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At least 883 records · Page 49Linked to original sources
PubMed2003

[Application of non-invasive hemodynamic monitoring on high-risk surgical patients in the early stages after emergency admission].

OBJECTIVE: Pulmonary artery (PA) catheterization monitoring (Swan-Ganz) is usually not available to critically high-risk surgical patients before admission to ICU, where action to correct values derived from such monitoring may be too late. To explored the effect of non-invasive monitoring systems that allow hemodynamic monitoring during the early stages after trauma. METHODS: The early temporal hemodynamic patterns after high-risk trauma with non-invasive monitoring systems were evaluated, and compared these to invasive PA monitoring. The study included 156 patients monitored shortly after admission to the emergency department. RESULTS: The non-invasive impedance cardiac output estimations under extenuating emergency conditions were similar to those of the thermodilution method: r=0.69, r(2)=0.87, P<0.001; bias and precision were (0.62+/-0.38)L. min(-1).m(-2). In ICU, these values improved further to: r=0.84, r(2)=0.93, P<0.001; bias and precision were (0.36+/-0.15) L.min(-1).m(-2). Monitoring revealed episodes of hypotension, low cardiac index, arterial hemoglobin desaturation, low transcutaneous oxygen and high transcutaneous carbon dioxide tension, and low oxygen consumption during initial resuscitation. Low flow and poor tissue perfusion were more pronounced in non-survivors by both METHODS. CONCLUSION: Multicomponent non-invasive monitoring systems offer continuous on-line, real-time display of hemodynamic data, they allow early recognition of circulatory dysfunction. Such systems provide information similar to that provided by the invasive thermodilution method, and are more effective and safer.

Adult↗
PubMed2004

Blood glucose self-monitoring in non-insulin-treated type 2 diabetes: a qualitative study of patients' perspectives.

BACKGROUND: Self-monitoring of blood glucose is controversial in the management of type 2 diabetes. Some research suggests that self-monitoring improves glycaemic control, whereas other research is sceptical about its value for people with type 2 diabetes who are not on insulin. Although blood glucose meters are widely available and used by this group, patients' own views are absent from the debate. AIM: To explore the pros and cons of glucose monitoring from the patients' perspectives. DESIGN OF STUDY: Qualitative repeat-interview study. SETTING: Patients were recruited from 16 general practices and three hospital clinics within four local healthcare cooperatives in Lothian, Scotland. METHOD: Interview data from 40 patients diagnosed with type 2 diabetes within the previous 6 months were analysed using thematic analysis informed by grounded theory. We report findings from round 1 and round 2 interviews. RESULTS: Glucose monitoring can heighten patients' awareness of the impact of lifestyle; for example, dietary choices, on blood glucose levels. Glucose monitoring amplifies a sense of 'success' or 'failure' about self-management, often resulting in anxiety and self-blame if glucose readings remain consistently high. Moreover, monitoring can negatively effect patients' self-management when readings are counter-intuitive. CONCLUSION: Our analysis highlights the importance of understanding the meanings that newly diagnosed patients attach to glucose self-monitoring. To maximise the positive effects of self-monitoring, health professionals should ensure that patients understand the purpose of monitoring and should clarify with patients how readings should be interpreted.

Adult↗
PubMed2006

Monitoring of drugs with a narrow therapeutic range in ambulatory care.

