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PubMed2005

Monthly access flow monitoring with increased prophylactic angioplasty did not improve fistula patency.

BACKGROUND: Regular access monitoring is recommended to detect and treat access stenosis in order to prevent access thrombosis and failure. METHODS: In 1999, we instituted monthly access blood flow monitoring using the ultrasound dilution technique (UDT). In a sequential observational trial, 222 patients were studied for the impact of UDT monitoring on patency of their first arteriovenous autogenous fistula. Group 1, the historic group (before 1999), had 146 arteriovenous fistulas (50.7% upper arm), followed for 259 access-years. Group 2, the UDT-monitored group, had 76 arteriovenous fistulas (60.5% upper arm), followed for 123 access-years. Decision to refer for angiography was based on clinical criteria for group 1, and clinical criteria plus results of UDT flow monitoring in group 2. RESULTS: Cumulative patency was longer (P < 0.01) and the thrombosis rate was lower (P < 0.05) in group 2. However, the improvement occurred prior to initiation of UDT flow monitoring. Comparing outcomes in group 2 patients whose fistula survived to start flow monitoring with group 1 patients whose fistula survived at least 160 days (the median time to starting UDT monitoring in group 2), there was a sevenfold increase in angioplasty procedures (0.67 vs. 0.09 per access-year) but no improvement in the thrombosis rate or cumulative fistula patency. CONCLUSION: UDT monitoring increased the rate of angioplasty procedures and thereby shortened primary unassisted patency, but did not decrease the thrombosis rate or improve cumulative fistula patency.

Angioplasty↗
PubMed2000

Modeling photon output caused by backscattered radiation into the monitor chamber from collimator jaws using a Monte Carlo technique.

Dose per monitor unit in photon fields generated by clinical linear accelerators can be affected by the backscattered radiation into the monitor chamber from collimator jaws. Thus, it is necessary to account for the backscattered radiation in computing monitor unit setting for a treatment field. In this work, we investigated effects of the backscatter from collimator jaws based on Monte Carlo simulations of a clinical linear accelerator. The backscattered radiation scored within the monitor chamber was identified as originating either from the upper jaws (Y jaws), or from the lower jaws (X jaws). From the results of Monte Carlo simulations, ratios of the monitor-chamber-scored dose caused by the backscatter to the dose caused by the forward radiation, R(x,y), were modeled as functions of the individual X and Y jaw positions. The amount of the backscattered radiation for any field setting was then computed as a compound contribution from both the X and Y jaws. The dose ratios of R(x,y) were then used to calculate the change in photon output caused by the backscatter, Scb(x,y). Results of these calculations were compared with available measured data based on counting the electron pulses or charge from the electron target of an accelerator. Data from this study showed that the backscattered radiation contributes approximately 3% to the monitor-chamber-scored dose. A majority of the backscattered radiation comes from the upper jaws, which are located closer to the monitor chamber. The amount of the backscatter decreases approximately in a linear fashion with the jaw opening. This results in about a 2% increase of photon output from a 10 cm x 10 cm field to a 40 cm x 40 cm field. The off-axis location of the jaw opening does not have a significant effect on the magnitude of the backscatter. The backscatter effect is significant for monitor chambers using kapton windows, particularly for treatment fields using moving jaws. Applying the backscatter correction improves the accuracy of monitor-unit calculation using a model-based dose calculation algorithm such as the convolution method.

Algorithms↗
PubMed2004

Detectability of catheters on bedside chest radiographs: comparison between liquid crystal display and high-resolution cathode-ray tube monitors.

