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Contini N, Soares SLZB, Falavigna A. Telemedicine for Patients with COVID-19: A Telehealth Experience in the Elderly at a Center in Southern Brazil. TELEMEDICINE REPORTS 2024; 5:205-211. [PMID: 39081456 PMCID: PMC11285998 DOI: 10.1089/tmr.2024.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 08/02/2024]
Abstract
Background Telemedicine has shown benefits in continuous care during the COVID-19 pandemic. This article discusses its practice in elderly patients with COVID-19, considering its limitations and benefits. Methods Patients with COVID-19, aged 60 years or older, were followed up through phone calls three times a week for 10 days at the Telemedicine Section of the Clinical Center of the University of Caxias do Sul (UCS) in the south of Brazil. The outcomes evaluated were referrals to hospital, basic health unit (BHU)/emergency care unit (ECU), and psychology and physiotherapy services; instructions about vaccination, isolation period, tests for COVID-19, taking a specific medication, and measuring oxygen saturation; guidance to family members; and avoiding going to hospitals. Results A total of 64 patients were followed up, the mean age was 69.28 years and 15.62% had at least one comorbidity. Among the patients, 7.81% were instructed about the vaccine, 23.43% about post-diagnostic tests, 25% about medication, 62.5% about isolation, 31.35% received guidance on saturation monitoring and 28.12% received guidance for family members, and 3.12% were referred to the hospital and 7.81% to the BHU/ECU (n = 5/64). Physiotherapy and psychology services were indicated for 4.68% of patients each, hospital visits were avoided in 31.25% and 93.75% recommended telemonitoring. Discussion In this experience, it is suggested that the telehealth service maximizes patient care and the health care effectiveness for patients with COVID-19. Furthermore, the sample studied showed good adherence and suggested the need for more guidance than face-to-face consultation.
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Affiliation(s)
- Natalia Contini
- Physicians graduated from the University of Caxias do Sul (UCS), Caxias do Sul, Brazil
| | | | - Asdrubal Falavigna
- Neurosurgery department at the University of Caxias do Sul, Rio Grande do Sul, Brazil
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Parr NJ, Beech EH, Young S, Valley TS. Racial and Ethnic Disparities in Occult Hypoxemia Prevalence and Clinical Outcomes Among Hospitalized Patients: A Systematic Review and Meta-analysis. J Gen Intern Med 2024:10.1007/s11606-024-08852-1. [PMID: 39020232 DOI: 10.1007/s11606-024-08852-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 05/31/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND There is growing concern that pulse oximeters are routinely less accurate in hospitalized patients with darker skin pigmentation, in turn increasing risk of undetected (occult) hypoxemia and adverse clinical outcomes. The aim of this systematic review and meta-analysis was to synthesize evidence on racial and ethnic disparities in occult hypoxemia prevalence and clinical impacts of undetected hypoxemia. METHODS Ovid MEDLINE, Embase, and CINAHL databases were searched for relevant articles published through January 2024. Eligible studies must have been conducted among adults in inpatient or outpatient settings and report occult hypoxemia prevalence stratified by patient race or ethnicity, or clinical outcomes stratified by patient race or ethnicity and occult hypoxemia status. Screening for inclusion was conducted independently by two investigators. Data extraction and risk of bias assessment were conducted by one investigator then checked by a second. Outcome data were synthesized using random-effects meta-analyses. RESULTS Fifteen primary studies met eligibility criteria and reported occult hypoxemia prevalence in 732,505 paired oximetry measurements from 207,464 hospitalized patients. Compared with White patients, occult hypoxemia is likely more common among Black patients (pooled prevalence ratio = 1.67, 95% CI 1.47 to 1.90) and among patients identifying as Asian, Latinx, Indigenous, multiracial, or other race or ethnicity (pooled prevalence ratio = 1.39, 95% CI 1.19 to 1.64). Findings from studies reporting clinical outcomes suggest that Black patients with undetected hypoxemia may experience poorer treatment delivery outcomes than White patients with undetected hypoxemia. No evidence was found from outpatient settings. DISCUSSION This review and included primary studies rely on self-identified race or ethnicity, which may obscure variability in occult hypoxemia risk. Findings underscore that clinicians should be aware of the risk of occult hypoxemia in hospitalized patients with darker skin pigmentation. Moreover, oximetry data from included studies suggests that the accuracy of pulse oximeters could vary substantially from patient to patient and even within individual patients. TRIAL REGISTRATION PROSPERO ( CRD42023402152 ).
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Affiliation(s)
- Nicholas J Parr
- VA Evidence Synthesis Program Coordinating Center, VA Portland Health Care System, 3710 SW US Veterans Hospital Road R&D 71, Portland, OR, 97239, USA.
| | - Erin H Beech
- VA Evidence Synthesis Program Coordinating Center, VA Portland Health Care System, 3710 SW US Veterans Hospital Road R&D 71, Portland, OR, 97239, USA
| | - Sarah Young
- VA Evidence Synthesis Program Coordinating Center, VA Portland Health Care System, 3710 SW US Veterans Hospital Road R&D 71, Portland, OR, 97239, USA
| | - Thomas S Valley
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
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Ximenes Braz B, Cavalcante Meneses G, Bezerra da Silva Junior G, Costa Martins AM, de Souza Mourão Feitosa AF, Cavalcante Lima Chagas G, De Francesco Daher E. Risk factors for mortality in coronavirus disease 2019 patients with silent hypoxemia. Rev Clin Esp 2024:S2254-8874(24)00089-4. [PMID: 38945525 DOI: 10.1016/j.rceng.2024.06.010] [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: 01/19/2024] [Accepted: 06/02/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE To describe the predictors of mortality in hospitalized patients with severe acute respiratory syndrome (SARS) due to COVID-19 presenting with silent hypoxemia. MATERIAL AND METHODS Retrospective cohort study of hospitalized patients with SARS due to COVID-19 and silent hypoxemia at admission, in Brazil, from January to June 2021. The primary outcome of interest was in-hospital death. Multivariable logistic regression analysis was performed. RESULTS Of 46,102 patients, the mean age was 59 ± 16 years, and 41.6% were female. During hospitalization, 13,149 patients died. Compared to survivors, non-survivors were older (mean age, 66 vs. 56 years; P < 0.001), less frequently female (43.6% vs. 40.9%; P < 0.001), and more likely to have comorbidities (74.3% vs. 56.8%; P < 0.001). Non-survivors had higher needs for invasive mechanical ventilation (42.4% vs. 6.6%; P < 0.001) and intensive care unit admission (56.9% vs. 20%; P < 0.001) compared to survivors. In the multivariable regression analysis, advanced age (OR 1.04; 95%CI 1.037-1.04), presence of comorbidities (OR 1.54; 95%CI 1.47-1.62), cough (OR 0.74; 95%CI 0.71-0.79), respiratory distress (OR 1.32; 95%CI 1.26-1.38), and need for non-invasive respiratory support (OR 0.37; 95%CI 0.35-0.40) remained independently associated with death. CONCLUSIONS Advanced age, presence of comorbidities, and respiratory distress were independent risk factors for mortality, while cough and requirement for non-invasive respiratory support were independent protective factors against mortality in hospitalized patients due to SARS due to COVID-19 with silent hypoxemia at presentation.
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Affiliation(s)
- Beatriz Ximenes Braz
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil; Internal Medicine Department, University of Miami, Miami, FL, United States
| | - Gdayllon Cavalcante Meneses
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil; Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Geraldo Bezerra da Silva Junior
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, CE, Brazil; Post-Graduation Program in Collective Health, Health Sciences Center, University of Fortaleza - UNIFOR, Fortaleza, CE, Brazil
| | - Alice Maria Costa Martins
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, CE, Brazil
| | | | - Gabriel Cavalcante Lima Chagas
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
| | - Elizabeth De Francesco Daher
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
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Sharma M, Brown AW, Powell NM, Rajaram N, Tong L, Mourani PM, Schootman M. Racial and skin color mediated disparities in pulse oximetry in infants and young children. Paediatr Respir Rev 2024; 50:62-72. [PMID: 38233229 PMCID: PMC11139570 DOI: 10.1016/j.prrv.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024]
Abstract
Race-based and skin pigmentation-related inaccuracies in pulse oximetry have recently been highlighted in several large electronic health record-based retrospective cohort studies across diverse patient populations and healthcare settings. Overestimation of oxygen saturation by pulse oximeters, particularly in hypoxic states, is disparately higher in Black compared to other racial groups. Compared to adult literature, pediatric studies are relatively few and mostly reliant on birth certificates or maternal race-based classification of comparison groups. Neonates, infants, and young children are particularly susceptible to the adverse life-long consequences of hypoxia and hyperoxia. Successful neonatal resuscitation, precise monitoring of preterm and term neonates with predominantly lung pathology, screening for congenital heart defects, and critical decisions on home oxygen, ventilator support and medication therapies, are only a few examples of situations that are highly reliant on the accuracy of pulse oximetry. Undetected hypoxia, especially if systematically different in certain racial groups may delay appropriate therapies and may further perpetuate health care disparities. The role of biological factors that may differ between racial groups, particularly skin pigmentation that may contribute to biased pulse oximeter readings needs further evaluation. Developmental and maturational changes in skin physiology and pigmentation, and its interaction with the operating principles of pulse oximetry need further study. Importantly, clinicians should recognize the limitations of pulse oximetry and use additional objective measures of oxygenation (like co-oximetry measured arterial oxygen saturation) where hypoxia is a concern.
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Affiliation(s)
- Megha Sharma
- Department of Pediatrics, Division of Neonatology, University of Arkansas for Medical Sciences, Little Rock, AR, United States; Arkansas Children's Research Institute, Little Rock, AR, United States.
| | - Andrew W Brown
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, United States; Arkansas Children's Research Institute, Little Rock, AR, United States
| | - Nicholas M Powell
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, United States
| | - Narasimhan Rajaram
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, United States; Winthrop P. Rockefeller Cancer Institute, Little Rock, AR, United States
| | - Lauren Tong
- Clinical Library Services, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Peter M Mourani
- Arkansas Children's Research Institute, Little Rock, AR, United States; Department of Pediatrics, Division of Pediatric Critical Care, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Mario Schootman
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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de la Merced Díaz-González C, Pérez-Bello C, De la Rosa-Hormiga M, González-Henríquez JJ, de las Mercedes Reyes-Noha M. Hospital Environmental Factors That Influence Peripheral Oxygen Saturation Measurements: A Cross-Sectional Study. Healthcare (Basel) 2024; 12:940. [PMID: 38727497 PMCID: PMC11083166 DOI: 10.3390/healthcare12090940] [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: 04/06/2024] [Revised: 04/28/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Pulse oximetry is a non-invasive, cost-effective, and generally reliable instrument measuring pulse rate and peripheral oxygen saturation (SpO2). However, these measurements can be affected by the patient's internal or external factors, including the type of pulse oximeter device (POD). (1) This study's objective was to identify potential environmental factors that may impact the measurements taken by three PODs. (2) Methods: A descriptive-analytical cross-sectional study was designed. The patients' SpO2 levels were measured using a standard monitor and two PODs owned by the professionals. The measurements were taken on the patients' fingers. Concurrently, we evaluated the surrounding environmental conditions, encompassing temperature, humidity, illuminance, and noise. (3) Results: This study involved 288 adult participants in the sample. For each 20-decibel increment in noise, there was a reduction in SpO2 by an average of 1%, whereas for every additional degree of ambient temperature, SpO2 decreased by an average of 2% (4) Conclusions: Significant correlations between SpO2 and age, as well as with noise and ambient temperature, were observed. No significant differences between oxygen saturation and lighting or humidity were observed. This study was prospectively registered with the Clinical Research Ethics Committee of Gran Canaria at the Dr. Negrín University Hospital, with protocol code 2019-247-1, and approved on 24 May 2019.
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Affiliation(s)
- Candelaria de la Merced Díaz-González
- Department of Nursing, Faculty of Health Sciences, University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Canary Islands, Spain; (C.P.-B.); (M.D.l.R.-H.)
| | - Cristina Pérez-Bello
- Department of Nursing, Faculty of Health Sciences, University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Canary Islands, Spain; (C.P.-B.); (M.D.l.R.-H.)
- Hospital Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Milagros De la Rosa-Hormiga
- Department of Nursing, Faculty of Health Sciences, University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Canary Islands, Spain; (C.P.-B.); (M.D.l.R.-H.)
| | - Juan José González-Henríquez
- Department of Mathematics, Faculty of Mathematics, University of Las Palmas de Gran Canaria, 35017 Las Palmas de Gran Canaria, Canary Islands, Spain;
| | - María de las Mercedes Reyes-Noha
- Continuous Training Department, Primary Care Management, Gran Canaria Health Area, 35006 Las Palmas de Gran Canaria, Canary Islands, Spain;
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León-Valladares D, Barrio-Mateu LA, Cortés-Carmona N, Fuentes-Lizana G, Cabanas AM, Latorre-Progulakis K, Fuentes-Guajardo M, Martín-Escudero P. Determining factors of pulse oximetry accuracy: a literature review. Rev Clin Esp 2024; 224:314-330. [PMID: 38599519 DOI: 10.1016/j.rceng.2024.04.005] [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: 01/18/2024] [Accepted: 03/17/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE Identify and reach consensus on the variables that affect the measurement of oxygen saturation using pulse oximetry. METHODS We applied inclusion and exclusion criteria to select relevant studies in databases such as Ebsco and PubMed. The search strategies, carried out until December 2023, focused on publications that addressed the technology of pulse oximeters and variables that influence their accuracy. We assessed the risk of bias of the included studies and used standardized methods for synthesis of results. RESULTS 23 studies were included. The synthesis of the results highlighted that equipment with tetrapolar technology showed greater precision in oxygen saturation measurements. Increased skin pigmentation, hemoglobinopathies and high skin temperatures can lead to an overestimation of SpO2, while factors such as low perfusion, cold skin temperature, nail polish or tattoos, hypoxemia, anemia and high altitude training, they may underestimate it. On the other hand, motion artifacts, light pollution, frequency >150 beats per minute, electromagnetic interference and location of the sensor can cause distortion of the photoplethymography signal. CONCLUSIONS The synthesis of the results highlighted that skin pigmentation and light interference can lead to an overestimation of SpO2, while other factors such as low perfusion and altitude tend to underestimate it. The studies presented variability and heterogeneity in their designs, evidencing limitations in the consistency and precision of the evidence. Despite these limitations, the results underscore the importance of considering multiple variables when interpreting pulse oximetry measurements to ensure their reliability. The findings have significant implications for clinical practice and future research.
