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Sesma-Sánchez L, Ruiz-Castellano M, Romero-Roldán A, Álvarez-García L, Morrás-Gómez M, Tabar-Liberal I, Pulido-Fontes M, Salmón-García B. Continuous Temperature Telemonitoring of Patients with COVID-19 and Other Infectious Diseases Treated in Hospital-at-Home: Viture ® System Validation. SENSORS (BASEL, SWITZERLAND) 2024; 24:5027. [PMID: 39124073 PMCID: PMC11314737 DOI: 10.3390/s24155027] [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: 05/31/2024] [Revised: 07/17/2024] [Accepted: 07/20/2024] [Indexed: 08/12/2024]
Abstract
Body temperature must be monitored in patients receiving Hospital-at-Home (HaH) care for COVID-19 and other infectious diseases. Continuous temperature telemonitoring (CTT) detects fever and patient deterioration early, facilitating decision-making. We performed a validation clinical study assessing the safety, comfort, and impact on healthcare practice of Viture®, a CTT system, compared with a standard digital axillary thermometer in 208 patients with COVID-19 and other infectious diseases treated in HaH at the Navarra University Hospital (HUN). Overall, 3258 pairs of measurements showed a clinical bias of -0.02 °C with limits of agreement of -0.96/+0.92 °C, a 95% acceptance rate, and a mean absolute deviation of 0.36 (SD 0.30) °C. Viture® detected 3 times more febrile episodes and revealed fever in 50% more patients compared with spot measurements. Febrile episodes were detected 7.23 h (mean) earlier and modified the diagnostic and/or therapeutic approach in 43.2% of patients. Viture® was validated for use in a clinical setting and was more effective in detecting febrile episodes than conventional methods.
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Affiliation(s)
| | - María Ruiz-Castellano
- Hospital at Home Unit, Navarra University Hospital (HUN), 31008 Pamplona, Navarra, Spain; (M.R.-C.); (L.Á.-G.); (M.M.-G.); (I.T.-L.); (M.P.-F.); (B.S.-G.)
| | | | - Laura Álvarez-García
- Hospital at Home Unit, Navarra University Hospital (HUN), 31008 Pamplona, Navarra, Spain; (M.R.-C.); (L.Á.-G.); (M.M.-G.); (I.T.-L.); (M.P.-F.); (B.S.-G.)
| | - Marta Morrás-Gómez
- Hospital at Home Unit, Navarra University Hospital (HUN), 31008 Pamplona, Navarra, Spain; (M.R.-C.); (L.Á.-G.); (M.M.-G.); (I.T.-L.); (M.P.-F.); (B.S.-G.)
| | - Idoia Tabar-Liberal
- Hospital at Home Unit, Navarra University Hospital (HUN), 31008 Pamplona, Navarra, Spain; (M.R.-C.); (L.Á.-G.); (M.M.-G.); (I.T.-L.); (M.P.-F.); (B.S.-G.)
| | - Marta Pulido-Fontes
- Hospital at Home Unit, Navarra University Hospital (HUN), 31008 Pamplona, Navarra, Spain; (M.R.-C.); (L.Á.-G.); (M.M.-G.); (I.T.-L.); (M.P.-F.); (B.S.-G.)
| | - Belén Salmón-García
- Hospital at Home Unit, Navarra University Hospital (HUN), 31008 Pamplona, Navarra, Spain; (M.R.-C.); (L.Á.-G.); (M.M.-G.); (I.T.-L.); (M.P.-F.); (B.S.-G.)
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Nunes T, Gaspar L, Faria JN, Portugal D, Lopes T, Fernandes P, Tavakoli M. Deployment and validation of a smart bed architecture for untethered patients with wireless biomonitoring stickers. Med Biol Eng Comput 2024:10.1007/s11517-024-03155-3. [PMID: 39037541 DOI: 10.1007/s11517-024-03155-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/10/2024] [Indexed: 07/23/2024]
Abstract
Conventional patient monitoring in healthcare has limitations such as delayed identification of deteriorating conditions, disruptions to patient routines, and discomfort due to extensive wiring for bed-bound patients. To address these, we have recently developed an innovative IoT-based healthcare system for real-time wireless patient monitoring. This system includes a flexible epidermal patch that collects vital signs using low power electronics and transmits the data to IoT nodes in hospital beds. The nodes connect to a smart gateway that aggregates the information and interfaces with the hospital information system (HIS), facilitating the exchange of electronic health records (EHR) and enhancing access to patient vital signs for healthcare professionals. Our study validates the proposed smart bed architecture in a clinical setting, assessing its ability to meet healthcare personnel needs, patient comfort, and data transmission reliability. Technical performance assessment involves analyzing key performance indicators for communication across various interfaces, including the wearable device and the smart box, and the link between the gateway and the HIS. Also, a comparative analysis is conducted on data from our architecture and traditional hospital equipment. Usability evaluation involves questionnaires completed by patients and healthcare professionals. Results demonstrate the robustness of the architecture proposed, exhibiting reliable and efficient information flow, while offering significant improvements in patient monitoring over conventional wired methods, including unrestricted mobility and improved comfort to enhance healthcare delivery.
