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PubMedDate not supplied

The role of clinical engineering in the redesign of existing hospital patient monitoring systems.

Clinical engineering can have a key role in the redesign of existing hospital patient monitoring systems. This paper presents a systematic approach to the process of reinstrumenting highly specialized cardiovascular operating suites. A detailed definition of system requirements is presented for both basic and specialized instrument sets. Configuration flexibility was given the utmost attention. The method presented here suggests that system requirements should reflect information gathered from direct interviews of both the clinical and support personnel. Consideration is given to all applicable codes, standards, and practices. Special attention must also be focused on proper and efficient interfacing of the components of the new system to all components of the existing system. The project described here was conducted within and supported by the University of Alabama Hospital of the University of Alabama at Birmingham.

Alabama↗
PubMed1998

Ambulatory physical activity monitoring system.

In this study, we have developed an ambulatory behaviour map and physical activity monitoring system by equipping our portable digital biosignal memory device developed previously with a GPS sensor and piezoresistive accelerometers. By this system, we can get the subjects behaviour map, his physical activities and posture changes in daily life.

Behavior↗
PubMed1995

Transcutaneous blood glucose monitoring system based on an ISFET glucose sensor and studies on diabetic patients.

A transcutaneous blood glucose monitoring system consists of an ion-sensitive field-effect transistor (ISFET) glucose sensor unit and a suction effusion fluid (SEF) collecting unit. The SEF is directly collected by a weak suction (400 mmHg absolute pressure) through the skin from which the corneum layer of the epidermis has been previously removed. An ISFET glucose sensor unit is able to measure glucose concentrations in a microliter order sampling volume. The system was applied to three diabetic patients during a 75 g oral glucose tolerance test for monitoring blood glucose levels. During the experiments, glucose changes in the SEF followed actual blood glucose levels with 10 min delays. Results suggest the feasibility of utilizing quasi-continuous, transcutaneous blood glucose monitoring for individual patients with various diabetic histories or diabetic complications.

Aged↗
PubMed1987

[Clinico-pathological study of choriocarcinoma localized in the lung with emphasis on hCG monitoring systems].

We studied 15 cases of lung choriocarcinoma clinico-pathologically with emphasis on hCG monitoring systems. The results are as follows: Vivid tumor cells (VTC) were found to persist in 83.3% (5/6) of cases with a continued "LH level" of urinary hCG over 4 weeks. VTC were found to persist in all 4 cases with cellular response and in 6 of 8 cases with no cellular response. The syncytial cell element was observed in 75% (3/4) of cases with cellular response, but in only 25% (2/8) of cases with no cellular response. VTC were recognized in 83.3% of cases (5/6) with serum beta-hCG higher than the sensitivity of the beta-hCG-RIA system (0.2 ng/ml or 1.5 miu/ml). Even though serum beta-hCG was lower than 0.2 ng/ml or 1.5 miu/ml, VTC were found to persist in 2 of 3 cases. All of 5 cases with beta-hCG-CTP higher than the sensitivity of beta-hCG-CTP-EIA (Enzyme-Immuno-Assay) system (0.2 miu/ml) showed VTC in operative specimens. These results indicate that beta-hCG-CTP-EIA is a most useful means to employ in the monitoring of serum hCG.

Choriocarcinoma↗
PubMed1992

[Computerized monitoring system in the operating center with UNIX and X-window].

We previously reported the fully automated data logging system in the operating center. Presently, we revised the system using a highly integrated operating system, UNIX instead of OS/9. With this multi-task and multi-window (X-window) system, we could monitor all 12 rooms in the operating center at a time. The system in the operating center consists of 2 computers, SONY NEWS1450 (UNIX workstation) and Sord M223 (CP/M, data logger). On the bitmapped display of the workstation, using X-window, the data of all the operating rooms can be visualized. Furthermore, 2 other minicomputers (Fujitsu A50 in the conference room, and A60 in the ICU) and a workstation (Sun3-80 in the ICU) were connected with ethernet. With the remote login function (NFS), we could easily obtain the data during the operation from outside the operating center. This system works automatically and needs no routine maintenance.

Operating Room Information Systems↗
PubMed1995

MONI: an intelligent database and monitoring system for surveillance of nosocomial infections.

