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PubMed2004

Recognition of early warning signs in patients with schizophrenia: a review of the literature.

This article reviews and discusses the literature on the recognition of the early warning signs of psychosis. The assumption is that nurses, in the everyday exercise of their profession, can contribute to the prevention of psychotic relapse in schizophrenic patients by the early recognition of warning signs. First, the process of psychotic relapse and the factors that influence it are described. Then research on the early signs of psychosis is discussed. This article questions the most common early signs, when they occur, and who can recognize them. Then the predictive value of the early signs is considered: how well can psychotic relapse be predicted with these early signs? Finally, the research on the effects of early recognition and early intervention is discussed, primarily with respect to the question of whether psychotic relapses can actually be prevented by making use of preventive intervention strategies. The conclusion is that the preliminary results are hopeful and invite further research on such matters as the application of this intervention strategy within nursing practice.

Humans↗

PubMed2005

Long-term effect of introducing an early warning score on respiratory rate charting on general wards.

The respiratory rate is an early indicator of disease, yet many clinicians underestimate its importance and hospitals report a poor level of respiratory rate recording. We studied the short- and long-term effects of introducing a new patient vital signs chart and the modified early warning score (MEWS), which incorporates respiratory rate on the prevalence of respiratory rate recording in six general wards of our hospital. Prior to the commencement of the study, the average percentage of occupied beds where at least one respiratory rate recording had been made in a single 24-h period was 29.5+/-13.5%. After the introduction of the new vital signs chart to all six wards, and the introduction of MEWS to three wards, this rose to 68.9+/-20.9%. When all six wards had been using both the new chart and the MEWS system for almost 1 year, the figure had reached 91.2+/-5.6%. During the pre-introduction period, there was no difference in the prevalence of respiratory rate recording between the specialties (orthopaedic, 26.9%; surgery, 32.9%; medicine, 29.8%; p=0.118). During the second two audit periods, the prevalence of respiratory rate monitoring was consistently higher on medical wards than on surgical and orthopaedic wards (p<0.001). The study confirms the long-term beneficial effect of introducing the MEWS system on respiratory rate recording into the general wards of our hospital. As respiratory rate abnormalities are early markers of disease, it is hoped that improved monitoring will have an impact on the nature and timeliness of the response to critical illness. This may have an impact on the future incidence of potentially avoidable cardiac arrest, deaths and unanticipated intensive care unit admission.

Forms and Records Control↗

PubMed1993

Monitoring the response of microcontaminants by dynamic Daphnia magna and Leuciscus idus assays in the Rhine Delta: biological early warning as a useful supplement.

Following some severe upstream calamities in the eighties, biological early warning systems with fish and waterfleas were installed at monitoring stations in the Rhine and the Meuse. Laboratory tests suggest that these whole-organism monitors are likely to respond at concentrations close to lethal levels. Current average and peak concentrations of compounds that can be identified and of which information on toxicity is available are often below these levels. Nevertheless, several alerts were registered in recent years. This may be attributed to the combined effect of known and unknown compounds under prevailing field conditions. Results are compared to experiences at other locations and some prospects on development in the future are given.

Animals↗

PubMed2026

An RPA-assisted homogeneous electrochemical DNA sensor for on-site eDNA detection toward early warning of crown-of-thorns starfish outbreaks.

Crown-of-thorns starfish (COTS) outbreaks seriously threaten coral reef ecosystems, while conventional monitoring approaches are time-consuming and often lack sufficient sensitivity for early warning. Existing electrochemical DNA sensors usually require complex electrode-surface immobilization procedures, which can lead to uneven probe distribution, significant steric hindrance, and poor stability. Meanwhile, the low concentration of environmental DNA (eDNA) in marine environments further complicates detection. To overcome these challenges, this study developed a homogeneous electrochemical DNA sensor assisted by recombinase polymerase amplification (RPA) for COTS eDNA detection. Target DNA was first amplified by RPA, and the amplification products were then hybridized in solution with capture probe (CP)-modified magnetic beads (MB) and biotin-labeled signal probe (SP) to form sandwich-structured MB complexes. These complexes were subsequently magnetically enriched and immobilized on the electrode surface for electrochemical signal readout. Under optimized conditions, the sensor displayed a linear response to COTS genomic DNA from 3.77 fg/μL to 1 ng/μL, with an LOD of 2.02 fg/μL and an LOQ of 3.77 fg/μL. The sensor was applied to Xisha Islands samples, and the results agreed with droplet digital PCR (ddPCR) (P > 0.05), demonstrating its potential for sensitive and reliable on-site COTS eDNA detection.

