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In upstate New York, birth certificates of all babies born in hospitals include response to a question on procedures used in fetal monitoring. During the first six months of 1978, some form of monitoring was reported on 47 per cent of all live births in hospitals, 33.6 per cent being monitored externally. The primary cesarean section rate in monitored women was over twice that among those not monitored.
The present status of cardiovascular monitoring in the coronary care unit is reviewed. Major emphasis is placed on electrocardiographic monitoring, the only form of monitoring used on most patients who have suffered recent myocardial infarction. The capabilities and limitations of computer systems to perform electrocardiographic monitoring are reviewed, as are present techniques for hemodynamic monitoring and computerized integration of electrocardiographic, hemodynamic, and other patient data.
Routine monitoring of a bipolar atrial electrogram (AEG) simultaneously with the electrocardiogram is a useful and safe clinical technique for the diagnosis of complex cardiac dysrhythmias. The large-amplitude A waves of the AEG can be more reliably identified than the corresponding low-amplitude p waves of the electrocardiogram. Epicardial wires placed during cardiac surgery, catheter-mounted endocardial electrodes, and esophageal electrodes can all be used for routine AEG monitoring. A multipurpose pulmonary arterial catheter with a pair of electrodes, and esophageal electrodes can all be used for routine AEG monitoring. A multipurpose pulmonary arterial catheter with a pair of electrodes mounted on the proximal shaft can be used for combined AEG and hemodynamic monitoring. The equipment needed for AEG monitoring and recording consists of an additional bedside amplifier with 12- to 100-Hz band-pass filter, a dual-channel display scope, and a dual-channel strip chart recorder. Care must be used to keep the atrial electrodes electrically isolated for patient safety. In addition to enhancing the diagnosis and management of dysrhythmias, recording an AEG provides a signal that is suitable for automatic processing.
The medical and economic benefits of a computer-aided monitoring system were evaluated in a prospective, randomized study of 810 patients after open-heart surgery. The design of the study separated benefits of systematized postoperative care from benefits unique to the computer system and established measurable criteria by which computer-aided monitoring systems could be objectively evaluated. Criteria for comparison included the rapidity, safety, and smoothness of convalescence and time spent for various nursing activities. The study showed that the computer-aided monitoring system did not provide discernible medical benefits nor favorably affect nursing activities. Downtime of the system averaged 1 day per week. Reliability and accuracy of the system were inadequate and the benefit/cost ratio was low. Future development of computer-aided monitoring systems for open cardiac surgery should stress reliability, accuracy and relevance of the monitored measurements.
A centralized EEG system installed in a neurologic intensive care unit is described. It is the first step to a computerized EEG monitoring which on the basis of conventional EEG recordings already permits a "brain monitoring" to some extent. It consists of a system for total EEG diagnosis which is connected with a central EEG laboratory via long-distance transmission lines, and of a system for EEG-monitoring which is part of the general beside monitor system. The possibilities of this system are demonstrated in monitoring of patients with epileptic seizures.
The mutual interest in nature by the general public and scientists has led to many collaborations, past and present. Community science shows great potential for monitoring species occurrences and distributions, especially in combination with scalable and (semi)-automated methods such as DNA-based monitoring, helping to obtain data from a broader geographic and temporal range than would be possible by the scientific community alone. Here, we present an overview of the complementarity between community science and DNA-based biomonitoring through examples from ongoing projects. The involvement of hobby experts is particularly crucial for building up the necessary species reference databases that enable DNA-based monitoring. Based on this overview, we identify some key points related to learning opportunities and participant recognition to maximise the success, impact and benefit of community participants in DNA-based monitoring.
