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1.
Nanotechnology ; 31(5): 055501, 2020 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-31484166

RESUMO

Humidity sensors based on flexible sensitive nanomaterials are very attractive in noncontact healthcare monitoring. However, the existing humidity sensors have some shortcomings such as limited sensitivity, narrow relative humidity (RH) range, and a complex process. Herein, we show that a tin sulphide (SnS) nanoflakes-based sensor presents high humidity sensing behaviour both in rigid and flexible substrate. The sensing mechanism based on the Schottky nature of a SnS-metal contact endows the as-fabricated sensor with a high response of 2491000% towards a wide RH range from 3% RH to 99% RH. The response and recovery time of the sensor are 6 s and 4 s, respectively. Besides, the flexible SnS nanoflakes-based humidity sensor with a polyimide substrate can be well attached to the skin and exhibits stable humidity sensing performance in the natural flat state and under bending loading. Moreover, the first-principles analysis is performed to prove the high specificity of SnS to the moisture (H2O) in the air. Benefiting from its promising advantages, we explore some application of the SnS nanoflakes-based sensors in detection of breathing patterns and non-contact finger tips sensing behaviour. The sensor can monitor the respiration pattern of a human being accurately, and recognize the movement of the fingertip speedily. This novel humidity sensor shows great promising application in physiological and physical monitoring, portable diagnosis system, and noncontact interface localization.


Assuntos
Técnicas Biossensoriais/instrumentação , Umidade , Nanoestruturas/química , Sulfetos/química , Compostos de Estanho/química , Água/química , Humanos , Monitorização Ambulatorial/instrumentação , Nanoestruturas/ultraestrutura , Tempo de Reação , Dióxido de Silício/química , Propriedades de Superfície
2.
Rev Assoc Med Bras (1992) ; 65(11): 1413-1420, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31800906

RESUMO

Parkinson's disease is the second most common neurodegenerative disease, with an estimated prevalence of 41/100,000 individuals affected aged between 40 and 49 years old and 1,900/100,000 aged 80 and over. Based on the essentiality of ascertaining which wearable devices have clinical literary evidence and with the purpose of analyzing the information revealed by such technologies, we conducted this scientific article of integrative review. It is an integrative review, whose main objective is to carry out a summary of the state of the art of wearable devices used in patients with Parkinson's disease. After the review, we retrieved 8 papers. Of the selected articles, only 3 were not systematic reviews; one was a series of cases and two prospective longitudinal studies. These technologies have a very rich field of application; however, research is still necessary to make such evaluations reliable and crucial to the well-being of these patients.


Assuntos
Doença de Parkinson/fisiopatologia , Dispositivos Eletrônicos Vestíveis , Humanos , Monitorização Ambulatorial/instrumentação , Monitorização Fisiológica/instrumentação
3.
Nervenarzt ; 90(12): 1221-1231, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31673723

RESUMO

Wearables are receiving much attention from both epilepsy patients and treating physicians, for monitoring of seizure frequency and warning of seizures. They are also of interest for the detection of seizure-associated risks of patients, for differential diagnosis of rare seizure types and prediction of seizure-prone periods. Accelerometry, electromyography (EMG), heart rate and further autonomic parameters are recorded to capture clinical seizure manifestations. Currently, a clinical use to document nocturnal motor seizures is feasible. In this review the available devices, data on the performance in the documentation of seizures, current options for clinical use and developments in data analysis are presented and critically discussed.


Assuntos
Epilepsia , Monitorização Ambulatorial , Acelerometria/instrumentação , Sistema Nervoso Autônomo , Eletroencefalografia/instrumentação , Epilepsia/diagnóstico , Frequência Cardíaca , Humanos , Monitorização Ambulatorial/instrumentação , Convulsões/diagnóstico
4.
Neurology ; 93(10): 450-458, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31477610

