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Şenaylı YA, Keskin G, Akın M, Şenaylı A, Ata R, Demirtaş G, Şenel E. A prospective study for an alternative probe site for pulse oximetry measurement in male patients with severe burn trauma: penile shaf. Turk J Med Sci 2023; 53:504-510. [PMID: 37476869 PMCID: PMC10388062 DOI: 10.55730/1300-0144.5610] [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: 10/01/2022] [Accepted: 02/02/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Authors widely use pulse oximetry in clinical monitoring of heart rate (HR) and peripheral oxygen saturation (SpO2) by attachment to the fingers; however, there can be a need for an alternative attachment site, especially for burned patients. We investigate the availability of a pulse oximeter probe attached to the penile shaft as an alternative site in pediatric male patients if all extremities became unavailable for pulse oximetry measurement due to severe burn and/or trauma. METHODS We designed a prospective comparative study in a training and research hospital. After local ethical committee approval, pediatric male cases eligible for penile and extremity pulse measurements were evaluated during general anesthesia for medical dressing and/or grafting due to severe burns. One probe was attached to the fingers of the unburned extremity, and the other was to the penile shaft. Furthermore, we recorded SpO2and HR values at 5-min intervals; 0th (baseline), 5th, 10th and 15th minutes. We compared HR and SpO2values measured by the finger probe with those measured by the penile probe. RESULTS Data of 51 patients (median age, 2.9 years (interquartile range, 2.0-5.0 years)) in whom the duration of dressing was at least 15min were analyzed. There was no significant difference either in comparisons of hemodynamic measurements (HR and SpO2 ) obtainedby finger probe and by a penile probe for each measurement time. The Bland-Altman plot analysis reveals agreement for penile and finger probes with a mean bias value between 0.20 and 0.37 on HR and between 0.43 and -0.20 on SpO2. DISCUSSION This clinical trial demonstrated that pulse oximetry measurement under nonhypoxic conditions we could perform confidently using penile probes in pediatric male patients whose extremities are unavailable for measurement.
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Affiliation(s)
- Yeşim Andıran Şenaylı
- Department of Anesthesia and Reanimation, School of Medicine, Bozok University Yozgat Turkey; Department of Pediatric Surgery, School of Medicine, Ankara Yıldırım Beyazıt University Ankara, Turkey
| | - Gülsen Keskin
- Department of Anesthesia and Reanimation, Ministry of Health Ankara City Hospital Ankara, Turkey
| | - Mine Akın
- Department of Anesthesia and Reanimation, Ministry of Health Ankara City Hospital Ankara, Turkey
| | - Atilla Şenaylı
- Department of Pediatric Surgery, School of Medicine, Bozok University, Yozgat, Turkey
| | - Rabia Ata
- Department of Pediatric Surgery, Çam ve Sakura City Hospital İstanbul, Turkey
| | - Gökhan Demirtaş
- Department of Pediatric Urology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Emrah Şenel
- Department of Pediatric Surgery, School of Medicine, Bozok University, Yozgat, Turkey
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Sheikh M, Ahmad H, Ibrahim R, Nisar I, Jehan F. Pulse oximetry: why oxygen saturation is still not a part of standard pediatric guidelines in low-and-middle-income countries (LMICs). Pneumonia (Nathan) 2023; 15:3. [PMID: 36739442 PMCID: PMC9899156 DOI: 10.1186/s41479-023-00108-6] [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: 02/14/2022] [Accepted: 01/13/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND With the high frequency of acute respiratory infections in children worldwide, particularly so in low-resource countries, the development of effective diagnostic support is crucial. While pulse oximetry has been found to be an acceptable method of hypoxemia detection, improving clinical decision making and efficient referral, many healthcare set ups in low- and middle-income countries have not been able to implement pulse oximetry into their practice. MAIN BODY A review of past pulse oximetry implementation attempts in low- and middle-income countries proposes the barriers and potential solutions for complete integration in the healthcare systems. The addition of pulse oximetry into WHO health guidelines would prove to improve detection of respiratory distress and ensuing therapeutic measures. Incorporation is limited by the cost and unavailability of pulse oximeters, and subsequent oxygen accessibility. This restriction is compounded by the lack of trained personnel, and healthcare provider misconceptions. These hurdles can be combated by focus on low-cost devices, and cooperation at national levels for development in healthcare infrastructure, resource transport, and oxygen delivery systems. CONCLUSION The implementation of pulse oximetry shows promise to improve child morbidity and mortality from pneumonia in low- and middle-income countries. Steady measures taken to improve access to pulse oximeters and oxygen supplies, along with enhanced medical provider training are encouraging steps to thorough pulse oximetry integration.
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Affiliation(s)
- Maheen Sheikh
- grid.7147.50000 0001 0633 6224Department of Pediatrics and Child Health, Aga Khan University, Karachi, 74800 Pakistan
| | - Huzaifa Ahmad
- grid.415235.40000 0000 8585 5745Department of Medicine, MedStar Washington Hospital Center, Washington, DC 20010 USA
| | - Romesa Ibrahim
- grid.7147.50000 0001 0633 6224Department of Pediatrics and Child Health, Aga Khan University, Karachi, 74800 Pakistan
| | - Imran Nisar
- grid.7147.50000 0001 0633 6224Department of Pediatrics and Child Health, Aga Khan University, Karachi, 74800 Pakistan
| | - Fyezah Jehan
- grid.7147.50000 0001 0633 6224Department of Pediatrics and Child Health, Aga Khan University, Karachi, 74800 Pakistan
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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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4
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Zhang M, Cui X, Li N. Smartphone-based mobile biosensors for the point-of-care testing of human metabolites. Mater Today Bio 2022; 14:100254. [PMID: 35469257 PMCID: PMC9034388 DOI: 10.1016/j.mtbio.2022.100254] [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: 01/04/2022] [Revised: 03/14/2022] [Accepted: 03/31/2022] [Indexed: 11/29/2022] Open
Abstract
Rapid, accurate, portable and quantitative profiling of metabolic biomarkers is of great importance for disease diagnosis and prognosis. The recent development in the optical and electric biosensors based on the smartphone is promising for profiling of metabolites with advantages of rapid, reliability, accuracy, low-cost and multi-analytes analysis capability. In this review, we introduced the optical biosensing platforms including colorimetric, fluorescent and chemiluminescent sensing, and electrochemical biosensing platforms including wired and wireless communication. Challenges and future perspectives desired for reliable, accurate, cost-effective, and multi-functions smartphone-based biosensing systems were also discussed. We envision that such smartphone-based biosensing platforms will allow daily and comprehensive metabolites monitoring in the future, thus unlocking the potential to transform clinical diagnostics into non-clinical self-testing. We also believed that this progress report will encourage future research to develop advanced, integrated and multi-functional smartphone-based Point-of-Care testing (POCT) biosensors for the monitoring and diagnosis as well as personalized treatments of a spectrum of metabolic-disorder related diseases.
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Abstract
Sleep plays a critical role in the development of healthy children. Detecting sleep and sleep disorders and the effectiveness of interventions for improving sleep in children require valid sleep measures. Assessment of sleep in children, in particular infants and young children, can be a quite challenging task. Many subjective and objective methods are available to evaluate various aspects of sleep in childhood, each with their strengths and limitations. None can, however, replace the importance of thorough clinical interview with detailed history and clinical examination by a sleep specialist.
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Affiliation(s)
- Barbara Gnidovec Stražišar
- Pediatric Department, Centre for Pediatric Sleep Disorders, General Hospital Celje, Oblakova ulica 5, Celje 3000, Slovenia; College of Nursing in Celje, Celje, Slovenia; Medical Faculty, University of Maribor, Maribor, Slovenia.
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6
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Hoppenbrouwer XLR, Rollinson AU, Dunsmuir D, Ansermino JM, Dumont G, Oude Nijeweme-d'Hollosy W, Veltink P, Garde A. Night to night variability of pulse oximetry features in children at home and at the hospital. Physiol Meas 2021; 42. [PMID: 34713819 DOI: 10.1088/1361-6579/ac278e] [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] [Received: 05/30/2021] [Accepted: 09/16/2021] [Indexed: 12/22/2022]
Abstract
Objective. Investigation of the night-to-night (NtN) variability of pulse oximetry features in children with suspicion of Sleep Apnea.Approach. Following ethics approval and informed consent, 75 children referred to British Columbia Children's Hospital for overnight PSG were recorded on three consecutive nights, including one at the hospital simultaneously with polysomnography and 2 nights at home. During all three nights, a smartphone-based pulse oximeter sensor was used to record overnight pulse oximetry (SpO2 and photoplethysmogram). Features characterizing SpO2 dynamics and heart rate were derived. The NtN variability of these features over the three different nights was investigated using linear mixed models.Main results. Overall most pulse oximetry features (e.g. the oxygen desaturation index) showed no NtN variability. One of the exceptions is for the signal quality, which was significantly lower during at home measurements compared to measurements in the hospital.Significance. At home pulse oximetry screening shows an increasing predictive value to investigate obstructive sleep apnea (OSA) severity. Hospital recordings affect subjects normal sleep and OSA severity and recordings may vary between nights at home. Before establishing the role of home monitoring as a diagnostic test for OSA, we must first determine their NtN variability. Most pulse oximetry features showed no significant NtN variability and could therefore be used in future at-home testing to create a reliable and consistent OSA screening tool. A single night recording at home should be able to characterize pulse oximetry features in children.
