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1.
JASA Express Lett ; 4(5)2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38717466

RESUMO

Machine learning enabled auscultating diagnosis can provide promising solutions especially for prescreening purposes. The bottleneck for its potential success is that high-quality datasets for training are still scarce. An open auscultation dataset that consists of samples and annotations from patients and healthy individuals is established in this work for the respiratory diagnosis studies with machine learning, which is of both scientific importance and practical potential. A machine learning approach is examined to showcase the use of this new dataset for lung sound classifications with different diseases. The open dataset is available to the public online.


Assuntos
Auscultação , Aprendizado de Máquina , Sons Respiratórios , Humanos , Auscultação/métodos , Sons Respiratórios/classificação
2.
Respir Res ; 25(1): 177, 2024 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-38658980

RESUMO

BACKGROUND: Computer Aided Lung Sound Analysis (CALSA) aims to overcome limitations associated with standard lung auscultation by removing the subjective component and allowing quantification of sound characteristics. In this proof-of-concept study, a novel automated approach was evaluated in real patient data by comparing lung sound characteristics to structural and functional imaging biomarkers. METHODS: Patients with cystic fibrosis (CF) aged > 5y were recruited in a prospective cross-sectional study. CT scans were analyzed by the CF-CT scoring method and Functional Respiratory Imaging (FRI). A digital stethoscope was used to record lung sounds at six chest locations. Following sound characteristics were determined: expiration-to-inspiration (E/I) signal power ratios within different frequency ranges, number of crackles per respiratory phase and wheeze parameters. Linear mixed-effects models were computed to relate CALSA parameters to imaging biomarkers on a lobar level. RESULTS: 222 recordings from 25 CF patients were included. Significant associations were found between E/I ratios and structural abnormalities, of which the ratio between 200 and 400 Hz appeared to be most clinically relevant due to its relation with bronchiectasis, mucus plugging, bronchial wall thickening and air trapping on CT. The number of crackles was also associated with multiple structural abnormalities as well as regional airway resistance determined by FRI. Wheeze parameters were not considered in the statistical analysis, since wheezing was detected in only one recording. CONCLUSIONS: The present study is the first to investigate associations between auscultatory findings and imaging biomarkers, which are considered the gold standard to evaluate the respiratory system. Despite the exploratory nature of this study, the results showed various meaningful associations that highlight the potential value of automated CALSA as a novel non-invasive outcome measure in future research and clinical practice.


Assuntos
Biomarcadores , Fibrose Cística , Sons Respiratórios , Humanos , Estudos Transversais , Masculino , Feminino , Estudos Prospectivos , Adulto , Fibrose Cística/fisiopatologia , Fibrose Cística/diagnóstico por imagem , Adulto Jovem , Adolescente , Auscultação/métodos , Tomografia Computadorizada por Raios X/métodos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Criança , Estudo de Prova de Conceito , Diagnóstico por Computador/métodos , Pessoa de Meia-Idade
3.
Midwifery ; 132: 103952, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38442530

RESUMO

AIM: This study aimed to explore student midwives' theoretical knowledge of intrapartum intermittent auscultation, their confidence in, and their experience of this mode of fetal monitoring. DESIGN AND SETTING: An online cross-section survey with closed and open questions. Descriptive statistics were used to analyse participants' intermittent auscultation knowledge, confidence, and experience. Reflexive thematic analysis was used to identify patterns within the free text about participants' experiences. PARTICIPANTS: Undergraduate midwifery students (n = 303) from Nursing and Midwifery Council-approved educational institutions within the United Kingdom. FINDINGS: Most participants demonstrated good theoretical knowledge. They had witnessed the technique being used in clinical practice, and when performed, the practice was reported to be in line with national guidance. In closed questions, participants reported feeling confident in their intermittent auscultation skills; however, these data contrasted with free-text responses. CONCLUSION: This cross-sectional survey found that student midwives possess adequate knowledge of intermittent auscultation. However, reflecting individual clinical experiences, their confidence in their ability to perform intermittent auscultation varied. A lack of opportunity to practice intermittent auscultation, organisational culture, and midwives' preferences have caused student midwives to question their capabilities with this essential clinical skill, leaving some with doubt about their competency close to registration.


