PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Remote Patient Monitoring”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 199 records · Page 11Linked to original sources
PubMed1999

Aerosol granulocyte macrophage-colony stimulating factor: a low toxicity, lung-specific biological therapy in patients with lung metastases.

The objective was to study the feasibility of granulocyte macrophage-colony stimulating factor (GM-CSF) delivery to the lung using an aerosol in humans. A Phase I dose escalation study provided GM-CSF at three dose levels as a twice-a-day (BID) x 7 days schedule. Pulmonary functions were monitored using a remote spirometry device. Blood counts were checked at the beginning and end of each week of GM-CSF nebulization. If no toxicity was encountered, patients rested for 7 days and then were treated at the next dose level. Six of seven patients were successfully dose escalated from 60 microg/dose BID x 7 days, to 120 microg/dose BID x 7 days, then 240 microg/dose BID x 7 days. No toxicity was seen. Comparison of day 0 and day 7 blood leukocyte counts showed no significant increases in either leukocyte numbers or percentage of neutrophils. Pulmonary functions test changes were minor. No significant change in forced vital capacity, FEV1, peak flow, or FEF 25-75 related to either time or dose level was observed. One patient's lung metastases progressed. The other five patients received an additional 2-6 months of intermittent aerosol GM-CSF at dose level 3 without side effects. One patient with Ewing's sarcoma has a complete response, and a patient with melanoma had a partial response; the other three had stabilization of pulmonary metastases for 2-6 months. Aerosol delivery of GM-CSF is feasible, safe, and possibly effective. Aerosol cytokine delivery may achieve effective immunological activation against cancer in the lung and is worthy of further study.

Administration, Inhalation↗
PubMed1998

Characterization and comparison of local onset and remote propagated electrographic seizures recorded with intracranial electrodes.

PURPOSE: To compared the ictal discharge patterns between local onset and remote propagated electrographic seizures recorded with chronic intracranial electrodes. METHODS: The electrophysiological data from 88 consecutive patients who underwent chronic intracranial EEG monitoring were retrospectively reviewed. The early and late discharge patterns of electrographic seizures at local onset and distant propagated sites were determined by blinded visual inspection and computerized analysis. RESULTS: Four early and three late electrographic seizure patterns were observed at the local onset sites. The four early patterns consisted of a rhythmic discharge in the beta range ("beta buzz"), rhythmic alpha-theta activity, rhythmic sharp waves in the delta range, and an irregular spike discharge. The three distinct late-discharge patterns consisted of a late beta buzz, rhythmic sharp theta activity, and a rhythmic polyspike and wave discharge. At remote propagated sites, electrographic seizures could be divided into two different types according to their early discharge pattern. The first was unique to remote propagated electrographic seizures and consisted of a rhythmic theta-delta activity correlated with the concurrent activity at the local-onset site. The second remote initiation type consisted of patterns indistinguishable from the earlier discharge patterns recorded at the local onset site. CONCLUSIONS: The initial ictal discharge pattern recorded with intracranial electrodes can assist in differentiating local onset and remote propagated electrographic seizures, with rhythmic round theta-delta activity being unique to distant propagated sites. Nevertheless, the initial discharge of a subclass of remote propagated electrographic seizures consists of an independent pattern indistinguishable from that observed at local onset sites.

Adolescent↗
PubMed1987

Acute arrhythmogenicity of doxorubicin administration.

The magnitude of acute arrhythmogenicity of doxorubicin administration has not been characterized. In this study the type and frequency of cardiac arrhythmia is determined in the first hour and first 24 hours following doxorubicin given as a 10-minute infusion. Twenty-nine patients with diverse malignancies were studied with Holter monitors on 33 postdoxorubicin days. Control recordings were made on days remote from doxorubicin treatment. The frequency of arrhythmia that could be attributed to doxorubicin was low: 3% of studies in the first hour postinfusion and 24% of studies in 1 to 24 hours postinfusion. The most commonly seen arrhythmia was an increased frequency of ventricular premature beats. Arrhythmia following doxorubicin infusion is rare in the first hour and more common in the remainder of the first 24 hours postinfusion. There are no acute or long-term adverse consequences related to the appearance of arrhythmia due to doxorubicin.

