Susannah Fleming

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BACKGROUND Although heart rate and respiratory rate in children are measured routinely in acute settings, current reference ranges are not based on evidence. We aimed to derive new centile charts for these vital signs and to compare these centiles with existing international ranges. METHODS We searched Medline, Embase, CINAHL, and reference lists for(More)
The photoplethysmogram (PPG) is the pulsatile waveform produced by the pulse oximeter, which is widely used for monitoring arterial oxygen saturation in patients. Various methods for extracting the breathing rate from the PPG waveform have been compared using a consistent data set, and a novel technique using autoregressive modelling is presented. This(More)
Accurate assessment of a child's health is critical for appropriate allocation of medical resources and timely delivery of healthcare in Emergency Departments. The accurate measurement of vital signs is a key step in the determination of the severity of illness and respiratory rate is currently the most difficult vital sign to measure accurately. Several(More)
BACKGROUND Large artery stiffening and wave reflections are independent predictors of adverse events. To date, their assessment has been limited to specialised techniques and settings. A new, more practical method allowing assessment of central blood pressure from waveforms recorded using a conventional automated oscillometric monitor has recently been(More)
OBJECTIVE To evaluate the utilisation of paper-based track and trigger (T&T) charts in a UK emergency department (ED). METHODS A single-centre prospective observational cohort study was conducted in the ED of a medium-sized teaching hospital. Charted vital-sign data were collected from adults attending the resuscitation room, majors or observation ward.(More)
BACKGROUND Placebos are widely used in clinical practice in spite of ethical restrictions. Whether such use is justified depends in part on the relative benefit of placebos compared to 'active' treatments. A direct test for differences between placebo and 'active' treatment effects has not been conducted. OBJECTIVES We aimed to test for differences(More)
Respiratory rate is recognised as a valuable predictor of the severity of illness in children, but it is not currently feasible to measure this automatically in a triage environment. Autoregressive modelling on data from the pulse oximeter photoplethysmogram has the potential to introduce automated breathing measurement into the realm of paediatric triage.(More)
BACKGROUND Most guidelines recommend the use of capillary refill time (CRT) as part of the routine assessment of unwell children, but there is little consensus on the optimum method of measurement and cut-off time. METHODS We searched Medline (from 1948), Embase (from 1980) and CINAHL (from 1991) to June 2014 to identify studies with information on the(More)
BACKGROUND We have previously reported that estimation of central blood pressure (BP) and augmentation using an automated oscillometric device are robust and feasible in a community setting. The same method has recently been validated for estimating aortic pulse wave velocity (aPWV) in laboratory settings, and its prognostic value has been confirmed in a(More)