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PubMed2001

A low-cost system for monitoring skin conductance during functional MRI.

We built a low-cost system for monitoring human skin conductance responses (SCRs) in a clinical magnetic resonance (MR) scanner during functional imaging. The average scanner-induced conductance noise level was suppressed sufficiently to allow SCR measurements over the full range of SCR amplitudes, and functional image signal-to-noise ratio was unaffected by the skin conductance apparatus. The system may be useful for a variety of imaging studies.

Galvanic Skin Response↗
PubMed1999

[A method for continuous monitoring of total peripheral and pulmonary vascular resistance in high risk cardiac patients].

In this study we present a computer-assisted monitoring system ("Opserver") which allows a continuous registration of directly measured values: hear rate (HR), systolic, diastolic and mean arterial pressure (SAP, DAP, MAP): systolic, diastolic and mean pulmonary arterial pressure (PAPs, PAPd, PAPm), central venous pressure (CVP), mixed venous oxygen saturation (SvO2), pulse-oxymetrically measured oxygen saturation (SaO2), cardiac output (CO) and calculated haemodynamic parameters: cardiac index (CI), total peripheral vascular resistance (TPVR) and pulmonary vascular resistance (PVR). The basic principle of this on-line monitoring system is the registration of calculated parameters combining data of various devices by specially-developed software. The procedure is shown in several clinical examples. The advantages of this system are:--monitoring of critical haemodynamic responses in cardiac high-risk patients relating to induction and finishing of anaesthesia including in- and extubation, recovery from anaesthesia, operation and transport and--exact documentation of the data for the purpose of clinical studies. Based on continuous measurement, this monitoring system allows an optimum evaluation of cardiorespiratory acute incidents, thereby permitting a problem-oriented therapy in high-risk patients with vasoactive medication in the perioperative period and in the intensive care unit.

Anesthesia, General↗
PubMedDate not supplied

Controversies in immunization practices: vaccine safety and implications for midwifery practice.

Adverse events occur only rarely after vaccine exposure. Yet, given the high vaccine coverage rates in the United States, the public is increasingly becoming concerned that vaccines may be causing immediate or long-term health problems and less concerned about the possibility of becoming infected. More than 10,000 reports of possible vaccine-related adverse events are reported every year to VAERS, the passive surveillance system that monitors vaccine safety after licensure. As providers of primary health care services to women, midwives are ideally positioned to answer women's questions about vaccine safety. This article provides the background midwives need to be able to help their clients make informed vaccine decisions. It discusses the incidence and risks of infection, the efficacy and risks of vaccines, issues complicating the evaluation of vaccine safety, the state of vaccine safety monitoring systems, and approaches consumers use in vaccine decision making.

Adverse Drug Reaction Reporting Systems↗
PubMed2001

Preventing falls from roofs: a critical review.

Work-related falls from roofs remain a significant problem for workers in the construction industry. Knowledge about the main causative or initiating factors leading to fall incidents is desperately needed for fall prevention intervention. From biomechanical and psychophysiological perspectives the majority of occupational falls, including falls from roofs, can be regarded as loss-of-balance incidents. The primary objective of this paper is to summarize the current knowledge from multiple fields about factors that are related to the control of balance during roofing work. An extensive literature review identified a number of environmental, task-related and personal factors that degrade the control of balance and could be associated with the initiation of falls from roofs. These factors include visual exposure to elevation; unstable visual cues and inadequate visual information in the work environment; 'confined' and inclined support surfaces; unexpected changes in roof surface properties; load handling; physical exertion; fatigue; task complexity that diverts workers' attention; individual differences; work experience and training; and personal protective equipment. Current measures to reduce falls from roofs focus mainly on fall protection procedures, such as the use of covers, guardrails, safety nets, and personal fall-arrest systems, or the application of warning-line systems, safety monitoring systems, and fall protection plans. In many instances, these procedures are not practical for the industry and current regulations allow the use of alternative means of fall protection, such as slide guards. Future research on preventing falls from roofs should consider the main effects and interactions of the environmental, task-related and personal factors that affect the balance control of workers. Research-supported improvements in the visual and physical characteristics of the roof work environment, the construction materials and methods, and work procedures and practices may result in improved workers' balance control as well as overall safety performance, and would ultimately reduce incidents of falling from a roof.

