-
Hospital Pediatrics Jul 2022Consumer home monitors (CHM), which measure vital signs, are popular products marketed to detect airway obstruction and arrhythmia. Yet, they lack evidence of infant...
BACKGROUND AND OBJECTIVES
Consumer home monitors (CHM), which measure vital signs, are popular products marketed to detect airway obstruction and arrhythmia. Yet, they lack evidence of infant death prevention, demonstrate suboptimal accuracy, and may result in false alarms that prompt unnecessary acute care visits. To better understand the hospital utilization and costs of CHM, we characterized emergency department (ED) and hospital encounters associated with CHM use at a children's hospital.
METHODS
We used structured query language to search the free text of all ED and admission notes between January 2013 and December 2019 to identify clinical documentation discussing CHM use. Two physicians independently reviewed the presence of CHM use and categorized encounter characteristics.
RESULTS
Evidence of CHM use contributed to the presentation of 36 encounters in a sample of over 300 000 encounters, with nearly half occurring in 2019. The leading discharge diagnoses were viral infection (13, 36%), gastroesophageal reflux (8, 22%) and false positive alarm (6, 17%). Median encounter duration was 20 hours (interquartile range: 3 hours to 2 days; max 10.5 days) and median cost of encounters was $2188 (interquartile range: $255 to $7632; max $84 928).
CONCLUSIONS
Although the annual rate of CHM-related encounters was low and did not indicate a major public health burden, for individual families who present to the ED or hospital for concerns related to CHMs, there may be important adverse financial and emotional consequences.
Topics: Child; Critical Care; Data Collection; Emergency Service, Hospital; Hospitalization; Hospitals, Pediatric; Humans; Infant; Retrospective Studies
PubMed: 35762227
DOI: 10.1542/hpeds.2021-006438 -
PeerJ 2022Humans can memorize and later recognize many objects and complex scenes. In this study, we prepared large photographs and presented participants with only partial views...
Humans can memorize and later recognize many objects and complex scenes. In this study, we prepared large photographs and presented participants with only partial views to test the fidelity of their memories. The unpresented parts of the photographs were used as a source of distractors with similar semantic and perceptual information. Additionally, we presented overlapping views to determine whether the second presentation provided a memory advantage for later recognition tests. Experiment 1 ( = 28) showed that while people were good at recognizing presented content and identifying new foils, they showed a remarkable level of uncertainty about foils selected from the unseen parts of presented photographs (false alarm, 59%). The recognition accuracy was higher for the parts that were shown twice, irrespective of whether the same identical photograph was viewed twice or whether two photographs with overlapping content were observed. In Experiment 2 ( = 28), the memorability of the large image was estimated by a pre-trained deep neural network. Neither the recognition accuracy for an image part nor the tendency for false alarms correlated with the memorability. Finally, in Experiment 3 ( = 21), we repeated the experiment while measuring eye movements. Fixations were biased toward the center of the original large photograph in the first presentation, and this bias was repeated during the second presentation in both identical and overlapping views. Altogether, our experiments show that people recognize parts of remembered photographs, but they find it difficult to reject foils from unseen parts, suggesting that their memory representation is not sufficiently detailed to rule them out as distractors.
Topics: Humans; Memory; Recognition, Psychology; Mental Recall; Eye Movements; Semantics
PubMed: 35411252
DOI: 10.7717/peerj.13187 -
Schizophrenia Research. Cognition Dec 2023Schizophrenia is characterized by memory impairments, yet the relationships between its distinct symptom clusters (i.e., positive, negative, disorganized) and specific...
Schizophrenia is characterized by memory impairments, yet the relationships between its distinct symptom clusters (i.e., positive, negative, disorganized) and specific aspects of memory dysfunction remain poorly characterized. In the present study, we compiled a large analog sample ( = 795) to test whether positive symptoms, versus negative and disorganized symptoms, were uniquely and differentially related to false alarm versus miss errors during recognition memory. Mixed-effects beta regression analyses revealed that both positive schizotypy and paranoia were more strongly associated with false alarms than misses. Disorganized schizotypy showed a similar pattern, though to a lesser extent; negative schizotypy showed a significant relationship with neither false alarm nor miss errors. We suggest that those higher in positive schizotypy are especially prone to misattribute signal to noise stimuli during recognition memory - characteristic of an "intrusive-like" profile of memory impairment, wherein context-irrelevant stimuli trigger spurious retrieval events - and speculate on the neural processes that might give rise to this asymmetry.
PubMed: 37869417
DOI: 10.1016/j.scog.2023.100291 -
International Journal of Environmental... Oct 2022Catastrophic landslides have much more frequently occurred worldwide due to increasing extreme rainfall events and intensified human engineering activity. Landslide...
