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PubMed1993

[Sequential changes in the left ventricular function during ramp exercise in patients with ischemic heart disease: continuous assessment of the left ventricular radioactivity with wireless telemetric cardiac monitoring system].

The left ventricular function during ramp exercise was assessed using 99mTc-labeled red blood cells and a Wireless Telemetric Cardiac Monitoring System (WTCMS) in 34 patients who received coronary angiography. Sequential changes in the left ventricular ejection fraction (EF) during exercise, were classified into the two types, normal response (up slope pattern) and abnormal response (horizontal, down slope and up-down slope pattern) when defined the response as 5 percent or more increment of EF as normal. Six patients without significant stenosis by coronary angiography showed normal response. Seventeen of 28 patients with coronary disease showed abnormal response (sensitivity 61%). Eight of 11 patients (73%) with coronary disease and normal response showed no redistribution on the stress thallium myocardial scintigraphy. Twelve of 17 patients (71%) with coronary disease and abnormal response showed redistribution by the stress thallium scintigraphy. Horizontal and down slope patterns of EF during exercise were more often noted in the groups with redistribution and multivessel coronary disease. After the exercise, the times to the over shoot was significantly longer in groups with redistribution (p < 0.01) in comparison with groups without redistribution. From these results, we conclude that the monitoring the changes in left ventricular activity during ramp exercise with the WTCMS is a very useful method for the evaluation of the sequential changes in left ventricular function in patients with ischemic heart disease.

Adult↗
PubMed2002

Development of an antibiotic resistance monitoring system in Hungary.

Because of the rapid development and spread of antimicrobial resistance it is important that a system be established to monitor antimicrobial resistance in pathogenic zoonotic and commensal bacteria of animal origin. Susceptibility testing of bacteria from carcasses and different samples of animal origin has been carried out in veterinary institutes for a long time but by an inconsistent methodology. The disc diffusion method proposed by the National Committee for Clinical Laboratory Standards (NCCLS) was introduced in all institutes in 1997. In order to obtain a coherent view of the antimicrobial resistance of bacteria a computer system was consulted, consisting of a central computer to store all data and some local computers attached to it through the network. At these local measuring stations computers are connected to a video camera, which displays the picture of Petri dishes on the monitor, and inhibition zone diameters of bacteria can be drawn with the mouse by the inspector. The software measures the diameters, evaluates whether or not the bacteria are sensitive, and stores the data. The evaluation is based upon the data of the NCCLS. The central computer can be connected to as many local computers with measuring stations as we wish, so it is suitable for an integrated system for monitoring trends in antimicrobial resistance of bacteria from animals, food and humans, facilitating comparison of the occurrence of resistance for each circumstance in the chain. It depends on the examiners which antibiotics they want to examine. Thirty-two different antibiotic panels were compiled, taking into consideration the active ingredients of medicinal products permitted for veterinary use in Hungary, natural resistance and cross-resistance, the mechanism of resistance and the animal species, i.e. which drugs were recommended for treatment in the given animal species, and the recommendations of the OIE Expert Group on Antimicrobial Resistance. The members of the panels can be changed any time, even during the measuring process. In addition to the inhibition zone diameters of bacteria the database also includes information about bacterial and animal species, the age of animals and the sample or organ where the bacteria are from. Since January 2001 the antibiotic susceptibility of E. coli, Salmonella, Campylobacter and Enterococcus strains isolated from the colons of slaughter cows, pigs and broiler chickens has also been examined. Each of the 19 counties of Hungary submits to the laboratory three tied colon samples from a herd of the above-mentioned animals every month.

Animals↗
PubMed2006

Efficacy of continuous glucose monitoring system (CGMS) to detect postprandial hyperglycemia and unrecognized hypoglycemia in type 1 diabetic patients.