RESUMO

OBJECTIVE: We hypothesized that cardiac electrical instability and abnormal autonomic tone result from cumulative cardiac injury sustained in recurrent seizures. We tested this hypothesis by comparing T-wave alternans (TWA) and heart rate variability (HRV), both established markers of sudden cardiac death (SCD) risk, in patients with chronic as compared to newly diagnosed epilepsy. METHODS: In this prospective, observational cohort study, patients (newly diagnosed epilepsy, n = 6, age 41.8 ± 6.8 years; chronic epilepsy, n = 6, age 40.2 ± 5.6 years [p = 0.85]) were monitored either with Holter recorder alone or simultaneously with 14-day Zio XT extended continuous ECG patch monitor. TWA was assessed by Food and Drug Administration-cleared Modified Moving Average analysis; HRV was calculated by rMSSD. RESULTS: TWA levels in chronic epilepsy were significantly higher than in newly diagnosed epilepsy (62 ± 5.4 vs 35 ± 1.3 µV, p < 0.002); the latter did not differ from healthy control adults. In all patients with chronic epilepsy, TWA exceeded the established ≥47-µV TWA cutpoint and rMSSD HRV was inversely related to TWA levels. Patients with chronic epilepsy exhibited elevated TWA levels equivalently on Holter and ECG patch recordings (p = 0.38) with a high correlation (r 2 = 0.99, p < 0.01) across 24 hours. CONCLUSION: Based on the limited number of patients studied, it appears that chronic epilepsy, the common use of sodium channel antagonists, or other factors are associated with higher TWA levels and simultaneously with lower rMSSD HRV, which is suggestive of autonomic dysfunction or higher sympathetic tone. The ECG patch monitor used has equivalent accuracy to Holter monitoring for TWA and HRV and permits longer-term ECG sampling.


Assuntos
Eletrocardiografia Ambulatorial/métodos , Epilepsia/diagnóstico , Epilepsia/fisiopatologia , Frequência Cardíaca/fisiologia , Adulto , Doença Crônica , Estudos de Coortes , Eletrocardiografia/instrumentação , Eletrocardiografia/métodos , Eletrocardiografia Ambulatorial/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial/instrumentação , Monitorização Ambulatorial/métodos , Estudos Prospectivos
6.
World J Pediatr Congenit Heart Surg ; 10(5): 628-631, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31496407

RESUMO

The Fontan operation for children with congenital heart disease places them in a physiological state of mildly elevated systemic venous pressure and low-normal cardiac output. Consequently, close follow-up is imperative, yet currently no method is available to obtain Fontan pressures without direct measurements in the cardiac catheterization laboratory while supine and sedated. We hypothesize that by suturing the CardioMEMS sensor device into the Fontan conduit during the standard Fontan operation for a child with single ventricular physiology, clinicians can accurately retrieve Fontan pathway pressure measurements noninvasively during normal physiological states.


Assuntos
Técnica de Fontan , Cardiopatias Congênitas/cirurgia , Monitorização Ambulatorial/instrumentação , Atresia Pulmonar/cirurgia , Cateterismo Cardíaco , Pré-Escolar , Desenho de Equipamento , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Período Pós-Operatório , Pressão , Função Ventricular
7.
Hipertens. riesgo vasc ; 36(3): 137-144, jul.-sept. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183953

RESUMO

Introducción y objetivos: El objetivo es cuantificar la validez diagnóstica de la medida de la presión arterial en farmacia comunitaria (PAFC) y establecer los puntos de corte de la presión arterial sistólica (PAS) y de la presión arterial diastólica (PAD) que maximicen la citada validez, usando como patrón de oro la monitorización ambulatoria de la presión arterial (MAPA) de 24 h. Material y métodos: Estudio transversal, con selección consecutiva de pacientes usuarios de la farmacia comunitaria andaluza. Se midió la PAFC y, a continuación, una MAPA de 24 h, con lo que se evaluó la validez diagnóstica de PAFC. También se calculó el área bajo la curva ROC para PAS y PAD, los valores predictivos positivos y negativos para diferentes prevalencias, así como la variación de la sensibilidad y de la especificidad para los distintos puntos de corte de PAS/PAD, lo que sirvió para el cálculo de los puntos de corte óptimos. Resultados: Colaboraron 167 farmacias comunitarias, con 1.170 pacientes, de los que 1.110 aportaron datos válidos. La PAFC presenta una sensibilidad del 60,41% (IC 95%: 56,40-64,29), una especificidad del 79,77% (IC 95%: 76,12-82,99), un valor predictivo positivo de 76,96% (IC 95%: 72,89-80,57) y un valor predictivo negativo de 64,31% (IC 95%: 60,55%-67,90%). Por el método de curva ROC, los puntos de corte óptimos para la PAS y para la PAD son, respectivamente, 134/81mm Hg, puntos donde la sensibilidad y la especificidad se equilibran y se maximiza el índice de Youden. Conclusiones: La sensibilidad es relativamente baja. Para mejorarla se propone bajar el punto de corte de PAS y PAD. El óptimo calculado es 134/81mm Hg. Viene ello a aportar datos sobre la conveniencia de revisar a la baja el actual punto de corte (140/90), como propone la guía de 2017 de ACC/AHA