Adult↗
PubMed1996

Chemically dependent physicians and informed consent disclosure.

Developments in law, professional guidelines, and public attitudes support informed consent disclosure by physicians who have been treated for chemical dependency. This view is built on the apparent materiality of the risk of relapse to informed treatment decisions by patients. Several considerations undercut this position. The probability is remote that a patient will be injured by a recovering physician who suffers an undetected relapse while being properly monitored. Monitoring by impaired physicians programs provides a more sensitive and specific mechanism for detecting relapsed physicians. Moreover, compromise of the privacy and employment rights of recovering physicians by consent disclosure is not justified if programs provide rigorous monitoring that protects the welfare of patients. Finally, required consent disclosure will reduce referrals of chemically dependent physicians to impaired physicians programs, thereby increasing the danger to patients. Limiting demands for required consent disclosure necessitates effective operation of impaired physicians programs.

Confidentiality↗
PubMed2002

The value of permanent follow-up of implantable pacemakers--first results of an European trial.

A clinical study investigates the use of Home Monitoring (HM) in pacemaker therapy. For 3 months patients are supervised by daily automatic HM messages. Endpoints are the technical feasibility and the clinical benefit of HM. Ninety three patients have currently been included and followed for 72 +/- 30 days. Three patients were excluded due to insufficient mobile net coverage at their living sites. For the other patients, 5311 of 5911 messages were successfully registered. Interrupts in the sequence of messages occurred 331 times. Two hundred ten of these (63%) lasted just 1 day, 14 interrupts (4%) lasted 5 or more days. Two patients did not show any interrupts, 34 patients (38%) had interrupts of 3 and more days. The clinical benefit of Home Monitoring was found in the remote detection of arrhythmia and lead dislocation.

Adult↗
PubMed1979

The potential uses of the medication monitor in the treatment of leprosy.

A medication monitor has been developed that utilizes radioactive material and photographic film to record the intervals at which patients take medication. In the author's opinion, this equipment represents the most efficient means that has so far become available for determining how regularly outpatients take medication. A monitor for the tuberculosis regimen of isoniazid and thiacetazone has been made at a sufficiently low cost that it is practical to use it in routine treatment programs. An inexpensive system for immediate development of the film that can be used in the most remote locations is also available. Undoubtedly, with appropriate engineering work, a monitor for leprosy regimens could be made. The device has been used with tuberculosis patients and revealed that many patients were grossly irregular in taking their medication. It has been used to oversee medication use by tuberculosis patients and to select those who require either extra attention to improve medication ingestion or completely supervised, directly administered programs. In the treatment of leprosy, it could be used to study new drug regimens, the causes of noncompliance, and for the routine supervision of patients.

Humans↗
PubMedDate not supplied

Remote analysis of physiological data from neurosurgical ICU patients.

Recent technical advances in Internet-based client/server applications and new multimedia communications protocols are enabling the development of cost-effective, platform-independent solutions to the problem of remote access to continuously acquired physiological data. The UCLA Neurosurgery Intensive Care Unit (ICU) has developed a distributed computer system that provides access over the World Wide Web (WWW) to current and previously acquired physiological data, such as intracranial pressure, cerebral perfusion pressure, and heart rate from critical care patients. Physicians and clinical researchers can access these data through personal computers from their offices, from their homes, or even while on the road. The system creates and continuously updates a database of all monitored parameters in data formats that can readily be used for further clinical studies. This paper describes an extension to this system that allows for remote interaction with and analysis of the data via the WWW. Physicians can now pose a limited, predefined set of clinically relevant questions to the system without having to be at the patient's bedside.