PURPOSE: To compare observer performance with a flat-panel liquid crystal display (LCD) monitor and with a high-resolution gray-scale cathode-ray tube (CRT) monitor in the detection of simulated support catheters on bedside chest radiographs. MATERIALS AND METHODS: The ethics committee did not require approval or patient informed consent when this study began. Because of a change in regulations, before images were acquired the nature of the study and procedures were explained to patients or their relatives, and consent was then obtained. A total of 131 catheter fragments (12-14 per radiograph) were superimposed over 10 anteroposterior bedside chest radiographs obtained with storage phosphor technology. Images were displayed on an LCD monitor (1536 x 2048 matrix) and a CRT monitor (2048 x 2560 matrix). Five radiologists independently located the catheter fragments and rated their confidence in detection with bright and subdued ambient light. A two-way analysis of variance and the Friedman test were used for statistical analysis. RESULTS: There was no significant difference for either display type with respect to correctly detected catheter fragments (mean sensitivity, 56.6% and 56.0% for the CRT and the LCD monitors, respectively, with bright light and 61.2% for both monitors with subdued light). With both display types, detection rate with bright light decreased significantly (P < .05). False-positive rates and confidence ratings were not significantly affected by monitor type or ambient light. CONCLUSION: In a study with simulation of clinical conditions, performance of the LCD monitor and high-resolution CRT monitor for detection of support catheters on bedside chest radiographs was equivalent. With both displays, detection performance was equally reduced with bright ambient light.

Aged↗
PubMed1998

Subtle pulmonary abnormalities: detection on monitors with varying spatial resolutions and maximum luminance levels compared with detection on storage phosphor radiographic hard copies.

PURPOSE: The purpose of this receiver operating characteristic study was to compare diagnostic efficacy with images displayed on monitors of varying spatial resolutions and maximum luminance levels to that with storage phosphor radiographic hard copies. MATERIALS AND METHODS: Seven types of simulated lesions were superimposed onto an anthropomorphic chest phantom. Images were viewed by five radiologists on a 2,560 x 2,048 pixel monitor (maximum luminance, 75 foot-lamberts), on two 1,024 x 1,024 monitors with maximum luminance levels of 25 foot-lamberts and 75 foot-lamberts, respectively, as well as on hard copies. Monitor images were viewed both without and with systematic magnification. RESULTS: Overall visualization of the lesions was best on hard copies, but visualization on the 2,560 x 2,048 monitor was not found to be substantially different. Lines, reticular opacifications, and catheters were found to be particularly poorly visualized with the 1,024 x 1,024 monitor. These results could be statistically significantly improved only with a systematic magnification; however, this involved a considerable increase in viewing time. Observer performance was markedly inferior with the 1,024 x 1,024 monitor with the lower luminance. CONCLUSION: Diagnostic performance with a 1,024 x 1,024 monitor is statistically significantly inferior to that with hard copies. A statistically significant improvement can be achieved with a high-resolution 2,560 x 2,048 monitor with a maximum luminance of 75 foot-lamberts.

Angiography, Digital Subtraction↗
PubMed2006

Monitoring of alcohol and drugs under scrutiny: output and shortcomings.

A major focus of Dutch addiction policy is to improve the monitoring of substance use and addiction - which surveys and registrations are important for the monitoring of alcohol and drugs problems, and what information is generated or needs to be generated by these monitors? Three methods were used: an inventorisation of existing monitoring projects, a survey among experts in the field of alcohol and drugs to study the information needs, and a study on the output and shortcomings of the existing monitors. Sixty monitors and 13 'umbrella' monitors were found. Experts formulated the needs of 11 topics which were matched with the output of the monitors. Coverage of the nature and extent of use in general is good. Shortcomings apply to the use and accessibility of the monitors, as well as to their completeness, standardisation and content. Especially questions with respect to problem use, treatment demand/need of help and user careers cannot be answered sufficiently with the existing information.

Humans↗
PubMed2005

Telemetry monitoring during transport of low-risk chest pain patients from the emergency department: is it necessary?