Assuntos
Competência Clínica , Estudantes de Enfermagem , Humanos , Estudos Transversais , Feminino , Reino Unido , Estudantes de Enfermagem/estatística & dados numéricos , Estudantes de Enfermagem/psicologia , Inquéritos e Questionários , Adulto , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Gravidez , Enfermeiros Obstétricos/estatística & dados numéricos , Enfermeiros Obstétricos/educação , Enfermeiros Obstétricos/psicologia , Frequência Cardíaca Fetal/fisiologia , Tocologia/educação , Tocologia/métodos , Tocologia/estatística & dados numéricos , Bacharelado em Enfermagem/métodos , Auscultação/métodos , Auscultação/estatística & dados numéricos , Auscultação/normas
4.
J Clin Hypertens (Greenwich) ; 26(5): 532-542, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38552166

RESUMO

This study evaluated an oscillometric device (OD), Microlife WatchBP Office AFIB, and a hybrid manual auscultatory device (AD), Greenlight 300TM, to determine a suitable blood pressure (BP) measurement device for the Korea National Health and Nutrition Examination Survey in a mercury-free context. Adhering to the 2018 Universal Standard's suggested consensus, the study involved 800 subjects (mean age 51.2 ± 17.5 years; 44.3% male), who underwent triplicate BP measurements following 5 min of rest in a randomized order (OD-first: 398 participants; AD-first: 402 participants). BP difference was calculated as OD value minus AD value, with results stratified by measurement sequence. The overall BP difference and tolerable error probability were -1.1 ± 6.5/-2.6 ± 4.9 mmHg and 89.2%/92.5% for systolic/diastolic BP (SBP/DBP), respectively. Lin's concordance correlation coefficient was 0.907/0.844 for SBP/DBP (OD-first/AD-first: 0.925/0.892 for SBP, 0.842/0.845 for DBP). The overall agreement for hypertension (BP ≥ 140 and/or 90 mmHg) was 0.71 (p < 0.0001), and the OD underestimated the overall hypertension prevalence by 5.1%. Analysis of the AD-first data revealed a lower level of agreement compared to the OD-first data; however, the observed blood pressure difference adhered to Criterion 1 of the 2018 Universal Standard. Microlife met the Criterion 1 of 2018 Universal Standard but underestimated the prevalence of hypertension. The BP discrepancy increased with higher BP levels, male sex, and smaller AC. With increasing age, the discrepancy decreased for SBP and increased for DBP.


Assuntos
Auscultação , Determinação da Pressão Arterial , Inquéritos Nutricionais , Oscilometria , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , República da Coreia/epidemiologia , Inquéritos Nutricionais/métodos , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/instrumentação , Determinação da Pressão Arterial/estatística & dados numéricos , Adulto , Oscilometria/instrumentação , Oscilometria/métodos , Idoso , Auscultação/métodos , Auscultação/instrumentação , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Pressão Sanguínea/fisiologia , Reprodutibilidade dos Testes
5.
J Obstet Gynecol Neonatal Nurs ; 53(3): e10-e48, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38363241

RESUMO

Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.


Assuntos
Monitorização Fetal , Frequência Cardíaca Fetal , Humanos , Feminino , Gravidez , Frequência Cardíaca Fetal/fisiologia , Monitorização Fetal/métodos , Auscultação Cardíaca/métodos , Auscultação/métodos , Cardiotocografia/métodos , Cardiotocografia/normas
6.
Nurs Womens Health ; 28(2): e1-e39, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38363259

RESUMO

Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.


