Research

11 pages, 1730 KiB

Open AccessArticle

The Visual Patient Avatar ICU Facilitates Information Transfer of Written Information by Visualization: A Multicenter Comparative Eye-Tracking Study

by Julie Viautour, Lukas Naegeli, Julia Braun, Lisa Bergauer, Tadzio R. Roche, David W. Tscholl and Samira Akbas

Diagnostics 2023, 13(22), 3432; https://doi.org/10.3390/diagnostics13223432 - 12 Nov 2023

Cited by 1 | Viewed by 842

Abstract

Patient monitoring is crucial in critical care medicine. Perceiving and interpreting multiple vital signs requires a high workload that can lead to decreased situation awareness and consequently inattentional blindness, defined as impaired perception of unexpectedly changing data. To facilitate information transfer, we developed [...] Read more.

Patient monitoring is crucial in critical care medicine. Perceiving and interpreting multiple vital signs requires a high workload that can lead to decreased situation awareness and consequently inattentional blindness, defined as impaired perception of unexpectedly changing data. To facilitate information transfer, we developed and validated the Visual-Patient avatar. Generated by numerical data, the animation displays the status of vital signs and patient installations according to a user-centered design to improve situation awareness. As a surrogate parameter for information transfer in patient monitoring, we recorded visual attention using eye-tracking data. In this computer-based study, we compared the correlation of visually perceived and correctly interpreted vital signs between a Visual-Patient-avatar ICU and conventional patient monitoring. A total of 50 recruited study participants (25 nurses, 25 physicians) from five European study centers completed five randomized scenarios in both modalities. Using a stationary eye tracker as the primary endpoint, we recorded how long different areas of interest of the two monitoring modalities were viewed. In addition, we tested for a possible association between the length of time an area of interest was viewed and the correctness of the corresponding question. With the conventional monitor, participants looked at the installation site the longest (median 2.13–2.51 s). With the Visual-Patient-avatar ICU, gaze distribution was balanced; no area of interest was viewed for particularly long. For both modalities, the longer an area was viewed, the more likely the associated question was answered incorrectly (OR 0.97, 95% CI 0.95–0.99, p = 0.008). The Visual-Patient-avatar ICU facilitates and improves information transfer through its visualizations, especially with written information. The longer an area of interest was viewed, the more likely the associated question was answered incorrectly. Full article

(This article belongs to the Special Issue Point-of-Care Diagnostics Technology and Applications)

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18 pages, 2130 KiB

Open AccessArticle

User Perceptions of Avatar-Based Patient Monitoring for Intensive Care Units: An International Exploratory Sequential Mixed-Methods Study

by Justyna Lunkiewicz, Greta Gasciauskaite, Tadzio Raoul Roche, Samira Akbas, Christoph B. Nöthiger, Michael T. Ganter, Patrick Meybohm, Sebastian Hottenrott, Kai Zacharowski, Florian Jürgen Raimann, Eva Rivas, Manuel López-Baamonde, Elisabeth Anna Beller, David Werner Tscholl and Lisa Bergauer

Diagnostics 2023, 13(21), 3391; https://doi.org/10.3390/diagnostics13213391 - 06 Nov 2023

Viewed by 1111

Abstract

Visual Patient Avatar ICU is an innovative approach to patient monitoring, enhancing the user’s situation awareness in intensive care settings. It dynamically displays the patient’s current vital signs using changes in color, shape, and animation. The technology can also indicate patient-inserted devices, such [...] Read more.

Visual Patient Avatar ICU is an innovative approach to patient monitoring, enhancing the user’s situation awareness in intensive care settings. It dynamically displays the patient’s current vital signs using changes in color, shape, and animation. The technology can also indicate patient-inserted devices, such as arterial lines, central lines, and urinary catheters, along with their insertion locations. We conducted an international, multi-center study using a sequential qualitative-quantitative design to evaluate users’ perception of Visual Patient Avatar ICU among physicians and nurses. Twenty-five nurses and twenty-five physicians from the ICU participated in the structured interviews. Forty of them completed the online survey. Overall, ICU professionals expressed a positive outlook on Visual Patient Avatar ICU. They described Visual Patient Avatar ICU as a simple and intuitive tool that improved information retention and facilitated problem identification. However, a subset of participants expressed concerns about potential information overload and a sense of incompleteness due to missing exact numerical values. These findings provide valuable insights into user perceptions of Visual Patient Avatar ICU and encourage further technology development before clinical implementation. Full article

