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PubMed2000

Growth monitoring in children.

EDITORIAL NOTE: This review is superseded by the published Cochrane Review, Taylor 2023: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD014785.pub2/full. BACKGROUND: Growth monitoring is widely accepted and strongly supported by health professionals, and is a standard component of community paediatric services throughout the world. We sought to evaluate research evidence of its impact. This requires definition, consideration of the setting, and discussion of the intended effects of this activity. In this review, we define growth monitoring as the regular recording of a child's weight, coupled with some specified remedial actions if the weight is abnormal in some way. Although the causes of growth faltering and the responses to it may be region specific, the process is the same, and we consider here growth monitoring in both the deprived and richer populations of the world. OBJECTIVES: Growth monitoring consists of routine measurements to detect abnormal growth, combined with some action when this is detected. As primary care workers worldwide invest time in this activity, we sought evidence of its benefits and harms. The review objectives are to evaluate the effects of routine growth monitoring on: 1. The child, in relation to preventing death, illness or malnutrition; and referrals for medical care, medical specialist assessment or professional social support follow-up. 2. The mother, in relation to nutritional knowledge, anxiety or reassurance about the child's health, and satisfaction with services. SEARCH STRATEGY: Cochrane Controlled Trials Register; MEDLINE; EMBASE; CINAHL; World Health Organization and World Bank publications; specialists in this area; citations in existing reviews and identified studies. SELECTION CRITERIA: Randomised or quasi-randomised trials comparing routine growth monitoring (regular monitoring of growth, plotting on a chart, combined with referral or intervention when growth is abnormal) with no growth monitoring. DATA COLLECTION AND ANALYSIS: Trial quality was assessed, and data abstracted by both reviewers. MAIN RESULTS: Two studies included, both conducted in developing countries. In one, the nutritional status at 30 months in 500 children showed no difference between those allocated to growth monitoring and those not. The other study examined whether counselling improved mothers' knowledge of the growth chart, and reported better test scores at four months. REVIEWER'S CONCLUSIONS: Given the level of investment in growth monitoring worldwide, it is surprising there is so little research evaluating its potential benefits and harms.

Child, Preschool↗
PubMed2005

Monitor position in laparoscopic surgery.

BACKGROUND: One of the key problems in laparoscopy is the ergonomic positioning of the monitor. In this study we tested task performance and muscle strain of subjects in relation to monitor position during laparoscopic surgery. METHODS: Eighteen subjects simulated laparoscopic suturing by threading tiny pearls with a curved needle. This was repeated in three monitor positions (15 min each): frontal at eye level (A), frontal in height of the operating field (B), and 45 degrees to the right side at eye level (C). Subjects were not allowed to turn their heads during these sessions. After the test they were asked for their preferred monitor position. During all tests the electromyographic (EMG) activity of the main neck muscles was recorded and the number of pearls was counted. RESULTS: The EMG activity was significantly lower for position A compared to positions C and B (p < 0.05). No significant difference was found between positions B and C. The number of threaded pearls as an indicator for task performance was highest for position B. The difference was statistically significant compared to position C (p = 0.0008) but not between positions A and C (p = 0.0508) or A and B (p = 0.0575). When asked for the preferred monitor position, nine subjects chose two monitors in the frontal positions A and B. No subject preferred the monitor at the side position (C). CONCLUSION: Regarding EMG data, the monitor positioned frontal at eye level is preferable. Reflecting personal preferences of subjects and task performance, it should be of advantage to place two monitors in front of the surgeon: one in position A for lowest neck strain and the other in position B for difficult tasks with optimal task performance. The monitor position at the side is not advisable.

Computer Terminals↗
PubMed2001

Evaluation of a flat CRT monitor for use in radiology.

