Relevant bibliographies by topics / Patient Deterioration

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  1. Journal articles
  2. Dissertations / Theses
  3. Books
  4. Book chapters
  5. Conference papers
  6. Reports

Academic literature on the topic 'Patient Deterioration'

Author: Grafiati
Published: 4 June 2021
Last updated: 19 February 2023

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Journal articles on the topic "Patient Deterioration"

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Sprinks, Jennifer. "Patient deterioration." Emergency Nurse 22, no. 9 (February 9, 2015): 17. http://dx.doi.org/10.7748/en.22.9.17.s17.

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Lee, Jinmi, Yujung Shin, Eunjoo Choi, Sunhui Choi, Jeongsuk Son, Youn Kyung Jung, and Sang-Bum Hong. "Impact of hospitalization duration before medical emergency team activation: A retrospective cohort study." PLOS ONE 16, no. 2 (February 19, 2021): e0247066. http://dx.doi.org/10.1371/journal.pone.0247066.

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Background The rapid response system has been implemented in many hospitals worldwide and, reportedly, the timing of medical emergency team (MET) attendance in relation to the duration of hospitalization is associated with the mortality of MET patients. We evaluated the relationship between duration of hospitalization before MET activation and patient mortality. We compared cases of MET activation for early, intermediate, and late deterioration to patient characteristics, activation characteristics, and patient outcomes. We also aimed to determine the relationship, after adjusting for confounders, between the duration of hospitalization before MET activation and patient mortality. Materials and methods We retrospectively evaluated patients who triggered MET activation in general wards from March 2009 to February 2015 at the Asan Medical Center in Seoul. Patients were categorized as those with early deterioration (less than 2 days after admission), intermediate deterioration (2–7 days after admission), and late deterioration (more than 7 days after admission) and compared them to patient characteristics, activation characteristics, and patient outcomes. Results Overall, 7114 patients were included. Of these, 1793 (25.2%) showed early deterioration, 2113 (29.7%) showed intermediate deterioration, and 3208 (45.1%) showed late deterioration. Etiologies of MET activation were similar among these groups. The clinical outcomes significantly differed among the groups (intensive care unit transfer: 34.1%, 35.6%, and 40.4%; p < 0.001 and mortality: 26.3%, 31.5%, and 41.2%; p < 0.001 for early, intermediate, and late deterioration, respectively). Compared with early deterioration and adjusted for confounders, the odds ratio of mortality for late deterioration was 1.68 (1.46–1.93). Conclusions Nearly 50% of the acute clinically-deteriorating patients who activated the MET had been hospitalized for more than 7 days. Furthermore, they presented with higher rates of mortality and ICU transfer than patients admitted for less than 7 days before MET activation and had mortality as an independent risk factor.
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Ruata, T. Annette. "Recognizing acute patient deterioration." Nursing Management (Springhouse) 47, no. 6 (June 2016): 8. http://dx.doi.org/10.1097/01.numa.0000483124.63354.cc.

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Albutt, Abigail, Jane O'Hara, Mark Conner, and Rebecca Lawton. "Involving patients in recognising clinical deterioration in hospital using the Patient Wellness Questionnaire: A mixed-methods study." Journal of Research in Nursing 25, no. 1 (September 25, 2019): 68–86. http://dx.doi.org/10.1177/1744987119867744.

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Background Measures exist to improve early recognition of, and response to deteriorating patients in hospital. Despite these, 7% of the deaths reported to the National Reporting and Learning System from acute hospitals in 2015 related to a failure to recognise or respond to deterioration. Interventions have been developed that allow patients and relatives to escalate patient deterioration to a critical care outreach team. However, there is not a strong evidence base for the clinical effectiveness of these interventions, or patients' ability to recognise deterioration. Aims The aims of this study were as follows. (a) To identify methods of involving patients in recognising deterioration in hospital, generated by health professionals. (b) To develop and evaluate an identified method of patient involvement in practice, and explore its feasibility and acceptability from the perspectives of patients. Methods The study used a mixed-methods design. A measure to capture patient-reported wellness during observation was developed (Patient Wellness Questionnaire) through focus group discussion with health professionals and patients, and piloted on inpatient wards. Results There was limited uptake where patients were asked to record ratings of their wellness using the Patient Wellness Questionnaire themselves. However, where the researcher asked patients about their wellness using the Patient Wellness Questionnaire and recorded their responses during observation, this was acceptable to most patients. Conclusions This study has developed a measure that can be used to routinely collect patient-reported wellness during observation in hospital and may potentially improve early detection of deterioration.
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Hamming-Vrieze, Olga, Simon van Kranen, Iris Walraven, Arash Navran, Abrahim Al-Mamgani, Margot Tesselaar, Michiel van den Brekel, and Jan-Jakob Sonke. "Deterioration of Intended Target Volume Radiation Dose Due to Anatomical Changes in Patients with Head-and-Neck Cancer." Cancers 13, no. 17 (August 24, 2021): 4253. http://dx.doi.org/10.3390/cancers13174253.

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Delivered radiation dose can differ from intended dose. This study quantifies dose deterioration in targets, identifies predictive factors, and compares dosimetric to clinical patient selection for adaptive radiotherapy in head-and-neck cancer patients. One hundred and eighty-eight consecutive head-and-neck cancer patients treated up to 70 Gy were analyzed. Daily delivered dose was calculated, accumulated, and compared to the planned dose. Cutoff values (1 Gy/2 Gy) were used to assess plan deterioration in the highest/lowest dose percentile (D1/D99). Differences in clinical factors between patients with/without dosimetric deterioration were statistically tested. Dosimetric deterioration was evaluated in clinically selected patients for adaptive radiotherapy with CBCT. Respectively, 16% and 4% of patients had deterioration over 1 Gy in D99 and D1 in any of the targets, this was 5% (D99) and 2% (D1) over 2 Gy. Factors associated with deterioration of D99 were higher baseline weight/BMI, weight gain early in treatment, and smaller PTV margins. The sensitivity of visual patient selection with CBCT was 22% for detection of dosimetric changes over 1 Gy. Large dose deteriorations in targets occur in a minority of patients. Clinical prediction based on patient characteristics or CBCT is challenging and dosimetric selection tools seem warranted to identify patients in need for ART, especially in treatment with small PTV margins.
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Chu, Julie, and Christine Cutugno. "DETERIORATION IN THE SURGICAL PATIENT." AJN, American Journal of Nursing 108, no. 1 (January 2008): 72CC—72DD. http://dx.doi.org/10.1097/01.naj.0000305137.20380.d2.

