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PubMed1979

Computer-based system for adverse drug reaction detection and prevention.

An online computer-based system for monitoring patients for potential adverse drug reactions during their hospital stay is described. The adverse drug reaction monitoring system uses a Digital Equipment Corporation (DEC) PDP-11 computer which is programmed in MUMPS (Masschusetts General Hospital Utility Multi-programming System). Primary references from the medical and scientific literature are analyzed and evaluated before being included in the data base. The patient's adverse reaction history, obtained by nursing personnel during a patient interview, is entered into the computer by pharmacy staff. The computer screens new prescription orders for potential adverse reactions; any adverse reaction reports are sent to the patient's physician. Other special programs that are used in the patient monitoring system include medication profiles, drug-drug interaction screening and prescription discontinuation date entry. The computer system enable detection of potential adverse drug reaction and notification of the patient's physician prior to administration of the prescribed drug.

Computers↗
PubMed2004

Diagnostic probes for Bacillus anthracis spores selected from a landscape phage library.

BACKGROUND: Recent use of Bacillus anthracis spores as a bioweapon has highlighted the need for a continuous monitoring system. Current monitoring systems rely on antibody-derived probes, which are not hardy enough to withstand long-term use under extreme conditions. We describe new, phage-derived probes that can be used as robust substitutes for antibodies. METHODS: From a landscape phage library with random octapeptides displayed on all copies of the major phage coat protein of the phage fd-tet, we selected clones that bound to spores of B. anthracis (Sterne strain). ELISA, micropanning, and coprecipitation assays were used to evaluate the specificity and selectivity with which these phage bound to B. anthracis spores. RESULTS: Peptides on the selected clones directed binding of the phage to B. anthracis spores. Most clones exhibited little or no binding to spores of distantly related Bacillus species, but some binding was observed with spores of closely related species. Our most specific spore-binding phage displayed a peptide EPRLSPHS (several thousand peptides per phage) and bound 3.5- to 70-fold better to spores of B. anthracis Sterne than to spores of other Bacillus species. CONCLUSIONS: The selected phage probes bound preferentially to B. anthracis Sterne spores compared with other Bacillus species. These phage could possibly be further developed into highly specific and robust probes suitable for long-term use in continuous monitoring devices and biosorbents.

Bacillus anthracis↗
PubMed1990

Preventive cardiology in general practice: computer-assisted hypertension care.

Research investigations of general practice on the prevention of cardiovascular disease indicate that preventive detection and intervention programmes can be effective. Long-term results on hypertension control are better when systematic follow-up accompanies surveillance of the hypertensive population. Based on research and international experience, we developed the Nijmegen Hypertension Monitoring System, a computer-assisted system consisting of monthly feedback of treatment results and regular meetings of the participating general practitioners. We describe an experiment in seven study practices and eight practices continuing with usual care, to study the effectiveness and feasibility of the system. This Monitoring System could also be adapted for other chronic diseases.

Adult↗
PubMedDate not supplied

Development of a system for monitoring infant state behavior.

The concept of infant state refers to patterns of behavior that comprise the sleep-wake cycle. The infant's ability to organize state behavior rhythmically is indicative of central nervous system maturation and predictive of later development. This article describes the development of a noninvasive, computerized infant monitoring system that can be used to categorize the infant's sleep-wake behavior into states. Development of the system occurred in two phases: In the first phase of the study, reliability and validity of the infant monitoring system for recording continuous behavioral and physiological data were assessed. These results were then used in the second phase to develop a rule-based computer program to interpret the signal data stored on a micro-diskette and to characterize the infant's state throughout the period of monitoring. The capability of computerized data collection and analysis of infant state behavior has expanded the application of this infant monitoring system. Its use as an investigative tool in clinical research is discussed.

Adult↗
PubMed1993

Dynamical monitoring network system for perinatal care.

