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Kitchen C, Chang HY, Weiner JP, Kharrazi H. Assessing the Added Value of Vital Signs Extracted from Electronic Health Records in Healthcare Risk Adjustment Models. Healthc Policy 2022; 15:1671-1682. [PMID: 36092549 PMCID: PMC9462838 DOI: 10.2147/rmhp.s356080] [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: 01/13/2022] [Accepted: 03/26/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Patient vital signs are related to specific health risks and outcomes but are underutilized in the prediction of health-care utilization and cost. To measure the added value of electronic health record (EHR) extracted Body Mass Index (BMI) and blood pressure (BP) values in improving healthcare risk and utilization predictions. Patients and Methods A sample of 12,820 adult outpatients from the Johns Hopkins Health System (JHHS) were identified between 2016 and 2017, having high data quality and recorded values for BMI and BP. We evaluated the added value of BMI and BP in predicting health-care utilization and cost through a retrospective cohort design. BMI, mean arterial pressure (MAP), systolic and diastolic BPs were summarized as annual aggregated values. Concurrent annual BMI and MAP changes were quantified as the difference between maximum and minimum recorded values. Model performance estimates consisted of repeated 10-fold cross validation, compared to base model point estimates for demographic and diagnostic, coded events: (1) patient age and sex, (2) age, sex, and the Charlson weighted index, (3) age, sex and the Johns Hopkins ACG system’s DxPM risk score. Results Both categorical BMI and BP were progressively indicative of disease comorbidity, but not uniformly related to health-care utilization or cost. Annual change in BMI and MAP improved predictions for most concurrent year outcomes when compared to base models. Conclusion When a healthcare system lacks relevant diagnostic or risk assessment information for a patient, vital signs may be useful for a simple estimation of disease risk, cost and utilization.
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Affiliation(s)
- Christopher Kitchen
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hsien-Yen Chang
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jonathan P Weiner
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hadi Kharrazi
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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2
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Non-contact physiological monitoring of post-operative patients in the intensive care unit. NPJ Digit Med 2022; 5:4. [PMID: 35027658 PMCID: PMC8758749 DOI: 10.1038/s41746-021-00543-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 11/28/2021] [Indexed: 11/08/2022] Open
Abstract
Prolonged non-contact camera-based monitoring in critically ill patients presents unique challenges, but may facilitate safe recovery. A study was designed to evaluate the feasibility of introducing a non-contact video camera monitoring system into an acute clinical setting. We assessed the accuracy and robustness of the video camera-derived estimates of the vital signs against the electronically-recorded reference values in both day and night environments. We demonstrated non-contact monitoring of heart rate and respiratory rate for extended periods of time in 15 post-operative patients. Across day and night, heart rate was estimated for up to 53.2% (103.0 h) of the total valid camera data with a mean absolute error (MAE) of 2.5 beats/min in comparison to two reference sensors. We obtained respiratory rate estimates for 63.1% (119.8 h) of the total valid camera data with a MAE of 2.4 breaths/min against the reference value computed from the chest impedance pneumogram. Non-contact estimates detected relevant changes in the vital-sign values between routine clinical observations. Pivotal respiratory events in a post-operative patient could be identified from the analysis of video-derived respiratory information. Continuous vital-sign monitoring supported by non-contact video camera estimates could be used to track early signs of physiological deterioration during post-operative care.
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Manullang MCT, Lin YH, Lai SJ, Chou NK. Implementation of Thermal Camera for Non-Contact Physiological Measurement: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2021; 21:7777. [PMID: 34883780 PMCID: PMC8659982 DOI: 10.3390/s21237777] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/06/2021] [Accepted: 11/19/2021] [Indexed: 01/03/2023]
Abstract
Non-contact physiological measurements based on image sensors have developed rapidly in recent years. Among them, thermal cameras have the advantage of measuring temperature in the environment without light and have potential to develop physiological measurement applications. Various studies have used thermal camera to measure the physiological signals such as respiratory rate, heart rate, and body temperature. In this paper, we provided a general overview of the existing studies by examining the physiological signals of measurement, the used platforms, the thermal camera models and specifications, the use of camera fusion, the image and signal processing step (including the algorithms and tools used), and the performance evaluation. The advantages and challenges of thermal camera-based physiological measurement were also discussed. Several suggestions and prospects such as healthcare applications, machine learning, multi-parameter, and image fusion, have been proposed to improve the physiological measurement of thermal camera in the future.
