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PubMed1999

Comparison of auscultatory and oscillometric automated blood pressure monitors in the setting of preeclampsia.

OBJECTIVE: The aim of this study was to compare the accuracy of 2 automated blood pressure monitors against mercury sphygmomanometry and intra-arterial blood pressure determination in women with preeclampsia. STUDY DESIGN: The auscultatory and oscillometric monitors were compared with mercury sphygmomanometry according to the British Hypertension Society protocol and criteria of the Association for the Advancement of Medical Instrumentation in a group of 30 women with proteinuric preeclampsia. In addition both monitors were compared with intra-arterial blood pressure measurements in a group of 6 women with severe preeclampsia. The mean (+/- SD) of the differences was calculated and a paired t test was used to compare values obtained with each monitor with intra-arterial measurements. RESULTS: Compared with mercury sphygmomanometry the auscultatory QuietTrak monitor markedly underestimated systolic and diastolic blood pressure by 13 +/- 15 mm Hg. The oscillometric SpaceLabs 90207 monitor also underestimated systolic pressure by 10 +/- 10 mm Hg and diastolic pressure by 8 +/- 7 mm Hg. According to the British Hypertension Society grading criteria both monitors achieved the lowest grade (D) for recording systolic and diastolic pressure. The 2 monitors also did not meet the accuracy criteria stipulated by the Association for the Advancement of Medical Instrumentation. Compared with intra-arterial readings the SpaceLabs monitor significantly underestimated systolic and mean arterial pressures (by 19 and 7 mm Hg, respectively, P <. 01). The QuietTrak monitor significantly underestimated systolic, diastolic, and mean arterial pressures (by 25 mm Hg, P <.05, 18 mm Hg, P <.01, and 20 mm Hg, P <.01, respectively). CONCLUSION: Neither monitor can be recommended for clinical use in women with proteinuric preeclampsia.

Auscultation↗
PubMed2002

How pharmacokinetic and pharmacodynamic drug monitoring can improve outcome in solid organ transplant recipients.

Within the field of solid organ transplantation there is an unprecedented interest in therapeutic drug monitoring of immunosuppressive drugs. Ideally therapeutic drug monitoring should cost-effectively lead to improved efficacy of the drug and to a reduction in side effects. Therapeutic drug monitoring will be most effective if there is a large interpatient variability and a small intrapatient variability. Therapeutic drug monitoring in transplantation is largely based on correlations between drug concentrations and toxicity or between drug concentrations and efficacy. Pharmacodynamic monitoring of immunosuppressive drugs has not reached the stage of widespread clinical application. In part this is caused by the fact that most of the pharmacodynamic assays are time-consuming, costly and in some cases only give a result after several days of incubation. Another reason for the limited interest in pharmacodynamic monitoring is the lack of data showing improved outcome if dose adjustment is based on pharmacodynamics rather than pharmacokinetics. On the other hand, such data are also lacking for pharmacokinetic monitoring. Prospective investigations on the contribution of therapeutic drug monitoring may result in further improvement of the safety and efficacy of our immunosuppressive regimens and more refined methods for therapeutic drug monitoring. There is no contest between pharmacokinetic and pharmacodynamic monitoring. Most likely the results of both ways of monitoring will be complementary.

Animals↗
PubMed1994

Clinical evaluation and temperature monitoring in predicting viability in replantations.

Experiences with temperature and clinical monitoring in a series of 111 patients with 188 revascularized digits were reviewed. Criteria for abnormal temperature monitoring were defined. Monitoring of only clinical parameters showed a sensitivity of 1.00 and specificity of .97, but this technique was time-consuming and required experienced interpretation of subtle clinical changes. Temperature monitoring gave a sensitivity of 1.00, while the specificity was only .61. Drops in temperature were frequently not associated with vascular problems. Review of digits with abnormal clinical or temperature monitoring showed five patterns of abnormality. The first three groups had either abnormal clinical or temperature monitoring, but all fingers survived without reexploration. The fourth and fifth groups showed abnormalities in both clinical and temperature monitoring; all but one finger were found to be nonviable. Combined clinical and temperature monitoring was highly effective in early prediction of vascular compromise, with a sensitivity of 1.00 and a specificity of .99. The authors recommend the use of temperature monitoring. If a temperature drop occurs, monitoring of the clinical parameters can then be done. If both temperature and clinical monitoring yield abnormal results after a specified time, intervention should be carried out.

