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Abstract
Interest in telemedicine has increased exponentially. There is a growing body of published evidence on the use of telemedicine for patients using continuous positive airway pressure. Telemedicine-ready devices can support the transmission on use time, apnea-hypopnea index, and leakage. This approach enables early activation of troubleshooting. Automated, personalized feedback for patients and patient access to their own data provide unprecedented opportunities for integrating comanagement approaches, multiactor interactions, and patient empowerment. Telemedicine is likely cost effective, but requires better evidence. Notwithstanding barriers for implementation that remain, telemedicine has to be embraced, leaving the physician and patient to accept it or not.
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Affiliation(s)
- Johan Verbraecken
- Department of Pulmonary Medicine and Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, Edegem, Antwerp 2650, Belgium.
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Heart Rate Variability Monitoring during Sleep Based on Capacitively Coupled Textile Electrodes on a Bed. SENSORS 2015; 15:11295-311. [PMID: 26007716 PMCID: PMC4481948 DOI: 10.3390/s150511295] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/08/2015] [Indexed: 11/26/2022]
Abstract
In this study, we developed and tested a capacitively coupled electrocardiogram (ECG) measurement system using conductive textiles on a bed, for long-term healthcare monitoring. The system, which was designed to measure ECG in a bed with no constraints of sleep position and posture, included a foam layer to increase the contact region with the curvature of the body and a cover to ensure durability and easy installation. Nine healthy subjects participated in the experiment during polysomnography (PSG), and the heart rate (HR) coverage and heart rate variability (HRV) parameters were analyzed to evaluate the system. The experimental results showed that the mean of R-peak coverage was 98.0% (95.5%–99.7%), and the normalized errors of HRV time and spectral measures between the Ag/AgCl system and our system ranged from 0.15% to 4.20%. The root mean square errors for inter-beat (RR) intervals and HR were 1.36 ms and 0.09 bpm, respectively. We also showed the potential of our developed system for rapid eye movement (REM) sleep and wake detection as well as for recording of abnormal states.
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Singh M, Agarwal A, Sinha V, Manoj Kumar R, Jaiswal N, Jindal I, Pant P, Kumar M. Application of Handheld Tele-ECG for Health Care Delivery in Rural India. Int J Telemed Appl 2014; 2014:981806. [PMID: 25368654 PMCID: PMC4195398 DOI: 10.1155/2014/981806] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 09/06/2014] [Accepted: 09/09/2014] [Indexed: 11/18/2022] Open
Abstract
Telemonitoring is a medical practice that involves remotely monitoring patients who are not at the same location as the health care provider. The purpose of our study was to use handheld tele-electrocardiogram (ECG) developed by Bhabha Atomic Research Center (BARC) to identify heart conditions in the rural underserved population where the doctor-patient ratio is low and access to health care is difficult. The objective of our study was clinical validation of handheld tele-ECG as a screening tool for evaluation of cardiac diseases in the rural population. ECG was obtained in 450 individuals (mean age 31.49 ± 20.058) residing in the periphery of Chandigarh, India, from April 2011 to March 2013, using the handheld tele-ECG machine. The data were then transmitted to physicians in Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, for their expert opinion. ECG was interpreted as normal in 70% individuals. Left ventricular hypertrophy (9.3%) was the commonest abnormality followed closely by old myocardial infarction (5.3%). Patient satisfaction was reported to be ~95%. Thus, it can be safely concluded that tele-ECG is a portable, cost-effective, and convenient tool for diagnosis and monitoring of heart diseases and thus improves quality and accessibility, especially in rural areas.
