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At least 937 records · Page 52Linked to original sources
PubMed1997

Effect of dedicated monitor watchers on patients' outcomes.

BACKGROUND: In 55% of progressive care units, someone is assigned to watch the cardiac monitors at all times, but the effect of this practice on patients' outcomes has not been examined. OBJECTIVE: To evaluate the effect of continual observation of telemetry units by a monitor watcher on mortality, frequency of transfer to a critical care unit, and the occurrence of five life-threatening dysrhythmias. METHODS: Data for this quasi-experimental study were collected on 1185 patients for a 9-month period in 1993 when the cardiac progressive care unit had a monitor watcher and on 1198 patients for a 9-month period in 1994 when the unit had no monitor watcher. RESULTS: We found no significant differences in mortality, frequency of transfer to a critical care unit, or the occurrence of three of the five dysrhythmias examined. The presence of a monitor watcher was associated with significantly fewer episodes of sustained ventricular tachycardia but more bradyarrhythmias. For both sustained ventricular tachycardia and bradyarrhythmias, the monitor watcher variable remained in the final multivariate logistic regression models. CONCLUSIONS: The presence of a monitor watcher was not associated with lower rates of most adverse outcomes evaluated; however, fewer episodes of sustained ventricular tachycardia occurred when a monitor watcher was present. Sustained ventricular tachycardia is life-threatening, disturbing to the patient, and may result in a longer hospital stay while medical therapy is being adjusted. The results of this study support the use of a monitor watcher to prevent sustained ventricular tachycardia.

Adult↗
PubMed2005

Variability among five over-the-counter blood glucose monitors.

BACKGROUND: The American Diabetes Association recommends that people with diabetes use self-monitoring to control their blood glucose concentration. To assess the need for standardization, we evaluated the variability among 5 of the most common monitors: MediSense Precision Xtra, Ascencia Dex, Prestige Smart System, OneTouch Ultra, and Accu-Chek Advantage. METHODS: We took steps to minimize preanalytical variation. We also eliminated user variability by using one trained operator to collect samples and perform all testing. Each monitor was used twice with each participant; one test was performed using an aged strip and the other using a fresh strip. We compared monitors using a separate ANOVA for each concentration range and strip lot. RESULTS: The total CVs and the within-strip lot CVs were not statistically different among monitors, ranging from 3.1% to 11.3% and from 2.1% to 8.5%, respectively. There were statistically significant differences among monitors for among-strip lot CVs, which ranged from nearly 0% to 7.5%. The degree of significance increased as the concentration range increased [3.9-5.5 mmol/l: p<0.05; 5.6-7.7 mmol/l: p =0.003; 7.8-11.1 mmol/l: p < 0.001]. The average percent difference between monitor pairs was statistically significant (p < 0.05) in more than half of the paired comparisons, with significant differences ranging from 5.7% to 32.0%. CONCLUSIONS: Monitor results can vary significantly so that agreement among them is poor. Standardization is necessary to minimize variability and to improve patient care.

Adult↗
PubMed1992

Effect on sleep--but not on blood pressure--of nocturnal non-invasive blood pressure monitoring.

OBJECTIVE: Nocturnal non-invasive ambulatory blood pressure monitoring inevitably causes an undesirable external stimulus due to the cuff pressure and, for some monitors, disturbing compressor sound. The objective of the present study was to determine whether non-invasive automated blood pressure monitoring during sleep provokes arousal and changes in blood pressure and/or heart rate. DESIGN: Sleep response and blood pressure reaction during and immediately after blood pressure monitoring were studied by means of simultaneous electroencephalography and blood pressure recordings. METHODS: Blood pressure and electroencephalogram were recorded simultaneously in 24 subjects (10 hypertensive, 14 normotensive). Blood pressure was registered with a non-invasive automatic blood pressure monitor every 20 min. Inflation and deflation of the cuff were registered on one of the electroencephalogram channels by means of a small pressure meter attached to the cuff. For each subject, blood pressure during uninterrupted sleep was compared with that during arousal provoked by the recordings. RESULTS: Blood pressure recording caused an arousal in 67% of the recordings. During 33% of the recordings, sleep continued. Neither systolic nor diastolic blood pressure differed significantly for recordings during 'uninterrupted sleep' when compared with arousal. Heart rate was significantly faster during arousal than during uninterrupted sleep. Analysed separately, hypertensive subjects showed an overall blood pressure response close to that of normotensive subjects. There was a significant trend towards lower blood pressure, parallel with deeper sleep. CONCLUSIONS: The results of this study show that non-invasive ambulatory blood pressure monitoring during sleep accurately records basal blood pressure and can distinguish blood pressure during superficial sleep from blood pressure during deep sleep. Sleep is often disturbed by blood pressure monitoring but, irrespective of whether recording provokes arousal, monitored blood pressure is the same.

