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At least 217 records · Page 12Linked to original sources
PubMed2005

Monitoring glycemic control: the importance of self-monitoring of blood glucose.

Several methods, each with differing utility and limitations, exist for monitoring glycemic control. Hemoglobin A1c (HbA1c) is considered the standard measure of long-term glycemic control, and HbA1c levels are strongly associated with complications of diabetes. However, HbA1c does not provide "real-time" information about individual hyperglycemic or hypoglycemic excursions. Urine glucose testing is noninvasive and inexpensive, but it is dependent on the patient's individual renal threshold and can only detect glucose concentrations above this threshold. As such, urine testing cannot be recommended for diabetes management that aims for near-normoglycemia. Self-monitoring of blood glucose (SMBG) complements HbA1c by providing real-time blood glucose data. It is an educational tool for both patients and their healthcare providers to understand the effects of diet, exercise, and medications on day-to-day glycemic control. However, guidelines from various international diabetes organizations vary in their level of specificity regarding the frequency and timing of self-monitoring. SMBG should be implemented for all patients as part of an overall diabetes management plan that includes specific instruction on how, when, and why to test.

Blood Glucose↗
PubMed2005

Deposition monitoring networks: what monitoring is required to give reasonable estimates of ammonia/ammonium?

Deposition is one of the main loss terms for ammonia and ammonium from the atmosphere. It is also the input for ecosystems that can lead to drastic changes and effects. Deposition networks are needed to evaluate the need and the effect of policies to reduce nitrogen emissions, but also for studying deposition parameters and for developing deposition models. As with ambient concentrations of ammonia, deposition, especially dry deposition, varies strongly in space and in time. Furthermore, the bi-directional surface-atmosphere exchange of ammonia makes the combination of ambient concentration measurements with inferential models inadequate. Developing deposition monitoring networks with reasonable accuracy and representativeness is therefore not straightforward. In Europe several projects have addressed deposition monitoring. From these results it is concluded that a monitoring strategy should consist of a network with a limited amount of super sites combined with a larger number of sites where low cost methods are applied, together with models for generalisation.

Air Pollutants↗
PubMed2006

Sediment reference concentrations of seldom monitored trace elements (Ag, Be, In, Ga, Sb, Tl) in four Swedish boreal lakes--comparison with commonly monitored elements.

This paper presents reference and recent acid-leachable concentrations of some seldom monitored trace elements (SMTE; Ag, Be, Ga, In, Sb and Tl) in sediments from four boreal oligotrophic lakes in a south to north transect in Sweden. For comparison commonly monitored trace elements (As, Cd, Co, Cr, Cu, Ni, Pb and Zn) are included as well as those of relevance for redistribution processes (Al, Ca, Fe, Mg and Mn). Pore water pH and the corresponding solid/solution distribution coefficients (Kd) indicated that redistribution of the elements due to acidification is minor. The depth of impact was defined as the level in the sediment where the mean values became constant on successive exclusion of metal concentrations in overlying strata. Reference concentrations were calculated below the depth of impact. The present concentration changes are estimated by the ratio between the average concentration above the depth of impact and the reference concentration. Reference concentration ranges for the SMT-elements are (mg/kg, dry wt.): Ag 0.16-0.66; Be 1.6-3.7; Ga 2.0-5.1; In 0.05-0.22; Sb 0.05-0.11 and Tl 0.17-0.70. The concentration ratios for these elements ranged in the two most southern lakes from 1.5 to 4.5 and in the two northern ones from 0.6 to 1.6. A high correlation between Kd for the SMT-elements, and iron, except for Sb and Tl, infer that the biogeochemistry of iron is quantitatively important for the accumulation of these elements. The reference concentration ranges for the commonly monitored trace elements are (mg/kg, dry wt.): As 7.0-29.6; Cd 0.33-0.98; Co 5.7-23.8; Cr 15.2-26.1; Cu 27.6-58.4; Ni 5.4-20.8; Pb 44-96. The corresponding concentration ratios were 1.2-18 (second highest 3.9) in the two most southern lakes and 0.8-1.6 in the two northern ones. Declining ratios were found from south to north, most obvious for cobalt and zinc. The copper ratios did not show a regional pattern, partly because of the impact from old mine waste. Increased concentrations of Ag, Be, Ga, In, Sb and Tl in recent sediments up to 4.5 times the reference levels in combination with the geographical pattern infer an elevated loading of these elements.

