A Cost-effective, Patient-facing Electronic Stethoscope For Telemedical Cardiac Auscultation

Introduction: The COVID19 pandemic spurred an unprecedented growth in telehealth utilization across medical specialties which challenged providers to adapt their standard history and physical protocols for the virtual realm. Heart failure clinicians could readily translate some aspects of physical examination such as jugular venous distention and lower extremity edema assessment over video incorporating bendopnea to gain additional information. However, objective data for clinicians to rely on and guide therapy was often missing. A myriad of technology is available to bridge this gap ranging from simple wearables to invasive hemodynamic monitors though come with varying price tags and avenues of accessibility. Objective(s): We sought to develop an affordable, patient-facing electronic stethoscope of comparable quality to those existing that could seamlessly integrate with any telemedicine platform for real-time or asynchronous clinician review. Method(s): A rigorous design process guided by clinician and patient input generated nearly 100 concepts stratified through a pugh decision matrix in reference to an existing product, the Eko Core, to decide on the most suitable design - the AusculBand. With the form factor of a wrist-band, the AusculBand encases a custom bell with a high fidelity microphone and unique circuitry to sit comfortably in the palm of a user's hand to facilitate self-auscultation over the chest wall for real-time clinician review via telemedicine. Recognizing cardiac sounds to fall between 20 Hz and 2000 Hz, frequency response testing was conducted to determine the cut-off frequency of the AusculBand. With knowledge of an industry standard signal-to-noise ratio of 10.31 dB, a simple comparative study was devised between our novel AusculBand and the commercial Eko Core. With each device, a single-user in replicative fashion collected cardiac signals from the chest wall and background noise from the bicep to generate signal-to-noise ratio readouts and compare overall sound quality. Result(s): In response to frequency testing, the AusculBand was found to attenuate frequencies higher than 1997 Hz when testing a signal that swept through a range of 0 to 3,000 Hz at a constant amplitude. This result was within 0.2% of the 2000 Hz upper-limit of cardiac sounds and surpassing our design input goal of <= 1%. Signal-to-noise ratio analysis revealed 27.29 dB for the AusculBand and 24.02 dB for the Eko Core each exceeding the industry standard of 10.31 dB. Head-to-head comparison revealed the AusculBand achieved nearly double the loudness of the Eko Core. The projected price of the AusculBand is $80. The Eko Core is currently marketed at $350. Conclusion(s): The AusculBand is a cost-effective, patient-facing electronic stethoscope that surpasses industry standards in signal-to-noise ratio and is readily adaptable to popular telemedicine platforms. Additional modification is underway to add a single-lead electrocardiogram to bolster the device as an all-in-one, affordable and accessible telemedicine tool for cardiac analysis.Copyright © 2022

Evaluation of an expert center video clinic for patients with chronic spontaneous urticaria

Background: The COVID-19 pandemic dramatically disrupts health care around the globe. The recent COVID-CU study performed at urticaria centers of reference and excellence (UCAREs) demonstrated that the rate of face-to- face consultations decreased from 90% to less than half, whereas the rate of remote consultations increased by more than 600%, from one in 10 to more than two thirds. As of now, it is largely unclear how this affects patients with chronic urticaria. Method(s): We assessed a UCARE video clinic for chronic spontaneous urticaria (CSU) for applicability and satisfaction by patients. Result(s): From January of to October of 2021, 78 patients (mean age 39.7 yrs, 73.3% female) with CSU participated in this survey study. More than 90% patients perceived the image transmission and sound quality as smooth and without distortion. Virtually all patients (96.9%) found that the previously provided explanations and instructions on technical handling were easy to understand and accurate. Patients rated the scheduling and planning of the video consultation as good (98.5%) and stated that it was effortless and within reasonable time (93.8%). Overall, 90.8% felt safe and well informed when using the technology. Most patients reported that the specified time of 20 minutes was sufficient (75.4%), that they were able to address all relevant points (68.8%), and that they received sufficient information about their disease (70.8%) during the video consultation. Almost 80% reported that they felt they were being treated professionally and that they were satisfied with how the conversation with their treating physician unfolded. The majority of patients adjusted quickly and easily to the situation of a video consultation (84.6%) and felt well treated with regard to their medical needs (73.9%). In general, the concept of a video clinic and remote treatment were well perceived and easy to use for most patients (81.5%), and the majority could imagine being treated regularly in this setting in the future (75.4%). Conclusion(s): UCARE video clinic consultations are well received by patients with CSU, which suggests that this instrument may be useful during and beyond the COVID-19 pandemic in the management of patients with chronic urticaria by specialized centers.