BACKGROUND: Low-risk emergency department (ED) patients with chest pain (CP) are often transported by nurses to monitored beds on telemetry monitoring, diverting valuable resources from the ED and delaying transport. OBJECTIVES: To test the hypothesis that transporting low-risk CP patients off telemetry monitoring is safe. METHODS: This was a secondary analysis of a prospective, observational cohort of ED patients with low-risk chest pain (no active chest pain, normal or nondiagnostic electrocardiogram, normal initial troponin I) admitted to a non-intensive care unit monitored bed who were transported off telemetry monitor by nonclinical personnel. A protocol allowing transportation of low-risk CP patients off telemetry monitoring to a monitored bed was developed, and an ongoing daily log of patients transported off telemetry was maintained for the occurrence of any adverse events en route to the floor. Adverse events requiring treatment included dysrhythmias, hypotension, syncope, and cardiac arrest. The study population included patients who presented during September-October 2004, whose data were abstracted from the medical records using standardized methodology. A subset of 10% of the medical records were reviewed by a second investigator for interrater reliability. Death, syncope, resuscitation, and dysrhythmias during transport or immediately on arrival to the floor were the outcomes measured. Descriptive statistics and confidence intervals (CIs) were used in data analysis. RESULTS: During the study period, 425 patients had CP of potentially ischemic origin, of whom 322 (75.8%) were low risk and met the inclusion criteria and were transported off monitors. Their mean (+/-standard deviation) age was 58.3 (+/-16.0) years; 48.1% were female. During transport from the ED, there was no patient with any adverse events requiring treatment and there was no death (95% CI = 0% to 0.93%). CONCLUSIONS: Transportation of low-risk ED chest pain patients off telemetry monitoring by nonclinical personnel to the floor appears safe. This may reduce diversion of ED nurses from the ED, helping to alleviate nursing shortages.

Cardiac Catheterization↗
PubMed1993

Adherence to oral tamoxifen: a comparison of patient self-report, pill counts, and microelectronic monitoring.

PURPOSE: Recent innovations allow the integration of microelectronics into drug packaging, providing a continuous record of the interactions of the patient with the drug package. We hypothesized that adherence to oral tamoxifen, as measured by a pressure-activated microelectronic monitoring device, would be significantly discrepant from traditional measures of patient adherence, ie, patient self-report (SR) and pill counts (PCs). PATIENTS AND METHODS: Twenty-six patients receiving oral tamoxifen therapy were assessed by patient SR, PCs, and Medication Event Monitoring System (MEMS; Aprex Corp, Fremont, CA) microelectronic monitoring. A microprocessor in the MEMS cap recorded each opening as a presumptive dose, listing the date, time, and duration of opening for later retrieval on a microcomputer. Patients were not informed that their adherence was to be monitored electronically or that PCs would be performed. RESULTS: A total of 2,102 days (70.1 months) of tamoxifen therapy were monitored; patients were monitored for a mean of 2.92 months of tamoxifen therapy. SR adherence to oral tamoxifen was significantly higher than that suggested by either PCs (SR missed doses only v PC, P = .008) or MEMS adherence monitoring (SR missed doses only v MEMS missed doses only, P = .005; SR dosing-interval errors only v MEMS dosing-interval errors only, P < .0001; SR all dosing errors v MEMS all dosing errors, P < .0005). PC data also suggested significantly higher adherence rates than MEMS monitoring. CONCLUSION: Microelectronic adherence monitoring provides both confirmatory and complimentary data regarding adherence behavior, while also allowing for the evaluation of patterns of nonadherence. Patient SRs and PCs likely overestimate the degree to which patients adhere to their tamoxifen regimen.

Administration, Oral↗
PubMed1999

Evaluation of intraoperative nerve-monitoring during insertion of an iliosacral implant in an animal model.

