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The Canadian National Calibration Reference Centre for In-Vivo Monitoring: thyroid monitoring. Part IV: Optimizing a counting system that uses a single-channel analyzer.

This article is the fourth of a five-part series covering various aspects of occupational thyroid monitoring. This article describes the energy calibration of the monitoring system with particular emphasis on techniques for optimizing a system that is based on a single-channel analyzer, or any system that does not have a multi-channel analyzer. These systems cannot directly show the operator the photopeak of the calibration source. The article also briefly discusses quality control and problem solving.

Calibration↗

The Canadian National Calibration Reference Centre for In-Vivo Monitoring. Part II: Sources of errors in thyroid monitoring of occupationally exposed personnel.

This article, the second of a five-part series covering various aspects of occupational thyroid monitoring, addresses the sources of error that can affect the final result obtained from thyroid monitoring, such as geometry effects (thyroid size, thyroid depth, precision and accuracy of the detector placement, and neck-detector distance). The article also suggests ways in which these errors can be minimized and identifies those errors that are difficult to quantify.

Adult↗

Medical devices; invitation for offers to submit or to develop a performance standard for breathing frequency monitor (neonatal apnea monitor)--FDA. Proposed rule.

The Food and Drug Administration (FDA) is issuing this notice to invite interested persons, including any Federal agency, to submit any existing standard as a proposed performance standard for the breathing frequency monitor intended for use on infants (also called the neonatal apnea monitor), or to submit an offer to develop such a proposed standard. If FDA does not receive any response to this notice, or receives a response but does not accept any existing standard or offer to develop a standard, the agency will proceed to develop a performance standard or take other appropriate action to facilitate the development of a performance standard for the device.

Apnea↗

[When in doubt, 24-hour monitoring. When 24-hour blood pressure monitoring is indicated].

Not only doctor's office hypertension, but also, conversely, doctor's office normotension can be detected by 24-hour blood pressure measurement. A diagnostic improvement is also achieved in patients with borderline or mild hypertension. A number of illnesses are associated with nocturnal blood pressure elevation. In particular patients with secondary hypertension experience this reversal of the usual decrease in blood pressure at night. In such cases, non-invasive 24-hour blood pressure measurement may provide the first evidence. In pregnant women in particular, untreated hypertension may have serious consequences. In such cases, close monitoring of blood pressure and treatment by long-term measurement is also of prognostic significance. Also, in patients with concomitant diseases, such as diabetes mellitus or renal disease, 24-hour blood pressure measurement for monitoring purposes should be done more often than in patients with a low risk profile.

Blood Pressure Monitoring, Ambulatory↗

Diagnosis and monitoring of hepatic injury. II. Recommendations for use of laboratory tests in screening, diagnosis, and monitoring.

PURPOSE: To review information on the use of laboratory tests in screening, diagnosis, and monitoring of acute and chronic hepatic injury. DATA SOURCES AND STUDY SELECTION: A MEDLINE search was performed for key words related to hepatic diseases, including acute hepatitis, chronic hepatitis, alcoholic hepatitis, cirrhosis, hepatocellular carcinoma, and etiologic causes. Abstracts were reviewed, and articles discussing use of laboratory tests selected for review. Additional articles were selected from the references. Guideline Preparation and Review: Drafts of the guidelines were posted on the Internet, presented at the AACC Annual Meeting in 1999, and reviewed by experts. Areas requiring further amplification or literature review were identified for further analysis. Specific recommendations were made based on analysis of published data and evaluated for strength of evidence and clinical impact. RECOMMENDATIONS: Although many specific recommendations are made in the guidelines, only some summary recommendations are listed here. In acute hepatic injury, prothrombin time and, to a lesser extent, total bilirubin are the best indicators of severity of disease. Although ALT is useful for detecting acute and chronic hepatic injury, it is not related to severity of acute hepatic injury and only weakly related to severity of chronic hepatic injury. Specific tests of viral markers should be the initial differential tests in both acute and chronic hepatic injury; when positive, they are also useful for monitoring recovery from hepatitis B and C.

Acute Disease↗

The SaM (Screening and Monitoring) approach to cardiovascular risk-reduction in primary care--cyclic monitoring and individual treatment of patients at cardiovascular risk using the electronic medical record.

