Review on the current trends in tongue diagnosis systems

AbstractTongue diagnosis is an essential process to noninvasively assess the condition of a patient's internal organs in traditional medicine. To obtain quantitative and objective diagnostic results, image acquisition and analysis devices called tongue diagnosis systems (TDSs) are required. These systems consist of hardware including cameras, light sources, and a ColorChecker, and software for color correction, segmentation of tongue region, and tongue classification. To improve the performance of TDSs, various types TDSs have been developed. Hyperspectral imaging TDSs have been suggested to acquire more information than a two-dimensional (2D) image with visible light waves, as it allows collection of data from multiple bands. Three-dimensional (3D) imaging TDSs have been suggested to provide 3D geometry. In the near future, mobile devices like the smart phone will offer applications for assessment of health condition using tongue images. Various technologies for the TDS have respective unique advantages and specificities according to the application and diagnostic environment, but this variation may cause inconsistent diagnoses in practical clinical applications. In this manuscript, we reviewed the current trends in TDSs for the standardization of systems. In conclusion, the standardization of TDSs can supply the general public and oriental medical doctors with convenient, prompt, and accurate information with diagnostic results for assessing the health condition

Advances in Patient Classification for Traditional Chinese Medicine: A Machine Learning Perspective

As a complementary and alternative medicine in medical field, traditional Chinese medicine (TCM) has drawn great attention in the domestic field and overseas. In practice, TCM provides a quite distinct methodology to patient diagnosis and treatment compared to western medicine (WM). Syndrome (ZHENG or pattern) is differentiated by a set of symptoms and signs examined from an individual by four main diagnostic methods: inspection, auscultation and olfaction, interrogation, and palpation which reflects the pathological and physiological changes of disease occurrence and development. Patient classification is to divide patients into several classes based on different criteria. In this paper, from the machine learning perspective, a survey on patient classification issue will be summarized on three major aspects of TCM: sign classification, syndrome differentiation, and disease classification. With the consideration of different diagnostic data analyzed by different computational methods, we present the overview for four subfields of TCM diagnosis, respectively. For each subfield, we design a rectangular reference list with applications in the horizontal direction and machine learning algorithms in the longitudinal direction. According to the current development of objective TCM diagnosis for patient classification, a discussion of the research issues around machine learning techniques with applications to TCM diagnosis is given to facilitate the further research for TCM patient classification

Diagnostic accuracy of pattern differentiation algorithm based on Chinese medicine theory: a stochastic simulation study

<p>Abstract</p> <p>Background</p> <p>Clinical practice of Chinese medicine requires little information for differentiation of <it>Zang-fu </it>patterns. This study is to test the impact of information amount on the diagnostic accuracy of pattern differentiation algorithm (PDA) using stochastic simulation of cases.</p> <p>Methods</p> <p>A dataset with 69 <it>Zang-fu </it>single patterns was used with manifestations according to the Four Examinations, namely inspection (Ip), auscultation and olfaction (AO), inquiry (Iq) and palpation (P). A variable quantity of available information (<it>N</it>_%) was randomly sampled to generate 100 true positive and 100 true negative manifestation profiles per pattern to which PDA was applied. Four runs of simulations were used according to the Four Examinations: Ip, Ip+AO, Ip+AO+Iq and Ip+AO+Iq+P. The algorithm performed pattern differentiation by ranking a list of diagnostic hypotheses by the amount of explained information <it>F</it>_%. Accuracy, sensitivity, specificity and negative and positive predictive values were calculated.</p> <p>Results</p> <p>Use the Four Examinations resulted in the best accuracy with the smallest cutoff value (<it>N</it>_%= 28.5%), followed by Ip+AO+Iq (33.5%), Ip+AO (51.5%) and Ip (52.0%). All tested combinations provided concave-shaped curves for accuracy, indicating an optimal value subject to <it>N</it>_{%-<it>cutoff</it>}. Use of <it>N</it>_%-cutoffas a secondary criterion resulted in 94.7% (94.3; 95.1) accuracy, 89.8% (89.1; 90.6) sensitivity, and 99.5% (99.3; 99.7) specificity with the Four Examinations.</p> <p>Conclusion</p> <p>Pattern differentiation based on both explained and optimum available information (<it>F</it>_%and <it>N</it>_{%-<it>cutoff</it>}) is more accurate than using explained and available information without cutoff (<it>F</it>_%and <it>N</it>_%). Both <it>F</it>_%and <it>N</it>_{%-<it>cutoff </it>}should be used as PDA's objective criteria to perform <it>Zang-fu </it>single pattern differentiation.</p

