Jornacion, Catrisha Elaine September 20, 2010

BSN122/Group87

I. Clinical Question

 Does this newly-invent low-cost with new-techniques system able to help

professional cardiologists to determine diagnosis of cardiovascular disorders at an
early stage?

II. Citation

 Knowledge based system with embedded intelligent heart sound analyser for
diagnosing cardiovascular disorders

III. Study Characteristics:

a. Patients included (population and sample)

o 40 patients aged from 16 to 79 years with various pathologies, as shown

below, were the subjects or respondents for this study

Disease No. of patients

Aortic stenosis 2
Aortic regurgitation 4
Atrial fibrillation 4
Aortic valve prolapse 3
Mitral regurgitation 11
Mitral stenosis 6
Mitral valve prolapse 4
Tricuspid regurgitation 1
Ventricle septal defect 1
Pulmonary valve prolapse 1
Normal 3
Total 40

b. Intervention compared

o There was no intervention compared in the study. Thou the main concern of
this study were to detect early diagnosis of the patients which make this an
intervention itself. The researchers merely conducted their study among the
chosen population and recorded their results.

c. Outcome monitored
 o The results of the study were that the knowledge based system can give quick
expert consultation on cardiovascular diseases to general physicians in rural
hospitals where expert cardiologists and advanced diagnostic equipment were
not available.

d. Does the study focus on the significant problem in clinical practice?

 Yes, absolutely. The center of attention or the focal point of this study was about the
diagnosis of cardiovascular disorder while it is still in its early stage. Since this study
allows us to learn more about how it develops to the incidence of heart failures, this
problem indicates significance in the clinical practice at present. Most of the cases in
some institution, CVD is one of the list of chronic ailments that needs a thorough
assessment and supervision because this may endangers the lives of our patients and
nursing responsibilities are highly needed. The different diseases occurred among
patients with CVD in this study are the same with that of the patients with CVD in
hospital nowadays. That’s why we can say that the main attention of this study is
related to the cases at present.

IV. Methodology/Design

a. Methodology

 For acquisition of data and pre-processing

The medical data and heart sound samples were collected from Institute Jantung
Negara (National Heart Institute) Kuala Lumpur and Hospital Fatimah Ipoh,
Malaysia. The recordings were made using a 3M Littmann electronic stethoscope.
Heart sounds were recorded in a quiet room with the assistance of a doctor. A senior
cardiologist has listened to all the recordings to assure good quality. The recordings
were then transferred to a nearby workstation using wireless infrared media. The
recordings were saved in a *.e4k format which is a propriety format produced by the
manufacturer of the stethoscope (a 16-bit signed integer code). The recorded
information of the patient was then transformed to *.wav format and digitized with a
sampling rate of 8 kHz, 16 bits/sample.

 Heart Sound Analyser

1. The HSA analyses the digitized heart sound signals to identify important cardiac
events and detect and classify heart murmurs.
2. A MATLAB command called specgram was used to calculate the discrete-time
FFT using a sliding window.
3. The Hanning window, which has smooth edges compared to the rectangular
window, was used to prevent oscillations in the spectrum known as the Gibbs
 phenomenon. However due to its smooth edges, the Hanning window tapers the
signal at the edges, eliminating important information present in the signal.

b. Design

 The segmentation algorithm is based on the spectral analysis of heart sounds and
provides segmented cardiac events. Most of the segmentation methods used earlier
depend on a reference signal like ECG, and/or the carotid pulse, requiring time
synchronization of both the recordings, which imposes hardware as well as
computational burden. However in the current work no reference signal was used.
The main idea is to locate the first heart sound (S1) and second heart sound (S2) using
the envelope of the original signal.

c. Setting

 The study took place at Institute Jantung Negara (National Heart Institute) Kuala
Lumpur and Hospital Fatimah Ipoh, Malaysia.

d. Data sources

 The research study was downloaded at EBSCOhost.com

Javed, F., Venkatachalam, P., & Hani, A. (2007). Knowledge based system with
embedded intelligent heart sound analyser for diagnosing cardiovascular disorders.
Journal of Medical Engineering & Technology, 31(5), 341-350.
doi:10.1080/03091900600887876.

e. Has the original study been replicated?