BACKGROUND: To evaluate the efficacy of continuous glucose monitoring system (CGMS) to detect postprandial hyperglycemia and unrecognized hypoglycemia in type 1 diabetes mellitus (DM1) patients. METHODS: We studied 46 patients (43.4%M/56.6%F), average age of 25.9+/-12.8 years, submitted to 72 h CGMS. It were analyzed: capillary glycemia (CG) and CGMS sensor's value, glycemic excursions, postprandial hyperglycemia, asymptomatic hypoglycemia and therapeutic management after CGMS. Correlation coefficient during hypo and hyperglycemia and sensitivity/specificity were determined. RESULTS: The mean capillary glucose values were 191.8+/-46.2mg/dl versus 190.9+/-42.1mg/dl by CGMS sensor, with no statistical difference by T-test (T=-0.6; p=0.79). The CGMS was significantly more efficient in detection of glycemic excursion than CG (p=0.001). The postprandial hyperglycemia was identified in 76.9% of diabetic patients and asymptomatic hypoglycemia was detected in 58.2% of these patients. The correlation coefficient presented no significance (p=0.16) during hypoglycemia versus during hyperglycemia (p=0.002). The CGMS sensor presented low sensitivity (79.1%) to detect hypoglycemia versus hyperglycemia (96.8%). CONCLUSIONS: The CGMS showed to be a good method to identify postprandial hyperglycemia, to improve therapeutics management and confirmed the low sensitivity of CGMS to detect unrecognized hypoglycemia in DM1 patients.

Adolescent↗
PubMed2004

Experience with the continuous glucose monitoring system in a medical intensive care unit.

Strict glycemic control improves clinical outcomes in critically ill patients. However, practical tools for frequent monitoring of blood glucose (BG) levels in the intensive care unit (ICU) are limited. The Continuous Glucose Monitoring System (CGMS, Medtronic MiniMed, Northridge, CA) is currently approved for detecting glycemic excursions in outpatients with diabetes mellitus. The use of this device has never been carefully examined in the inpatient setting. This preliminary study was designed to investigate the accuracy of the CGMS in critically ill patients admitted to a medical ICU (MICU). Subjects at risk for hyperglycemia were recruited from among all patients admitted to our MICU. CGMS sensors were implanted for up to 72 h. Study subjects wore between one and five consecutive sensors. Four or more standard capillary BG readings were recorded per 24 h. All paired meter-sensor (M-S) readings were used both for CGMS calibration and for data analysis. Twenty-two MICU patients wore 41 CGMS sensors, yielding 546 M-S BG pairs. Overall, the Pearson correlation coefficient ( r ) was 0.88, with a mean M-S difference of 3.3 +/- 26.7 mg/dL (0.6 +/- 17.4%) and a mean absolute M-S difference of 19.7 +/- 18.3 mg/dL (12.8 +/- 11.9%). Clarke Error Grid analysis categorized 98.7% of the M-S pairs within "clinically acceptable" zones A and B. The CGMS is promising for potential use in critically ill patients. If validated in larger studies, the device could serve as a useful research tool for investigating the role of hyperglycemia (and strict glycemic control) in ICU patients. If further developed as a "real-time" glucose sensor, CGMS technology could ultimately prove clinically useful in the ICU, by decreasing nursing workload and/or by providing alarm signals for impending glycemic excursions.

APACHE↗
PubMedDate not supplied

Automated monitoring system for determining embryo movement and death times following virus infection.

Design and performance information is presented on an automated embryo-monitoring system for intact eggs. The computer-based system has been used successfully for several months to characterize viral pathogenicity in embryonated eggs. Features include electronic sensing of embryo movement, automatic quantification of the amount of movement, and automatic recording of the results on electronic media. The system does not require that eggs be removed from the incubator or that the incubator be opened during the course of an experiment, as is necessary with the manual candling technique. It has greatly improved discrimination of viral pathogenicity effects in fertile eggs because of its sensitivity and reduced intervals between observations. One important potential application involves using the system to measure the effects on virulence of mixing closely related variants of the same strain of virus that differ in pathogenicity, which is the biological scenario most likely approximating a natural disease outbreak.

Animals↗
PubMedDate not supplied

What is hypoglycemia in patients with well-controlled type 1 diabetes treated by subcutaneous insulin pump with use of the continuous glucose monitoring system?