Introduction and objectives: The aim of this study is to determine the diagnostic validity of blood pressure measurement in the community pharmacy (CPBP), and to set the cut-off points in systolic blood pressure (SBP) and diastolic blood pressure (DBP) in order to maximise the aforementioned validity, using 24 hour ambulatory blood pressure monitoring (ABPM) as the reference method. Material and methods: A cross-sectional study with consecutive selection of patient users of the community pharmacy in Andalusia. The CPBP was measured, followed by 24-hour ABPM, which assessed the diagnostic validity of the CPBP. The AUC of the ROC curve was also calculated for SBP and DBP, along with the positive and negative predictive values, for different prevalences and the variation of sensitivity and specificity for the different cut-off points for SBP/DBP. Results: A total of 167 community pharmacy participated with 1,170 patients, of which 1,110 were valid. The CPBP showed a sensitivity of 60.41% (95% CI: 56.40-64.29), and a specificity of the 79.77% (95% CI: 76.12-82.99), a positive predictive values of 76.96% (95% CI: 72.89-80.57), and a negative predictive values of 64.31% (95% CI: 60.55%-67.90%). By using the ROC curve method, the optimal cut-off points are 134/81mm Hg, the point where the sensitivity and specificity and are balanced and the Youden index is maximised. Conclusions: The sensitivity is relatively low. To improve it tends to lower the cut-off points of SBP and DBP. The calculated optimum is 134/81mm Hg. This provides data on the desirability to review the current cut-off points (140/90), as proposed by the ACC/AHA 2017


Assuntos
Humanos , Pressão Arterial/fisiologia , Farmácias/organização & administração , Monitorização Ambulatorial/instrumentação , Monitorização Ambulatorial/métodos , Estudos Transversais , Sensibilidade e Especificidade , Intervalos de Confiança , Curva ROC
8.
BMC Public Health ; 19(1): 1100, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412839

RESUMO

BACKGROUND: Workers with physically demanding work may be at risk for injury, illness or other adverse health outcomes due to exposure to different occupational hazards, especially at higher age. Sensor technology applications may be useful in the workplace to unobtrusively measure and monitor work exposures and provide workers with real-time feedback or access to data on demand. Many aspects might impede the implementation of sensor technology applications in the workplace, which should be taken into consideration for a successful implementation. Moreover, needs and preferences of workers regarding the use of sensor technology applications during work performance need to be identified. Therefore, the aim of this study was to identify worker needs and preferences regarding the use of sensor technology applications in the workplace. METHODS: Four on-site focus group sessions were conducted in four different companies among workers with physically demanding work (n = 30). Semi-structured interview schedules were used to identify which work exposures should be measured, by which kind of sensor technology applications, under which (pre)conditions, how to motivate long-term use of sensor technology applications, and which type of feedback is preferred. For data analysis, a content-analysis with an inductive approach was performed. RESULTS: Participants mentioned that they want to use wearable sensor technology applications to measure and monitor physical job demands, occupational heat stress, noise and fatigue. Factors associated with quality, comfort and perceived ease of use were identified as potential barriers for implementation in the workplace. Long-term motivation was attributed to the ability to manage and monitor work exposures, positive feedback and data ownership. Participants indicated a need to both receive real-time feedback and access to data on demand. CONCLUSIONS: Sensor technology applications may support workers with physically demanding work to measure and monitor their work exposures. Potential barriers for implementation such as privacy aspects and quality, comfort and perceived ease of use of sensor technology applications need to be well considered to ensure successful implementation of sensor technology applications in the workplace.