 It is not stated in the article that the original study has been replicated.

f. What were the risk and benefit of the nursing actions/interventions tested in
the study?

 In the study, there were no any interventions done.

V. Results of the Study

 Based on the data collected from the heart sound analyser, the patient’s personal
and past medical history, clinical examination, chest x-ray and echocardiogram,
KBHSA provides diagnosis of heart diseases and their relevant probabilities of
occurrence. The diagnostic findings of the system coincide with those of expert
cardiologists. The system can also serve as a training platform for medical students
and trainee doctors. The system’s performance can be further improved by testing and
training it with more patients with different pathologies.

VI. Author’s Conclusions/Recommendations

a.) What contribution to the client’s health status does the nursing action make?

The nursing actions done in the study will help lessen the probability of worsening
the conditions of the patient with CVD. A good prognosis can be obtained if the
cardiovascular diseases are detected at an early stage. Therefore, with the help of the
nursing responsibilities, the patients will be able to be treated efficiently and swiftly.

b.) What overall contribution to nursing knowledge does the study make?

The study brought additional idea about the management of CVD through simple and
easy way to diagnosis its depth and severity without inflicting harm to the patients. This
study also contributes to the nursing knowledge by giving us that there are other invasive
strategies that can use to further assess CVD. Moreover, as future health care providers, it
is important to be of great help and capable of efficiently taking care of our patients. We
can also apply this learning when we encounter such cases/conditions in different hospital
settings.

c.) Applicability

a. Does the study provide a direct enough answer to your critical question in terms
of type of patients, interventions and outcome?

Yes. The study did provide enough answer since they stated each and
every result they obtained and the researcher specifically indentified the type of
patients they worked with. It was a great help since they provided adequate data
that I needed for the study.

b. Is it feasible to carry out the nursing action in the real world?

Yes. It is feasible to carry out the nursing action in the real world.
Nowadays, it is indicated that CVD is one of the most dangerous disorders among
humans because once you started to have this, there’s no turning back. It is also
 realistic since these cases are not rare in the field of medicine and these are very
popular especially in the country outside the Philippines.

d.) Reviewer’s Conclusion/Commentary

o As for me, the study was good. The one who invented the system is very
humane and wise. This technique that is non-invasive is just one of the other
techniques that don’t inflict harm to people and prioritize the safetiness of patient
first. There are other new experimental testing helping patients to diagnosis their
conditions at an early stage yet these would bring harmful adverse effects.

IX. Evaluating Nursing Care Practices

a. Safety

Nurses are responsible in providing the safety of patients. They should make sure
that they will not encounter any harm and publicity of their condition. To secure the
safety of the participants, researchers excluded women who were infected but
asymptomatic those whose symptoms could not be dated and those with inconclusive
serologic results from analysis. Participants who are included in the intervention were
informed properly of the procedure, and that their confidentiality is strictly done.

b. Competence of the care provider

The competency of the care provider should basically base from his or her skills
and experiences at work. A medical practitioner should have knowledge and skills
regarding the focus of this study in particular. They should be knowledgeable
regarding the procedure to be done and what will be the alternatives if there is
something terrible that will happen to his or her patients. Likewise, the nurse
should also be knowledgeable about the patient. In doing so, the nurse will be able
to make interventions suitable for the condition of the patient.

c. Acceptability

The nursing actions were acceptable since they are focused on improving the
over-all health of the client such as restoring the health of the client and
promoting wellness. And if by instance complications may occur they have the
right to be told of what sort of medical treatment, if any, will be available if
complications should arise. This study is acceptable since it didn’t bring danger
to the subjects’ well being and condition.
d. Effectiveness

Based from the study, they were able to determine that there are possible ways to
diagnose someone with CVD at an early stage. Through this, we can say that the
study was effective.

e. Appropriateness

Nurses are responsible in giving care to their patients. Therefore, they should
make sure that the interventions that will be done should be applicable to the
patient and the interventions should be specific and should match our patient’s
health needs.

f. Efficiency

It was not really stated in the study the duration of the intervention but they still
come up with the result that they want to achieve in the first place.