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With the innovation of wearable technology and the rapid development of biosensors, wearable biosensors based on flexible textile materials have become a hot topic. Such textile-based wearable biosensors promote the development of health monitoring, motion detection and medical management, and they have become an important support tool for human healthcare monitoring. Textile-based wearable biosensors not only non-invasively monitor various physiological indicators of the human body in real time, but they also provide accurate feedback of individual health information. This review examines the recent research progress of fabric-based wearable biosensors. Moreover, materials, detection principles and fabrication methods for textile-based wearable biosensors are introduced. In addition, the applications of biosensors in monitoring vital signs and detecting body fluids are also presented. Finally, we also discuss several challenges faced by textile-based wearable biosensors and the direction of future development.

Background: The smartphone application to activate a community first responder (my Responder) was launched in 2015 to activate volunteer first responders for Out-of-Hospital Cardiac Arrest (OHCA) patients in Singapore. This study aimed to investigate the impact of my Responder on provision of bystander CPR, bystander AED, and patient survival outcomes.

Methods: This was a retrospective analysis using the Singapore Pan-Asian Resuscitation Outcomes Study between 2016 and 2019 that included adult non-traumatic OHCA patients. Patients were categorized into my Responder activated and non-activated groups. The primary outcomes were bystander CPR and bystander AED. The secondary outcome was survival at 30-days with favorable neurological outcomes (cerebral performance category 1-2). A multivariable logistic regression analysis was performed and we reported adjusted odds ratio [aOR] and 95% confidence interval for the effect of activation.

Results: 9,167 patients were included in this analysis. The median (Interquartile range, IQR) age was 71 (59-82) years. The activated group comprised 5,499 (60%) of cases. The activated group was associated with higher bystander CPR (aOR [95%CI]: 5.69 [4.89-6.62]) and bystander AED (aOR [95% CI]: 2.23 [1.82-2.74]) compared to non-activated group. The activated group was associated with better survival at 30 days with favorable neurological outcomes (aOR [95% CI]: 1.54 [1.11-2.15]).

Conclusion: They found that the implementation of technology-activated first responders was associated with an improvement in the performance of bystander CPR, bystander AED application, and OHCA outcomes in an urban area. Further efforts should be made to promote the use of activated first responders in EMS systems.

 

This review provides a comprehensive overview of the latest advancements in wearable biosensors, emphasizing their applications in cardiovascular disease monitoring. Initially, the key sensing signals and biomarkers crucial for cardiovascular health, such as electrocardiogram, phonocardiography, pulse wave velocity, blood pressure, and specific biomarkers, are highlighted. Following this, advanced sensing techniques for cardiovascular disease monitoring are examined, including wearable electrophysiology devices, optical fibers, electrochemical sensors, and implantable cardiac devices. The review also delves into hydrogel-based wearable electrochemical biosensors, which detect biomarkers in sweat, interstitial fluids, saliva, and tears. Further attention is given to flexible electronics-based biosensors, including resistive, capacitive, and piezoelectric force sensors, as well as resistive and pyroelectric temperature sensors, flexible biochemical sensors, and sensor arrays. Moreover, the discussion extends to polymer-based wearable sensors, focusing on innovations in contact lens, textile-type, patch-type, and tattoo-type sensors. Finally, the review addresses the challenges associated with recent wearable biosensing technologies and explores future perspectives, highlighting potential groundbreaking avenues for transforming wearable sensing devices into advanced diagnostic tools with multifunctional capabilities for cardiovascular disease monitoring and other healthcare applications.

Background: Bystander cardiopulmonary resuscitation (CPR) and defibrillation of a shockable rhythm improve survival following out-of-hospital cardiac arrest (OHCA). Little data exists on bystander participation during genuine cardiac arrest calls.

Method: This was a prospective audit of bystander participation during OHCA calls to a single ambulance service in the United Kingdom. A convenience sample of consecutive OHCA calls from March 2022 until April 2023, where an adult cardiac arrest was confirmed and CPR was advised, was audited by a call handler. Cases with a valid do not attempt CPR decision were excluded. Data on key time intervals and bystander participation were extracted and analysed in R (v4.2).

Results: In total, 451 cases were analysed. Median time until cardiac arrest recognition was 42 s (IQR 94.7 s) and until the initiation of CPR was 161 s (IQR 124 s). A lone bystander was present in 162 (35.9%) cases, two bystanders in 149 (33.0%) cases, and three or more bystanders in 140 (31.0%) cases. CPR was attempted by a bystander in 382 (84.7%) cases. Physical inability, refusal, and inability to correctly position patient were common reasons for not performing CPR. A defibrillator was retrieved before the arrival of emergency medical services in 36 (8%) cases and a shock was administered in 9 (2%) cases, while a shock was not advised in 20 (4%) further cases.

