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At least 253 records · Page 14Linked to original sources

PubMed2005

[Efficient use and problems associated with "home remote medical support system"--utilization of videophones for homecare patients].

"Home Remote Medical Support System" (the support system) is an interactive real time communication system, consisting of a vital health measuring device and a near-television quality home digital videophone installed at a residence, to connect a primary medical care institution and a homecare patient by information communication lines. Exclusive use of a telephone, vital health measuring device, TV monitor and camera are installed as home devices to communicate with a primary personal computer at the medical institution to manage patient's data and to have video phone health consultations. We employed and conducted the support system with a help from "the remote medical assistant task" operated by the local government since April 2004. Two patients actually used the support system in the first year although we initially planned to have three. In conclusion, the support system appears to have been useful for the health management of patients with stable conditions. Meanwhile, we have to reassess the application of the support system and to balance its accountability among the user efficiency, the content of the support provider and user expenses.

Home Care Services↗

PubMed2003

[Development of an automatic measurement system of biological signals].

Recently, in-home treatment of hemodialysis has been focused on the enhancement of the quality of life (QOL) of patients. However, no medical staff monitors the treatment, and the family helpers have to take care of the patients during hemodialysis. Sometimes the patients themselves have to do it according to their circumstances. In order to reduce the burden placed on the patients and people around them, we are trying to develop a system for preliminary diagnosis of the patient's condition before the hemodialysis session, which estimates the condition of the patients and encourages a necessary treatment to them. In this paper, we describe an automatic measurement system of biological signals, which consists of two subsystems, a measurement system and a data collecting system. These subsystems are connected through wireless communication, allowing remote observation of patients' biological signals.

Activities of Daily Living↗

PubMed1976

Sleep patterns and gastric acid secretion in duodenal ucler disease.

Five normal volunteers and five patients with duodenal ulcer (DU) disease were studied for five consecutive nights. All subjects underwent placement of a nasogastric tube, continuous collection of gastric juice, and continuous electroencephalographic monitoring of sleep. Gastric juice was collected in 20-minute samples by remote suction (Gomco). Blood samples were drawn every 20 minutes on the third night via an indwelling venous needle. Results showed no significant correlations between the sleep variables and the gastric acid secretion measures or between the sleep variables and serum gastrin levels. Acid secretion decreased from hour 1 to hour 2 in controls and in patients with inactive DU disease, while it increased in patients with active DU disease. Each subject had at least one night of recording in which continuous gastric secretion was less than 0.1 mEq per 20-minute sample. It appears unlikely that the gastric discomfort of DU patients can be attributed to acid hypersecretion triggered by rapid eye movement sleep.

Duodenal Ulcer↗

PubMedDate not supplied

Optical merger of direct vision with virtual images for scaled teleoperation.

Scaled teleoperation is increasingly prevalent in medicine, as well as in other applications of robotics. Visual feedback in such systems is essential and should make maximal use of natural hand-eye coordination. This paper describes a new method of visual feedback for scaled teleoperation in which the operator manipulates the handle of a remote tool in the presence of a registered virtual image of the target in real time. The method adapts a concept already used successfully in a new medical device called the Sonic Flashlight, which permits direct in situ visualization of ultrasound during invasive procedures. The Sonic Flashlight uses a flat-panel monitor and a half-silvered mirror to merge the visual outer surface of a patient with a simultaneous ultrasound scan of the patient's interior. Adapting the concept to scaled teleoperation involves removing the imaging device and the target to a remote location and adding a master-slave control device. This permits the operator to see his hands, along with what appears to be the tool, and the target, merged in a workspace that preserves natural hand-eye coordination. Three functioning prototypes are described, one based on ultrasound and two on light microscopy. The limitations and potential of the new approach are discussed.

Algorithms↗

PubMed2002

Mild gestational hypertension: differences in ethnicity are associated with altered outcomes in women who undergo outpatient treatment.

