Explore Noxturnal 4.4 Note: This presentation is intended to summarize main changes from 3.2 up to 4.4. Detailed feature and bug fixes information for.

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Presentation transcript:

Explore Noxturnal 4.4 Note: This presentation is intended to summarize main changes from 3.2 up to 4.4. Detailed feature and bug fixes information for only upgrading Noxturnal 4.3 to 4.4 is addressed in the Release Bulletin for Noxturnal 4.4. .

Purpose Summary of main feature changes between Noxturnal 3.2 and 4.4 Serve as a self-training guide Offer material for other information about Noxturnal 4.4 Explain key differentiators of Noxturnal 4.4

Overview Software License Implementation Device Support A1 PSG recording setup (online and ambulatory) T3 PG setup with enhanced workflow options (ambulatory) Auxiliary device connections via Bluetooth and IP User Interface Enhancements New Scoring and Analysis Tools New Powerful and Flexible Report Engine Nox Calibrated RIP Technology Extended Data Export Functionality for Scientific Users Enhanced Network Support: Administrator / User Settings

Noxturnal 4 Licensing concept 60 day trial license after first installation with all functionality open After initial 60 day period: Full T3 functionality supported (including all analysis and reporting features) Any other optional license requires license activation Item Code Item Description Functionality (in addition to regular Nox T3 system ambulatory Polygraphy use) 53 40 10 Noxturnal A1 PSG File Format License Allows to read / write / analyze / report on any kind of Nox A1 recordings (incl. video playback), enables preparation and download for ambulatory Nox A1 PSG recordings. 53 60 10 Noxturnal A1 Online Acquisition License Enables online acquisition from PSG without video. At the same time it allows to read / write / analyze / report on any kind of Nox A1 recordings (incl. video playback), enables preparation and download for ambulatory Nox A1 PSG recordings. Major A1 Licenses 53 60 11 Noxturnal Video Online Acquisition License Required to add online video acquisition to regular PSG online acquisition 53 61 10 Noxturnal EBM PG File Format Reading License Required to read Embla format data in polygraphy recordings directly (raw data will be kept in ebm format – no conversion) 53 61 12 Noxturnal EBM PSG File Format Reading License Required to read Embla format data in Polysomnography recordings directly (raw data will be kept in ebm format – no conversion) 53 61 11 Noxturnal EDF File Format Reading License Required to read EDF data (raw data will be kept in edf format – no conversion) Optional Functionalities Note: Specific Knowledge Base Article about License concept and License activation is available on noxmedical.com

Device Handling in Noxturnal

Supported Nox Systems Nox A1 and Nox T3 systems Nox A1: ambulatory setup and download Nox A1: online acquisition via BlueGiga Access Point (optional incl. video) Nox T3: ambulatory setup and download Noxturnal App for flexible device control and setup in all online and ambulatory. studies BlueGiga Access-Point for Bluetooth to LAN conversation

Device Access and Download General start window w/o attached device: “View Existing Recordings” “Start a New Recording” (to start online recordings) Access to Analysis / Report / Device Profiles and Settings always available Attaching a Nox A1 / T3 device: Devices show up with SN and FW status “Download and View Recording” to be used for downloading “Start a New Recording” to be used for setup ambulatory recordings Communication with devices similar to USB drive (no drivers required)

Nox Systems Configuration Recording Templates combine Recording type Sensor selection AUX devices (in case of ambulatory studies) Battery selection Recording type configuration combine Customizable Workspaces (a combination of signal sheets) Customizable Analysis Protocol Customizable Report

Recording Templates Recording templates for Nox devices and type of use (ambulatory vs online): Standard Templates offered Any required custom profiles to be created either “Based on” or as “New” Final device preparation now faster by using prepared recording templates Example A1: EEG / EMG and bipolar channel setup Nox A1 and T3 Respiratory channel setup Sensor selection for bipolar and unipolar inputs New: Parallel recording option “Cannula and mask” Note: Specific Knowledge Base Article for Nox T3 users on Noxturnal 4.4 is available on noxmedical.com

Auxiliary Device Support Nox A1 PSG Nox T3 PG W7 - Interfaces (online and ambulatory) Nox W7 – S: Sentec (TcCO2) (incl. Sentec FW 8.0) Nox W7 – R: ResMed S9 Radiometer (TcCO2) (models: TCM4, TCM4 Combi M, TCM40, TOSCA) Nonin Respsense (EtCO2) Nox EtCO2 (ambulatory) Nonin Respsense (EtCO2) LAN – IP direct data access to Noxturnal TxLink (incl. EasyCare Tx 8.2) (including ResMed Air Solutions Devices) Sentec (TcCO2) (incl. Sentec FW 8.0) Note: Specific Knowledge Base Articles about the Integration of auxiliary devices is available on noxmedical.com

Nox T3 Firmware 1.5.1.4060 Noxturnal: Firmware status detection and upgrade advice (if upgrade chosen  automated procedure) Improved robustness for T3  Oximeter connection Connection process to oximeter faster Robust study startup connectivity to oximeter based on repeated connectivity checks and re-attempts Likelihood of conditional boot error in oximeters greatly reduced. Display / devices timeout is 2 minutes (previously 40 seconds). Improved RIP signal handling Disconnected RIP belts now displayed as flat lines.