Recording, recognition, and prevention of nosocomial infections are the primary responsibilities of the hospital infection control unit. To perform these tasks, this unit needs information from diverse sources--the patient's symptoms and signs, microbiological and virological test results, and information regarding antibiotics and treatment come from different levels of healthcare delivery. Because of the large amount of data (e.g., about 300 microbiological requests daily) a computer system is required to store this information and to provide a means for subsequent evaluation. MONI (Monitoring of nosocomial infections) is an intelligent database and monitoring system for surveillance and detection of nosocomial infections. Data can be entered into the system manually as well as transferred automatically from external information systems. The central feature of the system is the automatic detection of and calling attention to conditions that may be a detriment to patient recovery, such as possible hospital-acquired infections, risk factors, diseases to be reported, etc. By using this system, we seek to reduce the frequency of infection and the frequency of nosocomial deaths by improving the quality of patient treatment, shortening the length of stay in a hospital, and the use of fewer and/or cheaper antibiotics. MONI provides a means to access relevant medical data (names of infectious agents, antibiotics, department names, monitoring rules, etc.) from a library. This library can be updated or otherwise modified, even during use. An infection control team using this system can customize it to suit the demands of that particular unit. Automatic data transfer from external information systems is made possible by tables that translate between different code systems. The system also offers flexibility; the program can be configured to adapt it for use in other hospitals and institutions. The core element of MONI is the monitoring module, which is implemented as a layer between data input and the database. Upon data acquisition, the system checks the input against several monitoring tools and alerts the user to matches, which may indicate an infection risk. Processing of a rule may be deferred, depending on complexity of the rule and the actual and estimated workload of the system. Examples of the monitoring guidelines are: (1) suspicion of nosocomial infection; (2) infection at a normally sterile site; (3) infection due to bacteria with unusual antibiotic sensitivity patterns; (4) lab report indicates that patient is treated with ineffective antibiotic; (5) possible choice for less expensive antibiotic; (6) infection which is required to be reported to state and/or health authorities; (7) patients receiving prophylactic antibiotics longer than medically indicated; and (8) infections of two or more patients in different wards with the same bacteria (cf. Evans 85). The MONI system was developed at one of the largest hospitals in Europe, the Vienna General Hospital (2,200 beds). This facility serves as the teaching hospital of the University of Vienna Medical School. The size of the hospital and the large amount of data made it necessary to introduce such a system into clinical routine. MONI was programmed in C and C++ with a state-of-the-art graphical user interface (Presentation Manager, Workplace Shell) for OS/2. IBM Database 2 for OS/2 (dB 2/2) was used in constructing the database. The layer between the database and the monitoring application is driven by the multitasking and interprocess communication abilities of OS/2. A pen-based support system that assists in mobile data acquisition is currently under development.

Anti-Bacterial Agents↗
PubMed2004

The public health impact of the MiniMed Continuous Glucose Monitoring System (CGMS)-an assessment of the literature.

The Medtronic MiniMed (Northridge, CA) Continuous Glucose Monitoring System (CGMS) was approved by the U. S. Food and Drug Administration in 1999, for the continuous tracking of glucose concentration. The rationale for the use of this device is that frequent glucose measurements allow a more precise understanding of daily glucose fluctuations, without the inconvenience of frequent needle sticks. A review of the medical literature was undertaken to assess the public health impact of this device. Glucose readings from the MiniMed CGMS were found to correlate well with blood glucose (r = 0.73-0.92) and with hemoglobin A(1c) (HBA(1c)) (r = 0.53-0.59). Most important from a public health standpoint is the ability of the MiniMed device to detect episodes of asymptomatic hypoglycemia, and to lower HBA(1c) (absolute decline of 0.3%), as compared with controls. If these findings hold, the use of the MiniMed CGMS could result in a substantial reduction of morbidity and mortality associated with diabetes. The limitations of this analysis, most importantly the paucity of controlled studies that assess the ability of this device to result in improved control of diabetes over long periods of time, are discussed.

Blood Glucose↗
PubMed1994

Observation of sleep-related breathing disorders in patients with coronary artery disease by ambulatory electrocardiogram-respiration monitoring system.