BACKGROUND: Cardiovascular disease (CVD) prevention suffers from a major gap between clinical evidence (information) and clinical practice (implementation). Insufficient control risk factor levels and under-utilization of aspirin, statins, angiotensin-converting enzyme (ACE) inhibitors and beta-blockers are well-known examples. METHODS: The SaM (Screening and Monitoring) approach was devised by a family physician in order to facilitate closure of this gap. It does so by providing solutions to problems in the fields of information and implementation. A simple manipulation of the electronic medical record used in the practice serves to facilitate cyclic monitoring of patients with cardiovascular risk factors. Technological and human resources available in the primary care setting are used. The approach is described in the first part of the article. The second part presents results obtained by employing the approach on one family physician's patient population. RESULTS: The final results demonstrate a marked improvement over time in risk factor levels and use of medications in accordance with indications. The values achieved are superior to those reported in the literature. Blood pressure in hypertensive patients 134/75 mmHg; haemoglobin A1c 7.27%; low-density lipoprotein-cholesterol in patients with CVD or diabetes, 97 mg/dl; patients with CVD receiving anti-thrombotic medication, 94%; dyslipidaemic patients with CVD or diabetes receiving lipid-lowering drugs, 90%; post myocardial infarction patients receiving beta-blockers, 76%; hypertensive diabetics or patients with chronic heart failure (CHF) receiving ACE-inhibitors/angiotensin receptor blockers, 86%. CONCLUSIONS: In this one-practice pilot-study, the SaM approach was employed with marked improvement in risk factor levels and use of appropriate medications. This may translate into reductions in morbidity and mortality in a larger population.

Adult↗

Anaesthesia with ICI 35,868 monitored by the cerebral function analysing monitor (CFAM).

Ten patients who received bolus doses of the cremophor formulation of ICI 35,868 were monitored using the Cerebral Function Analysing Monitor (CFAM). Visual inspection of the traces obtained showed an easily recognizable pattern which was associated with an increasing depth of anaesthesia. Statistical analysis showed a high correlation between venous blood levels of the drug and changes recorded by the CFAM, although there was marked inter-patient variation. It is suggested that this variation is due to the effect of a time-lag between changes in drug concentration in the brain and venous blood.

Adult↗

[Telemetric labor monitoring using the fetal monitor BMT 941-1].

Recommendation of a telemetric system for the direct fetal monitoring using the monitor BMT 914-1 (Zwönitz). The free movement of parturients during labor is more comfortable and involves an increasing uterine activity, a labor progress and a decrease of oxytocic infusion rate.

Electrocardiography↗

Medical screening and biological monitoring for the effects of exposure in the workplace. Screening and monitoring: tools for prevention.

The mission of the National Institute for Occupational Safety and Health (NIOSH) is the prevention of work-related diseases and injuries. Medical screening and biological monitoring are recognized as important tools of prevention; however, the number of complex and sophisticated tests available has created new problems of choice in this field. Many of these tests have no relevance to preventing work-related diseases or injuries. To provide important guidelines in this area, NIOSH has identified the ten leading work-related diseases and injuries (Table 1). Several of these medical screening and biological monitoring techniques can be applied as tools for prevention. Within this framework, achieving the goal of preventing work-related diseases and injuries can be enhanced by collecting, analyzing, and interpreting information about occupational health problems.

Accidents, Occupational↗

Medical screening and biological monitoring for the effects of exposure in the workplace. Surveillance, monitoring, and regulatory concerns.

An international conference in Luxembourg on Ambient and Biological Monitoring in the Workplace brought out the difference in meaning between medical "surveillance" and medical "monitoring." These are reviewed against the Health Standards of the Occupational Safety and Health Administration (OSHA). The standards may be specification standards, that is, the details of the medical examinations and laboratory tests are specified; or they may be performance standards, where surveillance is largely left to the physician's discretion. Bearing in mind the limited number of qualified physicians available, OSHA, and therefore the Office of Occupational Medicine, treads a narrow line between specifics and performance to obtain a pragmatic approach that will meet the mandate of the Occupational Safety and Health Act and ensure a safe and healthful workplace for all American workers.

Environmental Exposure↗

Ventilation monitoring during monitored anesthesia care: a review.

