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Howie EE, Ambler O, Gunn EG, Dias RD, Wigmore SJ, Skipworth RJ, Yule SJ. Surgical Sabermetrics: A Scoping Review of Technology-enhanced Assessment of Nontechnical Skills in the Operating Room. Ann Surg 2024; 279:973-984. [PMID: 38258573 PMCID: PMC11086675 DOI: 10.1097/sla.0000000000006211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To evaluate the current evidence for surgical sabermetrics: digital methods of assessing surgical nontechnical skills and investigate the implications for enhancing surgical performance. BACKGROUND Surgeons need high-quality, objective, and timely feedback to optimize performance and patient safety. Digital tools to assess nontechnical skills have the potential to reduce human bias and aid scalability. However, we do not fully understand which of the myriad of digital metrics of performance assessment have efficacy for surgeons. METHODS A systematic review was conducted by searching PubMed, EMBASE, CINAHL, and PSYCINFO databases following PRISMA-ScR guidelines. MeSH terms and keywords included "Assessment," "Surgeons," and "Technology". Eligible studies included a digital assessment of nontechnical skills for surgeons, residents, and/or medical students within an operative context. RESULTS From 19,229 articles screened, 81 articles met the inclusion criteria. The studies varied in surgical specialties, settings, and outcome measurements. A total of 122 distinct objective, digital metrics were utilized. Studies digitally measured at least 1 category of surgical nontechnical skill using a single (n=54) or multiple objective measures (n=27). The majority of studies utilized simulation (n=48) over live operative settings (n=32). Surgical Sabermetrics has been demonstrated to be beneficial in measuring cognitive load (n=57), situation awareness (n=24), communication (n=3), teamwork (n=13), and leadership (n=2). No studies measured intraoperative decision-making. CONCLUSIONS The literature detailing the intersection between surgical data science and operative nontechnical skills is diverse and growing rapidly. Surgical Sabermetrics may provide a promising modifiable technique to achieve desirable outcomes for both the surgeon and the patient. This study identifies a diverse array of measurements possible with sensor devices and highlights research gaps, including the need for objective assessment of decision-making. Future studies may advance the integration of physiological sensors to provide a holistic assessment of surgical performance.
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Affiliation(s)
- Emma E. Howie
- Clinical Surgery, University of Edinburgh & Royal Infirmary of Edinburgh, Edinburgh, Scotland
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
| | - Olivia Ambler
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
| | - Eilidh G.M. Gunn
- Clinical Surgery, University of Edinburgh & Royal Infirmary of Edinburgh, Edinburgh, Scotland
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
| | - Roger D. Dias
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
- Human Factors and Cognitive Engineering Lab, STRATUS Centre for Medical Simulation, Brigham & Women’s Hospital, Boston, MA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA
| | - Stephen J. Wigmore
- Clinical Surgery, University of Edinburgh & Royal Infirmary of Edinburgh, Edinburgh, Scotland
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
| | - Richard J.E. Skipworth
- Clinical Surgery, University of Edinburgh & Royal Infirmary of Edinburgh, Edinburgh, Scotland
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
| | - Steven J. Yule
- Clinical Surgery, University of Edinburgh & Royal Infirmary of Edinburgh, Edinburgh, Scotland
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
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Pulcinelli M, Pinnelli M, Massaroni C, Lo Presti D, Fortino G, Schena E. Wearable Systems for Unveiling Collective Intelligence in Clinical Settings. SENSORS (BASEL, SWITZERLAND) 2023; 23:9777. [PMID: 38139623 PMCID: PMC10747409 DOI: 10.3390/s23249777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
Nowadays, there is an ever-growing interest in assessing the collective intelligence (CI) of a team in a wide range of scenarios, thanks to its potential in enhancing teamwork and group performance. Recently, special attention has been devoted on the clinical setting, where breakdowns in teamwork, leadership, and communication can lead to adverse events, compromising patient safety. So far, researchers have mostly relied on surveys to study human behavior and group dynamics; however, this method is ineffective. In contrast, a promising solution to monitor behavioral and individual features that are reflective of CI is represented by wearable technologies. To date, the field of CI assessment still appears unstructured; therefore, the aim of this narrative review is to provide a detailed overview of the main group and individual parameters that can be monitored to evaluate CI in clinical settings, together with the wearables either already used to assess them or that have the potential to be applied in this scenario. The working principles, advantages, and disadvantages of each device are introduced in order to try to bring order in this field and provide a guide for future CI investigations in medical contexts.
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Affiliation(s)
- Martina Pulcinelli
- Research Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy; (M.P.); (M.P.); (C.M.); (E.S.)
| | - Mariangela Pinnelli
- Research Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy; (M.P.); (M.P.); (C.M.); (E.S.)
| | - Carlo Massaroni
- Research Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy; (M.P.); (M.P.); (C.M.); (E.S.)