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Affiliation(s)
- Xenia L R Hoppenbrouwer
- Biomedical Signals and Systems group, Faculty of Electrical Engineering, Mathematics & Computer Science, University of Twente, Enschede, The Netherlands
| | - Aryannah U Rollinson
- The Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Dustin Dunsmuir
- The Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - J Mark Ansermino
- The Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Guy Dumont
- The Department of Electrical & Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy Oude Nijeweme-d'Hollosy
- Biomedical Signals and Systems group, Faculty of Electrical Engineering, Mathematics & Computer Science, University of Twente, Enschede, The Netherlands
| | - Peter Veltink
- Biomedical Signals and Systems group, Faculty of Electrical Engineering, Mathematics & Computer Science, University of Twente, Enschede, The Netherlands
| | - Ainara Garde
- Biomedical Signals and Systems group, Faculty of Electrical Engineering, Mathematics & Computer Science, University of Twente, Enschede, The Netherlands
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Modi AM, Kiourkas RD, Li J, Scott JB. Reliability of Smartphone Pulse Oximetry in Subjects at Risk for Hypoxemia. Respir Care 2021; 66:384-390. [PMID: 33023999 PMCID: PMC9994075 DOI: 10.4187/respcare.07670] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pulse oximeters are used to measure [Formula: see text] and pulse rate. These devices are either standalone machines or integrated into physiologic monitoring systems. Some smartphones now have pulse oximetry capabilities. Because it is possible that some patients might utilize this technology, we sought to assess the accuracy and usability of smartphone pulse oximeters. METHODS This was a prospective, observational study that involved noninvasive measurements of [Formula: see text] and heart rate with 3 devices: Masimo Radical-7, Kenek Edge with the Apple iPhone 6S, and the Samsung S8 smartphone. Ambulatory adult patients visiting our institution's pulmonary function lab for a 6-min walk test were eligible to participate in the study. Pretest and posttest results for each subject were obtained simultaneously using all 3 devices. All results were analyzed with the Spearman rho correlation test, and Bland-Altman plots were used to assess the agreement of measures between the devices. RESULTS Forty-seven subjects were enrolled in the study, with pulmonary hypertension (30%) and COPD (23%) being the 2 major diagnoses. The mean ± SD difference between the Masimo and Apple devices for pretest [Formula: see text] was 2.3 ± 2.4%, and the difference for posttest [Formula: see text] was 2.1 ± 3.9%. The mean difference between the Masimo and Samsung devices for pretest [Formula: see text] was 3.2 ± 2.8%, and the difference for posttest [Formula: see text] was 2.4 ± 3.5%. The number of subjects who were unable to obtain [Formula: see text] was higher with the Samsung device than with the Apple device in both pretest (14 of 47 vs 3 of 47) and posttest (17 of 47 vs 5 of 47). In contrast, the Masimo device was able to measure [Formula: see text] in all subjects. CONCLUSIONS Smartphone pulse oximeters were unreliable compared to a hospital pulse oximeter. Further research is needed with evolving technology to better understand smartphone pulse oximetry. (ClinicalTrials.gov registration NCT03534271.).
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Affiliation(s)
- Aashna M Modi
- Respiratory Care Services, Rush University Medical Center, Chicago, Illinois
| | - Renee D Kiourkas
- Respiratory Care Services, Rush University Medical Center, Chicago, Illinois
| | - Jie Li
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, Illinois
| | - J Brady Scott
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, Illinois.
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O'Mahony AM, Garvey JF, McNicholas WT. Technologic advances in the assessment and management of obstructive sleep apnoea beyond the apnoea-hypopnoea index: a narrative review. J Thorac Dis 2020; 12:5020-5038. [PMID: 33145074 PMCID: PMC7578472 DOI: 10.21037/jtd-sleep-2020-003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Obstructive sleep apnoea (OSA) is a growing and serious worldwide health problem with significant health and socioeconomic consequences. Current diagnostic testing strategies are limited by cost, access to resources and over reliance on one measure, namely the apnoea-hypopnoea frequency per hour (AHI). Recent evidence supports moving away from the AHI as the principle measure of OSA severity towards a more personalised approach to OSA diagnosis and treatment that includes phenotypic and biological traits. Novel advances in technology include the use of signals such as heart rate variability (HRV), oximetry and peripheral arterial tonometry (PAT) as alternative or additional measures. Ubiquitous use of smartphones and developments in wearable technology have also led to increased availability of applications and devices to facilitate home screening of at-risk populations, although current evidence indicates relatively poor accuracy in comparison with the traditional gold standard polysomnography (PSG). In this review, we evaluate the current strategies for diagnosing OSA in the context of their limitations, potential physiological targets as alternatives to AHI and the role of novel technology in OSA. We also evaluate the current evidence for using newer technologies in OSA diagnosis, the physiological targets such as smartphone applications and wearable technology. Future developments in OSA diagnosis and assessment will likely focus increasingly on systemic effects of sleep disordered breathing (SDB) such as changes in nocturnal oxygen and blood pressure (BP); and may also include other factors such as circulating biomarkers. These developments will likely require a re-evaluation of the diagnostic and grading criteria for clinically significant OSA.
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Affiliation(s)
- Anne M O'Mahony
- School of Medicine, University College Dublin, Dublin, Ireland
| | - John F Garvey
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Walter T McNicholas
- School of Medicine, University College Dublin, Dublin, Ireland.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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9
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Petersen CL, Görges M, Todorova E, West NC, Newlove T, Ansermino JM. Feasibility of Using a Single Heart Rate-Based Measure for Real-time Feedback in a Voluntary Deep Breathing App for Children: Data Collection and Algorithm Development. JMIR Perioper Med 2020; 3:e16639. [PMID: 33393917 PMCID: PMC7709837 DOI: 10.2196/16639] [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: 10/10/2019] [Revised: 03/04/2020] [Accepted: 08/13/2020] [Indexed: 11/26/2022] Open
Abstract
Background Deep diaphragmatic breathing, also called belly breathing, is a popular behavioral intervention that helps children cope with anxiety, stress, and their experience of pain. Combining physiological monitoring with accessible mobile technology can motivate children to comply with this intervention through biofeedback and gaming. These innovative technologies have the potential to improve patient experience and compliance with strategies that reduce anxiety, change the experience of pain, and enhance self-regulation during distressing medical procedures. Objective The aim of this paper was to describe a simple biofeedback method for quantifying breathing compliance in a mobile smartphone app. Methods A smartphone app was developed that combined pulse oximetry with an animated protocol for paced deep breathing. We collected photoplethysmogram data during spontaneous and subsequently paced deep breathing in children. Two measures, synchronized respiratory sinus arrhythmia (RSAsync) and the corresponding relative synchronized inspiration/expiration heart rate ratio (HR-I:Esync), were extracted from the photoplethysmogram. Results Data collected from 80 children aged 5-17 years showed a positive RSAsync effect in all participants during paced deep breathing, with a median (IQR; range) HR-I:Esync ratio of 1.26 (1.16-1.35; 1.01-1.60) during paced deep breathing compared to 0.98 (0.96-1.02; 0.82-1.18) during spontaneous breathing (median difference 0.25, 95% CI 0.23-0.30; P<.001). The measured HR-I:Esync values appeared to be independent of age. Conclusions An HR-I:Esync level of 1.1 was identified as an age-independent threshold for programming the breathing pattern for optimal compliance in biofeedback.
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Affiliation(s)
- Christian L Petersen
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Matthias Görges
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada.,Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Evgenia Todorova
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychology, BC Children's Hospital, Vancouver, BC, Canada
| | - Nicholas C West
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Theresa Newlove
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychology, BC Children's Hospital, Vancouver, BC, Canada
| | - J Mark Ansermino
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada.,Research Institute, BC Children's Hospital, Vancouver, BC, Canada
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10
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Enoch AJ, English M, McGivern G, Shepperd S. Variability in the use of pulse oximeters with children in Kenyan hospitals: A mixed-methods analysis. PLoS Med 2019; 16:e1002987. [PMID: 31891572 PMCID: PMC6938307 DOI: 10.1371/journal.pmed.1002987] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/21/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pulse oximetry, a relatively inexpensive technology, has the potential to improve health outcomes by reducing incorrect diagnoses and supporting appropriate treatment decisions. There is evidence that in low- and middle-income countries, even when available, widespread uptake of pulse oximeters has not occurred, and little research has examined why. We sought to determine when and with which children pulse oximeters are used in Kenyan hospitals, how pulse oximeter use impacts treatment provision, and the barriers to pulse oximeter use. METHODS AND FINDINGS We analyzed admissions data recorded through Kenya's Clinical Information Network (CIN) between September 2013 and February 2016. We carried out multiple imputation and generated multivariable regression models in R. We also conducted interviews with 30 healthcare workers and staff from 14 Kenyan hospitals to examine pulse oximetry adoption. We adapted the Integrative Model of Behavioural Prediction to link the results from the multivariable regression analyses to the qualitative findings. We included 27,906 child admissions from 7 hospitals in the quantitative analyses. The median age of the children was 1 year, and 55% were male. Three-quarters had a fever, over half had a cough; other symptoms/signs were difficulty breathing (34%), difficulty feeding (34%), and indrawing (32%). The most common diagnoses were pneumonia, diarrhea, and malaria: 45%, 35%, and 28% of children, respectively, had these diagnoses. Half of the children obtained a pulse oximeter reading, and of these, 10% had an oxygen saturation level below 90%. Children were more likely to receive a pulse oximeter reading if they were not alert (odds ratio [OR]: 1.30, 95% confidence interval (CI): 1.09, 1.55, p = 0.003), had chest indrawing (OR: 1.28, 95% CI: 1.17, 1.40, p < 0.001), or a very high respiratory rate (OR: 1.27, 95% CI: 1.13, 1.43, p < 0.001), as were children admitted to certain hospitals, at later time periods, and when a Paediatric Admission Record (PAR) was used (OR PAR used compared with PAR not present: 2.41, 95% CI: 1.98, 2.94, p < 0.001). Children were more likely to be prescribed oxygen if a pulse oximeter reading was obtained (OR: 1.42, 95% CI:1.25, 1.62, p < 0.001) and if this reading was below 90% (OR: 3.29, 95% CI: 2.82, 3.84, p < 0.001). The interviews indicated that the main barriers to pulse oximeter use are inadequate supply, broken pulse oximeters, and insufficient training on how, when, and why to use pulse oximeters and interpret their results. According to the interviews, variation in pulse oximeter use between hospitals is because of differences in pulse oximeter availability and the leadership of senior doctors in advocating for pulse oximeter use, whereas variation within hospitals over time is due to repair delays. Pulse oximeter use increased over time, likely because of the CIN's feedback to hospitals. When pulse oximeters are used, they are sometimes used incorrectly and some healthcare workers lack confidence in readings that contradict clinical signs. The main limitations of the study are that children with high levels of missing data were not excluded, interview participants might not have been representative, and the interviews did not enable a detailed exploration of differences between counties or across senior management groups. CONCLUSIONS There remain major challenges to implementing pulse oximetry-a cheap, decades old technology-into routine care in Kenya. Implementation requires efficient and transparent procurement and repair systems to ensure adequate availability. Periodic training, structured clinical records that include prompts, the promotion of pulse oximetry by senior doctors, and monitoring and feedback might also support pulse oximeter use. Our findings can inform strategies to support the use of pulse oximeters to guide prompt and effective treatment, in line with the Sustainable Development Goals. Without effective implementation, the potential benefits of pulse oximeters and possible hospital cost-savings by targeting oxygen therapy might not be realized.
