A Ballistographic Approach for Continuous and Non-Obtrusive Monitoring of Movement in Neonates
IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM
Authors: Joshi, Rohan; Bierling, Bart L.; Long, Xi; Weijers, Janna; Feijs, Loe; Van Pul, Carola; Andriessen, Peter
Abstract
Continuously monitoring body movement in preterm infants can have important clinical applications since changes in movement-patterns can be a significant marker for clinical deteriorations including the onset of sepsis, seizures, and apneas. This paper proposes a system and method to monitor body movement of preterm infants in a clinical environment using ballistography. The ballistographic signal (BSG) is acquired using a thin and a film-like sensor that is placed underneath an infant. Manual annotations based on video-recordings served as a reference standard for identifying movement. We investigated the performance of multiple features, constructed from the BSG waveform, to discriminate movement from no movement based on data acquired from 10 preterm infants. Since routine cardiorespiratory monitoring is prone to movement artifacts, we also compared the application of these features on the simultaneously acquired cardiorespiratory waveforms, i.e., the electrocardiogram, the chest impedance, and the photoplethysmogram. The BSG-based-features consistently outperformed those based on the routinely acquired cardiorespiratory waveforms. The best performing BSG-based feature-the signal instability index-had a mean (standard deviation) effect size of 0.90 (0.06), as measured by the area under the receiver operating curve. The proposed system for monitoring body movement is robust to noise, non-obtrusive, and has high performance in clinical settings.
A cost-effectiveness analysis of endoscopic eradication therapy for management of dysplasia arising in patients with Barrett's oesophagus in the United Kingdom
CURRENT MEDICAL RESEARCH AND OPINION
Authors: Pollit, Vicki; Graham, David; Leonard, Catherine; Filby, Alexandra; McMaster, Jessica; Mealing, Stuart J.; Lovat, Laurence B.; Haidry, Rehan J.
Abstract
Background and aims: Endoscopic eradication therapy (EET) is the first line approach for treating Barrett's oesophagus (BE) related neoplasia globally. The British Society of Gastroenterology (BSG) recommend EET with combined endoscopic resection (ER) for visible dysplasia followed by endoscopic ablation in patients with both low and high grade dysplasia (LGD and HGD). The aim of this study is to perform a cost-effectiveness analysis for EET for treatment of all grades of dysplasia in BE patients. Methods: A Markov cohort model with a lifetime time horizon was used to undertake a cost-effectiveness analysis. A hypothetical cohort of UK patients diagnosed with BE entered the model. Patients in the treatment arm with LGD and HGD received EET and patients with non-dysplastic BE (NDBE) received endoscopic surveillance only. In the comparator arm, patients with LGD, HGD and NDBE received endoscopic surveillance only. A UK National Health Service (NHS) perspective was adopted and the incremental cost-effectiveness ratio (ICER) was calculated. Sensitivity analysis was conducted on key input parameters. Results: EET for patients with LGD and HGD arising in BE is cost-effective compared to endoscopic surveillance alone (lifetime ICER 3006 pound per quality adjusted life year [QALY] gained). The results show that, as the time horizon increases, the treatment becomes more cost-effective. The 5 year financial impact to the UK NHS of introducing EET is 7.1m pound. Conclusions: EET for patients with low and high grade BE dysplasia, following updated guidelines from the BSG, has been shown to be cost-effective for patients with BE in the UK.