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PubMed2004

Physical health monitoring of patients with schizophrenia.

OBJECTIVE: Schizophrenia is associated with several chronic physical illnesses and a shorter life expectancy, compared with life expectancy in the general population. One approach to improving the health of patients with schizophrenia is to improve the monitoring of physical health that occurs in psychiatric settings. The authors discuss a consensus panel's recommendations for improving the physical health monitoring of patients with schizophrenia who are treated in outpatient settings. METHOD: A consensus meeting including psychiatric and other medical experts assembled on October 17-18, 2002, to evaluate the existing literature and to develop recommendations for physical health monitoring of patients with schizophrenia. Conference participants reviewed the literature in the following areas: 1) weight gain and obesity; 2) diabetes; 3) hyperlipidemia; 4) prolongation of the QT interval on the ECG; 5) prolactin elevation and related sexual side effects; 6) extrapyramidal side effects, akathisia, and tardive dyskinesia; 7) cataracts; and 8) myocarditis. Experts for each topic area formulated monitoring recommendations that were discussed by all of the participants until a consensus was reached. RESULTS: Consensus recommendations included regular monitoring of body mass index, plasma glucose level, lipid profiles, and signs of prolactin elevation or sexual dysfunction. Information from monitoring should guide the selection of antipsychotic agents. Specific recommendations were made for cardiac monitoring of patients who receive medications associated with QT interval prolongation, including thioridazine, mesoridazine, and ziprasidone, and for monitoring for signs of myocarditis in patients treated with clozapine. Patients who receive both first- and second-generation antipsychotic medications should be examined for extrapyramidal symptoms and tardive dyskinesia. Patients with schizophrenia should receive regular visual examinations. CONCLUSIONS: The conference participants recommended that mental health care providers perform physical health monitoring that typically occurs in primary care settings for their patients who do not receive physical health monitoring in those settings. This change in usual practice is recommended on the basis of the conference participants' belief that this additional monitoring will result in the earlier detection of common, serious risk factors that could, without detection and intervention, contribute to impaired health of patients with schizophrenia.

Adult↗
PubMed2003

Barriers to self-monitoring of blood glucose among adults with diabetes in an HMO: a cross sectional study.

BACKGROUND: Recent studies suggest that patients at greatest risk for diabetes complications are least likely to self-monitor blood glucose. However, these studies rely on self-reports of monitoring, an unreliable measure of actual behavior. The purpose of the current study was to examine the relationship between patient characteristics and self-monitoring in a large health maintenance organization (HMO) using test strips as objective measures of self-monitoring practice. METHODS: This cross-sectional study included 4,565 continuously enrolled adult managed care patients in eastern Massachusetts with diabetes. Any self-monitoring was defined as filling at least one prescription for self-monitoring test strips during the study period (10/1/92-9/30/93). Regular SMBG among test strip users was defined as testing an average of once per day for those using insulin and every other day for those using oral sulfonylureas only. Measures of health status, demographic data, and neighborhood socioeconomic status were obtained from automated medical records and 1990 census tract data. RESULTS: In multivariate analyses, lower neighborhood socioeconomic status, older age, fewer HbA1c tests, and fewer physician visits were associated with lower rates of self-monitoring. Obesity and fewer comorbidities were also associated with lower rates of self-monitoring among insulin-managed patients, while black race and high glycemic level (HbA1c>10) were associated with less frequent monitoring. For patients taking oral sulfonylureas, higher dose of diabetes medications was associated with initiation of self-monitoring and HbA1c lab testing was associated with more frequent testing. CONCLUSIONS: Managed care organizations may face the greatest challenges in changing the self-monitoring behavior of patients at greatest risk for poor health outcomes (i.e., the elderly, minorities, and people living in low socioeconomic status neighborhoods).

Adult↗
PubMed2003

The effect of cerebral monitoring on recovery after general anesthesia: a comparison of the auditory evoked potential and bispectral index devices with standard clinical practice.