Assuntos
Monitorização Fetal , Trabalho de Parto , Gravidez , Recém-Nascido , Feminino , Humanos , Monitorização Fetal/métodos , Frequência Cardíaca Fetal , Auscultação/métodos , Cardiotocografia/métodos
7.
Int Urol Nephrol ; 56(5): 1763-1771, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38093038

RESUMO

BACKGROUND AND AIMS: The management of complications of arteriovenous fistula (AVF) for hemodialysis, principally stenosis, remains a major challenge for clinicians with a substantial impact on health resources. Stenosis not infrequently preludes to thrombotic events with the loss of AVF functionality. A functioning AVF, when listened by a stethoscope, has a continuous systolic-diastolic low-frequency murmur, while with stenosis, the frequency of the murmur increases and the duration of diastolic component decreases, disappearing in severe stenosis. These evidences are strictly subjective and dependent from operator skill and experience. New generation digital stethoscopes are able to record sound and subsequently dedicated software allows to extract quantitative variables that characterize the sound in an absolutely objective and repeatable way. The aim of our study was to analyze with an appropriate software sounds from AVFs taken by a commercial digital stethoscope and to investigate the potentiality to develop an objective way to detect stenosis. METHODS: Between September 2022 and January 2023, 64 chronic hemodialysis (HD) patients were screened by two blinded experienced examiners for recognized criteria for stenosis by Doppler ultrasound (DUS) and, consequently, the sound coming from the AVFs using a 3 M™ Littmann® CORE Digital Stethoscope 8570 in standardized sites was recorded. The sound waves were transformed into quantitative variables (amplitude and frequency) using a sound analysis software. The practical usefulness of the core digital stethoscope for a quick identification of an AVF stenosis was further evaluated through a pragmatic trial. Eight young nephrologist trainees underwent a simple auscultatory training consisting of two sessions of sound auscultation focusing two times on a "normal" AVF sound by placing the digital stethoscope on a convenience site of a functional AVF. RESULTS: In 48 patients eligible, all sound components displayed, alone, a remarkable diagnostic capacity. More in detail, the AUC of the average power was 0.872 [95% CI 0.729-0.951], while that of the mean normalized frequency was 0.822 [95% 0.656-0.930]. From a total of 32 auscultations (eight different block sequences, each one comprising four auscultations), the young clinicians were able to identify the correct sound (stenosis/normal AVF) in 25 cases, corresponding to an overall accuracy of 78.12% (95% CI 60.03-90.72%). CONCLUSIONS: The analysis of sound waves by a digital stethoscope permitted us to distinguish between stenotic and no stenotic AVFs. The standardization of this technique and the introducing of data in a deep learning algorithm could allow an objective and fast method for a frequent monitoring of AVF.


Assuntos
Fístula Arteriovenosa , Derivação Arteriovenosa Cirúrgica , Humanos , Projetos Piloto , Constrição Patológica , Diálise Renal , Auscultação/métodos
8.
Comput Biol Med ; 168: 107784, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-38042100

RESUMO

The use of machine learning in biomedical research has surged in recent years thanks to advances in devices and artificial intelligence. Our aim is to expand this body of knowledge by applying machine learning to pulmonary auscultation signals. Despite improvements in digital stethoscopes and attempts to find synergy between them and artificial intelligence, solutions for their use in clinical settings remain scarce. Physicians continue to infer initial diagnoses with less sophisticated means, resulting in low accuracy, leading to suboptimal patient care. To arrive at a correct preliminary diagnosis, the auscultation diagnostics need to be of high accuracy. Due to the large number of auscultations performed, data availability opens up opportunities for more effective sound analysis. In this study, digital 6-channel auscultations of 45 patients were used in various machine learning scenarios, with the aim of distinguishing between normal and abnormal pulmonary sounds. Audio features (such as fundamental frequencies F0-4, loudness, HNR, DFA, as well as descriptive statistics of log energy, RMS and MFCC) were extracted using the Python library Surfboard. Windowing, feature aggregation, and concatenation strategies were used to prepare data for machine learning algorithms in unsupervised (fair-cut forest, outlier forest) and supervised (random forest, regularized logistic regression) settings. The evaluation was carried out using 9-fold stratified cross-validation repeated 30 times. Decision fusion by averaging the outputs for a subject was also tested and found to be helpful. Supervised models showed a consistent advantage over unsupervised ones, with random forest achieving a mean AUC ROC of 0.691 (accuracy 71.11%, Kappa 0.416, F1-score 0.675) in side-based detection and a mean AUC ROC of 0.721 (accuracy 68.89%, Kappa 0.371, F1-score 0.650) in patient-based detection.


