Chapters Transcript Video Zvu® Functional GI Software-Reflux Study Analysis Overview of using Zvu® Functional GI Software to perform reviewing reflux studies. Welcome to the diverse a tech healthcare Z view tutorial. Siri's Reflux Study Analysis Using Z View Here are our objectives. The objective of this tutorial is to give an overview of the process for reviewing a reflux study using Z view. At the conclusion of this tutorial, the participant will be able to open a Zeevi reflux study and toggle between available views, explained the study overview. Describe the features of the diary editor, demonstrate the review of measurements and the associate ID metrics and show how a report is selected and generated. Details of certain features will be dealt with in their own tutorial. Here are the steps for study review from the Seaview Home Page. Select Patient Management from the patient list. Select the tile for the study you wish to analyze, confirmed the patient information in the patient and study sections. An update any fields as needed. Then click Review Study to open the analysis page. The analysis page opens with the full study in view. The data is displayed in the stacked view with impedance contour on at a 50% opacity. This contour layer may be turned off or on at any time during the review by clicking the Contour Icon. Studies may also be reviewed in the fit to pro view. This view allows for various data layers to be displayed. Reviewer may choose a view or toggle back and forth between the views. We will review this study in the stacked view to begin the study overview. Note the recorded time of the study. In the timescale. 22 to 24 hours of recorded study usually yields at least 20 hours of analyzed data as meal periods air not analyzed. Next Review the annotation area to see if meal and recumbent periods seem appropriate based on what is known about the patient. For example, an eight hour meal during a 10 hour recumbent period does not appear to be correct unless the patient is on a continuous night time tube feeding four lines will show in the annotation area at a time. Individual symptoms each have their own line. The line order may be adjusted with a left click and drag on a line title. Additional lines may be displayed by clicking the up or down arrows in the annotation area. Changes to the individual annotations will be done through the diary editor. Next review. The impedance Wave forms to scan for artifact. The impedance wave forms often go to 10,000 homes when heiress swallowed, but the way forms come back to basil quickly as a swallow completes. This is especially evident during meals. Wave forms rising to 10,000 homes and staying there for a long period of time may indicate artifact. This occurs most commonly if the probe was temporarily disconnected. Artifact can be excluded from analysis to exclude a portion of the study, right click in the data area. Select add excluded area, then left, click and drag to the right to define the area to be excluded. Once created, the right or left edges of the exclusion box may be adjusted to delete on exclusion box, right click on the Exclusion box title bar and select delete Excluded area. The Ph way for may also be reviewed. For artifact artifact in the pH would look like wild swings in Ph or pH. Dropping to or below zero. Normal appearance of the pH is that it would dip below four on occasion, and when it dips below four, the wave form is filled in in red to indicate acid After this quick, high level overview, that study may be reviewed in a smaller timescale for a closer examination one hour or three. Our views are used commonly using the right and left arrow keys on the keyboard. The entire study may be viewed for artifact not seen in the high level. Overview. The scale of the way forms may be changed at any time. Once this review is complete, clamped wave forms stay within their own lanes and show a thicker line where the wave form has been truncated or clamped. Once the study is reviewed, opened the diary editor in the diary editor. Annotations maybe added, deleted or adjusted. The annotation list may be sorted by start time or annotation name by clicking on the title of the column. To rename an annotation, select the annotation, click relabel and select the correct label. The edit choice allows for a change to the time and or the label of a selected annotation. Multiple annotations, maybe relabeled all at once through the relabel or edit choices. The ad choice allows for annotations to be added to the study one at a time, once added ah Green message will appear in the upper right corner, indicating that the annotation was added successfully. Additional annotations maybe added, while in this choice when all desired annotations have been added, click done. The duplicates choice allows for all duplicate annotations of any type to be deleted at once. A duplicate is defined as an annotation of the same type. Within two minutes of the original select duplicates, all duplicate annotations will be highlighted. Click delete to remove the highlighted annotations. To delete one or more annotations, sort by start time or annotation. Select an annotation to be removed. Hold