Environmental Monitoring↗
PubMed2005

Home INR monitoring of oral anticoagulant therapy in children using the CoaguChek S point-of-care monitor and a robust education program.

INTRODUCTION: Management strategies such as self-monitoring of anticoagulant therapy have been reported with increased frequency. Whilst patient education is frequently mentioned, details regarding the educational interventions employed are scarce. This study aimed to improve the outcomes of home monitoring of warfarin therapy in children through the development and implementation of a robust intervention, based upon the PRECEDE model of education. MATERIALS AND METHODS: Participating parents had to complete an intensive education and training program. After demonstrating practical and theoretical competency, parents commenced home monitoring. Every second scheduled home INR (H-INR) required a paired INR on the same day, obtained by a trained pathology collector (C-INR). Demographic and statistical outcome data was collected. RESULTS: Parental understanding of warfarin therapy improved significantly following the educational intervention (p<0.0001). 65.5% of H-INRs and 64.4% of C-INRs were within the target range (ns). Lin's correlation coefficient between H-INRs and C-INRs was 0.949. There were no warfarin-related adverse events. CONCLUSION: This study demonstrated a significant improvement in parental knowledge following participation in a robust educational intervention. Furthermore, compared to previous reports in children, a greater level of correlation between home and hospital-based INRs was achieved by participating parents. The use of similar educational interventions may serve to improve the outcomes of similar management strategies.

Administration, Oral↗
PubMed2003

Randomized trial of a daily electronic home monitoring system in patients with advanced heart failure: the Weight Monitoring in Heart Failure (WHARF) trial.

BACKGROUND: Heart failure treatment guidelines emphasize daily weight monitoring for patients with heart failure, but data to support this practice are lacking. Using a technology-based heart failure monitoring system, we determined whether daily reporting of weight and symptoms in patients with advanced heart failure would reduce rehospitalization and mortality rates despite aggressive guideline-driven heart failure care. METHODS: This was a randomized, controlled trial. Patients hospitalized with New York Heart Association class III or IV heart failure, with a left ventricular ejection fraction < or =35% were randomized to receive heart failure program care or heart failure program care plus the AlereNet system (Alere Medical, Reno, Nev) and followed-up for 6 months. The primary end point was 6-month hospital readmission rate. Secondary end points included mortality, heart failure hospitalization readmission rate, emergency room visitation rate, and quality of life. RESULTS: Two hundred eighty patients from 16 heart failure centers across the United States were randomized: 138 received the AlereNet system and 142 received standard care. Mean age was 59 +/- 15 years and 68% were male. The population had very advanced heart failure, New York Heart Association class III (75%) or IV (25%), as evidenced by serum norepinepherine levels, 6-minute walk distance and outcomes. No differences in hospitalization rates were observed. There was a 56.2% reduction in mortality (P <.003) for patients randomized to the AlereNet group. CONCLUSIONS: This is the largest multicenter, randomized trial of a technology-based daily weight and symptom-monitoring system for patients with advanced heart failure. Despite no difference in the primary end point of rehospitalization rates, mortality was significantly reduced for patients randomized to the AlereNet system without an increase in utilization, despite specialized and aggressive heart failure care in both groups.

Body Weight↗
PubMed1996

Technical implementation and clinical findings/results of monitoring oxygen saturation in patients referred for long-term EEG monitoring.