OBJECTIVES: To describe the proportion of patients receiving drugs with a narrow therapeutic range who lacked serum drug concentration monitoring during a 1-year period of therapy and to identify patient characteristics associated with lack of monitoring. STUDY DESIGN: Retrospective cohort. METHODS: Ambulatory patients (n = 17,748) at 10 health maintenance organizations who were receiving ongoing continuous drug therapy with digoxin, carbamazepine, divalproex sodium, lithium carbonate, lithium citrate, phenobarbital sodium, phenytoin, phenytoin sodium, primidone, quinidine gluconate, quinidine sulfate, procainamide hydrochloride, theophylline, theophylline sodium glycinate, tacrolimus, or cyclosporine for at least 12 months between January 1, 1999, and June 30, 2001, were identified. Serum drug concentration monitoring was assessed from administrative data and from medical record data. RESULTS: Fifty percent or more of patients receiving digoxin, theophylline, procainamide, quinidine, or primidone were not monitored, and 25% to 50% of patients receiving divalproex, carbamazepine, phenobarbital, phenytoin, or tacrolimus were not monitored. Younger age was associated with lack of monitoring for patients prescribed digoxin (adjusted odds ratio, 1.86; 95% confidence interval, 1.39-2.48) and theophylline (adjusted odds ratio, 1.58; 95% confidence interval, 1.23-2.04), while older age was associated with lack of monitoring for patients prescribed carbamazepine (adjusted odds ratio, 0.59; 95% confidence interval, 0.44-0.80) and divalproex (adjusted odds ratio, 0.50; 95% confidence interval, 0.38-0.66). Patients with fewer outpatient visits were also less likely to be monitored (P < .001). CONCLUSIONS: A substantial proportion of ambulatory patients receiving drugs with narrow intervals between doses resulting in beneficial and adverse effects did not have serum drug concentration monitoring during 1 year of use. Clinical implications of this finding need to be evaluated.

Ambulatory Care↗
PubMedDate not supplied

New technology for noninvasive brain monitoring: continuous cerebral oximetry.

Although the central nervous system is the primary endpoint of most general anesthetics, it is still the least monitored organ in clinical anesthesiology. In the last decade, technological research has expanded the application of near-infrared spectroscopy to allow continuous, non-invasive, and bedside monitoring of cerebral oxygen saturation (rSO(2)) through the scalp and skull, providing accurate information on the balance between brain oxygen supply and demand. The aim of this review is to provide an overview on relevant technological issues of cerebral oximetry, describe a systematic approach to its use, and summarize current information on its possible impact on our daily practice. We reviewed studies published on peer-reviewed journals about technological development and clinical application of rSO(2) monitoring in different fields of application to clinical practice. Due to the wide patient-to-patient variability of baseline rSO(2) values in each patient the baseline value should be determined before inducing general anesthesia, and cerebral ischemia is related more to the changes from baseline than to the absolute value: a reduction of 20% from baseline is usually accepted as clinical threshold of cerebral ischemia. If baseline rSO(2) is lower than 50% the critical threshold should be reduced to 15%. Routine use of rSO(2) monitoring in patients undergoing cardiac surgery to guide the anesthesia plan has been demonstrated to improve patient outcome and shorten hospital stay. However, rSO(2) monitoring does not seem to provide information accurate enough to indicate the placement of a Javid's shunt during carotid endarterectomy. In patients with neurological pathology or head trauma rSO(2) monitoring has been reported accurate enough in detecting early changes in cerebral blood flow that might result in cerebral ischemia. In aged patients undergoing major abdominal surgery rSO(2) monitoring to guide the anesthesia plan has been reported to reduce the exposition to cerebral ischemia with less effects on cognitive decline and shorter hospital stay. In conclusion several clinical conditions routinely encountered in our daily practice have the potential to disrupt the balance between the brain oxygen supply and demand, exposing to the risk of intraoperative cerebral ischemia. These alterations in brain oxygen balance remain totally undiagnosed if we do not specifically monitor it; while the possibility of monitoring regional cerebral oxygen saturation through a simple and totally non-invasive device has the potential for optimizing our anesthesia plan to the real needs of our main targeted organ: the brain.

Brain Chemistry↗
PubMed1991

[Intraoperative monitoring with evoked potentials in spinal interventions].