Computer Communication Networks↗
PubMed1999

BRAVO/TeleTrend: a comprehensive WWW-based neuromonitoring system for the neurosurgery ICU.

This paper describes BRAVO/TeleTrend--a comprehensive client/server-based system for remote access, review and analyses of continuously acquired multiparametric physiological data from Intensive Care unit (ICU) patients. The system is designed as a distributed three tier model and implemented in Java (Sun Microsystems). TeleTrend is a data review package, which interfaces to existing physiological bedside monitors such as the BRAVO suite of products (Nicolet Biomedical, Madison, WI) and the vital signs monitors compatible with the Unity Network (Marquette Electronics, Milwaukee, WI). It does not transfer over the web the entire patient record, which can be hundreds of megabytes. Instead, it provides tools to view a compressed representation of the raw data in a trend display and to zoom into the raw data if needed. Thus, it eliminates the need for a high-bandwidth Internet connection and makes possible the use of a slower modem access to the vast amount of physiological data acquired per patient. In addition, TeleTrend features a rule-based module capable of generating clinical alerts, which is a potentially useful tool for neurointensivists and other critical care personnel. Finally, TeleTrend is intended as a multi-user, semi real-time telemedical application, which features built-in white-board and chat components. These components allow several physicians at different locations around the world to simultaneously view and brainstorm over critical chunks of continuously recorded raw and trend data. By allowing the end-user user to switch on-the-fly from monitoring patients in one ICU to those in another, and by integrating an HL7 interface TeleTrend steps over the boundaries of a single ICU. Thus, it can be provide a medical enterprise-wide solution to the remote access of an important component of the electronic patient medical record. Currently in house validation, verification and alpha testing of the system are underway.

Electroencephalography↗
PubMed2005

An algorithm for processing vital sign monitoring data to remotely identify operating room occupancy in real-time.

We developed an algorithm for processing networked vital signs (VS) to remotely identify in real-time when a patient enters and leaves a given operating room (OR). The algorithm addresses two types of mismatches between OR occupancy and VS: a patient is in the OR but no VS are available (e.g., patient is being hooked up), and no patient is in the OR but artifactual VS are present (e.g., because of staff handling of sensors). The algorithm was developed with data from 7 consecutive days (122 cases) in a 6 OR trauma center. The algorithm was then tested on data from another 7 consecutive days (98 cases), against patient in- and out-times captured by OR surveillance videos. When pulse oximetry, electrocardiogram, and temperature readings were used, OR occupancy was correctly identified 96% (95% confidence interval [CI] 95%-97%) and OR vacancy >99% of the time. Identified patient in- and out-times were accurate within 4.9 min (CI 4.2-5.7) and 2.8 min (CI 2.3-3.5), respectively, and were not different in accuracy from times reported by staff on OR records. The algorithm's usefulness was demonstrated partly by its continued operational use. We conclude that VS can be processed to accurately report OR occupancy in real-time.

Algorithms↗
PubMed1995

Digitized radiographs in skeletal trauma: a performance comparison between a digital workstation and the original film images.

PURPOSE: To evaluate the diagnostic performance of a teleradiology system in skeletal trauma. MATERIALS AND METHODS: Radiographs from 180 skeletal trauma patients were digitized (matrix, 2,000 x 2,500) and transmitted to a remote digital viewing console (1,200-line monitor). Four radiologists interpreted both the original film images and digital images. Each reader was asked to identify, locate, and characterize fractures and dislocations. Receiver operating characteristic curves were generated, and the results of the original and digitized film readings were compared. RESULTS: All readers performed better with the original film when interpreting fractures. Although the patterns varied between readers, all had statistically significant differences (P < .01) for the two image types. There was no statistically significant difference in performance with the two images when dislocations were diagnosed. CONCLUSION: The system tested is not a satisfactory alternative to the original radiograph for routine reading of fracture films.

Computer Communication Networks↗
PubMed1999

Choledochal cystic malignancies.

