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PubMed1990

Use of ambulatory electrocardiographic (Holter) monitoring.

PURPOSE: To evaluate the clinical efficacy of ambulatory electrocardiographic (ECG) monitoring and to develop guidelines for its use in clinical practice. DATA IDENTIFICATION: Studies reported since January 1978 were identified both through computer searches using Index Medicus and extensive manual searching of bibliographies of identified articles. STUDY SELECTION: Only studies that fulfilled methodologic criteria designed to limit bias were reviewed. DATA EXTRACTION: Information describing population and study results was assessed in four major categories (variability, diagnosis, prognosis, and therapy guidance) for both arrhythmia monitoring and ST-segment analysis. RESULTS OF DATA ANALYSIS: The day-to-day variability of arrhythmia and myocardial ischemia detected by ambulatory ECG monitoring may be considerable in an individual patient. Caution must therefore be used in interpreting serial tests. Ambulatory ECG monitoring with diary correlation permits documentation of cardiac arrhythmias causing symptoms, but the diagnostic yield is low unless symptoms are frequent. Such monitoring can provide information about prognosis in patients after acute myocardial infarction. The amount of prognostic information obtained is modest and is outweighed by other measures. There is insufficient information to make conclusions about such monitoring and prognosis in other conditions. Serial ambulatory ECG monitoring may be used to assess the effect of an antiarrhythmic drug in patients with frequent and reproducible ventricular ectopy. The effect of arrhythmia suppression on survival is uncertain. Because of its low sensitivity and specificity, analysis of ST-segment changes during ambulatory ECG monitoring is inaccurate in establishing or excluding the presence of coronary disease. Although anti-ischemic interventions reduce the frequency and duration of ST-segment changes on monitoring, there are no data on the utility of using reduction or elimination of the changes as the endpoint of therapy. CONCLUSIONS: Ambulatory ECG monitoring can provide diagnostic, prognostic, and therapeutic information in many situations, but similar information often may be better obtained in other ways.

Arrhythmias, Cardiac↗
PubMed1990

Placebo effect and adaptation to noninvasive monitoring of BP.

Three 24 h ambulatory monitorings of BP were performed at two-week intervals in 21 untreated hypertensives (mean age 38 +/- 10 yrs, 13 males and 9 females). After the first baseline monitoring, the patients were randomised, according to a cross-over design, to one of the following sequences: no therapy to placebo or placebo to no therapy. At the end of each period, noninvasive ambulatory monitoring was performed. Mean +/- SE 24 h systolic (SBP) and diastolic (DBP) pressures recorded at the first monitoring were 129.2 +/- 3.5 mmHg and 81.7 +/- 2.3 mmHg respectively. At the second and third monitorings, mean 24 h BP differences versus baseline levels were -2.9 +/- 1.8 and -4.7 +/- 1.7 mmHg for SBP, and -2.0 +/- 1.1 and -2.7 +/- 1.5 mmHg for DBP. Both SBP and DBP differences at repeated monitorings were significant by analysis of variance (P less than 0.05). No significant effects on BP of treatment sequence or of placebo administration were found. Analysis of covariance showed a significant relationship between initial 24 h BP and subsequent mean 24 h BP differences (SBP: beta = -0.260, DBP: beta = -0.124). ANOVA performed on waking and sleeping BP separately showed the observed differences to be significant only during waking hours. Regression analysis showed that the decrease in 24 h BP at repeated monitorings was significantly related to the extent of 'white coat'-induced BP increase only for DBP (P = 0.022). For both 24 h SBP and DBP, however, a negative correlation between the alarm reaction to the presence of the physician and 24 h BP decrease at repeated monitorings was observed. It is concluded that noninvasive ambulatory monitoring is subject to adaptative phenomena but not to placebo effect. Factors influencing the defence reactions to manual measurements and to ambulatory monitoring might be partly different.

Adult↗
PubMed2005

Devices for ambulatory and home monitoring of blood pressure, lipids, coagulation, and weight management, part 2.

