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Kaimakamis E, Kotoulas S, Tzimou M, Karachristos C, Giannaki C, Kilintzis V, Stefanopoulos L, Chatzis E, Beredimas N, Rocha B, Pessoa D, Paiva RP, Maglaveras N, Bitzani M. Back to the future: the novel art of digital auscultation applied in a prospective observational study of critically ill Covid-19 patients. Pneumonia (Nathan) 2024; 16:9. [PMID: 38835101 DOI: 10.1186/s41479-024-00131-1] [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: 10/10/2023] [Accepted: 03/27/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND The Covid-19 pandemic has caused immense pressure on Intensive Care Units (ICU). In patients with severe ARDS due to Covid-19, respiratory mechanics are important for determining the severity of lung damage. Lung auscultation could not be used during the pandemic despite its merit. The main objective of this study was to investigate associations between lung auscultatory sound features and lung mechanical properties, length of stay (LOS) and survival, in adults with severe Covid-19 ARDS. METHODS Consecutive patients admitted to a large ICU between 2020 and 2021 (n = 173) were included. Digital stethoscopes obtained auscultatory sounds and stored them in an on-line database for replay and further processing using advanced AI techniques. Correlation and regression analysis explored relationships between digital auscultation findings and lung mechanics or the ICU outcome. The resulting annotated lung sounds database is also publicly available as supplementary material. RESULTS The presence of squawks was associated with the ICU LOS, outcome and 90-day mortality. Other features (age, SOFA score & oxygenation index upon admission, minimum crackle entropy) had significant impact on outcome. Additional features affecting the 90-d survival were age and mean crackle entropy. Multivariate logistic regression showed that survival was affected by age, baseline SOFA, baseline oxygenation index and minimum crackle entropy. CONCLUSIONS Respiratory mechanics were associated with various adventitious sounds, whereas the lung sound analytics and the presence of certain adventitious sounds correlated with the ICU outcome and the 90-d survival. Spectral features of crackles sounds can serve as prognostic factors for survival, highlighting the importance of digital auscultation.
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Affiliation(s)
- Evangelos Kaimakamis
- 1st Intensive Care Unit, "G. Papanikolaou" General Hospital, Exochi Thessalonikis, 57010, Greece.
| | - Serafeim Kotoulas
- 1st Intensive Care Unit, "G. Papanikolaou" General Hospital, Exochi Thessalonikis, 57010, Greece
| | - Myrto Tzimou
- 1st Intensive Care Unit, "G. Papanikolaou" General Hospital, Exochi Thessalonikis, 57010, Greece
| | - Christos Karachristos
- 1st Intensive Care Unit, "G. Papanikolaou" General Hospital, Exochi Thessalonikis, 57010, Greece
| | - Chrysavgi Giannaki
- 1st Intensive Care Unit, "G. Papanikolaou" General Hospital, Exochi Thessalonikis, 57010, Greece
| | - Vassileios Kilintzis
- Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, The Medical School, Aristotle University, Thessaloniki, Greece
- 2nd Department of Obstetrics and Gynecology, The Medical School, Thessaloniki, 54124, Greece
| | - Leandros Stefanopoulos
- Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, The Medical School, Aristotle University, Thessaloniki, Greece
- 2nd Department of Obstetrics and Gynecology, The Medical School, Thessaloniki, 54124, Greece
| | - Evangelos Chatzis
- Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, The Medical School, Aristotle University, Thessaloniki, Greece
| | - Nikolaos Beredimas
- Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, The Medical School, Aristotle University, Thessaloniki, Greece
