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Stevens G, Larmuseau M, Damme AV, Vanoverschelde H, Heerman J, Verdonck P. Feasibility study of the use of a wearable vital sign patch in an intensive care unit setting. J Clin Monit Comput 2024:10.1007/s10877-024-01207-5. [PMID: 39158782 DOI: 10.1007/s10877-024-01207-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 08/05/2024] [Indexed: 08/20/2024]
Abstract
Multiple studies and review papers have concluded that early warning systems have a positive effect on clinical outcomes, patient safety and clinical performances. Despite the substantial evidence affirming the efficacy of EWS applications, persistent barriers hinder their seamless integration into clinical practice. Notably, EWS, such as the National Early Warning Score, simplify multifaceted clinical conditions into singular numerical indices, thereby risking the oversight of critical clinical indicators and nuanced fluctuations in patients' health status. Furthermore, the optimal deployment of EWS within clinical contexts remains elusive. Manual assessment of EWS parameters exacts a significant temporal toll on healthcare personnel. Addressing these impediments necessitates innovative approaches. In this regard, wearable medical technologies emerge as promising solutions capable of continual monitoring of hospitalized patients' vital signs. To overcome the barriers of the use of early warning scores, wearable medical technology has the potential to continuously monitor vital signs of hospitalised patients. However, a fundamental inquiry arises regarding the comparability of their reliability to the current used golden standards. This inquiry underscores the imperative for rigorous evaluation and validation of wearable medical technologies to ascertain their efficacy in augmenting extant clinical practices. This prospective, single-center study aimed to evaluate the accuracy of heart rate and respiratory rate measurements obtained from the Vivalink Cardiac patch in comparison to the ECG-based monitoring system utilized at AZ Maria Middelares Hospital in Ghent. Specifically, the study focused on assessing the concordance between the data obtained from the Vivalink Cardiac patch and the established ECG-based monitoring system among a cohort of ten post-surgical intensive care unit (ICU) patients. Of these patients, five were undergoing mechanical ventilation post-surgery, while the remaining five were not. The study proceeded by initially comparing the data recorded by the Vivalink Cardiac patch with that of the ECG-based monitoring system. Subsequently, the data obtained from both the Vivalink Cardiac patch and the ECG-based monitoring system were juxtaposed with the information derived from the ventilation machine, thereby providing a comprehensive analysis of the patch's performance in monitoring vital signs within the ICU setting. For heart rate, the Vivalink Cardiac patch was on average within a 5% error range of the ECG-based monitoring system during 85.11±10.81% of the measured time. For respiratory rate this was during 40.55±17.28% of the measured time. Spearman's correlation coefficient showed a very high correlation of ρ = 0.9 8 for heart rate and a moderate correlation of ρ = 0.66 for respiratory rate. In comparison with the ventilated respiratory rate (ventilation machine) the Vivalink and ECG-based monitoring system both had a moderate correlation of ρ = 0.68 . A very high correlation was found between the heart rate measured by the Vivalink Cardiac patch and that of the ECG-based monitoring system of the hospital. Concerning respiratory rate the correlation between the data from the Vivalink Cardiac patch, the ECG-based monitoring system and the ventilation machine was found to be moderate.
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Affiliation(s)
- Guylian Stevens
- Departement of Electronics and Information Systems - IBiTech, Ghent University, Korneel Heymanslaan, Gent, 9000, East-Flanders, Belgium.
- H3CareSolutions, Henegouwenstraat 41, Gent, 9000, East-Flanders, Belgium.
| | - Michiel Larmuseau
- Partnership of Anesthesia, AZ Maria Middelares Hospital, Buitenring Sint-Denijs 30, Gent, 9000, East-Flanders, Belgium
| | - Annelies Van Damme
- Partnership of Anesthesia, AZ Maria Middelares Hospital, Buitenring Sint-Denijs 30, Gent, 9000, East-Flanders, Belgium
| | - Henk Vanoverschelde
- Partnership of Anesthesia, AZ Maria Middelares Hospital, Buitenring Sint-Denijs 30, Gent, 9000, East-Flanders, Belgium
| | - Jan Heerman
- Partnership of Anesthesia, AZ Maria Middelares Hospital, Buitenring Sint-Denijs 30, Gent, 9000, East-Flanders, Belgium
| | - Pascal Verdonck
- Departement of Electronics and Information Systems - IBiTech, Ghent University, Korneel Heymanslaan, Gent, 9000, East-Flanders, Belgium
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Kontaxis S, Kanellos F, Ntanis A, Kostikis N, Konitsiotis S, Rigas G. An Inertial-Based Wearable System for Monitoring Vital Signs during Sleep. SENSORS (BASEL, SWITZERLAND) 2024; 24:4139. [PMID: 39000917 PMCID: PMC11244494 DOI: 10.3390/s24134139] [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: 04/26/2024] [Revised: 06/17/2024] [Accepted: 06/22/2024] [Indexed: 07/16/2024]
Abstract
This study explores the feasibility of a wearable system to monitor vital signs during sleep. The system incorporates five inertial measurement units (IMUs) located on the waist, the arms, and the legs. To evaluate the performance of a novel framework, twenty-three participants underwent a sleep study, and vital signs, including respiratory rate (RR) and heart rate (HR), were monitored via polysomnography (PSG). The dataset comprises individuals with varying severity of sleep-disordered breathing (SDB). Using a single IMU sensor positioned at the waist, strong correlations of more than 0.95 with the PSG-derived vital signs were obtained. Low inter-participant mean absolute errors of about 0.66 breaths/min and 1.32 beats/min were achieved, for RR and HR, respectively. The percentage of data available for analysis, representing the time coverage, was 98.3% for RR estimation and 78.3% for HR estimation. Nevertheless, the fusion of data from IMUs positioned at the arms and legs enhanced the inter-participant time coverage of HR estimation by over 15%. These findings imply that the proposed methodology can be used for vital sign monitoring during sleep, paving the way for a comprehensive understanding of sleep quality in individuals with SDB.
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Affiliation(s)
| | - Foivos Kanellos
- PD Neurotechnology Ltd., 45500 Ioannina, Greece
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | | | | | - Spyridon Konitsiotis
- University Hospital of Ioannina and Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
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Leenen JP, Schoonhoven L, Patijn GA. Wearable wireless continuous vital signs monitoring on the general ward. Curr Opin Crit Care 2024; 30:275-282. [PMID: 38690957 DOI: 10.1097/mcc.0000000000001160] [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: 05/03/2024]
Abstract
PURPOSE OF REVIEW Wearable wireless sensors for continuous vital signs monitoring (CVSM) offer the potential for early identification of patient deterioration, especially in low-intensity care settings like general wards. This study aims to review advances in wearable CVSM - with a focus on the general ward - highlighting the technological characteristics of CVSM systems, user perspectives and impact on patient outcomes by exploring recent evidence. RECENT FINDINGS The accuracy of wearable sensors measuring vital signs exhibits variability, especially notable in ambulatory patients within hospital settings, and standard validation protocols are lacking. Usability of CMVS systems is critical for nurses and patients, highlighting the need for easy-to-use wearable sensors, and expansion of the number of measured vital signs. Current software systems lack integration with hospital IT infrastructures and workflow automation. Imperative enhancements involve nurse-friendly, less intrusive alarm strategies, and advanced decision support systems. Despite observed reductions in ICU admissions and Rapid Response Team calls, the impact on patient outcomes lacks robust statistical significance. SUMMARY Widespread implementation of CVSM systems on the general ward and potentially outside the hospital seems inevitable. Despite the theoretical benefits of CVSM systems in improving clinical outcomes, and supporting nursing care by optimizing clinical workflow efficiency, the demonstrated effects in clinical practice are mixed. This review highlights the existing challenges related to data quality, usability, implementation, integration, interpretation, and user perspectives, as well as the need for robust evidence to support their impact on patient outcomes, workflow and cost-effectiveness.
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Affiliation(s)
- Jobbe Pl Leenen
- Connected Care Centre, Isala, Zwolle
- Research Group IT Innovations in Healthcare, Windesheim University of Applied Sciences, Zwolle
| | - Lisette Schoonhoven
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Gijs A Patijn
- Connected Care Centre, Isala, Zwolle
- Department of Surgery, Isala, Zwolle, The Netherlands
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Sigvardt E, Grønbaek KK, Jepsen ML, Søgaard M, Haahr L, Inácio A, Aasvang EK, Meyhoff CS. Workload associated with manual assessment of vital signs as compared with continuous wireless monitoring. Acta Anaesthesiol Scand 2024; 68:274-279. [PMID: 37735843 DOI: 10.1111/aas.14333] [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: 05/17/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Vital sign monitoring is considered an essential aspect of clinical care in hospitals. In general wards, this relies on intermittent manual assessments performed by clinical staff at intervals of up to 12 h. In recent years, continuous monitoring of vital signs has been introduced to the clinic, with improved patient outcomes being one of several potential benefits. The aim of this study was to determine the workload difference between continuous monitoring and manual monitoring of vital signs as part of the National Early Warning Score (NEWS). METHODS Three wireless sensors continuously monitored blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation in 20 patients admitted to the general hospital ward. The duration needed for equipment set-up and maintenance for continuous monitoring in a 24-h period was recorded and compared with the time spent on manual assessments and documentation of vital signs performed by clinical staff according to the NEWS. RESULTS The time used for continuous monitoring was 6.0 (IQR 3.2; 7.2) min per patient per day vs. 14 (9.7; 32) min per patient per day for the NEWS. Median difference in duration for monitoring of vital signs was 9.9 (95% CI 5.6; 21) min per patient per day between NEWS and continuous monitoring (p < .001). Time used for continuous monitoring in isolated patients was 6.6 (4.6; 12) min per patient per day as compared with 22 (9.7; 94) min per patient per day for NEWS. CONCLUSION The use of continuous monitoring was associated with a significant reduction in workload in terms of time for monitoring as compared with manual assessment of vital signs.
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Affiliation(s)
- Emilie Sigvardt
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Katja Kjaer Grønbaek
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mia Lind Jepsen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Marlene Søgaard
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Louise Haahr
- Department of Anesthesiology, Center of Organ and Cancer Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ana Inácio
- University of Porto, Faculty of Medicine, Porto, Portugal
| | - Eske Kvanner Aasvang
- Department of Anesthesiology, Center of Organ and Cancer Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Sylvest Meyhoff
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Haveman ME, Jonker LT, Hermens HJ, Tabak M, de Vries JPP. Effectiveness of current perioperative telemonitoring on postoperative outcome in patients undergoing major abdominal surgery: A systematic review of controlled trials. J Telemed Telecare 2024; 30:215-229. [PMID: 34723689 DOI: 10.1177/1357633x211047710] [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] [Indexed: 12/20/2022]
Abstract
BACKGROUND Perioperative telemonitoring of patients undergoing major surgery might lead to improved postoperative outcomes. The aim of this systematic review is to evaluate the effectiveness of current perioperative telemonitoring interventions on postoperative clinical, patient-reported, and financial outcome measures in patients undergoing major surgery. METHODS For this systematic review, PubMed, CINAHL, and Embase databases were searched for eligible articles published between January 1, 2009 and March 15, 2021. Studies were eligible as they described: (P) patients aged 18 years or older who underwent major abdominal surgery, (I) perioperative telemonitoring as intervention, (C) a control group receiving usual care, (O) any type of postoperative clinical, patient-reported, or financial outcome measures, and (S) an interventional study design. RESULTS The search identified 2958 articles of which 10 were eligible for analysis, describing nine controlled trials of 2438 patients. Perioperative telemonitoring comprised wearable biosensors (n = 3), websites (n = 3), e-mail (n = 1), and mobile applications (n = 2). Outcome measures were clinical (n = 8), patient-reported (n = 5), and financial (n = 2). Results show significant improvement of recovery time, stoma self-efficacy and pain in the early postoperative phase in patients receiving telemonitoring. Other outcome measures were not significantly different between the groups. CONCLUSION Evidence for the effectiveness of perioperative telemonitoring in major surgery is scarce. There is a need for good quality studies with sufficient patients while ensuring that the quality and usability of the technology and the adoption in care processes are optimal.
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Affiliation(s)
- Marjolein E Haveman
- Department of Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Leonie T Jonker
- Department of Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Hermie J Hermens
- Department of Biomedical Signals and Systems, University of Twente, the Netherlands
- eHealth group, Roessingh Research and Development, the Netherlands
| | - Monique Tabak
- Department of Biomedical Signals and Systems, University of Twente, the Netherlands
- eHealth group, Roessingh Research and Development, the Netherlands
| | - Jean-Paul Pm de Vries
- Department of Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
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Gonem S, Lemberger J, Baguneid A, Briggs S, McKeever TM, Shaw D. Real-world implementation of the National Early Warning Score-2 in an acute respiratory unit. BMJ Open Respir Res 2024; 11:e002095. [PMID: 38296608 PMCID: PMC10831462 DOI: 10.1136/bmjresp-2023-002095] [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: 09/26/2023] [Accepted: 01/09/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION The National Early Warning Score-2 (NEWS-2) is used to detect deteriorating patients in hospital settings. We aimed to understand how NEWS-2 functions in the real-life setting of an acute respiratory unit. METHODS Clinical observations data were extracted for adult patients (age ≥18 years), admitted under the care of respiratory medicine services from July to December 2019, who had at least one recorded task relating to clinical deterioration. The timing and nature of urgent out-of-hours medical reviews (escalations) were extracted through manual review of the case notes. RESULTS The data set comprised 765 admission episodes (48.9% women) with a mean (SD) age of 69.3 (14.8). 8971 out of 35 991 out-of-hours observation sets (24.9%) had a NEWS-2 ≥5, and 586 of these (6.5%) led to an escalation. Out of 687 escalations, 101 (14.7%) were associated with observation sets with NEWS-2<5. Rising oxygen requirement and extreme values of individual observations were associated with an increased risk of escalation. 57.6% of escalations resulted in a change in treatment. Inpatient mortality was higher in patients who were escalated at least once, compared with those who were not escalated. CONCLUSIONS Most observation sets with NEWS-2 scores ≥5 did not lead to a medical escalation in an acute respiratory setting out-of-hours, but more than half of escalations resulted in a change in treatment. Rising oxygen requirement is a key indicator of respiratory patient acuity which appears to influence the decision to request urgent out-of-hours medical reviews.