Assuntos
Inteligência Artificial , Auscultação , Humanos , Auscultação/métodos , Algoritmos , Aprendizado de Máquina , Pulmão
9.
Artigo em Inglês | MEDLINE | ID: mdl-38082606

RESUMO

In clinical practice, bowel sounds are often used to assess bowel motility. However, the mechanism of bowel-sound occurrence is unknown. Furthermore, there is no objective evidence indicating a relationship between bowel motility and bowel sounds, and diagnoses have been based on empirically established criteria. In this study, simultaneous X-ray fluoroscopy and bowel-sound measurements were used to reveal the mechanism of bowel-sound occurrence. The results indicate that the flow of luminal contents may cause bowel sounds. Additionally, on the basis of the hypothesis that bowel motility recovers with the postoperative course, bowel-sound features that reflect bowel motion were explored, revealing that the current diagnosis indices are appropriate.


Assuntos
Acústica , Auscultação , Humanos , Raios X , Auscultação/métodos , Motilidade Gastrointestinal , Fluoroscopia
10.
Artigo em Inglês | MEDLINE | ID: mdl-38082761

RESUMO

Noninvasive blood pressure (NIBP) devices are calibrated against validated auscultation sphygmomanometers using Korotkoff sounds. This study aimed to investigate the timing of Korotkoff sounds in relation to pulse appearance in the brachial artery and values of intra-arterial blood pressure. Experiments were carried out on 15 participants, (14 males, 64.3 ± 10.4 years; one female, 86 yo), undergoing coronary angiography. A conventional occluding cuff, with a microphone for Korotkoff sounds, was placed on the upper arm (on the brachial artery). Intra-arterial blood pressure (IABP) was measured below the cuff with a fluid-filled catheter inserted via the radial artery and an external transducer. Finger photoplethysmography was used to measure brachial pulse wave velocity (PWV). Korotkoff sounds were processed electronically and custom algorithms identified the cuff pressure (CP) at which the first and last Korotkoff sounds were heard. PWV and max slope of the IABP pressure pulse were recorded to estimate arterial stiffness. The brachial artery closed at a CP of 132.0 ± 17.1 mmHg. Systolic and diastolic blood pressure (SBP and DBP) were 147.6 ± 14.3 and 72.7 ± 10.1 mmHg; mean pressure (MP, 100.1 ± 10.4 mmHg) was similar to MP derived from the peak of the oscillogram (98.5 ± 13.6 mmHg). Difference between IABP and CP recorded at first and last occurrence of Korotkoff sounds were, SBP: 19.0 ± 8.3 (range 2-29) mmHg, DBP: 4.0 ± 4.3 (range 2-12) mmHg. SBP derived from the onset of Korotkoff sounds can underestimate IABP by up to 19 mmHg. Since Korotkoff sounds are the recommended method mandated by the universal standard for the validation of blood pressure measuring devices, these errors are propagated through to all NIBP measurement devices irrespective of whether they use auscultatory or oscillometric methods.