The use of capnography during general anesthesia has become not only state of the art but also a recommended standard of care. In intubated patients, measurements of partial pressure of carbon dioxide in exhaled pulmonary gases approximate partial pressure of carbon dioxide in arterial blood under stable conditions. End-tidal carbon dioxide measurement has allowed anesthetists to continuously follow carbon dioxide concentration in exhaled gases; indirectly, it has enabled them to continuously monitor carbon dioxide concentration in arterial blood. This information has proven indispensable in the care of patients receiving general anesthesia, with its accompanying respiratory depressant effects. Recently, attention has focused on the utilization of capnography in sedated, nonintubated patients to follow carbon dioxide concentrations and access respiratory system function. This review of the current body of literature outlines development in capnography monitoring for sedated, nonintubated patients. Emphasis is placed on current techniques of measurement, the degree of correlation, and ramifications for clinical practice.

Anesthesia↗

Pathologic effects in brain after intracranial pressure monitoring in clinically normal dogs, using a fiberoptic monitoring system.

During 2 separate studies, intracranial pressure (ICP) was measured in 13 healthy dogs (group A, n = 7; group B, n = 6), using a fiberoptic monitoring system implanted surgically in the right superficial cerebral cortex. Average ICP was measured for 15 minutes after a 15-minute postimplantation period of equilibration. Intracranial pressure was measured in group-A dogs at 2.0 and 1.3% end-tidal isoflurane concentrations. Mean +/- 1 SD ICP in group-A dogs at 2.0 and 1.3% end-tidal isoflurane concentrations was 11 +/- 2 and 11 +/- 3 mm of Hg, respectively. Dogs of group A were euthanatized immediately after measurements were obtained. Mean ICP +/- 1 SD in group-B dogs was 11 +/- 3 mm of Hg. After monitoring, but prior to euthanasia, group-B dogs underwent callosotomy, and were maintained for 30 days after surgery. The brain was removed from all dogs, formalin fixed, and examined grossly and microscopically for lesions associated with fiberoptic cable implantation. Variable degrees of hemorrhage and mechanical brain damage were seen focally around the catheter site in all brains from group-A dogs, especially when the cable entered through a sulcus. In 1 dog, local vacuolation was seen in the brain immediately adjacent to the tract associated with implantation of the fiberoptic catheter. In all other dogs, the additional cortex was histologically normal. Histologic lesions associated with cable implantation were not observed in group-B dogs.

Animals↗

[Intercalation monitoring PCR(IM-PCR), its principle and application: quantitative monitoring of HCV RNA in the course of IFN therapy].

We developed intercalation-monitoring PCR(IM-PCR), a homogeneous quantitative assay of DNA/RNA by PCR in the presence of a fluorescent DNA intercalative dye, while monitoring the fluorescence intensity of the PCR reaction mixture in the course of PCR cycles. We demonstrated the application of this assay to quantify HCV RNA in serum samples from patients with chronic hepatitis C. This assay gave efficient and reproducible results in a clinically useful dynamic range below 10(6) copies of HCV RNA for interferon therapy.

Antiviral Agents↗

Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting).

BACKGROUND: Temporary interruption of blood flow during carotid endarterectomy can be avoided by using a shunt across the clamped section of the carotid artery. This may improve outcome. OBJECTIVES: The objective of this review was to assess the effect of routine versus selective shunting during carotid endarterectomy, and to assess the best method for selecting patients for shunting. SEARCH STRATEGY: We searched the Cochrane Stroke Group trials register, Medline (1966 to 1994), Embase (1980 to 1995) and Index to Scientific and Technical Proceedings (1980 to 1994). We handsearched Annals of Surgery (1981 to 1995), British Journal of Surgery (1985 to 1995), European Journal of Vascular Surgery (1988 to 1995) and World Journal of Surgery (1978 to 1995). SELECTION CRITERIA: Randomised and quasi-randomised trials of routine shunting compared with no shunting, and trials that compared different shunting policies in patients undergoing carotid endarterectomy. DATA COLLECTION AND ANALYSIS: Two reviewers independently applied the inclusion criteria. The data were extracted by one reviewer and double-checked. Trial quality was assessed. MAIN RESULTS: Three trials were included. Two trials involving 590 patients compared routine shunting with no shunting. The other trial involving 131 patients compared shunting with a combination of electroencephalographic and carotid pressure measurement, with shunting by carotid pressure measurement alone. Allocation was adequately concealed in one trial, and one trial was quasi-randomised. Analysis was by intention-to-treat where possible. For routine versus no shunting, there was no significant difference in the rate of all stroke, ipsilateral stroke or death up to 30 days after surgery, although data were limited. There was no significant difference between the risk of ipsilateral stroke in patients selected for shunting with the combination of electroencephalographic and carotid pressure assessment compared to pressure assessment alone, although again the data were limited. REVIEWER'S CONCLUSIONS: The data presently available are too limited to either support or refute the use of routine or selective shunting in carotid endarterectomy. Large scale randomized trials using no shunting as the control group are required. No one method of monitoring in selective shunting has been shown to produce better outcomes.

