Towards developing a reliable medical device for automated epileptic seizure detection in the ICU

Abstract. Epilepsy is a prevalent neurological disorder that affects millions of people globally, and its diagnosis typically involves laborious manual inspection of electroencephalography (EEG) data. Automated detection of epileptic seizures in EEG signals could potentially improve diagnostic accuracy and reduce diagnosis time, but there should be special attention to the number of false alarms to reduce unnecessary treatments and costs. This research presents a study on the use of machine learning techniques for EEG seizure detection with the aim of investigating the effectiveness of different algorithms in terms of high sensitivity and low false alarm rates for feature extraction, selection, pre-processing, classification, and post-processing in designing a medical device for detecting seizure activity in EEG data. The current state-of-the-art methods which are validated clinically using large amounts of data are introduced. The study focuses on finding potential machine learning methods, considering KNN, SVM, decision trees and, Random forests, and compares their performance on the task of seizure detection using features introduced in the literature. Also using ensemble methods namely, bootstrapping and majority voting techniques we achieved a sensitivity of 0.80 and FAR/h of 2.10, accuracy of 97.1% and specificity of 98.2%. Overall, the findings of this study can be useful for developing more accurate and efficient algorithms for EEG seizure detection medical device, which can contribute to the early diagnosis and treatment of epilepsy in the intensive care unit for critically ill patients

Patient Monitoring Systems

book chapterBiomedical Informatic

Clinical deterioration detection for continuous vital signs monitoring using wearable sensors

Surgical patients are at risk of experiencing clinical deterioration events, especially when transferred to general wards during the postoperative period of their hospital stay. Cur rently, such events are detected by combining Early Warning Scores (EWS) with manual and periodical vital signs measurements, performed by nurses every 4 to 6 hours. Hence, deterioration may remain unnoticed for hours, delaying patient treatment, which might lead to increased morbidity and mortality. Also, EWS are inadequate to predict events so physiologically complex. So that early warning of deterioration could be provided, it was investigated the potential of warning systems that combine machine learning-based prediction models with continuous vital signs monitoring, provided by wearable sensors. This dissertation presents the development of such a warning system, fully indepen dent of manual measurements and based on a logistic regression prediction model with 85% sensitivity, 79% precision and 98% specificity. Additionally, a new personalized ap proach to handle missing data periods in vital signs and a novel variation of a RR-interval preprocessing technique were developed. The results obtained revealed a relevant im provement in the detection of deterioration events and a significant reduction in false alarms, when comparing the warning system with a commonly employed EWS (42% sensitivity, 14% precision and 90% specificity). It was also found that the developed sys tem can assess patient’s condition much more frequently and with timely deterioration detection, without even requiring nurses to interrupt their workflow. These findings sup port the idea that these warning systems are reliable, more practical, more appropriate and produce smarter alarms than current methods, making early deterioration detection possible, thus contributing for better patients outcomes. Nonetheless, the performance achieved may yet reveal insufficient for application in real clinical contexts. Therefore, further work is necessary to improve prediction performance to a greater extent and to confirm these systems reliability