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Affiliation(s)
- Martin Clinton Tosima Manullang
- Department of Electronic and Computer Engineering, National Taiwan University of Science and Technology, Taipei 10607, Taiwan; (M.C.T.M.); (S.-J.L.)
- Department of Informatics, Institut Teknologi Sumatera, South Lampung Regency 35365, Indonesia
| | - Yuan-Hsiang Lin
- Department of Electronic and Computer Engineering, National Taiwan University of Science and Technology, Taipei 10607, Taiwan; (M.C.T.M.); (S.-J.L.)
| | - Sheng-Jie Lai
- Department of Electronic and Computer Engineering, National Taiwan University of Science and Technology, Taipei 10607, Taiwan; (M.C.T.M.); (S.-J.L.)
| | - Nai-Kuan Chou
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei 10002, Taiwan
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4
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Singh A, Ravi P. Adoption of E-health platforms by medical practitioners: Mediating effect of attitude on E-health platforms usage. Health Mark Q 2021; 39:61-73. [PMID: 34720067 DOI: 10.1080/07359683.2021.1995637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study considers Theory of Reasoned Action and Technology Acceptance Model frameworks to test the mediating role of attitude towards using E-health platforms. 224 medical practitioners' responses are collected in the online mode. The mediation analysis supports the full mediation role of attitude towards using the E-health platforms in the relationship between perceived usefulness and intentions to use with (indirect effect = .15, SE = 0.03, LLCI = 0.09, and ULCI = .22). E-health platform developers should take active measures to improve the attitude of medical practitioners towards using such platforms, to derive the best results of the added features.
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Affiliation(s)
- Ankit Singh
- Symbiosis Institute of Health Sciences, A Constituent of Symbiosis International, Deemed University, Pune, India
| | - Priya Ravi
- Center for Online Learning, D. Y. Patil Vidyapeeth (Deemed to be University), Pune, India
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5
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Nishikawa A, Fujimori Y, Sakano N, Mushino T, Tamura S, Kasahara S, Akasaka H, Sonoki T. Remote vital signs data monitoring during home blood transfusion: A pilot study. Health Sci Rep 2021; 4:e380. [PMID: 34541335 PMCID: PMC8439429 DOI: 10.1002/hsr2.380] [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: 01/29/2021] [Revised: 08/10/2021] [Accepted: 08/26/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND AND AIMS Our study aimed to establish safer methods to manage home blood transfusion by using a remote vital signs data monitoring system. Home care is administered for patients with various medical disorders; however, home blood transfusion remains challenging owing to the risk of transfusion-related complications. METHODS We set up a remote vital signs data monitoring system to improve the safety of home blood transfusions. Using an Internet-based vital signs data monitoring system, the heart rate, electrocardiography, respiration rate, and percutaneous oxygen saturation (SpO2) were monitored and recorded during the entire home transfusion period. RESULTS Ten transfusions in three patients were monitored; two of the patients had an abnormality in a single vital sign (decreased SpO2 decrease and increased respiratory rate); these were not transfusion-related complications. Vital sign anomalies also occur because of errors in using the measurement device and noise associated with body movements. The presence of abnormalities in at least two vital signs among SpO2 decrease, tachycardia, and increased respiratory rate that persisted for >5 minutes was defined as a complicated vital sign abnormality (CVSA). There were no severe transfusion-related complications with CVSA in the present study. CONCLUSION This study indicates the feasibility and sustainability of real-time remote monitoring of vital signs for the safety of home transfusion. Although CVSA may function as an indicator of severe transfusion-related complications, these findings need to be confirmed with further studies.