Eighty-five coronary artery patients examined using an ambulatory electrocardiogram-respiration monitoring system (AERMS) in which a respiratory sensor was strapped to the right upper abdominal wall. Apnea was defined as a cessation of abdominal wall movement lasting at least 10 sec. Sleep-related breathing disorder (SRBD) was diagnosed if at least 30 apneic episodes were observed during sleep. The cardiac events evaluated during follow-up included occurrence of sudden death, myocardial infarction and ventricular tachycardia. SRBD was detected in 9 of 85 patients (11%). There were more patients with low EF (EF < 50%) in the SRBD group than in the non-SRBD group (p < 0.01). During follow-up for a mean period of 18.4 +/- 7.6 months after ambulatory recording, four of nine (44%) patients in the SRBD group had cardiac events, compared with only four of 79 (6%) patients in the non-SRBD group (p < 0.001). Thus, coronary artery patients who were complicated with SRBD showed poor cardiac function and had a high incidence of cardiac events.

Aged↗
PubMed2002

Nocturnal hypoglycemia detected with the Continuous Glucose Monitoring System in pediatric patients with type 1 diabetes.

OBJECTIVE: To use the Continuous Glucose Monitoring System (CGMS, MiniMed, Sylmar, Calif) to determine if bedtime blood glucose levels were associated with the occurrence of nocturnal hypoglycemia. STUDY DESIGN: Patients (n = 47, 18 boys, mean age 11.8 +/- 4.6 years) with type 1 diabetes used CGMS for 167 nights. Data were analyzed for glucose </=40 or </=50 mg/dL, comparing bedtime blood glucose levels of </=100 or >100 mg/dL and </=150 or >150 mg/dL. RESULTS: A glucose value of </=40 mg/dL occurred on 27% of nights and </=50 mg/dL on 35% of nights. There was a 2-fold increase (45% vs 22%, P =.015) in the incidence of hypoglycemia with a bedtime glucose </=100 mg/dL and a 1.7-fold increase (46% vs 26%, P =.01) with a value of </=150 mg/dL; most episodes occurred between 9 PM and 1 AM. There was no difference in hypoglycemia duration (86.4 minutes for glucose </=100 mg/dL vs 84.5 minutes for >100 mg/dL, P = NS), and no bedtime glucose value between 110 and 300 mg/dL decreased the incidence of nocturnal hypoglycemia to </=10%. The incidence of nocturnal hypoglycemia was similar for patients using insulin pump and injection therapy, and there was no correlation between hemoglobin A1c and incidence or duration of hypoglycemia. CONCLUSIONS: Nocturnal hypoglycemia is frequent, of long duration, associated with bedtime glucose values </=100 to 150 mg/dL, and predominately in the early part of the night. CGMS is a useful tool to diagnose asymptomatic nocturnal hypoglycemia.

Adult↗
PubMed2000

Miniaturized real-time monitoring system for L-lactate and glucose using microfabricated multi-enzyme sensors.

A miniaturized on-line monitoring system for the detection of L-lactate and glucose is presented. The system is based on a microfabricated multi-enzyme silicon sensor chip with flow channels integrated on the chip. The sensors were fabricated in containment technology. They were characterized in test solutions. The cross-talking behaviour was investigated and was found to be practically negligible. The linear measurement ranges of both glucose and lactate sensors were large enough for most practical applications. As a result of the miniaturization the analyte consumption could be reduced to a few nmol min(-1). The system was equipped with a microdialysis probe whose recovery was 45% for lactate and 37% for glucose in test solutions using a flow rate of 3 microl min(-1). Lower flow rates of 0.5 microl min(-1) resulted in recoveries of over 90%. The long-term stability of the system was acceptable. Initial measurements have also been performed in vitro using human blood serum.

Biosensing Techniques↗
PubMed1984

National Nutrition Monitoring System.

This issue contains three articles and two related reports on the National Nutrition Monitoring System (NNMS), an umbrella designation for a variety of activities carried out primarily by the U.S. Department of Health and Human Services and the U.S. Department of Agriculture. Uses of NNMS data are legion; some examples are provided. Full exploitation of NNMS data has been hampered by lack of coordination, delays in processing, and limited understanding on the part of the nutrition community. There has been recent progress in coordinating NNMS activities. Improved understanding among members of the nutrition community will require continued educational efforts.

Diet Surveys↗
PubMed1980

Use of a simple body-monitoring system in a pilot study on workers exposed to unsealed gamma-ray emitting material.