Assuntos
Promoção da Saúde/métodos , Monitorização Ambulatorial/instrumentação , Saúde do Trabalhador , Esforço Físico/fisiologia , Trabalho/fisiologia , Adulto , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Dispositivos Eletrônicos Vestíveis
9.
J Med Syst ; 43(10): 308, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31432270

RESUMO

New, emerging technologies, transform every day our life and have direct consequence on our health and well-being. More and more wearable medical devices (MD) with wireless communication technologies embedded are being developed by innovative academic community and companies. Optical wireless communication (OWC) consisting of Visible Light Communication (VLC), infrared (IR), Optical Camera Communication (OCC) and Light Fidelity (LiFi) along with the conventional Radio Frequency (RF) wireless communication are suitable technologies to be used for hybrid Wireless Integrated Medical Assistance Systems (WIMAS). The WIMAS addressed in this paper consists of two Wireless Medical Body Area Networks (WMBAN) (an insulin wearable kit and an ECG test device with VLC/OCC are considered) and an Emergency Remote Medical Assistance (ERMA) with LiFi technology embedded. Using RF in medical facilities is subject of strict regulations due to interferences with other RF medical devices, negative effects on human health and lack of security. VLC and OCC are suitable to be embedded in MDs in order to be used by the patients with wearable WMBAN. Research on IR transdermal communication for implantable MDs has also been demonstrated as feasible and both VLC and OCC have promising future, as well. On the other hand, LiFi technology, recently deployed on the market, is mature enough to be integrated in the ERMA system addressed here.


Assuntos
Redes de Comunicação de Computadores/instrumentação , Monitorização Ambulatorial/instrumentação , Dispositivos Eletrônicos Vestíveis , Tecnologia sem Fio/instrumentação , Segurança Computacional , Desenho de Equipamento , Humanos , Luz , Telemedicina
10.
Int J Med Inform ; 130: 103928, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31434042

RESUMO

BACKGROUND: Health monitoring is shifting towards continuous, ambulatory and clinically comparable wearable devices. Telemedicine and remote diagnosis could harness the capability of mobile cardiac health information, as the technology on bio-physical signal monitoring has improved significantly. OBJECTIVES: The purpose of this review article is (1) to systematically assess the viability of ambulatory electrocardiography (ECG), (2) to provide a systems level understanding of a broad spectrum of wearable heart signal monitoring approaches and (3) to identify areas of improvement in the existing technology needed to attain clinical grade diagnosis. RESULTS: Based on the included literature, we have identified (1) that the developments in ECG monitoring through wearable devices are reaching feasibility, and are capable of delivering diagnostic and prognostic information, (2) that reliable sensing is the major bottleneck in the entire process of ambulatory monitoring, (3) that there is a strong need for artificial intelligence and machine learning techniques to parse and infer the biosignals and (4) that aspects of wearer comfort has largely been ignored in the prevailing developments, which can become a key factor for consumer acceptance. CONCLUSIONS: Cardiac health information is crucial for diagnosis and prevention of several disease onsets. Mobile and continuous monitoring can aid avoiding risks involved with acute symptoms. The health information obtained through continuous monitoring can serve as the BigData of heart signals, and can facilitate new treatment methods and devise effective health policies.


Assuntos
Eletrocardiografia Ambulatorial/métodos , Monitorização Ambulatorial/métodos , Telemedicina/métodos , Dispositivos Eletrônicos Vestíveis/estatística & dados numéricos , Arritmias Cardíacas/fisiopatologia , Eletrocardiografia Ambulatorial/instrumentação , Humanos , Monitorização Ambulatorial/instrumentação
11.
Int J Behav Nutr Phys Act ; 16(1): 65, 2019 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-31419998

RESUMO

BACKGROUND: Pooling data from thigh-worn accelerometers across multiple studies has great potential to advance evidence on the health benefits of physical activity. This requires harmonization of information on body postures, physical activity types, volumes and time patterns across different brands of devices. The aim of this study is to compare the physical behavior estimates provided by three different brands of thigh-worn accelerometers. METHODS: Twenty participants volunteered for a 7-day free-living measurement. Three accelerometers - ActiGraph GT3X+, Axivity AX3 and ActivPAL Micro4 - were randomly placed in a vertical line on the midsection of the right thigh. Raw data from each accelerometer was processed and classified into 8 physical activities and postures using the Acti4 software. Absolute differences between estimates and the respective coefficient of variation (CV) were calculated. RESULTS: We observed very minor differences between physical behavior estimates from three different accelerometer brands. When averaged over 24 h (1,440 min), the absolute difference (CV) between accelerometers were: 1.2 mins (0.001) for lying/sitting, 3.4 mins (0.02) for standing, 3.5 mins (0.06) for moving, 1.9 mins (0.03) for walking, 0.1 mins (0.19) for running, 1.2 mins (0.19) for stair climbing, 1.9 mins (0.07) for cycling. Moreover, there was an average absolute difference of 282 steps (0.03) per 24 h. CONCLUSIONS: Physical behaviors were classified with negligible difference between the accelerometer brands. These results support harmonization of data from different thigh-worn accelerometers across multiple cohorts when analyzed in an identical manner.