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Affiliation(s)
- Akinori Nishikawa
- Division of Blood TransfusionWakayama Medical University HospitalWakayamaJapan
- Department of Hematology/OncologyWakayama Medical University HospitalWakayamaJapan
- Division of Medical InformationWakayama Medical University HospitalWakayamaJapan
- Akasaka ClinicKobeJapan
| | - Yoshihiro Fujimori
- Division of Hematology, Department of Internal Medicine Department of Transfusion Medicine and Cellular TherapyHyogo College of MedicineNishinomiyaJapan
| | - Noriko Sakano
- Department of Cardiovascular SurgeryOkayama University Graduate School of MedicineOkayamaJapan
| | - Toshiki Mushino
- Department of Hematology/OncologyWakayama Medical University HospitalWakayamaJapan
| | - Shinobu Tamura
- Department of Hematology/OncologyWakayama Medical University HospitalWakayamaJapan
| | - Shingo Kasahara
- Department of Cardiovascular SurgeryOkayama University Graduate School of MedicineOkayamaJapan
| | | | - Takashi Sonoki
- Division of Blood TransfusionWakayama Medical University HospitalWakayamaJapan
- Department of Hematology/OncologyWakayama Medical University HospitalWakayamaJapan
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Khanam FTZ, Perera AG, Al-Naji A, Gibson K, Chahl J. Non-Contact Automatic Vital Signs Monitoring of Infants in a Neonatal Intensive Care Unit Based on Neural Networks. J Imaging 2021; 7:122. [PMID: 34460758 PMCID: PMC8404938 DOI: 10.3390/jimaging7080122] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 12/28/2022] Open
Abstract
Infants with fragile skin are patients who would benefit from non-contact vital sign monitoring due to the avoidance of potentially harmful adhesive electrodes and cables. Non-contact vital signs monitoring has been studied in clinical settings in recent decades. However, studies on infants in the Neonatal Intensive Care Unit (NICU) are still limited. Therefore, we conducted a single-center study to remotely monitor the heart rate (HR) and respiratory rate (RR) of seven infants in NICU using a digital camera. The region of interest (ROI) was automatically selected using a convolutional neural network and signal decomposition was used to minimize the noise artefacts. The experimental results have been validated with the reference data obtained from an ECG monitor. They showed a strong correlation using the Pearson correlation coefficients (PCC) of 0.9864 and 0.9453 for HR and RR, respectively, and a lower error rate with RMSE 2.23 beats/min and 2.69 breaths/min between measured data and reference data. A Bland-Altman analysis of the data also presented a close correlation between measured data and reference data for both HR and RR. Therefore, this technique may be applicable in clinical environments as an economical, non-contact, and easily deployable monitoring system, and it also represents a potential application in home health monitoring.
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Affiliation(s)
- Fatema-Tuz-Zohra Khanam
- UniSA STEM, Mawson Lakes Campus, University of South Australia, Mawson Lakes, SA 5095, Australia; (A.G.P.); (A.A.-N.); (J.C.)
| | - Asanka G. Perera
- UniSA STEM, Mawson Lakes Campus, University of South Australia, Mawson Lakes, SA 5095, Australia; (A.G.P.); (A.A.-N.); (J.C.)
| | - Ali Al-Naji
- UniSA STEM, Mawson Lakes Campus, University of South Australia, Mawson Lakes, SA 5095, Australia; (A.G.P.); (A.A.-N.); (J.C.)
- Electrical Engineering Technical College, Middle Technical University, Baghdad 10022, Iraq
| | - Kim Gibson
- Clinical and Health Sciences, City East Campus, University of South Australia, North Terrace, Adelaide, SA 5000, Australia;
| | - Javaan Chahl
- UniSA STEM, Mawson Lakes Campus, University of South Australia, Mawson Lakes, SA 5095, Australia; (A.G.P.); (A.A.-N.); (J.C.)
