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IEEE Open Journal of Engineering in... 2024In light of the COVID-19 pandemic, the early diagnosis of respiratory diseases has become increasingly crucial. Traditional diagnostic methods such as computed...
In light of the COVID-19 pandemic, the early diagnosis of respiratory diseases has become increasingly crucial. Traditional diagnostic methods such as computed tomography (CT) and magnetic resonance imaging (MRI), while accurate, often face accessibility challenges. Lung auscultation, a simpler alternative, is subjective and highly dependent on the clinician's expertise. The pandemic has further exacerbated these challenges by restricting face-to-face consultations. This study aims to overcome these limitations by developing an automated respiratory sound classification system using deep learning, facilitating remote and accurate diagnoses. We developed a deep convolutional neural network (CNN) model that utilizes spectrographic representations of respiratory sounds within an image classification framework. Our model is enhanced with attention feature fusion of low-to-high-level information based on a knowledge propagation mechanism to increase classification effectiveness. This novel approach was evaluated using the ICBHI benchmark dataset and a larger, self-collected Pediatric dataset comprising outpatient children aged 1 to 6 years. The proposed CNN model with knowledge propagation demonstrated superior performance compared to existing state-of-the-art models. Specifically, our model showed higher sensitivity in detecting abnormalities in the Pediatric dataset, indicating its potential for improving the accuracy of respiratory disease diagnosis. The integration of a knowledge propagation mechanism into a CNN model marks a significant advancement in the field of automated diagnosis of respiratory disease. This study paves the way for more accessible and precise healthcare solutions, which is especially crucial in pandemic scenarios.
PubMed: 38899013
DOI: 10.1109/OJEMB.2024.3402139 -
Nurse Education in Practice Jun 2024This study evaluated the effect of simulation on auscultation skills, self-confidence and anxiety levels.
AIM
This study evaluated the effect of simulation on auscultation skills, self-confidence and anxiety levels.
BACKGROUND
Auscultation is an essential topic in nursing education and patient care. Simulation is efficacious in improving auscultation skills and self-confidence and reducing anxiety levels. It is a valuable educational approach whose effects should be evaluated and disseminated in the context of auscultation.
DESIGN
This study had a randomised controlled trial design.
METHODS
The study was conducted with second-year nursing students enrolled at a university in Turkey. One group of students studied auscultation of heart, lung and bowel sounds with a simulated patient (n = 28), the second group with a high fidelity simulator (n = 30) and the third group with traditional education (n = 28). Data were collected using a demographic information form, auscultation control list and Nursing Anxiety and Self-Confidence with Clinical Decision Making Scale. The students' psychomotor auscultation skills, self-confidence and anxiety levels were evaluated. Data on auscultation skills were assessed after the intervention, while data on self-confidence and anxiety levels were collected at baseline, after the intervention and after clinical practices throughout the academic year.
RESULTS
Anxiety and self-confidence levels showed statistically significant differences in intragroup evaluation. The self-confidence levels of the groups working with simulation did not change much in the follow-up test conducted after the end of clinical practices. The mean skill scores in the auscultation control list showed a statistically significant difference between the groups.
CONCLUSIONS
Simulation and traditional approaches are effective in learning auscultation skills. However, the positive effects of simulation, particularly in enhancing students' self-confidence and reducing anxiety levels, appear to be more permanent and impactful than traditional education. Therefore, it is recommended that simulation be prioritized for teaching auscultation skills.
PubMed: 38889525
DOI: 10.1016/j.nepr.2024.104016 -
The Journal of the Acoustical Society... Jun 2024This study proposes the use of vocal resonators to enhance cardiac auscultation signals and evaluates their performance for voice-noise suppression. Data were collected...
This study proposes the use of vocal resonators to enhance cardiac auscultation signals and evaluates their performance for voice-noise suppression. Data were collected using two electronic stethoscopes while each study subject was talking. One collected auscultation signal from the chest while the other collected voice signals from one of the three voice resonators (cheek, back of the neck, and shoulder). The spectral subtraction method was applied to the signals. Both objective and subjective metrics were used to evaluate the quality of enhanced signals and to investigate the most effective vocal resonator for noise suppression. Our preliminary findings showed a significant improvement after enhancement and demonstrated the efficacy of vocal resonators. A listening survey was conducted with thirteen physicians to evaluate the quality of enhanced signals, and they have received significantly better scores regarding the sound quality than their original signals. The shoulder resonator group demonstrated significantly better sound quality than the cheek group when reducing voice sound in cardiac auscultation signals. The suggested method has the potential to be used for the development of an electronic stethoscope with a robust noise removal function. Significant clinical benefits are expected from the expedited preliminary diagnostic procedure.
