我国省级卫生应急人员风险评估认知现状评价

?????? 目的 了解我国省级卫生应急人员对突发公共卫生事件风险评估的认知状况。方法 采用问卷调查的方法,对全国31个省（市、自治区）承担突发公共卫生事件应急处置的省级卫生应急工作人员进行调查,共计调查415名。结果 应急人员普遍意识到突发公共卫生事件信息监测的重要性,但对监测信息来源认知较局限;对风险评估概念熟悉程度较低,且不同机构之间的认知存在一定差异;对风险评估工作的认知也存在分歧,认知水平亟待进一步提高。结论 应完善信息获取途径、加强风险评估的宣传与培训、建立健全风险评估制度。     

Development and Internal Validation of a Predictive Model Including Pulse Oximetry for Hospitalization of Under-Five Children in Bangladesh

Background

The reduction in the deaths of millions of children who die from infectious diseases requires early initiation of treatment and improved access to care available in health facilities. A major challenge is the lack of objective evidence to guide front line health workers in the community to recognize critical illness in children earlier in their course.

Methods

We undertook a prospective observational study of children less than 5 years of age presenting at the outpatient or emergency department of a rural tertiary care hospital between October 2012 and April 2013. Study physicians collected clinical signs and symptoms from the facility records, and with a mobile application performed recordings of oxygen saturation, heart rate and respiratory rate. Facility physicians decided the need for hospital admission without knowledge of the oxygen saturation. Multiple logistic predictive models were tested.

Findings

Twenty-five percent of the 3374 assessed children, with a median (interquartile range) age of 1.02 (0.42–2.24), were admitted to hospital. We were unable to contact 20% of subjects after their visit. A logistic regression model using continuous oxygen saturation, respiratory rate, temperature and age combined with dichotomous signs of chest indrawing, lethargy, irritability and symptoms of cough, diarrhea and fast or difficult breathing predicted admission to hospital with an area under the receiver operating characteristic curve of 0.89 (95% confidence interval -CI: 0.87 to 0.90). At a risk threshold of 25% for admission, the sensitivity was 77% (95% CI: 74% to 80%), specificity was 87% (95% CI: 86% to 88%), positive predictive value was 70% (95% CI: 67% to 73%) and negative predictive value was 91% (95% CI: 90% to 92%).

Conclusion

A model using oxygen saturation, respiratory rate and temperature in combination with readily obtained clinical signs and symptoms predicted the need for hospitalization of critically ill children. External validation of this model in a community setting will be required before adoption into clinical practice.     

Effect of 30% Oxygen Administration on Verbal Cognitive Performance, Blood Oxygen Saturation and Heart Rate

This study investigated the effect of 30% oxygen administration on verbal cognitive performance, blood oxygen saturation, and heart rate. Five male (24.6(±0.9) years) and five female (22.2(±1.9) years) college students were selected as the subjects for this study. Two psychological tests were developed to measure the performance level of verbal cognition. The experiment consisted of two runs: one was a verbal cognition task, with normal air (21% oxygen) administered and the other was with hyperoxic air (30% oxygen) administered. The experimental sequence in each run consisted of Rest 1 (1 min), Control (1 min), Task (4 min), and Rest 2 (4 min). Blood oxygen saturation and heart rate were measured throughout the four phases. The results of the verbal behavioural analysis reveal that accuracy rates were enhanced with 30% oxygen administration compared to 21% oxygen. When 30% oxygen was supplied, blood oxygen saturation was increased significantly compared to that with 21% oxygen administration, whereas heart rate showed no significant difference. Significant positive correlations were found between changes in oxygen saturation and cognitive performance. This result supports the hypothesis that 30% oxygen administration would lead to increases in verbal cognitive performance.     

The physiologic and medical rationale for intrapartum fetal monitoring

In the United States and most industrialized countries, intrapartum fetal surveillance is performed primarily by electronic fetal heart rate monitoring. Following implementation of this technology into clinical practice, a reduction in perinatal mortality has been accompanied by a concomitant increase in the cesarean section rate to concerning levels. Although these trends are not solely due to one factor such as electronic fetal heart rate monitoring, it is well-recognized that this method of surveillance is hampered by subjectivity in interpretation and by a high false-positive (falsely nonreassuring) rate. The purpose of this review is to assess the physiologic rationale for intrapartum assessment, the significant limitations of current primary and ancillary monitoring methods, and the development of new technologies such as fetal oxygen saturation monitoring (pulse oximetry) that potentially hold great promise for the future.     