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Affiliation(s)
- Abigail J Enoch
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (former DPhil student)
| | - Mike English
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.,Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Gerald McGivern
- Warwick Business School, University of Warwick, Coventry, United Kingdom
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Jullian-Desayes I, Joyeux-Faure M, Baillieul S, Guzun R, Tamisier R, Pepin JL. [What prospects for the sleep apnea syndrome and connected health?]. Orthod Fr 2019; 90:435-442. [PMID: 34643529 DOI: 10.1051/orthodfr/2019019] [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: 06/13/2023]
Abstract
Connected health is a growing field and can be viewed from different perspectives, particularly in sleep apnea syndrome. The purpose of this review is to show how all these aspects of connected health are already used in the management of sleep apnea syndrome (SAS) and its comorbidities. First, it can give patients a better understanding and a better assessment of their health. It also facilitates their healthcare by allowing them a greater role in their care pathway. For healthcare providers, connected health tools make it possible to set up new procedures for diagnosing and monitoring ambulatory patients, and for the making of joint decisions by health professionals and patients. Finally, for researchers, e-health generates massive amounts of data, thus facilitating the acquisition of knowledge in real life situations and the development of new methodologies for clinical studies that are faster, less expensive and just as reliable. All these considerations are already applicable in the field of sleep apnea, both for proposed treatments and for comorbidities management and for the patient's involvement in his/her care pathway.
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Affiliation(s)
- Ingrid Jullian-Desayes
- Laboratoire HP2, INSERM U1042, Université Grenoble Alpes, Faculté de Médecine/Pharmacie, 38700 La Tronche, France Laboratoire HP2, INSERM U1042, Explorations Fonctionnelles Respiratoires, CHU Grenoble, France Service EFCR, Physiologie Sommeil et Exercice, Pole Thorax et Vaisseaux, CHU Grenoble, CS10217, 38043 Grenoble Cedex 9, France
| | - Marie Joyeux-Faure
- Laboratoire HP2, INSERM U1042, Université Grenoble Alpes, Faculté de Médecine/Pharmacie, 38700 La Tronche, France Laboratoire HP2, INSERM U1042, Explorations Fonctionnelles Respiratoires, CHU Grenoble, France Service EFCR, Physiologie Sommeil et Exercice, Pole Thorax et Vaisseaux, CHU Grenoble, CS10217, 38043 Grenoble Cedex 9, France
| | - Sébastien Baillieul
- Laboratoire HP2, INSERM U1042, Université Grenoble Alpes, Faculté de Médecine/Pharmacie, 38700 La Tronche, France Laboratoire HP2, INSERM U1042, Explorations Fonctionnelles Respiratoires, CHU Grenoble, France Service EFCR, Physiologie Sommeil et Exercice, Pole Thorax et Vaisseaux, CHU Grenoble, CS10217, 38043 Grenoble Cedex 9, France
| | - Rita Guzun
- Laboratoire HP2, INSERM U1042, Université Grenoble Alpes, Faculté de Médecine/Pharmacie, 38700 La Tronche, France Laboratoire HP2, INSERM U1042, Explorations Fonctionnelles Respiratoires, CHU Grenoble, France Service EFCR, Physiologie Sommeil et Exercice, Pole Thorax et Vaisseaux, CHU Grenoble, CS10217, 38043 Grenoble Cedex 9, France
| | - Renaud Tamisier
- Laboratoire HP2, INSERM U1042, Université Grenoble Alpes, Faculté de Médecine/Pharmacie, 38700 La Tronche, France Laboratoire HP2, INSERM U1042, Explorations Fonctionnelles Respiratoires, CHU Grenoble, France Service EFCR, Physiologie Sommeil et Exercice, Pole Thorax et Vaisseaux, CHU Grenoble, CS10217, 38043 Grenoble Cedex 9, France
| | - Jean-Louis Pepin
- Laboratoire HP2, INSERM U1042, Université Grenoble Alpes, Faculté de Médecine/Pharmacie, 38700 La Tronche, France Laboratoire HP2, INSERM U1042, Explorations Fonctionnelles Respiratoires, CHU Grenoble, France Service EFCR, Physiologie Sommeil et Exercice, Pole Thorax et Vaisseaux, CHU Grenoble, CS10217, 38043 Grenoble Cedex 9, France
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12
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Holz C, Ofek E. Doubling the Signal Quality of Smartphone Camera Pulse Oximetry Using the Display Screen as a Controllable Selective Light Source. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2018:1-4. [PMID: 30440314 DOI: 10.1109/embc.2018.8513286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Recent smartphones have the potential to bring camera oximetry to everyone using their powerful sensors and the capability to process measurements in real-time, potentially augmenting people's lives through always-available oximetry monitoring everywhere. The challenge of camera oximetry on smartphones is the low contrast between reflections from oxyhemoglobin and deoxyhemoglobin. In this paper, we show that this is the result of using the camera flash for illumination, which illuminates evenly across bands than thus leads to the diminished contrast in reflections. Instead, we propose capturing pulse using the front-facing camera and illuminating with the phone's display, a selective illuminant in the red, green, and blue band. We evaluate the spectral characteristics of the phone display using a spectroradiometer in a controlled experiment, convolve them with the sensitivity curves of the phone's camera, and show that the screen's narrow-band display illumination increases the contrast between the reflections in the desired bands by a factor of two compared to flash illumination. Our preliminary evaluation showed further support for our approach and findings.
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13
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Ding X, Nassehi D, Larson EC. Measuring Oxygen Saturation With Smartphone Cameras Using Convolutional Neural Networks. IEEE J Biomed Health Inform 2018; 23:2603-2610. [PMID: 30571649 DOI: 10.1109/jbhi.2018.2887209] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Arterial oxygen saturation ([Formula: see text]) is an indicator of how much oxygen is carried by hemoglobin in the blood. Having enough oxygen is vital for the functioning of cells in the human body. Measurement of [Formula: see text] is typically estimated with a pulse oximeter, but recent works have investigated how smartphone cameras can be used to infer [Formula: see text]. In this paper, we propose methods for the measurement of [Formula: see text] with a smartphone using convolutional neural networks and preprocessing steps to better guard against motion artifacts. To evaluate this methodology, we conducted a breath-holding study involving 39 participants. We compare the results using two different mobile phones. We compare our model with the ratio-of-ratios model that is widely used in pulse oximeter applications, showing that our system has significantly lower mean absolute error (2.02%) than a medical pulse oximeter.
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14
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Garde A, Hoppenbrouwer X, Dehkordi P, Zhou G, Rollinson AU, Wensley D, Dumont GA, Ansermino JM. Pediatric pulse oximetry-based OSA screening at different thresholds of the apnea-hypopnea index with an expression of uncertainty for inconclusive classifications. Sleep Med 2018; 60:45-52. [PMID: 31288931 DOI: 10.1016/j.sleep.2018.08.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Assessments of pediatric obstructive sleep apnea (OSA) are underutilized across Canada due to a lack of resources. Polysomnography (PSG) measures OSA severity through the average number of apnea/hypopnea events per hour (AHI), but is resource intensive and requires a specialized sleep laboratory, which results in long waitlists and delays in OSA detection. Prompt diagnosis and treatment of OSA are crucial for children, as untreated OSA is linked to behavioral deficits, growth failure, and negative cardiovascular consequences. We aim to assess the performance of a portable pediatric OSA screening tool at different AHI cut-offs using overnight smartphone-based pulse oximetry. MATERIAL AND METHODS Following ethics approval and informed consent, children referred to British Columbia Children's Hospital for overnight PSG were recruited for two studies including 160 and 75 children, respectively. An additional smartphone-based pulse oximeter sensor was used in both studies to record overnight pulse oximetry [SpO2 and photoplethysmogram (PPG)] alongside the PSG. Features characterizing SpO2 dynamics and heart rate variability from pulse peak intervals of the PPG signal were derived from pulse oximetry recordings. Three multivariate logistic regression screening models, targeted at three different levels of OSA severity (AHI ≥ 1, 5, and 10), were developed using stepwise-selection of features using the Bayesian information criterion (BIC). The "Gray Zone" approach was also implemented for different tolerance values to allow for more precise detection of children with inconclusive classification results. RESULTS The optimal diagnostic tolerance values defining the "Gray Zone" borders (15, 10, and 5, respectively) were selected to develop the final models to screen for children at AHI cut-offs of 1, 5, and 10. The final models evaluated through cross-validation showed good accuracy (75%, 82% and 89%), sensitivity (80%, 85% and 82%) and specificity (65%, 79% and 91%) values for detecting children with AHI ≥ 1, AHI ≥ 5 and AHI ≥ 10. The percentage of children classified as inconclusive was 28%, 38% and 16% for models detecting AHI ≥ 1, AHI ≥ 5, and AHI ≥ 10, respectively. CONCLUSIONS The proposed pulse oximetry-based OSA screening tool at different AHI cut-offs may assist clinicians in identifying children at different OSA severity levels. Using this tool at home prior to PSG can help with optimizing the limited resources for PSG screening. Further validation with larger and more heterogeneous datasets is required before introducing in clinical practice.