Cystic diseases of the bile ducts are rare, but relatively more prevalent in females, and more common in Japan and Asia. Most are diagnosed in children under 10 years of age, with varying patterns of symptoms including right upper quadrant pain, jaundice, and fever. Up to 20% of bile duct cysts are diagnosed in adults, including during pregnancy, in whom the diagnosis can be confounded by associated cholelithiasis, or by abnormalities of the pancreatic junction with pancreatitis. The risk of malignant transformation increases with age, and is more common in cysts of Alonso-Lej Types I, IV, and V (Caroli's Disease). Intracystic lithiasis is frequently associated with tumour, and can give similar radiological appearances. Tumours are often first diagnosed at laparotomy, and can already be unresectable. More than half the tumours are intracystic, but malignant change in cyst mucosa without a tumour mass is often not recognised at surgery. In addition, malignant change in bile duct epithelium can occur after cyst excision, sometimes after many years, and in areas of the biliary tree remote from the cyst, including the gall-bladder. Cyst excision should be attempted at all ages, and patients closely monitored thereafter. Malignancy should be suspected in all adults with bile duct cysts. Hepatectomy, partial or total with transplantation, is the treatment of choice in Caroli's disease.

Adolescent↗
PubMed1994

Innovations in intra-aortic balloon pump management: computer modem technology.

The computer modem technology being developed by Datascope Corporation for the purpose of off-site intra-aortic balloon pump (IABP) monitoring was clinically evaluated in 30 patients requiring IABP support. The Datascope System 95 model IABP with built-in modem was used on all patients. Remote communications via a personal computer with modem were conducted under both routine and emergency settings. The Datascope PC IABP software was evaluated for its user compatibility, efficiency, diagnostic capability and overall usefulness as a clinical tool. During the eight month evaluation period, 87 remote communications were conducted for both routine and emergency IABP evaluation checks. Adjustments were recommended on 22 occasions relevant to balloon timing, trigger mode selection and augmentation volume settings. Eight communications were initiated in emergency settings due to a variety of patient conditions. Emergency intervention was successful in diagnosing and resolving critical situations including atrial arrhythmias, pacemaker timing, low cardiac output syndrome, loss of trigger source, catheter malpositioning and poor augmentation. The diagnostic capabilities and efficient means of data collection by the computer software provide the clinician with a valuable tool for routine IABP clinical monitoring, as well as emergency problem resolution.

Adult↗
PubMed1997

Tuberculosis control in remote districts of Nepal comparing patient-responsible short-course chemotherapy with long-course treatment.

SETTING: A tuberculosis programme in hill and mountain districts of Nepal supported by an international non-governmental organisation (NGO). OBJECTIVE: To evaluate under programme conditions the effectiveness of unsupervised monthly-monitored treatment using an oral short-course regimen. DESIGN: In this prospective cohort study, outcomes for new cases of smear-positive tuberculosis starting treatment over a two-year period in four districts in which a 6-month rifampicin-containing regimen was introduced as first-line treatment (subjects) were compared to outcomes for similarly defined cases in four districts where a 12-month regimen with daily streptomycin injections in the intensive phase continued to be used (controls). RESULTS: Of 359 subjects started on the 6-month regimen, 85.2% completed an initial course of treatment compared to 62.8% of 304 controls started on the 12-month regimen (P < 0.001); 78.8% of subjects and 51.0% of controls were confirmed smear-negative at the end of treatment (P < 0.001). The case-fatality rate during treatment was 5.0% among subjects and 11.2% among controls (P = 0.003). Among those whose status was known at two years, 76.9% of subjects were smear-negative without retreatment, compared to 60.9% of controls (P < 0.001). CONCLUSION: In an NGO-supported tuberculosis control programme in remote districts of Nepal, patient-responsible short-course therapy supported by rapid tracing of defaulters achieved acceptable outcomes. Where access and health care infrastructure are poor, district-level tuberculosis teams responsible for treatment planning, drug delivery and programme monitoring can be an appropriate service model.

