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PubMed1995

A clinical monitoring system for centrifugal blood pumps.

In clinical application of rotary blood pumps, flow obstruction as a result of suction of the inflow cannula, kinking of tubing, or thrombus formation occurs quite frequently. Early detection of such problems is essential to avoid hemolysis, tissue degradation, or release of thrombi to the patient. A program was developed for automatic observation of pump performance, tubing resistance, and suction effects, which requires only the measurement of already available parameters (i.e., pump speed, pump flow, aortic pressure). The software is based on Visual-C and provides a user surface formatted in Windows. Pump flow, its time derivate, and the relationship between the pulsatile component and the mean graft flow are observed to detect suction in the left atrium. Furthermore, the generated pressure head is predicted from pump speed, graft flow, and the resistance of tubing/cannula and compared with the actually measured aortic pressure. An alarm sounds if a given limit between prediction and measurement is exceeded. In a mock circulation, suction events were detected in more than 95% with a mean deviation of actual aortic pressure from its predicted value of less than 5%. For in vivo application, even incomplete suction could be detected reliably in more than 90% of events. This system improves and standardizes monitoring of pump performance; it should therefore lead to greater safety during application of such devices.

Algorithms↗
PubMed1978

An information system for monitoring health system adequacy.

The design and initial implementation of a system to monitor health system adequacy in Georgia is described. Five profiles on county or sub-county areas comprise the system: Health Resources--an inventory of facilities, personnel, and programs; Health Demands--econometric estimates of demand for selected health services; Health System Adequacy--objective and subjective assessments of the health service system; Health Status--selected health indicators; Area--pertinent demographic characteristics. Innovative aspects include (a) the econometric demand estimates and (b) the subjective adequacy assessments derived using factors analysis to reduce 320 health service assessments to 19 interpretable factors. Potential system role in regional planning under P.L. 93-641 is described.

Delivery of Health Care↗
PubMed1995

An effective computer-based tardive dyskinesia monitoring system.

To promote early recognition and treatment of neuroleptic-induced tardive dyskinesia we used our facility's pharmacy and appointment data bases to develop an automated reminder system that significantly improved physician monitoring of patients receiving antipsychotic drug therapy. The system prompts staff to perform regular examinations for abnormal involuntary movements and to review patients' consent to therapy with antipsychotic medication. The average prevalences in the 15 months after automated reminders began, in a population of over 800 patients, increased from 53% to 85% for an annually completed abnormal involuntary movement scale in medical records and from 38 to 74% for a statement of informed consent. Now, 45 months later, prevalences of both measures approaches 100%. The integrated design of the Department of Veterans Affairs computer system allowed linking pharmacy and appointment scheduling data and facilitated the project. The reminder system effectively promoted rapid, marked, and sustained change in physicians' documentation of antipsychotic drug therapy.

Antipsychotic Agents↗
PubMed1990

[The survey on the perinatal variables and the incidence of cerebral palsy for 12 years before and after the application of the fetal monitoring systems].

The effects of electrical fetal monitoring such as cardiotocogram (CTG) and nonstress test (NST) were studied during the years 1975-86 in 6,981 cases (6,893 singletons, 41 twins and 2 triplets). These cases were divided into three groups according to the mode of fetal monitoring. The first group was managed without electrical fetal monitoring (control group). The second was managed mainly with intrapartum fetal monitoring (transitional group) and the third was managed with antepartum and intrapartum fetal monitoring (fully monitored group). The incidence of cerebral palsy (CP) was investigated at the social health center during the same period. The introduction of intrapartum fetal monitoring resulted in a reduction in neonatal asphyxia from 7.0% in the control group to 5.2% and 4.3% in the transitional group and fully monitored group respectively. The perinatal mortality rate showed a significant reduction from 0.61% in the period without antepartum fetal monitoring to 0.31% in the fully monitored group, and this was attributed to the significant reduction in the number of stillbirths. The incidence of CP in the district decreased from 2.2 to 0.2 per 1,000 children during the period studied. In these circumstances, the caesarean section rate increased from 7.0% in the control group to 11.8% in the transitional group but decreased to 9.8% in the fully monitored group. These results showed the clinical and social benefits of electrical fetal monitoring.