A portable body-monitoring system developed by the board uses two detectors, one for whole-body measurements and one for thyroid measurements. It can detect most commonly used gamma-ray emitting nuclides down to levels below those of interest for radiological protection purposes. The system has been used at 11 establishments including hospitals, universities, and research laboratories. Measurements have been made on 109 workers exposed to unsealed gamma-ray emitting material. Some activity other than that due to naturally occurring 40potassium was detected in a substantial proportion (30%) of those measured. The contaminating nuclides most often detected were 125iodine and 99mtechnetium. Some cases of contamination with 131iodine, 137caesium, 67gallium, and 85strontium were also detected. In most cases the level of activity detected was very low, but in three it was above the derived investigation level for routine monitoring of the nuclide concerned. The need for monitoring and possible monitoring programmes in which such a system would be useful are discussed.

Gamma Rays↗
PubMed1997

Ambulatory behavior map, physical activity and biosignal monitoring system.

In this study, we have developed an ambulatory human behavior map and physical activity monitoring system. This was accomplished by equipping our portable digital biosignal memory device developed previously with GPS sensors and piezoresistive accelerometers. Using this new system, we can get a subject's behavior map, and estimate his physical activities and posture changes in daily life.

Behavior↗
PubMed2005

[Accuracy, effect on insulin therapy and glycemic control and complications of the continuous glucose monitoring system in type 1 diabetic patients].

To evaluate the efficacy, safety and complications of continuous glucose monitoring system (CGMS) in type 1 diabetic patients (DM1), we retrospectively studied 30 patients (25.8 +/- 12.2 years) submitted to 72 hs CGMS (Medtronic; Northridge, CA) and analyzed: mean self monitoring blood glucose (SMBG) and mean CGMS sensors glycemic value; correlation coefficient (%), median absolute percent difference (MAD%), number of sensor reading, glycemic excursions (CGMS vs. SMBG), complications (trauma, local infection, disconnection) and therapeutic management after CGMS. A1c levels were measured 1 month before and 3 months after the study. Mean capillary glucose values were 186.5 +/- 43.3 mg/dl vs. 179.7 +/- 48.1 mg/dl by CGMS sensor, with significant correlation (p = 0.001). An average of 772.4 +/- 254.1 (VR > 680) glucose measurements was recorded for each patient, with 68.7 +/- 19.8 hs of exam. Correlation coefficient was 0.86 +/- 0.21 (VR > 0.79). Median absolute percent difference between sensor and glucometer values was 13.9 +/- 4.7% (VR < 28%). The CGMS was significant more efficient in detection of glycemic excursion related to capillary glycemia (p = 0.009). This data showed important decreased level of A1c in this population 3 months after the CGMS with statistical significance (p = 0.018). No complications were registered in 96.7% of patients. No trauma, local infection or bleeding were registered. The insulin therapeutic regimen was adjusted in 100% of patients. The CGMS showed to be a very safety method, well tolerated, with high accuracy in glycemic values and low complications rate. This method has to be more stimulated by physicians and patients.

Adolescent↗
PubMed2004

Alarms based on real-time sensor glucose values alert patients to hypo- and hyperglycemia: the guardian continuous monitoring system.

The purposes of this study were to demonstrate the accuracy and effectiveness of the Guardian Continuous Monitoring System (Medtronic MiniMed, Northridge, California) and to demonstrate that the application of real-time alarms to continuous monitoring alerts users to hypo and hyperglycemia and reduces excursions in people with diabetes. A total of 71 subjects with type 1 diabetes, mean hemoglobin A1c of 7.6 +/- 1.1%, age 44.0 +/- 11.4 years, and duration of diabetes 23.6 +/- 10.6 years were enrolled in this two-period, randomized, multicenter study. Subjects were randomized into either an Alert group or a Control group. The accuracy of the Guardian was evaluated by treating the study data as a single-sample correlational design. Effectiveness of the Guardian alerts was evaluated by comparing the Alert group with the Control group. The mean (median) absolute relative error between home blood glucose meter readings and sensor values was 21.3% (17.3%), and the Guardian, on average, read 12.8 mg/dL below the concurrent home blood glucose meter readings. The hypoglycemia alert was able to distinguished glucose values < or =70 mg/dL with 67% sensitivity, 90% specificity, and 47% false alerts. The hyperglycemia alert showed a similar ability to detect sensor values > or =250 mg/dL with 63% sensitivity, 97% specificity, and 19% false alerts. The Alert group demonstrated a median decrease in the duration of hypoglycemic excursions (-27.8 min) that was significantly greater than the median decrease in the duration of hypoglycemic excursions in the Control group (-4.5 min) (P = 0.03). A marginally significant increase in the frequency of hyperglycemic excursions (P = 0.07) between Period 1 and Period 2 was accompanied by a decrease of 9.6 min in the duration of hyperglycemic excursions in the Alert group. Glucose measurements differ between blood samples taken from the finger and interstitial fluid, especially when levels are changing rapidly; however, these results demonstrate that the Guardian is reasonably accurate while performing continuous glucose monitoring. The subjects' responses to hypoglycemia alerts resulted in a significant reduction in the duration of hypoglycemic excursions; however, overtreating hypoglycemia may have resulted in a marginally significant increase in the frequency of hyperglycemic excursions.

