Isikole Sesayensi Yezempilo Nezenhlalakahle, i-Helen McArdle Institute of Nursing and Nursing, University of Sunderland, Sunderland, UK
Nicholas Harland, School of Health Sciences and Welfare, Helen McArdle Institute of Nursing and Nursing, University of Sunderland City Campus, Chester Road, Sunderland SR1 3SD, UK.
Isikole Sesayensi Yezempilo Nezenhlalakahle, i-Helen McArdle Institute of Nursing and Nursing, University of Sunderland, Sunderland, UK
Nicholas Harland, School of Health Sciences and Welfare, Helen McArdle Institute of Nursing and Nursing, University of Sunderland City Campus, Chester Road, Sunderland SR1 3SD, UK.
Sebenzisa isixhumanisi esingezansi ukuze wabelane ngenguqulo yombhalo egcwele yalesi sihloko nabangani bakho nozakwenu.Funda kabanzi.
Isevisi ye-COVID-19 Oximetry@Home yenziwe yasebenza ezweni lonke.Lokhu kuvumela iziguli ezisengozini enkulu ezinezimpawu ezithambile ze-COVID-19 ukuthi zihlale ekhaya futhi zithole i-pulse oximeter ukuze zilinganise ukugcwala kwazo komoyampilo (SpO2) izikhathi ezi-2 kuya kwezi-3 ngosuku amasonto amabili.Iziguli zirekhoda ukufundwa kwazo ngesandla noma nge-elekthronikhi futhi zigadwa ithimba lasemtholampilo.Isinqumo somtholampilo sokusebenzisa i-algorithm sisekelwe ekufundweni kwe-SpO2 ngaphakathi kwebanga elincane, lapho izinguquko zamaphuzu angu-1-2 zingathinta ukunakekelwa.Kulesi sihloko, sixoxe ngezinto eziningi ezithinta ukufundwa kwe-SpO2, futhi abanye abantu “abavamile” bazoba nephuzu “eliphansi elivamile” embundwini wokuphathwa komtholampilo ngaphandle kwezinkinga zokuphefumula ezaziwayo.Sixoxisane ngobunzima obungaba khona bale nkinga ngokusekelwe ezincwadini ezifanele, futhi sacabangela ukuthi lokhu kuzokuthinta kanjani ukusetshenziswa kwesevisi ye-Oximetry@home, engase iphambanise kancane injongo yayo;ukunciphisa ukwelashwa ubuso nobuso.
Kunezinzuzo eziningi zokuphatha amacala angenamandla e-COVID-19 emphakathini, nakuba lokhu kuvimbela ukusetshenziswa kwemishini yezokwelapha efana nama-thermometers, ama-stethoscopes, nama-pulse oximeters ngesikhathi sokuhlola.Kodwa-ke, njengoba isilinganiso se-pulse oximetry yesiguli ekhaya siwusizo ekuvimbeleni ukuvakasha komnyango wezimo eziphuthumayo okungadingekile (Torjesen, 2020) kanye nokuhlonzwa kusenesikhathi kwe-asymptomatic hypoxia, nokho, i-NHS England incoma ukuthi izwe lonke Liphathise insizakalo ye- “Spo2 Measurement@Home” (NHSE , 2020a)) Ezigulini ezinezimpawu ezithambile ze-COVID-19 kodwa ezisengozini enkulu yokuwohloka kwesifo, i-pulse oximeter ingasetshenziswa izinsuku eziyi-14 zokwelashwa, ukuze izikhathi ezi-2-3 ngosuku Ukuzigada ngokugcwala kwawo komoyampilo (SpO2) .
Iziguli ezidluliselwe kusevisi ye-Oximetry@Home ngokuvamile ziqondiswa ukuthi zisebenzise uhlelo lokusebenza noma idayari yephepha ukuze zirekhode ezikubonile.Uhlelo lokusebenza luhlinzeka ngezimpendulo/izincomo ezizenzakalelayo, noma udokotela uqapha idatha.Uma kunesidingo, udokotela angathintana nesiguli, kodwa ngokuvamile kuphela ngamahora avamile okusebenza.Iziguli zitshelwa ukuthi ziyihumusha kanjani imiphumela yazo ukuze zikwazi ukuzimela lapho kudingeka, njengokufuna usizo oluphuthumayo.Ngenxa yobungozi obukhulu bokubhebhetheka kwalesi sifo, abantu abangaphezu kweminyaka engama-65 ubudala kanye/noma abanezifo eziningi ezichazwa njengabasengcupheni kakhulu baba yizisulu zale ndlela (NHSE, 2020a).