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Daniela Lo Presti
- Research Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy; (M.P.); (M.P.); (C.M.); (E.S.)
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Giancarlo Fortino
- DIMES, University of Calabria, Via P. Bucci 41C, 87036 Rende, Italy;
| | - Emiliano Schena
- Research Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy; (M.P.); (M.P.); (C.M.); (E.S.)
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
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Abahuje E, Reddy S, Rosu C, Lin KA, Mack L, Valukas C, Shapiro M, Alam HB, Halverson A, Bilimoria K, Coleman J, Stey AM. Relationship Between Residents' Physiological Stress and Faculty Leadership Skills in a Department of Surgery. JOURNAL OF SURGICAL EDUCATION 2023; 80:1129-1138. [PMID: 37336667 DOI: 10.1016/j.jsurg.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/21/2023] [Accepted: 05/21/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Leadership skills of team leaders can impact the functioning of their teams. It is unknown whether attending surgeons' leadership skills impact residents' physiological stress. This study sought to (1) assess the relationship between attending surgeons' leadership skills and residents' physiological stress and (2) to characterize lifestyle behaviors associated with resident physiological stress. We hypothesized that strong attending leadership skills would be associated with low resident physiological stress. STUDY DESIGN This prospective observational cohort study was conducted at a single urban, academic medical center in the US, over 12 months. Residents were enrolled during their rotation of 1 to 2 months on the Trauma and ICU services. The primary predictor was the attending surgeons' leadership skills that were measured using a weekly survey filled out by residents, using the Surgeons' Leadership Inventory (SLI). The SLI uses a 4-point Likert scale to measure surgeons' leadership skills across eight domains. The primary outcome was residents' physiological stress, which was measured by their Heart Rate Variability (HRV). We recorded the residents' HRV with a WHOOP strap that was continuously worn on the wrist or the bicep. We used multivariate repeated measures gamma regression to assess the relationship between attending leadership skills and residents' physiological stress, adjusting for hours of sleep, age, and service. RESULTS Sixteen residents were enrolled over 12 months. The median attending surgeons' leadership score was 3.8 (IQR: 3.2-4.0). The median residents' percent of maximal HRV was 70.8% (IQR: 56.7-83.7). Repeated measure gamma regression model demonstrated a minimal nonsignificant increase of 1.6 % (95% CI: -5.6, 8.9; p-value = 0.65) in the percent of maximal HRV (less resident physiological stress) for every unit increase in leadership score. There was an increase of 2.9% (95% CI= 1.6, 4.2; p-value < 0.001) in the percent of maximal HRV per hour increase in sleep and a significant decrease of 10.9% (95% CI= -16.8, -5.2; < 0.001) in the percent of HRV when working in the ICU compared to the Trauma service. CONCLUSION This study revealed that more residents' sleep was associated with lower physiological stress. Attending surgeons' leadership skills were not associated with residents' physiological stress.
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Affiliation(s)
- Egide Abahuje
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Massachusetts General Hospital, Institute of Health Professions, Boston, Massachusetts.
| | - Susheel Reddy
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Claudia Rosu
- Massachusetts General Hospital, Institute of Health Professions, Boston, Massachusetts
| | - Katherine A Lin
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lara Mack
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Catherine Valukas
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michael Shapiro
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Hasan B Alam
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amy Halverson
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Karl Bilimoria
- Department of Surgery, School of Medicine, Indian University, Indianapolis, Indiana
| | - Jamie Coleman
- Department of Surgery, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Anne M Stey
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Lee A, Torkamani-Azar M, Zheng B, Bednarik R. Unpacking the Broad Landscape of Intraoperative Stressors for Clinical Personnel: A Mixed-Methods Systematic Review. J Multidiscip Healthc 2023; 16:1953-1977. [PMID: 37484819 PMCID: PMC10361288 DOI: 10.2147/jmdh.s401325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 06/09/2023] [Indexed: 07/25/2023] Open
Abstract
Purpose The main goals of this mixed-methods systematic review are to identify what types of intraoperative stressors for operating room personnel have been reported in collected studies and examine the characteristics of each intraoperative stressor. Methods With a systematic literature search, we retrieved empirical studies examining intraoperative stress published between 2010 and 2020. To synthesize findings, we applied two approaches. First, a textual narrative synthesis was employed to summarize key study information of the selected studies by focusing on surgical platforms and study participants. Second, a thematic synthesis was employed to identify and characterize intraoperative stressors and their subtypes. Results Ninety-four studies were included in the review. Regarding the surgical platforms, the selected studies mainly focused on minimally invasive surgery and few studies examined issues around robotic surgery. Most studies examined intra-operative stress from surgeons' perspectives but rarely considered other clinical personnel such as nurses and anesthetists. Among seven identified stressors, technical factors were the most frequently examined followed by individual, operating room environmental, interpersonal, temporal, patient, and organizational factors. Conclusion By presenting stressors as multifaceted elements affecting collaboration and interaction between multidisciplinary team members in the operating room, we discuss the potential interactions between stressors which should be further investigated to build a safe and efficient environment for operating room personnel.
