Clinical Comparison of Acoustic and Electronic Stethoscopes and Design of a New Electronic Stethoscope

Grenier, Marie-Claude; Gagnon, Katerie; Genest, Jacques; Durand, Jocelyn; Durand, Louis-Gilles

doi:10.1016/s0002-9149(97)00977-6

Cited by 68 publications

(50 citation statements)

References 5 publications

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“…This often results in sound characteristics that are not entirely familiar to clinicians and may be responsible for the variable tele-auscultation accuracy between clinicians. 118 Asynchronous review of low-frequency heart sounds is further hampered on most computer-based systems that are optimized for much higher-frequency music playback. Second, any telemedicine system is bound to fail if it is not practical and simple to use.…”

Section: Tele-auscultationmentioning

confidence: 99%

Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

Satou¹,

Rheuban²,

Alverson³

et al. 2017

Circulation

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A dvancements in technology and broadband have revolutionized the current practice of medicine. The field of pediatric cardiology is no exception given the need for prompt diagnosis and reliance on cardiac imaging to identify infants and children with potentially life-threatening cardiovascular disease. As the relationship between telemedicine and pediatric cardiology has advanced, it has created a need to develop a broad, comprehensive document reviewing all the various aspects of telemedicine in pediatric cardiology. For more than a decade, a significant body of literature has been published describing individual experiences and practices, yet there remains no comprehensive statement or document summarizing this rapidly advancing field. In an effort to describe the collective experience and to provide structure and guidance for pediatric cardiology practitioners and healthcare providers, we have developed a scientific statement on the use of telemedicine in pediatric cardiology.Specific areas explored in this document include both neonatal and fetal teleechocardiography, implications for training community sonographers, pulse oximetry programs, qualitative improvement and appropriate use criteria initiatives, and remote electrophysiological monitoring. This document also includes teleconsultation and teleausculation, direct-to-consumer and home monitoring programs, and a look into the use of telemedicine and pediatric cardiology in the intensive care setting. Furthermore, a detailed review of the legislative, public policy, and legal aspects of telemedicine is provided, along with financial and reimbursement information.Several terms are used in the literature interchangeably; a brief explanation is provided to help readers of this document. The term telehealth is defined as the use of technology to bridge distances in any aspect of medicine; telemedicine is the specific application of technology to conduct clinical medicine at a distance. The term telecardiology is defined as the broad application of telemedicine in the field of cardiology specifically, and tele-echocardiography is the most common application used within this field. ECHOCARDIOGRAPHY AND TELEMEDICINEEchocardiography is the most commonly used noninvasive cardiovascular imaging modality and is considered to be both safe and cost-effective. Tele-echocardiography can be described as a process in which a provider or a technician obtains cardiovascular ultrasound images from a given patient and these images are subsequently transmitted to an offsite location where a cardiologist can provide further analysis and interpretation. Thus, tele-echocardiography enables expert interpretation and consultation in a rapid and potentially geographically disparate fashion, enabling prompt and accurate decision making involving triage, transport, and therapeutic priorities. Tele-echocardiography is now routinely used across the age and subspecialty spectrum in pediatric cardiology.

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Section: Tele-auscultationmentioning

confidence: 99%

Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

Satou¹,

Rheuban²,

Alverson³

et al. 2017

Circulation

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“…Detection of heart/lung sounds was hardest in the C-130 (84 to 88 dB SPL, ambient airborne noise), somewhat easier at the recommended distance from a fieldhospital generator (88 to 92 dB SPL), and easier in a HumVee field-ambulance (92 to 96 dB SPL). Of course those values are averages for all vital-sounds tested and across all stethoscopes, including the standard device, to show the overall effect of environmental differences on detection 7 . Table 3 lists device performance averaged over all conditions.…”

Section: Laboratory Evaluation Results and Discussionmentioning

confidence: 99%

“…Unfortunately, we were only able to report their performance to that safe level. Our averaged results are therefore most likely conservative 7 Figure 2 plots these same conditions, averaged with the standard stethoscope removed. (reduced) estimates of device performance.…”

Section: Laboratory Evaluation Results and Discussionmentioning

confidence: 99%

“…This research identified a major weakness in the conventional stethoscope: its sensitivity to the movements of the patient, hand tremor of the examiner, finger and nail movements, and self noise of the stethoscope's pickup-head moving against skin and against the pressure cuff during blood pressure measurement. Other limitations include the severe attenuation of sound transmission as a function of frequency, and the maxima and minima at very specific frequencies due to tubular resonance effects and differences in transmission properties observed between different stethoscopes (7).…”

Section: Introductionmentioning

confidence: 99%

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Noise Reduction Stethoscope for United States Navy Application

