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Luu AP, Nguyen TT, Cao VTC, Ha THD, Chung LTT, Truong TN, Nguyen Le Nhu T, Dao KB, Nguyen HV, Khanh PNQ, Le KTT, Tran LHB, Nhat PTH, Tran DM, Lam YM, Thwaites CL, Mcknight J, Vinh Chau NV, Van Nuil JI. Acceptance and User Experiences of a Wearable Device for the Management of Hospitalized Patients in COVID-19-Designated Wards in Ho Chi Minh City, Vietnam: Action Learning Project. JMIR Hum Factors 2024; 11:e44619. [PMID: 38180799 PMCID: PMC10773555 DOI: 10.2196/44619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/15/2023] [Accepted: 11/20/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Wearable devices have been used extensively both inside and outside of the hospital setting. During the COVID-19 pandemic, in some contexts, there was an increased need to remotely monitor pulse and saturated oxygen for patients due to the lack of staff and bedside monitors. OBJECTIVE A prototype of a remote monitoring system using wearable pulse oximeter devices was implemented at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam, from August to December 2021. The aim of this work was to support the ongoing implementation of the remote monitoring system. METHODS We used an action learning approach with rapid pragmatic methods, including informal discussions and observations as well as a feedback survey form designed based on the technology acceptance model to assess the use and acceptability of the system. Based on these results, we facilitated a meeting using user-centered design principles to explore user needs and ideas about its development in more detail. RESULTS In total, 21 users filled in the feedback form. The mean technology acceptance model scores ranged from 3.5 (for perceived ease of use) to 4.4 (for attitude) with behavioral intention (3.8) and perceived usefulness (4.2) scoring in between. Those working as nurses scored higher on perceived usefulness, attitude, and behavioral intention than did physicians. Based on informal discussions, we realized there was a mismatch between how we (ie, the research team) and the ward teams perceived the use and wider purpose of the technology. CONCLUSIONS Designing and implementing the devices to be more nurse-centric from their introduction could have helped to increase their efficiency and use during the complex pandemic period.
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Affiliation(s)
- An Phuoc Luu
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | | | | | | | | | - Khoa Bach Dao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Hao Van Nguyen
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | | | | | | | - Duc Minh Tran
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Yen Minh Lam
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Catherine Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffleld Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jacob Mcknight
- Centre for Tropical Medicine and Global Health, Nuffleld Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nguyen Van Vinh Chau
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Jennifer Ilo Van Nuil
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffleld Department of Medicine, University of Oxford, Oxford, United Kingdom
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2
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Hai HB, Cattrall JWS, Hao NV, Van HMT, Thuy DB, Nhat PTH, Khanh PNQ, Duong HTH, Duong TD, Lu P, Phuong LT, Greeff H, Zhu T, Yen LM, Clifton D, Thwaites CL. Heart Rate Variability Measured from Wearable Devices as a Marker of Disease Severity in Tetanus. Am J Trop Med Hyg 2024; 110:165-169. [PMID: 37983924 DOI: 10.4269/ajtmh.23-0531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/17/2023] [Indexed: 11/22/2023] Open
Abstract
Tetanus is a disease associated with significant morbidity and mortality. Heart rate variability (HRV) is an objective clinical marker with potential value in tetanus. This study aimed to investigate the use of wearable devices to collect HRV data and the relationship between HRV and tetanus severity. Data were collected from 110 patients admitted to the intensive care unit in a tertiary hospital in Vietnam. HRV indices were calculated from 5-minute segments of 24-hour electrocardiogram recordings collected using wearable devices. HRV was found to be inversely related to disease severity. The standard deviation of NN intervals and interquartile range of RR intervals (IRRR) were significantly associated with the presence of muscle spasms; low frequency (LF) and high frequency (HF) indices were significantly associated with severe respiratory compromise; and the standard deviation of differences between adjacent NN intervals, root mean square of successive differences between normal heartbeats, LF to HF ratio, total frequency power, and IRRR, were significantly associated with autonomic nervous system dysfunction. The findings support the potential value of HRV as a marker for tetanus severity, identifying specific indices associated with clinical severity thresholds. Data were recorded using wearable devices, demonstrating this approach in resource-limited settings where most tetanus occurs.
