Leicester Diagnostics Development Unit (DDU)

Integrated Non-Invasive DiagnosisBed in lab and flow chart

This project is a collaboration between Medicine, Space Science, Atmospheric Chemistry at the University of Leicester and a number of Industry partners. We focus on diagnosis in emergency care - an area of medicine where there is often not time to use conventional diagnostic methods and clinical decisions about treatment have to be made without the doctor having the full information about the patient's condition.

Our Aim

The non-invasive detection of disease.  Correlation of measurements with traditional diagnosis, leading to derivation of disease symptoms and leading to  bespoke 'Point of Care' devices.

Why?

Because invasive measurement/monitoring can be unpleasant, can lead to complications, infection and  possible exposure to radiation.  False positives and negatives can be produced and is conventional diagnostics can be time consuming with some results not being available for several days.

Our Concept

Will utilise the smell of disease (volatile organic compounds), the look of disease (space age imaging) and feeling the “pulse” (novel cardiovascular devices) using state of the art instrumentation installed in a resuscitation bay in the Emergency Department.

We provide a facility in which novel diagnostic and monitoring devices can be developed and tested. A large volume of patients with diverse medical conditions are available, as well as a large volume of ‘normals’. The facility is available for clinical testing for Industry.

The Location

Located in the Accident and Emergency Department at Leicester Royal Infirmary the DDU provides an immediate adjacency between the instrument room (left of picture) and a resuscitation bay (right of picture).

DDU In Situ
Photo of the DDU equipment room and its relationship to the resuscitation bay

A series of ports through the wall allow cables and tubes to pass from the instruments to the patient, but with maintainance of separation between the clinical and equipment areas. Data cabling links USB and data points each side of the wall.

Research studies can be carried out without interfering with normal clinical care, as the patient remains in a resuscitation area during monitoring. This also means that all severities of patient (from minor injuries to major illness) can be studied. Last year there were more than 150 000 patients treated in the Emergency Department - so almost all types of illness and injury can be studied.

Interdisciplinary Research

It is a University inter-college project between Cardiovascular Sciences, Emergency Medicine, Infection, Immunity and Inflammation, Chemistry, Physics and Astronomy, Space Research Centre, and IT services.

This concept has been supported by the award of support from NIHR Clinical Research Facility funding (in 2017).

Equipment

ImagingDDU cameras

  • IR Imager: temperature distribution
  • UV-VIS-NIR Spectrometers
  • Hyper spectral imager (2nm resolution): spectral features, patient pallor
  • Context Colour Imager


Breath and Other Gas Phase AnalysisDDU lab equipment

  • Mass Spectrometer and Spirometer:  composition and volume
  • Nitric Oxide Analyser
  • Micro-cantilever polymer based detector (gas and fluid)

Body State via

  • Thoracic Impedance Monitor
  • Blood Flow Monitor
  • Oxygenation Monitor
  • ECG

Papers published

2017

The haemodynamic dilemma in emergency care: Is fluid responsiveness the answer? A systematic review. Elwan MH, Roshdy A, Elsharkawy EM, Eltahan SM and Coats TJ. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2017;25(1):25.

Feasibility of Medical Infrared Imaging in the Emergency Department. Coats TJ, Naseer S, Charlton M, Keresztes K, Dexter K, Thompson JP and Sims MR. Journal of Diagnostic Techniques & Biomedical Analysis, 2017 6(1).

Development of Medical Infrared Imaging Protocol for the Emergency Department. Coats T J, Naseer S, Charlton M, Keresztes K, Dexter K, Thompson JP and Sims MR. Diagnostic Techniques & Biomedical Analysis, 2017 6(1).

Thoracic Electrical Bioimpedance versus Suprasternal Doppler in Emergency Care. Elwan MH, Hue J, Green S J, Eltahan SM, Sims MR, and Coats TJ. Emergency Medicine Australasia, 29: 391–393. doi:10.1111/1742-6723.12765

A Week of Pain in the Emergency Department. Thornton HS, Reynolds J, Coats TJ. British Journal of Pain. 2017. Sept 19. https://doi.org/10.1177/2049463717731898

Protocol for the upcoming study: patient input monitoring of pain in the emergency room: novel electronic log (PIMPERNEL): a randomised controlled trial of an electronic pain score display in adults in the emergency department. Thornton H, Coats T. Emerg Med J 2017 34 (12), A878-A878

2016

Handling missing data in large healthcare dataset: A case study of unknown trauma outcomes. Mirkes EM, Coats TJ, Levesley J, Gorban AN. Computers in Biology and Medicine 2016;75:203-16.

Valsalva using a syringe: pressure and variation. Thornton HS, Elwan MH, Reynolds JA, Coats TJ. Emerg Med J 2016:emermed-2016-205869.

Real-time analysis of exhaled volatile organic compounds (eVOC) in wheezy preschool children: European Respiratory Journal, 2016. Makinde M, Holden KA, Hussain S, Coats TJ, Galliard E. European Respiratory Journal 2016 48: PA3359; DOI: 10.1183/13993003.congress-2016.PA3359

2015

A Comparison Of Tidal And Incentive Breath Collection Methods For The Determination Of Breath Volatiles Concentration. Anderson K, Coats T, Monks P, White I, Pandya H, Beardsmore C. Emerg Med J 2015. 32 (12), 983-983

Metabolite profiling of Clostridium difficile ribotypes using small molecular weight volatile organic compounds. Kuppusami S, Clokie MRJ, Panayi, Ellis AM, Monks PS. Metabolomics (2015) 11:251-260 DOI 10.1007/s11306-014-0692-4

End-tidal CO2 detection during cadaveric ventilation. Coats T, Morgan B, Robinson C, et al. Emerg Med J 2015;32(9):753-54.

Known knowns, known unknowns, and unknown unknowns: can systems medicine provide a new approach to sepsis? Thompson JP, Coats TJ, Sims MR. BJA: British Journal of Anaesthesia, Volume 114, Issue 6, 1 June 2015, Pages 874–877,

Infrared cameras are potential traceable “fixed points” for future thermometry studies. Yap Kannan R, Keresztes K, Hussain S, Coats TJ, Bown MJ. Journal of Medical Engineering & Technology 2015;39(8):485-89.

Correlation Between Transcutaneous and Arterial CO2 Partial Pressures in Acute Care. Ward E, Hussain S, Coats T. Emerg Med J 2015. 32 (12), 985-985.

Real-time online analysis of volatile organic compounds in the exhaled breath of preschool children. Holden KA, Hussain SF, Roland D, Coats TJ, Gaillard EA. Thorax 2015. 70 (Suppl 3), A121-A122

Feasibility And Comparison Of Non-invasive Hemodynamic Devices In The Emergency Department; Uscom Vs Niccomo. Green SJ, Hussain S, Hue J, Patel J, Coats T, Sims M. Emerg Med J 2015. 32 (12), 999-1000

 

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