Adult↗
PubMed2006

Extended use of a new continuous glucose monitoring system with wireless data transmission in children with type 1 diabetes mellitus.

BACKGROUND: A new continuous glucose monitoring system (CGMS Datalogger, Medtronic MiniMed, Northridge, CA) potentiates extended sensor use by eliminating the cable connection to a monitor and by being waterproof. We evaluated the performance, safety, and patient tolerance of using the CGMS for 7 continuous days in children with type 1 diabetes mellitus who were encouraged to participate fully in their usual sports and activities in their home environment. METHODS: Twenty pediatric subjects (12.2 +/- 4.6 years old [mean +/- SD] and glycosylated hemoglobin of 8.06 +/- 1.22%) wore two CGMS devices simultaneously for 7 days. Sensor function was assessed by paired sensor-meter values obtained from the CGMS and their Paradigm Link (Medtronic Minimed) home glucose meter and a daily patient log of sensor and Datalogger sites. RESULTS: Subjects were wearing 90% of the sensors at the end of 7 days. The devices were well tolerated except for pruritus at the adhesive sites in 29% of subjects, and one sensor site (3%) became infected. Once a correction was made to the connection between the cable and Datalogger, 89% of the 18 sensors that initialized were functional at the end of 5 days [r = 0.91; percent mean absolute relative difference (%MARD) = 12.4%], and 78% were functioning at the end of 7 days (r = 0.91; %MARD s 15.4%). Patient comfort while wearing the device decreased after 5 days of sensor wear. CONCLUSIONS: This study demonstrates that the life of the glucose sensor can be extended well beyond the current labeling of 72 h. Once the cable connection was corrected, there was no statistically significant change in sensor performance over 7 days. Patients preferred to wear the device for a maximum of 5-6 days.

Adolescent↗
PubMed2006

Long-term effect of the Internet-based glucose monitoring system on HbA1c reduction and glucose stability: a 30-month follow-up study for diabetes management with a ubiquitous medical care system.

OBJECTIVE: To investigate the long-term effectiveness of the Internet-based glucose monitoring system (IBGMS) on glucose control in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: We conducted a prospective, randomized, controlled trial in 80 patients with type 2 diabetes for 30 months. The intervention group was treated with the IBGMS, while the control group made conventional office visits only. HbA1c (A1C) was performed at 3-month intervals. For measuring of the stability of glucose control, the SD value of A1C levels for each subject was used as the A1C fluctuation index (HFI). RESULTS: The mean A1C and HFI were significantly lower in the intervention group (n = 40) than in the control group (n = 40). (A1C [mean +/- SD] 6.9 +/- 0.9 vs. 7.5 +/- 1.0%, P = 0.009; HFI 0.47 +/- 0.23 vs. 0.78 +/- 0.51, P = 0.001; intervention versus control groups, respectively). Patients in the intervention group with a basal A1C >or=7% (n = 27) had markedly lower A1C levels than corresponding patients in the control group during the first 3 months and maintained more stable levels throughout the study (P = 0.022). Control patients with a basal A1C <7% (n = 15) showed the characteristic bimodal distribution of A1C levels, whereas the A1C levels in the intervention group remained stable throughout the study with low HFI. CONCLUSIONS: Long-term use of the IBGMS has proven to be superior to conventional diabetes care systems based on office visits for controlling blood glucose and achieving glucose stability.

Adult↗