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BioRxiv : the Preprint Server For... Nov 2023Anxiety affects 4.4-million children in the United States with an onset between childhood and adolescence, a period marked by neural changes that impact emotions and...
BACKGROUND
Anxiety affects 4.4-million children in the United States with an onset between childhood and adolescence, a period marked by neural changes that impact emotions and memory. Negative overgeneralization - or responding similarly to innocuous events that share features with past aversive experiences - is common in anxiety but remains mechanistically underspecified. The nucleus reuniens (RE) has been considered a crucial candidate in the modulation of memory specificity. Our study investigated its activation and functional connectivity with the medial prefrontal cortex (mPFC) and hippocampus (HPC) as neurobiological mechanisms of negative overgeneralization in anxious youth.
METHODS
As part of a secondary data analysis, we examined data from 34 participants between 9-14 years (mean age ± SD, 11.4 ± 2.0 years, 16 females) with varying degrees of anxiety severity. During the Study session participants rated images as negative, neutral, and positive. After 12-hours, participants returned for a Test session, where they performed a memory recognition test with repeated (targets) and similar (lures) images. Labeling negative relative to neutral lures as "old" (false alarms) was our operational definition of negative overgeneralization.
RESULTS
Negative relative to neutral false alarmed stimuli displayed elevated RE activation (at Study and Test) and increased functional connectivity with the CA1 (at Test only). Elevated anxiety severity was associated with reductions in the RE-mPFC functional coupling for neutral relative to negative stimuli. Exploratory analyses revealed similar patterns in activation and functional connectivity with positive stimuli.
CONCLUSIONS
Our findings demonstrate the importance of the RE in the overgeneralization of memories in anxious youth.
PubMed: 38014058
DOI: 10.1101/2023.11.14.567068 -
JMIR Human Factors Jun 2024The high number of unnecessary alarms in intensive care settings leads to alarm fatigue among staff and threatens patient safety. To develop and implement effective and...
BACKGROUND
The high number of unnecessary alarms in intensive care settings leads to alarm fatigue among staff and threatens patient safety. To develop and implement effective and sustainable solutions for alarm management in intensive care units (ICUs), an understanding of staff interactions with the patient monitoring system and alarm management practices is essential.
OBJECTIVE
This study investigated the interaction of nurses and physicians with the patient monitoring system, their perceptions of alarm management, and smart alarm management solutions.
METHODS
This explorative qualitative study with an ethnographic, multimethods approach was conducted in an ICU of a German university hospital. Using triangulation in data collection, 102 hours of field observations, 12 semistructured interviews with ICU staff members, and the results of a participatory task were analyzed. The data analysis followed an inductive, grounded theory approach.
RESULTS
Nurses and physicians reported interacting with the continuous vital sign monitoring system for most of their work time and tasks. There were no established standards for alarm management; instead, nurses and physicians stated that alarms were addressed through ad hoc reactions, a practice they viewed as problematic. Staff members' perceptions of intelligent alarm management varied, but they highlighted the importance of understandable and traceable suggestions to increase trust and cognitive ease.
CONCLUSIONS
Staff members' interactions with the omnipresent patient monitoring system and its alarms are essential parts of ICU workflows and clinical decision-making. Alarm management standards and workflows have been shown to be deficient. Our observations, as well as staff feedback, suggest that changes are warranted. Solutions for alarm management should be designed and implemented with users, workflows, and real-world data at the core.
Topics: Humans; Clinical Alarms; Qualitative Research; Intensive Care Units; Germany; Male; Female; Adult; Attitude of Health Personnel; Monitoring, Physiologic; Middle Aged; Critical Care
PubMed: 38888941
DOI: 10.2196/55571 -
Blood Pressure Dec 2023Impaired cardiovascular health is a concern for firefighters, with over 50% of line-of-duty deaths having cardiac causes. Many firefighters have hypertension and <25%...
BACKGROUND
Impaired cardiovascular health is a concern for firefighters, with over 50% of line-of-duty deaths having cardiac causes. Many firefighters have hypertension and <25% have their blood pressure (BP) controlled. The alarm response could be an unidentified cardiac risk, but interestingly, the BP response to different calls and on-the-job activity is unknown.
