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PubMed1999

Advanced dive monitoring system.

The US Navy supports deep diving operations with a variety of mixed-gas life support systems. A systems engineering study was conducted for the Naval Experimental Dive Unit (Panama City, FL) to develop a concept design for an advanced dive monitoring system. The monitoring system is intended primarily to enhance diver safety and secondarily to support diving medicine research. Distinct monitoring categories of diver physiology, life support system, and environment are integrated in the monitoring system. A system concept is proposed that accommodates real-time and quantitative measurements, noninvasive physiological monitoring, and a flexible and expandable implementation architecture. Human factors and ergonomic design considerations have been emphasized to assure that there is no impact on the diver's primary mission. The Navy has accepted the resultant system requirements and the basic design concept. A number of monitoring components have been implemented and successfully support deep diving operations.

Body Temperature↗
PubMed2002

Challenges in designing a multi-function patient monitor.

This article presents a discussion of some challenges in the design of a multi-function patient monitor. The term "multi-function patient monitor" refers to a single medical device that monitors multiple physiological parameters from the same patient. A common configuration of the monitor is a personal computer (PC) platform communicating with several modules each designed to monitor one physiological parameter. Although such an integration of modules allows the modules to access to the display screen, keyboard, power supply and printer of the PC, the integration also involves new design challenges. The foremost challenge is the increased demand on the PC's resources, while another challenge is compatibility among the various modules. Examples of compatibility are electromagnetic compatibility, and clinical compatibility. A well-known example of incompatibility is the non-invasive blood pressure monitor cuff cutting off blood flow to the finger with a pulse oximeter probe, resulting in a Low Signal alarm in the pulse oximeter. Other challenges include clutter on the display screen and confusing alarm annunciation. This article discusses these design challenges and proposes some solutions based on engineering principles, and common sense considerations. Examples will also be drawn from case reports available in the public domain.

Blood Pressure Monitors↗
PubMed2003

[Monitoring of 131I incorporation in nuclear medicine personnel by self accomplished measurements].

AIM: The personnel in nuclear medicine therapy wards must be monitored according to German guidelines for incorporations of (131)I. A surveillance with the employees measuring themselves similarly to the autonomous contamination survey using hand-foot-clothing monitors is presented as an alternative to the monitoring according to the official guidelines. METHOD: The employees use a dedicated device to measure themselves every working day. The automatic individual positioning of the device ensures reliable and reproducible results. The thyroid dose is determined from the measured time activity curve. The individual values of depth and mass of the thyroid are taken into account for activity measurement and dose evaluation, respectively. RESULTS: The employees measure themselves regularly and utilize the device to check for activities in the thyroid at an early stage after suspected incorporation. The almost complete surveillance permits a dosimetry with slight uncertainty. The determined thyroid doses of all monitored persons average to 0.35 mSv per month. CONCLUSION: The incorporation surveillance by autonomous monitoring allows a more reliable and more precise dosimetry than the monitoring according to the official guidelines. Despite numerous measurements the practice saves time and money as a result of the automation.

Guidelines as Topic↗
PubMed2003

Subcutaneous continuous glucose monitoring and dose adjustment decreases glycosylated hemoglobin in spontaneously diabetic cynomolgus monkeys.