Body Temperature↗
PubMed2000

Monitoring the patient with asthma: an evidence-based approach.

The monitoring of symptoms, airflow obstruction, and exacerbations is essential to asthma management. Patients who practice self-monitoring in conjunction with use of a written action plan and regular medical review have significantly fewer hospitalizations, emergency department visits, and lost time from work. Either symptom monitoring or peak expiratory flow monitoring is satisfactory, provided the results are interpreted with reference to the patient's own baseline asthma status. Regular monitoring by physicians also improves health outcomes for patients, provided the physician is systematic and monitors control, medications, and skills at regular intervals. Additional monitoring tools are under evaluation, and these include measures of airway responsiveness, airway inflammation, and Internet-based monitoring systems. Administrators need to monitor the quality and cost of care, as well as compliance with national management guidelines. Assessment of the hospitalization rate and regular audit may achieve these aims in the hospital setting. The best way to assess and monitor asthma in primary care remains an unresolved yet crucial issue because primary care physicians manage the vast burden of illness caused by asthma. Monitoring asthma outcomes is an essential step toward the successful implementation of national guidelines for the management of asthma.

Asthma↗
PubMed2002

Use of automated home blood pressure monitoring in pregnancy: is it safe?

OBJECTIVE: The purpose of this study was to investigate the relationship between blood pressure that is measured with the automated blood pressure monitor, Omron HEM-705CP (Omron Corporation, Tokyo, Japan), and mercury sphygmomanometry in normotensive and preeclamptic pregnant women. STUDY DESIGN: Healthy pregnant women (n = 101 women) underwent mercury and home Omron HEM-705CP monitor blood pressure measurements at 10 to 14, 19 to 22, 27 to 30, and 35 to 37 weeks of gestation and 5 to 9 weeks after delivery. After routine mercury blood pressure recordings that were taken by midwives, women with preeclampsia (n = 45 women) measured their own blood pressure using an Omron HEM-705CP monitor (n = 212 recordings). In the longitudinal cohort, mean +/- 2 SD were calculated for blood pressure levels throughout pregnancy. Individual variation in home Omron minus office mercury throughout pregnancy was determined. In preeclampsia, back-to-back blood pressure measurements by the two methods were correlated and quantified as being within 5, 10, and 15 mm Hg. Bland-Altman plots were calculated, and the sensitivity of the Omron HEM-705CP monitor to detect hypertension that was identified by mercury sphygmomanometry was evaluated. RESULTS: At 10 to 14, 19 to 22, 27 to 30, and 35 to 37 weeks of gestation, the upper limits for normal systolic blood pressure levels with the use of home Omron HEM-705CP monitor measurements were 132, 130, 133, and 138 mm Hg and for diastolic blood pressure levels were 82, 79, 81, and 88 mm Hg, respectively. For women who were normotensive and had preeclampsia (although group mean blood pressure values by mercury sphygmomanometry and Omron HEM-705CP monitor were similar), there were marked individual differences (</=40 mm Hg) between the devices. In preeclampsia, paired Omron monitor and mercury systolic and diastolic blood pressure levels were within 5, 10, and 15 mm Hg in 47%, 73%, and 82%, and 56%, 78%, and 92%, respectively. The Omron monitor identified >90% of mild hypertension (140/90 mm Hg) but missed one third of hypertension with a blood pressure level of >160/100 mm Hg by mercury sphygmomanometry. CONCLUSION: Clinicians should be aware of the potential differences between blood pressure measurements with mercury sphygmomanometers and Omron HEM-705CP monitors in pregnancy. The Omron HEM-705CP monitor should not be used to monitor hypertension in preeclampsia.