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Affiliation(s)
- Tânia Nunes
- Institute of Systems and Robotics, University of Coimbra, Coimbra, Portugal
| | - Luís Gaspar
- Institute of Systems and Robotics, University of Coimbra, Coimbra, Portugal
| | - José N Faria
- Institute of Systems and Robotics, University of Coimbra, Coimbra, Portugal
| | - David Portugal
- Institute of Systems and Robotics, University of Coimbra, Coimbra, Portugal.
| | - Telmo Lopes
- Institute of Systems and Robotics, University of Coimbra, Coimbra, Portugal
| | - Pedro Fernandes
- Institute of Systems and Robotics, University of Coimbra, Coimbra, Portugal
| | - Mahmoud Tavakoli
- Institute of Systems and Robotics, University of Coimbra, Coimbra, Portugal
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Antikainen E, Njoum H, Kudelka J, Branco D, Rehman RZU, Macrae V, Davies K, Hildesheim H, Emmert K, Reilmann R, Janneke van der Woude C, Maetzler W, Ng WF, O’Donnell P, Van Gassen G, Baribaud F, Pandis I, Manyakov NV, van Gils M, Ahmaniemi T, Chatterjee M. Assessing fatigue and sleep in chronic diseases using physiological signals from wearables: A pilot study. Front Physiol 2022; 13:968185. [PMID: 36452041 PMCID: PMC9702812 DOI: 10.3389/fphys.2022.968185] [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] [Received: 06/13/2022] [Accepted: 10/31/2022] [Indexed: 08/07/2023] Open
Abstract
Problems with fatigue and sleep are highly prevalent in patients with chronic diseases and often rated among the most disabling symptoms, impairing their activities of daily living and the health-related quality of life (HRQoL). Currently, they are evaluated primarily via Patient Reported Outcomes (PROs), which can suffer from recall biases and have limited sensitivity to temporal variations. Objective measurements from wearable sensors allow to reliably quantify disease state, changes in the HRQoL, and evaluate therapeutic outcomes. This work investigates the feasibility of capturing continuous physiological signals from an electrocardiography-based wearable device for remote monitoring of fatigue and sleep and quantifies the relationship of objective digital measures to self-reported fatigue and sleep disturbances. 136 individuals were followed for a total of 1,297 recording days in a longitudinal multi-site study conducted in free-living settings and registered with the German Clinical Trial Registry (DRKS00021693). Participants comprised healthy individuals (N = 39) and patients with neurodegenerative disorders (NDD, N = 31) and immune mediated inflammatory diseases (IMID, N = 66). Objective physiological measures correlated with fatigue and sleep PROs, while demonstrating reasonable signal quality. Furthermore, analysis of heart rate recovery estimated during activities of daily living showed significant differences between healthy and patient groups. This work underscores the promise and sensitivity of novel digital measures from multimodal sensor time-series to differentiate chronic patients from healthy individuals and monitor their HRQoL. The presented work provides clinicians with realistic insights of continuous at home patient monitoring and its practical value in quantitative assessment of fatigue and sleep, an area of unmet need.
