The nursing practice of monitoring patients in the post-operative (PO) phase upon returning to the general ward setting has traditionally consisted of the systematic collection of vital signs and observation of other aspects of the patient's recovery. For the most part the primary focus of this monitoring has been the detection of post-operative complications. There is a need for more substantive evidence to support an appropriate frequency of post-operative observation. The aim of this research was to identify if the current practice of PO vital sign collection detects PO complications in the first 24 hours after the patient has returned to the general ward setting. Due to the complex world in which nurses practice the research was undertaken using a combination of methods within a triangulated approach to collect data. A survey of 75 hospitals providing a surgical service enabled a description of the current models of PO monitoring as found in policy documents to be made. The majority of hospitals (91%) described a variety of regulated regimens for the collection of PO observations, with the most common for vital sign collection (27%) as hourly for the first four hours and then four hourly. An observation of 282 patient hours in two surgical wards identified the current practice of PO monitoring involved nurses collecting vital signs hourly for the first four hours, three hourly for the next eight hours and then every four hours. This was despite the existence of different models being described in the policies. The records of 144 patients were audited to identify what, if any, nursing interventions detected changes in a patient's recovery and to determine whether a relationship existed between vital sign collection and the detection of complications. It was found that the complications that occurred were minor in nature, occurred infrequently, and did not have a relationship with changes in vital signs. This research found that there was no relationship between the frequency of the collection of vital signs and the occurrence or detection of complications. PO observations were collected by nurses based on traditional patterns, were collected routinely, were ritualised and were not determined by individual clinician expertise or the needs of the individual patient. Recommendations are made regarding the need for a systematic program of research and alternative models of patient observation that focus on patient need rather than organisational need and that provide more efficient and effective practice in monitoring PO patient progress. / Thesis (Ph.D.)--School of Medicine, 2003.

Failure to recognize changes in a patient’s clinical condition is a barrier to the effectiveness of CCRT outreach programs. The development of a vital signs capture and decision system could alert care providers and CCRTs when a patient’s clinical condition deteriorates. However, point-of-care vital signs capture and documentation is often problematic in clinical practice. Ethnographic research was conducted to understand the difficulties of replacing pen and paper charts and barriers to electronic nursing documentation systems. Analysis of workflows directed the design of two solutions; 1) Apple iPhone facilitated manual vital signs entry, 2) Motorola MC55 enabled automatic data capturing from physiological monitors. Nurses participated in high-fidelity usability testing, comparing the traditional method of paper documentation with the two electronic solutions. As a result of user-centered design process, both solutions were comparable to the efficiency of paper methods, were found acceptable to nurses, and could be successfully incorporated into current workflows.

Failure to recognize changes in a patient’s clinical condition is a barrier to the effectiveness of CCRT outreach programs. The development of a vital signs capture and decision system could alert care providers and CCRTs when a patient’s clinical condition deteriorates. However, point-of-care vital signs capture and documentation is often problematic in clinical practice. Ethnographic research was conducted to understand the difficulties of replacing pen and paper charts and barriers to electronic nursing documentation systems. Analysis of workflows directed the design of two solutions; 1) Apple iPhone facilitated manual vital signs entry, 2) Motorola MC55 enabled automatic data capturing from physiological monitors. Nurses participated in high-fidelity usability testing, comparing the traditional method of paper documentation with the two electronic solutions. As a result of user-centered design process, both solutions were comparable to the efficiency of paper methods, were found acceptable to nurses, and could be successfully incorporated into current workflows.

No description available.