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Affiliation(s)
- Ahreum Lee
- Samsung Electronics Co. Ltd., Suwon, Gyeonggi-do, Republic of Korea
| | | | - Bin Zheng
- Department of Surgery, University of Alberta, Edmonton, Canada
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Wang H, Han M, Avouka T, Chen R, Wang J, Wei R. Research on fatigue identification methods based on low-load wearable ECG monitoring devices. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2023; 94:045103. [PMID: 38081271 DOI: 10.1063/5.0138073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/17/2023] [Indexed: 12/18/2023]
Abstract
The identification of fatigue in personal workers in particular environments can be achieved through early warning techniques. In order to prevent excessive fatigue of medical workers staying in infected areas in the early phase of the coronavirus disease pandemic, a system of low-load wearable electrocardiogram (ECG) devices was used as intelligent acquisition terminals to perform a continuous measurement ECG collection. While machine learning (ML) algorithms and heart rate variability (HRV) offer the promise of fatigue detection for many, there is a demand for ever-increasing reliability in this area, especially in real-life activities. This study proposes a random forest-based classification ML model to identify the four categories of fatigue levels in frontline medical workers using HRV. Based on the wavelet transform in ECG signal processing, stationary wavelet transform was applied to eliminate the main perturbation of ECG in the motion state. Feature selection was performed using ReliefF weighting analysis in combination with redundancy analysis to optimize modeling accuracy. The experimental results of the overall fatigue identification achieved an accuracy of 97.9% with an AUC value of 0.99. With the four-category identification model, the accuracy is 85.6%. These results proved that fatigue analysis based on low-load wearable ECG monitoring at low exertion can accurately determine the level of fatigue of caregivers and provide further ideas for researchers working on fatigue identification in special environments.
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Affiliation(s)
- Huiquan Wang
- School of Life Sciences, TianGong University, Tianjin 300387, China
- Tianjin Engineering Research Center of Biomedical Electronic Technology, Tianjin 300387, China
- Tianjin Key Laboratory of Quality Control and Evaluation Technology for Medical Devices, Tianjin 300384, China
| | - Mengting Han
- School of Life Sciences, TianGong University, Tianjin 300387, China
- Tianjin Engineering Research Center of Biomedical Electronic Technology, Tianjin 300387, China
- Tianjin Key Laboratory of Quality Control and Evaluation Technology for Medical Devices, Tianjin 300384, China
| | - Tasmia Avouka
- School of Life Sciences, TianGong University, Tianjin 300387, China
- Tianjin Engineering Research Center of Biomedical Electronic Technology, Tianjin 300387, China
- Tianjin Key Laboratory of Quality Control and Evaluation Technology for Medical Devices, Tianjin 300384, China
| | - Ruijuan Chen
- School of Life Sciences, TianGong University, Tianjin 300387, China
- Tianjin Engineering Research Center of Biomedical Electronic Technology, Tianjin 300387, China
- Tianjin Key Laboratory of Quality Control and Evaluation Technology for Medical Devices, Tianjin 300384, China
| | - Jinhai Wang
- School of Life Sciences, TianGong University, Tianjin 300387, China
- Tianjin Engineering Research Center of Biomedical Electronic Technology, Tianjin 300387, China
- Tianjin Key Laboratory of Quality Control and Evaluation Technology for Medical Devices, Tianjin 300384, China
| | - Ran Wei
- School of Life Sciences, TianGong University, Tianjin 300387, China
- Tianjin Engineering Research Center of Biomedical Electronic Technology, Tianjin 300387, China
- Tianjin Key Laboratory of Quality Control and Evaluation Technology for Medical Devices, Tianjin 300384, China
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Essibayi MA, Toma A, Mowrey W, Qin J, Hamad M, Ryvlin J, Holland R, Fluss R, Altschul D, Lin LM, Altschul DJ. Heart rate and heart rate variability during diagnostic and interventional neuroendovascular procedures. Interv Neuroradiol 2023:15910199231162472. [PMID: 36947484 DOI: 10.1177/15910199231162472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Heart rate variability (HRV) reflects the activity of the autonomic nervous system (ANS) and can be used as a potential predictor of stress-related cardiovascular diseases. This study aimed to assess whether physical and mental strain during the performance of cerebral endovascular procedure influence time-domain HRV parameters in operating surgeon. MATERIALS AND METHODS Heart rate (HR) and HRV metrics were measured using a HR sensor chest strap before, during, and after neuroendovascular interventions performed by a single neurosurgeon. Three consecutive data series were reported by recording time domain: before procedure, during and after performing endovascular procedures. HR and HRV parameters were recorded during diagnostic and interventional neuroendovascular procedures. HR and HRV measures were analyzed by procedure type and recording time domain. RESULTS HRV measures of a single endovascular neurosurgeon were recorded during 50 procedures. The median intraprocedural HRV score was the lowest and the median HR was the highest (HRV: 52, HR: 89 bpm) compared to preprocedural (HRV: 59, HR: 70 bpm) and postprocedural cardiovascular measures (HRV: 53, HR: 79, bpm, p < 0.001). On univariate linear regression, a negative association of interventional procedures with lower intraprocedural (β = -0.905, p = 0.001) and postprocedural (β = -1.12, p < 0.001) HRV scores compared to the diagnostic procedures was noted. CONCLUSIONS HRV is a reliable tool to measure cardiovascular and mental stress. Interventional neuro-endovascular procedures seem to negatively impact the cardiovascular measures of neurointerventionalists. Further longitudinal studies utilizing HRV are warranted to address their long-term effects on the mental health of physicians.
