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Fu H, Wang Z, Hu Z, Zhao T, Xin H, Wu F, Hou J, Yang Y, Zhang Y, Jiang W, Wang F, Deng N, Chen J. Pilot study of home-based monitoring for early prediction of acute exacerbations in patients with fibrosing interstitial lung diseases. Sci Rep 2024; 14:21101. [PMID: 39256540 PMCID: PMC11387483 DOI: 10.1038/s41598-024-71942-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 09/02/2024] [Indexed: 09/12/2024] Open
Abstract
This study aimed to assess the potential of home monitoring using a monitoring application for the early prediction of acute exacerbations (AEs) in patients with fibrosing interstitial lung diseases (F-ILDs) by tracking symptoms, peripheral blood oxygen saturation (SpO2), and heart rate (HR). Data on symptoms, SpO2, and HR before and after a 1-min sit-to-stand test (1STST) were collected using an online home monitoring application. Symptoms were recorded at least 3 times a week, including cough intensity and frequency (Cough Assessment Test scale (COAT) score), breathlessness grade (modified Medical Research Council (mMRC) score), and SpO2 and HR before and after 1STST. Eighty-five patients with stable F-ILDs were enrolled. We observed a significant increase in COAT and mMRC scores, alongside a significant decrease in SpO2 before and after 1STST, 2 weeks before the first recorded AE. Furthermore, a combination of variables-an increase in COAT (≥ 4) and mMRC(≥ 1) scores, a decrease in SpO2 at rest (≥ 5%), and a decrease in SpO2 after 1STST (≥ 4%)- proved the most effective in predicting AE onset in patients with F-ILDs at 2 weeks before the first recorded AE. Home telemonitoring of symptoms, SpO2 holds potential value for early AE detection in patients with F-ILDs.
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Affiliation(s)
- Hongyan Fu
- Department of Key Laboratory of Ningxia Stem Cell and Regenerative Medicine, Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, People's Republic of China
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, 710049, People's Republic of China
| | - Zhaojun Wang
- Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, People's Republic of China
| | - Zhengyu Hu
- Department of Key Laboratory of Ningxia Stem Cell and Regenerative Medicine, Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, People's Republic of China
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, People's Republic of China
- School of Ningxia Medical University, Yinchuan, 750004, Ningxia, People's Republic of China
| | - Tingting Zhao
- Department of Key Laboratory of Ningxia Stem Cell and Regenerative Medicine, Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, People's Republic of China
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, People's Republic of China
| | - Hongxia Xin
- Department of Key Laboratory of Ningxia Stem Cell and Regenerative Medicine, Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, People's Republic of China
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, People's Republic of China
| | - Fan Wu
- Guangzhou Institute of Respiratory Health and State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease and National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou National Laboratory, Guangzhou, People's Republic of China
| | - Jia Hou
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, People's Republic of China
| | - Yanjuan Yang
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, People's Republic of China
| | - Yanan Zhang
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, People's Republic of China
| | - Wangshu Jiang
- Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, People's Republic of China
| | - Faxuan Wang
- School of Public Health, Ningxia Medical University, Yinchuan, 750004, Ningxia, People's Republic of China
| | - Ning Deng
- Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, People's Republic of China
| | - Juan Chen
- Department of Key Laboratory of Ningxia Stem Cell and Regenerative Medicine, Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, People's Republic of China.
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, People's Republic of China.
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Chen Z, Liang N, Li H, Zhang H, Li H, Yan L, Hu Z, Chen Y, Zhang Y, Wang Y, Ke D, Shi N. Exploring explainable AI features in the vocal biomarkers of lung disease. Comput Biol Med 2024; 179:108844. [PMID: 38981214 DOI: 10.1016/j.compbiomed.2024.108844] [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] [Received: 01/02/2024] [Revised: 05/15/2024] [Accepted: 06/04/2024] [Indexed: 07/11/2024]
Abstract
This review delves into the burgeoning field of explainable artificial intelligence (XAI) in the detection and analysis of lung diseases through vocal biomarkers. Lung diseases, often elusive in their early stages, pose a significant public health challenge. Recent advancements in AI have ushered in innovative methods for early detection, yet the black-box nature of many AI models limits their clinical applicability. XAI emerges as a pivotal tool, enhancing transparency and interpretability in AI-driven diagnostics. This review synthesizes current research on the application of XAI in analyzing vocal biomarkers for lung diseases, highlighting how these techniques elucidate the connections between specific vocal features and lung pathology. We critically examine the methodologies employed, the types of lung diseases studied, and the performance of various XAI models. The potential for XAI to aid in early detection, monitor disease progression, and personalize treatment strategies in pulmonary medicine is emphasized. Furthermore, this review identifies current challenges, including data heterogeneity and model generalizability, and proposes future directions for research. By offering a comprehensive analysis of explainable AI features in the context of lung disease detection, this review aims to bridge the gap between advanced computational approaches and clinical practice, paving the way for more transparent, reliable, and effective diagnostic tools.
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Affiliation(s)
- Zhao Chen
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ning Liang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Haoyuan Li
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Haili Zhang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Huizhen Li
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lijiao Yan
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ziteng Hu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yaxin Chen
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yujing Zhang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanping Wang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Dandan Ke
- Special Disease Clinic, Huaishuling Branch of Beijing Fengtai Hospital of Integrated Traditional Chinese and Western Medicine, Beijing, China.
| | - Nannan Shi
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China; Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China.
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Shankar R, Hadinnapola CM, Clark AB, Adamali H, Chaudhuri N, Spencer LG, Wilson AM. Assessment of the impact of social deprivation, distance to hospital and time to diagnosis on survival in idiopathic pulmonary fibrosis. Respir Med 2024; 227:107612. [PMID: 38677526 DOI: 10.1016/j.rmed.2024.107612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a progressive condition associated with a variable prognosis. The relationship between socioeconomic status or distance travelled to respiratory clinics and prognosis is unclear. RESEARCH QUESTION To determine whether socioeconomic status, distance to hospital and time to referral affects survival in patients with IPF. STUDY DESIGN AND METHODS In this retrospective cohort study, we used data collected from the British Thoracic Society Interstitial Lung Diseases Registry, between 2013 and 2021 (n = 2359) and calculated the quintile of Index of Multiple Deprivation 2019 score, time from initial symptoms to hospital attendance and distance as the linear distance between hospital and home post codes. Survival was assessed using Cox proportional hazards models. RESULTS There was a significant association between increasing quintile of deprivation and duration of symptoms prior to hospital presentation, Gender Age Physiology (GAP) index and receipt of supplemental oxygen and antifibrotic therapies at presentation. The most deprived patients had worse overall survival compared to least deprived after adjusting for smoking status, GAP index, distance to hospital and time to referral (HR = 1.39 [1.11, 1.73]; p = 0.003). Patients living furthest from a respiratory clinic also had worse survival compared to those living closest (HR = 1.29 [1.01, 1.64]; p = 0.041). INTERPRETATION The most deprived patients with IPF have more severe disease at presentation and worse outcomes. Living far from hospital was also associated with poor outcomes. This suggests inequalities in access to healthcare and requires consideration in delivering effective and equitable care to patients with IPF.