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Beane, Abi, Wageesha Wijesiriwardana, Christopher Pell, N. P. Dullewe, J. A. Sujeewa, R. M. Dhanapala Rathnayake, Saroj Jayasinghe, Arjen M. Dondorp, Constance Schultsz, and Rashan Haniffa. "Recognising the deterioration of patients in acute care wards: a qualitative study." Wellcome Open Research 7 (April 19, 2022): 137. http://dx.doi.org/10.12688/wellcomeopenres.17624.1.

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Background: Infrastructure, equipment and staff constraints are often cited as barriers to the recognition and rescue of deteriorating patients in resource-limited settings. The impact of health-system organisation, decision-making and organisational culture on recognition of deterioration is however poorly understood. This study explores how health care providers recognise deterioration of patients in acute care in Sri Lanka. Methods: In-depth interviews exploring decision making and care processes related to recognition of deterioration, were conducted with a purposive sample of 23 health care workers recruited from ten wards at a district hospital in Sri Lanka. Interviews were audio-recorded, transcribed and coded thematically, line-by-line, using a general inductive approach. Results: A legacy of initial assessment on admission and inimical organisational culture undermined recognition of deteriorating patients in hospital. Informal triaging at the time of ward admission resulted in patients presenting with red-flag diagnoses and vital sign derangement requiring resuscitation being categorised as "bad". The legacy of this categorisation was a series of decision-making biases anchored in the initial assessment, which remained with the patient throughout their stay. Management for patients categorised as “bad” was prioritised by healthcare workers coupled with a sense of fatalism regarding adverse outcomes. Health care workers were reluctant to deviate from the original plan of care despite changes in patient condition (continuation bias). Organisational culture - vertical hierarchy, siloed working and a reluctance to accept responsibility- resulted in omissions which undermined recognition of deterioration. Fear of blame was a barrier to learning from adverse events. Conclusions: The legacy of admission assessment and hospital organisational culture undermined recognition of deterioration. Opportunities for improving recognition of deterioration in this setting may include establishing formal triage and medical emergency teams to facilitate timely recognition and escalation.
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Beane, Abi, Wageesha Wijesiriwardana, Christopher Pell, N. P. Dullewe, J. A. Sujeewa, R. M. Dhanapala Rathnayake, Saroj Jayasinghe, Arjen M. Dondorp, Constance Schultsz, and Rashan Haniffa. "Recognising the deterioration of patients in acute care wards: a qualitative study." Wellcome Open Research 7 (June 13, 2022): 137. http://dx.doi.org/10.12688/wellcomeopenres.17624.2.

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Background: Infrastructure, equipment and staff constraints are often cited as barriers to the recognition and rescue of deteriorating patients in resource-limited settings. The impact of health-system organisation, decision-making and organisational culture on recognition of deterioration is however poorly understood. This study explores how health care providers recognise deterioration of patients in acute care in Sri Lanka. Methods: In-depth interviews exploring decision making and care processes related to recognition of deterioration, were conducted with a purposive sample of 23 health care workers recruited from ten wards at a district hospital in Sri Lanka. Interviews were audio-recorded, transcribed and coded thematically, line-by-line, using a general inductive approach. Results: A legacy of initial assessment on admission and inimical organisational culture undermined recognition of deteriorating patients in hospital. Informal triaging at the time of ward admission resulted in patients presenting with red-flag diagnoses and vital sign derangement requiring resuscitation being categorised as "bad". The legacy of this categorisation was a series of decision-making biases anchored in the initial assessment, which remained with the patient throughout their stay. Management for patients categorised as “bad” was prioritised by healthcare workers coupled with a sense of fatalism regarding adverse outcomes. Health care workers were reluctant to deviate from the original plan of care despite changes in patient condition (continuation bias). Organisational culture - vertical hierarchy, siloed working and a reluctance to accept responsibility- resulted in omissions which undermined recognition of deterioration. Fear of blame was a barrier to learning from adverse events. Conclusions: The legacy of admission assessment and hospital organisational culture undermined recognition of deterioration. Opportunities for improving recognition of deterioration in this setting may include establishing formal triage and medical emergency teams to facilitate timely recognition and escalation.
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Harel, Ran, and Nachshon Knoller. "Acute Cervical Disk Herniation Resulting in Sudden and Severe Neurologic Deterioration: A Case Series." Surgery Journal 02, no. 03 (July 2016): e96-e101. http://dx.doi.org/10.1055/s-0036-1593357.

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Objective Nontraumatic acute cervical disk herniation resulting in acute severe neurologic deficit is a rare entity described in a limited number of case reports. We describe the management and outcome in patients presenting with severe neurologic deterioration caused by acutely herniated cervical disks. Methods Four patients (mean age 39.5 years) presented to our tertiary care academic medical center from September 2012 to September 2013 with severe progressive neurologic deficits due to cervical disk herniation and were included in the series. Patients' surgical, medical, and imaging records were retrospectively reviewed under an Institutional Review Board waiver of informed consent. Results Patients in the series presented with acute neurologic deterioration, including paraparesis, Brown-Séquard syndrome, or quadriparesis deteriorating to quadriplegia. Emergent magnetic resonance imaging (MRI) scans and emergent decompression and fusion for acute soft disk herniation were performed in all cases. All patients recovered to excellent functional status with Frankel score improvement from B (one patient)/C (three patients) to E (three patients)/D (one patient). Conclusions Acute cervical disk herniation with acute neurologic deterioration is a medical emergency necessitating emergent MRI and surgical decompression. Clinical presentation varies. In patients with rapid-onset neurologic deterioration, a high level of suspicion for this rare entity is indicated.
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White, Anne, Mary Beth R. Maguire, Jane Brannan, and Austin Brown. "Situational Awareness in Acute Patient Deterioration." Nurse Educator 46, no. 2 (January 20, 2021): 82–86. http://dx.doi.org/10.1097/nne.0000000000000968.

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Dissertations / Theses on the topic "Patient Deterioration"

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Ciccarelli, Gregory Alan. "Early warning of patient deterioration in the inpatient setting." Thesis, Massachusetts Institute of Technology, 2013. http://hdl.handle.net/1721.1/100870.

