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Performance of patient acuity rating by rapid response team nurses for predicting short-term prognosis.

ABSTRACT: BACKGROUND:Although scoring and machine learning methods have been developed to predict patient deterioration, bedside assessment by nurses should not be overlooked. This study aimed to evaluate the performance of subjective bedside assessment of the patient by the rapid response team (RRT) nurses in predicting short-term patient deterioration. METHODS:Patients noticed by RRT nurses based on the vital sign instability, abnormal laboratory results, and direct contact via phone between November 1, 2016, and December 12, 2017, were included. Five RRT nurses visited the patients according to their shifts and assessed the possibility of patient deterioration. Patient acuity rating (PAR), a scale of 1-7, was used as the tool of bedside assessment. Other scores, including the modified early warning score, VitalPAC early warning score, standardised early warning score, and cardiac arrest risk triage, were calculated afterwards. The performance of these scores in predicting mortality and/or intensive care unit admission within 1 day was compared by calculating the area under the receiver operating curve. RESULTS:A total of 1,426 patients were included in the study, of which 258 (18.1%) died or were admitted to the intensive care unit within 1 day. The area under the receiver operating curve of PAR was 0.87 (95% confidence interval [CI] 0.84-0.89), which was higher than those of modified early warning score (0.66, 95% CI 0.62-0.70), VitalPAC early warning score (0.69, 95% CI 0.66-0.73), standardised early warning score (0.67, 95% CI 0.63-0.70) and cardiac arrest risk triage (0.63, 95% CI 0.59-0.66) (P<0.001). CONCLUSIONS:PAR assessed by RRT nurses can be a useful tool for assessing short-term patient prognosis in the RRT setting.

SUBMITTER: Kim HJ

PROVIDER: S-EPMC6855430 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Performance of patient acuity rating by rapid response team nurses for predicting short-term prognosis.

Kim Hyung-Jun HJ Min Hyun-Ju HJ Lee Dong-Seon DS Choi Yun-Young YY Yoon Miae M Lee Da-Yun DY Song In-Ae IA Cho Jun Yeun JY Park Jong Sun JS Cho Young-Jae YJ Jo You-Hwan YH Yoon Ho Il HI Lee Jae Ho JH Lee Choon-Taek CT Lee Yeon Joo YJ

PloS one 20191114 11

<h4>Background</h4>Although scoring and machine learning methods have been developed to predict patient deterioration, bedside assessment by nurses should not be overlooked. This study aimed to evaluate the performance of subjective bedside assessment of the patient by the rapid response team (RRT) nurses in predicting short-term patient deterioration.<h4>Methods</h4>Patients noticed by RRT nurses based on the vital sign instability, abnormal laboratory results, and direct contact via phone betw ...[more]

PMID: 31725773

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Project description:Background: The impact on athletes based on grouping methods according to the date of birth within the constituent year, known as the relative effect of age (RAE), is a factor that can influence the achievement of sports success. Many studies have examined the magnitude of this phenomenon in sport; however, the relationship between the RAE and performance in team sports competition has not been accurately evaluated so far. The purpose of this study was to conduct a systematic review on the influence of the RAE on competition performance in team sports through analysis of published peer-reviewed articles from 2000 to 2019. Methods: According to Preferred Reporting Items for Systematic Reviews and Meta-Analysis systematic search guidelines, 19 studies were identified of the 2,093 that were found in the systematic searching process carried out in four databases: Sport Discus, PubMed, Web of Knowledge, and Scopus. The sample of the study was composed by 77,329 players, of which 92.08% were male and 7.92% were female, whereas the recorded performance measurements were 87,556. The relation between relative age effects and competition performance was registered according to constraints-based theoretical model: individual constraints (sample characteristics) and task constraints (sport context). Moreover, study quality analysis, Strengthening the Reporting of Observational Studies in Epidemiology, was carried out. Results: The short-term individual (10.20%) and collective (18.09%) performance was influenced by the RAE, whereas the long-term individual performance (49.71%) was affected by the RAE reverse. However, in 16.99% of the measurements, no relationship was found between the RAE and competition performance. In the analysis by subcategory, the influence of the RAE was higher in men, in adulthood (senior category), in invasion games, and in national contexts. Discussion: The findings clearly demonstrated that the RAE has a great influence on the performance in team sport. Possible implications for policy and practice should be discussed in order to prevent unequal practice based on biased models that prioritize the athlete's current performance and therefore obviate their maturational development. The heterogeneity and variability of the identified results require a relativization of the findings of this study.