Monitoring and surveillance are seen as statistical procedures that will help health authorities to achieve better health services with the existing resources-monitoring being an integrated system of making observations on health and environmental factors and of scrutinizing, storing, and retrieving those data, and surveillance being a closely associated system for collating and interpreting the data.Monitoring should be an action oriented activity and may encompass a wide range of health activities, for example, communicable and noncommunicable diseases, environmental pollutants, and specific problems in health care delivery systems. Both monitoring and surveillance systems have to be related to control measures, and, since the available resources are usually limited, a scale of priorities has to be developed by the statistician in cooperation with the competent authorities.MONITORING MAY BE PERFORMED ON EITHER THE INDIVIDUAL OR AGGREGATE LEVEL AND SHOULD BE PLANNED TO TAKE INTO ACCOUNT THE COURSE OF THE DISEASE UNDER CONSIDERATION: it is concerned with monitoring stimuli and events. Collection of data, for example, on exposure to a pollutant, may be continuous and automatically recorded, or regular or irregular through population sampling or registries. The statistical requirements of monitoring and surveillance systems are discussed and a checklist of features to be considered is given in an annex.
Antepartum nonstress fetal heart rate (FHR) monitoring may become a valuable screening tool for all pregnancies. Two methods proposed for an antepartum FHR monitor are examined: abdominal electrocardiogram (AECG) and variable range directional Doppler (RDD). A good quality (detailed, clearcut baseline) RDD FHR record was obtained in 74/75 (99%) examinations, and a good quality AECG record was obtained i31/75 (41%). Each patient was monitored in the supine, lateral and sitting positions. Considering all positions, 76% of the RDD records and 19% of the AECG records were good. The RDD system was efficacious for routine, clinical antepartum FHR monitoring, but the performance of the AECG was too limited for this purpose.
Immunological monitoring assays are of current value in the management of transplant recipients. These assays allow the pre-transplant quantitation of both donor-recipient histocompatibility and recipient "responder status." In addition, these assays allow the individualization of immunosuppression, permitting a more uniform and effective immunosuppression in the difficult early post-transplant period. Individualized modulation of recipient immune reactivity avoids the documented pitfalls of conventional stereotyped suppression and permits better abrogation of acute rejection responses and lesser rates of serious infections consequent to excessive immune suppression. Immunological monitoring of long-surviving recipients permits early detection of immune reactivity which often culminates in clinical chronic rejection, as well as permits the quantitation of immune facilitory mechanisms (reduced capability to generate anti-donor cytotoxic T cells and/or cellular suppressor mechanisms) that indicate an immune milieu conductive to long-term graft survival. The primary limitations to the more widespread use of immunological monitoring assays at present are the need for more consensual validations of the utility of these assays in different laboratories, more standardization and better controls of techniques, and improvement in the technology of the assays to permit rapid, reproducible, and accurate results with a lesser expenditure of laboratory time and money and greater economy in demands for recipient blood and donor tissue. Finally, immunological monitoring assays are notable for the great promise they offer in terms of immunobiological probes to dissect mechanisms of rejection, mechanisms of graft facilitation, mechanisms of action of immunosuppressive agents, and mechanisms by which empirical technology of recipient pre-treatment may condition the host to better acceptance of an incompatible graft.
The Medical Devices Amendments of 1976 (PL 94-295) will compel users of transcutaneous monitors to comply with Class II, Performance Standards. These standards will have to provide reasonable assurance of the safety and effectiveness of the device. Similar standards are in preparation for other cardiac and respiratory monitors. Dangers of tcPO2 monitors include shock and burn, which requires attention to the insulation of the monitor from the power line and from recorders used to record the output. Optimal safe time vs. temperature limits have not yet used to record to output. Optimal safe time vs. temperature limits have not yet been established, and these may vary with age, skin site, blood pressure and body and environmental temperature. The usefulness of alarms for PO2, sensor temperature and heating power, and their limits remain ot be defined by extensive clinical use. Standards for drift, reproducibility, recalibration interval and accuracy will have to be set after more extensive clinical use especially by groups not involved in the initial prototype development and testing. In order to prove that these devices are also effective, physicians will have to document that care would have been different, and might have impaired patient safety, if the device had not been used.