Assuntos
Determinação da Pressão Arterial , Análise de Onda de Pulso , Masculino , Humanos , Feminino , Pressão Sanguínea/fisiologia , Esfigmomanômetros , Auscultação/métodos
11.
Comput Biol Med ; 164: 107311, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37552916

RESUMO

Chest or upper body auscultation has long been considered a useful part of the physical examination going back to the time of Hippocrates. However, it did not become a prevalent practice until the invention of the stethoscope by Rene Laennec in 1816, which made the practice suitable and hygienic. Pulmonary disease is a kind of sickness that affects the lungs and various parts of the respiratory system. Lung diseases are the third largest cause of death in the world. According to the World Health Organization (WHO), the five major respiratory diseases, namely chronic obstructive pulmonary disease (COPD), tuberculosis, acute lower respiratory tract infection (LRTI), asthma, and lung cancer, cause the death of more than 3 million people each year worldwide. Respiratory sounds disclose significant information regarding the lungs of patients. Numerous methods are developed for analyzing the lung sounds. However, clinical approaches require qualified pulmonologists to diagnose such kind of signals appropriately and are also time consuming. Hence, an efficient Fractional Water Cycle Swarm Optimizer-based Deep Residual Network (Fr-WCSO-based DRN) is developed in this research for detecting the pulmonary abnormalities using respiratory sounds signals. The proposed Fr-WCSO is newly designed by the incorporation of Fractional Calculus (FC) and Water Cycle Swarm Optimizer WCSO. Meanwhile, WCSO is the combination of Water Cycle Algorithm (WCA) with Competitive Swarm Optimizer (CSO). The respiratory input sound signals are pre-processed and the important features needed for the further processing are effectively extracted. With the extracted features, data augmentation is carried out for minimizing the over fitting issues for improving the overall detection performance. Once data augmentation is done, feature selection is performed using proposed Fr-WCSO algorithm. Finally, pulmonary abnormality detection is performed using DRN where the training procedure of DRN is performed using the developed Fr-WCSO algorithm. The developed method achieved superior performance by considering the evaluation measures, namely True Positive Rate (TPR), True Negative Rate (TNR) and testing accuracy with the values of 0.963(96.3%), 0.932,(93.2%) and 0.948(94.8%), respectively.


Assuntos
Asma , Doença Pulmonar Obstrutiva Crônica , Humanos , Sons Respiratórios/diagnóstico , Pulmão , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Asma/diagnóstico , Auscultação/métodos
12.
Proc Inst Mech Eng H ; 237(6): 669-682, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37139865

RESUMO

The high prevalence of cardiac diseases around the world has created a need for quick, easy and cost effective approaches to diagnose heart disease. The auscultation and interpretation of heart sounds using the stethoscope is relatively inexpensive, requires minimal to advanced training, and is widely available and easily carried by healthcare providers working in urban environments or medically underserved rural areas. Since René-Théophile-Hyacinthe Laennec's simple, monoaural design, the capabilities of modern-day, commercially available stethoscopes and stethoscope systems have radically advanced with the integration of electronic hardware and software tools, however these systems are largely confined to the metropolitan medical centers. The purpose of this paper is to review the history of stethoscopes, compare commercially available stethoscope products and analytical software, and discuss future directions. Our review includes a description of heart sounds and how modern software enables the measurement and analysis of time intervals, teaching auscultation, remote cardiac examination (telemedicine) and, more recently, spectrographic evaluation and electronic storage. The basic methodologies behind modern software algorithms and techniques for heart sound preprocessing, segmentation and classification are described to provide awareness.


Assuntos
Ruídos Cardíacos , Estetoscópios , Auscultação/métodos , Software , Algoritmos , Auscultação Cardíaca
13.
Am J Emerg Med ; 67: 120-125, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36870252