OBJECTIVE: To analyze 72-hour interstitial glucose concentrations measured by a glucose sensor in adult subjects. METHODS: We compared glucose levels in 10 patients with type 1 diabetes mellitus (DM-1) and 10 normal control subjects with use of the Medtronic Continuous Glucose Monitoring System (CGMS). Hypoglycemic events identified by the CGMS, the patients, or both were compared in the patients with DM-1. In addition, the results between two glucose sensors placed at similar sites in the same subject were evaluated. RESULTS: Hemoglobin A1c and mean glucose values were higher in the DM-1 group than in the control group (P<0.01), whereas time spent at glucose levels of less than 60, 60 to 79, and 121 to 150 mg/dL were similar between the two study groups. Time spent at glucose levels above 150 mg/dL was greater in the DM-1 group than in the control group (P<0.05). Of the 74 total hypoglycemic events in the patients with DM-1, the sensor and the patient recognized 14%, only the patient recognized 9% (confirmed by readings of <55 mg/dL on a glucose meter), and only the sensor detected 77%. Of note, 41% of the patient-identified symptomatic hypoglycemic events were missed by the CGMS. When one patient with DM-1 and one control subject wore two glucose sensors simultaneously, one and not the other sensor often identified "hypoglycemia," and the correlation was only fair to good by intraclass correlation analysis. CONCLUSION: Many asymptomatic "hypoglycemic events" identified by the CGMS may not be actual hypoglycemia. Hypoglycemia is both overreported and underreported with use of the CGMS. Thus, adjustment of insulin doses to reduce asymptomatic hypoglycemia identified by the CGMS alone may not be warranted.

Adult↗
PubMed2004

Day-to-day glucose variability during pregnancy in women with Type 1 diabetes mellitus: glucose profiles measured with the Continuous Glucose Monitoring System.

OBJECTIVE: To observe day-to-day variability in glucose levels in pregnant women with Type 1 diabetes using the Continuous Glucose Monitoring System (CGMS) and to assess the usefulness of continuous glucose measurements for adjustment of insulin treatment. DESIGN: A prospective observational study. SETTING: The obstetrical outpatient clinic of the University Medical Centre Utrecht. POPULATION: Pregnant women with Type 1 diabetes mellitus. METHODS: Thirty-one pregnant women with Type 1 diabetes used the CGMS for two consecutive days. Patients were classified in two groups (high vs low day-to-day variability) based on visual inspection of the glucose excursions. The relationship between day-to-day variability and the variables HbA(1c), maternal age and body mass index (BMI), duration of diabetes, number of self-monitored blood glucose levels, number of insulin injections, gestational age, nutrition, physical activity, White classification, living with children and method of insulin administration was determined. The two days of the first 20 CGMS measurements were separated and four physicians were asked to give recommendations on treatment adjustment for each separate day. MAIN OUTCOME MEASURES: Mean absolute difference (MAD) was calculated for each patient as measure of day-to-day variability. RESULTS: Seventeen patients (55%) were classified as having low (MAD 0.92-2.33 mmol/L) and 14 (45%) as having high day-to-day variability (MAD 2.41-6.12 mmol/L). Of the variables measured, only the relation between MAD and HbA(1c) was significant (r= 0.58, P= 0.001). The difference in recommendation on treatment adjustment between the days of the CGMS measurement ranged from 29% to 48%. This percentage was significantly higher in the high day-to-day variability group (48 vs 33%, P= 0.01). CONCLUSION: Day-to-day glucose variability is high and the treatment of pregnant women with Type 1 diabetes is a problem. Fine-tuning of insulin regimens based on two-day measurements with the CGMS is not advisable.

Adult↗
PubMed1979

Cryosurgical and thermal monitoring system for management of malignancy.

A comprehensive evaluation of the major aspects of cryosurgery has been explored in this preliminary study. A thermal monitoring system has been used concomitantly with cryosurgery, and characteristic freezing pattern differences between normal and malignant tissue have been demonstrated. Morphologic examination of the sections from the control and experimental animals subjected to cryosurgery has been valuable to demonstrate consistent tissue damage. This study has also shown the feasibility of implementing a thermodynamic mathematical model to establish the basis for clinical application of cryosurgery on a more rational therapeutic basis.