PURPOSE: The equipment and methods used for ambulatory and home monitoring of blood pressure, lipids, coagulation, and weight management are discussed. SUMMARY: Over 100 million people in the United States have one or more chronic diseases, such as diabetes, hypertension, and asthma. With the goal to improve health while reducing costs and the overall health care burden, ambulatory and home monitoring by pharmacists and patients are receiving more attention. Ambulatory and home monitoring of blood pressure, cholesterol, coagulation, and weight management (including devices for assessing overweight and obese patients, heart rate monitors, and pedometers) are convenient for clinicians and patients. Such monitoring provides pharmacists with an opportunity to differentiate their practices. Studies suggest that patients who are involved in ambulatory and home monitoring take a more active role in their health and may have better adherence to a prescribed diet and medication regimens. Studies also show that ambulatory and home monitoring, if done correctly, provide clinicians with a large quantity of reliable readings for future therapeutic decisions. Devices are also a means for pharmacists to increase their provision of pharmacy services. Ambulatory monitoring is billable in many clinic settings, and the devices can be a profitable addition to prescription services. CONCLUSION: Many devices are available to assist patients and clinicians in monitoring blood pressure, lipids, coagulation, and weight management. Familiarity with the devices will help in their proper selection and use.

Blood Coagulation↗
PubMed2000

Incidence and costs of adverse drug reactions during hospitalisation: computerised monitoring versus stimulated spontaneous reporting.

OBJECTIVE: To implement a computer-based adverse drug reaction monitoring system and compare its results with those of stimulated spontaneous reporting, and to assess the excess lengths of stay and costs of patients with verified adverse drug reactions. DESIGN: A prospective cohort study was used to assess the efficacy of computer-based monitoring, and case-matching was used to assess excess length of stay and costs. SETTING: This was a study of all patients admitted to a medical ward of a university hospital in Germany between June and December 1997. PATIENTS AND PARTICIPANTS: 379 patients were included, most of whom had infectious, gastrointestinal or liver diseases, or sleep apnoea syndrome. Patients admitted because of adverse drug reactions were excluded. METHODS: All automatically generated laboratory signals and reports were evaluated by a team consisting of a clinical pharmacologist, a clinician and a pharmacist for their likelihood of being an adverse drug reaction. They were classified by severity and causality. For verified adverse drug reactions, control patients with similar primary diagnosis, age, gender and time of admission but without adverse drug reactions were matched to the cases in order to assess the excess length of hospitalisation caused by an adverse drug reaction. RESULTS: Adverse drug reactions were detected in 12% of patients by the computer-based monitoring system and stimulated spontaneous reporting together (46 adverse reactions in 45 patients) during 1718 treatment days. Computer-based monitoring identified adverse drug reactions in 34 cases, and stimulated spontaneous reporting in 17 cases. Only 5 adverse drug reactions were detected by both methods. The relative sensitivity of computer-based monitoring was 74% (relative specificity 75%), and that of stimulated spontaneous reporting was 37% (relative specificity 98%). All 3 serious adverse drug reactions were detected by computer-based monitoring, but only 2 out of the 3 were detected by stimulated spontaneous reporting. The percentage of automatically generated laboratory signals associated with an adverse drug reaction (positive predictive value) was 13%. The mean excess length of stay was 3.5 days per adverse drug reaction. 48% of adverse reactions were predictable and detected solely by computer-based monitoring. Therefore, the potential for savings on this ward from the introduction of computer-based monitoring can be calculated as EUR56 200/year ($US59 600/year) [ 1999 values]. CONCLUSION: Computer monitoring is an effective method for improving the detection of adverse drug reactions in inpatients. The excess length of stay and costs caused by adverse drug reactions are substantial and might be considerably reduced by earlier detection.

Adverse Drug Reaction Reporting Systems↗
PubMed1991

Cardiorespiratory monitoring.

Documented monitoring has many actual or potential advantages compared to undocumented monitoring. Due to the occurrence of monitor alarms in virtually all monitored infants and the potential for undue parental concern or noncompliance when excessive false alarms do occur, documented monitoring needs to become the standard for home electronic surveillance. The increased cost should be more than offset by net reductions in total duration of home monitoring and will be minimized by the integration of the home monitor and event recording components. Documented monitoring will quantify the frequency, duration, and type of each true event, whether related to apnea, bradycardia, desaturation, or a combination thereof. The availability of routine documented monitoring including SaO2 will be of dramatic benefit in enhancing our understanding regarding the pathophysiology of apparent life-threatening events and sudden death, providing the clinician with a heretofore unavailable powerful diagnostic and therapeutic modality.

