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Pu L, Coppieters MW, Smalbrugge M, Jones C, Byrnes J, Todorovic M, Moyle W. Associations between facial expressions and observational pain in residents with dementia and chronic pain. J Adv Nurs 2024; 80:3846-3855. [PMID: 38334268 DOI: 10.1111/jan.16063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 12/13/2023] [Accepted: 01/07/2024] [Indexed: 02/10/2024]
Abstract
AIM To identify specific facial expressions associated with pain behaviors using the PainChek application in residents with dementia. DESIGN This is a secondary analysis from a study exploring the feasibility of PainChek to evaluate the effectiveness of a social robot (PARO) intervention on pain for residents with dementia from June to November 2021. METHODS Participants experienced PARO individually five days per week for 15 min (once or twice) per day for three consecutive weeks. The PainChek app assessed each resident's pain levels before and after each session. The association between nine facial expressions and the adjusted PainChek scores was analyzed using a linear mixed model. RESULTS A total of 1820 assessments were completed with 46 residents. Six facial expressions were significantly associated with a higher adjusted PainChek score. Horizontal mouth stretch showed the strongest association with the score, followed by brow lowering parting lips, wrinkling of the nose, raising of the upper lip and closing eyes. However, the presence of cheek raising, tightening of eyelids and pulling at the corner lip were not significantly associated with the score. Limitations of using the PainChek app were identified. CONCLUSION Six specific facial expressions were associated with observational pain scores in residents with dementia. Results indicate that automated real-time facial analysis is a promising approach to assessing pain in people with dementia. However, it requires further validation by human observers before it can be used for decision-making in clinical practice. IMPACT Pain is common in people with dementia, while assessing pain is challenging in this group. This study generated new evidence of facial expressions of pain in residents with dementia. Results will inform the development of valid artificial intelligence-based algorithms that will support healthcare professionals in identifying pain in people with dementia in clinical situations. REPORTING METHOD The study adheres to the CONSORT reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION One resident with dementia and two family members of people with dementia were consulted and involved in the study design, where they provided advice on the protocol, information sheets and consent forms, and offered valuable insights to ensure research quality and relevance. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry number (ACTRN12621000837820).
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Affiliation(s)
- Lihui Pu
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Michel W Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, Queensland, Australia
- Amsterdam Movement Sciences - Program Musculoskeletal Health, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, The Netherlands
| | - Cindy Jones
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Joshua Byrnes
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
| | - Michael Todorovic
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
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Fernandes S, von Gunten A, Verloo H. Using AI-Based Technologies to Help Nurses Detect Behavioral Disorders: Narrative Literature Review. JMIR Nurs 2024; 7:e54496. [PMID: 38805252 PMCID: PMC11167323 DOI: 10.2196/54496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The behavioral and psychological symptoms of dementia (BPSD) are common among people with dementia and have multiple negative consequences. Artificial intelligence-based technologies (AITs) have the potential to help nurses in the early prodromal detection of BPSD. Despite significant recent interest in the topic and the increasing number of available appropriate devices, little information is available on using AITs to help nurses striving to detect BPSD early. OBJECTIVE The aim of this study is to identify the number and characteristics of existing publications on introducing AITs to support nursing interventions to detect and manage BPSD early. METHODS A literature review of publications in the PubMed database referring to AITs and dementia was conducted in September 2023. A detailed analysis sought to identify the characteristics of these publications. The results were reported using a narrative approach. RESULTS A total of 25 publications from 14 countries were identified, with most describing prospective observational studies. We identified three categories of publications on using AITs and they are (1) predicting behaviors and the stages and progression of dementia, (2) screening and assessing clinical symptoms, and (3) managing dementia and BPSD. Most of the publications referred to managing dementia and BPSD. CONCLUSIONS Despite growing interest, most AITs currently in use are designed to support psychosocial approaches to treating and caring for existing clinical signs of BPSD. AITs thus remain undertested and underused for the early and real-time detection of BPSD. They could, nevertheless, provide nurses with accurate, reliable systems for assessing, monitoring, planning, and supporting safe therapeutic interventions.
