A cross-sectional study on the nurses’attitude towards rapid response system activation for clinically deteriorated patients

Background:Hospitals have reported that implementing rapid response system activation(RRS)activation has increased patient safety.As a result,there has been growing interest in identifying factors that lead to successful RRS activation.While introducing an automated RRS activation system has prompted nurses to be more vigilant about monitoring vital signs,it has not necessarily encouraged them to conduct thorough patient assessments to identify early signs of deterioration.Purpose:The current study aimed to assess nurses’attitudes towards RRS activation for clinically deteriorated patients in the clinical units of King Abdul-Aziz Hospital.Methods:A descriptive cross-sectional research design was utilised in the study,and 144 nurses working in the medical and surgical units of King Abdul-Aziz Hospital were recruited to participate using a convenient non-probability sampling technique.Results:The study’s findings reported that nurses have a positive attitude towards RRS benefits(Mean=3.70;SD=0.70).Their overall attitude towards RRS activation among clinically deteriorated patients is still low positive(Mean=2.71;SD=0.61).The nurses’attitudes towards RRS benefits significantly differ among nationalities and the clinical area/unit where they were assigned,with a P-value of 0.0194 and 0.000,respectively.Attitudes towards RRS barriers significantly differ among nationality(P-value=0.0037),education level(P-value=0.0032),area of assignment(P-value=0.020),and whether they have a good understanding of abnormal observations(P-value=0.0122).Regarding the nurses’attitude towards management belief,the significant result is only with the clinical area/unit of assignment with a P-value of 0.000.Conclusion:The current study found a low positive attitude towards RRS activation among ward nurses,especially given that monitoring vital signs is critical to their job.Nurses may fear being perceived as clinically inept for redundant activations caused by poor quality,but their attitude towards activating the RRS in clinical deterioration is still largely negative.This is because most RRSs rely on ward nurses to recognise clinical deterioration and manually alert responders through phone calls,hospital communication systems,or face-to-face communication.

A Brief Review of a Common Clinical Question: Intravenous Diltiazem or Metoprolol for Atrial Fibrillation with Rapid Ventricular Response?

Two classes of rate controlling medications—beta blockers (BBs) and non- dihydropyridine calcium channel blockers (CCBs)—are given to patients who present with atrial fibrillation (AF) with rapid ventricular response (RVR). Both are Class I recommendations from the American Heart Association (AHA), American College of Cardiology (ACC), and Heart Rhythm Society (HRS) for the management of AF with RVR. Multiple studies support the view that diltiazem is more effective than metoprolol, even though data from the AFFIRM trial suggests BBs are more frequently used. CCBs are generally avoided in AF with RVR patients who have concomitant heart failure with reduced ejection fraction (HFrEF) for concern of triggering decompensation. However, some recent studies indicate this idea may be unfounded. The aim of this article is to compare the efficacy of diltiazem and metoprolol for rate control in AF with RVR and examine the use of diltiazem in patients with both AF with RVR and HFrEF.

Thermosensitive Poly(N-isopropylacrylamide-co-acrylonitrile) Hydrogels with Rapid Response

Acrylonitrile (AN) was copolymerized with N-isopropylacrylamide (NIPA) to synthesize thermosensitive hy-drogels, and the on-off switch behavior of poly(NIPA-co-AN) hydrogels with different fraction of hydrophobic compo-nent (AN) was investigated. It is found that the lower critical solution temperature (LCST), the swelling ratio at certain temperature and the reswelling rate of poly(NIPA-co-AN) hydrogels decreased as AN unit fraction in copolymers in-creased. In order to improve the responsive rate of poly(NIPA-co-AN) hydrogels, they were further treated by surface crosslinking using N, N′-methylene bisacrylamide (BIS) as a crosslinking agent. The swelling and deswelling behaviors of these copolymers were compared with those of the untreated hydrogels. The results indicated that the responsive rate of poly(NIPA-co-AN) hydrogel was improved by surface crosslinking. The resulting hydrogels bearing cyano groups with fast response have potential applications in the field of drug-controlled release and immobilization of biomolecules.

