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PubMed2001

The BIS monitor: a review and technology assessment.

In the administration of anesthesia, clinicians have traditionally relied on a variety of autonomic signs to assess the pharmacologic effects of anesthetic agents on the central nervous system. As any experienced clinician knows, these signs can be misleading and lead to overdosing or underdosing of anesthetic drugs. The development of a monitor to measure the bispectral index (BIS) provides anesthetists with the first clinically tested and US Food and Drug Administration-approved monitor to assess the effects of anesthesia on the cerebral cortex. This article reviews the development of the BIS monitor, compares the BIS monitor with other commonly used clinical monitors, assesses the cost-benefit from the use of this monitor, and explores some of the possible uses for this monitor outside of the operating suite.

Anesthesia↗

PubMed2002

Evaluation on the use of a portable unit versus the laboratory for the monitoring of International Normalized Ratio (INR) in orally anticoagulated patients.

INTRODUCTION: Measuring the International Normalized Ratio (INR) through a laboratory requires venipuncture and takes about 1 hour for results to be available. A portable monitor (CoaguChek Plus System), which measures the INR using fingerstick samples, is evaluated in this study to determine its clinical significance in anticoagulated and non-anticoagulated individuals. The hospital's outpatient and inpatient laboratories were also compared in the study. MATERIALS AND METHODS: Paired venous and capillary blood INRs were performed on anticoagulated patients using the monitor and the Singapore General Hospital (SGH) outpatient and inpatient laboratories (OPS and IPS labs). Paired INRs of control samples were also performed using the monitor and the IPS lab. RESULTS: We plotted the difference in INR by the 2 methods (monitor and OPS lab, n = 91) against their mean, and calculated the limits of agreement (95% of the difference would lie between -0.90 to 0.70). After a logarithmic transformation on the data, we found that for 95% of the cases, the OPS lab would differ from the monitor by 13% below to 14% above. There was also a marginal difference (95% limits of agreement of -0.14 to 0.10) when we compared the INR obtained from OPS and IPS laboratories (n = 43). Our control sample (n = 19) showed that the 95% confidence interval for the bias was -0.04 to 0.10. CONCLUSION: The monitor should be used with caution in patients with INR > 3. We suggest use of the monitor in situations where the non-anticoagulated state of a patient needs to be measured. There is a difference in INR measured by laboratories within the same institution.

Anticoagulants↗

PubMed2002

[Clinical value of remote fetal monitoring network in high-risk pregnancy].

OBJECTIVE: To investigate the clinical value of remote fetal monitoring network in high-risk pregnancy. METHODS: Non-stress test (NST) was carried on in 116 high-risk gravida by remote fetal monitoring network (study group). One hundred high-risk pregnant women served as control group, were monitored by fetal movement counting daily and regular NST check-up in hospital. Results of fetal monitoring, neonatal prognosis and cesarean section were analyzed between the study and control group. RESULTS: NST was applied more frequently in the study group (9.2 +/- 4.9) times than in control group (2.6 +/- 1.3) times (P < 0.001). But the costs were similar. The incidences of neonatal asphyxia (10.3%) and preterm birth (12.6%) in the study group were lower than those in the control group (20.8% and 24.5%) (P < 0.05). In the study group, there was significant difference in the rate of poor neonatal prognosis between normal and abnormal NST groups (64.8% and 17.7%) (P < 0.05). There was no significant difference in the rates of cesarean section (75.9% and 75.0%, respectively) and poor neonatal prognosis of cesarean section with abnormal NST (71.7% and 60.6%, respectively) between the study and control groups (P > 0.05). CONCLUSIONS: Remote fetal monitoring network can be used to improve the quality of fetal monitoring, especially in primary hospital. It decreased the rate of neonatal asphyxia and preterm delivery but didn't increase the cesarean section rate. It offers a reliable and economic method of self-monitoring for high-risk pregnant women.

Asphyxia Neonatorum↗

PubMed2000

[Multi-bed & multi-parameter central monitoring system based on TCP/IP protocol].

Communication is one of the key problems to a central monitoring system. In this paper we put forward a central monitoring system using TCP/IP as the network protocol, Windows NT4.0 as the platform, forming a Intranet in a hospital. We also discussed the communication problem between the bed-side monitoring station and the central monitoring station in detail and then put forward a new protocol--Hospital Central Monitor Protocol (HCMP) based on TCP/IP to transfer monitoring data. It is easy to achieve tele-monitoring through the current communication subsystem.