User Interface Enhancements

User Interface Enhancements Recording Result Page – new features PSG View (including spectrogram) Directly accessible artifact location (signal information) Directly accessible period markers (enter, delete period markers) Possibility for manual sleep scoring based on spectrogram Direct introduction and improved visibility for “Invalid data” periods General Sheet Layout Quick change access to analysis start / stop synchronized with “Recording Results” Quick introduction for all period markers (analysis, PAP, NAP …) Quick Split screen setup and access (incl. sheet synchronization) Special sheet templates for A1 – impedance data and TxLink Workspace Concept Combination of multiple sheet templates to allow for different user preferences All additional special views owned by Workspaces

User Interface Enhancements Permanent access to view / switch Scorer and Periods New view options Spectrogram Flow Volume Loops Support for Nox A1 impedance check and information Setting Changes: All settings unified in “Tools” – “Settings” menu New setting available for Navigation for flip full page / half page Others Customizable name properties for recording folder Customizable name properties for exported reports Patient Document Control within the recording folder

Recording Results and Scorer / Window Period Access Access and change for Scoring sessions. Special Sleep Information (Spectrogram, Hypnogram). Direct Print option for Results Page. Access and change for Time Periods.

Periods Definition / Scoring Access in Recording Results Manual Sleep Scoring from Spectrogram. Definition and identification of Period markers. “Invalid data” definition / improved period visibility. Information: Artefact location and duration.

Sheet Layout, Analysis (and others) Period Markers Access to general sheet layout options. Analysis Start: can be easily shifted on both shown locations.  Synchronizes with Recording Results. Analysis End: can be easily shifted on both shown locations.  Synchronizes with Recording Results. Red bar indicates time outside of the analysis window. All Period Markers: facilitated access and introduction (right mouse click on synchro-arrow in the time bar).

Split Screen and Window Synchronization Window Split Marker (after drag and drop) Synchronization Markers Window length indicator WindowSync- / Unsync- Option

Workspace Layouts and Direct Scoring Access Workspace and Sheet templates Access Custom Workspace Default Workspace Access and change for Scoring sessions

New View Options EEG - Spectrogram Whole night spectrogram as special view Quick channel selection and color scheme adjustment Note: previously offered derived trace spectrograms still available Visualization of inspiratory and expiratory flow and effort Differentiation between kind and severity of obstruction Powerful titration support Flow-Volume-Loop and Konno-Mead Loop * * Specific presentation for this topic is in preparation.

Nox A1 - Impedance Information Impedance Check: available only during Nox A1 running online acquisition Specific impedance test mode Accessible via icon (only during running online recording) Support for EEG hookup (continuous data until stop view) Always available information: Views: Continuous impedance data view – including numeric data Signal labels with impedance-feedback for the (re-referenced) signal (see color of the underlining)

Patient Document Control Within the Recording Folder New design for Recording properties Attachments as part of the recording folder All recording and patient related information with icon access Documents can be attached to a patient: Noxturnal derived reports with destination Recording Folder will automatically appear hear Additional patient documents (questionnaires, insurance papers …) can be selected and copied into the Recording Folder Result: centralized access for patient documents

Analysis and Scoring

New Analysis and Scoring Tools Automatic Analysis Automatic Sleep Staging Automatic Arousal Scoring (rec. EEG and Chin–EMG) Pulse Wave (Amplitude Drop) Analysis Improved sound derived Snoring analysis Automatic PAP analysis based on recorded pressure Desaturation Detection independent from Hypopnea Desaturation Link Manual Scoring Visual distinction of manual vs automatic events Powerful sleep scoring with centered epoch handling Improved access to “Single Click Scoring” Possibility to compare multiple sleep staging within one sheet

Automatic Analysis Changes - EEG New / Enhanced Analysis Analysis Results Sleep Scoring (AASM classification): C3, C4, O1, O2, 2 x Eyes, EMG Chin Automatic scoring also possible with less or adjusted input signals Arousal detection: C3, C4, O1, O2, EMG Chin Input signals selection customizable Quality threshold scale: -10 … +10 -10 … more specific / +10 … less specific

Analysis Changes - Others New / Enhanced Analysis Analysis Results Derivation of a Set Pressure signal Signal derived from Mask Pressure New signal available for custom PAP reporting purposes

Desaturation vs. Hypopnea Detection Independent detector for “Desaturation” vs. “Apnea/Hypopnea” (Hypopnea link to Desaturation) Customizable Desaturation detector (AASM: default 3% drop) ODI value based on these events scored Desaturation-Events Link Flow Amplitude Drop (AASM: 30% drop) to Desaturation Drop (AASM: default 3%) – all customizable Hypopneas detected by this threshold which is independent from the Desaturation-Events

Event Control and Sleep Scoring Sleep Scoring Support views Automatically centered scoring epoch Stage score shown as automatic / manual w/ scorer information and confidence level Start / Stop Scoring Easier: Click into the scoring bar  start ESC stop Events with scorer information and automatic / manual differentiation

Nox Calibrated RIP Technology* RIP signals vary, based on patient’s size, shape and placement of belts  RIP amplitudes must be weighted for correct flow derivation Summation of effort signals Estimated corrective factor (based on phase shift) Estimated Flow Curve (RIP Flow) Generating clear effort signals (no ECG disturbance) Calibration for amplitude summation Accurate Flow Curve Calculation * Specific presentation for this topic is in preparation.

