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At least 55 records · Page 3Linked to original sources

PubMed1979

Continuous blood pressure monitoring during hemodialysis.

As the number of patients suffering from circulatory problems increases, continuous blood pressure monitoring during hemodialysis is desirable. Monitoring of the fistulated venous pressure was proven to be a satisfactory substitute for that of the systemic arterial pressure, after fistulated venous pressure had been ascertained to correlate strictly with systemic arterial pressure. Utilization of a double-lumened cannula, one lumen for blood outflow and another for monitoring of fistulated venous pressure, was established and showed clinical applicability. This principle is considered to be useful not only for blood pressure monitoring, but also for activation of a dialysis machine control system.

Animals↗

PubMed1978

Physiologic monitoring goals for the critically ill patient.

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.

Blood Chemical Analysis↗

PubMed1979

[The Cerebral Function Monitor. Description, functioning and interpretation principles].

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.

Brain↗

PubMed1979

[Use of the Cerebral Function Monitor in cardiac surgery].

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.

Adolescent↗

PubMed1979

Continuous monitoring for ventricular arrhythmias during exercise tests.

Exercise stress testing is being increasingly used to verify exercise-induced arrhythmia and to aid in assessing antiarrhythmic drug efficacy. The true prevalence of ventricular arrhythmia during exercise testing is underestimated by means other than continuous monitoring. We compared the yield of ventricular premature beats (VPBs) between a continuous recording system ("trendscription") and intermittent monitoring among 39 patients undergoing a total of 50 consecutive exercise studies. By intermittent monitoring, 22 (44%) of 50 of the exercise tests demonstrated VPBs; with trendscription, 31 (62%) exhibited such arrhythmia. Most striking, however, was a sixfold increase in the disclosure of complex and repetitive forms of VPBs (56 vs nine episodes). Thus, this form of monitoring presents a cost-efficient, on-line method that allows concentration on the patient during exercise as well as clear recording of all arrhythmic events.

Anti-Arrhythmia Agents↗

PubMed1979

Evaluation of fetal monitoring by telemetry.

A radiotelemetry system for the direct monitoring of fetal heart rate and intrauterine pressure during labor has been evaluated at 5 different institutions. A conventional fetal scalp electrode and a special intrauterine pressure sensor are connected to a radio transmitter placed on the patient's thigh. The receiver can be located up to 50 feet away from the transmitter and is either a self-contained monitor or a unit that converts a conventional fetal monitor to a telemetric one. The telemetry recordings are of similar quality to those obtained from conventional monitors. Telemetry allows for greater patient comfort and mobility as well as greater convenience to the clinical staff. Continuous data can be obtained from patients while they are ambulatory or sitting in a chair as well as while they are in bed.

Electrodes↗

PubMed1979

Hemodynamic monitoring and care of the patient of high risk for anesthesia.

Hemodynamic monitoring and care of the patient at high risk for anesthesia require a careful and systematic approach. During preoperative evaluation the patient at increased risk must be identified and correctable problems must be solved. The patient's current medications must be reviewed because they may influence the choice of anesthetic approach and may alter the physiologic response to the stresses commonly associated with anesthesia. In addition to conventional clinical and electrocardiographic monitoring, perioperative hemodynamic monitoring may be desirable for patients at special risk, who are likely to have significant associated medical problems or to undergo complicated surgical procedures. No ideal induction agent exists, and hypotension secondary to peripheral vasodilation or myocardial depression, or both, is a potential problem. Patients with an inordinately high risk may benefit from mechanical circulatory assistance prior to induction of anesthesia. Attention to oxygenation, blood volume replacement and the prevention of hypertensive episodes are particularly important during anesthesia so that optimal cardiac performance is ensured and ischemia avoided. The stresses during emergence from anesthesia contribute to lability of the cardiovascular status and hypoxemia. The period of risk does not conclude with immediate recovery from anesthesia but extends through the postoperative phase. Careful monitoring and attention to the control of pain, prevention of hypotension and hypertension, adequate oxygenation, early mobilization and resumption of the administration of cardiac medications are important factors in a successful outcome.

Aged↗

PubMed1979

Failure of conventional monitoring to detect apnea resulting in hypoxemia.