RESUMO

OBJECTIVE: Although noise is known to negatively affect blood pressure (BP) measurements, its impact on different BP measurement methods remains unclear. The aim of this study is to compare the agreement of oscillometric and auscultatory BP measurement methods under in-ambulance noise levels. METHODS: This method-comparison study was conducted on 50 healthy volunteers in a tertiary emergency department (ED). Participants were divided into two groups of 25, and BP was measured using auscultatory and oscillometric methods in noisy and ambient environments by 2 emergency medicine technicians (EMT). The primary object of the study was to compare the agreement of auscultatory mercury sphygmomanometers and automated auscillometric BP measurements in ambient and noisy environments. RESULTS: We examined the agreement between auscultative and oscillometric measurements of BP conducted in an ambient environment (46.75 [IQR (41.2--55.18)] dB) and found that both systolic and diastolic BP were within the level of agreement (LoA) established before the study (systolic BP [-13.96 to 8.48 mmHG], diastolic BP [-7.44 to 8.08 mmHg]); whereas, in noisy environment (92.35 [IQR 88-96.55] dB) both systolic and diastolic BP were outside the range of LoA (systolic BP [-37.77 to 9.94 mmHg], diastolic BP [-21.73 to 16.37 mmHg]). Additionally, we found that in ambient environments, concordance correlation coefficients were higher than in noisy environments (0.943 [0.906-0.966], 0.957 [0.93-0.974]; 0.574 [0.419-0.697], 0.544 [0.326-0.707]; systolic and diastolic BP, respectively). CONCLUSION: The results of this study demonstrate that noise significantly affects the agreement between oscillometric and auscultatory blood pressure measurement methods.


Assuntos
Ambulâncias , Determinação da Pressão Arterial , Humanos , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/métodos , Esfigmomanômetros , Auscultação/métodos
14.
J Acoust Soc Am ; 153(3): 1496, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-37002066

RESUMO

Measurement of blood pressure (BP) through manual auscultation and the observation of Korotkoff sounds (KSs) remains the gold standard in BP methodology. Critical to determining BP levels via auscultation is the determination of KS audibility. While absolute sound level audibility is well researched, the problem has not been approached from the point of view of psychoacoustic masking of the sounds. Here, during manual auscultation of BP, a direct comparison is made between what an observer perceives as audible and the electronic analysis of audibility level determined from masking of sound signal levels. KSs are collected during auscultation with an electronic stethoscope, which allows simultaneously observing sound audibility and recording the sound electronically. By time-segmenting the recorded sound around Korotkoff peaks into a test segment and a masking segment, performing Fourier transforms on the segments, and comparing frequency-band sound energy levels, signal-to-noise ratios of a sound to its masking counterpart can be defined. Comparing these ratios to difference limen in the psychoacoustic masking literature, an approximate threshold for sound audibility is obtained. It is anticipated that this approach could have profound effects on future development of automated auscultation BP measurements.


Assuntos
Auscultação , Determinação da Pressão Arterial , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/métodos , Auscultação/métodos , Análise de Fourier , Som
15.
Biomed Phys Eng Express ; 9(3)2023 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-36796095

RESUMO

Objective.Cardiopulmonary auscultation is promising to get smart due to the emerging of electronic stethoscopes. Cardiac and lung sounds often appear mixed at both time and frequency domain, hence deteriorating the auscultation quality and the further diagnosis performance. The conventional cardiopulmonary sound separation methods may be challenged by the diversity in cardiac/lung sounds. In this study, the data-driven feature learning advantage of deep autoencoder and the common quasi-cyclostationarity characteristic are exploited for monaural separation.Approach.Different from most of the existing separation methods that only handle the amplitude of short-time Fourier transform (STFT) spectrum, a complex-valued U-net (CUnet) with deep autoencoder structure, is built to fully exploit both the amplitude and phase information. As a common characteristic of cardiopulmonary sounds, quasi-cyclostationarity of cardiac sound is involved in the loss function for training.Main results. In experiments to separate cardiac/lung sounds for heart valve disorder auscultation, the averaged achieved signal distortion ratio (SDR), signal interference ratio (SIR), and signal artifact ratio (SAR) in cardiac sounds are 7.84 dB, 21.72 dB, and 8.06 dB, respectively. The detection accuracy of aortic stenosis can be raised from 92.21% to 97.90%.Significance. The proposed method can promote the cardiopulmonary sound separation performance, and may improve the detection accuracy for cardiopulmonary diseases.


