BackgroundMassive wasp stings have been greatly underestimated and have not been systematically studied. The aim of this study was to identify the clinical features and treatment strategies of severe wasp stings.Methods and FindingsA multicenter retrospective study was undertaken in 35 hospitals and medical centers including 12 tertiary care hospitals and 23 secondary care hospitals in the Hubei Province, China. The detailed clinical data of 1091 hospitalized wasp sting patients were investigated. Over three-fourths (76.9%) of the cases had 10 or more stings and the in-hospital mortality of patients was 5.1%. Forty-eight patients died of organ injury following toxic reactions to the stings, whereas six died from anaphylactic shock. The in-hospital mortality in patients with >10 stings was higher than that of ≤10 stings (5.2% vs. 1.0%, p = 0.02). Acute kidney injury (AKI) was seen in 21.0% patients and most patients required blood purification therapy. Rhabdomyolysis was seen in 24.1% patients, hemolysis in 19.2% patients, liver injury in 30.1% patients, and coagulopathy in 22.5% patients. Regression analysis revealed that high creatinine level, shock, oliguria, and anemia were risk factors for death. Blood purification therapy was beneficial for patients with ≥20 stings and delayed hospital admission of patients (≥4 hours after sting).ConclusionsIn China, most patients with multiple wasp stings presented with toxic reactions and multiple organ dysfunction caused by the venom rather than an anaphylactic reaction. AKI is the prominent clinical manifestation of wasp stings with toxic reaction. High creatinine levels, shock, oliguria, and anemia were risk factors for death.

A point-of-care system for continuous health monitoring should be wearable, easy to use, and affordable to promote patient independence and facilitate acceptance of new home healthcare technology. Reconfigurability, interoperability, and scalability are important. Standardization supports these requirements, and encourages an open market where lower product prices result from vendor competition. This paper first discusses candidate standards for wireless communication, plug-and-play device interoperability, and medical information exchange in point-of-care systems. It then addresses the design and implementation of a wearable, plug-and-play system for home care which adopts the IEEE 1073 Medical Information Bus (MIB) standards, and uses Bluetooth as the wireless communication protocol. This standards-based system maximizes user mobility by incorporating a three-level architecture populated by base stations, wearable data loggers, and wearable sensors. Design issues include the implementation of the MIB standards on microcontroller-driven embedded devices, low power consumption, wireless data exchange, and data storage and transmission in a reconfigurable body-area network.

Abstract-Wireless body area networks (WBANs) and their supporting information infrastructures offer unprecedented opportunities to monitor state of health without constraining the activities of a wearer. These mobile point-of-care systems are now realizable due to the convergence of technologies such as low-power wireless communication standards, plug-andplay device buses, off-the-shelf development kits for low-power microcontrollers, handheld computers, electronic medical records, and the Internet. To increase acceptance of personal monitoring technology while lowering equipment cost, advances must be made in interoperability (at both the system and device levels) and security. This paper presents an overview of WBAN infrastructure work in these areas currently underway in the Medical Component Design Laboratory at Kansas State University (KSU) and at the University of Alabama in Huntsville (UAH). KSU efforts include the development of wearable health status monitoring systems that utilize ISO/IEEE 11073, Bluetooth, Health Level 7, and OpenEMed. WBAN efforts at UAH include the development of wearable activity and health monitors that incorporate ZigBee-compliant wireless sensor platforms with hardware-level encryption and the TinyOS development environment. WBAN infrastructures are complex, requiring many functional support elements. To realize these infrastructures through collaborative efforts, organizations such as KSU and UAH must define and utilize standard interfaces, nomenclature, and security approaches.

With minor modifications, the X73 standards can be successfully applied to wearable, wireless, point-of-care systems in the home.