Sustained virological response based on rapid virological response in genotype-3 chronic hepatitis C treated with standard interferon in the Pakistani population

AIM:To document the sustained virological response (SVR) in rapid virological responders (RVR) of genotype-3 chronic hepatitis C with standard interferon (SdIF). METHODS:Hepatitis C genotype-3 patients during the period July 2006 and June 2007 were included. Complete blood counts, prothrombin time, ALT, albumin, qualitative HCV RNA were done. SdIF and ribavirin were given for 4 wk and qualitative HCV RNA was repeated. Those testing negative were allocated to group-A while the rest were allocated to group-B. Treatment was continued a total of 16 and 24 wk for group A and B respectively. HCV RNA was repeated after 24 wk of treatment. End virological and sustained virological responses were compared by χ2 test. ROC of pretreatment age, ALT and albumin were plotted for failure to achieve SVR. RESULTS:Of 74 patients treated, RCV RNA after 16 wk of therapy became undetectable in 34 (45.9%) and was detectable in 40 (54.1%) and were allocated to groups A and B respectively. SVR was achieved in 58.8% and 27.8% in groups A and B respectively. SVR rates were significantly higher in patients who had RVR as compared to those who did not (P = 0.0;γ = 2). Both groups combined ETR and SVR were 70% and 33% respectively. ROC plots of pretreatment age, ALT and albumin for SVR showed only ALT to have a significantly large area under the curve.CONCLUSION:SVR rates were higher in patients who had RVR with SdIF and high pre treatment ALT values correlated to probability of having RVR.

High-quality perovskite MAPbI_3 single crystals for broad-spectrum and rapid response integrate photodetector

Organic–inorganic single-crystalline perovskites have attracted significant attentions due to their exceptional progress in intrinsic properties＇ investigation and applications in photovoltaics and optoelectronics. In this study, the large perovskite CH3NH3PbI3 single crystal with the largest length of 80 mm was prepared through the method of inverse-temperature crystallization. Meanwhile, the mass production of integrate photodetectors have been fabricated on the single-crystalline wafer and the photoresponse performances were investigated. The results show that the single-crystalline photodetectors have broad spectrum response to 900 nm, rapid response speed（〈40 μs） and excellent stability. These findings are of great importance for future promising perovskite single crystalline for integrated photoelectronic application.

Research on Application Technology Oriented Rapid Response Manufacturing in the Distributed Network Environment

A new chance of developing traditional manufacturing industry comes forth with the development of network technology. Application technology oriented rapid response manufacturing in the distributed network environments, that is, how to take advantage of the Intranet and Internet, combine the numerous manufacturing resources spread around the region, the country and even the globe is the key to the agile design, manufacturing and the buildup of comprehensively competitive power, at the same time, is also an important research direction in the field of advanced manufacturing technology. Rapid response manufacturing in the distributed network environment is a newly manufactory pattern that can be used to implement the conception of agile design and manufacturing, but there are some new problems coming with it, which will directly influence the enterprise’s ability of rapid response in the distributed network manufacturing pattern and lead to the failure of the league and the lost of the given orders. In this paper, we establish some approaches to solve these problems in product development process. The paper then presents the research on key application technologies and solutions includes: network safety strategy which guarantees data transferring among the leaguer members, production data management based on Web/DOT (Distributed Object Technology) and XML criteria which guarantees data exchange in structure-variance characteristic environments, the network platform which provides the conversion service of different types of CAD files each other. All of these solutions are aim for technology problems existing in the distributed network environments and among the league members. Finally, the paper takes one project, that is, the establishment of the online application service system for Shanghai Advance Manufacturing Technology Research Center as a good instance.