Recent technical developments allow the recording of a patient's oxygen saturation (SpO2) simultaneously with intensive long-term EEG monitoring (LTM). Clinically significant information from this enhanced multi-system physiological monitoring device can contribute to more accurate diagnoses in patients referred for LTM. This report covers the technical usage of combined SpO2/EEG recordings in a small group of patients. Clinically, the findings on the SpO2 monitor helped to define the diagnosis in many of these patients. In a few, the SpO2 changes were diagnostic in their own right and prompted referral to our Sleep Disorders Laboratory. From a research aspect, the details of the morphology and timing of the oxygen desaturations and EEG show several interesting relationships with respect to the dynamics of seizure semiology and respiratory physiology.

Adult↗
PubMed1999

Air pollution exposure monitoring and estimating. Part I. Integrated air quality monitoring system.

This paper presents an integrated exposure monitoring system, based on an expansion of existing air quality monitoring systems using dispersion modelling. The system allows: (1) identifying geographical areas whose inhabitants are most exposed to ambient pollution; (2) identifying how many people in an area are exposed to concentrations of pollution exceeding air quality guidelines; (3) describing the exposure of population subgroups (e.g. children); (4) planning pollution abatement measures and quantifying their effects; (5) establishing risk assessment and management programs, and (6) investigating the short- and long-term effects of both pollutants and pollution sources on public health. The effect of pollution is rarely very large and in order to discover it, exposure estimation must provide data that reflects both spatial and temporal variations. Estimates of pollution exposure are obtained using an integrated approach that combines results of measurements from monitoring programs with dispersion calculations. These values can serve as estimates for individual short-term or long-term exposure. The grouped data allows the expression of ambient pollution concentrations as the spatial distribution of estimates such as the mean or 98th percentile of such compounds as SO2, O3, NO2, PM10 and PM2.5. This integrated approach has been combined into a single software package, AirQUIS.

Air Movements↗
PubMed2003

Assessment of the Ventrix parenchymal intracranial pressure monitoring probe (NL950-P) and Monitor (NL950-100) in a 3 Tesla magnetic resonance scanner.

Magnetic resonance (MR) imaging and spectroscopy provide important information in patients with acute head injury. However, optimal patient management requires intracranial pressure (ICP) monitoring. There are few reports on the use of ICP sensors in an MR environment. We tested the Ventrix parenchymal intracranial pressure monitoring probe and monitor (Integra Neurosciences, USA), modified by the use of a fibre-optic extension cable, within a 3 Tesla MR system. The device performed well in the MR environment, but one element within the fibre-optic extension was significantly ferromagnetic. The ICP probe produced a small susceptibility artefact on spin echo images, and a larger artefact on gradient echo images. The MR safety of the integrated system is probably acceptable, but could be easily improved with minor modifications. Although the system is MR compatible and produces generally acceptable imaging even at 3 Tesla, there is significant degradation of image quality during gradient echo sequences.

Artifacts↗
PubMed1996

Compliance monitoring of NSAID drug therapy in ankylosing spondylitis, experiences with an electronic monitoring device.

We concluded a randomized, controlled trial to compare once-daily 20 mg piroxicam versus once-daily 20 mg tenoxicam in ankylosing spondylitis. We recorded patients' dosing histories with electronic monitors for an average of 225 days (range 55-379) in 34 recipients of piroxicam and 31 recipients of tenoxicam. Dosing histories with the two agents were similar and are combined. Patients took 81% of prescribed doses; 78% once daily (as prescribed) and 3% as two or more daily doses. On 19% of all monitored days, there was no record of a dose being taken; 68% were single no-dose days, the rest (32%) being 2 to >10 consecutive no-dose days. In 3% of monitored days, extra doses were evidently taken, 88% as twice daily and 12% as three or more doses. Only 22% of all patients (14/65) strictly complied with the regimen: one dose daily every day. The remainder alternated between no-dose days and extra-dose days. We found no correlation between patient compliance and improvement in reported pain or morning stiffness.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1980

Continuous transcutaneous oxygen monitoring during respiratory failure, cardiac decompensation, cardiac arrest, and CPR. Transcutaneous oxygen monitoring during arrest and CPR.

