Publications by authors named "Marco Pimentel"

The widespread administration of COVID-19 vaccines has prompted a need to understand their safety profile. This investigation focuses on the safety of inactivated and mRNA-based COVID-19 vaccines, particularly concerning potential cardiovascular and haematological adverse events. A retrospective cohort study was conducted for 1.

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Article Synopsis
  • The study focuses on improving patient monitoring after discharge from Intensive Care Units (ICUs) by developing an enhanced scoring system that predicts adverse events using ongoing vital signs and an initial risk score from ICU discharge.
  • A modified Delphi process helped identify relevant variables from electronic records, and a logistic regression model estimated the risk of complications, combining static and dynamic scoring to provide continuous updates on patient risk.
  • Validation of the scoring system demonstrated its effectiveness in predicting ICU readmissions or in-hospital deaths within 24 hours, outperforming existing scoring systems like the National Early Warning Score (EWS).
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Background: Intercropping is commonly implemented as a way of promoting sustainable agriculture. Some of the benefits of intercropping include improving resource-use efficiency and soil quality as well as promoting pest control. As for pest control, intercropping can often engender pest repellency/confusion and promote natural biological control.

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  • Wearable pulse oximeters, used for monitoring patients at risk of deterioration (like COVID-19 patients), lack established reliability in hospital environments.
  • The study evaluated the performance of different wearable pulse oximeters under motion and varying levels of oxygen saturation, revealing that movement negatively impacts accuracy but devices still detected hypoxemia effectively.
  • Overall, finger-worn pulse oximeters met international accuracy standards despite some degradation from motion, suggesting they are suitable for clinical use.
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Background: We have developed the Hospital Alerting Via Electronic Noticeboard (HAVEN) which aims to identify hospitalised patients most at risk of reversible deterioration. HAVEN combines patients' vital-sign measurements with laboratory results, demographics and comorbidities using a machine learnt algorithm.

Objectives: The aim of this study was to identify variables or concepts that could improve HAVEN predictive performance.

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  • The COVID-19 pandemic challenged the UK's National Health Service, prompting rapid updates to infection control protocols in hospitals, particularly in isolation wards for COVID-19 patients.
  • The study showcases a wearable ambulatory monitoring system (AMS) that incorporates a chest patch and finger-worn pulse oximeter to continuously track vital signs like heart rate, respiratory rate, and oxygen saturation, thereby minimizing infection risk for nursing staff.
  • The system utilized a secure web-based platform to relay data in real-time to nurses, allowing for efficient monitoring and integration of patient data, with significant uptake during the peak of COVID-19 cases in the UK.
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Background: The standard of care in general wards includes periodic manual measurements, with the data entered into track-and-trigger charts, either on paper or electronically. Wearable devices may support health care staff, improve patient safety, and promote early deterioration detection in the interval between periodic measurements. However, regulatory standards for ambulatory cardiac monitors estimating heart rate (HR) and respiratory rate (RR) do not specify performance criteria during patient movement or clinical conditions in which the patient's oxygen saturation varies.

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Article Synopsis
  • The systematic review aims to evaluate how ambulatory monitoring systems (AMS) impact the early detection of clinical deterioration and outcomes in hospitalized patients compared to standard care.
  • A thorough literature search will be conducted across multiple databases to gather studies that compare AMS with standard monitoring practices, focusing on outcomes like unplanned ICU admissions and emergency interventions.
  • The findings will be analyzed for quality and bias, with results likely presented through a meta-analysis or narrative synthesis, and the study will be shared in scientific publications and conferences.
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Late recognition of patient deterioration in hospital is associated with worse outcomes, including higher mortality. Despite the widespread introduction of early warning score (EWS) systems and electronic health records, deterioration still goes unrecognized. To develop and externally validate a Hospital- wide Alerting via Electronic Noticeboard (HAVEN) system to identify hospitalized patients at risk of reversible deterioration.

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Coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is rapidly spreading across the globe. The clinical spectrum of SARS-CoV-2 pneumonia requires early detection and monitoring, within a clinical environment for critical cases and remotely for mild cases, with a large spectrum of symptoms. The fear of contamination in clinical environments has led to a dramatic reduction in on-site referrals for routine care.