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Affiliation(s)
- Sofia Fernandes
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Sion, Switzerland
- Les Maisons de la Providence Nursing Home, Le Châble, Switzerland
- Faculty of Biology and Medicine, Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Henk Verloo
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Lin N, Zhou X, Chen W, He C, Wang X, Wei Y, Long Z, Shen T, Zhong L, Yang C, Dai T, Zhang H, Shi H, Ma X. Development and validation of a point-of-care nursing mobile tool to guide the diagnosis of malnutrition in hospitalized adult patients: a multicenter, prospective cohort study. MedComm (Beijing) 2024; 5:e526. [PMID: 38606361 PMCID: PMC11006711 DOI: 10.1002/mco2.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/07/2024] [Accepted: 03/10/2024] [Indexed: 04/13/2024] Open
Abstract
Malnutrition is a prevalent and severe issue in hospitalized patients with chronic diseases. However, malnutrition screening is often overlooked or inaccurate due to lack of awareness and experience among health care providers. This study aimed to develop and validate a novel digital smartphone-based self-administered tool that uses facial features, especially the ocular area, as indicators of malnutrition in inpatient patients with chronic diseases. Facial photographs and malnutrition screening scales were collected from 619 patients in four different hospitals. A machine learning model based on back propagation neural network was trained, validated, and tested using these data. The model showed a significant correlation (p < 0.05) and a high accuracy (area under the curve 0.834-0.927) in different patient groups. The point-of-care mobile tool can be used to screen malnutrition with good accuracy and accessibility, showing its potential for screening malnutrition in patients with chronic diseases.
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Affiliation(s)
- Nan Lin
- Department of BiotherapyCancer CenterWest China Hospital, Sichuan UniversityChengduChina
| | - Xueyan Zhou
- Department of BiotherapyState Key Laboratory of Biotherapy, Frontiers Science Center for Disease‐related Molecular Network, West China Hospital, and Key Laboratory of Bio‐Resource and Eco‐Environment of Ministry of Education, College of Life Sciences, Sichuan UniversityChengduSichuanChina
| | - Weichang Chen
- State Key Laboratory of Oral DiseasesNational Clinical Research Center for Oral Diseases, Sichuan UniversityChengduChina
| | | | - Xiaoxuan Wang
- Department of BiotherapyCancer CenterWest China Hospital, Sichuan UniversityChengduChina
| | - Yuhao Wei
- Department of BiotherapyCancer CenterWest China Hospital, Sichuan UniversityChengduChina
| | | | - Tao Shen
- Department of Colorectal SurgeryThe Third Affiliated Hospital of Kunming Medical University/Yunnan Tumor HospitalKunmingChina
| | - Lingyu Zhong
- Department of Clinical NutritionHospital of Chengdu Office of People’s Government of Tibetan Autonomous RegionChengduChina
| | - Chan Yang
- Division of Endocrinology and MetabolismState Key Laboratory of Biotherapy, West China Hospital, Sichuan UniversityChengduChina
| | - Tingting Dai
- Department of Clinical NutritionWest China Hospital, Sichuan UniversityChengduChina
| | - Hao Zhang
- Division of Pancreatic SurgeryDepartment of General SurgeryWest China Hospital, Sichuan UniversityChengduChina
| | - Hubing Shi
- Laboratory of Integrative MedicineClinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation CenterChengduSichuanChina
| | - Xuelei Ma
- Department of BiotherapyCancer CenterWest China Hospital, Sichuan UniversityChengduChina
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Pu L, Coppieters MW, Smalbrugge M, Jones C, Byrnes J, Todorovic M, Moyle W. Implementing PainChek and PARO to Support Pain Assessment and Management in Residents with Dementia: A Qualitative Study. Pain Manag Nurs 2023; 24:587-594. [PMID: 37105837 DOI: 10.1016/j.pmn.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 02/27/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Pain is a common problem but often undiagnosed and untreated in people with dementia. AIMS This study explored the experiences of residents with dementia, family, andformal carers with (1) pain assessment and management for residents with dementia; (2) the use of the PainChek app for pain assessment, and (3) the use of a social robot PARO for pain management in residents with dementia. DESIGN A qualitative study. SETTINGS/PARTICIPANTS Interviews were conducted with 13 residents withdementia, three family members, and 18 formal carers from a residential aged carefacility. METHOD Residents with dementia interacted with PARO for 15 mins, five days perweek for three weeks. The PainChek app assessed pain levels before and after eachsession. After three-week intervention, individual interviews were conducted withresidents, family, and formal carers who experienced or observed the use of PainChekapp and PARO for residents. Interviews were audio-recorded, transcribed, andanalyzed using thematic analysis. RESULTS Four themes were identified regarding pain in residents with dementia: (1) the impact, challenges and strategies of pain assessment and management; (2) benefits and barriers of using PainChek app to assess pain; (3) benefits of interacting with PARO to manage pain and behavioral symptoms; and (4) implementing PainChek app and PARO to support pain assessment and management in dementia care. CONCLUSIONS Technology, such as PainChek and PARO, is promising to improve painassessment and reduce pain for people with dementia. Barriers to using technologyinclude limited staff training and the implementation of person-centered care.