Blood Gas Monitoring, Transcutaneous↗
PubMed1987

Influence of transcutaneous oxygen monitoring on the incidence of retinopathy of prematurity.

This study was performed to determine whether the use of continuous transcutaneous oxygen tension (tcPO2) monitoring could reduce the incidence of retinopathy of prematurity in preterm infants receiving oxygen therapy. A total of 296 infants with birth weights less than or equal to 1,300 g were randomly assigned to a continuous monitoring or a standard care group. Infants in the continuous monitoring group had tcPO2 monitored continuously as long as they required supplemental oxygen, and infants in the standard care group had tcPO2 monitored only during the more acute state of their illness. Management of both groups was otherwise identical. Of 148 infants in the continuous monitoring group, 101 survived; of the 148 patients in the standard care group, 113 survived. Mean birth weights and gestational ages were similar for both groups. Duration of mechanical ventilation and oxygen therapy was also similar. The overall incidence of retinopathy of prematurity was 51% in the continuous monitoring group and 59% in the standard care group. As birth weight for infants greater than or equal to 1,000 g increased, a higher risk of retinopathy of prematurity developing was noted in the standard care group. Cicatricial retinopathy of prematurity developed in four infants in the continuous monitoring group and five in the standard care group. These results suggest that continuous tcPO2 monitoring may reduce the incidence of retinopathy of prematurity in infants with birth weights greater than 1,000 g but not in the smaller infants in whom this complication occurs more frequently and is more severe.

Birth Weight↗
PubMed2005

Improving laboratory monitoring at initiation of drug therapy in ambulatory care: a randomized trial.

BACKGROUND: The importance of laboratory monitoring for drugs is reflected in product labeling and published guidelines, but monitoring recommendations are followed inconsistently. Opportunity exists to improve monitoring, with the potential to decrease therapy complications. METHODS: The objective of this randomized trial was to determine whether computerized alerts were effective at increasing the percentage of ambulatory patients with laboratory monitoring at initiation of drug therapy. Physicians and pharmacists teamed up to develop organization-specific guidelines for monitoring selected drugs. In collaboration with physicians, pharmacists were alerted to missing laboratory test results, ordered missing tests, reminded patients to obtain tests, assessed test completion, reviewed test results, and managed abnormal results. Eligible individuals included patients with therapy initiated for any of 15 drugs among 400,000 health plan members. RESULTS: In the intervention group, 79.1% (n = 4076; 95% confidence interval [CI], 78.0%-80.2%) of dispensings were monitored compared with 70.2% (n = 3522; 95% CI, 68.9%-71.5%) in the usual-care group (P < .001). For example, 78.6% of amiodarone (95% CI, 73.1%-83.5%) dispensing was monitored in the intervention group vs 51.4% (95% CI, 44.4%-58.4%) in the group receiving usual care (P < .001). CONCLUSIONS: This study demonstrates the effectiveness of a computerized tool plus collaboration among health care professionals at increasing the percentage of patients receiving laboratory monitoring at initiation of therapy. Coupling data available from information systems with the knowledge and skills of physicians and pharmacists can result in improved patient monitoring.

Adult↗
PubMed2007

Laboratory monitoring of potassium and creatinine in ambulatory patients receiving angiotensin converting enzyme inhibitors and angiotensin receptor blockers.