Administration, Oral↗
PubMed2002

Collaboration by use of the Internet yields data of high quality and detects non-uniform management of patients with Helicobacter pylori infection.

BACKGROUND: The benefits of new technology steadily being introduced in medicine should be documented. In this study, remote entry of a set of data from the daily routine was submitted via the Internet to a common database. The usefulness and quality of the information are evaluated. METHODS: Fourteen hospitals reported a common data set on consecutive Hp+ve patients handled in accordance with daily practice. Participants submitted their data via the Internet to a database. There was no monitoring or other surveillance. No audit was planned or expected, but was nevertheless possible. Doctor compliance with the common agreement was checked, differences in medical practice were noted and quality was assessed comparing the most important source data with the data in the final database. RESULTS: Four-hundred-and-forty patients were included. The quality of the reported data was high, only 1.3% showing a discrepancy between source data and the database. Overall treatment success was 89%, with no significant differences between hospitals. There were significant differences in clinical practice between the centres, the proportion of patients treated for ulcer disease varying from 36% to 96% (P < 0.001). Doctor compliance with the agreed collaboration varied significantly (P < 0.001). CONCLUSION: Internet collaboration through remote data entry in a common database yields data of high quality without monitoring, and is a powerful and resource economic tool for clinical multicentre trials and quality assurance.

Clinical Trials as Topic↗
PubMed2006

Possibilities for cost containment in intensive care.

An intensive care unit (ICU) is valuable but consumes a disproportionately high amount of health-care resources. Accordingly, cost containment has been deemed a mandatory task. A review of the literature from many countries was completed to determine the strategies for reducing the cost of care in the ICU. The results of this review show that cost reduction can be achieved by using a variety of the following strategies: (i) instituting a closed ICU, where all the patient care is directed by intensivists or full-time critical care trained physicians; (ii) the utilization of interdisciplinary approaches to the care of patients in the ICU; (iii) developing and implementing a program of television-guided remote intensivists; (iv) the use of an alerting and reminding system; and (v) increasing the number of intermediate care beds for patients who require only monitoring and intensive nursing. The conclusion reached is that many of these strategies provide evidence for hospital manager decisions regarding cost containment strategies for the delivery of health care in the ICU.

Cost Control↗
PubMed2006

Heart period variability in trauma patients may predict mortality and allow remote triage.

INTRODUCTION: The high frequency to low frequency ratio (HF/LF) derived from analysis of heart period variability is elevated and associated with mortality in severely injured patients monitored in a hospital. The purpose of this study was to test the utility of heart period variability measurements as indicators of injury severity in patients prior to definitive medical intervention. We tested the hypothesis that survival is associated with low relative HF/LF, and death is associated with high relative HF/LF. METHODS: We performed retrospective analyses of 84 pre-hospital trauma patient records (n=42 non-survivors; n=42 survivors) collected during helicopter transport to a Level 1 urban trauma center. R-waves from 2-min segments of ECG waveforms were converted to the frequency domain with a Fourier transform. Spectral power was separated into low (LF; 0.04-0.15 Hz) and high (HF; 0.15-0.4 Hz) frequency bands for analysis and derivation of frequency ratios. RESULTS: Absolute HF, LF, and HF/LF were not distinguishable statistically between groups (p > or = 0.26), but HF/LF was higher (p = 0.04) for non-survivors (140 +/- 26) than survivors (74 +/- 19). After normalization to account for large intersubject variability, HFnu (43 +/- 3 vs. 28 +/- 2) and HF/LFnu (248 +/- 50 vs. 73 +/- 19) were higher (both p < 0.001), and LFnu (42 +/- 4 vs. 64 +/- 3) was lower (p = 0.0001) for non-survivors [19 h (median) before death] compared with survivors. CONCLUSIONS: Our results show that heart period variability analyses separate patients who die from patients who survive traumatic injury. We propose that such analyses could be employed for remote triage of injured patients in austere environments.

Adult↗