Abnormal Lung Sounds Research Articles

Nocardia nova identification in a transtracheal wash of a horse with recurrent airway obstruction

A horse with recurrent airway disease was presented with dyspnea, mucopurulent bilateral nasal discharge and abnormal lung sounds. Microbiological culture, ...

Timely diagnosis of dairy calf respiratory disease using a standardized scoring system.

Respiratory disease of young dairy calves is a significant cause of morbidity, mortality, economic loss, and animal welfare concern but there is no gold standard diagnostic test for antemortem diagnosis. Clinical signs typically used to make a diagnosis of respiratory disease of calves are fever, cough, ocular or nasal discharge, abnormal breathing, and auscultation of abnormal lung sounds. Unfortunately, routine screening of calves for respiratory disease on the farm is rarely performed and until more comprehensive, practical and affordable respiratory disease-screening tools such as accelerometers, pedometers, appetite monitors, feed consumption detection systems, remote temperature recording devices, radiant heat detectors, electronic stethoscopes, and thoracic ultrasound are validated, timely diagnosis of respiratory disease can be facilitated using a standardized scoring system. We have developed a scoring system that attributes severity scores to each of four clinical parameters; rectal temperature, cough, nasal discharge, ocular discharge or ear position. A total respiratory score of five points or higher (provided that at least two abnormal parameters are observed) can be used to distinguish affected from unaffected calves. This can be applied as a screening tool twice-weekly to identify pre-weaned calves with respiratory disease thereby facilitating early detection. Coupled with effective treatment protocols, this scoring system will reduce post-weaning pneumonia, chronic pneumonia, and otitis media.

PS-179 Is The Computerised Wheeze Detection Reliable During The First Months Of Life?

Background Most respiratory diseases are associated with abnormal adventitious lung sounds. In contrast to auscultation, computerised lung sound analysis is objective, can be done continuously over an extended period and audio recordings can be stored. To date, only little is known about its application in young infants. Therefore, the aim of this study was to compare computerised wheeze detection with the auditory assessment of trained clinicians during the first months of life. Methods Lung sounds were recorded in 120 sleeping infants on 144 test occasions by an automatic wheeze detection device (PulmoTrack ® ) at a median (interquartile range) postmenstrual age of 51(44.5–67.5) weeks. The records were blinded and evaluated retrospectively by three trained clinicians. If there was agreement in their assessment, these data were used to calculate optimal cut-off values for the automatically detected duration of inspiratory and expiratory wheezing related to the inspiratory or expiratory time, using ROC-analysis. Sensitivity, specificity and the inter-rater agreement were calculated. Results Optimal cut-off values for automatically detected inspiratory and expiratory wheezing were 2% and 3%, respectively. The resulting sensitivity of inspiratory and expiratory wheezing were 83.3% and 84.6%, and the specificity 78% and 82.5%, respectively (Figure). The inter-rater agreement was moderate with a Fleiss’ Kappa of 0.59 for inspiratory wheezing and 0.54 for expiratory wheezing. Conclusion Computerised lung sound analysis is feasible already during the first months of life and provides quantitative and noninvasive information about the extent of wheezing, whereas the assessment by trained clinicians was subjective and only moderate in inter-rater agreement.

Assessment of time–frequency representation techniques for thoracic sounds analysis

A step forward in the knowledge about the underlying physiological phenomena of thoracic sounds requires a reliable estimate of their time–frequency behavior that overcomes the disadvantages of the conventional spectrogram. A more detailed time–frequency representation could lead to a better feature extraction for diseases classification and stratification purposes, among others. In this respect, the aim of this study was to look for an omnibus technique to obtain the time–frequency representation (TFR) of thoracic sounds by comparing generic goodness-of-fit criteria in different simulated thoracic sounds scenarios. The performance of ten TFRs for heart, normal tracheal and adventitious lung sounds was assessed using time–frequency patterns obtained by mathematical functions of the thoracic sounds. To find the best TFR performance measures, such as the 2D local (ρmean) and global (ρ) central correlation, the normalized root-mean-square error (NRMSE), the cross-correlation coefficient (ρIF) and the time–frequency resolution (resTF) were used. Simulation results pointed out that the Hilbert–Huang spectrum (HHS) had a superior performance as compared with other techniques and then, it can be considered as a reliable TFR for thoracic sounds. Furthermore, the goodness of HHS was assessed using noisy simulated signals. Additionally, HHS was applied to first and second heart sounds taken from a young healthy male subject, to tracheal sound from a middle-age healthy male subject, and to abnormal lung sounds acquired from a male patient with diffuse interstitial pneumonia. It is expected that the results of this research could be used to obtain a better signature of thoracic sounds for pattern recognition purpose, among other tasks.