The transcutaneous oxygen sensor (PtcO2), which has been used to predict PaO2 in neonates, recently has been shown to follow changes in oxygen delivery, rather than PaO2 during shock and hypoxia in dogs. Six preterminal patients were continuously monitored with PtcO2 and monitored hemodynamically at frequent intervals during cardiac decompensation, arrest, and cardiopulmonary resuscitation (CPR). The weighted mean correlation coefficients between PtcO2 and O2 delivery as well as between PtcO2 and cardiac output were 0.94 and 0.96, respectively. Five patients died of severe ARDS and 1 patient died intraoperatively of hemorrhagic shock. Four patients were monitored 1-7 days before shock occurred. The correlation between PtcO2 and PaO2 was 0.91 during periods of normal cardiac output in the preterminal period. During cardiac decompensation, the cardiac output, PtcO2, and mixed venous oxygen tension (PcO2) of 25 torr was reached, the PtcO2 fell below the PvO2. This also corresponded to a decrease in VO2. The mean VO2 was 142 +/- 24 ml/min x M2 for PtcO2 values > torr, and 75 +/- 15 ml/min x M2 for PtcO2 < 25 torr (p < 0.01). A PtcO2 of > 40 torr corresponded to normal cardiac index, O2 delivery, VO2, PvO2, and arterial pH (pHa) while a PtcO2, of < 25 torr corresponded to large reductions of these variables. A PtcO2 of < 25 torr preceded cardiac arrest by 43 +/- 28 min.

Cardiac Output↗
PubMed1988

Italian collaborative study on the utilization of therapeutic drug monitoring in hospital departments. Italian Collaborative Group on Therapeutic Drug Monitoring.

A population base of 6,367 in-patients from 28 general hospital wards was included in a nation-wide project aimed at documenting the extension and criteria of therapeutic drug monitoring (TDM). On randomly selected index days over a 3-month period details of age, clinical status, renal and liver function, diseases, drug therapies, and drug monitoring of all in-patients of eight different clinical specialties were recorded and analyzed. A total of 648 requests for 387 patients (16.3% of the population given drugs for which TDM was available in the hospital) was traced. Digoxin was the most frequently monitored drug (481 requests for 289 patients), accounting for 74% of the overall requests. This finding is consistent with the yearly activity of the laboratories of the same hospitals, which documented that 63% of the whole in-hospital analytical work (29,396 out of 46,692 requests) concerned digoxin. From a more qualitative point of view, data are provided that document a largely inappropriate use of TDM, which was employed only for 20% of patients who might have benefited from it.

Digoxin↗
PubMed1995

Monitoring acrylic fiber workers for liver toxicity and exposure to dimethylacetamide. 1. Assessing exposure to dimethylacetamide by air and biological monitoring.

Worker exposure to N,N-dimethylacetamide (DMAC) in an acrylic fiber manufacturing facility was measured, over a 1-year study period, by full-shift (12 hours) personal air monitoring for DMAC and by biological monitoring for levels of DMAC, N-methylacetamide (MMAC), and acetamide in spot urine samples. Ninety-three of 127 male workers in seven job classifications in the solution preparation and spinning departments of the plant were monitored on the second consecutive workday after at least 3 days off for the first 10 months of the study and on both the first and second days during the study's final 2 months. Postshift urinary MMAC levels were significantly correlated (P < .0001, r2 = .54) with DMAC in air levels. An air level of 6.7 ppm 12-hour time-weighted average (TWA) corresponded to a urine MMAC level of 62 mg/g creatinine in a postshift spot urine sample obtained after the second consecutive workday. To minimize exposure misclassification due to variability in the regression relationship, a level of 35 mg MMAC/g creatinine in a postshift spot urine sample was recommended as a biomonitoring index. Postshift urine MMAC levels did not appear to plateau at higher air levels, nor did it appear that the DMAC demethylation metabolic mechanisms became saturated at threshold limit value (TLV)-level air-exposure levels. Urine MMAC levels in postshift samples obtained the second workday appeared to be greater than levels in postshift first-day samples, but the number of days until this postshift level would plateau could not be determined from this study.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetamides↗
PubMed2002

Future developments in ambulatory blood pressure monitoring and self-blood pressure monitoring in clinical practice.