OBJECTIVE: The purpose of this study was to evaluate the impact of ethnicity on outcome in women with mild gestational hypertension that is remote from term. STUDY DESIGN: Nulliparous women with mild gestational hypertension who participated in an outpatient monitoring program between January 1995 and December 1999 were candidates. Patients had a singleton pregnancy at <37 weeks of gestation and were followed up for a minimum of 2 days as an outpatient. Maternal and perinatal outcomes were compared between groups by the Student t test, Mann-Whitney U test, and Pearson chi2 analyses. RESULTS: One thousand one hundred eight-two women were included in the analysis. No clinically remarkable differences in gestational age or incidence of proteinuria at the start of observation were noted. Newborn infants of Hispanic and African American women had significantly smaller birth weights compared with those of white women. African American women had a higher incidence of abruptio placentae (n = 5), stillbirths (n = 3), and neonatal deaths (n = 2) versus the other groups (n = 0 for all). The frequency of progression to thrombocytopenia/HELLP (hemolysis, elevated liver enzymes, and low platelet count syndrome) and cesarean delivery rates were similar between groups. CONCLUSION: Differences in outcomes are observed between ethnic groups even when the women undergo the same intensive outpatient monitoring for mild gestational hypertension.

Abruptio Placentae↗

PubMed2001

Mild gestational hypertension remote from term: progression and outcome.

OBJECTIVE: Limited information is available regarding the progression of disease in women with mild gestational hypertension. Our purpose was to describe the prognostic signs in the natural course of mild gestational hypertension and pregnancy outcomes in women who were remote from term with mild gestational hypertension that was expectantly managed. STUDY DESIGN: Women with mild gestational hypertension participating in an outpatient hypertension monitoring program were studied. Inclusion criteria were patients with a singleton pregnancy between 24 and 35 weeks' gestation who had no proteinuria by dipstick (0 or trace) on the first 2 days of program participation. Progression to preeclampsia was the primary outcome. The rate of progression to severe preeclampsia, obstetric complications, and neonatal outcomes were secondary measures. Data were compared by independent Student t and Fisher exact tests where applicable. RESULTS: A total of 748 patients were studied during the observation period; preeclampsia (persistent proteinuria > or = 1+) developed in 343 (46%), and 72 (9.6%) had antepartum progression to severe preeclampsia. No significant differences in maternal age, race, marital status, or tobacco use were observed between those women in whom persistent proteinuria developed and those in whom it did not develop. Gestational age of the infants at delivery (36.5 +/- 2.4 vs 37.4 +/- 2.0 weeks), birth weight (2752 +/- 767 vs 3038 +/- 715 g), incidence of small-for-gestational-age newborns (24.8% vs 13.8%), and duration of neonatal hospital stay (7.1 +/- 10 vs 5.0 +/- 9.3 days) differed significantly in the patients with versus those without proteinuria (P <.001 for all). CONCLUSIONS: In patients with mild gestational hypertension remote from term, 46% ultimately had preeclampsia, with progression to severe disease in 9.6%. The development of proteinuria is associated with an earlier gestational age at delivery, lower birth weight, and an increased incidence of small-for-gestational age newborns.

Adult↗

PubMed2004

A wireless PDA-based physiological monitoring system for patient transport.

This paper proposes a mobile patient monitoring system, which integrates current personal digital assistant (PDA) technology and wireless local area network (WLAN) technology. At the patient's location, a wireless PDA-based monitor is used to acquire continuously the patient's vital signs, including heart rate, three-lead electrocardiography, and SpO2. Through the WLAN, the patient's biosignals can be transmitted in real-time to a remote central management unit, and authorized medical staffs can access the data and the case history of the patient, either by the central management unit or the wireless devices. A prototype of this system has been developed and implemented. The system has been evaluated by technical verification, clinical test, and user survey. The evaluation of performance yields a high degree of satisfaction (mean = 4.64, standard deviation--SD = 0.53 in a five-point Likert scale) of users who used the PDA-based system for intrahospital transport. The results also show that the wireless PDA model is superior to the currently used monitors both in mobility and in usability, and is, therefore, better suited to patient transport.

Adult↗

PubMed2004

Remote titration of carvedilol for heart failure patients by advanced practice nurses.

BACKGROUND: beta-blockers (BB) in the treatment of heart failure (HF) are frequently underprescribed and underdosed, perhaps because of recommendations for office visits at each dose change. In previous work, we demonstrated the feasibility of remote telephonically assisted BB titration and found favorable effects on morbidity, time to target dose, and low withdrawal rates. In the current expanded evaluation, we reasoned that a structured remote telephonic titration protocol would achieve outcomes comparable to US Carvedilol Trials in regard to optimal dose, titration time, and morbidity. METHODS: Seventy HF patients were initiated on BB therapy (carvedilol). Before therapy, patients were instructed on BB side effects, pulse taking, and weight monitoring. Patients reported weights, vital signs, and symptoms 3 times per week by phone. Advanced practice nurses counseled, educated, and reminded patients to increase their dose every 2 weeks until target doses were reached. RESULTS: A total of 96% reached a therapeutic dose (6.25 mg twice daily). Moreover, 71% of patients reached target doses of 25 mg twice weekly in approximately 8 weeks. No HF hospitalizations occurred during remote titration. CONCLUSIONS: The use of advanced practice nurses, titration protocols, and telemanagement technologies may improve the number of HF patients initiated and treated with appropriate doses of BB.