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Affiliation(s)
- Rashmi Shankar
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Charaka M Hadinnapola
- Norwich Medical School, University of East Anglia, Norwich, UK; Department of Respiratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Huzaifa Adamali
- Bristol Interstitial Lung Disease Service, Southmead General Hospital, Bristol, UK
| | | | - Lisa G Spencer
- Liverpool Regional Interstitial Lung Disease Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Andrew M Wilson
- Norwich Medical School, University of East Anglia, Norwich, UK; Department of Respiratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
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Althobiani MA, Ranjan Y, Russell AM, Jacob J, Orini M, Sankesara H, Conde P, Rashid Z, Dobson RJB, Hurst JR, Porter JC, Folarin AA. Home monitoring to detect progression of interstitial lung disease: A prospective cohort study. Respirology 2024; 29:513-517. [PMID: 38589216 DOI: 10.1111/resp.14708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/29/2024] [Indexed: 04/10/2024]
Affiliation(s)
- Malik A Althobiani
- UCL Respiratory, University College London, London, UK
- Interstitial Lung Disease Service, University College London Hospital, London, UK
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Yatharth Ranjan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Joseph Jacob
- UCL Respiratory, University College London, London, UK
- Satsuma Lab, Centre for Medical Image Computing, University College London Respiratory, University College London, London, UK
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, London, UK
| | - Heet Sankesara
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Pauline Conde
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Zulqarnain Rashid
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Richard J B Dobson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- Institute of Health Informatics, University College London, London, UK
- NIHR Biomedical Research Centre at University College London Hospitals, NHS Foundation Trust, London, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Joanna C Porter
- UCL Respiratory, University College London, London, UK
- Interstitial Lung Disease Service, University College London Hospital, London, UK
| | - Amos A Folarin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- Institute of Health Informatics, University College London, London, UK
- NIHR Biomedical Research Centre at University College London Hospitals, NHS Foundation Trust, London, UK
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Chai M, Li L, Wu H, Liu Y, Yi Z, Yu H. Lung toxicity induced by anti-HER2 antibody - drug conjugates for breast cancer. Crit Rev Oncol Hematol 2024; 195:104274. [PMID: 38295890 DOI: 10.1016/j.critrevonc.2024.104274] [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] [Received: 10/13/2023] [Revised: 01/20/2024] [Accepted: 01/26/2024] [Indexed: 02/10/2024] Open
Abstract
Human epidermal growth factor receptor 2 (HER2) serves as both a prognostic indicator and a therapeutic target for breast cancer. Therefore, anti-HER2 therapy plays a crucial role in the treatment of HER2-positive cancer. Antibody-drug conjugates (ADCs) are composed of a monoclonal antibody, a chemical linker and a payload, wherein their aim is to reduce the toxicity associated with chemotherapy drugs by utilizing specific antibodies. Among the anti-HER2 ADCs currently approved for clinical use, trastuzumab emtansine(T-DM1) and trastuzumab deruxtecan (T-Dxd) have demonstrated remarkable efficacy in treating HER2-positive breast cancer. However, it is essential to emphasize the occurrence of lung toxicity during the treatment process, which can be life-threatening. In this review, we provide an overview of the new epidemiological features associated with interstitial lung disease (ILD) related to anti-HER2 ADCs in breast cancer. We also summarize the potential pathogenesis and explore the diagnosis and treatment strategies within this field.
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Affiliation(s)
- Mengting Chai
- Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Li Li
- Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Huachao Wu
- Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Yue Liu
- Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Zongbi Yi
- Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.
| | - Haijun Yu
- Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.
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Boente RD, Schacht S, Borton R, Vincent J, Golzarri-Arroyo L, Rattray N. Assessing the acceptability and feasibility of remote spirometric monitoring for rural patients with interstitial lung disease: a multimethod approach. Respir Res 2024; 25:92. [PMID: 38378645 PMCID: PMC10877761 DOI: 10.1186/s12931-024-02735-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/14/2024] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Interstitial lung disease encompasses a group of rare lung conditions causing inflammation and scarring of lung tissue. The typical method of monitoring disease activity is through pulmonary function tests performed in a hospital setting. However, accessing care can be difficult for rural patients due to numerous barriers. This study assesses the feasibility and acceptability of home spirometry telemonitoring using MIR-Spirometers and the patientMpower home-monitoring platform for rural patients with interstitial lung disease. METHODS Unblinded, uncontrolled, prospective, multiple-methods study of the feasibility and utility of remote monitoring of 20 rural subjects with interstitial lung disease. Study assessments include adherence to twice weekly spirometry for 3 months in addition to mMRC dyspnea and EQ-5D-5L health-related quality of life questionnaires with each spirometry maneuver. Upon completion, subjects were encouraged to complete an 11-question satisfaction survey and participate in semi-structured qualitative interviews to further explore expectations and perceptions of rural patients to telehealth and remote patient monitoring. RESULTS 19 subjects completed the 3-month study period. Adherence to twice weekly spirometry was mean 53% ± 38%, with participants on average performing 2.26 ± 1.69 maneuvers per week. The median (Range) number of maneuvers per week was 2.0 (0.0, 7.0). The majority of participants responded favorably to the patient satisfaction survey questions. Themes regarding barriers to access included: lack of local specialty care, distance to center with expertise, and time, distance, and high cost associated with travel. Remote monitoring was well perceived amongst subjects as a way to improve access and overcome barriers. CONCLUSIONS Remote spirometry monitoring through web-based telehealth is acceptable and feasible for rural patients. Perceived benefits include overcoming access barriers like time, distance, and travel costs. However, cost, reimbursement, and internet access must be addressed before implementing it widely. Future studies are needed to ensure long-term feasibility and to compare outcomes with usual care.
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Affiliation(s)
- Ryan D Boente
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy, Sleep and Occupational Medicine, Indiana University School of Medicine, 1120 W. Michigan St, Gatch Hall, CL 290B, Indianapolis, IN, 46202, USA.
- Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA.
| | - Sydney Schacht
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy, Sleep and Occupational Medicine, Indiana University School of Medicine, 1120 W. Michigan St, Gatch Hall, CL 290B, Indianapolis, IN, 46202, USA
| | | | | | - Lilian Golzarri-Arroyo
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
| | - Nicholas Rattray
- Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Department of Medicine, Indiana School of Medicine, Indianapolis, IN, USA
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Sarmento A, King K, Sanchez-Ramirez DC. Using Remote Technology to Engage Patients with Interstitial Lung Diseases in a Home Exercise Program: A Pilot Study. Life (Basel) 2024; 14:265. [PMID: 38398774 PMCID: PMC10890249 DOI: 10.3390/life14020265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION The access and compliance of patients with interstitial lung diseases (ILDs) to exercise programs (EPs) remain challenges. OBJECTIVES We assessed the dropout rate, intervention completion, compliance with data acquisition and submission, safety, and satisfaction of a home EP delivered via video conference (EPVC group) or self-directed (EPSD group) to patients with ILD. Pre- and post-intervention changes in patient outcomes (dyspnea, fatigue, exercise capacity, lung function, and quality of life) were secondarily explored. MATERIAL AND METHODS Groups performed an eight-week virtual EP three times/week. Video conferences were led by a registered respiratory therapist, whereas self-directed exercises were completed following a pre-recorded video. Participants submitted spirometry, heart rate, and SpO2 results weekly to the research team. RESULTS Fourteen patients with ILD were equally assigned to the EPVC and EPSD groups, but three from the EPSD group dropped out after the initial assessment (dropout rate of 42.8% in the EPSD group). Eleven patients (mean age of 67 ± 12 years) completed 96.5% of sessions. Compliance with data acquisition and submission was optimal (≥97.6% in both groups), and no adverse events were reported. Changes in overall fatigue severity were significantly different between groups (p = 0.014, Cohen's r = 0.64). CONCLUSIONS The results suggest that a structured virtual EP delivered via video conference or pre-recorded video can be feasible, safe, and acceptable for patients with ILD.