Cerebral Palsy↗
PubMed2002

Prevalence of selected maternal behaviors and experiences, Pregnancy Risk Assessment Monitoring System (PRAMS), 1999.

PROBLEM/CONDITION: Various maternal behaviors and experiences before, during, and after pregnancy (e.g., unintended pregnancy, late entry into prenatal care, cigarette smoking, not breast-feeding) are associated with adverse health outcomes for both the mother and the infant. Information regarding maternal behaviors and experiences is needed to monitor trends, to enhance the understanding of the relations between behaviors and health outcomes, to plan and evaluate programs, to direct policy decisions, and to monitor progress toward Healthy People 2000 and 2010 objectives. REPORTING PERIOD COVERED: This report covers data from 1993 through 1999. DESCRIPTION OF SYSTEM: The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, state- and population-based surveillance system designed to monitor selected self-reported maternal behaviors and experiences that occur before, during, and after pregnancy among women who deliver a live-born infant. PRAMS employs a mixed-mode data collection methodology; up to three self-administered surveys are mailed to a sample of mothers, and nonresponders are followed up with a telephone interview. Self-reported survey data are linked to selected birth certificate data and weighted for sample design, nonresponse, and noncoverage to create annual PRAMS analysis data sets. PRAMS generates statewide estimates of various perinatal health topics among women delivering a live infant. Data for 1999 from 17 states are examined. In addition, trend data are examined for 12 states that had at least 3 years of data during 1993-1999. RESULTS: In 1999, the prevalence of unintended pregnancy resulting in a live birth ranged from 33.7% to 52% across the 17 states. During 1993-1999, only one state reported a decreasing trend in the prevalence of unintended pregnancy. Women aged <20 years, black women, women with less than or equal to a high school education, and women receiving Medicaid were more likely to report unintended pregnancy. The prevalence of late or no entry into prenatal care ranged from 16.1% to 29.9%. The prevalence of late or no entry into prenatal care significantly decreased over time in seven of the 12 states with trend data. In general, women aged <20 years, black women, women with less than a high school education, and women receiving Medicaid were more likely to report late or no entry into prenatal care. The prevalence of smoking during the last 3 months of pregnancy ranged from 6.2% to 27.2%, and the prevalence decreased in five states from 1993 to 1999. Overall, smoking during the last 3 months of pregnancy was associated with younger age (<25 years), non-Hispanic ethnicity, having less than or equal to a high school education, receiving Medicaid, and delivering a low birthweight infant. The prevalence of physical abuse by a husband or partner during pregnancy ranged from 2.1% to 6.3%. No trends were observed for physical abuse from 1996 to 1999, the only years for which these data were available. Across the 17 states, only Medicaid status was consistently associated with experiencing physical abuse during pregnancy. The prevalence of breast-feeding initiation ranged from 48% to 89%. Ten of 12 states with trend data reported increases in the prevalence of breast-feeding initiation. Overall, women aged <20 years, women with less than or equal to a high school education, and women receiving Medicaid were less likely to breast-feed. The prevalence of breast-feeding duration for at least 4 weeks ranged from 34.9% to 78.1%. From 1993 to 1999, increases in levels of breast-feeding for at least 4 weeks were observed in eight states. Women aged <25 years, black women, women with less than or equal to a high school education, and women receiving Medicaid were generally less likely to breast-feed for at least 4 weeks. The prevalence of back sleep position for infants ranged from 35.1% to 74.6%. Increases in the use of the back sleep position were observed in all 12 states with trend data from 1996 to 1999. Black race and having less than or equal to a high school education were consistently associated with not using the back sleep position. INTERPRETATION: For surveillance during 1993-1999, the majority or all states observed increases in breast-feeding initiation, breast-feeding for at least 4 weeks, and back sleep position. Approximately one half of the states observed decreases for late or no entry into prenatal care and smoking during the last 3 months of pregnancy. Little or no progress was observed in the prevalence of unintended pregnancy or physical abuse during pregnancy. With few exceptions, the 17 states failed to meet the Healthy People 2000 objectives for the seven reported behaviors in 1999. Certain de

Adolescent↗
PubMed2002

Validation of a remote monitoring system for the elderly: application to mobility measurements.