Spontaneously diabetic cynomolgus monkeys (Macaca fascicularis) exhibit a condition similar to human type 2 diabetes. These monkeys have been maintained by treatment with insulin therapy based on fasting blood glucose levels and glycosylated hemoglobin (HbA1c) values, which are determined periodically by blood sampling. Instead we sought to determine whether the MiniMed Continuous Glucose Monitoring System (CGMS, MiniMed Inc., Sylmer, Calif.), which takes glucose measurements continually over 24 h, would facilitate monitoring and treatment in diabetic cynomolgus monkeys. We attached the CGMS to five diabetic monkeys and obtained their blood glucose profiles. The performance of the CGMS was evaluated against blood glucose values obtained using a palm-sized blood glucose meter. The CGMS accurately measured the animals' blood glucose levels, with a median correlation of 0.95 and a mean absolute difference of 8.2% +/- 4.7% in comparison to the hand-held blood glucose meter. The diabetic monkeys were monitored two or three times during the 3-month study period. Throughout the study, the feeding time, dosage, and insulin administration time were changed in three of the five monkeys in light of the monitoring results. HbA1c levels were measured before and at 1 and 3 months after insulin adjustment. Although the adjusted dosage was not significantly different from the preceding one, HbA1c levels decreased from 7.6% +/- 1.3% to 6.5% +/- 1.1% (P < 0.05) by the end of the study. We concluded that the values from the CGMS closely correlated with those obtained with the hand-held blood glucose meter. Using the CGMS to determine blood glucose profiles allows the blood glucose levels of the monkeys to be monitored during the night as well as the day. Therefore, such continuous monitoring is useful in preventing nocturnal hypoglycemia and hypoglycemic seizures and may facilitate successful management of diabetes.

Animals↗
PubMed1992

Noninvasive monitoring in the pediatric patient.

Substantial technological improvements have been made in the field of noninvasive monitoring. Additionally, our understanding of what these monitors will and will not do has changed the practice of pediatric anesthesia. In the 1990s it has become apparent that many cardiorespiratory parameters can be easily and safely monitored noninvasively. It is also apparent that no single monitor is capable of providing all the information necessary to provide safe anesthetic care. Those of us who provide anesthesia for children on a regular basis have come to appreciate these monitors not as an annoyance required for medicolegal protection but as tools that help improve the quality and safety of the anesthesia care our children receive. Use of these monitors represents the leading edge of an effort to reduce anesthesia morbidity and mortality to zero.

Auscultation↗
PubMedDate not supplied

Prospective lung health monitoring in relation to a new power plant.

A new power plant has been in operation in Ashkelon since the end of 1990. In order to record the effect of the environmental changes on lung health, a prospective monitoring system was established during the planning and construction phase of the plant. Data about lung health in the general population as well as the sensitive population (asthma patients) are recorded, and air pollution is monitored by seven monitoring stations located within a 5-25 km radius of the power plant. The lung health monitoring system includes: (1) A record of all visits to the local emergency room. (2) A record of visits to ten representative outpatient clinics related to cardiac and pulmonary symptoms. (3) A close follow-up of 200 asthmatic children enrolled in the local pediatric pulmonary clinic. This includes spirometry four times yearly, an annual winter check-up by a pediatric pulmonologist, and daily symptoms diary filled in by each patient for two weeks after the spirometry. (4) Spirometry and health questionnaires filled out by the parents of the 3600 studied children once in three years. (5) Mortality rate monitoring, relying on the Ministry of Health death registration. This system has been in operation since 1988, collecting base line data; the follow-up is planned to be operating for ten years. A dynamic interaction of the environmental and epidemiological monitoring systems will facilitate more efficient control of the emmissions from the power plant and better protection of the health of the population.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1991

Patient and environmental factors affecting ambulatory blood pressure monitoring.

Several patient and environmental factors may limit the applicability of ambulatory BP monitoring. In children and in elderly patients, erroneous readings may occur more frequently. Comparison of 25 elderly (greater than 65 yr) vs 25 young subjects recently monitored for clinical reasons in our hypertension clinic showed slightly higher error rates (19% vs 15% of readings) in the elderly but similar willingness to undergo monitoring again (96% vs 84% of subjects, respectively). The technique has not been well validated in obesity. Arrhythmias may prevent currently available ambulatory BP machines from obtaining usable readings. Monitoring may prove unsatisfactory for patients engaged in physically active occupations, travelling in automobiles, or in environments where the noise of the ambulatory BP machine would be disruptive. Portable automatic monitors can detect abnormally elevated average BP during sleep but the diagnostic value of this pattern remains unknown. It is concluded that ambulatory BP monitoring may be successfully performed in most patients.

Age Factors↗
PubMed1996

Use of peripheral nerve stimulators to monitor patients with neuromuscular blockade in the ICU.