Medical radiographs based on familiar projection techniques are planar images traditionally displayed by placing on a flat surface viewbox. Presenting these planar images in digital form on a traditional monitor with a curved surface may cause distortions, possibly affecting diagnoses. This would be true especially if physical linear dimensions of the anatomy are important. Reflections from ambient lights behind the observer also could be a problem with curved displays. The goal of this study was to compare physical and psychophysical performance of a flat-surface display monitor with a traditional curved-surface monitor. Two display monitors with different types of front glass-panel surfaces were evaluated. The first monitor had a traditional curved surface, and the other had a flat surface. Physical measurements included dynamic range, display function, veiling glare, and spatial uniformity. An observer performance study used low-contrast, square-wave patterns to determine just-noticeable differences. Ambient lights were turned off in one condition and on in the other. Physical measurements showed that the display functions were nearly identical, but uniformity, veiling glare, and signal-to-noise-ratio were better for the curved monitor. Observer performance was better overall with the curved monitor, but the degradation in performance between lights off and lights on was greater for the curved than flat monitor. The greater degradation with the lights on could be attributed to more reflections off the curved than the flat monitor. A flat-surface display monitor may be useful for viewing clinical radiographs.

Computer Peripherals↗
PubMed1992

Impact of court monitoring on the adjudication of driving while intoxicated (DWI).

Court monitoring of driving while intoxicated (DWI) cases is a labor-intensive effort conducted by over 300 concerned citizen groups across the United States. The present study assessed the impact of court monitoring by analyzing the difference in court dispositions (guilty, not guilty, and dismissed) and case outcomes (jail, fine, and license suspension) between monitored cases and non-monitored cases. The data base for this study consisted of all 9,137 DWI arrests made in the state of Maine in one calendar year. The results demonstrated that court monitoring is an effective tool in affecting the adjudication process. In the presence of court monitors the conviction rates of DWI offenders were higher and their case dismissal rates were lower than those of drivers not court-monitored. Furthermore, once convicted, the likelihood of a jail sentence was higher and the length of the jail sentence was longer for court-monitored DWI drivers than for non-monitored drivers. Monitoring impact was most pronounced for first-time offenders with BAC levels of .10-.11, and those refusing the BAC test.

Alcohol Drinking↗
PubMed1994

Update on nutrition monitoring activities in the United States.

This article provides an overview of planned and proposed nutrition monitoring activities of the National Nutrition Monitoring and Related Research (NNMRR) Program. Key provisions of the NNMRR Act of 1990 are described, including the roles and responsibilities of the Interagency Board of Nutrition Monitoring and Related Research (IBNMRR) and the National Nutrition Monitoring Advisory Council and the development of the Ten-Year Comprehensive Plan. The Plan, which was developed under the guidance of the IBNMRR and reviewed by the National Nutrition Monitoring Advisory Council, is the basis for planning and coordinating the monitoring activities of 22 federal agencies. Also discussed are the resources generated from nutrition monitoring activities, from publications to conferences, that are available to dietitians and nutritionists. Professionals view the scientific reports that describe the nutritional status of the US population and the directories of federal and state monitoring activities as valuable resources. Suggestions from users of nutrition monitoring data related to their information and research needs have been extremely helpful to federal agencies in the development of future monitoring publications and the Ten-Year Comprehensive Plan. Continued communication between dietitians and the federal agencies responsible for the NNMRR Program is important.

Databases, Factual↗
PubMed1988

Growth monitoring--inappropriate promotion of an appropriate technology.

Growth monitoring has been identified as an important component of the 'Child Survival and Development Revolution'--an initiative advocated by UNICEF and supported by several other development agencies. In this initiative, improvements in the survival of children are attained through the widespread promotion, distribution and utilisation of selected health maintaining technologies by family members. Health workers, community institutions and welfare services help the family by providing encouragement, support and assistance. Growth monitoring has been identified as one of the key technologies--not only because it helps to promote the satisfactory nutrition of children, but also because it provides an opportunity for uniting other low-cost child health interventions. This paper re-examines the importance of widespread growth monitoring as a part of child care in developing countries. In the early sections, reasons for monitoring the growth of children are examined and the role of growth monitoring in primary health care is considered. The rationale for including growth monitoring in the child survival revolution is explored and the potential benefits of growth monitoring are reviewed. The authors then examine the results that have been achieved, to date, in a variety of programmes where child growth is being monitored. They conclude with a re-assessment of the importance of growth monitoring in child care. If the widespread promotion of growth monitoring is being considered as a means to improve the health of a community's children, three key questions must be answered. What are the risks associated with growth faltering or weight loss? To what extent can different health, educational or welfare interventions reduce these risks?(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1995

Dynamic on-line vectorcardiography improves and simplifies in-hospital ischemia monitoring of patients with unstable angina.