Time-of-Day Effect on Cardiac Responses to Progressive Exercise

This study was designed to examine time-of-day effects on markers of cardiac functional capacity during a standard progressive cycle exercise test. Fourteen healthy, untrained young males (mean?±?SD: 17.9?±?0.7 yrs of age) performed identical maximal cycle tests in the morning (08:00–11:00?h) and late afternoon (16:00–19:00?h) in random order. Cardiac variables were measured at rest, submaximal exercise, and maximal exercise by standard echocardiographic techniques. No differences in morning and afternoon testing values at rest or during exercise were observed for oxygen uptake, heart rate, cardiac output, or markers of systolic and diastolic myocardial function. Values at peak exercise for Vo₂ at morning and afternoon testing were 3.20?±?0.49 and 3.24?±?0.55?L min^?1, respectively, for heart rate 190?±?11 and 188?±?15?bpm, and for cardiac output 19.5?±?2.8 and 19.8?±?3.5?L min^?1. Coefficients of variation for morning and afternoon values for these variables were similar to those previously published for test-retest reproducibility. This study failed to demonstrate evidence for significant time-of-day variation in Vo₂max or cardiac function during standard progressive exercise testing in adolescent males. (Author correspondence: thomas.rowland@bhs.org)     

Feasibility and Safety of Fiber Optic Micro-Imaging in Canine Peripheral Airways

Purpose

To assess the feasibility and safety of imaging canine peripheral airways (<1 mm) with an experimental micro-imaging fiber optic bronchoscope.

Methods

Twenty healthy dogs were scoped with a micro-imaging fiber optic bronchoscope (0.8 mm outer diameter). Images at various levels of the bronchioles, mucosal color, and tracheal secretions were recorded. The apparatus was stopped once it was difficult to insert. CT imaging was performed simultaneously to monitor progression. The safety of the device was evaluated by monitoring heart rate (HR), respiratory rate (RR), mean artery pressure (MAP), peripheral oxygen saturation (SpO₂) and arterial blood gases (partial pressure of arterial carbon-dioxide, PaCO₂, partial pressure of arterial oxygen, PaO₂, and blood pH).

Results

(1) According to the CT scan, the micro-imaging fiber was able to access the peripheral airways (<1 mm) in canines. (2) There was no significant change in the values of HR, MAP, pH and PaCO₂ during the procedure (P>0.05). Comparing pre-manipulation and post-manipulation values, SpO₂ (F = 13.06, P<0.05) and PaO₂ (F = 3.01, P = 0.01) were decreased, whereas RR (F = 3.85, P<0.05) was elevated during the manipulation. (3) Self-limited bleeding was observed in one dog; severe bleeding or other complications did not occur.

Conclusion

Although the new apparatus had little effect on SpO₂, PaO₂ and RR, it can probe into small peripheral airways (<1 mm), which may provide a new platform for the early diagnosis of bronchiolar diseases.     

2-h postchallenge plasma glucose predicts cardiovascular events in patients with myocardial infarction without known diabetes mellitus

Background

Non-enzymatic glycation increases hemoglobin-oxygen affinity and reduces oxygen delivery to tissues by altering the structure and function of hemoglobin.

Objectives

We investigated whether an elevated blood concentration of glycosylated hemoglobin (HbA1c) could induce falsely high pulse oximeter oxygen saturation (SpO₂) in type 2 diabetic patients during mechanical ventilation or oxygen therapy.

Methods

Arterial oxygen saturation (SaO₂) and partial pressure of oxygen (PO₂) were determined with simultaneous monitoring of SpO₂ in 261 type 2 diabetic patients during ventilation or oxygen inhalation.

Results

Blood concentration of HbA1c was >7% in 114 patients and????7% in 147 patients. Both SaO₂ (96.2?±?2.9%, 95% confidence interval [CI] 95.7-96.7% vs. 95.1?±?2.8%, 95% CI 94.7-95.6%) and SpO₂ (98.0?±?2.6%, 95% CI 97.6-98.5% vs. 95.3?±?2.8%, 95% CI 94.9-95.8%) were significantly higher in patients with HbA1c >7% than in those with HbA1c????7% (Data are mean?±?SD, all p?<?0.01), but PO₂ did not significantly differ between the two groups. Bland-Altman analysis demonstrated a significant bias between SpO₂ and SaO₂ (1.83 ±0.55%, 95% CI 1.73% -1.94%) and limits of agreement (0.76% and 2.92%) in patients with HbA1c >7%. The differences between SpO₂ and SaO₂ correlated closely with blood HbA1c levels (Pearson??s r?=?0.307, p?<?0.01).