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Affiliation(s)
- Ainara Garde
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics & Computer Science, University of Twente, Enschede, the Netherlands; The Department of Electrical & Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada.
| | - Xenia Hoppenbrouwer
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics & Computer Science, University of Twente, Enschede, the Netherlands
| | - Parastoo Dehkordi
- The Department of Electrical & Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Guohai Zhou
- Center for Outcomes Research & Evaluation, School of Medicine, Yale University, New Haven, United States
| | - Aryannah Umedaly Rollinson
- The Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - David Wensley
- Division of Critical Care, The University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Guy A Dumont
- The Department of Electrical & Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada
| | - J Mark Ansermino
- The Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
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15
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Álvarez D, Crespo A, Vaquerizo-Villar F, Gutierrez-Tobal GC, Cerezo-Hernández A, Barroso-García V, Ansermino JM, Dumont GA, Hornero R, Del Campo F, Garde A. Symbolic dynamics to enhance diagnostic ability of portable oximetry from the phone oximeter in the detection of paediatric sleep apnoea. Physiol Meas 2018; 39:104002. [PMID: 30230476 DOI: 10.1088/1361-6579/aae2a8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study is aimed at assessing symbolic dynamics as a reliable technique to characterise complex fluctuations of portable oximetry in the context of automated detection of childhood obstructive sleep apnoea-hypopnoea syndrome (OSAHS). APPROACH Nocturnal oximetry signals from 142 children with suspected OSAHS were acquired using the Phone Oximeter: a portable device that integrates a pulse oximeter with a smartphone. An apnoea-hypopnoea index (AHI) ≥5 events/h from simultaneous in-lab polysomnography was used to confirm moderate-to-severe childhood OSAHS. Symbolic dynamics was used to parameterise non-linear changes in the overnight oximetry profile. Conventional indices, anthropometric measures, and time-domain linear statistics were also considered. Forward stepwise logistic regression was used to obtain an optimum feature subset. Logistic regression (LR) was used to identify children with moderate-to-severe OSAHS. MAIN RESULTS The histogram of 3-symbol words from symbolic dynamics showed significant differences (p <0.01) between children with AHI <5 events/h and moderate-to-severe patients (AHI ≥5 events/h). Words representing increasing oximetry values after apnoeic events (re-saturations) showed relevant diagnostic information. Regarding the performance of individual characterization approaches, the LR model composed of features from symbolic dynamics alone reached a maximum performance of 78.4% accuracy (65.2% sensitivity; 86.8% specificity) and 0.83 area under the ROC curve (AUC). The classification performance improved combining all features. The optimum model from feature selection achieved 83.3% accuracy (73.5% sensitivity; 89.5% specificity) and 0.89 AUC, significantly (p-value <0.01) outperforming the other models. SIGNIFICANCE Symbolic dynamics provides complementary information to conventional oximetry analysis enabling reliable detection of moderate-to-severe paediatric OSAHS from portable oximetry.
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Affiliation(s)
- Daniel Álvarez
- Pneumology Service, Rio Hortega University Hospital, Valladolid, Valladolid, SPAIN
| | - Andrea Crespo
- Pneumology Service, Rio Hortega University Hospital, Valladolid, Valladolid, SPAIN
| | - Fernado Vaquerizo-Villar
- Biomedical Engineering Group, ETSI Telecomunicación, Universidad de Valladolid, Valladolid, Castilla y León, SPAIN
| | - Gonzalo Cesar Gutierrez-Tobal
- Biomedical Engineering Group ETS Ingenieros de Telecommunicacion, Universidad de Valladolid, Camino del Cementerio sn, 47011 Valladoid, Valladolid, SPAIN
| | - Ana Cerezo-Hernández
- Pneumology Service, Rio Hortega University Hospital, Valladolid, Valladolid, SPAIN
| | - Verónica Barroso-García
- Biomedical Engineering Group, ETSI Telecomunicación, Universidad de Valladolid, Valladolid, Castilla y León, SPAIN
| | | | - Guy A Dumont
- University of British Columbia, Vancouver, British Columbia, CANADA
| | - Roberto Hornero
- Biomedical Engineering Group, ETSI Telecomunicación, Universidad de Valladolid, Valladolid, Castilla y León, SPAIN
| | - Felix Del Campo
- Pneumology Service, Rio Hortega University Hospital, Valladolid, Valladolid, SPAIN
| | - Ainara Garde
- Universiteit Twente, Enschede, 7500 AE, NETHERLANDS
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16
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Lundin J, Dumont G. Medical mobile technologies - what is needed for a sustainable and scalable implementation on a global scale? Glob Health Action 2018; 10:1344046. [PMID: 28838308 PMCID: PMC5786339 DOI: 10.1080/16549716.2017.1344046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Current advances within medical technology show great potential from a global health perspective. Inexpensive, effective solutions to common problems within diagnostics, medical procedures and access to medical information are emerging within almost all fields of medicine. The innovations can benefit health care both in resource-limited and in resource-rich settings. However, there is a big gap between the proof-of-concept stage and implementation. This article will give examples of promising solutions, with special focus on mobile image- and sensor-based diagnostics. We also discuss how technology and frugal innovations could be made sustainable and widely available. Finally, a list of critical factors for success is presented, based on both our own experiences and the literature.
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Affiliation(s)
- Johan Lundin
- a Institute for Molecular Medicine Finland - FIMM , University of Helsinki , Helsinki , Finland.,b Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
| | - Guy Dumont
- c Department of Electrical and Computer Engineering , University of British Columbia , Vancouver , Canada.,d Stellenbosch Institute for Advanced Study (STIAS) , Wallenberg Research Centre at Stellenbosch University , Stellenbosch , South Africa
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17
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Hoppenbrouwer XLR, Dehkordi P, Rollinson AU, Dunsmuir D, Ansermino JM, Dumont G, Garde A. Night to night pulse oximetry variability in children with suspected sleep apnea. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:179-182. [PMID: 30440367 DOI: 10.1109/embc.2018.8512216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Obstructive Sleep Apnea (OSA) is the most common form of sleep-disordered breathing in children. The gold standard to screen for OSA, polysomnography (PSG), requires an overnight stay in the hospital and is resource intensive. The Phone Oximeter is a non-invasive smartphone-based tool to record pulse oximetry. This portable device is able to measure patients over multiple nights while at home, causing less sleep disturbance than PSG and is able to measure night to night variability in sleep. This study analyzed the Screen My Sleep children (SMS) dataset, in which 74 children were monitored over multiple nights with the Phone Oximeter, including one night simultaneously with PSG in the hospital and two nights at home. In this study, we aim to investigate the night to night variability and assess the accuracy of the oxygen desaturation index (ODI) screening for children with significant OSA. In order to assess the performance of the ODI calculation in children, we implemented different ODIs at different desaturation levels and time durations. The variability was studied using a one-way ANOVA, and ODI's performance screening for OSA using the area under the ROC curve (AUC). The implemented ODIs provide similar OSA screening results, using different apnea/hypopnea index (AHI) thresholds, as the ODI recommended for adults by the American academy of sleep medicine (AASM). The ODI provides an AUC of around 0.77, 0.76, 0.94 and 0.97 classifying children with an AHI > 1, AHI > 5 AHI > 10 and AHI > 15, respectively. The SMS dataset shows no significant night to night variability between the two nights at home. However, when comparing with the night at the hospital, both nights at home show a decrease in the lowest SpO2 value as well as overall SpO2 signal quality percentage. This study shows that there is variability in SpO2 signal between at-home versus in hospital settings.
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18
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Cho YT. Noise Source Visualization Using a Digital Voice Recorder and Low-Cost Sensors. SENSORS (BASEL, SWITZERLAND) 2018; 18:s18041076. [PMID: 29614038 PMCID: PMC5948570 DOI: 10.3390/s18041076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 03/30/2018] [Accepted: 03/31/2018] [Indexed: 06/08/2023]
Abstract
Accurate sound visualization of noise sources is required for optimal noise control. Typically, noise measurement systems require microphones, an analog-digital converter, cables, a data acquisition system, etc., which may not be affordable for potential users. Also, many such systems are not highly portable and may not be convenient for travel. Handheld personal electronic devices such as smartphones and digital voice recorders with relatively lower costs and higher performance have become widely available recently. Even though such devices are highly portable, directly implementing them for noise measurement may lead to erroneous results since such equipment was originally designed for voice recording. In this study, external microphones were connected to a digital voice recorder to conduct measurements and the input received was processed for noise visualization. In this way, a low cost, compact sound visualization system was designed and introduced to visualize two actual noise sources for verification with different characteristics: an enclosed loud speaker and a small air compressor. Reasonable accuracy of noise visualization for these two sources was shown over a relatively wide frequency range. This very affordable and compact sound visualization system can be used for many actual noise visualization applications in addition to educational purposes.
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Affiliation(s)
- Yong Thung Cho
- Division of Mechanical and Automotive Engineering, Kongju National University, Cheonan, Chungnam 31080, Korea.