| | - Bruno Rocha
- Centre for Informatics and Systems of the University of Coimbra, Department of Informatics Engineering, University of Coimbra, LASI, Coimbra, Portugal
| | - Diogo Pessoa
- Centre for Informatics and Systems of the University of Coimbra, Department of Informatics Engineering, University of Coimbra, LASI, Coimbra, Portugal
| | - Rui Pedro Paiva
- Centre for Informatics and Systems of the University of Coimbra, Department of Informatics Engineering, University of Coimbra, LASI, Coimbra, Portugal
| | - Nicos Maglaveras
- 2nd Department of Obstetrics and Gynecology, The Medical School, Thessaloniki, 54124, Greece
| | - Militsa Bitzani
- 1st Intensive Care Unit, "G. Papanikolaou" General Hospital, Exochi Thessalonikis, 57010, Greece
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Kapetanidis P, Kalioras F, Tsakonas C, Tzamalis P, Kontogiannis G, Karamanidou T, Stavropoulos TG, Nikoletseas S. Respiratory Diseases Diagnosis Using Audio Analysis and Artificial Intelligence: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2024; 24:1173. [PMID: 38400330 PMCID: PMC10893010 DOI: 10.3390/s24041173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/03/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024]
Abstract
Respiratory diseases represent a significant global burden, necessitating efficient diagnostic methods for timely intervention. Digital biomarkers based on audio, acoustics, and sound from the upper and lower respiratory system, as well as the voice, have emerged as valuable indicators of respiratory functionality. Recent advancements in machine learning (ML) algorithms offer promising avenues for the identification and diagnosis of respiratory diseases through the analysis and processing of such audio-based biomarkers. An ever-increasing number of studies employ ML techniques to extract meaningful information from audio biomarkers. Beyond disease identification, these studies explore diverse aspects such as the recognition of cough sounds amidst environmental noise, the analysis of respiratory sounds to detect respiratory symptoms like wheezes and crackles, as well as the analysis of the voice/speech for the evaluation of human voice abnormalities. To provide a more in-depth analysis, this review examines 75 relevant audio analysis studies across three distinct areas of concern based on respiratory diseases' symptoms: (a) cough detection, (b) lower respiratory symptoms identification, and (c) diagnostics from the voice and speech. Furthermore, publicly available datasets commonly utilized in this domain are presented. It is observed that research trends are influenced by the pandemic, with a surge in studies on COVID-19 diagnosis, mobile data acquisition, and remote diagnosis systems.
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Affiliation(s)
- Panagiotis Kapetanidis
- Computer Engineering and Informatics Department, University of Patras, 26504 Patras, Greece (C.T.); (G.K.); (S.N.)
| | - Fotios Kalioras
- Computer Engineering and Informatics Department, University of Patras, 26504 Patras, Greece (C.T.); (G.K.); (S.N.)
| | - Constantinos Tsakonas
- Computer Engineering and Informatics Department, University of Patras, 26504 Patras, Greece (C.T.); (G.K.); (S.N.)
| | - Pantelis Tzamalis
- Computer Engineering and Informatics Department, University of Patras, 26504 Patras, Greece (C.T.); (G.K.); (S.N.)
| | - George Kontogiannis
- Computer Engineering and Informatics Department, University of Patras, 26504 Patras, Greece (C.T.); (G.K.); (S.N.)
| | - Theodora Karamanidou
- Pfizer Center for Digital Innovation, 55535 Thessaloniki, Greece; (T.K.); (T.G.S.)
| | | | - Sotiris Nikoletseas
- Computer Engineering and Informatics Department, University of Patras, 26504 Patras, Greece (C.T.); (G.K.); (S.N.)