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Affiliation(s)
- Ho Bich Hai
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Jonathan W S Cattrall
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Department of Psychiatry, University of Oxford, United Kingdom
| | - Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- University Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | | | | | | | | - Ha Thi Hai Duong
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom
| | - Tran Duc Duong
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Ping Lu
- Institute of Biomedical Engineering, University of Oxford, United Kingdom
| | - Le Thanh Phuong
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Heloise Greeff
- Institute of Biomedical Engineering, University of Oxford, United Kingdom
| | - Tingting Zhu
- Institute of Biomedical Engineering, University of Oxford, United Kingdom
| | - Lam Minh Yen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - David Clifton
- Institute of Biomedical Engineering, University of Oxford, United Kingdom
| | - C Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom
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3
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Du DH, Hao NQN, Van Hao N, Thanh TT, Loan HT, Yen LM, Thuy TTD, Thuy DB, Nguyen NT, Dung NTP, Kestelyn E, Duong HTH, Phong NT, Tuyen PT, Phu NH, Nghia HDT, Hanh BTB, Oanh PKN, Tho PV, Nhat PTH, Khanh PNQ, Wyncoll D, Day NPJ, Van Vinh Chau N, van Doorn HR, Van Tan L, Geskus RB, Thwaites CL. Urinary catecholamine excretion, cardiovascular variability, and outcomes in tetanus. Trop Med Health 2023; 51:20. [PMID: 36998027 PMCID: PMC10061701 DOI: 10.1186/s41182-023-00512-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/17/2023] [Indexed: 04/01/2023] Open
Abstract
Severe tetanus is characterized by muscle spasm and cardiovascular system disturbance. The pathophysiology of muscle spasm is relatively well understood and involves inhibition of central inhibitory synapses by tetanus toxin. That of cardiovascular disturbance is less clear, but is believed to relate to disinhibition of the autonomic nervous system. The clinical syndrome of autonomic nervous system dysfunction (ANSD) seen in severe tetanus is characterized principally by changes in heart rate and blood pressure which have been linked to increased circulating catecholamines. Previous studies have described varying relationships between catecholamines and signs of ANSD in tetanus, but are limited by confounders and assays used. In this study, we aimed to perform detailed characterization of the relationship between catecholamines (adrenaline and noradrenaline), cardiovascular parameters (heart rate and blood pressure) and clinical outcomes (ANSD, mechanical ventilation required, and length of intensive care unit stay) in adults with tetanus, as well as examine whether intrathecal antitoxin administration affected subsequent catecholamine excretion. Noradrenaline and adrenaline were measured by ELISA from 24-h urine collections taken on day 5 of hospitalization in 272 patients enrolled in a 2 × 2 factorial-blinded randomized controlled trial in a Vietnamese hospital. Catecholamine results measured from 263 patients were available for analysis. After adjustment for potential confounders (i.e., age, sex, intervention treatment, and medications), there were indications of non-linear relationships between urinary catecholamines and heart rate. Adrenaline and noradrenaline were associated with subsequent development of ANSD, and length of ICU stay.
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Affiliation(s)
- Duc Hong Du
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
| | - Nguyen Quan Nhu Hao
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- University Medical Center, Ho Chi Minh City, Vietnam
| | - Nguyen Van Hao
- University Medical Center, Ho Chi Minh City, Vietnam
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Tran Tan Thanh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Huynh Thi Loan
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Lam Minh Yen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | | | | | - Evelyne Kestelyn
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | | | - Pham Thi Tuyen
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Ho Dang Trung Nghia
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Pham Ngoc, Thach Medicine University, Ho Chi Minh City, Vietnam
| | - Bui Thi Bich Hanh
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Pham Ngoc, Thach Medicine University, Ho Chi Minh City, Vietnam
| | | | - Phan Vinh Tho
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | | | | | - Nicholas P J Day
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol Oxford Research Unit, Bangkok, Thailand
| | | | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Ronald B Geskus
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - C Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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Lu P, Ghiasi S, Hagenah J, Hai HB, Hao NV, Khanh PNQ, Khoa LDV, Thwaites L, Clifton DA, Zhu T. Classification of Tetanus Severity in Intensive-Care Settings for Low-Income Countries Using Wearable Sensing. Sensors (Basel) 2022; 22:6554. [PMID: 36081013 PMCID: PMC9460354 DOI: 10.3390/s22176554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
Infectious diseases remain a common problem in low- and middle-income countries, including in Vietnam. Tetanus is a severe infectious disease characterized by muscle spasms and complicated by autonomic nervous system dysfunction in severe cases. Patients require careful monitoring using electrocardiograms (ECGs) to detect deterioration and the onset of autonomic nervous system dysfunction as early as possible. Machine learning analysis of ECG has been shown of extra value in predicting tetanus severity, however any additional ECG signal analysis places a high demand on time-limited hospital staff and requires specialist equipment. Therefore, we present a novel approach to tetanus monitoring from low-cost wearable sensors combined with a deep-learning-based automatic severity detection. This approach can automatically triage tetanus patients and reduce the burden on hospital staff. In this study, we propose a two-dimensional (2D) convolutional neural network with a channel-wise attention mechanism for the binary classification of ECG signals. According to the Ablett classification of tetanus severity, we define grades 1 and 2 as mild tetanus and grades 3 and 4 as severe tetanus. The one-dimensional ECG time series signals are transformed into 2D spectrograms. The 2D attention-based network is designed to extract the features from the input spectrograms. Experiments demonstrate a promising performance for the proposed method in tetanus classification with an F1 score of 0.79 ± 0.03, precision of 0.78 ± 0.08, recall of 0.82 ± 0.05, specificity of 0.85 ± 0.08, accuracy of 0.84 ± 0.04 and AUC of 0.84 ± 0.03.