Computer Communication Networks↗

PubMed2003

Monitoring of water transfer from Katse Dam into the Upper Vaal river system: water utility's perspective.

Water quality is of prime importance to Rand Water's core business of ensuring a reliable supply of good quality drinking water to more than 10 million people. Rand Water has, therefore, implemented a water quality monitoring programme of the source water as well as the drinking water produced. The establishment of the Lesotho Highlands Water Transfer scheme necessitated the expansion of the monitoring programme. In 1996, Rand Water and Lesotho Highlands Development Authority (LHDA) signed an agreement to jointly develop an extensive water quality monitoring programme for the Lesotho Highlands Water Project (LHWP). Prior to this agreement, monitoring was mainly undertaken by consultants on behalf of LHDA in the main feeder rivers within the Katse Dam catchment (donor system). On the recipient system (Ash/Liebenbergsvlei), extensive physical and chemical monitoring was undertaken by Rand Water and Department of Water Affairs and Forestry (DWAF). Biological monitoring was however only carried out superficially prior to the release of water. Information gained from carrying out biological and chemical assessments clearly indicates that the water from LHWP has negatively impacted on the biological communities in the recipient system. The importance of detailed before and after biological and physiochemical monitoring of both donor and recipient systems is emphasised.

Conservation of Natural Resources↗

PubMed2004

Development of activity monitoring for determining load carriage patterns in school students.

The loads that school students are carrying to, around and from school is an issue of increasing concern particularly as the long term effects of excessive load carriage on school students' musculoskeletal health is unknown. A greater understanding of the temporal patterns of students' load carriage, which usually involves backpacking, would assist in determining the magnitude of the problem that is faced by school students. The aim of this study was to determine the duration of school students' walking, running and stair climbing while backpacking and identify when students take off and put on their backpacks using activity monitoring and video, and therefore validate activity monitoring as a tool for measuring the temporal patterns of backpacking in school students. An activity monitor was secured in the backpacks of six school students while they completed a predefined physical activity course. Participants firstly completed the course following a set time pattern ('set course') and then repeated the course while performing activities as they pleased ('free course'). Video footage and activity monitor data were captured simultaneously. The activity monitor provided consistent visual differentiation between walking, running and taking off and putting on a backpack. The greatest variation between measures was for walking during the 'free course' (mean 8, SD 7 seconds), while the least variation between measures was for stair climbing during the 'set course' (mean 3, SD 2 seconds). There were no statistical differences between the activity monitor and video camera determined durations for any of the activities. These preliminary results suggest that activity monitoring may enable valid analysis of the temporal patterns of backpacking with little disruption to the user, although more work is required to verify this.

Adolescent↗

PubMed2004

Efficacy of three microbiological monitoring methods in a ventilated cage rack.

The use of individually ventilated caging (IVC) to house mice presents new challenges for effective microbiological monitoring. Methods that exploit the characteristics of IVC have been developed, but to the authors' knowledge, their efficacy has not been systematically investigated. Air exhausted from the IVC rack can be monitored, using sentinels housed in cages that receive rack exhaust air as their supply air, or using filters placed on the exhaust air port. To aid laboratory animal personnel in making informed decisions about effective methods for microbiological monitoring of mice in IVC, the efficacy of air monitoring methods was compared with that of contact and soiled bedding sentinel monitoring. Mice were infected with mouse hepatitis virus (MHV), mouse parvovirus (MPV), murine rotavirus (agent of epizootic diarrhea of mice [EDIM]), Sendai virus (SV), or Helicobacter spp. All agents were detected using contact sentinels. Mouse hepatitis virus was effectively detected in air and soiled bedding sentinels, and SV was detected in air sentinels only. Mouse parvovirus and Helicobacter spp. were transmitted in soiled bedding, but the efficacy of transfer was dependent on the frequency and dilution of soiled bedding transferred. Results were similar when the IVC rack was operated under positive or negative air pressure. Filters were more effective at detecting MHV and SV than they were at detecting MPV. Exposure of sentinels or filters to exhaust air was effective at detecting several infectious agents, and use of these methods could increase the efficacy of microbiological monitoring programs, especially if used with soiled bedding sentinels. In contemporary mouse colonies, a multi-faceted approach to microbiological monitoring is recommended.

Air Pressure↗

PubMed2004

The LifeShirt: a multi-function ambulatory system monitoring health, disease, and medical intervention in the real world.

