Thesis (M.S.)--University of Michigan, 1981.

Thesis (M.S.)--University of Michigan, 1981.

Yes / Objectives The Computer-Aided Risk Score (CARS) estimates the risk of death following emergency admission to medical wards using routinely collected vital signs and blood test data. Our aim was to elicit the views of healthcare practitioners (staff) and service users and carers (SU/C) on (1) the potential value, unintended consequences and concerns associated with CARS and practitioner views on (2) the issues to consider before embedding CARS into routine practice. Setting This study was conducted in two National Health Service (NHS) hospital trusts in the North of England. Both had in-house information technology (IT) development teams, mature IT infrastructure with electronic National Early Warning Score (NEWS) and were capable of integrating NEWS with blood test results. The study focused on emergency medical and elderly admissions units. There were 60 and 39 acute medical/elderly admissions beds at the two NHS hospital trusts. Participants We conducted eight focus groups with 45 healthcare practitioners and two with 11 SU/Cs in two NHS acute hospitals. Results Staff and SU/Cs recognised the potential of CARS but were clear that the score should not replace or undermine clinical judgments. Staff recognised that CARS could enhance clinical decision-making/judgments and aid communication with patients. They wanted to understand the components of CARS and be reassured about its accuracy but were concerned about the impact on intensive care and blood tests. Conclusion Risk scores are widely used in healthcare, but their development and implementation do not usually involve input from practitioners and SU/Cs. We contributed to the development of CARS by eliciting views of staff and SU/Cs who provided important, often complex, insights to support the development and implementation of CARS to ensure successful implementation in routine clinical practice. / Health Foundation, National Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC)

Yes / Objectives There are no established mortality risk equations specifically for emergency medical patients who are admitted to a general hospital ward. Such risk equations may be useful in supporting the clinical decision-making process. We aim to develop and externally validate a computer-aided risk of mortality (CARM) score by combining the first electronically recorded vital signs and blood test results for emergency medical admissions. Design Logistic regression model development and external validation study. Setting Two acute hospitals (Northern Lincolnshire and Goole NHS Foundation Trust Hospital (NH)—model development data; York Hospital (YH)—external validation data). Participants Adult (aged ≥16 years) medical admissions discharged over a 24-month period with electronic National Early Warning Score(s) and blood test results recorded on admission. Results The risk of in-hospital mortality following emergency medical admission was 5.7% (NH: 1766/30 996) and 6.5% (YH: 1703/26 247). The C-statistic for the CARM score in NH was 0.87 (95% CI 0.86 to 0.88) and was similar in an external hospital setting YH (0.86, 95% CI 0.85 to 0.87) and the calibration slope included 1 (0.97, 95% CI 0.94 to 1.00). Conclusions We have developed a novel, externally validated CARM score with good performance characteristics for estimating the risk of in-hospital mortality following an emergency medical admission using the patient’s first, electronically recorded, vital signs and blood test results. Since the CARM score places no additional data collection burden on clinicians and is readily automated, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure. / The Health Foundation, National Institute for Health Research (NIHR) Yorkshire and Humberside Patient Safety Translational Research Centre

Yes / Background Avoidable hospital mortality is often attributable to inadequate patient vital signs monitoring, and failure to recognise or respond to clinical deterioration. The processes involved with vital sign collection and charting; their integration, interpretation and analysis; and the delivery of decision support regarding subsequent clinical care are subject to potential error and/or failure. Objective To determine whether introducing an electronic physiological surveillance system (EPSS), specifically designed to improve the collection and clinical use of vital signs data, reduced hospital mortality. Methods A pragmatic, retrospective, observational study of seasonally adjusted in-hospital mortality rates in three main hospital specialties was undertaken before, during and after the sequential deployment and ongoing use of a hospital-wide EPSS in two large unconnected acute general hospitals in England. The EPSS, which uses wireless handheld computing devices, replaced a paper-based vital sign charting and clinical escalation system. Results During EPSS implementation, crude mortality fell from a baseline of 7.75% (2168/27 959) to 6.42% (1904/29 676) in one hospital (estimated 397 fewer deaths), and from 7.57% (1648/21 771) to 6.15% (1614/26 241) at the second (estimated 372 fewer deaths). At both hospitals, multiyear statistical process control analyses revealed abrupt and sustained mortality reductions, coincident with the deployment and increasing use of the system. The cumulative total of excess deaths reduced in all specialties with increasing use of the system across the hospital. Conclusions The use of technology specifically designed to improve the accuracy, reliability and availability of patients’ vital signs and early warning scores, and thereby the recognition of and response to patient deterioration, is associated with reduced mortality in this study.

