Browsing by Author "Mosier, Jarrod"
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- ItemThe Connected Intensive Care Unit Patient: Exploratory Analyses and Cohort Discovery From a Critical Care Telemedicine Database.(0000-00-00) Essay, Patrick; Shahin, Tala B; Balkan, Baran; Mosier, Jarrod; Subbian, VigneshBACKGROUND Many intensive care units ICUs utilize telemedicine in response to an expanding critical care patient population off hours coverage and intensivist shortages particularly in rural facilities Advances in digital health technologies among other reasons have led to the integration of active well networked critical care telemedicine tele ICU systems across the United States which in turn provide the ability to generate large scale remote monitoring data from critically ill patients OBJECTIVE The objective of this study was to explore opportunities and challenges of utilizing multisite multimodal data acquired through critical care telemedicine Using a publicly available tele ICU or electronic ICU eICU database we illustrated the quality and potential uses of remote monitoring data including cohort discovery for secondary research METHODS Exploratory analyses were performed on the eICU Collaborative Research Database that includes deidentified clinical data collected from adult patients admitted to ICUs between 2014 and 2015 Patient and ICU characteristics top admission diagnoses and predictions from clinical scoring systems were extracted and analyzed Additionally a case study on respiratory failure patients was conducted to demonstrate research prospects using tele ICU data RESULTS The eICU database spans more than 200 hospitals and over 139 000 ICU patients across the United States with wide ranging clinical data and diagnoses Although mixed medical surgical ICU was the most common critical care setting patients with cardiovascular conditions accounted for more than 20 of ICU stays and those with neurological or respiratory illness accounted for nearly 15 of ICU unit stays The case study on respiratory failure patients showed that cohort discovery using the eICU database can be highly specific albeit potentially limiting in terms of data provenance and sparsity for certain types of clinical questions CONCLUSIONS Large scale remote monitoring data sources such as the eICU database have a strong potential to advance the role of critical care telemedicine by serving as a testbed for secondary research as well as for developing and testing tools including predictive and prescriptive analytical solutions and decision support systems The resulting tools will also inform coordination of care for critically ill patients intensivist coverage and the overall process of critical care telemedicine
- ItemTelebation: next-generation telemedicine in remote airway management using current wireless technologies.(2013-02-15) Mosier, Jarrod; Joseph, Bellal; Sakles, John CINTRODUCTION Since the first remote intubation with telemedicine guidance wireless technology has advanced to enable more portable methods of telemedicine involvement in remote airway management MATERIALS AND METHODS Three voice over Internet protocol VoIP services were evaluated for quality of image transmitted data lag and audio quality with remotely observed and assisted intubations in an academic emergency department The VoIP clients evaluated were Apple Cupertino CA FaceTime Skype a division of Microsoft Luxembourg City Luxembourg and Tango TangoMe Palo Alto CA Each client was tested over a Wi Fi network as well as cellular third generation 3G Skype and Tango RESULTS All three VoIP clients provided acceptable image and audio quality There is a significant data lag in image transmission and quality when VoIP clients are used over cellular broadband 3G compared with Wi Fi CONCLUSIONS Portable remote telemedicine guidance is possible with newer technology devices such as a smartphone or tablet as well as VoIP clients used over Wi Fi or cellular broadband
- ItemTelemedicine and telepresence for prehospital and remote hospital tracheal intubation using a GlideScope™ videolaryngoscope: a model for tele-intubation.(2011-04-19) Sakles, John C; Mosier, Jarrod; Hadeed, George; Hudson, Michael; Valenzuela, Terence; Latifi, RifatThe inability to secure a patient s airway in the prehospital setting is a major cause of potentially preventable death in the field of trauma and emergency medicine
- ItemTelepresent Intubation Supervision Is as Effective as In-Person Supervision of Procedurally Naive Operators.(2014-12-09) Prescher, Hannes; Grover, Emily; Mosier, Jarrod; Stolz, Uwe; Biffar, David E; Hamilton, Allan J; Sakles, John CAbstract Background Telepresence is emerging in clinical and educational settings as a potential modality to provide expert guidance during remote airway management This study aimed to compare the effectiveness of telepresent versus in person supervision of tracheal intubation Materials and Methods A randomized crossover study was performed in a university medical simulation center with 48 first and second year medical students with no formal procedural training in tracheal intubation Each participant was assigned to receive each of four study arms in random sequence 1 direct laryngoscopy DL with in person supervision 2 DL with telepresent supervision 3 videolaryngoscopy VL with in person supervision and 4 VL with telepresent supervision Telepresence was established with a smartphone Apple Cupertino CA iPhone via FaceTime connection The primary outcome measure was the time to successful intubation Secondary outcome measures included first pass success rate and the number of blade and tube attempts Results There was no significant difference between in person and telepresent supervision for any of the outcomes The median difference in person versus telepresent for time to intubation was 3 s 95 confidence interval CI 20 to 14 s The odds ratio for first attempt success was 0 7 95 CI 0 3 1 3 and the rate ratio for extra number of blade attempts i e attempts in addition to first was 1 1 95 CI 0 7 1 7 and 1 4 95 CI 0 9 2 2 for extra number of tube attempts Conclusions In this study population of procedurally naive medical students telepresent supervision was as effective as in person supervision for tracheal intubation