UNLABELLED: The use of cerebral monitoring may improve the ability of anesthesiologists to titrate anesthetic drugs. However, there is controversy regarding the impact of the alleged anesthetic-sparing effects of cerebral monitoring on the recovery process and patient outcome. We designed this prospective double-blinded, sham-controlled study to evaluate the impact of intraoperative monitoring with the electroencephalogram bispectral index (BIS) or auditory evoked potential (AEP) device on the usage of desflurane and the time to discharge from the recovery room, as well as on patient satisfaction with their anesthetic experience and recovery. Ninety healthy patients undergoing laparoscopic general surgery procedures using a standardized anesthetic technique were randomly assigned to one of three monitoring groups: standard clinical practice (control), BIS-guided, or AEP-guided. Both the BIS and AEP monitors were connected to all patients before induction of general anesthesia. In the control group, the anesthesiologists were not permitted to observe the BIS or AEP index values during the intraoperative period. In the BIS-guided group, the volatile anesthetic was titrated to maintain a BIS value in the range of 45-55. In the AEP-guided group, the targeted AEP index range was 15-20. The BIS and AEP indices, as well as end-tidal desflurane concentration, were recorded at 3-5 min intervals. Recovery times to awakening, tracheal extubation, fast-track score >or=12, and postanesthesia care unit (PACU) discharge criteria were recorded at 1-10 min intervals. In addition, patient satisfaction with anesthesia and quality of recovery were evaluated on 100- and 18-point scales, respectively, at 24 h after surgery. The AEP- and BIS-guided groups were administered significantly smaller average end-tidal desflurane concentrations than the control group (3.8 +/- 0.9 and 3.9 +/- 0.6 versus 4.7 +/- 1.7, respectively) (P < 0.01). Although the emergence times to eye opening, tracheal extubation, and obeying commands were consistently shorter in the AEP and BIS groups (6 +/- 4 and 6 +/- 5 versus 8 +/- 8 min; 6 +/- 5 and 6 +/- 4 versus 11 +/- 10 min; and 8 +/- 4 and 7 +/- 4 versus 12 +/- 9 min, respectively), only the extubation times were significantly different from the control group (P < 0.05). More importantly, the length of the PACU stay was significantly shorter in both the AEP- and BIS-guided groups (79 +/- 43 and 80 +/- 47 versus 108 +/- 58 min, respectively) (P < 0.05). The patients' quality of recovery was also significantly higher in the two monitored groups (15 +/- 2 versus 13 +/- 3 in the control group, P < 0.05). We concluded that cerebral monitoring with either the BIS or AEP devices reduced the maintenance anesthetic (desflurane) requirement, resulting in a shorter length of stay in the PACU and improved quality of recovery after laparoscopic surgery. However, there were no significant outcome differences between the two cerebral monitored groups. IMPLICATIONS: Compared with standard monitoring practices, use of an auditory evoked potential or bispectral index monitor to titrate the volatile anesthetic led to a significant reduction in the anesthetic requirement. The anesthetic-sparing effect of cerebral monitoring resulted in a shorter postanesthesia care unit stay and improved quality of recovery from the patient's perspective.

Adult↗
PubMed2004

Comparison of transcranial electric motor and somatosensory evoked potential monitoring during cervical spine surgery.

BACKGROUND: There has been little enthusiasm for somatosensory evoked potential monitoring in cervical spine surgery as a result, in part, of the increased risk of motor tract injury at this level, to which somatosensory monitoring may be insensitive. Transcranial electric motor evoked potential monitoring allows assessment of the motor tracts; therefore, we compared transcranial electric motor evoked potential and somatosensory evoked potential monitoring during cervical spine surgery to determine the temporal relationship between the changes in the potentials demonstrated by each type of monitoring and neurological sequelae and to identify patient-related and surgical factors associated with intraoperative neurophysiological changes. METHODS: Somatosensory evoked potential and transcranial electric motor evoked potential data recorded for 427 patients undergoing anterior or posterior cervical spine surgery between January 1999 and March 2001 were analyzed. All patients who showed substantial (at least 60%) or complete unilateral or bilateral amplitude loss, for at least ten minutes, during the transcranial electric motor evoked potential and/or somatosensory evoked potential monitoring were identified. RESULTS: Twelve of the 427 patients demonstrated substantial or complete loss of amplitude of the transcranial electric motor evoked potentials. Ten of those patients had complete reversal of the loss following prompt intraoperative intervention, whereas two awoke with a new motor deficit. Somatosensory evoked potential monitoring failed to identify any change in one of the two patients, and the change in the somatosensory evoked potentials lagged behind the change in the transcranial electric motor evoked potentials by thirty-three minutes in the other. No patient showed loss of amplitude of the somatosensory evoked potentials in the absence of changes in the transcranial electric motor evoked potentials. Transcranial electric motor evoked potential monitoring was 100% sensitive and 100% specific, whereas somatosensory evoked potential monitoring was only 25% sensitive; it was, however, 100% specific. CONCLUSIONS: Transcranial electric motor evoked potential monitoring appears to be superior to conventional somatosensory evoked potential monitoring for identifying evolving motor tract injury during cervical spine surgery. Surgeons should strongly consider using this modality when operating on patients with cervical spondylotic myelopathy in general and on those with ossification of the posterior longitudinal ligament in particular.