The development of internet-based technologies, the design and adoption of wireless wearable and smart devices have been a growing study spot in all domains. The healthcare sector as many others is making technological progress to improve healthcare services and patients wellbeing and avoid or minimize the use of manual and traditional practices such as the use of paper notes to record the vital signs parameters data. The vital signs parameters are the most monitored physiology features, they produce a big amount of data and request a close follow up to define the health condition of a patient. Continuous vital signs monitoring involves the usage of different devices and systems, which if appropriate positively impact the activities involved, by enabling the continuous generation of data and information about the overall health status of patients and contribute to the wellbeing of individuals, in terms of preventing and reducing fatal risks. To investigate this situation, this research’s focus was in three parts; first, investigate recent research about patient’s health predictions based on vital signs parameters and the impacts of continuous monitoring on the care given. Second, explore the availability in terms of i.e. sensors used in devices that can continuously track vital signs parameters. Last, to provide a possible design recommendation to improve and/or replace the existing devices for vital signs parameters measuring and monitoring in emergency and post-operative care. A qualitative approach and participatory design approach were used to collect data. The qualitative part was achieved through interviews and the participatory design part was accomplished by the future workshop and two prototyping techniques, paper and digital prototypes. The findings of this research were analysed using conceptual analysis, and also discussed using those concepts. Together with the participants, this research resulted in three design suggestions which if implemented shall improve the vital signs continuous monitoring activities, by facilitating the healthcare professionals in their clinical responsibilities and improving the patients wellbeing while admitted in Emergency and Post-operative wards.

Bakgrund: Att tidigt upptäcka symtom på allvarlig klinisk försämring hos en patient är av stor vikt för att minska lidande och förhindra allvarliga komplikationer. För detta har flera skattningsinstrument utvecklats, däribland olika early warning score-system. Dessa har implementerats på flera håll i världen men det finns indikationer på att det brister i följsamheten till dessa. Syfte: Studiens syfte var att undersöka följsamheten till Early Warning Scores samt de faktorer som påverkar följsamheten. Metod: Studien genomfördes som en litteraturöversikt där 14 vetenskapliga artiklar inkluderades. Studierna hade kvantitativa, kvalitativa och blandade ansatser. Artiklarna söktes i databaserna PubMed, CINAHL och Web of Science. En innehållsanalys av studiernas resultat genomfördes och resultatet sammanställdes i ett antal kategorier. Resultat: Följsamheten visade sig vara högre till observationer av patientens vitalparametrar än till de åtgärdsriktlinjer som finns. Faktorer som påverkar följsamheten var sjuksköterskans kliniska erfarenhet, samarbete mellan professioner, bemanning, felkalkylering, dokumentation och rapportering. Konklusion: Följsamhet till EWS brister på många sätt och flera faktorer påverkar följsamheten. Faktorerna som påverkade följsamheten är sjuksköterskans kliniska erfarenhet, samarbete mellan professioner, felkalkylering, bemanning, dokumentation och rapportering. / Background: Early recognition of serious clinical deterioration is of great importance for minimizing suffering and serious adverse events. For early recognition, several physiological track and trigger systems have been developed, among them the early warning scores. These have been implemented in many places across the world but there is uncertainty about adherence to these systems. Aim: The aim of this study was to investigate adherence to Early warning score-systems and to evaluate what factors affect this adherence. Method: The study was conducted as a literature review including 14 articles with quantitative, qualitative and mixed-methods approaches. Searches were made in the PubMed, CINAHL and Web of Science databases. Content-analysis was used to identify themes. Results: Adherence seems higher to observations than to clinical responses. The main factors affecting adherence are the clinical experience of nurses, collaboration between professions, staffing, miscalculation, documentation and reporting. Conclusion: Adherence to EWS is lacking in many ways and several causes for this have been accounted for. Factors affecting adherence was the clinical experience of nurses, cooperation between professions, staffing, miscalculation, documentation and reporting.

A WIoT is a wireless network of low-power sensing nodes placed on the human body. While operating, these networks routinely collect physiological signals to send to offsite medical professionals for review. In this manner, these networks support a concept known as pervasive healthcare in which patients can be continuously monitored and treated remotely. Given that these networks are used to guide medical treatment and depend on transmitting sensitive data, it is important to ensure that the communication channel remains secure. Symmetric pairwise cryptography is a traditional scheme that can be used to provide such security. The scheme functions by sharing a cryptographic key between a pair of sensors. Once shared, the key can then be used by both parties to encrypt and decrypt all future messages. To configure a WIoT to support the use of symmetric pairwise cryptography a key distribution protocol is required. Schemes for pre-deployment are often used to perform this distribution. These schemes usually require inserting key information into WIoT devices before they can be used in the network. Unfortunately, this need to manually configure WIoT devices can decrease their usability. In this thesis we propose and evaluate an alternative approach to key distribution that uses physiological signals derived from accelerometer and gyroscope sensors. The evaluation of our approach indicates that more study is required to determine techniques that will enable ballistocardiography-derived physiological signals to provide secure key distribution.