Accidental Falls↗
PubMed2004

New multiplexed flow cytometric assay to measure anti-peptide antibody: a novel tool for monitoring immune responses to peptides used for immunization.

Peptide-based vaccination has a great potential for the prevention and treatment of various diseases. There is, however, no appropriate monitoring system to measure immune responses to vaccinated peptides, which hampers the development of therapeutically effective vaccine regimens to various diseases. In this study a new multiplexed flow cytometric assay using the Luminex system to monitor humoral immune responses to vaccinated peptides is described. Although the sensitivity is mostly equal to that of the traditional enzyme-linked immunosorbent assay (ELISA), the new assay has several advantages over ELISA in that it minimizes the amount of sera needed, running costs and working periods, and thus will be a novel tool for monitoring immune responses to vaccinated peptides.

Antibodies↗
PubMedDate not supplied

The assessment of food additive usage and consumption: the Commission perspective.

Directive 89/107/EEC on food additives authorized for foodstuffs intended for human consumption includes the requirement that 'all food additives must be kept under continuous observation and must be re-evaluated whenever necessary in the light of changing conditions of use and new scientific information'. During the period June 1994 to March 1995, three specific directives have been adopted, each of them including an obligation for Member States to introduce systems to monitor the usage and consumption of food additives and to report their findings to the Commission within 3 years. They also require the Commission to submit reports to the European Parliament on changes in the additives market, the levels of use and consumption, and to propose amendments to the conditions of use if necessary within 5 years. This paper examines the legal obligations of the Member States and the Commission and proposes practical interpretation of the requirements which would allow realistic and comparable monitoring systems to be set up in the Member States within the limits of their scarce resources. The importance of focusing on public health-related aspects is stressed and consideration is given to the role of the various interested parties and the nature of the Commission's co-ordination responsibility.

Europe↗
PubMedDate not supplied

Portable and programmable clinical EOG diagnostic system.

Monitoring eye movements is clinically important in diagnosis of diseases of the central nervous system. Electrooculography (EOG) is one method of obtaining such records which uses skin electrodes, and utilizes the anterior posterior polarization of the eye. A new EOG diagnostic system has been developed that utilizes two off-the-shelf portable notebook computers, one projector and simple electronic hardware. It can be operated under Windows 95, 98, NT, and has significant advantages over any other similar equipment, including programmability, portability, improved safety and low cost. Especially, portability of the instrument is extremely important for acutely ill or handicapped patients. The purpose of this paper is to introduce the techniques of computer animation, data acquisition, real time analysis of measured data, and database management to implement a portable, programmable and inexpensive contacting EOG instrument. It is very convenient to replace the present expensive, inflexible and large-sized commercially available EOG instruments. A lot of interesting stimulation patterns for clinical application can be created easily in different shape, time sequence, and colour by programming in Delphi language. With the help of Winstar (a software package that is used to control I/O and interrupt functions of the computer under Windows 95, 98, NT), the I/O communication between two notebook computers and A/D interface module can be effectively programmed. In addition, the new EOG diagnostic system is battery operated and it has the advantages of low noise as well as isolation from electricity. Two kinds of EOG tests, pursuit and saccade, were performed on 20 normal subjects with this new portable and programmable instrument. Based on the test result, the performance of the new instrument is superior to the other commercially available instruments. In conclusion, we hope that it will be more convenient for doctors and researchers to do the clinical EOG diagnosis and basic medical science research by using this new creation.

Adult↗
PubMed2002

Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion.