Stephen Vincent Lees

<h3>BACKGROUND:</h3> Clinicians often use numerous bedside assessments for secretion retention in participants who are receiving invasive mechanical ventilation. This study aimed to evaluate inter-rater agreement between clinicians when using standard...

Orientation invariant ECG-based stethoscope tracking for heart auscultation training on augmented standardized patients

Auscultation, the act of listening to the heart and lung sounds, can reveal substantial information about patients’ health and other cardiac-related problems; therefore, competent training can be a key for accurate and reliable diagnosis. Standardized patients (SPs), who are healthy individuals trained to portray real patients, have been extensively used for such training and other medical teaching techniques; however, the range of symptoms and conditions they can simulate remains limited since they are only patient actors. In this work, we describe a novel tracking method for placing virtual symptoms in correct auscultation areas based on recorded ECG signals with various stethoscope diaphragm orientations; this augmented reality simulation would extend the capabilities of SPs and allow medical trainees to hear abnormal heart and lung sounds in a normal SP. ECG signals recorded from two different SPs over a wide range of stethoscope diaphragm orientations were processed and analyzed to accurately distinguish four different heart auscultation areas, aortic, mitral, pulmonic and tricuspid, for any stethoscope’s orientation. After processing the signals and extracting relevant features, different classifiers were applied for assessment of the proposed method; 95.1% and 87.1% accuracy were obtained for SP1 and SP2, respectively. The proposed system provides an efficient, non-invasive, and cost efficient method for training medical practitioners on heart auscultation.

Modeling occurrence tendency of adventitious sounds and noises for detection of abnormal lung sounds

Diagnosis of pulmonary emphysema by using a stethoscope is based on the common knowledge that abnormal respiratory (adventitious) sounds usually appear in patients with pulmonary emphysema. However, the spectral similarity between adventitious sounds and noises at auscultation makes highly accurate automatic detection of adventitious sounds difficult. In this paper, we have proposed a novel method for distinguishing between normal lung sounds in healthy subjects and abnormal sounds, including adventitious sounds in patients, taking into account the occurrence tendency of adventitious sounds and noises. According to our investigation results, adventitious sounds occur repeatedly in successive inspiratory/expiratory phases of patients. On the other hand, noise sounds mix at random in lung sounds of both patients and healthy subjects. In our method, the occurrence tendency of these sounds is described using Gaussian distribution of a random variable obtained by subtracting the acoustic likelihood for abnormal respiration from the likelihood for normal respiration. The spectral likelihood calculated using hidden Markov models and the validity score of the occurrence tendency of the adventitious/noise sounds are combined to derive the classification result. Our method achieved a higher classification rate of 94.1% between normal and abnormal lung sounds than that achieved using the conventional method (87.4%).

A simple electronic stethoscope for recording and playback of heart sounds

undergraduate teaching of cardiovascular physiology often involves lectures on heart sounds. To complement these lectures, online resources are commonly used. The audio files of heart sounds are available as free downloads on the internet from websites of stethoscope manufacturers such as Thinklabs

LOOKING Is Not SEEING and LISTENING Is Not HEARING:Effect of an Intervention to Enhance Auditory Skills of Graduate-Entry Nursing Students

Inspection/observation and listening/auscultation are essential skills for health care providers. Given that observational and auditory skills take time to perfect, there is concern about accelerated students' ability to attain proficiency in a timely manner. This article describes the impact of music auditory training (MAT) for nursing students in an accelerated master's entry program on their competence in detecting heart, lung, and bowel sounds. During the first semester, a two-hour MAT session with focused attention on pitch, timbre, rhythm, and masking was held for the intervention group; a control group received traditional instruction only. Students in the music intervention group demonstrated significant improvement in hearing bowel, heart, and lung sounds (p < .0001). The ability to label normal and abnormal heart sounds doubled; interpretation of normal and abnormal lung sounds improved by 50 percent; and bowel sounds interpretation improved threefold, demonstrating the effect of an adult-oriented, creative, yet practical method for teaching auscultation.

Pulmonary hypertension associated with Ehrlichia canis infection in a dog

CANINE monocytic ehrlichiosis (CME) is an important canine disease with a worldwide distribution. The clinical presentation can be acute, subclinical or chronic, and there may be a multitude of clinical...