Adult↗
PubMed2000

Real-time monitoring of particles, PAH, and CO in an occupied townhouse.

Beginning in October 1996, indoor and sometimes outdoor air at an occupied house in a suburban area of Virginia has been monitored continuously for particles, PAH, and CO. Two Climet monitors have been used to count particles in six size ranges between 0.3 and > 10 microns, with 1-minute averages being collected every 5 minutes. Two Ecochem PAH monitors have been used to sample for particle-bound PAHs once every minute. Also, two Langan CO monitor-data loggers have measured CO once each minute while logging the PAH data. Two Aethalometers measure black carbon. A single Scanning Mobility Particle Sizer (SMPS) measures ultrafine particles. The pairs of monitors are set up either to provide an indoor/outdoor or an upstairs office/downstairs kitchen comparison. Air exchange is occasionally measured using a Bruel & Kjaer 1302 SF6 monitor, as a parameter necessary for estimating deposition rates for particles and PAH. Results from the first 16 months of monitoring (approximately 10 M observations) include: neighborhood woodburning and morning rush hour traffic are the most important sources of PAH and black carbon outdoors; candles, matches, incense, and frying, sauteeing, broiling, deep-frying, and stir-frying are additional important indoor sources of PM. One citronella candle was an extremely powerful PAH source. Neither woodburning nor vehicles appears to be an important source of particles indoors, but frying, grilling, and sauteeing are extremely strong indoor sources, together with combustion events such as use of matches and candles. Physical movement was an important source of coarse but not fine particles. Use of the gas stove for extended periods of time led to increased CO concentrations--vehicles and woodburning were relatively minor sources in comparison. The gas oven, gas burners, and electric toaster oven were important sources of ultrafine particles (< 0.1 micron). A source-proximity effect was noted with the kitchen monitor reading two to five times higher than the upstairs monitor for particles from kitchen events, while the upstairs monitor often read higher than the kitchen monitor for events caused by physical activity alone.

Activities of Daily Living↗
PubMed2006

Assessing isocyanate exposures in polyurethane industry sectors using biological and air monitoring methods.

Isocyanates, as a chemical group, are considered to be the biggest cause of occupational asthma in the UK. Monitoring of airborne exposures to total isocyanate is costly, requiring considerable expertise, both in terms of sample collection and chemical analysis and cannot be used to assess the effectiveness of protection from wearing respiratory protective equipment (RPE). Biological monitoring by analysis of metabolites in urine can be a relatively simple and inexpensive way to assess exposure to isocyanates. It may also be a useful way to evaluate the effectiveness of control measures in place. In this study biological and inhalation monitoring were undertaken to assess exposure in a variety of workplaces in the non-motor vehicle repair sector. Companies selected to participate in the survey included only those judged to be using good working practices when using isocyanate formulations. This included companies that used isocyanates to produce moulded polyurethane products, insulation material and those involved in industrial painting. Air samples were collected by personal monitoring and were analysed for total isocyanate content. Urine samples were collected soon after exposure and analysed for the metabolites of different isocyanate species, allowing calculation of the total metabolite concentration. Details of the control measures used and observed contamination of exposed skin were also recorded. A total of 21 companies agreed to participate in the study, with exposure measurements being collected from 22 sites. The airborne isocyanate concentrations were generally very low (range 0.0005-0.066 mg m(-3)). A total of 50 of the 70 samples were <0.001 mg m(-3), the limit of quantification (LOQ), therefore samples below the LOQ were assigned a value of 1/2 LOQ (0.0005 mg m(-3)). Of the 70 samples, 67 were below the current workplace exposure limit of 0.02 mg m(-3). The highest inhalation exposures occurred during spray painting activities in a truck manufacturing company (0.066 mg m(-3)) and also during spray application of polyurethane foam insulation (0.023 mg m(-3)). The most commonly detected isocyanate in the urine was hexamethylene diisocyanate, which was detected in 21 instances. The geometric mean total isocyanate metabolite concentration for the dataset was 0.29 micromol mol(-1) creatinine (range 0.05-12.64 micromol mol(-1) creatinine). A total of 23 samples collected were above the agreed biological monitoring guidance value of 1.0 micromol mol(-1) creatinine. Activities that resulted in the highest biological monitoring results of the dataset included mixing and casting of polyurethane products (12.64 micromol mol(-1) creatinine), semi-automatic moulding (4.80 micromol mol(-1) creatinine) and resin application (3.91 micromol mol(-1) creatinine). The biological monitoring results show that despite low airborne isocyanate concentrations, it was possible to demonstrate biological uptake. This tends to suggest high sensitivity of the biological monitoring method and/or that in some instances the RPE being used by operators was not effective or that absorption may have occurred via dermal or other routes of exposure. This study demonstrates that biological monitoring is a useful tool when assessing worker exposure to isocyanates, providing a more complete picture on the efficacy of control measures in place than is possible by air monitoring alone. The results also demonstrated that where control measures were judged to be adequate, most biological samples were close to or < 1 micromol mol(-1) creatinine, the agreed biological monitoring benchmark.

