Newborn heart rate monitoring methods at birth and clinical outcomes: A systematic review.

Aim: Compare heart rate assessment methods in the delivery room on newborn clinical outcomes. Methods: A search of Medline, SCOPUS, CINAHL and Cochrane was conducted between January 1, 1946, to until August 16, 2023. (CRD 42021283438) Study Selection was based on predetermined criteria. Reviewers independently extracted data, appraised risk of bias and assessed certainty of evidence. Results: Two randomized controlled trials involving 91 newborns and 1 nonrandomized study involving 632 newborns comparing electrocardiogram (ECG) to auscultation plus pulse oximetry were included. No studies were found that compared any other heart rate measurement methods and reported clinical outcomes. There was no difference between the ECG and control group for duration of positive pressure ventilation, time to heart rate ≥ 100 beats per minute, epinephrine use or death before discharge. In the randomized studies, there was no difference in rate of tracheal intubation [RR 1.34, 95% CI (0.69-2.59)]. No participants received chest compressions. In the nonrandomized study, fewer infants were intubated in the ECG group [RR 0.75, 95% CI (0.62-0.90)]; however, for chest compressions, benefit or harm could not be excluded. [RR 2.14, 95% (CI 0.98-4.70)]. Conclusion: There is insufficient evidence to ascertain clinical benefits or harms associated with the use of ECG versus pulse oximetry plus auscultation for heart rate assessment in newborns in the delivery room.

Fast and accurate newborn heart rate monitoring at birth: A systematic review.

Aim: To examine speed and accuracy of newborn heart rate measurement by various assessment methods employed at birth. Methods: A search of Medline, SCOPUS, CINAHL and Cochrane was conducted between January 1, 1946, to until August 16, 2023. (CRD 42021283364) Study selection was based on predetermined criteria. Reviewers independently extracted data, appraised risk of bias and assessed certainty of evidence. Results: Pulse oximetry is slower and less precise than ECG for heart rate assessment. Both auscultation and palpation are imprecise for heart rate assessment. Other devices such as digital stethoscope, Doppler ultrasound, an ECG device using dry electrodes incorporated in a belt, photoplethysmography and electromyography are studied in small numbers of newborns and data are not available for extremely preterm or bradycardic newborns receiving resuscitation. Digital stethoscope is fast and accurate. Doppler ultrasound and dry electrode ECG in a belt are fast, accurate and precise when compared to conventional ECG with gel adhesive electrodes. Limitations: Certainty of evidence was low or very low for most comparisons. Conclusion: If resources permit, ECG should be used for fast and accurate heart rate assessment at birth. Pulse oximetry and auscultation may be reasonable alternatives but have limitations. Digital stethoscope, doppler ultrasound and dry electrode ECG show promise but need further study.

Implementation of stethoscope disinfection: an observational study on nursing staff practice and knowledge.

Background: Healthcare-associated infections cause high mortality and morbidity, and lack of stethoscope disinfection is one of the reasons for healthcare-associated infections. Nurses who frequently use stethoscopes in the clinic do not disinfect stethoscopes at high rates. This study aimed to identify the frequency of stethoscope disinfection by nurses and their knowledge about the same. Methods: This was a mixed-methods observational study. The quantitative part of the study included 202 nurses, the qualitative part included 12. Two researchers who made observations during stethoscope use recorded the procedures the nurses performed on the "Observation Form". Semi-structured in-depth interviews were conducted based on phenomenological methods. Results: 23.7% of the nurses disinfected their stethoscopes before contact with patients, 11.8% after contact with patients and 6.4% before and after contact with patients. The nurses used a stethoscope on an average of 7.42 patients without disinfecting it. In the qualitative interview, some nurses stated that they did not have information about the disinfectants to be used for stethoscopes and their effectiveness. Some of the participants in the present study stated that they did not receive training on stethoscope disinfection and that they did not know that there were guidelines about it. Conclusion: Since there were deficiencies in the implementation of stethoscope disinfection as well as knowledge, the transfer of knowledge in this context must receive more attention in education and training.

Assessment of a Teaching Module for Cardiac Auscultation of Horses by Veterinary Students.

