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PubMedDate not supplied

Nurse acceptance of a computerized arrhythmia monitoring system.

Implementation of a sophisticated computerized arrhythmia monitoring system in our institution initially met with negative attitudes from the critical care nurses in the ICCU and IMCU. This negative response can be attributed to several factors: (1) reliability of a computer monitoring system, (2) requirement of extensive education and training in the operational aspects of the system, and (3) time-consuming interface to the system. The nurses' responsibility to direct patient care did not allow enough time to properly adjust program parameters and react to the system. However, the comparative study performed by Zencka and colleagues overwhelmingly supported the effectiveness of the use of this system in the clinical setting. The introduction of the Arrhythmia Monitoring Technician obviated these problems. The technicians are responsible for the total operation of the monitoring system. Interface to the system occurs on two levels: (1) technician interface to the system by the adjustment of parameters and the verification of detected abnormalities and (2) technician interface to the nurses by notification of detected arrhythmias via remote transmission. In a recent survey, a majority of the nurses in the ICCU and IMCU indicated their positive support of the effectiveness of this computerized arrhythmia monitoring system. Critical care nurses in our institution consider computerized arrhythmia monitoring an essential component in the provision of quality patient care.

Allied Health Personnel↗
PubMed2004

CSHM: Web-based safety and health monitoring system for construction management.

INTRODUCTION: This paper describes a web-based system for monitoring and assessing construction safety and health performance, entitled the Construction Safety and Health Monitoring (CSHM) system. METHOD: The design and development of CSHM is an integration of internet and database systems, with the intent to create a total automated safety and health management tool. A list of safety and health performance parameters was devised for the management of safety and health in construction. A conceptual framework of the four key components of CSHM is presented: (a) Web-based Interface (templates); (b) Knowledge Base; (c) Output Data; and (d) Benchmark Group. RESULTS: The combined effect of these components results in a system that enables speedy performance assessment of safety and health activities on construction sites. With the CSHM's built-in functions, important management decisions can theoretically be made and corrective actions can be taken before potential hazards turn into fatal or injurious occupational accidents. IMPACT ON INDUSTRY: As such, the CSHM system will accelerate the monitoring and assessing of performance safety and health management tasks.

Benchmarking↗
PubMed2006

Development of a detection tablet for a portable NO2 monitoring system.

We have already developed a HCHO monitoring system which is called FP-30. In this experiment, we have developed a NO(2) detection tablet which can be used by the monitoring system. The detection tablet for the NO(2) was constructed with the sensing paper: porous cellulose paper that contains silica gel as an adsorbent, N-1-naphthylethylenediamine dihydrochloride (NED), and glycerin. The NO(2) in sample gas was blown over and adsorbed on the surface of the sensing paper. Then the NO(2) reacted with NED, producing a yellow compound. The coloring reaction took place on the surface of the sensing paper. The degree of color change of paper from white to yellow was monitored as a function of the intensity of the reflected light (lambda = 475 nm) of an LED. The detection limit was 0.01 ppm when the sampling time was 30 min, and the flow rate of sample gas was 250 ml/min. This sensing paper process was not interfered with by acetaldehyde, acetone, alcohols, hydrocarbons, carbon monoxide or carbon dioxide. The NO(2) concentrations in the rooms of a house or school were monitored using this monitoring system and the standard chemiluminescence method. The concentrations of NO(2) monitored by both methods were within 18% of the average. This highly sensitive, selective, and handy NO(2) gas monitoring system will be widely applicable and convenient for users who are not specialists in this field.

Air Pollutants↗
PubMed2005

The immunization data quality audit: verifying the quality and consistency of immunization monitoring systems.