Nox Calibrated RIP Technology Accurate flow information based on respiratory effort (RIP)  accurate scoring for flow limitation / hypopnea and apnea Cannula Flow Calibrated RIP Flow Un-calibrated RIP Flow

Report Engine

Powerful and Flexible Report Engine Powerful custom reporting and default reports (incl. legacy reports) Report customization in WYSIWYG editor (similar to MS-Word) Full text formatting choices Integrating bitmaps Creating tables and graphic charts Intuitive handling for report sections and interpretation notes Creating of “any” custom variables to report on Custom report fields based on signals and events properties Fields show logical explanation within templates and final reports New: “Arousal Association Table” prepared for custom reports Import reports from custom Word templates of Embla with automatic variables interpretation Report Export with filename and destination settings

Default and Custom Reports Selection of Default Reports available Custom Reports can get categorized and created either as “based on” or as new User and standard default reports also accessible via Win-Explorer All Reports fully customizable (no limitation to previous default sections) Legacy Reports (Noxturnal 3.2) have been partly converted into the new format and will get supported (limitation apply)

Report Customization in WYSIWYG Editor Complete MS-Word style report editing – create your own report library Design your own header / footer Design your own graphics, tables, any kind of sections , add pictures Drag and Drop: Add / save sections as new Report Parts Word style “look and feel” Report categories and available sections (fully customizable) Full text search in section names

Chart Customization in WYSIWYG Editor Library of charts available to draw: Signals and/or events Hypnogram / Spectrogram / position like graphics Create custom charts, format size in MS-Word style Define titles of variables Select required fields from the field library Preview result Customize color scheme and / or special chart formats Save all your report parts and charts and organize your categories Result

Custom Report Fields for Events Derive new reportable fields based on any possible event configuration (including associations with other events and / or signal conditions) Example: Desat Count with >= desats of 4% in Non-Supine during Sleep Choose primary new event condition, compare expected logic to the example given at the right side Edit step by step all required conditions (see the custom entries in blue)

Custom Report Fields for Signals Derive new reportable fields based on any possible signal condition (including associations with other events) Example: Total time with Saturation <= SpO2 in Supine during Sleep Choose primary new signal condition, compare expected logic to the example given at the right side Edit step by step all required conditions (see the custom entries in blue) Select required number format

Custom Report Fields Used With Reports New custom Report Fields get added to the Fields library Search function works in the Field Library and Descriptions Fields can get classified into existing or new categories Fields show up with name, short description (bottom) in the WYSIWYG window as “worded logic expression” when hovering over the variable

Report Custom Table – Arousal Associations Default table for Arousal Associations in Report parts Created custom Report Fields Created and filled Arousal Associations table All Report Fields show up with definition within the table (hover over) Table to be used for customizing reports (is not used in default reports !)

Import Word Reports from 3rd Parties Target: Facilitate change from existing systems and reports to Noxturnal Required: Word *.dot file and known variables definition First implementation for Embla Reports (Somnologica / RemLogic) Drag and Drop: Locate *.dot file and drag it into the Report WYSIWYG window Import of layout and bitmaps Automatic translation of known variables into “Noxturnal-language”  Display field definition in known “worded logic expression” Unknown variables (“?”) must be manually configured

Export Reporting Options Settings Reports: Define Name configuration for Report titles Define Saving Location (standard is the recording folder) Report “One Click” opening in Word Export reports to *.pdf / *.rtf and others

Exporting of Data

Extended Data Export Functionalities Standard export to EDF and EDF+ (and some other generic formats) Prepared HIS communication (name change from Vlink) HL-7 and GDT available Customizable field associations to be configured with IT support Customizable export for scientific use Event / signal grid export

Customizable Export for Scientific Data Use Signal and Event Grids Signal Grid: Signals data with time stamps and epoch info Spectral / statistical info can be derived from signals Formula editor for special mathematical functions Event Grid: Event data with time stamps and epoch info Customizable detailed event reporting !!! All custom “Grids” can be saved as sheet templates and exported to statistical programs.

Noxturnal Network Support: Administrator and User settings * Simplified administrator and user settings Network / Computer Administrator in Noxturnal Admin mode Define (and lock) general settings Define access to user settings Enable / disable user access to configurations / reports etc. User settings Settings on local machine per user Roaming user profiles within networks (regardless of network computer the user will open Noxturnal with his user privileges) * Knowledge base article available on noxmedical.com

For more information go to www. noxmedical For more information go to www.noxmedical.com/support and search for more detailed knowledge base articles Set standards  built in bluetooth Ahead of others  integrated sound, upcoming calibrated RIP