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Pessoa D, Rocha BM, Strodthoff C, Gomes M, Rodrigues G, Petmezas G, Cheimariotis GA, Kilintzis V, Kaimakamis E, Maglaveras N, Marques A, Frerichs I, Carvalho PD, Paiva RP. BRACETS: Bimodal repository of auscultation coupled with electrical impedance thoracic signals. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 240:107720. [PMID: 37544061 DOI: 10.1016/j.cmpb.2023.107720] [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: 03/21/2023] [Revised: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Respiratory diseases are among the most significant causes of morbidity and mortality worldwide, causing substantial strain on society and health systems. Over the last few decades, there has been increasing interest in the automatic analysis of respiratory sounds and electrical impedance tomography (EIT). Nevertheless, no publicly available databases with both respiratory sound and EIT data are available. METHODS In this work, we have assembled the first open-access bimodal database focusing on the differential diagnosis of respiratory diseases (BRACETS: Bimodal Repository of Auscultation Coupled with Electrical Impedance Thoracic Signals). It includes simultaneous recordings of single and multi-channel respiratory sounds and EIT. Furthermore, we have proposed several machine learning-based baseline systems for automatically classifying respiratory diseases in six distinct evaluation tasks using respiratory sound and EIT (A1, A2, A3, B1, B2, B3). These tasks included classifying respiratory diseases at sample and subject levels. The performance of the classification models was evaluated using a 5-fold cross-validation scheme (with subject isolation between folds). RESULTS The resulting database consists of 1097 respiratory sounds and 795 EIT recordings acquired from 78 adult subjects in two countries (Portugal and Greece). In the task of automatically classifying respiratory diseases, the baseline classification models have achieved the following average balanced accuracy: Task A1 - 77.9±13.1%; Task A2 - 51.6±9.7%; Task A3 - 38.6±13.1%; Task B1 - 90.0±22.4%; Task B2 - 61.4±11.8%; Task B3 - 50.8±10.6%. CONCLUSION The creation of this database and its public release will aid the research community in developing automated methodologies to assess and monitor respiratory function, and it might serve as a benchmark in the field of digital medicine for managing respiratory diseases. Moreover, it could pave the way for creating multi-modal robust approaches for that same purpose.
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Affiliation(s)
- Diogo Pessoa
- University of Coimbra Centre for Informatics and Systems of the University of Coimbra, Department of Informatics Engineering, 3030-290 Coimbra, Portugal.
| | - Bruno Machado Rocha
- University of Coimbra Centre for Informatics and Systems of the University of Coimbra, Department of Informatics Engineering, 3030-290 Coimbra, Portugal
| | - Claas Strodthoff
- Department of Anesthesiology, and Intensive Care Medicine, University Medical Center Schleswig-Holstein Campus Kiel, Kiel 24105, Schleswig-Holstein, Germany
| | - Maria Gomes
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal
| | - Guilherme Rodrigues
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal
| | - Georgios Petmezas
- 2nd Department of Obstetrics and Gynaecology, The Medical School, 54124 Thessaloniki, Greece
| | | | - Vassilis Kilintzis
- 2nd Department of Obstetrics and Gynaecology, The Medical School, 54124 Thessaloniki, Greece
| | - Evangelos Kaimakamis
- 1st Intensive Care Unit, "G. Papanikolaou" General Hospital of Thessaloniki, 57010 Pilea Hortiatis, Greece
| | - Nicos Maglaveras
- 2nd Department of Obstetrics and Gynaecology, The Medical School, 54124 Thessaloniki, Greece
| | - Alda Marques
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193 Aveiro, Portugal
| | - Inéz Frerichs
- Department of Anesthesiology, and Intensive Care Medicine, University Medical Center Schleswig-Holstein Campus Kiel, Kiel 24105, Schleswig-Holstein, Germany
| | - Paulo de Carvalho
- University of Coimbra Centre for Informatics and Systems of the University of Coimbra, Department of Informatics Engineering, 3030-290 Coimbra, Portugal
| | - Rui Pedro Paiva
- University of Coimbra Centre for Informatics and Systems of the University of Coimbra, Department of Informatics Engineering, 3030-290 Coimbra, Portugal
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Cheshmehzangi A, Su Z, Zou T. ICT applications and the COVID-19 pandemic: Impacts on the individual's digital data, digital privacy, and data protection. FRONTIERS IN HUMAN DYNAMICS 2023. [DOI: 10.3389/fhumd.2023.971504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
A prominent move amid the COVID-19 pandemic is related to the wide use of ICT applications for various reasons. Such services are context-specific and sector-specific, but we see transformative directions leading to digital data collection, monitory, and management platforms. For now, these have been beneficial to evaluate trends and issues related to the pandemic. Some aggregated data could also help decision-making processes, which are helpful to contain such disruptive events. However, the main concern is the use of the individual's data and information, which means we may shift to micro-management and eventual controlling tools that could harm data protection processes. Undoubtedly, the use of ICTs during the COVID-19 pandemic has been primarily positive at multiple scales, but we have to evaluate the pros and cons before accepting all data collection processes. Such ICT-mediated platforms and/or applications must remain beneficial to all and avoid breaching the individual's data protection. This short communication paper first introduces ICT applications during the COVID-19 before providing an overview and further analysis of the situation of the ICT applications. Afterward, it discusses issues of data privacy, data collection, and data use, which are the backbone of ICT applications. The discussions highlight that future research in this area could look into associated issues related to digital privacy, data-driven approaches, and data protection regulations.