Conclusion: Cardiac arrest was identified rapidly but there was a delay to initiation of CPR. A lone bystander was present in over one third of cases, eliminating the possibility of bystander defibrillation in the absence of a lay first responder.

Out-of-hospital cardiac arrest (OHCA) occurs in nearly 350,000 people each year in the United States (US). Despite advances in pre and in-hospital care, OHCA survival remains low and is highly variable across systems and regions. The critical barrier to improving cardiac arrest outcomes is not a lack of knowledge about effective interventions, but rather the widespread lack of systems of care to deliver interventions known to be successful. The Randomized Cluster Evaluation of Cardiac Arrest Systems (RACE-CARS) trial is a 7-year pragmatic, cluster-randomized trial of 62 counties (57 clusters) in North Carolina using an established registry and is testing whether implementation of a customized set of strategically targeted community-based interventions improves survival to hospital discharge with good neurologic function in OHCA relative to control/standard care. The multifaceted intervention comprises rapid cardiac arrest recognition and systematic bystander CPR instructions by 9-1-1 telecommunicators, comprehensive community CPR training and enhanced early automated external defibrillator (AED) use prior to emergency medical systems (EMS) arrival. Approximately 20,000 patients are expected to be enrolled in the RACE CARS Trial over 4 years of the assessment period. The primary endpoint is survival to hospital discharge with good neurologic outcome defined as a cerebral performance category (CPC) of 1 or 2. Secondary outcomes include the rate of bystander CPR, defibrillation prior to arrival of EMS, and quality of life. They aim to identify successful community- and systems-based strategies to improve outcomes of OHCA using a cluster randomized-controlled trial design that aims to provide a high level of evidence for future application.

Objectives: Project ADAM (Automated Defibrillators in Adam’s Memory) is a national collaborative to improve outcomes for out-of-hospital sudden cardiac arrest. Given Project ADAM’s expansion, we sought to identify effective methods to partner with community leaders and understand barriers to engagement. Our aim was to establish effective practices to guide affiliates and optimize site operations and partnerships.

Methods: We conducted a survey of all Project ADAM sites in 2020. Medical Directors and Program Coordinators were included for generalizability. The survey consisted of 20 questions covering the domains of communication, goals for partner organizations, partnership barriers, staff time commitments, and Project ADAM program needs.

Results: Thirty-one members responded: 14 Medical Directors and 17 Program Coordinators. E-mail was the predominant method to initiate (58%) and maintain (87%) contact with partner organizations, though telephone (21%) and in-person visits (14%) were common for initiating contact. Presentations at school board, Emergency Medical Services, and athletic director meetings and student/family testimonials were powerful engagement tools. Barriers to partnership varied, revolving around limited school budgets, overburdened staff, and Covid-19. Limited time, difficulty coordinating schedules, and lack of dedicated resources were common challenges for Project ADAM sites. Only 36% of Medical Directors receive institutional recognition of Project ADAM effort.

Conclusions: Project ADAM’s partnership with community stakeholders creates unique opportunities and challenges. Optimal communication methods should be identified early for each school, with regular interaction for long-term success. Institutional recognition of Project ADAM efforts may boost success. Additionally, the Covid-19 pandemic created numerous challenges and may spur operational changes.

Background: Out-of-hospital cardiac arrest (OHCA) is a major global health challenge, characterized by poor survival outcomes worldwide. Resource-limited settings are burdened with suboptimal emergency response and worse outcomes than high-resource areas. Engaging the community in the response to OHCA has the potential to improve outcomes, although an overview of community interventions in resource-limited settings has not been provided.

Objective: This review evaluated the scope of community-based OHCA interventions in resource-limited settings.

Methods: Literature searches in electronic databases (MEDLINE, EMBASE, Global Health, CINAHL, Cochrane Central Register of Controlled Clinical Trials) and grey literature sources were performed. Abstract screening, full-text review, and data extraction of eligible studies were conducted independently by two reviewers. The PCC (Population, Concept, and Context) framework was used to assess study eligibility. Studies that evaluated community-based interventions for laypeople (Population), targeting emergency response activation, cardiopulmonary resuscitation (CPR), or automated external defibrillator (AED) use (Concept) in resource-limited settings (Context) were included. Resource-limited settings were identified by financial pressures (low-income or lower-middle-income country, according to World Bank data on year of publication) or geographical factors (setting described using keywords indicative of geographical remoteness in upper-middle-income or high-income country).