PURPOSE: Serum potassium and creatinine monitoring is recommended for patients prescribed angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB). Much has been written about hyperkalemia associated with these drugs; little is known about laboratory monitoring patterns. The purpose of this retrospective cohort study was to assess creatinine and potassium monitoring and characteristics associated with monitoring among patients dispensed ACEi or ARB. METHODS: This study was conducted in 10 United States health maintenance organizations. Study patients (n = 52 906) were aged 18 or older with dispensings of ACEi or ARB for at least 1 year. Serum potassium and creatinine monitoring were assessed from administrative data and medical records. RESULTS: More than two-thirds (68.4%) of patients received laboratory monitoring. Likelihood of monitoring increased with age (adjusted odds ratio [OR] 2.10; 95% confidence interval [95%CI] 1.93, 2.28 [individuals >or= 80 compared to <50 years]), >9 outpatient visits (OR 1.46; 95%CI 1.39, 1.54), hospitalization (OR 1.15; 95%CI 1.06, 1.25), concomitant medications (potassium [OR 2.01; 95%CI 1.84, 2.20], diuretics [OR 1.54; 95%CI 1.47, 1.61], digoxin [OR 1.15; 95%CI 1.01, 1.30]), and comorbidities (diabetes [OR 1.68; 95%CI 1.61, 1.75], heart failure [OR 1.73; 95%CI 1.57, 1.90], chronic kidney disease [OR 2.95; 95%CI 2.48. 3.51]). CONCLUSIONS: Nearly one-third of patients dispensed ACEi or ARB did not undergo laboratory monitoring at least yearly. Though patients at increased risk of hyperkalemia were more likely to be monitored, many remained unmonitored.

Adult↗
PubMed1993

Accuracy and cross-sensitivity of 10 different anesthetic gas monitors.

OBJECTIVE: The objective of this study was to test the accuracy and cross-sensitivity of commercially available anesthetic gas monitors. METHODS: Using gas chromatography (GC) as a reference method, the accuracy, cross-sensitivity, and ability to recognize an erroneously selected agent were determined in the following 10 monitors for volatile anesthetics: Datex Capnomac Ultima-S, Datex Capnomac, Ohmeda 5330 agent monitor, Iris Dräger, Andros Dräger PM 8020 (all monochromatic, infrared analyzers), Nellcor N-2500E, Criticare POET II, Irina Dräger (all polychromatic, infrared analyzers), Siemens Servo Gas Monitor 120 (a piezoelectric analyzer), and Brüel & Kajer Type 1304 (a photoacoustic analyzer). Accuracy was determined at 0.5, 1, 2, and 4 times the minimal alveolar concentration (MAC) of either halothane or isoflurane in oxygen (O2). The cross-sensitivity tests were performed with 70 vol% nitrous oxide in O2, 5 vol% carbon dioxide in O2, 0.032 vol% alcohol in O2, and 70% water vapor in O2. The photoacoustic analyzer showed a higher accuracy for isoflurane than the polychromatic infrared monitors. The greatest inaccuracy with isoflurane was found in the Iris Dräger monitor, which had a maximal bias percentage by volume (vol%) of 0.09 at 0.5 MAC. (This bias was within the manufacturer's specified tolerance of +/- 0.1 vol% or 10% relative difference of reading, whichever is greater.) Irina Dräger was the most accurate analyzer with halothane (mean % bias [relative %] +/- SD, 0.9 +/- 2.0%). The greatest bias with halothane was found in the monochromatic infrared analyzers, with a maximal % bias at 0.5 MAC of 50.3% of the GC reading (12.4% with a new inner Nafion tube) found in the Datex Ultima monitor. The Siemens gas monitor showed a cross-sensitivity for water vapor (-0.248 vol%). The monochromatic infrared analyzers showed a small sensitivity to alcohol (additional deviation of 0.011 to 0.147 vol% at 2 MAC isoflurane) but no sensitivity to nitrous oxide. No cross-sensitivity was found in the polychromatic infrared and photoacoustic analyzers. An incorrect selection of anesthetic agent when using a monochromatic infrared analyzer can be fatal; for example, when using halothane and selecting isoflurane the values measured by the Datex Capnomac monitor were nearly 6 times: below the actual value (i.e., 1 vol% "isoflurane" on the display = 6 vol% halothane in reality). CONCLUSIONS: The photoacoustic measurement principle is more accurate than the other methods, although the polychromatic infrared analyzers are safer because they detect erroneously selected agents.

Anesthesia, Inhalation↗
PubMed1990

Home monitors for infants: use, misuse, and "over-the-counter" use.