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Affiliation(s)
- Muhammed Amir Essibayi
- Department of Neurological Surgery, 2013Montefiore Medical Center, 2006Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
| | - Aureliana Toma
- Department of Radiology, 2013Montefiore Medical Center, 2006Albert Einstein College of Medicine, Bronx, NY, USA
| | - Wenzhu Mowrey
- Department of Epidemiology & Population Health, 2006Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jiyue Qin
- Department of Epidemiology & Population Health, 2006Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mousa Hamad
- Department of Neurological Surgery, 2013Montefiore Medical Center, 2006Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jessica Ryvlin
- Department of Neurological Surgery, 2013Montefiore Medical Center, 2006Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ryan Holland
- Department of Neurological Surgery, 2013Montefiore Medical Center, 2006Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rose Fluss
- Department of Neurological Surgery, 2013Montefiore Medical Center, 2006Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dorothea Altschul
- Neurosurgery, 102724Valley Hospital, Neurosurgeons of NJ, Ridgewood, NJ, USA
| | - Li-Mei Lin
- Department of Neurosurgery, Carondelet Neurological Institute, 21944Carondelet Health Network, Tucson, Arizona, USA
| | - David J Altschul
- Department of Neurological Surgery, 2013Montefiore Medical Center, 2006Albert Einstein College of Medicine, Bronx, NY, USA
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Tjønnås MS, Guzmán-García C, Sánchez-González P, Gómez EJ, Oropesa I, Våpenstad C. Stress in surgical educational environments: a systematic review. BMC MEDICAL EDUCATION 2022; 22:791. [PMID: 36380334 PMCID: PMC9667591 DOI: 10.1186/s12909-022-03841-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/29/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The effects of stress on surgical residents and how stress management training can prepare residents to effectively manage stressful situations is a relevant topic. This systematic review aimed to analyze the literature regarding (1) the current stress monitoring tools and their use in surgical environments, (2) the current methods in surgical stress management training, and (3) how stress affects surgical performance. METHODS A search strategy was implemented to retrieve relevant articles from Web of Science, Scopus, and PubMed. The 787 initially retrieved articles were reviewed for further evaluation according to the inclusion/exclusion criteria (Prospero registration number CRD42021252682). RESULTS Sixty-one articles were included in the review. The stress monitoring methods found in the articles showed heart rate analysis as the most used monitoring tool for physiological parameters while the STAI-6 scale was preferred for psychological parameters. The stress management methods found in the articles were mental-, simulation- and feedback-based training, with the mental-based training showing clear positive effects on participants. The studies analyzing the effects of stress on surgical performance showed both negative and positive effects on technical and non-technical performance. CONCLUSIONS The impact of stress responses presents an important factor in surgical environments, affecting residents' training and performance. This study identified the main methods used for monitoring stress parameters in surgical educational environments. The applied surgical stress management training methods were diverse and demonstrated positive effects on surgeons' stress levels and performance. There were negative and positive effects of stress on surgical performance, although a collective pattern on their effects was not clear.
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Affiliation(s)
- Maria Suong Tjønnås
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, N-7491, Trondheim, Norway.
