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Respiratory Care Jun 2020Clinical alarms, including those for mechanical ventilation, have been one of the leading causes of health technology hazards. It has been reported that < 15% of alarms... (Review)
Review
Clinical alarms, including those for mechanical ventilation, have been one of the leading causes of health technology hazards. It has been reported that < 15% of alarms studied rose to the level of being clinically relevant or actionable. Most alarms in health care, whether by default or intention, are set to a hypothetical average patient, which is essentially a one size fits most approach. A method of tuning to individual patient characteristics is possible, similar to the treatment philosophy of precision medicine. The excessive amount of alarms in a clinical environment is thought to be the largest contributing factor to alarm-related adverse events. All these factors come to bear on human perception and response to mechanical ventilation and clinical alarms. Observations of human response to stimuli suggest that response to alarms is closely matched to the perceived reliability and value of the alarm system. This paper provides a review examining vulnerabilities in the current management of mechanical ventilation alarms and summarizes best practices identified to help prevent patient injury. This review examines the factors that affect alarm utility and provides recommendations for applying research findings to improve safety for patients, clinician efficiency, and clinician well-being.
Topics: Clinical Alarms; Humans; Monitoring, Physiologic; Patient Safety; Reproducibility of Results; Respiration, Artificial; Ventilators, Mechanical
PubMed: 32457173
DOI: 10.4187/respcare.07546 -
PLoS Biology Apr 2021Across many species, scream calls signal the affective significance of events to other agents. Scream calls were often thought to be of generic alarming and fearful...
Across many species, scream calls signal the affective significance of events to other agents. Scream calls were often thought to be of generic alarming and fearful nature, to signal potential threats, with instantaneous, involuntary, and accurate recognition by perceivers. However, scream calls are more diverse in their affective signaling nature than being limited to fearfully alarming a threat, and thus the broader sociobiological relevance of various scream types is unclear. Here we used 4 different psychoacoustic, perceptual decision-making, and neuroimaging experiments in humans to demonstrate the existence of at least 6 psychoacoustically distinctive types of scream calls of both alarming and non-alarming nature, rather than there being only screams caused by fear or aggression. Second, based on perceptual and processing sensitivity measures for decision-making during scream recognition, we found that alarm screams (with some exceptions) were overall discriminated the worst, were responded to the slowest, and were associated with a lower perceptual sensitivity for their recognition compared with non-alarm screams. Third, the neural processing of alarm compared with non-alarm screams during an implicit processing task elicited only minimal neural signal and connectivity in perceivers, contrary to the frequent assumption of a threat processing bias of the primate neural system. These findings show that scream calls are more diverse in their signaling and communicative nature in humans than previously assumed, and, in contrast to a commonly observed threat processing bias in perceptual discriminations and neural processes, we found that especially non-alarm screams, and positive screams in particular, seem to have higher efficiency in speeded discriminations and the implicit neural processing of various scream types in humans.
Topics: Adult; Auditory Pathways; Auditory Perception; Brain; Discrimination, Psychological; Fear; Female; Humans; Magnetic Resonance Imaging; Male; Pattern Recognition, Physiological; Recognition, Psychology; Sex Characteristics; Voice Recognition; Young Adult
PubMed: 33848299
DOI: 10.1371/journal.pbio.3000751 -
Endokrynologia Polska 2018Obesity, which affects about 13% of the world population, results in significant deterioration of health and serious clinical, mainly meta-bolic and cardiovascular... (Review)
Review
Obesity, which affects about 13% of the world population, results in significant deterioration of health and serious clinical, mainly meta-bolic and cardiovascular complications. Although the basis of therapeutic treatment is behavioural treatment, often non-pharmacological effects do not produce the desired effect. Currently there are several drugs with a safe action profile that improve the effect of treatment (5-10% weight reduction). The aim of the paper is to present the potential of modern pharmacotherapy in the treatment of obesity, in terms of mechanism of action, efficacy, and side effects, in order to individualise therapy. The drugs already registered include substances with a variety of mechanisms of action, including phentermine, orlistat, lorcaserin, and liraglutide. Compounded preparations (phenter-mine/topiramate, naltrexone SR/bupropion SR) are also available, which, by using low doses of active substances, have beneficial effects while reducing side effects. In addition, several drugs used to treat diabetes, such as metformin, SGLT2 inhibitors, GLP-1 agonists, and pramlintide, promote weight loss, although their use is reserved for diabetics, especially type 2 patients. Regarding the current alarm-ing epidemiological data there is a need for intensive prevention and treatment of obesity as well as the development of a new form of pharmacotherapy (new substances and treatment regimens) to develop effective, safe, and, above all, long-term effective therapy for the treatment of obesity.