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Affiliation(s)
- Sherif Gonem
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Joseph Lemberger
- Department of Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Abdulla Baguneid
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Steve Briggs
- Digital and Information, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Tricia M McKeever
- Lifespan and Population Health, University of Nottingham, Nottingham, UK
| | - Dominick Shaw
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
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Lu P, Creagh AP, Lu HY, Hai HB, Thwaites L, Clifton DA. 2D-WinSpatt-Net: A Dual Spatial Self-Attention Vision Transformer Boosts Classification of Tetanus Severity for Patients Wearing ECG Sensors in Low- and Middle-Income Countries. SENSORS (BASEL, SWITZERLAND) 2023; 23:7705. [PMID: 37765761 PMCID: PMC10535235 DOI: 10.3390/s23187705] [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: 07/14/2023] [Revised: 08/31/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023]
Abstract
Tetanus is a life-threatening bacterial infection that is often prevalent in low- and middle-income countries (LMIC), Vietnam included. Tetanus affects the nervous system, leading to muscle stiffness and spasms. Moreover, severe tetanus is associated with autonomic nervous system (ANS) dysfunction. To ensure early detection and effective management of ANS dysfunction, patients require continuous monitoring of vital signs using bedside monitors. Wearable electrocardiogram (ECG) sensors offer a more cost-effective and user-friendly alternative to bedside monitors. Machine learning-based ECG analysis can be a valuable resource for classifying tetanus severity; however, using existing ECG signal analysis is excessively time-consuming. Due to the fixed-sized kernel filters used in traditional convolutional neural networks (CNNs), they are limited in their ability to capture global context information. In this work, we propose a 2D-WinSpatt-Net, which is a novel Vision Transformer that contains both local spatial window self-attention and global spatial self-attention mechanisms. The 2D-WinSpatt-Net boosts the classification of tetanus severity in intensive-care settings for LMIC using wearable ECG sensors. The time series imaging-continuous wavelet transforms-is transformed from a one-dimensional ECG signal and input to the proposed 2D-WinSpatt-Net. In the classification of tetanus severity levels, 2D-WinSpatt-Net surpasses state-of-the-art methods in terms of performance and accuracy. It achieves remarkable results with an F1 score of 0.88 ± 0.00, precision of 0.92 ± 0.02, recall of 0.85 ± 0.01, specificity of 0.96 ± 0.01, accuracy of 0.93 ± 0.02 and AUC of 0.90 ± 0.00.
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Affiliation(s)
- Ping Lu
- Department of Engineering Science, University of Oxford, Oxford OX1 3PJ, UK
| | - Andrew P. Creagh
- Department of Engineering Science, University of Oxford, Oxford OX1 3PJ, UK
| | - Huiqi Y. Lu
- Department of Engineering Science, University of Oxford, Oxford OX1 3PJ, UK
| | - Ho Bich Hai
- Oxford University Clinical Research Unit, Ho Chi Minh City 700000, Vietnam
| | | | - Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City 700000, Vietnam
| | - David A. Clifton
- Department of Engineering Science, University of Oxford, Oxford OX1 3PJ, UK
- Oxford Suzhou Centre for Advanced Research, Suzhou 215123, China
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van Rossum MC, Bekhuis REM, Wang Y, Hegeman JH, Folbert EC, Vollenbroek-Hutten MMR, Kalkman CJ, Kouwenhoven EA, Hermens HJ. Early Warning Scores to Support Continuous Wireless Vital Sign Monitoring for Complication Prediction in Patients on Surgical Wards: Retrospective Observational Study. JMIR Perioper Med 2023; 6:e44483. [PMID: 37647104 PMCID: PMC10500362 DOI: 10.2196/44483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 06/16/2023] [Accepted: 07/07/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Wireless vital sign sensors are increasingly being used to monitor patients on surgical wards. Although early warning scores (EWSs) are the current standard for the identification of patient deterioration in a ward setting, their usefulness for continuous monitoring is unknown. OBJECTIVE This study aimed to explore the usability and predictive value of high-rate EWSs obtained from continuous vital sign recordings for early identification of postoperative complications and compares the performance of a sensor-based EWS alarm system with manual intermittent EWS measurements and threshold alarms applied to individual vital sign recordings (single-parameter alarms). METHODS Continuous vital sign measurements (heart rate, respiratory rate, blood oxygen saturation, and axillary temperature) collected with wireless sensors in patients on surgical wards were used for retrospective simulation of EWSs (sensor EWSs) for different time windows (1-240 min), adopting criteria similar to EWSs based on manual vital signs measurements (nurse EWSs). Hourly sensor EWS measurements were compared between patients with (event group: 14/46, 30%) and without (control group: 32/46, 70%) postoperative complications. In addition, alarms were simulated for the sensor EWSs using a range of alarm thresholds (1-9) and compared with alarms based on nurse EWSs and single-parameter alarms. Alarm performance was evaluated using the sensitivity to predict complications within 24 hours, daily alarm rate, and false discovery rate (FDR). RESULTS The hourly sensor EWSs of the event group (median 3.4, IQR 3.1-4.1) was significantly higher (P<.004) compared with the control group (median 2.8, IQR 2.4-3.2). The alarm sensitivity of the hourly sensor EWSs was the highest (80%-67%) for thresholds of 3 to 5, which was associated with alarm rates of 2 (FDR=85%) to 1.2 (FDR=83%) alarms per patient per day respectively. The sensitivity of sensor EWS-based alarms was higher than that of nurse EWS-based alarms (maximum=40%) but lower than that of single-parameter alarms (87%) for all thresholds. In contrast, the (false) alarm rates of sensor EWS-based alarms were higher than that of nurse EWS-based alarms (maximum=0.6 alarm/patient/d; FDR=80%) but lower than that of single-parameter alarms (2 alarms/patient/d; FDR=84%) for most thresholds. Alarm rates for sensor EWSs increased for shorter time windows, reaching 70 alarms per patient per day when calculated every minute. CONCLUSIONS EWSs obtained using wireless vital sign sensors may contribute to the early recognition of postoperative complications in a ward setting, with higher alarm sensitivity compared with manual EWS measurements. Although hourly sensor EWSs provide fewer alarms compared with single-parameter alarms, high false alarm rates can be expected when calculated over shorter time spans. Further studies are recommended to optimize care escalation criteria for continuous monitoring of vital signs in a ward setting and to evaluate the effects on patient outcomes.
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Affiliation(s)
- Mathilde C van Rossum
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
- Department of Cardiovascular and Respiratory Physiology, University of Twente, Enschede, Netherlands
| | - Robin E M Bekhuis
- Department of Surgery, Hospital Group Twente, Almelo, Netherlands
- Hospital Group Twente Academy, Hospital Group Twente, Almelo, Netherlands
| | - Ying Wang
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
- Hospital Group Twente Academy, Hospital Group Twente, Almelo, Netherlands
| | | | - Ellis C Folbert
- Department of Surgery, Hospital Group Twente, Almelo, Netherlands
| | | | - Cornelis J Kalkman
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Hermie J Hermens
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
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van Melzen R, Haveman ME, Schuurmann RCL, Struys MMRF, de Vries JPPM. Implementing Wearable Sensors for Clinical Application at a Surgical Ward: Points to Consider before Starting. SENSORS (BASEL, SWITZERLAND) 2023; 23:6736. [PMID: 37571519 PMCID: PMC10422413 DOI: 10.3390/s23156736] [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: 06/09/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023]
Abstract
Incorporating technology into healthcare processes is necessary to ensure the availability of high-quality care in the future. Wearable sensors are an example of such technology that could decrease workload, enable early detection of patient deterioration, and support clinical decision making by healthcare professionals. These sensors unlock continuous monitoring of vital signs, such as heart rate, respiration rate, blood oxygen saturation, temperature, and physical activity. However, broad and successful application of wearable sensors on the surgical ward is currently lacking. This may be related to the complexity, especially when it comes to replacing manual measurements by healthcare professionals. This report provides practical guidance to support peers before starting with the clinical application of wearable sensors in the surgical ward. For this purpose, the Non-Adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of technology adoption and innovations in healthcare organizations is used, combining existing literature and our own experience in this field over the past years. Specifically, the relevant topics are discussed per domain, and key lessons are subsequently summarized.
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Affiliation(s)
- Rianne van Melzen
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (R.C.L.S.); (J.-P.P.M.d.V.)
| | - Marjolein E. Haveman
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.E.H.); (M.M.R.F.S.)
| | - Richte C. L. Schuurmann
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (R.C.L.S.); (J.-P.P.M.d.V.)
| | - Michel M. R. F. Struys
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.E.H.); (M.M.R.F.S.)
| | - Jean-Paul P. M. de Vries
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (R.C.L.S.); (J.-P.P.M.d.V.)
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Garssen SH, Kant N, Vernooij CA, Mauritz GJ, Koning MV, Bosch FH, Doggen CJM. Continuous monitoring of patients in and after the acute admission ward to improve clinical pathways: study protocol for a randomized controlled trial (Optimal-AAW). Trials 2023; 24:405. [PMID: 37316919 DOI: 10.1186/s13063-023-07416-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/26/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Because of high demand on hospital beds, hospitals seek to reduce patients' length of stay (LOS) while preserving the quality of care. In addition to usual intermittent vital sign monitoring, continuous monitoring might help to assess the patient's risk of deterioration, in order to improve the discharge process and reduce LOS. The primary aim of this monocenter randomized controlled trial is to assess the effect of continuous monitoring in an acute admission ward (AAW) on the percentage of patients who are discharged safely. METHODS A total of 800 patients admitted to the AAW, for whom it is equivocal whether they can be discharged directly after their AAW stay, will be randomized to either receive usual care without (control group) or with additional continuous monitoring of heart rate, respiratory rate, posture, and activity, using a wearable sensor (sensor group). Continuous monitoring data are provided to healthcare professionals and used in the discharge decision. The wearable sensor keeps collecting data for 14 days. After 14 days, all patients fill in a questionnaire to assess healthcare use after discharge and, if applicable, their experience with the wearable sensor. The primary outcome is the difference in the percentage of patients who are safely discharged home directly from the AAW between the control and sensor group. Secondary outcomes include hospital LOS, AAW LOS, intensive care unit (ICU) admissions, Rapid Response Team calls, and unplanned readmissions within 30 days. Furthermore, facilitators and barriers for implementing continuous monitoring in the AAW and at home will be investigated. DISCUSSION Clinical effects of continuous monitoring have already been investigated in specific patient populations for multiple purposes, e.g., in reducing the number of ICU admissions. However, to our knowledge, this is the first Randomized Controlled Trial to investigate effects of continuous monitoring in a broad patient population in the AAW. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT05181111 . Registered on 6 January 2022. Start of recruitment: 7 December 2021.
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Affiliation(s)
- Sjoerd H Garssen
- Clinical Research Center, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Patient Care and Monitoring, Philips Research, Eindhoven, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - Niels Kant
- Clinical Research Center, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Enschede, The Netherlands
- Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Carlijn A Vernooij
- Department of Patient Care and Monitoring, Philips Research, Eindhoven, The Netherlands
| | - Gert-Jan Mauritz
- Department of Emergency Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Mark V Koning
- Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Frank H Bosch
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Internal Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Carine J M Doggen
- Clinical Research Center, Rijnstate Hospital, Arnhem, The Netherlands.
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Enschede, The Netherlands.
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11
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Avila FR, Carter RE, McLeod CJ, Bruce CJ, Giardi D, Guliyeva G, Forte AJ. Accuracy of Wearable Sensor Technology in Hand Goniometry: A Systematic Review. Hand (N Y) 2023; 18:340-348. [PMID: 34032154 PMCID: PMC10035090 DOI: 10.1177/15589447211014606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Wearable devices and sensor technology provide objective, unbiased range of motion measurements that help health care professionals overcome the hindrances of protractor-based goniometry. This review aims to analyze the accuracy of existing wearable sensor technologies for hand range of motion measurement and identify the most accurate one. METHODS We performed a systematic review by searching PubMed, CINAHL, and Embase for studies evaluating wearable sensor technology in hand range of motion assessment. Keywords used for the inquiry were related to wearable devices and hand goniometry. RESULTS Of the 71 studies, 11 met the inclusion criteria. Ten studies evaluated gloves and 1 evaluated a wristband. The most common types of sensors used were bend sensors, followed by inertial sensors, Hall effect sensors, and magnetometers. Most studies compared wearable devices with manual goniometry, achieving optimal accuracy. Although most of the devices reached adequate levels of measurement error, accuracy evaluation in the reviewed studies might be subject to bias owing to the use of poorly reliable measurement techniques for comparison of the devices. CONCLUSION Gloves using inertial sensors were the most accurate. Future studies should use different comparison techniques, such as infrared camera-based goniometry or virtual motion tracking, to evaluate the performance of wearable devices.
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Affiliation(s)
| | - Rickey E. Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | | | - Charles J. Bruce
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Davide Giardi
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Gunel Guliyeva
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
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12
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Eysenbach G, Oke J, Kardos A. ChroniSense National Early Warning Score Study: Comparison Study of a Wearable Wrist Device to Measure Vital Signs in Patients Who Are Hospitalized. J Med Internet Res 2023; 25:e40226. [PMID: 36745491 PMCID: PMC9941897 DOI: 10.2196/40226] [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: 06/12/2022] [Revised: 10/28/2022] [Accepted: 12/24/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Wearable devices could be used to continuously monitor vital signs in patients who are hospitalized, but they require validation. OBJECTIVE This study aimed to evaluate the clinical validity of the prototype of a semiautomated wearable wrist device (ChroniSense Polso) to measure vital signs and provide National Early Warning Scores (NEWSs). METHODS Vital signs and NEWSs measured using the wearable device were compared with standard, nurse-lead manual measurements. We enrolled adult patients (aged ≥18 years) who required vital sign measurements at least every 6 hours in a UK teaching district general hospital. Wearable device measurements were not used for clinical decision-making. The primary outcome was the agreement on the individual National Early Warning parameter scores and vital sign measurements: respiratory rate, oxygen saturation, body temperature, systolic blood pressure, and heart rate. Secondary outcomes were the agreement on the total NEWS, incidence of adverse events, and user acceptance. To compare the wearable device measurements with the standard measurements, we analyzed vital sign measurements by limits of agreement (Bland-Altman analysis) and conducted κ agreement analyses for NEWSs. A user experience survey was conducted with questions about comfort of the wrist device, safety, preference, and use. RESULTS We included 132 participants in the study, with a mean age of 62 (SD 15.81) years; most of them were men (102/132, 77.3%). The highest weighted κ values were found for heart rate (0.69, 95% CI 0.57-0.81 for all 385 measurements) and systolic blood pressure (0.39, 95% CI 0.30-0.47 for all 339 measurements). Weighted κ values were low for respiration rate (0.03, 95% CI -0.001 to 0.05 for all 445 measurements), temperature (0, 95% CI 0-0 for all 231 measurements), and oxygen saturation (-0.11, 95% CI -0.20 to -0.02 for all 187 measurements). Weighted κ using Cicchetti-Allison weights showed κ of 0.20 (95% CI 0.03-0.38) when using all 56 total NEWSs. The user acceptance survey found that approximately half (45/91, 49%) of the participants found it comfortable to wear the device and liked its appearance. Most (85/92, 92%) of them said that they would wear the device during their next hospital visit, and many (74/92, 80%) said that they would recommend it to others. CONCLUSIONS This study shows the promising use of a prototype wearable device to measure vital signs in a hospital setting. Agreement between the standard measurements and wearable device measurements was acceptable for systolic blood pressure and heart rate, but needed to be improved for respiration rate, temperature, and oxygen saturation. Future studies need to improve the clinical validity of this wearable device. Large studies are required to assess clinical outcomes and cost-effectiveness of wearable devices for vital sign measurement. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2018-028219.