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Affiliation(s)
| | | | - Diana C. Sanchez-Ramirez
- Department of Respiratory Therapy, University of Manitoba, Winnipeg, MB R3E 0T6, Canada; (A.S.); (K.K.)
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Althobiani MA, Shuttleworth R, Conway J, Dainton J, Duckworth A, Da Ponte AJ, Mandizha J, Lanario JW, Gibbons MA, Lines S, Scotton CJ, Hurst JR, Porter JC, Russell AM. Supporting self-management for patients with Interstitial Lung Diseases: Utility and acceptability of digital devices. PLOS DIGITAL HEALTH 2024; 3:e0000318. [PMID: 38190384 PMCID: PMC10773949 DOI: 10.1371/journal.pdig.0000318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/13/2023] [Indexed: 01/10/2024]
Abstract
INTRODUCTION Patients diagnosed with Interstitial Lung Diseases (ILD) use devices to self-monitor their health and well-being. Little is known about the range of devices, selection, frequency and terms of use and overall utility. We sought to quantify patients' usage and experiences with home digital devices, and further evaluate their perceived utility and barriers to adaptation. METHODS A team of expert clinicians and patient partners interested in self-management approaches designed a 48-question cross-sectional electronic survey; specifically targeted at individuals diagnosed with ILD. The survey was critically appraised by the interdisciplinary self-management group at Royal Devon University Hospitals NHS Foundation Trust during a 6-month validation process. The survey was open for participation between September 2021 and December 2022, and responses were collected anonymously. Data were analysed descriptively for quantitative aspects and through thematic analysis for qualitative input. RESULTS 104 patients accessed the survey and 89/104 (86%) reported a diagnosis of lung fibrosis, including 46/89 (52%) idiopathic pulmonary fibrosis (IPF) with 57/89 (64%) of participants diagnosed >3 years and 59/89 (66%) female. 52/65(80%) were in the UK; 33/65 (51%) reported severe breathlessness medical research council MRC grade 3-4 and 32/65 (49%) disclosed co-morbid arthritis or joint problems. Of these, 18/83 (22%) used a hand- held spirometer, with only 6/17 (35%) advised on how to interpret the readings. Pulse oximetry devices were the most frequently used device by 35/71 (49%) and 20/64 (31%) measured their saturations more than once daily. 29/63 (46%) of respondents reported home-monitoring brought reassurance; of these, for 25/63 (40%) a feeling of control. 10/57 (18%) felt it had a negative effect, citing fluctuating readings as causing stress and 'paranoia'. The most likely help-seeking triggers were worsening breathlessness 53/65 (82%) and low oxygen saturation 43/65 (66%). Nurse specialists were the most frequent source of help 24/63 (38%). Conclusion: Patients can learn appropriate technical skills, yet perceptions of home-monitoring are variable; targeted assessment and tailored support is likely to be beneficial.
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Affiliation(s)
| | - Rebecca Shuttleworth
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - John Conway
- Exeter Patients in Collaboration for Pulmonary Fibrosis Research (EPIC-PF), Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - Jonathan Dainton
- Exeter Patients in Collaboration for Pulmonary Fibrosis Research (EPIC-PF), Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - Anna Duckworth
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
- Exeter Respiratory Innovations Center, University of Exeter, Exeter, United Kingdom
| | - Ana Jorge Da Ponte
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - Jessica Mandizha
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
- Exeter Respiratory Innovations Center, University of Exeter, Exeter, United Kingdom
| | - Joseph W. Lanario
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
- Exeter Respiratory Innovations Center, University of Exeter, Exeter, United Kingdom
| | - Michael A. Gibbons
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
- Exeter Respiratory Innovations Center, University of Exeter, Exeter, United Kingdom
| | - Sarah Lines
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - Chris J. Scotton
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
- Exeter Respiratory Innovations Center, University of Exeter, Exeter, United Kingdom
| | - John R. Hurst
- Department of Medicine, University College London, London, United Kingdom
| | - Joanna C. Porter
- Department of Medicine, University College London, London, United Kingdom
| | - Anne-Marie Russell
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
- Exeter Respiratory Innovations Center, University of Exeter, Exeter, United Kingdom
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Tikellis G, Corte T, Glaspole IN, Goh NSL, Khor YH, Wrobel J, Symons K, Fuhrmeister L, Glenn L, Chirayath S, Troy LK, King B, Holland AE. Navigating the COVID-19 pandemic: Experiences and self-management approaches adopted by people with interstitial lung disease. Chron Respir Dis 2024; 21:14799731231226236. [PMID: 38193428 PMCID: PMC10777803 DOI: 10.1177/14799731231226236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND People with interstitial lung disease (ILD) were deemed more vulnerable to the SARS-CoV-2 virus and isolated as a means of reducing risk of infection. This study examined the impact of the pandemic on daily life, psychological wellbeing and access to healthcare and identified approaches undertaken to remain safe. METHODS Four specialist clinics in tertiary centres in Australia (Victoria: two sites; New South Wales: one site; Western Australia: one site) recruited patients with ILD during an 8-week period from March 2021. Semi-structured telephone interviews were conducted with transcripts analysed using principles of grounded theory. RESULTS Ninety participants were interviewed between April and December 2021. Participants were predominantly female, former smokers with an average age of 66 years. IPF and connective tissue-ILD being the most common subtypes. Five main themes were identified: vulnerability reduced social interaction and isolation, access to healthcare services and support, staying active, emotional and psychological impact. Self-management strategies included staying active both physically and mentally. DISCUSSION Self-management was key to managing the impact of the pandemic. In combination with advances in technology, implementation of strategies for monitoring wellbeing and support for self-management provides an opportunity to leverage the lessons learnt to ensure a more individualised model of care for people with ILD.
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Affiliation(s)
- Gabriella Tikellis
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, VIC, Australia
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia
| | - Tamera Corte
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia
- Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Ian N Glaspole
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, VIC, Australia
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
| | - Nicole S L Goh
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, VIC, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Yet H Khor
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Jeremy Wrobel
- Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Karen Symons
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
| | - Lisa Fuhrmeister
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Laura Glenn
- Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Shiji Chirayath
- Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia
| | - Lauren K Troy
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia
- Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Bill King
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Anne E Holland
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, VIC, Australia
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia
- Institute for Breathing and Sleep, Melbourne, VIC, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia
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10
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Huang B, Hu S, Liu Z, Lin CL, Su J, Zhao C, Wang L, Wang W. Challenges and prospects of visual contactless physiological monitoring in clinical study. NPJ Digit Med 2023; 6:231. [PMID: 38097771 PMCID: PMC10721846 DOI: 10.1038/s41746-023-00973-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023] Open
Abstract
The monitoring of physiological parameters is a crucial topic in promoting human health and an indispensable approach for assessing physiological status and diagnosing diseases. Particularly, it holds significant value for patients who require long-term monitoring or with underlying cardiovascular disease. To this end, Visual Contactless Physiological Monitoring (VCPM) is capable of using videos recorded by a consumer camera to monitor blood volume pulse (BVP) signal, heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2) and blood pressure (BP). Recently, deep learning-based pipelines have attracted numerous scholars and achieved unprecedented development. Although VCPM is still an emerging digital medical technology and presents many challenges and opportunities, it has the potential to revolutionize clinical medicine, digital health, telemedicine as well as other areas. The VCPM technology presents a viable solution that can be integrated into these systems for measuring vital parameters during video consultation, owing to its merits of contactless measurement, cost-effectiveness, user-friendly passive monitoring and the sole requirement of an off-the-shelf camera. In fact, the studies of VCPM technologies have been rocketing recently, particularly AI-based approaches, but few are employed in clinical settings. Here we provide a comprehensive overview of the applications, challenges, and prospects of VCPM from the perspective of clinical settings and AI technologies for the first time. The thorough exploration and analysis of clinical scenarios will provide profound guidance for the research and development of VCPM technologies in clinical settings.