Assuntos
Acelerometria/instrumentação , Exercício/fisiologia , Monitores de Aptidão Física , Monitorização Ambulatorial/instrumentação , Sono/fisiologia , Humanos , Postura/fisiologia , Software , Coxa da Perna/fisiologia
12.
J Therm Biol ; 84: 121-128, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31466744

RESUMO

The monitoring of body temperature is important for the diagnosis of the physiological state of the animal, being dependent on available methods and their applicability within production systems. This work evaluated techniques to monitor the body temperature of beef cattle kept on pasture and their ability to predict internal temperature. Twenty-three adult bovine females were monitored for six months, and collection data carried out in eleven campaigns (D0-D10) twelve days apart. During collections, the surface temperatures of ear base (ET, oC) and ocular globe (OGT, oC) were measured by infrared thermography, and the subcutaneous temperature (ST, oC) was measured with the use of transponder containing an implantable microchip. Rectal temperature (RT, oC) was considered as a reference for body temperature. Temperature and Humidity Index (THI), Black Globe Temperature and Humidity Index (BGHI) and Radiant Heat Load (RHL, W/m2) were calculated. ET (33.32 ±â€¯0.12 °C), ST (36.10 ±â€¯0.07 °C), OGT (37.40 ±â€¯0.06 °C) and RT (38.83 ±â€¯0.03 °C) differed significantly (P˂0.05). There was positive correlation of RT with OGT (r = 0.392), ET (r = 0.264) and ST (r = 0.236) (P˂0.05). Considering the bioclimatic indicators, the highest magnitude correlations were observed between ET and THI (r = 0.71), ET and BGHI (r = 0.65), and ET and RHL (r = 0.48). The use of microchip represented a practical method, but with limited predictability. On the other hand, infrared thermography proved to be safe and non-invasive, presenting greater precision for inference of internal body temperature. ET was more influenced by meteorological conditions.


Assuntos
Temperatura Corporal , Bovinos/fisiologia , Termografia/métodos , Animais , Fazendas , Feminino , Umidade , Raios Infravermelhos , Monitorização Ambulatorial/instrumentação , Monitorização Ambulatorial/métodos , Temperatura Ambiente
13.
J Stroke Cerebrovasc Dis ; 28(9): 2448-2452, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31307898

RESUMO

BACKGROUND AND AIMS: Increasingly, insertable cardiac monitors (ICM) have been used to detect Atrial Fibrillation (AF) in patients with cryptogenic stroke or embolic strokes of undetermined source (ESUS). We aim to examine the characteristics of these patients who were subsequently found to have AF. METHODS: We studied 83 consecutive patients who were comprehensively evaluated using neuroimaging and vessel imaging (computed tomography angiography, magnetic resonance angiography, or transcranial and extracranial Doppler sonography) to have met the previously established ESUS criteria. All 83 patients had ICM implanted between 2015 and 2017. All patients were followed up for at least 1 year, with a median follow-up period of 1.5 ± .5 years. We compared the baseline clinical, laboratory, echocardiographic, neuro-imaging profiles, and clinical outcomes in terms of functional recovery, recurrent stroke, and mortality in patients with and without detected AF. RESULTS: AF detection rate in this ESUS cohort was 12% over the study period. Patients with detected AF were associated with bilateral infarcts pattern at presentation (30% versus 5.5%, P = .035). Infarcts involving multiple vascular territories was not significantly associated with the detection of AF. There were no significant differences in the other clinical characteristics and outcomes between the AF group compared to the group without detected AF. Echocardiographic parameters including left ventricular ejection fraction and left atrial diameter were also not shown to be significantly different. CONCLUSION: Our study found that a neuroimaging profile of bilateral infarcts was associated with AF detection using insertable cardiac monitor in ESUS patients. Larger prospective studies are needed to validate our findings.