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Affiliation(s)
| | - Jason Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Attila Kardos
- Department of Cardiology, Translational Cardiovascular Research Group, Milton Keynes University Hospital, Milton Keynes, United Kingdom
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13
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Bonnechère B, Timmermans A, Michiels S. Current Technology Developments Can Improve the Quality of Research and Level of Evidence for Rehabilitation Interventions: A Narrative Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23020875. [PMID: 36679672 PMCID: PMC9866361 DOI: 10.3390/s23020875] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/19/2022] [Accepted: 01/05/2023] [Indexed: 06/01/2023]
Abstract
The current important limitations to the implementation of Evidence-Based Practice (EBP) in the rehabilitation field are related to the validation process of interventions. Indeed, most of the strict guidelines that have been developed for the validation of new drugs (i.e., double or triple blinded, strict control of the doses and intensity) cannot-or can only partially-be applied in rehabilitation. Well-powered, high-quality randomized controlled trials are more difficult to organize in rehabilitation (e.g., longer duration of the intervention in rehabilitation, more difficult to standardize the intervention compared to drug validation studies, limited funding since not sponsored by big pharma companies), which reduces the possibility of conducting systematic reviews and meta-analyses, as currently high levels of evidence are sparse. The current limitations of EBP in rehabilitation are presented in this narrative review, and innovative solutions are suggested, such as technology-supported rehabilitation systems, continuous assessment, pragmatic trials, rehabilitation treatment specification systems, and advanced statistical methods, to tackle the current limitations. The development and implementation of new technologies can increase the quality of research and the level of evidence supporting rehabilitation, provided some adaptations are made to our research methodology.
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Affiliation(s)
- Bruno Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- Technology-Supported and Data-Driven Rehabilitation, Data Science Institute, Hasselt University, 3590 Diepenbeek, Belgium
| | - Annick Timmermans
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Sarah Michiels
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- Department of Otorhinolaryngology, Antwerp University Hospital, 2650 Edegem, Belgium
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14
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Bonometti F, Bernocchi P, Vitali A, Savoldelli A, Rizzi C, Scalvini S. Usability of a continuous oxygen saturation device for home telemonitoring. Digit Health 2023; 9:20552076231194547. [PMID: 37588158 PMCID: PMC10426309 DOI: 10.1177/20552076231194547] [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: 01/18/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023] Open
Abstract
Background The emergency for the COVID-19 pandemic has led to greater use of home telemonitoring devices. The aim of this study was to assess the usability of continuous home-monitoring care with an oxygen saturation device on post-COVID-19 patients. Method The system consists of a digital continuous pulse oximeter and a smartphone with an App, which were provided to patients. A survey composed of a standard Post-Study System Usability Questionnaire, and a satisfaction questionnaire was exploited to conduct a usability and feasibility analysis of the service. Results A total of 29 patients (17.2% female) with a mean age of 65 ± 11.5 years were enrolled: 20 patients were smartphone users (69%) with a mean age of 60.2 ± 9.5 years, and 9 patients (31%) did not own a smartphone (mean age 76.8 ± 5.9). The monitoring period was 1 month: a total of 444 recordings were conducted, 15 recordings per patient averagely. In total, 82% of the recordings performed did not require any intervention, while 18% led to the production of a report and subsequent intervention by a nurse who verified, together with the specialist, the need to intervene (i.e. the patient accessed the clinic for medical control and/or modification of oxygen therapy). A total of 17 patients compiled a usability questionnaire. The service was perceived as useful and well-structured, although it often required caregiver support. Conclusions Using continuous home-monitoring care with an oxygen saturation device seems feasible and useful for patients who could be followed at home avoiding going back to the hospital every time a trend oximetry is needed. Further improvements in connections, data flow processes, and simplifications, based on patients' feedback, are needed to scale up the service.
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Affiliation(s)
- Francesco Bonometti
- Istituti Clinici Scientifici Maugeri IRCCS, Continuity of Care Service of the Institute of Lumezzane, Brescia, Italy
| | - Palmira Bernocchi
- Istituti Clinici Scientifici Maugeri IRCCS, Continuity of Care Service of the Institute of Lumezzane, Brescia, Italy
| | - Andrea Vitali
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - Anna Savoldelli
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - Caterina Rizzi
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri IRCCS, Continuity of Care Service of the Institute of Lumezzane, Brescia, Italy
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Rostam Niakan Kalhori S, Deserno TM, Haghi M, Ganapathy N. A protocol for a systematic review of electronic early warning/track-and-trigger systems (EW/TTS) to predict clinical deterioration: Focus on automated features, technologies, and algorithms. PLoS One 2023; 18:e0283010. [PMID: 36920960 PMCID: PMC10016632 DOI: 10.1371/journal.pone.0283010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 02/28/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND This is a systematic review protocol to identify automated features, applied technologies, and algorithms in the electronic early warning/track and triage system (EW/TTS) developed to predict clinical deterioration (CD). METHODOLOGY This study will be conducted using PubMed, Scopus, and Web of Science databases to evaluate the features of EW/TTS in terms of their automated features, technologies, and algorithms. To this end, we will include any English articles reporting an EW/TTS without time limitation. Retrieved records will be independently screened by two authors and relevant data will be extracted from studies and abstracted for further analysis. The included articles will be evaluated independently using the JBI critical appraisal checklist by two researchers. DISCUSSION This study is an effort to address the available automated features in the electronic version of the EW/TTS to shed light on the applied technologies, automated level of systems, and utilized algorithms in order to smooth the road toward the fully automated EW/TTS as one of the potential solutions of prevention CD and its adverse consequences. TRIAL REGISTRATION Systematic review registration: PROSPERO CRD42022334988.
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Affiliation(s)
- Sharareh Rostam Niakan Kalhori
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Braunschweig, Germany
- Health Information Management and Medical Informatics Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
- * E-mail:
| | - Thomas M. Deserno
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Braunschweig, Germany
| | - Mostafa Haghi
- Ubiquitous Computing Laboratory, Department of Computer Science, Konstanz University of Applied Sciences, Konstanz, Germany
| | - Nagarajan Ganapathy
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Braunschweig, Germany
- Biomedical Informatics Laboratory, Department of Biomedical Engineering, Indian Institute of Technology, Hyderabad, India
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Nantume A, Oketch BA, Otiangala D, Shah S, Cauvel T, Nyumbile B, Olayo B. Feasibility, performance and acceptability of an innovative vital signs monitor for sick newborns in Western Kenya: A mixed-methods study. Digit Health 2023; 9:20552076231182799. [PMID: 37434726 PMCID: PMC10331074 DOI: 10.1177/20552076231182799] [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: 05/08/2023] [Accepted: 06/01/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction Low- and middle-income countries (LMICs) account for 99% of the global neonatal mortality. Limited access to advanced technology, such as bedside patient monitors contributes to disproportionately poor outcomes for critically ill newborns in LMICs. We designed a study to assess the feasibility, performance, and acceptability of a low-cost wireless wearable technology for continuous monitoring of sick newborns in resource-limited settings. Methods This was a mixed-methods implementation study conducted between March and April 2021 at two health facilities in Western Kenya. Inclusion criteria for newborns monitored included: age 0 to 28 days, birthweight ≥2.0 kg, low-to-moderate severity of illness at admission and the guardian's willingness to provide informed consent. Medical staff who participated in monitoring the newborns were surveyed about their experience with the technology. We used descriptive statistics to summarize our quantitative findings and qualitative data was coded and analyzed as an iterative process to summarize quotes on user acceptability. Results The results of the study demonstrated that adoption of neoGuard was feasible and acceptable in this setting. Medical staff described the technology as safe, user-friendly and efficient, after successfully monitoring 134 newborns. Despite the positive user experience, we did observe some notable technology performance issues such as a high percentage of missing vital signs data. Conclusion The results of this study were critical in informing the iterative process of refining and validating an innovative vital signs monitor for patients in resource-limited settings. Further research and development are underway to optimize neoGuard's performance and to examine its clinical impact and cost effectiveness.
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Affiliation(s)
| | | | | | | | | | | | - Bernard Olayo
- Center for Public Health and Development, Nairobi, Kenya
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17
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Bonnechère B. Integrating Rehabilomics into the Multi-Omics Approach in the Management of Multiple Sclerosis: The Way for Precision Medicine? Genes (Basel) 2022; 14:63. [PMID: 36672802 PMCID: PMC9858788 DOI: 10.3390/genes14010063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/05/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Over recent years, significant improvements have been made in the understanding of (epi)genetics and neuropathophysiological mechanisms driving the different forms of multiple sclerosis (MS). For example, the role and importance of the bidirectional communications between the brain and the gut-also referred to as the gut-brain axis-in the pathogenesis of MS is receiving increasing interest in recent years and is probably one of the most promising areas of research for the management of people with MS. However, despite these important advances, it must be noted that these data are not-yet-used in rehabilitation. Neurorehabilitation is a cornerstone of MS patient management, and there are many techniques available to clinicians and patients, including technology-supported rehabilitation. In this paper, we will discuss how new findings on the gut microbiome could help us to better understand how rehabilitation can improve motor and cognitive functions. We will also see how the data gathered during the rehabilitation can help to get a better diagnosis of the patients. Finally, we will discuss how these new techniques can better guide rehabilitation to lead to precision rehabilitation and ultimately increase the quality of patient care.
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Affiliation(s)
- Bruno Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium;
- Technology-Supported and Data-Driven Rehabilitation, Data Science Institute, Hasselt University, 3590 Diepenbeek, Belgium
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18
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Mavragani A, Khau M, Lavoie-Hudon L, Vachon F, Drapeau V, Tremblay S. Comparing a Fitbit Wearable to an Electrocardiogram Gold Standard as a Measure of Heart Rate Under Psychological Stress: A Validation Study. JMIR Form Res 2022; 6:e37885. [PMID: 36542432 PMCID: PMC9813817 DOI: 10.2196/37885] [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: 03/10/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Wearable devices collect physiological and behavioral data that have the potential to identify individuals at risk of declining mental health and well-being. Past research has mainly focused on assessing the accuracy and the agreement of heart rate (HR) measurement of wearables under different physical exercise conditions. However, the capacity of wearables to sense physiological changes, assessed by increasing HR, caused by a stressful event has not been thoroughly studied. OBJECTIVE This study followed 3 objectives: (1) to test the ability of a wearable device (Fitbit Versa 2) to sense an increase in HR upon induction of psychological stress in the laboratory; (2) to assess the accuracy of the wearable device to capture short-term HR variations caused by psychological stress compared to a gold-standard electrocardiogram (ECG) measure (Biopac); and (3) to quantify the degree of agreement between the wearable device and the gold-standard ECG measure across different experimental conditions. METHODS Participants underwent the Trier Social Stress Test protocol, which consists of an oral phase, an arithmetic stress phase, an anticipation phase, and 2 relaxation phases (at the beginning and the end). During the stress protocol, the participants wore a Fitbit Versa 2 and were also connected to a Biopac. A mixed-effect modeling approach was used (1) to assess the effect of experimental conditions on HR, (2) to estimate several metrics of accuracy, and (3) to assess the agreement: the Bland-Altman limits of agreement (LoA), the concordance correlation coefficient, the coverage probability, the total deviation index, and the coefficient of an individual agreement. Mean absolute error and mean absolute percent error were calculated as accuracy indices. RESULTS A total of 34 university students were recruited for this study (64% of participants were female with a mean age of 26.8 years, SD 8.3). Overall, the results showed significant HR variations across experimental phases. Post hoc tests revealed significant pairwise differences for all phases. Accuracy analyses revealed acceptable accuracy according to the analyzed metrics of accuracy for the Fitbit Versa 2 to capture the short-term variations in psychological stress levels. However, poor indices of agreement between the Fitbit Versa 2 and the Biopac were found. CONCLUSIONS Overall, the results support the use of the Fitbit Versa 2 to capture short-term stress variations. The Fitbit device showed acceptable levels of accuracy but poor agreement with an ECG gold standard. Greater inaccuracy and smaller agreement were found for stressful experimental conditions that induced a higher HR. Fitbit devices can be used in research to measure HR variations caused by stress, although they cannot replace an ECG instrument when precision is of utmost importance.
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Affiliation(s)
| | - Michelle Khau
- Faculty of Social Sciences, Laval University, Québec, QC, Canada
| | | | - François Vachon
- School of Psychology, Faculty of Social Sciences, Laval University, Québec, QC, Canada
| | - Vicky Drapeau
- Quebec Heart and Lung Institute Research Center, Department of Physical Education, Faculty of Educational Sciences, Centre Nutrition, santé et société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Laval University, Québec, QC, Canada
| | - Sébastien Tremblay
- School of Psychology, Faculty of Social Sciences, Laval University, Québec, QC, Canada
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19
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Haveman ME, van Melzen R, Schuurmann RCL, Hermens HJ, Tabak M, de Vries JPPM. Feasibility and patient's experiences of perioperative telemonitoring in major abdominal surgery: an observational pilot study. Expert Rev Med Devices 2022; 19:515-523. [PMID: 35975601 DOI: 10.1080/17434440.2022.2108703] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Telemonitoring during the perioperative trajectory may improve patient outcomes and self-management. The aim of this study is to assess the feasibility of and patient's experiences with telemonitoring before and after major abdominal surgery to inform future study design. METHODS Patients planned for elective major abdominal surgery wore a sensor and answered well-being questions on a tablet daily for at least 2 weeks preoperatively up to 30-days postoperatively. Feasibility was assessed by participation and completion rate, compliance per day, weekly satisfaction scores, and reasons for nonscheduled contact. RESULTS Twenty-three patients were included (participation rate of 54.5%) with a completion rate of 69.6%. Median compliance with the wearable sensor and well-being questions was respectively: 94.7% and 83.3% preoperatively at home; 100% and 66.7% postoperatively in-hospital; and 95.4% and 85.8% postoperatively at home. Median weekly satisfaction scores for both wearing the sensor and well-being questions were 5 (IQR, 4-5). Contact moments were related to absence of sensor data and technological issues (76.0%) or patient discomfort and insecurity (24.0%). CONCLUSIONS In this study, telemonitoring showed high satisfaction and compliance during the perioperative trajectory. Future trial design regarding the effectiveness of telemonitoring requires embedding in clinical practice and support for patients, relatives, and healthcare personnel.