Cervical Vertebrae↗
PubMed2001

Evaluation of ambulatory and self-initiated blood pressure monitors by pregnant and postpartum women.

OBJECTIVE: To investigate the acceptability of an ambulatory blood pressure (ABP) monitor (SpaceLabs 90207) and a self-initiated blood pressure monitor (Omron HEM-705CP) to pregnant women. METHODS: Acceptability of the SpaceLabs 90207 and Omron HEM- 705CP monitors was evaluated, using a modified British Hypertension Device assessment form, by () healthy, pregnant women at <15 weeks (n = 120), 35-37 weeks (n = 81), and 5-9 weeks postpartum (n = 86); and () women with preeclampsia (n = 52). MAIN OUTCOME MEASURES: A monitor was acceptable if a woman graded the overall impression as "good" or "very good." RESULTS: Healthy women at <15 and 35-37 weeks' gestation and preeclamptic women reported the SpaceLabs 90207 monitor caused discomfort in 54%, 52%, and 60%, interfered with activities in 38%, 40%, and 23%, and disturbed sleep in 62%, 52% and 31%, respectively. Fewer than 12% in any group reported these problems with the Omron HEM-705CP monitor. In the 78 women who evaluated both monitors at 35-37 weeks, the SpaceLabs 90207 and Omron HEM-705CP were acceptable to 78% and 95% of healthy women, respectively (p = 0.005). Women with preeclampsia rated the Space-Labs 90207 as "bad" or "fair" (14%), "good" (58%), and "very good" (28%) compared with "bad" or "fair" (8%), "good" (28%), and "very good" (64%) for the Omron HEM-705CP monitor (p = 0.009). CONCLUSIONS: Pregnant women found the less intensive blood pressure monitoring with the Omron HEM-705CP more acceptable than the 24-h ABP monitoring with the SpaceLabs 90207. If accurate self-initiated blood pressure devices become available, pregnant women would prefer this method of home blood pressure monitoring.

Blood Pressure Monitoring, Ambulatory↗
PubMed1996

Monitoring of cerebral oxygenation in patients with severe head injuries: brain tissue PO2 versus jugular vein oxygen saturation.

Monitoring of cerebral oxygenation is considered to be of great importance in minimizing secondary hypoxic and ischemic brain damage following severe head injury. Although the threshold for cerebral hypoxia in jugular bulb oximetry (measurement of O2 saturation in the jugular vein (SjvO2)) is generally accepted to be 50% oxygen saturation, a comparable value in brain tissue PO2 (PtiO2) monitoring, a new method for direct assessment of PO2 in the cerebral white matter, has not yet been established. Hence, the purpose of this study was to compare brain PtiO2 with SjvO2 in severely head injured patients during phases of reduced cerebral perfusion pressure (CPP) to define a threshold in brain PtiO2 monitoring. In addition, the safety and data quality of both SjvO2 and brain PtiO2 monitoring were studied. In 15 patients with severe head injuries, SjvO2 and brain PtiO2 were monitored simultaneously. For brain PtiO2 monitoring a polarographic microcatheter was inserted in the frontal cerebral white matter, whereas for SjvO2 measurements were obtained by using a fiberoptic catheter placed in the jugular bulb. Intracranial pressure was monitored by means of an intraparenchymal catheter. Mean arterial blood pressure, CPP, end-tidal CO2, and arterial oxygen saturation (pulse oximetry) were continuously recorded. All data were simultaneously stored and analyzed using a multimodal computer system. For specific analysis, phases of marked deterioration in systemic blood pressure and consecutive reductions in CPP were investigated. There were no complications that could be attributed to the PtiO2 catheters, that is, no intracranial bleeding or infection. The "time of good data quality" was 95% in brain PtiO2 compared to 43% in SjvO2; PtiO2 monitoring could be performed twice as long as SjvO2 monitoring. During marked decreases in CPP, SjvO2 and brain PtiO2 correlated closely. A significant second-order regression curve of SjvO2 versus brain PtiO2 (p < 0.01) was plotted. At a threshold of 50% in SjvO2, brain PtiO2 was found to be within the range of 3 to 12 mm Hg, with a regression curve "best fit" value of 8.5 mm Hg. There was a close correlation between CPP and oxygenation parameters (PtiO2 and SjvO2) when CPP fell below a breakpoint of 60 mm Hg, suggesting intact cerebral autoregulation in most patients. This study demonstrates that monitoring brain PtiO2 is a safe, reliable, and sensitive diagnostic method to follow cerebral oxygenation. In comparison to SjvO2, PtiO2 is more suitable for long-term monitoring. It can be used to minimize episodes of secondary cerebral maloxygenation after severe head injury and may, hopefully, improve the outcome in severely head injured patients.