A new type of monitoring network system for perinatal care is proposed and has been developed. The patient monitoring system and data analyzing system are connected by a local area network (LAN). The doctor can retrieve past sampled data and results of data analysis, and make a detailed analysis at the same time that the patient is being monitored. The mainframe of the hospital information system (HIS) is connected with a data server in the perinatal care area via LAN. The database in perinatal care is supplied to the HIS and the doctor through this monitoring network system. If data sampled at maternity clinics or hospitals are once transmitted to the data server on LAN via the public telephone circuit, these data are available for the specialists on LAN. This function is utilized for supporting the obstetricians.

Computer Systems↗
PubMed1993

ASIM: a system for monitoring and evaluating the long-term care of the elderly and disabled.

OBJECTIVE: A system for monitoring and evaluating the long-term care of the elderly and disabled is presented, and its problems of completeness, reliability, and validity are discussed. DATA SOURCES/STUDY SETTING: Half-yearly (before 1987) and yearly (after 1987) surveys were taken from 1984 to 1990 of all persons living in the city of Solna, Sweden, who at May 1 and November 1, or November 1, were receiving long-term care services from the municipality or county council, or both. STUDY DESIGN: Completeness of observations was studied by linking survey and admission/discharge observations and checking for breaks in the chain of care. Reliability was estimated by comparing involuntary double registrations. Validity of the chosen measures of need was tested by comparing them with the actual provision of care services. DATA COLLECTION: Registrations concerning actually provided services, assessed need, social environment, and disability were collected on a regular basis by the staff responsible for the care services. PRINCIPAL FINDINGS: Completeness was estimated to be more than 99 percent after a special procedure was carried out for filling in gaps in the "care chain." Reliability testing of the disability measures showed between .69 and .76 Kappa coefficient of agreement. Disability variables were shown to explain 56 percent of variance in the need measure "appropriate level of care." CONCLUSIONS: Tests of completeness, reliability, and validity showed satisfactory results with regard to the purpose of the monitoring system and the limitations inherent in a system intended for routine application.

Activities of Daily Living↗
PubMed1989

A knowledge-based information system for monitoring drug levels.

The expert system shell SMR has been enhanced to include information system routines for designing data screens and providing facilities for data entry, storage, retrieval, queries and descriptive statistics. The data for inference making is abstracted from the data base record and inserted into a data array to which the knowledge base is applied to derive the appropriate advice and comments. The enhanced system has been used to develop an intelligent information system for monitoring serum drug levels which includes evaluation of temporal changes and production of specialized printed reports. The module for digoxin has been fully developed and validated. To demonstrate the extension to other drugs a module for phenytoin was constructed with only a rudimentary knowledge base. Data from the request forms together with the S-digoxin results are entered into the data base by the department secretary. The day's results are then reviewed by the clinical pharmacologist. For each case, previous results may be displayed and are taken into account by the system in the decision process. The knowledge base is applied to the data to formulate an evaluative comment on the report returned to the requestor. The report includes a semi-graphic presentation of the current and previous results and either the system's interpretation or one entered by the pharmacologist if he does not agree with it. The pharmacologist's comment is also recorded in the data base for future retrieval, analysis and possible updating of the knowledge base. The system is now undergoing testing and evaluation under routine operations in the clinical pharmacology service. It is a prototype for other applications in both laboratory and clinical medicine currently under development at Uppsala University Hospital. This system may thus provide a vehicle for a more intensive penetration of knowledge-based systems in practical medical applications.

Data Interpretation, Statistical↗
PubMed1991

Linking mass spectrometers to provide continuing monitoring during system failure.

Although multipatient monitoring with a time-shared mass spectrometer provides considerable cost advantages, failure of one component in a shared system can disrupt gas monitoring at all sites. We describe a simple method for linking two central mass spectrometer systems to provide continual monitoring during failure of one unit, without the need for time-consuming reconfiguration of individual patient sample line and display connections.

Equipment Failure↗
PubMed2006

Application of a multi-channel system for continuous monitoring and an early warning system.