Evaluating the Extraction Approaches of Flood Extended Area by Using ALOS-2/PALSAR-2 Images as a Rapid Response to Flood Disaster

Flash floods are recurrent events around the Japan region almost every year. Torrential rain occurred around Kanto and Tohoku area due to typhoon No. 18 in September 2015. Overflowing of the Kinugawa River led to river bank collapse. Thus, the flood extended into Joso City, Ibaraki Prefecture, Japan. ALOS-2/PALSAR-2 was the fastest satellite to record this flood disaster area. A quick method to extract the flood inundation area by utilizing the ALOS-2/ PALSAR-2 image as a rapid response to the flood disaster is required. This study evaluated three methods to extract the flood immediately after the flood occurring. This study compared the extraction approaches of flooded area by unsupervised classification, supervised classification and binary/threshold of backscattering value of flood. The results show that unsupervised classification and supervised classification are overestimated. This study recommends the binarization of the backscattering value to extract the extended flood area. This method is a straight forward approach and generates a similar distribution with the field survey by using the aerial photo with high accuracy (94% of kappa coefficient). We utilized slope map which derived from DEM data to eliminate the overestimated area due to shadowing effect in SAR images.

Characteristics of In-Hospital Patients with Congenital Heart Disease Requiring Rapid Response System Activations: A Japanese Database Study

Objectives:This study aimed to study the characteristics of in-hospital deterioration in patients with congenital heart disease who required rapid response system activation and identify risk factors associated with 1-month mortality.Methods:We retrospectively analysed data from a Japanese rapid response system registry with 35 participating hospitals.We included consecutive patients with congenital heart disease who required rapid response system activation between January 2014 and March 2018.Logistic regression analyses were performed to examine the associations between 1-month mortality and other patient-specific variables.Results:Among 9,607 patients for whom the rapid response system was activated,only 82(0.9%)had congenital heart disease.Only few patients with congenital heart disease were being treated at the cardiology and cardiovascular surgery departments(12.3%and 9.9%,respectively).Moreover,the incidences of rapid-response events after intensive care unit discharge or surgery were low(6.8% and 12.2%,respectively).The most common reason for rapid response system activation was respiratory dysfunction(desaturation:35.4%,tachypnoea:25.6%,and new dyspnoea:19.5%).Rapid response system interventions and intensive care unit transfers were required for 65.9% and 20.7%of patients,respectively.The mortality rate was 1.2% at the end of the rapid response system intervention and 11.0% after 1 month.Moreover,decreased respiratory rate and decreased heart rate at rapid response system activation were associated with increased 1-month mortality.The adjusted odds ratio was 1.10(95% confidence interval 1.02–1.19)and 1.02(95% confidence interval,1.00–1.04) for respiratory rate and heart rate,respectively.Conclusions:Rapid response systems were rarely activated after cardiac surgery and intensive care unit discharge,which were situations with a high risk of sudden deterioration in patients with congenital heart disease.Therefore,encouraging the use of the rapid response system in these departments will enable intervention by a third,specialised team for in-hospital emergencies and help provide comprehensive medical care to patients.Furthermore,1-month mortality was associated with vital signs at rapid response system activation.These findings may guide treatment selection for patients with congenital heart disease showing deterioration.

Interferon-λ-related genes and therapeutic response in Chinese hepatitis C patients

AIM: To determine the association between rapid viral response and IL28 B, IL28 RA, IL10 RB and Mx A polymorphisms in the Chinese Han population.METHODS: The study cohort consisted of 238 chronic hepatitis C patients treated with interferon(IFN)-α-2b and ribavirin. Six single nucleotide polymorphisms were genotyped using the ABI Taq Man allelic discrimination assay. Biochemical indices were measured at baseline. Serum hepatitis C virus(HCV) RNA was detected at weeks 0, 4, 12 and 24 of therapy.RESULTS: Only IL28 B rs12980275 was associated with treatment response in the Chinese Han population. Patients carrying AG/GG genotypes had a reduced rapid viral response compared with patients carrying the AA genotype(additive model: adjusted OR = 0.43, 95%CI: 0.24-0.75). It took less time for patients with the AA genotype to achieve a viral load < 500 copies/m L(logrank test, P = 0.004). In addition, the protective effect of genotype AA was independent of baseline viral load. HCV genotype, and baseline white blood cell count, α-fetoprotein and viral load might also help predict treatment response. The area under the receiveroperating characteristic curve was 0.726. CONCLUSION: IL28 B rs12980275 AA genotype is a strong predictor of positive response to IFN therapy in Chinese Han patients with hepatitis C.