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Affiliation(s)
- Bin Huang
- AI Research Center, Hangzhou Innovation Institute, Beihang University, 99 Juhang Rd., Binjiang Dist., Hangzhou, Zhejiang, China.
- School of Automation Science and Electrical Engineering, Beihang University, Beijing, China.
| | - Shen Hu
- Department of Obstetrics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Epidemiology, The Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Zimeng Liu
- School of Automation Science and Electrical Engineering, Beihang University, Beijing, China
| | - Chun-Liang Lin
- College of Electrical Engineering and Computer Science, National Chung Hsing University, 145 Xingda Rd., South Dist., Taichung, Taiwan.
| | - Junfeng Su
- Department of General Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Early Warning and Intervention of Multiple Organ Failure, China National Ministry of Education, Hangzhou, Zhejiang, China
| | - Changchen Zhao
- AI Research Center, Hangzhou Innovation Institute, Beihang University, 99 Juhang Rd., Binjiang Dist., Hangzhou, Zhejiang, China
| | - Li Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wenjin Wang
- Department of Biomedical Engineering, Southern University of Science and Technology, 1088 Xueyuan Ave, Nanshan Dist., Shenzhen, Guangdong, China.
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11
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Althobiani MA, Ranjan Y, Jacob J, Orini M, Dobson RJB, Porter JC, Hurst JR, Folarin AA. Evaluating a Remote Monitoring Program for Respiratory Diseases: Prospective Observational Study. JMIR Form Res 2023; 7:e51507. [PMID: 37999935 DOI: 10.2196/51507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/23/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Patients with chronic respiratory diseases and those in the postdischarge period following hospitalization because of COVID-19 are particularly vulnerable, and little is known about the changes in their symptoms and physiological parameters. Continuous remote monitoring of physiological parameters and symptom changes offers the potential for timely intervention, improved patient outcomes, and reduced health care costs. OBJECTIVE This study investigated whether a real-time multimodal program using commercially available wearable technology, home-based Bluetooth-enabled spirometers, finger pulse oximeters, and smartphone apps is feasible and acceptable for patients with chronic respiratory diseases, as well as the value of low-burden, long-term passive data collection. METHODS In a 3-arm prospective observational cohort feasibility study, we recruited 60 patients from the Royal Free Hospital and University College Hospital. These patients had been diagnosed with interstitial lung disease, chronic obstructive pulmonary disease, or post-COVID-19 condition (n=20 per group) and were followed for 180 days. This study used a comprehensive remote monitoring system designed to provide real-time and relevant data for both patients and clinicians. Data were collected using REDCap (Research Electronic Data Capture; Vanderbilt University) periodic surveys, Remote Assessment of Disease and Relapses-base active app questionnaires, wearables, finger pulse oximeters, smartphone apps, and Bluetooth home-based spirometry. The feasibility of remote monitoring was measured through adherence to the protocol, engagement during the follow-up period, retention rate, acceptability, and data integrity. RESULTS Lowest-burden passive data collection methods, via wearables, demonstrated superior adherence, engagement, and retention compared with active data collection methods, with an average wearable use of 18.66 (SD 4.69) hours daily (77.8% of the day), 123.91 (SD 33.73) hours weekly (72.6% of the week), and 463.82 (SD 156.70) hours monthly (64.4% of the month). Highest-burden spirometry tasks and high-burden active app tasks had the lowest adherence, engagement, and retention, followed by low-burden questionnaires. Spirometry and active questionnaires had the lowest retention at 0.5 survival probability, indicating that they were the most burdensome. Adherence to and quality of home spirometry were analyzed; of the 7200 sessions requested, 4248 (59%) were performed. Of these, 90.3% (3836/4248) were of acceptable quality according to American Thoracic Society grading. Inclusion of protocol holidays improved retention measures. The technologies used were generally well received. CONCLUSIONS Our findings provide evidence supporting the feasibility and acceptability of remote monitoring for capturing both subjective and objective data from various sources for respiratory diseases. The high engagement level observed with passively collected data suggests the potential of wearables for long-term, user-friendly remote monitoring in respiratory disease management. The unique piloting of certain features such as protocol holidays, alert notifications for missing data, and flexible support from the study team provides a reference for future studies in this field. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/28873.
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Affiliation(s)
- Malik A Althobiani
- Respiratory Medicine, University College London, London, United Kingdom
- Interstitial Lung Disease Service, University College London Hospital, London, United Kingdom
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Yatharth Ranjan
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Joseph Jacob
- Respiratory Medicine, University College London, London, United Kingdom
- Satsuma Lab, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Richard James Butler Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- National Institute for Health and Care Research, Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
- National Institute for Health and Care Research, Biomedical Research Centre at University College London Hospitals, National Institute for Health Foundation Trust, London, United Kingdom
| | - Joanna C Porter
- Respiratory Medicine, University College London, London, United Kingdom
- Interstitial Lung Disease Service, University College London Hospital, London, United Kingdom
| | - John R Hurst
- Respiratory Medicine, University College London, London, United Kingdom
| | - Amos A Folarin
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- National Institute for Health and Care Research, Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
- National Institute for Health and Care Research, Biomedical Research Centre at University College London Hospitals, National Institute for Health Foundation Trust, London, United Kingdom
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12
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Mandizha J, Lanario JW, Duckworth A, Lines S, Paiva A, Elworthy V, Muraleedharan V, Da Ponte AJ, Shuttleworth R, Brown G, Almond H, Bond C, Cosby M, Dallas J, Naqvi M, Russell AD, Berry A, Gibbons M, Scotton CJ, Russell AM. Patient perspectives on home-spirometry in interstitial lung disease: a qualitative co-designed study. BMJ Open Respir Res 2023; 10:e001837. [PMID: 37793682 PMCID: PMC10551997 DOI: 10.1136/bmjresp-2023-001837] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/01/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Opportunities for home-monitoring are increasing exponentially. Home- spirometry is reproducible and reliable in interstitial lung disease (ILD), yet patients' experiences are not reported. Given the morbidity and mortality associated with ILDs, maintaining health-related quality-of-life is vital. We report our findings from a codesigned, qualitative study capturing the perspectives and experiences of patients using home-spirometry in a UK regional ILD National Health Service England (NHSE) commissioned service. METHODS Patients eligible for home-spirometry as routine clinical care, able to give consent and able to access a smart phone were invited to participate. In-depth, semistructured interviews were conducted at serial time points (baseline, 1, 3 and 6 months), recorded, transcribed and analysed thematically. RESULTS We report on the experiences of 10 recruited patients (8 males; median age 66 years, range 50-82 years; 7 diagnosed with idiopathic pulmonary fibrosis, 3 other ILDs) who generally found spirometry convenient and easy to use, but their relationships with forced vital capacity results were complex. Main themes emerging were: (1) anticipated benefits-to identify change, trigger action and aid understanding of condition; (2) needs-clinical oversight and feedback, understanding of results, ownership, need for data and a need 'to know'; (3) emotional impact-worry, reassurance, ambivalence/conflicting feelings, reminder of health issues, indifference; (4) ease of home-spirometry-simplicity, convenience and (5) difficulties with home-spirometry-technical issues, technique, physical effort. CONCLUSION Home-spirometry has many benefits, but in view of the potential risks to psychological well-being, must be considered on an individual basis. Informed consent and decision-making are essential and should be ongoing, acknowledging potential limitations as well as benefits. Healthcare support is vital.