Automatic Pain Assessment by Learning from Multiple Biopotentials

Kivun täsmällinen arviointi on tärkeää kivunhallinnassa, erityisesti sairaan- hoitoa vaativille ipupotilaille. Kipu on subjektiivista, sillä se ei ole pelkästään aistituntemus, vaan siihen saattaa liittyä myös tunnekokemuksia. Tällöin itsearviointiin perustuvat kipuasteikot ovat tärkein työkalu, niin auan kun potilas pystyy kokemuksensa arvioimaan. Arviointi on kuitenkin haasteellista potilailla, jotka eivät itse pysty kertomaan kivustaan. Kliinisessä hoito- työssä kipua pyritään objektiivisesti arvioimaan esimerkiksi havainnoimalla fysiologisia muuttujia kuten sykettä ja käyttäytymistä esimerkiksi potilaan kasvonilmeiden perusteella. Tutkimuksen päätavoitteena on automatisoida arviointiprosessi hyödyntämällä koneoppimismenetelmiä yhdessä biosignaalien prosessointnin kanssa. Tavoitteen saavuttamiseksi mitattiin autonomista keskushermoston toimintaa kuvastavia biopotentiaaleja: sydänsähkökäyrää, galvaanista ihoreaktiota ja kasvolihasliikkeitä mittaavaa lihassähkökäyrää. Mittaukset tehtiin terveillä vapaaehtoisilla, joille aiheutettiin kokeellista kipuärsykettä. Järestelmän kehittämiseen tarvittavaa tietokantaa varten rakennettiin biopotentiaaleja keräävä Internet of Things -pohjainen tallennusjärjestelmä. Koostetun tietokannan avulla kehitettiin biosignaaleille prosessointimenetelmä jatku- vaan kivun arviointiin. Signaaleista eroteltiin piirteitä sekuntitasoon mukautetuilla aikaikkunoilla. Piirteet visualisoitiin ja tarkasteltiin eri luokittelijoilla kivun ja kiputason tunnistamiseksi. Parhailla luokittelumenetelmillä saavutettiin kivuntunnistukseen 90% herkkyyskyky (sensitivity) ja 84% erottelukyky (specificity) ja kivun voimakkuuden arviointiin 62,5% tarkkuus (accuracy). Tulokset vahvistavat kyseisen käsittelytavan käyttökelpoisuuden erityis- esti tunnistettaessa kipua yksittäisessä arviointi-ikkunassa. Tutkimus vahvistaa biopotentiaalien avulla kehitettävän automatisoidun kivun arvioinnin toteutettavuuden kokeellisella kivulla, rohkaisten etenemään todellisen kivun tutkimiseen samoilla menetelmillä. Menetelmää kehitettäessä suoritettiin lisäksi vertailua ja yhteenvetoa automaattiseen kivuntunnistukseen kehitettyjen eri tutkimusten välisistä samankaltaisuuksista ja eroista. Tarkastelussa löytyi signaalien eroavaisuuksien lisäksi tutkimusmuotojen aiheuttamaa eroa arviointitavoitteisiin, mikä hankaloitti tutkimusten vertailua. Lisäksi pohdit- tiin mitkä perinteisten prosessointitapojen osiot rajoittavat tai edistävät ennustekykyä ja miten, sekä tuoko optimointi läpimurtoa järjestelmän näkökulmasta.Accurate pain assessment plays an important role in proper pain management, especially among hospitalized people experience acute pain. Pain is subjective in nature which is not only a sensory feeling but could also combine affective factors. Therefore self-report pain scales are the main assessment tools as long as patients are able to self-report. However, it remains a challenge to assess the pain from the patients who cannot self-report. In clinical practice, physiological parameters like heart rate and pain behaviors including facial expressions are observed as empirical references to infer pain objectively. The main aim of this study is to automate such process by leveraging machine learning methods and biosignal processing. To achieve this goal, biopotentials reflecting autonomic nervous system activities including electrocardiogram and galvanic skin response, and facial expressions measured with facial electromyograms were recorded from healthy volunteers undergoing experimental pain stimulus. IoT-enabled biopotential acquisition systems were developed to build the database aiming at providing compact and wearable solutions. Using the database, a biosignal processing flow was developed for continuous pain estimation. Signal features were extracted with customized time window lengths and updated every second. The extracted features were visualized and fed into multiple classifiers trained to estimate the presence of pain and pain intensity separately. Among the tested classifiers, the best pain presence estimating sensitivity achieved was 90% (specificity 84%) and the best pain intensity estimation accuracy achieved was 62.5%. The results show the validity of the proposed processing flow, especially in pain presence estimation at window level. This study adds one more piece of evidence on the feasibility of developing an automatic pain assessment tool from biopotentials, thus providing the confidence to move forward to real pain cases. In addition to the method development, the similarities and differences between automatic pain assessment studies were compared and summarized. It was found that in addition to the diversity of signals, the estimation goals also differed as a result of different study designs which made cross dataset comparison challenging. We also tried to discuss which parts in the classical processing flow would limit or boost the prediction performance and whether optimization can bring a breakthrough from the system’s perspective

The Effect of Procedural Changes on the Rate of Clinical Alarms In the Intensive Care Unit