PURPOSE
We aimed to measure the physiological stress resulting from different call types (fire, medical) and job activity (riding apparatus, pre-alert alarms) through ambulatory BP (ABP) monitoring in a population of firefighters.
MATERIALS AND METHODS
During 111 12-h work shifts firefighters wore an ABP monitor. BP was measured at 30-min intervals and manual measurements were prompted when the pager went off or whenever they felt stress.
RESULTS
Firefighters were hypertensive (124.3 ± 9.9/78.1 ± 6.7 mmHg), overweight (30.2 ± 4.6 kg/m), middle-aged (40.5 ± 12.6 years) and experienced (17.3 ± 11.7 years). We calculated an average 11% increase in systolic and 10.5% increase in diastolic BP with alarm. Systolic BP (141.9 ± 13.2 mmHg) and diastolic BP (84.9 ± 11.1 mmHg) and the BP surges were higher while firefighters were responding to medical calls compared to fire calls. Between BP groups we found that medical call systolic BP ( = .001, = 1.2), diastolic BP ( = .017, = 0.87), and fire call systolic BP ( = .03, = 0.51) levels were higher in the hypertensive firefighters.
CONCLUSION
This is the first report of BP surge responses to alarms and to occupational activities in firefighters, and medical calls elicited the largest overall responses.PLAIN LANGUAGE SUMMARYCardiovascular disease and impaired cardiovascular health are substantially more prevalent in firefighters, with over 50% of line-of-duty deaths being cardiac related.Many firefighters are diagnosed with high blood pressure (hypertension), which is known to increase the risk of heart attacks, strokes, heart disease, and other serious health complications.Upon stress, our body enacts the 'fight or flight' response where sympathetic nervous system activity triggers an immediate increase in heart rate and blood pressure. This response can be dangerous when surges reach extreme levels due to underlying impaired cardiovascular function. It is known that alarm sounds trigger a stress response.Firefighters respond to different alarms while on the job, each indicating different call types, such as a house fire or a medical emergency. Due to the prevalence of impaired cardiovascular health in firefighters, the physical stress resulting from these alerts is cause for concern.The blood pressure surge response to different call types and job activities in healthy and hypertensive firefighters had not been measured before this study.Through the ambulatory blood pressure monitoring of 111 on-duty firefighters, this study discovered that medical calls caused the greatest blood pressure and heart rate surge.Also, firefighters with hypertension experienced a greater blood pressure surge in response to alarms than their non-hypertensive co-workers.
Topics: Middle Aged; Humans; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Firefighters; Hypertension; Stroke
PubMed: 36597210
DOI: 10.1080/08037051.2022.2161997 -
American Journal of Obstetrics &... May 2023The infrastructure of many labor and delivery units in the United States may dispose clinicians to overuse continuous and automated maternal physiological monitors....
BACKGROUND
The infrastructure of many labor and delivery units in the United States may dispose clinicians to overuse continuous and automated maternal physiological monitors. Overmonitoring low-risk patients can negatively affect patient care, primarily through generating alarm fatigue.
OBJECTIVE
Given the national attention to reducing alarm fatigue across healthcare settings and the concern for vital sign monitoring overuse on our labor and delivery unit, this quality improvement study aimed to evaluate vital sign monitoring patterns and alarm rates, and nursing experiences of alarm fatigue, before and after implementing a vital sign monitoring guideline for low-risk obstetrical patients.
STUDY DESIGN
This was a quality improvement study conducted on the labor and delivery unit of an urban, academic, tertiary hospital. The lack of guidance for maternal vital sign assessment in low-risk patients was identified as a potential safety challenge. A vital sign guideline was developed with multidisciplinary input, followed by a pre-post-implementation study evaluating vital sign volume and alarm rates. Total vital signs and alarm rates for all patients delivered during designated calendar days were assessed as a rate of vital signs per patient and compared across baseline, peri-intervention, and follow-up periods. Data were examined in p-type statistical process control charts and with time-series analysis. Patient characteristics and severe maternal morbidity, as a balancing metric, were compared across periods. Nursing perceptions of vital sign monitoring and experience of alarm fatigue were assessed via survey before and after implementation of the guideline.