The concept auf urban soundscapes in the context of alternative small-scale mobility interventions - the Be-MoVe Project

Einleitung For a transformation of cities into sustainable and health-promoting places, the development of suitable acoustic urban spaces is necessary. The acoustic environment, as a designable quality in urban spaces, can be understood as an important resource for a health-promoting city. In particular, motorized mobility plays a central role in urban areas, as recently demonstrated by the massive impact of the COVID-19 lockdown restrictions on the urban acoustic environment. The Be-MoVe (participation-based transformation of active mobility for health-promoting urban and transport infrastructures) project is a new public health intervention project, launched end of 2021. The main objective of the cooperation project of the Green Capital Agency of the city of Essen, the Institute for Mobility and Urban Planning and the Institute for Urban Public Health is to test co-created alternative forms of mobility and designs of public spaces in neighborhoods. Aim here is to present the study design of the sub-project urban soundscapes. The sub-project addresses the evaluation of planned temporary mobility interventions in terms of their impact on recorded noise emission as well as on the perceived acoustic environment of local residents. Methoden Real-World Labs will be set up in two Essen neighborhoods over the next two years. Together with local residents various temporary measures such as road closures, speed reductions, protected bike lanes and premium pedestrian routes will be implemented on an experimental basis for several months. To assess the perceived acoustic environment, we conduct soundwalks, a participatory instrument described and standardized in the DIN ISO 12913 series. The DIN standards provide guidelines for the application of soundwalks, including questionnaires. The questionnaires aim to identify distinctive sound sources as well as to evaluate the perceived sounds according to predefined criteria, including affective qualities. Soundwalks will be conducted before, during and after the interventions developed in the Real-World Labs. Eight sound walk groups of five people each are planned. Participants are recruited via public relations work, as well as by directly approaching local actors such as sports clubs and citizens' initiatives. In addition, automatic and binaural audio recordings are performed. The recordings allow to analyze the acoustic environment of primarily physical-acoustic characteristics from biophonic, geophonic and anthrophonic sounds and to compare changes of the acoustic environment due to the interventions independent of human perception. Ergebnisse - Schlussfolgerung The inclusion of the concept of sound quality in regard to mobility interventions as well as a link between perception-related and physical-acoustic parameters represent innovative components of this project. The implementation of the soundscape concept in participation-based urban transformations might help to motivate residents for a more health promoting and sustainable active mobility.

Remote instruction of airway intubation using virtual reality: A randomized controlled trial

INTRODUCTION/HYPOTHESES: Airway intubation is essential for critical care. Prompted by COVID restrictions on in-person instruction, we evaluated a novel method of remotely training airway intubation: livestreaming in immersive virtual reality (VR). We hypothesized that performance on the procedure, confidence, and subjective experience ratings would be higher for training with VR than a 2D display control. METHOD: 26 preclinical medical students participated (Mage=24 years, SD=2.2 years;50% were female). After IRB approval, 13 participants were assigned randomly to each condition: VR or 2D display (control). Participants used either VR or 2D display to receive instruction on airway intubation. Participants reported their confidence pre/posttraining and rated their experience with the technology on Likert items. Participants then attempted the procedure on a manikin using a video assisted laryngoscope. RESULTS: The average percent correct on the airway intubation procedure was 68% in the VR group (SD=19%) and 60% in the 2D group (SD=22%), but performance did not differ significantly by group (t[24]=0.996, p=.17, d=0.39, all reported p values are 1-tailed). Both groups reported more confidence following training (F[1,24]=72.89, p< .001, ηp 2=0.75), but confidence did not differ by group (F[1,24]=0.797, p=0.38, ηp 2=0.03). On the Likert items, participants rated VR as a more acceptable format than 2D display for airway intubation training (t[24]=1.691, p=.05, d=0.66), and rated the sound quality higher for VR (t[24]=1.712, p=.05, d=0.68). The other Likert items were rated in the predicted direction but did not reach significance: Enjoyment (t[19.81]=1.157, p=.13, d=0.45), Satisfaction (t[24]=1.254, p=.11, d=0.49), and Acceptability of Camera Placement (t[24] = 0.494, p=.31, d=0.19). Usability scores also did not differ by group (t[23]=-.200, p=.42, d=-0.08). CONCLUSIONS: Medical students rated VR as more acceptable for training airway intubation than a 2D display, but VR did not significantly affect performance or confidence when compared to an instructionally-equivalent 2D display condition. Most results were in the predicted direction with medium effect sizes, but statistical power was only sufficient for large effect sizes. Thus, further research is warranted on the degree to which VR adds value to remote training. .