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Affiliation(s)
- Meenu Singh
- Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Amit Agarwal
- ICMR Centre for Evidence Based Child Health, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Vineet Sinha
- Department of Electronic Division, Bhabha Atomic Research Center, Mumbai 400085, India
| | - Rohit Manoj Kumar
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Nishant Jaiswal
- ICMR Centre for Evidence Based Child Health, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Ishita Jindal
- ICMR Centre for Evidence Based Child Health, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Pankaj Pant
- ICMR Centre for Evidence Based Child Health, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Munish Kumar
- ICMR Centre for Evidence Based Child Health, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
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Flexible capacitive electrodes for minimizing motion artifacts in ambulatory electrocardiograms. SENSORS 2014; 14:14732-43. [PMID: 25120162 PMCID: PMC4179047 DOI: 10.3390/s140814732] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 08/05/2014] [Accepted: 08/07/2014] [Indexed: 11/16/2022]
Abstract
This study proposes the use of flexible capacitive electrodes for reducing motion artifacts in a wearable electrocardiogram (ECG) device. The capacitive electrodes have conductive foam on their surface, a shield, an optimal input bias resistor, and guarding feedback. The electrodes are integrated in a chest belt, and the acquired signals are transmitted wirelessly for ambulatory heart rate monitoring. We experimentally validated the electrode performance with subjects standing and walking on a treadmill at speeds of up to 7 km/h. The results confirmed the highly accurate heart rate detection capacity of the developed system and its feasibility for daily-life ECG monitoring.
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Baek HJ, Lee HJ, Lim YG, Park KS. Conductive polymer foam surface improves the performance of a capacitive EEG electrode. IEEE Trans Biomed Eng 2012; 59:3422-31. [PMID: 22961261 DOI: 10.1109/tbme.2012.2215032] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this paper, a new conductive polymer foam-surfaced electrode was proposed for use as a capacitive EEG electrode for nonintrusive EEG measurements in out-of-hospital environments. The current capacitive electrode has a rigid surface that produces an undefined contact area due to its stiffness, which renders it unable to conform to head curvature and locally isolates hairs between the electrode surface and scalp skin, making EEG measurement through hair difficult. In order to overcome this issue, a conductive polymer foam was applied to the capacitive electrode surface to provide a cushioning effect. This enabled EEG measurement through hair without any conductive contact with bare scalp skin. Experimental results showed that the new electrode provided lower electrode-skin impedance and higher voltage gains, signal-to-noise ratios, signal-to-error ratios, and correlation coefficients between EEGs measured by capacitive and conventional resistive methods compared to a conventional capacitive electrode. In addition, the new electrode could measure EEG signals, while the conventional capacitive electrode could not. We expect that the new electrode presented here can be easily installed in a hat or helmet to create a nonintrusive wearable EEG apparatus that does not make users look strange for real-world EEG applications.
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Affiliation(s)
- Hyun Jae Baek
- Graduate Program in Bioengineering, Seoul National University, Seoul 110-799, Korea
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Chang KM, Liu SH. Wireless portable electrocardiogram and a tri-axis accelerometer implementation and application on sleep activity monitoring. Telemed J E Health 2011; 17:177-84. [PMID: 21413872 DOI: 10.1089/tmj.2010.0078] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Night-to-night variability of sleep activity requires more home-based portable sleep monitoring instead of clinical polysomnography examination in the laboratory. In this article, a wireless sleep activity monitoring system is described. The system is light and small for the user. Sleep postures, such as supine or left/right side, were observed by a signal from a tri-axis accelerometer. An overnight electrocardiogram was also recorded with a single lead. Using an MSP430 as microcontroller, both physiological signals were transmitted by a Bluetooth chip. A Labview-based interface demonstrated the recorded signal and sleep posture. Three nights of sleep recordings were used to examine night-to-night variability. The proposed system can record overnight heart rate. Results show that sleep posture and posture change can be precisely detected via tri-axis accelerometer information. There is no significant difference within subject data sets, but there are statistically significant differences among subjects, both for heart rate and for sleep posture distribution. The wireless transmission range is also sufficient for home-based users.
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Affiliation(s)
- Kang-Ming Chang
- Department of Photonics and Communication Engineering, Asia University, Taichung, Taiwan.