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Affiliation(s)
- D León-Valladares
- Departamento de Ciencias de la Actividad Física y del Deporte, Facultad de Educación y Humanidades, Universidad de Tarapacá, Arica, Chile.
| | - L A Barrio-Mateu
- Departamento de Ciencias de la Actividad Física y del Deporte, Facultad de Educación y Humanidades, Universidad de Tarapacá, Arica, Chile
| | - N Cortés-Carmona
- Estudiante Semillero de Investigación, Departamento de Ciencias de la Actividad Física y del Deporte, Facultad de Educación y Humanidades, Universidad de Tarapacá, Arica, Chile
| | - G Fuentes-Lizana
- Estudiante Semillero de Investigación, Departamento de Ciencias de la Actividad Física y del Deporte, Facultad de Educación y Humanidades, Universidad de Tarapacá, Arica, Chile
| | - A M Cabanas
- Departamento de Física, Facultad de Ciencias, Universidad de Tarapacá, Arica, Chile
| | - K Latorre-Progulakis
- Departamento de Tecnología Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Arica, Chile
| | - M Fuentes-Guajardo
- Departamento de Tecnología Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Arica, Chile
| | - P Martín-Escudero
- Escuela de Medicina del Deporte, Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Medicina. UCM
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Siedner MJ, Sax PE. Repurposing Revisited: Exploring the Role of Metformin for Treatment of Coronavirus Disease 2019. Clin Infect Dis 2024:ciae154. [PMID: 38690870 DOI: 10.1093/cid/ciae154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Indexed: 05/03/2024] Open
Affiliation(s)
- Mark J Siedner
- Medical Practice Evaluation Center and Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Clinical Research Department, Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Paul E Sax
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Wilson JA, Berkenbosch JW. When (If) to Worry? Evaluating the Accuracy of Home-Grade Pulse Oximeter Devices. Respir Care 2024; 69:516-518. [PMID: 38538022 PMCID: PMC11108103 DOI: 10.4187/respcare.11960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Affiliation(s)
- Joseph A Wilson
- Department of PediatricsDivision of Pediatric Critical CareUniversity of Louisville School of MedicineLouisville, Kentucky
- "Just For Kids" Critical Care CenterNorton Children's HospitalLouisville, Kentucky
| | - John W Berkenbosch
- "Just For Kids" Critical Care CenterNorton Children's HospitalLouisville, Kentucky
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Kovesi T, Saban J, Haddad JF, Reddy D, Webster R, Udupa S. The Accuracy of Readily Available Consumer-Grade Oxygen Saturation Monitors in Pediatric Patients. Respir Care 2024; 69:387-394. [PMID: 38164568 PMCID: PMC11108112 DOI: 10.4187/respcare.11258] [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] [Indexed: 01/03/2024]
Abstract
BACKGROUND Pulse oximetry measurement is ubiquitous in acute health care settings in high-income countries and is familiar to any parent whose child has been treated in such a setting. Oximeters for home use are readily available online and are incorporated in several smartphones and smartwatches. METHODS We wished to determine how accurate are oximeters available online that are designated for adult and pediatric use, and the saturation monitor integrated in a smartphone, when used in children, compared to reference, hospital-grade oximeters. We evaluated a fingertip oximeter marketed for children purchased online; an adult fingertip oximeter purchased online; the oximeter integrated in a smartphone; and reference, hospital-grade oximeters. Participants were < 18 y of age. Bland-Altman charts were generated, and the estimated root mean square error (EARMS) was calculated. Rates of failure to obtain a measurement, relationship between device and time to successful measurement, relationship between age and time to successful measurement, and relationship between error (vs the reference device) and age were evaluated for each consumer-grade device. RESULTS We measured SpO2 in 74 children between 0.1-17.0 y of age. Subjects weighing < 30 kg had a median (interquartile range [IQR]) age of 2 (1.0 month-1.4 y) months, and subjects weighing ≥ 30 kg had a median (IQR) age of 14.3 (11.9-16.2) y. Readings could not be obtained in 7.5, 0, and 38.8% of subjects using the pediatric, adult, and smartphone oximeters, respectively. The time to successful reading had a modest negative correlation with age with the inexpensive adult and pediatric oximeters. The inexpensive pediatric oximeter had an overall negative bias, with a mean difference from the reference device of -4.5% (SD 7.9%) and an error that ranged from > 8% to < 33% the reference device. The EARMS was 7.92%. The inexpensive adult oximeter demonstrated no obvious trend in error in the limited saturation range evaluated of 87-99%. The overall mean difference was -0.7% (SD 2.5%). EARMS was 2.5%. The smartphone oximeter underestimated SpO2 at saturations < 94% and overestimated SpO2 for saturations > 94%. Saturations could read as much as > 4%, or < 17%, than the reference oximeter. The mean difference was -2.9% (SD 5.2%). EARMS was 5.1%. CONCLUSIONS Our findings suggest that the performance of consumer-grade devices varies considerably by both subject age and device. The pediatric fingertip device and smartphone application we tested are poorly suited for use in infants. The adult fingertip device we tested performed quite well in larger children with relatively normal oxygen saturations, and the pediatric fingertip device performed moderately well in subjects > 1 y of age who weighed < 30 kg. Given the vast number of devices available online and ever-changing technology, research to evaluate nonclinical oximeters will continue to be required.
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Affiliation(s)
- Thomas Kovesi
- Drs Kovesi, Saban, and Udupa are affiliated with Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada. Dr Haddad is affiliated with University of Calgary, Calgary, Canada. Ms Reddy and Dr Webster are affiliated with Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada.
| | - Jeremy Saban
- Drs Kovesi, Saban, and Udupa are affiliated with Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada. Dr Haddad is affiliated with University of Calgary, Calgary, Canada. Ms Reddy and Dr Webster are affiliated with Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - John Faissal Haddad
- Drs Kovesi, Saban, and Udupa are affiliated with Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada. Dr Haddad is affiliated with University of Calgary, Calgary, Canada. Ms Reddy and Dr Webster are affiliated with Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - Deepti Reddy
- Drs Kovesi, Saban, and Udupa are affiliated with Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada. Dr Haddad is affiliated with University of Calgary, Calgary, Canada. Ms Reddy and Dr Webster are affiliated with Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - Richard Webster
- Drs Kovesi, Saban, and Udupa are affiliated with Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada. Dr Haddad is affiliated with University of Calgary, Calgary, Canada. Ms Reddy and Dr Webster are affiliated with Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - Sharmila Udupa
- Drs Kovesi, Saban, and Udupa are affiliated with Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada. Dr Haddad is affiliated with University of Calgary, Calgary, Canada. Ms Reddy and Dr Webster are affiliated with Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
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Khushhal AA, Mohamed AA, Elsayed ME. Accuracy of Apple Watch to Measure Cardiovascular Indices in Patients with Chronic Diseases: A Cross Sectional Study. J Multidiscip Healthc 2024; 17:1053-1063. [PMID: 38496326 PMCID: PMC10941792 DOI: 10.2147/jmdh.s449071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/04/2024] [Indexed: 03/19/2024] Open
Abstract
Background The validity of the Apple Watch to measure the heart rate (HR) and oxygen saturation (Spo2) for patients with chronic diseases such as diabetes mellitus (DM), dyslipidemia, and hypertension is still unclear. Therefore, this study aims to investigate the accuracy of the Apple Watch in measuring the Spo2 and HR in patients with chronic diseases. Methods Forty-one patients with chronic diseases, including 20 with hypertension, 10 with diabetes, and 11 with dyslipidemia, completed a cross-sectional study. All participants used the Apple Watch against the Polar chest strap and the pulse oximeter at rest and during moderate intensity exercise sessions to measure HR and the SpO2 at rest for 5 minutes, during exercise for 16 minutes, and followed by 3 minutes of rest. The HR was measured during all previous periods, but evaluation of the Spo2 included 5 measures, done only before and after exercise, with a minute interval between each measure. Results Overall, a strong correlation exists between measuring the SpO2 using the Apple Watch against the pulse oximeter (Contec) at rest (r = 0.92, p < 0.001) and after exercise (r = 0.86, p < 0.001) in all patients. The HR had a very strong correlation between the Apple Watch and the Polar chest strap (r = 0.99, p < 0.001) in all patients. There was no significant difference (p = 0.76) between the twenty-seven white and fourteen brown-skinned patients. Conclusion The Apple Watch is valid to measure the HR and SpO2 in patients with chronic diseases. Clinical Trial Registration No NCT05271864.
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Affiliation(s)
- Alaa Abdulhafiz Khushhal
- Department of Medical Rehabilitation Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ashraf Abdelaal Mohamed
- Department of Medical Rehabilitation Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
- Department of Physical Therapy for Cardiovascular/ Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Mahmoud Elshahat Elsayed
- Cardiology Department, Umm Al-Qura University Medical Center, Umm Al-Qura University, Makkah, Saudi Arabia
- Cardiology Department, Faculty of Medicine, Al Azhar University, Cairo, Egypt
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Alessandri-Bonetti A, Sangalli L, Gallenzi P. Impact of Concurrent Use of N95 and Surgical Masks on Peripheral Oxygen Saturation and Heart Rate Frequency-A Prospective Study during the COVID-19 Outbreak. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:276. [PMID: 38399563 PMCID: PMC10890314 DOI: 10.3390/medicina60020276] [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: 01/04/2024] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: The COVID-19 outbreak has necessitated the prolonged use of N95 facemasks in addition to traditional surgical facemasks by healthcare workers. The aim of this study was to investigate the effect of wearing N95 facemasks in addition to surgical facemasks on peripheral oxygen saturation (SpO2) and heart rate (HR) among dental professionals during routine care. Materials and Methods: This prospective study compared SpO2 and HR between dental providers wearing N95 + surgical facemasks vs. wearing a surgical facemask only. SpO2 and HR were recorded using a portable pulse oximeter before wearing the facemask (T0); at 30 min (T1); at 1 h (T2); and at the end of clinical activity (T3). Inter-group and intra-group differences were assessed with independent t tests and repeated measures ANOVA, respectively. Results: A total of 88 participants (57 wearing N95 + surgical facemasks, and 31 wearing a surgical facemask only) completed the study. The two groups did not statistically differ in SpO2 at different timepoints nor showed any intra-group differences. The participants wearing N95 + surgical facemasks exhibited a statistically higher HR at T0 (p = 0.007), T2 (p = 0.010), and T3 (p = 0.014) compared to those wearing a surgical facemask only. A statistically significant decrease was observed in HR between T0 and T3 in those wearing N95 + surgical facemasks (p = 0.012). No intra-group differences were seen in HR over time in those wearing a surgical facemask only. Conclusions: The continuous use of an N95 in addition to a surgical facemask did not show any significant effects in SpO2 during routine care; however, the concurrent use of an N95 and a surgical facemask seemed to be accompanied by a decrease in HR, although the values remained within the normal range.
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Affiliation(s)
- Anna Alessandri-Bonetti
- Department of Dental Clinic and Maxillofacial Surgery, A. Gemelli University Policlinic IRCCS, Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy; (A.A.-B.); (P.G.)
| | - Linda Sangalli
- College of Dental Medicine—Illinois, Midwestern University, 555 31st Street, Downers Grove, IL 60515, USA
| | - Patrizia Gallenzi
- Department of Dental Clinic and Maxillofacial Surgery, A. Gemelli University Policlinic IRCCS, Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy; (A.A.-B.); (P.G.)
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12
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Fox TH, Mazalewski WR, Tran HS, Lindsey T, Krishnan A, Kantrow SP, Happel KI, Janz DR, deBoisblanc BP, Lammi MR. Discordance Between Invasive and NonInvasive Oxygen Saturation in Critically Ill COVID-19 Patients. J Intensive Care Med 2023; 38:1151-1157. [PMID: 37415515 PMCID: PMC10331117 DOI: 10.1177/08850666231186947] [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] [Indexed: 07/08/2023]
Abstract
OBJECTIVES To investigate discordance in oxy-hemoglobin saturation measured both by pulse oximetry (SpO2) and arterial blood gas (ABG, SaO2) among critically ill coronavirus disease 2019 (COVID-19(+)) patients compared to COVID-19(-) patients. METHODS Paired SpO2 and SaO2 readings were collected retrospectively from consecutive adult admissions to four critical care units in the United States between March and May 2020. The primary outcome was the rate of discordance (|SaO2-SpO2|>4%) in COVID-19(+) versus COVID-19(-) patients. The odds each cohort could have been incorrectly categorized as having a PaO2/FiO2 above or below 150 by their SpO2: Fractional inhaled oxygen ratio (pulse oximetry-derived oxyhemoglobin saturation:fraction of inspired oxygen ratio [SF]) was examined. A multivariate regression analysis assessed confounding by clinical differences between cohorts including pH, body temperature, renal replacement therapy at time of blood draw, and self-identified race. RESULTS There were 263 patients (173 COVID-19(+)) included. The rate of saturation discordance between SaO2 and SpO2 in COVID-19(+) patients was higher than in COVID-19(-) patients (27.9% vs 16.7%, odds ratio [OR] 1.94, 95% confidence interval [CI]: 1.11 to 2.27). The average difference between SaO2 and SpO2 for COVID-19(+) patients was -1.24% (limits of agreement, -13.6 to 11.1) versus -0.11 [-10.3 to 10.1] for COVID-19(-) patients. COVID-19(+) patients had higher odds (OR: 2.61, 95% CI: 1.14-5.98) of having an SF that misclassified that patient as having a PaO2:FiO2 ratio above or below 150. There was not an association between discordance and the confounders of pH, body temperature, or renal replacement therapy at time of blood draw. After controlling for self-identified race, the association between COVID-19 status and discordance was lost. CONCLUSIONS Pulse oximetry was discordant with ABG more often in critically ill COVID-19(+) than COVID-19(-) patients. However, these findings appear to be driven by racial differences between cohorts.
