Automated Detection of Patient Harm: Implementation and Prospective Evaluation of a Real-Time Broad-Spectrum Surveillance Application in a Hospital With Limited Resources.

OBJECTIVES: This study aimed to prospectively validate an application that automates the detection of broad categories of hospital adverse events (AEs) extracted from a basic hospital information system, and to efficiently mobilize resources to reduce the level of acquired patient harm. METHODS: Data were collected from an internally designed software, extracting results from 14 triggers indicative of patient harm, querying clinical and administrative databases including all inpatient admissions (n = 8760) from October 2019 to June 2020. Representative samples of the triggered cases were clinically validated using chart review by a consensus expert panel. The positive predictive value (PPV) of each trigger was evaluated, and the detection sensitivity of the surveillance system was estimated relative to incidence ranges in the literature. RESULTS: The system identified 394 AEs among 946 triggered cases, associated with 291 patients, yielding an overall PPV of 42%. Variability was observed among the trigger PPVs and among the estimated detection sensitivities across the harm categories, the highest being for the healthcare-associated infections. The median length of stay of patients with an AE showed to be significantly higher than the median for the overall patient population. CONCLUSIONS: This application was able to identify AEs across a broad spectrum of harm categories, in a real-time manner, while reducing the use of resources required by other harm detection methods. Such a system could serve as a promising patient safety tool for AE surveillance, allowing for timely, targeted, and resource-efficient interventions, even for hospitals with limited resources.

Adaptation and implementation of the "Kidney Disease: Improving Global Outcomes (KDIGO)" guidelines for evaluation and management of mineral and bone disorders in chronic kidney disease for practice in the Middle East countries.

This review presents the views of an expert group of nephrologists from the Middle East along with an international expert on adaptation and implementation of the 2009 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for evaluation and manage-ment of mineral and bone disorders in chronic kidney disease (CKD-MBD) for practice in the Middle East countries. The members of the panel examined the KDIGO guidelines and formulated recommendations that can be implemented practically for the management of CKD-MBD in the Middle East. There was a broad agreement on most of the recommendations made by the KDIGO work-group. However, the panelists commented on specific areas and amplified certain concepts that might help the nephrologists in the Middle East. The final document was reviewed by all participants as well as by members of the Middle East task force implementation group for KDIGO guidelines. Their comments were incorporated. The guideline statements are presented along with detailed rationale and relevant discussion as well as limitations of the evidence. The panel recognized the need to upgrade the suggestion of KDIGO related to lateral abdominal radiograph and echocardiogram in patients with CKD stages 3-5D into a stronger recommendation. The panel underlined the risk of hyper-phosphatemia to CKD-MBD and the importance of prompt initiation or modification of therapy according to rising trends in para-thyroid hormone level. They recommended the use of non-calcium-based phosphate binders as the first-line therapy in CKD patients with signs of vascular calcification. The panel agreed that all aspects of the KDIGO recommendations concerning bone biopsy, evaluation and treatment of bone disease after kidney trans-plantation should be implemented as such.

Validation of four automatic devices for self-measurement of blood pressure according to the international protocol of the European Society of Hypertension.

BACKGROUND: Four oscillometric devices for self-measurement of blood pressure (SBPM) were evaluated according to the European Society of Hypertension (ESH) international protocol and its 2010 revision in four separate studies. The Omron® M2, Omron M3, and Omron M6 measure blood pressure (BP) at the brachial level, while the Omron R2 measures BP at the wrist level. METHODS: The international protocol requires a total number of 33 subjects in which the validation is performed. The Omron M2 and Omron R2 were validated in 2009 according to the ESH international protocol, while the Omron M3 and Omron M6 were validated in 2010-2011 according to the 2010 ESH international protocol revision. The protocol procedures were followed precisely. RESULTS: All four tested devices passed the validation process. The mean differences between the device and mercury readings were 2.7 ± 5.0 and -1.4 ± 3.2 mmHg for systolic and diastolic BP, respectively, using the Omron M2 device, and 1.7 ± 3.2 and -0.9 ± 2.6 mmHg using the Omron M3, 1.6 ± 2.9 and -0.9 ± 2.5 mmHg using the Omron M6, and -1.1 ± 4.8 and -0.9 ± 4.3 mmHg using the Omron R2. CONCLUSION: Readings from the Omron M2, Omron M3, Omron M6, and Omron R2, differing by less than 5, 10, and 15 mmHg, fulfill the ESH international protocol and its 2010 revision requirements. Therefore, each of these four devices can be used by patients for SBPM.

Validation of three professional devices measuring office blood pressure according to three different methods: the Omron BP10, the Omron HBP T105 and the Pic Indolor Professional.

OBJECTIVE: Three professional devices for office blood pressure (BP) measurement, using three different algorithms to determine BP, were evaluated according to the International Protocol of the European Society of Hypertension. The Omron BP10 uses the oscillometric method, the Omron HBP T105 (module HBP-M3600) uses the smart inflation mode and high-speed measurement and the Pic Indolor Professional check is a hybrid sphygmomanometer. METHODS: The International Protocol of the European Society of Hypertension is divided into two phases and includes a total number of 33 participants on whom the validation is performed. In each study and for each participant, four BP measurements were performed simultaneously by two observers using mercury sphygmomanometers alternately with three measurements by the tested device. The difference between the observers and the device BP values was calculated for each measure. The 99 pairs BP differences were classified into three categories (

Validation of three automatic devices for self-measurement of blood pressure according to the International Protocol: The Omron M3 Intellisense (HEM-7051-E), the Omron M2 Compact (HEM 7102-E), and the Omron R3-I Plus (HEM 6022-E).

OBJECTIVE: Three oscillometric devices for the self blood pressure measurement were evaluated according to the International Protocol of the European Society of Hypertension in three separate studies. The Omron M3 Intellisense and the Omron M2 Compact measures blood pressure (BP) at the brachial level; the Omron R3-I Plus measures BP at the wrist level. METHODS: The International Protocol is divided into two phases and includes a total number of 33 participants on whom the validation is performed. In each study, and for each participant, four BP measurements were taken simultaneously by two observers using mercury sphygmomanometers alternately with three measurements with the tested device. The difference between the observers and the device BP values was calculated for each measurement. The 99 pairs of BP differences were classified into three categories (< or =5, < or =10, < or =15 mmHg). RESULTS: All three tested devices passed the first and second phase of the validation process. The mean differences between the device and mercury readings were 1.9+/-3.0 and -1.0+/-2.3 mmHg for systolic and diastolic BP, respectively, for the Omron M3 Intellisense device, 2.5+/-5.4 and -2.3+/-3.6 mmHg for the Omron M2 Compact device, and 1.4+/-4.5 and 0.8+/-4.6 mmHg for the Omron R3-I Plus device. CONCLUSION: Readings of the Omron M3 Intellisense, the Omron M2 Compact and the Omron R3-I Plus, differing by less than 5, 10, and 15 mmHg fulfill the International Protocol requirements and therefore can be used by patients for self blood pressure measurement.