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Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 2013.
Cataloged from PDF version of thesis.
Includes bibliographical references (p. 161-166).
Early signs of patient deterioration have been documented in the medical literature. Recognition of such signs offers the possibility of treatment with sufficient lead time to prevent irreversible organ damage and death. Pediatric hospitals currently utilize simple, human evaluated rubrics called early warning scores to detect early signs of patient deterioration. These scores comprise subjective (patient behavior, clinician's impression) and objective (vital signs) components to assess patient health and are computed intermittently by the nursing staff. At Boston Children's Hospital (BCH), early warning scores are evaluated at least every four hours for each patient. Many hospitals monitor inpatients continuously to alert caregivers to changes in physiological status. At BCH, each hospital bed is equipped with a bedside monitor that continuously collects and archives vital sign data, such as heart rate, respiration rate, and arterial oxygen saturation. Continuous access to these physiological variables allows for the definition of a continuously evaluated early warning score on a reduced rubric. This thesis quantitatively assesses the performance of BCH's current Children's Hospital Early Warning Score (CHEWS). We also apply several standard machine learning approaches to investigate the utility of automatically collected bedside monitoring trend data for prediction of patient deterioration. Our results suggest that CHEWS offers at least a 6-hour warning with sensitivity 0.78 and specificity 0.90 but only with a prohibitively large uncertainty (48 hours) surrounding the time of transfer. Performance using only standard bedside trend data is no better than chance; improvement may require exploiting additional intra-beat features of monitored waveforms. The full CHEWS appears to capture significant clinical features that are not present in the monitoring data used in this study.
by Gregory Alan Ciccarelli.
S.M.
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Hann, Alistair. "Multi-parameter monitoring for early warning of patient deterioration." Thesis, University of Oxford, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.670068.

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O'Leary, Jessica A. "Recognising paediatric deterioration in a simulated environment." Thesis, Queensland University of Technology, 2015. https://eprints.qut.edu.au/84892/1/Jessica_O%27Leary_Thesis.pdf.

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This thesis examined the impact of high fidelity patient simulation on paediatric critical care nurses' self-efficacy and knowledge for recognising and responding to paediatric deterioration. This research highlights the positive effect simulation education can have on nursing learning outcomes which may influence patient safety through the timely recognition and management of the deteriorating child.
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Harris, Norma Patricia. "Preparing Novice Nurses for Early Recognition Acute Deterioration." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6039.

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Hospitalized patients increasingly present with complex health issues that place them at risk for acute patient deterioration (APD). Novice nurses are ill-equipped with the critical clinical skills to function competently in recognizing APD, placing patients at risk for negative health outcomes. This project addressed the need to educate novice nurses to recognize APD and answered the project focused questions that asked if an educational intervention with high-fidelity simulation (HFS) would improve nurse knowledge and clinical confidence in recognizing APD. Benner's novice-to-expert and the constructivism theory were used to guide the project. Based upon a review of the literature, the HFS was developed to provide scenarios in which participants would view APD evolving case studies and demonstrate knowledge and skill for caring for patients with APD. A convenience sample of 11 novice nurses participated in the pre- and posttest design project to determine if knowledge and clinical competence increased. Data from the HFS program were analyzed; results showed no statistically significant change in knowledge or confidence post intervention (p = 0.441). A larger sample size is recommended for future HFS interventions at the site to determine if the program of education will increase knowledge and clinical confidence with future iterations of HFS. The project has the potential to promote positive social change as novice nurses learn to recognize and respond to APD and as APD events are reduced.
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Sosa, Tina M. D. "Optimizing Situation Awareness to Identify and Mitigate Inpatient Clinical Deterioration." University of Cincinnati / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1623242068876986.

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Hogg, George. "Can meso-level simulation increase medical students' confidence in recognising and responding to clinical deterioration in adult hospital patients?" Thesis, University of Dundee, 2015. https://discovery.dundee.ac.uk/en/studentTheses/43c02b4e-6b99-48ec-a49e-b44ced566206.

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Recognising Acute Deterioration: Active Response (RADAR) is a simulation based teaching session using simulated patients to portray acutely unwell adult hospital patients. The genesis, development and progress of RADAR will be discussed along with the findings of questionnaires and focus groups from two further cycles of action research. Readers will become aware of the impact which RADAR makes to the evidence and learning surrounding the recognition and assessment of clinical deterioration in adult hospital patients. The study investigated the impact of simulation on medical students’ confidence in recognising and responding to clinical deterioration in adult hospital patients using simulation, simulated patients and moulage (make-up).
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Khalid, Sara. "Data fusion models for detection of vital-sign deterioration in acutely ill patients." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:b8e13f5b-065c-4d2d-a8dc-d231109194f4.

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Vital signs can indicate patient deterioration prior to adverse events such as cardiac arrest, emergency admission to the intensive care unit (ICU), or death. However, many adverse events occur in wards outside the ICU where the level of care and the frequency of patient monitoring are lower than in the ICU. This thesis describes models for detection of deterioration in acutely ill patients in two environments: a step-down unit in which patients recovering from an ICU stay are continuously monitored, and a general ward where patients are intermittently monitored following upper gastrointestinal cancer surgery. Existing data fusion models for classification of vital signs depend on a threshold which defines a “region of normality”. Bradypnoea (low breathing rate) and bradycardia (low heart rate) are relatively rare, and so these two types of abnormalities tend to be misclassified by existing methods. In this thesis, techniques for selecting a threshold are described, such that the classification of vital-sign data is improved. In particular, the proposed approach reduces the misclassification of bradycardia and bradypnoea events, and indicates the type of abnormality associated with the deterioration in a patient’s vital signs. Patients recovering from upper gastrointestinal (GI) surgery have a high risk of emergency admission to the ICU. At present in the UK, most intermediate and general wards outside the ICU depend on intermittent, manual monitoring using track-and-trigger systems. Both manual and automated patient monitoring systems are reported to have high false alert rates. The models described in this thesis take into account the low monitoring frequency in the upper GI ward, such that the false alert rate is reduced. In addition to accuracy, early detection of deterioration is a highly desirable feature in patient monitoring systems. The models proposed in this thesis generate alerts for patients earlier than the early warning systems which are currently in use in hospitals in the UK. The improvements to existing models proposed in this thesis could be applied to continuous and intermittently acquired vital-sign data from other clinical environments.
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Shimokawa, Kenichi. "A Patient-Focused Psychotherapy Quality Assurance System: Meta-Analytic and Multilevel Analytic Review." BYU ScholarsArchive, 2010. https://scholarsarchive.byu.edu/etd/2544.