abstract: In the past half century, low-power wireless signals from portable radar sensors, initially continuous-wave (CW) radars and more recently ultra-wideband (UWB) radar systems, have been successfully used to detect physiological movements of stationary human beings. The thesis starts with a careful review of existing signal processing techniques and state of the art methods possible for vital signs monitoring using UWB impulse systems. Then an in-depth analysis of various approaches is presented. Robust heart-rate monitoring methods are proposed based on a novel result: spectrally the fundamental heartbeat frequency is respiration-interference-limited while its higher-order harmonics are noise-limited. The higher-order statistics related to heartbeat can be a robust indication when the fundamental heartbeat is masked by the strong lower-order harmonics of respiration or when phase calibration is not accurate if phase-based method is used. Analytical spectral analysis is performed to validate that the higher-order harmonics of heartbeat is almost respiration-interference free. Extensive experiments have been conducted to justify an adaptive heart-rate monitoring algorithm. The scenarios of interest are, 1) single subject, 2) multiple subjects at different ranges, 3) multiple subjects at same range, and 4) through wall monitoring. A remote sensing radar system implemented using the proposed adaptive heart-rate estimation algorithm is compared to the competing remote sensing technology, a remote imaging photoplethysmography system, showing promising results. State of the art methods for vital signs monitoring are fundamentally related to process the phase variation due to vital signs motions. Their performance are determined by a phase calibration procedure. Existing methods fail to consider the time-varying nature of phase noise. There is no prior knowledge about which of the corrupted complex signals, in-phase component (I) and quadrature component (Q), need to be corrected. A precise phase calibration routine is proposed based on the respiration pattern. The I/Q samples from every breath are more likely to experience similar motion noise and therefore they should be corrected independently. High slow-time sampling rate is used to ensure phase calibration accuracy. Occasionally, a 180-degree phase shift error occurs after the initial calibration step and should be corrected as well. All phase trajectories in the I/Q plot are only allowed in certain angular spaces. This precise phase calibration routine is validated through computer simulations incorporating a time-varying phase noise model, controlled mechanic system, and human subject experiment. / Dissertation/Thesis / Doctoral Dissertation Electrical Engineering 2018

Bakgrund: Årligen genomförs cirka 740 000 kirurgiska ingrepp inom slutenvården i Sverige som resulterar i postoperativ smärta. Postoperativ smärta är en typ av akut vävnadsskadesmärta som upplevs till följd av kirurgiskt ingrepp. Om obehandlad kan postoperativ smärta resultera sig i kronisk smärta, försämrad livskvalitet och ökad mortalitet. Musikterapi är en biverkningsfri och icke farmakologisk metod som kan implementeras i vården som ett komplement till traditionell behandling för att lindra postoperativ smärta samt öka patienternas välbefinnande.   Syfte: Att undersöka vilken påverkan musik har på postoperativ smärta och de fysiologiska reaktioner som uppstår vid postoperativ smärta.   Metod: Denna studie är en beskrivande allmän litteraturstudie med kvantativ ansats. Artikelsökningarna genomfördes i PubMeds– och CINAHLs databas med hjälp av MeSH genererade söktermer, där elva originalartiklar valdes att inkluderas i studien. Utav dessa var det en artikel som efter kvalitetsgranskning exkluderades, då dess kvalité inte var av medel eller högre kvalité. Resultat: Sju av tio studier visade att musik sänkte smärtintensiteten hos patienter som genomgått thorax- eller abdominal kirurgi. Ingen tydlig påverkan på fysiologiska reaktioner postoperativt kunde ses hos samtliga studier. Slutsats: Musik kan användas som en komplementär behandling till sedvanlig vård för att sänka smärtintensiteten hos postoperativa patienter och öka delaktigheten och självbestämmandet hos patienten. Musikterapi är varken kostsamt eller innehåller biverkningar och kan därför implementeras ute i samhället såväl som inom vården. Mer forskning behövs däremot för att se om musik har en påverkan på de fysiologiska reaktionerna som uppstår vid smärta. / Background: Approximately 740,000 surgical procedures are performed every year in Sweden, resulting in postoperative pain. Postoperative pain is a type of acute tissue injury that is experienced as a result of a surgical procedure. If not treated properly, postoperative pain can result in chronic pain, worsened quality of life and increased mortality. Music therapy is a cheap non-pharmacological method without side-effects that could be implemented in healthcare as a complement to traditional treatment, to alleviate postoperative pain and increase the well-being of patients.   Purpose: To investigate the impact music has on post-operative pain and the physiological reactions that arise from postoperative pain.   Method: A descriptive literature study using quantitative methods. The search for articles was done in the database of PubMed and CINAHL with the help of MeSH generated terms. Eleven original articles were included in this study, whereas one of them were excluded later on by not passing the criteria of the quality control.   Results: Seven out of ten studies showed that music reduced the pain intensity in patients that had undergone either thoracic- or abdominal surgery. No clear influence on physiological reactions could be seen postoperatively.   Conclusion: Music can be used as a complementary treatment to conventional care, to reduce the pain intensity of postoperative patients, and to have patients partake more in their treatment. Since music is cheap och does not involve any side-effect, it can be involved as a analgesic complementary method in society as well as in hospitals. Though more research is needed to see if music has an impact on the physiological responses resulting from pain.