by EMR) is associated with admission to the hospital, admission disposition, inpatient mortality, and length of stay (LOS) 4 years after its implementation. METHODS: A random sample of 3,000 patients' first encounter in the ED was extracted in the study period (between January 1, 2014 and May 31, 2015)...
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27036588/calibration-of-coronary-calcium-scores-determined-using-iterative-image-reconstruction-aidr-3d-at-120-100-and-80-kvp
#18
Joerg Blobel, Juergen Mews, Keith A Goatman, Joanne D Schuijf, Willem Overlaet
PURPOSE: Computed tomography (CT) radiation dose reduction is frequently achieved by applying lower tube voltages and using iterative reconstruction (IR). For calcium scoring, the reference protocol at 120 kVp with filtered back projection (FBP) is still used, because kVp and IR may influence the Agatston score (AS) and volume score (VS). The authors present a two-step method to optimize dose: first, to determine the lowest feasible exposure and highest noise thresholds; second, to define a calibration method that ensures that the AS and VS are similar to the reference protocol...
April 2016: Medical Physics
https://www.readbyqxmd.com/read/26986466/modified-early-warning-score-mews-identifies-critical-illness-among-ward-patients-in-a-resource-restricted-setting-in-kampala-uganda-a-prospective-observational-study
#19
Rebecca Kruisselbrink, Arthur Kwizera, Mark Crowther, Alison Fox-Robichaud, Timothy O'Shea, Jane Nakibuuka, Isaac Ssinabulya, Joan Nalyazi, Ashley Bonner, Tahira Devji, Jeffrey Wong, Deborah Cook
INTRODUCTION: Providing optimal critical care in developing countries is limited by lack of recognition of critical illness and lack of essential resources. The Modified Early Warning Score (MEWS), based on physiological parameters, is validated in adult medical and surgical patients as a predictor of mortality. The objective of this study performed in Uganda was to determine the prevalence of critical illness on the wards as defined by the MEWS, to evaluate the MEWS as a predictor of death, and to describe additional risk factors for mortality...
2016: PloS One
https://www.readbyqxmd.com/read/26947612/prediction-of-en-route-complications-during-interfacility-transport-by-outcome-predictive-scores-in-ed
#20
COMPARATIVE STUDY
Y K Wong, C T Lui, K K Li, C Y Wong, M M Lee, W L Tong, K L Ong, S Y H Tang
OBJECTIVE: The objective was to determine the accuracy of the outcome predictive scores (Modified Early Warning Score [MEWS]; Hypotension, Low Oxygen Saturation, Low Temperature, Abnormal ECG, Loss of Independence [HOTEL] score; and Simple Clinical Score [SCS]) in predicting en-route complications during interfacility transport (IFT) in emergency department. DESIGN: This was a retrospective cohort study. METHODS: All IFT cases by ambulances with either nurse-led or physician-led escort, occurring between 1 January 2011 and 31 December 2012, were included...
May 2016: American Journal of Emergency Medicine
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