Adolescent↗
PubMedDate not supplied

Elder acceptance of health monitoring devices in the home.

This study examined frail elders' acceptance of the concept of home monitoring devices. With the potential of such devices to ultimately assist many older persons, acceptance of the device in the individual's home is a critical component. Elders who view devices negatively--as unnecessary, unattractive, or intrusive--may be less likely to use the device if installed or less likely to allow them to be installed. For the participants in the current study, the results suggest strong acceptance of the concept of home health monitoring and the devices to make the system work. When questioned on device appearance a majority of the subjects felt that the devices would be acceptable in their homes, and initial reactions to the devices were primarily favorable. Equipment characteristics have been identified as one of the determining factors of perceived intrusiveness of home monitoring devices (Fisk, 1997). Study participants made several suggestions pertaining to device features and appearance. A common criticism related to device size, especially concerning the blood pressure cuff which was referred to as "gaudy" by one study participant. Participants offered suggestions such as making devices smaller, providing control for volume adjustment, and providing voice activation. At least one participant expressed a concern over device functioning in the event of distance traveling. Subjective comments such as "I think it would help many people," "It's very reasonable and important in several ways," and "...people would be more independent and safe," provided anecdotal support of device acceptance. Although a majority of the study participants had favorable responses to the devices and monitoring systems, many of their subjective comments reflected positive views regarding use by others as opposed to personal use. This finding may suggest that the participants did not personally identify with the need to use such devices but rather viewed the devices as relevant and acceptable for "the person who absolutely needs it." However, a majority of the participants identified "relieving personal worry" as a possible benefit of the home monitoring system which suggests personal identification with the potential benefits. The findings of study participants' willingness to pay, and a desire to maintain communications on a consistent basis with monitoring services, may demonstrate overall acceptance of the idea of home monitoring devices/services and establishes a need for continued research in product development. During the interviews, many of the subjects expressed enthusiasm and interest over the prospect of the home monitoring devices and systems with which they were relatively unfamiliar. This suggests a need for further consumer education regarding use of home monitoring devices and systems. Aside from the relatively small sample size, one limitation of this study relates to the study participants' understanding of the devices in relation to their current needs. The questionnaire results provided hypothetical acceptance of devices from a usefulness and aesthetic point of view. However, the findings may not totally reflect the study participants' actual willingness or desire to utilize the applicable devices in their homes. Further research is suggested in the area of assessment of potential consumer groups' perceptions of their current health status, functional limitations and needs, and more extensive research regarding perceptions of the potential benefits of using home monitoring devices. Further research in product development and clinical trials of existing home monitoring devices is also recommended.

Activities of Daily Living↗
PubMed2004

[Continuous glucose monitoring system, as a valuable tool in the care of children and adolescents with diabetes mellitus].

INTRODUCTION: Good metabolic control of diabetic patients is mainly based on the results of self measured blood glucose levels. Important excursions of blood glucose may, however, be hidden in the usual case of 4-5 daily determinations. The aim of this paper was to give detailed information about this new diagnostic tool and to report the first Hungarian pediatric experiences with continuous glucose monitoring. METHOD: Continuous glucose monitoring system (Mini-Med) is able to monitor the changes of tissue glucose levels for up to 72 hours by measuring glucose concentration via a s.c. canula every 5 minutes. In its present form the results of continuous glucose monitoring cannot be observed real time by the patient, it provides useful information retrospectively mainly for the doctor. RESULTS: The sensor detected unexpectedly high fluctuation of glucose levels in several patients. It was possible to distinguish between nighttime hypoglycaemia (Somogyi-effect) or dawn phenomenon-induced morning hyperglycaemiae by the use of continuous glucose monitoring. Fever may influence peripheral circulation representing a limitation in the use (or evaluation) of continuous tissue glucose monitoring. The authors found good correlation between continuous glucose monitoring and self blood glucose monitoring results. The best correlation was observed in the low blood glucose range. CONCLUSIONS: The continuous glucose monitoring results provide useful information for the diabetologist in order to modify insulin treatment. Continuous glucose monitoring-based changes in insulin treatment are reported to result in better long term metabolic control. Continuous glucose monitoring in the near future will obviously play a primary role in insulin pump therapy where it will provide glucose result for the pump.