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7
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Chaum E, Lindner E. A "Smart" Biosensor-Enabled Intravascular Catheter and Platform for Dynamic Delivery of Propofol to "Close the Loop" for Total Intravenous Anesthesia. Mil Med 2021; 186:370-377. [PMID: 33499544 DOI: 10.1093/milmed/usaa470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/04/2020] [Accepted: 10/30/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Target-controlled infusion anesthesia is used worldwide to provide user-defined, stable, blood concentrations of propofol for sedation and anesthesia. The drug infusion is controlled by a microprocessor that uses population-based pharmacokinetic data and patient biometrics to estimate the required infusion rate to replace losses from the blood compartment due to drug distribution and metabolism. The objective of the research was to develop and validate a method to detect and quantify propofol levels in the blood, to improve the safety of propofol use, and to demonstrate a pathway for regulatory approval for its use in the USA. METHODS We conceptualized and prototyped a novel "smart" biosensor-enabled intravenous catheter capable of quantifying propofol at physiologic levels in the blood, in real time. The clinical embodiment of the platform is comprised of a "smart" biosensor-enabled catheter prototype, a signal generation/detection readout display, and a driving electronics software. The biosensor was validated in vitro using a variety of electrochemical methods in both static and flow systems with biofluids, including blood. RESULTS We present data demonstrating the experimental detection and quantification of propofol at sub-micromolar concentrations using this biosensor and method. Detection of the drug is rapid and stable with negligible biofouling due to the sensor coating. It shows a linear correlation with mass spectroscopy methods. An intuitive graphical user interface was developed to: (1) detect and quantify the propofol sensor signal, (2) determine the difference between targeted and actual propofol concentration, (3) communicate the variance in real time, and (4) use the output of the controller to drive drug delivery from an in-line syringe pump. The automated delivery and maintenance of propofol levels was demonstrated in a modeled benchtop "patient" applying the known pharmacokinetics of the drug using published algorithms. CONCLUSIONS We present a proof-of-concept and in vitro validation of accurate electrochemical quantification of propofol directly from the blood and the design and prototyping of a "smart," indwelling, biosensor-enabled catheter and demonstrate feedback hardware and software architecture permitting accurate measurement of propofol in blood in real time. The controller platform is shown to permit autonomous, "closed-loop" delivery of the drug and maintenance of user-defined propofol levels in a dynamic flow model.
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Affiliation(s)
- Edward Chaum
- Vanderbilt University Medical Center, Department of Ophthalmology, Vanderbilt Eye Institute, Nashville, TN 37232, USA
| | - Ernő Lindner
- University of Memphis, Department of Biomedical Engineering, Engineering Technology Building Room 321D, Memphis, TN 38152, USA
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8
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A Longitudinal Study Regarding the Health Profile of the 2017 South African Hajj Pilgrims. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073607. [PMID: 33807142 PMCID: PMC8036399 DOI: 10.3390/ijerph18073607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022]
Abstract
The Hajj mass gathering annually attracts over two million Muslim pilgrims worldwide to the Kingdom of Saudi Arabia (KSA). We aimed to establish demographics and health profiles for the South African pilgrims performing the 2017 Hajj. Methods: This is a longitudinal survey-based study conducted on 1138 adult South African pilgrims in two phases (during and post-Hajj). Data on demographics, vaccination status, underlying health conditions, pre-Hajj training, health promotion, travel history, and health issues during and post-Hajj were collected using pre-designed questionnaires. Results: Participants had a mean age of 49.2 years (SD = 13.3; range 18–81), with a male: female ratio of 1.2:1. The majority of pilgrims were married (88.2%), of Indian/Asian background (73%), and literate (>99%). Nearly all pilgrims were vaccinated against meningococcal disease and yellow fever, but only 23.7% were vaccinated against Influenza. Hypertension, diabetes, and elevated cholesterol levels were the most common underlying health conditions reported by 22.6%, 13.2%, and 11.5% of pilgrims, respectively. One month after return to South Africa, nearly 65% of pilgrims reported illness during Hajj, while 40% reported falling ill post event upon return to South Africa. Nevertheless, only a few were admitted to hospitals (12 during Hajj and 15 post-Hajj). Among ill pilgrims, respiratory symptoms were the most commonly experienced symptoms during (70.2%) and post-Hajj (82.2%). Other symptoms such as walking-related symptoms include symptoms directly related or mainly caused by walking (e.g., leg pain, sore feet, blisters on the feet), dehydration, and gastrointestinal tract symptoms reported during Hajj. Medication to treat respiratory symptoms and antibiotics were the most commonly used medications during and post-Hajj. Having an underlying health condition was an independent predictor of falling ill during or post Hajj. Conclusion: Our study indicates that a sizable proportion of South African pilgrims are elderly with underlying health conditions and most contract respiratory tract infections during and post Hajj. Our study highlights the need for systematic collection of prospective pilgrims’ demographics and health data and more attention to post-Hajj health follow-ups of pilgrims.
