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PubMedDate not supplied

Staff experiences of an early warning indicator for unstable patients in Australia.

The objective of this study is to explore nursing and medical staff's perceptions of a clinical marker referral tool implemented to assist in the early identification of unstable patients in the general surgical and medical ward environment. A descriptive, exploratory survey design was undertaken 6 months after the implementation of a clinical marker referral tool. The target population for the survey was all ward nursing, junior medical staff and intensive care unit (ICU) registrars in a metropolitan tertiary referral hospital in Australia. The survey consisted of open-ended and closed-ended questions, as well as statements asking participants to explore their perceptions, attitudes and perceived understanding of the clinical marker referral tool. The surveys were sent to all targeted staff in a personally addressed envelope via the internal mail system. Overall, nursing and medical staff (n = 178) responses were positive to the clinical marker project/tool, offering clear guidelines for staff to respond to the patient's clinical condition and contact the medical staff and the ICU liaison team as appropriate. Furthermore, comments were made in relation to the ICU liaison team acting as a 'support' and 'prompt back-up' for nursing staff when needed. However, ward medical staff had reservations with the clinical markers chosen and with ward nurses being able to contact the ICU registrar after hours. Additionally, the ICU registrars commented on an increase to their workload in having to review unstable patients after hours. These results suggest that the ward nurses required additional support and guidance in caring for the unstable patient in the ward which may improve patient outcomes. Further research investigating the less-favourable responses of the ward medical staff and ICU medical staff is warranted.

Acute Disease↗
PubMed2002

Dinitrogen oxide detection for process failure early warning systems.

A number of experiments were conducted in order to establish whether the concentration of N2O in the off-gas from an activated sludge pilot plant could be used as a indicator for monitoring the nitrification process and as an early indication of ammonia appearing in the plant effluent. A strong correlation was found between ammonia shock loads and the concentration of N20 in the off-gas from the aeration tank for ammonia shock loads and dissolved oxygen depletion. When subjecting the experimental setup to doses of a nitrification inhibitor (allylthiourea) a similar pattern was seen with a correlation between nitrite build up in the aeration tank and concentration increase of N2O in the off-gas from the aeration tank. The results from this work suggest the concentration and the changes in the concentration of N2O in the exhaust gas from a nitrifying process may be a useful parameter for monitoring nitrifying activated sludge processes.

Ammonia↗
PubMed2006

An evaluation of an early warning clinical marker referral tool.

OBJECTIVES: The purpose of this study was to evaluate the introduction of a clinical marker tool using a pre- and post-test design in a tertiary university-affiliated hospital. The clinical marker tool was designed to assist in the early identification of unstable patients in the general surgical and medical ward environment based on abnormal vital signs. METHODS: A pre- and post-test design of the clinical marker tool was undertaken over a 3-year period. All unstable ward patients who were admitted to the Intensive Care Unit (ICU) from 1 February 2002 to 31 January 2003 (pre- implementation period) and from 1 February 2003 to 31 January 2005 (post-implementation period) were included in the study. A secondary analysis was performed on annual medical emergency calls made to the resuscitation team and mortality from such events from 1 January 2002 to 31 December 2004. RESULTS: Prior to implementing the clinical marker tool, 63 (41.2%) unplanned ICU admissions from the ward had clinical markers present for > or =6h. Following implementation of the clinical marker tool, 101 (24.5%) patients had clinical markers present for > or =6h (p=0.0002). There was no difference in ICU or hospital length of stay or hospital mortality for unplanned admissions to the ICU following implementation of the clinical marker tool. The number of patients found to be still breathing with a pulse on arrival of the resuscitation team was significantly increased from 56 (47.9%) patients to 181 (64.6%) patients post-implementation of the clinical marker tool (p=0.0024). Additionally, we found an associated increase in survival of this group of patients discharged home from 33 (59%) patients to 136 (75.1%) patients post-implementation of the clinical marker tool (p=0.0003). CONCLUSIONS: The clinical marker tool implemented by an ICU Liaison Team improved the management of patients in the ward environment, including proactive admission of patients to the ICU. Additionally, implementation of the clinical marker tool was associated with a reduction in the number of cardiac arrests and improvement in hospital mortality for patients experiencing a medical emergency call. The timeframe of instability on the ward prior to the ICU admission may be used as a quality indicator to measure ICU Liaison Team performance. Further research is required to substantiate these findings.

Biomarkers↗
PubMed2005

Early warnings: health care preparedness.

