ABSTRACT
Health monitoring that requires doctors and patients at the healthcare center may not be practical during the coronavirus disease 2019 (COVID-19) pandemic. Alternatively, mobile health (mHealth) should be embraced to minimize contact between patients and healthcare personnel. This research aims to enhance the detection of abnormal heart rate (HR) detection by developing a real-time heart rate monitoring (RTHM) application. Sixteen healthy adults participated in a physical real-time HR monitoring testbed. Participants HR was measured for three minutes resting and three minutes performing moderate-intensity physical activity. The results were compared with the polar beat app. Additionally, the energy consumption, the time taken to receive an alarm message, and an acceptance test were analyzed. The app is acceptably accurate, the mean absolute percentage error less than 2%. The response time to receive the alarm message is 30 seconds on average, which is under an acceptable range of medical standards. Moreover, the app is power efficient, 477 mW on average. Participants show a positive attitude towards using RTHM. RTHM is expected to provide a more plausible tool for monitoring the heart towards enhancing abnormal HR detection by promoting patient-oriented healthcare and minimizing sudden deaths due to heart failure. © 2023, Institute of Advanced Engineering and Science. All rights reserved.
ABSTRACT
Purpose: The Coronavirus 2019 (COVID-19) pandemic impacted adult out-of-hospital arrest (OHCA) outcomes in the United States. The impact of the pandemic on pediatric OHCA is unknown. Materials and methods: An analysis of the Cardiac Arrest Registry to Enhance Survival for non-traumatic pediatric OHCAs (≤18 years) was conducted. Outcomes during 3 pandemic surge periods in 2020 (March 16 to May 15, July 1 to August 15, and October 16 to December 31) were compared to the same time periods pre-pandemic in 2019. The primary outcomes were overall survival and neurologically favorable survival, defined as a cerebral performance score of 1 or 2 at the time of hospital discharge. Age groups included infants (<1 year), children (1 to 11 years), and adolescents (≥12 years). Results: A total of 1381 pandemic surge period arrests were compared to 1274 pre-pandemic arrests. There was an increase in OHCAs in adolescents (pandemic 26.6% [368/1381], pre-pandemic 22.4% [286/1274], p = 0.01). Therewere no differences in OHCAs by sex, race/ethnicity, witness status, location, initial rhythm, bystander CPR rates or bystander AED use. There were no differences in overall survival during the pandemic surge periods in 2020 (10.6% [147/ 1381]), as compared to the same months in 2019 (9.7% [123/1274], p = 0.40) or in neurologically favorable survival (2020: 8.9% [123/1381] vs. 2019: 7.3% [93/1274], p = 0.13). Conclusions: During the COVID-19 pandemic surge periods in 2020, pediatric OHCA survival rates in the United Stateswere similar to the rates of pediatric OHCA pre-pandemic. Further study is warranted to determine if pediatric survival for OHCA was affected during the delta and omicron COVID-19 surges in 2021.
ABSTRACT
Introduction The treatment of pediatric patients with COVID-19 associated myocardial injury and prothrombotic coagulation derangements remains to be established. We cared for an adolescent with COVID-19 and fulminant myocarditis who required veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Her course was complicated by a large intracardiac thrombus, which was successfully treated with systemic tissue plasminogen activator (tPA). Case Report A 17 year old unvaccinated female presented with fever and chest pain 7 days after testing positive for COVID-19. She had a peak troponin of 21.48 ng/ml, elevated brain natriuretic peptide (629 pg/ml), and severely diminished left ventricular systolic function. She progressed to cardiogenic shock and was cannulated to VA-ECMO via the neck. On ECMO day 2 while therapeutic on unfractionated heparin (UFH), a large thrombus was noted in the left ventricular apex, extending toward the aortic valve (Figure 1). Prior to this, she had no evidence of a deep vein thrombosis. Given the concern for an impending stroke upon restoration of ventricular function, a continuous systemic high-dose tPA infusion (0.1mg/kg/hr) was initiated, while she was continued on UFH. A twenty-fold increase in D-dimer levels and serial echocardiograms indicated a thrombolytic effect. After 22 hours of thrombolysis, the patient developed bleeding complications and tPA was discontinued. By ECMO day 4, the thrombus completely resolved. Once her bleeding was controlled, she was transitioned to bivalirudin. Cardiac function recovered by day 11 allowing for separation from ECMO. 25 days later, she was discharged without any neurologic deficits. Summary The coagulopathic derangements associated with COVID -19 pose significant challenges to the management of fulminant myocarditis. There are no guidelines regarding management of an intracardiac thrombus on ECMO. However, with careful monitoring, systemic tPA can be used to provide life-saving therapies with excellent neurological outcomes.
ABSTRACT
The existence of Information and Communication Technology (ICT) during the COVID-19 pandemic really helps retirees to increase their learning capacity and stay productive. The purpose of the study was to analyze the role of ICT in the relationship between self-directed capability learning, heutagogy and productivity for retirees. The research method uses a causal study. Data was collected through a survey using a questionnaire to 140 employees of Bank Rakyat Indonesia who had participated in entrepreneurship training in preparation for retirement who were randomly selected. Data analysis using path analysis. The results showed that an important stage in learning heutagogy is understanding learning to learn. Availability of ICT as a resource used to support the learning process independently to encourage the productivity of retirees. Retirees learn to independently design ICT learning needs and activities as hands-on experience-based learning practices. ICT makes it easier for retirees to identify the skills and competencies needed, network expansion to strengthen feedback through the community, self-reflection related to the learning process and increase output in the form of skills and understanding of the meaning of learning. ICT supports capacity building for independent learning that can boost productivity. © 2021 IEEE