The Experts below are selected from a list of 90 Experts worldwide ranked by ideXlab platform
Andres Martinez-fernandez - One of the best experts on this subject based on the ideXlab platform.
-
An open real-time tele-stethoscopy system
BioMedical Engineering OnLine, 2012Co-Authors: Ignacio Foche-perez, Rodolfo Ramirez-payba, German Hirigoyen-emparanza, Fernando Balducci-gonzalez, Francisco-javier Simo-reigadas, Joaquin Seoane-pascual, Jaime Corral-peñafiel, Andres Martinez-fernandezAbstract:Background Acute respiratory infections are the leading cause of childhood mortality. The lack of physicians in rural areas of developing countries makes difficult their correct diagnosis and treatment. The staff of rural health facilities (health-care technicians) may not be qualified to distinguish respiratory diseases by auscultation. For this reason, the goal of this project is the development of a tele-stethoscopy system that allows a physician to receive real-time cardio-respiratory sounds from a remote auscultation, as well as video images showing where the technician is placing the stethoscope on the patient’s body. Methods A real-time wireless stethoscopy system was designed. The initial requirements were: 1) The system must send audio and video synchronously over IP networks, not requiring an Internet connection; 2) It must preserve the quality of cardiorespiratory sounds, allowing to adapt the binaural pieces and the chestpiece of standard stethoscopes, and; 3) Cardiorespiratory sounds should be recordable at both sides of the communication. In order to verify the diagnostic capacity of the system, a clinical validation with eight specialists has been designed. In a preliminary test, twelve patients have been auscultated by all the physicians using the tele-stethoscopy system, versus a local auscultation using traditional stethoscope. The system must allow listen the cardiac (systolic and diastolic murmurs, gallop sound, arrhythmias) and respiratory (rhonchi, rales and crepitations, wheeze, diminished and bronchial breath sounds, Pleural Friction Rub) sounds. Results The design, development and initial validation of the real-time wireless tele-stethoscopy system are described in detail. The system was conceived from scratch as open-source, low-cost and designed in such a way that many universities and small local companies in developing countries may manufacture it. Only free open-source software has been used in order to minimize manufacturing costs and look for alliances to support its improvement and adaptation. The microcontroller firmware code, the computer software code and the PCB schematics are available for free download in a subversion repository hosted in SourceForge. Conclusions It has been shown that real-time tele-stethoscopy, together with a videoconference system that allows a remote specialist to oversee the auscultation, may be a very helpful tool in rural areas of developing countries. Introducción Las infecciones respiratorias agudas son la principal causa de mortalidad infantil. La falta de médicos en las zonas rurales de países en desarrollo hace difícil su correcto diagnóstico y tratamiento. El personal que atiende los puestos de salud rurales (técnicos de salud) no están formados para distinguir las enfermedades respiratorias por auscultación. Por esta razón, este proyecto propone el desarrollo de un sistema de tele-estetoscopia que permita a los médicos recibir en tiempo real los sonidos cardiorespiratorios de una auscultación que se está produciendo en un lugar remoto , así como ver la imagen del técnico para saber dónde está colocando el estetoscopio en el cuerpo del paciente. Métodos Se ha diseñado un estetoscopio inalámbrico de tiempo real. Los requerimientos iniciales fueron: 1) El sistema debe de enviar el audio y el vídeo de forma sincronizada, sobre redes IP, no requiriendo una conexión a Internet; 2) Se debe de preservar la calidad de los sonidos cardiorespiratorios, permitiendo adaptar la campana y las olivas de un estetoscopio convencional, y; 3) Los sonidos cardiorespiratorios deberían de poder ser grabados a ambos lados de la comunicación. Para verificar la capacidad diagnóstica del sistema se diseñó una validación clínica con ocho especialistas. En un estudio preliminar, cada uno de los ocho médicos auscultó a doce pacientes, utilizando tanto el sistema de tele-estetoscopia como un estetoscopio convencional. El sistema debe de permitir escuchar los sonidos cardiacos (murmullos diastólicos y sistólicos, galope, arritmias) y los respiratorios (roncus, estertores crepitantes, sibilancias, sonidos bronquiales atenuados y roce Pleural). Resultados Se describe en profundidad el diseño, la implementación y la evaluación inicial de un sistema inalámbrico de tiempo real de tele-estetoscopia. El sistema fue concebido con filosofía de código abierto y bajo coste, con a intención de que otras universidades y/o pequeñas empresas pudieran fabricarlo. Se ha utilizado únicamente software abierto para reducir los costes de fabricación y para buscar alianzas futuras para su mejora y adaptación. El firmware de microprocesador, el software del ordenador y los planos de la PCB están accesibles para su descarga en un repositorio de SourceForge. Conclusiones Se ha podido mostrar que un sistema de tele-estetoscopia en tiempo real, unido a un sistema de videoconferencia que permita a los especialistas realizar la auscultación a distancia, puede ser una herramienta muy útil en zonas rurales de países en desarrollo.