Assuntos
Fibrilação Atrial/diagnóstico , Infarto Encefálico/epidemiologia , Frequência Cardíaca , Embolia Intracraniana/epidemiologia , Monitorização Ambulatorial/instrumentação , Telemetria/instrumentação , Idoso , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/mortalidade , Fibrilação Atrial/terapia , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/mortalidade , Infarto Encefálico/terapia , Feminino , Humanos , Incidência , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/mortalidade , Embolia Intracraniana/terapia , Masculino , Pessoa de Meia-Idade , Neuroimagem/métodos , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Singapura/epidemiologia , Fatores de Tempo , Resultado do Tratamento
14.
Nervenarzt ; 90(8): 787-795, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31309270

RESUMO

Fitness and lifestyle trackers raise the awareness for wearable sensors in medical applications for clinical trials and healthcare. Various functional impairments of patients with neurological diseases are an ideal target to generate wearable-derived and patient-centered parameters that have the potential to support prevention, prediction, diagnostic procedures and therapy monitoring during the clinical work-up; however, substantial differences between clinical grade wearables and fitness trackers have to be acknowledged. For the application in clinical trials or individualized patient care distinct technical and clinical validation trials have to be conducted. The different test environments under laboratory conditions during standardized tests or under unsupervised home monitoring conditions have to be included in the algorithmic processing of sensor raw data in order to enable a clinical decision support under real-life conditions. This article presents the general understanding of the technical application for the most relevant functional impairments in neurology. While wearables used for sleep assessment have already reached a high level of technological readiness due to the defined test environment (bed, sleep), other wearable applications, e.g. for gait and mobility during home monitoring require further research in order to transfer the technical capabilities into real-life patient care.


Assuntos
Monitorização Ambulatorial , Doenças do Sistema Nervoso , Dispositivos Eletrônicos Vestíveis , Exercício , Monitores de Aptidão Física/normas , Marcha , Humanos , Monitorização Ambulatorial/instrumentação , Monitorização Ambulatorial/tendências , Doenças do Sistema Nervoso/terapia , Dispositivos Eletrônicos Vestíveis/normas
15.
Biosensors (Basel) ; 9(3)2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31336678

RESUMO

We conducted a pilot study to evaluate the accuracy of a custom built non-contactpressure-sensitive device in diagnosing obstructive sleep apnea (OSA) severity as an alternative toin-laboratory polysomnography (PSG) and a Type 3 in-home sleep apnea test (HSAT). Fourteenpatients completed PSG sleep studies for one night with simultaneous recording from ourload-cell-based sensing device in the bed. Subjects subsequently installed pressure sensors in theirbed at home and recorded signals for up to four nights. Machine learning models were optimized toclassify sleep apnea severity using a standardized American Academy of Sleep Medicine (AASM)scoring of the gold standard studies as reference. On a per-night basis, our model reached a correctOSA detection rate of 82.9% (sensitivity = 88.9%, specificity = 76.5%), and OSA severity classificationaccuracy of 74.3% (61.5% and 81.8% correctly classified in-clinic and in-home tests, respectively).There was no difference in Apnea Hypopnea Index (AHI) estimation when subjects wore HSATsensors versus load cells (LCs) only (p-value = 0.62). Our in-home diagnostic system providesan unobtrusive method for detecting OSA with high sensitivity and may potentially be used forlong-term monitoring of breathing during sleep. Further research is needed to address the lowerspecificity resulting from using the highest AHI from repeated samples.


Assuntos
Técnicas Biossensoriais , Serviços de Assistência Domiciliar , Monitorização Ambulatorial/métodos , Apneia Obstrutiva do Sono/diagnóstico , Adulto , Idoso , Análise de Variância , Automação , Análise de Dados , Feminino , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial/instrumentação
16.
J Med Eng Technol ; 43(3): 182-189, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31305192

RESUMO

Ambient measurement systems (AMSs) can enable continuous assessment of functional performance at home, increasing the availability of data for monitoring of neuromuscular disease. An AMS passively measures movement whenever someone is in range of the sensor, without the need for any wearable sensors. The current study evaluates the performance of an AMS for three metrics associated with functional assessments in Duchenne muscular dystrophy (DMD): ambulation speed, rise-to-stand speed and arm-raise speed. Healthy paediatric subjects performed a series of functional tasks and were graded by both a human rater and an AMS. Linear mixed-effect models were fit to calculate agreement between the two measurement methods. For all activities, the AMS and human rater supplied similar measurements of average speed, with correlation coefficients of 0.76-0.92 and systematic differences ranging in magnitude from 0 to 0.48 m per second. The largest systematic difference was for the 10-m run, which was likely due to human rater reaction time. Systematic differences in arm-raise measurements were due to incomplete execution of movements by test participants. These results are consistent with previous studies comparing automated and manual measurements of movement. This study demonstrates that an AMS device is able to measure ambulation speed, rise-to-stand speed and arm-raise speed in a paediatric population in a controlled setting without the need for complicated installation, calibration or worn sensors.


