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The usability of continuous monitoring devices with deterioration alerting systems in non-critical care units: scoping review
Get PDFBackground:
Delayed recognition of patient deterioration in a non–intensive care unit (ICU) setting contributes to serious adverse events. Continuous monitoring devices with alerting systems offer real-time data to support early detection, but their effectiveness depends on usability. While prior reviews focus on clinical outcomes, usability—defined by effectiveness, efficiency, and satisfaction—remains underexplored.
Objective:
This study aims to scope the evidence related to the usability of continuous monitoring devices with deterioration alerting in noncritical adult care units.
Methods:
A scoping review was conducted following the Joanna Briggs Institute methodology and reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A comprehensive search of MEDLINE, Embase, Emcare, Web of Science, and IEEE Xplore was performed for studies published up to November 2024. Title and abstract screening, full-text review, and data extraction were independently conducted by 2 reviewers. Studies were included if they (1) evaluated the usability—defined as effectiveness, efficiency, or satisfaction—of continuous monitoring devices; (2) focused on adult patients in non-ICU hospital settings; (3) used primary data; (4) were published in English; and (5) described how clinicians received alerts.
Results:
The search identified 1284 papers, with 35 included. Most studies focused on postoperative patients in surgical wards, mainly from the United States and the Netherlands. Only 2 studies used mixed methods, and 10 reported clinician characteristics. While effectiveness (71%) and efficiency (74%) were widely studied, satisfaction (46%) and usability barriers (29%) received less attention.
Conclusions:
Continuous monitoring devices with deterioration alerts may reduce rapid response team calls and ICU transfers, save time, and maintain acceptable alarm frequencies with high user satisfaction. However, usability challenges persist, including technical issues, alarm fatigue, patient discomfort, and limited training or workflow integration. This review mapped current use, usability, and barriers, categorized key usability factors for improvement, and identified the need for further research on clinician perspectives and broader health care settings to enhance generalizability
The clinical and cost-effectiveness of paravertebral blockade versus thoracic epidural blockade in reducing chronic post-thoracotomy pain: TOPIC2 RCT synopsis
Get PDFBackground
More than a third of patients undergoing thoracotomy suffer from debilitating chronic post-thoracotomy pain lasting months or years postoperatively. Aggressive management of acute pain during the perioperative period may mitigate this risk.
Objective(s)
To determine the clinical and cost-effectiveness of paravertebral blockade compared to thoracic epidural blockade, by testing the hypothesis that paravertebral blockade reduces the incidence of chronic post-thoracotomy pain.
Design and methods
A parallel, open, multicentre, randomised controlled with integrated health-economic evaluation and an internal pilot that incorporated a qualitative recruitment intervention.
Setting and participants
Adult patients undergoing thoracotomy in 15 United Kingdom centres.
Interventions
Paravertebral blockade compared to thoracic epidural blockade.
Main outcome measures
The primary outcome was the presence of chronic post-thoracotomy pain at 6 months post randomisation defined as ‘worst chest pain over the last week’ of at least moderate intensity, with a visual analogue scale score ≥ 40 mm. Secondary outcomes included visual analogue scale pain scores in the acute (days 1, 2, 3 and discharge) and chronic (3, 6 and 12 months) phases postoperatively; Brief Pain Inventory; Short Form McGill Pain Questionnaire 2; Hospital Anxiety and Depression Scale; patient satisfaction; analgesia use in the acute and chronic phases; complications (analgesic, surgical and pulmonary) and mortality. For the economic evaluation, the EuroQol-5 Dimensions, five-level version questionnaire was utilised.
Results
Between 8 January 2019 and 29 September 2023, 770 patients underwent randomisation; 33 did not proceed to thoracotomy. At 6 months, 59 (22%) of 272 participants in the paravertebral blockade group and 47 (16%) of 292 in the thoracic epidural blockade group developed chronic pain [adjusted risk ratio = 1.32 (95% confidence interval 0.93 to 1.86); adjusted risk difference = 0.05 (95% confidence interval −0.01 to 0.11); p = 0.12]. During the acute phase, both worst and average pain was higher on day 1 with paravertebral blockade [adjusted mean difference 7.7 mm (95% confidence interval 2.8 to 12.5) and 7.0 mm (95% confidence interval 2.7 to 11.2), respectively] but not different on days 2 and 3. Hypotension was less common in the paravertebral blockade group [adjusted risk ratio = 0.66 (95% confidence interval 0.46 to 0.94)], and overall complications were comparable between groups. The health-economic analysis demonstrated that thoracic epidural blockade produced an additional 0.04 quality-adjusted life-years when compared to paravertebral blockade, and was associated with slightly lower costs, but these differences were not statistically significant.
Limitations
The main limitation is the reduced sample size from 1026 to 770, which reduced the associated power from 90% to 80%. The key reasons are related to practice change over time resulting in a downgrade in equipoise and the COVID pandemic. Also, we cannot rule out that lack of blinding may have had some impact on the acute phase outcomes.