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Affiliation(s)
- Ping Lu
- Department of Engineering Science, University of Oxford, Oxford OX1 3PJ, UK
| | - Shadi Ghiasi
- Department of Engineering Science, University of Oxford, Oxford OX1 3PJ, UK
| | - Jannis Hagenah
- Department of Engineering Science, University of Oxford, Oxford OX1 3PJ, UK
| | - Ho Bich Hai
- Oxford University Clinical Research Unit, Ho Chi Minh City 700000, Vietnam
| | - Nguyen Van Hao
- Hospital of Tropical Diseases, Ho Chi Minh City 700000, Vietnam
| | | | - Le Dinh Van Khoa
- Oxford University Clinical Research Unit, Ho Chi Minh City 700000, Vietnam
| | | | - Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City 700000, Vietnam
| | - David A. Clifton
- Department of Engineering Science, University of Oxford, Oxford OX1 3PJ, UK
- Hthe Oxford Suzhou Centre for Advanced Research, University of Oxford, Suzhou Dushu Lake Science and Education Innovation District, Suzhou 215123, China
| | - Tingting Zhu
- Department of Engineering Science, University of Oxford, Oxford OX1 3PJ, UK
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5
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Tao NPH, Makram AM, Khanh PNQ, An NT, Safi A, Huy NT. Negative impact from school closures on children and parents in Vietnam during COVID-19. The Lancet Respiratory Medicine 2022; 10:736-738. [PMID: 35716675 PMCID: PMC9212984 DOI: 10.1016/s2213-2600(22)00221-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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6
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Van Hao N, Loan HT, Yen LM, Kestelyn E, Hong DD, Thuy DB, Nguyen NT, Duong HTH, Thuy TTD, Nhat PTH, Khanh PNQ, Dung NTP, Phu NH, Phong NT, Lieu PT, Tuyen PT, Hanh BTB, Nghia HDT, Oanh PKN, Tho PV, Tan Thanh T, Turner HC, van Doorn HR, Van Tan L, Wyncoll D, Day NP, Geskus RB, Thwaites GE, Van Vinh Chau N, Thwaites CL. Human versus equine intramuscular antitoxin, with or without human intrathecal antitoxin, for the treatment of adults with tetanus: a 2 × 2 factorial randomised controlled trial. The Lancet Global Health 2022; 10:e862-e872. [PMID: 35561721 PMCID: PMC9115864 DOI: 10.1016/s2214-109x(22)00117-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/11/2022] [Accepted: 03/07/2022] [Indexed: 12/14/2022] Open
Abstract
Background Intramuscular antitoxin is recommended in tetanus treatment, but there are few data comparing human and equine preparations. Tetanus toxin acts within the CNS, where there is limited penetration of peripherally administered antitoxin; thus, intrathecal antitoxin administration might improve clinical outcomes compared with intramuscular injection. Methods In a 2 × 2 factorial trial, all patients aged 16 years or older with a clinical diagnosis of generalised tetanus admitted to the intensive care unit of the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam, were eligible for study entry. Participants were randomly assigned first to 3000 IU human or 21 000 U equine intramuscular antitoxin, then to either 500 IU intrathecal human antitoxin or sham procedure. Interventions were delivered by independent clinicians, with attending clinicians and study staff masked to treatment allocations. The primary outcome was requirement for mechanical ventilation. The analysis was done in the intention-to-treat population. The study is registered at ClinicalTrials.gov, NCT02999815; recruitment is completed. Findings 272 adults were randomly assigned to interventions between Jan 8, 2017, and Sept 29, 2019, and followed up until May, 2020. In the intrathecal allocation, 136 individuals were randomly assigned to sham procedure and 136 to antitoxin; in the intramuscular allocation, 109 individuals were randomly assigned to equine antitoxin and 109 to human antitoxin. 54 patients received antitoxin at a previous hospital, excluding them from the intramuscular antitoxin groups. Mechanical ventilation was given to 56 (43%) of 130 patients allocated to intrathecal antitoxin and 65 (50%) of 131 allocated to sham procedure (relative risk [RR] 0·87, 95% CI 0·66–1·13; p=0·29). For the intramuscular allocation, 48 (45%) of 107 patients allocated to human antitoxin received mechanical ventilation compared with 48 (44%) of 108 patients allocated to equine antitoxin (RR 1·01, 95% CI 0·75–1·36, p=0·95). No clinically relevant difference in adverse events was reported. 22 (16%) of 136 individuals allocated to the intrathecal group and 22 (11%) of 136 allocated to the sham procedure experienced adverse events related or possibly related to the intervention. 16 (15%) of 108 individuals allocated to equine intramuscular antitoxin and 17 (16%) of 109 allocated to human antitoxin experienced adverse events related or possibly related to the intervention. There were no intervention-related deaths. Interpretation We found no advantage of intramuscular human antitoxin over intramuscular equine antitoxin in tetanus treatment. Intrathecal antitoxin administration was safe, but did not provide overall benefit in addition to intramuscular antitoxin administration. Funding The Wellcome Trust.