The aim of this paper is to introduce a smart tool for the assessment of the mobility of patient with motor disorders and to evaluate its performance through some initial experiments. These experiments are based on a system which is composed of sensors connected to a Personal Computer (PC) using data acquisition cards and a communication network. The PC includes a data acquisition and processing software. This system has been installed in a patient's housing (a bedroom and a washroom) in a long-stay setting. Pre-established travel and activity (going to bed, getting up, visiting the washroom em leader ) patterns of patient in the housing including their duration have been defined by physicians for the experiments. A volunteer participated in the experiments and the results of his mobility obtained by the data processing software were compared with his real mobility. An agreement was found between the proposed assessment system and the experiments, thereby validating functioning of the whole system. Then, the system has been used to monitor a patient over a period of 39 nights. Again there is a good agreement between the characteristics derived from the system and the findings of the caring staff in charge of the patient's routine night monitoring. Data collected during 24 consecutive hours have been used to identify and characterise the patient's whole day mobility. This study paves the way for a new assessment system of the mobility of patient thus allowing the follow up of patients suffering from dementia and to study their significant mobility changes over time by introducing an indicator of mobility which can be used to assess their motor behavioural disorders.

Aged↗
PubMed2006

Monitoring progress toward achieving Maternal and Infant Healthy People 2010 objectives--19 states, Pregnancy Risk Assessment Monitoring System (PRAMS), 2000-2003.