OBJECTIVE: Peripheral perfusion in critically ill patients frequently is assessed by use of clinical signs. Recently, the pulse oximetry signal has been suggested to reflect changes in peripheral perfusion. A peripheral perfusion index based on analysis of the pulse oximetry signal has been implemented in monitoring systems as an index of peripheral perfusion. No data on the variation of this index in the normal population are available, and clinical application of this variable in critically ill patients has not been reported. We therefore studied the variation of the peripheral perfusion index in healthy adults and related it to the central-to-toe temperature difference and capillary refill time in critically ill patients after changes in clinical signs of peripheral perfusion. DESIGN: Prospective study. SETTING: University-affiliated teaching hospital. PATIENTS: One hundred eight healthy adult volunteers and 37 adult critically ill patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Capillary refill time, peripheral perfusion index, and arterial oxygen saturation were measured in healthy adults (group 1). Capillary refill time, peripheral perfusion index, arterial oxygen saturation, central-to-toe temperature difference, and hemodynamic variables were measured in critically ill patients (group 2) during different peripheral perfusion profiles. Poor peripheral perfusion was defined as a capillary refill time >2 secs and central-to-toe temperature difference > or = 7 degrees C. Peripheral perfusion index and arterial oxygen saturation were measured by using the Philips Medical Systems Viridia/56S monitor. In group 1, measurements were made before and after a meal. In group 2, two measurements were made, with the second measurement taken when the peripheral perfusion profile had changed. A total of 216 measurements were carried out in group 1. The distribution of the peripheral perfusion index was skewed and values ranged from 0.3 to 10.0, median 1.4 (inner quartile range, 0.7-3.0). Seventy-four measurements were carried out in group 2. A significant correlation between the peripheral perfusion index and the core-to-toe temperature difference was found (R2=.52; p <.001). A cutoff peripheral perfusion index value of 1.4 (calculated by constructing a receiver operating characteristic curve) best reflected the presence of poor peripheral perfusion in critically ill patients. Changes in peripheral perfusion index and changes in core-to-toe temperature difference correlated significantly (R =.52, p <.001). CONCLUSIONS: The peripheral perfusion index distribution in the normal population is highly skewed. Changes in the peripheral perfusion index reflect changes in the core-to-toe temperature difference. Therefore, peripheral perfusion index measurements can be used to monitor peripheral perfusion in critically ill patients.

Adult↗
PubMed2000

Requirements management: keeping your technology acquisition project under control.

Whether you are acquiring clinical or business information systems, patient monitoring systems, or therapeutic and diagnostic systems, the odds are good that the project will be delivered late, will cost far more than predicted, and will not provide all the features promised. The principal reason for project failure is improper management of the requirements of the system. Requirements engineering and management is a skill from the systems engineering profession that can be learned by nearly any professional who is managing a technology acquisition project. The author discusses what requirements engineering and management is and how it is done.

Equipment and Supplies, Hospital↗
PubMed2004

Monitoring antebrachial compartmental pressure in displaced supracondylar elbow fractures in children.

PURPOSE: Our aim was to measure antebrachial volar compartment pressure in displaced supracondylar elbow fractures in children. METHODS: We conducted a prospective, observational study of 42 fractures. The mean age was 5.2 years. There was type II displacement in nine cases (21.4%) and type III in 33 (78.6%). A wick catheter (1.5 mm in diameter) was placed perioperatively and compartmental pressure was monitored on a intra-compartmental pressure monitor system (STIC monitor) with a +/- 1 mmHg margin of error. Compartmental, systolic and diastolic pressures were measured every day for the first three postoperative days and then for a 2-week follow-up period. Descriptive statistics, t-test and correlation with a P < 0.05 significance were studied. RESULTS: Mean compartmental pressure before reduction was 8.3 mmHg and 6.7, 4, 2.4, 1.7 and 1 mmHg during the first 3 days and at 1 and 2 weeks post-reduction, respectively. Pressure decreased 40% (P = 0.0005) from the first to the second day and 75% (P = 0.0005) from the first day to the first week. There was no correlation between compartmental pressure and systolic and diastolic pressure. The compartmental pressure decreased significantly by the third postoperative day (P = 0.02). CONCLUSION: Compartmental pressure decreased 60% the first 3 days. In displaced supracondylar fractures with clinical risk factors, it is advisable to monitor compartmental pressure during the first 24-48 h.