The prevalence of "over-the-counter" monitors, was surveyed in infants referred to five Belgian paediatric centres between September 1987 and March 1988 for evaluation of their risk for sudden infant death (SID). Questionnaires were collected from 1625 families. Of the infants, 8.9% were already being monitored at home. For 78.1% of the infants no medical advice had been solicited, and for 21.9%, a paediatrician or a general practitioner had advised home monitoring without previous evaluation. Forty of 824 infants referred with no history of SID, and no history of apparent life-threatening event (ALTE), were monitored (4.8%). Monitoring was started for 3.8% (5 out of 130) of the infants who had lost a cousin or an uncle to SID, and for 22.2% (69 of 310) of the younger siblings of a SID victim. Of the 341 infants who had presented with an ALTE, monitoring was started in 32 (9.4%). The infants were monitored with respiratory monitors only, and in 86% of the monitors, the alarm delay had been regulated unnecessarily low.

Belgium↗
PubMed1987

TRAM: a new concept in transport monitoring.

A new monitoring system has been designed to eliminate the need to interrupt monitoring to transport critically ill patients. The key innovation of the system is a self-contained multiparameter signal acquisition and processing module that contains a battery-backed microprocessor and retains monitor setup information when moved from one monitor to another. The module functions in Marquette Series 7010 surgical monitors and bedside monitors and in the new Marquette Transport Remote Acquisition Monitor (TRAM). Lines connecting the patient to the module remain connected. The TRAM module provides continuous, integrated multiparameter monitoring during transport. Monitored parameters include up to four simultaneous ECG leads, two invasive blood pressures, pulse rate, cardiac output and two temperatures (in place of cardiac output).

Computer Systems↗
PubMed1994

Monitoring during paediatric cardiac anaesthesia.

Monitoring of paediatric anaesthesia has become increasingly more complex in recent years and this is particularly true of cardiac anaesthesia. The purpose of this review is to give a comprehensive update of published material related to both routine and specialized cardiac monitoring. Routine monitoring can be particularly affected by the alterations of cardiac rhythm, blood flow, cardiac output and oxygenation which result from the congenital heart abnormalities themselves, the type of surgery undertaken and the effects of cardiopulmonary bypass. The use of specialized monitoring is becoming more widespread, particularly in the areas of cerebral function, mixed venous oxygenation, cardiac output measurement and coagulation. In the last five years, with the development of smaller probes, a great deal has been published on transoesophageal echocardiography. The use of the current monitors of cerebral function still remains controversial despite the need for a monitor of adequate brain perfusion, reflecting the need for a great deal of further research in this area. This review will concentrate on particular areas which have seen the most profound changes and on monitoring that may form the standards of tomorrow. Finally, amongst all the technology, it should not be forgotten that the most important clinical monitor is the bedside clinical monitoring of the physicians themselves.

Anesthesia, General↗
PubMed2005

Correlation of continuously monitored regional cerebral blood flow and brain tissue oxygen.

BACKGROUND: The purpose of this study was to investigate the relationship between continuously monitored regional cerebral blood flow (CBF) and brain tissue oxygen (PtiO2). METHODS: Continuous advanced multimodal neuromonitoring including monitoring of PtiO2 (Licox, GMS) and CBF (QFlow, Hemedex) was performed in eight patients after severe subarachnoid haemorrhage (n=5) and traumatic brain injury (n=3) for an average of 9.6 days. Parameters were measured using a flexible polarographic PtiO2-probe and a thermal diffusion CBF-microprobe. FINDINGS: Regarding the whole monitoring period in all patients, the data indicated a significant correlation between CBF and PtiO2 (r=0.36). In 72% of 400 analysed intervals of 30 minutes duration with PtiO2 changes larger than 5 mmHg, a strong correlation between CBF and PtiO2 existed (r>0.6). In 19% of intervals a still statistically significant correlation was observed (0.3<r<0.6). During the remaining 9% no correlation was found (r<0.3). Regarding the clinical stability of the monitoring devices, the CBF monitoring system allowed monitoring of CBF in 64% of the time when PtiO2 monitoring was possible only. Phases of non-monitoring were mostly due to fever of the patient, when the system does not allow monitoring to avoid overheating of the cerebral tissue. CONCLUSIONS: This study suggests a correlation between CBF and PtiO2. The level of PtiO2 seems to be predominately determined by regional CBF, since changes in PtiO2 were correlated in 90% of episodes to simultaneous changes of CBF.

Brain↗
PubMed2005

Risk-based prioritization of air pollution monitoring using fuzzy synthetic evaluation technique.