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Affiliation(s)
- Marjolein E Haveman
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rianne van Melzen
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Richte C L Schuurmann
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hermie J Hermens
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands.,eHealth Group, Roessingh Research and Development, Enschede, The Netherlands
| | - Monique Tabak
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands.,eHealth Group, Roessingh Research and Development, Enschede, The Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Chan PY, Ryan NP, Chen D, McNeil J, Hopper I. Novel wearable and contactless heart rate, respiratory rate, and oxygen saturation monitoring devices: a systematic review and meta-analysis. Anaesthesia 2022; 77:1268-1280. [PMID: 35947876 DOI: 10.1111/anae.15834] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 11/28/2022]
Abstract
We performed a systematic review and meta-analysis to identify, classify and evaluate the body of evidence on novel wearable and contactless devices that measure heart rate, respiratory rate and oxygen saturations in the clinical setting. We included any studies of hospital inpatients, including sleep study clinics. Eighty-four studies were included in the final review. There were 56 studies of wearable devices and 29 of contactless devices. One study assessed both types of device. A high risk of patient selection and rater bias was present in proportionally more studies assessing contactless devices compared with studies assessing wearable devices (p = 0.023 and p < 0.0001, respectively). There was high but equivalent likelihood of blinding bias between the two types of studies (p = 0.076). Wearable device studies were commercially available devices validated in acute clinical settings by clinical staff and had more real-time data analysis (p = 0.04). Contactless devices were more experimental, and data were analysed post-hoc. Pooled estimates of mean (95%CI) heart rate and respiratory rate bias in wearable devices were 1.25 (-0.31-2.82) beats.min-1 (pooled 95% limits of agreement -9.36-10.08) and 0.68 (0.05-1.32) breaths.min-1 (pooled 95% limits of agreement -5.65-6.85). The pooled estimate for mean (95%CI) heart rate and respiratory rate bias in contactless devices was 2.18 (3.31-7.66) beats.min-1 (pooled limits of agreement -6.71-10.88) and 0.30 (-0.26-0.87) breaths.min-1 (pooled 95% limits of agreement -3.94-4.29). Only two studies of wearable devices measured Sp O2 ; these reported mean measurement biases of 3.54% (limits of agreement -5.65-11.45%) and 2.9% (-7.4-1.7%). Heterogeneity was observed across studies, but absent when devices were grouped by measurement modality and reference standard. We conclude that, while studies of wearable devices were of slightly better quality than contactless devices, in general all studies of novel devices were of low quality, with small (< 100) patient datasets, typically not blinded and often using inappropriate statistical techniques. Both types of devices were statistically equivalent in accuracy and precision, but wearable devices demonstrated less measurement bias and more precision at extreme vital signs. The statistical variability in precision and accuracy between studies is partially explained by differences in reference standards.
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Affiliation(s)
- P Y Chan
- Department of Intensive Care Medicine, Eastern Health, Melbourne, Vic., Australia
| | - N P Ryan
- Department of Intensive Care Medicine, Eastern Health, Melbourne, Vic., Australia
| | - D Chen
- Department of Intensive Care Medicine, Eastern Health, Melbourne, Vic., Australia
| | - J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - I Hopper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
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Zahradka N, Pugmire J, Lever Taylor J, Wolfberg A, Wilkes M. Deployment of an End-to-End Remote, Digitalized Clinical Study Protocol in COVID-19: Process Evaluation. JMIR Form Res 2022; 6:e37832. [PMID: 35852933 PMCID: PMC9345299 DOI: 10.2196/37832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/24/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background The SARS-CoV-2 (COVID-19) pandemic may accelerate the adoption of digital, decentralized clinical trials. Conceptual recommendations for digitalized and remote clinical studies and technology are available to enable digitalization. Fully remote studies may break down some of the participation barriers in traditional trials. However, they add logistical complexity and offer fewer opportunities to intervene following a technical failure or adverse event. Objective Our group designed an end-to-end digitalized clinical study protocol, using the Food and Drug Administration (FDA)–cleared Current Health (CH) remote monitoring platform to collect symptoms and continuous physiological data of individuals recently infected with COVID-19 in the community. The purpose of this work is to provide a detailed example of an end-to-end digitalized protocol implementation based on conceptual recommendations by describing the study setup in detail, evaluating its performance, and identifying points of success and failure. Methods Primary recruitment was via social media and word of mouth. Informed consent was obtained during a virtual appointment, and the CH-monitoring kit was shipped directly to the participants. The wearable continuously recorded pulse rate (PR), respiratory rate (RR), oxygen saturation (SpO2), skin temperature, and step count, while a tablet administered symptom surveys. Data were transmitted in real time to the CH cloud-based platform and displayed in the web-based dashboard, with alerts to the study team if the wearable was not charged or worn. The study duration was up to 30 days. The time to recruit, screen, consent, set up equipment, and collect data was quantified, and advertising engagement was tracked with a web analytics service. Results Of 13 different study advertisements, 5 (38.5%) were live on social media at any one time. In total, 38 eligibility forms were completed, and 19 (50%) respondents met the eligibility criteria. Of these, 9 (47.4%) were contactable and 8 (88.9%) provided informed consent. Deployment times ranged from 22 to 110 hours, and participants set up the equipment and started transmitting vital signs within 7.6 (IQR 6.3-10) hours of delivery. The mean wearable adherence was 70% (SD 19%), and the mean daily survey adherence was 88% (SD 21%) for the 8 participants. Vital signs were in normal ranges during study participation, and symptoms decreased over time. Conclusions Evaluation of clinical study implementation is important to capture what works and what might need to be modified. A well-calibrated approach to online advertising and enrollment can remove barriers to recruitment and lower costs but remains the most challenging part of research. Equipment was effectively and promptly shipped to participants and removed the risk of illness transmission associated with in-person encounters during a pandemic. Wearable technology incorporating continuous, clinical-grade monitoring offered an unprecedented level of detail and ecological validity. However, study planning, relationship building, and troubleshooting are more complex in the remote setting. The relevance of a study to potential participants remains key to its success.
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Affiliation(s)
| | | | | | | | - Matt Wilkes
- Current Health Ltd, Edinburgh, United Kingdom
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22
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Iqbal FM, Joshi M, Khan S, Wright M, Ashrafian H, Darzi A. Key Stakeholder Barriers and Facilitators to Implementing Remote Monitoring Technologies: Protocol for a Mixed Methods Analysis. JMIR Res Protoc 2022; 11:e38437. [PMID: 35862185 PMCID: PMC9353674 DOI: 10.2196/38437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/08/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background The implementation of novel digital solutions within the National Health Service has historically been challenging. Since the start of the COVID-19 pandemic, there has been a greater push for digitization and for operating remote monitoring solutions. However, the implementation and widespread adoption of this type of innovation have been poorly studied. Objective We aim to investigate key stakeholder barriers and facilitators to implementing remote monitoring solutions to identify factors that could affect successful adoption. Methods A mixed methods approach will be implemented. Semistructured interviews will be conducted with high-level stakeholders from industry and academia and health care providers who have played an instrumental role in, and have prior experience with, implementing digital solutions, alongside the use of an adapted version of the Technology Acceptance Model questionnaire. Results Enrollment is currently underway, having started in February 2022. It is anticipated to end in July 2022, with data analysis scheduled to commence in August 2022. Conclusions The results of our study may highlight key barriers and facilitators to implementing digital remote monitoring solutions, thereby allowing for improved widespread adoption within the National Health Service in the future. Trial Registration ClinicalTrials.gov NCT05321004; https://clinicaltrials.gov/ct2/show/NCT05321004
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Affiliation(s)
| | - Meera Joshi
- Division of Surgery, Imperial College London, London, United Kingdom
| | - Sadia Khan
- West Middlesex University Hospital, London, United Kingdom
| | - Mike Wright
- Chelsea and Westminster National Health Service Foundation Trust, London, United Kingdom
| | - Hutan Ashrafian
- Division of Surgery, Imperial College London, London, United Kingdom
| | - Ara Darzi
- Division of Surgery, Imperial College London, London, United Kingdom
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23
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Joshi M, Ashrafian H, Arora S, Sharabiani M, McAndrew K, Khan SN, Cooke GS, Darzi A. A pilot study to investigate real-time digital alerting from wearable sensors in surgical patients. Pilot Feasibility Stud 2022; 8:140. [PMID: 35794669 PMCID: PMC9258087 DOI: 10.1186/s40814-022-01084-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/01/2022] [Indexed: 11/28/2022] Open
Abstract
Background Continuous vital sign monitoring may identify changes sooner than current standard monitoring. Objective To investigate if the use of real-time digital alerts sent to healthcare staff can improve the time taken to identify unwell patients and those with sepsis. Design A prospective cohort study design. Setting West Middlesex University Hospital, UK. Participants Fifty acutely unwell surgical patients admitted to hospital. Intervention Patients wore a lightweight wearable sensor measuring heart rate (HR), respiratory rate (RR) and temperature every 2 min whilst standard intermittent ward monitoring of vital signs was performed by nurses. Digital alerts were sent to healthcare staff from the sensor to a smartphone device. All alerts were reviewed for recruited patients to identify the exact time on the sensor in which deterioration occurred. The time to acknowledgement was then reviewed for each action and an average time to acknowledgement calculated. Results There were 50 patients recruited in the pilot study, of which there were vital sign alerts in 18 patients (36%). The total number of vital sign alerts generated in these 18 patients was 51. Of these 51 alerts, there were 7 alerts for high HR (13.7%), 33 for RR (64.7%) and 11 for temperature (21.6%). Out of the 27 acknowledged alerts, there were 2 alerts for HR, 17 for RR and 8 for temperature. The average time to staff acknowledgement of the notification for all alerts was 154 min (2.6 h). There were some patients which had shown signs of deterioration in the cohort. The frequency of routine observation monitoring was increased in 2 cases, 3 patients were referred to a senior clinician and 2 patients were initiated on the sepsis pathway. Conclusion This study demonstrates the evaluation of digital alerts to nurses in real time. Although not all alerts were acknowledged, deterioration on the ward observations was detected and actions were taken accordingly. Patients were started on the sepsis pathway and escalation to senior clinicians occurred. Further research is required to review why only some alerts were acknowledged and the effects of digital alerting on patient outcomes. Trial registration ClinicalTrials.gov, NCT04638738
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24
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Ghiasi S, Zhu T, Lu P, Hagenah J, Khanh PNQ, Hao NV, Thwaites L, Clifton DA. Sepsis Mortality Prediction Using Wearable Monitoring in Low-Middle Income Countries. SENSORS 2022; 22:s22103866. [PMID: 35632275 PMCID: PMC9145695 DOI: 10.3390/s22103866] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 02/05/2023]
Abstract
Sepsis is associated with high mortality—particularly in low–middle income countries (LMICs). Critical care management of sepsis is challenging in LMICs due to the lack of care providers and the high cost of bedside monitors. Recent advances in wearable sensor technology and machine learning (ML) models in healthcare promise to deliver new ways of digital monitoring integrated with automated decision systems to reduce the mortality risk in sepsis. In this study, firstly, we aim to assess the feasibility of using wearable sensors instead of traditional bedside monitors in the sepsis care management of hospital admitted patients, and secondly, to introduce automated prediction models for the mortality prediction of sepsis patients. To this end, we continuously monitored 50 sepsis patients for nearly 24 h after their admission to the Hospital for Tropical Diseases in Vietnam. We then compared the performance and interpretability of state-of-the-art ML models for the task of mortality prediction of sepsis using the heart rate variability (HRV) signal from wearable sensors and vital signs from bedside monitors. Our results show that all ML models trained on wearable data outperformed ML models trained on data gathered from the bedside monitors for the task of mortality prediction with the highest performance (area under the precision recall curve = 0.83) achieved using time-varying features of HRV and recurrent neural networks. Our results demonstrate that the integration of automated ML prediction models with wearable technology is well suited for helping clinicians who manage sepsis patients in LMICs to reduce the mortality risk of sepsis.
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Affiliation(s)
- Shadi Ghiasi
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; (T.Z.); (P.L.); (J.H.); (D.A.C.)
- Correspondence:
| | - Tingting Zhu
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; (T.Z.); (P.L.); (J.H.); (D.A.C.)
| | - Ping Lu
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; (T.Z.); (P.L.); (J.H.); (D.A.C.)
| | - Jannis Hagenah
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; (T.Z.); (P.L.); (J.H.); (D.A.C.)
| | - Phan Nguyen Quoc Khanh
- Oxford University Clinical Research Unit, Ho Chi Minh City 710400, Vietnam; (P.N.Q.K.); (L.T.)
| | - Nguyen Van Hao
- Hospital of Tropical Diseases, Ho Chi Minh City 700000, Vietnam;
| | | | - Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City 710400, Vietnam; (P.N.Q.K.); (L.T.)
| | - David A. Clifton
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; (T.Z.); (P.L.); (J.H.); (D.A.C.)
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25
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Solazzo M, Hartzell L, O’Farrell C, Monaghan MG. Beyond Chemistry: Tailoring Stiffness and Microarchitecture to Engineer Highly Sensitive Biphasic Elastomeric Piezoresistive Sensors. ACS APPLIED MATERIALS & INTERFACES 2022; 14:19265-19277. [PMID: 35452235 PMCID: PMC9073843 DOI: 10.1021/acsami.2c04673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/11/2022] [Indexed: 06/14/2023]
Abstract
Carbon-based nanoparticles and conductive polymers are two classes of materials widely used in the production of three-dimensional (3D) piezoresistive sensors. One conductive polymer, poly(3,4-ethylenedioxythiophene):polystyrenesulfonate (PEDOT:PSS) has excellent stability and conductivity yet is limited in its application as a sensor, often existing upon a base, limiting its performance and potential. Despite much progress in the field of materials chemistry and polymer synthesis, one aspect we consider worthy of exploration is the impact that microstructure and stiffness may have on the sensitivity of 3D sensors. In this study, we report a strategy for fabricating biphasic electroactive sponges (EAS) that combine 3D porous PEDOT:PSS scaffolds possessing either an isotropic or anisotropic microarchitecture, infused with insulating elastomeric fillers of varying stiffness. When characterizing the electromechanical behavior of these EAS, a higher stiffness yields a higher strain gauge factor, with values as high as 387 for an isotropic microarchitecture infused with a stiff elastomer. The approach we describe is cost-effective and extremely versatile, by which one can fabricate piezoresistive sensors with adaptable sensitivity ranges and excellent high strain gauge factor with the underlying microarchitecture and insulant stiffness dictating this performance.