BACKGROUND: Neuromuscular blockade is a frequently used therapy in the ICU. However, recent reports of prolonged paralysis and general muscular weakness in patients treated with this procedure have raised concerns about its use in intensive care. OBJECTIVE: The purpose of this study was to assess current monitoring practices of nurses who care for patients treated with neuromuscular blockade. METHODS: In January 1995, questionnaires were mailed to a random national sample of 2000 critical care nurses. Of the 2000 questionnaires mailed, 744 were returned. RESULTS: The number of patients per month who were treated with neuromuscular blockade in ICU settings ranged from 0 to 75 (mean = 6.82, SD = 9.15). For each patient, the average number of days of blockade ranged from less than 1 to 63 (mean = 4.12, SD = 3.36). The most common indications for neuromuscular blockade were to assist in mechanical ventilation, reduce oxygen consumption, and treat agitation. Only 41% of respondents (n = 306) reported using train-of-four stimuli and a peripheral nerve stimulator to monitor patients. Depth of neuromuscular blockade was routinely monitored by using clinical assessment (31%), a peripheral nerve stimulator (16%), or both (52%). CONCLUSIONS: Among the respondents, variations existed in monitoring practices and in the use of peripheral nerve stimulators, including the frequency of monitoring and use of the baseline milliamperage. Appropriate monitoring and titration of neuromuscular blocking agents by ICU nurses may aid in preventing adverse effects, including the potential for prolonged neuromuscular blockade. The existing variations in practice may affect patients' outcomes.

Critical Care↗
PubMed1996

Glucose monitoring of patients with diabetes mellitus receiving general anesthesia: a study of the practices of anesthesia providers in a large community hospital.

Surgical stress causes hyperglycemia with potential complications (e.g., impaired granulocytic function and delayed wound healing) particularly when glucose levels exceed 250 mg/dL. Standards of care for patients with diabetes undergoing surgery may vary by geographic locale, type of surgical procedure, and type of diabetes. We explored whether anesthesia providers monitor glucose levels in patients with diabetes. Records of 100 patients with diabetes who underwent surgery under general anesthesia (length of procedure: range, 1.9-11.8 hours) were reviewed. Demographic information, glucose levels, frequency of glucose monitoring, and treatment used for diabetes management preoperatively, intraoperatively, and postoperatively were recorded. There were 46 males and 54 females, aged 62 +/- 13 years (55% currently treated with insulin). Of the study cohort, 89% had preoperative, 23% had intraoperative, and 54% had postoperative glucose monitoring performed. As expected, postoperative glucose concentrations were significantly higher than preoperative glucose levels (mean difference, 99 mg/dL, P < .01). The mean postoperative glucose level was 262 +/- 89 mg/dL with 30 of the 54 monitored patients having a postoperative glucose level greater than 250 mg/dL. Individuals treated with insulin and those who underwent major surgery were more likely to have glucose levels monitored. These results suggest that better strategies for monitoring glucose levels during the surgical period are needed.

Aged↗
PubMed2006

Transcricothyroid, intraoperative monitoring of the vagus nerve.