As nurses, we represent the backbone of the health care system. It is essential that we have a core understanding of infectious disease emergencies and begin to use the strengths that characterize nursing. These strengths include the ability to evaluate situations and use evidence on which to base our actions. Early identification of an infectious disease emergency is one example of using nursing skills to strengthen emergency preparedness. During an infectious disease emergency, nurses certainly will bear the burden of patient management. Because of this, the need for infectious disease emergency preparedness has become a national priority and a moral imperative for all nurses. One topic necessary for ED and OH nurses' preparedness has been discussed in this article, but nurses must take the initiative to learn more about disaster preparedness and incorporate these skills into everyday practice.

Animals↗
PubMed1992

Five years of sentinel surveillance of acute respiratory infections (1985-1990): the benefits of an influenza early warning system.

For the last five years, the Brussels Institute of Hygiene and Epidemiology has been involved in the surveillance of acute respiratory infections (ARI). The four indicators used (number of encounters of ARI by GP's/100 encounters, virus isolations, absenteeism and mortality) are discussed. A regression procedure is applied to the data collected by a sentinel network of general practitioners (GP's). This procedure permits the baseline to be visualized and an epidemic threshold to be determined in order to recognize early an influenza outbreak. The traditional use of flu-like illnesses as an indicator might be improved by the addition of non-specific ARI which are more precocious, especially in children. The criteria for an accurate definition of an influenza epidemic are discussed. The same mathematical model can be used for the analysis of mortality linked with an outbreak. It shows that the last epidemic in the winter 1989-1990 was responsible for about 4900 deaths directly or indirectly related to influenza.

Absenteeism↗
PubMed1998

Gastric tonometry: early warning of tissue hypoperfusion.

Perfusion status of the critically ill and injured has, in the past, been assessed by indices such as blood pressure (BP), heart rate, and urine output. These indices represent global perfusion and may not reflect regional blood-flow abnormalities. These hypoperfused regions may lead to organ failure and subsequent death. The gastrointestinal (GI) tract remains one of these tissue beds that is extremely sensitive to low-flow states. Gastric tonometry is a noninvasive means in which these early symptoms of low flow may be monitored with early interventions to optimize tissue perfusion and patient outcome.

Carbon Dioxide↗
PubMedDate not supplied

Dead bird surveillance as an early warning system for West Nile virus.

As part of West Nile (WN) virus surveillance in New York State in 2000, 71,332 ill or dead birds were reported; 17,571 (24.6%) of these were American Crows. Of 3,976 dead birds tested, 1,263 (31.8%) were positive for WN virus. Viral activity was first confirmed in 60 of the state's 62 counties with WN virus-positive dead birds. Pathologic findings compatible with WN virus were seen in 1,576 birds (39.6% of those tested), of which 832 (52.8%) were positive for WN virus. Dead crow reports preceded confirmation of viral activity by several months, and WN virus-positive birds were found >3 months before the onset of human cases. Dead bird surveillance appears to be valuable for early detection of WN virus and for guiding public education and mosquito control efforts.

Animals↗
PubMed2006

Establishment of an early warning system against bluetongue virus in Switzerland.

Bluetongue (BT) is a vector-borne animal disease of economical importance due to the international trade restrictions likely to be put into place in a country once the infection is discovered. The presence of BT and its vectors in countries adjacent to Switzerland stresses the need of implementing a surveillance system and to raise disease awareness among potential stakeholders. A national survey in Switzerland 2003 indicated freedom of Bluetongue virus (BTV), although a single individual of the main BT vector Culicoides imicola was caught in the canton of Ticino. The survey also demonstrated that potential BT vectors, C. obsoletus and C. pulicaris are locally abundant in Switzerland. Therefore, a new surveillance method based on sentinel herds in high risk areas was implemented in 2004 for the early detection of both an incursion of BT vectors into Switzerland, and potential virus circulation among cattle.

Animals↗
PubMed1998

Red blood cell rigidification during cyclosporin therapy: a possible early warning signal for adverse reactions.

In a previous retrospective study with kidney-transplant patients, immunosuppressive treatment with Cyclosporin A (CsA) was found to be associated with impaired red blood cell (RBC) deformability. The aim of the present study was to evaluate and substantiate a possible causal relationship between the use of CsA and its effect on RBC deformability in a prospective study on non-transplant patients. Blood samples of 12 patients with psoriasis were taken before and after 2, 4, 8, 12 and 16 weeks of treatment with CsA (3-5 mg/day). Red cell deformability, expressed as Elongation Index (EI), was measured with the Laser-assisted Optical Rotational Cell Analyzer (LORCA), a new ektacytometric instrument. Mean values +/- SD for EI found after 16 weeks of treatment with cyclosporin (0.570 +/- 0.008) were significantly (p < 0.001) lower than the value before treatment (0.589 +/- 0.011). A dose-response relation could not be established within the small range of CsA doses used in this study. Irrespective of the dose, however, a significant correlation (r = -0.55; p = 0.0001) between duration of treatment and decrease in EI was demonstrated. In vitro incubation of blood with cyclosporin was not able to reproduce this effect, suggesting that a direct effect of the drug on RBCs is unlikely. Despite its use in relatively low doses, CsA causes a reduction in RBC deformability, an effect that increases during the course of treatment. It is suggested that this slow, but continuously increasing, RBC rigidification plays a role in the early pathogenesis of the adverse nephrotoxic complications frequently associated with this immunosuppressive regimen.