BACKGROUND: The use of continuous electromyographic and somatosensory-evoked-potential monitoring systems has been advocated to assist in avoiding nerve-root injury during operations on the pelvic ring. More recently, it was suggested that stimulus-evoked electromyographic monitoring may further decrease the risk of iatrogenic nerve-root injury during posterior pelvic fixation by enabling the surgeon to determine the actual distance of an implant from a nerve root. The purpose of the current study was to evaluate the relative efficacy of these three methods of monitoring for minimizing the risk of neural injury during the placement of iliosacral implants. METHODS: While the function of the first sacral nerve root was monitored with the use of stimulus-evoked electromyographic, continuous electromyographic, and somatosensory-evoked-potential monitoring techniques, a 2.0-millimeter stainless-steel Kirschner wire was progressively inserted, guided by a high-speed computerized tomographic scanner, into the first sacral body of seventeen hemipelves in nine dogs. The end point was contact with the nerve as demonstrated by the computerized tomographic images. It was expected that this end point would be heralded by a burst of spontaneous electromyographic activity and an abnormal somatosensory-evoked-potential signal. Anatomical dissection at the completion of the study documented the final position of the Kirschner wire. RESULTS: Anatomical dissection demonstrated compression or penetration of the nerve root in sixteen of the seventeen specimens. A spontaneous burst of electromyographic activity was not recorded for any specimen on continuous electromyographic monitoring; this finding was significantly different from what had been expected (p<0.001). Because of technical problems, somatosensory evoked potentials could be recorded for only twelve hemipelves that had nerve-root compression or penetration, and abnormal somatosensory evoked potentials were recorded for only one of the twelve; this finding was significantly different from what had been expected (p<0.001). A total of 113 stimulus-evoked electromyographic data points were obtained. The correlation coefficient for the relationship between the current threshold recorded with stimulus-evoked electromyographic monitoring and the distance of the wire from the nerve was 0.801 (p<0.001). The actual measured current thresholds were of an observed proportion not different from what had been expected (p = 0.48). CONCLUSIONS: Continuous electromyographic and somatosensory-evoked-potential monitoring techniques failed to indicate contact with the nerve root reliably in this animal model. However, stimulus-evoked electromyographic monitoring consistently provided reliable information indicating the proximity of the implant to the nerve root.

Animals↗
PubMed2000

1K versus 2K monitor: a clinical alternative free-response receiver operating characteristic study of observer performance using pulmonary nodules.

OBJECTIVE: The aim of this study was to investigate whether and how observer performance in detecting pulmonary nodules is influenced by the use of 1K and 2K monitors with and without voluntary postprocessing. MATERIALS AND METHODS: The study was conducted with clinical digital chest radiographs of 48 patients. CT images of the same patient group served as the gold standard. Data on four different monitor conditions (1K overview, 2K overview, 1K with postprocessing, and 2K with postprocessing) were collected using a 6-point confidence-rating scale and interpreted with an alternative free-response receiver operating characteristic. RESULTS: When magnification and window settings were applied on the 1K monitor at the expense of an increased interpretation time, observer performance with the 1K monitor was not significantly different from that with the 2K monitor. A significant difference only occurred between the 1K monitor postprocessing condition and the 1K monitor overview condition. CONCLUSION: Considering diagnostic accuracy, the 1K monitor is sufficient for the detection of pulmonary nodules, provided that postprocessing options--especially magnification--are applied. Further comparative monitor studies on the detectability of other abnormalities (e.g., fine interstitial structures) need to be performed.

Adult↗
PubMed2002

Delays in defibrillation: influence of different monitoring techniques.

BACKGROUND: Rapid defibrillation is the most important intervention required for a patient in cardiac arrest due to ventricular fibrillation or ventricular tachycardia. Isolated case reports of spurious asystole may have seen a change in practice, moving away from monitoring through defibrillator paddles and gel pads in favour of attaching electrocardiograph (ECG) leads for the initial monitoring of a collapsed patient. We surveyed current preferences for initial monitoring and estimated the difference in time taken to deliver the first shock with the following three monitoring techniques: defibrillator paddles and gel pads, ECG leads and hands-free adhesive pads. METHODS: Sixty Advanced Life Support (ALS) course directors, selected at random, were questioned to establish their current practice. Twenty ALS providers received 5 min revision in the three techniques for the initial monitoring of a collapsed patient and were then randomly tested to measure the time from confirmation of arrest to the first shock. RESULTS: Forty-two directors indicated their preferred methods for initial monitoring as 74% leads, 21% paddles and 5% hands-free adhesive pads. Before testing, 10 providers preferred paddles and 10 preferred leads. Monitoring through leads 54 (range 49-65) s was significantly slower than paddles 28 (24-31) s, P < 0.01 and adhesive pads 23 (19-27) s, P < 0.01. There was no significant difference in the time taken between paddles and adhesive pads. CONCLUSION: The current practice of monitoring through leads delays the time to deliver the first shock. We recommend that initial monitoring through leads be discontinued in favour of hands-free adhesive pads or defibrillator paddles/gel pads.