Computerized lung sound analysis as diagnostic aid for the detection of abnormal lung sounds: A systematic review and meta-analysis

The standardized use of a stethoscope for chest auscultation in clinical research is limited by its inherent inter-listener variability. Electronic auscultation and automated classification of recorded lung sounds may help prevent some of these shortcomings. We sought to perform a systematic review and meta-analysis of studies implementing computerized lung sound analysis (CLSA) to aid in the detection of abnormal lung sounds for specific respiratory disorders. We searched for articles on CLSA in MEDLINE, EMBASE, Cochrane Library and ISI Web of Knowledge through July 31, 2010. Following qualitative review, we conducted a meta-analysis to estimate the sensitivity and specificity of CLSA for the detection of abnormal lung sounds. Of 208 articles identified, we selected eight studies for review. Most studies employed either electret microphones or piezoelectric sensors for auscultation, and Fourier Transform and Neural Network algorithms for analysis and automated classification of lung sounds. Overall sensitivity for the detection of wheezes or crackles using CLSA was 80% (95% CI 72-86%) and specificity was 85% (95% CI 78-91%). While quality data on CLSA are relatively limited, analysis of existing information suggests that CLSA can provide a relatively high specificity for detecting abnormal lung sounds such as crackles and wheezes. Further research and product development could promote the value of CLSA in research studies or its diagnostic utility in clinical settings.

Assessment of multichannel lung sounds parameterization for two-class classification in interstitial lung disease patients

This work deals with the assessment of different parameterization techniques for lung sounds (LS) acquired on the whole posterior thoracic surface for normal versus abnormal LS classification. Besides the conventional technique of power spectral density (PSD), the eigenvalues of the covariance matrix and both the univariate autoregressive (UAR) and the multivariate autoregressive models (MAR) were applied for constructing feature vectors as input to a supervised neural network (SNN). The results showed the effectiveness of the UAR modeling for multichannel LS parameterization, using new data, with classification accuracy of 75% and 93% for healthy subjects and patients, respectively.

Influence of CRP testing and clinical findings on antibiotic prescribing in adults presenting with acute cough in primary care

Objective. Respiratory tract infections are the most common indication for antibiotic prescribing in primary care. The value of clinical findings in lower respiratory tract infection (LRTI) is known to be overrated. This study aimed to determine the independent influence of a point of care test (POCT) for C-reactive protein (CRP) on the prescription of antibiotics in patients with acute cough or symptoms suggestive of LRTI, and how symptoms and chest findings influence the decision to prescribe when the test is and is not used. Design. Prospective observational study of presentation and management of acute cough/LRTI in adults. Setting. Primary care research networks in Norway, Sweden, and Wales. Subjects. Adult patients contacting their GP with symptoms of acute cough/LRTI. Main outcome measures. Predictors of antibiotic prescribing were evaluated in those tested and those not tested with a POCT for CRP using logistic regression and receiver operating characteristic (ROC) curve analysis. Results. A total of 803 patients were recruited in the three networks. Among the 372 patients tested with a POCT for CRP, the CRP value was the strongest independent predictor of antibiotic prescribing, with an odds ratio (OR) of CRP ≥ 50 mg/L of 98.1. Crackles on auscultation and a patient preference for antibiotics perceived by the GP were the strongest predictors of antibiotic prescribing when the CRP test was not used. Conclusions. The CRP result is a major influence in the decision whether or not to prescribe antibiotics for acute cough. Clinicians attach less weight to discoloured sputum and abnormal lung sounds when a CRP value is available. CRP testing could prevent undue reliance on clinical features that poorly predict benefit from antibiotic treatment.

Asthma Assessment Tips

obstruction, airway hyperresponsiveness, and lung inflammation. Recurrent episodes of cough, wheezing, dyspnea, and chest tightness result from complex cellular interactions, rich in eosinophils. While its disease progression is incompletely understood, exercising control over the inflammatory nature of asthma may prevent airway remodeling and permanent airflow limitations. Approximately 34.1 million Americans have been diagnosed with asthma by a health care provider.1 As the incidence of asthma is increasing in the United States, nurse practitioners (NPs) must be cognizant of both classic asthma symptoms and covert clinical findings suggestive of asthma. In addition to history and physical examination, spirometry is the gold standard for measuring airflow obstruction and reversibility. National asthma guidelines recommend spirometry to be performed in those 5 years of age.2

Relationship of horse owner assessed respiratory signs index to characteristics of recurrent airway obstruction in two Warmblood families

The horse owner assessed respiratory signs index (HOARSI-1-4, healthy, mildly, moderately and severely affected, respectively) is based on owner-reported clinical history and has been used for the investigation of recurrent airway obstruction (RAO) genetics utilising large sample sizes. Reliable phenotype identification is of paramount importance in genetic studies. Owner reports of respiratory signs have shown good repeatability, but the agreement of HOARSI with an in-depth examination of the lower respiratory tract has not been investigated. To determine the correlation of HOARSI grades 3/4 with the characteristics of RAO and of HOARSI-2 with the characteristics of inflammatory airway disease. Further, to test whether there are phenotypic differences in the manifestation of lung disease between families. Seventy-one direct offspring of 2 RAO-affected Warmblood stallions (33 from the first family, 38 from the second) were graded as HOARSI-1-4 and underwent a clinical examination of the respiratory system, arterial blood gas analysis, endoscopic mucus scoring, cytology of tracheobronchial secretion (TBS) and bronchoalveolar lavage fluid (BALF), and clinical assessment of airway reactivity to methacholine chloride. HOARSI-3/4 animals in clinical exacerbation showed signs consistent with RAO: coughing, nasal discharge, abnormal lung sounds and breathing pattern as well as increased numbers of neutrophils in TBS and BALF, excessive mucus accumulation and airway hyper-responsiveness to methacholine. HOARSI-3/4 horses in remission only had increased amounts of tracheal mucus and TBS neutrophil percentages. Clinical phenotypes were not significantly different between the 2 families. HOARSI reliably identifies RAO-affected horses in our population.