Assuntos
Exercício/fisiologia , Monitorização Ambulatorial/instrumentação , Telemedicina/instrumentação , Criança , Pré-Escolar , Feminino , Voluntários Saudáveis , Humanos , Masculino , Movimento/fisiologia , Distrofia Muscular de Duchenne/fisiopatologia , Reprodutibilidade dos Testes
17.
BMC Health Serv Res ; 19(1): 366, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182093

RESUMO

BACKGROUND: Implementation of digital monitoring technology systems is considered beneficial for increasing the safety and quality of care for residents in nursing homes and simultaneously improving care providers' workflow. Co-creation is a suitable approach for developing and implementing digital technologies and transforming the service accordingly. This study aimed to identify the facilitators and barriers for implementation of digital monitoring technology in residential care for persons with dementia and wandering behaviour, and explore co-creation as an implementation strategy and practice. METHODS: In this longitudinal case study, we observed and elicited the experiences of care providers and healthcare managers in eight nursing homes, in addition to those of the information technology (IT) support services and technology vendors, during a four-year implementation process. We were guided by theories on innovation, implementation and learning, as well as co-creation and design. The data were analysed deductively using a determinants of innovation framework, followed by an inductive content analysis of interview and observation data. RESULTS: The implementation represented radical innovation and required far more resources than the incremental changes anticipated by the participants. Five categories of facilitators and barriers were identified, including several subcategories for each category: 1) Pre-implementation preparations; 2) Implementation strategy; 3) Technology stability and usability; 4) Building competence and organisational learning; and 5) Service transformation and quality management. The combination of IT infrastructure instability and the reluctance of the IT support service to contribute in co-creating value with the healthcare services was the most persistent barrier. Overall, the co-creation methodology was the most prominent facilitator, resulting in a safer night monitoring service. CONCLUSION: Successful implementation of novel digital monitoring technologies in the care service is a complex and time-consuming process and even more so when the technology allows care providers to radically transform clinical practices at the point of care, which offers new affordances in the co-creation of value with their residents. From a long-term perspective, the digital transformation of municipal healthcare services requires more advanced IT competence to be integrated directly into the management and provision of healthcare and value co-creation with service users and their relatives.


Assuntos
Demência/terapia , Monitorização Ambulatorial/instrumentação , Monitorização Fisiológica/instrumentação , Casas de Saúde/organização & administração , Tecnologia sem Fio , Idoso , Idoso de 80 Anos ou mais , Humanos , Estudos Longitudinais , Monitorização Ambulatorial/tendências , Monitorização Fisiológica/tendências , Tecnologia sem Fio/tendências
18.
Med J Aust ; 211(4): 175-180, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31231826

RESUMO

OBJECTIVE: To assess glucometric outcomes and to estimate the incidence of hypo- and hyperglycaemia among non-critical care inpatients in a major Australian hospital. DESIGN, SETTING AND PARTICIPANTS: A prospective 10-week observational study (7 March - 22 May 2016) of consecutive inpatients with diabetes or newly detected hyperglycaemia admitted to eight medical and surgical wards at the Royal Melbourne Hospital. Point-of-care blood glucose (BG) data were collected with networked glucose meters. MAIN OUTCOME MEASURES: Glycaemic control, as assessed with three glucometric models (by population, by patient, by patient-day); incidence of adverse glycaemic days (AGDs; patient-days with BG levels below 4 mmol/L or above 15 mmol/L). RESULTS: During the study period, there were 465 consecutive admissions of 441 patients with diabetes or newly detected hyperglycaemia, and 9817 BG measurements over 2953 patient-days. The mean patient-day BG level was 9.5 mmol/L (SD, 3.3 mmol/L). The incidence of hyperglycaemia was higher than for a United States hospital benchmark (patient-days with mean BG level above 10 mmol/L, 37% v 32), and that of hypoglycaemia lower (proportion of patient-days with mean BG level below 3.9 mmol/L, 4.1% v 6.1%). There were 260 (95% CI, 245-277) AGDs per 1000 patient-days; the incidence was higher in medical than surgical ward patients (290 [CI, 270-310] v 206 [CI, 181-230] per 1000 patient-days). 604 AGDs (79%) were linked with 116 patients (25%). Episodes of hyperglycaemia (BG above 15 mmol/L) were more frequent before lunch, dinner, and bedtime; 94 of 187 episodes of hypoglycaemia (BG below 4 mmol/L) occurred between 11 pm and 8 am. DISCUSSION: Glucometric analysis supported by networked glucose meter technology provides detailed inpatient data that could enable local benchmarking for promoting safe diabetes care in Australian hospitals.