Air pollution monitoring programs aim to monitor pollutants and their probable adverse effects at various locations over concerned area. Either sensitivity of receptors/location or concentration of pollutants is used for prioritizing the monitoring locations. The exposure-based approach prioritizes the monitoring locations based on population density and/or location sensitivity. The hazard-based approach prioritizes the monitoring locations using intensity (concentrations) of air pollutants at various locations. Exposure and hazard-based approaches focus on frequency (probability of occurrence) and potential hazard (consequence of damage), respectively. Adverse effects should be measured only if receptors are exposed to these air pollutants. The existing methods of monitoring location prioritization do not consider both factors (hazard and exposure) at a time. Towards this, a risk-based approach has been proposed which combines both factors: exposure frequency (probability of occurrence/exposure) and potential hazard (consequence). This paper discusses the use of fuzzy synthetic evaluation technique in risk computation and prioritization of air pollution monitoring locations. To demonstrate the application, common air pollutants like CO, NOX, PM10 and SOX are used as hazard parameters. Fuzzy evaluation matrices for hazard parameters are established for different locations in the area. Similarly, fuzzy evaluation matrices for exposure parameters: population density, location and population sensitivity are also developed. Subsequently, fuzzy risk is determined at these locations using fuzzy compositional rules. Finally, these locations are prioritized based on defuzzified risk (crisp value of risk, defined as risk score) and the five most important monitoring locations are identified (out of 35 potential locations). These locations differ from the existing monitoring locations.

Air Pollutants↗
PubMed2005

Internet-based monitoring of asthma: a long-term, randomized clinical study of 300 asthmatic subjects.

BACKGROUND: Experience from other fields of internal medicine shows that Internet-based technology can be used to monitor various diseases. The new technology handles complex calculation programs easily, and it is a unique way of communicating. These advantages might be used in optimizing the treatment for asthmatic subjects because undertreatment is a common problem found in European asthmatic subjects. OBJECTIVE: We sought to investigate the outcome of monitoring and treatment using a physician-managed online interactive asthma monitoring tool and to assess whether the outcome differs from that of monitoring and treatment in an outpatient respiratory clinic or in primary care. METHODS: Three hundred asthmatic subjects were randomized to 3 parallel groups in a 6-month prospective study: (1) Internet-based monitoring (n = 100); (2) specialist monitoring (n = 100); and (3) general practitioner (GP) monitoring (n = 100). All the patients were examined on entry into the study and after 6 months of treatment. RESULTS: The treatment and monitoring with the Internet-based management tool lead to significantly better improvement in the Internet group than in the other 2 groups regarding asthma symptoms (Internet vs specialist: odds ratio of 2.64, P = .002; Internet vs GP: odds ratio of 3.26; P < .001), quality of life (Internet vs specialist: odds ratio of 2.21, P = .03; Internet vs GP: odds ratio of 2.10, P = .04), lung function (Internet vs specialist: odds ratio of 3.26, P = .002; Internet vs GP: odds ratio of 4.86, P < .001), and airway responsiveness (Internet vs GP: odds ratio of 3.06, P = .02). CONCLUSION: When physicians and patients used an interactive Internet-based asthma monitoring tool, better asthma control was achieved.

Adolescent↗
PubMed2005

Cerebral monitoring with transcranial Doppler ultrasonography improves neurologic outcome during repairs of acute type A aortic dissection.

OBJECTIVE: Neurologic complications after repair of acute type A aortic dissection remain significant. The use of power M-mode transcranial Doppler monitoring to verify cerebral blood flow during these repairs might decrease cerebral ischemia by correcting malperfusion. The purpose of this study was to analyze the use of power M-mode transcranial Doppler monitoring during repairs of acute type A dissection with regard to neurologic outcome. METHODS: We performed a prospective study of patients undergoing repairs of acute type A aortic dissection. Repairs included profound hypothermic circulatory arrest and retrograde cerebral perfusion. Patients in whom transcranial Doppler monitoring was used to monitor cerebral blood flow and modify operative technique during repair (study group) were compared with those without monitoring and modification (control group). RESULTS: Between September 2001 and October 2003, we repaired 56 cases of acute type A dissection. Power M-mode transcranial Doppler monitoring was used in 50% (28/56) of cases. Power M-mode transcranial Doppler monitoring altered operative cannulation and guided retrograde cerebral perfusion flow in 28.5% (8/28) and 78.6% (22/28) of cases, respectively. Two patients presented with preoperative stroke, one in each group. One operative death occurred in each group. In-hospital mortality and the occurrence of new stroke were not significantly different between the 2 groups. Temporary neurologic dysfunction occurred less often in the study group (14.8% [4/27] vs 51.8% [14/27], P = .008). CONCLUSIONS: Identification of cerebral malperfusion requires cerebral monitoring. By ensuring cerebral blood flow by using power M-mode transcranial Doppler monitoring and correcting cerebral malperfusion by modifying operative technique, neurologic outcome was improved during repairs of acute type A aortic dissection.