Successful Treatment ofRhodococcus equiPneumonia in an Adult Horse

Successful Treatment of<i>Rhodococcus equi</i>Pneumonia in an Adult Horse

Tension Hemomediastinum Secondary to Blunt Chest Trauma in a Patient With an Anomalous Manubrial–Sternal Junction

CASE REPORT A previously healthy 25-year-old man presented to our emergency department at 9 AM after being assaulted. He complained of severe chest pain from being kicked in the chest approximately 4 hours earlier. He noted that his chest pain was worse with coughing and that he felt sweaty. He denied other medical problems, and stated that his recent drug use included alcohol and marijuana. Review of systems was otherwise unremarkable. Initial vital signs revealed a blood pressure of 125/65, heart rate of 111 bpm, respiratory rate of 18, and an oxygen saturation of 98%. The patient was a thin man, alert and oriented, with no external signs of trauma. He had tenderness across his entire anterior chest wall without crepitus, bruising, deformity, or abnormal heart or lung sounds. The initial chest X-ray was initially interpreted (mistakenly) as unremarkable (Fig. 1) and the patient’s pain improved with oral pain medication. Upon reevaluation and consideration for discharge, the patient was found to have a heart rate of 150 bpm. An intravenous line was placed and 2 L of saline were infused. A hematocrit, electrocardiogram, and urine drug screen were ordered. The patient then became hypoxic, requiring supplemental oxygen. His sleeping oxygen saturation was 88%, and his heart rate ranged from 120 to 130 bpm despite the fluid boluses. The patient’s chest X-ray was repeated to evaluate for pneumothorax (Fig. 2). This revealed a significantly widened mediastinum and an abnormal left heart border. A transthoracic echocardiogram and a computed tomography (CT) scan of the chest were performed. The echocardiogram was interpreted as abnormal. There was no pericardial effusion, but “an unidentified structure or fluid collection was seen to be impinging severely on the left atrium.” CT scan of the chest revealed a large anterior mediastinal hematoma with active bleeding in its center (Fig. 3). The patient’s heart rate progressively increased to 178 bpm, and his blood pressure was 137/80. He was immediately taken to the operating room for a median sternotomy. Left-side tube thoracostomy placement resulted in approximately 2 L of hemothorax being evacuated from his chest cavity. The left internal thoracic artery was identified as the source of bleeding, and was successfully ligated. The patient was taken to the intensive care unit, where he had an uneventful recovery.

The use of virtual patients to assess the clinical skills and reasoning of medical students: initial insights on student acceptance

Background: Web-based clinical cases (“virtual patients”, VPs) provide the potential for valid, cost-effective teaching and assessment of clinical skills, especially clinical reasoning skills, of medical students. However, medical students must embrace this teaching and assessment modality for it to be adopted widely.Method: We examined student acceptance of a web-based VP system, Web-SP, developed for teaching and assessment purposes, in a group of 15 second-year and 12 fourth-year medical students.Results: Student acceptance of this web-based method was high, with greater acceptance in pre-clinical (second-year) compared with clinical (fourth-year) medical students. Students rated VPs as realistic and appropriately challenging; they particularly liked the ability of VPs to show physical abnormalities (such as abnormal heart and lung sounds, skin lesions, and neurological findings), a feature that is absent in standardized patients.Conclusions: These results document high acceptance of web-based instruction and assessment by medical students. VPs of the complexity used in this study appear to be particularly well suited for learning and assessment purposes in early medical students who have not yet had significant clinical contact.

21-4 肺音を対象とした異常音検査実験システムの試作(第21部門 ヒューマンインフォメーション2)

21-4 肺音を対象とした異常音検査実験システムの試作(第21部門 ヒューマンインフォメーション2)

ヒューマンインフォメーション 呼吸の周期性を考慮した異常肺音の自動検出

The purpose of our research is to develop a method for recognizing abnormal lung sounds without the need of a medical specialist.Listening to the sounds of the human body is one of the most important methods of checking someone's health. However,identification of abnormal lung sounds is difficult for an untrained person.We differentiated true abnormal sounds from interfering noise by investigating the fact that lung sounds are generated periodically in relation to the breathing cycle.