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PubMed2003

Telemetry takes off.

After a slow start, payers are signing on to the telemedicine trend, as rural hospital and major medical centers come to see the benefits of cooperation.

Hospital Shared Services↗
PubMed2004

Tap into safer telemetry.

Use of wireless technologies in healthcare necessitates staff vigilance regarding patient safety.

Electromagnetic Fields↗
PubMed1974

ECG telemetry.

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Electrocardiography↗
PubMed1970

[Oral telemetry].

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Dental Caries↗
PubMed2000

Does in-patient ECG monitoring have an impact on medical care in chronic heart failure patients?

BACKGROUND: Heart failure patients' management in non-intensive care units might be improved by telemetry monitoring. However, telemetry adds the cost and evidence of this effectiveness is not available. AIM: To evaluate the utility of the ECG monitoring in chronic heart failure patients admitted to a non-intensive care unit. METHODS: A prospective analysis of the utility of telemetry in 711 patients admitted to a Heart Failure Unit from March 1996 to September 1997. RESULTS: One hundred and ninety-nine patients underwent telemetry; 108 telemetry findings were recorded, in 35% of NYHA class II, in 46% in NYHA class III-IV and 43% in unstable patients. Reasons for telemetry were: known arrhythmia (n=82), electrolytes disturbances (n=20), atrial fibrillation (n=12), symptoms (n=48), i.v. dobutamine (n=13), drugs control (n=16), devices control (n=8). Crossing reasons for telemetry and detected events we had, respectively, 63, 11, 2, 17, 5, 6, and 0 telemetry findings. Treatment was guided by telemetry results in only 33 cases (respectively in 18, 0, 4, 5, 5, 1, and 0 cases). Physicians perceived telemetry as unhelpful in 30% of cases; as helpful in 70%. The percentage of inutility, usefulness with and without related medical intervention were similar between stable and unstable patients (30, 18, 51% and 31, 15, 54%, respectively). CONCLUSION: In a heart failure unit ECG monitoring is mostly used in severe and unstable patients. However, medical decisions are rarely guided by the telemetry findings. The usefulness of telemetry might be underestimated because one of the uncounted results might be the avoidance of inappropriate intervention.

Anti-Arrhythmia Agents↗
PubMed1998

Use of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) to assist with triage of patients with chest pain or other symptoms suggestive of acute cardiac ischemia. A multicenter, controlled clinical trial.

BACKGROUND: Approximately 6 million U.S. patients present to emergency departments annually with symptoms suggesting acute cardiac ischemia. Triage decisions for these patients are important but remain difficult. OBJECTIVE: To test whether computerized prediction of the probability of acute ischemia, used with electrocardiography, improves the accuracy of triage decisions. DESIGN: Controlled clinical trial. SETTING: 10 hospital emergency departments in the midwestern, southeastern, and northeastern United States. PATIENTS: 10689 patients with chest pain or other symptoms suggestive of acute cardiac ischemia. INTERVENTION: The probability of acute ischemia predicted by the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI), either automatically printed or not printed on patients' electrocardiograms. MEASUREMENTS: Emergency department triage to a coronary care unit (CCU), telemetry unit, ward, or home. Other measurements were the bed capacity of the CCU relative to that of the telemetry unit; training or supervision status of the triaging physician; and patient diagnoses and outcomes based on clinical, electrocardiographic, and creatine kinase data. RESULTS: For patients without cardiac ischemia, in hospitals with high-capacity CCUs and relatively low-capacity cardiac telemetry units, use of ACI-TIPI was associated with a reduction in CCU admissions from 15% to 12%, a change of -16% (95% CI, -30% to 0%), and an increase in emergency department discharges to home from 49% to 52%, a change of 6% (CI, 0% to 14%; overall P=0.09). Across all hospitals, for patients evaluated by unsupervised residents, use of ACI-TIPI was associated with a reduction in CCU admissions from 14% to 10%, a change of -32% (CI, -55% to 3%); a reduction in telemetry unit admissions from 39% to 31%, a change of -20% (CI, -34% to -2%); and an increase in discharges to home from 45% to 56%, a change of 25% (CI, 8% to 45%; overall P=0.008). Among patients with stable angina, in hospitals with high-capacity CCUs, use of ACI-TIPI was associated with a reduction in CCU admissions from 26% to 13%, a change of -50% (CI, -70% to -17%), and an increase in discharges to home from 20% to 22%, a change of 10% (CI, -29% to 71%; overall P=0.02). At hospitals with high-capacity telemetry units, use of ACI-TIPI was associated with a reduction in telemetry unit admissions from 68% to 59%, a change of -14% (CI, -27% to 1%), and an increase in emergency department discharges to home from 10% to 21%, a change of 100% (CI, 22% to 230%; overall P=0.02). Among patients with acute myocardial infarction or unstable angina, use of ACI-TIPI did not change appropriate admission (96%) to the CCU or telemetry unit at hospitals with high-capacity CCUs or telemetry units. CONCLUSIONS: Use of ACI-TIPI was associated with reduced hospitalization among emergency department patients without acute cardiac ischemia. This result varied as expected according to the CCU and cardiac telemetry unit capacities and physician supervision at individual hospitals. Appropriate admission for unstable angina or acute infarction was not affected. If ACI-TIPI is used widely in the United States, its potential incremental impact may be more than 200000 fewer unnecessary hospitalizations and more than 100000 fewer unnecessary CCU admissions.