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Affiliation(s)
- Thomas H. Fox
- Section of Internal/Emergency Medicine, LSU School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - William R. Mazalewski
- Section of Pulmonary/Critical Care and Allergy/Immunology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Hai S. Tran
- Section of Pulmonary/Critical Care and Allergy/Immunology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Travis Lindsey
- Department of Psychiatry, LSU School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Amita Krishnan
- Section of Pulmonary/Critical Care and Allergy/Immunology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Stephen P. Kantrow
- Section of Internal/Emergency Medicine, LSU School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Kyle I. Happel
- Section of Internal/Emergency Medicine, LSU School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - David R. Janz
- Section of Pulmonary/Critical Care and Allergy/Immunology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- University Medical Center, New Orleans, LA, USA
| | - Bennett P. deBoisblanc
- Section of Pulmonary/Critical Care and Allergy/Immunology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Matthew R. Lammi
- Section of Pulmonary/Critical Care and Allergy/Immunology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Dcosta JV, Ochoa D, Sanaur S. Recent Progress in Flexible and Wearable All Organic Photoplethysmography Sensors for SpO 2 Monitoring. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2302752. [PMID: 37740697 PMCID: PMC10625116 DOI: 10.1002/advs.202302752] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/09/2023] [Indexed: 09/25/2023]
Abstract
Flexible and wearable biosensors are the next-generation healthcare devices that can efficiently monitor human health conditions in day-to-day life. Moreover, the rapid growth and technological advancements in wearable optoelectronics have promoted the development of flexible organic photoplethysmography (PPG) biosensor systems that can be implanted directly onto the human body without any additional interface for efficient bio-signal monitoring. As an example, the pulse oximeter utilizes PPG signals to monitor the oxygen saturation (SpO2 ) in the blood volume using two distinct wavelengths with organic light emitting diode (OLED) as light source and an organic photodiode (OPD) as light sensor. Utilizing the flexible and soft properties of organic semiconductors, pulse oximeter can be both flexible and conformal when fabricated on thin polymeric substrates. It can also provide highly efficient human-machine interface systems that can allow for long-time biological integration and flawless measurement of signal data. In this work, a clear and systematic overview of the latest progress and updates in flexible and wearable all-organic pulse oximetry sensors for SpO2 monitoring, including design and geometry, processing techniques and materials, encapsulation and various factors affecting the device performance, and limitations are provided. Finally, some of the research challenges and future opportunities in the field are mentioned.
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Affiliation(s)
- Jostin Vinroy Dcosta
- Mines Saint‐ÉtienneCentre Microélectronique de ProvenceDepartment of Flexible Electronics880, Avenue de MimetGardanne13541France
| | - Daniel Ochoa
- Mines Saint‐ÉtienneCentre Microélectronique de ProvenceDepartment of Flexible Electronics880, Avenue de MimetGardanne13541France
| | - Sébastien Sanaur
- Mines Saint‐ÉtienneCentre Microélectronique de ProvenceDepartment of Flexible Electronics880, Avenue de MimetGardanne13541France
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14
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Zhong Y, Jatav A, Afrin K, Shivaram T, Bukkapatnam STS. Enhanced SpO 2 estimation using explainable machine learning and neck photoplethysmography. Artif Intell Med 2023; 145:102685. [PMID: 37925216 DOI: 10.1016/j.artmed.2023.102685] [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: 12/25/2022] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 11/06/2023]
Abstract
Reflectance-based photoplethysmogram (PPG) sensors provide flexible options of measuring sites for blood oxygen saturation (SpO2) measurement. But they are mostly limited by accuracy, especially when applied to different subjects, due to the diverse human characteristics (skin colors, hair density, etc.) and usage conditions of different sensor settings. This study addresses the estimation of SpO2 at non-standard measuring sites employing reflectance-based sensors. It proposes an automated construction of subject inclusion-exclusion criteria for SpO2 measuring devices, using a combination of unsupervised clustering, supervised regression, and model explanations. This is perhaps among the first adaptation of SHAP to explain the clusters gleaned from unsupervised learning methods. As a wellness application case study, we developed a pillow-based wearable device to collect reflectance PPGs from both the brachiocephalic and carotid arteries around the neck. The experiment was conducted on 33 subjects, each under totally 80 different sensor settings. The proposed approach addressed the variations of humans and devices, as well as the heterogeneous mapping between signals and SpO2 values. It identified effective device settings and characteristics of their applicable subject groups (i.e., subject inclusion-exclusion criteria). Overall, it reduced the root mean squared error (RMSE) by 16%, compared to an empirical formula and a plain SpO2 estimation model.
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Affiliation(s)
- Yuhao Zhong
- Wm Michael Barnes '64 Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX 77840, USA.
| | - Ashish Jatav
- Wm Michael Barnes '64 Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX 77840, USA.
| | - Kahkashan Afrin
- Wm Michael Barnes '64 Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX 77840, USA.
| | - Tejaswini Shivaram
- Department of Electrical & Computer Engineering, Texas A&M University, College Station, TX 77840, USA.
| | - Satish T S Bukkapatnam
- Wm Michael Barnes '64 Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX 77840, USA.
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15
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Wu J, McKnight JC, Bønnelycke EMS, Bosco G, Giacon TA, Kainerstorfer JM. Self-calibrated pulse oximetry algorithm based on photon pathlength change and the application in human freedivers. JOURNAL OF BIOMEDICAL OPTICS 2023; 28:115002. [PMID: 38078151 PMCID: PMC10704087 DOI: 10.1117/1.jbo.28.11.115002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 12/18/2023]
Abstract
Significance Pulse oximetry estimates the arterial oxygen saturation of hemoglobin (SaO 2 ) based on relative changes in light intensity at the cardiac frequency. Commercial pulse oximeters require empirical calibration on healthy volunteers, resulting in limited accuracy at low oxygen levels. An accurate, self-calibrated method for estimating SaO 2 is needed to improve patient monitoring and diagnosis. Aim Given the challenges of calibration at low SaO 2 levels, we pursued the creation of a self-calibrated algorithm that can effectively estimate SaO 2 across its full range. Our primary objective was to design and validate our calibration-free method using data collected from human subjects. Approach We developed an algorithm based on diffuse optical spectroscopy measurements of cardiac pulses and the modified Beer-Lambert law (mBLL). Recognizing that the photon mean pathlength (⟨ L ⟩ ) varies with SaO 2 related absorption changes, our algorithm aligns/fits the normalized ⟨ L ⟩ (across wavelengths) obtained from optical measurements with its analytical representation. We tested the algorithm with human freedivers performing breath-hold dives. A continuous-wave near-infrared spectroscopy probe was attached to their foreheads, and an arterial cannula was inserted in the radial artery to collect arterial blood samples at different stages of the dive. These samples provided ground-truth SaO 2 via a blood gas analyzer, enabling us to evaluate the accuracy of SaO 2 estimation derived from the NIRS measurement using our self-calibrated algorithm. Results The self-calibrated algorithm significantly outperformed the conventional method (mBLL with a constant ⟨ L ⟩ ratio) for SaO 2 estimation through the diving period. Analyzing 23 ground-truth SaO 2 data points ranging from 41% to 100%, the average absolute difference between the estimated SaO 2 and the ground truth SaO 2 is 4.23 % ± 5.16 % for our algorithm, significantly lower than the 11.25 % ± 13.74 % observed with the conventional approach. Conclusions By factoring in the variations in the spectral shape of ⟨ L ⟩ relative to SaO 2 , our self-calibrated algorithm enables accurate SaO 2 estimation, even in subjects with low SaO 2 levels.
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Affiliation(s)
- Jingyi Wu
- Carnegie Mellon University, Department of Biomedical Engineering, Pittsburgh, Pennsylvania, United States
| | - J. Chris McKnight
- University of St Andrews, Sea Mammal Research Unit, St Andrews, United Kingdom
| | | | - Gerardo Bosco
- University of Padua, Department of Biomedical Sciences, Padua, Italy
| | - Tommaso Antonio Giacon
- University of Padua, Department of Biomedical Sciences, Padua, Italy
- Padua University Hospital, Institute of Anesthesia and Intensive Care, Padua, Italy
- University of Padua, Department of Medicine, Padua, Italy
| | - Jana M. Kainerstorfer
- Carnegie Mellon University, Department of Biomedical Engineering, Pittsburgh, Pennsylvania, United States
- Carnegie Mellon University, Neuroscience Institute, Pittsburgh, Pennsylvania, United States
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16
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Castro-Arellano SB, Sandoval-Mosqueda LE, Flores-Murrieta FJ. [Saturation index and fraction of inspired oxygen as a predictor in COVID-19]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:S416-S421. [PMID: 37934832 PMCID: PMC10735272 DOI: 10.5281/zenodo.8319752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/01/2023] [Indexed: 11/09/2023]
Abstract
Background Coronavirus disease leads to silent hypoxia, ARDS, and organ failure. The saturation and fraction of inspired oxygen have been related to the degree of lung damage, can be considered as a monitoring tool for lung function during hospitalization and a predictor of mortality in patients with pneumonia by COVID-19. Objective To evaluate the usefulness of the oxygen saturation index and fraction of inspired oxygen as a predictor of mortality in patients with COVID-19 pneumonia. Material and methods A retrospective, longitudinal, analytical study. Files of eligible patients with a diagnosis of SARS-CoV-2 pneumonia were admitted to HGR No.2, complete file, recording of oxygen saturation and inspired fraction of oxygen, were included. Patients dependent on supplemental oxygen, who did not require supplemental oxygen during their hospitalization, incomplete records, patients who have died from non-pulmonary causes, were excluded. Results A sample of 175 files with a diagnosis of pneumonia with SARS-CoV-2 was obtained. A logistic regression model was performed including age over 60 years BE of 2.68, with CI (1.09-6.5), DM2 with a BE of 2.35 with CI (0.99-5.59), HTA with a BE of 0.80, with CI (0.32-2.02), SAFI index less than 310 with a BE of 6.63, with a CI (2.64-16.65), endotracheal intubation with a BE 48.43, and a CI (2.64-16.65). Conclusion The SpO2/Fio2 index can be used for continuous monitoring of lung function in patients with COVID-19 pneumonia, in an accessible, easy and economical way. A relationship with mortality was obtained in patients with SpO2/FiO2 less than 310 associated with other factors.
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Affiliation(s)
- Shareni Berenice Castro-Arellano
- Instituto Mexicano del Seguro Social, Hospital General Regional No. 2 “Dr. Guillermo Fajardo Ortiz”, Servicio de Urgencias. Ciudad de México, México Instituto Mexicano del Seguro SocialMéxico
| | - Laura Elizabeth Sandoval-Mosqueda
- Instituto Mexicano del Seguro Social, Hospital General de Zona No. 48 “San Pedro Xalpa”, Servicio de Urgencias. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Francisco Javier Flores-Murrieta
- Instituto Mexicano del Seguro Social, Hospital General Regional No. 2 “Dr. Guillermo Fajardo Ortiz”, Servicio de Urgencias. Ciudad de México, México Instituto Mexicano del Seguro SocialMéxico
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17
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Aggarwal AN, Agarwal R, Dhooria S, Prasad KT, Sehgal IS, Muthu V. Impact of Fingernail Polish on Pulse Oximetry Measurements: A Systematic Review. Respir Care 2023; 68:1271-1280. [PMID: 37185113 PMCID: PMC10468177 DOI: 10.4187/respcare.10399] [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] [Indexed: 05/17/2023]
Abstract
BACKGROUND The effect of application of fingernail polish on SpO2 measurement remains unclear. We conducted this systematic review to ascertain the impact of fingernail polish on SpO2 measurement. METHODS We queried PubMed, Embase, and CINAHL databases for publications indexed through December 2022. We included studies providing paired SpO2 data from fingertips without and after nail polish application or reporting the number of subjects whose SpO2 could not be measured due to fingernail polish. We used random effects modeling to summarize standardized mean differences (SMDs) and corresponding 95% CI for different nail polish colors from comparative studies. RESULTS We retrieved 122 studies and included 21 publications, mostly performed on healthy volunteers. Of these, 17 (81.0%) studies had a low risk of bias. We summarized mean SMD for 10 nail polish colors (black, blue, brown, green, orange, pink, purple, red, white, and yellow) from 25 paired data sets on SpO2 across 20 studies. We found small (likely clinically insignificant) but statistically significant differences in mean SpO2 when fingers were coated with black, blue, brown, or purple nail polish (SMD -0.57, -0.47, -0.33, and -0.25, respectively; 95% CI -0.86 to -0.29, -0.84 to -0.10, -0.59 to -0.07, and -0.48 to -0.02, respectively). Only one of 4 studies reported a high proportion of unsuccessful oximeter readings from fingers painted with black (88.0%) or brown (36.0%) nail polish. CONCLUSIONS Although fingernail polish of some colors can marginally reduce SpO2 reading or occasionally impede SpO2 measurement, the variability is clinically insignificant.