Adult↗
PubMed2003

Multimodality monitoring of transcranial electric motor and somatosensory-evoked potentials during surgical correction of spinal deformity in patients with cerebral palsy and other neuromuscular disorders.

STUDY DESIGN: This prospective, descriptive study determined the reliability of transcranial electric motor and posterior tibial nerve somatosensory-evoked potentials in children with neuromuscular scoliosis. OBJECTIVE: To assess the applicability of transcranial electric motor and posterior tibial nerve somatosensory-evoked potentials during surgical correction of neuromuscular scoliosis, particularly with cerebral palsy-related deformity. SUMMARY OF BACKGROUND DATA: During corrective spinal surgery for neuromuscular scoliosis, intraoperative multimodality spinal cord monitoring is recommended. There exist conflicting, retrospective studies regarding the reliability of spinal cord monitoring in patients with neuromuscular scoliosis. METHODS: Transcranial electric motor potentials and posterior tibial nerve somatosensory-evoked potentials were monitored in all patients presenting for spinal fusion between 2000 and 2001. Anesthesia was standardized for all patients. RESULTS: There were 68 patients subdivided into two subject groups. Group I consisted of 39 patients with neuromuscular scoliosis associated with cerebral palsy, and Group II consisted of 29 children with neuromuscular scoliosis due to a disease process other than cerebral palsy. Five of the 68 patients had significant amplitude changes in 1 or both monitoring methods during surgery relative to baseline. Of these, one had permanent neurologic deficit despite standard intervention. Somatosensory-evoked potentials were monitored successfully in 82% of the cerebral palsy and 86% of the noncerebral palsy patients. Transcranial electric motor-evoked potentials, on the other hand, were monitorable in 63% of patients with mild or moderate degrees of cerebral palsy and 39% of those with severe involvement. Eighty-six percent of those with noncerebral palsy-related neuromuscular scoliosis had recordable motor-evoked potentials at baseline. CONCLUSION: Both transcranial electric motor and posterior tibial nerve somatosensory-evoked potentials can be monitored reliably in most patients with neuromuscular scoliosis. Those with severe cerebral palsy present the greatest challenge to successful neurophysiologic monitoring.

Adolescent↗
PubMed1992

What's new in monitoring the coronary surgery patient?

Monitoring has been extensively reviewed in most textbooks of cardiothoracic surgery and anaesthesia, particularly in the recent textbooks on monitoring edited by Carol L Lake 1 and Casey D Blitt 2 and in the Journal of Clinical Monitoring. Although monitoring properly includes both pre- and postoperative periods, this review will concentrate exclusively on the operative period. I will also concentrate on new approaches or information which relate to more traditional approaches to monitoring. The emphasis in this review will not be on what we can monitor, but rather on what we should monitor. In this regard, I will analyse accuracy and identify sources of error and try to answer the following questions. Does the device or parameter measure (monitor) what we want to know? Does it improve patient outcome and safety? Is it cost-effective? Unfortunately, data are not always available to answer all these questions at present, but hopefully the discussions will make us aware of what we do and do not know, and what we should look for in the near future.

Cardiac Surgical Procedures↗
PubMed1990

Monitoring epidural analgesia in the parturient.

Appropriate monitoring during obstetric epidural analgesia consists of: 1. Indirect BP and pulse monitoring before epidural insertion, frequently after every dose, and intermittently thereafter. 2. The aspiration test before all injections. 3. Frequent clinical monitoring for signs of intravascular injection during administration of small intermittent doses (not more than 3-5 ml at a time). 4. Frequent clinical monitoring for sympathetic, sensory and motor signs indicating upward extension of the block. 5. Frequent monitoring of the fetal heart rate (FHR) and other signs of fetal welfare. In many instances continuous tocogram with fetal heart rate (CTG) monitoring is useful. We do not believe CTG use is mandatory for epidural analgesia in the uncomplicated pregnancy, but we do advocate that it (and other appropriate fetal monitoring techniques) be used when risk factors or complications, either fetal or maternal, are present or suspected. The anaesthetist should be familiar with fetal monitoring techniques, their use and interpretation. He or she should be prepared to recommend their use when it is considered appropriate to do so.