Auscultation of heart sounds is an important veterinary skill requiring an understanding of anatomy, physiology, pathophysiology and pattern recognition. This cross-sectional study was developed to evaluate a targeted, audio-visual training resource for veterinary students to improve their understanding and auscultation of common heart conditions in horses. Fourth- and fifth-year 2021 and 2022 Bachelor of Veterinary Science students at the University of Queensland (UQ) were provided the learning resource and surveyed via online pre- and post-intervention surveys. Results were quantitatively analyzed using descriptive statistics and Mann-Whitney U tests. Open-ended survey questions were qualitatively analyzed by thematic analysis and Leximancer™ Version 4 program software analysis. Over the two-year period, 231 fourth-year and 222 fifth-year veterinary students had access to the resource; 89 completed the pre-intervention survey and 57 completed the post-intervention survey. Quantitative results showed the resource helped students prepare for practicals and their perception of competency and confidence when auscultating equine cardiac sounds improved (p < 0.05). Compared to fifth-year students, fourth-year students felt less competent at identifying murmurs and arrythmias prior to accessing the learning resource (p < 0.05). Fourth-year and fifth-year students' familiarity with detection of murmurs improved after completing the learning resource (p < 0.001). Qualitative analysis demonstrated a limited number of opportunities to practice equine cardiac auscultation throughout the veterinary degree, especially during the COVID-19 pandemic, and that integrated audio-visual resources are an effective means of teaching auscultation.

Contralateral Tension Pneumothorax in One-Lung Ventilation: A Case Report and Systematic Review.

Contralateral tension pneumothorax is a rare but fatal complication of one-lung ventilation. The life-saving decompression of pleural space was frequently delayed by the difficult confirmation of diagnosis because of general anesthesia that masks specific clinical presentations when the patient is alert. We reported a case of tension pneumothorax in a patient who underwent thoracic spine instrumentation. There were no contralateral tension pneumothorax cases on file from the search of the Anesthesia Quality Institute Closed Claims Database from 2001 to 2017. We systematically searched PubMed, Ovid MEDLINE, Embase, and Google Scholar. Over the past 30 years, there were 21 single case reports and two case series were retrieved. It was a consensus that difficult confirmation of the diagnosis of contralateral tension pneumothorax is the culprit of delayed life-saving intervention. Difficulty of oxygenation with increasing inspiratory pressure was usually the first sign suggesting contralateral pneumothorax; however, earlier presentations of cardiovascular system failure than respiratory failure have significantly increased the incidence of cardiac arrest and death. It is paramount to maintain a high suspicion of tension pneumothorax. The application of esophageal stethoscope, lung ultrasound, and simulator training may improve the chance of early diagnosis and patient outcome.

Acoustically Enhanced Triboelectric Stethoscope for Ultrasensitive Cardiac Sounds Sensing and Disease Diagnosis.

Electronic stethoscope used to detect cardiac sounds that contain essential clinical information is a primary tool for diagnosis of various cardiac disorders. However, the linear electromechanical constitutive relation makes conventional piezoelectric sensors rather ineffective to detect low-intensity, low-frequency heart acoustic signal without the assistance of complex filtering and amplification circuits. Herein, it is found that triboelectric sensor features superior advantages over piezoelectric one for microquantity sensing originated from the fast saturated constitutive characteristic. As a result, the triboelectric sensor shows ultrahigh sensitivity (1215 mV Pa-1) than the piezoelectric counterpart (21 mV Pa-1) in the sound pressure range of 50-80 dB under the same testing condition. By designing a trumpet-shaped auscultatory cavity with a power function cross-section to achieve acoustic energy converging and impedance matching, triboelectric stethoscope delivers 36 dB signal-to-noise ratio for human test (2.3 times of that for piezoelectric one). Further combining with machine learning, five cardiac states can be diagnosed at 97% accuracy. In general, the triboelectric sensor is distinctly unique in basic mechanism, provides a novel design concept for sensing micromechanical quantities, and presents significant potential for application in cardiac sounds sensing and disease diagnosis.

SonicGuard Sensor-A Multichannel Acoustic Sensor for Long-Term Monitoring of Abdominal Sounds Examined through a Qualification Study.