Ukuhlolwa kweziguli kusevisi ye-Oximetry@Home okokuqala ukukala ukugcwala kwazo komoyampilo nge-pulse oximeter SpO2, bese kucatshangelwa ezinye izimpawu nezimpawu.Kusetshenziswa izilinganiso ezibomvu, ezi-amber, neziluhlaza (RAG), uma i-SpO2 yesiguli ingama-92% noma ngaphansi, isiguli sibhekwa njengesibomvu, futhi uma i-SpO2 yaso iyi-93% noma i-94%, ihlukaniswa njenge-amber, uma ngabe i-SpO2 yabo zingama-95% noma ngaphezulu, zihlukaniswa njengeziluhlaza.Ngokuvamile, iziguli eziluhlaza kuphela ezifaneleka ukusebenzisa i-Oximetry@Home (NHSE, 2020b).Nokho, izici ezihlukahlukene ezingahlobene nezifo zingathinta isikolo se-SpO2, futhi lezi zici zingase zingacatshangwa endleleni.Kulesi sihloko, sixoxe ngezinto ezihlukahlukene ezithinta i-SpO2 ezingase zithinte ukufinyelela kweziguli ku-Oximetry@Home services.Lezi zici zingase zidideke kancane injongo yayo yokunciphisa ingcindezi yezinsizakalo zezokwelapha zobuso nobuso.
Ibanga elamukelekayo lokugcwala “okujwayelekile” komoyampilo wegazi elikalwa nge-pulse oximeter (SpO2) lingu-95% -99%.Naphezu kokuba khona kwemibhalo efana ne-World Health Organization Pulse Oximetry Training Manual (WHO, 2011), lesi sitatimende sitholakala yonke indawo kangangokuthi izihloko zezokwelapha azivamile ukusho.Lapho usesha idatha yokulawula ku-SpO2 kubantu okungezona ezezokwelapha, kutholakala ulwazi oluncane.Ocwaningweni lwabantu abangama-791 abaneminyaka engama-65 nangaphezulu (Rodríguez-Molinero et al., 2013), ngemuva kokucubungula okuguquguqukayo okufana ne-COPD, isilinganiso esingu-5% se-SpO2 sasingu-92%, okubonisa isilinganiso esingu-5% Ukugcwala komoyampilo wegazi labantu. iphansi kakhulu kunalokho ngaphandle kwencazelo yezokwelapha eyaziwayo.Kolunye ucwaningo lwabantu abangu-458 abaneminyaka engu-40-79 (Enright & Sherrill, 1998), uhla lokugcwala komoyampilo ngaphambi kokuhlolwa kwemizuzu engu-6 lokuhamba lwalungu-92% -98% ku-5th percentile, naku-95th percentile.I-percentile yokuqala ingamaphesenti angama-93-99%.Zombili izifundo azizange zibhale phansi izinqubo ezisetshenziselwa ukukala i-SpO2 ngokuningiliziwe.
Ucwaningo lwabantu abangu-5,152 eNorway (Vold et al., 2015) luthole ukuthi u-11.5% wabantu une-SpO2 engezansi noma elingana nomkhawulo ophansi noma ophansi ongu-95% wejwayelekile.Kulolu cwaningo, bambalwa kuphela abantu abane-SpO2 ephansi okubikwa ukuthi banesifuba somoya (18%) noma i-COPD (13%), kuyilapho iningi labantu abane-BMI ebaluleke ngokwezibalo lidlule ama-25 (77%) futhi babebakhulu Abanye baneminyaka engama-70 noma abadala (46%).E-United Kingdom, u-24.4% wamacala ahlolelwe i-COVID-19 phakathi kukaMeyi no-Agasti 2020 ayeneminyaka engama-60 noma ngaphezulu, kanti angu-15% ayeneminyaka engama-70 noma ngaphezulu[8] (UNgqongqoshe Wezempilo Nokunakekelwa Komphakathi, 2020).Nakuba ucwaningo lwaseNorway lubonisa ukuthi i-11.5% yanoma yisiphi isibalo sabantu singase sibe ne-SpO2 ephansi, futhi iningi lalezi zimo azikho ukuxilongwa kokuphefumula okwaziwayo, izincwadi zibonisa ukuthi kungase kube "izigidi" ze-COPD engakatholakali (Bakerly & Cardwell, 2016) Futhi okungenzeka Amazinga aphezulu we-hypoventilation syndromes engatholakali ukukhuluphala ngokweqile (Masa et al., 2019).Ingxenye ebaluleke ngokwezibalo yezikolo ze-SpO2 ezingachazwanga “ezijwayelekile eziphansi” ezitholakala ezifundweni zabantu zingase zibe nezifo zokuphefumula ezingakahlonzwa.