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Affiliation(s)
- Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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18
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Kagiyama N, Hiki M, Matsue Y, Dohi T, Matsuzawa W, Daida H, Minamino T, Kasai T. Validation of telemedicine-based self-assessment of vital signs for patients with COVID-19: A pilot study. J Telemed Telecare 2023; 29:600-606. [PMID: 33966523 PMCID: PMC10466931 DOI: 10.1177/1357633x211011825] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/15/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION In the ongoing COVID-19 pandemic, the development of a system that would prevent the infection of healthcare providers is in urgent demand. We sought to investigate the feasibility and validity of a telemedicine-based system in which healthcare providers remotely check the vital signs measured by patients with COVID-19. METHODS Patients hospitalized with confirmed or suspected COVID-19 measured and uploaded their vital signs to secure cloud storage. Additionally, the respiratory rates were monitored using a mat-type sensor placed under the bed. We assessed the time until the values became available on the Cloud and the agreements between the patient-measured vital signs and simultaneous healthcare provider measurements. RESULTS Between 26 May-23 September 2020, 3835 vital signs were measured and uploaded to the cloud storage by the patients (n=16, median 72 years old, 31% women). All patients successfully learned how to use these devices with a 10-minute lecture. The median time until the measurements were available on the cloud system was only 0.35 min, and 95.2% of the vital signs were available within 5 min of the measurement. The agreement between the patients' and healthcare providers' measurements was excellent for all parameters. Interclass coefficient correlations were as follows: systolic (0.92, p<0.001), diastolic blood pressure (0.86, p<0.001), heart rate (0.89, p<0.001), peripheral oxygen saturation (0.92, p<0.001), body temperature (0.83, p<0.001), and respiratory rates (0.90, p<0.001). CONCLUSIONS Telemedicine-based self-assessment of vital signs in patients with COVID-19 was feasible and reliable. The system will be a useful alternative to traditional vital sign measurements by healthcare providers during the COVID-19 pandemic.
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Affiliation(s)
- Nobuyuki Kagiyama
- Department of Digital Health and Telemedicine R&D, Juntendo University, Japan
- Department of Cardiovascular Biology and Medicine, Juntendo University, Japan
| | - Makoto Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University, Japan
- Department of Emergency Medicine, Juntendo University, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Biology and Medicine, Juntendo University, Japan
| | | | - Hiroyuki Daida
- Department of Digital Health and Telemedicine R&D, Juntendo University, Japan
- Department of Cardiovascular Biology and Medicine, Juntendo University, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University, Japan
| | - Takatoshi Kasai
- Department of Digital Health and Telemedicine R&D, Juntendo University, Japan
- Department of Cardiovascular Biology and Medicine, Juntendo University, Japan
- Cardiovascular Respiratory Sleep Medicine, Juntendo University, Japan
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19
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Hirsch K, Cubbidge RP, Heitmar R. Dual wavelength retinal vessel oximetry - influence of fundus pigmentation. Eye (Lond) 2023; 37:2246-2251. [PMID: 36460856 PMCID: PMC9716545 DOI: 10.1038/s41433-022-02325-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/17/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Clinical methods examining oxygenation parameters in humans have been used in many different care settings, but concerns have been raised regarding their clinical utility when assessing people with darker skin pigmentation. While saturation values can be crucial in emergency medicine, they are equally valuable in assessing disease mechanisms and monitoring change in disease progression. Retinal pigmentation varies across individuals and hence, can impact on retinal oxygen parameters. The objective of this study was to quantify and eliminate the impact of retinal pigmentation on retinal vessel oxygen saturation parameters measured in the superficial retinal arterioles and venules. METHODS 105 healthy individuals of varying skin colour, iris colour and heritage were included. Following a full eye exam to exclude any ocular abnormality, all participants underwent intraocular pressure, systemic blood pressure measurements and dilated dual wavelength retinal photography. Rotation matrices were employed to minimise the dependency of retinal pigmentation on arterial and venous oxygen saturation measurements determined in a concentric measurement annulus. RESULTS Retinal oxygen saturation in venules showed a linear correlation with retinal pigmentation (y = 0.34 × x + 38.598), whereas arterial saturation followed a polynomial pattern (y = 0.0089 × x2 + 0.7499 × x + 85.073). Both arterial and venous saturation values were corrected using local fundus pigmentation. Pre-correction retinal arterial and venous oxygen saturation were 89.0% (±13.1) and 43.7% (±11.5), respectively, and post- correction values were 94.8% (±8.7) for arteries and 56.3% (±7.0) veins. CONCLUSIONS When assessing multi-ethnic cohorts, it is important to consider the impact of pigmentation on imaging parameters and to account for it prior to clinical interpretation.
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Affiliation(s)
- Katrin Hirsch
- The University of the West of England, School of Health and Social Wellbeing, Glenside Campus, Bristol, BS16 1DD, UK.
| | - Robert P Cubbidge
- ABDO College, Godmersham Park, Canterbury, Kent, CT4 7DT, UK
- Aston University, Aston Triangle, Birmingham, B4 7ET, UK
| | - Rebekka Heitmar
- University of Huddersfield, School of Applied Sciences, Centre for Vision across the Life Span, Queensgate, HD1 3DH, UK.
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Naghashpour M, Adelipour M, Mobarak S, Piri M, Seyedtabib M, Maghsoudi F, Golabi S. Evaluation of Possible Association between Serum Levels of Aldosterone and Cortisol with Clinical Symptoms Progression in COVID-19 Suspicious Outpatients Tested for SARS-CoV2 RT-PCR: An Analytical Cross-Sectional Study. ARCHIVES OF RAZI INSTITUTE 2023; 78:923-933. [PMID: 38028858 PMCID: PMC10657945 DOI: 10.22092/ari.2021.356094.1774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/18/2021] [Indexed: 12/01/2023]
Abstract
Aldosterone is a key component of Renin-Angiotensin-Aldosterone System (RAAS). The RAAS could play a substantial role in the pathophysiology of coronavirus disease 2019 (COVID-19). Moreover, the dynamics of the Hypothalamic-Pituitary-Adrenal (HPA) axis may have changed in COVID-19. Cortisol, as an important factor in assessing immune system activity, is an important part of this axis. The present study compared the serum levels of aldosterone and cortisol in COVID-19 outpatients with those of potentially non-infected participants. It was also aimed to assess the possible association between serum levels of aldosterone and cortisol with clinical symptoms progression in COVID-19 outpatients. Demographic characteristics (i.e., gender and age) and clinical data (i.e., oxygen saturation [SPO2], respiratory rate [RR], and heart rate) were collected. Serum cortisol and aldosterone measurements were conducted using the ELISA technique. Clinical symptoms of the positive polymerase chain reaction (PCR) group were followed up on for 28 days in weekly intervals. SPO2 was significantly lower in the positive PCR group; however, the RR was significantly higher (P=0.03 and P=0.001, respectively). Significantly higher levels of aldosterone were found in males of the negative PCR group, compared to females (P=0.05). Cortisol (OR=0.937, P=0.033) and aldosterone (OR=1.005, P=0.020) levels had a decreasing and increasing effect on the chances of respiratory symptoms occurring over time, respectively. Furthermore, over time, women were twice as likely as men to develop neurologic symptoms (OR=0.530, P=0.015). According to the findings of this study, cortisol and aldosterone are associated with the chance of respiratory symptoms occurring over time. However, the levels of these two markers do not seem to be related to the progression of clinical symptoms of lower grades of COVID-19.
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Affiliation(s)
- M Naghashpour
- Department of Nutrition, School of Medicine, Abadan University of Medical Sciences, Abadan, Iran
| | - M Adelipour
- Department of Biochemistry, School of Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - S Mobarak
- Department of Infectious Diseases, School of Medicine, Abadan University of Medical Sciences, Abadan, Iran
| | - M Piri
- Vice Chancellor for Health, Abadan University of Medical Sciences, Abadan, Iran
| | - M Seyedtabib
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - F Maghsoudi
- Department of Public Health, School of Health, Abadan University of Medical Sciences, Abadan, Iran
| | - S Golabi
- Department of Medical Physiology, School of Medicine, Abadan University of Medical Sciences, Abadan, Iran
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21
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Swenson KE, Hardin CC. Pathophysiology of Hypoxemia in COVID-19 Lung Disease. Clin Chest Med 2023; 44:239-248. [PMID: 37085217 PMCID: PMC9682047 DOI: 10.1016/j.ccm.2022.11.007] [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] [Indexed: 11/24/2022]
Abstract
As the pandemic has progressed, our understanding of hypoxemia in coronavirus disease 2019 (COVID-19) lung disease has become more nuanced, although much remains to be understood. In this article, we review ventilation-perfusion mismatching in COVID-19 and the evidence to support various biologic theories offered in explanation. In addition, the relationship between hypoxemia and other features of severe COVID-19 lung disease such as respiratory symptoms, radiographic abnormalities, and pulmonary mechanics is explored. Recognizing and understanding hypoxemia in COVID-19 lung disease remains essential for risk stratification, prognostication, and choice of appropriate treatments in severe COVID-19.
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Affiliation(s)
- Kai E Swenson
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Bulfinch 148, 55 Fruit Street, Boston, MA 02114, USA.
| | - Charles C Hardin
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Bulfinch 148, 55 Fruit Street, Boston, MA 02114, USA
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22
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Wemple ML, Swenson KE, Swenson ER. Oxygen Therapy Part 1 - History, Physiology, and Evaluation. NEJM EVIDENCE 2023; 2:EVIDra2300005. [PMID: 38320050 DOI: 10.1056/evidra2300005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
History, Physiology, and Evaluation of Oxygen TherapyOxygen is standard therapy for acute cardiopulmonary diseases, and long-term oxygen therapy is common in the outpatient setting. In part I of a two-part review, Wemple and colleagues discuss the physiology of tissue hypoxia, mechanisms of hypoxemia, and its clinical assessment.
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Affiliation(s)
- Matthew L Wemple
- Division of Pulmonary, Critical Care and Sleep Medicine, VA Puget Sound Health Care System, University of Washington, Seattle
| | - Kai E Swenson
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Erik R Swenson
- Division of Pulmonary, Critical Care and Sleep Medicine, VA Puget Sound Health Care System, University of Washington, Seattle
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23
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Smily Jeya Jothi E, Justin J, Vanithamani R, Varsha R. On-mask sensor network for lung disease monitoring. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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24
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Sjoding MW, Iwashyna TJ, Valley TS. Change the Framework for Pulse Oximeter Regulation to Ensure Clinicians Can Give Patients the Oxygen They Need. Am J Respir Crit Care Med 2023; 207:661-664. [PMID: 36260769 PMCID: PMC10037469 DOI: 10.1164/rccm.202209-1773ed] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Michael W Sjoding
- Department of Internal Medicine and Center for Computational Medicine and Bioinformatics University of Michigan Medical School Ann Arbor, Michigan and Max Harry Weil Institute for Critical Care Research and Innovation University of Michigan Ann Arbor, Michigan and Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor, Michigan
| | - Theodore J Iwashyna
- Department of Medicine and Department of Health Policy and Management Johns Hopkins University Baltimore, Maryland
| | - Thomas S Valley
- Department of Internal Medicine University of Michigan Medical School Ann Arbor, Michigan and Institute for Healthcare Policy and Innovation and Center for Bioethics and Social Sciences in Medicine University of Michigan Ann Arbor, Michigan and Veterans Affairs Center for Clinical Management Research Ann Arbor, Michigan
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25
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Kim HJ, Sritandi W, Xiong Z, Ho JS. Bioelectronic devices for light-based diagnostics and therapies. BIOPHYSICS REVIEWS 2023; 4:011304. [PMID: 38505817 PMCID: PMC10903427 DOI: 10.1063/5.0102811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 12/28/2022] [Indexed: 03/21/2024]
Abstract
Light has broad applications in medicine as a tool for diagnosis and therapy. Recent advances in optical technology and bioelectronics have opened opportunities for wearable, ingestible, and implantable devices that use light to continuously monitor health and precisely treat diseases. In this review, we discuss recent progress in the development and application of light-based bioelectronic devices. We summarize the key features of the technologies underlying these devices, including light sources, light detectors, energy storage and harvesting, and wireless power and communications. We investigate the current state of bioelectronic devices for the continuous measurement of health and on-demand delivery of therapy. Finally, we highlight major challenges and opportunities associated with light-based bioelectronic devices and discuss their promise for enabling digital forms of health care.