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Affiliation(s)
- Lihui Pu
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Australia.
| | - Michel W Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; Amsterdam Movement Sciences - Program Musculoskeletal Health, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Martin Smalbrugge
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medicine for Older People, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, The Netherlands
| | - Cindy Jones
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| | - Joshua Byrnes
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Michael Todorovic
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Australia
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Yu C, Sommerlad A, Sakure L, Livingston G. Socially assistive robots for people with dementia: Systematic review and meta-analysis of feasibility, acceptability and the effect on cognition, neuropsychiatric symptoms and quality of life. Ageing Res Rev 2022; 78:101633. [PMID: 35462001 DOI: 10.1016/j.arr.2022.101633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 04/05/2022] [Accepted: 04/14/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND There is increasing interest in using robots to support dementia care but little consensus on the evidence for their use. The aim of the study is to review evidence about feasibility, acceptability and clinical effectiveness of socially assistive robots used for people with dementia. METHOD We conducted a systematic review and meta-analysis. We searched MEDLINE, EMBASE, PsychINFO, CINHAL, IEEE Xplore Digital Library, and EI Engineering Village from inception to 04 - 02-2022 - included primary studies assessing feasibility, acceptability, or effectiveness of socially assistive robots for people with dementia. Two independent reviewers screened studies for eligibility, and assessed quality. Narrative synthesis prioritized higher quality studies, and random-effect meta-analyses compared robots with usual care (UC) or active control (AC) immediately after the intervention (short-term; ST) or long-term (LT) on cognition, neuropsychiatric symptoms, and quality of life. FINDINGS 66 studies and four categories of robots were eligible: Companion robots (Pet and humanoid companion robots), telepresence communication robots, homecare assistive robots and multifunctional robots. PARO (companion robot seal) was feasible and acceptable but limited by its weight, cost, and sound. On meta-analysis, PARO had no ST or LT compared to UC or AC over 5-12 weeks on agitation (ST vs UC, 4 trials, 153 participants: pooled standardized mean difference (SMD) 0.25; - 0.57 to 0.06; LT vs UC; 2 trials, 77 participants, SMD = -0.24; - 0.94, 0.46), cognition (ST vs UC, 3 trials, 128 participants: SMD= 0.03; -0.32, 0.38), overall neuropsychiatric symptoms (ST vs UC, 3 trials, 169 participants: SMD= -0.01; -0.32, 0.29; ST vs AC, 2 trials, 145 participants: SMD =0.02, -0.71, 0.85), apathy (ST vs AC, 2 trials, 81 participants: SMD= 0.14; 0.29, 0.58), depression (ST vs UC, 4 trials, 181 participants; SMD= 0.08; -0.52, 0.69; LT vs UC: 2 trials, 77 participants: SMD =0.01; -0.75, 0.77), anxiety (ST vs UC: 2 trials, 104 participants, SMD= 0.24; -0.85, 1.33) and quality of life (ST vs UC, 2 trials, 127 participants: SMD=-0.05; -0.52, 0.42; ST vs AC: 2 trials, 159 participants, SMD =-0.36, -0.76, 0.05). Robotic animals, humanoid companion robots, telepresence robots and multifunctional robots were feasible and acceptable. However, humanoid companion robots have speech recognition problems, and telepresence robots and multifunctional robots were often difficult to use. There was mixed evidence about the feasibility of homecare robots. There was little evidence on any of these robots' effectiveness. CONCLUSION Although robots were generally feasible and acceptable, there is no clear evidence that people with dementia derive benefit from robots for cognition, neuropsychiatric symptoms, or quality of life. We recommend that future research should use high quality designs to establish evidence of effectiveness.
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