A multi-channel continuous toxicity monitoring system developed in our laboratory, based on two-stage mini-bioreactors, was successfully implemented in the form of computer-based data acquisition. The multi-channel system consists of a series of a two-stage minibioreactor systems connected by a fiber optic probe to a luminometer, and uses genetically engineered bioluminescent bacteria for the detection of the potential toxicity from the soluble chemicals. This system can be stably and continuously operated due to the separation of the culture reactor from the test reactor and accomplish easy and long-term monitoring without system shut down by abrupt inflows of severe polluting chemicals. Four different recombinant bioluminescent bacteria were used in different channels so that the modes of the samples toxicities can be reasonably identified and evaluated based upon the response signature of each channel. The bioluminescent signatures were delivered from four channels by switching one at once, while the data is automatically logged to an IBM compatible computer. We also achieved the enhancement of the system through the manipulation of the dilution rate and the use of thermo-lux fusion strains. Finally, this system is now being implemented to a drinking water reservoir and river for remote sensing as an early warning system.

Bacteria↗
PubMed1997

Clinical-HINTS: integrated intelligent ICU patient monitoring and information management system.

Clinical-HINTS (Health Intelligence System) is a horizontally integrated decision support system (DSS) designed to meet the requirements for intelligent real-time clinical information management in critical care medical environments and to lay the foundation for the development of the next generation of intelligent medical instrumentation. The system presented was developed to refine and complement the information yielded by clinical laboratory investigations, thereby benefiting the management of the intensive care unit (ICU) patient. More specifically, Clinical-HINTS was developed to provide computer-based assistance with the acquisition, organisation and display, storage and retrieval, communication and generation of real-time patient-specific clinical information in an ICU. Clinical-HINTS is an object-oriented system developed in C+2 to run under Microsoft Windows as an embryo intelligent agent. Current generic reasoning skills include perception and reactive cognition of patient status but exclude therapeutic action. The system monitors the patient by communicating with the available sources of data and uses generic reasoning skills to generate intelligent alarms, or HINTS, on various levels of interpretation of an observed dysfunction, even in the presence of complex disorders. The system's communication and information management capabilities are used to acquire physiological data, and to store them along with their interpretations and any interventions for the dynamic recognition of interrelated pathophysiological states or clinical events.

Artificial Intelligence↗
PubMed1993

Assessment of national systems for the surveillance and monitoring of animal health.

Continued growth in international trade and the developing concepts of zoning and risk assessment demand effective assessment of national surveillance and monitoring systems for animal health. The ideal national epidemiological delivery system incorporates surveillance for disease agents, host monitoring and environmental assessment. An extensive veterinary infrastructure is necessary to support the ideal epidemiological delivery system. While the full spectrum of epidemiological services is represented worldwide, a standardized approach to assessing national surveillance and monitoring systems is proposed, in order to meet the emerging demand for scientifically-based import regulations.

Animal Diseases↗
PubMed2004

A novel approach for monitoring extracellular acidification rates: based on bead injection spectrophotometry and the lab-on-valve system.

Monitoring extracellular acidification rates (ECARs) is important for the study of cellular activities, since it allows for the evaluation of factors that alter metabolic function, such as stimulants, inhibitors, toxins as well as receptor and non-receptor mediated events. While the light addressable potentiometric sensor (Cytosensor Microphysiometer) has been the principal tool for ECARs measurement in the past, this work introduces a novel method that exploits an immobilized pH indicator on the surface of microcarrier beads (Sephadex) and is probed with a fiber optic coupled spectrophotometer. Likewise, live cells under investigation were also immobilized on microcarrier beads (Cytopore). These beads are metered, transported and monitored within a microfluidic system, termed as the Lab-on-Valve (LOV). Use of carrier beads in conjunction with Bead Injection Spectrophotometry and a Lab-on-Valve module (BIS-LOV), makes ECAR measurements reliable and automated. The feasibility of the BIS-LOV approach is demonstrated measuring ECARs of the mouse hepatocyte cell line, TABX.2S, grown on Cytopore beads packed within the central channel of the LOV system. These immobilized cells were perfused in a phosphate buffer carrier solution (capacity: 1 mmol L(-1), pH 7.4). Protons extruded from 10(5) to 10(6) cells were accumulated during a stopped flow period of 220 s followed by a pH measurement, detected by changes in absorbance of the pH indicator bonded to the microcarrier beads. Addition of metabolic inhibitors (sodium azide, oxamic acid) to the carrier buffer solution can induced an increase or decrease of the basal proton extrusion rate in a very reproducible manner. Comparison of the BIS-LOV technique to the Cytosensor microphysiometer and literature confirms the validity of this novel approach, highlighting its advantages and suggesting future improvements that will make the BIS-LOV a practical tool for routine ECARs measurement.