Alanine aminotransferase normalization at week 8 predicts viral response during hepatitis C treatment

AIM:To investigate alanine aminotransferase(ALT)and sustained virological response(SVR)in chronic hepatitis C(CHC)during peginterferon-ribavirin treatment.METHODS:One hundred and fifty-one genotype 1CHC patients underwent treatment for 48 wk with peginterferon and ribavirin,and were retrospectively divided into two groups as having a rapid virological response(RVR)(Group 1,n=52)and not having an RVR(Group 2,n=99).We also subdivided each group into two according to the initial ALT level being high(Group1h and Group 2h)or normal(Group 1n and Group 2n).HCV RNA and ALT levels were measured at baseline;at 4,12,24 and 48 wk during the treatment period;and at 24 wk follow-up.ALT levels were also obtained at 8 wk.According to the results of ALT,patients were enrolled in either the follow-up abnormal or follow-up normalized ALT groups at each interval.Patients with high and normal ALT levels were compared for each interval in terms of SVR.RESULTS:The SVR rates were 83%vs 40%(P=0.000),82%vs 84%(P=0.830),and 37%vs 44%(P=0.466)when comparing Group 1 with 2,1h with1n,and 2h with 2n,respectively.In Group 2h,the SVR rates were 34%vs 40%(P=0.701),11%vs 52%(P=0.004),12%vs 50%(P=0.007),7%vs 50%(P=0.003),6%vs 53%(P=0.001),and 0%vs 64%(P=0.000)when comparing patients with high and normalized ALT levels at week 4,8,12,24,48 and 72,respectively.The multiple logistic regression analysis revealed that RVR(OR=7.05;95%CI:3.1-16.05,P=0.000),complete early virological response(cEVR)(OR=17.55;95%CI:6.32-48.76,P=0.000),normalization of ALT at8 wk(OR=3.04;95%CI:1.31-7.06,P=0.008),and at 12 wk(OR=4.21;95%CI:1.65-10.76,P=0.002)were identified as independent significant predictive factors for SVR.CONCLUSION:Normalization of ALT at 8 wk may predict viral response during peginterferon-ribavirin treatment in genotype-1 CHC patients especially without RVR.

Infrared response of the lateral PIN structure of a highly titanium-doped silicon-on-insulator material

The intermediate band （IB） solar cell is a promising third-generation solar cell that could possibly achieve very high efficiency above the Shockley-Queisser limit. One of the promising ways to synthesize IB material is to introduce heavily doped deep level impurities in conventional semiconductors. High-doped Ti with a concentration of 10^20 cm^-3- 10^21 cm^-3 in the p-type top Si layer of silicon-on-insulator （SOI） substrate is obtained by ion implantation and rapid thermal annealing （RTA）. Secondary ion mass spectrometry measurements confirm that the Ti concentration exceeds the theoretical Mott limit, the main requirement for the formation of an impurity intermediate band. Increased absorption is observed in the infrared （IR） region by Fourier transform infrared spectroscopy （FTIR） technology. By using a lateral p-i-n structure, an obvious infrared response in a range of 1100 nm 2000 nm is achieved in a heavily Ti-doped SOI substrate, suggesting that the improvement on IR photoresponse is a result of increased absorption in the IR. The experimental results indicate that heavily Ti-implanted Si can be used as a potential kind of intermediate-band photovoltaic material to utilize the infrared photons of the solar spectrum.

Coseismic responses of groundwater levels in the Three Gorges well-network to the Wenchuan M_S8.0 earthquake

We systematically analyze coseismic responses and post-seismic characteristics of groundwater levels in the Three Gorges well-network to the Ms8.0 Wenchuan earthquake on 12 May 2008. The results indicate that these characteristics differ among wells. On the conditions of similar borehole configurations, the differences are associated with geological structural sites of wells, burial types of aquifers monitored, and transmissivities of aquifer systems. We explored coseismic and post-seismic step-rise and step-drop mechanical mechanisms and their implication to earthquake prediction. We validated the inference that the residual step-rise zone is a possible earthquake risk zone based on recent seismic activity on the Xiannüshan fault in the area.