Air Pollutants, Occupational↗
PubMed2001

BIS monitoring to prevent awareness during general anesthesia.

BACKGROUND: Unexpected awareness is a rare but well-described complication of general anesthesia that has received increased scientific and media attention in the past few years. Transformed electroencephalogram monitors, such as the Bispectral Index monitor, have been advocated as tools to prevent unexpected recall. METHODS: The authors conducted a power analysis to estimate how many patients would be needed in an appropriately powered study to demonstrate the Bispectral Index monitor reduces awareness, as well as a cost analysis to assess the cost of using the monitor for this purpose alone. RESULTS: If unexpected recall is rare (1 in 20,000), it will require a large study to demonstrate that the monitor reduces awareness (200,000-800,000 patients), and the cost of using it for this purpose alone would be high ($400,000 per case prevented). If awareness is common (1 in 100), then the number of patients needed in a study to demonstrate that the monitor works becomes tractable (1,000-4,000 patients), and the cost of using the monitor for this purpose alone becomes lower ($2,000 per case prevented). Because there are reported cases of awareness despite Bispectral Index monitoring, the authors are certain that the effectiveness of the monitor is less than 100%. As the performance of the monitor decreases from 100%, the size of the study needed to demonstrate that it works increases, as does the cost of using it to prevent awareness. CONCLUSION: The contention that Bispectral Index monitoring reduces the risk of awareness is unproven, and the cost of using it for this indication is currently unknown.

Anesthesia, General↗
PubMedDate not supplied

AHA scientific statement: practice standards for electrocardiographic monitoring in hospital settings: an American Heart Association Scientific Statement from the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: endorsed by the International Society of Computerized electrocardiology and the American Association of Critical-Care Nurses.

The goals of electrocardiographic (ECG) monitoring in hospital settings have expanded from simple heart rate and basic rhythm determination to the diagnosis of complex arrhythmias, myocardial ischemia, and prolonged QT interval. Whereas Computerized arrhythmia analysis is automatic in cardiac monitoring systems, computerized ST-segment ischemia analysis is available only in newer-generation monitors, and computerized QT-interval monitoring is currently unavailable. Even in hospitals with ST-monitoring capability, ischemia monitoring is vastly underutilized by healthcare professionals. Moreover, because no computerized analysis is available for QT monitoring, healthcare professionals must determine when it is appropriate to manually measure QT intervals (eg, when a patient is started on a potentially proarrhythmic drug). The purpose of the present review is to provide "best practices" for hospital ECG monitoring. Randomized clinical trials in this area are almost nonexistent; therefore, expert opinions are based upon clinical experience and related research in the field of electrocardiography. This consensus document encompasses all areas of hospital cardiac monitoring in both children and adults. The emphasis is on information clinicians need to know to monitor patients safely and effectively. Recommendations are made with regard to indications, time frames, and strategies to improve the diagnostic accuracy of cardiac arrhythmia, ischemia, and QT-interval monitoring. Currently available ECG lead systems are described, and recommendations related to staffing, training, and methods to improve quality are provided.