Animals↗

PubMed2006

Suitability of Crangonyx pseudogracilis (Crustacea: Amphipoda) as an early warning indicator in the multispecies freshwater biomonitor.

BACKGROUND: Biological monitors are increasingly important in 'Biological Early Warning Systems' (BEWS) for monitoring water quality. This study examines the freshwater amphipod Crangonyx pseudogracilis as a potential new indicator species when used in the Multispecies Freshwater Biomonitor (MFB). The MFB is an online continuous biomonitor which uses impedance conversion to record behavioural responses of vertebrates and invertebrates. METHODS: Four experiments were undertaken to establish: (1) if the electrical field generated by the MFB affected the organisms' behaviour, (2) if defined behaviours and their response to a gradient of ammonium chloride could be detected by the MFB, (3) if there was variation in the behaviour of C. pseudogracilis over a diel cycle, and (4) if behaviour changed significantly in response to a pulse of ammonium chloride. RESULTS AND DISCUSSION: Results showed no significant effect of the MFB's current on behaviour of C. pseudogracilis. Four behaviours; swimming, walking, grooming and inactivity, were observed and identified in the MFB. In the MFB, each behaviour changed significantly in response to an increasing gradient of ammonium chloride exposure. The MFB also detected increases in nocturnal activity by C. pseudogracilis. The MFB also detected a significant increase in activity after a pulse of ammonium chloride. CONCLUSION: The range of behaviours exhibited by Crangonyx pseudogracilis, together with its ease of culture, suggest future potential of this species as an indicator species for the Multispecies Freshwater Biomonitor. RECOMMENDATIONS AND OUTLOOK: Further testing is required over a range of toxicants and concentration gradients to establish threshold responses and the full compliment of behaviours that could be useful in online biomonitoring.

Ammonium Chloride↗

PubMed2006

The value of Modified Early Warning Score (MEWS) in surgical in-patients: a prospective observational study.

INTRODUCTION: The Modified Early Warning Score (MEWS) is a simple, physiological score that may allow improvement in the quality and safety of management provided to surgical ward patients. The primary purpose is to prevent delay in intervention or transfer of critically ill patients. PATIENTS AND METHODS: A total of 334 consecutive ward patients were prospectively studied. MEWS were recorded on all patients and the primary end-point was transfer to ITU or HDU. RESULTS: Fifty-seven (17%) ward patients triggered the call-out algorithm by scoring four or more on MEWS. Emergency patients were more likely to trigger the system than elective patients. Sixteen (5% of the total) patients were admitted to the ITU or HDU. MEWS with a threshold of four or more was 75% sensitive and 83% specific for patients who required transfer to ITU or HDU. CONCLUSIONS: The MEWS in association with a call-out algorithm is a useful and appropriate risk-management tool that should be implemented for all surgical in-patients.

Critical Care↗

PubMed2004

"The future should not take us by surprise": preparation of an early warning system in Denmark.

OBJECTIVES: To explore and test methods for the operation of a national Early Warning System (EWS) in Denmark and to support decision making by the Danish Centre for Evaluation and Health Technology Assessment on this issue. METHODS: On the basis of literature reviews, information from members of EuroScan, and supported by clinical experts and stakeholders, existing methods were adapted and new methods were developed as part of a feasibility study. RESULTS: Approximately 200 technologies in 30 specialties were identified on the basis of information by EuroScan. A new instrument was developed to distinguish between important and unimportant technologies (filtering). Clinical experts in six specialties applied the instrument to sixty-two technologies in their respective fields, of which nine (15%) were judged potentially important for the Danish health care system. For priority setting, adapting a Dutch instrument to the Danish context was discussed. In principle, the instrument was acceptable, but several changes were proposed, for example, relating to the decentralized structure of the Danish health care system. For early assessment, the format and methods applied by SBU and Canadian Coordinating Office for Health Technology Assessment (CCOHTA) were compared and applied to pharmaceuticals (glitazones in treatment of type 2 diabetes mellitus) and a procedure (embolization of uterine fibromas). Given the main target group of the Danish EWS, local decision makers, the CCOHTA format was preferred. CONCLUSIONS: The findings of the study have laid the foundation for an EWS using appropriate methods adapted to local circumstances. On the basis of the findings, a decision was made to start an EWS.