Acute Disease↗
PubMed2006

Marine monitoring: Its shortcomings and mismatch with the EU Water Framework Directive's objectives.

The main goal of the EU Water Framework Directive (WFD) is to achieve good ecological status across European surface waters by 2015 and as such, it offers the opportunity and thus the challenge to improve the protection of our coastal systems. It is the main example for Europe's increasing desire to conserve aquatic ecosystems. Ironically, since c. 1975 the increasing adoption of EU directives has been accompanied by a decreasing interest of, for example, the Dutch government to assess the quality of its coastal and marine ecosystems. The surveillance and monitoring started in NL in 1971 has declined since the 1980s resulting in a 35% reduction of sampling stations. Given this and interruptions the remaining data series is considered to be insufficient for purposes other than trend analysis and compliance. The Dutch marine managers have apparently chosen a minimal (cost-effective) approach despite the WFD implicitly requiring the incorporation of the system's 'ecological complexity' in indices used to evaluate the ecological status of highly variable systems such as transitional and coastal waters. These indices should include both the community structure and system functioning and to make this really cost-effective a new monitoring strategy is required with a tailor-made programme. Since the adoption of the WFD in 2000 and the launching of the European Marine Strategy in 2002 (and the recently proposed Marine Framework Directive) we suggest reviewing national monitoring programmes in order to integrate water quality monitoring and biological monitoring and change from 'station oriented monitoring' to 'basin or system oriented monitoring' in combination with specific 'cause-effect' studies for highly dynamic coastal systems. Progress will be made if the collected information is integrated and aggregated in valuable tools such as structure- and functioning-oriented computer simulation models and Decision Support Systems. The development of ecological indices integrating community structure and system functioning, such as in Ecological Network Analysis, are proposed to meet a cost-effective approach at the national level and full assessment of the ecosystem status at the EU level. The WFD offers the opportunity to re-consider and re-invest in environmental research and monitoring. Using examples from the Netherlands and, to a lesser extent, the United Kingdom, the present paper therefore reviews marine monitoring and marine environmental research in combination and in the light of such major policy initiatives such as the WFD.

Animals↗
PubMed2005

Very high survival among patients defibrillated at an early stage after in-hospital ventricular fibrillation on wards with and without monitoring facilities.

BACKGROUND: The association between the interval between collapse and defibrillation and outcome is well described in out of hospital cardiac arrest but not as well in in-hospital cardiac arrest. We report the outcome among patients who suffered an in-hospital cardiac arrest and were found in ventricular fibrillation (VF) with the emphasis on the delay to defibrillation. METHODS AND RESULTS: In patients who suffered an in-hospital cardiac arrest at Sahlgrenska University Hospital in Göteborg between 1994 and 2002 there were 1.570 calls for the rescue team of which 71% had suffered a cardiac arrest. Among cardiac arrests 47% took place on monitored wards. The proportion of patients found in VF was 59% on wards with monitoring facilities and 45% on wards without (p<0.0001). Approximately 90% of these patients were defibrillated 12 min. On monitored wards, the survival was 63% if defibrillated 3 min after collapse (NS). The corresponding values for non-monitored wards were 72% and 35%, respectively (p=0.0003). Cerebral function among survivors at discharge appeared to be good among the majority of patients both in monitored and non monitored wards. CONCLUSION: If patients with in hospital VF were defibrillated early in both monitored and non monitored wards survival to hospital discharge was high. This highlights the importance of being prepared for the rapid defibrillation on wards without monitoring facilities.

Aged↗