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Outcome research has documented worsening among a minority of the patient population (5 to 10%). In this study a psychotherapy quality assurance system intended to enhance outcomes in patients at risk of treatment failure was reviewed through the use of meta-analytic, mega-analytic, and multilevel analytic techniques. A pooled dataset from six major studies conducted at a large university counseling center and a hospital outpatient setting (N = 6151, mean age = 23.3 years, female = 63.2%, Caucasian = 85%) were re-analyzed to examine the effects of progress feedback on patient outcome. In this quality assurance system, the Outcome Questionnaire-45 was routinely administered to patients to monitor their therapeutic progress and was utilized as part of an early alert system to identify patients at risk of treatment failure. Patient progress feedback based on this alert system was provided to clinicians to help them intervene before treatment failure occurred. Intent-to-treat and efficacy analyses of the effects of feedback interventions were conducted to obtain the estimates of effects expected from implementation of this quality assurance system as a policy as well as in clinical trials. Three forms of feedback interventions—integral elements of this quality assurance system—were effective in enhancing treatment outcome, especially for signal alarm patients. Two of the three feedback interventions were also effective in preventing treatment failure (Clinical Support Tools and the provision of patient progress feedback to therapists). The Clinical Support Tool intervention was effective not only in terms of the amount of outcome enhancing effect, but also in the rate of patient recovery. The current state of evidence appears to support the efficacy and effectiveness of feedback interventions in enhancing treatment outcome.
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Nangalia, V. "ML-EWS - Machine Learning Early Warning System : the application of machine learning to predict in-hospital patient deterioration." Thesis, University College London (University of London), 2017. http://discovery.ucl.ac.uk/1565193/.

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Preventing hospitalised patients from suffering adverse event (AEs) (unexpected cardiac, arrest, intensive care unit admission, surgery or death) is a priority in healthcare. Almost 50% of these AEs, caused by mistakes/poor standards of care, are thought to be preventable. The identification and referral of a patient at risk of an AE to a dedicated rapid response team is a key mechanism for their reduction. Focussing on variables that are routinely collected and electronically stored (blood test data, and administrative data: demographics, date and method of admission, and co-morbidities), along with their trends, I have collected data on ~8 million admissions. I have explained how to navigate the complex ethical and legal landscape of performing such an ambitious data linkage and collection project. Analysing data on ~2 million hospital admissions with an in-hospital blood test result, I have 1. described how these variables (particularly urea and creatinine blood tests, method of admission, and date of admission) influence in-hospital mortality rate in different groups of patient. 2. created four machine learning (ML) models that have the highest accuracy yet described for identifying a patient at risk of an SAE, while at the same time capturing the majority of patients likely to die (high sensitivity). These models ML-Dehydration, ML-AKI, ML-Admission, and ML-Two- Tests, can be applied to admissions with limited data, specific syndromes, or on all patients in hospital at different time points in their hospital trajectory respectively. Their area under the receiver operator curves are 79.6%, 85.9%, 93% and 90.6% respectively. 3. built and deployed a technology platform Patient Rescue that allows for the automated application of any model in any hospital, as well as the communication of rich patient level reports to clinicians, all in real-time. The ML models and the Patient Rescue platform together form the ML – Early Warning System.
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Picone, Meghan C. "Situation Awareness in LPNs: a Pilot Study." eScholarship@UMMS, 2020. https://escholarship.umassmed.edu/gsn_diss/61.

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Purpose: The purpose of this pilot study was to describe situation awareness (SA) among licensed practical nurses (LPNs) working in direct patient care. Specific Aims: The specific aims for this study are 1) to examine SA scores, as measured by the Situation Awareness Global Assessment Technique (SAGAT), in LPNs working in direct patient care and compare to published data on SA in registered nurses (RNs), 2) to examine the relationship between SA scores and years of LPN experience, 3) to examine differences in SA scores by type of workplace setting and 4) to describe the relationship between levels of satisfaction with simulation, as measured by the Satisfaction with Simulation Experience Scale (SSES) and SA scores among LPNs. Framework: Situation Awareness Theory, as described by Endsley, was used as the framework for this study. Design: A cross-sectional, descriptive design using the Situation Awareness Global Assessment Technique was used to gather data from a convenience sample of LPNs. Results: LPNs (N=24) participated in the study and achieved an average SAGAT score of 72.6%. There were no differences in scores between those LPNs enrolled in an RN program and those who were not enrolled. Individual scores on the SAGAT were comparable or better than scores in a similar study of RNs. Conclusion: LPNs in this study demonstrated adequate situation awareness. Key Words: Situation awareness, licensed practical nurse, patient deterioration, clinical simulation
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Books on the topic "Patient Deterioration"

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Pátina o suciedad. [Barcelona]: Bisagra, 2002.

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Scott-Brown, Martin. Dying from cancer. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0330.

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For many patients, dying from cancer has been an ever-present reality from the time they were diagnosed with incurable recurrent or metastatic cancer. Treatment may have delayed the inevitable, but there does come a point where aggressive management no longer improves the prognosis or can only prolong life that is of such a poor quality that it is not valued by the patient. It sometimes is easier to continue with treatment than to take the time with the patient to discuss the reasons why further treatment is not appropriate. For patients with advanced cancer and whose condition is deteriorating, a number of questions should be considered before initiating treatment aimed at prolonging life. Is this the final stage of a progressive deterioration or an acute event? Are the causes of this deterioration reversible? Are there any further oncological treatments that may improve the prognosis? What is the patient’s perception of their quality of life? Is there a realistic chance of return to a quality of life that will be of value to the patient? Is the patient dying? The ICU is usually not appropriate for patients with advanced cancer. Treatment of correctable causes (e.g. obstructive uropathy, chest infection) may still not be in the patient’s best interest if they recover only to face a period of further deterioration and distressing symptoms before they die. However, patients and their families must be included in discussions as to the level of further intervention and the reasons for stopping active treatment.
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De Deyne, Cathy, and Jo Dens. Neurological assessment of the acute cardiac care patient. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0016.

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Many techniques are currently available for cerebral physiological monitoring in the intensive cardiac care unit environment. The ultimate goal of cerebral monitoring applied during the acute care of any patient with/or at risk of a neurological insult is the early detection of regional or global hypoxic/ischaemic cerebral insults. In the most ideal situation, cerebral monitoring should enable the detection of any deterioration before irreversible brain damage occurs or should at least enable the preservation of current brain function (such as in comatose patients after cardiac arrest). Most of the information that affects bedside care of patients with acute neurologic disturbances is now derived from clinical examination and from knowledge of the pathophysiological changes in cerebral perfusion, cerebral oxygenation, and cerebral function. Online monitoring of these changes can be realized by many non-invasive techniques, without neglecting clinical examination and basic physiological variables such as invasive arterial blood pressure monitoring or arterial blood gas analysis.
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De Deyne, Cathy, Ward Eertmans, and Jo Dens. Neurological assessment of the acute cardiac care patient. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0016_update_001.