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Affiliation(s)
- Jessica Mandizha
- Interstitial Lung Disease Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Joseph W Lanario
- Interstitial Lung Disease Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
- School of Medicine, University of Plymouth, Plymouth, UK
| | - Anna Duckworth
- Clinical & Biomedical Science, University of Exeter, Exeter, Devon, UK
| | - Sarah Lines
- Interstitial Lung Disease Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Ana Paiva
- Interstitial Lung Disease Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Victoria Elworthy
- Interstitial Lung Disease Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Veena Muraleedharan
- Interstitial Lung Disease Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Ana Jorge Da Ponte
- Interstitial Lung Disease Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Rebecca Shuttleworth
- Interstitial Lung Disease Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Graham Brown
- EPIC Group, University of Exeter, Exeter, Devon, UK
| | | | - Carole Bond
- EPIC Group, University of Exeter, Exeter, Devon, UK
| | - Maureen Cosby
- Interstitial Lung Disease Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Joanne Dallas
- Respiratory Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Marium Naqvi
- Respiratory Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Alex Berry
- Academy of Nursing, University of Exeter, Exeter, Devon, UK
| | - Michael Gibbons
- Interstitial Lung Disease Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | | | - Anne-Marie Russell
- Interstitial Lung Disease Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
- Medical School, University of Exeter, Exeter, Devon, UK
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13
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Monteleone G, Terzulli G, Cefaloni F, Bonini M, Richeldi L. The Impact of Telemedicine during Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic and Future Perspectives: A Systematic Review. Respiration 2023; 102:879-890. [PMID: 37742627 DOI: 10.1159/000533621] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
INTRODUCTION Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread worldwide since December 2019, causing the COVID-19 pandemic. Several measures have taken place in many countries to avoid further spread of the virus and to manage infected people according to disease severity. Notably, telemedicine (TM) was successfully used to manage less severe patients. Our aim was to assess the impact and the edges of using TM in home-isolated or hospitalized patients affected by SARS-CoV-2 infection and its further application. METHODS We performed a systematic review according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, focusing on randomized controlled trials (RCTs) published in English and available on PubMed database. Full texts were blindly reviewed and then assessed according to PICO model. RESULTS Our research identified a total of 1,959 records, of which 24 were potentially eligible through the articles full-text review. Six papers were included for data extraction and 18 articles were excluded: 10 articles were not RCTs and 8 articles did not involve SARS-CoV-2 patients. The TM application showed an improvement in psychological stress, mental disorders, and a significant reduction of general stress in patients affected by SARS-CoV-2 infection. The effectiveness of using TM in rehabilitative respiratory programs has been also reported. Furthermore, the benefits of TM application in tailored monitoring of vital parameters in home-isolated patients helped clinicians to early identify a deterioration of clinical conditions. CONCLUSION The use of TM during COVID-19 pandemic represented a novel, intriguing, versatile, and useful tool to support clinical practice. This evidence suggests considering TM in a wider range of clinical applications.
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Affiliation(s)
- Giorgio Monteleone
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Terzulli
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Cefaloni
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy,
| | - Matteo Bonini
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Neurological, ENT and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- National Heart and Lung Institute (NHLI), Imperial College, London, UK
| | - Luca Richeldi
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Neurological, ENT and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
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14
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Alvarado E, Grágeda N, Luzanto A, Mahu R, Wuth J, Mendoza L, Stern RM, Yoma NB. Automatic Detection of Dyspnea in Real Human-Robot Interaction Scenarios. SENSORS (BASEL, SWITZERLAND) 2023; 23:7590. [PMID: 37688044 PMCID: PMC10490721 DOI: 10.3390/s23177590] [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: 07/18/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023]
Abstract
A respiratory distress estimation technique for telephony previously proposed by the authors is adapted and evaluated in real static and dynamic HRI scenarios. The system is evaluated with a telephone dataset re-recorded using the robotic platform designed and implemented for this study. In addition, the original telephone training data are modified using an environmental model that incorporates natural robot-generated and external noise sources and reverberant effects using room impulse responses (RIRs). The results indicate that the average accuracy and AUC are just 0.4% less than those obtained with matched training/testing conditions with simulated data. Quite surprisingly, there is not much difference in accuracy and AUC between static and dynamic HRI conditions. Moreover, the beamforming methods delay-and-sum and MVDR lead to average improvement in accuracy and AUC equal to 8% and 2%, respectively, when applied to training and testing data. Regarding the complementarity of time-dependent and time-independent features, the combination of both types of classifiers provides the best joint accuracy and AUC score.
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Affiliation(s)
- Eduardo Alvarado
- Speech Processing and Transmission Laboratory, Electrical Engineering Department, University of Chile, Santiago 8370451, Chile; (E.A.); (N.G.); (A.L.); (R.M.); (J.W.)
| | - Nicolás Grágeda
- Speech Processing and Transmission Laboratory, Electrical Engineering Department, University of Chile, Santiago 8370451, Chile; (E.A.); (N.G.); (A.L.); (R.M.); (J.W.)
| | - Alejandro Luzanto
- Speech Processing and Transmission Laboratory, Electrical Engineering Department, University of Chile, Santiago 8370451, Chile; (E.A.); (N.G.); (A.L.); (R.M.); (J.W.)
| | - Rodrigo Mahu
- Speech Processing and Transmission Laboratory, Electrical Engineering Department, University of Chile, Santiago 8370451, Chile; (E.A.); (N.G.); (A.L.); (R.M.); (J.W.)
| | - Jorge Wuth
- Speech Processing and Transmission Laboratory, Electrical Engineering Department, University of Chile, Santiago 8370451, Chile; (E.A.); (N.G.); (A.L.); (R.M.); (J.W.)
| | - Laura Mendoza
- Hospital Clínico Universidad de Chile, Santiago 8380420, Chile;
- Clínica Alemana, Santiago 7630000, Chile
| | - Richard M. Stern
- Department of Electrical and Computer Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, USA;
| | - Néstor Becerra Yoma
- Speech Processing and Transmission Laboratory, Electrical Engineering Department, University of Chile, Santiago 8370451, Chile; (E.A.); (N.G.); (A.L.); (R.M.); (J.W.)
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15
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Oliveira A, Fabbri G, Gille T, Bargagli E, Duchemann B, Evans R, Pinnock H, Holland AE, Renzoni E, Ekström M, Jones S, Wijsenbeek M, Dinh-Xuan AT, Vagheggini G. Holistic management of patients with progressive pulmonary fibrosis. Breathe (Sheff) 2023; 19:230101. [PMID: 37719243 PMCID: PMC10501708 DOI: 10.1183/20734735.0101-2023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/18/2023] [Indexed: 09/19/2023] Open
Abstract
Progressive pulmonary fibrosis (PF) is a complex interstitial lung disease that impacts substantially on patients' daily lives, requiring personalised and integrated care. We summarise the main needs of patients with PF and their caregivers, and suggest a supportive care approach. Individualised care, education, emotional and psychological support, specialised treatments, and better access to information and resources are necessary. Management should start at diagnosis, be tailored to the patient's needs, and consider end-of-life care. Pharmacological and non-pharmacological interventions should be individualised, including oxygen therapy and pulmonary rehabilitation, with digital healthcare utilised as appropriate. Further research is needed to address technical issues related to oxygen delivery and digital healthcare. Educational aims To identify the main needs of patients with PF and their caregivers.To describe the components of a comprehensive approach to a supportive care programme for patients with PF.To identify further areas of research to address technical issues related to the management of patients with PF.