Russotti¹,

Jackman²,

Santoro³

et al. 2000

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conducted in compliance with all applicable federal regulations governing the protection of human subjects in research.The authors wish to acknowledge Derek Schwaller, our biomedical engineer, for his tireless, conscientious achievements in instrumentation, data gathering, digital editing and signal analysis. Special acknowledgment is due to Surgeon Commander Steven Ryder, Royal Navy for invaluable guidance during the design of this research and clinical evaluation of our selected "patients". We greatly appreciate the voluntary efforts of LT Michael Waltz, MC, who took over as medical monitor for LT Jackman MC, and who, was not only able to enlist our highly trained medical listeners on short notice, but also endured at least five hours as a subject himself. We appreciate the efforts of all our participants for their conscientious performance, patience and endurance in such a demanding task. We are intensely grateful to Lynne Marshall for her extensive editorial efforts as a reviewer to help make this report more clearly convey our findings.This research is dedicated to Thomas E. Hanna, a Braveheart who led by example. Thanks for your confidence and support from the onset.Joseph S Russotti, is Principal Investigator, and Thomas P. Santoro, LT Robert Jackman, MC, LT Deborah White, MSC, are all Associate Investigators on this project at the Naval Submarine Medical Research Laboratory. The co-authors are listed in alphabetical order since each contributed equally to this research project.ii SUMMARY PAGEThe Problem: Conventional stethoscopes cannot function effectively unless ambient noise is maintained at approximate examination-room levels. This serious limitation inhibits diagnosis and monitoring of patients in a variety of common military medical situations: in field hospitals, in high ambient noise environments such as engine rooms, in vehicles such as ambulances, fixed and rotary wing aircraft, or in hyperbaric chamber treatment facilities. Trying to measure blood pressure, determining if a faint heart-beat is present in a casualty, or listening to respiratory events can be nearly impossible under field conditions.The Approach: The objective of this project was to evaluate commercial off-the-shelf (COTS) products and recommend one or several compact noise-reducing/canceling stethoscopes for field, medical-transport, and shipboard use, in moderately noisy environments (up to 90 dB SPL). At the onset of this project a working group was convened to assess Navy need and requirements for a noise-reducing stethoscope for casualty care and general medical use. In general terms, given present and projected COTS state-of-the-art technology, a modular approach using a simpler device tailored to the application, will be more cost-effective, for general-issue, than a single device. We selected three such simpler devices for laboratory testing using both the listening-headsets provided, and a highly accurate active noise cancellation (ANC) headset.The Findings: Laboratory data show exceptional performance of noise reducti...

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“…10 There is little in the recent literature regarding the mechanical aspects of stethoscopes. As stated before, if it is possible to clearly hear from low-frequency heart sounds and murmurs to high-frequency heart sounds using an ordinary stethoscope, it would be an ideal stethoscope.…”

Section: Discussionmentioning

confidence: 99%

New Stethoscope With Extensible Diaphragm

Takashina¹,

Shimizu

Muratake³

et al. 2016

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp (Figure A, Left). The EPDM diaphragm is firmly fixed and the force is extended by tightening a lid with a spiral groove, which lifts the center by 1 mm, thus increasing the vibration of the plastic plate, and so the sound volume also increases. The comparative structure of the SDS and EDS is shown in Figure A, Right.As a preliminary test, 2 of the authors investigated the acoustic characteristics of various stethoscopes, both diaphragm and bell type, using an acoustic response test system, and found that the Master Classic II (Littmann) was the best and most suitable for the comparative study ( Figure S1).The acoustic differences of the EDS and SDS were recorded during auscultation testing of 3 patients by 5 physicians. The 3 patients (69-year-old male with angina pectoris; 42-year-old male with hypertrophic cardiomyopathy; 83-year-old male with hypertensive heart disease) gave informed consent. The 5 physicians (4 cardiologists, 1 internist) were not informed about the purpose of the test of listening to S4 sounds using 2 types of stethoscope (EDS and SDS). They were instructed to listen to S4 at a marked point of the apex, in 3 stages (no hand pressure, mild pressure, and moderate pressure), after they were handed an EDS or SDS randomly by an assistant. After listening to S4, all the examiners agreed that the EDS was louder and much clearer (Levine's criteria) when using mild pressure (Figure B), compared with the SDS. Furthermore, to confirm this auscultation test, one of the authors used both the SDS and EDS to test S3 and S4 sounds stored in a cardiology patient simulator, 9 as another comparative study. The examiner turned the sound volume switch down as low as possible, -30 points (lowest: -50). First the SDS, Master Classic II (Littmann), was tested and then the EDS under the same n 1816, Rene T. Laennec, was the first person in the world to use a wooden cylinder as an auscultation instrument. 1 After this, the forms and materials of stethoscopes have been modified, but since information technology such as electronic stethoscopes and echocardiography has been introduced into the medical field, stethoscopes have been gradually losing their significance as an important diagnostic tool. Today, there is some controversy concerning the diagnostic significance of cardiac auscultation in various clinical settings. 2-7We wondered if the reason for declining auscultation skills was related to difficulty in hearing heart sounds or murmurs by examiners, or a structural problem of the stethoscope itself? The most commonly used stethoscopes have double-headed chest pieces and single-headed chest pieces have been popular in the past 3 decades. The suspended diaphragm stethoscope (SDS) is considered able to catch all heart sounds, from low frequency (S3 and S4) to high frequency, 8 but it does not differentiate these sounds well. Therefore, we developed a new extensible diaphragm stethoscope (EDS), which has a different st...

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Clinical Comparison of Acoustic and Electronic Stethoscopes and Design of a New Electronic Stethoscope

Cited by 68 publications

References 5 publications

Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

Noise Reduction Stethoscope for United States Navy Application

New Stethoscope With Extensible Diaphragm

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