Arteriovenous Shunt, Surgical↗

Evaluation of the clinical usefulness of COBAS AMPLICOR HCV MONITOR assay (ver2.0): Comparison with AMPLICOR HCV MONITOR assay (ver1.0) and HCV core protein level.

The quantitation of serum levels of hepatitis C virus (HCV) RNA in chronic hepatitis C has been regarded as one of the most important indicators for the outcome of interferon (IFN) therapy. The AMPLICOR HCV MONITOR version 1.0 (AMPLICOR v1.0) assay is widely used for the evaluation of the HCV level. A new generation assay called the COBAS AMPLICOR HCV MONITOR version 2.0 (COBAS v2.0) assay, which is semiautomated and modified to amplify all genotypes equally, has been developed. The aim of this study was to evaluate the clinical relevance of the COBAS v2.0 assay in comparison with the AMPLICOR v1.0 assay and HCV core protein assay in patients with chronic hepatitis C before IFN therapy. HCV RNA was detectable in 230 cases (97.5%) and undetectable in 6 cases (2.5%) by the COBAS v2.0 assay. The RNA levels measured by the AMPLICOR v1.0 assay correlated significantly with those measured by the COBAS v2.0 assay, and the sensitivity of the new version 2.0 assay was better than that of version 1.0, especially in serotype 2. In relation to the outcome of IFN therapy, HCV RNA levels from virologically sustained responders by the AMPLICOR v1.0 assay were 82.3 +/- 22.9 kcopies/ml in serotype 1 and 36.9 +/- 13.4 kcopies/ml in serotype 2, and those from virologically nonsustained responders were 525.2 +/- 48.6 kcopies/ml in serotype 1 and 76.7 +/- 19.5 kcopies/ml in serotype 2. The rates of sustained response to <100 kcopies/ml were 34/63 (54.0%) in serotype 1 and 24/48 (50.0%) in serotype 2. A statistically significant virological response was seen in serotype 1 (P < 0.0001), but not in serotype 2. In contrast, the levels in virologically sustained responders by the COBAS v2.0 assay were 88.2 +/- 20.5 KIU/ml in serotype 1 and 136.8 +/- 40.1 KIU/ml in serotype 2, and those in virologically nonsustained responders were 608.8 +/- 48.4 KIU/ml in serotype 1 and 328.3 +/- 62.8 KIU/ml in serotype 2. The rates of sustained response to <100 KIU/ml were 33/60 (55.0%) in serotype 1 and 21/35 (60.0%) in serotype 2. Statistical significance in virological response was seen in both serotype 1 (P < 0.0001) and serotype 2 (P < 0.05). Although the sensitivity of the HCV core protein assay was lower than that with the COBAS v2.0 assay, the HCV core protein levels also correlated well with the results of the COBAS v2.0 assay. The HCV core protein levels of virologically sustained responders were 37.6 +/- 12.0 pg/ml in serotype 1, 81.3 +/- 37.0 pg/ml in serotype 2, and those of virologically nonsustained responders were 289.9 +/- 23.5 pg/ml in serotype 1, 191.4 +/- 32.1 pg/ml in serotype 2. This assay could predict the outcome of IFN therapy in both serotype 1 (P < 0.0001) and serotype 2 (P < 0.05). Thus, both the COBAS v2.0 assay and the HCV core protein assay showed that the viral load was an indicator of virologically sustained response in serotype 2 and in serotype 1.

Adolescent↗

Quantitative selected ion monitoring processing system: software and hardware for the automated collection and analysis of selected ion monitoring data acquired for use in pharmacokinetic studies.