An investigation into the effects of commencing haemodialysis in the critically ill

&lt;b&gt;Introduction:&lt;/b&gt; We have aimed to describe haemodynamic changes when haemodialysis is instituted in the critically ill. 3 hypotheses are tested: 1)The initial session is associated with cardiovascular instability, 2)The initial session is associated with more cardiovascular instability compared to subsequent sessions, and 3)Looking at unstable sessions alone, there will be a greater proportion of potentially harmful changes in the initial sessions compared to subsequent ones. &lt;b&gt;Methods:&lt;/b&gt; Data was collected for 209 patients, identifying 1605 dialysis sessions. Analysis was performed on hourly records, classifying sessions as stable/unstable by a cutoff of &gt;+/-20% change in baseline physiology (HR/MAP). Data from 3 hours prior, and 4 hours after dialysis was included, and average and minimum values derived. 3 time comparisons were made (pre-HD:during, during HD:post, pre-HD:post). Initial sessions were analysed separately from subsequent sessions to derive 2 groups. If a session was identified as being unstable, then the nature of instability was examined by recording whether changes crossed defined physiological ranges. The changes seen in unstable sessions could be described as to their effects: being harmful/potentially harmful, or beneficial/potentially beneficial. &lt;b&gt;Results:&lt;/b&gt; Discarding incomplete data, 181 initial and 1382 subsequent sessions were analysed. A session was deemed to be stable if there was no significant change (&gt;+/-20%) in the time-averaged or minimum MAP/HR across time comparisons. By this definition 85/181 initial sessions were unstable (47%, 95% CI SEM 39.8-54.2). Therefore Hypothesis 1 is accepted. This compares to 44% of subsequent sessions (95% CI 41.1-46.3). Comparing these proportions and their respective CI gives a 95% CI for the standard error of the difference of -4% to 10%. Therefore Hypothesis 2 is rejected. In initial sessions there were 92/1020 harmful changes. This gives a proportion of 9.0% (95% CI SEM 7.4-10.9). In the subsequent sessions there were 712/7248 harmful changes. This gives a proportion of 9.8% (95% CI SEM 9.1-10.5). Comparing the two unpaired proportions gives a difference of -0.08% with a 95% CI of the SE of the difference of -2.5 to +1.2. Hypothesis 3 is rejected. Fisher’s exact test gives a result of p=0.68, reinforcing the lack of significant variance. &lt;b&gt;Conclusions:&lt;/b&gt; Our results reject the claims that using haemodialysis is an inherently unstable choice of therapy. Although proportionally more of the initial sessions are classed as unstable, the majority of MAP and HR changes are beneficial in nature

Acupuncture during stroke rehabilitation: development of a manual for researching a complex intervention

BACKGROUND AND AIMS Evidence on acupuncture during stroke rehabilitation is inconsistent, with methodological problems including inappropriately standardized treatment protocols. This project developed and assessed feasibility of methods to study an individualized acupuncture intervention during acute stroke rehabilitation. DESIGN AND METHODS This three-part project aimed to 1) develop a manual for post-stroke acupuncture therapy; 2) determine feasibility of methods for future study and 3) explore stakeholder perceptions of acupuncture’s impact. First, a treatment manual was developed. Second, a cohort study used the manual to treat 48 inpatients, who had elected acupuncture treatment(n=25) or usual care only (n=23). Acupuncture was given 3-4 times weekly for 2-4 weeks. Outcomes assessed for feasibility included the Functional Independence Measure (FIM), Modified Rankin Scale of global disability (mRS) and assessments of sleep, swallowing and bowel function(at baseline and discharge, with mRS also at 6-month follow-up). Confidence intervals were compared across mild, moderate and severe subgroups. The third study assessed stakeholder perceptions of acupuncture impact. Acupuncture patients were briefly interviewed, with surveys given to family, rehabilitation therapists, nurses and physicians. Impacts of acupuncture were identified using thematic analysis, and compared quantitatively across severity groups. RESULTS Improvement in FIM scores was similar in self-selected cohorts choosing acupuncture (Mdn=37.5) and usual care (Mdn=35), 95% CI [-6, 6]. FIMiii motor domain scores trended higher in the moderate subgroup only. Feasibility criteria were met for the outcomes of 6-month mRS, bowel function, and sleep. Findings of Project 3 included a wide range of perceived benefits, with no negative impact. Benefits included improved upper and lower extremity motor function, walking, relaxation, and pain reduction. Staff reported better mood and participation in physical and occupational therapy. Reported benefits differed across severity subgroups, but proportion of stakeholders perceiving benefit was similar. CONCLUSIONS Further research on acupuncture during stroke rehabilitation is feasible, given mutually appropriate intervention, patient population and outcome measures. The widely used FIM appears inappropriate for future study, except possibly for patients in the moderate range of severity. No outcome reached statistical significance in this small non-randomized study. Trends favored the acupuncture group on most secondary outcomes including 6-month mRS, sleep and bowel function. Additional directions for further study include the relationship between cortical damage and acupuncture responsiveness, and possible benefit to the rehabilitation process itself