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Abstract
Respiratory rate (RR) is a basic vital sign, measured and monitored throughout a wide spectrum of health care settings, although RR is historically difficult to measure in a reliable fashion. We explore an automated method that computes RR only during intervals of clean, regular, and consistent respiration and investigate its diagnostic use in a retrospective analysis of prehospital trauma casualties. At least 5 s of basic vital signs, including heart rate, RR, and systolic, diastolic, and mean arterial blood pressures, were continuously collected from 326 spontaneously breathing trauma casualties during helicopter transport to a level I trauma center. "Reliable" RR data were identified retrospectively using automated algorithms. The diagnostic performances of reliable versus standard RR were evaluated by calculation of the receiver operating characteristic curves using the maximum-likelihood method and comparison of the summary areas under the receiver operating characteristic curves (AUCs). Respiratory rate shows significant data-reliability differences. For identifying prehospital casualties who subsequently receive a respiratory intervention (hospital intubation or tube thoracotomy), standard RR yields an AUC of 0.59 (95% confidence interval, 0.48-0.69), whereas reliable RR yields an AUC of 0.67 (0.57-0.77), P < 0.05. For identifying casualties subsequently diagnosed with a major hemorrhagic injury and requiring blood transfusion, standard RR yields an AUC of 0.60 (0.49-0.70), whereas reliable RR yields 0.77 (0.67-0.85), P < 0.001. Reliable RR, as determined by an automated algorithm, is a useful parameter for the diagnosis of respiratory pathology and major hemorrhage in a trauma population. It may be a useful input to a wide variety of clinical scores and automated decision-support algorithms.
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Shin JH, Lee KM, Park KS. Non-constrained monitoring of systolic blood pressure on a weighing scale. Physiol Meas 2009; 30:679-93. [PMID: 19525570 DOI: 10.1088/0967-3334/30/7/011] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this study, we developed a novel technique for estimating non-constrained and cuffless blood pressure (BP) that was based on electrocardiogram (ECG) and ballistocardiogram (BCG). The BCG was non-invasively measured using a common electronic weighing scale when a subject was standing on it. The ECG was measured using three different methods: on the chest using Ag/AgCl electrodes, on the hands using dry electrodes and on the feet also using dry electrodes. For a BP correlated parameter, a time interval parameter, which was defined as the time difference between the ECG R-peak and BCG J-peak, was employed for evaluating and estimating beat-to-beat BP. Under a BP varying experiment with a Valsalva manoeuvre, the R-J intervals were extracted at every beat cycle and a systolic blood pressure (SBP) estimation equation was established using linear regression analysis for each subject. In the case of feet delivered ECG (F-ECG), an ensemble average technique synchronized at the BCG J-peak point was applied to extract the ECG signal from the feet. The performance of the proposed method was evaluated using Finapres, a non-invasive blood pressure measurement system, as a reference BP signal, and a scatter plot was used to find the regression line between the reference values and estimated BPs. A moving-window averaging technique was applied to remove the high-frequency noise in the R-J intervals and was applied to enhance the accuracy of the SBP estimation. For all individuals, the estimated SBP was similar to the measured SBP with a reliable correlation, which makes the proposed method suitable for use in a home healthcare system to monitor blood pressure on a weighing scale at the same time as measuring weight.
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Affiliation(s)
- Jae Hyuk Shin
- Interdisciplinary Program of Biomedical Engineering, Seoul National University, Seoul, Republic of Korea.