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Many techniques are currently available for cerebral physiological monitoring in the intensive cardiac care unit environment. The ultimate goal of cerebral monitoring applied during the acute care of any patient with/or at risk of a neurological insult is the early detection of regional or global hypoxic/ischaemic cerebral insults. In the most ideal situation, cerebral monitoring should enable the detection of any deterioration before irreversible brain damage occurs or should at least enable the preservation of current brain function (such as in comatose patients after cardiac arrest). Most of the information that affects bedside care of patients with acute neurologic disturbances is now derived from clinical examination and from knowledge of the pathophysiological changes in cerebral perfusion, cerebral oxygenation, and cerebral function. Online monitoring of these changes can be realized by many non-invasive techniques, without neglecting clinical examination and basic physiological variables—with possible impact on optimal cerebral perfusion/oxygenation—such as invasive arterial blood pressure monitoring or arterial blood gas analysis.
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Creed, Fiona, and Christine Spiers, eds. Care of the Acutely Ill Adult. 2nd ed. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198793458.001.0001.

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The new edition of Care of the Acutely Ill Adult enables nursing staff to develop an in-depth understanding of the knowledge required to care for patients whose condition is deteriorating. The book emphasizes the importance of systematic assessment, interpretation of clinical signs of deterioration, and the need to escalate the patient in a timely manner. Current evidence-based practice and up-to-date guidelines are included in each systems-based chapter and case studies are used throughout the book to enable nurses to apply knowledge to patient scenarios. In recognition of the dynamic nature of acute care delivery, new chapters have been included that focus on pain management and planning for care when recovery is unlikely. This book remains an essential purchase for any nurse working in an acute care setting.
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Noris, Marina, and Tim Goodship. The patient with haemolytic uraemic syndrome/thrombotic thrombocytopenic purpura. Edited by Giuseppe Remuzzi. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0174.

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The patient who presents with microangiopathic haemolytic anaemia, thrombocytopenia, and evidence of acute kidney injury presents a diagnostic and management challenge. Haemolytic uraemic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) are two of the conditions that frequently present with this triad. They are characterized by low platelet count with normal or near-normal coagulation tests, anaemia, and signs of intravascular red cell fragmentation on blood films, and high LDH levels.HUS associated with shiga-like toxins produced usually by E.coli (typically O157 strains) may occur in outbreaks or sporadically, with geographical variations in incidence. It is predominantly a disease of young children in which painful blood diarrhoea in a minority of infected patients is succeeded by microangiopathy and acute kidney injury. Management is supportive and recovery is usual, although permanent renal damage may lead to later deterioration. Older patients may be affected and tend to have worse outcomes. Neuraminidase-producing Streptococcus pneumoniae infections (usually pneumonia) very rarely cause a similar HUS.Atypical HUS occurs sporadically and is increasingly associated with defects in the regulation of the complement pathway, either genetic or autoimmune-caused. It may respond to plasma exchange for fresh frozen plasma. Recurrences are common, including after transplantation.TTP is associated with more neurological disease and less renal involvement, but HUS and TTP overlap substantially in their manifestations. The underlying problem is in von Willebrand factor (vWF) cleavage. The plasma metalloprotease ADAMTS13 is responsible for cleaving vWF multimers, a process that is important to prevent thrombosis in the microvasculature. Autoantibodies or rarely genetic deficiency may impair this process. Plasma exchange may remove antibodies and replenish the protease.
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Adam, Sheila, Sue Osborne, and John Welch. Cardiac arrest and cardiopulmonary resuscitation. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199696260.003.0006.

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Critically ill patients are at high risk of cardiac arrest, and the critical care nurse needs to recognize early signs of deterioration, understand what can be done to prevent arrest, and understand the different functions of cardiac arrest team members. This chapter outlines the pathophysiology associated with cardiac arrest, reviews the management of arrest, the practicalities of the techniques and drugs used in cardiopulmonary resuscitation, and the care of the patient and family following both successful and unsuccessful resuscitation.
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Price, Susanna, Brian F. Keogh, and Lorna Swan. Congenital heart disease in adults. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0060.

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The number of patients with congenital heart disease surviving to adulthood is increasing, with many requiring ongoing medical attention. Although recommendations are that these patients should be cared for in specialist centres, the clinical state of the acutely unwell patient may preclude transfer prior to the instigation of lifesaving treatment. Although the principles of resuscitation in this patient population differ little from those with acquired heart disease, the acutely unwell adult congenital heart disease patient presents a challenge, with potential pitfalls in examination, assessment/monitoring, and intervention. Keys to avoiding errors include: knowledge of the primary pathophysiology, any interventions that have been undertaken, residual lesions present (static or dynamic), and the normal physiological status for that patient-to determine the precise cause for the acute deterioration and to appreciate the effects (detrimental or otherwise) that any supportive and/or therapeutic interventions might have. Expert advice should be sought at the earliest opportunity.
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Price, Susanna, Brian F. Keogh, and Lorna Swan. Congenital heart disease in adults. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0060_update_001.

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The number of patients with congenital heart disease surviving to adulthood is increasing, with many requiring ongoing medical attention. Although recommendations are that these patients should be cared for in specialist centres, the clinical state of the acutely unwell patient may preclude transfer prior to the instigation of lifesaving treatment. Although the principles of resuscitation in this patient population differ little from those with acquired heart disease, the acutely unwell adult congenital heart disease patient presents a challenge, with potential pitfalls in examination, assessment/monitoring, and intervention. Keys to avoiding errors include: knowledge of the primary pathophysiology, any interventions that have been undertaken, residual lesions present (static or dynamic), and the normal physiological status for that patient-to determine the precise cause for the acute deterioration and to appreciate the effects (detrimental or otherwise) that any supportive and/or therapeutic interventions might have. Expert advice should be sought at the earliest opportunity.
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Javed, Jeffrey K., and Jason E. Moore. Respiratory Failure and Hypoxemia (DRAFT). Edited by Raghavan Murugan and Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0006.

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Respiratory failure and hypoxemia are among the most common problems encountered by the rapid response team (RRT) and can lead to rapid patient deterioration and arrest. A brief, systematic approach focusing on treatment priorities such as airway patency, correcting hypoxemia, and supporting work of breathing, allows RRT responders to quickly provide the appropriate level of supportive care and narrow the complex differential diagnosis of acute respiratory failure. This chapter reviews a logical and efficient clinical diagnostic evaluation, therapeutic modalities including rescue treatments and mechanical ventilation, and transport considerations for this patient group. The pragmatic, problem-based clinical approach discussed in this chapter will help RRTs provide effective care for this group of patients.
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Book chapters on the topic "Patient Deterioration"

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Curry, J. Paul. "Postoperative Monitoring for Clinical Deterioration." In Patient Safety in Surgery, 79–114. London: Springer London, 2014. http://dx.doi.org/10.1007/978-1-4471-4369-7_8.