RESULTS
A total of 35 individual 24-hour periods were evaluated with regard to vital sign and alarm volume. There was a decrease in vital signs per patient from a mean of 208.34 to 135.46 (incidence rate ratio, 0.65) and in alarms per patient from a mean of 14.31 to 10.51 (incidence rate ratio, 0.73) after implementation, with no difference in severe maternal morbidity. There were 85 total respondents to the nursing surveys, and comparison of modified task-load index scores before and after implementation demonstrated overall lower scores in the postperiod, although these were not statistically significant.
CONCLUSION
Introducing a maternal vital sign guideline for low-risk patients on the labor and delivery unit decreased vital signs measured as well as alarms, which may ultimately reduce alarm fatigue. This strategy should be considered on labor and delivery units widely to improve patient safety and optimize outcomes.
Topics: Humans; Monitoring, Physiologic; Clinical Alarms; Vital Signs; Patient Safety; Quality Improvement
PubMed: 36781120
DOI: 10.1016/j.ajogmf.2023.100893 -
Epilepsia Open Sep 2022To assess the performance of a multimodal seizure detection device, first tested in adults (sensitivity 86%, PPV 49%), in a pediatric cohort living at home or...
OBJECTIVE
To assess the performance of a multimodal seizure detection device, first tested in adults (sensitivity 86%, PPV 49%), in a pediatric cohort living at home or residential care.
METHODS
In this multicenter, prospective, video-controlled cohort-study, nocturnal seizures were detected by heartrate and movement changes in children with epilepsy and intellectual disability. Participants with a history of >1 monthly major motor seizure wore Nightwatch bracelet at night for 3 months. Major seizures were defined as tonic-clonic, generalized tonic >30 s, hyperkinetic, or clusters (>30 min) of short myoclonic or tonic seizures. The video of all events (alarms and nurse diaries) and about 10% of whole nights were reviewed to classify major seizures, and minor or no seizures.
RESULTS
Twenty-three participants with focal or generalized epilepsy and nightly motor seizures were evaluated during 1511 nights, with 1710 major seizures. First 1014 nights, 4189 alarms occurred with average of 1.44/h, showing average sensitivity of 79.9% (median 75.4%) with mean PPV of 26.7% (median 11.1%) and false alarm rate of 0.2/hour. Over 90% of false alarms in children was due to heart rate (HR) part of the detection algorithm. To improve this rate, an adaptation was made such that the alarm was only triggered when the wearer was in horizontal position. For the remaining 497 nights, this was tested prospectively, 384 major seizures occurred. This resulted in mean PPV of 55.5% (median 58.1%) and a false alarm rate 0.08/h while maintaining a comparable mean sensitivity of 79.4% (median 93.2%).
SIGNIFICANCE
Seizure detection devices that are used in bed which depend on heartrate and movement show similar sensitivity in children and adults. However, children do show general higher false alarm rate, mostly triggered while awake. By correcting for body position, the false alarms can be limited to a level that comes close to that in adults.
Topics: Adult; Algorithms; Child; Electroencephalography; Epilepsy; Epilepsy, Tonic-Clonic; Humans; Prospective Studies; Seizures
PubMed: 35666848
DOI: 10.1002/epi4.12618 -
IEEE Access : Practical Innovations,... 2020Bedside patient monitors are ubiquitous tools in modern critical care units to provide timely patient status. However, current systems suffer from high volume of false...
Bedside patient monitors are ubiquitous tools in modern critical care units to provide timely patient status. However, current systems suffer from high volume of false alarms leading to alarm fatigue, one of top technical hazards in clinical settings. Many studies are racing to develop improved algorithms towards precision patient monitoring, while little has been done to investigate the aspect of algorithm generalizability across different health institutions. Our group has been developing an evolving framework termed SuperAlarm that extracts multivariate patterns in data streams (monitor alarms, electronic health records and physiologic waveforms) of modern health enterprise to predict patient deterioration and has demonstrated great potential in mitigating alarm fatigue. In this study, we further investigate the generalizability of SuperAlarm by designing a comprehensive approach to achieve performance comparison in predicting in-hospital code blue (CB) events across two health institutions. SuperAlarm model trained with alarm data in one institution is tested on both internal and external test sets. Results show comparable performance with sensitivity up to 80% within one-hour window of events and over 90% in reduction of false alarms in both institutions. Cross-institutional performance agreement can be further improved by predicting a more stringent CB subtype (cardiopulmonary arrest), with internal sensitivity lying within 95% confident interval of external one up to 8-hour before event onset. The cross-institutional performance comparison offers first-hand knowledge on both advantages and challenges in generalizing a prediction algorithm across different institutions, which hold key information to guide the design of model training and deployment strategy.