Arrhythmias, Cardiac↗
PubMed2002

Iatrogenic nerve injury in acetabular fracture surgery: a comparison of monitored and unmonitored procedures.

OBJECTIVES: To review our experience with iatrogenic nerve injuries and to evaluate the efficacy of intraoperative monitoring in a large consecutive series of operatively treated acetabular fractures. DESIGN: Retrospective, nonrandomized. SETTING: Level I Trauma Center, January 1, 1992 through December 31, 1998. PATIENTS/PARTICIPANTS: A total of 256 consecutive acetabular fractures were operatively treated at our institution; 140 unmonitored procedures and 112 monitored procedures were available for review. The decision to use monitoring was at the discretion of the treating surgeon. INTERVENTION: Open reduction and internal fixation of the acetabular fracture. MAIN OUTCOME MEASUREMENT: Preoperative and postoperative neurologic examinations, fracture type, use of traction, dislocation, operative approach, and complications were analyzed. Motor strength, sensation, the need for gait aids, orthoses, and extent of recovery were evaluated. RESULTS: Traumatic nerve palsies were present in eleven of 140 (7.9 percent) unmonitored and thirteen of 112 (11.6 percent) monitored fractures (p = 0.314). There were fourteen iatrogenic sciatic nerve palsies in 252 cases (5.6 percent). There were four iatrogenic sciatic palsies (2.9 percent) in the unmonitored group and ten iatrogenic palsies (8.9 percent) in the monitored group (p = 0.037). In the unmonitored group one of eighty-one Kocher-Langenbeck approaches (1.2 percent), two of fifty-two ilioinguinal (3.9 percent), and one of three extended iliofemoral approaches developed a sciatic palsy. In the monitored group six of seventy-seven Kocher-Langenbeck approaches (7.8 percent), three of twenty-five ilioinguinal (12 percent), and one of six combined approaches (16.7 percent) developed a sciatic palsy. In seven of the ten iatrogenic palsies in the monitored group, the intraoperative monitoring was normal. Seventy-six patients were monitored with somatosensory evoked potential alone, and nine had iatrogenic injuries (11.8 percent). Thirty-six patients were monitored with somatosensory evoked potential and electromyography, and one had an iatrogenic injury (2.8 percent) (p = 0.164). Clinical follow-up was available for three of the four patients with iatrogenic injuries in the unmonitored group, with a mean follow-up of twenty-seven months (range 8 to 60 months). Two patients had full motor recovery at a mean of six months, and one had no recovery at fourteen months. CONCLUSIONS: The use of intraoperative monitoring did not decrease the rate of iatrogenic sciatic palsy. Further study involving larger prospective, randomized methodology appears warranted. Sciatic nerve injury was more common in ilioinguinal approaches in both groups, likely due to reduction techniques for the posterior column performed with the hip flexed, placing the sciatic nerve under tension.

Acetabulum↗
PubMed1990

Comparison of evaluation of gastroesophageal reflux in infants using different feedings during intraesophageal pH monitoring.

The effect of two different types of feedings on results of esophageal pH monitoring was prospectively studied in 49 infants undergoing evaluation for gastroesophageal reflux (GER). Infants were randomly assigned to receive either apple juice (AJ) or formula for the first feeding during extended pH monitoring (EPM). Each infant received the alternate liquid for the second feeding. During the rest of the monitoring period, infants received formula feedings. The percentage of time that esophageal pH was less than 4.0 following both types of feedings and the percentage of time that pH was lower than 5.0 following formula feedings were determined. Following AJ feeding, the mean percentage of time pH was less than 4.0 was 43.8% in contrast to 5.1% following formula feeding. However, following formula feeding, pH was less than 5.0 35.7% of time, similar to the percentage of time pH was less than 4.0 after AJ feeding. Ability to detect GER with short-term monitoring after the two feedings was compared to detection following extended monitoring. Detection of GER with short-term monitoring following AJ feeding correlated well with extended monitoring (r = 0.67; p less than 0.001). There was a weaker, although significant, correlation between short-term monitoring following formula feeding using pH less than 5.0 as the reflux criterion and extended monitoring (r = 0.3; p less than 0.01). We conclude that outpatient GER evaluation with intraesophageal pH monitoring during a feeding interval following an AJ feeding may serve as an acceptable substitute for extended pH monitoring when it is not practical or desirable to admit the patient to the hospital.