OBJECTIVES: This study sought to validate computerized vectorcardiography against the established technique of Holter electrocardiographic (ECG) monitoring and to compare the feasibility of the two methods for monitoring patients with unstable angina pectoris. BACKGROUND: Detection of myocardial ischemic episodes is an important objective in patients admitted to the hospital for unstable angina pectoris. Standard ECG monitoring may be sufficient for detection of symptomatic episodes but will often overlook silent ischemia. Holter ECG monitoring has a higher likelihood of discovering such episodes, but analysis is time-consuming, and the results are not available on-line. METHODS: We simultaneously monitored 53 consecutive patients with unstable angina, 46 of whom had technically adequate 24-h Holter ECGs and computerized vectorcardiograms. RESULTS: The Holter tapes had a mean (+/- SD) of 15.3 +/- 10.3 h of recording with both channels technically adequate for analysis compared with 23.7 +/- 1.77 h of vectorcardiographic recording that could be analyzed (p < 0.01). Of the 15 symptomatic episodes detected by Holter ECG monitoring, 13 were also detected with dynamic vectorcardiography. In contrast, eight patients had 18 episodes of chest pain, with simultaneous ST segment changes detected by dynamic vectorcardiography; only 9 of these episodes were also detected by Holter ECG monitoring. CONCLUSIONS: Monitoring of myocardial ischemia with dynamic vectorcardiography seems to be more efficient than Holter monitoring and may have a higher sensitivity. Computerized, continuous vectorcardiography has a complete real-time capacity, allowing monitoring over prolonged periods of time, and the results are immediately available without time-consuming analysis.

Adult↗
PubMed2005

Ancillary study to the PREFER trial: a descriptive study of participants' patterns of self-monitoring--rationale, design and preliminary experiences.

BACKGROUND: The treatment of obesity, marked by a high rate of recidivism, lacks strategies that sustain the improved lifestyle behaviors that led to the weight loss. Self-monitoring, a behavioral strategy to increase awareness of one's behavior, is the cornerstone of behavioral treatment in weight loss management. However, adherence to self-monitoring is less than ideal. The actual patterns of self-monitoring of eating behaviors in weight loss treatment programs have not been studied previously; if done, these data could provide information on how self-monitoring patterns affect weight loss and if interventions can be developed that address deficits in self-monitoring. Technology now permits an instrumented paper-and-pencil diary to record the real time of individuals' self-monitoring behaviors (invivodata, inc.), thus providing more information about self-reported behaviors. This technology differs from PDA based products (ex. e-diary, e-trials, logpad, PICS) because, to the user, it is no different from a standard paper-and-pencil diary. METHODS: The purposes of this ancillary study are: (1) to describe the electronically recorded patterns of self-monitoring of eating behaviors by weight-loss study participants; (2) compare reported vs. electronically recorded self-monitoring; and (3) examine the relationship between the electronically validated adherence to self-monitoring goals and success in weight loss in a sub-sample of participants in the PREFER study. This paper describes the design, methods and preliminary 6-month results. RESULTS: Preliminary results reveal that participants frequently report recording their eating behavior during times when the binder was not opened. Two examples of data are shown that demonstrate the lack of concordance between the self-reported and the electronically recorded data. CONCLUSIONS: These unobtrusively collected electronic data can lead to the development of strategies that can promote improved adherence to self-monitoring.

Behavior Therapy↗
PubMed2004

Additional self-monitoring tools in the dietary modification component of The Women's Health Initiative.