OBJECTIVE: To develop a reliable, user-friendly, intraoperative, electromyographic monitoring technique to decrease the incidence of injury to the recurrent and superior laryngeal nerves. DESIGN: Prospective, nonrandomized, clinical trial of a nerve monitoring technique. SETTING: Private tertiary care community hospital. PATIENTS: A population-based sample of 31 patients scheduled to undergo thyroid surgery was enrolled consecutively. Included in the study were patients older than 18 years who were scheduled for surgery and who were able to provide informed consent. Exclusion criteria were pregnancy, implanted metallic devices, and history of laryngeal surgery, injury, paresis, hoarseness, or paralysis. No patients were excluded, and all completed the study and returned for follow-up visits. INTERVENTIONS: Twenty-nine patients required total thyroidectomy, of which 10 involved malignancy, and the other 2 patients required lobectomy. Each patient completed the Voice Handicap Index and underwent a preoperative fiberoptic laryngeal examination. Continuous monitoring was performed using a widely available, commercial nerve integrity monitor and a paired electrode placed into the cricothyroid space under direct vision. Postoperatively, participants completed a follow-up Voice Handicap Index survey and underwent a laryngeal examination. MAIN OUTCOME MEASURES: The incidence of vocal paresis, or paralysis, and the preoperative and postoperative voice handicap score were recorded. The usefulness of the device based on the surgeon's subjective and immediate postoperative impressions was rated on a visual analog scale. RESULTS: Sixty-two recurrent laryngeal nerves were identified with continuous electromyographic monitoring. Vocal cord paresis or paralysis was not observed. Postoperative Voice Handicap Index scores were unchanged from preoperative assessment. The technique was given a rating of 1 (most useful) on a 5-point scale in 70% of cases. CONCLUSIONS: The technique described is sensitive, easy to use, accurate, and associated with a high degree of surgeon satisfaction. This technique is not associated with additional risk to the patient and offers the potential to reduce injury. Monitoring provides assurance that the nerve is intact and functioning prior to extubation.

Adolescent↗
PubMed1988

Sudden infant death and home monitors.

During a two-year period, ten infants died suddenly and unexpectedly with a home cardiorespiratory monitor available. We investigated the compliance with appropriate monitoring technique as well as the medical and demographic factors associated with these deaths (90% were due to sudden infant death syndrome). At least six and probably eight of these ten families were noncompliant with appropriate monitoring technique. The main comparison group consisted of 211 patients for whom care with home cardiorespiratory monitors was initiated and continued. Bronchopulmonary dysplasia and severe, apparent life-threatening events were significantly increased in the subjects, as were the following characteristics: black race; lack of private medical insurance; unmarried mother; maternal age of less than 25 years; cigarette smoking by mother during pregnancy; and low Apgar scores. These diagnostic and demographic factors may be useful in predicting the infant at highest risk for sudden and unexpected death when a home monitor is prescribed. Noncompliance with proper monitoring technique patients; methods of educating parents of infants at high risk of sudden infant death syndrome with the necessity for compliance need to be developed.

Bronchopulmonary Dysplasia↗
PubMed1995

Access to home apnea monitoring and its impact on rehospitalization among very-low-birth-weight infants.

OBJECTIVE: To examine the relationship between home apnea monitoring and sociodemographic, socioeconomic, and medical factors and the risk for rehospitalization among very-low-birth-weight infants (birth weight < 1500 g). DESIGN AND SETTING: Analysis of live infants born weighing less than 1500 g; these data were obtained from the 1988 National Maternal and Infant Health Survey. Data from this survey were obtained by maternal questionnaires and from birth certificates and medical records. OUTCOME MEASURE: One or more hospitalizations after discharge from the hospital of delivery. RESULTS: Home apnea monitor use was strikingly lower among black infants (19.8%) compared with nonblack infants (43.7%) (P < .001). The rate of rehospitalization for blacks was 24.8%, which was lower than the rate of 34.3% for nonblacks (P = .001). Neither annual family income nor method of hospital payment was associated with rehospitalization. The use of an apnea monitor in the home was associated with an increased odds ratio for rehospitalization for both blacks (odds ratio, 2.56; 95% confidence interval, 1.56 to 4.21) and nonblacks (odds ratio, 2.28; 95% confidence interval, 1.51 to 3.45). With adjustment for the use of an apnea monitor, the odds ratio for rehospitalization of blacks vs nonblacks was no longer significant (odds ratio, 0.80; 95% confidence interval, 0.60 to 1.08). CONCLUSIONS: The use of an apnea monitor in the home was highly associated with an increased risk for rehospitalization. Whether this increased risk was attributable to a valid reason for rehospitalization or to closer scrutiny of the infant could not be determined. The lower prevalence of apnea monitor use among blacks is unexplained.

Adolescent↗
PubMed1976

Pressure monitoring devices. Overlooked source of nosocomial infection.