Topics: Humans; Heart Auscultation; Stethoscopes; Signal Processing, Computer-Assisted; Male; Female; Adult; Heart Sounds; Sound Spectrography; Equipment Design; Voice; Middle Aged; Voice Quality; Vibration; Noise
PubMed: 38874464
DOI: 10.1121/10.0026237 -
Indian Pediatrics Jun 2024Conventional stethoscope is a useful clinical examination tool to aid evaluation of the underlying clinical condition, especially respiratory and cardiac illnesses, even...
Conventional stethoscope is a useful clinical examination tool to aid evaluation of the underlying clinical condition, especially respiratory and cardiac illnesses, even before definitive imaging studies are performed. Auscultation with a stethoscope becomes highly challenging when wearing personal protective equipment (PPE) because the hood of the PPE covers both the ears. Herein, we describe an innovation that involves refashioning of the head cover device of the PPE suit to facilitate conventional auscultation using a stethoscope. In resource-limited settings where advanced gadgets such as wireless stethoscopes may be lacking, redesigning the head cover of the PPE suit can allow the use of manual stethoscopes without increasing the risk of exposure to the pathogen of concern.
Topics: Humans; Personal Protective Equipment; Stethoscopes; Auscultation; Equipment Design
PubMed: 38872294
DOI: No ID Found -
The American Journal of Medicine Jun 2024Validated syncope risk scores were aimed to predict a cardiac etiology and are mainly used in the decision of hospital admission. Whether these scores could also predict...
INTRODUCTION
Validated syncope risk scores were aimed to predict a cardiac etiology and are mainly used in the decision of hospital admission. Whether these scores could also predict the outcomes of inpatient cardiac evaluation is unknown and was the aim of our study.
METHODS
An observational study including consecutive patients admitted for syncope evaluation. All patients completed prolonged ECG monitoring and an echocardiography before discharge. The area under the receiver operating curve (AUC) was used to evaluate the ability of validated risk scores to predict positive inpatient findings. Subsequently, a multivariate regression was performed to identify independent predictors for positive cardiac evaluation, which were then incorporated into the best predictive risk scores.
RESULTS
397 patients were included, 56 (14%) with a positive inpatient cardiac evaluation. The Osservatorio Epidemiologico sulla Sincope Lazio (OESIL) and Canadian Syncope Risk Score (CSRS) achieved the largest AUC (0.701, 95% CI 0.63-0.77 and 0.694, 95% CI 0.62-0.77, respectively). Yet, all scores provided relatively high sensitivity with low specificity. Multivariate regression revealed age ≥75 (adjusted OR 3.50, 95% CI 1.5-7.9) and abnormal cardiac auscultation (AOR 4.79, 95% CI 2.5-9.1) to be independent predictors. Incorporating these factors led to a significantly higher prediction ability of the OESIL (AUC of 0.787, p<0.01) and CSRS (AUC 0.778, p<0.01) modified scores.
CONCLUSION
Current syncope risk scores provide limited prediction ability for the outcomes of inpatient cardiac syncope work-up. One should specifically consider at age > 75 and either cardiac murmur of irregular heart rate on examination very significant in implying a cardiac etiology for syncope. While these factors may be obvious, current risk scores can be interpreted in such a fashion that ignores the importance of findings extracted from a good history and physical examination.
PubMed: 38871205
DOI: 10.1016/j.amjmed.2024.05.035 -
Computers in Biology and Medicine Jun 2024The auscultation is a non-invasive and cost-effective method used for the diagnosis of lung diseases, which are one of the leading causes of death worldwide. However,...