Cyclosporine↗
PubMed2003

Women's early warning symptoms of acute myocardial infarction.

BACKGROUND: Data remain sparse on women's prodromal symptoms before acute myocardial infarction (AMI). This study describes prodromal and AMI symptoms in women. METHODS AND RESULTS: Participants were 515 women diagnosed with AMI from 5 sites. Using the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey, we surveyed them 4 to 6 months after discharge, asking about symptoms, comorbidities, and demographic characteristics. Women were predominantly white (93%), high school educated (54.8%), and older (mean age, 66+/-12), with 95% (n=489) reporting prodromal symptoms. The most frequent prodromal symptoms experienced more than 1 month before AMI were unusual fatigue (70.7%), sleep disturbance (47.8%), and shortness of breath (42.1%). Only 29.7% reported chest discomfort, a hallmark symptom in men. The most frequent acute symptoms were shortness of breath (57.9%), weakness (54.8%), and fatigue (42.9%). Acute chest pain was absent in 43%. Women had more acute (mean, 7.3+/-4.8; range, 0 to 29) than prodromal (mean, 5.71+/-4.36; range, 0 to 25) symptoms. The average prodromal score, symptom weighted by frequency and intensity, was 58.5+/-52.7, whereas the average acute score, symptom weighted by intensity, was 16.5+/-12.1. These 2 scores were correlated (r=0.61, P<0.001). Women with more prodromal symptoms experienced more acute symptoms. After controlling for risk factors, prodromal scores accounted for 33.2% of acute symptomatology. CONCLUSIONS: Most women have prodromal symptoms before AMI. It remains unknown whether prodromal symptoms are predictive of future events.

Adult↗
PubMed2003

Detection of chemical threat agents in drinking water by an early warning real-time biomonitor.

Having a safe water supply for civilian organizations and military personnel is an important objective to avoid toxic contamination of civilians and soldiers. Chemical warfare (CW) agents, especially organophosphorous nerve compounds, are the most toxic of known chemical agents. The Daphnia Toximeter system is a continuously working test system that uses Daphnia magna as a sensitive organism for monitoring drinking water. Both small doses (allowable for short-term water ingestion) and graduated higher concentrations induced toxic reactions in the Daphnia Toximeter system, leading to alarms sounding. The system is sensitive to a wide range of CW agents and their hydrolysis products. Concentrations below acute human toxicity can be discovered in a very short time, with the actual time depending on the concentrations applied. In every case alarms were triggered within 2 h at concentrations in water low enough for that water to be allowed for use as drinking water in exceptional conditions.

Animals↗
PubMed2000

Effects of 2,4-dichlorophenol on the net-spinning behavior of hydropsyche slossonae larvae (Trichoptera; Hydropsychidae), an early warning signal of chronic toxicity.

In order to assess the potential of hydropsychid capture net anomalies as a bioindicator of chronic toxicity in streams and rivers, the effects of 2,4-dichlorophenol (2,4-DCP) exposure on the net-spinning behavior of Hydropsyche slossonae were examined for anomalies after 0, 5, 10, 15, and 20 exposure days to gradient concentration of 2,4-dichlorophenol. The net-spinning behavior was significantly affected when larvae were exposed to 1.0, 10, 25, and 50 microg small middle dotL(-1), as expressed by the occurrence of two distinct abnormalities. The first one was a distortion of the midline meshes, where the normal diamond-shape structure is disrupted and the meshes are separated by extra strands (called "midline anomaly). The second aberration observed was called "chaotic net, where the nets are highly irregular without any real structure or well-defined areas. A good correlation was found between the chaotic net frequencies and the reduction of ATP concentrations in the larvae, indicating possible uncoupling effects of 2,4-DCP on the oxidative phosphorylation process. Toxicity curves demonstrate that the sensitivity threshold of chaotic net frequencies ranged from 3.5 to 7 microg small middle dotL(-1), which is highly sensitive compared with other sublethal effects of 2,4-DCP on other aquatic species.

Abnormalities, Drug-Induced↗