Topics: Female; Humans; Male; Obesity
PubMed: 30209803
DOI: 10.5603/EP.2018.0048 -
Journal of Neuroscience Research Nov 2022The ability to discriminate between one's own and others' body parts can be lost after brain damage, as in patients who misidentify someone else's hand as their own...
The ability to discriminate between one's own and others' body parts can be lost after brain damage, as in patients who misidentify someone else's hand as their own (pathological embodiment). Surprisingly, these patients do not use visual information to discriminate between the own and the alien hand. We asked whether this impaired visual discrimination emerges only in the ecological evaluation when the pathological embodiment is triggered by the physical alien hand (the examiner's one) or whether it emerges also when hand images are displayed on a screen. Forty right brain-damaged patients, with (E+ = 20) and without (E- = 20) pathological embodiment, and 24 healthy controls underwent two tasks in which stimuli depicting self and other hands was adopted. In the Implicit task, where participants judged which of two images matched a central target, the self-advantage (better performance with Self than Other stimuli) selectively emerges in controls, but not in patients. Moreover, E+ patients show a significantly lower performance with respect to both controls and E- patients, whereas E- patients were comparable to controls. In the Explicit task, where participants judged which stimuli belonged to themselves, both E- and E+ patients performed worst when compared to controls, but only E+ patients hyper-attributed others' hand to themselves (i.e., false alarms) as observed during the ecological evaluation. The VLSM revealed that SLF damage was significantly associated with the tendency of committing false alarm errors. We demonstrate that, in E+ patients, the ability to visually recognize the own body is lost, at both implicit and explicit level.
Topics: Body Image; Brain Injuries; Hand; Humans; Visual Perception
PubMed: 35869668
DOI: 10.1002/jnr.25109 -
Journal of Electrocardiology 2018Research demonstrates that the majority of alarms derived from continuous bedside monitoring devices are non-actionable. This avalanche of unreliable alerts causes... (Review)
Review
Research demonstrates that the majority of alarms derived from continuous bedside monitoring devices are non-actionable. This avalanche of unreliable alerts causes clinicians to experience sensory overload when attempting to sort real from false alarms, causing desensitization and alarm fatigue, which in turn leads to adverse events when true instability is neither recognized nor attended to despite the alarm. The scope of the problem of alarm fatigue is broad, and its contributing mechanisms are numerous. Current and future approaches to defining and reacting to actionable and non-actionable alarms are being developed and investigated, but challenges in impacting alarm modalities, sensitivity and specificity, and clinical activity in order to reduce alarm fatigue and adverse events remain. A multi-faceted approach involving clinicians, computer scientists, industry, and regulatory agencies is needed to battle alarm fatigue.
Topics: Clinical Alarms; Diagnostic Errors; Electrocardiography; Equipment Failure; Humans; Patient Safety; Point-of-Care Systems; Sound
PubMed: 30077422
DOI: 10.1016/j.jelectrocard.2018.07.024 -
Texas Heart Institute Journal Dec 2015
Topics: Age Factors; Aged, 80 and over; Aortic Valve; Aortic Valve Stenosis; Atrioventricular Block; Attitude to Death; Calcinosis; Clinical Alarms; Equipment Design; Equipment Failure; Female; Geriatric Assessment; Humans; Hypothyroidism; Noise; Pacemaker, Artificial
PubMed: 26664301
DOI: 10.14503/THIJ-15-5555 -
Kidney Medicine May 2022The Henry Ford Health System provides patients with a safe, improved system of continuous kidney replacement therapy using a proprietary, 24-hour sustained... (Review)
Review
The Henry Ford Health System provides patients with a safe, improved system of continuous kidney replacement therapy using a proprietary, 24-hour sustained low-efficiency dialysis (SLED). The SLED system utilizes regional citrate anticoagulation (RCA) in conventional hemodialysis machines that have been configured to provide slow dialytic therapy. Within our hospital complex, SLED-RCA systems are deployed in intensive care units distributed over 4 floors in 2 buildings. This widespread footprint represents a spatial challenge for hemodialysis technicians. Fifteen SLED-RCA machines may be running at one time, and each deployed unit may signal an alarm for multiple reasons. Previously, audible alarms prompted intensive care unit nurses to identify the alarming machine and manually notify technicians by telephone. Technicians would then travel to resolve the alarm. To improve the process of addressing SLED-RCA machine alarms, we developed a remote alert alarm system that wirelessly notifies hemodialysis technicians of specific machine alarms. A quality improvement analysis of nearly 1,000 SLED-RCA alarms over a 1-week period revealed that the average time for alarm correction with a remote alert alarm system was approximately 5 minutes. Reducing alarm resolution time may free technicians and nurses for other critical duties.