The auscultation is a non-invasive and cost-effective method used for the diagnosis of lung diseases, which are one of the leading causes of death worldwide. However, the efficacy of the auscultation suffers from the limitations of the analog stethoscopes and the subjective nature of human interpretation. To overcome these limitations, the accurate diagnosis of these diseases by employing the computer based automated algorithms applied to the digitized lung sounds has been studied for the last decades. This study proposes a novel approach that uses a Tunable Q-factor Wavelet Transform (TQWT) based statistical feature extraction followed by individual and ensemble learning model training with the aim of lung disease classification. During the learning stage various machine learning algorithms are utilized as the individual learners as well as the hard and soft voting fusion approaches are employed for performance enhancement with the aid of the predictions of individual models. For an objective evaluation of the proposed approach, the study was structured into two main tasks that were investigated in detail by using several sub-tasks to comparison with state-of-the-art studies. Among the sub-tasks which investigates patient-based classification, the highest accuracy obtained for the binary classification was achieved as 97.63% (healthy vs. non-healthy), while accuracy values up to 66.32% for three-class classification (obstructive-related, restrictive-related, and healthy), and 53.42% for five-class classification (asthma, chronic obstructive pulmonary disease, interstitial lung disease, pulmonary infection, and healthy) were obtained. Regarding the other sub-task, which investigates sample-based classification, the proposed approach was superior to almost all previous findings. The proposed method underscores the potential of TQWT based signal decomposition that leverages the power of its adaptive time-frequency resolution property satisfied by Q-factor adjustability. The obtained results are very promising and the proposed approach paves the way for more accurate and automated digital auscultation techniques in clinical settings.
PubMed: 38861896
DOI: 10.1016/j.compbiomed.2024.108698 -
Chest Jun 2024A 57-year-old man was admitted to our hospital via the ED presenting in reduced general condition because of an infection of unknown origin, generalized edema, and...
A 57-year-old man was admitted to our hospital via the ED presenting in reduced general condition because of an infection of unknown origin, generalized edema, and dyspnea at rest (peripheral capillary oxygen saturation, 89%) that required 2 L/min intranasal oxygen. Anamnesis was complicated by an infection-triggered delirium, but his wife reported an increasing physical decay that had led to bed confinement. The BP was reduced at 88/55 mm Hg with a normal heart rate of 86 beats/min. Lung auscultation showed mild bipulmonal rales. Previous comorbidities were a BMI of 42 kg/m, an insulin-dependent type 2 diabetes mellitus with a severe diabetes-related chronic kidney disease stage G4A3, and systemic arterial hypertension.
Topics: Humans; Male; Middle Aged; Pulmonary Artery; Vascular Calcification; Tomography, X-Ray Computed; Diagnosis, Differential
PubMed: 38852977
DOI: 10.1016/j.chest.2024.02.022 -
Journal of Renal Care Jun 2024The success of haemodialysis (HD) critically depends on the effective use of arteriovenous fistulas (AVFs). The precise needling technique is vital to minimise...
BACKGROUND
The success of haemodialysis (HD) critically depends on the effective use of arteriovenous fistulas (AVFs). The precise needling technique is vital to minimise complications and ensure functional vascular access.
OBJECTIVE
This study assesses the effectiveness of a nursing consultation protocol, which integrates physical examination (PE) with Doppler Ultrasound (DUS), in preparing patients for the first AVF needling.
DESIGN/PARTICIPANTS
A cross-sectional analysis at a Portuguese National Health Service Hospital engaged thirty new HD patients, four HD needling experienced nurses and one HD vascular access nurse. This study examines the accuracy of PE in assessing the matured AVF by the four nurses compared to a trained vascular access nurse encompassing systematic PE and DUS.
MEASUREMENTS
The primary data incorporated AVF characteristics derived from PE (inspection, palpation, and auscultation) and DUS findings (vein depth, diameter, and blood flow). A secondary focus was evaluating the change in nurses' perceived needling complexity following the nursing consultation.
RESULTS
The nursing consultation significantly enhanced the identification of crucial AVF features, such as accessory veins (p = 0.002), and improved the accuracy of AVF morphology assessments. This led to identifying longer needling tracks (p = 0.031) and a higher number of safe needling points (p = 0.016). Nurses reported a notable reduction in perceived complexity and potential adverse events following this method (p = 0.027).