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Affiliation(s)
- Ana Oliveira
- Lab 3R Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), IBMED Aveiro PT, Aveiro, Portugal
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, ON, Canada
| | - Gaia Fabbri
- Respiratory Diseases and Lung Transplantation Unit, Department of Medical and Surgical Sciences and Neuro-Sciences, University of Siena, Siena, Italy
| | - Thomas Gille
- Inserm U1272 “Hypoxia & the Lung”, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
- Service Physiologie et Explorations Fonctionnelles, Hôpitaux Universitaires de Paris Seine-Saint-Denis, Assistance Publique – Hôpitaux de Paris, Bobigny, France
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplantation Unit, Department of Medical and Surgical Sciences and Neuro-Sciences, University of Siena, Siena, Italy
| | - Boris Duchemann
- Inserm U1272 “Hypoxia & the Lung”, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
- Service d'oncologie médicale et thoracique, Hôpitaux Universitaires de Paris Seine-Saint-Denis, Assistance Publique – Hôpitaux de Paris, Bobigny, France
| | - Rachel Evans
- Department of Respiratory Sciences, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Anne E. Holland
- Central Clinical School, Monash University and Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Elisabetta Renzoni
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Margaret Turner Warwick Centre for Fibrosing Lung Diseases, NHLI, Imperial College, London, UK
| | - Magnus Ekström
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund, Sweden
| | - Steve Jones
- European Pulmonary Fibrosis Federation, Brussels, Belgium
| | - Marlies Wijsenbeek
- Centre for Expertise for Interstitial Lung Disease and Sarcoidosis, Department of Respiratory Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Anh Tuan Dinh-Xuan
- Service de Physiologie-Explorations Fonctionnelles, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Université Paris Cité, Paris, France
| | - Guido Vagheggini
- Department of Internal Medicine and Medical Specialties, Respiratory Failure Pathway, Azienda USL Toscana Nordovest, Pisa, Italy
- Fondazione Volterra Ricerche ONLUS, Volterra (PI), Italy
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16
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Pinnock H, Hui CY, van Boven JF. Implementation of digital home monitoring and management of respiratory disease. Curr Opin Pulm Med 2023; 29:302-312. [PMID: 37132298 PMCID: PMC10241431 DOI: 10.1097/mcp.0000000000000965] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
PURPOSE OF REVIEW Digital respiratory monitoring interventions (e.g. smart inhalers and digital spirometers) can improve clinical outcomes and/or organizational efficiency, and the focus is shifting to sustainable implementation as an approach to delivering respiratory care. This review considers key aspects of the technology infrastructure, discusses the regulatory, financial and policy context that influence implementation, and highlights the over-arching societal themes of equity, trust and communication. RECENT FINDINGS Technological requirements include developing interoperable and connected systems; establishing stable, wide internet coverage; addressing data accuracy and monitoring adherence; realising the potential of artificial intelligence; and avoiding clinician data overload. Policy challenges include concerns about quality assurance and increasingly complex regulatory systems. Financial barriers include lack of clarity over cost-effectiveness, budget impact and reimbursement. Societal concerns focus on the potential to increase inequities because of poor e-health literacy, deprivation or lack of available infrastructure, the need to understand the implications for patient/professional interactions of shifting care to remote delivery and ensuring confidentiality of personal data. SUMMARY Understanding and addressing the implementation challenges posed by gaps in policy, regulatory, financial, and technical infrastructure is essential to support delivery of equitable respiratory care that is acceptable to patients and professionals.
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Affiliation(s)
| | - Chi Yan Hui
- Usher Institute, The University of Edinburgh, UK
| | - Job F.M. van Boven
- Department of Clinical Pharmacy and Pharmacology, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, The Netherlands
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17
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Nakshbandi G, Moor CC, Wijsenbeek MS. Role of the internet of medical things in care for patients with interstitial lung disease. Curr Opin Pulm Med 2023; 29:285-292. [PMID: 37212372 PMCID: PMC10241441 DOI: 10.1097/mcp.0000000000000971] [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: 05/23/2023]
Abstract
PURPOSE OF REVIEW Online technologies play an increasing role in facilitating care for patients with interstitial lung disease (ILD). In this review, we will give an overview of different applications of the internet of medical things (IoMT) for patients with ILD. RECENT FINDINGS Various applications of the IoMT, including teleconsultations, virtual MDTs, digital information, and online peer support, are now used in daily care of patients with ILD. Several studies showed that other IoMT applications, such as online home monitoring and telerehabilitation, seem feasible and reliable, but widespread implementation in clinical practice is lacking. The use of artificial intelligence algorithms and online data clouds in ILD is still in its infancy, but has the potential to improve remote, outpatient clinic, and in-hospital care processes. Further studies in large real-world cohorts to confirm and clinically validate results from previous studies are needed. SUMMARY We believe that in the near future innovative technologies, facilitated by the IoMT, will further enhance individually targeted treatment for patients with ILD by interlinking and combining data from various sources.
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Affiliation(s)
- Gizal Nakshbandi
- Department of Respiratory Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
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18
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Farrand E, Swigris JJ. Digital outcome measures in pulmonary clinical trials. Curr Opin Pulm Med 2023; 29:322-327. [PMID: 37191175 DOI: 10.1097/mcp.0000000000000972] [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: 05/17/2023]
Abstract
PURPOSE OF REVIEW We highlight recent advances in the development and use of digital outcome measures in clinical trials, focusing on how to select the appropriate technology, use digital data to define trial endpoints, and glean important lessons from current experiences with digital outcome measures in pulmonary medicine. RECENT FINDINGS A review of emerging literature demonstrates that the use of digital health technologies, particularly pulse oximeters, remote spirometers, accelerometers, and Electronic Patient-Reported Outcomes, has surged in both pulmonary practice and clinical trials. Lessons learned from their use can help researchers to design the next generation of clinical trials leveraging digital outcomes to improve health. SUMMARY In pulmonary diseases, digital health technologies provide validated, reliable, and usable data on patients in real-world environments. More broadly, digital endpoints have accelerated innovation in clinical trial design, improved clinical trial efficiency, and centered patients. As investigators adopt digital health technologies, it is important to follow a framework informed by both the opportunities and challenges of digitization. Successful use of digital health technologies will transform clinical trials by improving accessibility, efficiency, patient-centricity, and expanding opportunities for personalized medicine.
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Affiliation(s)
- Erica Farrand
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Jeffrey J Swigris
- Division of Pulmonary, Critical Care and Sleep Medicine, Interstitial Lung Disease Program, National Jewish Health, Denver, Colorado, USA
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19
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Tarantino P, Ricciuti B, Pradhan SM, Tolaney SM. Optimizing the safety of antibody-drug conjugates for patients with solid tumours. Nat Rev Clin Oncol 2023:10.1038/s41571-023-00783-w. [PMID: 37296177 DOI: 10.1038/s41571-023-00783-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/12/2023]
Abstract
Over the past 5 years, improvements in the design of antibody-drug conjugates (ADCs) have enabled major advances that have reshaped the treatment of several advanced-stage solid tumours. Considering the intended rationale behind the design of ADCs, which is to achieve targeted delivery of cytotoxic molecules by linking them to antibodies targeting tumour-specific antigens, ADCs would be expected to be less toxic than conventional chemotherapy. However, most ADCs are still burdened by off-target toxicities that resemble those of the cytotoxic payload as well as on-target toxicities and other poorly understood and potentially life-threatening adverse effects. Given the rapid expansion in the clinical indications of ADCs, including use in curative settings and various combinations, extensive efforts are ongoing to improve their safety. Approaches currently being pursued include clinical trials optimizing the dose and treatment schedule, modifications of each ADC component, identification of predictive biomarkers for toxicities, and the development of innovative diagnostic tools. In this Review, we describe the determinants of the toxicities of ADCs in patients with solid tumours, highlighting key strategies that are expected to improve tolerability and enable improvements in the treatment outcomes of patients with advanced-stage and those with early stage cancers in the years to come.