Adolescent↗
PubMed1992

Accuracy and precision of a portable anticoagulation monitor in a clinical setting.

BACKGROUND: Office-based anticoagulation monitors offer significant advantages in convenience, yet their performance has been inadequately characterized. METHODS: We characterized the performance of a portable anticoagulation monitoring system with respect to precision and agreement with a reference laboratory. Eighty-five patients from a university outpatient anticoagulation clinic provided 143 whole blood sample pairs for evaluating agreement between the monitor and the laboratory. Fifty-four patients each provided a second pair of samples for assessing the monitor's precision, and 23 pairs of measurements from the reference laboratory were used for assessing the laboratory's precision. Anticoagulation was measured using International Normalized Ratio (INR) values. Agreement between monitor and laboratory was evaluated as the difference between paired measurements. Precision was calculated as the within-patient standard deviation based on paired values. RESULTS: Within the range of 2.0 to 3.0 INR units, the monitor yielded values that were up to 0.3 units higher on average than the laboratory values. Within the range of greater than 3.0 to 4.5 INR units, the monitor yielded values that were up to 0.5 units lower on average than the laboratory values. Seventy-five percent of paired monitor and laboratory values were within 0.7 INR units; 90% were within 0.9 units. Within-patient standard deviation was 0.23 units for the monitor and 0.19 units for the laboratory. CONCLUSIONS: The monitor differed systematically from the laboratory and was moderately less precise. The magnitude of these effects was not great, however, and accuracy was best at around INR = 3.0, the border between low and high therapeutic ranges. The clinic-based monitor is useful for patients requiring frequent surveillance of anticoagulation status.

Anticoagulants↗
PubMed1995

Biosensors and bioprobes in anaesthesia and intensive care. From in vitro to in vivo monitoring.

In vitro monitoring is inherently invasive with discrete measurements on blood samples and the results are often delayed an hour or more when the analyses are performed in the central laboratory. The delay may be greatly reduced if the analyses are performed near the patient. In vivo monitoring may be non-invasive and may provide continuous real-time data but the accuracy usually does not match that of in vitro measurements. In vivo monitoring therefore finds its application in the detection of trends of change, and it is needed only for quantities that change rapidly and unpredictably and where a suitable therapeutic action is available. In critically ill patients, this applies to the arterial pO2, pCO2, and pH, and the mixed venous pO2. Ideal in vivo monitoring techniques are not available for all these quantities. In the newborn, the arterial pO2 may be monitored with a transcutaneous pO2 electrode. In the adult, the arterial pO2 may be monitored indirectly by monitoring the arterial oxygen saturation with a pulse oximeter and the mixed venous pO2 by monitoring the mixed venous oxygen saturation with a catheter tip sensor. The arterial pCO2 may be monitored with a transcutaneous pCO2 electrode or by capnography, i.e., by monitoring the end-expiratory pCO2. Other in vivo monitoring techniques such as gastric tonometry for the gastric mucosal pH and thoracic impedance measurement have found some routine application, whereas near-infrared spectrometry for oxy- and deoxyhaemoglobin in the brain, and magnetic resonance spectroscopy for tissue ATP are at the stage of research and development.

Adult↗
PubMed1987

Monitoring for multiple malformations in the detection of epidemics of birth defects.