Η παρούσα διπλωματική εργασία εκπονήθηκε στα πλαίσια της ενασχόλησης με Έργο ανάπτυξης Δικτύου Τηλεϊατρικής. Το Δίκτυο Τηλεϊατρικής συνίσταται από φορητές μονάδες ικανές να λαμβάνουν και να μεταδίδουν τα ζωτικά σήματα των ασθενών σε κάποιο Κέντρο Συντονισμού. Το κέντρο αυτό, στελεχωμένο από κατάλληλο ιατρικό προσωπικό, έχει τη δυνατότητα αφού αξιολογήσει τα λαμβανόμενα δεδομένα, να δώσει χρήσιμες συμβουλές παροχής πρωτοβάθμιας βοήθειας στον ασθενή, έως ότου μεταφερθεί σε κάποιο νοσοκομείο. Η διπλωματική εργασία επικεντρώνεται στο σχεδιασμό και στην ανάπτυξη της εφαρμογής Θέσεως Εργασίας, η οποία είναι βασικό τμήμα του Κέντρου Συντονισμού. Στελεχώνεται από εξειδικευμένους ιατρούς και έχει ως σκοπό, χρησιμοποιώντας όλα τα παρεχόμενα ιατρικά δεδομένα, να προσφέρει τη βέλτιστη προ-νοσοκομειακή φροντίδα στους ασθενείς, οι οποίοι βρίσκονται στον τόπο του φορητού τερματικού. Μέσω του ολοκληρωμένου Δικτύου Τηλεϊατρικής, η Θέση Εργασίας προσπελαύνει όλα τα στοιχεία ενός τρέχοντος περιστατικού τηλεϊατρικής, όπως ζωτικά σήματα, ιστορικό από το Ολοκληρωμένο Πληροφοριακό Σύστημα (Ο.Π.Σ.) των νοσοκομείων, φωτογραφίες καθώς και άλλα ιατρικά δεδομένα. Χρησιμοποιεί, επίσης, την υπηρεσία τηλεδιάσκεψης για να έχει οπτικοακουστική επαφή με το φορητό τερματικό και για να εκμεταλλευτεί το συμβουλευτικό ρόλο των Περιφερειακών Αιθουσών Τηλεδιάσκεψης. Η Θέση Εργασίας μετά το πέρας των περιστατικών ενημερώνει τους ιατρικούς φακέλους των ασθενών στο Ο.Π.Σ., ενώ έχει τη δυνατότητα να εκτελέσει σωρεία λειτουργιών εκτός σύνδεσης, ώστε να ανατρέξει σε χρήσιμα δεδομένα του Δικτύου, όπως παλιά περιστατικά, και να ολοκληρώσει την εξυπηρέτηση των περιστατικών. Η ανάπτυξη της εφαρμογής πραγματοποιήθηκε σε γλώσσα προγραμματισμού Visual Basic .NET με χρήση της πλατφόρμας Visual Studio 2005 Professional Edition. Η υλοποίηση περιλαμβάνει τη δημιουργία Κεντρικής Βάσης Δεδομένων Τηλεϊατρικής, για την οποία επιλέχθηκε η Oracle 10g, ενώ για τη διαχείριση κι εποπτεία της βάσης χρησιμοποιήθηκαν οι εφαρμογές Oracle Client 10g και Oracle JDeveloper 10g / The present thesis was carried out through participation in a project concerning the development of a Telemedicine Network. The Telemedicine Network consists of mobile units capable of obtaining and transmitting patients’ vital signs to a Coordination Center. This centre is occupied by specialized medical personnel and has the capacity, after evaluating the received data, to provide useful healthcare advice prior to the patients’ transfer to a hospital. This thesis focuses on the design and development of the Treatment Workstation application, which is a basic part of the Coordination Center. It is operated by doctors and aims to provide, through the use of all the available information, an optimum pre-hospital care to the patients placed near the mobile unit. Utilizing the resources provided by the Telemedicine Network, the Treatment Workstation accesses all the data of a current telemedicine incident, e.g. vital signs, medical history by the hospitals’ Integrated Information System (I.I.M.), photos and other medical information. It also uses the teleconference service to establish an audiovisual communication with the mobile unit and to take advantage of the advisory contribution of the Peripheral Teleconference Room. After the incidents’ termination, the Treatment Workstation updates the patients’ medical files at the I.I.M. and is also able to perform a series of offline actions, in order to access Network’s useful data (e.g. old incidents) and to complete pending incidents. The application was developed in Visual Basic .NET through the platform Visual Studio 2005 Professional Edition. The implementation includes the creation of a Central Telemedicine Database, using Oracle 10g, while the management and supervision of the database was performed with the use of Oracle Client 10g and Oracle JDeveloper 10g.