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Cooper, Simon JR, and Mary Anne Biro. "Hybrid simulated patient methodology: managing maternal deterioration." In Simulated Patient Methodology, 120–25. Chichester, UK: John Wiley & Sons, Ltd, 2014. http://dx.doi.org/10.1002/9781118760673.ch17.

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Snowden, John, and Rafael F. Duarte. "Patient Referral." In The EBMT/EHA CAR-T Cell Handbook, 225–27. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-030-94353-0_44.

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AbstractEarly and efficient patient referral is a critical step in the ability of potential candidates to access CAR-T therapy. Despite improvements in centre qualification and availability, regulatory and reimbursement frameworks, and addressing the educational needs of the various members of the health care team, referring haematologists and oncologists identify major barriers to prescribing CAR-T therapy, including cumbersome logistics, high cost and toxicity, and clinical challenges, such as deterioration of the patient prior to CAR-T administration and the need for bridging chemotherapy while awaiting manufacturing.
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Frighi, Valeria, and Matthew Stephenson. "Deterioration of Pre-Existing Diabetes in a Patient on Low Dose Quetiapine." In HbA1cin Diabetes, 47. Oxford, UK: Wiley-Blackwell, 2010. http://dx.doi.org/10.1002/9781444320343.ch19.

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Khalid, Sara, David A. Clifton, and Lionel Tarassenko. "A Bayesian Patient-Based Model for Detecting Deterioration in Vital Signs Using Manual Observations." In Foundations of Health Information Engineering and Systems, 146–58. Berlin, Heidelberg: Springer Berlin Heidelberg, 2014. http://dx.doi.org/10.1007/978-3-642-53956-5_10.

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Santos, Mauro D., David A. Clifton, and Lionel Tarassenko. "Performance of Early Warning Scoring Systems to Detect Patient Deterioration in the Emergency Department." In Foundations of Health Information Engineering and Systems, 159–69. Berlin, Heidelberg: Springer Berlin Heidelberg, 2014. http://dx.doi.org/10.1007/978-3-642-53956-5_11.

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Lee, Youngjo, Maengseok Noh, and Il Do Ha. "The Real-Time Tracking and Alarming the Early Neurological Deterioration Using Continuous Blood Pressure Monitoring in Patient with Acute Ischemic Stroke." In ICSA Book Series in Statistics, 33–37. Singapore: Springer Singapore, 2018. http://dx.doi.org/10.1007/978-981-10-8168-2_4.

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Jevon, Philip, Beverley Ewens, and Jagtar Singh Pooni. "Recognition and Management of the Deteriorating Patient." In Monitoring the Critically III Patient, 1–24. West Sussex, UK: John Wiley & Sons, Ltd,., 2013. http://dx.doi.org/10.1002/9781118702932.ch1.

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Lau, Alvin. "Complex Regional Pain Syndrome (CRPS) and Progressive Medical and Psychiatric Deterioration." In Integrated Care for Complex Patients, 157–65. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-61214-0_21.

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Mukherjee, S., and S. J. Brett. "On the Response to Acutely Deteriorating Patients." In Intensive Care Medicine, 531–38. New York, NY: Springer New York, 2010. http://dx.doi.org/10.1007/978-1-4419-5562-3_49.

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Conference papers on the topic "Patient Deterioration"

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AlNuaimi, Noura, Mohammad M Masud, and Farhan Mohammed. "ICU Patient Deterioration Prediction : A Data-Mining Approach." In Fourth International Conference on Advanced Information Technologies and Applications. Academy & Industry Research Collaboration Center (AIRCC), 2015. http://dx.doi.org/10.5121/csit.2015.51517.

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Schmidt, Thomas, Annmarie Lassen, and Uffe Kock Wiil. "A Patient Deterioration Warning System for Boosting Situational Awareness of Monitored Patients." In 2016 IEEE International Conference on Healthcare Informatics (ICHI). IEEE, 2016. http://dx.doi.org/10.1109/ichi.2016.21.

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"PROBABILISTIC PATIENT MONITORING USING EXTREME VALUE THEORY - A Multivariate, Multimodal Methodology for Detecting Patient Deterioration." In International Conference on Bio-inspired Systems and Signal Processing. SciTePress - Science and and Technology Publications, 2010. http://dx.doi.org/10.5220/0002690200050012.

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Hogg, G., and P. Christie. "P41 Exploring the impact of moulage on assessment of patient deterioration." In Abstracts of the Association for Simulation Practice in Healthcare Annual Conference, 6th to 7th November 2017, Telford, UK. The Association for Simulated Practice in Healthcare, 2017. http://dx.doi.org/10.1136/bmjstel-2017-aspihconf.125.

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Tarassenko, L. "BIOSIGN™ : multi-parameter monitoring for early warning of patient deterioration." In 3rd IEE International Seminar on Medical Applications of Signal Processing. IEE, 2005. http://dx.doi.org/10.1049/ic:20050334.

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Neves, Sandra, Vera Oliveira, and Maria Guarino. "Using Co-Design Methods to Develop a Patient Monitoring System in Hospital Emergency Care to Support Patient Safety." In 13th International Conference on Applied Human Factors and Ergonomics (AHFE 2022). AHFE International, 2022. http://dx.doi.org/10.54941/ahfe1001405.

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Efforts have been made to develop a collaborative model to engage healthcare professionals and patients in healthcare services and resources improvement (Neves et al. 2021) This paper aims to understand how a collaborative model can enhance how design researchers work with healthcare communities in Portugal. Within relation to the development of a patient monitoring system to support patient safety for hospitalised people, this paper reports how design researchers are collaborating with the more traditional healthcare support specialisms in the research team. The design researchers are introducing methods and tools to involve all key stakeholders (i.e., nurses, doctors and patient and public representatives) in the design of the new patient monitoring system, which involves the continuous monitoring of vital signs for early detection of clinical deterioration to ensure patient safety in emergency care at the hospital. Specifically, through the nature of co-design workshops and the use of participative tools, these approaches are intended to better empower patients and healthcare professionals in this co-development process, to allow them to mediate the decision-making process in this context. This paper presents the first phase of this co-development process, highlighting the importance of using a participatory co-design approach to enable healthcare professionals and patients to voice their issues when developing a patient monitoring system.
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Wang, Ziqi, Ambika Agrawal, Imani Carson, Luke Liu, Harini Pennathur, Hadi Saab, Amy Cohn, Amanda Moreno-Hernandez, and Hitinder Gurm. "Incorporating Patient Deterioration When Simulating Utilization of a Cardiovascular Intensive Care Unit." In 2020 Winter Simulation Conference (WSC). IEEE, 2020. http://dx.doi.org/10.1109/wsc48552.2020.9384084.