-
An open real-time tele-stethoscopy system.
Biomedical engineering online, 2012Co-Authors: Ignacio Foche-perez, Rodolfo Ramirez-payba, German Hirigoyen-emparanza, Fernando Balducci-gonzalez, Francisco-javier Simo-reigadas, Joaquin Seoane-pascual, Jaime Corral-peñafiel, Andres Martinez-fernandezAbstract:Background: Acute respiratory infections are the leading cause of childhood mortality. The lack of physicians in rural areas of developing countries makes difficult their correct diagnosis and treatment. The staff of rural health facilities (health-care technicians) may not be qualified to distinguish respiratory diseases by auscultation. For this reason, the goal of this project is the development of a tele-stethoscopy system that allows a physician to receive real-time cardio-respiratory sounds from a remote auscultation, as well as video images showing where the technician is placing the stethoscope on the patient’s body. Methods: A real-time wireless stethoscopy system was designed. The initial requirements were: 1) The system must send audio and video synchronously over IP networks, not requiring an Internet connection; 2) It must preserve the quality of cardiorespiratory sounds, allowing to adapt the binaural pieces and the chestpiece of standard stethoscopes, and; 3) Cardiorespiratory sounds should be recordable at both sides of the communication. In order to verify the diagnostic capacity of the system, a clinical validation with eight specialists has been designed. In a preliminary test, twelve patients have been auscultated by all the physicians using the tele-stethoscopy system, versus a local auscultation using traditional stethoscope. The system must allow listen the cardiac (systolic and diastolic murmurs, gallop sound, arrhythmias) and respiratory (rhonchi, rales and crepitations, wheeze, diminished and bronchial breath sounds, Pleural Friction Rub) sounds. Results: The design, development and initial validation of the real-time wireless tele-stethoscopy system are described in detail. The system was conceived from scratch as open-source, low-cost and designed in such a way that many universities and small local companies in developing countries may manufacture it. Only free open-source software has been used in order to minimize manufacturing costs and look for alliances to support its improvement and adaptation. The microcontroller firmware code, the computer software code and the PCB schematics are available for free download in a subversion repository hosted in SourceForge.
Victor F. Tapson - One of the best experts on this subject based on the ideXlab platform.
-
The Evaluation of Suspected Pulmonary Embolism
The New England journal of medicine, 2003Co-Authors: Peter F. Fedullo, Victor F. TapsonAbstract:An otherwise healthy 51-year-old woman presents to her physician with pleuritic right posterior chest pain, without dyspnea or hemoptysis. Her temperature is 38.2°C, and her pulse is 102 beats per minute. Physical examination discloses a Pleural Friction Rub over the posterior right hemithorax but is otherwise unremarkable. A chest radiograph is normal. She is treated with an antiinflammatory agent for presumed viral pleurisy. Three days later, she returns, reporting dyspnea. How should she be evaluated?
-
This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical
2003Co-Authors: Peter F. Fedullo, Victor F. TapsonAbstract:An otherwise healthy 51-year-old woman presents to her physician with pleuritic right posterior chest pain, without dyspnea or hemoptysis. Her temperature is 38.2°C, and her pulse is 102 beats per minute. Physical examination discloses a Pleural Friction Rub over the posterior right hemithorax but is otherwise unremarkable. A chest radiograph is normal. She is treated with an antiinflammatory agent for presumed viral pleurisy. Three days later, she returns, reporting dyspnea. How should she be evaluated?
Ignacio Foche-perez - One of the best experts on this subject based on the ideXlab platform.
