Remlogic Scoring

Remlogic Scoring

Postby slowdavesleep » Wed Jan 21, 2009 5:39 pm

We've been looking at switching to Embla Remlogic. Just wondering how people find the event scoring? There are concerns here that declaring an event type after you click an event will mean excessive clicking. People want the feature we currently have where an event type can be tied to a specific channel.

Let me know how scoring on Somnoligica or Remlogic is if you can, thanks!
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Postby theboyns1 » Fri Jan 23, 2009 9:04 am

What are you using now? I have been working with Remlogic and Somnologica for the past year and the Remlogic is much better to score on than the Somnologica. Mostly due to the fact that the Remlogic will associate arousals automatically and the somnologica doesn't.

There are single click options in the remlogic. If you have a lot of different types of respiratory it can be difficult. It is very hard to explain but you will have to change your event type when you change from a Hypopnea to Apnea for example.

Or the other option for scoring events is just choosing what it is after you mark the event. That can be time consuming.

The biggest problem is that you can really screw the study up if you are not paying attention! You can mark anything on any channel. For example you can mark hypopneas in the eeg. And if you are not careful you can mark multiple events right on top of eachother and not know it.

If I was Buying a System I would stay away from it. I have worked on a lot of systems and this is the least user friendly I have used. It is a lot better with REMLOGIC upgrade but still very time consuming. It generally takes me twice as long to score a study on the REMLOGIC compared to Sandman, Alice or Compumedics.

Oh and not to mention there belts! they are one size fits all! and after you stretch them some the wont fit on a average sized patient. And the belts cost 600.00 a pair!

I could go on forever. Just dont buy it!
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Postby somnonaut » Fri Jan 23, 2009 1:24 pm

Well,
I disagree.
There is no way to put two of the same event types on top of each other. Even under REMbrnadt 9.0, Embla expunged that possibliy. The last one will automatically erase the previous one.
As for multiple Resp event types, just assign the channel to event type, and go down each of your resp channels for event types.
RERA on PFLOW
Obs Hypopnea on Temp FLOW
Cent Hypopnea on CFLOW
Obstructive on Chest
Central on Abdomen.

All one then has to do is point to the channel in question and swipe away. If I am not mistaken, they also allow hotkeys, so you can just assign event types to hotkeys, and click where the start of the event ocurrs (anywhere on the record), and hit the hotkey, and a default event for that hotkey will be entered. (typically 10 sec for resp , 3 sec for arousals)

As for the belts. The universal belts are adustable, and with the battery connector (Lithium which lasts about 2 yrs, though I wish they would make it rechargable) the belt fits 90% of the patient types. I also made new wires to retro-fit the disposalble RIP belt system that we purchased for the Artisan Amps, but ended up being way too complicated to use with the powere hijacking connectors, etc, etc, I realized that the belt is just a wire, and therefore, if I made a new connecto to plug into the disposable belt connector, I could use the circuitry in the battery connector of the universal belts. So, a purchase of a RIP extender, and the sacrifice of some clip on EKG wires later, I was able to make a disposable RIP belt interface that would use the Universal Battery connector (which I mounted on the wall with velcro) and now my lab has a second option for RIP using disposable delts. I should make this into a tutorial, or sell the dang things.
This then fits the need for peds, contagious and very thin adults whic the universal is too big to fit. Does anyone else make disposable RIP belts?

BTW, these disposable RIP belts, with this "fix" will work on ANY SYSTEM, as it plugs into the ehadbox in any AC pinset. CHx +-

I am pissed at Embla for not porting more of the very useful REMbrandt features over to REMlogic. I HATE the stupid friggin hand that moves the waveform around within the channel realestate. Now that REMlogic 1.1 came out with the REMBRANDT overlay, we get back some of the rembrandt right button click channel control and look and feel of Rembrandt in Remlogic. My sources say there is a 1.2 coming out too.
For upgrading, I am told that REMBRANDT 9.0 will function the new Silver Amplifiers, and one does not HAVE to transitiion to Remlogic to upgrade the hardware. This is an upgrade path I considering in our present expansion to 8 from 4 beds. Go to the new amps, work everything out while still using the existing experience in the staff on the current software and then a future date upgrade the software when it has progressed to a more malleable form.

As for Remlogic specifically, it has the most user friendly QA comparisons. Just start a seperate scoring workspace session, and then compare them. It allows all sorts of event windowing allowablity (0% to 100% event overlap) allowing for the dreaded well my Obstruction starts 5 sec before his, so...)