This review article delineates the physiology and methodological principles of somatosensory (SEP) and motor evoked potentials (MEP), as well as our own results in 40 patients monitored during spinal surgery. In 29 patients an intraoperative SEP and in 15 patients a MEP monitoring was performed. Both modalities were applied in 4 patients. 19 patients had an intramedullary tumor, 15 patients had an intradural extramedullary tumor, 4 patients had an extradural mass lesion, and 2 patients had a spinal arteriovenous malformation. Technical problems with SEP monitoring occurred in 3 of 29 cases, problems with MEP monitoring occurred in 4 of 15 cases. Whereas anesthesia showed only little influence on SEP, an appropriate anesthesiological management was of major importance for MEP monitoring. Other factors, e.g. body temperature and blood pressure, also affected the evoked potentials. In all 35 patients in whom intraoperative SEP and/or MEP monitoring was successfully performed, evoked potentials showed a clear correlation with the initial postoperative neurological findings i.e. there were only cases of correct positive or correct negative monitoring. Transient evoked potential changes could always be attributed to surgical maneuvers. Our results show that intraoperative spinal cord monitoring with both SEP and MEP can supply helpful information on neural integrity. The choice of the evoked potential modality to be used and the choice of the sites of stimulation and recording depends on individual pathoanatomical findings and on the operative procedure required. Intraoperative evoked potential monitoring is indispensable during high risk spinal surgery such as surgery for intramedullary tumor or for mass lesions above C5.

Afferent Pathways↗
PubMed1990

Patient attitude toward home uterine activity monitoring.

Forty private patients using a home uterine activity monitoring system and daily contact with nursing staff (Term Guard monitor and Tokos Perinatal Nursing Service; Tokos Medical Corp., Santa Ana, CA) were surveyed after delivery. Twenty-seven responses (67.5%) were obtained. The majority of the responding patients (81%) felt that the monitor helped their pregnancy and 92% would recommend it to family and friends. Eighty-five percent thought that the monitor and related nursing services would be something that they would use in future pregnancies. No subject concluded that the monitor depersonalized their obstetric care. Forty-one percent of the patients felt that the device was an intrusion into their life-style. Seventy-eight percent thought that the device was beneficial in their understanding of preterm labor and in learning to perceive their own baseline uterine activity. Almost 60% of the subjects noted that the monitor was useful in determining uterine activity because they did not perceive any contractions. Approximately 65% felt that unnecessary trips to the hospital for prolonged monitoring were prevented by the availability of 24-hour-a-day, 7-day-a-week emergency transmission and nurse contact. Nearly three-fourths of the patients felt that unnecessary calls to the physician were prevented by their ability to monitor. In summary, the services were well accepted by the patients and, despite the intrusion into their life-style, most felt that home uterine activity monitoring improved the outcome of their pregnancy.

Attitude to Health↗
PubMed1989

Bridging the gap between hemodynamics and monitoring.

Hurst states that "hemodynamic monitoring is a complement of, rather than a replacement for, clinical judgment." Holder explains that "hemodynamic parameters add sufficient clarity for physicians to a difficult patient management problem." However, it is nursing which must bring clarity to the parameters. It is the nurse who must be ever-vigilant and strive for excellence in invasive hemodynamic monitoring of critically ill patients--as the caregiver who is with the patient 24 hours a day, 7 days a week. Effective hemodynamic monitoring starts with an understanding of the hemodynamic mechanisms that monitoring aims to measure. Then, measuring the hemodynamic mechanisms requires technical expertise to provide accurate parameters from the monitoring equipment. Lastly, an appreciation for the risks and benefits, together with patient responses to being monitored, helps the nurse evaluate the contribution invasive hemodynamic monitoring has on patient outcomes. Nurses who couple knowledge of cardiovascular physiology, technical expertise, and thorough assessment and diagnosis of patient responses to hemodynamic instability and invasive monitoring bring the essence of holistic nursing care to hemodynamic monitoring.

Hemodynamics↗
PubMed1988

Evaluation of serum phenytoin monitoring in an acute care setting.