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Affiliation(s)
- Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Huynh Thi Loan
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Lam Minh Yen
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Evelyne Kestelyn
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Duc Du Hong
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | | | | | | | - Phung Tran Huy Nhat
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Phan Nguyen Quoc Khanh
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Thi Phuong Dung
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Hoan Phu
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Pham Thi Lieu
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Pham Thi Tuyen
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Bui Thi Bich Hanh
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Ho Dang Trung Nghia
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | | | - Phan Vinh Tho
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Tran Tan Thanh
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Hugo C Turner
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK
| | - Le Van Tan
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Nicholas Pj Day
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK; Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ronald B Geskus
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK
| | - Guy E Thwaites
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK
| | | | - C Louise Thwaites
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK.
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Ghiasi S, Zhu T, Lu P, Hagenah J, Khanh PNQ, Hao NV, Thwaites L, Clifton DA. Sepsis Mortality Prediction Using Wearable Monitoring in Low-Middle Income Countries. Sensors (Basel) 2022; 22:s22103866. [PMID: 35632275 PMCID: PMC9145695 DOI: 10.3390/s22103866] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 02/05/2023]
Abstract
Sepsis is associated with high mortality—particularly in low–middle income countries (LMICs). Critical care management of sepsis is challenging in LMICs due to the lack of care providers and the high cost of bedside monitors. Recent advances in wearable sensor technology and machine learning (ML) models in healthcare promise to deliver new ways of digital monitoring integrated with automated decision systems to reduce the mortality risk in sepsis. In this study, firstly, we aim to assess the feasibility of using wearable sensors instead of traditional bedside monitors in the sepsis care management of hospital admitted patients, and secondly, to introduce automated prediction models for the mortality prediction of sepsis patients. To this end, we continuously monitored 50 sepsis patients for nearly 24 h after their admission to the Hospital for Tropical Diseases in Vietnam. We then compared the performance and interpretability of state-of-the-art ML models for the task of mortality prediction of sepsis using the heart rate variability (HRV) signal from wearable sensors and vital signs from bedside monitors. Our results show that all ML models trained on wearable data outperformed ML models trained on data gathered from the bedside monitors for the task of mortality prediction with the highest performance (area under the precision recall curve = 0.83) achieved using time-varying features of HRV and recurrent neural networks. Our results demonstrate that the integration of automated ML prediction models with wearable technology is well suited for helping clinicians who manage sepsis patients in LMICs to reduce the mortality risk of sepsis.
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Affiliation(s)
- Shadi Ghiasi
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; (T.Z.); (P.L.); (J.H.); (D.A.C.)