(This article belongs to the Special Issue Point-of-Care Diagnostics Technology and Applications)

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14 pages, 2435 KiB

Open AccessArticle

Using Visual Patient to Show Vital Sign Predictions, a Computer-Based Mixed Quantitative and Qualitative Simulation Study

by Amos Malorgio, David Henckert, Giovanna Schweiger, Julia Braun, Kai Zacharowski, Florian J. Raimann, Florian Piekarski, Patrick Meybohm, Sebastian Hottenrott, Corinna Froehlich, Donat R. Spahn, Christoph B. Noethiger, David W. Tscholl and Tadzio R. Roche

Diagnostics 2023, 13(20), 3281; https://doi.org/10.3390/diagnostics13203281 - 23 Oct 2023

Viewed by 719

Abstract

Background: Machine learning can analyze vast amounts of data and make predictions for events in the future. Our group created machine learning models for vital sign predictions. To transport the information of these predictions without numbers and numerical values and make them easily [...] Read more.

Background: Machine learning can analyze vast amounts of data and make predictions for events in the future. Our group created machine learning models for vital sign predictions. To transport the information of these predictions without numbers and numerical values and make them easily usable for human caregivers, we aimed to integrate them into the Philips Visual-Patient-avatar, an avatar-based visualization of patient monitoring. Methods: We conducted a computer-based simulation study with 70 participants in 3 European university hospitals. We validated the vital sign prediction visualizations by testing their identification by anesthesiologists and intensivists. Each prediction visualization consisted of a condition (e.g., low blood pressure) and an urgency (a visual indication of the timespan in which the condition is expected to occur). To obtain qualitative user feedback, we also conducted standardized interviews and derived statements that participants later rated in an online survey. Results: The mixed logistic regression model showed 77.9% (95% CI 73.2–82.0%) correct identification of prediction visualizations (i.e., condition and urgency both correctly identified) and 93.8% (95% CI 93.7–93.8%) for conditions only (i.e., without considering urgencies). A total of 49 out of 70 participants completed the online survey. The online survey participants agreed that the prediction visualizations were fun to use (32/49, 65.3%), and that they could imagine working with them in the future (30/49, 61.2%). They also agreed that identifying the urgencies was difficult (32/49, 65.3%). Conclusions: This study found that care providers correctly identified >90% of the conditions (i.e., without considering urgencies). The accuracy of identification decreased when considering urgencies in addition to conditions. Therefore, in future development of the technology, we will focus on either only displaying conditions (without urgencies) or improving the visualizations of urgency to enhance usability for human users. Full article

(This article belongs to the Special Issue Point-of-Care Diagnostics Technology and Applications)

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24 pages, 2960 KiB

Open AccessArticle

Evaluation of a 3-Item Health Index in Predicting Mortality Risk: A 12-Year Follow-Up Study

by Silvin P. Knight, Mark Ward, Eoin Duggan, Feng Xue, Rose Anne Kenny and Roman Romero-Ortuno

Diagnostics 2023, 13(17), 2801; https://doi.org/10.3390/diagnostics13172801 - 29 Aug 2023

Viewed by 915

Abstract

This study was carried out using a large cohort (N = 4265; 416 deceased) of older, community-dwelling adults from The Irish Longitudinal Study on Ageing (TILDA). The study compared the performance of a new 3-item health index (HI) with two existing measures, [...] Read more.