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Affiliation(s)
- Paolo Tarantino
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Biagio Ricciuti
- Harvard Medical School, Boston, MA, USA
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Shan M Pradhan
- Office of Oncologic Diseases, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Sara M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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20
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Grant-Orser A, Adderley NA, Stuart K, Fell CD, Johannson KA. Patient and Physician Assessments of Clinical Status: A Mixed-methods Study of Interstitial Lung Disease. CHEST PULMONARY 2023; 1:100003. [PMID: 38013669 PMCID: PMC10043950 DOI: 10.1016/j.chpulm.2023.100003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Background The SARS-CoV-2 pandemic necessitated novel health care delivery for patients with interstitial lung disease (ILD), including reduced in-person appointments and physiologic testing to minimize transmission. Clinicians often have been required to rely on patients' subjective assessments of their clinical status during phone follow-up appointments. It is unknown how accurate a patient's self-assessment is compared with that of their physician during an in-person evaluation. Research Question Are patients' self-assessments of their clinical status in agreement with their physicians' assessments, and are telemedicine vs in-person visits acceptable? Study Design and Methods Patients were enrolled prospectively from the University of Calgary ILD clinic. Participants were asked by phone before the in-person appointment and after the appointment to rate their clinical status on a five-point Likert scale. Physicians then rated the patient's clinical status after the appointment on a similar five-point Likert scale, masked to patient responses. Patients and physicians were asked if an in-person appointment was necessary or if telemedicine would have sufficed. Clinical variables associated with physician assessments were assessed. Results Fifty patients with mean age of 67 ± 11.8 years participated. Mean time since last follow-up was 5.0 ± 3.0 months. No correlation was found between the preclinical patient self-assessment and postclinical physician assessment (P = .18; κ = 0.28). Correlation of postclinical assessment was statistically significant (P < .001), with moderate agreement (κ = 0.49). Physicians thought telephone visits were acceptable for 58% of appointments, whereas only 12% of patients preferred telephone visits. Physician's assessment of clinical status seemed to be driven by change in diffusion capacity of the lungs for carbon monoxide (P = .039). Interpretation Telemedicine may improve access to care for patients during pandemic management, in rural communities, and for those with impaired mobility. Despite these benefits, our data support that patients and physicians may not agree on determination of clinical status and that patients generally prefer in-person patient-physician interactions.
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Affiliation(s)
- Amanda Grant-Orser
- Division of Respirology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nicola A Adderley
- Division of Respirology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Katelyn Stuart
- Division of Respirology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Charlene D Fell
- Division of Respirology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kerri A Johannson
- Division of Respirology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
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21
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Ilić M, Javorac J, Milenković A, Živanović D, Miljković D, Kašiković Lečić S, Savić N, Tot Vereš K, Kovačević D, Vujičić E, Kopitović I. Home-Based Spirometry in Patients with Interstitial Lung Diseases: A Real-Life Pilot "FACT" Study from Serbia. J Pers Med 2023; 13:jpm13050793. [PMID: 37240962 DOI: 10.3390/jpm13050793] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/10/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: home-based spirometry, as a form of telemedicine in pulmonology, was previously successfully implemented in clinical practice in developed countries. However, experiences from developing countries are lacking. The aim of this study was to assess the reliability and feasibility of home-based spirometry in patients with interstitial lung diseases from Serbia. (2) Methods: 10 patients were given a personal hand-held spirometer with operating instructions and asked to perform daily domiciliary spirometry for the next 24 weeks. The K-BILD questionnaire was used to assess patients' quality of life, while the questionnaire designed specifically for this study was used to assess their attitudes toward and satisfaction with domiciliary spirometry. (3) Results: there was a significant positive correlation between office- and home-based spirometry at the beginning (r = 0.946; p < 0.001) and end of the study (r = 0.719; p = 0.019). The compliance rate was nearly 70%. The domiciliary spirometry did not affect patients' overall quality of life or anxiety levels, as measured via different domains of the K-BILD. Patients expressed positive experiences and high satisfaction with the home spirometry program. (4) Conclusions: home-based spirometry may represent a reliable form of spirometry, exploited in routine clinical practice; however, additional research in developing countries with a larger sample size is required.
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Affiliation(s)
- Miroslav Ilić
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Jovan Javorac
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Ana Milenković
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Dejan Živanović
- Department of Psychology, College of Social Work, 11000 Belgrade, Serbia
- Department of Medical Sciences, College of Vocational Studies "Sirmium", 22000 Sremska Mitrovica, Serbia
| | - Dejan Miljković
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Svetlana Kašiković Lečić
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Nevena Savić
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Kristina Tot Vereš
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Dragica Kovačević
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Emilija Vujičić
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Ivan Kopitović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
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22
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Vagg T, Deasy KF, Chapman WW, Ranganathan SC, Plant BJ, Shanthikumar S. Virtual monitoring in CF - the importance of continuous monitoring in a multi-organ chronic condition. Front Digit Health 2023; 5:1196442. [PMID: 37214343 PMCID: PMC10192704 DOI: 10.3389/fdgth.2023.1196442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/17/2023] [Indexed: 05/24/2023] Open
Abstract
Cystic Fibrosis (CF) is a chronic life-limiting condition that affects multiple organs within the body. Patients must adhere to strict medication regimens, physiotherapy, diet, and attend regular clinic appointments to manage their condition effectively. This necessary but burdensome requirement has prompted investigations into how different digital health technologies can enhance current care by providing the opportunity to virtually monitor patients. This review explores how virtual monitoring has been harnessed for assessment or performance of physiotherapy/exercise, diet/nutrition, symptom monitoring, medication adherence, and wellbeing/mental-health in people with CF. This review will also briefly discuss the potential future of CF virtual monitoring and some common barriers to its current adoption and implementation within CF. Due to the multifaceted nature of CF, it is anticipated that this review will be relevant to not only the CF community, but also those investigating and developing digital health solutions for the management of other chronic diseases.