Assuntos
Benchmarking , Glicemia/metabolismo , Hiperglicemia/prevenção & controle , Corpo Clínico Hospitalar/normas , Recursos Humanos de Enfermagem no Hospital/normas , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/prevenção & controle , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/prevenção & controle , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Hiperglicemia/sangue , Hiperglicemia/etiologia , Hipoglicemia/etiologia , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial/instrumentação , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Prospectivos , Centros de Atenção Terciária , Vitória
19.
PLoS One ; 14(5): e0217545, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31120994

RESUMO

BACKGROUND: Hospital stays are associated with high levels of sedentary behavior and physical inactivity. To objectively investigate physical behavior of hospitalized patients, these is a need for valid measurement instruments. The aim of this study was to assess the criterion validity of three accelerometers to measure lying, sitting, standing and walking. METHODS: This cross-sectional study was performed in a university hospital. Participants carried out several mobility tasks according to a structured protocol while wearing three accelerometers (ActiGraph GT9X Link, Activ8 Professional and Dynaport MoveMonitor). The participants were guided through the protocol by a test leader and were recorded on video to serve as reference. Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were determined for the categories lying, sitting, standing and walking. RESULTS: In total 12 subjects were included with a mean age of 49.5 (SD 21.5) years and a mean body mass index of 23.8 kg/m2 (SD 2.4). The ActiGraph GT9X Link showed an excellent sensitivity (90%) and PPV (98%) for walking, but a poor sensitivity for sitting and standing (57% and 53%), and a poor PPV (43%) for sitting. The Activ8 Professional showed an excellent sensitivity for sitting and walking (95% and 93%), excellent PPV (98%) for walking, but no sensitivity (0%) and PPV (0%) for lying. The Dynaport MoveMonitor showed an excellent sensitivity for sitting (94%), excellent PPV for lying and walking (100% and 99%), but a poor sensitivity (13%) and PPV (19%) for standing. CONCLUSIONS: The validity outcomes for the categories lying, sitting, standing and walking vary between the investigated accelerometers. All three accelerometers scored good to excellent in identifying walking. None of the accelerometers were able to identify all categories validly.


Assuntos
Acelerometria/instrumentação , Postura Sentada , Posição Ortostática , Caminhada , Adulto , Idoso , Estudos Transversais , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial/instrumentação , Postura , Comportamento Sedentário
20.
J Med Eng Technol ; 43(1): 66-81, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31119965

RESUMO

The digital health field has seen a surge in product development over the last decade, with product introductions ranging from wrist monitors, epidermal electronics, electronic pills and smart garments, much of these precipitated through the commercialisation and commoditisation of sensor technology. The emergence of wearable technology has recently garnered heightened interest by physicians and the general public. The convenient use of wireless technology to track and monitor physiological parameters, such as heart rate, distance, sleep and stress, has emerged to become relevant to patient care and human performance assessment. However, collecting data is not enough to inform clinical decision-making. It is essential to translate the acquired data into information relevant to clinicians. Our experiences tell us that team competencies must mirror the interdisciplinary technology itself. Thus, an interdisciplinary team blending expertise from engineering, medicine, and nursing is believed to be essential in translating wearable technology into the field. This review discusses the application of wearable sensors to monitor human performance assessment in domains necessitating accurate, reliable, and timely transmission of acquired bio-metric and bio-vital data. A key result disseminating from our investigations is the need to develop predictive models based off of the data acquired from wearable devices to necessitate the development of athlete-centred treatment plans to expedite the return-to-play time and to maximise performance.


Assuntos
Monitorização Ambulatorial/instrumentação , Medicina Esportiva/instrumentação , Dispositivos Eletrônicos Vestíveis , Tecnologia sem Fio , Humanos , Sono/fisiologia , Estresse Fisiológico/fisiologia
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