Continuous monitoring of high-risk patients and early prediction of severe outcomes is crucial to prevent avoidable deaths. Current clinical monitoring is primarily based on intermittent observation of vital signs and the early warning scores (EWS). The drawback is lack of time series dynamics and correlations among vital signs. This study presents an approach to real-time outcome prediction based on machine learning from continuous recording of vital signs. Systolic blood pressure, diastolic blood pressure, heart rate, pulse rate, respiration rate and peripheral blood oxygen saturation were continuously acquired by wearable devices from 292 post-operative high-risk patients. The outcomes from serious complications were evaluated based on review of patients' medical record. The descriptive statistics of vital signs and patient demographic information were used as features. Four machine learning models K-Nearest-Neighbors (KNN), Decision Trees (DT), Random Forest (RF), and Boosted Ensemble (BE) were trained and tested. In static evaluation, all four models had comparable prediction performance to that of the state of the art. In dynamic evaluation, the models trained from the static evaluation were tested with continuous data. RF and BE obtained the lower false positive rate (FPR) of 0.073 and 0.055 on no-outcome patients respectively. The four models KNN, DT, RF and BE had area under receiver operating characteristic curve (AUROC) of 0.62, 0.64, 0.65 and 0.64 respectively on outcome patients. RF was found to be optimal model with lower FPR on no-outcome patients and a higher AUROC on outcome patients. These findings are encouraging and indicate that additional investigations must focus on validating performance in a clinical setting before deployment of the real-time outcome prediction.

Objective: To understand the brain motor functions and neurophysiological changes due to motor disorder by comparing electroencephalographic data between healthy people and amyotrophic lateral sclerosis (ALS) patients. Methods: The movement related cortical potential (MRCP) was recorded from seven healthy subjects and four amyotrophic lateral sclerosis (ALS) patients. They were asked to imagine right wrist extension at two speeds (fast and slow). The peak negativity (PN) and rebound rate (RR) were extracted from MRCP for comparison. Results: The statistical analysis has showed that there was no significant difference in PN between the healthy and the ALS subjects. However, the healthy subjects presented faster RR than ALS during both fast and slow movement imagination. Conclusions: The weaker rebound rate of ALS patients might reflect the impairment of motor output pathways or the degree of motor degeneration. Significance: The comparison between healthy people and ALS patients provides a way to explain the movement disorder through brain electrical signal. In addition, the charac-teristics of MRCP could be used to monitor and guide brain plasticity in patients.

Epilepsy is the second most common neurological disorder characterized by recurrent and unpredictable seizures. Accurate seizure detection is important for diagnosis and treatment of epilepsy. Many researches achieved good performance on patient-specific seizure detection. However, they were tailored to each specific individual which are less applicable clinically than the patient non-specific detection, which lacked good performance. Despite several decades of research on automatic seizure detection, seizure detection is currently still based on visual inspection of video-EEG (Electroencephalogram) in clinical setting. It is time consuming and prone to human error and subjectivity. This study aims to improve patient non-specific seizure detection to assist neurologist with efficient and objective evaluation of epileptic EEG. The clinical data used was from the open access Siena Scalp EEG Database which consists of 14 patients. First the data were pre-processed to remove artifacts and noises. Second the features from time domain, frequency domain and entropy were extracted from each channel and then concatenated into a feature vector. Finally, a machine learning approach based on random forest was employed for seizure detection with leave-one-patient-out cross-validation scheme. Automatic seizure detection was carried out with the trained model. The study achieved a specificity of 99.38%, sensitivity of 81.43% and 3.61 FP/h (False Positives per hour), which outperformed some other patient non-specific detectors found in literature. The findings from the study shows the possibility of clinical application of automatic seizure detection and indicate that further work should focus on dealing with reducing false positives.

The nervous and cardiovascular systems are intricately interconnected in both healthy and diseased conditions. The field of Neurocardiology, which focuses on the complex interaction between the nervous and cardiovascular systems, has grown rapidly over the past years. In addition, growing evidence shows that alterations in Brain-Heart Interplay (BHI) may contribute to neurological and cardiovascular disorders. BHI has great potential as a valuable biomarker to detect autonomic dysfunction, and reveal the mechanisms underlying conditions including sleep-related autonomic disorders and neurodegenerative diseases. However, the physiological characterization of linear or non-linear brain-heart relationships remains unclear. This review presents a comprehensive analysis of the current methods used to characterize BHI across multiple domains, with an emphasis on Electroencephalogram (EEG), Electrocardiogram (ECG), or Photoplethysmogram (PPG). Such non-invasive modalities allow for long-term and time-varying assessment of cortical and autonomic activity. In this work, we review how BHI modulates across various physiological and pathological states and highlight key findings from recent studies. In addition, we review potential data-driven methods to examine complex BHI, including measures of synchronization, directionality, and information transfer. As a result, studying BHI using these strategies offers a new angle on the complex and dynamic interaction of cortical and autonomic processes. This provides an opportunity to understand the intricate interplay between brain and heart functions, and has the potential to advance diagnosis, monitoring, and therapeutic interventions in neurocardiac conditions.

Monitoring of high-risk patients in hospital wards is crucial in identifying and preventing clinical deterioration. Sympathetic nervous system activity measured continuously and non-invasively by Electrodermal activity (EDA) may relate to complications, but the clinical use remains untested. The aim of this study was to explore associations between deviations of EDA and subsequent serious adverse events (SAE). Patients admitted to general wards after major abdominal cancer surgery or with acute exacerbation of chronic obstructive pulmonary disease were continuously EDA-monitored for up to 5 days. We used time-perspectives consisting of 1, 3, 6, and 12 h of data prior to first SAE or from start of monitoring. We constructed 648 different EDA-derived features to assess EDA. The primary outcome was any SAE and secondary outcomes were respiratory, infectious, and cardiovascular SAEs. Associations were evaluated using logistic regressions with adjustment for relevant confounders. We included 714 patients and found a total of 192 statistically significant associations between EDA-derived features and clinical outcomes. 79% of these associations were EDA-derived features of absolute and relative increases in EDA and 14% were EDA-derived features with normalized EDA above a threshold. The highest F1-scores for primary outcome with the four time-perspectives were 20.7–32.8%, with precision ranging 34.9–38.6%, recall 14.7–29.4%, and specificity 83.1–91.4%. We identified statistically significant associations between specific deviations of EDA and subsequent SAE, and patterns of EDA may be developed to be considered indicators of upcoming clinical deterioration in high-risk patients.

The monitoring of oxygen therapy when patients are admitted to medical and surgical wards could be important because exposure to excessive oxygen administration (EOA) may have fatal consequences. We aimed to investigate the association between EOA, monitored by wireless pulse oximeter, and nonfatal serious adverse events (SAEs) and mortality within 30 days. We included patients in the Capital Region of Copenhagen between 2017 and 2018. Patients were hospitalized due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD) or after major elective abdominal cancer surgery, and all were treated with oxygen supply. Patients were divided into groups by their exposure to EOA: no exposure, exposure for 1–59 min or exposure over 60 min. The primary outcome was SAEs or mortality within 30 days. We retrieved data from 567 patients for a total of 43,833 h, of whom, 63% were not exposed to EOA, 26% had EOA for 1–59 min and 11% had EOA for ≥60 min. Nonfatal SAEs or mortality within 30 days developed in 24%, 12% and 22%, respectively, and the adjusted odds ratio for this was 0.98 (95% CI, 0.96–1.01) for every 10 min. increase in EOA, without any subgroup effects. In conclusion, we did not observe higher frequencies of nonfatal SAEs or mortality within 30 days in patients exposed to excessive oxygen administration.