Can continuous remote vital sign monitoring reduce the number of room visits to patients suspected of COVID-19: A quasi-experimental study.

BACKGROUND: Continuous remote monitoring of vital signs on the hospital ward gained popularity during the Severe Acute Respiratory Syndrome coronavirus 2 pandemic due to its ability to support early detection of respiratory failure, and the possibility to do so without physical contact between patient and clinician. The effect of continuous monitoring on patient room visits has not been established yet. OBJECTIVES: To assess the impact of continuous monitoring on the number of patient room visits for patients suspected of Corona Virus Disease 2019 (COVID-19) and the use of personal protection equipment. DESIGN AND METHODS: We performed a before-after study at a ward with private rooms for patients suspected of COVID-19 at a tertiary hospital in Nijmegen, The Netherlands. Non-participant observers observed hospital staff during day, evening and night shifts to record patient room visits and personal protection equipment usage. After eleven days, wearable continuous vital sign monitoring was introduced. An interrupted time series analysis was applied to evaluate the effect of continuous monitoring on the number of patient room visits, visits for obtaining vital signs (Modified Early Warning Score visits) and the amount of personal protection equipment used. RESULTS: During the 45 day study period, 86 shifts were observed. During each shift, approximately six rooms were included. A total of 2347 patient room visits were recorded. The slope coefficient for the number of patient room visits did not change after introducing continuous vital sign monitoring (B -0.003, 95% confidence interval -0.022/0.016). The slope coefficients of the number of Modified Early Warning Score visits and the amount of personal protection equipment used did not change either (B -0.002, 95% confidence interval -0.021/0.017 and B 0.046, 95% confidence interval -0.008/0.099). The number of Modified Early Warning Score visits did show a decline over the entire study period, however this decline was not influenced by the intervention. Evening and night shifts were associated with fewer patient room visits compared to day shifts. CONCLUSION: Introduction of continuous vital sign monitoring at a general ward for patients with suspected COVID-19 did not reduce the number of patient room visits or the usage of personal protection equipment by hospital staff. The number of Modified Early Warning Score visits declined over time, but this was not related to the introduction of continuous monitoring. Detailed analysis of the influence of continuous monitoring on the workflow of hospital staff reveals key points to increase efficacy of this intervention.

International cancer seminars: a focus on esophageal squamous cell carcinoma.

The International Agency for Research on Cancer (IARC) and the US National Cancer Institute (NCI) have initiated a series of cancer-focused seminars [Scelo G, Hofmann JN, Banks RE et al. International cancer seminars: a focus on kidney cancer. Ann Oncol 2016; 27(8): 1382-1385]. In this, the second seminar, IARC and NCI convened a workshop in order to examine the state of the current science on esophageal squamous cell carcinoma etiology, genetics, early detection, treatment, and palliation, was reviewed to identify the most critical open research questions. The results of these discussions were summarized by formulating a series of 'difficult questions', which should inform and prioritize future research efforts.

Wireless non-invasive continuous respiratory monitoring with FMCW radar: a clinical validation study.

Altered respiratory rate is one of the first symptoms of medical conditions that require timely intervention, e.g., sepsis or opioid-induced respiratory depression. To facilitate continuous respiratory rate monitoring on general hospital wards a contactless, non-invasive, prototype monitor was developed using frequency modulated continuous wave radar. We aimed to study whether radar can reliably measure respiratory rate in postoperative patients. In a diagnostic cross-sectional study patients were monitored with the radar and the reference monitor (pneumotachograph during mechanical ventilation and capnography during spontaneous breathing). Eight patients were included; yielding 796 min of observation time during mechanical ventilation and 521 min during spontaneous breathing. After elimination of movement artifacts the bias and 95 % limits of agreement for mechanical ventilation and spontaneous breathing were -0.12 (-1.76 to 1.51) and -0.59 (-5.82 to 4.63) breaths per minute respectively. The radar was able to accurately measure respiratory rate in mechanically ventilated patients, but the accuracy decreased during spontaneous breathing.

[Artists, their performances, their muscles and their fears]. / L'artiste, sa performance, ses muscles et son angoisse.

A thorough physical examination of the artist is a prerequisite of good physiotherapy. A musician should bring his/her instrument(s) and should undress in order to be examined. Being able to examine a dancer at the exercise barre is a significant advantage. In addition, this examination should always include quality medical iconography. Physiotherapy is a genuine treatment. This, however, also means that it has its own restrictions and involves dangers and contraindications.

Prediction of clinical conditions after coronary bypass surgery using dynamic data analysis.

This work studies the impact of using dynamic information as features in a machine learning algorithm for the prediction task of classifying critically ill patients in two classes according to the time they need to reach a stable state after coronary bypass surgery: less or more than 9 h. On the basis of five physiological variables (heart rate, systolic arterial blood pressure, systolic pulmonary pressure, blood temperature and oxygen saturation), different dynamic features were extracted, namely the means and standard deviations at different moments in time, coefficients of multivariate autoregressive models and cepstral coefficients. These sets of features served subsequently as inputs for a Gaussian process and the prediction results were compared with the case where only admission data was used for the classification. The dynamic features, especially the cepstral coefficients (aROC: 0.749, Brier score: 0.206), resulted in higher performances when compared to static admission data (aROC: 0.547, Brier score: 0.247). The differences in performance are shown to be significant. In all cases, the Gaussian process classifier outperformed to logistic regression.

Online detection of an emotional response of a horse during physical activity.