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Affiliation(s)
- Matteo Solazzo
- Department
of Mechanical, Manufacturing and Biomedical Engineering, Trinity College Dublin, Dublin 2, Ireland
- Trinity
Centre for Biomedical Engineering, Trinity
College Dublin, Dublin 2, Ireland
| | - Linette Hartzell
- Department
of Mechanical, Manufacturing and Biomedical Engineering, Trinity College Dublin, Dublin 2, Ireland
- Trinity
Centre for Biomedical Engineering, Trinity
College Dublin, Dublin 2, Ireland
| | - Ciara O’Farrell
- Department
of Mechanical, Manufacturing and Biomedical Engineering, Trinity College Dublin, Dublin 2, Ireland
- Trinity
Centre for Biomedical Engineering, Trinity
College Dublin, Dublin 2, Ireland
| | - Michael G. Monaghan
- Department
of Mechanical, Manufacturing and Biomedical Engineering, Trinity College Dublin, Dublin 2, Ireland
- Trinity
Centre for Biomedical Engineering, Trinity
College Dublin, Dublin 2, Ireland
- Advance
Materials and BioEngineering Research (AMBER) Centre at Trinity College Dublin and the Royal College of Surgeons
in Ireland, Dublin 2, Ireland
- CÚRAM,
Centre for Research in Medical Devices, National University of Ireland, Galway, Newcastle Road, H91 W2TY Galway, Ireland
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26
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Leenen JPL, Dijkman EM, van Hout A, Kalkman CJ, Schoonhoven L, Patijn GA. Nurses' experiences with continuous vital sign monitoring on the general surgical ward: a qualitative study based on the Behaviour Change Wheel. BMC Nurs 2022; 21:60. [PMID: 35287678 PMCID: PMC8919550 DOI: 10.1186/s12912-022-00837-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 03/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background To support early recognition of clinical deterioration on a general ward continuous vital signs monitoring (CMVS) systems using wearable devices are increasingly being investigated. Although nurses play a crucial role in successful implementation, reported nurse adoption and acceptance scores vary significantly. In-depth insight into the perspectives of nurses regarding CMVS is lacking. To this end, we applied a theoretical approach for behaviour change derived from the Behaviour Change Wheel (BCW). Aim To provide insight in the capability, opportunity and motivation of nurses working with CMVS, in order to inform future implementation efforts. Methods A qualitative study was conducted, including twelve nurses of a surgical ward in a tertiary teaching hospital with previous experience of working with CMVS. Semi-structured interviews were audiotaped, transcribed verbatim, and analysed using thematic analysis. The results were mapped onto the Capability, Opportunity, Motivation – Behaviour (COM-B) model of the BCW. Results Five key themes emerged. The theme ‘Learning and coaching on the job’ linked to Capability. Nurses favoured learning about CVSM by dealing with it in daily practice. Receiving bedside guidance and coaching was perceived as important. The theme ‘interpretation of vital sign trends’ also linked to Capability. Nurses mentioned the novelty of monitoring vital sign trends of patients on wards. The theme ‘Management of alarms’ linked to Opportunity. Nurses perceived the (false) alarms generated by the system as excessive resulting in feelings of irritation and uncertainty. The theme ‘Integration and compatibility with clinical workflow’ linked to Opportunity. CVSM was experienced as helpful and easy to use, although integration in mobile devices and the EMR was highly favoured and the management of clinical workflows would need improvement. The theme ‘Added value for nursing care’ linked to Motivation. All nurses recognized the potential added value of CVSM for postoperative care. Conclusion Our findings suggest all parts of the COM-B model should be considered when implementing CVSM on general wards. When the themes in Capability and Opportunity are not properly addressed by selecting interventions and policy categories, this may negatively influence the Motivation and may compromise successful implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-00837-x.
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Affiliation(s)
- J P L Leenen
- Department of Surgery, Isala, Dr. van Heesweg 2, 8025 AB, Zwolle, The Netherlands. .,Connected Care Centre, Isala, Dr. van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
| | - E M Dijkman
- Department of Surgery, Isala, Dr. van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - A van Hout
- Research Group IT Innovations in Health Care, Windesheim University of Applied Sciences, Campus 2-6, Zwolle, 8017CA, The Netherlands
| | - C J Kalkman
- Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - L Schoonhoven
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Rd, Southampton, SO17 1BJ, UK
| | - G A Patijn
- Department of Surgery, Isala, Dr. van Heesweg 2, 8025 AB, Zwolle, The Netherlands.,Connected Care Centre, Isala, Dr. van Heesweg 2, 8025 AB, Zwolle, The Netherlands
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27
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Kooij L, Peters GM, Doggen CJM, van Harten WH. Remote continuous monitoring with wireless wearable sensors in clinical practice, nurses perspectives on factors affecting implementation: a qualitative study. BMC Nurs 2022; 21:53. [PMID: 35255894 PMCID: PMC8899789 DOI: 10.1186/s12912-022-00832-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 02/23/2022] [Indexed: 11/14/2022] Open
Abstract
Background Continuous monitoring using wireless wearable sensors is a promising solution for use in clinical practice and in the home setting. It is important to involve nurses to ensure successful implementation. This paper aims to provide an overview of 1) factors affecting implementation of continuous monitoring using wireless wearable sensors by evaluating nurses’ experiences with its use on the nursing ward, and 2) nurses’ expectations for use in the home setting. Methods Semi-structured interviews were conducted with 16 nurses from three teaching hospitals in the Netherlands, covering constructs from the Consolidated Framework for Implementation Research (CFIR). A deductive approach of directed content analysis was applied. One additional factor was added using the Unified Theory for Acceptance of Technology (UTAUT). The quotes and domains were rated on valence (positive, neutral, negative) and strength (strong: − 2, + 2, neutral 0, and weak: − 1, + 1). Results Data was collected on 27 CFIR constructs and 1 UTAUT construct. In the experience of at least 8 nurses, five constructs had a strong positive influence on implementation on the nursing ward, including relative advantage (e.g., early detection of deterioration), patient needs and resources (e.g. feeling safe), networks and communications (e.g. execute tasks together), personal attributes (e.g. experience with intervention), and implementation leaders (e.g., project leader). Five constructs had a strong negative influence: evidence strength and quality (e.g. lack of evidence from practical experience), complexity (e.g. number of process steps), design quality and packaging (e.g., bad sensor quality), compatibility (e.g, change in work) and facilitating conditions (e.g, Wi-Fi connection). Nurses expected continuous monitoring in the home setting to be hindered by compatibility with work processes and to be facilitated by staff’s access to information. Technical facilitating conditions (e.g. interoperability) were suggested to be beneficial for further development. Conclusions This paper provides an overview, of factors influencing implementation of continuous monitoring including relative importance, based on nurses’ experiences with use on nursing wards, and their perspectives for use in the home setting. Implementation of continuous monitoring is affected by a wide range of factors. This overview may be used as a guideline for future implementations. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-00832-2.
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Affiliation(s)
- Laura Kooij
- Rijnstate, Arnhem, the Netherlands.,Department of Health Technology and Services Research, Techmed Centre, University of Twente, Drienerlolaan 5, Enschede, the Netherlands
| | - Guido M Peters
- Department of Health Technology and Services Research, Techmed Centre, University of Twente, Drienerlolaan 5, Enschede, the Netherlands.,Rijnstate, Clinical Research Center, Arnhem, the Netherlands
| | - Carine J M Doggen
- Department of Health Technology and Services Research, Techmed Centre, University of Twente, Drienerlolaan 5, Enschede, the Netherlands.,Rijnstate, Clinical Research Center, Arnhem, the Netherlands
| | - Wim H van Harten
- Rijnstate, Arnhem, the Netherlands. .,Department of Health Technology and Services Research, Techmed Centre, University of Twente, Drienerlolaan 5, Enschede, the Netherlands. .,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
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28
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Michard F, Thiele RH, Saugel B, Joosten A, Flick M, Khanna AK. Wireless wearables for postoperative surveillance on surgical wards: a survey of 1158 anaesthesiologists in Western Europe and the USA. BJA OPEN 2022; 1:100002. [PMID: 37588692 PMCID: PMC10430871 DOI: 10.1016/j.bjao.2022.100002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/12/2022] [Indexed: 08/18/2023]
Abstract
Background Several continuous monitoring solutions, including wireless wearable sensors, are available or being developed to improve patient surveillance on surgical wards. We designed a survey to understand the current perception and expectations of anaesthesiologists who, as perioperative physicians, are increasingly involved in postoperative care. Methods The survey was shared in 40 university hospitals from Western Europe and the USA. Results From 5744 anaesthesiologists who received the survey link, there were 1158 valid questionnaires available for analysis. Current postoperative surveillance was mainly based on intermittent spot-checks of vital signs every 4-6 h in the USA (72%) and every 8-12 h in Europe (53%). A majority of respondents (91%) considered that continuous monitoring of vital signs should be available on surgical wards and that wireless sensors are preferable to tethered systems (86%). Most respondents indicated that oxygen saturation (93%), heart rate (80%), and blood pressure (71%) should be continuously monitored with wrist devices (71%) or skin adhesive patches (54%). They believed it may help detect clinical deterioration earlier (90%), decrease rescue interventions (59%), and decrease hospital mortality (54%). Opinions diverged regarding the impact on nurse workload (increase 46%, decrease 39%), and most respondents considered that the biggest implementation challenges are economic (79%) and connectivity issues (64%). Conclusion Continuous monitoring of vital signs with wireless sensors is wanted by most anaesthesiologists from university hospitals in Western Europe and in the USA. They believe it may improve patient safety and outcome, but may also be challenging to implement because of cost and connectivity issues.
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Affiliation(s)
| | - Robert H. Thiele
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg–Eppendorf, Hamburg, Germany
- Outcomes Research Consortium, Cleveland, OH, USA
| | - Alexandre Joosten
- Department of Anesthesiology, University Paris Saclay, Paul Brousse Hospital, Villejuif, France
| | - Moritz Flick
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg–Eppendorf, Hamburg, Germany
| | - Ashish K. Khanna
- Outcomes Research Consortium, Cleveland, OH, USA
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Reamer C, Chi WN, Gordon R, Sarswat N, Gupta C, Gaznabi S, White VanGompel E, Szum I, Morton-Jost M, Vaughn J, Larimer K, Victorson D, Erwin J, Halasyamani L, Solomonides A, Padman R, Shah NS. Continuous remote patient monitoring in heart failure patients (CASCADE study): mixed methods feasibility protocol (Preprint). JMIR Res Protoc 2022; 11:e36741. [PMID: 36006689 PMCID: PMC9459840 DOI: 10.2196/36741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/24/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022] Open
Abstract
Background Heart failure (HF) is a prevalent chronic disease and is associated with increases in mortality and morbidity. HF is a leading cause of hospitalizations and readmissions in the United States. A potentially promising area for preventing HF readmissions is continuous remote patient monitoring (CRPM). Objective The primary aim of this study is to determine the feasibility and preliminary efficacy of a CRPM solution in patients with HF at NorthShore University HealthSystem. Methods This study is a feasibility study and uses a wearable biosensor to continuously remotely monitor patients with HF for 30 days after discharge. Eligible patients admitted with an HF exacerbation at NorthShore University HealthSystem are being recruited, and the wearable biosensor is placed before discharge. The biosensor collects physiological ambulatory data, which are analyzed for signs of patient deterioration. Participants are also completing a daily survey through a dedicated study smartphone. If prespecified criteria from the physiological data and survey results are met, a notification is triggered, and a predetermined electronic health record–based pathway of telephonic management is completed. In phase 1, which has already been completed, 5 patients were enrolled and monitored for 30 days after discharge. The results of phase 1 were analyzed, and modifications to the program were made to optimize it. After analysis of the phase 1 results, 15 patients are being enrolled for phase 2, which is a calibration and testing period to enable further adjustments to be made. After phase 2, we will enroll 45 patients for phase 3. The combined results of phases 1, 2, and 3 will be analyzed to determine the feasibility of a CRPM program in patients with HF. Semistructured interviews are being conducted with key stakeholders, including patients, and these results will be analyzed using the affective adaptation of the technology acceptance model. Results During phase 1, of the 5 patients, 2 (40%) were readmitted during the study period. The study completion rate for phase 1 was 80% (4/5), and the study attrition rate was 20% (1/5). There were 57 protocol deviations out of 150 patient days in phase 1 of the study. The results of phase 1 were analyzed, and the study protocol was adjusted to optimize it for phases 2 and 3. Phase 2 and phase 3 results will be available by the end of 2022. Conclusions A CRPM program may offer a low-risk solution to improve care of patients with HF after hospital discharge and may help to decrease readmission of patients with HF to the hospital. This protocol may also lay the groundwork for the use of CRPM solutions in other groups of patients considered to be at high risk. International Registered Report Identifier (IRRID) DERR1-10.2196/36741
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Affiliation(s)
- Courtney Reamer
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Wei Ning Chi
- Outcomes Research Network, NorthShore University HealthSystem, Evanston, IL, United States
| | - Robert Gordon
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Nitasha Sarswat
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Charu Gupta
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Safwan Gaznabi
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Emily White VanGompel
- Department of Family Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Izabella Szum
- Home and Hospice Services, NorthShore University HealthSystem, Evanston, IL, United States
| | - Melissa Morton-Jost
- Home and Hospice Services, NorthShore University HealthSystem, Evanston, IL, United States
| | | | | | - David Victorson
- Department of Medical Social Sciences, Northwestern University, Evanston, IL, United States
| | - John Erwin
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Lakshmi Halasyamani
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Anthony Solomonides
- Outcomes Research Network, NorthShore University HealthSystem, Evanston, IL, United States
| | - Rema Padman
- Heinz College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Nirav S Shah
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
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Santos M, Vollam S, Pimentel MA, Areia C, Young L, Roman C, Ede J, Piper P, King E, Harford M, Shah A, Gustafson O, Tarassenko L, Watkinson P. The Use of Wearable Pulse Oximeters in the Prompt Detection of Hypoxemia and During Movement: Diagnostic Accuracy Study. J Med Internet Res 2022; 24:e28890. [PMID: 35166690 PMCID: PMC8889481 DOI: 10.2196/28890] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/04/2021] [Accepted: 11/21/2021] [Indexed: 01/20/2023] Open
Abstract
Background Commercially available wearable (ambulatory) pulse oximeters have been recommended as a method for managing patients at risk of physiological deterioration, such as active patients with COVID-19 disease receiving care in hospital isolation rooms; however, their reliability in usual hospital settings is not known. Objective We report the performance of wearable pulse oximeters in a simulated clinical setting when challenged by motion and low levels of arterial blood oxygen saturation (SaO2). Methods The performance of 1 wrist-worn (Wavelet) and 3 finger-worn (CheckMe O2+, AP-20, and WristOx2 3150) wearable, wireless transmission–mode pulse oximeters was evaluated. For this, 7 motion tasks were performed: at rest, sit-to-stand, tapping, rubbing, drinking, turning pages, and using a tablet. Hypoxia exposure followed, in which inspired gases were adjusted to achieve decreasing SaO2 levels at 100%, 95%, 90%, 87%, 85%, 83%, and 80%. Peripheral oxygen saturation (SpO2) estimates were compared with simultaneous SaO2 samples to calculate the root-mean-square error (RMSE). The area under the receiver operating characteristic curve was used to analyze the detection of hypoxemia (ie, SaO2<90%). Results SpO2 estimates matching 215 SaO2 samples in both study phases, from 33 participants, were analyzed. Tapping, rubbing, turning pages, and using a tablet degraded SpO2 estimation (RMSE>4% for at least 1 device). All finger-worn pulse oximeters detected hypoxemia, with an overall sensitivity of ≥0.87 and specificity of ≥0.80, comparable to that of the Philips MX450 pulse oximeter. Conclusions The SpO2 accuracy of wearable finger-worn pulse oximeters was within that required by the International Organization for Standardization guidelines. Performance was degraded by motion, but all pulse oximeters could detect hypoxemia. Our findings support the use of wearable, wireless transmission–mode pulse oximeters to detect the onset of clinical deterioration in hospital settings. Trial Registration ISRCTN Registry 61535692; http://www.isrctn.com/ISRCTN61535692 International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2019-034404
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Affiliation(s)
- Mauro Santos
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Sarah Vollam
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom.,Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Marco Af Pimentel
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Carlos Areia
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom.,Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Louise Young
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom.,Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Cristian Roman
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Jody Ede
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Philippa Piper
- Adult Intensive Care Unit, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Elizabeth King
- Adult Intensive Care Unit, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom.,Therapies Clinical Service, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Mirae Harford
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom.,Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Akshay Shah
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Owen Gustafson
- Adult Intensive Care Unit, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Peter Watkinson
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom.,Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Adult Intensive Care Unit, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
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Haveman ME, van Rossum MC, Vaseur RME, van der Riet C, Schuurmann RCL, Hermens HJ, de Vries JPPM, Tabak M. Continuous Monitoring of Vital Signs With Wearable Sensors During Daily Life Activities: Validation Study. JMIR Form Res 2022; 6:e30863. [PMID: 34994703 PMCID: PMC8783291 DOI: 10.2196/30863] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/17/2021] [Accepted: 10/05/2021] [Indexed: 01/19/2023] Open
Abstract
Background Continuous telemonitoring of vital signs in a clinical or home setting may lead to improved knowledge of patients’ baseline vital signs and earlier detection of patient deterioration, and it may also facilitate the migration of care toward home. Little is known about the performance of available wearable sensors, especially during daily life activities, although accurate technology is critical for clinical decision-making. Objective The aim of this study is to assess the data availability, accuracy, and concurrent validity of vital sign data measured with wearable sensors in volunteers during various daily life activities in a simulated free-living environment. Methods Volunteers were equipped with 4 wearable sensors (Everion placed on the left and right arms, VitalPatch, and Fitbit Charge 3) and 2 reference devices (Oxycon Mobile and iButton) to obtain continuous measurements of heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), and temperature. Participants performed standardized activities, including resting, walking, metronome breathing, chores, stationary cycling, and recovery afterward. Data availability was measured as the percentage of missing data. Accuracy was evaluated by the median absolute percentage error (MAPE) and concurrent validity using the Bland-Altman plot with mean difference and 95% limits of agreement (LoA). Results A total of 20 volunteers (median age 64 years, range 20-74 years) were included. Data availability was high for all vital signs measured by VitalPatch and for HR and temperature measured by Everion. Data availability for HR was the lowest for Fitbit (4807/13,680, 35.14% missing data points). For SpO2 measured by Everion, median percentages of missing data of up to 100% were noted. The overall accuracy of HR was high for all wearable sensors, except during walking. For RR, an overall MAPE of 8.6% was noted for VitalPatch and that of 18.9% for Everion, with a higher MAPE noted during physical activity (up to 27.1%) for both sensors. The accuracy of temperature was high for VitalPatch (MAPE up to 1.7%), and it decreased for Everion (MAPE from 6.3% to 9%). Bland-Altman analyses showed small mean differences of VitalPatch for HR (0.1 beats/min [bpm]), RR (−0.1 breaths/min), and temperature (0.5 °C). Everion and Fitbit underestimated HR up to 5.3 (LoA of −39.0 to 28.3) bpm and 11.4 (LoA of −53.8 to 30.9) bpm, respectively. Everion had a small mean difference with large LoA (−10.8 to 10.4 breaths/min) for RR, underestimated SpO2 (>1%), and overestimated temperature up to 2.9 °C. Conclusions Data availability, accuracy, and concurrent validity of the studied wearable sensors varied and differed according to activity. In this study, the accuracy of all sensors decreased with physical activity. Of the tested sensors, VitalPatch was found to be the most accurate and valid for vital signs monitoring.