Despite advances made in health-related ambulatory monitoring, medical practitioners and researchers have remained seriously constrained in their ability to acquire concurrent assessments of multiple physiological systems, as well as patient reports of symptoms and well being in daily life: Almost all past and current applications have been limited to the registration of a single variable (e.g. the electrocardiogram or blood pressure), and this has resulted in incomplete information about other relevant physiological and environmental factors likely to contribute to disease or its amelioration. Monitoring of multiple physiological functions has been too complicated to achieve and has required special measurement devices that have been unavailable, too expensive, or too cumbersome to effectively employ. Concurrent assessment of pertinent information about patient activities during monitoring has remained difficult to accomplish, although such information is likely to be crucial for the interpretation of physiological findings and patients' perceptions of improvement. The LifeShirt (Vivometrics, Inc., Ventura, CA, U.S.A.) is a multi-function ambulatory device capable of simultaneously monitoring several physiological signals and patient reports of symptoms and well being. The LifeShirt system is an extensible data acquisition and processing platform consisting of a garment, a data recorder, and PC-based analysis software. Sensors in the LifeShirt garment continuously monitor respiration, the electrocardiogram, activity and posture. Other functions are easily plugged into the system, including pulse oximetry, EEG/ EOG measurement, blood pressure, temperature, capnometry and acoustic monitoring. Subjective patient data may also be entered into the LifeShirt recorder, and all data are encrypted and written to a flash memory card. Vivologic(TM) analysis software provides full-disclosure analysis and display of high-resolution waveforms and over 30 derived parameters; the software also produces summary reports for clinical diagnostic purposes. The LifeShirt has been rigorously tested for more than 38,000 hours in 90 studies with 1,750 subjects. The device has received all necessary regulatory approvals and is currently used in leading research institutions throughout the United States, Canada and Europe. Clinical applications include sleep diagnostics, heart disease, pulmonary disorders, cardiopulmonary rehabilitation, early hospital discharge and pre- and post-operative monitoring, human-factors in ergonomics and behavioral medicine.

Cardiovascular Diseases↗

PubMed2005

Correlation of the Bispectral Index Monitor with the COMFORT scale in the pediatric intensive care unit.

OBJECTIVE: The COMFORT scale is a commonly used observational scoring system to assess the level of sedation in ventilated children in pediatric intensive care units (PICUs). The bispectral index (BIS) monitor is a processed electroencephalographic parameter that noninvasively measures the hypnotic effect of anesthetic and sedative drugs on the brain. The objective of this study was to assess the degree of correlation between the COMFORT scale and the BIS monitor. DESIGN: A prospective study in a tertiary level PICU. RESULTS: A total of 75 children were enrolled in the study, resulting in 869 valid paired observations of BIS values and COMFORT scores. The median age was 10 months, with a range of 1 month to 12 yrs. The median COMFORT score was 11 (range, 8-40). The median BIS value was 52 (range, 0-98). In a repeated-measures analysis, the correlation coefficient between COMFORT scores and BIS values averaged over time was 0.61 (p < .0001). CONCLUSIONS: The BIS monitor may be a valid and useful monitor of the level of sedation of children in the PICU. We cannot expect perfect correlation between BIS values and observational scales because they measure different variables. The BIS monitor may be the best objective monitor currently available for children receiving neuromuscular blockade because it does not rely on subjective measures such as those used in the COMFORT scale. The ability of the BIS monitor to distinguish between very deep levels of sedation may be useful to prevent over-sedation of children in PICUs and to help clarify the appropriate target level of sedation for each child.

Child↗

PubMed1991

Accuracy of bedside electrocardiographic monitoring: a report on current practices of critical care nurses.

Diagnostic criteria for many arrhythmias can be observed from any monitoring lead; however, other important criteria are "lead specific," such as the diagnostic QRS patterns in V1 that aid in distinguishing ventricular tachycardia from supraventricular tachycardia with bundle branch block or aberration. Therefore, it makes a great deal of difference which leads are selected for bedside monitoring. Our purpose was to determine which leads nurses select for monitoring, and the accuracy of lead placement. From a random sample of nurses who were members of the American Association of Critical-Care Nurses, 302 returned a monitoring questionnaire. Average critical care experience was 8.5 years. Lead II was most often selected (74%) for single-channel monitoring; lead II plus V1 (or MCL1) were most often selected (87%) for dual-channel monitoring. Only 37% of nurses demonstrated proper technique for obtaining their single lead of choice; even fewer (13%) demonstrated proper technique for obtaining their dual leads of choice. These results suggest that misdiagnosis of arrhythmias such a wide complex tachycardia in monitored patients may be caused by inappropriate lead selection as well as inaccurate lead placement.