Conclusions

Elevated blood HbA1c levels lead to an overestimation of SaO₂ by SpO₂, suggesting that arterial blood gas analysis may be needed for type 2 diabetic patients with poor glycemic control during the treatment of hypoxemia.     

存在睡眠呼吸异常的慢病患者呼吸影响心率变异性的初步分析*

目的: 基于整体整合生理学医学理论提出的呼吸引起循环指标变异的假说,分析研究存在睡眠呼吸异常的慢病患者睡眠期间呼吸和心率变异之间的相关关系。方法: 纳入存在睡眠呼吸异常且呼吸暂停低通气指数（AHI）≥15次/小时的慢病患者11例,签署知情同意书后完成标准化症状限制性极限运动的心肺运动试验（CPET）和睡眠呼吸监测,计算分析病人睡眠期间波浪式呼吸（OB）期与正常平稳呼吸期的呼吸鼻气流、心电图R-R间期心率变异的规律。结果: 存在睡眠呼吸异常的慢病患者CPET峰值摄氧量（Peak VO₂）和无氧阈（AT）为（70.8±13.6）%pred和（71.2±6.1）%pred;CPET有5例存在运动诱发的波浪式呼吸（EIOB）,6例为呼吸不稳定,提示整体功能状态低于正常人。本组慢病患者AHI为每小时（28.8±10.0）次,睡眠呼吸异常总时间占睡眠总时间的比值为（0.38±0.25）;OB周期的平均时间长度为（51.1±14.4）s。本组慢病患者正常平稳呼吸期的呼吸周期数与心率变异周期数的比值（B-n/HRV-B-n）为1.00±0.04,每个呼吸周期节律的心率变异平均幅度（HRV-B-M）为（2.64±1.59） bpm,虽然低于正常人（P<0.05）,但却与无睡眠呼吸异常的慢病患者相似（P>0.05）;HRV-B-M的变异度CV（HRV-B-M的SD/x）为( 0.33±0.11）,期间血氧饱和度（SpO₂）虽略低,但并无明显规律性下降与上升。本组慢病患者的OB期间呼吸周期数与心率变异周期数（OB-B-n/OB-HRV-B-n）比值为（1.22±0.18）,OB期每个呼吸周期节律的心率变异平均幅度（OB-HRV-B-M）为（3.56±1.57）bpm及其变异度（OB-CV =OB-HRV-B-M的SD/x）为（0.59±0.28）,每个OB周期节律的心率变异平均幅度（OB-HRV-OB-M）为（13.75±4.25）bpm,OB期间低通气时SpO₂出现明显的下降,OB期间SpO₂平均变异幅度（OB-SpO₂-OB-M）为（4.79±1.39）%,OB期的OB-B-n/OB-HRV-B-n比值、OB-HRV-OB-M比其正常平稳呼吸期对应指标显著增大（P<0.01）。OB-HRV-B-M虽然与正常平稳呼吸期HRV-B-M相比差异无统计学意义（P>0.05）,但其变异度OB-CV却显著增大（P<0.01）。结论: 睡眠呼吸异常的慢病患者OB期的心率变异幅度大于其正常平稳呼吸期,当呼吸模式发生改变时心率变异也发生明显改变,其平稳呼吸期的呼吸周期数与心率变异周期数的比值与正常人以及无睡眠呼吸异常的慢病患者相同,证实心率变异为呼吸源性;而其OB期间心率变异周期数相对于呼吸周期减少直接源于此时的低通气或者呼吸暂停,心率变异也是呼吸源性。     

Smart textile for respiratory monitoring and thoraco‐abdominal motion pattern evaluation

The use of wearable systems for monitoring vital parameters has gained wide popularity in several medical fields. The focus of the present study is the experimental assessment of a smart textile based on 12 fiber Bragg grating sensors for breathing monitoring and thoraco‐abdominal motion pattern analysis. The feasibility of the smart textile for monitoring several temporal respiratory parameters (ie, breath‐by‐breath respiratory period, breathing frequency, duration of inspiratory and expiratory phases), volume variations of the whole chest wall and of its compartments is performed on 8 healthy male volunteers. Values gathered by the textile are compared to the data obtained by a motion analysis system, used as the reference instrument. Good agreement between the 2 systems on both respiratory period (bias of 0.01 seconds), breathing frequency (bias of ?0.02 breaths/min) and tidal volume (bias of 0.09 L) values is demonstrated. Smart textile shows good performance in the monitoring of thoraco‐abdominal pattern and its variation, as well.      

