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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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van der Stam JA, Mestrom EHJ, Scheerhoorn J, Jacobs FENB, Nienhuijs S, Boer AK, van Riel NAW, de Morree HM, Bonomi AG, Scharnhorst V, Bouwman RA. The Accuracy of Wrist-Worn Photoplethysmogram-Measured Heart and Respiratory Rates in Abdominal Surgery Patients: Observational Prospective Clinical Validation Study. JMIR Perioper Med 2023; 6:e40474. [PMID: 36804173 PMCID: PMC9989911 DOI: 10.2196/40474] [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: 06/23/2022] [Revised: 01/12/2023] [Accepted: 01/31/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Postoperative deterioration is often preceded by abnormal vital parameters. Therefore, vital parameters of postoperative patients are routinely measured by nursing staff. Wrist-worn sensors could potentially provide an alternative tool for the measurement of vital parameters in low-acuity settings. These devices would allow more frequent or even continuous measurements of vital parameters without relying on time-consuming manual measurements, provided their accuracy in this clinical population is established. OBJECTIVE This study aimed to assess the accuracy of heart rate (HR) and respiratory rate (RR) measures obtained via a wearable photoplethysmography (PPG) wristband in a cohort of postoperative patients. METHODS The accuracy of the wrist-worn PPG sensor was assessed in 62 post-abdominal surgery patients (mean age 55, SD 15 years; median BMI 34, IQR 25-40 kg/m2). The wearable obtained HR and RR measurements were compared to those of the reference monitor in the postanesthesia or intensive care unit. Bland-Altman and Clarke error grid analyses were performed to determine agreement and clinical accuracy. RESULTS Data were collected for a median of 1.2 hours per patient. With a coverage of 94% for HR and 34% for RR, the device was able to provide accurate measurements for the large majority of the measurements as 98% and 93% of the measurements were within 5 bpm or 3 rpm of the reference signal. Additionally, 100% of the HR and 98% of the RR measurements were clinically acceptable on Clarke error grid analysis. CONCLUSIONS The wrist-worn PPG device is able to provide measurements of HR and RR that can be seen as sufficiently accurate for clinical applications. Considering the coverage, the device was able to continuously monitor HR and report RR when measurements of sufficient quality were obtained. TRIAL REGISTRATION ClinicalTrials.gov NCT03923127; https://www.clinicaltrials.gov/ct2/show/NCT03923127.
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Affiliation(s)
- Jonna A van der Stam
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.,Clinical Laboratory, Catharina Hospital, Eindhoven, Netherlands.,Expert Center Clinical Chemistry Eindhoven, Eindhoven, Netherlands
| | - Eveline H J Mestrom
- Department of Anesthesiology, Intensive Care & Pain Medicine, Catharina Hospital, Eindhoven, Netherlands
| | - Jai Scheerhoorn
- Department of Surgery, Catharina Hospital, Eindhoven, Netherlands
| | - Fleur E N B Jacobs
- Department of Medical Physics, Catharina Hospital, Eindhoven, Netherlands
| | - Simon Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, Netherlands
| | - Arjen-Kars Boer
- Clinical Laboratory, Catharina Hospital, Eindhoven, Netherlands.,Expert Center Clinical Chemistry Eindhoven, Eindhoven, Netherlands
| | - Natal A W van Riel
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.,Expert Center Clinical Chemistry Eindhoven, Eindhoven, Netherlands.,Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Helma M de Morree
- Patient Care & Monitoring Department, Philips Research, Eindhoven, Netherlands
| | - Alberto G Bonomi
- Patient Care & Monitoring Department, Philips Research, Eindhoven, Netherlands
| | - Volkher Scharnhorst
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.,Clinical Laboratory, Catharina Hospital, Eindhoven, Netherlands.,Expert Center Clinical Chemistry Eindhoven, Eindhoven, Netherlands
| | - R Arthur Bouwman
- Department of Anesthesiology, Intensive Care & Pain Medicine, Catharina Hospital, Eindhoven, Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
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Haveman ME, van Melzen R, El Moumni M, Schuurmann RCL, Hermens HJ, Tabak M, de Vries JPPM. Determining the Reliable Measurement Period for Preoperative Baseline Values With Telemonitoring Before Major Abdominal Surgery: Pilot Cohort Study. JMIR Perioper Med 2022; 5:e40815. [PMID: 36441586 DOI: 10.2196/40815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/07/2022] [Accepted: 10/29/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Preoperative telemonitoring of vital signs, physical activity, and well-being might be able to optimize prehabilitation of the patient's physical and mental condition prior to surgery, support setting alarms during in-hospital monitoring, and allow personalization of the postoperative recovery process. OBJECTIVE The primary aim of this study was to evaluate when and how long patients awaiting major abdominal surgery should be monitored to get reliable preoperative individual baseline values of heart rate (HR), daily step count, and patient-reported outcome measures (PROMs). The secondary aim was to describe the perioperative course of these measurements at home. METHODS In this observational single-center cohort study, patients used a wearable sensor during waking hours and reported PROMs (pain, anxiety, fatigue, nausea) on a tablet twice a day. Intraclass correlation coefficients (ICCs) were used to evaluate the reliability of mean values on 2 specific preoperative days (the first day of telemonitoring and the day before hospital admission) and randomly selected preoperative periods compared to individual reference values. Mean values of HR, step count, and PROMs per day were visualized in a boxplot from 14 days before hospital admission until 30 days after surgery. RESULTS A total of 16 patients were included in the data analyses. The ICCs of mean values on the first day of telemonitoring were 0.91 for HR, 0.71 for steps, and at least 0.86 for PROMs. The day before hospital admission showed reliability coefficients of 0.76 for HR, 0.71 for steps, and 0.92-0.99 for PROMs. ICC values of randomly selected measurement periods increased over the continuous period of time from 0.68 to 0.99 for HR and daily step counts. A lower bound of the 95% CI of at least 0.75 was determined after 3 days of measurements. The ICCs of randomly selected PROM measurements were 0.89-0.94. Visualization of mean values per day mainly showed variable preoperative daily step counts (median 2409, IQR 1735-4661 steps/day) and lower postoperative daily step counts (median 884, IQR 474-1605 steps/day). In addition, pain was visually reduced until 30 days after surgery at home. CONCLUSIONS In this prospective pilot study, for patients awaiting major abdominal surgery, baseline values for HR and daily step count could be measured reliably by a wearable sensor worn for at least 3 consecutive days and PROMs during any preoperative day. No clear conclusions were drawn from the description of the perioperative course by showing mean values of HR, daily step count, and PROM values over time in the home situation.
