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Because of the low nurse-to-patient ratio on surgical wards and the intermittent nature of blood pressure spot-checks, there is increasing evidence that hemodynamic deterioration may be overlooked for hours. Several non-obtrusive systems have recently been developed to monitor blood pressure continuously and non-invasively. They may help to free nurses from time-consuming and repetitive tasks and to detect clinical deterioration earlier, decrease the number of rapid response team interventions, ICU admissions, cardiac arrests, and deaths. From a sensor standpoint, wireless wearables are emerging as the ideal solution for monitoring on the wards because they are patient friendly and they enable early mobilization, which is a key element of enhanced recovery programs. Clinical studies are needed to clarify what are the best strategies to effectively respond to early deterioration alerts. Such strategies may include the quick assessment of cardiac function with a POCUS device. Future trials will also have to investigate what is the impact on key outcome variables such as ICU admission and hospital length of stay, and which patients may benefit the most from recent mobile monitoring and ultrasound innovations.
Because of the low nurse-to-patient ratio on surgical wards and the intermittent nature of blood pressure spot-checks, there is increasing evidence that hemodynamic deterioration may be overlooked for hours. Several non-obtrusive systems have recently been developed to monitor blood pressure continuously and non-invasively. They may help to free nurses from time-consuming and repetitive tasks and to detect clinical deterioration earlier, decrease the number of rapid response team interventions, ICU admissions, cardiac arrests, and deaths. From a sensor standpoint, wireless wearables are emerging as the ideal solution for monitoring on the wards because they are patient friendly andenable early mobilization,a key element of enhanced recovery programs. Clinical studies are needed to clarify what are the best strategies to effectively respond to early deterioration alerts. Such strategies may include the quick assessment of cardiac function with a POCUS device.
This confirmatory study aimed to examine whether we can foresee recurrence of depressive symptoms using personalized modeling of rises in restlessness.
Methods
Participants were formerly depressed patients (N = 41) in remission who (gradually) discontinued antidepressants. Participants completed five smartphone-based Ecological Momentary Assessments (EMA) a day, for a period of 4 months, yielding a total of 21 180 observations. Statistical Process Control by means of Exponentially Weighted Moving Average (EWMA) control charts was used to detect rises in the EMA item ‘I feel restless’, for each individual separately.
Results
An increase in restlessness was detected in 68.3% of the participants with recurring depressive symptoms, and in 26.3% of those who stayed in remission (Fisher's exact test p = 0.01, sensitivity was 68.3%, specificity was 73.7%). In the participants with a recurrence and an increase in restlessness, this increase could be detected in the prodromal phase of depression in 93.3% of the cases and at least a month before the onset of the core symptoms of depression in 66.7% of the cases.
Conclusions
Restlessness is a common prodromal symptom of depression. The sensitivity and specificity of the EWMA charts was at least as good as prognostic models based on cross-sectional patient characteristics. An advantage of the current idiographic method is that the EWMA charts provide real-time personalized insight in a within-person increase in early signs of depression, which is key to alert the right patient at the right time.
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