Remlogic DOES NOT open as many seperate timebased acquistion windows (2) as Compumedics (10). Which is something I give much credence. Ekg at 5 sec (nice and blown up) Staging at 30, REsp at 180 sec, and Oximetry at 5min.
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Postby theboyns1 » Sat Jan 24, 2009 5:51 am

Are you speaking of Rembrant or Remlogic when you say you cant overlap events? On Remlogic You can overlap events. What I mean when I say this is you can mark a hypopnea on the Belts and flow signal right on top of each other and it will count both of them in the report. with that said if your night technician is scoring events on one channel which is labeled flow but you are scoring under a different template and that flow channel is not on the montage then the report will count the events 2 times. This has happened to me more than once. I had to go through and delete all of the extra channels that embla set the system up with and it seems to be fixed now.

There is a lot of room for error with Remlogic. Some of the flexability of the system is nice at times. But if you have someone who does not know what they are doing they can screw it up easily as well.

Rembrant and Remlogic are very different systems. And if you are speaking of Remlogic for assigning channels how do you do this? I have not found that option and I would love to know how to do that.

As for the belts being disposable belts I agree I do like that setup better. But the few labs I have worked for that used Somno they just wanted to buy the belts and use them over and over again. I think it would have been nicer to have the disposable belts. Especially for Peds. The reusable belts do have one adjustment on them. But my point was that over time they will stretch and will not fit 180lb patient. Our belts that are a year old should be replaced soon because of this. We may be talking about different belts though, I am not sure. But the belts I am using are the same belts that Embla has given me in 3 different Somnologica labs accross the country.

Let me know about that channel assignment.. I really would like to know how to do that! :)
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Postby Channels » Wed Apr 29, 2009 4:23 am

I don't like the idea of assigning channels. The RemLogic workspace takes up so much space, if I can get rid of the CFLOW at least, I will. And RERA as an arousal event? What's up with that?
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Postby theboyns1 » Wed Apr 29, 2009 5:56 am

Well isnt a RERA technically an arousal. Respiratory Event Related Arousal.... Correct me if I am wrong.
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Postby somnonaut » Wed Apr 29, 2009 12:23 pm

theboyns1 wrote:Well isnt a RERA technically an arousal. Respiratory Event Related Arousal.... Correct me if I am wrong.


You are correct.

But not here: "On Remlogic You can overlap events."
Not in the latest version of 1.1. Why would you want two events to represent the same waveform/timeframe? That would be double dipping.
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Postby Neil » Thu Apr 30, 2009 12:12 pm

I beg to disagree on the RERA. Literally, it reads as an arousal, but in context it's really a very badly named respiratory event.

In essence, it's a respiratory event that requires an arousal be present at termination of the respiratory event in order for the respiratory event to be scored.

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Postby slowdavesleep » Thu Apr 30, 2009 12:49 pm

Apnea and hypopnea have a start and an end, flow limitation is a not so much an event but a state of breathing that leads to the arousal. Patients can be flow limited for 10 minutes or longer before it leads to an arousal. So IMO trying to mark a discrete flow limiation event on the resp channels is an exercise in futility (unless maybe you have an esophageal catheter).
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Postby Neil » Thu Apr 30, 2009 1:04 pm

One of the older definitions of RERA (i.e. NOT the one adopted by the AASM - surprise, surprise, surprise) did incorporate a distinct respiratory end to a RERA. As for the beginining/duration of 10 mins or so, you have a point, but I'm still a believer of the RERA as a "real" respiratory event.

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Postby Channels » Wed May 06, 2009 2:24 pm

So for you, 'RERA is an arousal' folks, do you change arousals to RERA's when you score your respiratory pass?

The fact that the Respiratory Effort-Related Arousal Rule is number 5 under Respiratory Rules sure seems to point to it being a respiratory event. Couple in the sample Figure shows only resp channels. I know our docs would flip if they couldn't visually see a 'RERA' in the respiratory channel.
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Postby slowdavesleep » Wed May 06, 2009 4:25 pm

Semantics. At our lab based on the software we use, we mark arousals and then we mark the event which becomes tied to the arousal, this changes the arousal type automatically. For RERA place a token 1 second tag just prior to the arousal and we do not try to indicate where the RERA "began". Yes I do place my RERA tag on the flow or belts.
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Postby Channels » Wed May 06, 2009 7:45 pm

SWD, if you are thinking of the RemLogic software you will need to create a 'token' tag that will accomplish this. Getting it to associate and report correctly is a little tricky.

So when reporting your RDI, is it pulling the number of RERA's from the arousal event or the 'token' event.
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Postby slowdavesleep » Wed May 06, 2009 9:38 pm

We currently use Sensormedics, which was what I described. I should have been more clear. Senromedics calculates RDI from the token markers. The association is more important in hypopnea, apnea and leg kicks where we get a count with and without associated arousal. We actually get a count of RERAs with and without arousals, but if any do not have arousals someone clicked badly...
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