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Affiliation(s)
- Marjolein E Haveman
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Mathilde C van Rossum
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Department of Cardiovascular and Respiratory Physiology, University of Twente, Enschede, Netherlands
| | - Roswita M E Vaseur
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Claire van der Riet
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Richte C L Schuurmann
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Hermie J Hermens
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,eHealth group, Roessingh Research and Development, Enschede, Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Monique Tabak
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,eHealth group, Roessingh Research and Development, Enschede, Netherlands
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Haveman ME, van Melzen R, Schuurmann RCL, El Moumni M, Hermens HJ, Tabak M, de Vries JPPM. Continuous monitoring of vital signs with the Everion biosensor on the surgical ward: a clinical validation study. Expert Rev Med Devices 2021; 18:145-152. [PMID: 34937478 DOI: 10.1080/17434440.2021.2019014] [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: 10/19/2022]
Abstract
BACKGROUND Wearable sensors enable continuous vital sign monitoring, although information about their performance on nursing wards is scarce. Vital signs measured by telemonitoring and nurse measurements on a surgical ward were compared to assess validity and reliability. METHODS In a prospective observational study, surgical patients wore a wearable sensor (Everion, Biovotion AG, Zürich, Switzerland) that continuously measured heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), and temperature during their admittance on the ward. Validity was evaluated using repeated-measures correlation and reliability using Bland-Altman plots, mean difference, and 95% limits of agreement (LoA). RESULTS Validity analyses of 19 patients (median age, 68; interquartile range, 62.5-72.5 years) showed a moderate relationship between telemonitoring and nurse measurements for HR (r = 0.53; 95% confidence interval, 0.44-0.61) and a poor relationship for RR, SpO2, and temperature. Reliability analyses showed that Everion measured HR close to nurse measurements (mean difference, 1 bpm; LoA, -16.7 to 18.7 bpm). Everion overestimated RR at higher values, whereas SpO2 and temperature were underestimated. CONCLUSIONS A moderate relationship was determined between Everion and nurse measurements at a surgical ward in this study. Validity and reliability of telemonitoring should also be assessed with gold standard devices in future clinical trials.
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Affiliation(s)
- Marjolein E Haveman
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rianne van Melzen
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Surgery, Division of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Richte C L Schuurmann
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mostafa El Moumni
- Department of Surgery, Division of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hermie J Hermens
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands.,eHealth Group, Roessingh Research and Development, Enschede, The Netherlands
| | - Monique Tabak
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands.,eHealth Group, Roessingh Research and Development, Enschede, The Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Kant N, Peters GM, Voorthuis BJ, Groothuis-Oudshoorn CGM, Koning MV, Witteman BPL, Rinia-Feenstra M, Doggen CJM. Continuous vital sign monitoring using a wearable patch sensor in obese patients: a validation study in a clinical setting. J Clin Monit Comput 2021; 36:1449-1459. [PMID: 34878613 DOI: 10.1007/s10877-021-00785-y] [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: 07/01/2021] [Accepted: 11/27/2021] [Indexed: 10/19/2022]
Abstract
Our aim was to determine the agreement of heart rate (HR) and respiratory rate (RR) measurements by the Philips Biosensor with a reference monitor (General Electric Carescape B650) in severely obese patients during and after bariatric surgery. Additionally, sensor reliability was assessed. Ninety-four severely obese patients were monitored with both the Biosensor and reference monitor during and after bariatric surgery. Agreement was defined as the mean absolute difference between both monitoring devices. Bland Altman plots and Clarke Error Grid analysis (CEG) were used to visualise differences. Sensor reliability was reflected by the amount, duration and causes of data loss. The mean absolute difference for HR was 1.26 beats per minute (bpm) (SD 0.84) during surgery and 1.84 bpm (SD 1.22) during recovery, and never exceeded the 8 bpm limit of agreement. The mean absolute difference for RR was 1.78 breaths per minute (brpm) (SD 1.90) during surgery and 4.24 brpm (SD 2.75) during recovery. The Biosensor's RR measurements exceeded the 2 brpm limit of agreement in 58% of the compared measurements. Averaging 15 min of measurements for both devices improved agreement. CEG showed that 99% of averaged RR measurements resulted in adequate treatment. Data loss was limited to 4.5% of the total duration of measurements for RR. No clear causes for data loss were found. The Biosensor is suitable for remote monitoring of HR, but not RR in morbidly obese patients. Future research should focus on improving RR measurements, the interpretation of continuous data, and development of smart alarm systems.
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Affiliation(s)
- Niels Kant
- Department of Anesthesiology and Pain Management, Rijnstate Hospital, Arnhem, The Netherlands
| | - Guido M Peters
- Scientific Bureau, Rijnstate Hospital, Rijnstate Research Center, Wagnerlaan 55, PO Box 9555, 6800 TA, Arnhem, The Netherlands.,Technical Medical Centre, Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Brenda J Voorthuis
- Technical Medical Centre, Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | | | - Mark V Koning
- Department of Anesthesiology and Pain Management, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Myra Rinia-Feenstra
- Department of Anesthesiology and Pain Management, Rijnstate Hospital, Arnhem, The Netherlands
| | - Carine J M Doggen
- Scientific Bureau, Rijnstate Hospital, Rijnstate Research Center, Wagnerlaan 55, PO Box 9555, 6800 TA, Arnhem, The Netherlands. .,Technical Medical Centre, Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands.
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McGillion M, Dvirnik N, Yang S, Belley-Côté E, Lamy A, Whitlock R, Marcucci M, Borges F, Duceppe E, Ouellette C, Bird M, Carroll SL, Conen D, Tarride JE, Harsha P, Scott T, Good A, Gregus K, Sanchez K, Benoit P, Owen J, Harvey V, Peter E, Petch J, Vincent J, Graham M, Devereaux PJ. Continuous non-invasive remote automated blood pressure monitoring with novel wearable technology: A Validation Study. JMIR Mhealth Uhealth 2021; 10:e24916. [PMID: 34876396 PMCID: PMC8922156 DOI: 10.2196/24916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/21/2021] [Accepted: 11/12/2021] [Indexed: 11/24/2022] Open
Abstract
Background Wearable continuous monitoring biosensor technologies have the potential to transform postoperative care with early detection of impending clinical deterioration. Objective Our aim was to validate the accuracy of Cloud DX Vitaliti continuous vital signs monitor (CVSM) continuous noninvasive blood pressure (cNIBP) measurements in postsurgical patients. A secondary aim was to examine user acceptance of the Vitaliti CVSM with respect to comfort, ease of application, sustainability of positioning, and aesthetics. Methods Included participants were ≥18 years old and recovering from surgery in a cardiac intensive care unit (ICU). We targeted a maximum recruitment of 80 participants for verification and acceptance testing. We also oversampled to minimize the effect of unforeseen interruptions and other challenges to the study. Validation procedures were according to the International Standards Organization (ISO) 81060-2:2018 standards for wearable, cuffless blood pressure (BP) measuring devices. Baseline BP was determined from the gold-standard ICU arterial catheter. The Vitaliti CVSM was calibrated against the reference arterial catheter. In static (seated in bed) and supine positions, 3 cNIBP measurements, each 30 seconds, were taken for each patient with the Vitaliti CVSM and an invasive arterial catheter. At the conclusion of each test session, captured cNIBP measurements were extracted using MediCollector BEDSIDE data extraction software, and Vitaliti CVSM measurements were extracted to a secure laptop through a cable connection. The errors of these determinations were calculated. Participants were interviewed about device acceptability. Results The validation analysis included data for 20 patients. The average times from calibration to first measurement in the static position and to first measurement in the supine position were 133.85 seconds (2 minutes 14 seconds) and 535.15 seconds (8 minutes 55 seconds), respectively. The overall mean errors of determination for the static position were –0.621 (SD 4.640) mm Hg for systolic blood pressure (SBP) and 0.457 (SD 1.675) mm Hg for diastolic blood pressure (DBP). Errors of determination were slightly higher for the supine position, at 2.722 (SD 5.207) mm Hg for SBP and 2.650 (SD 3.221) mm Hg for DBP. The majority rated the Vitaliti CVSM as comfortable. This study was limited to evaluation of the device during a very short validation period after calibration (ie, that commenced within 2 minutes after calibration and lasted for a short duration of time). Conclusions We found that the Cloud DX’s Vitaliti CVSM demonstrated cNIBP measurement in compliance with ISO 81060-2:2018 standards in the context of evaluation that commenced within 2 minutes of device calibration; this device was also well-received by patients in a postsurgical ICU setting. Future studies will examine the accuracy of the Vitaliti CVSM in ambulatory contexts, with attention to assessment over a longer duration and the impact of excessive patient motion on data artifacts and signal quality. Trial Registration ClinicalTrials.gov NCT03493867; https://clinicaltrials.gov/ct2/show/NCT03493867
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Affiliation(s)
- Michael McGillion
- School of Nursing, McMaster University, 1280 Main St W, Hamilton, CA
| | - Nazari Dvirnik
- Faculty of Health Sciences, McMaster University, Hamilton, CA
| | | | | | - Andre Lamy
- Population Health Research Institute, Hamilton, CA
| | | | | | | | | | - Carley Ouellette
- School of Nursing, McMaster University, 1280 Main St W, Hamilton, CA
| | - Marissa Bird
- School of Nursing, McMaster University, 1280 Main St W, Hamilton, CA
| | - Sandra L Carroll
- School of Nursing, McMaster University, 1280 Main St W, Hamilton, CA
| | - David Conen
- Population Health Research Institute, Hamilton, CA
| | | | - Prathiba Harsha
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, CA
| | - Ted Scott
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, CA
| | - Amber Good
- Population Health Research Institute, Hamilton, CA
| | - Krysten Gregus
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, CA
| | | | - Pamela Benoit
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, CA
| | - Julian Owen
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, CA
| | | | | | - Jeremy Petch
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, CA.,University of Toronto, Toronto, CA.,Faculty of Health Sciences, McMaster University, Hamilton, CA.,Population Health Research Institute, Hamilton, CA
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Fliegner MA, Sukul D, Thompson MP, Shah NJ, Soroushmehr R, McCullough JS, Likosky DS. Evaluating treatment-specific post-discharge quality-of-life and cost-effectiveness of TAVR and SAVR: Current practice & future directions. IJC HEART & VASCULATURE 2021; 36:100864. [PMID: 34522766 PMCID: PMC8427226 DOI: 10.1016/j.ijcha.2021.100864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 08/23/2021] [Indexed: 11/06/2022]
Abstract
Post-TAVR HRQOL shows more rapid short-term improvement than SAVR within trials. Higher TAVR use requires better real-world TAVR/SAVR cost-effectiveness comparisons. Wearable devices should be used in real-world settings to compare TAVR/SAVR HRQOL.