Self-monitoring promotes behavior changes by promoting awareness of eating habits and creates self-efficacy. It is an important component of the Women's Health Initiative dietary intervention. During the first year of intervention, 74% of the total sample of 19,542 dietary intervention participants self-monitored. As the study progressed the self-monitoring rate declined to 59% by spring 2000. Participants were challenged by inability to accurately estimate fat content of restaurant foods and the inconvenience of carrying bulky self-monitoring tools. In 1996, a Self-Monitoring Working Group was organized to develop additional self-monitoring options that were responsive to participant needs. This article describes the original and additional self-monitoring tools and trends in tool use over time. Original tools were the Food Diary and Fat Scan. Additional tools include the Keeping Track of Goals, Quick Scan, Picture Tracker, and Eating Pattern Changes instruments. The additional tools were used by the majority of participants (5,353 of 10,260 or 52% of participants who were self-monitoring) by spring 2000. Developing self-monitoring tools that are responsive to participant needs increases the likelihood that self-monitoring can enhance dietary reporting adherence, especially in long-term clinical trials.

Aged↗
PubMed2005

Treatment of morbid obesity in low-income adolescents: effects of parental self-monitoring.

OBJECTIVE: This study examined the extent to which consistency of self-monitoring by participants and their parents was related to weight control over an initial period of 3 months within the context of a treatment program for morbidly obese low-income minority adolescents. RESEARCH METHODS AND PROCEDURES: Eighty-three obese adolescents (mean age, 13.0 years; 51% boys; 92% African American; mean BMI, 43.0 kg/m2; mean BMI z-score, 6.0) and at least one parent participated in a long-term treatment program that included a very-low-fat dietary focus, weekly group cognitive-behavior therapy, monthly nutrition education classes, a 12-week physical therapy class, and medical monitoring. RESULTS: Participants who self-monitored on the majority of days compared with those who did not self-monitor at all or who self-monitored infrequently attended more sessions and generally lost more weight over the first 3 months. Although parents signed behavioral contracts committing to self-monitor their own eating and exercising over the first month, only 12% did so. Nonetheless, participants whose parents self-monitored were much more likely to self-monitor consistently and lose weight during the first 3 months. DISCUSSION: These results indicate that self-monitoring is a cornerstone of successful weight control even for morbidly obese low-income minority adolescents; targeting consistency of self-monitoring among these high-risk weight controllers and their parents should be just as important as it is for more affluent and less overweight adolescents.

Adolescent↗
PubMed1985

Monitoring of formaldehyde in air.

Any one of several monitoring methods, depending on requirement and circumstance, can be used to measure employee exposure to formaldehyde. Ordinarily, monitoring at DuPont is performed by sampling with impingers containing 1% aqueous sodium bisulfite or with silica gel tubes. The collected formaldehyde is measured spectrophotometrically after reaction with chromotropic acid. Results from studies on a selected number of formaldehyde monitoring methods reveal that reliable methods are available for area and personnel monitoring over both short term and long term. Accurate results are obtained from short-term monitoring (15 min at 1 L/min) with impingers of formaldehyde concentrations as low as 0.14 ppm. The current studies show that long-term monitoring (8 hr at 0.5 L/min) can be performed accurately at concentrations as low as 0.05 ppm. Accurate results also are obtained from short-term monitoring (15 min at 500 mL/min) with silica gel tubes of concentrations as low as 0.11 ppm formaldehyde; the lower limit established in the current studies for long-term monitoring (8 hr at 30 mL/min) is 0.15 ppm. Passive monitors provide the most convenient means of obtaining 8-hour time-weighted average (TWA) data. The Pro-Tek Formaldehyde Badge was demonstrated to reliably monitor formaldehyde concentrations varying from 0-0.5 ppm or 0-3 ppm. All of these methods satisfy the NIOSH criterion for acceptability that all results fall within +/- 25% of the true value at the 95% confidence level. Investigation of the Lion Formaldemeter disclosed that instantaneous and accurate (+/- 5%) measurement of formaldehyde in air can be made over a concentration range of 0.3-5 ppm in the absence of other substances that are oxidizable in its fuel cell detector.

Air Pollutants, Occupational↗
PubMed2006

Child and parental self-monitoring as determinants of success in the treatment of morbid obesity in low-income minority children.