Ngaphezu kokuhluka okuphelele, izici ezithile zephrothokholi esetshenziselwa ukukala i-SpO2 zingathinta imiphumela.Kunomehluko obalulekile ngokwezibalo phakathi kwesilinganiso esithathwe ngesikhathi sokuphumula kanye nesilinganiso esithathwe ngenkathi uhlezi (Ceylan et al., 2015).Ngaphezu kwalokho, kanye nezici zeminyaka nokukhuluphala ngokweqile, i-SpO2 ingase yehle phakathi nemizuzu engu-5-15 yokuphumula (i-Mehta ne-Parmar, i-2017), ikakhulukazi ngesikhathi sokuzindla (Bernardi et al., 2017).Izinga lokushisa lomzimba elihlobene nezinga lokushisa elizungezile lingase libe nomthelela obalulekile ngokwezibalo (Khan et al., 2015), njengokukhathazeka, nokuba khona kokukhathazeka kungase kunciphise amaphuzu ngephuzu eligcwele (Ardaa et al., 2020).Okokugcina, kwaziwa kahle ukuthi iphutha elijwayelekile lokulinganisa i-pulse oximeter liyi-± 2% uma liqhathaniswa nesilinganiso segesi segazi se-arterial esivumelanisiwe i-SaO2 (i-American Thoracic Society, 2018), kodwa ngokombono womtholampilo, ngokombono ongokoqobo, ngoba Ayikho indlela yokucabangela lo mehluko, kufanele ulinganiswe futhi kusetshenzwe ngawo ngenani elibonakalayo.
Izinguquko ku-SpO2 ngokuhamba kwesikhathi nokulinganisa okuphindaphindiwe kungenye inkinga, futhi kunolwazi oluncane kakhulu mayelana nalokhu kubantu abangewona abezokwelapha.Usayizi omncane wesampula (n = 36) ucwaningo luhlole izinguquko ze-SpO2 phakathi nehora elilodwa [16] (Bhogal & Mani, 2017), kodwa alizange libike ukuhlukahluka phakathi nezilinganiso eziphindaphindiwe emavikini ambalwa, njengaku-Oximetry@ Ngesikhathi Sekhaya.
Phakathi nenkathi yokuqapha ye-Oximetry@Home yezinsuku eziyi-14, i-SpO2 ikalwa izikhathi ezi-3 ngosuku, okungenzeka kuvame kakhulu ezigulini ezikhathazekile, futhi izilinganiso ezingama-42 zingathathwa.Ngisho nokucabangela ukuthi iphrothokholi yokulinganisa efanayo isetshenziswa esimweni ngasinye futhi isimo somtholampilo sizinzile, kunesizathu sokukholelwa ukuthi kunomehluko othile kulezi zilinganiso.Izifundo zabantu zisebenzisa isilinganiso esisodwa zibonisa ukuthi abantu abangu-11.5% bangase babe ne-SpO2 engu-95% noma ngaphansi.Ngokuhamba kwesikhathi, ngokuhamba kwesikhathi, amathuba okuthola ukufundwa okuphansi ngesikhathi sokulinganisa okuphindaphindiwe kwenzeka ngokuhamba kwesikhathi isiphakamiso se-COVID -19 singase sibe ngaphezu kuka-11.5%.