PubMed: 35518838
DOI: 10.1016/j.xkme.2022.100452 -
Journal of Diabetes Science and... Apr 2015Soon after the discovery that insulin regulates blood glucose by Banting and Best in 1922, the symptoms and risks associated with hypoglycemia became widely recognized.... (Review)
Review
Soon after the discovery that insulin regulates blood glucose by Banting and Best in 1922, the symptoms and risks associated with hypoglycemia became widely recognized. This article reviews devices to warn individuals of impending hypo- and hyperglycemia; biosignals used by these devices include electroencephalography, electrocardiography, skin galvanic resistance, diabetes alert dogs, and continuous glucose monitors (CGMs). While systems based on other technology are increasing in performance and decreasing in size, CGM technology remains the best method for both reactive and predictive alarming of hypo- or hyperglycemia.
Topics: Algorithms; Blood Glucose; Blood Glucose Self-Monitoring; Diabetes Mellitus, Type 1; Humans; Hyperglycemia; Hypoglycemia; Monitoring, Ambulatory
PubMed: 25931581
DOI: 10.1177/1932296815583507 -
International Journal of Medical... Jan 2024Alarm fatigue in nurses is a major patient safety concern in the intensive care unit. This is caused by exposure to high rates of false and non-actionable alarms.... (Review)
Review
BACKGROUND
Alarm fatigue in nurses is a major patient safety concern in the intensive care unit. This is caused by exposure to high rates of false and non-actionable alarms. Despite decades of research, the problem persists, leading to stress, burnout, and patient harm resulting from true missed events. While engineering approaches to reduce false alarms have spurred hope, they appear to lack collaboration between nurses and engineers to produce real-world solutions. The aim of this bibliometric analysis was to examine the relevant literature to quantify the level of authorial collaboration between nurses, physicians, and engineers.
METHODS
We conducted a bibliometric analysis of articles on alarm fatigue and false alarm reduction strategies in critical care published between 2010 and 2022. Data were extracted at the article and author level. The percentages of author disciplines per publication were calculated by study design, journal subject area, and other article-level factors.
RESULTS
A total of 155 articles with 583 unique authors were identified. While 31.73 % (n = 185) of the unique authors had a nursing background, publications using an engineering study design (n = 46), e.g., model development, had a very low involvement of nursing authors (mean proportion at 1.09 %). Observational studies (n = 58) and interventional studies (n = 33) had a higher mean involvement of 52.27 % and 47.75 %, respectively. Articles published in nursing journals (n = 32) had the highest mean proportion of nursing authors (80.32 %), while those published in engineering journals (n = 46) had the lowest (9.00 %), with 6 (13.04 %) articles having one or more nurses as co-authors.
CONCLUSION
Minimal involvement of nursing expertise in alarm research utilizing engineering methodologies may be one reason for the lack of successful, real-world solutions to ameliorate alarm fatigue. Fostering a collaborative, interdisciplinary research culture can promote a common publication culture across fields and may yield sustainable implementation of technological solutions in healthcare.
Topics: Humans; Monitoring, Physiologic; Alert Fatigue, Health Personnel; Critical Care; Intensive Care Units; Bibliometrics
PubMed: 37977055
DOI: 10.1016/j.ijmedinf.2023.105285