Decision Making, Organizational↗

PubMedDate not supplied

Sertoli cells in culture and mRNA differential display provide a sensitive early warning assay system to detect changes induced by xenobiotics.

We have used cultured rat Sertoli cells as an "early warning system" to monitor for morphological and biochemical changes induced by two different xenobiotics-cadmium acetate and polychlorinated biphenyls (PCBs). Sertoli cells begin to round, become vacuolized, and detach from their substrate within 24 hours of culture in the presence of cadmium at concentrations of 0.5-1.0 microM. Similar results were obtained with a lower dose of cadmium (0.01 microM) after 72 hours. When Sertoli cells are cultured for 24 hours in the presence of a mixture of PCBs (3,3',4,4'-tetrachlorobiphenyl, 2,2',4,6,6'-pentachlorophenyl, and 2,2',3,3',4,5,5', 6,6'-nonachlorobiphenyl) at concentrations of 1.0-2.0 microM, they enlarge. After 72 hours, a lower dose of PCBs (0.01 microM) produces similar cellular enlargement. Despite their changes in morphology, no reduction in Sertoli cell viability was seen at any of the concentrations or time points studied for either toxicant. Using mRNA differential display, a number of novel cDNAs were detected when cells were cultured with either cadmium or the PCBs, demonstrating that changes in gene expression accompany the changes in Sertoli cell structure. We propose that Sertoli cells in culture and mRNA differential display provide a sensitive morphological and biochemical assay system to detect early direct effects of low concentrations of toxicants on mammalian Sertoli cells.

Acetates↗

PubMed2004

A randomised trial of early warning signs relapse prevention training in the treatment of alcohol dependence.

A pragmatic randomised trial examined the effects of Early Warning Signs Relapse Prevention Training (EWSRPT) on drinking in alcohol dependent persons with history of relapse. Participants were 124 abstinent alcohol dependent patients with a history of relapse (median five relapses) who entered the trial as they completed a 6-week day treatment programme. They were randomly allocated to receive either (1) Aftercare as Usual (AU) or (2) AU plus 15 individual sessions of EWSRPT using Gorski's protocol. Assessment carried out at entry to the trial, and 4, 8, and 12 months later, included self-report of drinking, blood tests (gamma glutamyl transferase, GGT; serum alanine aminotransferase, ALT) and measures of functioning (Alcohol Problems Questionnaire, APQ; SF36, Brief Symptom Inventory, BSI; Assessment of Warning-signs of Relapse, AWARE). Intention to treat analysis found no significant differences in continuous abstinence during the follow-up year (17% of 58 AU, 31% of 58 EWSRPT, p=0.08). The EWSRPT participants had a significantly lower probability of drinking heavily (74% of AU, 55% of EWSRPT, p=0.04), and significantly fewer days drinking (p=0.05) and heavy drinking (p=0.04). These clinically worthwhile effects for a relapse-prone group justify further research into EWSRPT.

Adult↗

PubMed2006

Calculating early warning scores--a classroom comparison of pen and paper and hand-held computer methods.

To assist in the early detection of critical illness, many hospitals now use a "track and trigger" system that allocates points to routine vital signs measurements on the basis of their derangement from an arbitrarily agreed "normal" range. These points are summed to provide an early warning score (EWS). Little is known about the accuracy with which EWS are calculated and charted. We compared the speed and accuracy of charting the weighted value attributed to each vital sign, and of calculating the EWS, using the traditional pen and paper method with that using a specially programmed, personal digital assistant (VitalPAC). Incorrect entries or omissions occurred in 24 (29%) of 84 EWS computed using pen/paper compared to 8 (10%) computed using the VitalPAC method. Fewer incorrect clinical actions were indicated using EWS derived via the VitalPAC method (4/84, 5%) than from those calculated using pen/paper (12/84, 14%). The mean time (+/-S.D.) taken for participants to calculate and chart a set of weighted values and EWS using the pen/paper method was 67.6+/-35.3 s (n=84). The corresponding time taken to enter a set of physiological data using the VitalPAC was 43.0+/-23.5 s (n=84). By comparison with the conventional pen/paper method, the use of VitalPAC was on average 1.6-times faster. The use of a device such as VitalPAC offers significant advantages both in speed and accuracy of recording of EWS.