Conclusions
In our study, paravertebral blockade and thoracic epidural blockade appear to be equivalent in clinical and cost-effectiveness in preventing chronic post-thoracotomy at 6 months; this may be paving the way for both techniques likely to continue in National Health Service thoracic settings, based on clinician and patient’s choices.
Future work
Using full TOPIC-2 data sets, defined according to the European Society of Thoracic Surgeons data set, to explore the trajectory of the development from acute to chronic post-surgery pain.
Funding
This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 16/111/111
Geomorphological characterisation, pattern, and distribution of ice-margin positions of the former Scandinavian Ice Sheet
Get PDFRetreating ice sheets leave behind rich landform records which can be used to understand glaciological processes and the responses of ice sheets to warming climates. Ice-marginal landforms are formed along glacier margins, and their distribution on the beds of palaeo-ice sheets can be used to reconstruct former ice-margin positions. Here we scrutinised high-resolution (1–2 m/pixel) digital terrain models across Norway, Sweden, and Finland, applying a consistent approach to observe ice-marginal landforms and then synthesising these to reconstruct former ice-margin positions of the Scandinavian Ice Sheet. We present a map of ∼51,000 pieces of ice marginal evidence defined by assemblages of landforms. Each ice margin is categorised by the dominant landform type that defines it: moraines 250 m wide, De Geer moraines, hummocky moraines, ice-marginal meltwater channels, or glaciofluvial fans and deltas. The distribution of the landform type that defines each ice margin is found to vary across the ice sheet. We investigate these spatial patterns and suggest; i) sediment cover controls the location of ice-margin positions interpreted from meltwater channels; ii) there is a climatic control on the formation of ice-margin positions interpreted from hummocky moraines; iii) moraine size is influenced by the presence or absence of a marine or lake environment at the ice margin. Our ice-margin positions are made available as maps and GIS data and complement the rich record of ice-marginal landforms previously reported in the literature. Importantly, our database provides seamless, internally-consistent maps and data for use with ice sheet modelling investigations
Temporalities of mining and displacement/resettlement in Mozambique’s coal frontier
Get PDFCommunity displacement and resettlement is an integral part of mining operations and closely linked with mining temporalities. Previous studies have examined the temporalities on displacement and resettlement and their impacts. What is less examined is the implication of ownership shifts during displacement and resettlement processes for affected communities. In Tete, an emerging coalmining region in central Mozambique, before the start of coal production in 2011, the Brazilian mining firm Vale led the resettlement of more than a thousand families in Moatize District. In 2022, however, Vale sold its coal project to the Indian mining company, Vulcan, and transferred the ongoing resettlement project to Vulcan. This article shows that such shifts in ownership have triggered changes in the corporate displacement and resettlement policy along with changing engagements with national mining policies. These changes have forced the community residents in the coalmining region to cope with increased long-term uncertainties regarding the resettlement project. The article advances scholarship on the relationship between multi-dimensional temporalities and displacement and resettlement processes by foregrounding the underexplored implications of temporal disruptions caused by shifts in investors and the resulting effects on community residents. As more investor shifts are expected in coal projects due to increasing decarbonsiation efforts, the role of host governments has become more important in protecting the community residents’ interests and improving long-term resettlement outcomes
Targeting ERAP1 to disarm Gli activation in Sonic Hedgehog medulloblastoma
No full textThe Hedgehog (Hh) signaling pathway is a fundamental regulator of embryonic development, tissue patterning, and stem cell maintenance. The Hh pathway is activated by one of any three ligands: Sonic, Indian, or Desert Hh. Hh ligand binding to the receptor PTCH1, a 12-transmembrane cholesterol transporter, relieves PTCH1’s inhibition of SMO, a G protein-coupled receptor. Once active, SMO localizes to the primary cilium, where it promotes activation of the Gli transcription factors while preventing their proteasomal processing. Dysregulation of Hh signaling is implicated in several malignancies, most notably Sonic Hedgehog-type medulloblastoma (Shh-MB), the most common malignant pediatric brain tumor. In Shh-MB, loss-of-function mutations in PTCH1 or gain-of-function mutations in SMO lead to constitutive activation of Gli transcription factors, locking cerebellar granule neuron progenitors in a proliferative state and preventing terminal differentiation. Despite the development of SMO inhibitors such as vismodegib and sonidegib, their use in children is contraindicated due to irreversible growth plate closure and skeletal toxicity. Moreover, resistance frequently emerges through mutations downstream of SMO, underscoring the need for alternative strategies that target the pathway at its terminal effectors
Design and optimization of miniaturized co-planar Vivaldi antennas for enhanced microwave imaging in brain hemorrhage detection