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Affiliation(s)
- Tamara Vagg
- Cork Centre for Cystic Fibrosis (3CF), Cork University Hospital, Cork, Ireland
- HRB Clinical Research Facility Cork, University College Cork, Cork, Ireland
- Department of Medicine, University College Cork, Cork, Ireland
| | - Kevin F. Deasy
- Cork Centre for Cystic Fibrosis (3CF), Cork University Hospital, Cork, Ireland
- HRB Clinical Research Facility Cork, University College Cork, Cork, Ireland
- Department of Medicine, University College Cork, Cork, Ireland
| | - Wendy W. Chapman
- The Centre for Digital Transformation of Health, University of Melbourne, Melbourne, VIC, Australia
| | - Sarath C. Ranganathan
- Respiratoryand Sleep Medicine Department, Royal Children’s Hospital, Melbourne, VIC, Australia
- Respiratory Diseases Research, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Barry J. Plant
- Cork Centre for Cystic Fibrosis (3CF), Cork University Hospital, Cork, Ireland
- HRB Clinical Research Facility Cork, University College Cork, Cork, Ireland
- Department of Medicine, University College Cork, Cork, Ireland
| | - Shivanthan Shanthikumar
- Respiratoryand Sleep Medicine Department, Royal Children’s Hospital, Melbourne, VIC, Australia
- Respiratory Diseases Research, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
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Alvarado E, Grágeda N, Luzanto A, Mahu R, Wuth J, Mendoza L, Yoma NB. Dyspnea Severity Assessment Based on Vocalization Behavior with Deep Learning on the Telephone. SENSORS (BASEL, SWITZERLAND) 2023; 23:2441. [PMID: 36904646 PMCID: PMC10007248 DOI: 10.3390/s23052441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/08/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
In this paper, a system to assess dyspnea with the mMRC scale, on the phone, via deep learning, is proposed. The method is based on modeling the spontaneous behavior of subjects while pronouncing controlled phonetization. These vocalizations were designed, or chosen, to deal with the stationary noise suppression of cellular handsets, to provoke different rates of exhaled air, and to stimulate different levels of fluency. Time-independent and time-dependent engineered features were proposed and selected, and a k-fold scheme with double validation was adopted to select the models with the greatest potential for generalization. Moreover, score fusion methods were also investigated to optimize the complementarity of the controlled phonetizations and features that were engineered and selected. The results reported here were obtained from 104 participants, where 34 corresponded to healthy individuals and 70 were patients with respiratory conditions. The subjects' vocalizations were recorded with a telephone call (i.e., with an IVR server). The system provided an accuracy of 59% (i.e., estimating the correct mMRC), a root mean square error equal to 0.98, false positive rate of 6%, false negative rate of 11%, and an area under the ROC curve equal to 0.97. Finally, a prototype was developed and implemented, with an ASR-based automatic segmentation scheme, to estimate dyspnea on line.
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Affiliation(s)
- Eduardo Alvarado
- Speech Processing and Transmission Laboratory, Electrical Engineering Department, University of Chile, Santiago 8370451, Chile
| | - Nicolás Grágeda
- Speech Processing and Transmission Laboratory, Electrical Engineering Department, University of Chile, Santiago 8370451, Chile
| | - Alejandro Luzanto
- Speech Processing and Transmission Laboratory, Electrical Engineering Department, University of Chile, Santiago 8370451, Chile
| | - Rodrigo Mahu
- Speech Processing and Transmission Laboratory, Electrical Engineering Department, University of Chile, Santiago 8370451, Chile
| | - Jorge Wuth
- Speech Processing and Transmission Laboratory, Electrical Engineering Department, University of Chile, Santiago 8370451, Chile
| | - Laura Mendoza
- Clinical Hospital, University of Chile, Santiago 8380420, Chile
| | - Néstor Becerra Yoma
- Speech Processing and Transmission Laboratory, Electrical Engineering Department, University of Chile, Santiago 8370451, Chile
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Home Spirometry in Children with Cystic Fibrosis. Bioengineering (Basel) 2023; 10:bioengineering10020242. [PMID: 36829736 PMCID: PMC9952128 DOI: 10.3390/bioengineering10020242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/04/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
We report the implementation of a pediatric home spirometry program at our institution. A respiratory therapist provided either a virtual or an in-person initiation visit that included a coached spirometry session. Families were instructed to perform daily uncoached spirometry sessions for 5 days. The program's quality assurance component was deemed not to be human research by the local IRB. In total, 52 subjects completed an initiation visit (34 with at least 3 additional uncoached spirometry sessions). The clinic spirometry and coached (same-day) sessions and uncoached (same-week) sessions were completed by 12 and 17 subjects, respectively. The median (99% CI) coefficients of variation for FEV1% of the uncoached maneuvers were 3.5% (2.9-5.9%). The median (IQR) FEV1% and FEV1 (mL) absolute differences between coached and uncoached home spirometry were -2% (-4 and +3%) and -25 mL (-93 and +93 mL), respectively. The median (IQR) absolute differences in FEV1% and FEV1 (mL) between coached or uncoached home spirometry and clinic spirometry were -6% (-10 and -2%) and -155 mL (-275 and -88 mL), and -4% (-10 and +5%), and -110 mL (-280 and +9 mL), respectively. Differences in absolute FEV1 (L) and FEV1% were found among different modalities of spirometry performed by people with cystic fibrosis. Understanding the variability of uncoached home spirometry and the differences among coached and uncoached home spirometry, hospital and coached home spirometry, and hospital and uncoached home spirometry for any given individual is crucial to effectively utilize this tool in clinical care.
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25
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Holland AE, Glaspole I. Lockdown as the mother of invention: disruptive technology in a disrupted time. THE LANCET. RESPIRATORY MEDICINE 2023; 11:9-11. [PMID: 36206781 PMCID: PMC9531920 DOI: 10.1016/s2213-2600(22)00291-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Anne E Holland
- Department of Respiratory Medicine, The Alfred, Melbourne, VIC, Australia; Department of Physiotherapy, The Alfred, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne 3004, VIC, Australia; Institute for Breathing and Sleep, Melbourne, VIC, Australia.
| | - Ian Glaspole
- Department of Respiratory Medicine, The Alfred, Melbourne, VIC, Australia,Central Clinical School, Monash University, Melbourne 3004, VIC, Australia
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Raghu G, Mehrotra A. Licensure laws and other barriers to telemedicine and telehealth: an urgent need for reform. THE LANCET. RESPIRATORY MEDICINE 2023; 11:11-13. [PMID: 36521508 PMCID: PMC9744441 DOI: 10.1016/s2213-2600(22)00482-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Ganesh Raghu
- Department of Medicine and Department of Laboratory Medicine and Pathology, University of Washington, Seattle 98195, WA, USA.
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Stanel SC, Rivera-Ortega P. Present and future perspectives in early diagnosis and monitoring for progressive fibrosing interstitial lung diseases. Front Med (Lausanne) 2023; 10:1114722. [PMID: 36873896 PMCID: PMC9975385 DOI: 10.3389/fmed.2023.1114722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/26/2023] [Indexed: 02/17/2023] Open
Abstract
Progressive fibrosing interstitial lung diseases (PF-ILDs) represent a group of conditions of both known and unknown origin which continue to worsen despite standard treatments, leading to respiratory failure and early mortality. Given the potential to slow down progression by initiating antifibrotic therapies where appropriate, there is ample opportunity to implement innovative strategies for early diagnosis and monitoring with the goal of improving clinical outcomes. Early diagnosis can be facilitated by standardizing ILD multidisciplinary team (MDT) discussions, implementing machine learning algorithms for chest computed-tomography quantitative analysis and novel magnetic-resonance imaging techniques, as well as measuring blood biomarker signatures and genetic testing for telomere length and identification of deleterious mutations in telomere-related genes and other single-nucleotide polymorphisms (SNPs) linked to pulmonary fibrosis such as rs35705950 in the MUC5B promoter region. Assessing disease progression in the post COVID-19 era also led to a number of advances in home monitoring using digitally-enabled home spirometers, pulse oximeters and other wearable devices. While validation for many of these innovations is still in progress, significant changes to current clinical practice for PF-ILDs can be expected in the near future.
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Affiliation(s)
- Stefan Cristian Stanel
- Interstitial Lung Disease (ILD) Unit, North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Wythenshawe, United Kingdom.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Pilar Rivera-Ortega
- Interstitial Lung Disease (ILD) Unit, North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Wythenshawe, United Kingdom
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