I-algorithm ngemuva kwesevisi ye-Oximetry@Home iphakamisa ukuthi imiphumela engemihle ihlotshaniswa nezikolo eziphansi ze-SpO2 [17] (Shah et al., 2020);labo abane-SpO2 ewela ku-93% kuya ku-94% kufanele bahlolwe ubuso nobuso bezokwelapha futhi bacatshangelwe ukuthi bamukelwe, 92 % Futhi ngezansi kufanele bathole usizo lwezokwelapha lwesibili oluphuthumayo.Ngokusetshenziswa kwesevisi ye-Oximetry@Home ezweni lonke, izilinganiso eziphindaphindiwe ze-SpO2 ezithathwa iziguli ekhaya zizoba isici esibalulekile ekuchazeni izimo zazo zomtholampilo.
Ukulinganisa kwe-SpO2 kuvame ukwenziwa phakathi nesikhathi esifushane lapho i-oximeter ibekwe.Isiguli sihlala isikhathi esingaphumuli.Ukuhamba usuka endaweni yokulinda uya endaweni yomtholampilo kuzophazamisa abanye.Ngokwenziwa kusebenze kwesevisi ye-Oximetry@Home, ividiyo ye-YouTube ye-NHS (2020) isikhishiwe.Ividiyo incoma ukuthi iziguli ezithatha izilinganiso ekhaya zilale phansi imizuzu emi-5, zibeke i-oximeter, bese zithola ukufundwa okuzinzile ngomzuzu ongu-1 ngemva kokubekwa.Lesi sixhumanisi sevidiyo sisatshalaliswe ngekhasi leplathifomu ye-NHS yesikhathi esizayo ehlobene nomuntu omisa isevisi ye-Oximetry@Home, kodwa akubonakali kukhombisa ukuthi lokhu kungase kunikeze ukufundwa okuphansi uma kuqhathaniswa nokufundwa okuthathwa ngenkathi uhlezi.Kuyaphawuleka ukuthi enye ividiyo yezemfundo yezempilo ye-NHS eNgilandi ephephandabeni i-Daily Mail incoma umthetho olandelwayo ohluke ngokuphelele, okufanele uwufunde uhlezi (Daily Mail, 2020).
Kumuntu ongaziwa ngokuvamile, amaphuzu aphansi angama-95%, ngisho nokwehla kwephuzu elilodwa ngenxa yokutheleleka nge-COVID-19 kungase kubangele isilinganiso se-Amber, okuholela ekunakekelweni komtholampilo okuqondile.Okungacacile ukuthi iphuzu elilodwa lokwehla lizokwenza ukunakekelwa komtholampilo okuqondile kube ukusetshenziswa ngempumelelo kwezinsiza phakathi kwabantu abanamaphuzu aphansi e-pre-morbid.
Nakuba i-algorithm kazwelonke iphinde ikhulume ngokwehla kwe-SpO2, njengoba iningi lamacala alizange lirekhode amaphuzu e-SpO2 angaphambi kwesifo, lesi sici asikwazi ukuhlolwa ngaphambi kwanoma yikuphi ukwehla kokuqala okubangelwa igciwane elibangele ukuhlolwa kwe-SpO2.Ngokombono wokwenza izinqumo, akucaci ngokomtholampilo ukuthi izinga lokugcwala/lokufaka eliphelele komuntu ngesikhathi ehlezi kufanele lisetshenziswe njengesisekelo sokunakekelwa kwezicubu, noma izinga lokugcwala/lokugcwala elincishisiwe lapho ulele phansi ngemva kokuphumula kufanele lisetshenziswe isisekelo.Awubonakali umgomo okuvunyelenwe ngawo izwe ngalokhu.
I-SpO2% iyipharamitha ephoqelelayo etholakala esidlangalaleni yokuhlola i-COVID-19.I-NHS England ithenge ama-oximeter angu-370,000 ukuze asetshenziswe iziguli eziningi ukuze zisatshalaliswe ezinsizeni.