Esophagus↗
PubMed1998

Intracranial pressure monitor placement by midlevel practitioners.

BACKGROUND: The timely treatment of patients with head injuries is affected by the availability and commitment of neurosurgeons. Use of midlevel practitioners (MLPs) may permit more efficient neurosurgical coverage. Intracranial pressure monitoring is among the most frequently used neurosurgical procedures. The purpose of this study was to examine the placement of intracranial pressure (ICP) monitors by MLPs. METHODS: Medical records and trauma registry data for a Level I trauma center were reviewed from December 1993 to June 1997. Patients who had ICP monitors placed were included. Patient data recorded were age, mechanism of injury, injury type, ICP monitor placement and length of placement, complications related to the ICP monitor, and outcomes. RESULTS: Two hundred ten patients had 215 monitors placed. ICP monitors were placed by neurosurgeons (105), MLPs (97), and general surgery residents (13), and remained in place a mean of 4 days. No major complications attributable to ICP monitor placement occurred; 19 minor complications (malfunction, dislodgment) were noted. Eleven monitors placed by neurosurgeons (10%), seven placed by MLPs (7%), and one placed by a resident (8%) had complications. CONCLUSION: ICP monitor placement by MLPs is safe. Use of MLPs may aid neurosurgeons in providing prompt monitoring of patients with head injuries.

Adolescent↗
PubMed2002

Technical reliability of the CSA activity monitor: The EarlyBird Study.

PURPOSE: To evaluate the technical performance of the CSA accelerometer-based activity monitor. METHODS: Twenty-three CSA monitors were subjected to intra- and inter-instrument variability tests by controlled trials using a motorized turntable. The CSA monitor measures change in acceleration, and precision was tested by producing sinusoidal variations in speed around two fixed baseline speeds (fast and medium). The angle of the monitor to the line of force along the radius of the turntable was varied using tilted blocks. Three sets of tests were carried out. 1. Intra-instrument variability: seven monitors were tested three times in each of the four quadrants. 2. All 23 monitors were used for inter-instrument tests. 3. The effects of tilt at 15 degrees, 30 degrees, and 45 degrees were carried out on six monitors. RESULTS: Intra-instrument coefficients of variation (CV) never exceeded 2% for fast or medium speed and achieved "between run" intra-class correlation coefficients (ICC) of 0.92 and 0.84 respectively. There were no significant differences between the monitors in terms of repeatability (fast: = 0.97, medium: = 0.77). Although there were significant differences between monitors in terms of mean score, inter-instrument variability did not exceed 5% at either speed. Inter-batch ICCs ranged from 0.87 to 0.98 for fast and from 0.71 to 0.99 for medium. The angle test results corresponded closely to those predicted theoretically, with a loss in mean score of only 6% when the monitor was tilted from 0 degrees to 15 degrees. CONCLUSION: The CSA monitor provides a precise tool for measuring changes in acceleration in laboratory settings. Technically, the device performs well, and is likely to prove a useful tool in the assessment of physical activity in children and adults.

Adult↗
PubMed2004

Placement of intracranial pressure monitors: are "normal" coagulation parameters necessary?