Adrenergic beta-Antagonists↗

PubMedDate not supplied

Continuous EEG monitoring in the intensive care unit: an overview.

Due to technological advances, it is now feasible to record continuous digital EEG (CEEG), with or without video, in critically ill patients and review recordings remotely. Nonconvulsive seizures (NCSzs) are more common than previously recognized and are associated with worse outcome. The majority of seizures in ICU patients are nonconvulsive and will be missed without CEEG. Factors associated with an increased risk for NCSzs include coma, prior clinical seizures, CNS infection, brain tumor, recent neurosurgery, and periodic epileptiform discharges. In addition to detecting seizures, CEEG is also useful for characterizing paroxysmal spells such as posturing or autonomic changes, detecting ischemia, assessing level of sedation, following long-term EEG trends, and prognosticating. Most NCSzs will be detected in the first 24 hours of CEEG in noncomatose patients, but longer recording periods may be required in comatose patients or in those with periodic epileptiform discharges. EEG patterns in encephalopathic or comatose patients are often equivocal. How aggressively to treat NCSzs and equivocal EEG patterns in these patients is unclear and requires further research. Real-time detection of ischemia at a reversible stage is technologically feasible with CEEG and should be developed into a practical form for prevention of in-hospital infarction in the near future.

Brain Ischemia↗

PubMed2004

Quantitative and qualitative usage data of an Internet-based asthma monitoring tool.

BACKGROUND: In May 2000, AstraZeneca launched a Web service for asthma patients and health-care providers called LinkMedica, which includes an asthma diary for monitoring and self-management. In the diary, the patient enters his or her peak flow, number of doses of rescue medication, and if there have been any asthma symptoms during the previous 24 hours. The patient receives an immediate response from LinkMedica, telling him or her if the asthma is under control and what to do if not, eg, increase the dose of inhaled steroid. Health-care providers have access to the patient diary. OBJECTIVES: The primary objective of the study was to describe patients' and health-care providers' use of LinkMedica. Secondary objectives were to evaluate their perception of the system and how the users' interaction with the system is influenced by their everyday lives. METHODS: Site statistics regarding number of registered users and diary usage were analyzed. An online survey among users (85 respondents), a mailed questionnaire to health-care providers (131 respondents; response rate 26.8%), as well as in-depth interviews with 10 patients and 5 general practitioners, elicited further quantitative and qualitative data on users' perceptions. RESULTS: In February 2003, a total of 7653 users had registered. During 2002, the growth in registered users averaged 50 per month. In the same period, the number of unique diary users per month decreased from 307 to 138. Patients usually stopped using the diary after a short time; the doctors were reluctant to introduce the diary to patients because of time constraints. Several user subtypes were identified among patients and their relatives. CONCLUSION: The self-selected survey responses and in-depth interviews indicated that LinkMedica is generally considered a trustworthy and reliable site by both patients and doctors. However, there was a contrast between users' positive perception of LinkMedica and their unwillingness to use the site for more than short periods. The primary reason for this was that LinkMedica did not fit into their everyday lives because of technical and psychological aspects. A number of recommendations to improve LinkMedica are suggested.

Adolescent↗

PubMed1996

Telemedicine: history, applications, and impact on librarianship.

This paper traces the uses of telecommunications in health care from the Civil War era to the present. Topics include the National Aeronautics and Space Administration's involvement in the origins of current telemedicine systems and the impact of television. Applications of telemedicine discussed include remote consultation and diagnosis, specialty clinical care (including examples from anesthesia, dermatology, cardiology, psychiatry, radiology, critical care, and oncology), and others (including examples of patient education, home monitoring, and continuing education). The concluding section highlights how telemedicine affects health sciences librarianship, beginning with the development of online computerized literature searching. This section also discusses the medical resources available to health sciences librarians as a result of the Internet.

Computer Communication Networks↗

PubMed1995

A client/server system for remote diagnosis of cardiac arrhythmias.

