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Xu W, Wells CI, Seo SH, Sebaratnam G, Calder S, Gharibans A, Bissett IP, O'Grady G. Feasibility and Accuracy of Wrist-Worn Sensors for Perioperative Monitoring During and After Major Abdominal Surgery: An Observational Study. J Surg Res 2024; 301:423-431. [PMID: 39033592 DOI: 10.1016/j.jss.2024.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 05/20/2024] [Accepted: 06/21/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Continuous, ambulatory perioperative monitoring using wearable devices has shown promise for earlier detection of physiological deterioration and postoperative complications, preventing 'failure-to-rescue'. This study aimed to compare the accuracy of vital signs measured by wrist-based wearables with gold standard measurements from vital signs monitors or nurse assessments in major abdominal surgery. METHODS Adult patients were eligible for inclusion in this prospective observational study validating the Empatica E4 wrist sensor intraoperatively and postoperatively. The primary outcomes were the 95% limits of agreement (LoA) between manual and device recordings of heart rate (HR) and temperature evaluated via Bland-Altman analysis. Secondary analysis was conducted using Clarke-Error grid analysis. RESULTS Overall, 31 patients were recruited, and 27 patients completed the study. The median duration of recording per patient was 70.3 h, and a total of 2112 h of data recording were completed. Wrist-based HR measurement was accurate and moderately precise (bias: 0.3 bpm; 95% LoA -15.5 to 17.1), but temperature measurement was neither accurate nor precise (bias -2.2°C; 95% LoA -6.0 to 1.6). On Clarke-Error grid analysis, 74.5% and 29.6% of HR and temperature measurements, respectively, fell within the acceptable range of reference standards. CONCLUSIONS Continuous perioperative monitoring of HR and temperature after major abdominal surgery using wrist-based sensors is feasible but was limited in this study by low precision. While wrist-based devices offer promise for the continuous monitoring of high-risk surgical patients, current technology is inadequate. Ongoing device hardware and software innovation with robust validation is required before such technologies can be routinely adopted in clinical practice.
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Affiliation(s)
- William Xu
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Cameron I Wells
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Sean Hb Seo
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | | | - Stefan Calder
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Armen Gharibans
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ian P Bissett
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Gregory O'Grady
- Department of Surgery, University of Auckland, Auckland, New Zealand; Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.
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Leenen JP, Schoonhoven L, Patijn GA. Wearable wireless continuous vital signs monitoring on the general ward. Curr Opin Crit Care 2024; 30:275-282. [PMID: 38690957 DOI: 10.1097/mcc.0000000000001160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
PURPOSE OF REVIEW Wearable wireless sensors for continuous vital signs monitoring (CVSM) offer the potential for early identification of patient deterioration, especially in low-intensity care settings like general wards. This study aims to review advances in wearable CVSM - with a focus on the general ward - highlighting the technological characteristics of CVSM systems, user perspectives and impact on patient outcomes by exploring recent evidence. RECENT FINDINGS The accuracy of wearable sensors measuring vital signs exhibits variability, especially notable in ambulatory patients within hospital settings, and standard validation protocols are lacking. Usability of CMVS systems is critical for nurses and patients, highlighting the need for easy-to-use wearable sensors, and expansion of the number of measured vital signs. Current software systems lack integration with hospital IT infrastructures and workflow automation. Imperative enhancements involve nurse-friendly, less intrusive alarm strategies, and advanced decision support systems. Despite observed reductions in ICU admissions and Rapid Response Team calls, the impact on patient outcomes lacks robust statistical significance. SUMMARY Widespread implementation of CVSM systems on the general ward and potentially outside the hospital seems inevitable. Despite the theoretical benefits of CVSM systems in improving clinical outcomes, and supporting nursing care by optimizing clinical workflow efficiency, the demonstrated effects in clinical practice are mixed. This review highlights the existing challenges related to data quality, usability, implementation, integration, interpretation, and user perspectives, as well as the need for robust evidence to support their impact on patient outcomes, workflow and cost-effectiveness.