This study was carried out using a large cohort (N = 4265; 416 deceased) of older, community-dwelling adults from The Irish Longitudinal Study on Ageing (TILDA). The study compared the performance of a new 3-item health index (HI) with two existing measures, the 32-item frailty index (FI) and the frailty phenotype (FP), in predicting mortality risk. The HI was based on the objective measurement of resting-state systolic blood pressure sample entropy, sustained attention reaction time performance, and usual gait speed. Mortality data from a 12-year follow up period were analyzed using Cox proportional regression. All data processing was performed using MATLAB and statistical analysis using STATA 15.1. The HI showed good discriminatory power (AUC = 0.68) for all-cause mortality, similar to FI (AUC = 0.68) and superior to FP (AUC = 0.60). The HI classified participants into Low-Risk (84%), Medium-Risk (15%), and High-Risk (1%) groups, with the High-Risk group showing a significant hazard ratio (HR) of 5.91 in the unadjusted model and 2.06 in the fully adjusted model. The HI also exhibited superior predictive performance for cardiovascular and respiratory deaths (AUC = 0.74), compared with FI (AUC = 0.70) and FP (AUC = 0.64). The HI High-Risk group had the highest HR (15.10 in the unadjusted and 5.61 in the fully adjusted models) for cardiovascular and respiratory mortality. The HI remained a significant predictor of mortality even after comprehensively adjusting for confounding variables. These findings demonstrate the effectiveness of the 3-item HI in predicting 12-year mortality risk across different causes of death. The HI performed similarly to FI and FP for all-cause mortality but outperformed them in predicting cardiovascular and respiratory deaths. Its ability to classify individuals into risk groups offers a practical approach for clinicians and researchers. Additionally, the development of a user-friendly MATLAB App facilitates its implementation in clinical settings. Subject to external validation in clinical research settings, the HI can be more useful than existing frailty measures in the prediction of cardio-respiratory risk. Full article

(This article belongs to the Special Issue Point-of-Care Diagnostics Technology and Applications)

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14 pages, 6893 KiB

Open AccessArticle

Painless Capillary Blood Collection: A Rapid Evaluation of the Onflow Device

by Lara Dominique Noble, Caitlin Dixon, Alison Moran, Charlotte Trottet, Mohammed Majam, Shameema Ismail, Vanessa Tiyamike Msolomba, Kegomoditswe Mathobela, Arthur Queval, Jaya George, Lesley Erica Scott and Wendy Susan Stevens

Diagnostics 2023, 13(10), 1754; https://doi.org/10.3390/diagnostics13101754 - 16 May 2023

Cited by 3 | Viewed by 2914

Abstract

Blood-based diagnostics are critical for many medical decisions, but mostly rely on venepuncture, which can be inconvenient and painful. The Onflow Serum Gel (Loop Medical SA, Vaud, Lausanne, Switzerland) is a novel blood collection device that utilises needle-free technology to collect capillary blood. [...] Read more.

Blood-based diagnostics are critical for many medical decisions, but mostly rely on venepuncture, which can be inconvenient and painful. The Onflow Serum Gel (Loop Medical SA, Vaud, Lausanne, Switzerland) is a novel blood collection device that utilises needle-free technology to collect capillary blood. In this pilot study, 100 healthy participants were enrolled and provided two Onflow collected specimens and one venous blood specimen. Five chemistry analytes (AST, ALT, LDH, potassium, creatinine) and haemolysis were measured per specimen, and laboratory analyte results were compared. Onflow was found to be more acceptable than venepuncture with lower pain ratings, and 96.5% of participants would use the Onflow method again. All phlebotomists (100%) found Onflow intuitive and user-friendly, with ~1 mL of Onflow blood successfully collected from 99% of participants in <12 min (mean: 6 min, 40 s) and 91% collected on the first attempt. ALT and AST analytes showed no difference in performance, while creatinine generated a negative bias (−5.6 µmol/L), and increased variability was noted with potassium (3.6%CV) and LDH (6.7%CV), although none were clinically relevant. These differences may be due to 35% of Onflow collected specimens having “mild” haemolysis. Onflow is a promising alternative blood collection device that should now be evaluated in participants with expected abnormal chemistries and as an option for self-collection. Full article

(This article belongs to the Special Issue Point-of-Care Diagnostics Technology and Applications)

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12 pages, 1654 KiB

Open AccessArticle

Salivary ATR-FTIR Spectroscopy Coupled with Support Vector Machine Classification for Screening of Type 2 Diabetes Mellitus

by Douglas Carvalho Caixeta, Murillo Guimarães Carneiro, Ricardo Rodrigues, Deborah Cristina Teixeira Alves, Luís Ricardo Goulart, Thúlio Marquez Cunha, Foued Salmen Espindola, Rui Vitorino and Robinson Sabino-Silva

Diagnostics 2023, 13(8), 1396; https://doi.org/10.3390/diagnostics13081396 - 12 Apr 2023

Cited by 5 | Viewed by 2036

Abstract

The blood diagnosis of diabetes mellitus (DM) is highly accurate; however, it is an invasive, high-cost, and painful procedure. In this context, the combination of ATR-FTIR spectroscopy and machine learning techniques in other biological samples has been used as an alternative tool to [...] Read more.