Analgesia, Epidural↗
PubMed2007

Will esophageal impedance replace pH monitoring?

Esophageal impedance, a technique based on the fact that the passage of a bolus changes the impedance between esophageal segments, is being used more and more. Multiple esophageal impedance combined with pH monitoring is advocated to become the preferred technique to measure acid and nonacid gastroesophageal reflux. Compared with pH monitoring, impedance has the advantage of being independent of pH and, as a consequence, is better adapted to measure reflux (especially in the postprandial period when reflux is buffered) and detect symptoms associated with nonacid- or weakly acid-reflux episodes. Conversely, the analysis of an impedance tracing requires more time and knowledge than a pH tracing and is possibly subjected to higher interobserver variability. Day-to-day reproducibility and interobserver variability are considerable. Episodes detected only by pH monitoring or impedance are numerous in pediatrics; therefore, pH monitoring and impedance should be associated in analyses of multiple esophageal impedance combined with pH monitoring. Up to now, there has been a striking absence of literature showing attempts to link data from diagnostic procedures to clinical outcome in symptomatic patients. Furthermore, data suggesting that impedance does offer a clear-cut benefit in pediatric clinical routine are missing. High cost of the material and the investment in time necessary for interpretation of the recording remain a handicap. However, because pH monitoring is part of impedance technology, it is likely that the latter will soon replace pH monitoring despite the current need of scientific evidence demonstrating a relation between symptoms, esophageal damage or response to reflux treatment, and results of multiple esophageal impedance combined with pH monitoring.

Child↗
PubMed2001

Telephone subsidy: an effective incentive for successful participation in home memory monitor study.

CONTEXT: The Collaborative Home Infant Monitoring Evaluation (CHIME) study enrolled healthy term infants and 3 groups of infants considered to be at increased risk for sudden infant death syndrome to evaluate apnea and bradycardia events in the home. Mother-infant pairs without a telephone were ineligible for enrollment. OBJECTIVE: To determine whether mother-infant pairs who were offered a telephone subsidy would agree to enroll in CHIME and achieve protocol compliance rates comparable with those of matched subjects able to afford telephones. DESIGN: Thirty-one telephone subsidy subjects were retrospectively compared with 55 control subjects matched for study group, site, birth weight, and maternal race, age, and education. SETTING: Collaborative Home Infant Monitoring Evaluation clinical research centers in Honolulu, Hawaii, and Toledo, Ohio. INTERVENTION: Provision of telephone subsidy to otherwise eligible enrollees for CHIME. MAIN OUTCOME MEASURES: Frequency of compliance with protocol requirements for follow-up evaluations and for extent of home monitoring. RESULTS: Subsidy subjects achieved protocol completion rates that were comparable with those of control subjects, for developmental assessments at 56 and 92 weeks postconceptional age (PCA), and for the polysomnogram. Unexpectedly, however, subsidy subjects were more likely to have a developmental assessment at 44 weeks PCA (P =.02), as well as a cry analysis (P =.04). They were also more likely to use the CHIME home monitor for more hours during weeks 2 through 5 (P =.004), have a higher percentage using the monitor for 10 or more hours per week during weeks 2 through 5 (P =.009), and have a higher total number of days of monitor use throughout 6 months (P <.001). Mean cost of the subsidy was $3.25 per day of monitor use, and monitor use per day was directly related to total cost of the subsidy (P =.02). CONCLUSIONS: Telephone subsidy is an effective financial incentive. At least within the context of the CHIME study, telephone subsidy enhanced access to health care, and in some categories it resulted in enhanced protocol compliance.

Adult↗
PubMed1992

Monitoring for myocardial ischemia during noncardiac surgery. A technology assessment of transesophageal echocardiography and 12-lead electrocardiography. The Study of Perioperative Ischemia Research Group.