Background Aortic stenosis is a prevalent valvular heart disease that is treated primarily by surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR), which are common treatments for addressing symptoms secondary to valvular heart disease. This narrative review article focuses on the existing literature comparing recovery and cost-effectiveness for SAVR and TAVR. Methods Major databases were searched for relevant literature discussing HRQOL and cost-effectiveness of TAVR and SAVR. We also searched for studies analyzing the use of wearable devices to monitor post-discharge recovery patterns. Results The literature focusing on quality-of-life following TAVR and SAVR has been limited primarily to single-center observational studies and randomized controlled trials. Studies focused on TAVR report consistent and rapid improvement relative to baseline status. Common HRQOL instruments (SF-36, EQ-5D, KCCQ, MLHFQ) have been used to document that TF-TAVR is advantageous over SAVR at 1-month follow-up, with the benefits leveling off following 1 year. TF-TAVR is economically favorable relative to SAVR, with estimated incremental cost-effectiveness ratio values ranging from $50,000 to $63,000/QALY gained. TA-TAVR has not been reported to be advantageous from an HRQOL or cost-effectiveness perspective. Conclusions While real-world experiences are less described, large-scale trials have advanced our understanding of recovery and cost-effectiveness of aortic valve replacement treatment strategies. Future work should focus on scalable wearable device technology, such as smartwatches and heart-rate monitors, to facilitate real-world evaluation of TAVR and SAVR to support clinical decision-making and outcomes ascertainment.
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Affiliation(s)
- Maximilian A Fliegner
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Devraj Sukul
- Division of Cardiovascular Medicine, Department of General Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Michael P Thompson
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Nirav J Shah
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Reza Soroushmehr
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States
| | - Jeffrey S McCullough
- Department of Health Management and Policy, School of Public Health, University of Michigan., Ann Arbor, MI, United States
| | - Donald S Likosky
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
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Morgado Areia C, Santos M, Vollam S, Pimentel M, Young L, Roman C, Ede J, Piper P, King E, Gustafson O, Harford M, Shah A, Tarassenko L, Watkinson P. A Chest Patch for Continuous Vital Sign Monitoring: Clinical Validation Study During Movement and Controlled Hypoxia. J Med Internet Res 2021; 23:e27547. [PMID: 34524087 PMCID: PMC8482195 DOI: 10.2196/27547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/15/2021] [Accepted: 06/21/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The standard of care in general wards includes periodic manual measurements, with the data entered into track-and-trigger charts, either on paper or electronically. Wearable devices may support health care staff, improve patient safety, and promote early deterioration detection in the interval between periodic measurements. However, regulatory standards for ambulatory cardiac monitors estimating heart rate (HR) and respiratory rate (RR) do not specify performance criteria during patient movement or clinical conditions in which the patient's oxygen saturation varies. Therefore, further validation is required before clinical implementation and deployment of any wearable system that provides continuous vital sign measurements. OBJECTIVE The objective of this study is to determine the agreement between a chest-worn patch (VitalPatch) and a gold standard reference device for HR and RR measurements during movement and gradual desaturation (modeling a hypoxic episode) in a controlled environment. METHODS After the VitalPatch and gold standard devices (Philips MX450) were applied, participants performed different movements in seven consecutive stages: at rest, sit-to-stand, tapping, rubbing, drinking, turning pages, and using a tablet. Hypoxia was then induced, and the participants' oxygen saturation gradually reduced to 80% in a controlled environment. The primary outcome measure was accuracy, defined as the mean absolute error (MAE) of the VitalPatch estimates when compared with HR and RR gold standards (3-lead electrocardiography and capnography, respectively). We defined these as clinically acceptable if the rates were within 5 beats per minute for HR and 3 respirations per minute (rpm) for RR. RESULTS Complete data sets were acquired for 29 participants. In the movement phase, the HR estimates were within prespecified limits for all movements. For RR, estimates were also within the acceptable range, with the exception of the sit-to-stand and turning page movements, showing an MAE of 3.05 (95% CI 2.48-3.58) rpm and 3.45 (95% CI 2.71-4.11) rpm, respectively. For the hypoxia phase, both HR and RR estimates were within limits, with an overall MAE of 0.72 (95% CI 0.66-0.78) beats per minute and 1.89 (95% CI 1.75-2.03) rpm, respectively. There were no significant differences in the accuracy of HR and RR estimations between normoxia (≥90%), mild (89.9%-85%), and severe hypoxia (<85%). CONCLUSIONS The VitalPatch was highly accurate throughout both the movement and hypoxia phases of the study, except for RR estimation during the two types of movements. This study demonstrated that VitalPatch can be safely tested in clinical environments to support earlier detection of cardiorespiratory deterioration. TRIAL REGISTRATION ISRCTN Registry ISRCTN61535692; https://www.isrctn.com/ISRCTN61535692.
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Affiliation(s)
- Carlos Morgado Areia
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- National Institute for Health Research, Biomedical Research Centre, Oxford, United Kingdom
| | - Mauro Santos
- National Institute for Health Research, Biomedical Research Centre, Oxford, United Kingdom
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Sarah Vollam
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- National Institute for Health Research, Biomedical Research Centre, Oxford, United Kingdom
| | - Marco Pimentel
- National Institute for Health Research, Biomedical Research Centre, Oxford, United Kingdom
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Louise Young
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- National Institute for Health Research, Biomedical Research Centre, Oxford, United Kingdom
| | - Cristian Roman
- National Institute for Health Research, Biomedical Research Centre, Oxford, United Kingdom
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Jody Ede
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- National Institute for Health Research, Biomedical Research Centre, Oxford, United Kingdom
| | - Philippa Piper
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Elizabeth King
- Therapies Clinical Service Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Owen Gustafson
- Therapies Clinical Service Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Mirae Harford
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- National Institute for Health Research, Biomedical Research Centre, Oxford, United Kingdom
| | - Akshay Shah
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Lionel Tarassenko
- National Institute for Health Research, Biomedical Research Centre, Oxford, United Kingdom
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Peter Watkinson
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- National Institute for Health Research, Biomedical Research Centre, Oxford, United Kingdom
- Kadoorie Centre for Critical Care Research and Education, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
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Abstract
Telemedicine represents an area of rapid growth in anesthesiology. Remote preoperative evaluation is associated with high patient and physician satisfaction scores, reduced patient travel and wait times, and similar procedure cancellation rates compared with in-person clinic evaluation. Preoperative tele-evaluation has facilitated a return to normal function during the coronavirus disease 2019 (COVID-19) pandemic. Intraoperatively, remote vital sign monitoring and telecommunications technology combined with a care team model allows provision of expert care in areas experiencing a shortage of anesthesiologists. Virtual intensive care units provide overflow capability for postoperative patients, whereas patient smartphones can reduce the need for in-person evaluation.
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Affiliation(s)
- Kathryn Harter Bridges
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 25 Courtenay Drive, Suite 4200, MSC 240, Charleston, SC 29425, USA.
| | - Julie Ryan McSwain
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 25 Courtenay Drive, Suite 4200, MSC 240, Charleston, SC 29425, USA
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38
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Winterbottom FA. The Role of Tele-Critical Care in Rescue and Resuscitation. Crit Care Nurs Clin North Am 2021; 33:357-368. [PMID: 34340796 DOI: 10.1016/j.cnc.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Tele-critical care (TCC) is a health care delivery model that connects medical information, interprofessional teams, patients, and families through advanced pathways, such as audio-video interfaces, machine learning, risk prediction algorithms, smart alarms, artificial intelligence, and physiologic sensing devices. TCC expands critical care services and expertise beyond the walls of the intensive care unit to logistic centers, emergency departments, general wards, war zones, disaster settings, and pandemics. This article describes the broad use of TCC for rescue and resuscitation and provides case presentations.
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Affiliation(s)
- Fiona A Winterbottom
- Critical Care Medicine, Ochsner Health, Pulmonary Critical Care, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA, USA.
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39
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Kasperbauer TJ. Conflicting roles for humans in learning health systems and AI-enabled healthcare. J Eval Clin Pract 2021; 27:537-542. [PMID: 33164284 DOI: 10.1111/jep.13510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 12/31/2022]
Abstract
The goals of learning health systems (LHS) and of AI in medicine overlap in many respects. Both require significant improvements in data sharing and IT infrastructure, aim to provide more personalized care for patients, and strive to break down traditional barriers between research and care. However, the defining features of LHS and AI diverge when it comes to the people involved in medicine, both patients and providers. LHS aim to enhance physician-patient relationships while developments in AI emphasize a physicianless experience. LHS also encourage better coordination of specialists across the health system, but AI aims to replace many specialists with technology and algorithms. This paper argues that these points of conflict may require a reconsideration of the role of humans in medical decision making. Although it is currently unclear to what extent machines will replace humans in healthcare, the parallel development of LHS and AI raises important questions about the exact role for humans within AI-enabled healthcare.
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Affiliation(s)
- T J Kasperbauer
- Indiana University Center for Bioethics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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40
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Shan’an Y, Qin Y. Energy-efficient IoT based improved health monitoring system for sports persons. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2021. [DOI: 10.3233/jifs-219015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nowadays, wearable technology and the Internet of Things (IoT) are transforming the healthcare sector by refining the way how devices, applications, and people connect and interact with each other. IoT applications in sports are tremendously useful to monitor health and reduce the risk factor. The battery life of wearable and accurate monitoring has been considered a significant challenge in sports medicine. Hence, in this paper, Energy Efficient IoT based Improved Health Monitoring system (EEIoT-IHMS) has been proposed for accurate and continuous sports person’s health monitoring system. This paper determines the optimal set of clusters based on sensor features, in which power usage has been minimized by duty cycling with optimized prediction accuracy. The experimental results demonstrate that the proposed (EEIoT-IHMS) enhances accuracy ratio, improves battery life, and reduces energy consumption compared to other popular methods.
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Affiliation(s)
- Yu Shan’an
- Department of Physical Education, Shanghai University of Electric Power, Yangpu, Shanghai, China
| | - Yunfei Qin
- Department of Physical Education, Guangxi Sports College, Nanning, Guangxi, China
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41
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Groenendaal W, Lee S, van Hoof C. Wearable Bioimpedance Monitoring: Viewpoint for Application in Chronic Conditions. JMIR BIOMEDICAL ENGINEERING 2021; 6:e22911. [PMID: 38907374 PMCID: PMC11041432 DOI: 10.2196/22911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 03/01/2021] [Accepted: 04/06/2021] [Indexed: 01/20/2023] Open
Abstract
Currently, nearly 6 in 10 US adults are suffering from at least one chronic condition. Wearable technology could help in controlling the health care costs by remote monitoring and early detection of disease worsening. However, in recent years, there have been disappointments in wearable technology with respect to reliability, lack of feedback, or lack of user comfort. One of the promising sensor techniques for wearable monitoring of chronic disease is bioimpedance, which is a noninvasive, versatile sensing method that can be applied in different ways to extract a wide range of health care parameters. Due to the changes in impedance caused by either breathing or blood flow, time-varying signals such as respiration and cardiac output can be obtained with bioimpedance. A second application area is related to body composition and fluid status (eg, pulmonary congestion monitoring in patients with heart failure). Finally, bioimpedance can be used for continuous and real-time imaging (eg, during mechanical ventilation). In this viewpoint, we evaluate the use of wearable bioimpedance monitoring for application in chronic conditions, focusing on the current status, recent improvements, and challenges that still need to be tackled.
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Affiliation(s)
| | - Seulki Lee
- Imec the Netherlands / Holst Centre, Eindhoven, Netherlands
| | - Chris van Hoof
- Imec, Leuven, Belgium
- One Planet Research Center, Wageningen, Netherlands
- Department of Engineering Science, KU Leuven, Leuven, Belgium
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42
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Jacobs F, Scheerhoorn J, Mestrom E, van der Stam J, Bouwman RA, Nienhuijs S. Reliability of heart rate and respiration rate measurements with a wireless accelerometer in postbariatric recovery. PLoS One 2021; 16:e0247903. [PMID: 33909642 PMCID: PMC8081266 DOI: 10.1371/journal.pone.0247903] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/16/2021] [Indexed: 11/30/2022] Open
Abstract
Recognition of early signs of deterioration in postoperative course could be improved by continuous monitoring of vital parameters. Wearable sensors could enable this by wireless transmission of vital signs. A novel accelerometer-based device, called Healthdot, has been designed to be worn on the skin to measure the two key vital parameters respiration rate (RespR) and heart rate (HeartR). The goal of this study is to assess the reliability of heart rate and respiration rate measured by the Healthdot in comparison to the gold standard, the bedside patient monitor, during the postoperative period in bariatric patients. Data were collected in a consecutive group of 30 patients who agreed to wear the device after their primary bariatric procedure. Directly after surgery, a Healthdot was attached on the patients’ left lower rib. Vital signs measured by the accelerometer based Healthdot were compared to vital signs collected with the gold standard patient monitor for the period that the patient stayed at the post-anesthesia care unit. Over all patients, a total of 22 hours of vital signs obtained by the Healthdot were recorded simultaneously with the bedside patient monitor data. 87.5% of the data met the pre-defined bias of 5 beats per minute for HeartR and 92.3% of the data met the pre-defined bias of 5 respirations per minute for RespR. The Healthdot can be used to accurately derive heart rate and respiration rate in postbariatric patients. Wireless continuous monitoring of key vital signs has the potential to contribute to earlier recognition of complications in postoperative patients. Future studies should focus on the ability to detect patient deterioration in low-care environments and at home after discharge from the hospital.