Results: Among 14,810 records identified from literature searches, 60 studies from 28 unique countries were included in this review. Studies were conducted in high-income (n = 35), upper-middle-income (n = 2), lower-middle-income (n = 22), and low-income countries (n = 1). Community interventions included bystander CPR and/or AED training (n = 34), community responder programs (n = 8), drone-delivered AED networks (n = 6), dispatcher-assisted CPR programs (n = 4), regional resuscitation campaigns (n = 3), public access defibrillation programs (n = 3), and crowdsourcing technologies (n = 2). CPR and/or AED training were the only interventions evaluated in low-income, lower-middle-income, and upper-middle-income countries.

Conclusions: Interventions aimed at improving the community response to OHCA in resource-limited settings differ globally. There is a lack of reported studies from low-income countries and certain continental regions, including South America, Africa, and Oceania. Evaluation of interventions other than CPR and/or AED training in low- and middle-income countries is needed to guide community emergency planning and health policies.

Introduction Although the global survival rate of patients after out-of-hospital cardiac arrest (OHCA) has increased in the previous years, there still remain significant multifactorial public health challenges with many important aspects influencing the overall survival rate of these patients. The objective of this article is to analyze basic epidemiological parameters of OHCA in Serbia and to evaluate the influence of pre-hospitalization factors on the survival of OHCA patients. Methods Data on OHCA within the Eureca Serbia Registry was collected according to the EuReCa Study protocol during the period October 1, 2014 – December 31, 2019, and included basic demographic data of the patients, data related to OHCA prior to hospital arrival, as well as data regarding subsequent hospitalization. Results The study included 6,266 EuReCa events (54% males), with a median age of 73 years [interquartile range (IQR) 63-82]. Cardiac arrest was witnessed in 3,111 out of 6,266 cases (49.6%), of which 2,725 cases (87.6%) were witnessed by bystanders and 286 cases (12.4%) by the emergency medical service (EMS) team. Resuscitation measures were attempted in 2,097 of 3,111 (67.4%) witnessed OHCA cases. Bystander cardiopulmonary resuscitation (CPR) was initiated in 288 cases within the bystander-witnessed group of 2,725 cases (10.6%). An initial shockable rhythm was detected in 323 out of 3,111 witnessed cases (10.4%). Any return of spontaneous circulation (ROSC) prior to hospital arrival was observed in 441 out of 2,097 cases where CPR was initiated (21.0%). Within the group of 2,097 events where CPR was initiated, in 287 cases the patient was transported to the hospital with ROSC (13.7%). An automated external defibrillator (AED) was used by bystanders in three cases. The collapse in locations other than the place of residence [p < 0.01; odds ratio (OR) 3.928], attempt to initiate CPR by a bystander (p < 0.01; OR 2.169), and presence of initial shockable rhythm (p = 0.01; OR 2.070) were observed as significant predictors of any ROSC in OHCA patients. Out of 287 patients hospitalized with ROSC, 54 (18.8%) were discharged alive. Conclusion Collapse outside of residence place, bystander CPR initiation, and initially detected shockable rhythm are important predictors of ROSC prior to hospital arrival and overall survival. Key factors of CPR-providing performance observed in this study were witnessing OHCA, CPR initiated by a bystander, presence of initial shockable rhythm, and any ROSC prior to hospital arrival.

 

Objectives: Cardiac disease is the leading cause of death worldwide. If a proper diagnosis is made early, cardiovascular problems can be prevented. The ECG test is a diagnostic method used on the screen for heart disease. Based on a combination of multi-field extraction and nonlinear analysis of ECG data, this paper presents a framework for automated detection of heart disease. The main aim of this study is to develop a model for future diagnosis of cardiac vascular disease using ECG analysis and symptom-based detection.

Methods: Discrete wavelet transform and Nonlinear Vector Decomposed Neural Network methods are used to predict Cardiac disease. Here is the discrete wavelet transform used for preprocessing to remove unwanted noise or artifacts. The neural network was fed with thirteen clinical features as input which was then trained using a non-linear vector decomposition of the presence or absence of heart disease.

Results: The modules were implemented, trained, and tested using UCI and Physio net data repositories. The sensitivity, specificity and accuracy of this research work are 92.0%, 89.33% and 90.67% CONCLUSIONS: The proposed approach can discover complex non-linear correlations between dependent and independent variables without requiring traditional statistical training. The suggested approach improves ECG classification accuracy, allowing for more accurate cardiac disease diagnosis. The accuracy of ECG categorization in identifying cardiac illness is far greater than these other approaches.