Computers, Handheld↗

PubMed1992

Averting CQI failure: five early warning signs.

Many hospitals, disappointed with their quality programs, are starting to ask, "What went wrong?" This article identifies five early warning signs of failing programs--and what to do about them.

Hospital Administration↗

PubMed1998

Early warning of new health care technologies in the United Kingdom.

In this paper we describe the present range of organizations that have a role in the early warning of new and emerging health care technologies in the United Kingdom. We discuss in more detail the processes and prioritization criteria used by the U.K. horizon-scanning project for the NHS Health Technology Assessment Programme, and the principal methods of technology identification for the horizon-scanning project are outlined. The United Kingdom plans to develop an integrated system for the identification of technologies for commercial planning, health service research prioritization, financial planning, and provision of information to policy makers, purchasers, and providers of health care.

Diffusion of Innovation↗

PubMed2004

Strengthening early warning function of surveillance in the Republic of Serbia: lessons learned after a year of implementation.

The Republic of Serbia, with WHO support, has implemented an early warning system (ALERT) for priority communicable diseases, to complement the routine surveillance system which notifies individual confirmed cases. The results of its evaluation, conducted one year after implementation is presented here. ALERT relies on notification of 11 syndromes by primary care facilities. Data is analysed weekly at district level and transmitted to national epidemiologists. ALERT is perceived to be a simple and flexible tool. Acceptability is higher at national level than at district level. Some districts perceive ALERT as a parallel system poorly connected to control measures. Sensitivity of ALERT in detecting cases of meningitis is 93%, and 37% for cases of hepatitis. Retrospective analysis of ALERT data identified 9 outbreaks, 5 of which had been recognized by epidemiologists. ALERT was the timeliest system for detecting 4 outbreaks identified by both systems. ALERT was useful for triggering timely investigation and control of outbreaks of hantavirus and salmonellosis and for detecting the start of the influenza season. However, ALERT did not detect clusters of brucellosis and tularaemia targeted by the unexplained fever syndrome. This evaluation underlined the need for a global review of surveillance activities when implementing new components such as ALERT. While control measures based on notification of individual confirmed cases are well understood and implemented, the investigation and verification process that should result from an increase in ALERT syndromes is not fully understood. Field epidemiology training programmes, such as the EPIET programme, are best suited to bring about this change of perspective.

Communicable Disease Control↗

PubMed2006

The second EURADOS intercomparison of national network systems used to provide early warning of a nuclear accident.

In 1999 and 2002, the EURADOS Working Group on Environmental Monitoring organised two European intercomparison exercises of national network systems used to provide early warning in case of a nuclear accident. In total, 12 European countries, represented by more than 40 scientists, participated in these two intercomparisons with more than 35 different dose rate detectors. In addition, an in situ gamma spectrometry intercomparison was performed by a group of European scientists during the 2002 exercise. Results of these spectrometry measurements will be reported elsewhere. This report summarises the results of the second intercomparison, performed in 2002, at the environmental dosimetry facilities of the Physikalisch-Technische Bundesanstalt (PTB) in Germany. The unique combination of the ultra-low background Underground Laboratory (UDO) and two free-field sites (a floating platform on a lake showing an almost pure cosmic radiation field and a free-field gamma ray irradiation facility) provide the particular opportunity to precisely quantify the inherent background of the detectors and to calibrate them almost free of any background and traceable to PTB's primary standards. In addition, the intercomparison comprised investigations on the energy and dose rate dependence of the detectors' response to gamma radiation as well as on the response to cosmic radiation. Finally, the sensitivity of the detector systems to small dose rate variations, similar to that caused by a passing overhead radioactive plume, was studied under realistic free-field conditions. Following the Council Directive 96/29/EURATOM, the participants of the 2002 intercomparison were asked to report their results in terms of the operational quantity ambient dose equivalent, H(*)(10). Although the verification of the individual calibrations showed smaller discrepancies than those in the 1999 intercomparison, in a few cases, these discrepancies would be still unacceptably high in the case of a real emergency situation as demonstrated by the plume results. This shows the clear need for further efforts towards a European harmonisation in environmental dosimetry. For this purpose, a further intercomparison shall be held at the PTB in 2006, especially with the participation of new members of the European Union.