Acute Disease↗
PubMed1995

Validation of a radiotelemetry system for continuous blood pressure and heart rate monitoring in dogs.

A blood pressure telemetry system with catheter placement in the femoral artery was evaluated over a 119-day period in eight mongrel dogs. Every 3 weeks, the pressures recorded by telemetry were compared with direct, simultaneously recorded blood pressures measured from a femoral artery catheter implanted on the contralateral side. One telemetry device failed within 1 week of implant and was replaced before the beginning of data collection. Continuous blood pressure measures were accurate for a minimum of 17 weeks in all eight dogs. Acute changes in blood pressure and heart rate were not evaluated. Validation by simultaneous recording with a physiological monitor indicated that there was no drift in the telemetry blood pressure or heart rate during the 17-week period. Heart rates recorded by telemetry and a physiological monitor were identical, as were mean arterial pressures. The systolic pressure measured by the physiological monitor was consistently higher than that measured by telemetry. This may have been due to differences in the compliance of the catheter material in the two systems. Two devices failed within approximately 6 months of implant, apparently because of exhaustion of the battery. These findings indicate that this telemetry device can be used for periods of up to 17 weeks without appreciable drift or attenuation of the blood pressure signal. The results also describe a validation procedure for monitoring the accuracy of the telemetry system over extended periods of use. We conclude that this telemetry device can be used for the long-term assessment of blood pressure and heart rate in the dog.

Animals↗
PubMed1994

A CMOS integrated circuit for multichannel multiple-subject biotelemetry using bidirectional optical transmissions.

A CMOS integrated circuit for a noninvasive biological-signal telemetry system specified for use in medical and physiological studies of the influence of weightlessness in space is presented. The system can monitor multichannel (4 channels maximum) biological signals from multiple subjects (4 subjects maximum) in real time by using time multiplexing. A key technique, so-called synchronized multiple-subject telemetry, to achieve multiple-subject telemetry has been proposed. This technique utilizes bidirectional optical transmissions with direct and scattered infrared lights between an observer and each of the subjects. An experimental CMOS IC to give a small light-weight low-power, and smart telemetry instrument for use on animals has been developed. This IC is for evaluating circuit blocks of the implantable monolithic telemetry instrument. The major circuit blocks include CMOS digital circuits for synchronization, subject selection and time multiplexing, analog circuits for pulse interval modulation (PIM), and other blocks such as a CMOS optical pulse receiver and an LED driver. A preliminary experimental multichannel telemetry from two subjects has been performed with the implemented IC chips, and the principal operation of the multiple-subject optical biotelemetry has been demonstrated.

Aerospace Medicine↗
PubMed1990

The use of radiotelemetry after discharge from the coronary care unit.