OBJECTIVE: Transesophageal echocardiography (TEE) and 12-lead electrocardiography (ECG) are sophisticated techniques that are increasingly being used to monitor for myocardial ischemia during noncardiac surgery. We examined whether the routine use of these techniques has incremental clinical value in identifying patients at high risk for perioperative ischemic outcomes when compared with preoperative clinical data and intraoperative monitoring using continuous two-lead bipolar ECG. DESIGN: Cohort study. SETTING: Veterans Affairs medical center. PATIENTS: A total of 332 men undergoing noncardiac surgery who had or were at high risk for coronary artery disease. INTERVENTIONS: TEE, 12-lead ECG, and two-lead ECG were performed continuously during noncardiac surgery (47% vascular, 53% nonvascular). Monitoring results were not available to anesthesiologists or surgeons, and data were blindly analyzed after surgery. MAIN OUTCOME MEASURE: Perioperative ischemic outcomes (cardiac death, nonfatal myocardial infarction, unstable angina). RESULTS: In a subset of 285 patients who were adequately studied by all three techniques, 111 patients (39%) were identified as having intraoperative myocardial ischemia (by one or more monitoring techniques). By univariate analysis, intraoperative ischemia was associated with all perioperative cardiac outcomes, including ischemic outcomes, congestive heart failure, and ventricular tachycardia (P less than or equal to .02 for each of the three monitoring techniques). However, when monitoring results for TEE and 12-lead ECG were added to a multivariate model that included preoperative clinical data and continuous two-lead ECG results, the incremental value of TEE was small (odds ratio, 2.6; 95% confidence interval [CI], 1.2 to 5.7; P = .02) and that of 12-lead ECG was not significant (odds ratio, 1.5; 95% CI, 0.6 to 3.8). Furthermore, when the multivariate analysis was repeated with only ischemic outcomes, neither TEE nor 12-lead ECG retained significant associations (odds ratio, 2.2; 95% CI, 0.5 to 9.4, and odds ratio, 1.1; 95% CI, 0.2 to 6.1, respectively). CONCLUSION: When compared with preoperative clinical data and intraoperative monitoring using two-lead ECG, routine monitoring for myocardial ischemia with TEE or 12-lead ECG during noncardiac surgery has little incremental clinical value in identifying patients at high risk for perioperative ischemic outcomes.

Aged↗
PubMed2005

Clinical study of continuous non-invasive cerebrovascular autoregulation monitoring in neurosurgical ICU.

Ultrasonic "time-of-flight" monitor (Vittamed) was used for continuous monitoring of intracranial blood volume (IBV) pulse, respiratory, slow waves and cerebrovascular autoregulation (CA). The objectives are to compare of invasively and non-invasively monitored slow intracranial waves and CA of ICU patients and to evaluate the phase shift between ABP and IBV respiratory waves as a possible estimator of CA. CA monitoring has been performed in 13 patients with severe TBI (age mean/range 30.5/(18-64)). Data were collected from 87 one-hour sessions of simultaneous invasive and non-invasive wave monitoring and from 53 one-hour sessions of invasive and non-invasive CA monitoring. High correlation (R > 0.9) has been obtained between invasively and non-invasively recorded intracranial slow waves. Bland Altman difference between invasively and non-invasively recorded intracranial slow waves is clinically not significant (mean =-0.07, SD = 0.089, alpha = 0.05). Agreement has been confirmed between invasive and non-invasive CA monitoring data in a wide range of R = [-0.85; +0.96]. Hypothesis of the coincidence of invasive and non-invasive CA assessment is accepted (p < 0.05). Phase shift monitoring of permanent respiratory ABP waves and IBV waves permit continuous non-invasive CA estimation without unnatural physical or pharmacological stimulations of CA system.

Blood Pressure↗
PubMed1987

Intraoperative monitoring of sensory evoked potentials may be neither a proven nor an indicated technique.

Excluding specific neurosurgical indications for cortical localization or peripheral nerve surgery, the use of sensory evoked potentials as a monitor in the operating room should be controversial at this time. Whether appropriate or not, legal and medical forces have largely established the use of somatosensory evoked potential monitoring as a standard during procedures that threaten the integrity of the spinal cord. The author believes that such monitoring should not replace the use of a "wake-up" test during these procedures because of the recognized possible occurrence of false negative results (i.e., normal evoked potentials despite abnormal spinal cord function). Another apparent established practice is monitoring of brainstem auditory evoked potentials to recognize the onset of disturbance in the auditory system. It has not been established that other recommended evoked potential monitoring practices, such as somatosensory evoked potential monitoring for such purposes as recognizing cerebral ischemia, or brainstem auditory evoked potential monitoring for recognizing untoward medullary stimulation, are as good as or better for these purposes than currently recognized and simpler monitors.

Evoked Potentials, Somatosensory↗
PubMed1992

Prolonged intraesophageal pH monitoring with 16-hr overnight recording. Comparison with "24-hr" analysis.