Catastrophic landslides have much more frequently occurred worldwide due to increasing extreme rainfall events and intensified human engineering activity. Landslide susceptibility evaluation (LSE) is a vital and effective technique for the prevention and control of disastrous landslides. Moreover, about 80% of disastrous landslides had not been discovered ahead and significantly impeded social and economic sustainability development. However, the present studies on LSE mainly focus on the known landslides, neglect the great threat posed by the potential landslides, and thus to some degree constrain the precision and rationality of LSE maps. Moreover, at present, potential landslides are generally identified by the characteristics of surface deformation, terrain, and/or geomorphology. The essential disaster-inducing mechanism is neglected, which has caused relatively low accuracies and relatively high false alarms. Therefore, this work suggests new synthetic criteria of potential landslide identification. The criteria involve surface deformation, disaster-controlling features, and disaster-triggering characteristics and improve the recognition accuracy and lower the false alarm. Furthermore, this work combines the known landslides and discovered potential landslides to improve the precision and rationality of LSE. This work selects Chaya County, a representative region significantly threatened by landslides, as the study area and employs multisource data (geological, topographical, geographical, hydrological, meteorological, seismic, and remote sensing data) to identify potential landslides and realize LSE based on the time-series InSAR technique and XGBoost algorithm. The LSE precision indices of AUC, Accuracy, TPR, F1-score, and Kappa coefficient reach 0.996, 97.98%, 98.77%, 0.98, and 0.96, respectively, and 16 potential landslides are newly discovered. Moreover, the development characteristics of potential landslides and the cause of high landslide susceptibility are illuminated. The proposed synthetic criteria of potential landslide identification and the LSE idea of combining known and potential landslides can be utilized to other disaster-serious regions in the world.
Topics: Humans; Landslides; Geographic Information Systems; Disasters; Geology; Machine Learning
PubMed: 36361127
DOI: 10.3390/ijerph192114241 -
BMJ Quality & Safety Sep 2020
Topics: Child; Clinical Alarms; Hospitals, Pediatric; Humans; Sound
PubMed: 32086299
DOI: 10.1136/bmjqs-2019-010561 -
Psychiatry 2021Suicide is among the leading causes of death in the US and worldwide. Devastatingly, it disproportionately affects youth, making it a leading contributor to years of...
Suicide is among the leading causes of death in the US and worldwide. Devastatingly, it disproportionately affects youth, making it a leading contributor to years of life lost as well. Whereas the US federal government has prioritized the study and prevention of other causes of death, causing mortality rates from them to drop precipitously (e.g., cancer, heart disease, HIV/AIDS), this is not true of suicide. Funding for suicide prevention research is less than one-third of that allocated to other leading causes of death, and as a result the US suicide rate now is virtually identical to what it was 100 years ago. This situation is alarming and requires immediate action.
Topics: Adolescent; Humans; Suicide Prevention
PubMed: 33871311
DOI: 10.1080/00332747.2021.1907871 -
Journal of Clinical Monitoring and... Aug 2023The poor design of conventional auditory medical alarms has contributed to alarm desensitization, and eventually, alarm fatigue in medical personnel. This study tested a...
The poor design of conventional auditory medical alarms has contributed to alarm desensitization, and eventually, alarm fatigue in medical personnel. This study tested a novel multisensory alarm system which aims to help medical personnel better interpret and respond to alarm annunciation during periods of high cognitive load such as those found within intensive care units. We tested a multisensory alarm that combined auditory and vibrotactile cues to convey alarm type, alarm priority, and patient identity. Testing was done in three phases: control (conventional auditory), Half (limited multisensory alarm), and Full (complete multisensory alarm). Participants (N = 19, undergraduates) identified alarm type, priority, and patient identity (patient 1 or 2) using conventional and multisensory alarms, while simultaneously completing a cognitively demanding task. Performance was based on reaction time (RT) and identification accuracy of alarm type and priority. Participants also reported their perceived workload. RT was significantly faster for the Control phase (p < 0.05). Participant performance in identifying alarm type, priority, and patient did not differ significantly between the three phase conditions (p = 0.87, 0.37, and 0.14 respectively). The Half multisensory phase produced the lowest mental demand, temporal demand, and overall perceived workload score. These data suggest that implementation of a multisensory alarm with alarm and patient information may decrease perceived workload without significant changes in alarm identification performance. Additionally, a ceiling effect may exist for multisensory stimuli, with only part of an alarm benefitting from multisensory integration.
Topics: Humans; Workload; Feasibility Studies; Clinical Alarms; Reaction Time; Intensive Care Units; Monitoring, Physiologic
PubMed: 37133627
DOI: 10.1007/s10877-023-01014-4 -
Revista Brasileira de Enfermagem 2018To measure the response time of health professionals before sound alarm activation and the implications for patient safety. (Observational Study)
Observational Study
OBJECTIVE
To measure the response time of health professionals before sound alarm activation and the implications for patient safety.