the shift key down on the keyboard to select more than one annotation in a row. Hold the control key down on the keyboard to click on individual annotations to select those not in sequence. When all annotations to be deleted are selected. Click delete. When all desire changes to the annotations list has been made, click close. Once the annotations have been adjusted, Select Auto Scan Auto Scan will review the study for reflux episodes and will create measurements. Auto scan settings are based on the prototype and the age of the patient. The metrics will open once auto scan has run double left click in the data display area to magnify the study to a 10 minute window. Alternatively, the timescale may be used to magnify into a different time window. When two magnification levels have been selected, the toggle icon will navigate back and forth between the last two magnification zones. The move to icon can be used to navigate through the study by one of several features. If the move to is set to measurement measurement, then the arrow icons will move forward or back through the study. One measurement at a time. The keyboard right and left arrows do the same as do the tab and shift tab keys. One measurement at a time is selected or active. The Z Reflux Brown title bar shows all the time. The pH measurements appear with a dashed blue border. Until a pH measurement is selected. One selected the brown pH Measurement title bar will be displayed. The measurement metrics shows the data for the active measurement. The wheel on the mouse can be used to zoom into or pan out from a selected spot on the study. Measurements may be viewed with or without the impedance contour in the background In order to speed the review process, the recalculation may be turned off. Click to de select automatic in the upper right of the study metric section. Now, when adjustments are made in the study, there will be no wait for recalculation. The study metrics will go blank until it is once again updated. After a few or several adjustments have been made, calculate maybe clicked for a one time update, click calculate, then select a measurement to show the study data in a measurement. Braces and baselines ca NBI adjusted by left clicking and dragging on the mark to be moved. Marx CA NBI added or deleted with a right click. Measurements can be added if it appears there is an unmarked reflux episode. Likewise, measurements can be deleted if it appears that there is no reflux. If the move to options is set to symptom to symptom, the symptom Correlation window will show for the active symptom. This window allows for viewing the study in any timescale. The symptom correlation window defaults to five minutes prior to a symptom. The time frame for a window maybe changed on a per symptom basis through the properties feature. If during the review. A Correlation window or loan vertical dash line is showing without an annotation bubble. Use the slide arrows in the annotation area to display the hidden symptom. If a reflux episode occurs within the Correlation window, the symptom will be correlated to reflux on the report. Z reflux correlations are calculated separately from Ph Correlations. The study is reviewed for accuracy of reflux episodes identified by auto scan, especially those that fall within the correlation windows of the various symptoms. If the move to option is set to a choice other than symptom by symptom, the Correlation window can be seen by left clicking and holding on the symptom bubble in the annotation area. During the review, the metrics could be noted for individual active measurements or for the aggregate study metrics. A few of the metrics fields may be overridden by the reviewer. Abnormal values show in red. In the study metrics, the data for the impedance measurements are separated from the data in the pH measurements. The number in the respective tabs indicates how many of each measurement type there are in the study. Once the study has been reviewed, the calculate button maybe clicked one more time so that the current aggregate data is being reviewed before completing the fields. In the study summary section, the notations in the study summary section will migrate to any report that is generated. Click the report icon. If report templates other than those designated in the workflow are desired, click managed templates and select the desired report types for this study, then generate the report or reports. Once generated, the reports may be moved outside of the Z View software, to be edited by selecting send reports or they can be reviewed directly in the software. Reports reviewed directly in the software should not be edited as the edits won't be saved, but reports sent out of the software are unencrypted and cannot be joined back to the software at this time. Changes to the notes, impressions, diagnosis or diagnostic tags can be made in the study. Some resection changes to the format or content of a report can be done by creating a custom template. The study is automatically saved when a report is generated. This concludes the tutorial on the basic steps of analysis and review of a reflux study with the new Z View software Created by