In summary, our findings support and confirm the concerns of many investigators that present methods of cardiorespiratory monitoring are inadequate for the detection of many forms of apnea. Nurses underrecord both the frequency and duration of apneic episodes. Bradycardia is an unreliable index of hypoxemia. Thoracic impedance monitors are unreliable because they detect only a fixed duration of respiratory pause and are sensitive to many artifacts unavoidable in a clinical setting. Finally, ineffective breathing patterns such as disorganized breathing, obstructive apnea, and paradoxical breathing are undetectable by thoracic impedance monitoring. We warn against the reliance on heart rate and thoracic impedance monitoring alone for infants with recurrent apnea.

Apnea↗

PubMed1976

Monitoring of midmyocardial and subendocardial pH in normal and ischemic ventricles.

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.

Animals↗

PubMed1979

Facilitating generalization of on-task behavior through self-monitoring of academic tasks.

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.

Behavior Therapy↗

PubMed1977

Comparison of Myo-Monitor centric position to centric relation and centric occlusion.

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.

Adult↗

PubMed1977

Watching the monitors: "PAID" prescriptions, fiscal intermediaries and drug-utilization review.

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.

Blue Cross Blue Shield Insurance Plans↗

PubMed2024

SJPedPanel: A Pan-Cancer Gene Panel for Childhood Malignancies to Enhance Cancer Monitoring and Early Detection.

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.

Humans↗

PubMed1979

New translocations in human lymphocytes: a mutagen monitoring system.

The human lymphocyte is a premier cell for monitoring chromosome aneuploidy. The lymphocyte is easily obtained, can be studied before and after culture, and has been extensively investigated. Assays available for lymphocytes include the scoring of chromosome breaks (subjective and laborious), the analysis of chromosome abnormalities such as increase or decrease in number (versus normal background), dicentrics etc., and the micronucleus test (presumable end-state phenomena). We propose the monitoring of somatic chromosome translocations in human lymphocytes. Background data available from North America indicate that the frequency of de novo chromosome translocations in Halifax, Portland, Denver, and Atlanta is about 1.7 x 10(-3). The most common translocation arising in lymphocytes is between chromosomes 7 and 14 (with a frequency of 4 x 10(-4). All translocations occurring de novo in human lymphocytes tend to appear balanced with no evidence for loss or gain of chromosome material. Cytogenetic laboratories are processing lymphocytes daily. The resultant photographs and karyotypes are all scorable for de novo translocations. Suitable data on exposure to possible mutagenic agents could be collected in advance of these chromosome studies. This would provide a new method for monitoring chromosome changes in the population. The cost of monitoring lymphocyte chromosomes for somatic translocations would be small, since numerous laboratories study lymphocytes rountinely for clinical diagnostic purposes. There may be merit in availing ourselves of easily available data from a very available species: man.

Chromosome Aberrations↗

PubMedDate not supplied

Observations on ambulatory electrocardiographic monitoring in clinical practice.

Holter monitoring is a practical technique for determining rate, rhythm, contour, and conduction changes in the electrocardiogram of the ambulatory patient. This kind of information may be of great clinical importance in coronary artery disease with or without myocardial infarction, in patients with permanent pacemakers, in the presence of central nervous system symptoms, and perhaps in patients with chronic obstructive pulmonary disease. Correlating ambulatory electrocardiographic findings in patients with these diseases and syndromes provides insight into the severity of the process involved. It may also define the response to therapy and to specific social and work situations. Present instrumentation, although reasonably effective, may be considered in an early developmental stage. Future progress in terms of miniaturization, automatic patient warning systems, and activation of central recording units, may further broaden the implications for ambulatory electrocardiographic monitoring. The scope of these observations and the variety of unsuspected rhythm and contour abnormalities defined may ultimately rival the information gained in monitored hospitalized patients. It is hoped that this information will have an impact on the therapy of the ambulatory patient comparable to that which coronary-care unit monitoring has had on the hospitalized patient with acute myocardial infarction.

Adult↗

PubMed1977

[Continuous monitoring of the pulmonary artery pressure in acute myocardial infarction (author's transl)].

The method of continuous pulmonary artery pressure (PAP) monitoring and its use in 66 patients with acute myocardial infarction is described. Measurement of PAP should be the first diagnostic step in hemodynamic monitoring and early recognition of left ventricular failure. In cases of elevated PAP and critical general state of the patient, monitoring should be extended by measuring pulmonary wedge pressure and cardiac output. Hemodynamic monitoring should be continued for 3 to 5 days, since some cases of acute myocardial infarction with increasing PAP up to the 4th day after the onset were recorded. With the safety precautions mentioned, neither threatening, arrhythmia, nor thromboembolic or septic complications were observed.