Diastolic time – frequency relation in the stress echo lab: filling timing and flow at different heart rates

 

A cutaneous force-frequency relation recording system based on first heart sound amplitude vibrations has been recently validated. Second heart sound can be simultaneously recorded in order to quantify both systole and diastole duration.

Aims

1- To assess the feasibility and extra-value of operator-independent, force sensor-based, diastolic time recording during stress.

Methods

We enrolled 161 patients referred for stress echocardiography (exercise 115, dipyridamole 40, pacing 6 patients). The sensor was fastened in the precordial region by a standard ECG electrode. The acceleration signal was converted into digital and recorded together with ECG signal. Both systolic and diastolic times were acquired continuously during stress and were displayed by plotting times vs. heart rate. Diastolic filling rate was calculated as echo-measured mitral filling volume/sensor-monitored diastolic time.

Results

Diastolic time decreased during stress more markedly than systolic time. At peak stress 62 of the 161 pts showed reversal of the systolic/diastolic ratio with the duration of systole longer than diastole. In the exercise group, at 100 bpm HR, systolic/diastolic time ratio was lower in the 17 controls (0.74 ± 0.12) than in patients (0.86 ± 0.10, p < 0.05 vs. controls). Diastolic filling rate increased from 101 ± 36 (rest) to 219 ± 92 ml/m²* s^-1 at peak stress (p < 0.5 vs. rest).

Conclusion

Cardiological systolic and diastolic duration can be monitored during stress by using an acceleration force sensor. Simultaneous calculation of stroke volume allows monitoring diastolic filling rate. Stress-induced "systolic-diastolic mismatch" can be easily quantified and is associated to several cardiac diseases, possibly expanding the spectrum of information obtainable during stress.     

The steady-state rate of ATP synthesis in the perfused rat heart measured by 31P NMR saturation transfer

The steady-state rate of ATP synthesis in the isolated, Langendorff-perfused rat heart was determined using a ³¹P NMR saturation transfer method. At 37°C and a perfusion pressure of 70 cm H₂O the value is 2.8 ± 0.3 (n=5 ± S.E.M.) μmol.s^?1. (g. dry wt.)^?1. The activity of creatine phosphokinase measured in the same experiments was 14.6 ± 1.0 μ mol.s^?1 .(g. dry wt.)^?1. From the rate of ATP synthesis and the separately measured oxygen consumption we calculated an apparent mitochondrial ADP:O ratio of 3.5 ± 0.8 in the intact tissue.     

EFFECTS OF AEROBIC EXERCISE ON THE CIRCADIAN RHYTHM OF HEART RATE AND BLOOD PRESSURE

Although the effects of aerobic exercise on resting heart rate, heart rate variability, and blood pressure have been investigated, there are scant data on the effects of aerobic exercise on the circadian rhythm of such cardiovascular parameters. In this study, we investigated the effects of aerobic exercise on the 24?h rhythm of heart rate and ambulatory blood pressure in the morning, when cardiovascular events are more common. Thirty-five healthy young subjects were randomized to control and aerobic exercise groups. Subjects in the latter group participated in their respective exercise program for two months, while those in the former group did not exercise. Twenty-four-hour electrocardiogram and ambulatory blood pressure monitoring data were obtained at baseline and at the end of the exercise intervention. The control group showed no changes, while the aerobic exercise group showed a significant decrease in heart rate (73.7?±?6.6?bpm to 69.5?±?5.1?bpm, p?<?0.005) and sympathetic activity such as LF/HF ratio (2.0?±?0.7 to 1.8?±?0.6, p?<?0.05) throughout the 24?h period, particularly in the daytime. The decrease in the heart rate was most prominent in the morning. However, heart rate and LF/HF ratio showed no statistical changes during the night. No significant changes were observed in blood pressure. These findings suggest aerobic exercise exerts beneficial effects on the circadian rhythm of heart rate, especially in the morning. (Author correspondence: hshio@kobe-u.ac.jp)     