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Affiliation(s)
- Jobbe Pl Leenen
- Connected Care Centre, Isala, Zwolle
- Research Group IT Innovations in Healthcare, Windesheim University of Applied Sciences, Zwolle
| | - Lisette Schoonhoven
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Gijs A Patijn
- Connected Care Centre, Isala, Zwolle
- Department of Surgery, Isala, Zwolle, The Netherlands
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Wells CI, Xu W, Penfold JA, Keane C, Gharibans AA, Bissett IP, O’Grady G. OUP accepted manuscript. BJS Open 2022; 6:6564495. [PMID: 35388891 PMCID: PMC8988014 DOI: 10.1093/bjsopen/zrac031] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/03/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background Wearable devices have been proposed as a novel method for monitoring patients after surgery to track recovery, identify complications early, and improve surgical safety. Previous studies have used a heterogeneous range of devices, methods, and analyses. This review aimed to examine current methods and wearable devices used for monitoring after abdominal surgery and identify knowledge gaps requiring further investigation. Methods A scoping review was conducted given the heterogeneous nature of the evidence. MEDLINE, EMBASE, and Scopus databases were systematically searched. Studies of wearable devices for monitoring of adult patients within 30 days after abdominal surgery were eligible for inclusion. Results A total of 78 articles from 65 study cohorts, with 5153 patients were included. Thirty-one different wearable devices were used to measure vital signs, physiological measurements, or physical activity. The duration of postoperative wearable device use ranged from 15 h to 3 months after surgery. Studies mostly focused on physical activity metrics (71.8 per cent). Continuous vital sign measurement and physical activity tracking both showed promise for detecting postoperative complications earlier than usual care, but conclusions were limited by poor device precision, adherence, occurrence of false alarms, data transmission problems, and retrospective data analysis. Devices were generally well accepted by patients, with high levels of acceptance, comfort, and safety. Conclusion Wearable technology has not yet realized its potential to improve postoperative monitoring. Further work is needed to overcome technical limitations, improve precision, and reduce false alarms. Prospective assessment of efficacy, using an intention-to-treat approach should be the focus of further studies.
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Affiliation(s)
- Cameron I. Wells
- Correspondence to: Cameron Wells, Department of Surgery, University of Auckland, Private Bag 92019, Auckland Mail Centre 1142, New Zealand (e-mail:)
| | - William Xu
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - James A. Penfold
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Celia Keane
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Armen A. Gharibans
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Ian P. Bissett
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Department of Surgery, Auckland District Health Board, Auckland, New Zealand
| | - Greg O’Grady
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
- Department of Surgery, Auckland District Health Board, Auckland, New Zealand
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Yang L, Wang H, Yuan W, Li Y, Gao P, Tiwari N, Chen X, Wang Z, Niu G, Cheng H. Wearable Pressure Sensors Based on MXene/Tissue Papers for Wireless Human Health Monitoring. ACS APPLIED MATERIALS & INTERFACES 2021; 13:60531-60543. [PMID: 34894673 DOI: 10.1021/acsami.1c22001] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Though the widely available, low-cost, and disposable papers have been explored in flexible paper-based pressure sensors, it is still difficult for them to simultaneously achieve ultrahigh sensitivity, low limit and broad range of detection, and high-pressure resolution. Herein, we demonstrate a novel flexible paper-based pressure sensing platform that features the MXene-coated tissue paper (MTP) sandwiched between a polyimide encapsulation layer and a printing paper with interdigital electrodes. After replacing the polyimide with weighing paper in the MTP pressure sensor, the silver interdigital electrodes can be recycled through incineration. The resulting pressure sensor with polyimide or paper encapsulation exhibits a high sensitivity of 509.5 or 344.0 kPa-1, a low limit (∼1 Pa) and a broad range (100 kPa) of detection, and outstanding stability over 10 000 loading/unloading cycles. With ultrahigh sensitivity over a wide pressure range, the flexible pressure sensor can monitor various physiological signals and human movements. Configuring the pressure sensors into an array layout results in a smart artificial electronic skin to recognize the spatial pressure distribution. The flexible pressure sensor can also be integrated with signal processing and wireless communication modules on a face mask as a remote respiration monitoring system to wirelessly detect various respiration conditions and respiratory abnormalities for early self-identification of opioid overdose, pulmonary fibrosis, and other cardiopulmonary diseases.
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Affiliation(s)
- Li Yang
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Department of Electrical Engineering, Hebei University of Technology, Tianjin 300130, China
| | - Hongli Wang
- Department of Mechanical Engineering, Hebei University of Technology, Tianjin 300130, China
| | - Wenjing Yuan
- Tianjin Key Laboratory of Materials Laminating Fabrication and Interface Control Technology, Department of Materials Science & Engineering, Hebei University of Technology, Tianjin 300130, China
| | - Yuhang Li
- Institute of Solid Mechanics, Beihang University (BUAA), Beijing 100191, China
| | - Peng Gao
- Department of Electronic Information, Hebei University of Technology, Tianjin 300130, China
| | - Naveen Tiwari
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Xue Chen
- Department of Mechanical Engineering, Hebei University of Technology, Tianjin 300130, China
| | - Zihan Wang
- Department of Mechanical Engineering, Hebei University of Technology, Tianjin 300130, China
| | - Guangyu Niu
- Department of Architecture and Art, Hebei University of Technology, Tianjin 300130, China
| | - Huanyu Cheng
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
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