- SINTEF Digital, Health Department, Trondheim, Norway.
| | - Carmen Guzmán-García
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Madrid, Spain
| | - Patricia Sánchez-González
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Enrique Javier Gómez
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Ignacio Oropesa
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Madrid, Spain
| | - Cecilie Våpenstad
- SINTEF Digital, Health Department, Trondheim, Norway
- Department of Clinical and Molecular Medicine (IKOM), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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Srinivasan K, Currim F, Ram S. A Human-in-the-loop Segmented Mixed-effects Modeling Method For Analyzing Wearables Data. ACM TRANSACTIONS ON MANAGEMENT INFORMATION SYSTEMS 2022. [DOI: 10.1145/3564276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Wearables are an important source of big data as they provide real-time high-resolution data logs of health indicators of individuals. Higher-order associations between pairs of variables is common in wearables data. Representing higher-order association curves as piece-wise linear segments in a regression model makes them more interpretable. However, existing methods for identifying the change points for segmented modeling either overfit or have low external validity for wearables data containing repeated measures. Therefore, we propose a human-in-the-loop method for segmented modeling of higher-order pairwise associations between variables in wearables data. Our method uses the smooth function estimated by a generalized additive mixed model to allow the analyst to annotate change point estimates for a segmented mixed-effects model, and thereafter employs the Brent's constrained optimization procedure to fine-tuning the manually provided estimates. We validate our method using three real-world wearables datasets. Our method not only outperforms state-of-the-art modeling methods in terms of prediction performance but also provides more interpretable results. Our study contributes to health data science in terms of developing a new method for interpretable modeling of wearables data. Our analysis uncovers interesting insights on higher order associations for health researchers.
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Affiliation(s)
| | - Faiz Currim
- Eller College of Management, University of Arizona, Tucson AZ, U.S
| | - Sudha Ram
- Eller College of Management, University of Arizona, Tucson AZ, U.S
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Torkamani-Azar M, Lee A, Bednarik R. Methods and Measures for Mental Stress Assessment in Surgery: A Systematic Review of 20 Years of Literature. IEEE J Biomed Health Inform 2022; 26:4436-4449. [PMID: 35696473 DOI: 10.1109/jbhi.2022.3182869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Real-time mental stress monitoring from surgeons and surgical staff in operating rooms may reduce surgical injuries, improve performance and quality of medical care, and accelerate implementation of stress-management strategies. Motivated by the increase in usage of objective and subjective metrics for cognitive monitoring and by the gap in reviews of experimental design setups and data analytics, a systematic review of 71 studies on mental stress and workload measurement in surgical settings, published in 2001-2020, is presented. Almost 61% of selected papers used both objective and subjective measures, followed by 25% that only administered subjective tools - mostly consisting of validated instruments and customized surveys. An overall increase in the total number of publications on intraoperative stress assessment was observed from mid-2010 s along with a momentum in the use of both subjective and real-time objective measures. Cardiac activity, including heart-rate variability metrics, stress hormones, and eye-tracking metrics were the most frequently and electroencephalography (EEG) was the least frequently used objective measures. Around 40% of selected papers collected at least two objective measures, 41% used wearable devices, 23% performed synchronization and annotation, and 76% conducted baseline or multi-point data acquisition. Furthermore, 93% used a variety of statistical techniques, 14% applied regression models, and only one study released a public, anonymized dataset. This review of data modalities, experimental setups, and analysis techniques for intraoperative stress monitoring highlights the initiatives of surgical data science and motivates research on computational techniques for mental and surgical skills assessment and cognition-guided surgery.
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Faria MT, Rodrigues S, Campelo M, Dias D, Rego R, Rocha H, Sá F, Tavares-Silva M, Pinto R, Pestana G, Oliveira A, Pereira J, Cunha JPS, Rocha-Gonçalves F, Gonçalves H, Martins E. Does the type of seizure influence heart rate variability changes? Epilepsy Behav 2022; 126:108453. [PMID: 34864377 DOI: 10.1016/j.yebeh.2021.108453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Heart rate variability (HRV), an index of the autonomic cardiac activity, is decreased in patients with epilepsy, and a low HRV is associated with a higher risk of sudden death. Generalized tonic-clonic seizures are one of the most consistent risk factors for SUDEP, but the influence (and relative risk) of each type of seizure on cardiac function is still unknown. Our objective was to assess the impact of the type of seizure (focal to bilateral tonic-clonic seizure - FBTCS - versus non-FBTCS) on periictal HRV, in a group of patients with refractory epilepsy and both types of seizures. METHODS We performed a 48-hour Holter recording on 121 patients consecutively admitted to our Epilepsy Monitoring Unit. We only included patients with both FBTCS and non-FBTCS on the Holter recording and selected the first seizure of each type to analyze. To evaluate HRV parameters (AVNN, SDNN, RMSSD, pNN20, LF, HF, and LF/HF), we chose 5-min epochs pre- and postictally. RESULTS We included 14 patients, with a median age of 36 (min-max, 16-55) years and 64% were female. Thirty-six percent had cardiovascular risk factors, but no previously known cardiac disease. In the preictal period, there were no statistically significant differences in HRV parameters, between FBTCS and non-FBTCS. In the postictal period, AVNN, RMSSD, pNN20, LF, and HF were significantly lower, and LF/HF and HR were significantly higher in FBTCS. From preictal to postictal periods, FBTCS elicited a statistically significant rise in HR and LF/HF, and a statistically significant fall in AVNN, RMSSD, pNN20, and HF. Non-FBTCS only caused statistically significant changes in HR (decrease) and AVNN (increase). SIGNIFICANCE/CONCLUSION This work emphasizes the greater effect of FBTCS in autonomic cardiac function in patients with refractory epilepsy, compared to other types of seizures, with a significant reduction in vagal tonus, which may be associated with an increased risk of SUDEP.