METHOD
This is a quantitative and observational research conducted in an Adult Intensive Care Unit of a teaching hospital. Three researchers conducted non-participant observations for seven hours. Data collection occurred simultaneously in 20 beds during the morning shift. When listening the alarm activation, the researchers turned on the stopwatches and recorded the motive, the response time and the professional conduct. During collection, the unit had 90% of beds occupied and teams were complete.
RESULT
We verified that from the 103 equipment activated, 66.03% of alarms fatigued. Nursing was the professional category that most provided care (31.06%) and the multi-parameter monitor was the device that alarmed the most (66.09%).
CONCLUSION
Results corroborate the absence or delay of the response of teams, suggesting that relevant alarms might have been underestimated, compromising patient safety.
Topics: Auditory Fatigue; Brazil; Clinical Alarms; Humans; Intensive Care Units; Length of Stay; Monitoring, Physiologic; Patient Safety; Time Factors
PubMed: 30517409
DOI: 10.1590/0034-7167-2017-0481 -
Minerva Anestesiologica Jan 2016Opioid analgesics are important therapeutic options for chronic non-cancer pain (CNCP), recognized as a major public health issue with high social and economic burden.... (Review)
Review
Opioid analgesics are important therapeutic options for chronic non-cancer pain (CNCP), recognized as a major public health issue with high social and economic burden. The increasing therapeutic opioid use for CNCP, misuse and abuse of prescription opioids have become matters of severe concern in USA. The recent position paper of the American Academy of Neurology (AAN) about the use of opioids in USA expresses growing alarms about opioid misuse/abuse, and has alerted physicians worldwide to rethink about their prescription practice. Current US practice in opioid prescription has been associated with morbidity and mortality of epidemic proportions: over 100,000 people directly or indirectly died from prescribed opioids in USA in the last twenty years, reaching 16,651 deaths in 2010. The actually alarming data from US have initiated pain physicians and researchers to re-evaluate their prescribing policies and attitudes for long-term treatment of non-cancer patients with opioids. In this position paper it is explained that any change in clinical behavior should not be based on an uncritical generalization of the US data that do not reflect the European situation. The primary objective of pain physicians remains to adequately treat chronic pain. Opioids are and will continue to remain an essential part of the "armamentarium against pain"; physicians should use them in the best way, i.e. after thorough diagnosis, assessment of alternative therapeutic options in the context of a multimodal treatment concept, and with repeated careful re-evaluations of the proper indication by a close long-term follow-up of any chronic opioid patient.
Topics: Analgesics, Opioid; Chronic Pain; Humans; Opioid-Related Disorders; Practice Patterns, Physicians'; United States
PubMed: 26173558
DOI: No ID Found -
Journal of Cardiovascular... May 2022A wearable cardioverter defibrillator (WCD) is indicated in appropriate patients to reduce the risk for sudden cardiac death. Challenges for patients wearing a WCD have...
INTRODUCTION
A wearable cardioverter defibrillator (WCD) is indicated in appropriate patients to reduce the risk for sudden cardiac death. Challenges for patients wearing a WCD have been frequent false shock alarms primarily due to electrocardiogram noise and wear discomfort. The objective of this study was to test a contemporary WCD designed for reduced false shock alarms and improved comfort.
METHODS
One hundred and thirty patients with left ventricular ejection fraction ≤40% and an active implantable cardioverter defibrillator (ICD) were fitted with the ASSURE WCD (Kestra Medical Technologies) and followed for 30 days. WCD detection was enabled and shock alarm markers recorded, but shocks and shock alarms were disabled. All WCD episodes and ICD ventricular tachycardia/ventricular fibrillation (VT/VF) episodes were adjudicated. The primary endpoint was the false-positive shock alarm rate with a performance goal of 1 every 3.4 days (0.29 per patient-day).
RESULTS
Of 163 WCD episodes, 4 were VT/VF and 159 non-VT/VF (121 rhythms with noise, 32 uncertain with noise, 6 atrial flutter without noise). Only three false-positive shock alarm markers were recorded; one false-positive shock alarm every 1333 patient-days (0.00075 per patient-day, 95% confidence interval: 0.00015-0.00361; p < .001). No ICD recorded VT/VF episodes meeting WCD detection criteria (≥170 bpm for ≥20 s) were missed by the WCD during 3501 patient-days of use. Median wear was 31.0 days (interquartile range [IQR] 2.0) and median daily use 23.0 h (IQR 1.7). Adverse events were mostly mild: skin irritation (19.4%) and musculoskeletal discomfort (8.5%).
CONCLUSION
The ASSURE WCD demonstrated a low false-positive shock alarm rate, low patient-reported discomfort, and no serious adverse events.
Topics: Arrhythmias, Cardiac; Death, Sudden, Cardiac; Defibrillators; Defibrillators, Implantable; Electric Countershock; Electrocardiography; Humans; Stroke Volume; Ventricular Fibrillation; Ventricular Function, Left; Wearable Electronic Devices
PubMed: 35174572
DOI: 10.1111/jce.15417