Organ Donation After Acute Brain Death: Addressing Limitations of Time and Resources in the Emergency Department

It is not unusual for emergency physicians to quickly identify whether a patient would have wanted to be resuscitated or intubated in a cardiac arrest situation, but patients’ other preferences for end-of-life care or organ donation are less commonly ascertained in the emergency department. Typically, the decision process regarding such goals at end of life may be “deferred” to the intensive care unit. We present a case illustrative of the complexity of discussing organ donation in the emergency department and suggest that patients who die in the emergency department should be afforded the respect and consideration provided in other parts of the hospital, including facilitation of organ transplantation. As circulatory determination of death becomes a more common antecedent to organ transplantation, specific questions may arise in the emergency department setting. When in the emergency department, how should organ donation be addressed and by whom? Should temporary organ preservation be initiated in the setting of uncertainty regarding a patient’s wishes? To better facilitate discussions about organ donation when they arise in emergency settings, we propose increased coordination between organ procurement organizations and emergency physicians to improve awareness of organ transplantation.     

Determination of CO₂ sensitivity of micro-organisms in shaken bioreactors. II. Novel online monitoring method

In the present study, a new online monitoring method for the determination of the CO? sensitivity of micro-organisms, based on the values of the respiration factors [OTR (oxygen transfer rate) and CTR (carbon dioxide transfer rate)], obtained by using the RAMOS (respiratory activity monitoring system) device considering a variety of aeration rates in the measuring flask, is investigated. Based on the data of the OTR, obtained by RAMOS under a variety of specific aeration rates, the proposed new method was developed as an online monitoring method for CO? sensitivity of micro-organisms in shaken bioreactors. A maximum accumulated CO? concentration of 12% was derived in applied methods, provided that the cultivation system is carried out under optimal conditions. Additionally, to predict these conditions, an unsteady-state gas transfer model in shaken bioreactors would be very advantageous. The data of OTR obtained using the RAMOS device were analysed and recalculated by a programme considering the calibration factor (Cf). The major advantage of the new method is the possibility to determine the metabolic activity, regardless of manual sampling.     

吸氧对椎管内麻醉下剖宫产术后疼痛的影响

目的:评价麻醉前和术中持续吸氧对椎管内麻醉下剖宫产术后疼痛的效果。方法:选择ASAI-II级择期行剖宫产手术的初产妇100例,将其随机分为面罩吸氧组和空气吸入组(对照组)。吸氧组于术前30 min及术中通过面罩全程给氧,吸入氧浓度为60%,空气组则不给予特殊处理。检测和比较两组产妇不同时点的心率、血压及SpO2的变化,手术时间,视觉模拟评分(VAS),新生儿Apgar评分,胎儿氧饱和度,新生儿脐动静脉血气,产妇血气以及术后24 h内恶心呕吐的发生率。结果:两组产妇各时间点心率、血压、SpO2、手术时间及新生儿Apgar评分、胎儿氧饱和度比较均无显著性差异(P0.05)。吸氧组术后6 h、12 h、24 h的VAS评分分别为(4.07±0.10)、(2.13±0.12)和(0.42±0.08),均明显低于对照组的(6.10±0.11)、(4.02±0.13)及(1.10±0.22)(P0.05)。吸氧组新生儿脐动静脉血气、产妇血气氧分压均显著高于对照组(P0.05),术后24h内恶心呕吐的发生率显著低于对照组(P0.05)。结论:麻醉前和术中持续吸氧能显著减轻椎管内麻醉下剖宫产术后疼痛,同时有效降低术后恶心呕吐的发生率。     

Centrale de mesure ambulatoire biomédicale sur PSoC

Improvement in quality and efficiency of health and medicine, at home and in hospital, has become of paramount importance. The solution to this problem would require the continuous monitoring of several key patient parameters, including the assessment of autonomic nervous system (ANS) activity using non-invasive sensors, providing information for emotional, sensorial, cognitive and physiological analysis of the patient. Recent advances in embedded systems, microelectronics, sensors and wireless networking enable the design of wearable systems capable of such advanced health monitoring. The subject of this article is an ambulatory system comprising of a small wrist device connected to several sensors for the detection of the autonomic nervous system activity. It affords monitoring of skin resistance, skin temperature and heart activity. It is also capable of recording the data on a removable media or sending it to computer via a wireless communication. The wrist device is based on a programmable system-on-chip (PSoC) from Cypress.     