- Correspondence:
| | - Tingting Zhu
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; (T.Z.); (P.L.); (J.H.); (D.A.C.)
| | - Ping Lu
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; (T.Z.); (P.L.); (J.H.); (D.A.C.)
| | - Jannis Hagenah
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; (T.Z.); (P.L.); (J.H.); (D.A.C.)
| | - Phan Nguyen Quoc Khanh
- Oxford University Clinical Research Unit, Ho Chi Minh City 710400, Vietnam; (P.N.Q.K.); (L.T.)
| | - Nguyen Van Hao
- Hospital of Tropical Diseases, Ho Chi Minh City 700000, Vietnam;
| | | | - Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City 710400, Vietnam; (P.N.Q.K.); (L.T.)
| | - David A. Clifton
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; (T.Z.); (P.L.); (J.H.); (D.A.C.)
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Minh LHN, Khoi Quan N, Le TN, Khanh PNQ, Huy NT. COVID-19 Timeline of Vietnam: Important Milestones Through Four Waves of the Pandemic and Lesson Learned. Front Public Health 2021; 9:709067. [PMID: 34900885 PMCID: PMC8651614 DOI: 10.3389/fpubh.2021.709067] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/28/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
- Le Huu Nhat Minh
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam
| | | | - Tran Nhat Le
- Hue University of Medicine and Pharmacy, Hue, Vietnam
| | - Phan Nguyen Quoc Khanh
- Centre for Tropical Medicine and Global Health, Oxford University Clinical Research Unit, Ho Chi Minh, Vietnam
| | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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9
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Chau NVV, Hong NTT, Ngoc NM, Thanh TT, Khanh PNQ, Nguyet LA, Nhu LNT, Ny NTH, Man DNH, Hang VTT, Phong NT, Que NTH, Tuyen PT, Tu TNH, Hien TT, Minh NNQ, Hung LM, Truong NT, Yen LM, Rogier van Doorn H, Dung NT, Thwaites G, Dung NT, Van Tan L. Superspreading Event of SARS-CoV-2 Infection at a Bar, Ho Chi Minh City, Vietnam. Emerg Infect Dis 2020; 27. [PMID: 33063657 PMCID: PMC7774544 DOI: 10.3201/eid2701.203480] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
We report a superspreading event of severe acute respiratory syndrome coronavirus 2 infection initiated at a bar in Vietnam with evidence of symptomatic and asymptomatic transmission, based on ministry of health reports, patient interviews, and whole-genome sequence analysis. Crowds in enclosed indoor settings with poor ventilation may be considered at high risk for transmission.
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10
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Van Tan L, Thi Thu Hong N, My Ngoc N, Tan Thanh T, Thanh Lam V, Anh Nguyet L, Nguyen Truc Nhu L, Thi Ha Ny N, Ngoc Quang Minh N, Nguyen Huy Man D, Thi Ty Hang V, Nguyen Quoc Khanh P, Chanh Xuan T, Thanh Phong N, Nguyen Hoang Tu T, Tinh Hien T, Manh Hung L, Thanh Truong N, Min Yen L, Thanh Dung N, Thwaites G, Van Vinh Chau N. SARS-CoV-2 and co-infections detection in nasopharyngeal throat swabs of COVID-19 patients by metagenomics. J Infect 2020; 81:e175-e177. [PMID: 32562797 PMCID: PMC7403860 DOI: 10.1016/j.jinf.2020.06.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/14/2020] [Indexed: 01/17/2023]
Affiliation(s)
- Le Van Tan
- Oxford University Clinical Research Unit, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam.
| | - Nguyen Thi Thu Hong
- Oxford University Clinical Research Unit, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | - Nghiem My Ngoc
- Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | - Tran Tan Thanh
- Oxford University Clinical Research Unit, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | - Vo Thanh Lam
- Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | - Lam Anh Nguyet
- Oxford University Clinical Research Unit, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | - Le Nguyen Truc Nhu
- Oxford University Clinical Research Unit, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | - Nguyenn Thi Ha Ny
- Oxford University Clinical Research Unit, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | - Ngo Ngoc Quang Minh
- Children's Hospital 1, 341 Su Van Hanh, District 10, Ho Chi Minh City, Vietnam
| | - Dinh Nguyen Huy Man
- Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | - Vu Thi Ty Hang
- Oxford University Clinical Research Unit, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | - Phan Nguyen Quoc Khanh
- Oxford University Clinical Research Unit, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | | | - Nguyen Thanh Phong
- Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | - Tran Nguyen Hoang Tu
- Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | - Tran Tinh Hien
- Oxford University Clinical Research Unit, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam; Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Le Manh Hung
- Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | - Nguyen Thanh Truong
- Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | - Lamh Min Yen
- Oxford University Clinical Research Unit, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | - Nguyen Thanh Dung
- Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | - Guy Thwaites
- Oxford University Clinical Research Unit, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam; Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Nguyen Van Vinh Chau
- Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
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