Blood Pressure↗
PubMed2006

Critical care in the emergency department: monitoring the critically ill patient.

The aim of monitoring patients is to detect organ dysfunction and guide the restoration and maintenance of tissue oxygen delivery. Monitoring is a crucial part of the care of the critically ill patient in the emergency department as the physiological response to critical illness is linked strongly to outcome. As it is important to appreciate the limitations of monitoring systems and monitored data, and to understand that invasive monitoring may be hazardous, this review concentrates on the techniques used to monitor critically ill patients in the emergency department. End tidal carbon dioxide monitoring, pulse oximetry, arterial blood pressure monitoring, central venous pressure monitoring, continuous central venous oxygenation saturation monitoring, temperature monitoring, and urine output are discussed. Practitioners should be familiar with the physiology and technology underlying these monitoring techniques and be aware of the pitfalls in interpretation of monitored data.

Aged↗
PubMedDate not supplied

Measuring and improving preventive care for patients with diabetes in primary health centers.

Diabetes care among medically underserved patients is suboptimal. Few studies, however, have described successful strategies to improve diabetes care in these patient populations. To address this issue, 4 Montana community health centers and 1 urban Indian health center implemented quality improvement efforts along with an office-based electronic system for monitoring diabetes care. After a median of 17 months follow-up, preventive services and clinical outcomes were assessed for all patients at baseline (N = 332) and follow-up (N = 590), and for a cohort (N = 164) who had 1 or more visits 6 months after baseline. In cross-sectional analyses, there were increases from baseline to follow-up in the percent of patients who had received an annual foot examination (50% to 68%), microalbuminuria testing (34% to 62%), annual retinal examination (14% to 30%), pneumococcal immunization (30% to 61%), and smoking assessment (77% to 91%). But neither HbA1c testing in the previous 6 months (64% to 55%) nor annual LDL-C testing (59% to 61%) showed any improvement. There were no significant changes from baseline to follow-up in the median hemoglobin A1c (HbAlc), low density lipoprotein-cholesterol (LOL-C), or in systolic and diastolic blood pressure values. Similar improvements in preventive care were seen in the cohort of patients with diabetes. But overall outcomes were not improved. Our findings suggest that office-based monitoring systems can support systems' changes to improve the delivery of preventive services to patients with diabetes in primary care facilities for the underserved, but outcomes are more difficult to enhance over a short period of follow-up. Also, our findings suggest that over a relatively short-term period, cross-sectional and cohort analyses of quality improvement measures do yield similar measures of diabetes care in such settings.

Adolescent↗
PubMed2006

Bioacoustic monitoring of aggression in group-housed rhesus macaques.

Many captive primate facilities house rhesus macaques in multimale-multifemale social groups in large enclosures that simulate the natural social and environmental features characteristic of the species, enhancing their reproductive performance as well as their psychological well-being, yet one of the most difficult management problems in socially housed macaques is their propensity for exhibiting spontaneous bouts of deleterious aggression. To address this management problem, an automated bioacoustic monitoring system might be developed that is capable of detecting and forecasting problematic patterns of contact aggression. To evaluate the utility of this approach, this study examined the magnitude of aggression and the co-occurrence of certain vocalization types and aggression in 10 groups of rhesus macaques. The data confirmed aggression as a significant problem in rhesus groups and indicated that certain patterns of vocalizations are indicative of the type or level of aggression. The detection and classification of these vocalization types need further research to eventually design and implement an efficacious bioacoustic system for monitoring aggression in rhesus macaques.