-
An open real-time tele-stethoscopy system
BioMedical Engineering OnLine, 2012Co-Authors: Ignacio Foche-perez, Rodolfo Ramirez-payba, German Hirigoyen-emparanza, Fernando Balducci-gonzalez, Francisco-javier Simo-reigadas, Joaquin Seoane-pascual, Jaime Corral-peñafiel, Andres Martinez-fernandezAbstract:Background Acute respiratory infections are the leading cause of childhood mortality. The lack of physicians in rural areas of developing countries makes difficult their correct diagnosis and treatment. The staff of rural health facilities (health-care technicians) may not be qualified to distinguish respiratory diseases by auscultation. For this reason, the goal of this project is the development of a tele-stethoscopy system that allows a physician to receive real-time cardio-respiratory sounds from a remote auscultation, as well as video images showing where the technician is placing the stethoscope on the patient’s body. Methods A real-time wireless stethoscopy system was designed. The initial requirements were: 1) The system must send audio and video synchronously over IP networks, not requiring an Internet connection; 2) It must preserve the quality of cardiorespiratory sounds, allowing to adapt the binaural pieces and the chestpiece of standard stethoscopes, and; 3) Cardiorespiratory sounds should be recordable at both sides of the communication. In order to verify the diagnostic capacity of the system, a clinical validation with eight specialists has been designed. In a preliminary test, twelve patients have been auscultated by all the physicians using the tele-stethoscopy system, versus a local auscultation using traditional stethoscope. The system must allow listen the cardiac (systolic and diastolic murmurs, gallop sound, arrhythmias) and respiratory (rhonchi, rales and crepitations, wheeze, diminished and bronchial breath sounds, Pleural Friction Rub) sounds. Results The design, development and initial validation of the real-time wireless tele-stethoscopy system are described in detail. The system was conceived from scratch as open-source, low-cost and designed in such a way that many universities and small local companies in developing countries may manufacture it. Only free open-source software has been used in order to minimize manufacturing costs and look for alliances to support its improvement and adaptation. The microcontroller firmware code, the computer software code and the PCB schematics are available for free download in a subversion repository hosted in SourceForge. Conclusions It has been shown that real-time tele-stethoscopy, together with a videoconference system that allows a remote specialist to oversee the auscultation, may be a very helpful tool in rural areas of developing countries. Introducción Las infecciones respiratorias agudas son la principal causa de mortalidad infantil. La falta de médicos en las zonas rurales de países en desarrollo hace difícil su correcto diagnóstico y tratamiento. El personal que atiende los puestos de salud rurales (técnicos de salud) no están formados para distinguir las enfermedades respiratorias por auscultación. Por esta razón, este proyecto propone el desarrollo de un sistema de tele-estetoscopia que permita a los médicos recibir en tiempo real los sonidos cardiorespiratorios de una auscultación que se está produciendo en un lugar remoto , así como ver la imagen del técnico para saber dónde está colocando el estetoscopio en el cuerpo del paciente. Métodos Se ha diseñado un estetoscopio inalámbrico de tiempo real. Los requerimientos iniciales fueron: 1) El sistema debe de enviar el audio y el vídeo de forma sincronizada, sobre redes IP, no requiriendo una conexión a Internet; 2) Se debe de preservar la calidad de los sonidos cardiorespiratorios, permitiendo adaptar la campana y las olivas de un estetoscopio convencional, y; 3) Los sonidos cardiorespiratorios deberían de poder ser grabados a ambos lados de la comunicación. Para verificar la capacidad diagnóstica del sistema se diseñó una validación clínica con ocho especialistas. En un estudio preliminar, cada uno de los ocho médicos auscultó a doce pacientes, utilizando tanto el sistema de tele-estetoscopia como un estetoscopio convencional. El sistema debe de permitir escuchar los sonidos cardiacos (murmullos diastólicos y sistólicos, galope, arritmias) y los respiratorios (roncus, estertores crepitantes, sibilancias, sonidos bronquiales atenuados y roce Pleural). Resultados Se describe en profundidad el diseño, la implementación y la evaluación inicial de un sistema inalámbrico de tiempo real de tele-estetoscopia. El sistema fue concebido con filosofía de código abierto y bajo coste, con a intención de que otras universidades y/o pequeñas empresas pudieran fabricarlo. Se ha utilizado únicamente software abierto para reducir los costes de fabricación y para buscar alianzas futuras para su mejora y adaptación. El firmware de microprocesador, el software del ordenador y los planos de la PCB están accesibles para su descarga en un repositorio de SourceForge. Conclusiones Se ha podido mostrar que un sistema de tele-estetoscopia en tiempo real, unido a un sistema de videoconferencia que permita a los especialistas realizar la auscultación a distancia, puede ser una herramienta muy útil en zonas rurales de países en desarrollo.
-
An open real-time tele-stethoscopy system.
Biomedical engineering online, 2012Co-Authors: Ignacio Foche-perez, Rodolfo Ramirez-payba, German Hirigoyen-emparanza, Fernando Balducci-gonzalez, Francisco-javier Simo-reigadas, Joaquin Seoane-pascual, Jaime Corral-peñafiel, Andres Martinez-fernandezAbstract:Background: Acute respiratory infections are the leading cause of childhood mortality. The lack of physicians in rural areas of developing countries makes difficult their correct diagnosis and treatment. The staff of rural health facilities (health-care technicians) may not be qualified to distinguish respiratory diseases by auscultation. For this reason, the goal of this project is the development of a tele-stethoscopy system that allows a physician to receive real-time cardio-respiratory sounds from a remote auscultation, as well as video images showing where the technician is placing the stethoscope on the patient’s body. Methods: A real-time wireless stethoscopy system was designed. The initial requirements were: 1) The system must send audio and video synchronously over IP networks, not requiring an Internet connection; 2) It must preserve the quality of cardiorespiratory sounds, allowing to adapt the binaural pieces and the chestpiece of standard stethoscopes, and; 3) Cardiorespiratory sounds should be recordable at both sides of the communication. In order to verify the diagnostic capacity of the system, a clinical validation with eight specialists has been designed. In a preliminary test, twelve patients have been auscultated by all the physicians using the tele-stethoscopy system, versus a local auscultation using traditional stethoscope. The system must allow listen the cardiac (systolic and diastolic murmurs, gallop sound, arrhythmias) and respiratory (rhonchi, rales and crepitations, wheeze, diminished and bronchial breath sounds, Pleural Friction Rub) sounds. Results: The design, development and initial validation of the real-time wireless tele-stethoscopy system are described in detail. The system was conceived from scratch as open-source, low-cost and designed in such a way that many universities and small local companies in developing countries may manufacture it. Only free open-source software has been used in order to minimize manufacturing costs and look for alliances to support its improvement and adaptation. The microcontroller firmware code, the computer software code and the PCB schematics are available for free download in a subversion repository hosted in SourceForge.