OBJECTIVE: To evaluate the consistency and quality of immunization monitoring systems in 27 countries during 2002-03 using standardized data quality audits (DQAs) that had been launched within the framework of the Global Alliance for Vaccines and Immunization. METHODS: The consistency of reporting systems was estimated by determining the proportion of third doses of diphtheria-tetanuspertussis (DTP-3) vaccine reported as being administered that could be verified by written documentation at health facilities and districts. The quality of monitoring systems was measured using quality indices for different components of the monitoring systems. These indices were applied to each level of the health service (health unit, district and national). FINDINGS: The proportion of verified DTP-3 doses was lower than 85% in 16 countries. Difficulties in verifying the doses administered often arose at the peripheral level of the health service, usually as the result of discrepancies in information between health units and their corresponding districts or because completed recording forms were not available from health units. All countries had weaknesses in their monitoring systems; these included the inconsistent use of monitoring charts; inadequate monitoring of vaccine stocks, injection supplies and adverse events; unsafe computer practices; and poor monitoring of completeness and timeliness of reporting. CONCLUSION: Inconsistencies in immunization data occur in many countries, hampering their ability to manage their immunization programmes. Countries should use these findings to strengthen monitoring systems so that data can reliably guide programme activities. The DQA is an innovative tool that provides a way to independently assess the quality of immunization monitoring systems at all levels of a health service and serves as a point of entry to make improvements. It provides a useful example for other global health initiatives.

Child↗
PubMed2002

In situ calibration and evaluation of the accuracy of a waste water monitoring system.

A new method to estimate the reliability of a waste water monitoring system was developed and substantiated. To estimate the reliability means (1) to verify the representativeness of the sample fed into the monitoring system, and (2) to calibrate the detectors of the monitoring system. To verify the representativeness, test water spiked with 32P was prepared in a storage tank, and the monitoring system was operated. For all of the experiments, the radioactivity concentrations of the water fed into the monitoring system agreed well with those of the water in the storage tank at 725 +/- 45 s after the start of the sampling pump. Therefore, the representativeness was verified. Calibration was carried out with active water in the storage tank and in a specially designed calibration tank. The efficiency of a plastic scintillation detector (PSD), one of the detectors used in the monitoring system, for 32P was determined to be 4.91 +/- 0.10%. Using the calibration tank significantly reduced the cost and labor for calibration. In addition, calibration with natural potassium (40K) proved to be effective for periodic checks of the detector.

Calibration↗
PubMed1993

Reliability of a monitoring system for respiratory emergency room admissions.

A respiratory emergency room admissions monitoring system (RERAMS) was set up in Barcelona between 1985-1989, in order to investigate asthma epidemics in the city. Information on emergency room admissions for asthma and chronic obstructive pulmonary disease (COPD) was recorded daily from the four main hospitals of the city. The present study aims at assessing the reliability and coverage of this monitoring system. Identification of asthma and COPD emergencies was repeated by a reference observer, following the same protocol to extract data as that used by the register. To assess the coverage of the monitoring system, information was collected over 28 randomly selected days, from the emergency room clinical records for the seven additional hospitals in the city with five or more daily emergencies. Identification of asthma emergencies was highly reliable (kappa value, kappa = 0.81) as was the discrimination between asthma and COPD diagnoses (kappa = 0.91). Reliability for emergencies classified as COPD was lower, but still good (kappa = 0.65). The monitoring system covered 76 and 78% of all Barcelona asthma and COPD emergency room admissions, respectively. Emergency room admissions from our monitoring system did not differ in terms of social and demographic characteristics from emergencies recorded at the other hospitals. We conclude that the monitoring system for the Barcelona respiratory emergency room admissions was highly reliable, which suggests that, when adequately collected, information from clinical records of respiratory emergencies could be used for environmental epidemiological purposes.

Asthma↗
PubMed2005

An intelligent remote monitoring system for artificial heart.