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19
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Abstract
Sleep medicine has been an expanding discipline during the last few decades. The prevalence of sleep disorders is increasing, and sleep centers are expanding in hospitals and in the private care environment to meet the demands. Sleep medicine has evidence-based guidelines for the diagnosis and treatment of sleep disorders. However, the number of sleep centers and caregivers in this area is not sufficient. Many new methods for recording sleep and diagnosing sleep disorders have been developed. Many sleep disorders are chronic conditions and require continuous treatment and monitoring of therapy success. Cost-efficient technologies for the initial diagnosis and for follow-up monitoring of treatment are important. It is precisely here that telemedicine technologies can meet the demands of diagnosis and therapy follow-up studies. Wireless recording of sleep and related biosignals allows diagnostic tools and therapy follow-up to be widely and remotely available. Moreover, sleep research requires new technologies to investigate underlying mechanisms in the regulation of sleep in order to better understand the pathophysiology of sleep disorders. Home recording and non-obtrusive recording over extended periods of time with telemedicine methods support this research. Telemedicine allows recording with little subject interference under normal and experimental life conditions.
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Affiliation(s)
- Thomas Penzel
- Interdisciplinary Sleep medicine Center, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Christoph Schöbel
- Interdisciplinary Sleep medicine Center, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ingo Fietze
- Interdisciplinary Sleep medicine Center, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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20
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Tania MH, Lwin K, Hossain MA. Advances in automated tongue diagnosis techniques. Integr Med Res 2018; 8:42-56. [PMID: 30949431 PMCID: PMC6428917 DOI: 10.1016/j.imr.2018.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/18/2018] [Accepted: 03/02/2018] [Indexed: 01/03/2023] Open
Abstract
Tongue diagnosis can be an effective, noninvasive method to perform an auxiliary diagnosis any time anywhere, which can support the global need in the primary healthcare system. This work reviews the recent advances in tongue diagnosis, which is a significant constituent of traditional oriental medicinal technology, and explores the literature to evaluate the works done on the various aspects of computerized tongue diagnosis, namely preprocessing, tongue detection, segmentation, feature extraction, tongue analysis, especially in traditional Chinese medicine (TCM). In spite of huge volume of work done on automatic tongue diagnosis (ATD), there is a lack of adequate survey, especially to combine it with the current diagnosis trends. This paper studies the merits, capabilities, and associated research gaps in current works on ATD systems. After exploring the algorithms used in tongue diagnosis, the current trend and global requirements in health domain motivates us to propose a conceptual framework for the automated tongue diagnostic system on mobile enabled platform. This framework will be able to connect tongue diagnosis with the future point-of-care health system.
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Affiliation(s)
- Marzia Hoque Tania
- Anglia Ruskin IT Research Institute, Anglia Ruskin University, Chelmsford, UK
| | - Khin Lwin
- Anglia Ruskin IT Research Institute, Anglia Ruskin University, Chelmsford, UK
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21
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De Ridder B, Van Rompaey B, Kampen JK, Haine S, Dilles T. Smartphone Apps Using Photoplethysmography for Heart Rate Monitoring: Meta-Analysis. JMIR Cardio 2018; 2:e4. [PMID: 31758768 PMCID: PMC6834218 DOI: 10.2196/cardio.8802] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/03/2017] [Accepted: 12/18/2017] [Indexed: 11/19/2022] Open
Abstract
Background Smartphone ownership is rising at a stunning rate. Moreover, smartphones prove to be suitable for use in health care due to their availability, portability, user-friendliness, relatively low price, wireless connectivity, far-reaching computing capabilities, and comprehensive memory. To measure vital signs, smartphones are often connected to a mobile sensor or a medical device. However, by using the white light-emitting diode as light source and the phone camera as photodetector, a smartphone could be used to perform photoplethysmography (PPG), enabling the assessment of vital signs. Objective The objective of this meta-analysis was to evaluate the available evidence on the use of smartphone apps to measure heart rate by performing PPG in comparison with a validated method. Methods PubMed and ISI Web of Knowledge were searched for relevant studies published between January 1, 2009 and December 7, 2016. The reference lists of included studies were hand-searched to find additional eligible studies. Critical Appraisal Skills Programme (CASP) Diagnostic Test Study checklist and some extra items were used for quality assessment. A fixed effects model of the mean difference and a random effects model of Pearson correlation coefficient were applied to pool the outcomes of the studies. Results In total, 14 studies were included. The pooled result showed no significant difference between heart rate measurements with a smartphone and a validated method (mean difference −0.32; 99% CI −1.24 to 0.60; P=.37). In adults, the Pearson correlation coefficient of the relation between heart rate measurement with a smartphone and a validated method was always ≥.90. In children, the results varied depending on measuring point and heart rate. The pooled result showed a strong correlation that was significant (correlation coefficient .951; 95% CI 0.906-0.975; P<.001). The reported limits of agreement showed good agreement between a smartphone and a validated method. There was a moderately strong significant negative correlation between the year of publication of the included studies and the mean difference (r=−.69; P<.001). Conclusions Smartphone apps measuring heart rate by performing PPG appear to agree with a validated method in an adult population during resting sinus rhythm. In a pediatric population, the use of these apps is currently not validated.
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Affiliation(s)
- Benjamin De Ridder
- University Hospital Ghent, Ghent, Belgium.,Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Bart Van Rompaey
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Jarl K Kampen
- Wageningen University, Biometris, Wageningen, Netherlands.,StatUa Center for Statistics, University of Antwerp, Antwerp, Belgium
| | - Steven Haine
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.,Department of Cardiology, University of Antwerp, Antwerp, Belgium
| | - Tinne Dilles
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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22
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Garde A, Dekhordi P, Petersen CL, Ansermino JM, Dumont GA. Detecting obstructive sleep apnea in children by self-affine visualization of oximetry. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:3757-3760. [PMID: 29060715 DOI: 10.1109/embc.2017.8037674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Obstructive sleep apnea (OSA), characterized by cessations of breathing during sleep due to upper airway collapse, can affect the healthy growth and development of children. The gold standard for OSA diagnosis, polysomnography(PSG), is expensive and resource intensive, resulting in long waiting lists to perform a PSG. Previously, we investigated the time-frequency analysis of blood oxygen saturation (SpO2) to screen for OSA. We used overnight pulse oximetry from 146 children, collected using a smartphone-based pulse oximeter (Phone Oximeter), simultaneously with standard PSG. Sleep technicians manually scored PSG and provided the average of apnea/hypoapnea events per hour (AHI). In this study, we proposed an alternative method for analyzing SpO2, in which a set of contracting transformations form a self-affine set with a 2D attractor, previously developed for qualitative visualization of the photoplethysmogram and electroencephalogram. We applied this technique to the overnight SpO2 signal from individual patients and extracted features based on the distribution of points (radius and angle) in the visualization. The cloud of points in children without OSA (NonOSA) was more confined than in children with OSA, which was reflected by more empty pixels (radius and angles). The maximum value, skewness and standard deviation of the distribution of points located at different radius and angles were significantly (Bonferroni corrected) higher in NonOSA compared to OSA children. To detect OSA defined at different levels (AHI≥5, AHI≥10 and AHI≥15), three multivariate logistic regression models were implemented using a stepwise feature selection and internally validated through bootstrapping. The models (AHI≥5, AHI≥10, AHI≥15), consisting of 3, 4 and 1 features respectively, provided a bootstrap-corrected AUC of 73%, 81%, 73%. Thus, applying this visualization to nocturnal SpO2 could yield both visual and quantitative information that might be useful for screening children for OSA.
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23
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Phelps T, Hall DA. Development of a smartphone-based pulse oximeter with adaptive SNR/power balancing. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:3297-3300. [PMID: 29060602 DOI: 10.1109/embc.2017.8037561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Millions worldwide suffer from diseases that exhibit early warnings signs that can be detected by standard clinical-grade diagnostic tools. Unfortunately, such tools are often prohibitively expensive to the developing world leading to inadequate healthcare and high mortality rates. To address this problem, a smartphone-based pulse oximeter is presented that interfaces with the phone through the audio jack, enabling point-of-care measurements of heart rate (HR) and oxygen saturation (SpO2). The device is designed to utilize existing phone resources (e.g., the processor, battery, and memory) resulting in a more portable and inexpensive diagnostic tool than standalone equivalents. By adaptively tuning the LED driving signal, the device is less dependent on phone-specific audio jack properties than prior audio jack-based work making it universally compatible with all smartphones. We demonstrate that the pulse oximeter can adaptively optimize the signal-to-noise ratio (SNR) within the power constraints of a mobile phone (<; 10mW) while maintaining high accuracy (HR error <; 3.4% and SpO2 error <; 3.7%) against a clinical grade instrument.
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24
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Majumder S, Mondal T, Deen MJ. Wearable Sensors for Remote Health Monitoring. SENSORS (BASEL, SWITZERLAND) 2017; 17:E130. [PMID: 28085085 PMCID: PMC5298703 DOI: 10.3390/s17010130] [Citation(s) in RCA: 369] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/12/2016] [Accepted: 12/21/2016] [Indexed: 01/01/2023]
Abstract
Life expectancy in most countries has been increasing continually over the several few decades thanks to significant improvements in medicine, public health, as well as personal and environmental hygiene. However, increased life expectancy combined with falling birth rates are expected to engender a large aging demographic in the near future that would impose significant burdens on the socio-economic structure of these countries. Therefore, it is essential to develop cost-effective, easy-to-use systems for the sake of elderly healthcare and well-being. Remote health monitoring, based on non-invasive and wearable sensors, actuators and modern communication and information technologies offers an efficient and cost-effective solution that allows the elderly to continue to live in their comfortable home environment instead of expensive healthcare facilities. These systems will also allow healthcare personnel to monitor important physiological signs of their patients in real time, assess health conditions and provide feedback from distant facilities. In this paper, we have presented and compared several low-cost and non-invasive health and activity monitoring systems that were reported in recent years. A survey on textile-based sensors that can potentially be used in wearable systems is also presented. Finally, compatibility of several communication technologies as well as future perspectives and research challenges in remote monitoring systems will be discussed.
