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Modified Early Warning System

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https://www.readbyqxmd.com/read/28440868/improved-outcomes-after-successful-implementation-of-a-pediatric-early-warning-system-pews-in-a-resource-limited-pediatric-oncology-hospital
#1
Asya Agulnik, Lupe Nataly Mora Robles, Peter W Forbes, Doris Judith Soberanis Vasquez, Ricardo Mack, Federico Antillon-Klussmann, Monica Kleinman, Carlos Rodriguez-Galindo
BACKGROUND: Hospitalized pediatric oncology patients are at high risk of clinical decline and mortality, particularly in resource-limited settings. Pediatric early warning systems (PEWS) aid in the early identification of clinical deterioration; however, there are limited data regarding their feasibility or impact in low-resource settings. This study describes the successful implementation of PEWS at the Unidad Nacional de Oncología Pediátrica (UNOP), a pediatric oncology hospital in Guatemala, resulting in improved inpatient outcomes...
April 25, 2017: Cancer
https://www.readbyqxmd.com/read/28434059/early-warning-score-independently-predicts-adverse-outcome-and-mortality-in-patients-with-acute-pancreatitis
#2
Michael J Jones, Christopher P Neal, Wee Sing Ngu, Ashley R Dennison, Giuseppe Garcea
PURPOSE: The aim of this study was to compare the prognostic value of established scoring systems with early warning scores in a large cohort of patients with acute pancreatitis. METHODS: In patients presenting with acute pancreatitis, age, sex, American Society of Anaesthesiologists (ASA) grade, Modified Glasgow Score, Ranson criteria, APACHE II scores and early warning score (EWS) were recorded for the first 72 h following admission. These variables were compared between survivors and non-survivors, between patients with mild/moderate and severe pancreatitis (based on the 2012 Atlanta Classification) and between patients with a favourable or adverse outcome...
April 22, 2017: Langenbeck's Archives of Surgery
https://www.readbyqxmd.com/read/28385419/vital-signs-and-other-observations-used-to-detect-deterioration-in-pregnant-women-an-analysis-of-vital-sign-charts-in-consultant-led-uk-maternity-units
#3
G B Smith, R Isaacs, L Andrews, M Y K Wee, E van Teijlingen, D E Bick, V Hundley
BACKGROUND: Obstetric early warning systems are recommended for monitoring hospitalised pregnant and postnatal women. We decided to compare: (i) vital sign values used to define physiological normality; (ii) symptoms and signs used to escalate care; (iii) type of chart used; and (iv) presence of explicit instructions for escalating care. METHODS: One-hundred-and-twenty obstetric early warning charts and escalation protocols were obtained from consultant-led maternity units in the UK and Channel Islands...
May 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28351349/development-and-validation-of-the-efficacy-safety-score-ess-a-novel-tool-for-postoperative-patient-management
#4
Erlend Skraastad, Johan Ræder, Vegard Dahl, Lars J Bjertnæs, Vladimir Kuklin
BACKGROUND: Several reports have shown that postoperative monitoring of general safety and quality issues, including pain treatment, after discharge from recovery is often non-systematic and inadequate. We suggest a new score with assessment of key recovery parameters, as a supportive tool for postoperative care and a call-out algorithm for need of extra help. The aim of this investigation was to validate the score. METHODS: After suggesting a prototype score from a pilot study in 182 postoperative patients, we performed a Delphi process by using international experts to create consensus on the final score contents and called the revised tool the Efficacy Safety Score (ESS)...
March 28, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28338520/integration-of-single-center-data-driven-vital-sign-parameters-into-a-modified-pediatric-early-warning-system
#5
Catherine E Ross, Iliana J Harrysson, Veena V Goel, Erika J Strandberg, Peiyi Kan, Deborah E Franzon, Natalie M Pageler
OBJECTIVES: Pediatric early warning systems using expert-derived vital sign parameters demonstrate limited sensitivity and specificity in identifying deterioration. We hypothesized that modified tools using data-driven vital sign parameters would improve the performance of a validated tool. DESIGN: Retrospective case control. SETTING: Quaternary-care children's hospital. PATIENTS: Hospitalized, noncritically ill patients less than 18 years old...
May 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28323444/evaluating-driver-drowsiness-countermeasures
#6
John G Gaspar, Timothy L Brown, Chris W Schwarz, John D Lee, Julie Kang, James S Higgins
OBJECTIVE: Driver drowsiness contributes to a substantial number of fatal and nonfatal crashes, with recent estimates attributing up to 21% of fatal crashes to drowsiness. This article describes recent NHTSA research on in-vehicle drowsiness countermeasures. Recent advances in technology and state detection algorithms have shown success in detecting drowsiness using a variety of data sources, including camera-based eye tracking, steering wheel position, yaw rate, and vehicle lane position...
March 21, 2017: Traffic Injury Prevention
https://www.readbyqxmd.com/read/28257122/research-and-application-of-an-air-quality-early-warning-system-based-on-a-modified-least-squares-support-vector-machine-and-a-cloud-model
#7
Jianzhou Wang, Tong Niu, Rui Wang
The worsening atmospheric pollution increases the necessity of air quality early warning systems (EWSs). Despite the fact that a massive amount of investigation about EWS in theory and practicality has been conducted by numerous researchers, studies concerning the quantification of uncertain information and comprehensive evaluation are still lacking, which impedes further development in the area. In this paper, firstly a comprehensive warning system is proposed, which consists of two vital indispensable modules, namely effective forecasting and scientific evaluation, respectively...