Animals↗
PubMed2004

Comparison of two monitoring systems for Cu and Mo in the Swedish environment.

Bio-geochemical samples (BGS) are roots of certain aquatic plants and mosses suitable for monitoring elements dissolved in stream water. The moose, a wild ruminant living in most parts of Sweden, represents higher trophic level and another manifestation of bioavailability. By analyzing BGS (n approximately 33600) and moose liver (n approximately 2400), a systematic survey has been performed in the terrestrial environment of Sweden. Cu and Mo are essential elements for life, and their presence is especially important for the Cu-dependent processes in ruminants. The availability of Cu and Mo as monitored in BGS and moose was visualized in the form of maps and subjected to further statistical analysis. The medians, with lower and upper quartiles indicated as intervals, for the country as a whole were: moose liver, Cu = 34 (20-59), Mo = 0.82 (0.58-1.06) mg kg(-1) wet weight; BGS, Cu = 50 (35-77), Mo = 9.0 (5.3-18.0) mg kg(-1) dry weight. The ranges of medians for the 22 Swedish counties were: moose liver, Cu = (20-62), Mo = (0.54-1.18) mg kg(-1) wet weight; BGS, Cu = (28-115), Mo = (5-47) mg kg(-1) dry weight. The relationships between the counties and the connections between the monitoring variables were elucidated by principal component analysis (PCA). It was demonstrated that two monitoring systems could give divergent results. An unexpectedly strong negative correlation was found between the county medians for Cu in BGS and moose liver. A possible explanation, based on the interaction between Cu and Mo in moose, could not be verified.

Animals↗
PubMed2006

Integrated electronic monitoring systems could revolutionize care for patients with cognitive impairment.

Dementia and other causes of functional disability can create considerable burdens for families and society as a whole, but it may be possible to partially alleviate this strain through technical innovations that replace some functions of human caregivers. This article proposes the hypothesis that cell phones, internet communication and global positioning satellite receivers could be integrated into computer based care-giving systems to provide orientation and safety cues, daily reminders of activities, protection against wandering and direct links to medical assistance in case of incapacitation. Hypothetical case histories describe assistance systems for a patient with moderate Alzheimer's disease living at home, a patient in a nursing home with more advanced dementia and incontinence, an epileptic with intermittent transient postictal amnesia, and a head injury survivor with explosive disorder.

Activities of Daily Living↗
PubMed1990

Risk factors as reflected by an intensive drug monitoring system.

Age and gender are often suspected to be risk factors predisposing to ADRs. Therefore the data obtained by the Heidelberg Intensive Drug Monitoring System were analysed for possible correlations between these two variables and the incidence of ADRs. Based on the medical records comprising the time period between 1980 and 1987 information was available on 70,500 admissions to the Heidelberg University Hospital, Department of Medicine. Age, gender, number of prescriptions and ADRs were analysed. The percentage of patients affected by ADRs rises with advancing age; however the number of prescribed drugs also increases. When the incidence of ADRs in various age groups was analysed in relation to prescription data, no effect of age could be found. In contrast there was a linear correlation between the overall incidence of ADRs (independent of age) and the number of prescriptions per patient (per single admission). These results clearly document that age does not seem to be relevant to the incidence of ADRs, but that the risk is related to the number of drugs prescribed to a particular patient.

Adult↗
PubMed1992

Application of an automated plasma filtration device and a blood monitoring system for LDL apheresis.