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Affiliation(s)
- Sumit Majumder
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON L8S 4L8, Canada.
| | - Tapas Mondal
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada.
| | - M Jamal Deen
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON L8S 4L8, Canada.
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Majumder S, Mondal T, Deen MJ. Wearable Sensors for Remote Health Monitoring. SENSORS (BASEL, SWITZERLAND) 2017; 17:s17010130. [PMID: 28085085 DOI: 10.1109/jsen.2017.2726304] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/12/2016] [Accepted: 12/21/2016] [Indexed: 05/27/2023]
Abstract
Life expectancy in most countries has been increasing continually over the several few decades thanks to significant improvements in medicine, public health, as well as personal and environmental hygiene. However, increased life expectancy combined with falling birth rates are expected to engender a large aging demographic in the near future that would impose significant burdens on the socio-economic structure of these countries. Therefore, it is essential to develop cost-effective, easy-to-use systems for the sake of elderly healthcare and well-being. Remote health monitoring, based on non-invasive and wearable sensors, actuators and modern communication and information technologies offers an efficient and cost-effective solution that allows the elderly to continue to live in their comfortable home environment instead of expensive healthcare facilities. These systems will also allow healthcare personnel to monitor important physiological signs of their patients in real time, assess health conditions and provide feedback from distant facilities. In this paper, we have presented and compared several low-cost and non-invasive health and activity monitoring systems that were reported in recent years. A survey on textile-based sensors that can potentially be used in wearable systems is also presented. Finally, compatibility of several communication technologies as well as future perspectives and research challenges in remote monitoring systems will be discussed.
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Affiliation(s)
- Sumit Majumder
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON L8S 4L8, Canada.
| | - Tapas Mondal
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada.
| | - M Jamal Deen
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON L8S 4L8, Canada.
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Wu TH, Chang CC, Vaillant J, Bruyant A, Lin CW. DNA biosensor combining single-wavelength colorimetry and a digital lock-in amplifier within a smartphone. LAB ON A CHIP 2016; 16:4527-4533. [PMID: 27778010 DOI: 10.1039/c6lc01170e] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Smartphone camera based gold nanoparticle colorimetry (SCB-AuNP colorimetry) has shown good potential for point-of-care applications. However, due to the use of a camera as a photo-detector, there are major limitations to this technique such as a low bit resolution (∼8 bits mainstream) and a low data acquisition rate. These issues have limited the ultimate sensitivity of smartphone based colorimetry as well as the possibility to integrate efficiently a more sensitive approach such as detection based on a lock-in amplifier (LIA). In this paper, we improve the metrological performance of the smartphone to overcome existing issues by adding the LIA capability to AuNP sensing. In this work, instead of using the camera as a photo-detector, the audio jack is used as a photo-detector reader and function generator for driving a laser diode in order to achieve a smartphone based digital lock-in amplifier AuNP colorimetric (SBLIA-AuNP colorimetry) system. A full investigation on the SBLIA design, parameters and performance is comprehensively provided. It is found that the SBLIA can reduce most of the noise and provides a detection noise-to-signal ratio down to -63 dB, which is much better than the -49 dB of the state-of-the-art SCB based method. A DNA detection experiment is demonstrated to reveal the efficacy of the proposed metrological method. The results are compared to UV-visible spectrometry, which is the gold standard for colorimetric measurement. Based on our results, the SBLIA-AuNP colorimetric system has a detection limit of 0.77 nM on short strand DNA detection, which is 5.7 times better than the 4.36 nM limit of a commercial UV-visible spectrometer. Judging from the results, we believe that the sensitive SBLIA would be further extended to other optical diagnostic tools in the near future.
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Affiliation(s)
- Tzu-Heng Wu
- Institute of Bio-informatics and Bioelectronics, National Taiwan University, Taiwan, Republic of China. and ICD-LNIO, Université de Technologie de Troyes, France.
| | - Chia-Chen Chang
- Institute of Biomedical Engineering, National Taiwan University, Taiwan, Republic of China
| | | | | | - Chii-Wann Lin
- Institute of Bio-informatics and Bioelectronics, National Taiwan University, Taiwan, Republic of China. and Institute of Biomedical Engineering, National Taiwan University, Taiwan, Republic of China
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Garde A, Zhou G, Raihana S, Dunsmuir D, Karlen W, Dekhordi P, Huda T, Arifeen SE, Larson C, Kissoon N, Dumont GA, Ansermino JM. Respiratory rate and pulse oximetry derived information as predictors of hospital admission in young children in Bangladesh: a prospective observational study. BMJ Open 2016; 6:e011094. [PMID: 27534987 PMCID: PMC5013424 DOI: 10.1136/bmjopen-2016-011094] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Hypoxaemia is a strong predictor of mortality in children. Early detection of deteriorating condition is vital to timely intervention. We hypothesise that measures of pulse oximetry dynamics may identify children requiring hospitalisation. Our aim was to develop a predictive tool using only objective data derived from pulse oximetry and observed respiratory rate to identify children at increased risk of hospital admission. SETTING Tertiary-level hospital emergency department in Bangladesh. PARTICIPANTS Children under 5 years (n=3374) presenting at the facility (October 2012-April 2013) without documented chronic diseases were recruited. 1-minute segments of pulse oximetry (photoplethysmogram (PPG), blood oxygen saturation (SpO2) and heart rate (HR)) and respiratory rate were collected with a mobile app. PRIMARY OUTCOME The need for hospitalisation based on expert physician review and follow-up. METHODS Pulse rate variability (PRV) using pulse peak intervals of the PPG signal and features extracted from the SpO2 signal, all derived from pulse oximetry recordings, were studied. A univariate age-adjusted logistic regression was applied to evaluate differences between admitted and non-admitted children. A multivariate logistic regression model was developed using a stepwise selection of predictors and was internally validated using bootstrapping. RESULTS Children admitted to hospital showed significantly (p<0.01) decreased PRV and higher SpO2 variability compared to non-admitted children. The strongest predictors of hospitalisation were reduced PRV-power in the low frequency band (OR associated with a 0.01 unit increase, 0.93; 95% CI 0.89 to 0.98), greater time spent below an SpO2 of 98% and 94% (OR associated with 10 s increase, 1.4; 95% CI 1.3 to 1.4 and 1.5; 95% CI 1.4 to 1.6, respectively), high respiratory rate, high HR, low SpO2, young age and male sex. These variables provided a bootstrap-corrected AUC of the receiver operating characteristic of 0.76. CONCLUSIONS Objective measurements, easily obtained using a mobile device in low-resource settings, can predict the need for hospitalisation. External validation will be required before clinical adoption.
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Affiliation(s)
- Ainara Garde
- Department of Electrical & Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Guohai Zhou
- Department of Statistics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shahreen Raihana
- Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Dustin Dunsmuir
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Walter Karlen
- Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Parastoo Dekhordi
- Department of Electrical & Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Tanvir Huda
- Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Shams El Arifeen
- Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Charles Larson
- Department of Pediatrics, British Columbia Children's Hospital and The University of British Columbia, Vancouver, British Columbia, Canada
| | - Niranjan Kissoon
- Department of Pediatrics, British Columbia Children's Hospital and The University of British Columbia, Vancouver, British Columbia, Canada
| | - Guy A Dumont
- Department of Electrical & Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada
| | - J Mark Ansermino
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
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Enoch AJ, English M, Shepperd S. Does pulse oximeter use impact health outcomes? A systematic review. Arch Dis Child 2016; 101:694-700. [PMID: 26699537 PMCID: PMC4975806 DOI: 10.1136/archdischild-2015-309638] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/24/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Do newborns, children and adolescents up to 19 years have lower mortality rates, lower morbidity and shorter length of stay in health facilities where pulse oximeters are used to inform diagnosis and treatment (excluding surgical care) compared with health facilities where pulse oximeters are not used? DESIGN Studies were obtained for this systematic literature review by systematically searching the Database of Abstracts of Reviews of Effects, Cochrane, Medion, PubMed, Web of Science, Embase, Global Health, CINAHL, WHO Global Health Library, international health organisation and NGO websites, and study references. PATIENTS Children 0-19 years presenting for the first time to hospitals, emergency departments or primary care facilities. INTERVENTIONS Included studies compared outcomes where pulse oximeters were used for diagnosis and/or management, with outcomes where pulse oximeters were not used. MAIN OUTCOME MEASURES mortality, morbidity, length of stay, and treatment and management changes. RESULTS The evidence is low quality and hypoxaemia definitions varied across studies, but the evidence suggests pulse oximeter use with children can reduce mortality rates (when combined with improved oxygen administration) and length of emergency department stay, increase admission of children with previously unrecognised hypoxaemia, and change physicians' decisions on illness severity, diagnosis and treatment. Pulse oximeter use generally increased resource utilisation. CONCLUSIONS As international organisations are investing in programmes to increase pulse oximeter use in low-income settings, more research is needed on the optimal use of pulse oximeters (eg, appropriate oxygen saturation thresholds), and how pulse oximeter use affects referral and admission rates, length of stay, resource utilisation and health outcomes.
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Affiliation(s)
- Abigail J Enoch
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Mike English
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Abstract
As part of the "Grand Convergence: Aligning Technologies and Realities in Global Health" Collection, Cyril Engmann and colleagues discuss promising innovations that have the potential to move the RMNCH agenda forward.