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9
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Jovanovic K, Schwier A, Matheson E, Xiloyannis M, Rozeboom E, Hochhausen N, Vermeulen B, Graf B, Wolf P, Nawrat Z, Escuder J, Mechelinck M, Sorensen B, Boscolo PR, Obach M, Tognarelli S, Jankovic M, Leroux C, Ferrigno G, Siepel FJ, Stramigioli S. Digital Innovation Hubs in Health-Care Robotics Fighting COVID-19: Novel Support for Patients and Health-Care Workers Across Europe. IEEE ROBOTICS & AUTOMATION MAGAZINE 2021; 28:40-47. [DOI: 10.1109/mra.2020.3044965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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10
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Lewin S, Lees C, Regueiro M, Hart A, Mahadevan U. International Organization for the Study of Inflammatory Bowel Disease: Global Strategies for Telemedicine and Inflammatory Bowel Diseases. J Crohns Colitis 2020; 14:S780-S784. [PMID: 33085971 PMCID: PMC7665391 DOI: 10.1093/ecco-jcc/jjaa140] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Before the onset of the COVID-19 pandemic, the majority of care for inflammatory bowel disease patients was provided in-person. The practice of gastroenterology care has since rapidly transformed, with telemedicine emerging as an essential tool to provide medical care to patients while maintaining social distancing and conserving personal protective equipment. This article provides insight into past and current practices among inflammatory bowel disease specialists and shares regulatory, financial and practical considerations for incorporating telemedicine into clinical practice. Continued government and other payer support for telemedicine and ongoing innovation to provide remote objective patient data will help to sustain the use of telemedicine long after the current pandemic subsides.
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Affiliation(s)
- Sara Lewin
- Division of Gastroenterology, University of California, San Francisco, CA, USA
| | - Charles Lees
- Institute of Genetics & Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Ailsa Hart
- IBD Unit, St Mark’s Hospital, London, UK
| | - Uma Mahadevan
- Division of Gastroenterology, University of California, San Francisco, CA, USA
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Emerick T, Alter B, Jarquin S, Brancolini S, Bernstein C, Luong K, Morrisseyand S, Wasan A. Telemedicine for Chronic Pain in the COVID-19 Era and Beyond. PAIN MEDICINE 2020; 21:1743-1748. [PMID: 32914858 PMCID: PMC7543644 DOI: 10.1093/pm/pnaa220] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Trent Emerick
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
- Correspondence to: Trent Emerick, MD, MBA, Department of Anesthesiology and Perioperative Medicine, Division of Chronic Pain, University of Pittsburgh Medical Center, Falk Medical Building – 6th floor, 3601 Fifth Avenue, Pittsburgh, PA 15213, USA. Tel: 412-692-2234; Fax: 412-692-2235; E-mail:
| | - Benedict Alter
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Susan Jarquin
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Scott Brancolini
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Cheryl Bernstein
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Kevin Luong
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Shannon Morrisseyand
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Ajay Wasan
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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12
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Emerick T, Alter B, Jarquin S, Brancolini S, Bernstein C, Luong K, Morrisseyand S, Wasan A. Telemedicine for Chronic Pain in the COVID-19 Era and Beyond. PAIN MEDICINE (MALDEN, MASS.) 2020. [PMID: 32914858 DOI: 10.1093/pm/pnaa220.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Trent Emerick
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Benedict Alter
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Susan Jarquin
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Scott Brancolini
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Cheryl Bernstein
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Kevin Luong
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Shannon Morrisseyand
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Ajay Wasan
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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13
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Duncan HP, Fule B, Rice I, Sitch AJ, Lowe D. Wireless monitoring and real-time adaptive predictive indicator of deterioration. Sci Rep 2020; 10:11366. [PMID: 32647214 PMCID: PMC7347866 DOI: 10.1038/s41598-020-67835-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/15/2020] [Indexed: 11/09/2022] Open
Abstract
To assist in the early warning of deterioration in hospitalised children we studied the feasibility of collecting continuous wireless physiological data using Lifetouch (ECG-derived heart and respiratory rate) and WristOx2 (pulse-oximetry and derived pulse rate) sensors. We compared our bedside paediatric early warning (PEW) score and a machine learning automated approach: a Real-time Adaptive Predictive Indicator of Deterioration (RAPID) to identify children experiencing significant clinical deterioration. 982 patients contributed 7,073,486 min during 1,263 monitoring sessions. The proportion of intended monitoring time was 93% for Lifetouch and 55% for WristOx2. Valid clinical data was 63% of intended monitoring time for Lifetouch and 50% WristOx2. 29 patients experienced 36 clinically significant deteriorations. The RAPID Index detected significant deterioration more frequently (77% to 97%) and earlier than the PEW score ≥ 9/26. High sensitivity and negative predictive value for the RAPID Index was associated with low specificity and low positive predictive value. We conclude that it is feasible to collect clinically valid physiological data wirelessly for 50% of intended monitoring time. The RAPID Index identified more deterioration, before the PEW score, but has a low specificity. By using the RAPID Index with a PEW system some life-threatening events may be averted.