PubMed: 33747677
DOI: 10.1109/access.2020.3009667 -
Sensors (Basel, Switzerland) Jun 2023Due to the characteristics of the cotton picker working in the field and the physical characteristics of cotton, it is easy to burn during the operation, and it is...
Due to the characteristics of the cotton picker working in the field and the physical characteristics of cotton, it is easy to burn during the operation, and it is difficult to be detected, monitored, and alarmed. In this study, a fire monitoring system of cotton pickers based on GA optimized BP neural network model was designed. By integrating the monitoring data of SHT21 temperature and humidity sensors and CO concentration monitoring sensors, the fire situation was predicted, and an industrial control host computer system was developed to monitor the CO gas concentration in real time and display it on the vehicle terminal. The BP neural network was optimized by using the GA genetic algorithm as the learning algorithm, and the data collected by the gas sensor were processed by the optimized network, which effectively improved the data accuracy of CO concentration during fires. In this system, the CO concentration in the cotton box of the cotton picker was validated, and the measured value of sensor was compared with the actual value, which verified the effectiveness of the optimized BP neural network model with GA. The experimental verification showed that the system monitoring error rate was 3.44%, the accurate early warning rate was over 96.5%, and the false alarm rate and the missed alarm rate were less than 3%. In this study, the fire of cotton pickers can be monitored in real time and an early warning can be made in time, and a new method was provided for accurate monitoring of fire in the field operation of cotton pickers.
Topics: Algorithms; Cotton Fiber; Fires; Agriculture; Carbon Monoxide; Software; Temperature
PubMed: 37420720
DOI: 10.3390/s23125553 -
Research in Nursing & Health Aug 2020Bed and chair alarms are widely used in hospitals, despite lack of effectiveness and unintended negative consequences. In this cross-sectional, observational study, we... (Comparative Study)
Comparative Study Observational Study
Bed and chair alarms are widely used in hospitals, despite lack of effectiveness and unintended negative consequences. In this cross-sectional, observational study, we examined alarm prevalence and contributions of patient- and unit-level factors to alarm use on 59 acute care nursing units in 57 US hospitals participating in the National Database of Nursing Quality Indicators®. Nursing unit staff reported data on patient-level fall risk and fall prevention measures for 1,489 patients. Patient-level propensity scores for alarm use were estimated using logistic regression. Expected alarm use on each unit, defined as the mean patient propensity-for-alarm score, was compared with the observed rate of alarm use. Over one-third of patients assessed had an alarm in the "on" position. Patient characteristics associated with higher odds of alarm use included recent fall, need for ambulation assistance, poor mobility judgment, and altered mental status. Observed rates of unit alarm use ranged from 0% to 100% (median 33%, 10th percentile 5%, 90th percentile 67%). Expected alarm use varied less (median 31%, 10th percentile 27%, and 90th percentile 45%). Only 29% of variability in observed alarm use was accounted for by expected alarm use. Unit assignment was a stronger predictor of alarm use than patient-level fall risk variables. Alarm use is common, varies widely across hospitals, and cannot be fully explained by patient fall risk factors; alarm use is driven largely by unit practices. Alarms are used too frequently and too indiscriminately, and guidance is needed for optimizing alarm use to reduce noise and encourage mobility in appropriate patients.
Topics: Accidental Falls; Adult; Aged; Aged, 80 and over; Clinical Alarms; Cross-Sectional Studies; Female; Hospitals; Hospitals, Rural; Hospitals, Urban; Humans; Intensive Care Units; Male; Middle Aged; Patient Safety; United States
PubMed: 32515837
DOI: 10.1002/nur.22049 -
JMIR Human Factors Oct 2018Delayed or no response to impending patient safety-related calls, poor care provider experience, low job satisfaction, and adverse events are all unwanted outcomes of...