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Dehkordi P, Garde A, Karlen W, Petersen CL, Wensley D, Dumont GA, Mark Ansermino J. Evaluation of cardiac modulation in children in response to apnea/hypopnea using the Phone Oximeter(™). Physiol Meas 2016; 37:187-202. [PMID: 26732019 DOI: 10.1088/0967-3334/37/2/187] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Individuals with sleep disordered breathing (SDB) can experience changes in automatic cardiac regulation as a result of frequent sleep fragmentation and disturbance in normal respiration and oxygenation that accompany most apnea/hypopnea events. In adults, these changes are reflected in enhanced sympathetic and reduced parasympathetic activity. In this study, we examined the autonomic cardiac regulation in children with and without SDB, through spectral and detrended fluctuation analysis (DFA) of pulse rate variability (PRV). PRV was measured from pulse-to-pulse intervals (PPIs) of the photoplethysmogram (PPG) recorded from 160 children using the Phone Oximeter(™) in the standard setting of overnight polysomnography. Spectral analysis of PRV showed the cardiac parasympathetic index (high frequency, HF) was lower (p < 0.01) and cardiac sympathetic indices (low frequency, LF and LF/HF ratio) were higher (p < 0.01) during apnea/hypopnea events for more than 95% of children with SDB. DFA showed the short- and long-range fluctuations of heart rate were more strongly correlated in children with SDB compared to children without SDB. These findings confirm that the analysis of the PPG recorded using the Phone Oximeter(™) could be the basis for a new screening tool for assessing PRV in non-clinical environment.
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Affiliation(s)
- Parastoo Dehkordi
- Department of Electrical and Computer Engineering, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
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Raihana S, Dunsmuir D, Huda T, Zhou G, Rahman QSU, Garde A, Moinuddin M, Karlen W, Dumont GA, Kissoon N, El Arifeen S, Larson C, Ansermino JM. Development and Internal Validation of a Predictive Model Including Pulse Oximetry for Hospitalization of Under-Five Children in Bangladesh. PLoS One 2015; 10:e0143213. [PMID: 26580403 PMCID: PMC4651571 DOI: 10.1371/journal.pone.0143213] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 11/02/2015] [Indexed: 11/22/2022] Open
Abstract
Background The reduction in the deaths of millions of children who die from infectious diseases requires early initiation of treatment and improved access to care available in health facilities. A major challenge is the lack of objective evidence to guide front line health workers in the community to recognize critical illness in children earlier in their course. Methods We undertook a prospective observational study of children less than 5 years of age presenting at the outpatient or emergency department of a rural tertiary care hospital between October 2012 and April 2013. Study physicians collected clinical signs and symptoms from the facility records, and with a mobile application performed recordings of oxygen saturation, heart rate and respiratory rate. Facility physicians decided the need for hospital admission without knowledge of the oxygen saturation. Multiple logistic predictive models were tested. Findings Twenty-five percent of the 3374 assessed children, with a median (interquartile range) age of 1.02 (0.42–2.24), were admitted to hospital. We were unable to contact 20% of subjects after their visit. A logistic regression model using continuous oxygen saturation, respiratory rate, temperature and age combined with dichotomous signs of chest indrawing, lethargy, irritability and symptoms of cough, diarrhea and fast or difficult breathing predicted admission to hospital with an area under the receiver operating characteristic curve of 0.89 (95% confidence interval -CI: 0.87 to 0.90). At a risk threshold of 25% for admission, the sensitivity was 77% (95% CI: 74% to 80%), specificity was 87% (95% CI: 86% to 88%), positive predictive value was 70% (95% CI: 67% to 73%) and negative predictive value was 91% (95% CI: 90% to 92%). Conclusion A model using oxygen saturation, respiratory rate and temperature in combination with readily obtained clinical signs and symptoms predicted the need for hospitalization of critically ill children. External validation of this model in a community setting will be required before adoption into clinical practice.
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Affiliation(s)
- Shahreen Raihana
- Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Dustin Dunsmuir
- Centre for International Child Health, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.,The Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Tanvir Huda
- Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Guohai Zhou
- The Department of Statistics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Qazi Sadeq-Ur Rahman
- Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Ainara Garde
- The Department of Electrical & Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Md Moinuddin
- Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Walter Karlen
- The Department of Electrical & Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Guy A Dumont
- Centre for International Child Health, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.,The Department of Electrical & Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Niranjan Kissoon
- Centre for International Child Health, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.,The Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shams El Arifeen
- Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Charles Larson
- Centre for International Child Health, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.,The Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - J Mark Ansermino
- Centre for International Child Health, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.,The Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
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Hypoxaemia as a Mortality Risk Factor in Acute Lower Respiratory Infections in Children in Low and Middle-Income Countries: Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0136166. [PMID: 26372640 PMCID: PMC4570717 DOI: 10.1371/journal.pone.0136166] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 07/31/2015] [Indexed: 02/03/2023] Open
Abstract
Objective To evaluate the association between hypoxaemia and mortality from acute lower respiratory infections (ALRI) in children in low- and middle-income countries (LMIC). Design Systematic review and meta-analysis. Study Selection Observational studies reporting on the association between hypoxaemia and death from ALRI in children below five years in LMIC. Data Sources Medline, Embase, Global Health Library, Lilacs, and Web of Science to February 2015. Risk of Bias Assessment Quality In Prognosis Studies tool with minor adaptations to assess the risk of bias; funnel plots and Egger’s test to evaluate publication bias. Results Out of 11,627 papers retrieved, 18 studies from 13 countries on 20,224 children met the inclusion criteria. Twelve (66.6%) studies had either low or moderate risk of bias. Hypoxaemia defined as oxygen saturation rate (SpO2) <90% associated with significantly increased odds of death from ALRI (OR 5.47, 95% CI 3.93 to 7.63) in 12 studies on 13,936 children. An Sp02 <92% associated with a similar increased risk of mortality (OR 3.66, 95% CI 1.42 to 9.47) in 3 studies on 673 children. Sensitivity analyses (excluding studies with high risk of bias and using adjusted OR) and subgroup analyses (by: altitude, definition of ALRI, country income, HIV prevalence) did not affect results. Only one study was performed on children living at high altitude. Conclusions The results of this review support the routine evaluation of SpO2 for identifying children with ALRI at increased risk of death. Both a Sp02 value of 92% and 90% equally identify children at increased risk of mortality. More research is needed on children living at high altitude. Policy makers in LMIC should aim at improving the regular use of pulse oximetry and the availability of oxygen in order to decrease mortality from ALRI.
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A Single-Chip CMOS Pulse Oximeter with On-Chip Lock-In Detection. SENSORS 2015; 15:17076-88. [PMID: 26184225 PMCID: PMC4541923 DOI: 10.3390/s150717076] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 06/08/2015] [Accepted: 07/06/2015] [Indexed: 12/04/2022]
Abstract
Pulse oximetry is a noninvasive and continuous method for monitoring the blood oxygen saturation level. This paper presents the design and testing of a single-chip pulse oximeter fabricated in a 0.35 µm CMOS process. The chip includes photodiode, transimpedance amplifier, analogue band-pass filters, analogue-to-digital converters, digital signal processor and LED timing control. The experimentally measured AC and DC characteristics of individual circuits including the DC output voltage of the transimpedance amplifier, transimpedance gain of the transimpedance amplifier, and the central frequency and bandwidth of the analogue band-pass filters, show a good match (within 1%) with the circuit simulations. With modulated light source and integrated lock-in detection the sensor effectively suppresses the interference from ambient light and 1/f noise. In a breath hold and release experiment the single chip sensor demonstrates consistent and comparable performance to commercial pulse oximetry devices with a mean of 1.2% difference. The single-chip sensor enables a compact and robust design solution that offers a route towards wearable devices for health monitoring.
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McCollum ED, King C, Hollowell R, Zhou J, Colbourn T, Nambiar B, Mukanga D, Burgess DCH. Predictors of treatment failure for non-severe childhood pneumonia in developing countries--systematic literature review and expert survey--the first step towards a community focused mHealth risk-assessment tool? BMC Pediatr 2015; 15:74. [PMID: 26156710 PMCID: PMC4496936 DOI: 10.1186/s12887-015-0392-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 06/24/2015] [Indexed: 11/30/2022] Open
Abstract
Background Improved referral algorithms for children with non-severe pneumonia at the community level are desirable. We sought to identify predictors of oral antibiotic failure in children who fulfill the case definition of World Health Organization (WHO) non-severe pneumonia. Predictors of greatest interest were those not currently utilized in referral algorithms and feasible to obtain at the community level. Methods We systematically reviewed prospective studies reporting independent predictors of oral antibiotic failure for children 2–59 months of age in resource-limited settings with WHO non-severe pneumonia (either fast breathing for age and/or lower chest wall indrawing without danger signs), with an emphasis on predictors not currently utilized for referral and reasonable for community health workers. We searched PubMed, Cochrane, and Embase and qualitatively analyzed publications from 1997–2014. To supplement the limited published evidence in this subject area we also surveyed respiratory experts. Results Nine studies met criteria, seven of which were performed in south Asia. One eligible study occurred exclusively at the community level. Overall, oral antibiotic failure rates ranged between 7.8-22.9 %. Six studies found excess age-adjusted respiratory rate (either WHO-defined very fast breathing for age or 10–15 breaths/min faster than normal WHO age-adjusted thresholds) and four reported young age as predictive for oral antibiotic failure. Of the seven predictors identified by the expert panel, abnormal oxygen saturation and malnutrition were most highly favored per the panel’s rankings and comments. Conclusions This review identified several candidate predictors of oral antibiotic failure not currently utilized in childhood pneumonia referral algorithms; excess age-specific respiratory rate, young age, abnormal oxygen saturation, and moderate malnutrition. However, the data was limited and there are clear evidence gaps; research in rural, low-resource settings with community health workers is needed. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0392-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eric D McCollum
- Department of Pediatrics, Division of Pulmonology, Johns Hopkins School of Medicine, Baltimore, USA. .,Institute for Global Health, University College London, London, UK.
| | - Carina King
- Institute for Global Health, University College London, London, UK.
| | | | - Janet Zhou
- Bill & Melinda Gates Foundation, Seattle, USA.
| | - Tim Colbourn
- Institute for Global Health, University College London, London, UK.
| | - Bejoy Nambiar
- Institute for Global Health, University College London, London, UK.