同步间歇指令通气和适应性支持通气对COPD合并呼吸衰竭患者周围循环和血气的影响

目的:研究同步间歇指令通气(SIMV)与适应性支持通气(ASV)对慢性阻塞性肺部疾病(COPD)合并呼衰患者机体外周血循环、血气指标的影响。方法:选取2006年3月至2013年12月在我院接受治疗的COPD合并呼吸衰竭患者86例,对其分别先后采用ASV、SIMV呼吸模式,记录呼吸机参数、外周血循环参数及血气指标。结果:ASV组呼吸频率(RR)、潮气量(TV)、吸气峰值压(PIP)均显著低于SIMV组(均P0.01);ASV组外周血心率(HR)、收缩压(SBP)、舒张压(DBP)、中心静脉压(CVP)均显著低于SIMV组(均P0.01);ASV组动脉血氧分压(PaO_2)、pH、血氧饱和度(Sa O2)均较SIMV组显著升高(均P0.05)。结论:ASV模式下治疗COPD合并呼吸衰竭患者的呼吸参数、外周血循环参数、血气改善效果优于SIMV模式。     

Mobile nocturnal long-term monitoring of wheezing and cough.

Changes in normal lung sounds are an important sign of pathophysiological processes in the bronchial system and lung tissue. For the diagnosis of bronchial asthma, coughing and wheezing are important symptoms that indicate the existence of obstruction. In particular, nocturnal long-term acoustic monitoring and assessment make sense for qualitative and quantitative detection and documentation. Previous methods used for lung function diagnosis require active patient cooperation that is not possible during sleep. We developed a mobile device based on the CORSA standard that allows the recording of respiratory sounds throughout the night. To date, we have recorded 133 patients with different diagnoses (80 male, 53 female), of whom 38 were children. In 68 of the patients we could detect cough events and in 87 we detected wheezing. The recording method was tolerated by all participating adults and children. Our mobile system allows non-invasive and cooperation-independent nocturnal monitoring of acoustic symptoms in the domestic environment, especially at night, when most ailments occur.     

Physiologic Status Monitoring via the Gastrointestinal Tract

Reliable, real-time heart and respiratory rates are key vital signs used in evaluating the physiological status in many clinical and non-clinical settings. Measuring these vital signs generally requires superficial attachment of physically or logistically obtrusive sensors to subjects that may result in skin irritation or adversely influence subject performance. Given the broad acceptance of ingestible electronics, we developed an approach that enables vital sign monitoring internally from the gastrointestinal tract. Here we report initial proof-of-concept large animal (porcine) experiments and a robust processing algorithm that demonstrates the feasibility of this approach. Implementing vital sign monitoring as a stand-alone technology or in conjunction with other ingestible devices has the capacity to significantly aid telemedicine, optimize performance monitoring of athletes, military service members, and first-responders, as well as provide a facile method for rapid clinical evaluation and triage.     

Monitoring Vital Signs: Development of a Modified Early Warning Scoring (Mews) System for General Wards in a Developing Country

Objective

The aim of the study was to develop and validate, by consensus, the construct and content of an observations chart for nurses incorporating a modified early warning scoring (MEWS) system for physiological parameters to be used for bedside monitoring on general wards in a public hospital in South Africa.

Methods

Delphi and modified face-to-face nominal group consensus methods were used to develop and validate a prototype observations chart that incorporated an existing UK MEWS. This informed the development of the Cape Town ward MEWS chart.

Participants

One specialist anaesthesiologist, one emergency medicine specialist, two critical care nurses and eight senior ward nurses with expertise in bedside monitoring (N = 12) were purposively sampled for consensus development of the MEWS. One general surgeon declined and one neurosurgeon replaced the emergency medicine specialist in the final round.

Results

Five consensus rounds achieved ≥70% agreement for cut points in five of seven physiological parameters respiratory and heart rates, systolic BP, temperature and urine output. For conscious level and oxygen saturation a relaxed rule of <70% agreement was applied. A reporting algorithm was established and incorporated in the MEWS chart representing decision rules determining the degree of urgency. Parameters and cut points differed from those in MEWS used in developed countries.

Conclusions

A MEWS for developing countries should record at least seven parameters. Experts from developing countries are best placed to stipulate cut points in physiological parameters. Further research is needed to explore the ability of the MEWS chart to identify physiological and clinical deterioration.