OBJECTIVE: To examine self-monitoring by children and parents as related to weight control over 6 months within a long-term multidisciplinary program for low-income minority children with morbid obesity. METHODS: The weight changes of 228 children with obesity were evaluated according to frequency of child and parental self-monitoring. Predictors of self-monitoring were also evaluated. RESULTS: Children who self-monitored on most days lost more weight over 6 months of treatment compared with less-consistent self-monitors. Children whose parents self-monitored were also more likely to self-monitor and lose weight. CONCLUSIONS: Self-monitoring seems just as critical for successful weight control among low-income minority children with obesity as it is in the middle-class populations. Although lower education and higher levels of psychosocial stress may decrease self-monitoring and participation by these families, they might still benefit from targeting highly consistent self-monitoring (by parents and children) as a primary goal in weight-control programs.

Body Mass Index↗
PubMed2004

Holter monitoring in the diagnosis of stroke mechanism.

BACKGROUND: Atrial fibrillation (AF), an important and treatable cause of ischaemic stroke, can occur as a sustained or a paroxysmal arrhythmia. Continuous cardiac rhythm monitoring (Holter monitoring) is often performed in stroke patients to identify paroxysmal AF, which is an indication for warfarin anti-coagulation in this patient population. AIM: The aim of this study was to assess the clinical utility of Holter monitoring in detecting occult AF in patients with possible cardioembolic stroke. METHODS: The medical records of ischaemic stroke patients consecutively hospitalized at a single academic centre during a one-year period were reviewed. Data regarding patient demographics, stroke characteristics, electrocardiography and echocardiography results and duration and findings of Holter monitoring were abstracted. The primary outcome was yield of newly diagnosed AF on Holter monitoring. RESULTS: Of 465 consecutive patients admitted with a diagnosis of new ischaemic stroke, 210 underwent Holter monitoring. The mean duration of monitoring was 22.8 +/- 4.0 h. Previously undiscovered AF was -identified in five cases (2.4%), all of which represented non-rheumatic AF. In three cases, the Holter test was negative despite AF documented on an admission electro-cardiogram. CONCLUSIONS: Holter monitoring can identify occult paroxysmal AF, assisting targeted secondary prevention in patients with new ischaemic stroke. However, the standard 24-h duration of monitoring probably under-estimates the prevalence of paroxysmal AF in this population. Prospective studies are indicated to evaluate the value of longer monitoring periods in stroke populations.

Aged↗
PubMed2000

Multicenter comparison of Roche COBAS AMPLICOR MONITOR version 1.5, Organon Teknika NucliSens QT with Extractor, and Bayer Quantiplex version 3.0 for quantification of human immunodeficiency virus type 1 RNA in plasma.

The performance and characteristics of Roche COBAS AMPLICOR HIV-1 MONITOR version 1.5 (CA MONITOR 1.5) UltraSensitive (usCA MONITOR 1. 5) and Standard (stCA MONITOR 1.5) procedures, Organon Teknika NucliSens HIV-1 RNA QT with Extractor (NucliSens), and Bayer Quantiplex HIV RNA version 3.0 (bDNA 3.0) were compared in a multicenter trial. Samples used in this study included 460 plasma specimens from human immunodeficiency virus (HIV) type 1 (HIV-1)-infected persons, 100 plasma specimens from HIV antibody (anti-HIV)-negative persons, and culture supernatants of HIV-1 subtype A to E isolates diluted in anti-HIV-negative plasma. Overall, bDNA 3.0 showed the least variation in RNA measures upon repeat testing. For the Roche assays, usCA MONITOR 1.5 displayed less variation in RNA measures than stCA MONITOR 1.5. NucliSens, at an input volume of 2 ml, showed the best sensitivity. Deming regression analysis indicated that the results of all three assays were significantly correlated (P < 0.0001). However, the mean difference in values between CA MONITOR 1.5 and bDNA 3.0 (0.274 log(10) RNA copies/ml; 95% confidence interval, 0.192 to 0.356) was significantly different from 0, indicating that CA MONITOR 1.5 values were regularly higher than bDNA 3.0 values. Upon testing of 100 anti-HIV-negative plasma specimens, usCA MONITOR 1.5 and NucliSens displayed 100% specificity, while bDNA 3.0 showed 98% specificity. NucliSens quantified 2 of 10 non-subtype B viral isolates at 1 log(10) lower than both CA MONITOR 1.5 and bDNA 3.0. For NucliSens, testing of specimens with greater than 1,000 RNA copies/ml at input volumes of 0.1, 0.2, and 2.0 ml did not affect the quality of results. Additional factors differing between assays included specimen throughput and volume requirements, limit of detection, ease of execution, instrument work space, and costs of disposal. These characteristics, along with assay performance, should be considered when one is selecting a viral load assay.