Clinical alarms have become an indispensable part of medical environment, but issues related to alarm artifacts, false alarms, and alarm fatigue have been identified. A national online survey administered to hospitals stated healthcare workers determined that 81% of respondents agreed that alarms occur frequently, 77% agreed that excessive clinical alarms disrupt patient care, and 78% agreed that reduced trust in alarms cause caregivers to disable them (Korniewicz, Clark, & David, 2008). Studies have suggested that preparation of skin of the patient improves electrode-skin contact, thereby resulting in fewer artifacts (Hermens, Freriks, Disselhorst-Klug, & Rau, 2000). Additionally, clinical studies have shown that the electrode-skin interface is frequently overlooked as a major source of artifact affecting many electro-physiologic recordings (Oster, 1998). The purpose of the thesis is to evaluate how the implementation of procedural changes, specifically implementing a patient\u27s chest preparation procedure prior to electrode placement influences the rate of clinical alarms, (i.e., critical or warning cardiac alarms) in an intensive care unit (ICU). Data from clinical alarms were collected from a regional hospital in South Carolina. The data contained the number of clinical alarms recorded with and without nurse administered chest preparation. Functional data analysis was used to evaluate if chest preparation procedure had a significant impact on the rate of clinical alarms produced over an 8-hour shift. The results suggest that there is no significant reduction in the alarm frequency after the implementation of nurse administered chest preparation. However, a nominal decrease in the number of alarms per hour per patient and some preliminary trends were observed during the data analysis that warrants the need for future research in this direction

C-Trend parameters and possibilities of federated learning

Abstract. In this observational study, federated learning, a cutting-edge approach to machine learning, was applied to one of the parameters provided by C-Trend Technology developed by Cerenion Oy. The aim was to compare the performance of federated learning to that of conventional machine learning. Additionally, the potential of federated learning for resolving the privacy concerns that prevent machine learning from realizing its full potential in the medical field was explored. Federated learning was applied to burst-suppression ratio’s machine learning and it was compared to the conventional machine learning of burst-suppression ratio calculated on the same dataset. A suitable aggregation method was developed and used in the updating of the global model. The performance metrics were compared and a descriptive analysis including box plots and histograms was conducted. As anticipated, towards the end of the training, federated learning’s performance was able to approach that of conventional machine learning. The strategy can be regarded to be valid because the performance metric values remained below the set test criterion levels. With this strategy, we will potentially be able to make use of data that would normally be kept confidential and, as we gain access to more data, eventually develop machine learning models that perform better. Federated learning has some great advantages and utilizing it in the context of qEEGs’ machine learning could potentially lead to models, which reach better performance by receiving data from multiple institutions without the difficulties of privacy restrictions. Some possible future directions include an implementation on heterogeneous data and on larger data volume.C-Trend-teknologian parametrit ja federoidun oppimisen mahdollisuudet. Tiivistelmä. Tässä havainnointitutkimuksessa federoitua oppimista, koneoppimisen huippuluokan lähestymistapaa, sovellettiin yhteen Cerenion Oy:n kehittämään C-Trend-teknologian tarjoamaan parametriin. Tavoitteena oli verrata federoidun oppimisen suorituskykyä perinteisen koneoppimisen suorituskykyyn. Lisäksi tutkittiin federoidun oppimisen mahdollisuuksia ratkaista yksityisyyden suojaan liittyviä rajoitteita, jotka estävät koneoppimista hyödyntämästä täyttä potentiaaliaan lääketieteen alalla. Federoitua oppimista sovellettiin purskevaimentumasuhteen koneoppimiseen ja sitä verrattiin purskevaimentumasuhteen laskemiseen, johon käytettiin perinteistä koneoppimista. Kummankin laskentaan käytettiin samaa dataa. Sopiva aggregointimenetelmä kehitettiin, jota käytettiin globaalin mallin päivittämisessä. Suorituskykymittareiden tuloksia verrattiin keskenään ja tehtiin kuvaileva analyysi, johon sisältyi laatikkokuvioita ja histogrammeja. Odotetusti opetuksen loppupuolella federoidun oppimisen suorituskyky pystyi lähestymään perinteisen koneoppimisen suorituskykyä. Menetelmää voidaan pitää pätevänä, koska suorituskykymittarin arvot pysyivät alle asetettujen testikriteerien tasojen. Tämän menetelmän avulla voimme ehkä hyödyntää dataa, joka normaalisti pidettäisiin salassa, ja kun saamme lisää dataa käyttöömme, voimme lopulta kehittää koneoppimismalleja, jotka saavuttavat paremman suorituskyvyn. Federoidulla oppimisella on joitakin suuria etuja, ja sen hyödyntäminen qEEG:n koneoppimisen yhteydessä voisi mahdollisesti johtaa malleihin, jotka saavuttavat paremman suorituskyvyn saamalla tietoja useista eri lähteistä ilman yksityisyyden suojaan liittyviä rajoituksia. Joitakin mahdollisia tulevia suuntauksia ovat muun muassa heterogeenisen datan ja suurempien tietomäärien käyttö