Serum phenytoin monitoring is frequently used in the management of epileptic patients because phenytoin has a narrow therapeutic index and exhibits nonlinear pharmacokinetics. This study prospectively evaluated serum phenytoin monitoring in an acute care teaching hospital. Two sets of criteria were established a priori to define (a) appropriate selection of patients with regard to serum phenytoin monitoring, and (b) inappropriate serum phenytoin determinations (SPDs). Eighty patients receiving phenytoin were studied, of whom 58 (72.5%) were appropriately selected. These included 35 patients (43.8%) for whom monitoring was indicated and was performed, and 23 patients (28.7%) for whom monitoring was not indicated and was not performed. There were 39 patients with no indications for serum phenytoin monitoring; however, 16 (41%) of them were monitored. A total of 113 SPDs were performed, of which 83 (73.5%) were deemed to be inappropriate. Seventy percent of SPDs resulted in phenytoin concentrations outside the usual therapeutic range (10-20 micrograms/ml). Overall, physicians appropriately selected patients with regard to serum phenytoin monitoring; however, when inappropriate selection did occur, it tended to involve monitoring of patients who did not require it. The majority of SPDs performed were deemed to be inappropriate, since they were done too soon after admission or a change in therapy to reliably indicate steady-state serum concentrations.

Acute Disease↗
PubMedDate not supplied

Monitoring the anesthetized patient in the operating room.

In general, monitors used by the anesthesiologist in the operating room provide three basic functions: assessment of machine and patient status to ensure safety; assessment of depth of anesthesia; and determination of physiologic variables. Improved monitoring should reduce risk and improve patient care. Some monitoring techniques are used in only a few specialized procedures, particularly in high-risk patients or for prolonged or difficult surgery. However, many less-sophisticated techniques are used in routine daily practice and require similar philosophies of monitoring. The status of the cardiovascular system is assessed primarily by monitoring the electrocardiogram and blood pressure waveforms. Although desired effects of anesthesia impact the central nervous system, this vital organ system is not routinely monitored. Likewise, widespread monitoring of the respiratory system is not routinely accomplished. Monitoring for anesthesia in the operating room has evolved to some extent in response to what can be accomplished rather than what needs to be done. While the potential for an integrated monitoring system--including all patient and delivery system variables--clearly exists, numerous difficulties preclude its becoming a reality. What is required is the development of an integrated system that can augment the anesthesiologist's sixth sense. Initial efforts toward device interface standardization, configurability, and flexibility must be encouraged to pave the way for the integrated, automated anesthesia delivery system of the future.

Anesthesia↗
PubMed1995

Efficacy of intraoperative neurophysiological monitoring.

Intraoperative neurophysiological monitoring is of benefit in protecting tissue at risk for trauma or ischemia during surgical procedures. Monitoring modalities include EEG, computer processed EEG, somatosensory (SEP), auditory (BAEP), and visual evoked potentials (VEP), and cranial nerve monitoring. The efficacy of monitoring is controversial, because no properly controlled prospective study of outcome with and without monitoring has been done. The weight of evidence suggests that loss of spontaneous EEG and SEP correlate well with critical reductions of cerebral blood flow. Meta-analysis of series comprising 3,028 patients undergoing carotid endarterectomies shows that SEP deteriorated in 5.6% of cases, with 20% of these having postoperative deficits, but more might have had deficits if they had not been shunted. SEP monitoring can be useful in surgery affecting brain and cord vasculature. Monitoring is not indicated for routine lumbosacral spine surgery. BAEPs have predictive value for preservation of hearing after acoustic neuroma surgery, and other surgery near the brainstem. VEPs have been too variable to be of major use in the operating room. For neurophysiologic monitoring to be useful, it must be performed by an experienced team, and the surgeon must be willing to act on the findings. Under these circumstances, monitoring can reduce surgical complications in selected cases.

Brain↗
PubMed1996

Model of multiple exposure to contaminants in monitoring the environmental impact on population health.

