|Commenced in January 2007||Frequency: Monthly||Edition: International||Paper Count: 16|
In clinical practices, it is common that while facing the unknown progress of their disease, palliative care patients may easily feel anxious and depressed. These types of reactions are a cause of psychosomatic diseases and may also influence treatment results. However, the purpose of palliative care is to provide relief from all kinds of pains. Therefore, how to make patients more comfortable is an issue worth studying. This study adopted the “bio-psycho-social model” proposed by Engel and applied spontaneous breathing training, in the hope of seeing patients’ psychological state changes caused by their physiological state changes, improvements in their anxious conditions, corresponding adjustments of their cognitive functions, and further enhancement of their social functions and the social support system. This study will be a one-year study. Palliative care outpatients will be recruited and assigned to the experimental group or the control group for six outpatient visits (once a month), with 80 patients in each group. The patients of both groups agreed that this study can collect their physiological quantitative data using an HRV device before the first outpatient visit. They also agreed to answer the “Beck Anxiety Inventory (BAI)”, the “Taiwanese version of the WHOQOL-BREF questionnaire” before the first outpatient visit, to fill a self-report questionnaire after each outpatient visit, and to answer the “Beck Anxiety Inventory (BAI)”, the “Taiwanese version of the WHOQOL-BREF questionnaire” after the last outpatient visit. The patients of the experimental group agreed to receive the breathing training under HRV monitoring during the first outpatient visit of this study. Before each of the following three outpatient visits, they were required to fill a self-report questionnaire regarding their breathing practices after going home. After the outpatient visits, they were taught how to practice breathing through an HRV device and asked to practice it after going home. Later, based on the results from the HRV data analyses and the pre-tests and post-tests of the “Beck Anxiety Inventory (BAI)”, the “Taiwanese version of the WHOQOL-BREF questionnaire”, the influence of the breathing training in the bio, psycho, and social aspects were evaluated. The data collected through the self-report questionnaires of the patients of both groups were used to explore the possible interfering factors among the bio, psycho, and social changes. It is expected that this study will support the “bio-psycho-social model” proposed by Engel, meaning that bio, psycho, and social supports are closely related, and that breathing training helps to transform palliative care patients’ psychological feelings of anxiety and depression, to facilitate their positive interactions with others, and to improve the quality medical care for them.
Heart is the most important part in the body of living organisms. It affects and is affected by any factor in the body. Therefore, it is a good detector for all conditions in the body. Heart signal is a non-stationary signal; thus, it is utmost important to study the variability of heart signal. The Heart Rate Variability (HRV) has attracted considerable attention in psychology, medicine and has become important dependent measure in psychophysiology and behavioral medicine. The standards of measurements, physiological interpretation and clinical use for HRV that are most often used were described in many researcher papers, however, remain complex issues are fraught with pitfalls. This paper presents one of the nonlinear techniques to analyze HRV. It discusses many points like, what Poincaré plot is and how Poincaré plot works; also, Poincaré plot's merits especially in HRV. Besides, it discusses the limitation of Poincaré cause of standard deviation SD1, SD2 and how to overcome this limitation by using complex correlation measure (CCM). The CCM is most sensitive to changes in temporal structure of the Poincaré plot as compared toSD1 and SD2.
Non linear methods of heart rate variability (HRV) analysis are becoming more popular. It has been observed that complexity measures quantify the regularity and uncertainty of cardiovascular RR-interval time series. In the present work, SampEn has been evaluated in healthy normal sinus rhythm (NSR) male and female subjects for different data lengths and tolerance level r. It is demonstrated that SampEn is small for higher values of tolerance r. Also SampEn value of healthy female group is higher than that of healthy male group for short data length and with increase in data length both groups overlap each other and it is difficult to distinguish them. The SampEn gives inaccurate results by assigning higher value to female group, because male subject have more complex HRV pattern than that of female subjects. Therefore, this traditional algorithm exhibits higher complexity for healthy female subjects than for healthy male subjects, which is misleading observation. This may be due to the fact that SampEn do not account for multiple time scales inherent in the physiologic time series and the hidden spatial and temporal fluctuations remains unexplored.
A five-class density histogram with an index named cumulative density was proposed to analyze the short-term HRV. 150 subjects participated in the test, falling into three groups with equal numbers -- the healthy young group (Young), the healthy old group (Old), and the group of patients with congestive heart failure (CHF). Results of multiple comparisons showed a significant differences of the cumulative density in the three groups, with values 0.0238 for Young, 0.0406 for Old and 0.0732 for CHF (p<0.001). After 7 days and 14 days, 46 subjects from the Young and Old groups were retested twice following the same test protocol. Results showed good-to-excellent interclass correlations (ICC=0.783, 95% confidence interval 0.676-0.864). The Bland-Altman plots were used to reexamine the test-retest reliability. In conclusion, the method proposed could be a valid and reliable method to the short-term HRV assessment.
Synchronization between 0.1 Hz oscillations in heart rate and blood pressure is studied and its change during vertical tilt is evaluated in 37 myocardial infarction patients. Two groups of patients are identified with decreased and increased, respectively, synchronization of the studied oscillations as a response to a tilt test. It is shown that assessment of synchronization of 0.1 Hz oscillations as a response to vertical tilt can be used as a guideline for selecting optimal dose of beta-blocker treatment in post-myocardial infarction patients.
This paper describes a new method for extracting the fetal heart rate (fHR) and the fetal heart rate variability (fHRV) signal non-invasively using abdominal maternal electrocardiogram (mECG) recordings. The extraction is based on the fundamental frequency (Fourier-s) theorem. The fundamental frequency of the mother-s electrocardiogram signal (fo-m) is calculated directly from the abdominal signal. The heart rate of the fetus is usually higher than that of the mother; as a result, the fundamental frequency of the fetal-s electrocardiogram signal (fo-f) is higher than that of the mother-s (fo-f > fo-m). Notch filters to suppress mother-s higher harmonics were designed; then a bandpass filter to target fo-f and reject fo-m is implemented. Although the bandpass filter will pass some other frequencies (harmonics), we have shown in this study that those harmonics are actually carried on fo-f, and thus have no impact on the evaluation of the beat-to-beat changes (RR intervals). The oscillations of the time-domain extracted signal represent the RR intervals. We have also shown in this study that zero-to-zero evaluation of the periods is more accurate than the peak-to-peak evaluation. This method is evaluated both on simulated signals and on different abdominal recordings obtained at different gestational ages.