Contaminated pressure monitoring devices recently have been implicated as a source of epidemic organisms in three outbreaks of nosocomial bacteremia, one outbreak of candidemia, and one outbreak of hepatitis. Measures necessary to prevent monitoring-related infections have not always been appreciated or taken. As a minimum, pressure monitoring devices should be sterilized between use with different patients; strict aseptic technique should be employed when setting up and using monitoring systems; and each patient's monitoring tubing, fluid, and monitoring devices should be changed at regular intervals.

Blood Pressure Determination↗
PubMed1998

Lithium in the over-65s: who is taking it and who is monitoring it? A survey of older adults on lithium in the Cambridge Mental Health Services catchment area.

OBJECTIVES: To determine the prevalence of lithium therapy in the over-65s in the Cambridge Mental Health Services catchment area, to obtain a profile of this group and to find out how well and by whom lithium treatment is being monitored. METHODS: A census was carried out of patients over the age of 65 in the Cambridge Mental Health Services catchment area who were on lithium therapy on 1 February 1995. The records of these patients were examined retrospectively for demographic details, details of lithium therapy, information about lithium monitoring and risk factors associated with lithium treatment. RESULTS: One hundred and forty-eight patients were identified representing a point prevalence of 0.27%. GPs carried out lithium monitoring for the majority of this group and 47% had not been seen by a psychiatrist in the 12 months leading up to the census date. Thirty-two per cent of the group were on thyroxine treatment or had raised TSH levels. CONCLUSIONS: The prevalence of lithium therapy in this study was greater than the prevalences reported in studies of patients of all ages. Standards of monitoring varied widely and were not always better where psychiatrists monitored the treatment, although psychiatrists were more likely than GPs to monitor renal function. There was a high rate of thyroid dysfunction in the study group.

Aged↗
PubMed1999

Automated monitoring of diaphragm end-expiratory position for real-time navigator echo MR coronary angiography.

Real-time navigator echo (NE)-gated magnetic resonance coronary angiography (MRCA) during free respiration is now possible. However, the mean diaphragm end-expiratory position (DEEP) drifts over time, and this results in a reduction in scanning efficiency and increased artifacts due to the acquisition of data during periods of high diaphragm velocity. To address these problems, a diaphragm monitoring program that follows the mean DEEP over time has been developed. Fifteen subjects with ischemic heart disease underwent continuous NE monitoring of their diaphragm for 30 minutes. Using these diaphragm traces, theoretical MRCA scans were performed. Several diaphragm monitoring algorithms were developed and compared with the simplest case (a stationary 5 mm NE acceptance window placed around the mean DEEP, as measured by NE monitoring at the outset of the scan). An overall scan efficiency was calculated, and the number of completed scans where the mean DEEP lay within the NE acceptance window was recorded. Of the six algorithms considered, the most effective one monitored the mean DEEP and prospectively placed the upper limit of the NE acceptance window on this position for the subsequent acquisition. Using this algorithm in comparison with the simplest stationary scenario, both scan efficiency (47.9% vs. 38.5%, P = 0.01) and the number of completed scans where the mean DEEP lay within the NE acceptance window (71.2 vs. 30.3, P < 0.001) were improved. The implementation of such a monitoring algorithm, in combination with adaptive motion correction techniques, should improve overall scan efficiency while maintaining the end-expiratory position at the top end of the NE acceptance window, to reduce image artifacts.

Adult↗
PubMed2005

Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin.