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Affiliation(s)
- Emmi Antikainen
- VTT Technical Research Centre of Finland Ltd., Tampere, Finland
| | | | - Jennifer Kudelka
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Diogo Branco
- LASIGE, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Rana Zia Ur Rehman
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Victoria Macrae
- NIHR Newcastle Biomedical Research Centre and NIHR Newcastle Clinical Research Facility, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Kristen Davies
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Hanna Hildesheim
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Kirsten Emmert
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Ralf Reilmann
- George-Huntington-Institute, University of Münster, Münster, Germany
- Department of Clinical Radiology, University of Münster, Münster, Germany
- Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | | | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Wan-Fai Ng
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
- NIHR Newcastle Biomedical Research Centre and NIHR Newcastle Clinical Research Facility, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Patricio O’Donnell
- Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, MA, United States
| | | | | | | | | | - Mark van Gils
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Teemu Ahmaniemi
- VTT Technical Research Centre of Finland Ltd., Tampere, Finland
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Dollard J, Hill KD, Wilson A, Ranasinghe DC, Lange K, Jones K, Boyle EM, Zhou M, Ng N, Visvanathan R. Patient Acceptability of a Novel Technological Solution (Ambient Intelligent Geriatric Management System) to Prevent Falls in Geriatric and General Medicine Wards: A Mixed-Methods Study. Gerontology 2022; 68:1070-1080. [PMID: 35490669 PMCID: PMC9501724 DOI: 10.1159/000522657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 02/02/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction As effective interventions to prevent inpatient falls are lacking, a novel technological intervention was trialed. The Ambient Intelligent Geriatric Management (AmbIGeM) system used wearable sensors that detected and alerted staff of patient movements requiring supervision. While the system did not reduce falls rate, it is important to evaluate the acceptability, usability, and safety of the AmbIGeM system, from the perspectives of patients and informal carers. Methods We conducted a mixed-methods study using semistructured interviews, a pre-survey and post-survey. The AmbIGeM clinical trial was conducted in two geriatric evaluation and management units and a general medical ward, in two Australian hospitals, and a subset of participants were recruited. Within 3 days of being admitted to the study wards and enrolling in the trial, 31 participants completed the pre-survey. Prior to discharge (post-intervention), 30 participants completed the post-survey and 27 participants were interviewed. Interview data were thematically analyzed and survey data were descriptively analyzed. Results Survey and interview participants had an average age of 83 (SD 9) years, 65% were female, and 41% were admitted with a fall. Participants considered the AmbIGeM system a good idea. Most but not all thought the singlet and sensor component as acceptable and comfortable, with no privacy concerns. Participants felt reassured with extra monitoring, although sometimes misunderstood the purpose of AmbIGeM as detecting patient falls. Participants' acceptability was strongly positive, with median 8+ (0–10 scale) on pre- and post-surveys. Discussion/Conclusion Patients' acceptability is important to optimize outcomes. Overall older patients considered the AmbIGeM system as acceptable, usable, and improving safety. The findings will be important to guide refinement of this and other similar technology developments.
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Affiliation(s)
- Joanne Dollard
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
- *Joanne Dollard,
| | - Keith D. Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Washington, Australia
| | - Anne Wilson
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Damith C. Ranasinghe
- School of Computer Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Kylie Lange
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Katherine Jones
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Washington, Australia
| | - Eileen Mary Boyle
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Washington, Australia
| | - Mengqi Zhou
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Nicholas Ng
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Aged & Extended Care Services, The Queen Elizabeth Hospital & Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
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Xintarakou A, Sousonis V, Asvestas D, Vardas PE, Tzeis S. Remote Cardiac Rhythm Monitoring in the Era of Smart Wearables: Present Assets and Future Perspectives. Front Cardiovasc Med 2022; 9:853614. [PMID: 35299975 PMCID: PMC8921479 DOI: 10.3389/fcvm.2022.853614] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/08/2022] [Indexed: 12/14/2022] Open
Abstract
Remote monitoring and control of heart function are of primary importance for patient evaluation and management, especially in the modern era of precision medicine and personalized approach. Breaking technological developments have brought to the frontline a variety of smart wearable devices, such as smartwatches, chest patches/straps, or sensors integrated into clothing and footwear, which allow continuous and real-time recording of heart rate, facilitating the detection of cardiac arrhythmias. However, there is great diversity and significant differences in the type and quality of the information they provide, thus impairing their integration into daily clinical practice and the relevant familiarization of practicing physicians. This review will summarize the different types and dominant functions of cardiac smart wearables available in the market. Furthermore, we report the devices certified by official American and/or European authorities and the respective sources of evidence. Finally, we comment pertinent limitations and caveats as well as the potential answers that flow from the latest technological achievements and future perspectives.