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Affiliation(s)
- Maria Teresa Faria
- Nuclear Medicine Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.
| | - Susana Rodrigues
- Institute for Systems Engineering and Computers Technology and Science (INESC TEC), Porto, Portugal
| | - Manuel Campelo
- Cardiology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Duarte Dias
- Institute for Systems Engineering and Computers Technology and Science (INESC TEC), Porto, Portugal
| | - Ricardo Rego
- Neurophysiology Unit, Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Helena Rocha
- Neurophysiology Unit, Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Francisca Sá
- Neurophysiology Unit, Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Marta Tavares-Silva
- Cardiology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Department of Surgery and Physiology, Cardiovascular R&D Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Roberto Pinto
- Cardiology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Gonçalo Pestana
- Cardiology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Ana Oliveira
- Nuclear Medicine Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Jorge Pereira
- Nuclear Medicine Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - João Paulo Silva Cunha
- Institute for Systems Engineering and Computers Technology and Science (INESC TEC), Porto, Portugal; Faculty of Engineering, University of Porto, Porto, Portugal
| | | | - Hernâni Gonçalves
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS, Faculty of Medicine, University of Porto, Portugal
| | - Elisabete Martins
- Cardiology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
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11
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Heart rate variability in patients with refractory epilepsy: The influence of generalized convulsive seizures. Epilepsy Res 2021; 178:106796. [PMID: 34763267 DOI: 10.1016/j.eplepsyres.2021.106796] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/05/2021] [Accepted: 10/15/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Patients with epilepsy, mainly drug-resistant, have reduced heart rate variability (HRV), linked to an increased risk of sudden death in various other diseases. In this context, it could play a role in SUDEP. Generalized convulsive seizures (GCS) are one of the most consensual risk factors for SUDEP. Our objective was to assess the influence of GCS in HRV parameters in patients with drug-resistant epilepsy. METHODS We prospectively evaluated 121 patients with refractory epilepsy admitted to our Epilepsy Monitoring Unit. All patients underwent a 48-hour Holter recording. Only patients with GCS were included (n = 23), and we selected the first as the index seizure. We evaluated HRV (AVNN, SDNN, RMSSD, pNN50, LF, HF, and LF/HF) in 5-min epochs (diurnal and nocturnal baselines; preictal - 5 min before the seizure; ictal; postictal - 5 min after the seizure; and late postictal - >5 h after the seizure). These data were also compared with normative values from a healthy population (controlling for age and gender). RESULTS We included 23 patients, with a median age of 36 (min-max, 16-55) years and 65% were female. Thirty percent had cardiovascular risk factors, but no previously known cardiac disease. HRV parameters AVNN, RMSSD, pNN50, and HF were significantly lower in the diurnal than in the nocturnal baseline, whereas the opposite occurred with LF/HF and HR. Diurnal baseline parameters were inferior to the normative population values (which includes only diurnal values). We found significant differences in HRV parameters between the analyzed periods, especially during the postictal period. All parameters but LF/HF suffered a reduction in that period. LF/HF increased in that period but did not reach statistical significance. Visually, there was a tendency for a global reduction in our patients' HRV parameters, namely AVNN, RMSSD, and pNN50, in each period, comparing with those from a normative healthy population. No significant differences were found in HRV between diurnal and nocturnal seizures, between temporal lobe and extra-temporal-lobe seizures, between seizures with and without postictal generalized EEG suppression, or between seizures of patients with and without cardiovascular risk factors. SIGNIFICANCE/CONCLUSION Our work reinforces the evidence of autonomic cardiac dysfunction in patients with refractory epilepsy, at baseline and mainly in the postictal phase of a GCS. Those changes may have a role in some SUDEP cases. By identifying patients with worse autonomic cardiac function, HRV could fill the gap of a lacking SUDEP risk biomarker.