A web-based database system for intelligent remote monitoring of an artificial heart has been developed. It is important for patients with an artificial heart implant to be discharged from the hospital after an appropriate stabilization period for better recovery and quality of life. Reliable continuous remote monitoring systems for these patients with life support devices are gaining practical meaning. The authors have developed a remote monitoring system for this purpose that consists of a portable/desktop monitoring terminal, a database for continuous recording of patient and device status, a web-based data access system with which clinicians can access real-time patient and device status data and past history data, and an intelligent diagnosis algorithm module that noninvasively estimates blood pump output and makes automatic classification of the device status. The system has been tested with data generation emulators installed on remote sites for simulation study, and in two cases of animal experiments conducted at remote facilities. The system showed acceptable functionality and reliability. The intelligence algorithm also showed acceptable practicality in an application to animal experiment data.

Decision Support Systems, Clinical↗
PubMed1988

Dynamics of invasive pressure monitoring systems: clinical and laboratory evaluation.

Seven pressure monitoring systems were evaluated in the clinical setting and in the laboratory to assess their adequacy for recording invasive blood pressures. We found that a large number of systems used in the clinical setting gave erroneous pressure results because of inadequate dynamic response. Results of testing similar systems in the clinical setting and under optimal laboratory conditions differed greatly. Four major findings were made: (1) Air bubbles in the monitoring systems near the transducer accounted for most of the variability of the dynamic characteristics of systems in the clinical setting; (2) simple catheter transducer system setups performed better, suggesting that simple "kits" be used; (3) membrane domes perform adequately if they are attached with care and according to the manufacturer's specifications; and (4) extension tubing was detrimental to the dynamic response of all systems, especially for pulmonary artery catheters. Fast-flush testing of pressure monitoring systems is needed to ensure the adequacy of dynamic response characteristics in the clinical setting. If the fast-flush characteristics are inadequate, physicians and nurses have the opportunity to troubleshoot the system and remove air bubbles and excessive tubing and to properly attach the transducer domes until optimal characteristics are obtained.

Blood Pressure Determination↗
PubMed2006

A mobile phone-based ECG monitoring system.

We have developed a telemedicine system for monitoring a patient's electrocardiogram during daily activities. The recording system consists of three ECG chest electrodes, a variable gain instrumentation amplifier, a low power 8-bit single-chip microcomputer, a 256 KB EEPROM and a 2.4 GHz low transmitting power mobile phone (PHS). The complete system is mounted on a single, lightweight, chest electrode array. When a heart discomfort is felt, the patient pushes the data transmission switch on the recording system. The system sends the recorded ECG waveforms of the two prior minutes and ECG waveforms of the two minutes after the switch is pressed, directly in the hospital server computer via the PHS. The server computer sends the data to the physician on call. The data is displayed on the doctor's Java mobile phone LCD (Liquid Crystal Display), so he or she can monitor the ECG regardless of their location. The developed ECG monitoring system is not only applicable to at-home patients, but should also be useful for monitoring hospital patients.

Amplifiers, Electronic↗
PubMed2003

Randomized trial of a daily electronic home monitoring system in patients with advanced heart failure: the Weight Monitoring in Heart Failure (WHARF) trial.

BACKGROUND: Heart failure treatment guidelines emphasize daily weight monitoring for patients with heart failure, but data to support this practice are lacking. Using a technology-based heart failure monitoring system, we determined whether daily reporting of weight and symptoms in patients with advanced heart failure would reduce rehospitalization and mortality rates despite aggressive guideline-driven heart failure care. METHODS: This was a randomized, controlled trial. Patients hospitalized with New York Heart Association class III or IV heart failure, with a left ventricular ejection fraction < or =35% were randomized to receive heart failure program care or heart failure program care plus the AlereNet system (Alere Medical, Reno, Nev) and followed-up for 6 months. The primary end point was 6-month hospital readmission rate. Secondary end points included mortality, heart failure hospitalization readmission rate, emergency room visitation rate, and quality of life. RESULTS: Two hundred eighty patients from 16 heart failure centers across the United States were randomized: 138 received the AlereNet system and 142 received standard care. Mean age was 59 +/- 15 years and 68% were male. The population had very advanced heart failure, New York Heart Association class III (75%) or IV (25%), as evidenced by serum norepinepherine levels, 6-minute walk distance and outcomes. No differences in hospitalization rates were observed. There was a 56.2% reduction in mortality (P <.003) for patients randomized to the AlereNet group. CONCLUSIONS: This is the largest multicenter, randomized trial of a technology-based daily weight and symptom-monitoring system for patients with advanced heart failure. Despite no difference in the primary end point of rehospitalization rates, mortality was significantly reduced for patients randomized to the AlereNet system without an increase in utilization, despite specialized and aggressive heart failure care in both groups.