Masahiro Miyo - One of the best experts on this subject based on the ideXlab platform.
-
Does this patient have a Pleural effusion?
JAMA : the journal of the American Medical Association, 2009Co-Authors: Camilla L Wong, Jayna Holroyd-leduc, Shinko Onda, Masaru Kamonji, Shinji Sugiyama, Hiroshi Fukuda, Takehisa Matsuda, Stephen E Straus, Masahiro MiyoAbstract:CONTEXT: Pleural effusion is a common finding among patients presenting with respiratory symptoms. The value of the bedside examination to detect Pleural effusion is unclear. OBJECTIVE: To systematically review the evidence regarding the accuracy of the physical examination in assessing the probability of a Pleural effusion. DATA SOURCES: We searched MEDLINE (1950-October 2008) and EMBASE (1980-October 2008) using Ovid to identify English-language studies conducted in a clinical setting. Additional studies were identified by searching the bibliographies of retrieved articles and contacting experts in the field. STUDY SELECTION: We included prospective studies of diagnostic accuracy that compared at least 1 physical examination maneuver with radiographic confirmation of Pleural effusion. DATA EXTRACTION: Three authors independently appraised study quality and extracted relevant data. Data regarding participant recruitment, reference standard, diagnostic test(s), and test accuracy were extracted. Disagreements were resolved by consensus. DATA SYNTHESIS: We identified 310 unique citations, but only 5 prospectively conducted studies met inclusion criteria (N = 934 patients). A random-effects model was used for quantitative synthesis. Of the 8 physical examination maneuvers evaluated in the included studies (conventional percussion, auscultatory percussion, breath sounds, chest expansion, tactile vocal fremitus, vocal resonance, crackles, and Pleural Friction Rub), dullness to conventional percussion was most accurate for diagnosing Pleural effusion (summary positive likelihood ratio, 8.7; 95% confidence interval, 2.2-33.8), while the absence of reduced tactile vocal fremitus made Pleural effusion less likely (negative likelihood ratio, 0.21; 95% confidence interval, 0.12-0.37). CONCLUSIONS: Based on the limited number of studies, dullness to percussion and tactile fremitus are the most useful findings for Pleural effusion. Dull chest percussion makes the probability of a Pleural effusion much more likely but requires a chest radiograph to confirm the diagnosis. When the pretest probability of Pleural effusion is low, the absence of reduced tactile vocal fremitus makes Pleural effusion less likely so that a chest radiograph might not be necessary depending on the overall clinical situation.
Peter F. Fedullo - One of the best experts on this subject based on the ideXlab platform.
-
The Evaluation of Suspected Pulmonary Embolism
The New England journal of medicine, 2003Co-Authors: Peter F. Fedullo, Victor F. TapsonAbstract:An otherwise healthy 51-year-old woman presents to her physician with pleuritic right posterior chest pain, without dyspnea or hemoptysis. Her temperature is 38.2°C, and her pulse is 102 beats per minute. Physical examination discloses a Pleural Friction Rub over the posterior right hemithorax but is otherwise unremarkable. A chest radiograph is normal. She is treated with an antiinflammatory agent for presumed viral pleurisy. Three days later, she returns, reporting dyspnea. How should she be evaluated?
-
This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical
2003Co-Authors: Peter F. Fedullo, Victor F. TapsonAbstract:An otherwise healthy 51-year-old woman presents to her physician with pleuritic right posterior chest pain, without dyspnea or hemoptysis. Her temperature is 38.2°C, and her pulse is 102 beats per minute. Physical examination discloses a Pleural Friction Rub over the posterior right hemithorax but is otherwise unremarkable. A chest radiograph is normal. She is treated with an antiinflammatory agent for presumed viral pleurisy. Three days later, she returns, reporting dyspnea. How should she be evaluated?