Get PDFWe designed and optimized a miniaturized coplanar Vivaldi antenna specifically for microwave imaging in cerebral hemorrhage detection. The antenna measures 80 mm × 80 mm × 1 mm and features an arc-shaped radiating arm, a 3 mm × 3 mm optimized pad layout, and an improved metallized via structure with nine vias, each 0.5 mm in diameter. These enhancements significantly improve the antenna's directivity, impedance matching, and signal penetration capability. Experimental results demonstrate that the antenna operates stably within the ultra-wide frequency band of 1.6-8 GHz, achieving a reflection coefficient as low as -45 dB at 4 GHz, a voltage standing wave ratio (VSWR) consistently below 1.5, and a peak gain of 9.5 dB at 6.5 GHz. These characteristics fully meet the sensitivity and penetration depth requirements for medical imaging. In addition to presenting a novel antenna design, this study validates its effectiveness under realistic biological conditions. Comparative analysis between 18- and 36-element antenna arrays demonstrates that the 36-element configuration improves image resolution and signal uniformity, while the 18-element array offers faster acquisition and better suitability for emergency or point-of-care screening scenarios. Additionally, in realistic skull model experiments, we employed rotating antenna technology (with a 20° step size) and multi-angle signal acquisition, further optimizing imaging uniformity and detection accuracy in hemorrhagic regions. By integrating real-time differential imaging technology and beamforming algorithms such as Delayed Sum (DAS) and Delayed Multiplication and Sum (DMAS), the experimental results indicate substantial progress in the identification of brain hemorrhage areas. This research provides critical technical support for the development of portable and non-invasive cerebral hemorrhage detection systems. Overall, by integrating miniaturization, performance optimization, and targeted enhancements, this study provides a robust technical basis for the development of early stroke detection systems
Delusion as embodied emotion: a qualitatively-driven, multimethod study in first-episode psychosis in the UK
Get PDFEstimating the number of incorrect tuberculosis diagnoses in low- and middle-income countries
Get PDFTuberculosis (TB) is the greatest cause of infectious disease deaths worldwide. In highly affected countries, effective TB control requires prompt identification and treatment of individuals with active disease. We examined the performance of TB case-finding in low- and middle-income countries based on a comprehensive analysis of TB diagnosis data reported to the World Health Organization. Using these data we estimated the total number of individuals correctly and incorrectly diagnosed with TB, for 111 countries with a collective 6.8 million TB notifications in 2023. Here we estimate that in 2023, 2.05 (1.83-2.27) million individuals were incorrectly diagnosed with TB (false-positives), and 1.00 (0.71-1.36) million received a false-negative diagnosis, at an assumed 25% disease prevalence among individuals evaluated for TB. As many as three of every ten TB notifications may not have TB, and many individuals with TB receive false-negative diagnoses. Compared to current diagnostic performance, scaling-up new polymerase chain reaction-based diagnostics would substantially reduce under-diagnosis but only produce a small reduction in false-positive diagnoses. Major improvements in TB diagnosis will likely require higher-sensitivity bacteriological tests combined with reduced reliance on clinical diagnosis
Radiological outcome of early surgical fixation versus cast immobilization for adults with a scaphoid waist fracture:five-year follow-up of the Scaphoid Waist Internal Fixation for Fractures Trial
Get PDFAims In the Scaphoid Waist Internal Fixation for Fractures Trial (SWIFFT), surgical fixation was compared with cast immobilization, with the primary endpoint being the outcomes at one year. The aim of the current study was to assess the radiological outcomes (union and the development of osteoarthritis (OA)) of the two forms of treatment at five years. Methods Patients who remained in the trial at five years after randomization were invited to have plain radiographs and a CT scan of the injured wrist, and a posterior-anterior radiograph of the contralateral wrist. This imaging was reviewed by three observers independently for union of the fracture and the distribution and severity of OA. This analysis followed a pre-specified statistical analysis plan. The relationship between OA and the Patient-Rated Wrist Evaluation (PRWE) scores at five years was assessed. Results Of the 439 patients who were randomized, 267 (60.8%) provided imaging at five years. Their characteristics were similar to those of the original cohort. A total of 182 patients (68.2%) (n = 92 fixation, n = 90 cast) had complete union and seven had a nonunion (2.6%; n = 3 fixation, n = 4 cast). Fractures with a minimum of 20% union at one year consolidated with the passage of time without intervention. Progression of OA in the joints around the scaphoid was seen in both groups from baseline to five years. By five years, 140 patients (52.4% of those with imaging at five years) had OA in at least one joint with similar prevalences in both groups. The prevalence of OA, the number of arthritic joints and the maximum severity of OA, was similar in the two groups. A total of 344 of the initial cohort of 439 patients (78.4%) provided a valid PRWE score at five years and the mean score was higher in those with more severe OA, indicating worse pain and function. Conclusion Between one and five years after randomization, union consolidated in those with > 20% bridging without intervention. The proportion of patients with full, almost full, partial, slight, and nonunion for the two forms of treatment remained similar at five years. The prevalence and severity of OA increased during the five years but was similar in both groups. Cite this article: Bone Joint J 2026;108-B(1):87–95
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