Forty-six of 110 consecutive admissions to the coronary care unit (CCU) were monitored by telemetry after discharge from the unit. One of three patients with sudden cardiac death was resuscitated successfully and four patients developed atrial fibrillation which resulted in investigation by echocardiography and treatment with anticoagulants. Significant ventricular ectopic activity was detected in four other patients. Arbitrary selection of patients resulted in those with complicated courses in the CCU being more likely to be monitored by telemetry after transfer to the ward than those which were uncomplicated. There were no cases of sudden cardiac death in patients who did not have telemetry. The cost of telemetry was 2,775 pounds per system. All 19 districts in the North-West region of the UK responded to a questionnaire. Five of the 19 used telemetry but only two of these used the technique routinely after discharge from the CCU whereas four used radiotelemetry to monitor patients on the ward when coronary care beds were unavailable. Eight districts wanted telemetry but needed funds. We conclude that radiotelemetry is an inexpensive way to detect serious arrhythmias in patients transferred from the CCU to the general ward. Monitored from the CCU, cardiac arrest can be immediately detected and treated by experienced staff. Asymptomatic atrial fibrillation leads to prompt investigation by echocardiography and possible treatment with anticoagulants. The importance of noticing major ventricular ectopic activity is likely to increase with the possibility of selecting patients with a high risk of life-endangering arrhythmias so that antiarrhythmic drugs or techniques such as automatic defibrillators can be used appropriately.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Continuous telemetric monitoring of fetal oxygen partial pressure during labor.

INTRODUCTION: Upright or ambulatory birth positions are favorable for fetal oxygenation. Studies of fetal oxygenation with regard to maternal position require free maternal mobility. Therefore, telemetry for a fetal sensor for such investigations is a pre-requisite. Telemetry-if technically feasible-could enable monitoring of fetal oxygen partial pressure using an existing sensor without restricting the mobility of the parturient woman. We have developed a telemetry system for use with a fetal transcutaneous partial oxygen pressure sensor (ttcpO(2)) and have studied effects of maternal position and position changes during normal labor. MATERIALS AND METHODS: The monitoring system consists of three parts: the telemetry unit with the ttcpO(2) sensor to transmit the tcpO(2) and the heating output telemetrically, a modified CTG monitor and a personal computer storing the measurements. All data were plotted on the CTG recording paper and fed into a new purpose-designed software, displaying fetal heart rate, the uterine contraction intensity, ttcpO(2) and the heating output. Three laboring women, randomly and successively adopting "classical birth positions" (supine or side positions), sitting or vertical or walking position, were studied. RESULTS: Fetal heart rate, uterine contractions, ttcpO(2) and heating output are influenced by the birth positions and by changes of the birth position. In the classical supine and side position there seemed to be lower fetal oxygenation. Sitting, standing and especially walking were more favorable. DISCUSSION: Telemetry is useful to study a possible clinical benefit of individual birth positions.

Equipment Design↗
PubMed2003

Low-dose angiotensin II enhances pressor responses without causing sustained hypertension.

Subpressor doses of angiotensin II (SP-Ang II) cause a slow increase in blood pressure in rats as assessed by tail cuff plethysmography (TCP), reflecting either sustained hypertension or an exaggerated pressor response to diverse stimuli. We examined whether subpressor doses of Ang II enhance blood pressure responses to simple stress (handling of trained rats for TCP). We implanted telemetry in Sprague-Dawley rats. After 10 days of recovery and TCP training, we implanted osmotic minipumps with either SP-Ang II (50 ng/kg per minute) or vehicle, and then measured systolic blood pressure continuously in unrestrained rats for 13 days. We also recorded telemetry readings while obtaining TCP measurements every 2 days. SP-Ang II increased blood pressure from 134+/-19 to 159+/-22 mm Hg by TCP, which matched the simultaneous telemetry readings of 131+/-20 to 154+/-25 mm Hg. In contrast, SP-Ang II did not change the blood pressure in the unrestrained rats (measured with continuous telemetry: 124+/-2 versus 127+/-1 mm Hg). The blood pressure in the control rats did not change in the unrestrained state (125+/-3 versus 128+/-5 mm Hg on days 0 and 12, respectively), and only slightly increased during TCP (11+/-5 and 6+/-4 mm Hg by TCP and simultaneous telemetry, respectively; P=NS). In summary, SP-Ang II, although unable to provoke sustained hypertension, nonetheless magnifies the pressor response to otherwise trivial stimuli. We speculate that even modestly elevated Ang II levels may contribute to hypertensive complications because such levels promote the punctuation of an apparent normotensive state by episodic hypertension occasioned by seemingly innocuous stimuli.

Angiotensin II↗