Auscultation is a fundamental diagnostic technique that provides valuable diagnostic information about different parts of the body. With the increasing prevalence of digital stethoscopes and telehealth applications, there is a growing trend towards digitizing the capture of bodily sounds, thereby enabling subsequent analysis using machine learning algorithms. This study introduces the SonicGuard sensor, which is a multichannel acoustic sensor designed for long-term recordings of bodily sounds. We conducted a series of qualification tests, with a specific focus on bowel sounds ranging from controlled experimental environments to phantom measurements and real patient recordings. These tests demonstrate the effectiveness of the proposed sensor setup. The results show that the SonicGuard sensor is comparable to commercially available digital stethoscopes, which are considered the gold standard in the field. This development opens up possibilities for collecting and analyzing bodily sound datasets using machine learning techniques in the future.

Evaluation of a digital stethoscope for electrocardiographic recording in donkeys: Preliminary results.

The digital stethoscope (DS) is a cost-effective single-lead digital stethoscope that allows simultaneous electrocardiographic (ECG) and phonocardiographic recordings on a smartphone. Despite its application in small animals and horses, there are currently no studies on its use in donkeys. The aim of this study was to evaluate the use of a new smartphone-based DS device in recording ECG tracings in donkeys. Standard base-apex lead ECG (sECG) and single-lead DS ECG (dECG) were simultaneously recorded for at least 30 s. Both sECG and dECG tracings were analysed by the same operator, recording heart rate, ECG waves and intervals, and the presence and duration of artefacts. Thirty-seven donkeys were included. The dECG tracings were interpretable in all the animals (100 %). The results showed perfect agreement between the sECG and dECG data for the classification of heart rhythm and P-wave polarity. Strong agreement was found in the evaluation of heart rate calculated manually and automatically by the smartphone app, QRS complex polarity, T wave polarity, and duration of the PR interval. However, no agreement was found in the evaluation of P wave duration, QRS complex duration and amplitude, and T wave duration and amplitude. In conclusion, although this is only a preliminary study, the DS was a valid, practical, and easy to use electrocardiographic tool for recording good-quality ECG tracings to assess the ECGs of donkeys in the field.

Henry Ingersoll Bowditch: The Prominent Physician Who Introduced Thorax Examination and Trocar Thoracentesis in the United States of America.

Born in a wealthy family with a tradition in science, Henry Ingersoll Bowditch (1808-1882) with studies at Harvard Medical School and in Europe had succeeded in leaving his mark in the American history of medicine. He had been a pioneer in the stethoscope's use, which was promoted and suggested to all physicians of his era. He had widely used thoracentesis, an ancient procedure, for pleuritic effusions, diagnosed with a stethoscope. Inside his most popular treatise "The Young Stethoscopist," he had given a plethora of data concerning the auscultation of the lungs, heart, and vessels; obstetrics; and veterinary. To help younger physicians, he demonstrated through figures local anatomy and positions for auscultation, providing information for various types of stethoscopes being in use during the mid-19th century. He was a humanist and reformer for public hygiene. This historical vignette aims to present Henry Ingersoll Bowditch and his work concerning the thorax. For his contributions to education and public hygiene, he should be celebrated as one of the most important figures of the eve of American medicine.

The reverse stethoscope technique: a rapid intervention for old age hearing loss.

OBJECTIVES: Presbycusis is highly prevalent, affecting between a third and two-thirds of elderly populations. Effective communication between patient and physician has been shown to directly correlate with the quality of patient care. The Reverse Stethoscope Technique (RST) involves placing the earpieces into the patient's ears and speaking into the diaphragm. Here, we aim to show the RST is a simple and effective method to communicate with patients suffering from presbycusis in inpatient settings. METHODS: Medical inpatients aged >60 years old without cognitive impairment were included in the study. A simple repetition exercise of basic English sentences was performed with and without the RST to assess hearing ability. Patients then undertook a short questionnaire. RESULTS: Our study included 109 patients with varied 'self-reported' hearing. 50.5% of our cohort reported past communication difficulties with health-care professionals due to hearing difficulties. We identified that the RST increased the mean number of sentences a patient could repeat from 2.6 to 3.5 representing a statistically significant increase (p < 0.001). The technique was most beneficial for patients with 'okay' and 'poor' hearing. The majority of patients (77/109) also stated the technique reduced background noise. The RST was equally effective with facemasks. CONCLUSION: Current techniques to enhance communication with patients with hearing loss are often underutilized or poorly accessible. Our study identified that the RST is a quick and effective solution that can be easily implemented for patients struggling to communicate with health-care professionals in inpatient scenarios.

Deep learning of heart-sound signals for efficient prediction of obstructive coronary artery disease.