Assuntos
Ruídos Cardíacos , Estetoscópios , Humanos , Sons Respiratórios/diagnóstico , Processamento de Sinais Assistido por Computador , Auscultação/métodos
16.
Dysphagia ; 38(1): 305-314, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-35838785

RESUMO

This study investigated the reliability and validity (sensitivity and specificity) of cervical auscultation (CA) using both swallow and pre-post swallow-respiratory sounds, as compared with Flexible Endoscopic Evaluation of Swallowing (FEES). With 103 swallow-respiratory sequences from 23 heterogenic patients, these swallows sounds were rated by eight CA-trained Speech-Language Pathologists (SLPs) to investigate: (1) if the swallow was safe (primary outcome); (2) patient dysphagia status; (3) the influence of liquid viscosity on CA accuracy (secondary outcomes). Primary outcome data showed high CA sensitivity (85.4%), and specificity (80.3%) with all consistencies for the safe measurement, with CA predictive values of [Formula: see text] 90% to accurately detect unsafe swallows. Intra-rater reliability was good (Kappa [Formula: see text] 0.65), inter rater reliability moderate (Kappa [Formula: see text] 0.58). Secondary outcome measures showed high sensitivity (80.1%) to identify if a patient was dysphagic, low specificity (22.9%), and moderate correlation (rs [Formula: see text] 0.62) with FEES. A difference across bolus viscosities identified that CA sensitivities (90.1%) and specificities ([Formula: see text] 84.7%) for thin liquids were greater than for thick liquids (71.0-77.4% sensitivities, 74.0-81.3% specificities). Results demonstrate high validity and moderate-good reliability of CA-trained SLPs to determine swallow safety when compared with FEES. Data support the use of CA as an adjunct to the clinical swallow examination. CA should include pre-post respiratory sounds and requires specific training. Clinical implications: The authors advocate for holistic dysphagia management including instrumental assessment and ongoing CSE/review [Formula: see text] CA. Adding CA to the CSE/review does not replace instrumental assessment, nor should CA be used as a stand-alone tool.


Assuntos
Transtornos de Deglutição , Humanos , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/complicações , Deglutição , Reprodutibilidade dos Testes , Sons Respiratórios , Auscultação/métodos
17.
J Med Biogr ; 31(4): 234-245, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34279155

RESUMO

In the middle third of the 19th century, George Phillip Cammann became known for the stethoscope improvement that came to bear his name and for the development of the then-popular diagnostic technique of auscultatory percussion. During his postgraduate training at the Paris hospitals in 1828-1830, he acquired a special interest in auscultation while attending lectures given by a friend and colleague of Laennec's, French physician Pierre-Charles-Alexandre Louis (1787-1872). In his New York City practice, caring primarily for the working poor, he recognized the need for a better stethoscope and developed a modification that came to bear his name. He conducted research aimed at increasing the accuracy of physical diagnosis by improving and reporting on the technique of auscultatory percussion. An examination of the medical literature, both textbooks and journals, reveals the extent of influence that Cammann had on clinical practice resulting from his contributions to the improvement of the stethoscope and auscultatory percussion.


Assuntos
Médicos , Estetoscópios , Humanos , Masculino , Auscultação/história , Auscultação/métodos , Percussão/métodos , Estetoscópios/história
18.
Int J Med Robot ; 19(1): e2461, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36097703

RESUMO

BACKGROUND: Since most developed countries are facing an increase in the number of patients per healthcare worker due to a declining birth rate and an ageing population, relatively simple and safe diagnosis tasks may need to be performed using robotics and automation technologies, without specialists and hospitals. This study presents an automated robotic platform for remote auscultation, which is a highly cost-effective screening tool for detecting abnormal clinical signs. METHOD: The developed robotic platform is composed of a 6-degree-of-freedom cooperative robotic arm, LiDAR camera, and a spring-based mechanism holding an electric stethoscope. The platform enables autonomous stethoscope positioning based on external body information acquired using the LiDAR camera-based multi-way registration; the platform also ensures safe and flexible contact, maintaining the contact force within a certain range through the passive-actuated mechanism. RESULTS: Our preliminary results confirm that the robotic platform enables estimation of the landing positions required for cardiac examinations based on the depth and landmark information of the body surface. It also handles the stethoscope while maintaining the contact force without relying on the push-in displacement by the robotic arm. CONCLUSION: The developed robotic platform enables the estimation of the landing positions and handling the stethoscope while maintaining the contact force, which promises the potential of automatic remote auscultation.