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Affiliation(s)
- Marjolein E Haveman
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Rianne van Melzen
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Surgery, Division of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Mostafa El Moumni
- Department of Surgery, Division of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Richte C L Schuurmann
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Hermie J Hermens
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Monique Tabak
- 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, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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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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Wearable Technologies for Pediatric Patients with Surgical Infections—More than Counting Steps? BIOSENSORS 2022; 12:bios12080634. [PMID: 36005030 PMCID: PMC9405945 DOI: 10.3390/bios12080634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/30/2022] [Accepted: 08/09/2022] [Indexed: 12/04/2022]
Abstract
Reliable vital sign assessments are crucial for the management of patients with infectious diseases. Wearable devices enable easy and comfortable continuous monitoring across settings, especially in pediatric patients, but information about their performance in acutely unwell children is scarce. Vital signs were continuously measured with a multi-sensor wearable device (Everion®, Biofourmis, Zurich, Switzerland) in 21 pediatric patients during their hospitalization for appendicitis, osteomyelitis, or septic arthritis to describe acceptance and feasibility and to compare validity and reliability with conventional measurements. Using a wearable device was highly accepted and feasible for health-care workers, parents, and children. There were substantial data gaps in continuous monitoring up to 24 h. The wearable device measured heart rate and oxygen saturation reliably (mean difference, 2.5 bpm and 0.4% SpO2) but underestimated body temperature by 1.7 °C. Data availability was suboptimal during the study period, but a good relationship was determined between wearable device and conventional measurements for heart rate and oxygen saturation. Acceptance and feasibility were high in all study groups. We recommend that wearable devices designed for medical use in children be validated in the targeted population to assure future high-quality continuous vital sign assessments in an easy and non-burdening way.
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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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Bustos-López M, Cruz-Ramírez N, Guerra-Hernández A, Sánchez-Morales LN, Cruz-Ramos NA, Alor-Hernández G. Wearables for Engagement Detection in Learning Environments: A Review. BIOSENSORS 2022; 12:509. [PMID: 35884312 PMCID: PMC9312492 DOI: 10.3390/bios12070509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022]
Abstract
Appropriate teaching-learning strategies lead to student engagement during learning activities. Scientific progress and modern technology have made it possible to measure engagement in educational settings by reading and analyzing student physiological signals through sensors attached to wearables. This work is a review of current student engagement detection initiatives in the educational domain. The review highlights existing commercial and non-commercial wearables for student engagement monitoring and identifies key physiological signals involved in engagement detection. Our findings reveal that common physiological signals used to measure student engagement include heart rate, skin temperature, respiratory rate, oxygen saturation, blood pressure, and electrocardiogram (ECG) data. Similarly, stress and surprise are key features of student engagement.
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Affiliation(s)
- Maritza Bustos-López
- Instituto de Investigaciones en Inteligencia Artificial, Universidad Veracruzana, Xalapa, Veracruz 91097, Mexico; (M.B.-L.); (N.C.-R.); (A.G.-H.)
| | - Nicandro Cruz-Ramírez
- Instituto de Investigaciones en Inteligencia Artificial, Universidad Veracruzana, Xalapa, Veracruz 91097, Mexico; (M.B.-L.); (N.C.-R.); (A.G.-H.)
| | - Alejandro Guerra-Hernández
- Instituto de Investigaciones en Inteligencia Artificial, Universidad Veracruzana, Xalapa, Veracruz 91097, Mexico; (M.B.-L.); (N.C.-R.); (A.G.-H.)
| | - Laura Nely Sánchez-Morales
- Division of Research and Postgraduate Studies, CONACYT-Tecnológico Nacional de México/I. T. Orizaba, Av. Oriente 9 852 Col. Emiliano Zapata, Orizaba, Veracruz 94320, Mexico;
| | - Nancy Aracely Cruz-Ramos
- Division of Research and Postgraduate Studies, Tecnológico Nacional de México/I. T. Orizaba, Av. Oriente 9 852 Col. Emiliano Zapata, Orizaba, Veracruz 94320, Mexico;
| | - Giner Alor-Hernández
- Division of Research and Postgraduate Studies, Tecnológico Nacional de México/I. T. Orizaba, Av. Oriente 9 852 Col. Emiliano Zapata, Orizaba, Veracruz 94320, Mexico;
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