A number of factors interact to promote the increased clinical use of both ambulatory blood pressure monitoring (ABPM) and self-blood pressure monitoring (SBPM). These include the phasing out of mercury, evidence of the unreliability of clinic measurements, technical advances in automated blood pressure measurement, increasing evidence that out-of-office measurements give the best risk assessment, and a gradual recognition by payers of the clinical utility of ABPM and SBPM. Both ABPM and SBPM have been endorsed by the two major guidelines for managing hypertensive patients (World Health Organization-International Society of Hypertension and Joint National Committee VI). The use of SBPM has grown enormously over the past few years, mostly because of direct sales to patients. Although SBPM may give a better estimate of the true blood pressure than clinic readings, there are concerns about the accuracy of the monitors in individual patients. The main clinical indication for ABPM is the diagnosis of white-coat hypertension. This requires the demonstration that the blood pressure is normal outside the clinic, which can be established using SBPM and confirmed by ABPM. Even though ABPM may save drug costs in patients with white-coat hypertension, its use may also lead to increased drug expenditure in others in whom it demonstrates suboptimal blood pressure control. SBPM has the potential to reduce the number of clinic visits and also to improve blood pressure control. The ultimate validation of both procedures will be whether they can prevent cardiovascular morbidity. There have been suggestions that a non-dipping pattern of nocturnal blood pressure may carry a bad prognosis, but this may apply only to certain disease end-points. The greater recognition of the relevance of dipping status should provide an additional stimulus to the growth of both procedures. It is anticipated that, in the future, hypertension will be managed by the 'virtual hypertension clinic', using ABPM for the initial diagnosis, and SBPM with electronic linkage between the patient and the health-care provider for maintenance and follow-up.

Blood Pressure Determination↗
PubMed1991

New noninvasive transcutaneous approach to blood glucose monitoring: successful glucose monitoring on human 75 g OGTT with novel sampling chamber.

A novel noninvasive and quasi-continuous method of transcutaneous blood glucose monitoring for use with the human 75 g oral glucose tolerance test (OGTT) has been developed. The effused fluid was obtained by applying suction on the skin surface and labeled suction effusion fluid (SEF). The system consists of two main parts: a suction apparatus and the glucose sensor system. The suction apparatus applies vacuum to the patient's skin at 400 mmHg absolute pressure to collect the SEF. The miniature ion sensitive field effect transistor (ISFET) based glucose sensor can measure glucose in small SEF quantities. The monitoring system is based on the association between the glucose concentration in the SEF and in the serum. During the 75 g OGTT, the glucose change in the SEF was measured every 10 min. Although a response delay of up to 20 min was observed in the SEF glucose change, it was possible to perform the 75 g OGTT by this noninvasive monitoring method.

Animals↗
PubMed1993

Noninvasive monitoring of respiratory volume. Experimental evaluation of a breath monitoring device.

The authors studied the accuracy of the noninvasive breath monitor (Voltek Enterprise, Willowdale, Ontario, Canada) in predicting the tidal volumes in five healthy human volunteers. The signals of the breath monitor were compared with the volumes estimated by a calibrated pneumotachograph. The results show that the breath monitor is considerably accurate and can be accepted as a reliable device for clinical applications.

Evaluation Studies as Topic↗
PubMed1979

Intrapartum fetal monitoring with the cerebral function monitor.

We report a trial of the technical feasibility of monitoring the state of the fetal brain during labour using the Cerebral Function Monitor (CFM). This device was developed for long-term monitoring of the electroencephalogram (EEG). A tripolar scalp electrode allows removal of the fetal electrocardiograph (ECG) from the fetal EEG. Technically satisfactory recordings were obtained from 15 fetuses during labour for periods of up to 6 1/2 hours before delivery. There were alterations of CFM trace with fetal distress and also during general anesthesia for Caesarean section.