Branched DNA Signal Amplification Assay↗
PubMed2000

Is routine growth monitoring effective? A systematic review of trials.

BACKGROUND: Growth monitoring consists of routine measurements to detect abnormal growth, combined with some action when this is detected. It aims to improve nutrition, reduce the risk of death or inadequate nutrition, help educate carers, and lead to early referral for conditions manifest by growth disorders. As primary care workers world wide invest time in this activity, evidence for its benefits and harms was sort. INCLUSION CRITERIA STUDIES: randomised or quasi-randomised controlled trials of growth monitoring. INTERVENTIONS: regular growth monitoring, combined with some intervention targeted at abnormal growth, compared with controls. OUTCOMES: anthropometric measures; referrals to primary and specialist care, or community services; maternal knowledge, anxiety, and satisfaction; child morbidity and mortality. COMPARISONS: Routine growth monitoring compared with no routine growth monitoring; routine growth monitoring by plotting onto a standard chart compared with monitoring with no chart. SEARCH STRATEGY: Cochrane controlled trials register; World Health Organisation and World Bank publications; contact with specialist community paediatricians working in the field. RESULTS: Two trials met the inclusion criteria. One compared growth monitoring with no growth monitoring, in a cluster randomised trial nested in a nutritional intervention programme, and detected no difference in nutritional outcomes between the two groups. Another trial compared growth monitoring with and without a standard chart, measuring maternal knowledge of women about nutrition. It showed small numerical differences in test scores. DISCUSSION AND IMPLICATIONS: Current policies appear to be based on the opinion that investment in the activity has worthwhile health benefits, and does no harm. No reliable evidence was found to support or refute this.

Child↗
PubMed2001

Randomized assessment of syncope trial: conventional diagnostic testing versus a prolonged monitoring strategy.

BACKGROUND: Establishing a diagnosis in patients with unexplained syncope is complicated by infrequent and unpredictable events. Prolonged monitoring may be an alternative strategy to conventional testing with short-term monitoring and provocative tilt and electrophysiological testing. METHODS AND RESULTS: Sixty patients (aged 66+/-14 years, 33 male) with unexplained syncope were randomized to "conventional" testing with an external loop recorder and tilt and electrophysiological testing or to prolonged monitoring with an implantable loop recorder with 1 year of monitoring. If patients remained undiagnosed after their assigned strategy, they were offered crossover to the alternate strategy. A diagnosis was obtained in 14 of 27 patients randomized to prolonged monitoring compared with 6 of 30 patients undergoing conventional testing (52% versus 20%, P=0.012). Crossover was associated with a diagnosis in 1 of 6 patients undergoing conventional testing compared with 8 of 13 patients who completed monitoring (17% versus 62%, P=0.069). Overall, prolonged monitoring was more likely to result in a diagnosis than was conventional testing (55% versus 19%, P=0.0014). Bradycardia was detected in 14 patients undergoing monitoring compared with 3 patients undergoing conventional testing (40% versus 8%, P=0.005). CONCLUSIONS: A prolonged monitoring strategy is more likely to provide a diagnosis than conventional testing in patients with unexplained syncope. Consideration should be given to earlier implementation of a monitoring strategy.

Aged↗
PubMed2004

Quality indicators and monitoring of mental health services: what do frontline providers think?