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Affiliation(s)
| | - Balazs Fule
- Birmingham Children’s Hospital, Steelhouse Lane, B4 6NH UK
| | | | - Alice J. Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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14
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Lyon KA, Qi X, Benardete EA, Stevens AB, Huang JH. COVID-19: Initiating the Expansion of Telemedicine in Neurosurgery. ACTA ACUST UNITED AC 2020; 9:90-94. [PMID: 34164624 DOI: 10.34297/ajbsr.2020.09.001359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective As COVID-19 spreads around the world, so does telemedicine across many medical specialties including neurosurgery. Given the unique patient population in neurosurgery, arising opportunities for integration and expansion of telemedicine into neurosurgery practice come with challenges for both the patient and the provider. Methods A literature review has been performed, and a survey has been sent out to neurosurgery providers in Texas to determine if providers are satisfied with the current state of telemedicine in their clinical practice. Results Patients who live far away from a medical center have cited increased convenience when routine postoperative visits have been converted to telemedicine. For providers, challenges have arisen in performing physical exams, especially when performing detailed neurological exams in the diagnosis of a spine disorder. Survey results of neurosurgery providers have revealed mixed opinions since the initiation of telemedicine. Conclusion Although it is unclear what role telemedicine will have after the social distancing restrictions are lifted, many providers surveyed have expressed interest in keeping telemedicine in their clinical practice.
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Affiliation(s)
- Kristopher A Lyon
- Department of Neurosurgery, Baylor Scott & White Health, Temple, Texas, USA.,College of Medicine, Texas A&M University Health Science Center, College Station, Texas, USA
| | - Xiaoming Qi
- Department of Neurosurgery, Baylor Scott & White Health, Temple, Texas, USA
| | - Ethan A Benardete
- Department of Neurosurgery, Baylor Scott & White Health, Temple, Texas, USA.,College of Medicine, Texas A&M University Health Science Center, College Station, Texas, USA
| | - Alan B Stevens
- College of Medicine, Texas A&M University Health Science Center, College Station, Texas, USA.,Center for Applied Health Research, Baylor Scott & White Health, Temple, Texas, USA.,Center for Population Health & Aging, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Jason H Huang
- Department of Neurosurgery, Baylor Scott & White Health, Temple, Texas, USA.,College of Medicine, Texas A&M University Health Science Center, College Station, Texas, USA
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Tan KK, Moran BJ, Solomon MJ. Avoiding collateral mortality in a pandemic - time to change our mindset in surgical oncology. Nat Rev Clin Oncol 2020; 17:383-385. [PMID: 32372035 PMCID: PMC7199649 DOI: 10.1038/s41571-020-0383-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The coronavirus disease 19 (COVID-19) pandemic has become the focus of attention worldwide, and herein we seek to highlight the potential problem of ‘collateral mortality’ from delayed or deferred treatments in patients with cancer. We propose potential solutions to ensure continuity of care in the field of surgical oncology.
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Affiliation(s)
- Ker-Kan Tan
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Brendan J Moran
- Peritoneal Malignancy Institute, North Hampshire Hospital Basingstoke, Hampshire, UK
| | - Michael J Solomon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. .,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. .,The Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital-University of Sydney, Camperdown, New South Wales, Australia.
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16
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Posthuma LM, Downey C, Visscher MJ, Ghazali DA, Joshi M, Ashrafian H, Khan S, Darzi A, Goldstone J, Preckel B. Remote wireless vital signs monitoring on the ward for early detection of deteriorating patients: A case series. Int J Nurs Stud 2020; 104:103515. [PMID: 32105974 DOI: 10.1016/j.ijnurstu.2019.103515] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/24/2019] [Accepted: 12/28/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Remote wireless monitoring is a new technology that allows the continuous recording of ward patients' vital signs, supporting nurses by measuring vital signs frequently and accurately. A case series is presented to illustrate how these systems might contribute to improved patient surveillance. METHODS AND RESULTS Five hospitals in three European countries installed a remote wireless vital signs monitoring system on medical or surgical wards. Heart rate, respiratory rate and temperature were measured by the system every 2 min. Four cases of (paroxysmal) atrial fibrillation are presented, two cases of sepsis and one case each of pyrexia, cardiogenic pulmonary edema and pulmonary embolisms. All cases show that the remote monitoring system revealed the first signs of ventilatory and circulatory deterioration before a change in the trends of the respective values became obvious by manual vital signs measurement. DISCUSSION This case series illustrates that a wireless remote vital signs monitoring system on medical and surgical wards has the potential to reduce time to detect deteriorating patients.
