Telemedicine Alert API Engine System for Vital Signs.

Telemedicine is used to assist and support remote medical care for patients. Our objective was to build up a REST Webservices alert engine that receives clinical parameters from patients of vital signs and basic laboratories to monitor patients remotely. We built a REST API using FHIR, so it can interoperate with other applications, send data to be processed, and receive a response. If the API detects a health risk situation, it sends an alert about the medical parameters that are controlled. The results of the processed data, news and alert, can return synchronously or asynchronously, at the same time that the data to be processed is being sent. The alerts generated can be automatically sent to a web service, mail or WhatsApp of the physician. The alert message comes out as normal, low, medium and high risk. The presented approach establishes communication that enables timely health information exchange. We conducted an experiment (with fictitious data) where we sent several queries by Postman. Finally, we evaluated the communication to be successful by manual checking. The use of the API significantly improves the monitoring of chronic patients. Many works show the effectiveness of telemedicine to improve the control of certain chronic diseases. In addition, telemedicine interventions were also found to significantly improve other health outcomes. Our API enables us to transfer data and produce alerts successfully. This gives us hope that a future with ubiquitous healthcare information interoperability is possible using our system.

Are We Missing the Mark? Understanding Health Literacy in A Rural-Border Hospital.

Low health literacy (LHL) significantly impacts patients' ability to participate actively in their healthcare. Registered nurses (RNs) play a crucial role in identifying LHL and addressing patient knowledge gaps and skill deficits. This correlational study examined the relationship between RNs' predictions of patients' health literacy levels (HLL) and the actual HLL of a predominately Hispanic patient population. In addition, personal factors (i.e., demographics) were analyzed to determine their influence on the nurse's predictions and patients' HLL. Data were collected from 84 participant patient-nurse couplets admitted to a medical-surgical unit in a rural setting located on the United States-Mexico border. In addition to demographic information collected via survey, RNs were asked to predict their patient's health literacy abilities while the Newest Vital Sign, a health literacy assessment tool, was deployed to determine the actual HLL of patients participating in the study. Data were analyzed using descriptive statistics, t-tests, and chi-square tests while a Spearman correlational model was used to examine the relationship between predicted HLL and actual HLL. Finally, a logistic regression model was used to analyze the relationship between personal factors and HL data for RNs and patients. Analysis of the data revealed that RNs consistently overestimated patients' abilities, as evidenced by the disparity between patients' actual HLL (mean 1.71) and predicted HLL (mean 4.26) by RNs, with a moderately strong positive relationship (rs = .418). Notably, higher academic preparation and years of experience did not enhance the RNs' ability to identify LHL while the highest level of education completed was the only statistically significant predictor of adequate health literacy in the patient population sampled. These findings emphasize the need to prioritize effective health literacy education in RN academic preparation and clinical practice to support the detection of LHL when a standardized health literacy assessment tool is not utilized in the clinical setting. By recognizing the presence of LHL, healthcare professionals can better support patients' needs and bridge the knowledge gap, ultimately improving patient outcomes.

Heart Rate, Responsiveness to Intravenous Immunoglobulin, and Coronary Artery Aneurysms in Kawasaki Disease.

OBJECTIVE: To evaluate whether heart rate (HR) was associated with intravenous immunoglobulin (IVIG) responsiveness or development of coronary artery lesions (CALs) in patients with Kawasaki disease. STUDY DESIGN: We conducted a retrospective cohort study using data from in patients with Kawasaki disease who were hospitalized in our institution from 2006 to 2016. The patients were divided into 5 groups according to the age- and temperature-adjusted HR z score (HRZage/temp) just before IVIG administration. The ORs of outcomes were estimated by using logistic regression models, with the middle group set as the reference. RESULTS: Of the 322 patients, a total of 98 patients (30%) were refractory to initial IVIG treatment. The patients whose HRZage/temp belonged to the lowest group were at the highest risk of being refractory to the initial IVIG treatment (OR 2.10 [95% CI 1.01-4.37]). Multivariable analyses showed the same trend, though this was not statistically significant. The patients with the highest HRZage/temp were most likely to develop CALs (OR 2.61 [95%CI 0.86-7.92]). CONCLUSIONS: In patients with Kawasaki disease , HRs has a different relationship with IVIG responsiveness and CALs. Low HRZage/temp might be associated with high risk of being refractory to the initial IVIG treatment, while the risk of developing CALs increased among those whose HRs were high. Further studies are necessary to investigate the mechanisms regarding HR and these outcomes in Kawasaki disease.