Animals↗
PubMed2003

AnyHeart: a single-piece heart-saving implantable artificial heart (BVAD)--monitoring and estimation.

AnyHeart is a single-piece, implantable biventricular assist device. This electromechanical BVAD has a moving-actuator mechanism. To monitor the status of AnyHeart from anywhere at any time, a portable personal digital assistant (PDA) monitor and web-based remote monitoring system were developed. The PDA local monitoring system has replaced bulky personal computer monitoring systems. The web-based remote monitoring system has several functions such as data collecting, storing, and posting through the internet. Basically, interventricular pressure (IVP) is a parameter indicating the filling level of the blood chambers of AnyHeart. The pump output can be estimated using IVP, which is acquired noninvasively from AnyHeart. With the proposed method, we can estimate the pump output with a small margin of error.

Computers, Handheld↗
PubMedDate not supplied

Process evaluation of a monitoring log system for community coalition activities: five-year results and lessons learned.

PURPOSE: Coalitions can be a successful way to promote healthy initiatives throughout a community. To properly measure the success of coalition-based interventions, it is important to conduct a process evaluation of coalition activities and establish a system for evaluating outcomes. This article describes a process evaluation of a monitoring and feedback system for community coalitions targeting chronic disease risk reduction. METHODS: Community coalitions in six rural, southeast Missouri counties collaborated with the Missouri Department of Health and Saint Louis University to track coalition events using the process described in the Centers for Disease Control and Prevention manual Evaluating Community Efforts to Prevent Cardiovascular Diseases. SUMMARY: First, we describe the methodology used to monitor monthly activities and to evaluate satisfaction with the process. Next, we discuss the data that resulted from the monitoring system and interviews with recorders. Third, we discuss changes made to the monitoring system and lessons learned along the way. Finally, we end with recommendations for incorporating this monitoring system in community practice. CONCLUSIONS: When used properly, this system is an effective way of evaluating and promoting sustainability of community interventions.

Cardiovascular Diseases↗
PubMed1987

Pharmacy-based computer system for monitoring and reporting drug interactions.

A pharmacy-based computer system for monitoring and reporting drug interactions is described, and physicians' responses to patient management suggestions generated by the system are reported. Using information from a commercially available drug-interaction database, a pharmacist chose 41 potentially interacting drug combinations to include in the pharmacy's automated system. A warning notice appears on the computer screen if one of these drug combinations is prescribed. Pharmacists who encounter these notices while entering medication orders telephone the prescribing physician if the combination represents a Class I interaction (immediate onset, major severity, established documentation); for Class II interactions, which have a delayed onset, a copy of the warning notice and suggestions for patient management are placed in the prescribing physician's mailbox. The system was evaluated during a three-month period in 1985 to determine physicians' responses to the patient management suggestions. A total of 927 patients had 1004 potentially interacting drug combinations prescribed for them. Changes in drug dosage were made in 44% of these instances, and in 75%, patients were monitored for the development of adverse clinical effects. A computerized drug-interaction monitoring system can help increase physicians' awareness of possibly interacting drug combinations and provide them with useful information about the clinical management of patients for whom such drug combinations have been prescribed.

Adolescent↗