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Affiliation(s)
- L M Posthuma
- Department of Anaesthesiology, Amsterdam UMC, location AMC, H1-148, Amsterdam UMC, location AMC, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - C Downey
- Leeds Institute of Medical Research at St. James's, University of Leeds, United Kingdom
| | - M J Visscher
- Department of Anaesthesiology, Amsterdam UMC, location AMC, H1-148, Amsterdam UMC, location AMC, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - D A Ghazali
- Emergency Department, University Hospital of Bichat, Paris, France
| | - M Joshi
- Department of Surgery & Cancer, Academic Surgical Unit, St Mary's Hospital, Imperial College London, London, United Kingdom; Chelsea and Westminster Hospital NHS Foundation Trust, West Middlesex University Hospital, London, United Kingdom
| | - H Ashrafian
- Department of Surgery & Cancer, Academic Surgical Unit, St Mary's Hospital, Imperial College London, London, United Kingdom
| | - S Khan
- Chelsea and Westminster Hospital NHS Foundation Trust, West Middlesex University Hospital, London, United Kingdom
| | - A Darzi
- Department of Surgery & Cancer, Academic Surgical Unit, St Mary's Hospital, Imperial College London, London, United Kingdom
| | - J Goldstone
- Chief Intensivist, King Edward VII Hospital, The London Clinic and University College London Hospitals NHS Trust, London, United Kingdom
| | - B Preckel
- Department of Anaesthesiology, Amsterdam UMC, location AMC, H1-148, Amsterdam UMC, location AMC, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
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17
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Villarroel M, Chaichulee S, Jorge J, Davis S, Green G, Arteta C, Zisserman A, McCormick K, Watkinson P, Tarassenko L. Non-contact physiological monitoring of preterm infants in the Neonatal Intensive Care Unit. NPJ Digit Med 2019; 2:128. [PMID: 31872068 PMCID: PMC6908711 DOI: 10.1038/s41746-019-0199-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 11/14/2019] [Indexed: 11/09/2022] Open
Abstract
The implementation of video-based non-contact technologies to monitor the vital signs of preterm infants in the hospital presents several challenges, such as the detection of the presence or the absence of a patient in the video frame, robustness to changes in lighting conditions, automated identification of suitable time periods and regions of interest from which vital signs can be estimated. We carried out a clinical study to evaluate the accuracy and the proportion of time that heart rate and respiratory rate can be estimated from preterm infants using only a video camera in a clinical environment, without interfering with regular patient care. A total of 426.6 h of video and reference vital signs were recorded for 90 sessions from 30 preterm infants in the Neonatal Intensive Care Unit (NICU) of the John Radcliffe Hospital in Oxford. Each preterm infant was recorded under regular ambient light during daytime for up to four consecutive days. We developed multi-task deep learning algorithms to automatically segment skin areas and to estimate vital signs only when the infant was present in the field of view of the video camera and no clinical interventions were undertaken. We propose signal quality assessment algorithms for both heart rate and respiratory rate to discriminate between clinically acceptable and noisy signals. The mean absolute error between the reference and camera-derived heart rates was 2.3 beats/min for over 76% of the time for which the reference and camera data were valid. The mean absolute error between the reference and camera-derived respiratory rate was 3.5 breaths/min for over 82% of the time. Accurate estimates of heart rate and respiratory rate could be derived for at least 90% of the time, if gaps of up to 30 seconds with no estimates were allowed.