The model study is focused on possibilities of comprehensive evaluation of the multiple exposure of humans to selected inorganic contaminants (arsenic, cadmium, lead, zinc) monitored within the subsystems of the monitoring the environmental impact on population health (inhalation and ingestion exposure from air, drinking water and foodstuffs and biological monitoring). The mean daily intake of contaminants of average adults is assessed using the monitoring and literature data. The exposure balance showed that the total intake of individual contaminants studied did not exceed the limit values given by the exposure standards (acceptable daily intake). The highest value of exposure reaching 28% of the limit was reported for cadmium. The prevailing pathway of exposure is ingestion of foodstuffs: more than 95% in all contaminants under study. Information on the intake of contaminants is used as input in a linear multicompartmental model describing their kinetics and retention in the human organism. The results of the model computation are compared with the laboratory data obtained in the biological monitoring of adult urine. The model and monitoring sets of results were found to conform well for cadmium and zinc. For arsenic and lead the model values are roughly one order of magnitude lower than the monitored ones which should be considered as acceptable for the model studies of this type. The model study of contaminant monitoring data processing and evaluation suggests further applications of health risk assessment representing one of the basic outputs of monitoring the environmental impact on population health.

Adult↗
PubMed1997

Effect of a monitored care unit on resource utilization in a pediatric ICU.

OBJECTIVE: To determine the effect of a monitored care unit on resource utilization in a pediatric ICU. METHODS: The study was done at a 205-bed pediatric medical center located in northern California. Efficiency of resource utilization in the pediatric ICU was evaluated by comparing the following factors before and after the implementation of a monitored care unit: (1) efficiency in the pediatric ICU, (2) number of patients turned away for lack of beds, (3) hours of nursing care per patient day, and (4) cost (as estimated from charge ratios) in the monitored care unit for care of patients admitted because of some common reasons. RESULTS: Efficiency in the pediatric ICU increased significantly after implementation of a monitored care unit. The number of patients not admitted to the pediatric ICU because not enough beds were available was identical before and after establishment of the monitored care unit. After the monitored care unit was established, hours of nursing care per patient day were significantly reduced, enabling the number of patient days to be increased without increasing cost. In addition, cost comparisons showed a decrease in both length of stay and total cost per admission for patients undergoing ventriculoperitoneal shunt revision and lambdoidal suture synostectomy. CONCLUSIONS: Use of beds in the pediatric ICU was more efficient when a high-observation setting was available for low-risk monitored patients. Key differences in patterns of use were observed. Compared with the pediatric ICU, the monitored care unit requires fewer personnel and less expensive equipment and supplies, but it still allows potentially life-threatening complications to be recognized and treated. For patients who meet its admission criteria, the monitored care unit is a safe alternative to the pediatric ICU.

Adolescent↗
PubMed2003

Urethral wash cytopathology for monitoring patients after cystoprostatectomy with urinary diversion.

BACKGROUND: Urethral wash cytopathology (UWC) has been recommended for monitoring patients after cystoprostatectomy with preservation of the penile urethra and urinary diversion. The rationale has been that early detection of urethral neoplasms (recurrences) would allow for urethrectomy to be performed before an invasive tumor developed and thus prevent or delay disease progression. Negative results of UWC would spare the patient a major surgical procedure. The authors analyzed the clinical and pathologic records of patients undergoing cystoprostatectomy with urinary diversion and preservation of the penile urethra to determine the cytohistologic correlations and to document the effect of UWC monitoring on the rate of disease progression. METHODS: All cases of men undergoing a cystoprostatectomy with urinary diversion and preservation of the penile urethra over a 12-year period at the study institution were included. Records were reviewed to determine the degree of risk associated with the pathologic findings at surgery and to document the presence or absence of disease progression for each individual. The pathologic specimens of all cases monitored with UWC were reviewed separately by both authors to establish cytohistologic correlations. Standard statistical methods were applied. RESULTS: Of 176 patients, urethral recurrence and disease progression occurred in both high-risk and low-risk groups. Among the 48 individuals monitored with UWC, 13 had a positive diagnosis, and 10 of these 13 had been subsequently treated with urethrectomy. Among 128 patients not monitored with UWC, 16 underwent urethrectomy. Patients in both groups had recurrent urethral neoplasms. Most lesions were focal carcinomas in situ occupying the paraurethral glands. One individual in each group had no further disease progression, even though the urethral tumor was invasive. Urethrectomy was found to have no statistically significant association with the rate of disease progression, regardless of whether the procedure resulted from a positive UWC or was provoked by patient/clinician concern. When groups were compared on the basis of monitoring with UWC, there was no statistical difference in the rate of disease progression between those monitored with UWC and those who were not. Within the monitored group, however, the cytopathologic interpretations of UWC were statistically significant; patients with positive findings were found to have the highest rate of disease progression, and those with negative findings experienced the lowest (P < 0.04). CONCLUSIONS: Both monitoring with UWC and urethrectomy might benefit selected individuals, but neither method appeared to have a statistically significant effect on disease progression in a nonrandomized group of patients. A positive UWC was associated with a high likelihood of disease progression and could justify more intensive follow-up for progressive disease at other sites.