Definition of the appropriate therapeutic goals for physiologic monitoring of patients postoperatively was approached by analyzing more than 50,000 values of the 20 most commonly monitored variables in a series of 113 critically ill patients throughout their immediate postoperative course. In general, normal values were poor criteria for monitoring, since normal values were restored in an average of 75 per cent of the survivors and 76 per cent of the nonsurvivors for the five most frequently measured variables; that is, arterial pressure, heart rate, central venous pressure, wedge pressure and cardiac output. Moreover, an average of 56 per cent of the 20 most commonly monitored variables of nonsurvivors was restored to the normal range. Furthermore, 34 per cent of all the nonsurvivors' values were within the normal range; this was only 2.4 per cent less than the percentage of normal values for the survivors. The empirically determined median value of the survivors taken in the late stage during periods remote from therapy was found to be a better criterion for therapeutic goals for most variables, including blood flow, oxygen transport and most intravascular pressures. However, normal values were satisfactory for arterial pressure, peripheral resistance, pH, mixed venous oxygen tension and arterial carbon dioxide tension, largely because of the biphasic patterns of these variables.
The Monitor of Cerebral Function enables continuous monitoring of the cerebral electrical activity and this over long periods due to the slow recording speeds. The cerebral electrical signals picked up by the electrodes attached to the scalp are registered in the form of a curve which fluctuates to a greater or lesser extent depending on the recording speed. The examination of the height of the curve with respect to zero and its amplitude indicates the voltage of the cerebral activity and yields information regarding polymorphism. It is thus possible to monitor variations in cerebral activity over a prolonged period during anaesthesia as well as during the revival phase with the Monitor of Cerebral Function, the electroencephalogram being reserved as an aid to precise diagnosis and for localization and close scruting of the anomalies.
Having employed routinely the monitor of cerebral function in cardiac surgery operations for about a year, the authors now present an analysis of the variations in the traces of a group of 57 patients. They have found, when there is no major haemodynamic consequence associated with the induction of anaesthesia, and when there are no difficulties of a surgical or a technical nature accompanying the artificial extra-corporeal circulation, that the monitor curve stays perfectly stable. On the other hand, all sudden haemodynamic changes result in hypotension (haemorrhage, dysrhythmia, and a fall in flow in the extracorporeal circulation) that is reflected in the level of the monitor curve which also falls. They conclude, using examples of certain variations, that the monitor curve is a supplementary form of surveillance and that the trace recorded simultaneously with the anaesthetic sheet allows retrospective analysis of the haemodynamic events to be performed for each operation.
Midmyocardial and subendocardial pH monitoring was used as an indirect method for continuous evaluation of regional canine myocardial ischemia. Left ventricular midmyocardial pH (pHm) at 4 mm. depth was monitored in 10 dogs, under resting conditions, by means of a 5 mm. Beckman pH probe. pHm was 6.96 +/- 0.03, recorded at myocardial temperatures of 35 to 37 degrees C. Ischemia was then produced by snare occlusion of the proximal left main coronary artery for 2 minutes. pHm decreased to 6.87 +/- 0.03 (p less than 0.01) at 1 minute and 6.80 +/- 0.04 (p less than 0.005) in 2 minutes. When flow was restored, pHm returned toward normal within 2 minutes (pH 6.86 +/- 0.03) and at 5 minutes had returned to control values (pH 6.93 +/- 0.03). In another 5 dogs under similar conditions, pHm at 4 mm. and subendocardial pH (pHe at 8 mm.) were measured. Baseline pHm (6.97 +/- 0.01) and pHe (6.84 +/- 0.02) levels were significantly different (p less than 0.0005). After 2 minutes of ischemia, pHm was 6.82 +/- 0.03, whereas pHe decreased to 6.78 +/- 0.04 (p less than 0.1). Five minutes after snare release, pHe remained at 6.73 +/- 0.07; pHm (6.93 +/- 0.03) returned to control values. Both pHm (6.93 +/- 0.02) and pHe (6.84 +/- 0.09) levels were normal 15 minutes after release of the snare. The midmyocardium and subendocardium have different pH levels which can be monitored. Ischemia produces different pH patterns in these layers. pHm returns to control values within 5 minutes after 2 minutes of ischemia, whereas pHe remains depressed for at least 5 minutes. pH monitoring provides an accurate and simple method for on-line evaluation of endocardial ischemia.