Although most known human teratogens often produce a combination of birth defects in an affected infant, surveillance programs aimed at detecting epidemics of birth defects usually only monitor rates of individual defects. A drawback to this approach is that an increase in the rate of infants affected with a specific combination of defects may lead to little or no increase in the rates of component defects. Using the Poisson distribution, we show that, compared with monitoring for individual defects, monitoring for combinations of two and three defects may require fewer numbers of births to detect an epidemic. In general, an increase can be detected more rapidly by monitoring the rates of defect combinations than by monitoring the rates of individual defects if most affected infants have combinations of defects rather than isolated defects. For example, in the case of Congenital rubella syndrome (CRS), monitoring for the combination of cataracts with deafness and/or patent ductus arteriosus could have led to earlier detection of an epidemic than could monitoring for cataracts alone. In contrast, in the case of thalidomide embryopathy, monitoring for reduction defects of upper limbs in combination with reduction defects of lower limbs and/or microtia/anotia would not have led to earlier detection of an epidemic than would monitoring for reduction defects of upper limbs alone. This is due mainly to the low frequency of defect combinations among affected cases. When used with regular monitoring for individual defects, surveillance of defect combinations can enhance the ability of monitoring programs to detect epidemics of birth defects.

Abnormalities, Drug-Induced↗
PubMed2002

PACS monitors: an evolution of radiologist's viewing techniques.

When initially evaluating picture archiving communication systems (PACS) many radiologists try to duplicate the film environment and believe that multiple monitors are required to maintain the productivity of the radiologist. The authors were under the same impression initially but found that they underwent a paradigm shift over a period of time. This report documents the evolution that the radiologists underwent. The author's department consists of 28 diagnostic radiologists and 21 residents who actively read cases on a PACS. The department has been filmless for 6 months, although they have been reading soft copy films for 2 years. All modalities except mammography are included. The authors conducted interviews with both attending radiologists and residents to evaluate the change in methodology from the preconceptions to initial use to current use. The number and kind of monitors preferred for plain films, ultrasound scan, computed tomography (CT), and magnetic resonance imaging (MRI) were recorded. Additionally, viewing methods of different modalities were discussed. The authors found that there was a decrease in the number of monitors from preconceptions to actual use. Furthermore, to a lesser degree, there is a reduction of monitors used initially to that which is currently being used. The style of viewing cross-sectional images has changed. There has been a decrease in the number of images displayed on each monitor. The use of the roller ball on the mouse has affected this viewing style. Changing from a film-based reading environment to PACS environment not only brings about change in the overall technology in image delivery but also in the viewing techniques by radiologists. At our institution we have evolved from initially expecting to use 4 monitors all the time to actually preferring 2 monitors and occasionally 1 monitor to view images. Presentation software and viewing aids such as the roller ball on a mouse for viewing CTs in stack mode are key contributions to this paradigm shift. The decrease in monitors makes PACS more affordable and will allow further penetration of filmless radiology. The authors have found that after using PACS, radiologists prefer using 2 monitors. The style of reading films has changed with experience. Hospitals that plan to purchase PACS should consider this and ensure that the vendor has presentation software that optimizes the 2 monitor system.

Computer Terminals↗
PubMed2006

Self-monitoring of oral anticoagulation: a systematic review and meta-analysis.

BACKGROUND: Near-patient testing has made self-monitoring of anticoagulation with warfarin feasible, and several trials have suggested that such monitoring might be equal to or better than standard monitoring. We did a systematic review and meta-analysis of all randomised controlled trials that assessed the effects of self-monitoring or self-management (self-testing and self-dosage) of anticoagulation compared with standard monitoring. METHODS: We searched the Cochrane Register of Controlled Trials, MEDLINE, EMBASE to April 2005, and contacted manufacturers and authors of relevant studies. Outcomes analysed were: major haemorrhage, thromboembolic events, death, tests in range, minor haemorrhage, frequency of testing, and feasibility of self-monitoring. FINDINGS: We identified 14 randomised trials of self-monitoring: pooled estimates showed significant reductions in thromboembolic events (odds ratio 0.45, 95% CI 0.30-0.68), all-cause mortality (0.61, 0.38-0.98), and major haemorrhage (0.65, 0.42-0.99). Trials of combined self-monitoring and self-adjusted therapy showed significant reductions in thromboembolic events (0.27, 0.12-0.59) and death (0.37, 0.16-0.85), but not major haemorrhage (0.93, 0.42-2.05). No difference was noted in minor haemorrhage. 11 trials reported improvements in the mean proportion of international normalisation ratios in range. INTERPRETATION: Self-management improves the quality of oral anticoagulation. Patients capable of self-monitoring and self-adjusting therapy have fewer thromboembolic events and lower mortality than those who self-monitor alone. However, self-monitoring is not feasible for all patients, and requires identification and education of suitable candidates.