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Affiliation(s)
| | | | | | - Panos E Vardas
- Heart Sector, Hygeia Hospitals Group, HHG, Athens, Greece.,European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | - Stylianos Tzeis
- Department of Cardiology, Hygeia Group, Mitera Hospital, Athens, Greece
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Remote Monitoring of Chronic Critically Ill Patients after Hospital Discharge: A Systematic Review. J Clin Med 2022; 11:jcm11041010. [PMID: 35207287 PMCID: PMC8879658 DOI: 10.3390/jcm11041010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/29/2022] [Accepted: 02/11/2022] [Indexed: 12/22/2022] Open
Abstract
Background: Over the past few decades, critical care has seen many advancements. These advancements resulted in a considerable increase in the prevalence of chronically critically ill patients requiring prolonged medical care, which led to a massive increase in healthcare utilization. Methods: We performed a search for suitable articles using PubMed and Google Scholar from the inception of these databases to 15 May 2021. Results: Thirty-four articles were included in the review and analyzed. We described the following characteristics and problems with chronic critically ill patient management: the patient population, remote monitoring, the monitoring of physiological parameters in chronic critically ill patients, the anatomical location of sensors, the barriers to implementation, and the main technology-related issues. The main challenges in the management of these patients are (1) the shortage of caretakers, (2) the periodicity of vital function monitoring (e.g., episodic measuring of blood pressure leads to missing important critical events such as hypertension, hypotension, and hypoxia), and (3) failure to catch and manage critical physiological events at the right time, which can result in poor outcomes. Conclusions: The prevalence of critically ill patients is expected to grow. Technical solutions can greatly assist medical personnel and caregivers. Wearable devices can be used to monitor blood pressure, heart rate, pulse, respiratory rate, blood oxygen saturation, metabolism, and central nervous system function. The most important points that should be addressed in future studies are the performance of the remote monitoring systems, safety, clinical and economic outcomes, as well as the acceptance of the devices by patients, caretakers, and healthcare professionals.
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Rajbhandary PL, Nallathambi G, Selvaraj N, Tran T, Colliou O. ECG Signal Quality Assessments of a Small Bipolar Single-Lead Wearable Patch Sensor. Cardiovasc Eng Technol 2022; 13:783-796. [PMID: 35292914 PMCID: PMC8923108 DOI: 10.1007/s13239-022-00617-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/23/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE There is an increasing clinical interest in the adoption of small single-lead wearable ECG sensors for continuous cardiac monitoring. The purpose of this work is to assess ECG signal quality of such devices compared to gold standard 12-lead ECG. METHODS The ECG signal from a 1-lead patch was systematically compared to the 12-lead ECG device in thirty subjects to establish its diagnostic accuracy in terms of clinically relevant signal morphology, wave representation, fiducial markers and interval and wave duration. One minute ECG segments with good signal quality was selected for analysis and the features of ECG were manually annotated for comparative assessment. RESULTS The patch showed closest similarity based on correlation and normalized root-mean-square error to the standard ECG leads I, II, [Formula: see text] and [Formula: see text]. P-wave and QRS complexes in the patch showed sensitivity (Se) and positive predictive value (PPV) of at least 99.8% compared to lead II. T-wave representation showed Se and PPV of at least 99.9% compared to lead [Formula: see text] and [Formula: see text]. Mean errors for onset and offset of the ECG waves, wave durations, and ECG intervals were within 2 samples based on 125Hz patch ECG sampling frequency. CONCLUSION This study demonstrates the diagnostic capability with similar morphological representation and reasonable timing accuracy of ECG signal from a patch sensor compared to 12-lead ECG. The advantages and limitations of small bipolar single-lead wearable patch sensor compared to 12-lead ECG are discussed in the context of relevant differences in ECG signal for clinical applications.
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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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Huang N, Zhou M, Bian D, Mehta P, Shah M, Rajput KS, Selvaraj N. Novel Continuous Respiratory Rate Monitoring Using an Armband Wearable Sensor. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:7470-7475. [PMID: 34892821 DOI: 10.1109/embc46164.2021.9630025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Photoplethysmography (PPG) and accelerometer (ACC) are commonly integrated into wearable devices for continuous unobtrusive pulse rate and activity monitoring of individuals during daily life. However, obtaining continuous and clinically accurate respiratory rate measurements using such wearable sensors remains a challenge. This article presents a novel algorithm for estimation of respiration rate (RR) using an upper-arm worn wearable device by deriving multiple respiratory surrogate signals from PPG and ACC sensing. This RR algorithm is retrospectively evaluated on a controlled respiratory clinical testing dataset from 38 subjects with simultaneously recorded wearable sensor data and a standard capnography monitor as an RR reference. The proposed RR method shows great performance and robustness in determining RR measurements over a wide range of 4-59 brpm with an overall bias of -1.3 brpm, mean absolute error (MAE) of 2.7±1.6 brpm, and a meager outage of 0.3±1.2%, while a standard PPG Smart Fusion method produces a bias of -3.6 brpm, an MAE of 5.5±3.1 brpm, and an outage of 0.7±2.5% for direct comparison. In addition, the proposed algorithm showed no significant differences (p=0.63) in accurately determining RR values in subjects with darker skin tones, while the RR performance of the PPG Smart Fusion method is significantly (P<0.001) affected by the darker skin pigmentation. This study demonstrates a highly accurate RR algorithm for unobtrusive continuous RR monitoring using an armband wearable device.