Arrhythmias, Cardiac↗

PubMed1990

Electroencephalographic (EEG) video monitoring.

Electroencephalographic (EEG) video monitoring is the simultaneous documentation of the clinical and electroencephalographic manifestations of seizures. The video recording permits repeated viewing of the clinical sequence and enables comparisons with recordings of known seizures. Epilepsy is a clinical diagnosis in which most cases can be characterized with the standard clinical history, examination, and EEG. Studies of the treatment of intractable seizures (unsatisfactory control of seizure) indicate that more complex cases may require the data obtained with EEG video monitoring. For patients with intractable seizures, EEG video monitoring may help to confirm or support a diagnosis of epilepsy or confirm or support a differential diagnosis of physiologic or psychogenic seizures (nonepileptic attacks) from epilepsy. Monitoring also may provide a more accurate classification of the epileptic seizures and, for patients evaluated for surgical treatment, establish clinical focality. Estimates of the percentage of epilepsy patients requiring EEG video monitoring range from 5 to 30 percent. The average length of monitoring is approximately 10 to 16 days. In some cases outpatient monitoring in conjunction with activation procedures provides patient evaluation in only 6 to 8 hours.

Attitude of Health Personnel↗

PubMed1990

Mothers' behavior with home infant apnea monitors.

This study presents findings from 35 interviews with mothers of infants who were monitored for apnea following discharge from the same neonatal intensive care unit. The interviews took place at a mean of 28 weeks following discontinuation of the infant home apnea monitor and focused upon the mothers' behavior with the monitor. One family had independently ceased to use the monitor within 1 week of their infant's hospital discharge. All other mothers reported always having used the monitor at night, and 92% always used it during their infants' daytime naps. Approximately one half of the mothers would not have been able to consistently hear an alarm, however, when their infant was asleep. Consistency of availability to a monitored infant was not related to the mothers' background, attitudes, or experiences with their infant. These data indicate the need to emphasize for all caregivers the importance of being available to their monitored infant at all times.

Adult↗

PubMed1990

Lack of correlation between extended pH monitoring and scintigraphy in the evaluation of infants with gastroesophageal reflux.

Sixty-nine infants younger than 1 year of age, with symptoms of persistent vomiting, recurrent choking, apnea, persistent cough, or stridor, were evaluated for gastroesophageal reflux. All infants underwent extended intraesophageal pH monitoring for 16 to 24 hours as well as gastroesophageal scintigraphy with technetium 99m sulfur colloid to study the correlation between the two tests. Forty-eight infants exhibited reflux with extended pH monitoring whereas 46 infants showed reflux with scintigraphy. However, the diagnosis of reflux in individual patients by extended pH monitoring corresponded poorly with the diagnosis of reflux in the same patients by scintigraphy. Similarly, no correlation was observed between extended pH monitoring and scintigraphy results, whether expressed as percent gastric emptying or as gastroesophageal reflux ratio. We conclude that extended pH monitoring and scintigraphy measure different pathophysiologic phenomena and detect reflux under different conditions. The ability of these tests to detect reflux may be complementary and they may be of greatest value when used together to enhance the sensitivity and specificity of the diagnostic evaluation. Extended pH monitoring and scintigraphy should not be used interchangeably to monitor gastroesophageal reflux.

Esophagus↗

PubMedDate not supplied

1989 A/S/G/E survey of endoscopic sedation and monitoring practices.

Monitoring practices for conscious sedation during gastrointestinal endoscopic procedures are not standardized. A questionnaire was sent to 509 randomly selected A/S/G/E members to define current national sedation and monitoring practices. Responses were returned by 290 members (57%) from 45 states. The average respondent was between 35 and 54 years of age and had 12.4 years of endoscopic experience. Excluding flexible sigmoidoscopy, most patients were routinely sedated for endoscopic procedures. Meperidine (87%), midazolam (73%), diazepam (49%), and naloxone (30%) were the drugs most often used during conscious sedation. When a minor tranquilizer was used, midazolam (62%) was used more often than diazepam (38%). Cardiopulmonary sedation-related complications had a low annual occurrence rate of less than 0.5%. Most endoscopists monitor vital signs before and after procedures (greater than 90%) but less often during procedures (77%). Pulse oximeters and electrocardiographic monitoring were used by 65% and 55% of endoscopists, respectively. Electronic monitoring was used more often for patients undergoing endoscopy in hospitals (99.5%) than in private offices (27%). Fifty-four percent of respondents reported that they had a written endoscopy unit policy concerning conscious sedation. Among endoscopists and gastrointestinal assistants, basic life-support certification was common (76% and 77%, respectively), but advanced cardiac life-support was far less common (30% and 18%). This survey found the use of intravenous conscious sedation for gastrointestinal endoscopic procedures to be safe. Monitoring of patients with vital signs is used regularly; moreover, the majority of endoscopists now also employ electronic monitoring equipment.