This study (1) examined whether a self-monitoring procedure taught in a laboratory setting would increase independent on-task behavior there and would generalize without further teaching to a classroom setting, and (2) analyzed the durability of the training effects over the course of 5 months for one subject and 10 months for two other subjects. Two multiple-baseline designs, one across three normal and the other across three deviant children, showed that self-monitoring of academic task-completions facilitated on-task responding for all subjects in the generalization (classroom) setting. A subsequent reversal design showed that these effects were durable, in two of the three subjects still available, at least as much as 1 year after commencement of training. This latter design also suggested that one subject who was not maintained by self-monitoring could be supported in on-task behavior by a peer who was maintained by self-monitoring.
Twenty dentulous subjects were selected at random. A Hight tracer, fixed on the labial surface of the teeth by special clutches, was used to indicate a record of centric relation and centric occlusion. The Myo-Monitor centric position was recorded and compared to centric occlusion and centric relation in anteroposterior and lateral dimensions. This study indicated that: 1. Myo-Monitor centric position is always anterior to centric relation, with an average of 3.8 min. 2. Myo-Monitor centric position is always anterior to centric occlusion, with an average of 1.8 mm. 3. In 18 of 20 subjects, the Myo-Monitor registration was to the right or to the left side of the line between centric relation and centric occlusion. 4. In all subjects, centric occlusion was an average of 2.2 mm. anterior to centric relation.
Prescription monitoring evolved from the need of drug firms to obtain marketing information. Today, extensive monitoring is also done by fiscal intermediaries who administer prepaid drug benefit plans, both private and governmental, particularly Medicaid. The most important such agent is PAID Prescriptions. Under various contracts, PAID monitors physician, pharmacy, and patient behavior related to prescriptions and uses review processes that evaluate certain kinds of behavior for appropriateness. The criteria of appropriateness are essentially those that save money. PAID negotiates a program fee with the insurer (public or private) and applies constraints so that prescription and administrative costs do not overrun that fee. PAID and other monitors have contemplated expansion into the realm of defining and encouraging appropriate prescribing under the concept of "drugutilization review." The actual practices of PAID, particularly the background of fiscal enforcement, may impede the development of an actual drug-utilization review process.
PURPOSE: The purpose of the study was to design a pan-cancer gene panel for childhood malignancies and validate it using clinically characterized patient samples. EXPERIMENTAL DESIGN: In addition to 5,275 coding exons, SJPedPanel also covers 297 introns for fusions/structural variations and 7,590 polymorphic sites for copy-number alterations. Capture uniformity and limit of detection are determined by targeted sequencing of cell lines using dilution experiment. We validate its coverage by in silico analysis of an established real-time clinical genomics (RTCG) cohort of 253 patients. We further validate its performance by targeted resequencing of 113 patient samples from the RTCG cohort. We demonstrate its power in analyzing low tumor burden specimens using morphologic remission and monitoring samples. RESULTS: Among the 485 pathogenic variants reported in RTCG cohort, SJPedPanel covered 86% of variants, including 82% of 90 rearrangements responsible for fusion oncoproteins. In our targeted resequencing cohort, 91% of 389 pathogenic variants are detected. The gene panel enabled us to detect ∼95% of variants at allele fraction (AF) 0.5%, whereas the detection rate is ∼80% at AF 0.2%. The panel detected low-frequency driver alterations from morphologic leukemia remission samples and relapse-enriched alterations from monitoring samples, demonstrating its power for cancer monitoring and early detection. CONCLUSIONS: SJPedPanel enables the cost-effective detection of clinically relevant genetic alterations including rearrangements responsible for subtype-defining fusions by targeted sequencing of ∼0.15% of human genome for childhood malignancies. It will enhance the analysis of specimens with low tumor burdens for cancer monitoring and early detection.