Body Weight↗
PubMedDate not supplied

[Accuracy, utility and complications of continuous glucose monitoring system (CGMS) in pediatric patients with type 1 diabetes].

OBJECTIVE: To evaluate the accuracy, utility and complications of continuous glucose monitoring system in children and adolescents with type 1 diabetes. METHODS: This retrospective study assessed 16 type 1 diabetic patients (16.12+/-4.41 years) submitted to continuous glucose monitoring system (Medtronic; Northridge, CA) for 72 hours. The following parameters were analyzed: mean capillary glucose level and mean glucose value measured by the continuous glucose monitoring system; glucose excursions (continuous glucose monitoring system vs. capillary glucose measurement), postprandial hyperglycemia (NR < 140 mg/dl), nocturnal hypoglycemia, complications (trauma, local infection, disconnection) and therapeutic management after continuous glucose monitoring. A1c levels were measured at the beginning and after 3 months of the study. RESULTS: The mean capillary glucose values were 214.3+/-66.5 mg/dl vs. 207.6+/-54.6 mg/dl by continuous glucose monitoring system, with a significant correlation (p = 0.001). The correlation coefficient and mean absolute error were 0.86+/-0.21 and 12.6% of the median, respectively. The continuous glucose monitoring system was significantly more efficient in detecting glucose excursion than fingerstick capillary blood sampling (p = 0.04; W = 74), and postprandial hyperglycemia was identified in 60% of type 1 diabetic patients with a median value of 157 mg/dl (< 140 mg/dl). Nocturnal hypoglycemia was detected in 46.7% of these patients. The evaluation of A1c levels in eight (50%) patients before continuous glucose monitoring and after 3 months showed a significantly lower level of A1c in this population (8.18+/-1.5 vs. 7.28+/-1.3; p = 0.034). The therapeutic management of type 1 diabetes was changed in 100% of patients. No complications were detected in 93.7% of patients. CONCLUSIONS: The continuous glucose monitoring system showed to be a very safe, well-tolerated and highly accurate method, with a low complication rate. It is a good method to identify glucose excursion and postprandial hyperglycemia, and to improve metabolic changes in therapeutic strategies, with a significant impact on the A1c levels of pediatric diabetic patients. The efficacy of the continuous glucose monitoring system in detecting hypoglycemia is still unclear in the medical literature.

Adolescent↗
PubMed1976

A computerized fetal monitoring system.

A computerized fetal monitoring system has been developed at the Cedars-Sinai Medical Center in Los Angeles, California. It utilizes unmodified fetal monitors feeding fetal heart rate and uterine pressure data into a minicomputer. The overall accuracy on internal monitoring is 91%. The concept of on-line computer analysis of fetal monitoring records has met with clinical acceptance and is utilized for all patients in labor at the Cedars-Sinai Medical Center.

Blood Pressure↗
PubMed2004

The Aerocrine exhaled nitric oxide monitoring system NIOX is cleared by the US Food and Drug Administration for monitoring therapy in asthma.