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"OPTIMISING CLASSIFIERS FOR THE DETECTION OF PHYSIOLOGICAL DETERIORATION IN PATIENT VITAL-SIGN DATA." In International Conference on Bio-inspired Systems and Signal Processing. SciTePress - Science and and Technology Publications, 2011. http://dx.doi.org/10.5220/0003138904250428.

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Parthasarathy, S., D. Alejos, W. Li, and A. Kakkar. "RV Thrombus- a Hidden Iceberg Behind Sudden Deterioration in a COVID-19 Patient." In American Thoracic Society 2021 International Conference, May 14-19, 2021 - San Diego, CA. American Thoracic Society, 2021. http://dx.doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3505.

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Mathews, April, Sophia Chen, Michael T. Bigham, and Katie Mansel. "Oops: rapid Deterioration of the Transport Patient Admitted to the General Care Floor." In Selection of Abstracts From NCE 2016. American Academy of Pediatrics, 2018. http://dx.doi.org/10.1542/peds.141.1_meetingabstract.728.

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Reports on the topic "Patient Deterioration"

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Ciapponi, Agustín. Do rapid-response systems improve clinical outcomes? SUPPORT, 2017. http://dx.doi.org/10.30846/1701152.

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Rapid-response systems were created to improve recognition of and response to deterioration of hospitalized patients, with the goal of reducing the incidence of cardiorespiratory arrest and hospital mortality. A rapid-response system consists of providers who immediately assess and treat unstable patients. Examples include medical emergency teams and rapid response teams. Preliminary evidence of improvements in patient outcomes led to widespread utilization of rapid response systems.
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Yang, Ying, Xiangting Huang, Yuge Wang, and Lan Chen. The impact of Triglyceride-Glucose Index on Ischemic Stroke: a systematic review and meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, November 2022. http://dx.doi.org/10.37766/inplasy2022.11.0145.

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Review question / Objective: This Systematic review, describes two issues. 1. in the general population, a high TyG index predicts the risk of ischaemic stroke (IS) P: the general population without ischaemic stroke. I: higher TyG index. C: lower TyG index. O: first ischaemic stroke occurrence. S: Observational study. 2.In the ischaemic stroke(IS) population, a high tyg index predicts poor prognostic outcome. P: ischaemic stroke patient population. I: higher TyG index. C: lower TyG index O: death, stroke recurrence, poor functional outcome, deterioration in neurological function. S: Observational study. Information sources: We searched the Cochrane Library, Embase, MEDLINE, Web of Science, PubMed, and other relevant English databases and related websites. In addition, we reviewed the references for inclusion for literature that we may not have retrieved.
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Litwin, Tomasz, Lukasz Smolinski, Agnieszka Antos, Bembenek Jan, Czlonkowska Anna, Iwona Kurkowska-Jastrzębska, Adam Przybyłkowski, and Marta Skowronska. Early neurological deterioration in Wilson’s disease: a systematic literature review and meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, September 2022. http://dx.doi.org/10.37766/inplasy2022.9.0111.

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Review question / Objective: The frequency and predictors of early neurological deterioration in patients with Wilson’s disease (WD). Condition being studied: Early neurological deterioration in WD. Eligibility criteria: All studies published until 15 September 2022 for original studies (prospective and retrospective), and case series or case reports analyzing early neurological deterioration in WD. Included will be studies published in English.
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MOSKALENKO, OLGA, and ROMAN YASKEVICH. ANXIETY-DEPRESSIVE DISORDERS IN PATIENTS WITH ARTERIAL HYPERTENSION. Science and Innovation Center Publishing House, March 2021. http://dx.doi.org/10.12731/2658-4034-2021-12-1-2-185-190.

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Our article presents a review of the literature and considers the most pressing problem of modern medicine - a combination of anxiety-depressive states in patients with cardiovascular diseases, which are more common in people of working age, having a negative impact on the quality of life of patients, contributing to the deterioration of physical, mental and social adaptation, which further leads to negative socio-economic consequences.
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MacFarlane, Andrew. 2021 medical student essay prize winner - A case of grief. Society for Academic Primary Care, July 2021. http://dx.doi.org/10.37361/medstudessay.2021.1.1.