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Affiliation(s)
| | - Weni Sritandi
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore
| | | | - John S. Ho
- Author to whom correspondence should be addressed:
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26
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Davydov R, Zaitceva A, Davydov V, Isakova D, Mazing M. New Methodology of Human Health Express Diagnostics Based on Pulse Wave Measurements and Occlusion Test. J Pers Med 2023; 13:jpm13030443. [PMID: 36983623 PMCID: PMC10052938 DOI: 10.3390/jpm13030443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023] Open
Abstract
Nowadays, with the increase in the rhythm of life, the relevance of using express diagnostics methods for human health state estimation has significantly increased. We present a new express diagnostics method based on non-invasive measurements (the pulse wave shape, heart rate, blood pressure, and oxygen saturation of blood vessels and tissues). A feature of these measurements is that they can be carried out both in the hospital and at home. The new compact and portable optical hardware–software complex has been developed to measure tissue oxygen saturation. This complex makes it possible to reduce the measurement time from 60 min to 7–8 min, which reduces the likelihood of artifacts in the measurement process and increases its reliability. A new technique has been developed to carry out these measurements. A new optical sensor based on a line of charge-coupled devices has been developed to register a pulse wave in the far peripheral zone. The developed new technique for processing the pulse waveform and data on the oxygen saturation of hemoglobin in the blood and tissues allows a person to obtain additional information about their state of health independently. It will help to make conclusions about taking the necessary measures. This additional information allows the attending physician to provide more effective control over the course of treatment of the patient at any time since the methods of express diagnostics proposed by us have no restrictions on the number of applications. The functional state of more than 300 patients was studied. The results of various measurements are presented.
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Affiliation(s)
- Roman Davydov
- Institute of Physics and Mechanics, Peter the Great St. Petersburg Polytechnic University, 195251 St. Petersburg, Russia
- Correspondence:
| | - Anna Zaitceva
- Institute for Analytical Instrumentation of the Russian Academy of Sciences, 190103 St. Petersburg, Russia
- Institute of Biomedical Systems and Biotechnology, Peter the Great, St. Petersburg Polytechnic University, 195251 St. Petersburg, Russia
| | - Vadim Davydov
- Institute of Electronics and Telecommunications, Peter the Great St. Petersburg Polytechnic University, 195251 St. Petersburg, Russia
- Department of Photonics and Communication Lines, The Bonch-Bruevich Saint Petersburg State University of Telecommunication, 193232 St. Petersburg, Russia
| | - Daria Isakova
- Department of Photonics and Communication Lines, The Bonch-Bruevich Saint Petersburg State University of Telecommunication, 193232 St. Petersburg, Russia
| | - Maria Mazing
- Institute for Analytical Instrumentation of the Russian Academy of Sciences, 190103 St. Petersburg, Russia
- Institute of Electronics and Telecommunications, Peter the Great St. Petersburg Polytechnic University, 195251 St. Petersburg, Russia
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27
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Wijsenbeek MS, Moor CC, Johannson KA, Jackson PD, Khor YH, Kondoh Y, Rajan SK, Tabaj GC, Varela BE, van der Wal P, van Zyl-Smit RN, Kreuter M, Maher TM. Home monitoring in interstitial lung diseases. THE LANCET. RESPIRATORY MEDICINE 2023; 11:97-110. [PMID: 36206780 DOI: 10.1016/s2213-2600(22)00228-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/08/2022] [Accepted: 06/08/2022] [Indexed: 11/05/2022]
Abstract
The widespread use of smartphones and the internet has enabled self-monitoring and more hybrid-care models. The COVID-19 pandemic has further accelerated remote monitoring, including in the heterogenous and often vulnerable group of patients with interstitial lung diseases (ILDs). Home monitoring in ILD has the potential to improve access to specialist care, reduce the burden on health-care systems, improve quality of life for patients, identify acute and chronic disease worsening, guide treatment decisions, and simplify clinical trials. Home spirometry has been used in ILD for several years and studies with other devices (such as pulse oximeters, activity trackers, and cough monitors) have emerged. At the same time, challenges have surfaced, including technical, analytical, and implementational issues. In this Series paper, we provide an overview of experiences with home monitoring in ILD, address the challenges and limitations for both care and research, and provide future perspectives. VIDEO ABSTRACT.
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Affiliation(s)
- Marlies S Wijsenbeek
- Centre of Excellence for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands.
| | - Catharina C Moor
- Centre of Excellence for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Kerri A Johannson
- Department of Medicine and Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| | - Peter D Jackson
- Department of Pulmonary and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Yet H Khor
- Central Clinical School, Monash University, Melbourne, VIC, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Sujeet K Rajan
- Department of Chest Medicine, Bombay Hospital Institute of Medical Sciences, Bhatia Hospital, Mumbai, India
| | - Gabriela C Tabaj
- Department of Respiratory Medicine, Cetrángolo Hospital, Buenos Aires, Argentina
| | - Brenda E Varela
- Department of Respiratory Medicine, Hospital Alemán, Buenos Aires, Argentina
| | - Pieter van der Wal
- Patient expert, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Richard N van Zyl-Smit
- Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases and Interdisciplinary Center for Sarcoidosis, Thoraxklinik, University Hospital Heidelberg, Germany; German Center for Lung Research, Heidelberg, Germany; Department of Pneumology, RKH Clinics Ludwigsburg, Ludwigsburg, Germany
| | - Toby M Maher
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; National Heart and Lung Institute, Imperial College London, London, UK
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28
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Lin YF, Wu X, Li Y, Bian J, Li K, Jiang Y, Lu Z, Zhang B, Yang C, Sun C, Sun L, Zou H. Impact of combination preventative interventions on hospitalization and death under the pandemic of SARS-CoV-2 Omicron variant in China. J Med Virol 2023; 95:e28335. [PMID: 36418175 DOI: 10.1002/jmv.28335] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/06/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022]
Abstract
With a large population most susceptible to Omicron and emerging SARS-CoV-2 variants, China faces uncertain scenarios if reopening its border. Thus, we aimed to predict the impact of combination preventative interventions on hospitalization and death. An age-stratified susceptible-infectious-quarantined-hospitalized-removed-susceptible (SIQHRS) model based on the new guidelines of COVID-19 diagnosis and treatment (the ninth edition) was constructed to simulate the transmission dynamics of Omicron within 365 days. At baseline, we assumed no interventions other than 60% booster vaccination in individuals aged ≤60 years and 80% in individuals aged >60 years, quarantine and hospitalization. Oral antiviral medications for COVID-19 and nonpharmaceutical interventions (NPIs) such as social distancing and antigen self-testing were considered in subsequent scenarios. Sensitivity analyses were conducted to reflect different levels of interventions. A total of 0.73 billion cumulative quarantines (95% CI 0.53-0.83), 33.59 million hospitalizations (22.41-39.31), and 0.62 million deaths (0.40-0.75) are expected in 365 days. The case fatality rate with pneumonia symptoms (moderate, severe and critical illness) is expected to be 1.83% (1.68-1.99%) and the infected fatality rate is 0.38‰ (0.33-0.4‰). The highest existing hospitalization and ICU occupations are 3.11 (0.30-3.85) and 20.33 (2.01-25.20) times of capacity, respectively. Sensitivity analysis showed that interventions can be adjusted to meet certain conditions to reduce the total number of infections and deaths. In conclusion, after sufficient respiratory and ICU beds are prepared and the relaxed NPIs are in place, the SARS-CoV-2 Omicron variant would not seriously impact the health system.
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Affiliation(s)
- Yi-Fan Lin
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Xinsheng Wu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yuwei Li
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Junye Bian
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Kuibiao Li
- Guangzhou Center for Diseases Control and Prevention, Guangzhou, China
| | - Yawen Jiang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Zhen Lu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Bing Zhang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Chongguang Yang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Caijun Sun
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Litao Sun
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
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29
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Cavallazzi R, Ramirez JA. How and when to manage respiratory infections out of hospital. Eur Respir Rev 2022; 31:31/166/220092. [PMID: 36261157 DOI: 10.1183/16000617.0092-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/19/2022] [Indexed: 12/13/2022] Open
Abstract
Lower respiratory infections include acute bronchitis, influenza, community-acquired pneumonia, acute exacerbation of COPD and acute exacerbation of bronchiectasis. They are a major cause of death worldwide and often affect the most vulnerable: children, elderly and the impoverished. In this paper, we review the clinical presentation, diagnosis, severity assessment and treatment of adult outpatients with lower respiratory infections. The paper is divided into sections on specific lower respiratory infections, but we also dedicate a section to COVID-19 given the importance of the ongoing pandemic. Lower respiratory infections are heterogeneous entities, carry different risks for adverse events, and require different management strategies. For instance, while patients with acute bronchitis are rarely admitted to hospital and generally do not require antimicrobials, approximately 40% of patients seen for community-acquired pneumonia require admission. Clinicians caring for patients with lower respiratory infections face several challenges, including an increasing population of patients with immunosuppression, potential need for diagnostic tests that may not be readily available, antibiotic resistance and social aspects that place these patients at higher risk. Management principles for patients with lower respiratory infections include knowledge of local surveillance data, strategic use of diagnostic tests according to surveillance data, and judicious use of antimicrobials.
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Affiliation(s)
- Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Louisville, KY, USA
| | - Julio A Ramirez
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, KY, USA
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30
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Arandia N, Garate JI, Mabe J. Embedded Sensor Systems in Medical Devices: Requisites and Challenges Ahead. SENSORS (BASEL, SWITZERLAND) 2022; 22:9917. [PMID: 36560284 PMCID: PMC9781231 DOI: 10.3390/s22249917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/03/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
The evolution of technology enables the design of smarter medical devices. Embedded Sensor Systems play an important role, both in monitoring and diagnostic devices for healthcare. The design and development of Embedded Sensor Systems for medical devices are subjected to standards and regulations that will depend on the intended use of the device as well as the used technology. This article summarizes the challenges to be faced when designing Embedded Sensor Systems for the medical sector. With this aim, it presents the innovation context of the sector, the stages of new medical device development, the technological components that make up an Embedded Sensor System and the regulatory framework that applies to it. Finally, this article highlights the need to define new medical product design and development methodologies that help companies to successfully introduce new technologies in medical devices.
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Affiliation(s)
- Nerea Arandia
- TEKNIKER, Basque Research and Technology Alliance (BRTA), 20600 Eibar, Spain
| | - Jose Ignacio Garate
- Department of Electronics Technology, University of the Basque Country (UPV/EHU), 48080 Bilbao, Spain
| | - Jon Mabe
- TEKNIKER, Basque Research and Technology Alliance (BRTA), 20600 Eibar, Spain
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31
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Feng X, Liu Z, He X, Wang X, Yuan C, Huang L, Song R, Wu Y. Risk of Malnutrition in Hospitalized COVID-19 Patients: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14245267. [PMID: 36558436 PMCID: PMC9780808 DOI: 10.3390/nu14245267] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/26/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
(1) Background: Studies have reported that COVID-19 may increase the risk of malnutrition among patients. However, the prevalence of such risk in hospitalized COVID-19 patients is uncertain due to the inconsistent use of assessment methods. (2) Methods: PubMed, Web of Science, and EMBASE were searched to identify studies on the nutritional status of hospitalized COVID-19 patients. A pooled prevalence of malnutrition risk evaluated by Nutrition Risk Score (NRS-2002) was obtained using a random effects model. Differences by study-level characteristics were examined by hospitalization setting, time of assessment, age, and country. Risk of bias was assessed using the Newcastle−Ottawa Scale. (3) Results: 53 studies from 17 countries were identified and summarized. A total of 17 studies using NRS-2002, including 3614 COVID-19 patients were included in the primary meta-analysis. The pooled prevalence of risk of malnutrition was significantly higher among ICU patients (92.2%, 95% CI: 85.9% to 96.8%) than among general ward patients (70.7%, 95% CI: 56.4% to 83.2%) (p = 0.002). No significant differences were found between age groups (≥65 vs. <65 years, p = 0.306) and countries (p = 0.893). (4) Conclusions: High risk of malnutrition is common and concerning in hospitalized patients with COVID-19, suggesting that malnutrition screening and nutritional support during hospitalization are needed.
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Affiliation(s)
- Xiaoru Feng
- Institute for Hospital Management, Tsinghua University, Beijing 100084, China
| | - Zeqi Liu
- Institute for Hospital Management, Tsinghua University, Beijing 100084, China
| | - Xiaotong He
- School of Labor and Human Resources, Renmin University of China, Beijing 100872, China
| | - Xibiao Wang
- Department of Occupational Hygiene Engineering, China University of Labor Relations, Beijing 100048, China
| | - Changzheng Yuan
- School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Liyan Huang
- School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Rui Song
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - You Wu
- Institute for Hospital Management, Tsinghua University, Beijing 100084, China
- School of Medicine, Tsinghua University, Beijing 100084, China
- Correspondence: ; Tel.: +86-13641181601
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32
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Racial Disparity in Oxygen Saturation Measurements by Pulse Oximetry: Evidence and Implications. Ann Am Thorac Soc 2022; 19:1951-1964. [PMID: 36166259 DOI: 10.1513/annalsats.202203-270cme] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The pulse oximeter is a ubiquitous clinical tool used to estimate blood oxygen concentrations. However, decreased accuracy of pulse oximetry in patients with dark skin tones has been demonstrated since as early as 1985. Most commonly, pulse oximeters may overestimate the true oxygen saturation in individuals with dark skin tones, leading to higher rates of occult hypoxemia (i.e., clinically unrecognized low blood oxygen saturation). Overestimation of oxygen saturation in patients with dark skin tones has serious clinical implications, as these patients may receive insufficiently rigorous medical care when pulse oximeter measurements suggest that their oxygen saturation is higher than the true value. Recent studies have linked pulse oximeter inaccuracy to worse clinical outcomes, suggesting that pulse oximeter inaccuracy contributes to known racial health disparities. The magnitude of device inaccuracy varies by pulse oximeter manufacturer, sensor type, and arterial oxygen saturation. The underlying reasons for decreased pulse oximeter accuracy for individuals with dark skin tones may be related to failure to control for increased absorption of red light by melanin during device development and insufficient inclusion of individuals with dark skin tones during device calibration. Inadequate regulatory standards for device approval may also play a role in decreased accuracy. Awareness of potential pulse oximeter limitations is an important step for providers and may encourage the consideration of additional clinical information for management decisions. Ultimately, stricter regulatory requirements for oximeter approval and increased manufacturer transparency regarding device performance are required to mitigate this racial bias.