CONCLUSIONS
Integrating structured PE with DUS in a nursing consultation framework significantly improves the preparation for AVF needling. This approach enhances the efficiency and safety of AVF needling and boosts nurse confidence and patient care in HD settings.
PubMed: 38850083
DOI: 10.1111/jorc.12505 -
European Journal of Case Reports in... 2024Small cell lung cancer is an aggressive tumor with a poor prognosis that requires prompt treatment. While radiotherapy may enhance survival when superior vena cava...
BACKGROUND
Small cell lung cancer is an aggressive tumor with a poor prognosis that requires prompt treatment. While radiotherapy may enhance survival when superior vena cava syndrome is present, radiation therapy-induced pericardial disease can be a potential complication.
CASE REPORT
A 55-year-old man, who recently underwent radiotherapy for stage IV small-cell lung cancer complicated by superior vena cava syndrome, presented with chest pain and dyspnea. In the emergency room, he was dyspneic, hypotensive, and tachycardic. Pulmonary auscultation revealed the absence of lung sounds on the right. The initial electrocardiogram showed ST-segment elevation in lateral leads and in lead DII, with reciprocal changes in lead DIII. A bedside transthoracic echocardiogram revealed cardiac tamponade and emergent pericardiocentesis was performed, removing 500 ml of purulent fluid, resulting in an immediate clinical improvement. Thoracentesis was also performed, showing no empyema. Large spectrum empirical antibiotic therapy was started. Cultures from the pericardial fluid and peripheral blood grew multi-sensitive . Cytological analysis of the pericardial fluid was consistent with infection. The patient improved after 2 weeks of targeted antibiotic therapy and underwent the first cycle of chemotherapy. He was discharged with an early scheduled pulmonology appointment.
CONCLUSIONS
Although the most common causes of pericardial effusion in lung cancer are malignant, non-malignant etiologies should also be considered. This patient had an infectious pericardial effusion most probably due to a pericardial-mediastinal mass fistula caused by radiotherapy. This was a diagnostic challenge, both in the emergency room as well in the inpatient setting.
LEARNING POINTS
Small cell lung cancer is a fast-growing cancer that exhibits aggressive behavior.In patients with lung cancer, malignant pericardial effusions are more common than non-malignant ones.Purulent pericardial effusions, especially those due to lung cancer, are rare in developed countries with very few reports in the literature.
PubMed: 38846671
DOI: 10.12890/2024_004477 -
Pneumonia (Nathan Qld.) Jun 2024The Covid-19 pandemic has caused immense pressure on Intensive Care Units (ICU). In patients with severe ARDS due to Covid-19, respiratory mechanics are important for...
BACKGROUND
The Covid-19 pandemic has caused immense pressure on Intensive Care Units (ICU). In patients with severe ARDS due to Covid-19, respiratory mechanics are important for determining the severity of lung damage. Lung auscultation could not be used during the pandemic despite its merit. The main objective of this study was to investigate associations between lung auscultatory sound features and lung mechanical properties, length of stay (LOS) and survival, in adults with severe Covid-19 ARDS.
METHODS
Consecutive patients admitted to a large ICU between 2020 and 2021 (n = 173) were included. Digital stethoscopes obtained auscultatory sounds and stored them in an on-line database for replay and further processing using advanced AI techniques. Correlation and regression analysis explored relationships between digital auscultation findings and lung mechanics or the ICU outcome. The resulting annotated lung sounds database is also publicly available as supplementary material.
RESULTS
The presence of squawks was associated with the ICU LOS, outcome and 90-day mortality. Other features (age, SOFA score & oxygenation index upon admission, minimum crackle entropy) had significant impact on outcome. Additional features affecting the 90-d survival were age and mean crackle entropy. Multivariate logistic regression showed that survival was affected by age, baseline SOFA, baseline oxygenation index and minimum crackle entropy.
CONCLUSIONS
Respiratory mechanics were associated with various adventitious sounds, whereas the lung sound analytics and the presence of certain adventitious sounds correlated with the ICU outcome and the 90-d survival. Spectral features of crackles sounds can serve as prognostic factors for survival, highlighting the importance of digital auscultation.
PubMed: 38835101
DOI: 10.1186/s41479-024-00131-1