Health care practitioners are often faced with the task of interpreting complex heart rhythms from electrocardiograms (ECGs) produced by 12-lead ECG machines, ambulatory (Holter) monitoring systems, and intensive-care unit monitors. Usually, the practitioner caring for the patient does not have specialized training in cardiology or in ECG interpretation; and commercial programs that interpret 12-lead ECGs have been well-documented in the medical literature to perform poorly at analyzing cardiac rhythm. We believe that a system capable of providing comprehensive ECG interpretation as well as access to online consultations will be beneficial to the health care system. We hypothesized that we could develop a client-server based telemedicine system capable of providing access to (1) an on-line knowledge-based system for remote diagnosis of cardiac arrhythmias and (2) an on-line cardiologist for real-time interactive consultation using readily available resources on the Internet. Furthermore, we hypothesized that Macintosh and Microsoft Windows-based personal computers running an X server could function as the delivery platform for the developed system. Although we were successful in developing such a system that will run efficiently on a UNIX-based work-station, current personal computer X server software are not capable of running the system efficiently.

Arrhythmias, Cardiac↗

PubMed2000

Radiolabeled leucocyte imaging in diffuse granulomatous involvement of the meninges in Wegener's granulomatosis: scintigraphic findings and their role in monitoring treatment response to specific immunotherapy (humanized monoclonal antilymphocyte antibodies).

BACKGROUND AND PURPOSE: Diffuse involvement of the meninges by remote granulomas in Wegener's granulomatosis is rare. This study reports the radiolabeled leucocyte imaging findings in five such patients. The diagnosis was made by MR imaging in five patients and confirmed in four by findings at meningeal biopsy. The potential role of serial radiolabeled leucocyte examinations in assessing treatment response is discussed. METHODS: Three of the five patients underwent whole-body planar 111In-labeled leucocyte imaging. Two of these patients had serial imaging and one had, in addition, a 99mTc-HMPAO-labeled leucocyte single-photon emission CT brain examination. Two of the five patients had whole-body planar 99mTc-HMPAO-labeled leucocyte imaging. Of these, one patient had serial imaging. The radiolabeled leucocyte imaging findings were correlated with MR findings and with the patients' clinical course. RESULTS: In four patients there was a midline linear area of increased tracer uptake in the brain, and in one of these, tracer uptake also extended laterally over the brain convexity. In two patients linear tracer uptake extended in an inferolateral direction from the midline. These abnormalities correlated with meningeal thickening in the falx, over the brain convexity, and in the tentorium cerebelli on MR images. Serial imaging in three patients revealed a reduction or disappearance in tracer uptake after treatment with anti-CD52, which correlated with clinical improvement. CONCLUSION: In patients with Wegener's granulomatosis, abnormal uptake corresponding to meningeal thickening can be seen on planar radiolabeled leucocyte images. Leucocyte imaging may be useful for monitoring treatment response.

Adult↗

PubMed2004

Cost-effective health services for interactive continuous monitoring of vital signs parameters--the e-Vital concept.

The objective of the e-Vital project is the validation of the market concerning the provision of a novel remote telemedicine service aimed at large sensitive parts of the European population, the "at-risk" citizens, who are usually patients with a stable medical condition that allow a near normal life but may suddenly deteriorate and put life at risk. This service will increase their quality of life and their feeling of safety concerning their health. The e-Vital project focuses on the implementation and exploitation of a modular and ambulatory secure telemedicine platform, which is using easily wearable vital signs monitoring devices, causing minimal discomfort to patients, and which transfer in real time and on-line critical vital parameters to doctors and/or medical experts/consultants, regardless of their location, while getting feedback to increase their feeling of comfort or in case of alarm. The interactive continuous monitoring promises cost effective health services, more active involvement of patients in their own care, and a new sense of realism in making a diagnosis.

Computer Communication Networks↗

PubMedDate not supplied

Home blood pressure monitoring for pregnant patients with hypertension.