Project description:BackgroundPatient hand-offs at physician shift changes have limited ability to convey the primary team's longitudinal insight. The Patient Acuity Rating (PAR) is a previously validated, 7-point scale that quantifies physician judgment of patient stability, where a higher score indicates a greater risk of clinical deterioration. Its impact on cross-covering physician understanding of patients is not known.ObjectiveTo determine PAR contribution to sign-outs.DesignCross-sectional survey.SubjectsIntern physicians at a university teaching hospital.InterventionsSubjects were surveyed using randomly chosen, de-identified patient sign-outs, previously assigned PAR scores by their primary teams. For each sign-out, subjects assigned a PAR score, then responded to hypothetical cross-cover scenarios before and after being informed of the primary team's PAR.Main measureChanges in intern assessment of the scenario before and after being informed of the primary team's PAR were measured. In addition, responses between novice and experienced interns were compared.Key resultsBetween May and July 2008, 23 of 39 (59 %) experienced interns and 25 of 42 (60 %) novice interns responded to 480 patient scenarios from ten distinct sign-outs. The mean PAR score assigned by subjects was 4.2 ± 1.6 vs. 3.8 ± 1.8 by the primary teams (p < 0.001). After viewing the primary team's PAR score, interns changed their level of concern in 47.9 % of cases, their assessment of the importance of immediate bedside evaluation in 48.7 % of cases, and confidence in their assessment in 43.2 % of cases. For all three assessments, novice interns changed their responses more frequently than experienced interns (p = 0.03, 0.009, and <0.001, respectively). Overall interns reported the PAR score to be theoretically helpful in 70.8 % of the cases, but this was more pronounced in novice interns (81.2 % vs 59.6 %, p < 0.001).ConclusionsThe PAR adds valuable information to sign-outs that could impact cross-cover decision-making and potentially benefit patients. However, correct training in its use may be required to avoid unintended consequences.

Project description:ObjectiveThe purpose of this meta-analysis was to study the short-term adaptations on sprint and vertical jump (VJ) performance following Complex Training (CT) in team-sports. CT is a resistance training method aimed at developing both strength and power, which has a direct effect on sprint and VJ. It consists on alternating heavy resistance training exercises with plyometric/power ones, set for set, on the same workout.MethodsA search of electronic databases up to July 2016 (PubMed-MEDLINE, SPORTDiscus, Web of Knowledge) was conducted. Inclusion criteria: 1) at least one CT intervention group; 2) training protocols ≥4-wks; 3) sample of team-sport players; 4) sprint or VJ as an outcome variable. Effect sizes (ES) of each intervention were calculated and subgroup analyses were performed.ResultsA total of 9 studies (13 CT groups) met the inclusion criteria. Medium effect sizes (ES) (ES = 0.73) were obtained for pre-post improvements in sprint, and small (ES = 0.41) in VJ, following CT. Experimental-groups presented better post-intervention sprint (ES = 1.01) and VJ (ES = 0.63) performance than control-groups.Sprintlarge ESs were exhibited in younger athletes (<20 years old; ES = 1.13); longer CT interventions (≥6 weeks; ES = 0.95); conditioning activities with intensities ≤85% 1RM (ES = 0.96) and protocols with frequencies of <3 sessions/week (ES = 0.84). Medium ESs were obtained in Division I players (ES = 0.76); training programs >12 total sessions (ES = 0.74).VjLarge ESs in programs with >12 total sessions (ES = 0.81). Medium ESs obtained for under-Division I individuals (ES = 0.56); protocols with intracomplex rest intervals ≥2 min (ES = 0.55); conditioning activities with intensities ≤85% 1RM (ES = 0.64); basketball/volleyball players (ES = 0.55). Small ESs were found for younger athletes (ES = 0.42); interventions ≥6 weeks (ES = 0.45).ConclusionsCT interventions have positive medium effects on sprint performance and small effects on VJ in team-sport athletes. This training method is a suitable option to include in the season planning.

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Performance of patient acuity rating by rapid response team nurses for predicting short-term prognosis.

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Performance of patient acuity rating by rapid response team nurses for predicting short-term prognosis.

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