Adult↗
PubMed2002

Pulmonary nodule detection and visual search: P45 and P104 monochrome versus color monitor displays.

RATIONALE AND OBJECTIVES: The faceplate of a cathode-ray tube (CRT) display monitor is covered on the vacuum side with a phosphor screen. The different phosphors that can be used for this screen have distinctly different physical properties that can affect the noise properties of the display. Differences in noise affect the signal-to-noise ratio and, hence, may affect diagnostic performance. This study evaluated observer performance and visual search parameters in the detection of pulmonary nodules, comparing two monochrome CRT monitors with different phosphors (P45 and P104) and a color CRT monitor. MATERIALS AND METHODS: The receiver operating characteristic paradigm was used to evaluate observer performance with a series of radiographic chest images containing solitary pulmonary nodules. Eye position was recorded as the observers searched the images on each type of monitor. RESULTS: Observer performance, as indicated by the area under the receiver operating characteristic curve and compared by means of an analysis of variance test, was best for the P45 monitor, next best for the P104 monitor, and worst for the color monitor. All differences were statistically significant. Eye-position parameters were also affected by monitor type. The time required to fixate the lesion and overall search times were longest with the color monitor. CONCLUSION: The type of phosphor used in the CRT monitor faceplate can affect diagnostic performance and visual search parameters. Care should be taken in the selection of monitors for use in clinical radiology.

Analysis of Variance↗
PubMed1994

Passive badges for compliance monitoring internationally.

Passive organic vapor monitors are used throughout the world to monitor workplace exposure to a variety of organic vapors. Exxon industrial hygienists were surveyed to determine the current state of government regulations regarding exposure monitoring and the level of acceptance within their own country or region for the use of passive organic vapor monitors for compliance monitoring. The data indicates that, in countries where the regulation of worker exposure to specific compounds exists, the selection of an appropriate air monitoring technique in most cases is left to the individual hygiene professional. In cases where a specific methodology is cited, alternative methods that can demonstrate acceptable levels of precision and accuracy also may be used. Passive organic vapor monitor methods have been developed and evaluated successfully by agencies such as the National Institute for Occupational Health and Safety in the United States and the Health and Safety Executive in the United Kingdom for the monitoring of compounds such as aliphatic and aromatic hydrocarbons and formaldehyde. The data indicates that use of passive monitors for regulatory compliance monitoring has been accepted by regulatory authorities in countries where specific monitoring methodology is not required.

Air Pollutants, Occupational↗
PubMed2000

A comparative evaluation of three accelerometry-based physical activity monitors.

PURPOSE: Accelerometry-based activity monitors offer promise for the assessment of free-living physical activity. They provide an objective record of frequency, intensity, and duration of physical activity with minimal burden on participants. The purpose of this study was to evaluate the absolute and relative validity of three contemporary activity monitors (Computer Science and Applications, Inc. [CSA], Tritrac, and Biotrainer) under both laboratory and field conditions. METHODS: Fifty-two participants completed two 30-min choreographed routines designed to simulate a variety of lifestyle physical activities. Three different treadmill paces were completed in both routines to evaluate reliability and validity under laboratory conditions. Six different lifestyle activities were also examined to evaluate the validity of the monitors under field conditions. During each routine, the activity levels of participants were monitored with the three activity monitors as well as by indirect calorimetry systems. RESULTS: The correlations between the monitors and measured VO2 were higher for treadmill activity (mean r = 0.86) compared with lifestyle activity (mean r = 0.55). Correlations among the different monitors were high for both treadmill (r = 0.86) and lifestyle activities (r = 0.70), suggesting that the monitors provide similar information under both conditions. Under laboratory conditions, the CSA yielded accurate predictions of energy expenditure (EE), whereas the Tritrac and Biotrainer tended to overestimate the EE (101-136% of measured value). The Tritrac, however, was found to have less error in individual estimates of EE. Under field conditions, all of the monitors underestimated EE (range: 42-67% of measured value). CONCLUSION: The observed differences among the monitors were attributed primarily to differences in the accuracy of the calibration equations rather than to the monitors themselves. Further research is needed to better understand how to use these devices for field-based assessments of physical activity.

Activities of Daily Living↗
PubMed2004

Time period required for transcranial Doppler monitoring of embolic signals to predict recurrent risk of embolic transient ischemic attack and stroke from arterial stenosis.