Izici ezichazwe zingabangela izinguquko eziningi zesilinganiso se-SpO2 sephuzu elilodwa, okubangela ukubuyekezwa kwesiguli ubuso nobuso ekunakekelweni okuyinhloko noma eminyangweni ephuthumayo.Ngokuhamba kwesikhathi, izinkulungwane zeziguli emphakathini zingase ziqashelwe i-SpO2, okungaholela enanini elikhulu lokubuyekezwa okungadingekile kobuso nobuso.Lapho umthelela wezinto ezithinta ukufundwa kwe-SpO2 ezimeni ze-COVID-19 uhlaziywa futhi ubekwe kumongo wezilinganiso zomtholampilo nezasekhaya ezisekelwe kubantu, umthelela ongaba khona ubaluleke kakhulu ngokwezibalo, ikakhulukazi kulezo “zigidi ezingekho” I-SpO2 ebucayi kungenzeka kakhulu.Ukwengeza, isevisi ye-Oximetry@Home cishe ikhetha abantu abanesikolo esinqanyuliwe ngokukhomba abantu abangaphezu kweminyaka engama-65 kanye nalabo okungenzeka babe ne-BMI ephakeme ehlobene ne-commorbidities.Ucwaningo luye lwabonisa ukuthi inani labantu “eliphansi elivamile” lizobalela okungenani u-11.5% wabo bonke abantu, kodwa ngenxa yenqubo yokukhetha yesevisi ye-Oximetry@Home, leli phesenti libonakala liphakeme kakhulu.
Njengoba izici ezibhalwe phansi ezithonya imiphumela ye-SpO2 zisemsebenzini, iziguli ezinamaphuzu ngokuvamile aphansi, ikakhulukazi lezo ezinamaphuzu angu-95%, zingase zihambe phakathi kwezilinganiso eziluhlaza kanye ne-amber izikhathi eziningi.Lesi senzo singase senzeke ngisho naphakathi kwesilinganiso sokuprakthiza emtholampilo lapho kudluliselwa ku-Oximetry@Home kanye nesilinganiso sokuqala lapho isiguli sisebenzisa umthetho olandelwayo wokulala phansi wemizuzu engu-6 ekhaya.Uma isiguli sizizwa singaphilile, ukukhathazeka ngesikhathi sokulinganisa kungase futhi kwehlise labo abanamaphuzu anqanyuliwe angaphansi kuka-95% futhi bafune ukunakekelwa.Lokhu kungase kuphumele ekunakekelweni kobuso nobuso okungadingekile okuningi, kubeka ingcindezi eyengeziwe kumasevisi afinyelele noma adlule umthamo.
Ngisho nangaphandle komzila okhishiwe we-Oximetry@Home kanye nezinto zokwelapha ezinikeza iziguli ama-oximeter, imibiko yezindaba mayelana nokuba usizo kwama-pulse oximeters isabalele, futhi akwaziwa ukuthi bangaki abantu abangaba nama-pulse oximeters ukuphendula ubhubhane lwe-COVID -19, nakuba kunabathengisi abaningi abahlukahlukene abahlinzeka ngezinto zokusebenza ezishibhile nemibiko yemishini ethengisiwe (CNN, 2020), le nombolo ingaba okungenani ngamakhulu ezinkulungwane.Izici ezichazwe kulesi sihloko zingase zithinte laba bantu futhi zifake ingcindezi eyengeziwe enkonzweni.
Simemezela ukuthi ababhali ngamunye abasohlwini babe negalelo elikhulu ekukhiqizweni kwalesi sihloko, futhi baba nesandla emibonweni nasekubhalweni okubhaliwe.
Ngenxa yokugunyazwa kokuhlaziywa kwezincwadi kanye nekomidi lezimiso zocwaningo, alisebenzi ekuhanjisweni kwalesi sihloko.
Ukwabelana ngedatha akusebenzi kulesi sihloko ngoba awekho amasethi edatha akhiqizwe noma ahlaziywa phakathi nesikhathi samanje socwaningo.
Sicela uhlole i-imeyili yakho ukuze uthole imiyalelo yokusetha kabusha iphasiwedi yakho.Uma ungayitholi i-imeyili phakathi nemizuzu eyi-10, ikheli lakho le-imeyili lingase lingabhaliswa futhi ungase udinge ukudala i-akhawunti entsha ye-Wiley Online Library.
Uma ikheli lifana ne-akhawunti ekhona, uzothola i-imeyili eneziyalezo zokubuyisa igama lomsebenzisi
Isikhathi sokuthumela: Jul-15-2021