Electric Countershock↗
PubMed2003

Hysteroscopic removal of foreign bodies and its method of monitoring.

OBJECTIVE: To evaluate transcervical removal of foreign bodies (TCRF) and to estimate the effectiveness of its monitoring methods. METHODS: One hundred and thirteen women were identified as having residual intrauterine devices (IUD), residual pregnancy products, unabsorbed strings and broken hooks, which were not removed during routine curettage or IUD removal. All patients were monitored using B ultrasonography while TCRF was performed. Four cases were monitored by laparoscopy simultaneously. One case was monitored by laparoscopic ultrasonography. RESULTS: Foreign bodies of one hundred and nine patients were taken out by TCRF. Uterine bleeding, amenorrhoea, discharge, abdominal pain, micturition and hematuria disappeared postoperatively. Fetal bones embedded into intramural uterin in four cases were not removed completely. Of these four, one became pregnant 4 months later after TCRF and term delivered. One case encountered uterine perforation that was sutured by laparoscopy. CONCLUSIONS: TCRF is safe and efficient. Sufficient cervical canal distension, selection of equipment and methods to be used is important for successful TCRF. As a non-invasive and effective monitoring method, B ultrasonography is the first choice to monitor for TCRF. For patients with high risk factors for uterine perforation, laparoscopic monitoring should be done simultaneously. Laparoscopic ultrasonography monitoring has both the advantages of B ultrasonography and laparoscopy monitoring, but is invasive and expensive.

Adult↗
PubMed2005

Optimal frequency of CD4 cell count and HIV RNA monitoring prior to initiation of antiretroviral therapy in HIV-infected patients.

CONTEXT: Guidelines regarding the frequency of CD4 cell count and HIV RNA monitoring in HIV-infected patients vary, with recommended strategies ranging from every 2 to every 6 months. OBJECTIVE: To determine optimal CD4 cell count and HIV RNA monitoring frequency in HIV-infected patients prior to antiretroviral therapy initiation. DESIGN: Cost-effectiveness (CE) analysis using an HIV simulation model incorporating CD4 cell count and HIV RNA as immunological and virological predictors of clinical outcomes. SETTING: Hypothetical clinical setting. PATIENTS: Simulated cohort based on initial clinical presentation of HIV-infected patients in the US. INTERVENTION: CD4 cell count and HIV RNA monitoring at frequencies ranging from every 2 to 24 months prior to antiretroviral initiation, as well as accelerated monitoring frequencies as CD4 cell counts approach a specified treatment threshold. OUTCOME MEASURES: Life expectancy, quality-adjusted life expectancy and costs. RESULTS: For patients presenting with median CD4 cell count 546/mm3 and median HIV RNA 4.8 log10 copies/ml, incremental CE ratios ranged from US$37800/quality-adjusted life year (QALY) gained for a constant testing frequency of every 18 months compared with every 24 months, to US$303300/QALY gained for a constant testing frequency of every 2 months compared with every 4 months when starting treatment at a CD4 cell count of 350/mm3. Monitoring every 12 months until a warning CD4 cell count threshold of 450/mm3 followed by every 3 months until 350/mm3 had an incremental CE ratio of US$74700/QALY gained. When starting antiretroviral therapy at CD4 cell count 200/mm3, monitoring every 12 months until 300/mm3 followed by every 2 months until treatment initiation yielded an incremental CE ratio of US$52200/QALY gained compared with the next best strategy. Increasing monitoring frequency as CD4 cell counts approached a treatment threshold yielded greater incremental clinical benefit for less cost than strategies using a constant frequency. CONCLUSIONS: Monitoring HIV-infected patients every 12 months until 100 CD4 cells/mm3 prior to a specified treatment threshold followed by more frequent monitoring every 2 or 3 months until antiretroviral therapy initiation is both more effective and cost-effective than the current standard of care.