OBJECTIVE: To determine whether automated measurement of blood pressure and pulse in a home setting can be easily accomplished by pregnant women with chronic hypertension. STUDY DESIGN: In this prospective investigation, seven women with chronic hypertension complicating pregnancy recorded their blood pressure at home twice a day. These data were offloaded once daily into a computer at a remote site, and a computerized printout of these data was received by the physician. RESULTS: The patients participated in the study for 12.2 +/- 5.8 weeks (range 4 to 18 weeks) and were between 23 and 42 weeks' gestation. Average mean arterial pressure in the home was 102 +/- 10 mm Hg, and average pulse was 81 +/- 11 beats per minute. In the clinic, the values were 112 +/- 13 mm Hg and 90 +/- 30 beats per minute (p < 0.05). Each patient was easily taught how to use the machine. CONCLUSIONS: The home blood pressure monitoring device was easy to use and correlated well with values recorded by health professionals for this limited number of subjects. It was particularly helpful to patients (n = 5) who lived long distances (more than 60 miles) from the clinic and to women who needed adjustments of antihypertensive medication.

Blood Pressure↗

PubMed1986

Intracranial pressure monitors. Epidemiologic study of risk factors and infections.

An increase in the number of cases of gram-negative ventriculomeningitis in patients followed with intracranial pressure monitors when compared with patients with craniotomy alone was revealed by routine surveillance data. A study was undertaken at four area institutions to describe the infections, risk factors, and management. Two hundred fifty-five patients with diagnoses of intracerebral hemorrhage (n = 86), closed trauma (n = 66), open trauma (n = 21), tumor (n = 66), and miscellaneous other conditions were compared with their nonmonitored counterparts for type of intracranial pressure monitor used, use of drains, prophylactic antibiotics, and steroids, and remote presence of infection. The presence of intracranial pressure monitor with craniotomy was associated with an 11 percent infection rate whereas craniotomy alone demonstrated a 6 percent rate. Of the intracranial pressure monitors used, the subarachnoid screw was associated with the lowest infection rate (7.5 percent) followed by the subdural cup catheter (14.9 percent) and the ventriculostomy catheter (21.9 percent). Regardless of the monitor used, infection was twice as likely to develop in patients with open trauma or hemorrhage. The use of bacitracin flush solutions for maintenance of lumen patency was more often associated with infections. Use of prophylactic antibiotics did not significantly influence outcome.

Adolescent↗

PubMedDate not supplied

A survey of nurse associate training programs.

A survey of nurse associate training programs in the United States and its territories was made in 1972. Data were obtained by questionnaires mailed to program directors, with mail and telephone followup, for 60 operating programs and 9 programs being planned. The response rate was 79 percent of an estimated 87 programs in existence. The survey data indicated that the "typical" nurse associate training program lasts 4 to 6 months, began instruction in 1971, and is sponsored solely by a university or a 4-year college. The most frequently mentioned sources of financial support are the sponsoring institutions or the National Institutes of Health, or both. The typical program receives about 24 trainee applications a year and can accommodate 16 new students annually; 12 students graduate each year at a cost of about $3,536 per graduate. Most students in nurse associate training are white women who have either a diploma or bachelor's nursing degree. In addition to a substantial amount of nursing experience, they are likely to have a guarantee of employment on graduation. Nurse associates are expected to exercise a significant amount of independent judgment in tasks performed, and they are likely to work with primary care physicians in a wide range of settings, including rural and remote areas. They are likely to perform a variety of tasks and activities, including giving physical examinations, ordering tests and medications (under standing order), instructing, counseling, and monitoring patients, and management of disease.

Costs and Cost Analysis↗

PubMed1991

Will knowing the variability of ambulatory blood pressure improve clinical outcome? An additional consideration in the critical evaluation of this technology.

The range through which blood pressure varies from moment to moment and from wakefulness to sleep confounds the assessment of the patient with suspected hypertension. The clinical application of this information depends upon the needs and resources available to the physician. Awareness of the variance between average clinic and average ambulatory blood pressures, acquired by ambulatory monitoring, may influence diagnostic and therapeutic decisions to the benefit of the patient. However, the hypothesis that those 20-30% of patients referred for management of mild to moderate hypertension after initial screening who are normotensive when remote from the clinic environment do not require treatment has not been tested prospectively. Two studies using intra-arterial recordings and one large study using a non-invasive device have demonstrated a relationship between ambulatory blood pressure variability and cardiovascular consequences of hypertension that is independent of the level of arterial pressure. Loss of information and problems with accuracy during activity preclude similar calculations of blood pressure variability by currently available portable non-invasive recorders. The hypothesis that actions based upon knowledge of blood pressure variability can improve clinical outcome is attractive, but waits, for its confirmation, large and rigorous trials based on advances in technologic capabilities that will permit accurate, continuous, yet non-invasive monitoring of ambulatory blood pressure.

Blood Pressure↗