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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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11
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Murali S, Brugger N, Rincon F, Mashru M, Cook S, Goy JJ. Cardiac Ambulatory Monitoring: New Wireless Device Validated Against Conventional Holter Monitoring in a Case Series. Front Cardiovasc Med 2020; 7:587945. [PMID: 33330650 PMCID: PMC7733961 DOI: 10.3389/fcvm.2020.587945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/30/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Cardiac arrhythmias are very common but underdiagnosed due to their transient and asymptomatic nature. An optimization of arrhythmia detection would permit to better treat patients and could substantially reduce morbidity and mortality. The SmartCardia ScaAI wireless patch is a novel CE IIa approved, single-lead electrocardiographic (ECG) ambulatory monitor designed for cardiac arrhythmias detection. Hypothesis: The accuracy of the new SmartCardia wireless patch to detect arrhythmias is comparable to the conventional Holter monitoring. Methods: Patients referred for a suspicion of arrhythmia between February and March 2020 were included in the trial. Simultaneous ambulatory ECG were recorded using a conventional 24-h Holter and the SmartCardia. The primary endpoint was the detection of cardiac arrhythmias over the total wear time of the devices, defined as premature atrial contraction (PAC), supraventricular tachycardia ≥3 beats, premature ventricular contraction (PVC), and ventricular tachycardia ≥3 beats. Conduction abnormalities, pause ≥2 s and atrioventricular block (AVB), were also tracked. McNemar's test was used to compare the matched pairs of data from both devices. Results: A total of 40 patients were included in the trial. Over the total wear time, there was no significant difference between the devices for ventricular and supraventricular arrhythmias detection. Pauses and AVB were equally identified by the two devices in three patients. Conclusion: Over the total wear time, the SmartCardia device showed an accuracy to detect arrhythmia similar to the 24-h Holter monitoring: single-lead, adhesive-patch monitoring might become an interesting alternative to the conventional Holter monitoring.
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Affiliation(s)
- Srinivasan Murali
- École polytechnique fédérale de Lausanne Innovation Park, Lausanne, Switzerland
| | | | - Francisco Rincon
- École polytechnique fédérale de Lausanne Innovation Park, Lausanne, Switzerland
| | - Manoj Mashru
- Sir Harkisandas Narottamdas Reliance Hospital, Mumbai, India
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12
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Rajbhandary PL, Nallathambi G. Feasibility of Continuous Monitoring of Core Body Temperature Using Chest-worn Patch Sensor. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:4652-4655. [PMID: 33019031 DOI: 10.1109/embc44109.2020.9175579] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
With rapid advancement in wearable biosensor technology, systems capable of real time, continuous and ambulatory monitoring of vital signs are increasingly emerging and their use can potentially help improve patient outcome. Monitoring continuous body temperature offers insights into its trend, allows early detection of fever and is critical in several diseases and clinical conditions including septicemia, infectious disease and others. There is a complex interaction between physiological and ambient parameters including heart rate, respiratory rate, muscle rigors and shivers, diaphoresis, local humidity, clothing, body, skin and ambient temperatures among others. This article presents feasibility analysis of a wireless biosensor patch device called as VitalPatch in capturing this physio-ambient-thermodynamic interaction to determine core body temperature, and details comparative performance assessments using oral thermometer and ingestible pill as reference devices. Based on a study on a cohort of 30 subjects with reference oral temperature, the proposed method showed a bias of 0.1 ± 0.37 °C, mean absolute error (MAE) of 0.29 ± 0.25 °C. Another cohort of 22 subjects with continuous core body temperature pill as reference showed a bias of 0.16 ± 0.38 °C and MAE of 0.42 ± 0.22 °C.Clinical Relevance- Non-invasive, continuous and real time body temperature monitoring can lead to earlier fever detection and provides remote patient monitoring that can result in improved patient and clinical outcome.