The objective of this research was to develop a non-invasive method to detect an emotional response of a horse to novelty during physical activity. Two horses performed 20 trials each, in which the horse's heart rate (HR) and physical activity were continuously measured. The relationship between the horse's physical activity and HR was described by a mathematical model allowing online decomposition of the horse's HR into a physical component and a component containing information about its emotional state. Exposure to the novel object resulted in an increase in the emotional component of HR, which allowed automatic detection of an emotional response of the horse in 33/40 trials. In the remaining seven trials no stable model could be built or data were missing. The results show that model-based decomposition of HR can be a useful tool for quantification of certain aspects of temperament.

[Lumbago and physiotherapy]. / Les lombalgies et la kinésithérapie.

Among treatments of locomotive affections, low back pain is the pathology for which the treatment has evolved the most in the last few years. Between 40 and 45% of the Belgian population declares having had a low back pain crisis during the last six months. Between 85 and 95% from those low back pains are ordinary low back pain without specific cause and without sign of seriousness. Literature demonstrated the importance of dynamic and active rehabilitation in the therapeutic management of low back pain to improve the physical condition of those patients. We will explain the therapeutic protocol conceived by the department of physical therapy from H.I.S., Etterbeek-Ixelles Hospital, which is also easy to apply at private consulting-rooms. This therapeutic procedure is developed around three facets: analytic physiotherapy, on an individual basis during the acute stage; gestural improvement of the patient (notions of ergonomics, lifting techniques) as soon as the intense pain has decreased; exercises and physical training, during 4 to 6 weeks, together with more ergonomics activities.

Structured antiretroviral treatment interruptions in chronically HIV-1-infected subjects.

The risks and benefits of structured treatment interruption (STI) in HIV-1-infected subjects are not fully understood. A pilot study was performed to compare STI with continuous highly active antiretroviral therapy (HAART) in chronic HIV-1-infected subjects with HIV-1 plasma RNA levels (VL) <400 copies per ml and CD4(+) T cells >400 per microl. CD4(+) T cells, VL, HIV-1-specific neutralizing antibodies, and IFN-gamma-producing HIV-1-specific CD8(+) and CD4(+) T cells were measured in all subjects. STIs of 1-month duration separated by 1 month of HAART, before a final 3-month STI, resulted in augmented CD8(+) T cell responses in all eight STI subjects (P = 0.003), maintained while on HAART up to 22 weeks after STI, and augmented neutralization titers to autologous HIV-1 isolate in one of eight subjects. However, significant decline of CD4(+) T cell count from pre-STI level, and VL rebound to pre-HAART baseline, occurred during STI (P = 0.001 and 0.34, respectively). CD4(+) T cell counts were regained on return to HAART. Control subjects (n = 4) maintained VL <400 copies per ml and stable CD4(+) T cell counts, and showed no enhancement of antiviral CD8(+) T cell responses. Despite increases in antiviral immunity, no control of VL was observed. Future studies of STI should proceed with caution.

Safety of high doses of recombinant human growth hormone.

Recombinant human growth hormone (r-hGH) is given as substitution therapy to growth hormone-deficient children at 0.01-0.025 mg/kg/day. Higher doses are used for short stature due to Turner's syndrome and for idiopathic short stature (approximately 0.05 mg/kg/day). For metabolic indications such as AIDS-associated wasting and severe burns, even higher doses are required, up to 0.2 mg/kg/day. Worldwide experience with low and medium doses of r-hGH is well documented. Data on long-term treatment with pharmacological doses of r-hGH are scarce. Serono's clinical program for AIDS-associated wasting provides placebo-controlled data on 355 treated patients. The total experience in clinical trials covers more than 100 person-years of treatment on approximately 600 patients. The most common side effects were tissue turgor complex and musculoskeletal discomfort. Leukopenia was found more frequently in placebo patients. Neoplasm, hyperglycemia, hypertriglyceridemia, carpal tunnel syndrome, pseudotumor cerebri and hypercalcemia were not found to be more significant than with substitution therapy.

Limb saving surgery in bone tumours: experiences in Hungary.

A retrospective clinical review of 28 low- and 47 high-grade bone tumours, managed by limb salvage operations, was performed in the Orthopaedics Department of the Semmelweis University Medical School, Budapest. The mean follow-up period was 37.2 months. Ten bone tumours were classified as stage I/A, 18 as I/B, 16 as II/A and 31 as II/B. The overall 3 years survival rate was 97% in low-grade bone tumours, 84% in osteosarcomas and 50% in Ewing's sarcomas. Local recurrences were observed in 14%. Tumour prostheses were implanted in 25 patients (33%); 2 complications in this material were seen. In 50 patients resection and reconstruction with autografts or allografts were performed; 13 complications (26%) were registered in 9 patients. These results suggest that limb saving surgery is an acceptable method in selected cases of early recognized bone tumours which respond well to the chemotherapy.

Neural tube defects after infertility treatment: a review.

OBJECTIVE: To investigate whether an association exists between ovulation induction and neural tube defects (NTDs). MATERIALS AND METHODS: Risk estimations in the medical literature were identified through Medline, and validity and power were assessed. Large in vitro fertilization-embryo transfer (IVF-ET) registries represent another source of information. The total number of NTDs and the total number of fetuses were computed from five registries. These data were expressed as proportions and compared with data from the general population. RESULTS: Only one study could be identified as both valid and powerful, through literature review. This case-control study concluded there was no association between ovulation induction and NTDs. The pool of IVF-ET registry data represents another powerful epidemiologic tool. Analysis of the registry data confirms the findings of the case-control study. CONCLUSIONS: Ovulation induction does not seem to represent a risk factor for NTDs in the offspring.