PROBLEM/CONDITION: Certain modifiable maternal behaviors and experiences before, during, and after pregnancy are associated with adverse health outcomes for the mother and her infant (e.g., physical abuse, insufficient folic acid consumption, smoking during pregnancy, and improper infant sleep position). Information about these behaviors and experiences is needed to monitor trends in maternal and infant health, enhance understanding of the relation between maternal behaviors and infant health outcomes, plan and evaluate maternal and infant health programs, direct policy decisions, and monitor progress toward achieving the national Healthy People 2010 [HP 2010] objectives (US Department of Health and Human Services. Healthy people 2010. 2nd ed. With understanding and improving health and objectives for improving health [2 vols.]. Washington, DC: US Department of Health and Human Services; 2000). REPORTING PERIOD COVERED: 2000-2003. DESCRIPTION OF SYSTEM: The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, state- and population-based surveillance system designed to monitor selected maternal behaviors and experiences that occur before, during, and after pregnancy among women who deliver live-born infants. PRAMS employs a mixed mode data-collection methodology; up to three self-administered surveys are mailed to a sample of mothers; nonresponders are followed up with telephone interviews. Self-reported survey data are linked to selected birth certificate data and weighted for sample design, nonresponse, and noncoverage to create annual PRAMS analysis data sets that can be used to produce statewide estimates of perinatal health behaviors and experiences among women delivering live infants. This report summarizes data for 2000-2003 from 19 states (Alabama, Alaska, Arkansas, Colorado, Florida, Hawaii, Illinois, Louisiana, Maine, Nebraska, New Mexico, New York, North Carolina, Ohio, Oklahoma, South Carolina, Utah, Washington, and West Virginia) that measured progress toward achieving HP 2010 objectives for eight perinatal indicators: 1) pregnancy intention, 2) multivitamin use, 3) physical abuse, 4) cigarette smoking during pregnancy, 5) cigarette smoking cessation, 6) drinking alcohol during pregnancy, 7) breastfeeding initiation, and 8) infant sleep position. RESULTS: In 2003, prevalence of intended pregnancy among women having a live birth ranged from 48.1% in Louisiana to 66.5% in Maine; during 2000-2003, no state experienced a statistically significant (p< or =0.05) increase in prevalence of intended pregnancy, and one state experienced a significant decrease. In 2003, prevalence of multivitamin use at least four times per week during the month before pregnancy ranged from 23.0% in Arkansas to 45.2% in Maine; during 2000-2003, multivitamin use increased significantly in three states (Illinois, North Carolina, and Utah). In 2003, prevalence of physical abuse by a husband or partner during the 12 months before pregnancy ranged from 2.2% in Maine to 7.6% in New Mexico; during 2000-2003, significant decreases were recorded in three states (Alaska, Hawaii, and Nebraska). In 2003, prevalence of abstinence from cigarette smoking during the last 3 months of pregnancy ranged from 72.5% in West Virginia to 96.1% in Utah; during 2000-2003, a significant increase was recorded in Utah. In 2003, prevalence of smoking cessation during pregnancy ranged from 30.2% in West Virginia to 65.8% in Utah; during 2000-2003, a significant increase was recorded in Utah. In 2003, prevalence of abstinence from alcohol during the last 3 months of pregnancy ranged from 91.3% in Colorado to 98.0% in Utah; during 2000-2003, abstinence increased significantly in Louisiana and Utah but decreased significantly in Florida and Nebraska. In 2003, prevalence of mothers who breastfed their babies in the early postpartum period ranged from 51.2% in Louisiana to 90.3% in Alaska; during 2000-2003, significant increases were recorded in six states (Arkansas, Illinois, Louisiana, Nebraska, North Carolina, and South Carolina). In 2003, prevalence of healthy full-term infants who were placed to sleep on their backs ranged from 50.0% in Arkansas to 78.7% in Washington; during 2000-2003, significant increases were recorded in eight states (Alaska, Colorado, Illinois, Louisiana, Maine, Nebraska, North Carolina, and West Virginia). In 2003, all 19 states achieved or exceeded the HP 2010 objective for smoking cessation during pregnancy, and 16 states achieved the HP 2010 objective for abstinence from alcohol during the last 3 months of pregnancy. In addition, nearly half of the states achieved the objectives for breastfeeding in the early postpartum period and infant back sleep position. However, no state achieved the HP 2010 objectives for intended pregnancy, multivitamin use before pregnancy, absence of physical abuse before pregnancy, or abstinence from smoking during pregnancy. INTERPRETATION: PRAMS data indicate variability among states regarding progress toward achieving HP 2010 objectives in the area of maternal and child health. More progress has been made in achieving objectives focused on the period during and after pregnancy (e.g., smoking cessation and proper infant sleep position); less progress has been made in achieving objectives related to behaviors and experiences in the preconception period (e.g., pregnancy intention and multivitamin use). PUBLIC HEALTH ACTION: State maternal and child health programs can use these state- and population-based data to monitor progress toward achieving HP 2010 objectives, identify indicators to target for intervention, and plan and evaluate programs that promote positive maternal and infant health behaviors, experiences, and outcomes. These data also can be used to guide policy decisions that could affect the health of mothers and infants.

Adult↗
PubMed1975

Recent experience with a respiratory monitoring system in intensive care.

