Photoplethysmography-Based Continuous Systolic Blood Pressure Estimation Method for Low Processing Power Wearable Devices

Regardless of age, it is always important to detect deviations in long-term blood pressure from normal levels. Continuous monitoring of blood pressure throughout the day is even more important for elderly people with cardiovascular diseases or a high risk of stroke. The traditional cuff-based method for blood pressure measurements is not suitable for continuous real-time applications and is very uncomfortable. To address this problem, continuous blood pressure measurement methods based on photoplethysmogram (PPG) have been developed. However, these methods use specialized high-performance hardware and sensors, which are not available for common users. This paper proposes the continuous systolic blood pressure (SBP) estimation method based on PPG pulse wave steepness for low processing power wearable devices and evaluates its suitability using the commercially available CMS50FW Pulse Oximeter. The SBP estimation is done based on the PPG pulse wave steepness (rising edge angle) because it is highly correlated with systolic blood pressure. The SBP estimation based on this single feature allows us to significantly reduce the amount of data processed and avoid errors, due to PPG pulse wave amplitude changes resulting from physiological or external factors. The experimental evaluation shows that the proposed SBP estimation method allows the use of off-the-shelf wearable PPG measurement devices with a low sampling rate (up to 60 Hz) and low resolution (up to 8-bit) for precise SBP measurements (mean difference MD = −0.043 and standard deviation SD = 6.79). In contrast, the known methods for continuous SBP estimation are based on equipment with a much higher sampling rate and better resolution characteristics

Explainable Artificial Intelligence-Based Decision Support System for Assessing the Nutrition-Related Geriatric Syndromes

The use of artificial intelligence in geriatrics is very promising and relevant, as the diagnosis of a geriatric patient is a complex, experience-based, and time-consuming process that involves a variety of questionnaires and subjective and inaccurate patient responses. This paper proposes the explainable artificial intelligence-based (XAI) clinical decision support system (CDSS) to assess nutrition-related factors (symptoms) and to determine the likelihood of geriatric patient health risks associated with four syndromes: malnutrition, oropharyngeal dysphagia, dehydration, and eating disorders in dementia. The proposed system’s prototype was tested under real conditions at the geriatric department of Lithuanian University of Health Sciences Kaunas Hospital. The subjects of this study were 83 geriatric patients with various health conditions. The assessments of the nutritional status and syndromes of the patients provided by the CDSS were compared with the diagnoses of the physicians obtained using standard assessment methods. The results show that proposed CDSS can efficiently diagnose nutrition-related geriatric syndromes with high accuracy: 87.95% for malnutrition, 87.95% for oropharyngeal dysphagia, 90.36% for eating disorders in dementia, and 86.75% for dehydration. The research confirms that the proposed XAI-based CDSS is an effective tool, able to assess nutrition-related health risk factors and their dependencies and, in some cases, makes even a more accurate decision than a less experienced physician

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit