Effects of audio and visual distraction on patients' vital signs and tolerance during esophagogastroduodenoscopy: a randomized controlled trial

Classifying metro drivers' cognitive distractions during manual operations using machine learning and random forest-recursive feature elimination

Metro drivers are more likely to trigger accidents if they suffer from cognitive distractions during manual driving. However, identifying metro drivers' cognitive distractions faces challenges as generally no obvious behavior can be found during the distractions. To address the challenge, this paper identifies metro drivers' cognitive distractions based on Electrocardiogram (ECG) signals collected by wearable devices in simulated driving experiments. The ECG signals are processed to generate ultra-short-term heart rate and heart rate variability (HR-HRV) features. The HR-HRV features are extracted by 30-s and 60-s time-windows in driving phase, and 25-s time-windows in parking phase, respectively. Machine learning approaches are developed to identify distractions (binary) and distinguish the degrees of distractions (multi-class). The optimal input features are determined by a random forest and recursive feature elimination (RF-RFE) algorithm. Results show that the DT with only one HR-HRV feature extracted from 30-s time-windows and XGBoost with 20 h-HRV features extracted from 60-s time-windows are optimal models for binary and multi-class classification for distractions during driving phase, respectively. The features including NN20, pNN20, SD1/SD2, Max-HR, Min-HR, and MEDNN are the most critical HR-HRV features associated with distractions. Cognitive distractions in parking phase are difficult to be detected using HR-HRV features.

Effect of Virtual Reality Distraction on Satisfaction and Tolerability in Patients Undergoing In-Office KTP Laser Procedure

OBJECTIVES

To study the effect of virtual reality (VR) on satisfaction, discomfort, stress, and cooperation in patients undergoing in-office potassium titanyl phosphate (KTP) laser procedure.

STUDY DESIGN

Prospective study.

METHODS

Thirty-seven patients were enrolled in this prospective study. The State Anxiety Scale of Spielberg's State-Trait Anxiety Inventory was used to measure the level of state anxiety. Satisfaction, discomfort, pain, stress, acceptance of VR, relaxation with VR, and willingness to wear VR were evaluated using a 100-mm visual analog scale (VAS). A 5-point Likert-like scale was used to rate the patient cooperation.

RESULTS

All procedures were completed successfully with cooperation of patients. Satisfaction score in VR group was 88.3 ± 9.0, and in control group was 81.6 ± 9.7 (P = 0.040). There were significant differences in both nasal cavity and laryngopharynx discomfort between two groups (P = 0.030 and P = 0.016, respectively). The pain score of control group was higher than that of VR group but it was not statistically significant (P = 0.140). The stress of control group during procedure was more obvious than that of VR group (30.5 ± 24.0 versus 17.0 ± 9.2, P = 0.021). The mean VAS scores of acceptance of VR were all more than 75. The results of regression analysis showed that VR had significant effects on satisfaction with the procedure (P = 0.004), discomfort of nasal cavity (P = 0.030) and laryngopharynx (P = 0.016), and feeling of stress (P = 0.021) during the procedure.

CONCLUSION

Distraction of VR can enhance satisfaction in both procedure and stress management for patients undergoing in-office KTP laser procedure. Acceptance of VR in VR group was relatively good.

A self-assessment tool for predicting discomfort and tolerance in Chinese patients undergoing esophagogastroduodenoscopy

Background

For patients taking esophagogastroduodenoscopy (EGD), sedation should ideally be used individually based on patients’ comfort and tolerance level. However, currently there is no valid predictive tool. We undertook this study to develop and temporally validate a self-assessment tool for predicting discomfort and tolerance in Chinese patients undergoing EGD.

Methods

We recruited 1522 patients undergoing routine diagnostic EGD without sedation. We collected candidate predictor variables before endoscopy and evaluated discomfort and tolerance with a 5-point visual analogue scale after the procedure. We developed logistic regression predictive models based on the first 2/3 of participants, and evaluated the calibration and discrimination of the models in the later 1/3 of patients.

Results

30.2% and 23.0% participants reported severe discomfort or poor tolerance to EGD respectively. The predictive factors in the model for discomfort included sex, education, expected level of discomfort, and anxiety before endoscopy. The model for tolerance included income, expected level of discomfort, and anxiety before endoscopy. In the validation population, the established models showed a moderate discriminative ability with a c-index of 0.74 for discomfort and 0.78 for tolerance. Hosmer–Lemeshow test suggested the models had fine calibration ability (discomfort: P = 0.37, tolerance: P = 0.41).

Conclusions

Equations for predicting discomfort and tolerance in Chinese patients undergoing EGD demonstrated moderate discrimination and variable calibration. Further studies are still required to validate these tools in other population.

Trial registration

Chinese Clinical Trial Registry (ChiCTR1800020236).

Improvement of acceptability in patients undergoing esophagogastroduodenoscopy using auditory and visual stimulation

Esophagogastroduodenoscopy (EGD) has become an indispensable examination to discover upper gastrointestinal diseases, including cancer, and perform endoscopic treatment. However, many individuals who undergo the procedure have feelings of anxiety and fear regarding EGD. Although the use of medication for sedation during EGD is useful for reducing anxiety and the stability of hemodynamics, sedation may increase the likelihood of complications. Several noninvasive distractions have been introduced to decrease pain and anxiety during endoscopic examinations;however, most assessments of these distractions evaluated subjective items such as impression. We herein add the results of our studies using objective items and review the effectiveness of distractions for EGD. J. Med. Invest. 69 : 8-18, February, 2022.