Adherence to clinical guidelines for syncope management was low; many diagnostic tests were performed with low diagnostic yield. Important differences were observed between syncope diagnoses at the ED and by SC decision.
Nurses can be overwhelmed by the growing need for documentation derived from the implantation of electronic health records. The objective was to describe the evolution of nursing workload since the implementation of the EHR. We performed a longitudinal study of global workload indicators over a 5-year period at a referral hospital in Spain since introduction of the EHR (2014). Clinical activity records of each nurse were monitored using audit logs of their accesses to EHRs. During the study period, the number of EHR sessions, the number of EHR sessions in which a nursing order was changed, and the time needed to complete each session significantly increased. The number of mouse clicks and keystrokes and the time required to complete each nursing order decreased. Documentation of the following nursing tasks increased: administration of medication, peripheral vascular catheters, urinary catheters, pressure ulcers, nursing assessment forms, and pre-surgical verification. In conclusion, since the implementation of the EHR, an increase in the workload of nursing professionals-estimated through indirect indicators-has been observed due to greater documentation.
Heart rate (HR) shows oscillations with different periods as a result of the sympatho-vagal balance. The most studied ones are short-period variations and the circadian pattern. However, the existence of rhythms of longer periods has not been systematically studied.The aim of this work is to study HR long-period rhythms in a multicentric database including 336 patients in sinus rhythm, with implanted cardioverter defibrillator. We used two methodological approaches: First a rhythmometric procedure to automatically select the statistically significant rhythms present in the signal; Second, the LASSO path approach to analyze the order of activation of the rhythms, representing the importance of each rhythm.Most of the population showed a significant annual rhythm (78% day/80% night). Weekly and quarterly rhythms were also present (weekly 26% /26% ; quarterly 22%/21%). Monthly rhythm was rarely present. Most present rhythm combinations were annual plus weekly (21%/21%) and annual plus quarterly (19%/18%). The order of activation given by the LASSO path was in agreement with the multicomponent rhythmometric model in the 86%/85% of the cases.The unusual long monitoring period, and the high number of patients, represent an ideal scenario to robustly assess the existence of long-term rhythms.
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