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Baek HJ, Lee HB, Kim JS, Choi JM, Kim KK, Park KS. Nonintrusive Biological Signal Monitoring in a Car to Evaluate a Driver’s Stress and Health State. Telemed J E Health 2009; 15:182-9. [DOI: 10.1089/tmj.2008.0090] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Hyun Jae Baek
- Graduate Program in Bioengineering, Seoul National University, Seoul, Korea
| | - Haet Bit Lee
- Graduate Program in Bioengineering, Seoul National University, Seoul, Korea
| | - Jung Soo Kim
- Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul, Korea
| | - Jong Min Choi
- Research Center for Sensory Organ, Medical Research Center, Seoul National University, Seoul, Korea
| | - Ko Keun Kim
- Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul, Korea
| | - Kwang Suk Park
- Department of Biomedical Engineering, College of Medicine, Seoul National University, Seoul, Korea
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Cheng CM, Hsu YL, Young CM. Development of a Portable Device for Telemonitoring of Physical Activities During Sleep. Telemed J E Health 2008; 14:1044-56. [DOI: 10.1089/tmj.2008.0026] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chih-Ming Cheng
- Department of Mechanical Engineering, Yuan Ze University, Chung-Li, Taiwan, ROC
| | - Yeh-Liang Hsu
- Department of Mechanical Engineering, Yuan Ze University, Chung-Li, Taiwan, ROC
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Reisner AT, Chen L, McKenna TM, Reifman J. Automatically-Computed Prehospital Severity Scores are Equivalent to Scores Based on Medic Documentation. ACTA ACUST UNITED AC 2008; 65:915-23. [DOI: 10.1097/ta.0b013e31815eb142] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vanagas G, Žaliūnas R, Benetis R, Šlapikas R. Factors Affecting Relevance of Tele-ECG Systems Application to High Risk for Future Ischemic Heart Disease Events Patients Group. Telemed J E Health 2008; 14:345-9. [DOI: 10.1089/tmj.2007.0060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Rimantas Benetis
- Departments of Heart Surgery, Institute of Cardiology, Kaunas, Lithuania
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Kim J, Park J, Kim K, Chee Y, Lim Y, Park K. Development of a nonintrusive blood pressure estimation system for computer users. Telemed J E Health 2007; 13:57-64. [PMID: 17309356 DOI: 10.1089/tmj.2006.0034] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An individual's cardiovascular health is important. The measurement of blood pressure (BP) can be performed nonintrusively during normal daily activities. A study was designed to estimate systolic BP by measuring pulse arrival time (PAT) nonintrusively. PAT was obtained nonintrusively to estimate each individual's BP while he or she worked at a computer. Electrocardiogram (ECG) was measured with a capacitive-coupled electrocardiogram (CC-ECG) system and photoplethysmogram (PPG) was measured using specially installed circuits in a computer mouse. PAT was calculated from CC-ECG and PPG, and compared to PAT measured by the standard method. Three individuals participated in this study. Results correlated well. An equation to estimate BP from the measured PAT was derived for each of three individuals during a training period. Estimated BP was compared with measured BP in a series of experiments under varied BP conditions. For each individual, the estimated BP followed the measured BP within a tolerable error range. This method was also used for long-term BP monitoring. Results showed that this method could be useful for monitoring BP for telemedicine and e-health.
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Affiliation(s)
- Jungsoo Kim
- Interdisciplinary Program in Biomedical Engineering, Seoul National University, Seoul, Republic of Korea
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Kim JS, Chee YJ, Park JW, Choi JW, Park KS. A new approach for non-intrusive monitoring of blood pressure on a toilet seat. Physiol Meas 2006; 27:203-11. [PMID: 16400206 DOI: 10.1088/0967-3334/27/2/010] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Pulse arrival time (PAT) was measured non-intrusively to estimate each individual's blood pressure. Electrocardiogram (ECG) was measured with copper-coated electrodes and photoplethysmogram (PPG) was measured using a specially designed toilet seat apparatus. Non-intrusively measured PATs were compared with PATs measured by the standard method, and the results showed a good correlation. An equation was used to estimate blood pressure from the measured PAT during a training period for each individual. Estimated blood pressures were compared with measured blood pressures in a series of blood pressure varying experiments. For each individual, the estimated blood pressure was similar to the measured blood pressure within a tolerable error range. This method was also practiced for long-term monitoring, and the results show the value of this method for continuous home monitoring of blood pressure.
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Affiliation(s)
- Jung Soo Kim
- Interdisciplinary Program in Biomedical Engineering, Seoul National University, Seoul, Korea.
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