Assuntos
Robótica , Humanos , Auscultação/métodos , Automação , Pessoal de Saúde
19.
Asian J Anesthesiol ; 61(3): 142-148, 2023 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-38320860

RESUMO

BACKGROUND: In pediatric patients due to shorter trachea suboptimal positioning of endotracheal tube (ETT) is seen in 20%-50% of patients triggering grave complications. We compared standard auscultation and ultrasound-guided lung sliding to confirm the position of ETT in children. METHODS: Seventy-five pediatric patients between 2-8 years of age, American Society of Anesthesiologists physical status classification I and II scheduled for surgery under general anesthesia with endotracheal intubation were studied. The position of ETT was confirmed by chest auscultation for the breath sounds bilaterally and by ultrasound on the same sites for lung-sliding signs. The data obtained were compared to findings on waveform capnography. Study outcomes included position of the ETT; tracheal or esophageal, accuracy of diagnosis and time taken till confirming the diagnosis. RESULTS: Compared to waveform capnography findings, an ultrasound revealed a sensitivity of 94.31%, a specificity of 72.33%, and an accuracy of 90.7% while that for standard auscultation were 82.8%, 47.28%, and 74.67%, respectively. The mean time taken for confirmation of ETT position was significantly shorter with waveform capnography (10.29 ± 2.25 s) compared to auscultation (12.96 ± 2.23 s) and ultrasonography (USG) (14.28 ± 3.77 s). CONCLUSION: Confirmation of ETT position using USG or waveform capnography is essential because of high false results using standard auscultation alone. Ultrasound-guided lung sliding method is a simple, fast, and a reliable method used for detecting tube malposition.


Assuntos
Intubação Intratraqueal , Traqueia , Humanos , Criança , Intubação Intratraqueal/métodos , Traqueia/diagnóstico por imagem , Ultrassonografia , Anestesia Geral , Auscultação/métodos
20.
J Emerg Med ; 63(4): 582-591, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36244855

RESUMO

BACKGROUND: Auscultation for an extended period of time using a wearable stethoscope enables objective computerized analysis and longitudinal assessment of lung sounds. However, this auscultation method differs from bedside auscultation in that clinicians are not present to optimize the quality of auscultation. No prior studies have compared these two auscultation methods. OBJECTIVE: The aim of this study was to compare intermittent auscultation using a conventional stethoscope with continuous auscultation using a wearable stethoscope for wheeze detection in patients who present with acute respiratory distress. METHODS: Patients presenting to the emergency department with acute respiratory distress were enrolled. The Strados Remote Electronic Stethoscope Platform (RESP™) was used for continuous auscultation, and intermittent auscultation was performed using a U.S. Food and Drug Administration-cleared electronic stethoscope. A recording was made with an electronic stethoscope. Subsequently, continuous recording was made using RESP™, which continued until the patient was admitted or discharged from the emergency department. The number of captured wheezes in each recording was counted and validated by two board-certified physicians. RESULTS: From May 2018 to May 2019, 43 patients were enrolled in the study. Three patients were excluded from analysis due to incomplete audio recording data. The mean length of recording was 62.3 min for continuous auscultation and 0.7 min for intermittent auscultation; 77.5% (31 of 40) of intermittent recordings contained wheezes, in contrast to 85% (34 of 40) of continuous recordings. CONCLUSIONS: Extending the duration of auscultation using a wearable stethoscope in a noisy clinical environment showed comparable performance to standard of care intermittent auscultation in identifying patients who have wheezes.


Assuntos
Síndrome do Desconforto Respiratório , Estetoscópios , Humanos , Sons Respiratórios/diagnóstico , Auscultação/métodos
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