Anesthesia, General↗
PubMed1999

Dual pH probe monitoring versus single pH probe monitoring in infants on milk feeds: the impact on diagnosis.

OBJECTIVES: Oesophageal pH monitoring is the gold standard technique for the detection of gastro-oesophageal reflux in adults and children. A standard parameter used to define "abnormal" reflux is the percentage of recording time for which the gastric pH is < 4. This study investigated the relevance of this measure in infants on regular milk feeds whose gastric contents and refluxate will be neutral for most of the recording time. METHODS: Simultaneous oesophageal and gastric pH monitoring was carried out on all infants who were milk fed exclusively and admitted to hospital for suspected gastro-oesophageal reflux. In vitro studies were performed to establish the buffering capacities of the fruit juice, Dioralyte (a glucose electrolyte solution), breast milk, and milk formula feeds available on the paediatric wards. RESULTS: Complete sets of data were obtained from 30 babies with a mean age of 4 months. Gastric pH was </= 4 for a mean (SEM) of 42.4 (4.9)% of the recording time. The mean (SEM) percentage time that oesophageal pH was < 4 for the total recording period was 6.89 (0.92)%. Recalculation of the percentage of time that the gastric pH was > 4 increased this value to 17.81 (2. 46)%. Using a cut off point of 10%, 11 of the 30 babies would have been diagnosed positive for reflux using the conventional method; however, recalculation by ignoring the time for which gastric pH was high doubled this to 22 positive for reflux. CONCLUSION: Combined oesophageal and gastric pH monitoring greatly increases the number of positive results from tests in infants on regular milk feeds.

Animals↗
PubMed2002

Monitoring high-dose heparin levels by ACT and HMT during extracorporeal circulation: diagnostic accuracy of three compact monitors.

The correct monitoring of heparin therapy and its reversal determines the successful conduct of cardiovascular surgery with extracorporeal circulation (ECC). The activated coagulation time (ACT) and the heparin management test (HMT) are the most frequently used tests in the operating room. Three compact monitors for ACT or HMT are here evaluated. Forty samples were obtained, at 10-min intervals, from eight patients during ECC. The ACT or HMT was immediately performed using: Hemochron juniors ACT, CoaguCeck Pro (ACT) and Rapid Point Coag (HMT). Data were compared between them and with the heparin levels, measured as anti-Xa. The simple least squares linear regression among, respectively, Hemochron Junior ACT, CoaguCeck Pro ACT, Rapid Point Coag HMT and anti-Xa activity were i=452.3, s=15.2, Sy/x=37.5, r=0.18; i=411.9, s=22.1, Sy/x=48.7, r=0.21 and i=479.4, s=9.0, Sy/x=9.3; r=0.41. CoaguCeck Pro ACT results were above the upper detection limit (500 s) in 37 of 40 determinations. The comparison between ACT Hemocron and HMT Rapid Point Coag shows i=35.7, s=0.9, Sy/x=35.4, r=0.68, with a bias of 29.0 s (CI: 17.9-40.1), 95% of agreement between -41.5 s (CI: -60.7 to -22.3) and 99.5 s (CI: 80.4-118.7). Taking a concentration of 2.0 U/ml of heparin to discriminate between high- and low-risk conditions, receiver-operator characteristic (ROC) curve was used to rank the performance of the methods. Areas under the ROC curve+/-SE for Hemochron Junior ACT and Rapid Point Coag HMT were 0.629+/-0.097 and 0.543+/-0.096. The results obtained by HMT appear similar to those obtained by the ACT for monitoring high-dose heparin therapy in patients undergoing ECC. HMT appeared to perform better than ACT in measuring the heparin effect, while the ROC analysis gives a little more accuracy for ACT. Neither of the two methods is able to achieve enough evidence of diagnostic accuracy. Since these tests are widely used, and there are no laboratory alternatives, a real comparison with the outcome of the patients should be helpful for an evidence-based evaluation of these point-of-care tests.

Aged↗