Anti-HIV Agents↗
PubMed2005

The immunization data quality audit: verifying the quality and consistency of immunization monitoring systems.

OBJECTIVE: To evaluate the consistency and quality of immunization monitoring systems in 27 countries during 2002-03 using standardized data quality audits (DQAs) that had been launched within the framework of the Global Alliance for Vaccines and Immunization. METHODS: The consistency of reporting systems was estimated by determining the proportion of third doses of diphtheria-tetanuspertussis (DTP-3) vaccine reported as being administered that could be verified by written documentation at health facilities and districts. The quality of monitoring systems was measured using quality indices for different components of the monitoring systems. These indices were applied to each level of the health service (health unit, district and national). FINDINGS: The proportion of verified DTP-3 doses was lower than 85% in 16 countries. Difficulties in verifying the doses administered often arose at the peripheral level of the health service, usually as the result of discrepancies in information between health units and their corresponding districts or because completed recording forms were not available from health units. All countries had weaknesses in their monitoring systems; these included the inconsistent use of monitoring charts; inadequate monitoring of vaccine stocks, injection supplies and adverse events; unsafe computer practices; and poor monitoring of completeness and timeliness of reporting. CONCLUSION: Inconsistencies in immunization data occur in many countries, hampering their ability to manage their immunization programmes. Countries should use these findings to strengthen monitoring systems so that data can reliably guide programme activities. The DQA is an innovative tool that provides a way to independently assess the quality of immunization monitoring systems at all levels of a health service and serves as a point of entry to make improvements. It provides a useful example for other global health initiatives.

Child↗
PubMed2006

Point-of-care International Normalised Ratios: UK NEQAS experience demonstrates necessity for proficiency testing of three different monitors.

External quality assessment (EQA) or proficiency testing is widely considered to be necessary for International Normalised Ratio (INR) determinations performed in conventional laboratory settings. There is increasing use of near-patient-test (NPT) or point-of-care (POC) INR devices and it is not known whether EQA is also necessary for these monitors. We report here on six years experience of proficiency testing for POC monitors used by health care professionals. Three devices were used by >10 centres who participated in the programme, the CoaguChek (CUC), the CUC-S and the TAS or Rapidpoint Coag. Not all users of the same type of monitor obtained the same INR result when analysing the same plasma sample. For the three monitors the CV of results in different centres was 11-14%. The variation between results in different centres could relate to inappropriately handled proficiency testing material, inaccuracies in the calibration of the system by the manufacturer or deterioration during transport/storage of the test strips. In each survey 10-11% of centres using POC monitors obtained INR results which were >15% different from those in other centres using the same monitors. For hospital laboratories using conventional INR techniques this figure was 12%. The relationship between INR results obtained by users of the Rapidpoint Coag or TAS monitor and results obtained by conventional techniques was not constant over the period of study. During one period INRs with TAS were 13.7% greater than with conventional methods. For the remaining three time periods results were similar. Our data suggest that the variation between INR results determined with three POC monitors show similar variation to that observed in hospital laboratories using conventional methods. Based on our data we recommend that users of these POC monitors participate regularly in an independent external proficiency testing programme.

Calibration↗
PubMed1989

[Effect of intensive cardiotocographic monitoring on the time and method of completion of labor].