Background: Due to the limitations of current methods for detecting obstructive coronary artery disease (CAD), many individuals are mistakenly or unnecessarily referred for coronary angiography (CAG). Objectives: Our goal is to create a comprehensive database of heart sounds in CAD and develop accurate deep learning algorithms to efficiently detect obstructive CAD based on heart sound signals. This will enable effective screening before undergoing CAG. Methods: We included 320 subjects suspected of CAD who underwent CAG. We employed advanced filtering techniques and state-of-the-art deep learning models (VGG-16, 1D CNN, and ResNet18) to analyze the heart sound signals and identify obstructive CAD (defined as at least one ≥50 % stenosis). To assess the performance of our models, we prospectively recruited an additional 80 subjects for testing. Results: In the test set, VGG-16 exhibited the highest performance with an area under the ROC curve (AUC) of 0.834 (95 % CI, 0.736-0.930), while ResNet-18 and CNN-7 achieved AUCs of only 0.755 (95 % CI, 0.614-0.819) and 0.652 (95 % CI, 0.554-0.770) respectively. VGG-16 demonstrated a sensitivity of 80.4 % and specificity of 86.2 % in the test set. The combined diagnostic model of VGG and DF scores achieved an AUC of 0.915 (95 % CI: 0.855-0.974), and the AUC for VGG combined with PTP scores was 0.908 (95 % CI: 0.845-0.971). The sensitivity and specificity of VGG-16 exceeded 0.85 in patients with coronary artery occlusion and those with 3 vascular lesions. Conclusions: Our deep learning model, based on heart sounds, offers a non-invasive and efficient screening method for obstructive CAD. It is expected to significantly reduce the number of unnecessary referrals for downstream screening.

Personal stethoscope disinfection practices and bacterial contamination: A cross-sectional study at the University Hospital Emergency Department in Belgrade, Serbia.

BACKGROUND: A significant reduction in bacterial growth on stethoscope membranes has been noticed after performing daily disinfection. Nevertheless, disinfection is rarely performed. We aimed to assess self-reported stethoscope disinfection practices among medical doctors, detect bacterial contamination on personal stethoscopes, and estimate the effectiveness of 70% ethanol as a stethoscope disinfecting agent. METHODS: To determine stethoscope disinfection practices, participants filled out a questionnaire (N = 47), followed by providing stethoscopes for bacterial analysis. Differences in bacterial contamination were observed through the self-reported frequency and method of stethoscope disinfection. The effect of disinfecting with 70% ethanol was evaluated by comparing the presence of bacterial growth before and after disinfection. RESULTS: The presence of bacterial growth was found in 78.7% of the stethoscope samples, with the median (interquartile range) number of colony-forming units at 25 (10-105). The frequency of disinfection greatly impacted the number of colony-forming units, and the method affected the presence of bacterial growth. Disinfection of stethoscope membranes using 70% ethanol resulted in a compelling 97.3% reduction of bacterial growth. CONCLUSIONS: Adequate stethoscope disinfection is highly efficient in reducing bacterial contamination and as such should be considered a critical step in hygienic practices.

Evaluation of arteriovenous fistula for hemodialysis with a new generation digital stethoscope: a pilot study.

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.

Validation of 3D printed MAYO tubes and stethoscope in simulated medical environment - Tools fabricated with additive manufacturing for emergency care.

Emergency and disaster medical care often face resource or equipment shortages. 3D printing technology has been proven to be effective in cases with insufficient supply chains. MAYO tubes and stethoscopes are essential components of ABCDE patient examinations; however, 3D-printed variants have not been fully tested. These 3D-printed instruments were substituted and validated in a simulated pre-hospital environment. In total, 26 participants were included in this study. Fifteen clinicians or paramedics with at least 3 years of professional experience and 10 medical students. One student was excluded because he had relevant experience with emergency care. As basic tasks, the placement of MAYO tubes and auscultation with stethoscopes were performed using medical simulators. 3D printed instruments were compared with conventional clinical devices by measuring the time required for the intervention, success rate, and user satisfaction. In the study FFF (Fused Filament Fabrication (FFF), SLS (Selective Laser Sintering (SLS), and SLA (stereolithography) 3D printing were used in this study. The times required for implementation and auscultation were examined for each instrument. There was no significant difference between the MAYO tube (p = 0.798) and the stethoscope (p = 0.676). In the case of stethoscopy, the study investigated the correct diagnosis, and no significant difference was found (p = 0.239), although an interesting trend was observed. Regarding the MAYO tube, the study found no significant difference in correct position formation (p = 0.163). The experience levels of the groups did not influence these factors. However, significant differences in user satisfaction were found in both cases in favour of the conventional versions (p < 0.001). Overall, the results of this study suggest that 3D-printed devices could be suitable replacements for clinic-based devices in emergency situations. The 3D-printed devices did not perform inferiorly at any of the indicated points compared to their classical counterparts. However, the practical applicability of the devices used in this study requires further investigation.