The Aerocrine exhaled nitric oxide (NO) monitoring system NIOX was cleared by the US Food and Drug Administration for clinical application in patients with asthma in May 2003. The fractional concentration of exhaled NO has been extensively researched as a marker of airway inflammation in asthma and other diseases and is now poised to enter clinical application. The American Thoracic and European Respiratory Societies' current guidelines recommend measurement at constant expiratory flow, which is difficult for some adults and children. The NIOX NO monitoring system was designed to facilitate standardized measurement according to guidelines. A clinical study was performed together with in vitro testing to obtain clearance. Exhaled NO levels were measured in unstable steroid-naive adult and pediatric asthmatic subjects and again after a 2-week treatment with inhaled corticosteroids. Exhaled NO levels decreased highly significantly, with 95% confidence limits for the decrease of -40% to -60% accompanied by clinical improvement. This trial, together with extensive in vitro testing, led to the clearance of NIOX by the US Food and Drug Administration. This article in the journal's "New products" feature section will describe background material regarding exhaled NO, special features of the NIOX NO monitoring system, and how this tool can be incorporated into clinical asthma management.

Adolescent↗
PubMed1976

Computerized medication monitoring system.

A computerized medication monitoring system for alerting and warning of potential adverse drug reactions is described. The system integrates computerized data on each hospital patient (medications, clinical laboratory, blood gas, ECG, ALLERGIES, DIAGNOSIs, etc.) and returns to the pharmacist warning messages and suggestions regarding patient drug therapy. The broad data base allows for nearly complete drug therapy monitoring. When a warning message is received, the pharmacist contacts the physician or nursing staff and explains the potential problem. The system also generates prescription labels and patient drug profiles which are used in a unit dose dispensing system. Five percent of 13,727 patients monitored have had drug alerts. Of these alterts, 44.9% were drug-laboratory contraindications and only 28.9% were drug-drug interactions. Of the 690 alerts received, 77% resulted in the physician changing the patient's therapy.

Computers↗
PubMed2001

[The development of multi-lead EEG telemetry and tele-monitoring system].

This paper introduces a kind of EEG Telemetry and Tele-monitoring system. With the use of the public telephone network to transport signals and the portable EEG recording system as the sender of system, the EEG data of 20 standard leads can be transmitted to the receiver of system (monitoring center) synchronously. And at the monitoring center, the waves can be displayed real-time, freezing, stored, reviewed, analyzed and printed, thus providing aid in remote diagnosis and treatment consultations.

Computer Communication Networks↗
PubMed2002

[Clinical use of the VIA Blood Gas Monitor System].

VIA Blood Gas Monitor System (Baxter) withdrawals and reinforces blood automatically and measures pH, PaCO2, PaO2, sodium, potassium, and hematocrit. We evaluated VIA for use during cardiopulmonary bypass in 8 patients and during differential lung ventilation in 6 patients. The bias and precision were calculated on all the measured parameters. A total of 127 blood samples were obtained for comparison. Blood gas data measured by VIA were clinically acceptable except sodium. These findings suggest that VIA is useful for the management of patients in whom frequent arterial gas measurements are necessary.

Aged↗
PubMed2006

Patient experience with, and use of, an electronic monitoring system to assess vaccination responses.

OBJECTIVE: To evaluate the user experience and acceptability of an electronic patient monitoring system. SETTING AND PARTICIPANTS: 822 Military and civilian personnel at a health clinic at a major US military headquarters used an Internet and telephone-based electronic monitoring system to report vaccination-site responses and symptoms after receiving the smallpox vaccination. Focus groups of vaccinees were conducted to help develop a survey about the experience that was distributed to 379 vaccinees (96% completion rate). RESULTS: Users of the electronic monitoring system reported that it was fast and easy to use and reported they would use a system like this again and recommend an electronic monitoring system to a friend or relative. Most users (84%) were comfortable with a physician tracking their vaccine reaction using their electronic reports, but only half (51%) were comfortable with eliminating the post-vaccination follow-up visit with their health-care provider based on their electronic reports. CONCLUSIONS: This electronic monitoring system was well received by vaccinees and allowed health-care providers to track the status of vaccinees. However, vaccinees were not comfortable replacing a physician visit with electronic monitoring, at least for the smallpox vaccination. A monitoring system like this may be useful in public health settings, such as mass vaccination or prophylaxis during a bioterrorism event, a pandemic influenza outbreak, or another public health emergency.

Adult↗