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Affiliation(s)
- Fleur Jacobs
- Department of Medical Physics, Catharina Hospital, Eindhoven, The Netherlands
| | - Jai Scheerhoorn
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Eveline Mestrom
- Department of Anaesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Jonna van der Stam
- Department of Clinical Chemistry, Catharina Hospital, Eindhoven, The Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - R Arthur Bouwman
- Department of Anaesthesiology, Catharina Hospital, Eindhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Simon Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
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43
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van Rossum M, Leenen J, Kingma F, Breteler M, van Hillegersberg R, Ruurda J, Kouwenhoven E, van Det M, Luyer M, Nieuwenhuijzen G, Kalkman C, Hermens H. Expectations of Continuous Vital Signs Monitoring for Recognizing Complications After Esophagectomy: Interview Study Among Nurses and Surgeons. JMIR Perioper Med 2021; 4:e22387. [PMID: 33576743 PMCID: PMC7910120 DOI: 10.2196/22387] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/18/2020] [Accepted: 01/16/2021] [Indexed: 01/12/2023] Open
Abstract
Background Patients undergoing esophagectomy are at serious risk of developing postoperative complications. To support early recognition of clinical deterioration, wireless sensor technologies that enable continuous vital signs monitoring in a ward setting are emerging. Objective This study explored nurses’ and surgeons’ expectations of the potential effectiveness and impact of continuous wireless vital signs monitoring in patients admitted to the ward after esophagectomy. Methods Semistructured interviews were conducted at 3 esophageal cancer centers in the Netherlands. In each center, 2 nurses and 2 surgeons were interviewed regarding their expectations of continuous vital signs monitoring for early recognition of complications after esophagectomy. Historical data of patient characteristics and clinical outcomes were collected in each center and presented to the local participants to support estimations on clinical outcome. Results The majority of nurses and surgeons expected that continuous vital signs monitoring could contribute to the earlier recognition of deterioration and result in earlier treatment for postoperative complications, although the effective time gain would depend on patient and situational factors. Their expectations regarding the impact of potential earlier diagnosis on clinical outcomes varied. Nevertheless, most caregivers would consider implementing continuous monitoring in the surgical ward to support patient monitoring after esophagectomy. Conclusions Caregivers expected that wireless vital signs monitoring would provide opportunities for early detection of postoperative complications in patients undergoing esophagectomy admitted to the ward and prevent sequelae under certain circumstances. As the technology matures, clinical outcome studies will be necessary to objectify these expectations and further investigate overall effects on patient outcome.
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Affiliation(s)
- Mathilde van Rossum
- Department of Cardiovascular and Respiratory Physiology, University of Twente, Enschede, Netherlands.,Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Department of Anesthesiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jobbe Leenen
- Department of Surgery, Isala, Zwolle, Netherlands.,Connected Care Centre, Isala, Zwolle, Netherlands
| | - Feike Kingma
- Department of Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Martine Breteler
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Jelle Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Marc van Det
- Department of Surgery, ZGT Hospital, Almelo, Netherlands
| | - Misha Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, Netherlands
| | | | - Cor Kalkman
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Hermie Hermens
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
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44
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Can continuous remote vital sign monitoring reduce the number of room visits to patients suspected of COVID-19: A quasi-experimental study. Int J Nurs Stud 2021; 115:103868. [PMID: 33465579 PMCID: PMC7778830 DOI: 10.1016/j.ijnurstu.2020.103868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/18/2020] [Accepted: 12/29/2020] [Indexed: 01/16/2023]
Abstract
Background Continuous remote monitoring of vital signs on the hospital ward gained popularity during the Severe Acute Respiratory Syndrome coronavirus 2 pandemic due to its ability to support early detection of respiratory failure, and the possibility to do so without physical contact between patient and clinician. The effect of continuous monitoring on patient room visits has not been established yet. Objectives To assess the impact of continuous monitoring on the number of patient room visits for patients suspected of Corona Virus Disease 2019 (COVID-19) and the use of personal protection equipment. Design and methods We performed a before-after study at a ward with private rooms for patients suspected of COVID-19 at a tertiary hospital in Nijmegen, The Netherlands. Non-participant observers observed hospital staff during day, evening and night shifts to record patient room visits and personal protection equipment usage. After eleven days, wearable continuous vital sign monitoring was introduced. An interrupted time series analysis was applied to evaluate the effect of continuous monitoring on the number of patient room visits, visits for obtaining vital signs (Modified Early Warning Score visits) and the amount of personal protection equipment used. Results During the 45 day study period, 86 shifts were observed. During each shift, approximately six rooms were included. A total of 2347 patient room visits were recorded. The slope coefficient for the number of patient room visits did not change after introducing continuous vital sign monitoring (B -0.003, 95% confidence interval -0.022/0.016). The slope coefficients of the number of Modified Early Warning Score visits and the amount of personal protection equipment used did not change either (B -0.002, 95% confidence interval -0.021/0.017 and B 0.046, 95% confidence interval -0.008/0.099). The number of Modified Early Warning Score visits did show a decline over the entire study period, however this decline was not influenced by the intervention. Evening and night shifts were associated with fewer patient room visits compared to day shifts. Conclusion Introduction of continuous vital sign monitoring at a general ward for patients with suspected COVID-19 did not reduce the number of patient room visits or the usage of personal protection equipment by hospital staff. The number of Modified Early Warning Score visits declined over time, but this was not related to the introduction of continuous monitoring. Detailed analysis of the influence of continuous monitoring on the workflow of hospital staff reveals key points to increase efficacy of this intervention.
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45
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Drummond GB, Fischer D, Arvind DK. Current clinical methods of measurement of respiratory rate give imprecise values. ERJ Open Res 2020; 6:00023-2020. [PMID: 33015146 PMCID: PMC7520170 DOI: 10.1183/23120541.00023-2020] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/01/2020] [Indexed: 11/05/2022] Open
Abstract
Background Respiratory rate is a basic clinical measurement used for illness assessment. Errors in measuring respiratory rate are attributed to observer and equipment problems. Previous studies commonly report rate differences ranging from 2 to 6 breaths·min-1 between observers. Methods To study why repeated observations should vary so much, we conducted a virtual experiment, using continuous recordings of breathing from acutely ill patients. These records allowed each breathing cycle to be precisely timed. We made repeated random measures of respiratory rate using different sample durations of 30, 60 and 120 s. We express the variation in these repeated rate measurements for the different sample durations as the interquartile range of the values obtained for each subject. We predicted what values would be found if a single measure, taken from any patient, were repeated and inspected boundary values of 12, 20 or 25 breaths·min-1, used by the UK National Early Warning Score, for possible mis-scoring. Results When the sample duration was nominally 30 s, the mean interquartile range of repeated estimates was 3.4 breaths·min-1. For the 60 s samples, the mean interquartile range was 3 breaths·min-1, and for the 120 s samples it was 2.5 breaths·min-1. Thus, repeat clinical counts of respiratory rate often differ by >3 breaths·min-1. For 30 s samples, up to 40% of National Early Warning Scores could be misclassified. Conclusions Early warning scores will be unreliable when short sample durations are used to measure respiratory rate. Precision improves with longer sample duration, but this may be impractical unless better measurement methods are used.
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Affiliation(s)
- Gordon B Drummond
- Dept of Anaesthesia, Critical Care, and Pain Medicine, University of Edinburgh, Edinburgh UK
| | - Darius Fischer
- Centre for Speckled Computing, School of Informatics, University of Edinburgh, Edinburgh, UK
| | - D K Arvind
- Centre for Speckled Computing, School of Informatics, University of Edinburgh, Edinburgh, UK
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46
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Hassaniazad M, Ghazisaeedi M, Baniasadi T. Technology-Based Solutions to Improve Management of COVID-19: A Call for More Utilization in Iran. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:1588-1589. [PMID: 33083343 PMCID: PMC7554394 DOI: 10.18502/ijph.v49i8.3912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Mehdi Hassaniazad
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Marjan Ghazisaeedi
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Tayebeh Baniasadi
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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47
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Leenen JPL, Leerentveld C, van Dijk JD, van Westreenen HL, Schoonhoven L, Patijn GA. Current Evidence for Continuous Vital Signs Monitoring by Wearable Wireless Devices in Hospitalized Adults: Systematic Review. J Med Internet Res 2020; 22:e18636. [PMID: 32469323 PMCID: PMC7351263 DOI: 10.2196/18636] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/07/2020] [Accepted: 05/14/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Continuous monitoring of vital signs by using wearable wireless devices may allow for timely detection of clinical deterioration in patients in general wards in comparison to detection by standard intermittent vital signs measurements. A large number of studies on many different wearable devices have been reported in recent years, but a systematic review is not yet available to date. OBJECTIVE The aim of this study was to provide a systematic review for health care professionals regarding the current evidence about the validation, feasibility, clinical outcomes, and costs of wearable wireless devices for continuous monitoring of vital signs. METHODS A systematic and comprehensive search was performed using PubMed/MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from January 2009 to September 2019 for studies that evaluated wearable wireless devices for continuous monitoring of vital signs in adults. Outcomes were structured by validation, feasibility, clinical outcomes, and costs. Risk of bias was determined by using the Mixed Methods Appraisal Tool, quality assessment of diagnostic accuracy studies 2nd edition, or quality of health economic studies tool. RESULTS In this review, 27 studies evaluating 13 different wearable wireless devices were included. These studies predominantly evaluated the validation or the feasibility outcomes of these devices. Only a few studies reported the clinical outcomes with these devices and they did not report a significantly better clinical outcome than the standard tools used for measuring vital signs. Cost outcomes were not reported in any study. The quality of the included studies was predominantly rated as low or moderate. CONCLUSIONS Wearable wireless continuous monitoring devices are mostly still in the clinical validation and feasibility testing phases. To date, there are no high quality large well-controlled studies of wearable wireless devices available that show a significant clinical benefit or cost-effectiveness. Such studies are needed to help health care professionals and administrators in their decision making regarding implementation of these devices on a large scale in clinical practice or in-home monitoring.
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Affiliation(s)
| | | | | | | | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
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48
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Sun L, Joshi M, Khan SN, Ashrafian H, Darzi A. Clinical impact of multi-parameter continuous non-invasive monitoring in hospital wards: a systematic review and meta-analysis. J R Soc Med 2020; 113:217-224. [PMID: 32521195 PMCID: PMC7439595 DOI: 10.1177/0141076820925436] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/21/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Delayed response to clinical deterioration as a result of intermittent vital sign monitoring is a cause of preventable morbidity and mortality. This review focuses on the clinical impact of multi-parameter continuous non-invasive monitoring of vital signs (CoNiM) in non-intensive care unit patients. DESIGN Systematic review and meta-analysis of primary studies. Embase, MEDLINE, HMIC, PsycINFO and Cochrane were searched from April 1964 to 18 June 2019 with no language restriction. SETTING The search was limited to hospitalised, non-intensive care unit adult patients who had two or more vital signs continuously monitored. PARTICIPANTS All primary studies that evaluated the clinical impact of using multi-parameter CoNiM in adult hospital wards outside of the intensive care unit. MAIN OUTCOME MEASURES Clinical impact of multi-parameter CoNiM. RESULTS This systematic review identified 14 relevant studies from 3846 search results. Five studies were classified as Group A - associations found between measured vital signs and clinical parameters. Nine studies were classified as Group B - comparison between clinical outcomes of patients with and without multi-parameter CoNiM. Vital signs data from CoNiM were found to associate with type of presenting complaint, level of renal function and incidence of major clinical events. CoNiM also assisted in diagnosis by differentiating between patients with acute heart failure, stroke and sepsis (with sub-clustering of septic patients). In the meta-analysis, patients on multi-parameter CoNiM had a 39% decrease in risk of mortality (risk ratio [RR] 0.61; 95% confidence interval [95% CI] -0.39-0.95) when compared to patients with regular intermittent monitoring. There was a trend of reduced intensive care unit transfer (RR 0.86; 95% CI -0.67-1.11) and reduced rapid response team activation (RR 0.61; 95% CI 0.26-1.43). A trend towards reduced hospital length of stay was also found using weighted mean difference (WMD -3.32 days; 95% CI -8.82-2.19 days). CONCLUSION There is evidence of clinical benefit in implementing CoNiM in non-intensive care unit patients. This review supports the use of multi-parameter CoNiM outside of intensive care unit with further large-scale RCTs required to further affirm clinical impact.
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Affiliation(s)
- Lin Sun
- Department of Surgery and Cancer,
Imperial
College London, London SW7 2AZ, UK
| | - Meera Joshi
- Department of Surgery and Cancer,
Imperial
College London, London SW7 2AZ, UK
| | - Sadia N Khan
- West Middlesex University Hospital,
Isleworth TW7 6AF, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer,
Imperial
College London, London SW7 2AZ, UK
| | - Ara Darzi
- Department of Surgery and Cancer,
Imperial
College London, London SW7 2AZ, UK
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49
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Tsiouris KM, Gatsios D, Tsakanikas V, Pardalis AA, Kouris I, Androutsou T, Tarousi M, Vujnovic Sedlar N, Somarakis I, Mostajeran F, Filipovic N, op den Akker H, Koutsouris DD, Fotiadis DI. Designing interoperable telehealth platforms: bridging IoT devices with cloud infrastructures. ENTERP INF SYST-UK 2020. [DOI: 10.1080/17517575.2020.1759146] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Kostas M. Tsiouris
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
- Unit of Medical Technology and Intelligent Information Systems, Department of Material Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Dimitrios Gatsios
- Unit of Medical Technology and Intelligent Information Systems, Department of Material Science and Engineering, University of Ioannina, Ioannina, Greece
- Department of Neurology, Medical School, University of Ioannina, Ioannina, Greece
| | - Vassilios Tsakanikas
- Unit of Medical Technology and Intelligent Information Systems, Department of Material Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Athanasios A. Pardalis
- Unit of Medical Technology and Intelligent Information Systems, Department of Material Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Ioannis Kouris
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Thelma Androutsou
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Marilena Tarousi
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | | | | | - Fariba Mostajeran
- Human-Computer Interaction, Department of Informatics, University of Hamburg, Hamburg, Germany
| | - Nenad Filipovic
- BioIRC Bioengineering Research and Development Center, Kragujevac, Serbia
- Faculty of Engineering, University of Kragujevac, Kragujevac, Serbia
| | - Harm op den Akker
- eHealth Group, Roessingh Research and Development, Enschede, The Netherlands
| | - Dimitrios D. Koutsouris
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Dimitrios I. Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Department of Material Science and Engineering, University of Ioannina, Ioannina, Greece
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, FORTH, Ioannina, Greece
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50
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Tully J, Dameff C, Longhurst CA. Wave of Wearables: Clinical Management of Patients and the Future of Connected Medicine. Clin Lab Med 2020; 40:69-82. [PMID: 32008641 DOI: 10.1016/j.cll.2019.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The future of connected health care will involve the collection of patient data or enhancement of clinician workflows through various biosensors and displays found on wearable electronic devices, many of which are marketed directly to consumers. The adoption of wearables in health care is being driven by efforts to reduce health care costs, improve care quality, and increase clinician efficiency. Wearables have significant potential to achieve these goals but are currently limited by lack of widespread integrations into electronic health records, biosensor data collection types, and a lack of scientifically rigorous literature showing benefit.
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Affiliation(s)
- Jeffrey Tully
- Department of Anesthesiology and Pain Medicine, University of California Davis Medical Center, 2315 Stockton Boulevard, Sacramento, CA 95817, USA.
| | - Christian Dameff
- Department of Emergency Medicine, University of California San Diego, 200 West Arbor Drive #8676, San Diego, CA 92103, USA; Department of Biomedical Informatics, UC San Diego Health, University of California San Diego, 9500 Gilman Drive, MC 0728, La Jolla, California 92093-0728, USA; Department of Computer Science and Engineering, University of California San Diego, 9500 Gilman Drive, Mail Code 0404, La Jolla, CA 92093-0404, USA
| | - Christopher A Longhurst
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
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