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33
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Khamkar AM, Pote PD, Jose GE. A Comparison of Finger Pulse Oximeter and SET-Based Neonatal Pulse Oximeter in Neonates in Terms of SpO 2 Values and Response Time. Indian J Pediatr 2022; 89:1120-1122. [PMID: 35763217 DOI: 10.1007/s12098-022-04274-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 05/06/2022] [Indexed: 11/26/2022]
Abstract
Pulse oximetry is an imperative noninvasive tool to detect hypoxia. Signal extraction technology (SET)-based pulse oximeters recommended in neonates are expensive, while finger pulse oximeters are cheaper and widely available. Oxygen saturation (SpO2) values and reliable saturation reading time of 30 neonates were obtained using MEDITIVE MPO-03 fingertip pulse oximeter and Masimo SET-Rad-97 pulse oximeter on the right hand and right foot. Bland-Altman technique, paired t-test and Pearson correlational analysis were used. There was a good agreement of paired SpO2 measurements between the two oximeters on right foot. The agreement limits and bias were -1.2% to 0.8%, -0.1% for right hand, and -0.7% to 0.7%, -0.01% for right foot, respectively with a confidence interval of 95%. The mean response time obtained for finger pulse oximeter on right hand and right foot was 66.4 ± 4.6 and 58.9 ± 5.0 and for SET-based pulse oximeter was 47.8 ± 2.9 and 48.3 ± 3.0 s, respectively. Finger pulse oximeters can be considered in low-resource settings on the foot of the neonate, with a response time of 59 s.
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Affiliation(s)
- Anilkumar M Khamkar
- Department of Neonatology, Noble Hospital and Research Center, Hadapsar, Pune, Maharashtra, 411013, India
| | - P D Pote
- Department of Neonatology, Noble Hospital and Research Center, Hadapsar, Pune, Maharashtra, 411013, India
| | - Georgeena Elsa Jose
- Department of Neonatology, Noble Hospital and Research Center, Hadapsar, Pune, Maharashtra, 411013, India.
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34
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Junaid SB, Imam AA, Balogun AO, De Silva LC, Surakat YA, Kumar G, Abdulkarim M, Shuaibu AN, Garba A, Sahalu Y, Mohammed A, Mohammed TY, Abdulkadir BA, Abba AA, Kakumi NAI, Mahamad S. Recent Advancements in Emerging Technologies for Healthcare Management Systems: A Survey. Healthcare (Basel) 2022; 10:healthcare10101940. [PMID: 36292387 PMCID: PMC9601636 DOI: 10.3390/healthcare10101940] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
In recent times, the growth of the Internet of Things (IoT), artificial intelligence (AI), and Blockchain technologies have quickly gained pace as a new study niche in numerous collegiate and industrial sectors, notably in the healthcare sector. Recent advancements in healthcare delivery have given many patients access to advanced personalized healthcare, which has improved their well-being. The subsequent phase in healthcare is to seamlessly consolidate these emerging technologies such as IoT-assisted wearable sensor devices, AI, and Blockchain collectively. Surprisingly, owing to the rapid use of smart wearable sensors, IoT and AI-enabled technology are shifting healthcare from a conventional hub-based system to a more personalized healthcare management system (HMS). However, implementing smart sensors, advanced IoT, AI, and Blockchain technologies synchronously in HMS remains a significant challenge. Prominent and reoccurring issues such as scarcity of cost-effective and accurate smart medical sensors, unstandardized IoT system architectures, heterogeneity of connected wearable devices, the multidimensionality of data generated, and high demand for interoperability are vivid problems affecting the advancement of HMS. Hence, this survey paper presents a detailed evaluation of the application of these emerging technologies (Smart Sensor, IoT, AI, Blockchain) in HMS to better understand the progress thus far. Specifically, current studies and findings on the deployment of these emerging technologies in healthcare are investigated, as well as key enabling factors, noteworthy use cases, and successful deployments. This survey also examined essential issues that are frequently encountered by IoT-assisted wearable sensor systems, AI, and Blockchain, as well as the critical concerns that must be addressed to enhance the application of these emerging technologies in the HMS.
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Affiliation(s)
| | - Abdullahi Abubakar Imam
- School of Digital Science, Universiti Brunei Darussalam, Brunei Darussalam, Jalan Tungku Link, Gadong BE1410, Brunei
- Correspondence: (A.A.I.); or (A.O.B.)
| | - Abdullateef Oluwagbemiga Balogun
- Department of Computer Science, University of Ilorin, Ilorin 1515, Nigeria
- Department of Computer and Information Science, Universiti Teknologi PETRONAS, Sri Iskandar 32610, Malaysia
- Correspondence: (A.A.I.); or (A.O.B.)
| | | | | | - Ganesh Kumar
- Department of Computer and Information Science, Universiti Teknologi PETRONAS, Sri Iskandar 32610, Malaysia
| | - Muhammad Abdulkarim
- Department of Computer Science, Ahmadu Bello University, Zaria 810211, Nigeria
| | - Aliyu Nuhu Shuaibu
- Department of Electrical Engineering, University of Jos, Bauchi Road, Jos 930105, Nigeria
| | - Aliyu Garba
- Department of Computer Science, Ahmadu Bello University, Zaria 810211, Nigeria
| | - Yusra Sahalu
- SEHA Abu Dhabi Health Services Co., Abu Dhabi 109090, United Arab Emirates
| | - Abdullahi Mohammed
- Department of Computer Science, Ahmadu Bello University, Zaria 810211, Nigeria
| | | | | | | | - Nana Aliyu Iliyasu Kakumi
- Patient Care Department, General Ward, Saudi German Hospital Cairo, Taha Hussein Rd, Huckstep, El Nozha, Cairo Governorate 4473303, Egypt
| | - Saipunidzam Mahamad
- Department of Computer and Information Science, Universiti Teknologi PETRONAS, Sri Iskandar 32610, Malaysia
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Coronavirus 2019 disease: Are corticosteroids the key treatment? A retrospective case-control study in Brazil. Ann Med Surg (Lond) 2022; 82:104746. [PMID: 36186492 PMCID: PMC9513996 DOI: 10.1016/j.amsu.2022.104746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/17/2022] [Accepted: 09/18/2022] [Indexed: 11/21/2022] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is the putative cause of coronavirus disease 2019 (COVID-19), a serious disease that has severely impacted the world. Although vaccines have been developed, it will take time to inoculate the global population. Current guidelines have focused on the treatment of severe cases in hospital settings; however, a void has been created regarding appropriate measures for those in the initial stage of COVID-19 and those experiencing moderate disease severity progressing to desaturation. We assessed clinical outcomes in patients with COVID-19 with pneumonia at initial presentation treated with corticosteroids. Methods Data of 177 consecutive high-risk patients with COVID-19, monitored by telemedicine, were collected and analyzed. Of those, 68 patients were in the initial inflammatory phase of the disease without desaturation and received corticosteroids. The outcomes were evaluated after a follow up of 14 days. Four patients were immediately referred to the hospital because they had explicit desaturation at presentation. Results After 14 days, all patients in the inflammatory phase at presentation who were treated with corticosteroids before desaturation were alive and without complications. However, of the four patients with desaturation, one died at the hospital. Conclusion In this study, the use of corticosteroids during the initial pulmonary phase of COVID-19 before desaturation, in addition to daily monitoring of patients, prevented disease progression, decreased the risk of complications and incidence of hospitalization and death. However, additional studies with larger number of patients are needed to confirm these findings. Use of corticosteroids in COVID-19 patients before desaturation increased survival. Patients who reached desaturation needed hospitalization. Approximately 25% mortality was observed in hospitalized patients. The use of corticosteroids before desaturation prevented hospitalization and death. Corticosteroids can be used to decrease the risk of complications of COVID-19.
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Mah AJ, Nguyen T, Ghazi Zadeh L, Shadgan A, Khaksari K, Nourizadeh M, Zaidi A, Park S, Gandjbakhche AH, Shadgan B. Optical Monitoring of Breathing Patterns and Tissue Oxygenation: A Potential Application in COVID-19 Screening and Monitoring. SENSORS (BASEL, SWITZERLAND) 2022; 22:7274. [PMID: 36236373 PMCID: PMC9573619 DOI: 10.3390/s22197274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
The worldwide outbreak of the novel Coronavirus (COVID-19) has highlighted the need for a screening and monitoring system for infectious respiratory diseases in the acute and chronic phase. The purpose of this study was to examine the feasibility of using a wearable near-infrared spectroscopy (NIRS) sensor to collect respiratory signals and distinguish between normal and simulated pathological breathing. Twenty-one healthy adults participated in an experiment that examined five separate breathing conditions. Respiratory signals were collected with a continuous-wave NIRS sensor (PortaLite, Artinis Medical Systems) affixed over the sternal manubrium. Following a three-minute baseline, participants began five minutes of imposed difficult breathing using a respiratory trainer. After a five minute recovery period, participants began five minutes of imposed rapid and shallow breathing. The study concluded with five additional minutes of regular breathing. NIRS signals were analyzed using a machine learning model to distinguish between normal and simulated pathological breathing. Three features: breathing interval, breathing depth, and O2Hb signal amplitude were extracted from the NIRS data and, when used together, resulted in a weighted average accuracy of 0.87. This study demonstrated that a wearable NIRS sensor can monitor respiratory patterns continuously and non-invasively and we identified three respiratory features that can distinguish between normal and simulated pathological breathing.
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Affiliation(s)
- Aaron James Mah
- Implantable Biosensing Laboratory, ICORD, Vancouver, BC V5Z 1M9, Canada
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z7, Canada
| | - Thien Nguyen
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Health, Rockville, MD 20847, USA
| | - Leili Ghazi Zadeh
- Implantable Biosensing Laboratory, ICORD, Vancouver, BC V5Z 1M9, Canada
| | - Atrina Shadgan
- Implantable Biosensing Laboratory, ICORD, Vancouver, BC V5Z 1M9, Canada
| | - Kosar Khaksari
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Health, Rockville, MD 20847, USA
| | - Mehdi Nourizadeh
- Implantable Biosensing Laboratory, ICORD, Vancouver, BC V5Z 1M9, Canada
| | - Ali Zaidi
- Implantable Biosensing Laboratory, ICORD, Vancouver, BC V5Z 1M9, Canada
| | - Soongho Park
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Health, Rockville, MD 20847, USA
| | - Amir H. Gandjbakhche
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Health, Rockville, MD 20847, USA
| | - Babak Shadgan
- Implantable Biosensing Laboratory, ICORD, Vancouver, BC V5Z 1M9, Canada
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z7, Canada
- Department of Orthopedics, University of British Columbia, Vancouver, BC V6T 1Z7, Canada
- Department of Biomedical Engineering, University of British Columbia, Vancouver, BC V6T 1Z7, Canada
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Hoffman JS, Viswanath VK, Tian C, Ding X, Thompson MJ, Larson EC, Patel SN, Wang EJ. Smartphone camera oximetry in an induced hypoxemia study. NPJ Digit Med 2022; 5:146. [PMID: 36123367 PMCID: PMC9483471 DOI: 10.1038/s41746-022-00665-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/25/2022] [Indexed: 11/28/2022] Open
Abstract
Hypoxemia, a medical condition that occurs when the blood is not carrying enough oxygen to adequately supply the tissues, is a leading indicator for dangerous complications of respiratory diseases like asthma, COPD, and COVID-19. While purpose-built pulse oximeters can provide accurate blood-oxygen saturation (SpO2) readings that allow for diagnosis of hypoxemia, enabling this capability in unmodified smartphone cameras via a software update could give more people access to important information about their health. Towards this goal, we performed the first clinical development validation on a smartphone camera-based SpO2 sensing system using a varied fraction of inspired oxygen (FiO2) protocol, creating a clinically relevant validation dataset for solely smartphone-based contact PPG methods on a wider range of SpO2 values (70–100%) than prior studies (85–100%). We built a deep learning model using this data to demonstrate an overall MAE = 5.00% SpO2 while identifying positive cases of low SpO2 < 90% with 81% sensitivity and 79% specificity. We also provide the data in open-source format, so that others may build on this work.
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Affiliation(s)
- Jason S Hoffman
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, USA.
| | - Varun K Viswanath
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA.,The Design Lab, University of California San Diego, La Jolla, CA, USA
| | - Caiwei Tian
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, USA
| | - Xinyi Ding
- Department of Computer Science, Southern Methodist University, Dallas, TX, USA
| | - Matthew J Thompson
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Eric C Larson
- Department of Computer Science, Southern Methodist University, Dallas, TX, USA
| | - Shwetak N Patel
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, USA.,Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, USA
| | - Edward J Wang
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA.,The Design Lab, University of California San Diego, La Jolla, CA, USA
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Lohiya DV, Pathak SS. Role of Technology in Detection of COVID-19. Cureus 2022; 14:e29138. [PMID: 36259008 PMCID: PMC9573002 DOI: 10.7759/cureus.29138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/13/2022] [Indexed: 12/01/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus caused coronavirus infection termed as COVID-19, an illness that has spread devastation all over the world. It was developed first in China and had swiftly spread throughout the world. COVID has created imposed burden on health in the lives of all individuals around the globe. This article provides a number of unprecedented detection technologies used in the detection of infection. COVID has created a large number of symptoms in the young, adolescent as well as elderly population. Old age people are susceptible to fatal serious symptoms because of low immunity. With these goals in mind, this article includes substantial condemning descriptions of the majority of initiatives in order to create diagnostic tools for easy diagnosis. It also provides the reader with a multidisciplinary viewpoint on how traditional approaches such as serology and reverse transcriptase polymerase chain reaction (RT-PCR) along with the frontline techniques such as clustered regularly interspaced short palindromic repeats (CRISPR)/Cas and artificial intelligence/machine learning have been utilized to gather information. The story will inspire creative new ways for successful detection therapy and to prevent this pandemic among a wide audience of operating and aspiring biomedical scientists and engineers.