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Vorisek CN, Lehne M, Klopfenstein SAI, Mayer PJ, Bartschke A, Haese T, Thun S. Fast Healthcare Interoperability Resources (FHIR) for Interoperability in Health Research: A Systematic Review (Preprint). JMIR Med Inform 2021; 10:e35724. [PMID: 35852842 PMCID: PMC9346559 DOI: 10.2196/35724] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/22/2022] [Accepted: 05/18/2022] [Indexed: 01/04/2023] Open
Abstract
Background The standard Fast Healthcare Interoperability Resources (FHIR) is widely used in health information technology. However, its use as a standard for health research is still less prevalent. To use existing data sources more efficiently for health research, data interoperability becomes increasingly important. FHIR provides solutions by offering resource domains such as “Public Health & Research” and “Evidence-Based Medicine” while using already established web technologies. Therefore, FHIR could help standardize data across different data sources and improve interoperability in health research. Objective The aim of our study was to provide a systematic review of existing literature and determine the current state of FHIR implementations in health research and possible future directions. Methods We searched the PubMed/MEDLINE, Embase, Web of Science, IEEE Xplore, and Cochrane Library databases for studies published from 2011 to 2022. Studies investigating the use of FHIR in health research were included. Articles published before 2011, abstracts, reviews, editorials, and expert opinions were excluded. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and registered this study with PROSPERO (CRD42021235393). Data synthesis was done in tables and figures. Results We identified a total of 998 studies, of which 49 studies were eligible for inclusion. Of the 49 studies, most (73%, n=36) covered the domain of clinical research, whereas the remaining studies focused on public health or epidemiology (6%, n=3) or did not specify their research domain (20%, n=10). Studies used FHIR for data capture (29%, n=14), standardization of data (41%, n=20), analysis (12%, n=6), recruitment (14%, n=7), and consent management (4%, n=2). Most (55%, 27/49) of the studies had a generic approach, and 55% (12/22) of the studies focusing on specific medical specialties (infectious disease, genomics, oncology, environmental health, imaging, and pulmonary hypertension) reported their solutions to be conferrable to other use cases. Most (63%, 31/49) of the studies reported using additional data models or terminologies: Systematized Nomenclature of Medicine Clinical Terms (29%, n=14), Logical Observation Identifiers Names and Codes (37%, n=18), International Classification of Diseases 10th Revision (18%, n=9), Observational Medical Outcomes Partnership common data model (12%, n=6), and others (43%, n=21). Only 4 (8%) studies used a FHIR resource from the domain “Public Health & Research.” Limitations using FHIR included the possible change in the content of FHIR resources, safety, legal matters, and the need for a FHIR server. Conclusions Our review found that FHIR can be implemented in health research, and the areas of application are broad and generalizable in most use cases. The implementation of international terminologies was common, and other standards such as the Observational Medical Outcomes Partnership common data model could be used as a complement to FHIR. Limitations such as the change of FHIR content, lack of FHIR implementation, safety, and legal matters need to be addressed in future releases to expand the use of FHIR and, therefore, interoperability in health research.
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Affiliation(s)
- Carina Nina Vorisek
- Core Facility Digital Medicine and Interoperability, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Moritz Lehne
- Core Facility Digital Medicine and Interoperability, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sophie Anne Ines Klopfenstein
- Core Facility Digital Medicine and Interoperability, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Institute for Medical Informatics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Paula Josephine Mayer
- Core Facility Digital Medicine and Interoperability, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Bartschke
- Core Facility Digital Medicine and Interoperability, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Haese
- Core Facility Digital Medicine and Interoperability, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sylvia Thun
- Core Facility Digital Medicine and Interoperability, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
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