Acute Disease↗

PubMed2025

The time has come for revising the rules of clozapine blood monitoring in Europe. A joint expert statement from the European Clozapine Task Force.

The European Clozapine Task Force is a group of psychiatrists and pharmacologists practicing in 18 countries under European Medicines Agency (EMA) regulation, who are deeply concerned about the underuse of clozapine in European countries. Although clozapine is the most effective antipsychotic for people with treatment-resistant schizophrenia, a large proportion of them do not have access to this treatment. Concerns about clozapine-induced agranulocytosis and stringent blood monitoring rules are major barriers to clozapine prescribing and use. There is a growing body of evidence that the incidence of clozapine-induced agranulocytosis is very low after the first year of treatment. Maintaining lifelong monthly blood monitoring after this period contributes to unjustified discontinuation of clozapine. We leverage recent and replicated evidence on the long-term safety of clozapine to call for the revision and updating of the EMA's blood monitoring rules, thus aiming to overcome this major barrier to clozapine prescribing and use. We believe the time has come for relaxing the rules without increasing the risks for people using clozapine in Europe.

Clozapine↗

PubMed2026

Health Literacy and Capecitabine Adherence in a Remote Monitoring Pilot Trial for Breast Cancer: Post Hoc Exploratory Analysis.

BACKGROUND: Oral anticancer therapy enables convenient, home-based cancer care but can introduce adherence challenges, particularly with complex dosing schedules. Capecitabine is commonly used in breast cancer, often as adjuvant therapy or in advanced disease, and typically requires twice-daily dosing on cyclical schedules, increasing the risk of missed or incorrect doses. Low health literacy may exacerbate these difficulties, and emerging remote monitoring tools may help close this gap. OBJECTIVE: In this post hoc exploratory analysis, we evaluated whether health literacy (1) was associated with capecitabine adherence and (2) modified a remote monitoring intervention's effectiveness. METHODS: We conducted post hoc analyses of a 2-arm pilot trial that randomized women with breast cancer treated with capecitabine to enhanced usual care (EUC) or remote patient monitoring (RPM). Adherence was captured with a smart pill bottle, Nomi by SMRxT, that recorded dose timing and quantity. Participants in the RPM group received messages for missed or incorrect doses and weekly symptom assessments. Incorrect or missed doses and severe symptoms triggered alerts to the oncologist. Health literacy was assessed at enrollment. To evaluate moderation, we used linear regression with an interaction term (health literacy × intervention arm) predicting adherence (proportion of days). Marginal effects quantified differences in adherence by study arm and health literacy. RESULTS: Among 28 participants (EUC, n=15 and RPM, n=13), 9 (32.1%) had lower health literacy, 16 (57.1%) identified as Black, 10 (35.7%) identified as White, and 15 (53.6%) had income below 200% of the federal poverty level. In the regression model, the health literacy × randomized group interaction did not reach statistical significance (-16.3 percentage points, 95% CI -35.5 to 2.9; P=.09). Predicted adherence among lower health literacy participants was 87.5% in the RPM group and 65.5% in the EUC group (difference: +22.1 percentage points, 95% CI 6.2-37.9; P=.008). Among participants with higher health literacy, adherence was 89.9% in the RPM group and 84.1% in the EUC group (difference: +5.7 percentage points, 95% CI -5.2 to 16.7; P=.29). Within the EUC group, predicted adherence was 18.6 percentage points lower among those with lower versus higher health literacy (95% CI -32.4 to -4.9; P=.01); within the RPM group, this difference was 2.3 percentage points lower among those with lower versus higher health literacy (95% CI -15.8 to 11.1; P=.73). CONCLUSIONS: In this post hoc exploratory analysis, the estimated difference in capecitabine adherence between the RPM and EUC groups was larger among participants with lower health literacy. Although the formal interaction test was not statistically significant, the magnitude and direction of the observed difference support further investigation of RPM as a potential approach to improve adherence among patients facing health literacy-related adherence barriers. Larger, prospectively powered studies are needed to confirm these findings and evaluate downstream clinical outcomes.

Humans↗