Adult↗

PubMed1990

Preventing preterm birth in twin gestation: home uterine activity monitoring and perinatal nursing support.

In this investigation, 45 women with twin gestations in four centers were randomly assigned to either daily home uterine activity monitoring and perinatal nursing support (19) or an education group (26). Patients in the home uterine activity monitoring and perinatal nursing support group monitored uterine activity twice daily, transmitted the data each day, and had 24 hour-a-day access to nursing support. Education patients were counseled regarding the common signs and symptoms of preterm labor. Both groups had scheduled prenatal visits at least every 2 weeks. Sixteen (62%) of the education group and 14 (74%) of the home uterine activity monitoring and perinatal nursing support group developed preterm labor, values that were not significantly different. Of the monitored group who experienced preterm labor, all 14 were dilated 3 cm or less at diagnosis of the first preterm labor, compared with ten of 16 in the education group (P = .01; one-tailed Fisher test). The mean cervical dilatation at the first preterm labor episode in the group receiving daily monitoring and contact (1.6 cm) was significantly less (P = .01) than that in the education group (2.9 cm). Thus, fewer preterm births were recorded in the home uterine activity monitoring and perinatal nursing support group and significantly fewer patients delivered because of failed tocolysis (P = .03).

Adult↗

PubMed1990

Management of preterm labor patients at home: does daily uterine activity monitoring and nursing support make a difference?

Daily home uterine activity monitoring and perinatal nursing support were compared with standard care in managing patients with recurrent preterm labor during the current pregnancy in an effort to reduce preterm birth. Sixty-seven successfully treated preterm labor patients were randomly assigned in this multicenter study to daily home uterine activity monitoring and perinatal nursing support or to a standard-care group. Recurrent preterm labor occurred in 15 (45%) of monitored patients and 19 (56%) of standard-care patients. The risk of preterm birth (before 37 weeks) for patients with recurrent preterm labor was significantly reduced (P = .025) in the monitored group (seven, or 47%) compared with the standard-care group (16, or 84%). The relative risk of delivering because of failed tocolysis was 2.8 for the standard-care group versus the monitored group. There were no patients in the monitored group who delivered at the first recurrence of preterm labor for failed tocolysis. The data suggest that home uterine activity monitoring and perinatal nursing support are helpful in achieving term birth through earlier detection and treatment of recurrent preterm labor.

Adult↗

PubMed1990

Intracranial pressure monitoring: review of risk factors associated with infection.

Invasive intracranial pressure (ICP) monitoring and the data it provides have merit as a treatment and prognostic indicator. The most common complication associated with ICP monitoring is infection. This article categorizes and reviews the risk factors associated with ICP monitor-related infections, and outlines recommendations to minimize the risk of infection. The factor most consistently associated with ICP monitor-related infections was the duration of monitoring. Additional factors related to the development of infection were the age and diagnosis of the patient monitored, the consistency of maintaining a closed system, the insertion environment and technique, and the type of ICP monitor device used.

Age Factors↗

PubMed1989

[Monitoring routines at Danish anesthesia departments].

By means of a questionnaire investigation, 84 Danish anaesthetic departments were questioned in January 1987 about their monitoring routines during anaesthesia and recovery. 100% replied. The investigation revealed that measurement of the blood pressure in adults was the routine in all of the departments. Patients were monitored routinely with EGG in 62 departments where minor surgical interventions were concerned while, in major surgical intervention, ECG monitoring was the routine in 91% of the departments. Patients were observed postoperatively in the recovery room or intensive care unit in 51% of the departments. The questionnaire investigation revealed great variation in the monitoring and supervision routines in the anaesthetic departments in Denmark. Hitherto, it has not been possible to demonstrate that monitoring of the functions of vital organs in operation patients can reduce the morbidity and mortality connected with the anaesthesia. It is concluded that it would be desirable to carry out clinically controlled investigations to illustrate whether monitoring equipment can reduce the morbidity connected with anaesthesia and to develop a Danish recommendation concerning peroperative monitoring and postoperative observation.

Anesthesia Department, Hospital↗