Alarm-Related Workload in Default and Modified Alarm Settings and the Relationship Between Alarm Workload, Alarm Response Rate, and Care Provider Experience: Quantification and Comparison Study.
BACKGROUND
Delayed or no response to impending patient safety-related calls, poor care provider experience, low job satisfaction, and adverse events are all unwanted outcomes of alarm fatigue. Nurses often cite increases in alarm-related workload as a reason for alarm fatigue, which is a major contributor to the aforementioned unwanted outcomes. Increased workload affects both the care provider and the patient. No studies to date have evaluated the workload while caring for patients and managing alarms simultaneously and related it to the primary measures of alarm fatigue-alarm response rate and care provider experience. Many studies have assessed the effect of modifying the default alarm setting; however, studies on the perceived workload under different alarm settings are limited.
OBJECTIVE
This study aimed to assess nurses' or assistants' perceived workload index of providing care under different clinical alarm settings and establish the relationship between perceived workload, alarm response rate, and care provider experience.
METHODS
In a clinical simulator, 30 participants responded to alarms that occurred on a physiological monitor under 2 conditions (default and modified) for a given clinical condition. Participants completed a National Aeronautics and Space Administration-Task Load Index questionnaire and rated the demand experienced on a 20-point visual analog scale with low and high ratings. A correlational analysis was performed to assess the relationships between the perceived workload score, alarm response rate, and care provider experience.
RESULTS
Participants experienced lower workloads when the clinical alarm threshold limits were modified according to patients' clinical conditions. The workload index was higher for the default alarm setting (57.60 [SD 2.59]) than for the modified alarm setting (52.39 [SD 2.29]), with a statistically significant difference of 5.21 (95% CI 3.38-7.04), t=5.838, P<.05. Significant correlations were found between the workload index and alarm response rate. There was a strong negative correlation between alarm response rate and perceived workload, ρ=-.54, P<.001 with workload explaining 29% of the variation in alarm response rate. There was a moderate negative correlation between the experience reported during patient care and the perceived workload, ρ=-.49, P<.05.
CONCLUSIONS
The perceived workload index was comparatively lower with alarm settings modified for individual patient care than in an unmodified default clinical alarm setting. These findings demonstrate that the modification of clinical alarm limits positively affects the number of alarms accurately addressed, care providers' experience, and overall satisfaction. The findings support the removal of nonessential alarms based on patient conditions, which can help care providers address the remaining alarms accurately and provide better patient care.
PubMed: 30355550
DOI: 10.2196/11704 -
International Journal of Environmental... Feb 2023Alarm fatigue refers to the desensitisation of medical staff to patient monitor clinical alarms, which may lead to slower response time or total ignorance of alarms and...
Alarm fatigue refers to the desensitisation of medical staff to patient monitor clinical alarms, which may lead to slower response time or total ignorance of alarms and thereby affects patient safety. The reasons behind alarm fatigue are complex; the main contributing factors include the high number of alarms and the poor positive predictive value of alarms. The study was performed in the Surgery and Anaesthesia Unit of the Women's Hospital, Helsinki, by collecting data from patient monitoring device clinical alarms and patient characteristics from surgical operations. We descriptively analysed the data and statistically analysed the differences in alarm types between weekdays and weekends, using chi-squared, for a total of eight monitors with 562 patients. The most common operational procedure was caesarean section, of which 149 were performed (15.7%). Statistically significant differences existed in alarm types and procedures between weekdays and weekends. The number of alarms produced was 11.7 per patient. In total, 4698 (71.5%) alarms were technical and 1873 (28.5%) were physiological. The most common physiological alarm type was low pulse oximetry, with a total of 437 (23.3%). Of all the alarms, the number of alarms either acknowledged or silenced was 1234 (18.8%). A notable phenomenon in the study unit was alarm fatigue. Greater customisation of patient monitors for different settings is needed to reduce the number of alarms that do not have clinical significance.
Topics: Pregnancy; Humans; Female; Clinical Alarms; Retrospective Studies; Cesarean Section; Monitoring, Physiologic; Reaction Time
PubMed: 36901201
DOI: 10.3390/ijerph20054193