Computer based instrumentation for continuous monitoring of airway flow, pressure, O2 and CO2 concentration offers an improved noninvasive management technique for patients on mechanical ventilators. Computation of these basic signals provides routinely the following measurements: respiratory rate, tidal volume in and out, minute ventilation, positive end-expiratory pressure, mean airway pressure, inspiration-expiration ra measurements, except for O2 consumption and partially for tco2 production. The system works as a monitor of the respirator (detection of malfunction) and as a monitor of the lung function of the patient. It is particularly useful when adjusting the respirator and at time of weaning a patient from the respirator. These maneuvers can be made more safely because they are based on objective measurements and followed by immediate new sets of data. Defining the optimal values of tidal volume and positive end-expiratory pressure has been simplified by the use of pressure-volume plots. A "fighting", is now used as a measure of the severity of "fighting", that is of the effort of the patient to breathe spontaneously while being ventilated. It can detect fighting before it is diagnosed clinically and so can provide a warning that significant physiological changes will occur unless the fighting is controlled. New information about the distribution of ventilation-perfusion ratio can be derived from the expired concentration curve for CO2. Quantitative measurement of the distribution of ventilation shows a very close correlation with clinical events and can be carried out automatically during the normal routine of care of the patient. These on-line quantitative measurements, with the immediate reporting of results, appear to make a positive contribution to patient care.

Belgium↗
PubMed1977

Low-cost daily pacemaker monitoring system.

To reduce the cost of pacemaker monitoring, we developed an inexpensive cardiac pacemaker interval monitor that detects electromagnetic radiation of the electrical pulse generated by an implanted pacemaker. The pulse interval is timed by logic systems and a piezoelectric crystal. Pulse interval is computed to the nearest 0.1 msec. The device is battery powered and can be used at home by the patient to monitor pulse interval daily with little cost after the initial expenditure. The unit may also be used by the physician to detect the stability or constancy of random variation of the pulse interval. From a daily record of measurements of the pulse interval, limits are set by the physician to predict impending battery exhaustion. Eight patients have been monitored for up to 24 months.

Costs and Cost Analysis↗
PubMed2003

Surveillance for selected maternal behaviors and experiences before, during, and after pregnancy. Pregnancy Risk Assessment Monitoring System (PRAMS), 2000.

PROBLEM/CONDITION: Various maternal behaviors and experiences are associated with adverse health outcomes for both the mother and the infant. These behaviors and experiences can occur before pregnancy (e.g., insufficient intake of folic acid), during pregnancy (e.g., complications requiring hospitalization, such as high blood pressure), and after pregnancy (e.g., inadequate follow-up of infants who were discharged early). Information regarding maternal behaviors and experiences is needed to monitor trends, to enhance the understanding of the relations between behaviors and health outcomes, to plan and evaluate programs, to direct policy decisions, and to monitor progress toward Healthy People 2010 objectives (US Department of Health and Human Services. Healthy People 2010. 2nd. ed. With understanding and improving health and objectives for improving health [2 vols.]. Washington DC: US Department of Health and Human Services, 2000). REPORTING PERIOD COVERED: This report covers data for 2000. DESCRIPTION OF SYSTEM: The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, state- and population-based surveillance system designed to monitor selected self-reported maternal behaviors and experiences that occur before, during, and after pregnancy among women who deliver a live-born infant in 31 states and New York City. PRAMS employs a mixed-mode data collection methodology; as many as three self-administered surveys are mailed to a sample of mothers, and nonresponders are followed up with a telephone interview. Self-reported survey data are linked to selected birth certificate data and weighted for sample design, nonresponse, and noncoverage to create annual PRAMS analysis data sets. PRAMS data can be used to produce statewide estimates of various perinatal health behaviors and experiences among women delivering a live infant. Four indicators for the year 2000 (multivitamin use, pregnancy-related complications, infant checkup, and postpartum contraceptive use) from 19 states are examined in this report. RESULTS: In 2000, the prevalence of multivitamin use > or =4 times per week in the month before pregnancy ranged from 25.0% to 40.7% across the 19 states. Prevalence of pregnancy-related complications requiring hospitalization ranged from 8.8% to 16.3%. Prevalence of infant checkups within 1 week of early (< or =48 hours) hospital discharge ranged from 51.5% to 88.6%. Prevalence of postpartum contraceptive use ranged from 77.9% to 89.9%. INTERPRETATION: PRAMS data indicate that 19 states are well below the Healthy People 2010 objective for folic acid consumption, as measured by multivitamin use. Data for infant checkups indicate that guidelines for care are not being followed for as many as half of those discharged early. However, data for additional years are needed to assess trends in these four indicators. PUBLIC HEALTH ACTION: State maternal and child health programs can use these population-based data to monitor progress toward Healthy People 2010 objectives, evaluate adherence to guidelines for care, and assess changes in prevalence of other health behaviors. The data can be shared with policy makers to direct policy decisions that might affect the health of mothers and infants. By providing data on maternal behaviors and experiences that are associated with adverse outcomes, PRAMS supports the activities of two CDC initiatives-to promote safe motherhood and to reduce infant mortality and low birthweight.