The blood diagnosis of diabetes mellitus (DM) is highly accurate; however, it is an invasive, high-cost, and painful procedure. In this context, the combination of ATR-FTIR spectroscopy and machine learning techniques in other biological samples has been used as an alternative tool to develop a non-invasive, fast, inexpensive, and label-free diagnostic or screening platform for several diseases, including DM. In this study, we used the ATR-FTIR tool associated with linear discriminant analysis (LDA) and a support vector machine (SVM) classifier in order to identify changes in salivary components to be used as alternative biomarkers for the diagnosis of type 2 DM. The band area values of 2962 cm⁻¹, 1641 cm⁻¹, and 1073 cm⁻¹ were higher in type 2 diabetic patients than in non-diabetic subjects. The best classification of salivary infrared spectra was by SVM, showing a sensitivity of 93.3% (42/45), specificity of 74% (17/23), and accuracy of 87% between non-diabetic subjects and uncontrolled type 2 DM patients. The SHAP features of infrared spectra indicate the main salivary vibrational modes of lipids and proteins that are responsible for discriminating DM patients. In summary, these data highlight the potential of ATR-FTIR platforms coupled with machine learning as a reagent-free, non-invasive, and highly sensitive tool for screening and monitoring diabetic patients. Full article

(This article belongs to the Special Issue Point-of-Care Diagnostics Technology and Applications)

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18 pages, 1888 KiB

Open AccessArticle

Analysis of Factors Affecting Neutralizing Antibody Production after COVID-19 Vaccination Using Newly Developed Rapid Point-of-Care Test

by Hyeon Woo Shim, Jae hang Shin, Shang Cheol Shin, Hwa Jung Lee, Kyung Soon So, So Young Lee, Jae Woo Jun, Jeong Ku Seo, Hwa Seop Lee, Suk Young Lee, Seung Hyun Kim, Sun Jong Kim, Kyoung-Chol Kim and Gyu Ha Ryu

Diagnostics 2022, 12(8), 1924; https://doi.org/10.3390/diagnostics12081924 - 09 Aug 2022

Cited by 5 | Viewed by 2408

Abstract

(1) Objective: To investigate the factors that affect rates of neutralizing antibody production and duration after vaccination using the newly developed SARS-CoV-2 POCT. (2) Methods: The production of immunoglobulin and neutralizing antibody in clinical subjects who completed various vaccines was analyzed using the [...] Read more.

(1) Objective: To investigate the factors that affect rates of neutralizing antibody production and duration after vaccination using the newly developed SARS-CoV-2 POCT. (2) Methods: The production of immunoglobulin and neutralizing antibody in clinical subjects who completed various vaccines was analyzed using the POCT, the semi-quantitative was interpreted by measurement application, and the quantified neutralizing antibody titers were using the ELISA. (3) Results: According to the clinical performance analysis of the POCT, the clinical sensitivity and the specificity were 96.8% (90/93) and 97.7% (167/171), respectively, for the S1 RBD IgG antibody. The clinical sensitivity was 92.22% (83/90), and the clinical specificity was 100.00% (174/174) for neutralizing antibodies. Factors influencing antibody production were analyzed using the whole blood of the five types of second-completed vaccinators (N = 736, 20–80 years old). General and neutralizing antibody and showed significant differences in age (p < 0.0001), vaccine type (p < 0.0001), inoculation interval (p < 0.0001), pain score (p < 0.0001), diabetes (p < 0.0001), and hypertension (p = 0.002). The gender (p = 0.021) and chronic fatigue (p = 0.02) did not show the significance. (4) Conclusions: An acquisition of immunoglobulin and neutralizing antibody varies according to vaccine type, age, days after vaccination, pain degree after vaccination, and underlying diseases. The POCT used in this study will be utilized for clinical recommendations such as deciding whether to receive additional vaccines through the immediate rapid determination of neutralizing antibody generation in the clinical site. Full article