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Zhang T. Study on the current situation and clinical needs of risk assessment of intraoperative stress injury among nurses in operating room. Minerva Surg 2021; 77:193-195. [PMID: 34523307 DOI: 10.23736/s2724-5691.21.09040-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tielin Zhang
- Department of Anesthesiology, Affiliated Hospital of Hebei University, Baoding, China -
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13
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Kodithuwakku Arachchige SNK, Burch V RF, Chander H, Turner AJ, Knight AC. The use of wearable devices in cognitive fatigue: current trends and future intentions. THEORETICAL ISSUES IN ERGONOMICS SCIENCE 2021. [DOI: 10.1080/1463922x.2021.1965670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Reuben F. Burch V
- Industrial & Systems Engineering, Mississippi State University, Starkville, MS, USA
- Human Factors & Athlete Engineering, Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS, USA
| | - Harish Chander
- Neuromechanics Laboratory, Department of Kinesiology, Mississippi State University, Starkville, MS, USA
- Human Factors & Athlete Engineering, Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS, USA
| | - Alana J. Turner
- Neuromechanics Laboratory, Department of Kinesiology, Mississippi State University, Starkville, MS, USA
| | - Adam C. Knight
- Neuromechanics Laboratory, Department of Kinesiology, Mississippi State University, Starkville, MS, USA
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14
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Tominaga T, Nonaka T, Fukuda A, Shiraisi T, Hashimoto S, Araki M, Sumida Y, Sawai T, Nagayasu T. Combined transabdominal and transperineal endoscopic pelvic exenteration for colorectal cancer: feasibility and safety of a two-team approach. Ann Surg Treat Res 2021; 101:102-110. [PMID: 34386459 PMCID: PMC8331559 DOI: 10.4174/astr.2021.101.2.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/16/2020] [Accepted: 01/15/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Pelvic exenteration (PE) is a highly invasive procedure with high morbidity and mortality rates. Promising options to reduce this invasiveness have included laparoscopic and transperineal approaches. The aim of this study was to identify the safety of combined transabdominal and transperineal endoscopic PE for colorectal malignancies. Methods Fourteen patients who underwent combined transabdominal and transperineal PE (T group: 2-team approach, n = 7; O group: 1-team approach, n = 7) for colorectal malignancies between April 2016 and March 2020 in our institutions were included in this study. Clinicopathological features and perioperative outcomes were compared between groups. Results All patients successfully underwent R0 resection. Operation time tended to be shorter in the T group (463 minutes) than in the O group (636 minutes, P = 0.080). Time to specimen removal was significantly shorter (258 minutes vs. 423 minutes, P = 0.006), blood loss was lower (343 mL vs. 867 mL, P = 0.042), and volume of blood transfusion was less (0 mL vs. 560 mL, P = 0.063) in the T group, respectively. Postoperative complications were similar between groups. Conclusion Combined transabdominal and transperineal PE under a synchronous 2-team approach was feasible and safe, with the potential to reduce operation time, blood loss, and surgeon stress.
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Affiliation(s)
- Tetsuro Tominaga
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Takashi Nonaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Akiko Fukuda
- Department of Surgery, Sasebo City General Hospital, Nagasaki, Japan
| | - Toshio Shiraisi
- Department of Surgery, Sasebo City General Hospital, Nagasaki, Japan
| | | | - Masato Araki
- Department of Surgery, Sasebo City General Hospital, Nagasaki, Japan
| | - Yorihisa Sumida
- Department of Surgery, Sasebo City General Hospital, Nagasaki, Japan
| | - Terumitsu Sawai
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
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15
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Labus A, Radenković B, Rodić B, Barać D, Malešević A. Enhancing smart healthcare in dentistry: an approach to managing patients' stress. Inform Health Soc Care 2021; 46:306-319. [PMID: 33784958 DOI: 10.1080/17538157.2021.1893322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This paper presents a model of a smart healthcare service for stress management in dental patients during the interventions. The main goal is to provide dental clinics with a model that enables introducing a stress management service into everyday practice and provides patients with a better experience in a typically stressful situation. The approach is based on employing wearable sensors for monitoring physiological parameters, and a mobile application for progressive muscle relaxation therapy. Dental patients were divided into experimental and control groups. Participants from the experimental group were treated with progressive muscle relaxation through mobile health application with audio content, and patients from the control group were not exposed to any relaxation method. Heart rate was measured in both groups through three test phases: pre-intervention, intervention, and post-intervention. Evaluation of the anxiety level was performed using the STAI test. Results show that the measured heart rate in the post-intervention phase is lower than in the intervention phase in both testing groups, as well as in the pre-intervention phase. STAI scores were significantly higher in the control group through all test phases. The research found that the proposed system applied to dentist patients may relieve their anxiety symptoms and decrease stress level, which improves the patients' experience and leads to higher patients' satisfaction.