Contraception Behavior↗
PubMed1988

A computer controlled non-invasive haemodynamic monitoring system.

A system for the non-invasive monitoring, recording and storing haemodynamic indices has been developed using an Apple II microcomputer, a Dinamap automatic arterial pressure monitor and a non-invasive cardiac output monitor based on bio-electrical impedance. This system was used during the induction and maintenance of anaesthesia. Numerical and graphical displays of heart rate, arterial pressure, cardiac output and systemic vascular resistance are available. A print-out of data can be produced for later analysis.

Blood Pressure↗
PubMed1988

A bed temperature monitoring system for assessing body movement during sleep.

A method of monitoring and analysing temperature distribution in a patient's bed during bed rest and sleep is described. The system consists of 16 temperature sensors, a solid-state recorder and a personal computer. The temperature sensors are attached on the surface of a bed mat. The temperature of the 16 measurement points are recorded and stored on a multichannel solid-state recorder, where a programmable read-only memory (PROM) is used as the memory device. The PROM is detachable from the recorder, and the temperature data is read by a computer. A two-dimensional temperature distribution pattern is obtained by interpolating the temperature between measured points. The system was effective for long-term temperature monitoring without patient discomfort, and it proved reliable and easy to use. The temperature distribution and changes in the distribution indicated body movement and hence periods of sleep.

Beds↗
PubMed2004

A Wireless Health Outcomes Monitoring System (WHOMS): development and field testing with cancer patients using mobile phones.

BACKGROUND: Health-Related Quality of Life assessment is widely used in clinical research, but rarely in clinical practice. Barriers including practical difficulties administering printed questionnaires have limited their use. Telehealth technology could reduce these barriers and encourage better doctor-patient interaction regarding patient symptoms and quality-of-life monitoring. The aim of this study was to develop a new system for transmitting patients' self-reported outcomes using mobile phones or the internet, and to test whether patients can and will use the system via a mobile phone. METHODS: We have developed a prototype of a Wireless Health Outcomes Monitoring System, which allows structured questionnaires to be sent to the patient by their medical management team. The patients' answers are directly sent to an authorised website immediately accessible by the medical team, and are displayed in a graphic format that highlights the patient's state of health. In the present study, 97 cancer inpatients were asked to complete a ten-item questionnaire. The questionnaire was delivered by display on a mobile phone, and was answered by the patients using the mobile phone keypad. RESULTS: Of the 97 patients, 56 (58%) attempted the questionnaire, and all of these 56 completed it. Only 6% of the total number of questions were left unanswered by patients. Forty-one (42%) patients refused to participate, mostly due to their lack of familiarity with mobile phone use. Compared with those who completed the questionnaire, patients who refused to participate were older, had fewer years of education and were less familiar with new communications technology (mobile phone calls, mobile phone SMS, internet, email). CONCLUSION: More than half of the patients self-completed the questionnaire using the mobile phone. This proportion may increase with the use of multichannel communications which can be incorporated into the system. The proportion may also increase if the patient's partner and/or family were able to assist the patient with using the technology. These preliminary results encourage further studies to identify specific diseases or circumstances where this system could be useful in patients' distance monitoring. Such a system is likely to detect patient suffering earlier, and to activate a well-timed intervention.

Cell Phone↗