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Affiliation(s)
- Mauricio Villarroel
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Sitthichok Chaichulee
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - João Jorge
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Sara Davis
- Neonatal Unit, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - Gabrielle Green
- Neonatal Unit, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - Carlos Arteta
- Visual Geometry Group, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Andrew Zisserman
- Visual Geometry Group, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Kenny McCormick
- Neonatal Unit, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - Peter Watkinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
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18
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Sommer C, Zuccolin D, Arnera V, Schmitz N, Adolfsson P, Colombo N, Gilg R, McDowell B. Building clinical trials around patients: Evaluation and comparison of decentralized and conventional site models in patients with low back pain. Contemp Clin Trials Commun 2018; 11:120-126. [PMID: 30094387 PMCID: PMC6072894 DOI: 10.1016/j.conctc.2018.06.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/07/2018] [Accepted: 06/26/2018] [Indexed: 11/21/2022] Open
Abstract
Clinical trials are slow and costly, built around the research centers that study local participants. Building clinical trials around patients in their homes and community through remote visits and monitoring could enhance recruitment and increase convenience for participants. This study evaluated different trial settings, a decentralized arm via telemedicine center (virtual study conduct), a conventional arm via health clinic (onsite study conduct) and a mixed model arm. Acute low-back pain patients (20-65 years) were recruited to this non-interventional trial in Switzerland. The study consisted of a screening period and a 2-week data collection period using direct data capture (eSource), electronic informed consent form (eICF), electronic diary (eDiary) and wearable actigraphy sensor. A higher number of patients were enrolled in the decentralized arm (N = 18) compared to the conventional arm (N = 5) and none in the mixed model arm. The decentralized arm consisted of a diverse population with increased participation from rural areas. In the decentralized arm 89% of enrolled patients completed the study compared to 60% in the conventional arm. All the patients reported satisfaction with the use of eICF, eDiary and remote visits; whereas patients reported a lower level of satisfaction with the wearable sensor. The decentralized setting was operationally feasible and well accepted by patients. Faster recruitment and improved access to patients was observed in the decentralized arm. This study supports broader adoption of the decentralized model in clinical trials, though further investigations in larger interventional trials are needed to confirm the benefits from this patient-centric approach.
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Zhao F, Li M, Jiang Z, Tsien JZ, Lu Z. Camera-Based, Non-Contact, Vital-Signs Monitoring Technology May Provide a Way for the Early Prevention of SIDS in Infants. Front Neurol 2016; 7:236. [PMID: 28066320 PMCID: PMC5179534 DOI: 10.3389/fneur.2016.00236] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 12/09/2016] [Indexed: 12/12/2022] Open
Abstract
Sudden infant death syndrome (SIDS) is the unexplained death, usually during sleep, of a baby younger than 1-year-old. Even though researchers have discovered some factors that may put babies at extra risk, SIDS remains unpredictable up until now. One hypothesis is that impaired cardiovascular control may play a role in the underlying mechanism of SIDS. A reduction of heart rate variability (HRV) and progressive decrease in heart rate (HR) have been observed in infants who have later succumbed to SIDS. Many clues indicated the heart could be the final weakness in SIDS. Therefore, continuous monitoring of the dynamic changes within the heart may provide a possible preventive strategy of SIDS. Camera-based photoplethysmography was recently demonstrated as a contactless method to determine HR and HRV. This perspective presents a hypothesis that a camera-based, non-contact, vital-sign monitoring technology, which can indicate abnormal changes or a sudden loss of vital signs in a timely manner, may enable a crucial and low-cost means for the early prevention of SIDS in newborn infants.
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Affiliation(s)
- Fang Zhao
- Brain and Behavior Discovery Institute and Department of Neurology, Medical College of Georgia, Augusta University, Augusta, GA, USA; Banna Biomedical Research Institute, Xi-Shuang-Ban-Na, Yunnan, China
| | - Meng Li
- Brain and Behavior Discovery Institute and Department of Neurology, Medical College of Georgia, Augusta University , Augusta, GA , USA
| | - Zhongyi Jiang
- Department of Thoracic and Cardiac Surgery, Shanghai Children's Medical Center, Affiliated with Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Joe Z Tsien
- Brain and Behavior Discovery Institute and Department of Neurology, Medical College of Georgia, Augusta University, Augusta, GA, USA; Banna Biomedical Research Institute, Xi-Shuang-Ban-Na, Yunnan, China
| | - Zhaohui Lu
- Department of Thoracic and Cardiac Surgery, Shanghai Children's Medical Center, Affiliated with Shanghai Jiaotong University School of Medicine , Shanghai , China
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