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13
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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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14
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Murali S, Rincon F, Cassina T, Cook S, Goy JJ. Heart Rate and Oxygen Saturation Monitoring With a New Wearable Wireless Device in the Intensive Care Unit: Pilot Comparison Trial. JMIR BIOMEDICAL ENGINEERING 2020. [DOI: 10.2196/18158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background
Continuous cardiac monitoring with wireless sensors is an attractive option for early detection of arrhythmia and conduction disturbances and the prevention of adverse events leading to patient deterioration. We present a new sensor design (SmartCardia), a wearable wireless biosensor patch, for continuous cardiac and oxygen saturation (SpO2) monitoring.
Objective
This study aimed to test the clinical value of a new wireless sensor device (SmartCardia) and its usefulness in monitoring the heart rate (HR) and SpO2 of patients.
Methods
We performed an observational study and monitored the HR and SpO2 of patients admitted to the intensive care unit (ICU). We compared the device under test (SmartCardia) with the ICU-grade monitoring system (Dräger-Healthcare). We defined optimal correlation between the gold standard and the wireless system as <10% difference for HR and <4% difference for SpO2. Data loss and discrepancy between the two systems were critically analyzed.
Results
A total of 58 ICU patients (42 men and 16 women), with a mean age of 71 years (SD 11), were included in this study. A total of 13.49 (SD 5.53) hours per patient were recorded. This represents a total recorded period of 782.3 hours. The mean difference between the HR detected by the SmartCardia patch and the ICU monitor was 5.87 (SD 16.01) beats per minute (bias=–5.66, SD 16.09). For SpO2, the average difference was 3.54% (SD 3.86; bias=2.9, SD 4.36) for interpretable values. SmartCardia’s patch measures SpO2 only under low-to-no activity conditions and otherwise does not report a value. Data loss and noninterpretable values of SpO2 represented 26% (SD 24) of total measurements.
Conclusions
The SmartCardia device demonstrated clinically acceptable accuracy for HR and SpO2 monitoring in ICU patients.
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15
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Alwashmi MF, Fitzpatrick B, Davis E, Farrell J, Gamble JM, Hawboldt J. Features of a mobile health intervention to manage chronic obstructive pulmonary disease: a qualitative study. Ther Adv Respir Dis 2020; 14:1753466620951044. [PMID: 32894025 PMCID: PMC7479870 DOI: 10.1177/1753466620951044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/07/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The use of mobile health (mHealth) interventions has the potential to enhance chronic obstructive pulmonary disease (COPD) treatment outcomes. Further research is needed to determine which mHealth features are required to potentially enhance COPD self-management. AIM The aim of this study was to explore the potential features of an mHealth intervention for COPD management with healthcare providers (HCPs) and patients with COPD. It could inform the development and successful implementation of mHealth interventions for COPD management. METHODS This was a qualitative study. We conducted semi-structured individual interviews with HCPs, including nurses, pharmacists and physicians who work directly with patients with COPD. Interviews were also conducted with a diverse sample of patients with COPD. Interview topics included demographics, mHealth usage, the potential use of medical devices and recommendations for features that would enhance an mHealth intervention for COPD management. RESULTS A total of 40 people, including nurses, physicians and pharmacists, participated. The main recommendations for the proposed mHealth intervention were categorised into two categories: patient interface and HCP interface. The prevalent features suggested for the patient interface include educating patients, collecting baseline data, collecting subjective data, collecting objective data via compatible medical devices, providing a digital action plan, allowing patients to track their progress, enabling family members to access the mHealth intervention, tailoring the features based on the patient's unique needs, reminding patients about critical management tasks and rewarding patients for their positive behaviours. The most common features of the HCP interface include allowing HCPs to track their patients' progress, allowing HCPs to communicate with their patients, educating HCPs and rewarding HCPs. CONCLUSION This study identifies important potential features so that the most effective, efficient and feasible mHealth intervention can be developed to improve the management of COPD.The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Meshari F. Alwashmi
- Health Sciences Centre, Memorial University of
Newfoundland, 300 Prince Philip Drive, St John’s, NL A1B 3V6, Canada
| | | | - Erin Davis
- Memorial University of Newfoundland, St John’s,
NL, Canada
| | - Jamie Farrell
- Memorial University of Newfoundland, St John’s,
NL, Canada
| | - John-Michael Gamble
- School of Pharmacy, Faculty of Science,
University of Waterloo, Waterloo, ON, Canada
| | - John Hawboldt
- Memorial University of Newfoundland, St John’s,
NL, Canada
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