This study describes the adaptation of a filtration separation device (AK 10 from Gambro, München, FRG) and a blood monitor system (BTS 100 from Diamed, Köln, FRG) to the automated adsorption/desorption device for LDL apheresis. Plasma separation by filtration was performed by a hollow-fiber filter (OP5, Asahi Corp., Japan). In order to evaluate the quality of the plasma obtained by filtration, the platelet contamination, the activity of factors V and VIII and the concentration of the immunoglobulins IgG and IgM were determined. The following results were found: Platelet contamination of the plasma was 2,740/microliters. As compared to the patient's pretreatment values, activity of factor V was 94%, activity of factor VIII was 104%, concentration of IgG was 96%, concentration of IgM was 94%. Ten LDL aphereses were evaluated: red cell counts, platelet counts, hemoglobin concentration and hematocrit were not changed significantly. Thus, this new combination system represents an improved alternative to previously performed centrifugation methods.

Blood Cell Count↗
PubMedDate not supplied

The Pregnancy Risk Assessment Monitoring System (PRAMS): current methods and evaluation of 2001 response rates.

OBJECTIVES: Our objectives were to describe the methodology of the Pregnancy Risk Assessment Monitoring System (PRAMS), examine recent response rates, determine characteristics associated with response, and track response patterns over time. METHODS: PRAMS is a mixed-mode surveillance system, using mail and telephone surveys. Rates for response, contact, cooperation, and refusal were computed for 2001. Logistic regression was used to examine the relationship between maternal and infant characteristics and the likelihood of response. Response patterns from 1996 to 2001 were compared for nine states. RESULTS: The median response rate for the 23 states in 2001 was 76% (range: 49% to 84%). Cooperation rates ranged from 86% to 97% (median 91%); contact rates ranged from 58% to 93% (median 82%). Response rates were higher for women who were older, white, married, had more education, were first-time mothers, received early prenatal care, and had a normal birthweight infant. Education level was the most consistent predictor of response, followed by marital status and maternal race. From 1996 to 2001, response to the initial mailing decreased in all states compared, but the decrease was offset by increases in mail follow-up and telephone response rates. Overall response rates remained unchanged. CONCLUSIONS: The PRAMS mail/telephone methodology is an effective means of reaching most recent mothers in the 23 states examined, but some population subgroups are more difficult to reach than others. Through more intensive follow-up efforts, PRAMS states have been able to maintain high response rates over time despite decreases in response to the initial mailing.

Adolescent↗
PubMed1991

Annual disease incidence in Colorado cow-calf herds participating in rounds 2 and 3 of the National Animal Health Monitoring System from 1986 to 1988.

Thirty-nine and 47 randomly selected Colorado cow-calf operations participated in the National Animal Health Monitoring System (NAHMS) during rounds 2 (October 1986 to September 1987) and 3 (October 1987 to September 1988), respectively. Data on the incidence of disease conditions within each herd were collected by federal and state Veterinary Medical Officers and university veterinarians through monthly visits to the ranches. Annual disease incidence for disease classes and the most frequently reported individual disease conditions were determined and expressed on a per 100 cow basis. The mean annual disease incidences for all diseases in these herds were 48.8 and 47.7 new cases per 100 cows for rounds 2 and 3, respectively. The ranges for herd annual disease incidence were wide in both study years. The enteric disease class had the highest mean annual disease incidence in both years of the study, and this was primarily because of diarrhea of unknown cause in calves. Diarrhea of unknown cause accounted for approximately 25% of all new disease cases in both rounds of the study. The mean annual disease incidences were not different for any disease class between the two rounds. The data indicate that, on the average, diarrhea of unknown cause, pneumonia, dystocia, foot rot (interdigital necrobacillosis), pinkeye (infectious keratoconjunctivitis), respiratory tract infection, death of unknown cause, and nonpregnancy had the highest incidences in these Colorado beef herds during the study period. However, because of the wide variation of the predominant disease problems between herds, a herd's disease history as well as the common disease problems in the geographic area of a herd must be considered in designing a herd health program.

Animals↗
PubMed1997

Information analysis and validation of intelligent monitoring systems in intensive care units.

Validation of intelligent systems is an important task to perform. Typically the results of the validation analysis are used to verify whether or not the system satisfies the initial design requirements, and to acquire new knowledge and/or refine the knowledge already acquired. In practice, the validation of intelligent systems usually requires the application of several different techniques (e.g., retrospective, prospective, quantitative). In this work the authors present the methodology devised to validate PATRICIA: an intelligent monitoring system designed to advise clinicians on the management of patients dependent on mechanical ventilation. The application of this methodology requires that appropriate validation paradigms are selected, depending on both the application domain and the characteristics of the intelligent system. The article also presents and discusses validation results.