Solution of false alarm and slow response in flame detector

A new flame detector with one ultraviolet and two infrared detectors is designed. The ultraviolet detector is of rapid response(≤10 μs) while the two infrared detectors usually have a response time of more than 5 ms. The ultraviolet detector is applied to deal with the flame of large scales. When facing the flame of mid or small scales, the three detectors cooperate. Employing the high-order derivatives of the sample data of the infrared circuits to improve the sensitivity, the response speed is greatly improved. The data of the temperature sensor is used to adjust circuit parameters in real time, thus reducing the effect of temperature drift. The flame detectors are tested at different distances and the response time is as rapid as 0.65 ms. The test results show that the new flame detector has the characteristics of high speed and a low rate of false alarms.

快速反应团队工作模式对重症孕产妇抢救效率及救治结局的影响

目的:观察对重症孕产妇实施快速反应团队(RRT)工作模式的干预效果。方法:回顾性收集2021年10月-2022年10月开展常规护理模式的148例重症孕产妇临床资料纳入对照组,2022年11月-2023年11月开展RRT工作模式的152例重症孕产妇临床资料纳入观察组。比较两组抢救效率、救治结局、新生儿情况、重症孕产妇并发症。结果:观察组处理时间(22.6±4.0min)、抢救情况(10.5%)、剖宫产率(35.5%)、新生儿死亡率(0)、ICU入住率(2.0%)、住院时间(7.56±1.34d)、并发症总发生率(2.6%)均少于对照组(33.0±4.5min、18.9%、52.0%、4.1%、27.7%、10.86±3.33d、12.2%),预警情况(40.1%)、有效处理率(98.0%)、5minApagar评分(8.74±0.58分)、脐带血pH值(7.64±1.96)高于对照组(27.7%、81.8%、8.46±0.64分、4.96±1.34)(均P<0.05),两组孕产妇死亡率、新生儿1minApagar评分无差异(P>0.05)。结论:RRT工作模式可提高重症孕产妇的抢救效率,改善救治结局、新生儿情况。

数字化重症快速反应体系建设探索

目的:建设数字化重症快速反应体系,实现急危重症患者早期识别和干预,保障患者医疗安全。方法:利用物联网、大数据和人工智能等技术,建设重症快速反应信息平台,完善快速反应管理体系。结果:构建急危重症大数据中心、智能预警及快速反应系统、组织管理体系三位一体的重症快速反应体系,为患者提供智慧、同质、高效的医疗服务。结论:重症快速反应体系建设在我国尚处于探索阶段,通过全流程的信息化、数字化管理,切实提高患者医疗安全保障,不断推动构建适合我国医疗高质量发展的重症快速反应体系。

复杂信息环境下的情报快速反应机制研究

在科技飞速发展和大国博弈日益白热化的背景下,情报成为抢占国家发展先机的重要工具之一。在复杂信息环境的情报生产新环境和决策新要求下,本文以如何实现情报支撑国家战略决策为研究问题,通过文献调研与案例分析等方法,在总结梳理相关理论和实践经验的基础上,对情报快速反应机制的内涵、特征和决策支撑场景进行深入探究。本文创新性地提出一套适用于复杂信息环境下的“3+5+9情报快速反应机制”,以“早发现、早预判、早报告、早决策、早应对”为五大核心目标,以“联动协调、信息监测、信息资源、情报分析、应急处置、技术支撑、专家协作、组织保障、跟踪评估监督”为九大支撑子体系,适用于常态化监测、回应关切和突发应急三类重要决策支撑场景的情报工作机制,以期为未来相关实践提供较为扎实的理论基础。