Adult↗
PubMed2003

Short-term event recording as a measure to rule out false alarms and to shorten the duration of home monitoring in infants.

Apnea and cardiorespiratory home monitors are commonly used for electronic surveillance of infants. Frequent alarms can be very stressful for parents and lead to unnecessarily prolonged home monitoring. The aims of this study were to determine the frequency and type of significant events by using short-term home event recordings of respiratory, electrocardiogram and oxygenation patterns, to consider the pros and cons of oxygenation recording, to correlate the findings with observations made by parents and to find out whether parents could be reassured by the use of these monitors. We investigated recordings from 26 healthy symptomless infants (14 male, 12 female) whose parents experienced anxiety and stress owing to frequent alarms on their apnea (n = 2) or cardiorespiratory home monitors (n = 24). 770 events were analyzed and compared with the parents' interpretation. Median duration of monitoring was 10 days. Only 39/770 alarms (5.1%) were classified as true alarms. Of these, 30 alarms (76.9%) were misinterpreted as false alarms by parents. In contrast, of 218 alarms regarded as true by parents only 15 (6.9%) were in fact true, alarms. The comparison of monitor data and the parents' reports showed no correlation in interpretation of alarms, for both true (r = 0.06) and false alarms (r = -0.09). Of 283 oxygenation alarms, only two were due to real desaturation. Following short-term monitoring, 21/26 parents (80.7%) declared they were reassured. Monitoring could immediately be discontinued in 17/26 infants (65.4%). Short-term event recording can clarify the significance of frequent alarms, reassure parents and shorten the duration of home monitoring.

Cost of Illness↗
PubMed1999

Establishing a Regional Monitoring Strategy: The Pacific Northwest Forest Plan.

/ This paper identifies lessons learned and issues raised during the development of an ecosystem monitoring strategy intended to support the Northwest Forest Plan. Adaptive ecosystem management, which requires monitoring as essential feedback to management, recognizes that action is necessary or appropriate, although knowledge may be imperfect. We suggest that this principle be explicitly acknowledged in the design of monitoring programs, and we coin the term adaptive monitoring design. Adaptive monitoring design is an iterative process that refines the specifications for monitoring over time as a result of experience in implementing a monitoring program, assessing results, and interacting with users. An adaptive design therefore facilitates ecosystem management. We also discuss lessons of temporal and spatial scales raised by the consideration of a design for ecosystem management. Three additional issues-integration of information from different sources, institutional infrastructure, and the roles of individuals working in an interagency setting-are also identified, but not developed in detail. KEY WORDS: Northwest Forest Plan; Monitoring; Ecosystem management; Adaptive management; Adaptive monitoring

Journal Article↗
PubMed2000

Monitoring Diffuse Impacts: Australian Tourism Developments.