Desarrollo de un prototipo para su uso como herramienta de apoyo al personal médico en la gradación de triaje para pacientes en los servicios de urgencias basado en sus signos vitales

Se presenta el desarrollo de un prototipo para su uso como herramienta de apoyo al personal médico en la gradación de triaje para pacientes en los servicios de urgencias basado en sus signos vitales. El prototipo consta principalmente de un módulo de instrumentación que mide los signos vitales luego de adquirir y procesar bioseñales presentes en los pacientes. Consta también de una interfaz en plataforma web donde se almacenan y procesan las medidas para gradar en un nivel de urgencia a los pacientes. Para enlazar el módulo de instrumentación y la interfaz de usuario se construye un módulo de comunicaciones basado en la tecnología inalámbrica wifi. Se indican las características principales de los elementos utilizados, configuraciones y protocolos. Se realizan pruebas con el módulo de instrumentación comparando las medidas con las obtenidas por los métodos convencionales usados por los profesionales médicos. Las pruebas se someten a 29 pacientes distintos, 72,4% de los cuales eran del género femenino y 27,6% masculino. El promedio de edad en total fue de 29,4 años; los porcentajes de error que se consiguen son admisibles. Se concluye indicando cómo el sistema descrito puede ser de gran ayuda al personal médico en la toma de decisiones al momento de asignar un nivel de triaje a los pacientes, disminuyendo así el tiempo de clasificación de estos en los servicios de urgencia.

We present the development of a prototype for use as a personal medical support tool in triage grading for patients in emergency services based on their vital signs. The prototype consists of an instrumentation module that measures vital signs after acquiring and processing biosignals present in patients. It also consists of an interface on the web platform where the measures are stored and processed to classify patients at an emergency level; To link the instrumentation module and the user interface, a communications module based on wireless Wi-Fi technology is built. The main characteristics of the elements used, configurations and protocols are indicated. The tests are performed with the instrumentation module that compares the measurements with those obtained by the conventional methods used by medical professionals, the tests are submitted to 29 different patients, 72.4% of which were female and 27.6% male, the average age was 29.4 years; The percentages of error that are obtained are admissible. It can be identified how the treatment system can be of great personal medical help in the decision making when assigning a level of triage to the patients, thus reducing the time of classification of these in the emergency services.

Apresenta-se o desenvolvimento de um protótipo para seu uso como ferramenta de apoio pessoa médico na gradação da triagem para pacientes nos serviços de urgências com base nos seus sinais vitais logo de adquirir e processar bio-sinais presentes nos pacientes. Além disso, o protótipo tem uma interface na plataforma web onde armazene os dados e processam as medidas para gerar um nível da triagem para os pacientes. Para ligar o modulo de instrumentação e a interface do usuário construiu-se um modulo de comunicações com base na tecnologia sem fio wifi. Indica-se as características principais dos elementos usados, configurações e protocolos. Realizam-se provas com o modulo de instrumentação comparado com as medidas obtidas pelos métodos convencionais usados pelos profissionais médicos. As provas foram sometidas a 29 pacientes diferentes, 72,4% mulheres e 27,6% homens. A media de idade foi de 29,4 anos; as porcentagens do erro são admissíveis. As conclusões encontram que o sistema descrito pode ser de ajuda para o pessoal médico na toma de decisões no memento de assignar o nível da triagem para os pacientes, diminuindo o tempo de classificação destes serviços de urgência.

Cross-cultural adaptation and validation of the Newest Vital Sign (NVS) health literacy instrument in general population and highly educated samples of Brazilian adults.

OBJECTIVE: The present work aimed at cross-cultural adaptation and validation of the health literacy assessment tool Newest Vital Sign (NVS) in general population (GP) and highly educated (HE) samples of Brazilian adults. DESIGN: An expert committee reviewed the translation and back-translation processes and the cultural adaptation. The construct validity was analysed with confirmatory factor analysis and via associations with features of the study population. SETTING: The final validation test was performed in two different populations from Londrina, a large town in southern Brazil. SUBJECTS: Brazilian adults: GP (adult clients of community pharmacies; n 189) and HE (public school teachers; n 301). RESULTS: The tool under validation showed good cross-cultural adaptation and internal consistency, with Cronbach's α of 0·75 for GP and 0·74 for HE. Confirmatory factor analysis showed acceptable models and identified two independent factors according to the relationship between components and numeracy for both GP and HE data. According to the Brazilian Portuguese version of the NVS instrument (NVS-BR), 48·7 % of GP and 33·5 % of HE presented adequate health literacy; this condition was inversely associated with age for both populations and directly correlated with educational level for GP. CONCLUSIONS: The NVS-BR showed good validity in two different populations of Brazilian adults and can be considered an alternative in screening for inadequate health literacy.