INTRODUCTION: Patients with head injuries frequently have abnormal coagulation studies. Monitoring intracranial pressure (ICP) in head injured patients is common practice, but no best practice guidelines exist for coagulation parameters for ICP monitor placement. PURPOSE: To test the hypothesis that hemorrhagic complication rates from ICP monitor placement are low and that the use of FFP to correct coagulation parameters to "normal" is not indicated. METHODS: Retrospective review of all patients admitted to a Level I trauma center over a 3 year period, who underwent fiberoptic intraparenchymal ICP monitoring was undertaken. Inclusion criteria were coagulation studies (prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), platelet count) before ICP monitor placement and head CT scans to assess for hemorrhage before and after monitor placement. Data collected included age, Glasgow coma score (GCS), head region abbreviated injury score (H_AIS), time to ICP monitor placement, complications and outcomes. RESULTS: From 8/1/00 through 7/31/03, 5163 trauma patients were admitted, and 157 met inclusion criteria. Patients were stratified by INR, at the time of ICP placement as normal (0.8-1.2, 103 patients), borderline (1.3-1.6, 42 patients) and increased (>/=1.7, 12 patients). There was no difference between the groups in age, gender or H_AIS. Twenty two patients had component therapy to correct coagulopathy before ICP insertion, but 10 had INRs in the borderline group and 12 remained with INRs >/=1.7. Eleven patients had platelet counts 50,000-100,000 at ICP monitor placement, despite platelet transfusions. Time from admission to ICP monitor placement was significantly longer in patients who received component therapy (19.2 +/- 19.7 hours versus 8.8 +/- 13.9 hours, p < 0.002). Three patients had clinically insignificant, petechial hemorrhages (1.9%); one in each group, with INRs of 1.2, 1.3, and 2.5, respectively. CONCLUSIONS: In patients with INR </=1.6, hemorrhagic complications after ICP monitor placement were infrequent. The use of FFP to "normalize" INR below this threshold is not supported by this data and delays monitor placement.

Adult↗
PubMed2006

Evaluation of invasive and noninvasive hemodynamic monitoring in trauma patients.

OBJECTIVES: The aim of this study was to compare a recently developed and improved noninvasive hemodynamic monitoring system with the conventional invasive monitoring by pulmonary artery catheterization (PAC) in acute emergency trauma patients. METHODS: In a large, university-run, inner city public hospital, we monitored 993 trauma patients noninvasively; 262 of these were simultaneously monitored with both noninvasive hemodynamic and invasive PAC monitoring. The noninvasive monitoring was begun shortly after admission to the emergency department and the invasive PAC monitoring was started in the operating room, or as soon as the patient arrived in the intensive care unit. Noninvasive monitoring included cardiac index (CI) by the IQ or Physio Flow bioimpedance device, together with mean arterial blood pressure, heart rate, pulse oximetry (SapO2), transcutaneous oxygen (PtcO2), and carbon dioxide (PtcCO2) tensions. We compared CI by simultaneous measurements with both invasive and noninvasive methods 907 times in 262 patients. RESULTS: The CI by thermodilution (CItd) correlated well with simultaneous measurements with the bioimpedance (CIbi), r2 = 0.915, r2 = 0.84, p < 0.001. The bias and precision of simultaneous measurements was -0.070 +/- 0.47 L/min/m2; agreement was considered satisfactory. In the initial resuscitation period of both monitoring systems, the CI, mean arterial blood pressure, SapO2, and tissue perfusion (reflected by invasive DO2 and VO2, and by noninvasive PtcO2/FiO2 ratio) were higher in survivors than in nonsurvivors, whereas heart rate values were higher in the nonsurvivors. We concluded that noninvasive hemodynamic monitoring provided a feasible, safe, inexpensive, accurate, continuous, on-line real-time graphic displays that are equivalent to the essential features of invasive pulmonary artery catheter monitoring.

Adult↗
PubMed2004

Glucose self-monitoring in primary care: a survey of current practice.