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Affiliation(s)
- Aleksandra Labus
- Department for e-Business, Faculty of Organizational Sciences, University of Belgrade, Belgrade, Serbia
| | - Božidar Radenković
- Department for e-Business, Faculty of Organizational Sciences, University of Belgrade, Belgrade, Serbia
| | - Branka Rodić
- Academy for Applied Studies Belgrade, College of Health Sciences, Belgrade, Serbia
| | - Dušan Barać
- Department for e-Business, Faculty of Organizational Sciences, University of Belgrade, Belgrade, Serbia
| | - Adam Malešević
- Faculty of Stomatology Pancevo, Pančevo University, Business Academy, Pančevo, Serbia
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16
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Inci S, Karakaya D. Intraoperative Aneurysm Rupture: Surgical Experience and the Rate of Intraoperative Rupture in a Series of 1000 Aneurysms Operated on by a Single Neurosurgeon. World Neurosurg 2021; 149:e415-e426. [PMID: 33639284 DOI: 10.1016/j.wneu.2021.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study aims to examine the risk factors that can cause intraoperative rupture (IOR), and especially, the role of surgical experience. To our knowledge, this is the first study to analyze the effect of the surgeon's experience on the IOR rate in 2 different perspectives. METHODS A total of 1000 aneurysms in 775 patients were operated on by a single neurosurgeon. The clinical and radiologic data and intraoperative video recordings of all patients were retrospectively analyzed. To evaluate the role of the surgeon's experience on the IOR rate, the aneurysms were divided chronologically into both 5-year periods and each 100 aneurysms. Number, stage, severity, location, management of IORs, and patients' outcomes were determined. RESULTS IOR occurred in 55 aneurysms (5.5% per aneurysm). The incidence of IOR decreased gradually in the first 2 groups of 5-year periods (11.4% and 5.9%, respectively). However, in the last 3 groups, the decline remained stable (4%-5%). Considering all groups, this decrease was statistically significant (P = 0.037). When this evaluation was made for each group of 100 aneurysms, similar results were obtained. Mortality also gradually decreased over the years (P = 0.035). Of 8 possible risk factors, rupture status was found to be the only independent predictor for IOR (OR, 8.68; 95% confidence interval, 3.69-20.47; P <0.001). CONCLUSIONS Increased surgical experience reduces the IOR rate from 10%-11% to 4%-5% after an average of 250 aneurysm operations. However, this rate does not decrease further with more experience. To our knowledge, a learning curve regarding IOR is presented for the first time in the literature.
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Affiliation(s)
- Servet Inci
- Department of Neurosurgery, Medical Faculty, Hacettepe University, Ankara, Turkey.
| | - Dicle Karakaya
- Department of Neurosurgery, Medical Faculty, Hacettepe University, Ankara, Turkey
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Silva MC, Amorim VJP, Ribeiro SP, Oliveira RAR. Field Research Cooperative Wearable Systems: Challenges in Requirements, Design and Validation. SENSORS (BASEL, SWITZERLAND) 2019; 19:E4417. [PMID: 31614802 PMCID: PMC6832741 DOI: 10.3390/s19204417] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/06/2019] [Accepted: 10/08/2019] [Indexed: 12/13/2022]
Abstract
The widespread availability of wearable devices is evolving them into cooperative systems. Communication and distribution aspects such as the Internet of Things, Wireless Body Area Networks, and Local Wireless Networks provide the means to develop multi-device platforms. Nevertheless, the field research environment presents a specific feature set, which increases the difficulty in the adoption of this technology. In this text, we review the main aspects of Field Research Gears and Wearable Devices. This review is made aiming to understand how to create cooperative systems based on wearable devices directed to the Field Research Context. For a better understanding, we developed a case study in which we propose a cooperative system architecture and provide validation aspects. For this matter, we provide an overview of a previous device architecture and study an integration proposal.
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Affiliation(s)
- Mateus C Silva
- Department of Computing, Federal University of Ouro Preto, Morro do Cruzeiro Campus, Ouro Preto 35400-000, Brazil.
| | - Vicente J P Amorim
- Department of Computing, Federal University of Ouro Preto, Morro do Cruzeiro Campus, Ouro Preto 35400-000, Brazil.
| | - Sérvio P Ribeiro
- Department of Biology, Federal University of Ouro Preto, Morro do Cruzeiro Campus, Ouro Preto 35400-000, Brazil.
| | - Ricardo A R Oliveira
- Department of Computing, Federal University of Ouro Preto, Morro do Cruzeiro Campus, Ouro Preto 35400-000, Brazil.
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