BACKGROUND AND PURPOSE: We aimed to investigate whether the time period of transcranial Doppler monitoring for embolic signals can be reduced without loss of clinical yield compared with routinely performed 1-hour monitoring. METHODS: Investigations on the basis of a post hoc analysis of a previously published cohort of 86 patients (55 men, 31 women; mean age 60.6 years) with a nondisabling arterioembolic ischemic event in the anterior circulation within the last 30 days (mean 7.3) and an ipsilateral medium-grade or high-grade stenosis of the carotid or middle cerebral artery. Patients underwent 1-hour monitoring for embolic signals and were followed up prospectively for 6 weeks to evaluate the relationship between embolic signals and risk of an early ischemic recurrence. Risk was also calculated after fictitious reduction of the monitoring period from 60 minutes to 50, 40, 30, 20, and 10 minutes, respectively, and compared with the results obtained from the 1-hour period. RESULTS: The number of patients positive for embolic signals decreased with the decreasing monitoring period. By this, the odds ratio of embolic signals for an early ischemic recurrence "decreased" from 40 (derived from the 1-hour monitoring) to 10 when the monitoring lasted < or =30 minutes. The relationship between the rate of embolic signals per hour and risk of a recurrent stroke is described by an S-shaped curve. As a consequence, risk estimated from reduced monitoring periods can differ considerably from that derived from the 1-hour monitoring if the signal frequency lies within a medium range (eg, between 3 and 15 signals in 30 minutes). CONCLUSIONS: The time period of monitoring for embolic signals may be reduced without loss of clinical relevant information when signal frequency is low or already high during the reduced monitoring period, but it should be prolonged to maximally an hour at signal numbers within a medium range. However, our results need to be externally validated on an independent cohort of patients or confirmed by a prospective study before this modification can be recommended in general.

Aged↗
PubMed2000

Clinical performance of an in-line point-of-care monitor in neonates.

OBJECTIVE: To evaluate the bias, precision, and blood loss characteristics of an ex vivo in-line point-of-care testing blood gas and electrolyte monitor designed for use in critically ill newborn infants. STUDY DESIGN: Study participants included consecutive neonates with an umbilical artery catheter (UAC) in use for clinical laboratory testing. The in-line monitor (VIA LVM Blood Gas and Chemistry Monitoring System, VIA Medical, San Diego, CA) was directly connected to the participant's UAC and the monitor's determinations of pH, PCO(2), PO(2), sodium, potassium, and hematocrit (Hct) were compared with those simultaneously drawn and measured with a standard bench top laboratory instrument (Radiometer 625 ABL; Radiometer America, Inc, Westlake, OH). The bias (the mean difference from the reference method) and precision (1 standard deviation of the mean difference) performance criteria of the in-line monitor were derived using standard laboratory procedures. RESULTS: Sixteen neonates monitored for a total of 37 days had a total of 229 paired blood samples available for comparison by the 2 methods. Bias and precision performance characteristics of the in-line monitor were similar to reports of other point-of-care devices (ie, pH: -.003 +/-.024; PCO(2):.35 +/- 2.84 mm Hg; PO(2):.39 +/- 7.30 mm Hg; sodium:.52 +/- 2.34 mmol/L; potassium:.17 +/-.18 mmol/L; and Hct:.61 +/- 2.80%). The range of values observed for each parameter included much of the range anticipated among critically ill neonates (ie, pH: 7.15-7.65; PCO(2): 25-75 mm Hg; PO(2): 25-275 mm Hg; sodium: 127-150 mmol/L; potassium: 2.6-5.5 mmol/L; and Hct: 32%-60%). Mean blood loss (+/- standard deviation) per sample with the in-line monitor was approximately one-tenth that of the reference method: 24 +/- 7 microL versus 250 microL, respectively. There was no evidence of hemolysis and no patient related safety issues were identified with use of the in-line monitor. CONCLUSIONS: Repeated laboratory testing of critically ill neonates using an ex vivo in-line monitor designed for use in neonates provides reliable laboratory results. The blood loss and hemolysis data obtained suggests that this monitoring device offers potential for reducing neonatal blood loss-and possibly transfusion needs-during the first weeks of life. Before this promising technology can be routinely recommended for care of critically ill neonates, greater practical experience in a variety of clinical settings is needed.

Blood Gas Analysis↗