SAMMANFATTNING     Bakgrund: Patienter på kirurgavdelningar är komplexa såtillvida att de förutom den kirurgiska åkomman kan ha olika medicinska diagnoser vilket ofta komplicerar både vården, behandlingen samt medför svårigheter i att upptäcka ett försämrat tillstånd. För att kunna bedöma patientens tillstånd och få en uppfattning om hur denne mår måste objektiva och lätt mätbara parametrar användas. Modified Early Warning Score (MEWS) är ett poängsystem som mäter några av patientens vitala funktioner och baseras på sex mätbara/bedömningsbara  funktioner: andningsfrekvens, puls, systoliskt blodtryck, kroppstemperatur, vakenhet och urinmängd. Poängsumman varierar mellan 0 och 17, där 0 är normalt.   Syfte: Att kartlägga fördelningen av poäng enligt MEWS hos akuta patienter med kirurgiska åkommor på två kirurgavdelningar på ett universitetssjukhus i Sverige samt undersöka vilka åtgärder som vidtagits vid respektive poäng enligt MEWS.   Metod: Retrospektiv journalgranskningsstudie  där dokumentation av mätningar med MEWS för 94 patienter granskades.   Resultat: Totalt återfanns 229 poäng enligt MEWS varav 76 var från mätningar vid ankomst till avdelning och resterande  153 från mätningar under fortsatt vårdtid. Antalet MEWS-mätningar per patient varierade mellan  1 och 31. Nitton åtgärder som ingår i sjuksköterskans profession kopplade till en poäng enligt MEWS återfanns. De mest förekommande åtgärderna var att ge smärtstillande läkemedel på generell ordination samt att utföra upprepade kontroller av patientens vitala funktioner. Tjugotvå medicinska åtgärder kopplade till en poäng enligt MEWS återfanns. De mest  förekommande medicinska åtgärderna var att ordinera provtagning eller odling samt att ordinera  extra dropp. Inte i något fall ledde en poäng enligt MEWS till att någon patient flyttade till en högre vårdnivå.   Slutsats: Det fanns mätningar enligt MEWS för 85 % av patienterna där medianpoängen var 1 av maximala 17. Medianpoängen när åtgärd som ingår i sjuksköterskans profession eller medicinska åtgärder vidtogs var 4. De vanligaste åtgärderna var att ge smärtstillande läkemedel på generell ordination, göra upprepade kontroller, ordinera provtagning,  odling eller extra dropp. / ABSTRACT     Background: Patients with surgical conditions are complex, since many patients have various medical diagnoses besides their surgical condition. Apart from complicating care and treatment, this makes it difficult to detect deterioration in the patient's condition. In order to assess the patient's condition, objective and easily measurable parameters are preferably used. A scoring system, the Modified Ear­ ly Waming Score, MEWS, was developed in the early 1990s and based on some ofthe patient's vital functions: respiratory rate, heart rate, systolic blood pressure, body temperature, alertness/awareness and urine output. The result varies between 0 and 17, with 0 demonstrating normal vital functions.   Objective: To describe the distribution of MEWS scores for emergency patients with surgical condi­ tions in two surgical wards at a university hospital in Sweden, and to examine what actions had been taken based on the MEWS scores.   Methods: A retrospective review was performed on MEWS measurements and medical records for 94 patients.   Results: In total, 229 MEWS measurements had been performed, ofwhich 76 were taken on arrival at the ward, and the remaining 153 <luring the continued hospitalization. The number ofMEWS measurements per patient ranged from 1 to 31. Nineteen actions, based on MEWS scores, related the nursing professions were found, with the administration of painkillers and repeated checks ofthe pa­ tient's vital functions, being the two most common. Twenty-two medical procedures, based on MEWS scores, were identified, where sampling for bacterial cultures or prescribing extra intravenous fluid were the most frequent. No patient was transferred toa higher level of care because of their MEWS score.   Conclusion: MEWS measurements were performed in 85% of the patients and the median result was 1 of maximum 17. Different actions, related the nursing or medical profession, were taken at a me­ dian result of 4. No patient was transferred toa higher level of care. The most common actions were administration of painkillers, repeated checks ofthe patient's vital functions, sampling for bacterial cultures and prescribing extra intravenous fluid

The work was based on my own watching and the aim of this work was to determine basic vital signs of dairy cows breed in grazing system in the submontane area of South Bohemia. Herd of breeding cows, consisting of the Holstein breed, the Jersey breed and the Czech Pied Cattle crossbred with the Jersey, in quantity of 53 heads. During the year 2010 there were six behavioral watchings namely from June to October. Each watching lasted 24 hours and there was used the method of watching in the group with the time interval of 10 minutes. Cattle vital signs were watched: feed intake-grazing, lying down-resting, standing and movement.

We have received a mission from a surgical ward at a hospital in northern Sweden; they want a solution that can be used on portable devices. On these devices the healthcare professionals should be able to document the measured vital signs and the results should automatically be documented in the patient record. In the context of a Participatory Design project we conducted design sessions which focused on the user interface of the solution but also deliberated possible functionalities that were not mentioned in the original mission description. The purpose of this study is to describe the situation surrounding the measurement of vital signs of patients. It is currently done manually on a paper form and then registered in the digital patient record. Our aim was to find a design and formulate the functional requirement of a tablet application together with the staff at a hospital in Sweden.

Abstract The main objective of this thesis project is to implement a wireless vital signs monitoring system for measuring the ECG of a patient in the home environment. The research focuses on two specific research objectives: 1) the development of a distributed healthcare system for vital signs monitoring using wireless sensor network devices and 2) a practical test and performance evaluation for the reliability for such low-rate wireless technology in ubiquitous health monitoring applications. The first section of the thesis describes the design and implementation of a ubiquitous healthcare system constructed from tiny components for the home healthcare of elderly persons. The system comprises a smart shirt with ECG electrodes and acceleration sensors, a wireless sensor network node, a base station and a server computer for the continuous monitoring of ECG signals. ECG data is a commonly used vital sign in clinical and trauma care. The ECG data is displayed on a graphical user interface (GUI) by transferring it to a PDA or a terminal PC. The smart shirt is a wearable T-shirt designed to collect ECG and acceleration signals from the human body in the course of daily life. In the second section, a performance evaluation of the reliability of IEEE 802.15.4 low-rate wireless ubiquitous health monitoring is presented. Three scenarios of performance studies are applied through practical tests: 1) the effects of the distance between sensor nodes and base-station, 2) the deployment of the number of sensor nodes in a network and 3) data transmission using different time intervals. These factors were measured to analyse the reliability of the developed technology in low-rate wireless ubiquitous health monitoring applications. The results showed how the relationship between the bit-error-rate (BER) and signal-to-noise ratio (SNR) was affected when varying the distance between sensor node and base-station, through the deployment of the number of sensor nodes in a network and through data transmission using different time intervals.

No description available.