The Quantitative Selected Ion Monitoring Processing System (QSIMPS) is a collection of software and hardware which was designed with the capacity to analyze 30,600 samples per year in support of pharmacokinetic studies. On a per sample basis, QSIMPS was designed to inject a sample into the GC, control the GC divert valve, collect selected ion monitoring data, identify the peaks for the drug and one metabolite and each compound's reference standard, fit the peaks to a relevant chromatographic model, calculate chromatographic features of merit, calculate the peak heights and ratio of the drug and its reference standard and the metabolite and its reference standard, and, using calibration data, convert the ratio to an amount of drug. On a per tray (batch) basis, QSIMPS was designed to fit all the peak height ratios from the calibration standards to either a linear equation, or a generalized nonlinear isotope dilution equation, report a statistical analysis of the fit, and, using aliquot factors, convert the measured amount of drug into concentrations. On a per project basis, QSIMPS prints reports summarizing statistical data on the calibration standards and the quality assurance samples, and prints reports presenting the concentration data as a function of, for examples, subject, drug treatment, time postdose, etc., along with other ancillary data such as subject sex, weight, species, etc. In addition, QSIMPS can fit the concentration data to a number of common pharmacokinetic model-derived equations, and report the resulting pharmacokinetic parameters along with a statistical comparison of the parameters.

Chromatography, Gas↗

Competition of nitroxyl contrast agents as an in vivo tissue redox probe: comparison of pharmacokinetics by the bile flow monitoring (BFM) and blood circulating monitoring (BCM) methods using X-band EPR and simulation of decay profiles.

Nitroxyl radicals used as tissue redox-sensitive contrast agents in electron paramagnetic resonance (EPR) and/or NMR imaging should satisfy the following two conditions: 1) the molecules disperse into tissues rapidly, and 2) paramagnetic loss occurs by simple reduction of the radical. The pharmacokinetic trends of several nitroxyl contrast agents were compared with the results obtained by bile flow monitoring (BFM) and blood circulation monitoring (BCM) methods using X-band EPR. The nitroxyl radicals (TEMPO, TEMPONE (oxo-TEMPO), and amino-TEMPO) showed additional EPR signals in the bile that were attributed to metabolites formed during transport from blood to bile through the liver. However, the highly hydrophilic CAT-1 (trimethylammonium-TEMPO), which has low membrane permeability, showed minimal concentration in the bile. Probes that have carboxyl moiety, such as carboxy-TEMPO and carboxy-PROXYL, can be transported via anion transporter into hepatic cells. The EPR signal decay profiles of the nitroxyl radicals were simulated based on the experimental data. The simulation, which we previously applied to mouse blood, was modified to simultaneously fit the experimental results of BFM and BCM obtained with rats. The simulation data showed the simplicity/complexity of the pharmacokinetic mechanisms and that carbamoyl-PROXYL and TEMPOL (hydroxy-TEMPO) are suitable contrast agents for assessing tissue redox status.

Animals↗

Comparative evaluation of the Cobas Amplicor HIV-1 Monitor Ultrasensitive Test, the new Cobas AmpliPrep/Cobas Amplicor HIV-1 Monitor Ultrasensitive Test and the Versant HIV RNA 3.0 assays for quantitation of HIV-1 RNA in plasma samples.

BACKGROUND: There are several commercially available assays for the quantitation of HIV RNA. A new automated specimen preparation system, the Cobas AmpliPrep, was developed to automate this last part of the PCR. OBJECTIVES AND STUDY DESIGN: We compared the results obtained by the Roche Cobas Amplicor HIV-1 Monitor Ultrasensitive Test (MCA, manual sample preparation) with those by the Versant HIV-1 RNA 3.0 assay (bDNA). Secondly we compared the MCA with the new Cobas AmpliPrep/Cobas Amplicor HIV Monitor Ultrasensitive Test (CAP/CA, automated specimen preparation) by investigating clinical patient samples and a panel of HIV-1 non-B subtypes. Furthermore, we assessed the assay throughput and workflow (especially hands-on time) for all three assays. RESULTS: Seventy-two percent of the 140 investigated patient samples gave concordant results in the bDNA and MCA assays. The MCA values were regularly higher than the bDNA values. One sample was detected only by the MCA within the linear range of quantification. In contrast, 38 samples with results <50 copies/ml in the MCA showed in the bDNA results between 51 and 1644 copies/ml (mean value 74 copies/ml); 21 of these specimens were shown to have detectable HIV RNA < 50 copies/ml in the MCA assay. The overall agreement between the MCA and the CAP/CA was 94.3% (551/584). The quantification results showed significant correlation, although the CAP/CA generated values slightly lower than those generated by the manual procedure. We found that the CAP/CA produced comparable results with the MCA test in a panel of HIV-1 non-B subtypes. CONCLUSIONS: All three assays showed comparable results. The bDNA provides a high sample throughput without the need of full automation. The new CAP/CA provides reliable test results with no HIV-subtype specific influence and releases time for other works in the laboratory; thus it is suitable for routine diagnostic PCR.

Automation↗