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Fiorini L, Rovini E, Russo S, Toccafondi L, D’Onofrio G, Cornacchia Loizzo FG, Bonaccorsi M, Giuliani F, Vignani G, Sancarlo D, Greco A, Cavallo F. On the Use of Assistive Technology during the COVID-19 Outbreak: Results and Lessons Learned from Pilot Studies. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22176631. [PMID: 36081090 PMCID: PMC9460223 DOI: 10.3390/s22176631] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 05/04/2023]
Abstract
As a consequence of the COVID-19 emergency, frail citizens felt isolated because of social isolation, suspended and/or strongly reduced home assistance, and limited access to hospitals. In this sense, assistive technology could play a pivotal role in empowering frail older adults reducing their isolation, as well as in reinforcing the work of formal caregivers and professionals. In this context, the goal of this paper is to present four pilot studies-conducted from March 2020 to April 2021-to promptly react to COVID-19 by providing assistive technology solutions, aiming to (1) guarantee high-quality service to older adults in-home or in residential facility contexts, (2) promote social inclusion, and (3) reduce the virus transmission. In particular, four services, namely, telepresence service, remote monitoring service, virtual visit, and environmental disinfection, were designed, implemented, and tested in real environments involving 85 end-users to assess the user experience and/or preliminary assess the technical feasibility. The results underlined that all the proposed services were generally accepted by older adults and professionals. Additionally, the results remarked that the use of telepresence robots in private homes and residential facilities increased enjoyment reducing anxiety, whereas the monitoring service supported the clinicians in monitoring the discharged COVID-19 patients. It is also worth mentioning that two new services/products were developed to disinfect the environment and to allow virtual visits within the framework of a hospital information system. The virtual visits service offered the opportunity to expand the portfolio of hospital services. The main barriers were found in education, technology interoperability, and ethical/legal/privacy compliance. It is also worth mentioning the key role played by an appropriate design and customer needs analysis since not all assistive devices were designed for older persons.
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Affiliation(s)
- Laura Fiorini
- Department of Industrial Engineering, University of Florence, 50139 Florence, FI, Italy
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pontedera, PI, Italy
- Correspondence:
| | - Erika Rovini
- Department of Industrial Engineering, University of Florence, 50139 Florence, FI, Italy
| | - Sergio Russo
- ICT, Innovation and Research Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
| | - Lara Toccafondi
- Umana Persone Development & Research Social Enterprise, 58100 Grosseto, GR, Italy
| | - Grazia D’Onofrio
- Clinical Psychology Service, Health Department, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
| | | | | | - Francesco Giuliani
- ICT, Innovation and Research Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
| | - Gianna Vignani
- Umana Persone Development & Research Social Enterprise, 58100 Grosseto, GR, Italy
| | - Daniele Sancarlo
- Geriatrics Unit, Department of Medical Sciences, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
| | - Antonio Greco
- Geriatrics Unit, Department of Medical Sciences, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
| | - Filippo Cavallo
- Department of Industrial Engineering, University of Florence, 50139 Florence, FI, Italy
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pontedera, PI, Italy
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Hospitalization as an outcome in ambulatory COVID-19 trials-not applicable in every setting. Clin Microbiol Infect 2022; 28:1187-1188. [PMID: 35654313 PMCID: PMC9148857 DOI: 10.1016/j.cmi.2022.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/16/2022] [Accepted: 05/21/2022] [Indexed: 02/05/2023]
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Webster LR, Cater J, Smith T. Pharmacokinetics of Buprenorphine Buccal Film and Orally-administered Oxycodone in a Respiratory Study: An Analysis of Secondary Outcomes from a Randomized Controlled Trial. Pain Ther 2022; 11:817-825. [PMID: 35524938 PMCID: PMC9314471 DOI: 10.1007/s40122-022-00380-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/22/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To evaluate pharmacokinetic (PK) parameters and oxygen saturation as markers of abuse potential after administration of buprenorphine buccal film (BBF) and immediate-release (IR) oxycodone. METHODS This was a secondary analysis of data from a phase I randomized controlled trial. A total of 19 healthy subjects who self-identified as recreational opioid users were enrolled, with 15 completing the study. Subjects were administered 300, 600, and 900 µg BBF; 30 and 60 mg orally-administered oxycodone; and placebo. For PK analysis, blood samples were collected before dosing and at 0.5, 1, 2, 3, 4, and 6 h postdose. Respiratory drive/ventilatory response to hypercapnia and oxygen saturation were evaluated before dosing and up to 8 h after administration of test drugs. RESULTS Median time to maximum concentration (Tmax) was 2.17 h for 900 µg BBF and 1.17 h for 60 mg oxycodone and was similar across all doses for each drug. Mean maximum concentration (Cmax) was 1.06 ng/mL for 900 µg BBF and 132 ng/mL for 60 mg oxycodone. The abuse quotient, defined as Cmax/Tmax, was substantially higher for oxycodone compared to BBF. Respiratory depression (maximum decrease in minute ventilation) was similar for all 3 doses of BBF, consistent with a potential ceiling effect. In addition, respiratory depression occurred sooner with oxycodone vs BBF, and a greater mean decrease in oxygen saturation was observed for oxycodone 30- and 60-mg doses, compared with BBF. CONCLUSION These results indicate that BBF may have a decreased risk of abuse and respiratory depression compared with the full µ-opioid receptor agonist oxycodone. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT03996694.
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Affiliation(s)
- Lynn R. Webster
- US Center of Policy, 1455 Pennsylvania Ave NW, Suite 400, Washington, DC 20004 USA
| | | | - Thomas Smith
- grid.431845.f0000 0004 0408 3827BioDelivery Sciences International, Inc, Raleigh, NC USA
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Anson R, Willcott A, Toperoff W, Karim A, Tang M, Wooten D, Lonergan JT, Bamford L. COVID-19 Telemedicine and Vaccination at an Urban Safety Net HIV Medicine Clinic. J Nurse Pract 2022; 18:837-840. [PMID: 35844811 PMCID: PMC9274297 DOI: 10.1016/j.nurpra.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In response to the emerging coronavirus disease 2019 (COVID-19) pandemic in March 2020, the Owen Clinic at UC San Diego Health scaled up telemedicine to ensure the continuity of human immunodeficiency virus primary care. A group of nurse practitioners, physicians, and a physician assistant developed a dedicated COVID-19 telemedicine clinic to provide virtual health care services to patients with or at risk for severe acute respiratory syndrome coronavirus 2 infection. This effort contributed to successful health outcomes for the clinic's 476 patients diagnosed with COVID-19. The Owen Clinic was also the first ambulatory clinic within UC San Diego Health to implement on-site COVID-19 vaccines. Nurse practitioners and a physician assistant spearheaded these 2 clinical initiatives.
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Shi C, Goodall M, Dumville J, Hill J, Norman G, Hamer O, Clegg A, Watkins CL, Georgiou G, Hodkinson A, Lightbody CE, Dark P, Cullum N. The accuracy of pulse oximetry in measuring oxygen saturation by levels of skin pigmentation: a systematic review and meta-analysis. BMC Med 2022; 20:267. [PMID: 35971142 PMCID: PMC9377806 DOI: 10.1186/s12916-022-02452-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, there have been concerns regarding potential bias in pulse oximetry measurements for people with high levels of skin pigmentation. We systematically reviewed the effects of skin pigmentation on the accuracy of oxygen saturation measurement by pulse oximetry (SpO2) compared with the gold standard SaO2 measured by CO-oximetry. METHODS We searched Ovid MEDLINE, Ovid Embase, EBSCO CINAHL, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform (up to December 2021) for studies with SpO2-SaO2 comparisons and measuring the impact of skin pigmentation or ethnicity on pulse oximetry accuracy. We performed meta-analyses for mean bias (the primary outcome in this review) and its standard deviations (SDs) across studies included for each subgroup of skin pigmentation and ethnicity and used these pooled mean biases and SDs to calculate accuracy root-mean-square (Arms) and 95% limits of agreement. The review was registered with the Open Science Framework ( https://osf.io/gm7ty ). RESULTS We included 32 studies (6505 participants): 15 measured skin pigmentation and 22 referred to ethnicity. Compared with standard SaO2 measurement, pulse oximetry probably overestimates oxygen saturation in people with the high level of skin pigmentation (pooled mean bias 1.11%; 95% confidence interval 0.29 to 1.93%) and people described as Black/African American (1.52%; 0.95 to 2.09%) (moderate- and low-certainty evidence). The bias of pulse oximetry measurements for people with other levels of skin pigmentation or those from other ethnic groups is either more uncertain or suggests no overestimation. Whilst the extent of mean bias is small or negligible for all subgroups evaluated, the associated imprecision is unacceptably large (pooled SDs > 1%). When the extent of measurement bias and precision is considered jointly, pulse oximetry measurements for all the subgroups appear acceptably accurate (with Arms < 4%). CONCLUSIONS Pulse oximetry may overestimate oxygen saturation in people with high levels of skin pigmentation and people whose ethnicity is reported as Black/African American, compared with SaO2. The extent of overestimation may be small in hospital settings but unknown in community settings. REVIEW PROTOCOL REGISTRATION: https://osf.io/gm7ty.
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Affiliation(s)
- Chunhu Shi
- School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Jean McFarlane Building, Oxford Rd, Manchester, M13 9PL, UK.
- NIHR Applied Research Collaboration Greater Manchester (ARC-GM), Manchester, UK.
| | - Mark Goodall
- Institute of Population Health, University of Liverpool, Liverpool, L69 3GF, UK
- NIHR Applied Research Collaboration North West Coast (ARC-NWC), Manchester, UK
| | - Jo Dumville
- School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Jean McFarlane Building, Oxford Rd, Manchester, M13 9PL, UK
- NIHR Applied Research Collaboration Greater Manchester (ARC-GM), Manchester, UK
| | - James Hill
- NIHR Applied Research Collaboration North West Coast (ARC-NWC), Manchester, UK
- Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Gill Norman
- School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Jean McFarlane Building, Oxford Rd, Manchester, M13 9PL, UK
- NIHR Applied Research Collaboration Greater Manchester (ARC-GM), Manchester, UK
| | - Oliver Hamer
- NIHR Applied Research Collaboration North West Coast (ARC-NWC), Manchester, UK
- Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Andrew Clegg
- NIHR Applied Research Collaboration North West Coast (ARC-NWC), Manchester, UK
- Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Caroline Leigh Watkins
- NIHR Applied Research Collaboration North West Coast (ARC-NWC), Manchester, UK
- Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - George Georgiou
- NIHR Applied Research Collaboration North West Coast (ARC-NWC), Manchester, UK
- Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Alexander Hodkinson
- NIHR School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, M13 9PL, UK
| | | | - Paul Dark
- NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, M13 9WL, UK
- Northern Care Alliance NHS Foundation Trust, Salford Care Organisation, Salford, M6 8HD, Greater Manchester, UK
| | - Nicky Cullum
- School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Jean McFarlane Building, Oxford Rd, Manchester, M13 9PL, UK
- NIHR Applied Research Collaboration Greater Manchester (ARC-GM), Manchester, UK
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Taylor-Williams M, Spicer G, Bale G, Bohndiek SE. Noninvasive hemoglobin sensing and imaging: optical tools for disease diagnosis. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:JBO-220074VR. [PMID: 35922891 PMCID: PMC9346606 DOI: 10.1117/1.jbo.27.8.080901] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/27/2022] [Indexed: 05/08/2023]
Abstract
SIGNIFICANCE Measurement and imaging of hemoglobin oxygenation are used extensively in the detection and diagnosis of disease; however, the applied instruments vary widely in their depth of imaging, spatiotemporal resolution, sensitivity, accuracy, complexity, physical size, and cost. The wide variation in available instrumentation can make it challenging for end users to select the appropriate tools for their application and to understand the relative limitations of different methods. AIM We aim to provide a systematic overview of the field of hemoglobin imaging and sensing. APPROACH We reviewed the sensing and imaging methods used to analyze hemoglobin oxygenation, including pulse oximetry, spectral reflectance imaging, diffuse optical imaging, spectroscopic optical coherence tomography, photoacoustic imaging, and diffuse correlation spectroscopy. RESULTS We compared and contrasted the ability of different methods to determine hemoglobin biomarkers such as oxygenation while considering factors that influence their practical application. CONCLUSIONS We highlight key limitations in the current state-of-the-art and make suggestions for routes to advance the clinical use and interpretation of hemoglobin oxygenation information.