(This article belongs to the Special Issue Point-of-Care Diagnostics Technology and Applications)

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Review

Jump to: Research, Other

19 pages, 1699 KiB

Open AccessReview

Review on the Advancements of Stethoscope Types in Chest Auscultation

by Jun Jie Seah, Jiale Zhao, De Yun Wang and Heow Pueh Lee

Diagnostics 2023, 13(9), 1545; https://doi.org/10.3390/diagnostics13091545 - 25 Apr 2023

Cited by 6 | Viewed by 5573

Abstract

Stethoscopes were originally designed for the auscultation of a patient’s chest for the purpose of listening to lung and heart sounds. These aid medical professionals in their evaluation of the cardiovascular and respiratory systems, as well as in other applications, such as listening [...] Read more.

Stethoscopes were originally designed for the auscultation of a patient’s chest for the purpose of listening to lung and heart sounds. These aid medical professionals in their evaluation of the cardiovascular and respiratory systems, as well as in other applications, such as listening to bowel sounds in the gastrointestinal system or assessing for vascular bruits. Listening to internal sounds during chest auscultation aids healthcare professionals in their diagnosis of a patient’s illness. We performed an extensive literature review on the currently available stethoscopes specifically for use in chest auscultation. By understanding the specificities of the different stethoscopes available, healthcare professionals can capitalize on their beneficial features, to serve both clinical and educational purposes. Additionally, the ongoing COVID-19 pandemic has also highlighted the unique application of digital stethoscopes for telemedicine. Thus, the advantages and limitations of digital stethoscopes are reviewed. Lastly, to determine the best available stethoscopes in the healthcare industry, this literature review explored various benchmarking methods that can be used to identify areas of improvement for existing stethoscopes, as well as to serve as a standard for the general comparison of stethoscope quality. The potential use of digital stethoscopes for telemedicine amidst ongoing technological advancements in wearable sensors and modern communication facilities such as 5G are also discussed. Based on the ongoing trend in advancements in wearable technology, telemedicine, and smart hospitals, understanding the benefits and limitations of the digital stethoscope is an essential consideration for potential equipment deployment, especially during the height of the current COVID-19 pandemic and, more importantly, for future healthcare crises when human and resource mobility is restricted. Full article

(This article belongs to the Special Issue Point-of-Care Diagnostics Technology and Applications)

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17 pages, 1434 KiB

Open AccessReview

A Review of the Nucleic Acid-Based Lateral Flow Assay for Detection of Breast Cancer from Circulating Biomarkers at a Point-of-Care in Low Income Countries

by Busiswa Dyan, Palesa Pamela Seele, Amanda Skepu, Phumlane Selby Mdluli, Salerwe Mosebi and Nicole Remaliah Samantha Sibuyi

Diagnostics 2022, 12(8), 1973; https://doi.org/10.3390/diagnostics12081973 - 15 Aug 2022

Cited by 8 | Viewed by 2842

Abstract

The current levels of breast cancer in African women have contributed to the high mortality rates among them. In South Africa, the incidence of breast cancer is also on the rise due to changes in behavioural and biological risk factors. Such low survival [...] Read more.

The current levels of breast cancer in African women have contributed to the high mortality rates among them. In South Africa, the incidence of breast cancer is also on the rise due to changes in behavioural and biological risk factors. Such low survival rates can be attributed to the late diagnosis of the disease due to a lack of access and the high costs of the current diagnostic tools. Breast cancer is asymptomatic at early stages, which is the best time to detect it and intervene to prevent high mortality rates. Proper risk assessment, campaigns, and access to adequate healthcare need to be prioritised among patients at an early stage. Early detection of breast cancer can significantly improve the survival rate of breast cancer patients, since therapeutic strategies are more effective at this stage. Early detection of breast cancer can be achieved by developing devices that are simple, sensitive, low-cost, and employed at point-of-care (POC), especially in low-income countries (LICs). Nucleic-acid-based lateral flow assays (NABLFAs) that combine molecular detection with the immunochemical visualisation principles, have recently emerged as tools for disease diagnosis, even for low biomarker concentrations. Detection of circulating genetic biomarkers in non-invasively collected biological fluids with NABLFAs presents an appealing and suitable method for POC testing in resource-limited regions and/or LICs. Diagnosis of breast cancer at an early stage will improve the survival rates of the patients. This review covers the analysis of the current state of NABLFA technologies used in developing countries to reduce the scourge of breast cancer. Full article