/ The scientific quality of monitoring for diffuse environmental impacts has rarely been quantified. This paper presents an analysis of all formal environmental monitoring programs for Australian tourism developments over a 15-year period from 1980 to 1995. The tourism sector provides a good test bed for this study because tourism developments are (1) often adjacent to or even within conservation reserves and other relatively undisturbed natural environments, and (2) often clustered, with resulting cumulative impacts that require detection at an early stage. Here we analyze the precision and reliability with which monitoring programs as actually implemented can detect diffuse environmental impacts against natural variation. Of 175 Australian tourism developments subject to EIA from 1980 to 1993 inclusive, only 13 were subject to formal monitoring. Only 44 individual parameters, in total, were monitored for all these developments together. No baseline monitoring was conducted for nine of the 44 parameters. For the remaining 35, only one was monitored for a full year. Before, after, control, impact, paired sampling (BACIP) monitoring designs were used for 24 of the 44 parameters, and power analysis in 10. The scientific quality of monitoring was significantly better for developments subject to control by the Great Barrier Reef Marine Park Authority (GBRMPA). The key factor appears to be the way in which GBRMPA uses external referees and manages external consultants. The GBRMPA model merits wider adoption.

Journal Article↗
PubMed2005

The influence of liquid crystal display (LCD) monitors on observer performance for the detection of nodular lesions on chest radiographs.

PURPOSE: To access the influence of liquid crystal display (LCD) monitors on the detectability of nodular lesions depicted on chest radiographs by comparing them with a high-resolution cathode ray tube (CRT) monitor. MATERIAL AND METHODS: Ten radiologists interpreted 247 soft-copy images on LCD monitors with pixel arrays of 1,024x1,280, 1,200x1,600, 1,536x2,048 and 2,048x2,560, and a CRT monitor with a pixel array of 2,048x2,560, and were asked to indicate their individual confidence levels regarding the presence of a nodule. These images were chest radiographs with and without a lung nodule from the "Standard Digital Image Database" created by the Japanese Society of Radiological Technology. The luminance distributions of all monitors were adjusted to the same, and the ambient illumination was 200 lux. Observer performance was analyzed in terms of the receiver-operating characteristics. RESULTS: No significant statistical differences in nodule detection performance were found among the four LCD monitors and the CRT monitor. CONCLUSION: The nodule detection performance on the LCD monitors with a spatial resolution higher than a matrix size of 1,024x1,280 was found to be equivalent to that on the high-resolution CRT monitor.

Analysis of Variance↗
PubMed2004

Does postoperative pH monitoring predict complicated gastroesophageal reflux in patients with esophageal atresia?

Gastroesophageal reflux (GER) is common after repair of esophageal atresia with a distal tracheoesophageal fistula (EATOF). In a retrospective study we assessed whether early 18-h pH monitoring can predict the development of EATOF-associated gastroesophageal reflux. During 1980-1997, 90 consecutive patients had primary repair for EATOF. Development of GER was classified as favorable if the patient developed no esophagitis or mild esophagitis and needed no antireflux medication, and as unfavorable if the patient developed moderate or secondary esophagitis or required an antireflux procedure. Patients who developed unfavorable GER outcome before pH monitoring or needed secondary reconstruction or those whose endoscopic follow-up data were insufficient were excluded. Eighteen-hour pH monitoring was considered pathologic if esophageal pH was <4 more than 10% of the recorded time or 5% of the recorded time minus 2 h after each meal, or if there were more than three preprandial reflux periods lasting longer than 5 min. A total of fifty patients were included into the study. pH monitoring was performed at the median age of 9.2 (range 2.5-95.0) months and classified as pathologic in 10 and normal in 40 patients. After a median follow-up of 59 (0.3-217.6) months, nine of 10 (90%) patients with pathologic pH monitoring and five of 40 (12.5%) patients with normal pH monitoring developed unfavorable outcomes ( p<.05). We conclude that early pH monitoring predicts the development of significant GER, but because 12.5% of patients with normal early pH monitoring also developed significant GER, early pH monitoring alone does not rule out the development of significant GER.

Adolescent↗