UNLABELLED: From studies in 43 patients (17 male, 26 female, mean age 51 years), we compared the analysis of the routine complete "24-hr" ambulatory esophageal pH monitoring study to that of the 16-hr overnight interval (4:00 PM to 8:00 AM). The latter included a major meal with an upright postprandial period and a recumbent period. All patients were monitored for at least 20 hr (median = 22.6 hr). The percent distal esophageal pH less than 4.0 and number of reflux episodes were measured for the total, upright, and recumbent periods of both the 16-hr and "24-hr" monitoring times. Significant (P less than 0.001) positive correlations were found for all comparisons between the two monitoring periods including percent time of pH less than 4.0 (total: r = 0.98; upright: r = 0.96) and number of episodes (totals r = 0.97; upright: r = 0.93). Patients were separated into normal and abnormal refluxers based on results of "24-hr" monitoring (pH below 4.0 greater than 4.2% total time; greater than 6.0% upright; greater than 1.2% recumbent). Based on this, sensitivity and specificity for 16-hr monitoring were as follows: total study: 86% and 95%; upright: 80% and 91%; recumbent: 100% for both. CONCLUSIONS: (1) a 16-hr overnight pH monitoring period can provide a reliable representation of "24-hr" distal esophageal acid exposure, (2) this shorter monitoring may improve patient acceptability and compliance, and (3) the symptom index was changed in 26.3% of patients using the 16-hr evaluation.

Electrodes↗
PubMed1989

Evaluation of a continuous noninvasive blood pressure monitor in obstetric patients undergoing spinal anesthesia.

A noninvasive blood pressure monitor (Finapres) that continuously displays the arterial waveform using the Penaz methodology has recently been introduced into clinical practice. We compared this device with an automated oscillometric blood pressure monitor (Dinamap 1846SX) in 20 patients during spinal anesthesia for nonemergency cesarean section according to a procedure suggested by the Association for the Advancement of Medical Instrumentation. After administration of the spinal anesthetic, the Finapres monitor produced systolic, mean, and diastolic pressure measurements greater than those of the Dinamap monitor (6.6 +/- 12.5, 3.3 +/- 10.4, and 7.2 +/- 9.8 mm Hg, respectively). In most patients, the Finapres measurements were similar to those determined by the Dinamap; however, in 4 patients, mean systolic differences were greater than 20 mm Hg. These patients did not differ from the others in age, height, weight, or baseline blood pressure, and the pressure values recorded by the Finapres monitor were substantially higher than those measured by auscultation in the labor room. In 30% of the patients, the offset between Dinamap and Finapres blood pressure measurements changed markedly over the course of the surgical procedure. The Finapres monitor occasionally stopped working and had to be restarted. In 1 patient (not included in this analysis), the Dinamap monitor was unable to determine the blood pressure due to patient shivering; this did not appear to interfere with the Finapres. We conclude that the Finapres monitor does not consistently provide blood pressure information equivalent to that of the Dinamap in obstetric patients undergoing spinal anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Continuous monitoring of cerebral tissue pressure in neurosurgical practice--experiences with 100 patients.

The authors present their experience with the use of continuous monitoring of cerebral tissue pressure (CTP) in a neurosurgical intensive care unit. The CTP was monitored in 100 patients with a variety of neurosurgical diseases. In 13 patients simultaneous recording of the ventricular fluid pressure (VFP) was carried out for up to 134 h. In 21 patients intrahemispheric gradients of CTP were recorded and in 66 patients CTP alone was recorded (59 supratentorial, 7 infratentorial). In general CTP monitoring gave excellent results with no additional risk to the patient and low costs for the monitoring system. The behaviour of CTP in various clinical conditions and the indications and limitations of CTP monitoring compared with VFP or epidural pressure monitoring are outlined. The authors recommend monitoring of VFP as the method of choice in ICP supervision. Continuous monitoring of CTP is the preferred method in the posterior fossa, after large craniectomies, for postoperative supervision following open surgery and in cases of narrowed ventricles.

Catheters, Indwelling↗
PubMed1993

Gastro-oesophageal reflux in children: comparison of different durations, positions and sleep-awake periods of pH monitoring in the same patient.