(This article belongs to the Special Issue Point-of-Care Diagnostics Technology and Applications)

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Other

Jump to: Research, Review

5 pages, 228 KiB

Open AccessBrief Report

Feedback on the Implementation of a Rapid and Connectable Point-of-Care COVID-19 Antigen Test in an Emergency Department

by Caroline Coulon, Anne-Sophie Bargnoux, Océane Jourdan, Vincent Foulongne, Anne-Marie Mondain, Anne-Marie Dupuy, Mustapha Sebbane and Jean-Paul Cristol

Diagnostics 2023, 13(23), 3508; https://doi.org/10.3390/diagnostics13233508 - 22 Nov 2023

Viewed by 893

Abstract

Faced with the pandemic viral circulation of SARS-CoV-2, healthcare establishments have had to maintain an effective screening strategy in order to prevent nosocomial clusters. Automated antigenic tests appear to be a reliable and complementary alternative to RT-PCR (reverse transcriptase polymerase chain reaction) in [...] Read more.

Faced with the pandemic viral circulation of SARS-CoV-2, healthcare establishments have had to maintain an effective screening strategy in order to prevent nosocomial clusters. Automated antigenic tests appear to be a reliable and complementary alternative to RT-PCR (reverse transcriptase polymerase chain reaction) in order to optimize patient care in the emergency department. We report our experience of the deployment of the LumiraDx antigen tests on the LumiraDx platform, as well as the comparison of these tests’ results with the RT-PCR results on a population of patients sampled in the emergency department. Full article

(This article belongs to the Special Issue Point-of-Care Diagnostics Technology and Applications)

6 pages, 8252 KiB

Open AccessCase Report

When a Rapid Accurate Diagnosis Changes Therapeutic Approach: Recognizing Acute Abdominal Pain with Ascites as a Possible Presentation of Systemic Lupus Erythematosus

by Szu-Cheng Huang, Yi-Ling Chan, Hao-Tsai Cheng, Zhong Ning Leonard Goh, Yon-Cheong Wong, Chen-Ken Seak, Joanna Chen-Yeen Seak, Chih-Huang Li, Hsien-Yi Chen and Chen-June Seak

Diagnostics 2022, 12(11), 2605; https://doi.org/10.3390/diagnostics12112605 - 27 Oct 2022

Viewed by 1627

Abstract

Systemic lupus erythematosus (SLE) is a chronic, multi-organ autoimmune disease which rarely presents with peritoneal involvement. As such, its diagnosis in the emergency department (ED) based on a clinical presentation of gastrointestinal symptoms is extremely challenging. Yet, reaching such a diagnosis in the [...] Read more.

Systemic lupus erythematosus (SLE) is a chronic, multi-organ autoimmune disease which rarely presents with peritoneal involvement. As such, its diagnosis in the emergency department (ED) based on a clinical presentation of gastrointestinal symptoms is extremely challenging. Yet, reaching such a diagnosis in the ED is crucial for avoiding unnecessary surgical intervention and initiating early glucocorticoid therapy to maximise patient outcomes. Here, we report a case of newly diagnosed SLE in a 28-year-old lady who presented atypically and unusually with abdominal pain and ascites. She required extensive but methodical investigations, and was eventually diagnosed with lupus mesenteric vasculitis with underlying newly diagnosed SLE in the ED. The patient was promptly treated with methylprednisolone resulting in marked clinical improvement. Emergency physicians should be mindful of abdominal pain with ascites as an extremely rare but important clinical presentation of SLE. Early diagnosis and commencement of glucocorticoid therapy in these patients are crucial in halting disease progression and averting the need for surgical intervention. Full article

(This article belongs to the Special Issue Point-of-Care Diagnostics Technology and Applications)

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