OBJECTIVE: Many health care organizations are giving feedback to mental health care providers about their performance on quality indicators. Mental health care providers may be more likely to respond to this feedback if they believe the indicators are meaningful and within their "sphere of influence." The authors surveyed frontline mental health care providers to elicit their perceptions of widely used indicators for quality monitoring in mental health services. METHOD: The survey was distributed to a stratified, random sample of 1,094 eligible mental health care providers at 52 Department of Veterans Affairs facilities; 684 (63%) returned the survey. The survey elicited perceptions of 21 widely used indicators in five quality domains (access, utilization, satisfaction, process, and outcomes). The data were analyzed with descriptive and multivariate methods. RESULTS: Most mental health care providers (65%) felt that feedback about these widely used indicators would be valuable in efforts to improve care; however, only 38% felt able to influence performance related to these monitors and just 13% were willing to accept incentives/risk for their performance. Providers were most positive about satisfaction monitors and preferentially included satisfaction, access, and process monitors in performance sets to measure overall quality. Despite providers' relatively positive views of monitors, 41% felt that monitoring programs did not assist them in improving care. Providers cited numerous barriers to improving care processes. CONCLUSIONS: Mental health care providers may be more receptive to monitoring efforts if satisfaction, access, and process monitors are emphasized. However, providers' views of monitoring programs appear to be less affected by concerns about specific monitors than by concerns about the accuracy of quality measurement and barriers to changing care processes.

Attitude of Health Personnel↗
PubMed1996

Comments on past and present situation of intensive monitoring of the fetus during labor.

Modern intensive monitoring of the fetus during labor affords the opportunity for the greatest possible safety to the infant, whilst at the same time dispensing with unnecessary operations to terminate labor which can be dangerous for the mother and her child. Developments over the past 28 years, since cardiotocography has been in clinical use, have unfortunately also been accompanied by confusion and mistakes. We think that there are two main reasons for this: I. Many who use cardiotocography have not assessed its efficiency correctly. Heart rate pattern with all their variations have too often been regarded as the only diagnostic criteria for the determination of fetal hypoxia. However this procedure only allows a rough selection of actually endangered fetuses. In more than 50% of the cases with a suspicious or pathologic cardiotocogram there is no concrete clinical evidence of manifest danger of hypoxia. II. Investigations concerning the practical importance of monitoring the fetus during labor were often not based on actual clinical indications. Attempts were made to prove that continuous electronic monitoring of the fetal heart rate could be replaced by simple traditional auscultation. Furthermore due to failure to appreciate the real efficiency of cardiotocography, this truly excellent method was in fact blamed for the faults arising from wrong interpretation, instead of underlining the lack of logic of the investigators concerned. After all, several prospective studies, that have examined the efficiency of various monitoring strategies, demonstrate the shortcomings of these techniques in the clinical setting and have shown them to have no relevance in every practice. Presently the most suitable way to monitor the fetus during labor is to combine cardiotocography with a biochemical method. At the moment fetal blood analysis is the most suitable test to be performed in cases where the cardiotocogram is not normal. Then the role of fetal blood analysis is to find out whether in fact a danger of hypoxia is threatened or not. Today the most urgent task when monitoring the fetus during labor is not so much to reduce the number of cases of cerebral palsy since these are seldom caused by intrapartum asphyxia. The major objective is now recognised to be to prevent early morbidity of the fetus, newborn, and the consequences that flow from this. The excellent results of combined intensive monitoring of the fetus during labor are particularly well illustrated by the intrapartum mortality in our hospital during different periods when monitoring practice has been progressively and methodically improved by stages. During the period when monitoring consisted of simple auscultation used on its own, the intrapartum mortality was 0.56%. After the introduction of fetal blood analysis--at that time cardiotocography did not yet exist--the mortality sank to 0.32%. During the first ten years of cardiotocography combined with fetal blood analysis the mortality reduced further to 0.17%, and during the following 13 years it reached to a minimal level of 0.4%. Finally, in this review, other aspects are commented on such as oximetry. Oximetry, presently used as pulse oximetry, as an additional biochemical method will possibly be incorporated as the third method of monitoring the fetus during labor. Oximetry could also be used as an automatic alarm system in the labor ward when fetal O2 levels drop below a particular limit to draw the attention of the staff to the case concerned. Up to now this has not been convincingly achieved with the use of cardiotocography.

Cardiotocography↗