BACKGROUND: Self-monitoring of blood glucose (SMBG) has been found to be effective for patients with type 1 diabetes and for patients with type 2 diabetes using insulin. There is much debate on the effectiveness of SMBG as a tool in the self-management for patients with type 2 diabetes who are not using insulin. OBJECTIVES: The objective of this review was to assess the effects of SMBG in patients with type 2 diabetes mellitus who are not using insulin. SEARCH STRATEGY: Studies were obtained from searches of multiple electronic bibliographic databases supplemented with hand searches of references of retrieved articles. Date of last search: September 2004. SELECTION CRITERIA: We included randomised controlled trails investigating the effects of SMBG compared with usual care and/or with self-monitoring of urine glucose in patients with type 2 diabetes who where not using insulin. Included studies should have used at least one of the following outcome measures: glycaemic control, quality of life, well-being, patient satisfaction, or hypoglycaemic episodes. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data from included studies and assessed study quality. Data from the studies were compared to decide whether they were sufficiently homogeneous to pool in a meta-analysis. MAIN RESULTS: Six randomised controlled trials were included in the review. Four trials compared SMBG with usual care, one trial compared SMBG with self-monitoring of urine glucose and there was one three-armed trial comparing SMBG with self-monitoring of urine glucose and usual care. Because of the differences in patient characteristics, interventions and outcomes between the studies, it was not possible to perform a meta-analysis. The methodological quality of studies was low. Two of the six studies reported a significant lowering effect of self-monitoring of blood glucose on HbA1c. However, one of these studies had a co-intervention with education on diet and lifestyle. There were few data on the effects of other outcomes and these effects were not statistically significant. AUTHORS' CONCLUSIONS: From this review we concluded that self-monitoring of blood glucose might be effective in improving glycaemic control in patients with type 2 diabetes who are not using insulin. To assess the potential beneficial effects of SMBG in these patients a large and well-designed randomised controlled trial is required. This long-term trial should also investigate patient-related outcomes like quality of life, well-being and patient satisfaction, and provide adequate education to the patient to allow SMBG to be effective.

Blood Glucose Self-Monitoring↗
PubMed1999

Statistics and environmental policy: case studies from long-term environmental monitoring data.

Environmental objectives are statements of policy which are intended to be assessed using information from a monitoring program. An environmental monitoring program has to be adequate in its quality and quantity of data so that the environmental objectives can be assessed. Also, the resulting data should be able to contribute information towards decisions to modify policy at a later time if desirable. However, monitoring programs can fail to return satisfactory information for policymakers because future statistical needs have not been anticipated, potential confounding factors were not considered, or sampling protocols did not specify suitable randomization. A key intermediate role exists for the use of statistical inference in providing a logical framework for using monitoring data to test hypotheses about fulfillment of environmental objectives. The undertaking of a statistical inferential approach to monitoring design can result in data which are more general in their interpretation and, thus, more useful as input to policy development and review. Some case studies from the Victorian EPA monitoring programs will be presented to illustrate these points.

Environmental Monitoring↗
PubMed1995

The total costs of drug therapy for rheumatoid arthritis. A model based on costs of drug, monitoring, and toxicity.

OBJECTIVE: We created a model to estimate the total medication costs of treating patients with rheumatoid arthritis with 6 second-line agents for the first 6 months of treatment. METHODS: Drug costs were obtained from a survey of pharmacies; monitoring costs were calculated from utilization information obtained in a survey of rheumatologists; toxicity costs were obtained using decision trees to represent the evaluation and treatment of potential toxicities. Monitoring and toxicity costs were estimated using costs from the Boston University Medical Center or, for hospitalizations, using appropriate diagnosis-related group categories. The sum of the 3 components determined the total medication costs. RESULTS: The least expensive medication was penicillamine, at $10.62/week, and the most expensive was injectable gold, at $30.89/week. In terms of monitoring costs, methotrexate had the highest costs associated with necessary laboratory tests and office visits. Hydroxychloroquine had the lowest monitoring costs for office visits, and oral gold had the lowest for laboratory costs. Hematologic toxicities were the largest component of toxicity costs for all 6 medications, and renal toxicities were costly for patients taking oral gold, penicillamine, and injectable gold. Total medication costs revealed oral gold as the least expensive medication and injectable gold as the most expensive. The combination of monitoring and toxicity costs accounted for more than 60% of the total costs for all medications except injectable gold. In all cases, the cost of treating toxicities was the smallest of the 3 components. CONCLUSION: When calculating the costs of drug therapy, it is important to consider not only the price of the drug, but also the costs of monitoring and treating the toxicities that might occur. Failure to do so will result in underestimating the true costs of treatment with these medications.

Antirheumatic Agents↗