March 2, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/28244298/differences-in-the-clinical-characteristics-of-rapid-response-system-activation-in-patients-admitted-to-medical-or-surgical-services
#8
Yeon Joo Lee, Dong Seon Lee, Hyunju Min, Yun Young Choi, Eun Young Lee, Inae Song, Yeonyee E Yoon, Jin Won Kim, Jong Sun Park, Young Jae Cho, Jae Hyuk Lee, Jung Won Suh, You Hwan Jo, Kyuseok Kim, Sangheon Park
Variability in rapid response system (RRS) characteristics based on the admitted wards is unknown. We aimed to compare differences in the clinical characteristics of RRS activation between patients admitted to medical versus surgical services. We reviewed patients admitted to the hospital who were detected by the RRS from October 2012 to February 2014 at a tertiary care academic hospital. We compared the triggers for RRS activation, interventions performed, and outcomes of the 2 patient groups. The RRS was activated for 460 patients, and the activation rate was almost 2...
April 2017: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/28110990/quick-sofa-scores-predict-mortality-in-adult-emergency-department-patients-with-and-without-suspected-infection
#9
Adam J Singer, Jennifer Ng, Henry C Thode, Rory Spiegel, Scott Weingart
STUDY OBJECTIVE: The Quick Sequential Organ Failure Assessment (qSOFA) score (composed of respiratory rate ≥22 breaths/min, systolic blood pressure ≤100 mm Hg, and altered mental status) may identify patients with infection who are at risk of complications. We determined the association between qSOFA scores and outcomes in adult emergency department (ED) patients with and without suspected infection. METHODS: We performed a single-site, retrospective review of adult ED patients between January 2014 and March 2015...
January 19, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28099733/implementation-of-a-modified-obstetric-early-warning-system-to-improve-the-quality-of-obstetric-care-in-zimbabwe
#10
Abi Merriel, Bobb T Murove, Samuel W D Merriel, Thabani Sibanda, Sikangezile Moyo, Joanna Crofts
OBJECTIVE: To implement a modified obstetric early warning system (MOEWS) to promote identification and stabilization of unwell women. METHODS: A before-and-after study of MOEWS implementation took place between April 2013 and January 2014 in a government referral hospital in Bulawayo, Zimbabwe. After piloting MOEWS, cesarean case files were retrospectively assessed to compare preoperative stabilization. A longitudinal "spot-check" study measured use of MOEWS and action taken on abnormal results...
February 2017: International Journal of Gynaecology and Obstetrics
https://www.readbyqxmd.com/read/27832564/defining-a-reference-range-for-vital-signs-in-healthy-term-pregnant-women-undergoing-caesarean-section
#11
A Dennis, L Hardy
Early warning systems (EWS), used to identify deteriorating hospitalised patients, are based on measurement of vital signs. When the patients are pregnant, most EWS still use non-pregnant reference ranges of vital signs to determine trigger thresholds. There are no published reference ranges for all vital signs in pregnancy. We aimed to define vital signs reference ranges for term pregnancy in the preoperative period, and to determine the appropriateness of EWS trigger criteria in pregnancy. We conducted a one-year retrospective study in a tertiary referral obstetric hospital...
November 2016: Anaesthesia and Intensive Care
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
#12
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
#13
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/27804076/the-predictive-value-of-the-modified-early-warning-score-with-rapid-lactate-level-views-l-for-mortality-in-patients-of-age-65-or-older-visiting-the-emergency-department
#14
Hasan Basri Cetınkaya, Ozlem Koksal, Deniz Sigirli, Emrah Habip Leylek, Ozlem Karasu
The purpose of this study is to detect the predictive power of the modified early warning score with rapid lactate level (ViEWS-L) on mortality in critical patients over the age of 65 years admitted to the emergency department (ED). A total of 616 non-traumatic patients admitted to the Uludag University Faculty of Medicine ED who were 65 years of age or older were included in this study (Ethics board number: 2015-4/8). In this prospective study; the ViEWS-L score of the patients were calculated. The results have been evaluated with rate of mortality in the first 24 h starting from submission...
November 1, 2016: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/27783733/modified-early-warning-score-evaluation-of-trauma-patients
#15
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
#16
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/27694098/prediction-of-sepsis-in-the-intensive-care-unit-with-minimal-electronic-health-record-data-a-machine-learning-approach
#17
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/27686826/a-modified-delphi-study-to-identify-factors-associated-with-clinical-deterioration-in-hospitalized-children
#18
Kristina Krmpotic, Ann Van den Bruel, Anna-Theresa Lobos
OBJECTIVE: Hospitalized children who are admitted to the inpatient ward can deteriorate and require unplanned transfer to the PICU. Studies designed to validate early warning scoring systems have focused mainly on abnormalities in vital signs in patients admitted to the inpatient ward. The objective of this study was to determine the patient and system factors that experienced clinicians think are associated with progression to critical illness in hospitalized children. METHODS: We conducted a modified Delphi study with 3 iterations, administered electronically...
October 2016: Hospital Pediatrics
https://www.readbyqxmd.com/read/27649072/quick-sepsis-related-organ-failure-assessment-systemic-inflammatory-response-syndrome-and-early-warning-scores-for-detecting-clinical-deterioration-in-infected-patients-outside-the-intensive-care-unit
#19
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). OBJECTIVES: We sought to compare qSOFA with other commonly used early warning scores. METHODS: All admitted patients who first met the criteria for suspicion of infection in the emergency department (ED) or hospital wards from November 2008 until January 2016 were included...
April 1, 2017: 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
#20
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...
February 2017: Journal of Critical Care
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