The authors examined selected groups of pregnant women so as to define the influence of intensive cardiotocographic monitoring of a foetus on the time and procedure of completing a labour. Two groups of pregnant women were selected: with high risk-pregnancy and with normal pregnancy monitored cardiotocographically. The results obtained were evaluated by means of the Hammacher scale. Two control groups were also examined--one group of high-risk pregnancies and the other of normal pregnancies, both monitored in the classical way (auscultation of the heart of a foetus, amnioscopy and obstetric examination). In the group of pregnant women monitored cardiotocographically, the authors found a good tolerance of the labour lasting more than 12 hours. The condition of mothers and foeti, in spite of high-risk pregnancies, was good. This was confirmed by high evaluation of newborns by means of the Apgar scale and the level of pH in the blood in the umbilical artery. In the group monitored by classical methods, from the moment of appearing a condition threatening the foetus, there was a tendency towards a fast completion of the labor. In some cases, this was worse, not better. By comparing a procedure of completing a labour in women monitored cardiotocographically and those monitored by classical methods the authors found that in the group monitored cardiotocographically labour was completed instrumentally in 25% of women, whereas in the group monitored classically--in 39% of women, which is statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiotocography↗
PubMed1995

Monitoring clinical research: an obligation unfulfilled.

The revelation that data obtained for the US-based National Surgical Adjuvant Breast and Bowel Project (NSABP) from subjects enrolled at Hôpital Saint-Luc in Montreal was falsified has eroded public trust in research. Institutions can educate researchers and help prevent unethical research practices by establishing procedures to monitor research involving human subjects. Research monitoring encompasses four categories of activity: annual reviews of continuing research, monitoring of informed consent, monitoring of adherence to approved protocols and monitoring of the integrity of data. The authors describe characteristics of research projects that may call for monitoring procedures in each category. The form taken by such monitoring depends on the nature of the protocol. Although appropriate research monitoring requires substantial investment of personnel and financial resources, it is required under guidelines regulating research involving human subjects in Canada. Research monitoring is a step forward in re-establishing public confidence in medical research.

Canada↗
PubMed1993

[Experience of parents in home monitoring of apnea for prevention of sudden infant death (SIDS)].

89 of 119 parents of infants with apnea home monitoring answered to a standard questionnaire concerning different aspects of home monitoring. In almost all cases the home monitoring was finished at the begin of the study, lasting from six months to 12 months. The indications for an apnea monitor were: apparent life threatening event (n = 8), SIDS-sibling (n = 24), sleep apnea syndrome (n = 40) and parents pressing request (n = 17). 90% of parents felt to have got enough information about the function of the apnea monitor (mostly Graseby MR-10 monitor) and what they have to do when there is an apnea alarm. 6% of parents changed the monitor because of technical problems. Most of the alarms were registrated by almost all parents between 24 h and 6 h. 35% of parents stimulated their infants in case of an apnea alarm gently to vigorously, one infant had a mouth to mouth resuscitation. Questions concerning the psychological and social impact of home monitoring on parents demonstrated that there was some stress like anxiety, sleep disturbances mainly in the mothers. We conclude from parents experience with apnea home monitoring the need for an adequate medical, technical and psychological support.

Adaptation, Psychological↗
PubMed1996

An alternative approach to monitoring cancer patient survival.

BACKGROUND: Monitoring patient survival, a practice routinely employed by many cancer registries, is an essential component of the evaluation of progress against cancer. However, changes in prognosis over time are disclosed with considerable delay, with traditional methods of monitoring cumulative survival. METHODS: This article introduces an alternative approach, denoted "period monitoring." which aims at more timely detection of such changes. The conceptual background and the computational realization of the proposed method are outlined, and its application is illustrated by an empirical example from the population-based cancer registry of Saarland, Germany. RESULTS: The principle of period monitoring is shown to be analogous to the well established use of period life tables in the field of demography. Computational realization of period monitoring can be achieved with simple modifications of standard survival analysis techniques. Compared with traditional methods of monitoring survival, period monitoring can advance detection of changes in cumulative survival considerably. CONCLUSION: Despite some limitations with respect to the ease of data interpretation. period monitoring offers a useful supplement to existing methods of monitoring patient survival.

Humans↗