Clinical validation study of the SignCare Vital Signs Monitor of Fundación Cardiovascular de Colombia / Estudio de validación clínica del monitor de signos vitales SignCare de la Fundación Cardiovascular de Colombia

Abstract Introduction: In Colombia, due to the difficult access to health services and to geographic conditions, the implementation and innovation of telemedicine technological tools is a priority. Having a validated vital signs monitor (VSM) improves proper medical treatment and diagnosis. Objective: To design and perform clinical trials for the SignCare VSM. Materials and methods: A device for continuous monitoring of electrocardiography, respiration, oxygen saturation, temperature and noninvasive blood pressure (NIBP) was designed. This device was validated in a laboratory in order to ensure a robust prototype, close to the level of commercial medical devices. Clinical trials were performed through a cross -section study with 98 patients, whose vital signs were measured using the SignCare monitor and a commercial monitor. These two measurements were compared using Pearson's correlation coefficients. Results: There were no statistically significant differences between the results obtained with the SignCare VSM and the commercial monitor. The highest correlations were found for the following items: heart rate by electrocardiogram (r=0.844), heart rate by oxymetry (r=0.821), body temperature (r=0.895), systolic blood pressure (r=0.780), and diastolic blood pressure (r=0.811). Conclusions: The SignCare device is as reliable as the commercial monitor in the qualitative detection of morphologic alterations of electrocardiogram records, as well as in breathing, temperature, oxygen saturation and blood pressure parameters, which makes it recommendable for clinical use in adult population.

Resumen Introducción. Debido a las dificultades geográficas y de acceso a los servicios de salud en Colombia, la implementación e innovación con herramientas de telemedicina se convierte en un tema prioritario; contar con un monitor de signos vitales validado favorece el tratamiento médico oportuno. Objetivos Diseñar y realizar la validación clínica del monitor de signos vitales SignCare. Materiales y métodos. Se diseñó un equipo para el monitoreo constante de las señales de electrocardiografía, respiración, saturación de oxígeno, temperatura y presión arterial no invasiva. El dispositivo fue validado en el laboratorio para asegurar un prototipo robusto a nivel de dispositivos médicos comerciales. La validación clínica se hizo mediante un estudio de corte transversal en 98 pacientes a los que se les realizaron mediciones con el monitor SignCare y con un monitor comercial. Se compararon estas dos mediciones mediante coeficientes de correlación de Pearson. Resultados. No hubo diferencias estadísticamente significativas en cuanto a los resultados obtenidos con el monitor SignCare y con el monitor comercial. Las mayores correlaciones se presentaron en la frecuencia cardíaca por electrocardiograma (r=0.844), frecuencia cardíaca por oximetría (r=0.821), temperatura corporal (r=0.895), tensión arterial sistólica (r=0.780) y tensión arterial diastólica (0.811). Conclusiones. El monitor SignCare es tan confiable como el monitor comercial para la detección cualitativa de alteraciones morfológicas del registro electrocardiográfico, lo que hace posible su recomendación para uso clínico en población adulta.

Implementação de um programa de controle da dor em hospital de traumatologia e ortopedia. Relato de caso / Implementation of pain control program in a traumatology and orthopedics hospital. Case report

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor é uma das mais frequentes queixas clínicas na prática diária, ambulatorial e hospitalar. Independentemente da sua causa, permanece subvalorizada e, consequentemente, sem tratamento adequado, resultando em insucessos no seu controle, prejudicando uma proposta de reabilitação física e social. O objetivo deste estudo foi apresentar o programa de controle da dor e divulgar as reais vantagens de sua implementação. RELATO DO CASO: Trata-se de um estudo descritivo com relato de experiência, em um hospital cirúrgico ortopédico, de referência nacional que atende exclusivamente pacientes do sistema único de saúde. CONCLUSÃO: Essa experiência e seus resultados incentivam a manutenção da Política de Controle da Dor e contribuem para referenciar a outras instituições de saúde os benefícios da implementação de programas e políticas semelhantes.

ABSTRACT BACKGROUND AND OBJECTIVES: Pain is one of the most frequent clinical complaint in daily, ambulatory and hospital practice. Regardless of its cause, it remains undervalued and, as a consequence, without adequate management, resulting in poor control, thus impairing a physical and social rehabilitation proposal. This study aimed at presenting a pain control program and at spreading the real advantages of its implementation. CASE REPORT: This is a descriptive study with experience report of a national reference orthopedic surgical hospital exclusively assisting Single Health System patients. CONCLUSION: This experience and its results encourage the maintenance of the Pain Control Policy and contribute to reference to other health institutions the benefits of implementing similar programs and policies.