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As a student undertaking a Longitudinal Integrated Clerkship (LIC)1 based in a GP practice in a rural community in the North of Scotland, I have been lucky to be given responsibility and my own clinic lists. Every day I conduct consultations that change my practice: the challenge of clinically applying the theory I have studied, controlling a consultation and efficiently exploring a patient's problems, empathising with and empowering them to play a part in their own care2 – and most difficult I feel – dealing with the vast amount of uncertainty that medicine, and particularly primary care, presents to both clinician and patient. I initially consulted with a lady in her 60s who attended with her husband, complaining of severe lower back pain who was very difficult to assess due to her pain level. Her husband was understandably concerned about the degree of pain she was in. After assessment and discussion with one of the GPs, we agreed some pain relief and a physio assessment in the next few days would be a practical plan. The patient had one red flag, some leg weakness and numbness, which was her ‘normal’ on account of her multiple sclerosis. At the physio assessment a few days later, the physio felt things were worse and some urgent bloods were ordered, unfortunately finding raised cancer and inflammatory markers. A CT scan of the lung found widespread cancer, a later CT of the head after some developing some acute confusion found brain metastases, and a week and a half after presenting to me, the patient sadly died in hospital. While that was all impactful enough on me, it was the follow-up appointment with the husband who attended on the last triage slot of the evening two weeks later that I found completely altered my understanding of grief and the mourning of a loved one. The husband had asked to speak to a Andrew MacFarlane Year 3 ScotGEM Medical Student 2 doctor just to talk about what had happened to his wife. The GP decided that it would be better if he came into the practice - strictly he probably should have been consulted with over the phone due to coronavirus restrictions - but he was asked what he would prefer and he opted to come in. I sat in on the consultation, I had been helping with any examinations the triage doctor needed and I recognised that this was the husband of the lady I had seen a few weeks earlier. He came in and sat down, head lowered, hands fiddling with the zip on his jacket, trying to find what to say. The GP sat, turned so that they were opposite each other with no desk between them - I was seated off to the side, an onlooker, but acknowledged by the patient with a kind nod when he entered the room. The GP asked gently, “How are you doing?” and roughly 30 seconds passed (a long time in a conversation) before the patient spoke. “I just really miss her…” he whispered with great effort, “I don’t understand how this all happened.” Over the next 45 minutes, he spoke about his wife, how much pain she had been in, the rapid deterioration he witnessed, the cancer being found, and cruelly how she had passed away after he had gone home to get some rest after being by her bedside all day in the hospital. He talked about how they had met, how much he missed her, how empty the house felt without her, and asking himself and us how he was meant to move forward with his life. He had a lot of questions for us, and for himself. Had we missed anything – had he missed anything? The GP really just listened for almost the whole consultation, speaking to him gently, reassuring him that this wasn’t his or anyone’s fault. She stated that this was an awful time for him and that what he was feeling was entirely normal and something we will all universally go through. She emphasised that while it wasn’t helpful at the moment, that things would get better over time.3 He was really glad I was there – having shared a consultation with his wife and I – he thanked me emphatically even though I felt like I hadn’t really helped at all. After some tears, frequent moments of silence and a lot of questions, he left having gotten a lot off his chest. “You just have to listen to people, be there for them as they go through things, and answer their questions as best you can” urged my GP as we discussed the case when the patient left. Almost all family caregivers contact their GP with regards to grief and this consultation really made me realise how important an aspect of my practice it will be in the future.4 It has also made me reflect on the emphasis on undergraduate teaching around ‘breaking bad news’ to patients, but nothing taught about when patients are in the process of grieving further down the line.5 The skill Andrew MacFarlane Year 3 ScotGEM Medical Student 3 required to manage a grieving patient is not one limited to general practice. Patients may grieve the loss of function from acute trauma through to chronic illness in all specialties of medicine - in addition to ‘traditional’ grief from loss of family or friends.6 There wasn’t anything ‘medical’ in the consultation, but I came away from it with a real sense of purpose as to why this career is such a privilege. We look after patients so they can spend as much quality time as they are given with their loved ones, and their loved ones are the ones we care for after they are gone. We as doctors are the constant, and we have to meet patients with compassion at their most difficult times – because it is as much a part of the job as the knowledge and the science – and it is the part of us that patients will remember long after they leave our clinic room. Word Count: 993 words References 1. ScotGEM MBChB - Subjects - University of St Andrews [Internet]. [cited 2021 Mar 27]. Available from: https://www.st-andrews.ac.uk/subjects/medicine/scotgem-mbchb/ 2. Shared decision making in realistic medicine: what works - gov.scot [Internet]. [cited 2021 Mar 27]. Available from: https://www.gov.scot/publications/works-support-promote-shared-decisionmaking-synthesis-recent-evidence/pages/1/ 3. Ghesquiere AR, Patel SR, Kaplan DB, Bruce ML. Primary care providers’ bereavement care practices: Recommendations for research directions. Int J Geriatr Psychiatry. 2014 Dec;29(12):1221–9. 4. Nielsen MK, Christensen K, Neergaard MA, Bidstrup PE, Guldin M-B. Grief symptoms and primary care use: a prospective study of family caregivers. BJGP Open [Internet]. 2020 Aug 1 [cited 2021 Mar 27];4(3). Available from: https://bjgpopen.org/content/4/3/bjgpopen20X101063 5. O’Connor M, Breen LJ. General Practitioners’ experiences of bereavement care and their educational support needs: a qualitative study. BMC Medical Education. 2014 Mar 27;14(1):59. 6. Sikstrom L, Saikaly R, Ferguson G, Mosher PJ, Bonato S, Soklaridis S. Being there: A scoping review of grief support training in medical education. PLOS ONE. 2019 Nov 27;14(11):e0224325.
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Tang, Jiqin, Gong Zhang, Jinxiao Xing, Ying Yu, and Tao Han. Network Meta-analysis of Heat-clearing and Detoxifying Oral Liquid of Chinese Medicines in Treatment of Children’s Hand-foot-mouth Disease：a protocol for systematic review. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, January 2022. http://dx.doi.org/10.37766/inplasy2022.1.0032.

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Review question / Objective: The type of study was clinical randomized controlled trial (RCT). The object of study is the patients with HFMD. There is no limit to gender and race. In the case of clear diagnosis standard, curative effect judgment standard and consistent baseline treatment, the experimental group was treated with pure oral liquid of traditional Chinese medicine(A: Fuganlin oral liquid, B: huangzhihua oral liquid, C: Lanqin oral liquid, D: antiviral oral liquid, E: Huangqin oral liquid, F: Pudilan oral liquid, G: Shuanghuanglian oral liquid.)and the control group was treated with ribavirin or any oral liquid of traditional Chinese medicine. The data were extracted by two researchers independently, cross checked and reviewed according to the pre-determined tables. The data extraction content is (1) Basic information (including the first author, published journal and year, research topic). (2) Relevant information (including number of cases, total number of cases, gender, age, intervention measures, course of treatment of the experimental group and the control group in the literature). (3) Design type and quality evaluation information of the included literature. (4) Outcome measures (effective rate, healing time of oral ulcer, regression time of hand and foot rash, regression time of fever, adverse reactions.). The seven traditional Chinese medicine oral liquids are comparable in clinical practice, but their actual clinical efficacy is lack of evidence-based basis. Therefore, the purpose of this study is to use the network meta-analysis method to integrate the clinical relevant evidence of direct and indirect comparative relationship, to make quantitative comprehensive statistical analysis and sequencing of different oral liquid of traditional Chinese medicine with the same evidence body for the treatment of the disease, and then to explore the advantages and disadvantages of the efficacy and safety of different oral liquid of traditional Chinese medicine to get the best treatment plan, so as to provide reference value and evidence-based medicine evidence for clinical optimization of drug selection. Condition being studied: Hand foot mouth disease (HFMD) is a common infectious disease in pediatrics caused by a variety of enteroviruses. Its clinical manifestations are mainly characterized by persistent fever, hand foot rash, oral herpes, ulcers, etc. Because it is often found in preschool children, its immune system development is not perfect, so it is very vulnerable to infection by pathogens and epidemic diseases, resulting in rapid progress of the disease. A few patients will also have neurogenic pulmonary edema Meningitis, myocarditis and other serious complications even lead to death, so effectively improve the cure rate, shorten the course of disease, prevent the deterioration of the disease as the focus of the study. In recent years, traditional Chinese medicine has played an important role in the research of antiviral treatment. Many clinical practices have confirmed that oral liquid of traditional Chinese medicine can effectively play the role of antiviral and improve the body's immunity.
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Better care of deteriorating patients has reduced US mortality after surgery. National Institute for Health Research, April 2019. http://dx.doi.org/10.3310/signal-000764.

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Checklists are no substitute for experience in spotting patients who are deteriorating. National Institute for Health Research, November 2017. http://dx.doi.org/10.3310/signal-000503.

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