A group of 72 children (mean age: 21.7 months, range: 14 days-19 years) with symptoms of gastro-oesophageal reflux were investigated by 22 h pH monitoring. Using a Proxeda software, we compared, in the same patient, the specificity and sensitivity of pH monitoring during 3 h, 6 h, 12 h, 12 nocturnal hours and 3 postprandial hours, as well as the influence of position and the sleep and alert periods. Results showed that all the short pH monitorings were statistically less sensitive than 22 h pH monitoring (P < 0.025). As regards specificity, only the 12 nocturnal hours pH monitoring was not statistically different from the 22 h pH monitoring. Gastro-oesophageal reflux was more frequent when the patient was awake than during sleep. pH monitoring seemed more reliable in the recumbent than in the upright position. We conclude that long-term pH monitoring (22 h) is the test of choice to diagnose gastro-oesophageal reflux because it included sleep and alert periods as well as different positions.

Adolescent↗
PubMedDate not supplied

Respiratory function monitoring during mechanical ventilation in pediatric intensive care unit.

Noninvasive monitoring of lung function during mechanical ventilation has been used to study disease processes causing respiratory failure. Pediatric pulmonary function monitoring during mechanical ventilation in the pediatric intensive care unit in patient with respiratory failure is becoming more common in western countries. The article describes a review of principles and methods of respiratory function monitoring in the pediatric age group. It attempts to incorporate experience from original articles previously published as well as the experience in monitoring pulmonary mechanics at our institution. Routine monitoring of pulmonary mechanics in patients being mechanically ventilated may have significant impact on morbidity and/or mortality of pediatric patients with respiratory failure. Key articles pertaining to lung function testing in pediatric age group from past 15 years were used as well as clinical experience encountered by attending pediatric intensivists at Henrico Doctors' Hospital was incorporated. Over the past ten years the use of monitoring of gas exchange and bedside pulmonary mechanics monitoring as a part of respiratory function monitoring has become more common. With better clinical information to precisely document the status of lung function, it may lead to improved methods of ventilator management which may prevent complications and may significantly impact on morbidity and/or mortality of mechanically ventilated pediatric patients.

Child↗
PubMed1985

Continuous mixed venous oxygen saturation measurement: a significant advance in hemodynamic monitoring?

Development of the flow-directed pulmonary artery catheter in combination with reflective fiberoptic oximetry techniques allows the clinician to continuously measure mixed venous oxygen saturation (SvO2). A brief review of the determinants of oxygen balance, the Fick principle, and the technology of continuous SvO2 monitoring is preliminary to a debate between two clinicians on the usefulness of SvO2 monitoring. One clinician highly recommends use of the flow-directed pulmonary artery catheter in patients who require pulmonary artery catheterization. Monitoring of SvO2 is described as a safe, convenient, and reliable option that is cost-effective. Continuous availability of this dynamic physiologic monitor is of great value in improving understanding of serious disturbances in oxygen balance, providing information for rapid diagnosis, and guiding therapeutic interventions. Another clinician suggests a less enthusiastic approach to SvO2 monitoring and argues that SvO2 is a nonspecific index of the matching of oxygen delivery with supply. Although it is a useful adjunct in specific clinical situations, it provides uncertain information in the presence of a number of diseases. Major mistakes in patient management could follow from overreliance upon either absolute SvO2 measurements or analysis of trends over time. Use of the SvO2 monitor has not been proven cost-effective and may actually increase monitoring costs. Both clinicians agree that continuous SvO2 monitoring is valuable in many clinical circumstances, provided the limitations of the measurement are understood.

Cardiac Output↗
PubMed1990

Universities and the clinical monitoring industry: feckless independents or fruitful partners?

Since 1955 clinical monitoring in anesthesia care and critical care has improved markedly. However, both industry and academia find temptation to congratulate themselves on this achievement. Reflection, however, might suggest that, in comparison with analogous unrelated fields, the process of progress has been tardy, wasteful, expensive, and inefficient. 'State of the art' clinical monitoring may actually be viewed as woefully inadequate when measured by the yardstick of the possible. Analysis suggests that industry sometimes fails to grasp opportunities for progress by shared effort while academia, sometimes guilty of aloofness and isolation, may occasionally fail to cooperate actively to promote progress by sharing its experience with industry. To hasten the more efficient development of clinical monitoring by a new alliance of the clinical monitoring and computing industry and those universities, professors, and physicians with interests in clinical monitoring and computing is here proposed. A Foundation for Research, Development, and Advancement of Clinical Monitoring and Computing Devices should be established, to promote basic and practical research and development (R&D), sponsor shared specialized clinical testing facilities, special scholarships for physicians training as specialists in development of clinical monitoring devices, and promote and expand continuing medical education programs. By this multidisciplinary, cooperative activity, it is asserted that progress in the introduction of useful new clinical monitoring devices can be accelerated.

Critical Care↗