BACKGROUND: The role of long-term glycaemic control in minimizing long-term complications of diabetes mellitus is evidence-based and national guidelines recommend a target glycosylated haemoglobin level of approximately 7%. Although the role of self-monitoring blood and urine glucose is less well defined, this activity consumes vast National Health Service (NHS) resources. AIMS: The aims of this study were to (i) determine the current practice of glucose self-monitoring in primary care, (ii) determine any changes to therapy made as a result and (iii) compare monitoring and frequency of monitoring in those patients using insulin with those patients taking oral hypoglycaemic agents. METHODS: Postal questionnaire to 311 patients using insulin or oral hypoglycaemic agents identified from three general practices. RESULTS: The response rate was 59.8% (186/311), with the majority of responding patients (n = 158, 87.3%) performing self-monitoring. The patients using insulin were more likely to be self-monitoring than those taking oral therapy (chi(2), P < 0.001, d.f. = 1). The majority of patients who self-monitored and were using insulin (n = 45, 61.1%) altered the dose of insulin if a reading was beyond their target range. However, the majority of patients who self-monitored and were taking oral therapy (n = 48, 68.6%) took no action at all. CONCLUSIONS: Blood glucose self-monitoring was common in those treated with insulin or oral hypoglycaemics, although those using insulin were more likely to self-monitor. Notably many patients, particularly those on oral therapy, took no action based on the results of self-monitoring.

Administration, Oral↗
PubMed2004

An evaluation of the adequacy of outpatient monitoring of thyroid replacement therapy.

OBJECTIVES: Hypothyroid patients managed with excessive or insufficient thyroid replacement therapy are often difficult to clinically recognize. Monitoring may prevent or minimize the consequences of adverse drug events (ADEs). We sought to develop an explicit model of medication monitoring and to evaluate monitoring processes and ADEs in patients taking levothyroxine. METHODS: A retrospective chart review of 400 outpatients receiving levothyroxine therapy between 1 January 2000 and 1 January 2001 at a large North American tertiary care hospital. We measured the proportion of patients satisfying minimum monitoring criteria, experiencing specific monitoring errors and having levothyroxine-related ADEs. Explicit monitoring criteria were derived from the literature and through expert opinion. Adverse drug events were identified using structured implicit reviews. RESULTS: Overall, only 56% (95% confidence interval [95% CI] 51-62%) of the patients prescribed levothyroxine received the minimal recommended monitoring. Errors were identified at all stages of the monitoring model. Patients who received the recommended monitoring had fewer levothyroxine-related ADEs (1% vs. 6%, P=0.013) than those who did not. Minority status (white people 2% vs. black people 4% vs. Hispanics 14%, P=0.023) and primary language (English 3% vs. Non-English 20%, P=0.002) were the patient characteristics associated with levothyroxine-related ADEs. CONCLUSION: Only half of outpatients taking levothyroxine at one tertiary care hospital received the recommended monitoring during one year of follow-up. Levothyroxine-related ADEs were more frequent in patients with lower-quality monitoring and in minorities and non-English speakers.

Ambulatory Care↗
PubMed2004

Practice standards for electrocardiographic monitoring in hospital settings: an American Heart Association scientific statement from the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses.

The goals of electrocardiographic (ECG) monitoring in hospital settings have expanded from simple heart rate and basic rhythm determination to the diagnosis of complex arrhythmias, myocardial ischemia, and prolonged QT interval. Whereas computerized arrhythmia analysis is automatic in cardiac monitoring systems, computerized ST-segment ischemia analysis is available only in newer-generation monitors, and computerized QT-interval monitoring is currently unavailable. Even in hospitals with ST-monitoring capability, ischemia monitoring is vastly underutilized by healthcare professionals. Moreover, because no computerized analysis is available for QT monitoring, healthcare professionals must determine when it is appropriate to manually measure QT intervals (eg, when a patient is started on a potentially proarrhythmic drug). The purpose of the present review is to provide 'best practices' for hospital ECG monitoring. Randomized clinical trials in this area are almost nonexistent; therefore, expert opinions are based upon clinical experience and related research in the field of electrocardiography. This consensus document encompasses all areas of hospital cardiac monitoring in both children and adults. The emphasis is on information clinicians need to know to monitor patients safely and effectively. Recommendations are made with regard to indications, timeframes, and strategies to improve the diagnostic accuracy of cardiac arrhythmia, ischemia, and QT-interval monitoring. Currently available ECG lead systems are described, and recommendations related to staffing, training, and methods to improve quality are provided.

Arrhythmias, Cardiac↗