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Development of a screening tool for sleep disordered breathing in children using the phone Oximeter™. PLoS One 2014; 9:e112959. [PMID: 25401696 PMCID: PMC4234680 DOI: 10.1371/journal.pone.0112959] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 10/13/2014] [Indexed: 11/24/2022] Open
Abstract
Background Sleep disordered breathing (SDB) can lead to daytime sleepiness, growth failure and developmental delay in children. Polysomnography (PSG), the gold standard to diagnose SDB, is a highly resource-intensive test, confined to the sleep laboratory. Aim To combine the blood oxygen saturation (SpO2) characterization and cardiac modulation, quantified by pulse rate variability (PRV), to identify children with SDB using the Phone Oximeter, a device integrating a pulse oximeter with a smartphone. Methods Following ethics approval and informed consent, 160 children referred to British Columbia Children's Hospital for overnight PSG were recruited. A second pulse oximeter sensor applied to the finger adjacent to the one used for standard PSG was attached to the Phone Oximeter to record overnight pulse oximetry (SpO2 and photoplethysmogram (PPG)) alongside the PSG. Results We studied 146 children through the analysis of the SpO2 pattern, and PRV as an estimate of heart rate variability calculated from the PPG. SpO2 variability and SpO2 spectral power at low frequency, was significantly higher in children with SDB due to the modulation provoked by airway obstruction during sleep (p-value ). PRV analysis reflected a significant augmentation of sympathetic activity provoked by intermittent hypoxia in SDB children. A linear classifier was trained with the most discriminating features to identify children with SDB. The classifier was validated with internal and external cross-validation, providing a high negative predictive value (92.6%) and a good balance between sensitivity (88.4%) and specificity (83.6%). Combining SpO2 and PRV analysis improved the classification performance, providing an area under the receiver operating characteristic curve of 88%, beyond the 82% achieved using SpO2 analysis alone. Conclusions These results demonstrate that the implementation of this algorithm in the Phone Oximeter will provide an improved portable, at-home screening tool, with the capability of monitoring patients over multiple nights.
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Huang CY, Chan MC, Chen CY, Lin BS. Novel wearable and wireless ring-type pulse oximeter with multi-detectors. SENSORS 2014; 14:17586-99. [PMID: 25244586 PMCID: PMC4208240 DOI: 10.3390/s140917586] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 09/09/2014] [Accepted: 09/17/2014] [Indexed: 11/16/2022]
Abstract
The pulse oximeter is a popular instrument to monitor the arterial oxygen saturation (SPO2). Although a fingertip-type pulse oximeter is the mainstream one on the market at present, it is still inconvenient for long-term monitoring, in particular, with respect to motion. Therefore, the development of a wearable pulse oximeter, such as a finger base-type pulse oximeter, can effectively solve the above issue. However, the tissue structure of the finger base is complex, and there is lack of detailed information on the effect of the light source and detector placement on measuring SPO2. In this study, the practicability of a ring-type pulse oximeter with a multi-detector was investigated by optical human tissue simulation. The optimal design of a ring-type pulse oximeter that can provide the best efficiency of measuring SPO2 was discussed. The efficiency of ring-type pulse oximeters with a single detector and a multi-detector was also discussed. Finally, a wearable and wireless ring-type pulse oximeter was also implemented to validate the simulation results and was compared with the commercial fingertip-type pulse oximeter.
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Affiliation(s)
- Cheng-Yang Huang
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan 711, Taiwan.
| | - Ming-Che Chan
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan 711, Taiwan.
| | - Chien-Yue Chen
- Department of Electronics Engineering, National Yunlin University of Science and Technology, Yunlin 640, Taiwan.
| | - Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan 711, Taiwan.
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Azzazy HME, Elbehery AHA. Clinical laboratory data: acquire, analyze, communicate, liberate. Clin Chim Acta 2014; 438:186-94. [PMID: 25172035 DOI: 10.1016/j.cca.2014.08.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 08/13/2014] [Accepted: 08/19/2014] [Indexed: 01/07/2023]
Abstract
The availability of portable healthcare devices, which can acquire and transmit medical data to remote experts would dramatically affect healthcare in areas with poor infrastructure. Smartphones, which feature touchscreen computer capabilities and sophisticated cameras, have become widely available with over billion units shipped in 2013. In the clinical laboratory, smartphones have recently brought the capabilities of key instruments such as spectrophotometers, fluorescence analyzers and microscopes into the palm of the hand. Several research groups have developed sensitive and low-cost smartphone-based diagnostic assay prototypes for testing cholesterol, albumin, vitamin D, tumor markers, and the detection of infectious agents. This review covers the use of smartphones to acquire, analyze, communicate, and liberate clinical laboratory data. Smartphones promise to dramatically improve the quality and quantity of healthcare offered in resource-limited areas.
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Affiliation(s)
- Hassan M E Azzazy
- Novel Diagnostics and Therapeutics, Yousef Jameel Science & Technology Research Centre, and Department of Chemistry, School of Sciences & Engineering, The American University in Cairo, New Cairo, Egypt.
| | - Ali H A Elbehery
- Graduate Program of Biotechnology, School of Sciences and Engineering, The American University in Cairo, New Cairo, Egypt
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Na Y, Joo HS, Yang H, Kang S, Hong SH, Woo J. Smartphone-based hearing screening in noisy environments. SENSORS 2014; 14:10346-60. [PMID: 24926692 PMCID: PMC4118395 DOI: 10.3390/s140610346] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/05/2014] [Accepted: 06/10/2014] [Indexed: 11/25/2022]
Abstract
It is important and recommended to detect hearing loss as soon as possible. If it is found early, proper treatment may help improve hearing and reduce the negative consequences of hearing loss. In this study, we developed smartphone-based hearing screening methods that can ubiquitously test hearing. However, environmental noise generally results in the loss of ear sensitivity, which causes a hearing threshold shift (HTS). To overcome this limitation in the hearing screening location, we developed a correction algorithm to reduce the HTS effect. A built-in microphone and headphone were calibrated to provide the standard units of measure. The HTSs in the presence of either white or babble noise were systematically investigated to determine the mean HTS as a function of noise level. When the hearing screening application runs, the smartphone automatically measures the environmental noise and provides the HTS value to correct the hearing threshold. A comparison to pure tone audiometry shows that this hearing screening method in the presence of noise could closely estimate the hearing threshold. We expect that the proposed ubiquitous hearing test method could be used as a simple hearing screening tool and could alert the user if they suffer from hearing loss.
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Affiliation(s)
- Youngmin Na
- School of Electrical Engineering, Biomedical Engineering, University of Ulsan, Ulsan 680-749, Korea.
| | - Hyo Sung Joo
- School of Electrical Engineering, Biomedical Engineering, University of Ulsan, Ulsan 680-749, Korea.
| | - Hyejin Yang
- School of Electrical Engineering, Biomedical Engineering, University of Ulsan, Ulsan 680-749, Korea.
| | - Soojin Kang
- School of Electrical Engineering, Biomedical Engineering, University of Ulsan, Ulsan 680-749, Korea.
| | - Sung Hwa Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul 330-714, Korea.
| | - Jihwan Woo
- School of Electrical Engineering, Biomedical Engineering, University of Ulsan, Ulsan 680-749, Korea.
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Smartphones for Cell and Biomolecular Detection. Ann Biomed Eng 2014; 42:2205-17. [DOI: 10.1007/s10439-014-1055-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022]
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Freshwater ES, Crouch R. Technology for trauma: testing the validity of a smartphone app for pre-hospital clinicians. Int Emerg Nurs 2014; 23:32-7. [PMID: 24837711 DOI: 10.1016/j.ienj.2014.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/17/2014] [Accepted: 04/22/2014] [Indexed: 02/03/2023]
Abstract
INTRODUCTION With the introduction of regional trauma networks in England, ambulance clinicians have been required to make triage decisions relating to severity of injury, and appropriate destination for the patient, which may require 'bypassing' the nearest Emergency Department. A 'Trauma Unit Bypass Tool' is utilised in this process. The Major Trauma Triage tool smartphone application (App) is a digital representation of a tool, available for clinicians to use on their smartphone. Prior to disseminating the application, validity and performance against the existing paper-based tool was explored. METHODS A case-based study using clinical scenarios was conducted. Scenarios, with appropriate triage decisions, were agreed by an expert panel. Ambulance clinicians were assigned to either the paper-based tool or smartphone app group and asked to make a triage decision using the available information. The positive predictive value (PPV) of each tool was calculated. RESULTS The PPV of the paper tool was 0.76 and 0.86 for the smartphone app. User comments were mainly positive for both tools with no negative comments relating to the smartphone app. CONCLUSION The smartphone app version of the Trauma Unit Bypass Tool performs at least as well as the paper version and can be utilised safely by pre-hospital clinicians in supporting triage decisions relating to potential major trauma.
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Affiliation(s)
- Eleanor S Freshwater
- Emergency Department, University Hospital Southampton, Tremona Road, Southampton, Hampshire, UK, SO16 6YD; Faculty of Health Sciences, University of Southampton, 104 Burgess Road, Southampton, SO17 1BJ.
| | - Robert Crouch
- Emergency Department, University Hospital Southampton, Tremona Road, Southampton, Hampshire, UK, SO16 6YD; Faculty of Health Sciences, University of Southampton, 104 Burgess Road, Southampton, SO17 1BJ
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