Aggression↗
PubMed2005

Faraday current sensor with temperature monitoring.

We present a novel optical current sensor based on the Faraday effect that incorporates a temperature monitoring system. The monitoring element is a temperature-dependent birefringent plate placed at the Faraday sensor head. Measurement of the plate retardation permits compensation for the temperature dependence of the Verdet constant. Validation experiments are presented and discussed.

Journal Article↗
PubMed2005

A two-center randomized controlled feasibility trial of insulin pump therapy in young children with diabetes.

OBJECTIVE: Our goals were to determine if continuous subcutaneous insulin infusion (CSII), compared with those continuing multiple daily injections (MDIs), can be safely used in young children, if those on CSII will have superior glycemic control, if subjects using CSII will have less hypoglycemia for their level of control, and if families using CSII will report an improved quality of life. RESEARCH DESIGN AND METHODS: We conducted a randomized 1-year feasibility trial comparing CSII with continuing MDIs in preschool children with a history of type 1 diabetes for at least 6 months' duration. Prospective outcomes included measures of overall glycemic control (HbA1c and continuous glucose monitoring system), the incidence of severe hypoglycemia and diabetic ketoacidosis, the percent of glucose values below 3.9 mmol/l, and the parents' report of quality of life. RESULTS: The 19 subjects' ages ranged from 1.7 to 6.1 (mean 3.6) years, duration of diabetes ranged from 0.6 to 2.6 (mean 1.4) years, and baseline HbA1c ranged from 6.7 to 9.6% (mean 7.9%). Seven subjects were male. Nine subjects were randomized to start CSII and 10 to continue on MDI. All baseline characteristics were well balanced. Overall metabolic control, diabetes quality of life, and the incidence of hypoglycemia were similar in the two groups. No subject had diabetic ketoacidosis, while one subject in each group had an episode of severe hypoglycemia. No CSII subject discontinued using the pump during or after the study. CONCLUSIONS: CSII can be a safe and effective method to deliver insulin in young children.

Blood Glucose↗
PubMedDate not supplied

Adaptive monitoring in the ICU: a dynamic and contextual study.

The wealth of physiological data made available by current medical monitoring systems can be used efficiently only if the monitoring system is capable of relieving human personnel of relatively low-level tasks by performing intelligent data interpretation, contextual analysis and advice tasks. The system described in this paper can choose the variables to which most processing time will be devoted on the basis of the evolution of the patient.

Data Interpretation, Statistical↗
PubMedDate not supplied

[Anticonvulsants (carbamazepine, valproate, lamotrigine) in bipolar affective disorder].

The introduction of anticonvulsants to the treatment of recurring affective disorders, has significantly broadened the possibilities of helping the ill, especially in the prophylaxis of recurring symptoms of bipolar affective disorders. Carbamazepine and valproate (probably also lamotrigine) are a valuable alternative of Lithium Carbonate. The application of anticonvulsants requires strict rule regiment, which includes: gradual dose increase (especially in lamotrigine), gradual dose reduction when planning ending of the therapy, drug blood-level monitoring, liver action monitoring, haemopoietic system monitoring, in the case of the appearance of flu-like symptoms and skin changes--withdrawal of the drug. In simultaneous application of other drugs (e.g. psychotropic), probable interactions should be considered.

Anticonvulsants↗
PubMed2003

[Surgical services in Denmark--time for reorganization?].

Denmark is a small country (about 5 million inhabitants) and has a unique registration of hospital admissions, surgical procedures and specific person-numbers in national registers. However, there is currently no system to monitor the overall quality of surgical care. Also, surgical services are provided in a large number of hospitals. In order to provide a rational basis of professional and administrative strategies to monitor and improve the quality of surgical care, establishment of a nation-wide monitoring system and quality improvement programme is required as well as regionalisation of major procedures.

Denmark↗