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Chan AHY, Te Ao B, Baggott C, Cavadino A, Eikholt AA, Harwood M, Hikaka J, Gibbs D, Hudson M, Mirza F, Naeem MA, Semprini R, Chang CL, Tsang KCH, Shah SA, Jeremiah A, Abeysinghe BN, Roy R, Wall C, Wood L, Dalziel S, Pinnock H, van Boven JFM, Roop P, Harrison J. DIGIPREDICT: physiological, behavioural and environmental predictors of asthma attacks-a prospective observational study using digital markers and artificial intelligence-study protocol. BMJ Open Respir Res 2024; 11:e002275. [PMID: 38777583 PMCID: PMC11116853 DOI: 10.1136/bmjresp-2023-002275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/11/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Asthma attacks are a leading cause of morbidity and mortality but are preventable in most if detected and treated promptly. However, the changes that occur physiologically and behaviourally in the days and weeks preceding an attack are not always recognised, highlighting a potential role for technology. The aim of this study 'DIGIPREDICT' is to identify early digital markers of asthma attacks using sensors embedded in smart devices including watches and inhalers, and leverage health and environmental datasets and artificial intelligence, to develop a risk prediction model to provide an early, personalised warning of asthma attacks. METHODS AND ANALYSIS A prospective sample of 300 people, 12 years or older, with a history of a moderate or severe asthma attack in the last 12 months will be recruited in New Zealand. Each participant will be given a smart watch (to assess physiological measures such as heart and respiratory rate), peak flow meter, smart inhaler (to assess adherence and inhalation) and a cough monitoring application to use regularly over 6 months with fortnightly questionnaires on asthma control and well-being. Data on sociodemographics, asthma control, lung function, dietary intake, medical history and technology acceptance will be collected at baseline and at 6 months. Asthma attacks will be measured by self-report and confirmed with clinical records. The collected data, along with environmental data on weather and air quality, will be analysed using machine learning to develop a risk prediction model for asthma attacks. ETHICS AND DISSEMINATION Ethical approval has been obtained from the New Zealand Health and Disability Ethics Committee (2023 FULL 13541). Enrolment began in August 2023. Results will be presented at local, national and international meetings, including dissemination via community groups, and submission for publication to peer-reviewed journals. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry ACTRN12623000764639; Australian New Zealand Clinical Trials Registry.
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Affiliation(s)
- Amy Hai Yan Chan
- School of Pharmacy, The University of Auckland Faculty of Medical and Health Sciences, Auckland, Region, New Zealand
| | - Braden Te Ao
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Christina Baggott
- Department of Respiratory Medicine and Respiratory research unit, Waikato Hospital, Hamilton, New Zealand
| | - Alana Cavadino
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Amber A Eikholt
- University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD, Groningen, Netherlands
- Medication Adherence Expertise Center of the northern Netherlands (MAECON), Groningen, Netherlands
| | - Matire Harwood
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Joanna Hikaka
- Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand
| | - Dianna Gibbs
- Pinnacle Midlands Health Network, Hamilton, New Zealand
| | - Mariana Hudson
- School of Pharmacy, The University of Auckland Faculty of Medical and Health Sciences, Auckland, Region, New Zealand
| | - Farhaan Mirza
- Department of IT and Software Engineering, Auckland University of Technology, Auckland, New Zealand
| | - Muhammed Asif Naeem
- Department of IT and Software Engineering, Auckland University of Technology, Auckland, New Zealand
- National University of Computer and Emerging Sciences, Islamabad, Pakistan
| | - Ruth Semprini
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Catherina L Chang
- Department of Respiratory Medicine and Respiratory research unit, Waikato Hospital, Hamilton, New Zealand
| | - Kevin C H Tsang
- University College London, London, UK
- The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, Edinburgh, UK
| | - Syed Ahmar Shah
- The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, Edinburgh, UK
| | - Aron Jeremiah
- Department of Electrical, Computer and Software Engineering, University of Auckland, Auckland, New Zealand
| | - Binu Nisal Abeysinghe
- Department of Electrical, Computer and Software Engineering, University of Auckland, Auckland, New Zealand
| | - Rajshri Roy
- Department of Nutrition and Dietetics, University of Auckland, Auckland, New Zealand
| | - Clare Wall
- Department of Nutrition and Dietetics, University of Auckland, Auckland, New Zealand
| | - Lisa Wood
- Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia
| | - Stuart Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
| | - Hilary Pinnock
- The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, Edinburgh, UK
| | - Job F M van Boven
- University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD, Groningen, Netherlands
- Medication Adherence Expertise Center of the northern Netherlands (MAECON), Groningen, Netherlands
| | - Partha Roop
- Department of Electrical, Computer and Software Engineering, University of Auckland, Auckland, New Zealand
| | - Jeff Harrison
- School of Pharmacy, The University of Auckland Faculty of Medical and Health Sciences, Auckland, Region, New Zealand
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Lobdell KW, Grant MC, Salenger R. Temporary mechanical circulatory support & enhancing recovery after cardiac surgery. Curr Opin Anaesthesiol 2024; 37:16-23. [PMID: 38085881 DOI: 10.1097/aco.0000000000001332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
PURPOSE OF REVIEW This review highlights the integration of enhanced recovery principles with temporary mechanical circulatory support associated with adult cardiac surgery. RECENT FINDINGS Enhanced recovery elements and efforts have been associated with improvements in quality and value. Temporary mechanical circulatory support technologies have been successfully employed, improved, and the value of their proactive use to maintain hemodynamic goals and preserve long-term myocardial function is accruing. SUMMARY Temporary mechanical circulatory support devices promise to enhance recovery by mitigating the risk of complications, such as postcardiotomy cardiogenic shock, organ dysfunction, and death, associated with adult cardiac surgery.