组建快速反应小组开通绿色通道对胎儿窘迫患者妊娠结局的影响

目的 探讨组建快速反应小组开通绿色通道对胎儿窘迫患者妊娠结局的影响。方法 选取2019年1月至2021年6月首都医科大学附属北京妇产医院急诊科因胎儿窘迫行急诊剖宫产的96例孕妇为研究对象,根据随机数字表法将其分为对照组(48例)和试验组(48例)。对照组接受常规就诊流程,试验组在快速反应小组的接诊下开通绿色通道进行手术,两组均观察至出院。比较两组挂号到发现胎儿窘迫的时间、发现胎儿窘迫到送达手术室的时间、决定手术至胎儿娩出时间(DDI)、手术开始到胎儿出生的时间、胎儿出生到手术结束的时间;比较两组产妇分娩结局及新生儿结局。结果 试验组发现胎儿窘迫到送达手术室的时间、DDI短于对照组(P<0.05);两组挂号到发现胎儿窘迫的时间、手术开始到胎儿出生的时间、胎儿出生到手术结束的时间比较,差异无统计学意义(P>0.05)。试验组产妇并发症总发生率低于对照组(P<0.05)。两组5 min Apgar评分、转入新生儿重症监护病房、pH值及乳酸浓度比较,差异无统计学意义(P>0.05)。结论 组建快速反应小组开通绿色通道可明显缩短胎儿窘迫患者从挂号到手术室的时间,并可改善产妇分娩结局,但对新生儿结局无影响。

基于关联规则的发射系统敏捷响应要素辨识

当今高性能发射系统追求的大负载、轻量化、低成本、敏捷响应等设计要求通常是相互矛盾的,必须考虑多种约束条件下,多参数匹配的综合优化,才能突破系统各性能指标相互制约的瓶颈。针对以上问题,采用关联规则挖掘方法研究了发射系统设计因素的影响,建立了发射系统设计因素关联规则挖掘模型。在“支持度-置信度”模式的基础上,引入附加评估度量Kulc和IR,提高挖掘结果的准确性。通过工程算例,研究了设计参数对发射系统敏捷响应能力的影响。算例结果表明,提出的方法能够识别对敏捷响应能力起关键作用的设计变量,实现精炼设计空间、简化优化问题,以及提高设计优化效率的目的。

智能呼叫系统在肝胆外科病房的应用及效果评价

目的探讨智能呼叫系统在肝胆外科病房的应用效果,为推进病房智能呼叫系统的建设提供参考。方法将2022年1-9月肝胆外科病房收治的2406例(呼叫120449例次)患者作为传统呼叫组,采用传统呼叫系统;2022年10月至2023年6月收治的2676例(呼叫129798例次)患者作为智能呼叫组,采用智能呼叫系统,实现精准呼叫、自动呼叫、快捷应答等功能。结果手机App后台显示,智能呼叫组签收率为92.0%,监测到患者非正常外出432例次,系统自动发送异常空间警示短信432条次;监测异常呼吸876例次,系统向护士端发送异常呼吸频率报警提示短信876条次;监测异常心率提示639例次,系统向护士端发送异常心率报警提示短信639条次。智能呼叫组呼叫响应时间为4.52(3.92,5.16)s,显著短于传统呼叫组51.52(43.39,59.79)s;护理人员对智能呼叫系统精准性能评价总分为9(8,9)分,显著高于对传统呼叫系统评价总分[5.5(1,10)分](均P<0.05)。结论智慧呼叫系统在呼叫应答及时性、精准性和智能性方面优于传统呼叫系统,有利于实现医护患良好沟通。

早期预警评分联合快速反应团队救护重度子痫前期患者的研究

目的 探讨早期预警评分联合快速反应团队对重度子痫前期患者的应用效果。方法 将2020年1-12月在急诊就诊的126例重度子痫前期患者为对照组,采用常规护理方法;2021年7月至2022年6月同类患者126作为干预组,采用早期预警评分表,客观对孕妇进行评估,早期预警评分触动快速反应系统,立即启动快速反应团队对患者进行紧急救护。比较两组患者母婴结局情况。结果 干预组孕妇就诊后收缩压和舒张压控制情况优于对照组,在急诊留观时间显著缩短(均P<0.05);干预组孕妇HELLP综合征、胎盘早剥、胎膜早破、宫缩乏力和产后出血发生率显著低于对照组(均P<0.05);干预组早产、胎儿窘迫和新生转ICU率显著低于对照组(均P<0.05)。结论 早期预警评分联合快速反应团队可有效降低重度子痫前期患者母婴不良结局,有助于保障母婴安全。