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Affiliation(s)
- Michaela Taylor-Williams
- University of Cambridge, Department of Physics, Cavendish Laboratory, Cambridge, United Kingdom, United Kingdom
- University of Cambridge, Cancer Research UK Cambridge Institute, Cambridge, United Kingdom, United Kingdom
| | - Graham Spicer
- University of Cambridge, Department of Physics, Cavendish Laboratory, Cambridge, United Kingdom, United Kingdom
- University of Cambridge, Cancer Research UK Cambridge Institute, Cambridge, United Kingdom, United Kingdom
| | - Gemma Bale
- University of Cambridge, Department of Physics, Cavendish Laboratory, Cambridge, United Kingdom, United Kingdom
- University of Cambridge, Electrical Division, Department of Engineering, Cambridge, United Kingdom, United Kingdom
| | - Sarah E Bohndiek
- University of Cambridge, Department of Physics, Cavendish Laboratory, Cambridge, United Kingdom, United Kingdom
- University of Cambridge, Cancer Research UK Cambridge Institute, Cambridge, United Kingdom, United Kingdom
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Assessment of Clinical Profile and Treatment Outcome in Vaccinated and Unvaccinated SARS-CoV-2 Infected Patients. Vaccines (Basel) 2022; 10:vaccines10071125. [PMID: 35891289 PMCID: PMC9321523 DOI: 10.3390/vaccines10071125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 12/10/2022] Open
Abstract
Vaccines against severe acute respiratory syndrome-corona virus-2 (SARS-CoV-2) infection, which causes coronavirus disease–19 (COVID-19) in humans, have been developed and are being tested for safety and efficacy. We conducted the cross-sectional prospective cohort study on 820 patients who were positive for SARS-CoV-2 and were admitted to Princess Krishnajammanni trauma care centre (PKTCC), Mysore, which was converted to a designated COVID hospital between April 2021 to July 2021. After obtaining the informed consent, RT-PCR report, vaccination certificate and patient history, patients were classified according to their vaccination status. Results from the study showed decreases in serum ferritin levels, clinical symptoms, improvement in oxygen saturation, early recovery in patients having diabetes and hypertension, and a substantial reduction in the overall duration of hospital stay in vaccinated patients compared to unvaccinated patients. Further, fully vaccinated patients showed better outcomes compared to single dose vaccinated and nonvaccinated patients. Taken together, our findings reaffirm the vaccine’s effectiveness in reducing case fatality and promoting faster recovery compared to nonvaccinated patients. Efforts to increase the number of immunized subjects in the community help to achieve herd immunity and offer protection against the severity of COVID-19 and associated complications while minimizing the public health and economic burden.
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Silverston P, Ferrari M, Quaresima V. Pulse oximetry and the pandemic. BMJ 2022; 378:e071474. [PMID: 35798377 DOI: 10.1136/bmj-2022-071474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Paul Silverston
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Marco Ferrari
- Department of Life, Health and Environmental Science, University of L'Aquila, L'Aquila, Italy
| | - Valentina Quaresima
- Department of Life, Health and Environmental Science, University of L'Aquila, L'Aquila, Italy
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Valbuena VSM, Seelye S, Sjoding MW, Valley TS, Dickson RP, Gay SE, Claar D, Prescott HC, Iwashyna TJ. Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013-19: multicenter, retrospective cohort study. BMJ 2022; 378:e069775. [PMID: 35793817 PMCID: PMC9254870 DOI: 10.1136/bmj-2021-069775] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate measurement discrepancies by race between pulse oximetry and arterial oxygen saturation (as measured in arterial blood gas) among inpatients not in intensive care. DESIGN Multicenter, retrospective cohort study using electronic medical records from general care medical and surgical inpatients. SETTING Veteran Health Administration, a national and racially diverse integrated health system in the United States, from 2013 to 2019. PARTICIPANTS Adult inpatients in general care (medical and surgical), in Veteran Health Administration medical centers. MAIN OUTCOMES MEASURES Occult hypoxemia (defined as arterial blood oxygen saturation (SaO2) of <88% despite a pulse oximetry (SpO2) reading of ≥92%), and whether rates of occult hypoxemia varied by race and ethnic origin. RESULTS A total of 30 039 pairs of SpO2-SaO2 readings made within 10 minutes of each other were identified during the study. These pairs were predominantly among non-Hispanic white (21 918 (73.0%)) patients; non-Hispanic black patients and Hispanic or Latino patients accounted for 6498 (21.6%) and 1623 (5.4%) pairs in the sample, respectively. Among SpO2 values greater or equal to 92%, unadjusted probabilities of occult hypoxemia were 15.6% (95% confidence interval 15.0% to 16.1%) in white patients, 19.6% (18.6% to 20.6%) in black patients (P<0.001 v white patients, with similar P values in adjusted models), and 16.2% (14.4% to 18.1%) in Hispanic or Latino patients (P=0.53 v white patients, P<0.05 in adjusted models). This result was consistent in SpO2-SaO2 pairs restricted to occur within 5 minutes and 2 minutes. In white patients, an initial SpO2-SaO2 pair with little difference in saturation was associated with a 2.7% (95% confidence interval -0.1% to 5.5%) probability of SaO2 <88% on a later paired SpO2-SaO2 reading showing an SpO2 of 92%, but black patients had a higher probability (12.9% (-3.3% to 29.0%)). CONCLUSIONS In general care inpatient settings across the Veterans Health Administration where paired readings of arterial blood gas (SaO2) and pulse oximetry (SpO2) were obtained, black patients had higher odds than white patients of having occult hypoxemia noted on arterial blood gas but not detected by pulse oximetry. This difference could limit access to supplemental oxygen and other more intensive support and treatments for black patients.
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Affiliation(s)
- Valeria S M Valbuena
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
- National Clinician Scholars Program, University of Michigan, Ann Arbor, MI, USA
| | - Sarah Seelye
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Michael W Sjoding
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Thomas S Valley
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Robert P Dickson
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Steven E Gay
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Dru Claar
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Hallie C Prescott
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Theodore J Iwashyna
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
- National Clinician Scholars Program, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Nemomssa HD, Raj H. Evaluation of a New Smartphone Powered Low-cost Pulse Oximeter Device. Ethiop J Health Sci 2022; 32:841-848. [PMID: 35950062 PMCID: PMC9341018 DOI: 10.4314/ejhs.v32i4.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background Measurement of blood oxygen saturation is a vital part of monitoring coronavirus 2019 (COVID-19) patients. Pulse oximetry is commonly used to measure blood oxygen saturation and pulse rate for appropriate clinical intervention. But the majority of direct-to-consumer grade pulse oximeters did not pass through in-vivo testing, which results in their accuracy being questionable. Besides this, the ongoing COVID-19 pandemic exposed the limitations of the device in resource limited areas since independent monitoring is needed for COVID-19 patients. The purpose of this study was to perform an in-vivo evaluation of a newly developed smartphone powered low-cost pulse oximeter. Methods The new prototype of a smartphone powered pulse oximeter was evaluated against the standard pulse oximeter by taking measurements from fifteen healthy volunteers. The accuracy of measurement was evaluated by calculating the percentage error and standard deviation. A repeatability and reproducibility test were carried out using the ANOVA method. Results The average accuracy for measuring spot oxygen saturation (SPO2) and pulse rate (PR) was 99.18% with a standard deviation of 0.57 and 98.78% with a standard deviation of 0.61, respectively, when compared with the standard pulse oximeter device. The repeatability and reproducibility of SPO2 measurements were 0.28 and 0.86, respectively, which is in the acceptable range. Conclusion The new prototype of smartphone powered pulse oximeter demonstrated better performance compared to the existing low-cost fingertip pulse oximeters. The device could be used for independent monitoring of COVID-19 patients at health institutions and also for home care.
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Affiliation(s)
- Hundessa Daba Nemomssa
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Oromia, Ethiopia
| | - Hakkins Raj
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Oromia, Ethiopia
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Patient experience and healthcare utilization for a COVID-19 telemedicine home monitoring program offered in English and Spanish. PLoS One 2022; 17:e0270754. [PMID: 35771749 PMCID: PMC9246185 DOI: 10.1371/journal.pone.0270754] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 06/16/2022] [Indexed: 01/10/2023] Open
Abstract
Background Telemedicine is a vital component of the healthcare system’s response to COVID-19. In March of 2020, Providence health system rapidly implemented a telemedicine home monitoring program (HMP) for COVID-19 patients that included use of at-home pulse oximeters and thermometers and text-based surveys to monitor symptoms. By June 2020, Providence updated the HMP to be offered in Spanish. This program was implemented before COVID-19 testing was readily available and therefore was offered to all patients suspected of having COVID-19. This study examines engagement, experience, and utilization patterns for English and Spanish-speaking patients engaged in the COVID-19 HMP. Methods A retrospective review of program data was used to understand HMP patient engagement (responsiveness to three daily text to monitor symptoms), satisfaction with the program (likelihood to recommend the program) as well as comfort using home monitoring devices and comfort recovering from home. To understand impact on care for COVID-19 confirmed cases, we used electronic health records to measure patterns in healthcare use for COVID-19 positive HMP participants and non-HMP propensity weighted controls. All patients enrolled in the COVID-19 HMP from March–October 2020 were included in the study. Patients tested for COVID-19 during the time window and not enrolled in HMP were included in the propensity-weighted comparison group. Descriptive and regression analyses were performed overall and stratified by English and Spanish speakers. Results Of the 4,358 HMP participants, 75.5% identified as English speakers and 18.2% identified as Spanish speakers. There was high level of responsiveness to three daily text-based surveys monitoring symptoms engagement (>80%) and a high level of comfort using the home monitoring devices (thermometers and pulse oximeters) for English- and Spanish-speaking participants (97.3% and 99.6%, respectively). The majority of English (95.7%) and Spanish-speaking (100%) patients felt safe monitoring their condition from home and had high satisfaction with the HMP (76.5% and 83.6%, respectively). English and Spanish-speaking COVID-19 positive HMP participants had more outpatient and emergency departments (ED) encounters than non-participants 7 and 30 days after their positive test. Conclusion This widely implemented HMP provided participants with a sense of safety and satisfaction and its use was associated with more outpatient care and ED encounters. These outcomes were comparable across English and Spanish-speakers, highlighting the importance and potential impact of language-concordant telemedicine.
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50
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Liu D, Mowrey W, Fisher M, Basalely A, McCarthy J, Kumar N, Thakkar J, Azzi Y, Brogan M, Golestaneh L, Reidy KJ, Chen W. Associations of Dysnatremia with COVID-19 Status and Mortality. KIDNEY360 2022; 3:1323-1331. [PMID: 36176656 PMCID: PMC9416846 DOI: 10.34067/kid.0001062022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/20/2022] [Indexed: 01/21/2023]
Abstract
Background In patients without COVID-19, dysnatremia is associated with mortality. These relationships are not well established in patients with COVID-19. We tested the hypotheses that patients with COVID-19 were more likely to have dysnatremia than those without COVID-19 and that, among those with COVID-19, dysnatremia is associated with mortality. Methods We conducted a retrospective observational study of patients admitted to a tertiary care center in the Bronx, New York, during the COVID-19 surge from March 11 to April 26, 2020. Using multinomial logistic regression models, we compared the prevalence of hypernatremia (serum sodium ≥150 mEq/L) and hyponatremia (serum sodium <130 mEq/L) on admission between patients with and without COVID-19. Among patients with COVID-19, we used Cox proportional hazards models to examine the association of dysnatremia with mortality. Results Compared with those without COVID-19 (n=1265), patients with COVID-19 (n=3345) had a higher prevalence of hypernatremia (7% versus 4%, P<0.001) and hyponatremia (7% versus 6%, P=0.04). In adjusted models, COVID-19-positive patients had a higher likelihood of having hypernatremia (adjusted odds ratio=1.87, 95% CI, 1.3 to 2.57, P=0.001) compared with COVID-19-negative patients, whereas the association between hyponatremia and COVID-19 status was no longer significant (P=0.06). Among patients with COVID-19, 775 (23%) died after a median follow-up of 17 days (IQR 7-27 days). Among nonsurvivors, 15% had hypernatremia and 8% had hyponatremia on admission. Hypernatremia was associated with a higher risk of mortality (adjusted hazard ratio=1.28, 95% CI, 1.01 to 1.63, P=0.04) compared with patients with eunatremia. Conclusions In patients hospitalized during the spring 2020 COVID-19 surge, COVID-19 status was associated with hypernatremia on admission. Among patients with COVID-19, hypernatremia was associated with higher mortality. Hypernatremia may be a potential prognostic marker for mortality in COVID-19 patients.
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Affiliation(s)
- Diane Liu
- Division of Pediatric Nephrology, Weill Cornell Medical Center, New York, New York,Division of Pediatric Nephrology, Children’s Hospital at Montefiore, Bronx, New York
| | - Wenzhu Mowrey
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Molly Fisher
- Division of Nephrology, Montefiore Medical Center, Bronx, New York
| | - Abby Basalely
- Division of Pediatric Nephrology, Children’s Hospital at Montefiore, Bronx, New York,Division of Pediatric Nephrology, Cohen Children’s Medical Center, New Hyde Park, New York
| | - John McCarthy
- Division of Nephrology, Albert Einstein College of Medicine, Bronx, New York
| | - Neelja Kumar
- Division of Nephrology, Montefiore Medical Center, Bronx, New York
| | - Jyotsana Thakkar
- Division of Nephrology, Montefiore Medical Center, Bronx, New York
| | - Yorg Azzi
- Division of Nephrology, Montefiore Medical Center, Bronx, New York
| | - Maureen Brogan
- Division of Nephrology, Montefiore Medical Center, Bronx, New York
| | - Ladan Golestaneh
- Division of Nephrology, Montefiore Medical Center, Bronx, New York
| | - Kimberly J Reidy
- Division of Pediatric Nephrology, Children’s Hospital at Montefiore, Bronx, New York
| | - Wei Chen
- Division of Nephrology, Montefiore Medical Center, Bronx, New York,Division of Nephrology, Albert Einstein College of Medicine, Bronx, New York,Division of Nephrology, University of Rochester School of Medicine and Dentistry, Rochester, New York
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