Air Pollution, Radioactive↗

PubMedDate not supplied

Drug information systems, early warning, and new drug trends: can drug monitoring systems become more sensitive to emerging trends in drug consumption?

Drug Information Systems (DIS) are called upon to provide an early warning of emerging trends in drug use. However, little theoretical attention is directed toward exploring conceptual issues in this area. In this paper a typology of existing DIS is offered. Among the features that distinguish DIS are their structure (human network or organization systems) and the range of information sources used. Indicators of drug use can be placed on a continuum of sensitivity ranging from leading edge indicators to lagged indicators. Sensitivity implies volatility as sensitive indicators also react to fluctuations that do not become trends. DIS conventionally are largely reliant upon lagged indicators. What is required are DIS that combine a critical information processing function with the ongoing systematic collection of data from a range of data sources.

Data Collection↗

PubMed2006

Malaria early warnings based on seasonal climate forecasts from multi-model ensembles.

The control of epidemic malaria is a priority for the international health community and specific targets for the early detection and effective control of epidemics have been agreed. Interannual climate variability is an important determinant of epidemics in parts of Africa where climate drives both mosquito vector dynamics and parasite development rates. Hence, skilful seasonal climate forecasts may provide early warning of changes of risk in epidemic-prone regions. Here we discuss the development of a system to forecast probabilities of anomalously high and low malaria incidence with dynamically based, seasonal-timescale, multi-model ensemble predictions of climate, using leading global coupled ocean-atmosphere climate models developed in Europe. This forecast system is successfully applied to the prediction of malaria risk in Botswana, where links between malaria and climate variability are well established, adding up to four months lead time over malaria warnings issued with observed precipitation and having a comparably high level of probabilistic prediction skill. In years in which the forecast probability distribution is different from that of climatology, malaria decision-makers can use this information for improved resource allocation.

Animals↗

PubMed2004

[The early warning signs of deterioration of severe acute respiratory syndrome].

OBJECTIVE: To explore the risk factors related to severe cases of severe acute respiratory syndrome (SARS) in order to find the early warning signs of deterioration of this disease. METHODS: Three hundred and fifty-five patients with severe SARS and 841 patients with regular SARS from Beijing were studied. RESULTS: Patients with elder age or with comorbid conditions were more likely to develop into severe cases. Data also showed the following characteristics in those severe cases: sustained fever, tachycardia (pulse rate being over 100 per minute), persistent decrease in lymphocytes (< 0.9 x 10(9)/L), increase in neutrophils (> 7.1 x 10(9)/L, 80%), and rapid changes in abnormal chest X-ray. The Cox proportional hazard multi-variable stepwise analysis showed the prediction model of severe SARS included age, comorbid disease, body temperature being still abnormal after 2 days of hospitalization, neutrophil percentage began to increase steadily to more than 80% after 3 days of hospitalization, counts of lymphocytes persisted < 0.9 x 10(9)/L after 4 days of hospitalization. CONCLUSIONS: According to patient's age, comorbid conditions, one can effectively predict the development of the severe SARS by closely monitoring temperature, pulse rate, the counts of lymphocytes and percent of neutrophils.

Adult↗

PubMedDate not supplied

Early warning system scores and response times: an audit.

In response to NHS reforms within critical care, the surgical directorate of the Southern Derbyshire Acute Hospitals NHS Trust developed and introduced a modified early warning system (DMEWS). Anecdotal evidence from nursing staff indicated that response times by doctors, when triggered by use of the DMEWS, were outside the established timescale. An audit was undertaken to determine the response times to calls for assistance triggered by use of the DMEWS and to identify any disparity between response times. The audit confirmed that whilst DMEWS triggered the nurses to initiate action for immediate treatment, response by members of the surgical teams was below the agreed standards. Further studies are planned to indicate whether longer response times have an adverse effect on patient welfare or outcome.

Critical Care↗