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Affiliation(s)
- Kevin W Lobdell
- Sanger Heart & Vascular Institute, Advocate Health, Charlotte, North Carolina
| | - Michael C Grant
- Johns Hopkins University School of Medicine, Anesthesiology and Critical Care Medicine, Baltimore
| | - Rawn Salenger
- University of Maryland School of Medicine, Department of Surgery, Towson, Maryland, USA
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Syversen A, Dosis A, Jayne D, Zhang Z. Wearable Sensors as a Preoperative Assessment Tool: A Review. SENSORS (BASEL, SWITZERLAND) 2024; 24:482. [PMID: 38257579 PMCID: PMC10820534 DOI: 10.3390/s24020482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024]
Abstract
Surgery is a common first-line treatment for many types of disease, including cancer. Mortality rates after general elective surgery have seen significant decreases whilst postoperative complications remain a frequent occurrence. Preoperative assessment tools are used to support patient risk stratification but do not always provide a precise and accessible assessment. Wearable sensors (WS) provide an accessible alternative that offers continuous monitoring in a non-clinical setting. They have shown consistent uptake across the perioperative period but there has been no review of WS as a preoperative assessment tool. This paper reviews the developments in WS research that have application to the preoperative period. Accelerometers were consistently employed as sensors in research and were frequently combined with photoplethysmography or electrocardiography sensors. Pre-processing methods were discussed and missing data was a common theme; this was dealt with in several ways, commonly by employing an extraction threshold or using imputation techniques. Research rarely processed raw data; commercial devices that employ internal proprietary algorithms with pre-calculated heart rate and step count were most commonly employed limiting further feature extraction. A range of machine learning models were used to predict outcomes including support vector machines, random forests and regression models. No individual model clearly outperformed others. Deep learning proved successful for predicting exercise testing outcomes but only within large sample-size studies. This review outlines the challenges of WS and provides recommendations for future research to develop WS as a viable preoperative assessment tool.
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Affiliation(s)
- Aron Syversen
- School of Computing, University of Leeds, Leeds LS2 9JT, UK
| | - Alexios Dosis
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (A.D.); (D.J.)
| | - David Jayne
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (A.D.); (D.J.)
| | - Zhiqiang Zhang
- School of Electrical Engineering, University of Leeds, Leeds LS2 9JT, UK;
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Angelucci A, Canali S, Aliverti A. Digital technologies for step counting: between promises of reliability and risks of reductionism. Front Digit Health 2023; 5:1330189. [PMID: 38152629 PMCID: PMC10751316 DOI: 10.3389/fdgth.2023.1330189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/30/2023] [Indexed: 12/29/2023] Open
Abstract
Step counting is among the fundamental features of wearable technology, as it grounds several uses of wearables in biomedical research and clinical care, is at the center of emerging public health interventions and recommendations, and is gaining increasing scientific and political importance. This paper provides a perspective of step counting in wearable technology, identifying some limitations to the ways in which wearable technology measures steps and indicating caution in current uses of step counting as a proxy for physical activity. Based on an overview of the current state of the art of technologies and approaches to step counting in digital wearable technologies, we discuss limitations that are methodological as well as epistemic and ethical-limitations to the use of step counting as a basis to build scientific knowledge on physical activity (epistemic limitations) as well as limitations to the accessibility and representativity of these tools (ethical limitations). As such, using step counting as a proxy for physical activity should be considered a form of reductionism. This is not per se problematic, but there is a need for critical appreciation and awareness of the limitations of reductionistic approaches. Perspective research should focus on holistic approaches for better representation of physical activity levels and inclusivity of different user populations.
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