Tonic-clonic seizure detection using accelerometry-based wearable sensors: A prospective, video-EEG controlled study.

PURPOSE: The aim of this prospective, video-electroencephalography (video-EEG) controlled study was to evaluate the performance of an accelerometry-based wearable system to detect tonic-clonic seizures (TCSs) and to investigate the accuracy of different seizure detection algorithms using separate training and test data sets. METHODS: Seventy-five epilepsy surgery candidates undergoing video-EEG monitoring were included. The patients wore one three-axis accelerometer on each wrist during video-EEG. The accelerometer data was band-pass filtered and reduced using a movement threshold and mapped to a time-frequency feature space representation. Algorithms based on standard binary classifiers combined with a TCS specific event detection layer were developed and trained using the training set. Their performance was evaluated in terms of sensitivity and false positive (FP) rate using the test set. RESULTS: Thirty-seven available TCSs in 11 patients were recorded and the data was divided into disjoint training (27 TCSs, three patients) and test (10 TCSs, eight patients) data sets. The classification algorithms evaluated were K-nearest-neighbors (KNN), random forest (RF) and a linear kernel support vector machine (SVM). For the TCSs detection performance of the three algorithms in the test set, the highest sensitivity was obtained for KNN (100% sensitivity, 0.05 FP/h) and the lowest FP rate was obtained for RF (90% sensitivity, 0.01 FP/h). CONCLUSIONS: The low FP rate enhances the clinical utility of the detection system for long-term reliable seizure monitoring. It also allows a possible implementation of an automated TCS detection in free-living environment, which could contribute to ascertain seizure frequency and thereby better seizure management.

Effect of Complex Working Conditions on Nurses Who Exert Coercive Measures in Forensic Psychiatric Care.

Nurses who exert coercive measures on patients within psychiatric care are emotionally affected. However, research on their working conditions and environment is limited. The purpose of the current study was to describe nurses' experiences and thoughts concerning the exertion of coercive measures in forensic psychiatric care. The investigation was a qualitative interview study using unstructured interviews; data were analyzed with inductive content analysis. Results described participants' thoughts and experiences of coercive measures from four main categories: (a) acting against the patients' will, (b) reasoning about ethical justifications, (c) feelings of compassion, and (d) the need for debriefing. The current study illuminates the working conditions of nurses who exert coercive measures in clinical practice with patients who have a long-term relationship with severe symptomatology. The findings are important to further discuss how nurses and leaders can promote a healthier working environment. [Journal of Psychosocial Nursing and Mental Health Services, 54(9), 37-43.].