Expert Systems↗
PubMed2005

Early postnatal care among healthy newborns in 19 States: pregnancy risk assessment monitoring system, 2000.

OBJECTIVE: To examine early postnatal care among healthy newborns during 2000 in 19 states. METHODS: Using data from the Pregnancy Risk Assessment Monitoring System, a multistate population-based postpartum survey of women, we calculated prevalences of early discharge (ED; stays of < or =2 days after vaginal delivery and < or =4 days after Cesarean delivery) and early follow-up (within 1 week) after ED. We used logistic regression to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) describing how ED and lack of early follow-up were associated with state legislation and maternal characteristics. RESULTS: While most healthy term newborns (83.5-93.4%) were discharged early, and most early-discharged newborns (51.5-88.5%) received recommended early follow-up, substantial proportions of early-discharged newborns did not. Compared with newborns in states where legislation covered both length of hospital stay (LOS) and follow-up, newborns in states without such legislation were more likely to have ED (aOR: 1.25; CI: 1.01-1.56). Lack of early follow-up was more likely among newborns in states with neither LOS nor follow-up legislation (aOR: 2.70, CI: 2.32-3.14), and only LOS legislation (aOR: 1.38, CI: 1.22-1.56) compared with those in states with legislation for both. ED was more likely among newborns born to multiparous women and those delivered by Cesarean section and less likely among those born to black and Hispanic mothers and mothers with less education. CONCLUSIONS: Lack of early follow-up among ED newborns remains a problem, particularly in states without relevant legislation. These findings indicate the need for continued monitoring and for programmatic and policy strategies to improve receipt of recommended care.

Adult↗
PubMed2003

Hypoglycemia prevalence in prepubertal children with type 1 diabetes on standard insulin regimen: use of continuous glucose monitoring system.

OBJECTIVE: To determine hypoglycemia prevalence in prepubertal children on thrice (TID) and twice (BID) daily insulin regimens, using the Medtronic Minimed Continuous Glucose Monitoring System. RESEARCH DESIGN AND METHODS: Twenty-eight children aged <12 years (median 9.8, range 6.9-11.8) wore the sensor for three consecutive days and nights. Hypoglycemia was defined as glucose <60 mg/dl for >15 min. Data are expressed as the percentage of time period spent hypoglycemic. RESULTS: Hypoglycemia prevalence was 10.1% (mean 2.6 h. subject(-1) x day(-1)). Hypoglycemia was more common at night compared with daytime (18.81 vs. 4.4%, P < 0.001); 78 and 43% of subjects showed hypoglycemia on at least one night and two or more nights, respectively. Nocturnal episodes were prolonged (median 3.3 h) and asymptomatic (91% of episodes). Prevalence was greater between 0400 and 0730 h than between 2200 and 0400 h (25.5 vs. 15.4%, P < 0.001). On a TID compared with a BID regimen, nocturnal hypoglycemia prevalence was reduced, particularly between 0400-0730 h (22.9 vs. 27.4%, P = 0.005), whereas hypoglycemia the following morning (0730-1200 h) was greater (7.8 vs. 2.8%, P < 0.001). Nocturnal hypoglycemia risk was associated with decreasing age (by a factor of 0.6 for a year less in age), increased insulin dose (by 1.6 for an increase of 0.1 units. kg(-1) x day(-1)), insulin regimen (by 0.2 on a BID compared with a TID regimen), and increased weight standard deviation score (SDS) (by 2.7 for a one SDS rise). CONCLUSIONS: Use of standard insulin regimens results in high prevalence and large intraindividual variation in hypoglycemia, particularly at night. Independent risk factors for nocturnal hypoglycemia were younger age, greater daily insulin dose, insulin regimen, and increasing weight.

Blood Glucose Self-Monitoring↗