Exploring Microphone Technologies for Digital Auscultation Devices.

The aim of this work is to present a preliminary study for the design of a digital auscultation system, i.e., a novel wearable device for patient chest auscultation and a digital stethoscope. The development and testing of the electronic stethoscope prototype is reported with an emphasis on the description and selection of sound transduction systems and analog electronic processing. The focus on various microphone technologies, such as micro-electro-mechanical systems (MEMSs), electret condensers, and piezoelectronic diaphragms, intends to emphasize the most suitable transducer for auscultation. In addition, we report on the design and development of a digital acquisition system for the human body for sound recording by using a modular device approach in order to fit the chosen analog and digital mics. Tests were performed on a designed phantom setup, and a qualitative comparison between the sounds recorded with the newly developed acquisition device and those recorded with two commercial digital stethoscopes is reported.

Dr Graham Steell and monaural stethoscopes: Cardiology before the ECG.

Dr Graham Steell, MB CM MD FRCP (1851-1942), an Edinburgh graduate, was a physician at the Manchester Royal Infirmary (1878-1911) and professor of medicine at the Victoria Manchester University (1907-1911). He is mainly remembered for describing the 'Graham Steel murmur', however his name is also associated with the 'Graham Steell monaural stethoscope', which he designed. His clinical examination of the cardiovascular system at the bedside was meticulous, using only his stethoscope, percussion hammer, and a sphygmograph to record the radial pulse. His work is described in his monograph, Diseases of the Heart (1906) and other numerous papers. The University of Manchester Museum of Medicine and Health has a collection of monaural stethoscopes, percussors and sphygmographs. This article explores Dr Steell's clinical techniques and contribution to cardiology in an era before chest X-rays and electrocardiography, and also discusses the use of monaural stethoscopes and percussion hammers by the wider medical profession during the Victorian and Edwardian period.

Swallowing sound index analysis using electronic stethoscope and artificial intelligence for patients with Parkinson's disease.

BACKGROUND AND PURPOSE: Several noninvasive tools assess swallowing disorders, including electronic stethoscope artificial intelligence (AI) analysis for remote diagnosis, with the potential for telemedicine. This study investigated the swallowing sound index in patients with Parkinson's disease (PD). METHODS: This single-arm, open-label trial assessed the impact of cervical percutaneous interferential current stimulation on swallowing in patients with PD classified as Hoehn-Yahr stages 2-4. Stimulation was conducted for 8 weeks. Baseline data were used to examine the link between the swallowing sound index and indicators such as videofluoroscopy (VF). Furthermore, we examined changes in the swallowing sound index after the intervention. RESULTS: Twenty-five patients were included. The swallowing sound index in patients with PD was higher than that in those with amyotrophic lateral sclerosis but considerably lower than that in healthy controls. The number of patients with normal EAT-10 scores positively correlated with the swallowing sound index, whereas elevated C-reactive protein levels were negatively correlated with the swallowing sound index. However, the index displayed no correlation with other indicators, including the VF results. Despite the intervention, the index remained unchanged throughout the study. CONCLUSION: In patients with PD, a decrease in the swallowing sound index suggests a potential association between swallowing disorders and the risk of aspiration pneumonia. TRIAL REGISTRATION NUMBER: jRCTs062220013.

A Microbiological Assessment of Stethoscopes Used by Clinicians in a Tertiary Hospital in Benin City, Nigeria.