Reducing infusion failure in children by the addition of low-dose heparin to infusate

Nurses are frequently ‘involved in the initiation and management of intravenous (IV) infusions in infants, children and adults. Many patients tend to develop adverse local venous reactions and the infusions fail. Failure of such infusions due to extravasation and/or phlebitis/infusion thrombophlebitis is probably the commonest iatrogenic sequelae to IV therapy. The implications of this study for nursing/nurses would include fewer' problems with IV' solution flOW’ rates, a reduction in medical/nursing hours associated with frequent re—cannulations, less likelihood of systemic sepsis and less patient worry and discomfort due to local venous reactions and re—cannulations. MOST IMPORTANT IS THE BENEFIC IAL IMPROVEMENT OF WELFARE TO CHILDREN (directly) AND THEIR PARENTS (indirectly). Failure of infusions due to the development of phlebitis or extravasation may cause considerable patient discomfort and pain, interfere with IV therapy, increase workload for hospital staff, cause parental worry and concern and in children, induce fear and anxiety. In patients requiring prolonged treatment, loss of veins may become problematic, thereby compromising medication and fluid administration. The failure of intravenous infusion is common. While many studies have been performed on adults, few have been performed on children. The aim of this stndy (Study 1), was to report and compare the incidence of survival of peripheral infusion sites in children in three hospitals. A survey technique was used and data were collected using a standard form. Information such as type and size of cannula, sex, age, date and time of Cannulation, site, signs of phlebitis/extravasation, reasons for cannula removal and itype of fluids and drugs infused were recorded. Univariate (lifetable) survival analysis was performed. with the significance of differences between the surveys determined by the log rank test. Results showed that survival time was greater in those children who received hydrocortisone and heparin added to the infusate. Infusion of metronidazole was also associated with reduced survival. The use of heparin has been found to decrease the failure of intravenous infusions. In Stufiy' 2, a. double-blind. randomised trial was conducted where patients were allocated into control and treatment groups. The treatment group received pre—mixed IV fluids containing 1 unit of heparin per 1ml of solution whilst the control group received standard fluids. Data were collected using a standard form. Information such as type and size of cannula, sex, age, date and time of cannulationh site, signs of phlebitis/extravasation, reasons for cannularemoval and type of fluids and drugs infused were‘ recorded. Failure incidence was analysedoby Life table method and Cox's multivariate proportional haZards model. Survival of infusion sites was considerably greater for the heparin group than the control with median survival half lives of 97 and 43 hours respectively. The difference due to the effect of heparin was highly significant (p<0.0001). Multivariate analysis confirmed this result. Other factors found to influence infusion site survival were ampicillin and flucloxacillin. One of the limitations of Study 2 was the 12 week shelf life imposed by manufacturers for solutions containing heparin. The aim of Study 3 was to see if long—term stability of heparin in dextrose and dextrose—saline solutions could be maintained over variable time periods. Heparin sodium was added at l iu per ml to 500 ml bags of normal saline, 5% dextrose or 3.75% dextrose plus 0.225% sodium chloride (dextrose—saline) which were then stored at 20—25°C (room temperature). Bags of each type of fluid were removed at intervals and their pH was measured with a pH meter and a combination electrode. Activated partial thromboplastin time (APTT) and the thrombin time (TT) were then measured on aliquots mixed with equal volumes of citrated plasma. Also bags of saline and 5% dextrose with 10 in per ml of heparin were stored at room temperature and bags of normal saline, 5% dextrose, 3.75% dextrose plus 0.225% sodium chloride and 2.5% dextrose plus 0.45% sodium chloride with l iu per ml of heparin were stored at 2.9T; AfTT and TT measurements were made on these only at O and 12 months. Results have shown that over a 12 month period, heparin. at 1 iu/ml is stable in saline and. dextrose—saline solutions but not in 5% dextrose. Further studies are required to determine the minimal effective concentration of heparin needed to prevent infusion failure. It is also recommended that manufacturers initiate the production of dextrose—saline solutions containing 1 i.u. per ml of heparin for the purpose of reducing infusion failure in patients within the hospital setting