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Background: The global pandemic of coronavirus disease 2019 (COVID-19) has placed a huge strain on UK hospitals. Early studies suggest that patients can deteriorate quickly after admission to hospital. The aim of this study was to model changes in vital signs for patients hospitalised with COVID-19.

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Objectives: National guidelines for identifying physiological deterioration and sepsis in hospitals depend on thresholds for blood pressure that do not account for age or sex. In populations outside hospital, differences in blood pressure are known to occur with both variables. Whether these differences remain in the hospitalised population is unknown.

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Introduction: Automated continuous ambulatory monitoring may provide an alternative to intermittent manual vital signs monitoring. This has the potential to improve frequency of measurements, timely escalation of care and patient safety. However, a major barrier to the implementation of these wearable devices in the ward environment is their uncertain reliability, efficiency and data fidelity.

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Objectives: To calculate fractional inspired oxygen concentration (FiO) thresholds in ward patients and add these to the National Early Warning Score (NEWS). To evaluate the performance of NEWS-FiO against NEWS when predicting in-hospital death and unplanned intensive care unit (ICU) admission.

Methods: A multi-centre, retrospective, observational cohort study was carried out in five hospitals from two UK NHS Trusts.

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Estimation of respiratory rate (RR) from photoplethysmography (PPG) signals has important applications in the healthcare sector, from assisting doctors onwards to monitoring patients in their own homes. The problem is still very challenging, particularly during the motion for large segments of data, where results from different methods often do not agree. The authors aim to propose a new technique which performs motion reduction from PPG signals with the help of simultaneous acceleration signals where the PPG and accelerometer sensors need to be embedded in the same sensor unit.

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Aims: To compare the ability of the National Early Warning Score (NEWS) and the National Early Warning Score 2 (NEWS2) to identify patients at risk of in-hospital mortality and other adverse outcomes.

Methods: We undertook a multi-centre retrospective observational study at five acute hospitals from two UK NHS Trusts. Data were obtained from completed adult admissions who were not fit enough to be discharged alive on the day of admission.

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Aim: The National Early Warning System (NEWS) is based on vital signs; the Laboratory Decision Tree Early Warning Score (LDT-EWS) on laboratory test results. We aimed to develop and validate a new EWS (the LDTEWS:NEWS risk index) by combining the two and evaluating the discrimination of the primary outcome of unanticipated intensive care unit (ICU) admission or in-hospital mortality, within 24 h.

Methods: We studied emergency medical admissions, aged 16 years or over, admitted to Oxford University Hospitals (OUH) and Portsmouth Hospitals (PH).

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Background: Data smoothing of vital signs has been reported in the anesthesia literature, suggesting that clinical staff are biased toward measurements of normal physiology. However, these findings may be partially explained by clinicians interpolating spurious values from noisy signals and by the undersampling of physiological changes by infrequent manual observations. We explored the phenomenon of data smoothing using a method robust to these effects in a large postoperative dataset including respiratory rate, heart rate, and oxygen saturation (SpO2).

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The role of sensing technologies, such as wearables, in delivering precision care is becoming widely acceptable. Given the very large quantities of sensor data that rapidly accumulate, there is a need to employ automated algorithms to label biosignal sensor data. In many real-life clinical applications, no such expert labels are available, and algorithms for processing sensor data must be relied upon, without access to the "ground truth.

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Breathing rate (BR) is a key physiological parameter used in a range of clinical settings. Despite its diagnostic and prognostic value, it is still widely measured by counting breaths manually. A plethora of algorithms have been proposed to estimate BR from the electrocardiogram (ECG) and pulse oximetry (photoplethysmogram, PPG) signals.

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Objective: Respiratory rate (RR) estimation algorithms based on the photoplethymogram (PPG) and electrocardiogram (ECG) lack clinical robustness. This is because the PPG and ECG respiratory modulations are dependent on patient physiology, regardless of general signal quality. The present work describes an RR estimation algorithm using respiratory quality indices (RQIs) that assess the presence or absence of the PPG- and ECG-derived respiratory modulations.

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