Background: The hospital environment serves as a niche for pathogenic microorganisms, so efforts are constantly being made to identify the potential mode of microbial pathogen transmission causing clinical infections. Objective: The aim of this study was to microbiologically examine the stethoscopes used by clinicians at the University of Benin Teaching Hospital (UBTH) in Benin, Nigeria. Methods: A total of 106 clinicians' stethoscopes were cleaned using cotton-tipped swabs dampened with normal saline. This included both earpieces along with the diaphragm (three samples per stethoscope). The samples were then sent to the Medical Microbiology Laboratory of UBTH and processed immediately as per the standard guidelines. The emergent colonies were subsequently identified, and antimicrobial susceptibility tests were performed. Results: A total of 114 (35.8%) bacterial isolates were recovered, including Staphylococcus aureus (S. aureus) (33.3%), coagulase-negative staphylococci (CoNS) (33.3%), Bacillus spp. (22.8%), Acinetobacter spp. (5.3%), Escherichia coli (E. coli) (1.8%) and Klebsiella spp. (3.5%). Diaphragms had the highest yield of methicillin-resistant S. aureus (MRSA) (46.2%) and CoNS (17.9%). Age (P = 0.0387) and cadre of clinician (P = 0.0043) were risk factors for contamination, whereas clinicians who never cleaned their stethoscopes (P = 0.0044) or cleaned only the earpieces (P = 0.0001) had more contaminated stethoscopes. Conclusion: The contamination rate of stethoscopes used by clinicians in Benin City was 56.6%. There is a need to establish proper stethoscope cleaning practices for all cadres of personnel in clinical practice to minimise health risks to patients and healthcare workers (HCW).

Use of Digital Stethoscope to Measure Heart Rate in Birds: Comparison of Different Counting Methods Using Phonocardiograms.

The high cardiac contractility of birds poses a challenge to traditional cardiac auscultation, particularly for the accurate determination of heart rate (HR). The objectives of this study were to 1) evaluate the feasibility of using phonocardiograms of adequate length and quality to assess HR in different avian species with a commercially available digital stethoscope, 2) compare 5 counting methods, including 2 direct reading methods (manual counting and using a semiautomatic computerized algorithm as a reference method) and 3 listening methods (progressive mental counting, counting by 10s, and counting with a smartphone application tap counter), and 3) obtain the HR in selected birds and identify a correlation between body weight and HR in different avian species. An inverse correlation on a logarithmic scale was identified between the mean body weight and HR in 60 different bird species (n = 211; R = -0.72, P < 0.0001). Manual reading of phonocardiograms was the most reliable method and had the highest agreement with the reference method; this was followed by the counting by 10s method, the tapping method, and the progressive mental counting method, which was the least reliable. The agreement levels for the different methods were comparable for HRs <200 beats per minute (bpm) in birds weighing >1 kg. For HRs >500 bpm in birds weighing <150 g, only the reading method maintained a good agreement level. A digital stethoscope can be a useful tool for accurately determining the HR in birds, including very small species with high HRs.

Swallowing sound evaluation using an electronic stethoscope and artificial intelligence analysis for patients with amyotrophic lateral sclerosis.

Background and purpose: Non-invasive, simple, and repetitive swallowing evaluation is required to prevent aspiration pneumonia in neurological care. We investigated the usefulness of swallowing sound evaluation in patients with amyotrophic lateral sclerosis (ALS) using our new electronic stethoscope artificial intelligence (AI) analysis tool. Methods: We studied patients with ALS who provided written informed consent. We used an electronic stethoscope, placed a Bluetooth-enabled electronic stethoscope on the upper end of the sternum, performed a 3-mL water swallow three times, and remotely identified the intermittent sound components of the water flow caused at that time by AI, with the maximum value as the swallowing sound index. We examined the correlation between the swallowing sound index and patient background, including swallowing-related parameters. Results: We evaluated 24 patients with ALS (age 64.0 ± 11.8 years, 13 women, median duration of illness 17.5 months). The median ALS Functional Rating Scale-Revised (ALSFRS-R) score was 41 (minimum 18, maximum 47). In all cases, the mean swallowing sound index was 0.209 ± 0.088. A multivariate analysis showed that a decrease in the swallowing sound index was significantly associated with a low ALSFRS-R score, an ALSFRS-R bulbar symptom score, % vital capacity, tongue pressure, a Mann Assessment of Swallowing Ability (MASA) score, and a MASA pharyngeal phase-related score. Conclusion: Swallowing sound evaluation using an electronic stethoscope AI analysis showed a correlation with existing indicators in swallowing evaluation in ALS and suggested its usefulness as a new method. This is expected to be a useful examination method in home and remote medical care.