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PubMedDate not supplied

Full-disclosure monitoring: a concept that will change the way arrhythmias are detected and interpreted in the hospitalized patient.

Conventional methods of detecting and documenting arrhythmia in the hospitalized patient are inadequate. A system of full-disclosure monitoring has been expanded from its roots in Holter monitoring to real-time telemetry. This archiving system stores 24 hours of electrocardiogram (ECG) tracing per patient in computer memory and prints 60 minutes (one minute per line, 60 lines per page) of ECG hourly. This technique eliminates the fear of missing ventricular tachycardia, heart block, or automatic implantable cardioverter defibrillator discharges and ensures that onsets and terminations of runs are captured. Documentation is facilitated by the use of a laser printer that makes standard-sized tracings. The retrospective capability of full disclosure monitoring aids in correlating symptoms to ECG changes and serves as a tool for quality control, bed utilization, and research.

Arrhythmias, Cardiac↗

PubMed1993

Patient adaptation to technology: an application of the Roy model to nursing research.

Structured interviews were used to explore 75 medical-surgical patients' reactions to intravenous (invasive) and telemetry (noninvasive) attachment. Dependent variables operationalizing constructs of comfort, self-esteem, patient role, and social relationships derived from Roy's four effector modes were organized into 19 adaptation items. It was hypothesized that patients attached to invasive technology would report more stimuli and need for behavioral responses than those attached to noninvasive technology. In keeping with the exploratory nature of the study and use of a new adaptation interview tool, item-by-item analysis was used to test the hypotheses. Most support for the hypotheses occurred when patients were attached to only one invasive device and for less than 3 days. Findings also provide new insights on how technology connections might put patients at risk for coping difficulties.

Adaptation, Psychological↗

PubMed1993

Monitoring core temperature during exercise: ingestible sensor vs. rectal thermistor.

A telemetry monitoring system using an ingestible temperature sensor has recently become available commercially, but to our knowledge no published data on exercise applications have been reported. Consequently, core temperature was measured by both ingestible capsule sensors and standard rectal thermistors in six trained subjects (three cyclists, three runners) during 30 to 90 min of progressive cycling or treadmill exercise. Testing was conducted 3-9 h after ingestion of the capsule. The telemetered temperature was lower than the rectal temperature both at rest and during exercise in every subject, with resulting significant (p < 0.005) mean differences (+/- S.D.) of 36.91 (+/- 0.41) vs. 37.50 (+/- 0.21) and 38.01 (+/- 0.33) vs. 38.94 degrees C (+/- 0.24), respectively. The mean temperature difference increased by 58% from rest (0.59 degrees C) to peak exercise (0.93 degrees C). These preliminary findings demonstrate a consistently lower temperature from the capsule sensor located within the GI tract compared to rectal thermistors. Replication of these results and investigation into this disparity are necessary before these ingestible capsules should be used for routine monitoring of core temperature.

Adult↗

PubMed1993

Reliability and variability of indicators of heart-rate monitoring in children.

We describe the daily heart-rate patterns and the between-day and within-day reliabilities of several heart rate indicators measured in 131 Anglo-, African-, and Mexican-American children aged 5-7 yr. Heart rates were measured over 12 waking hours with a Quantum XL Telemetry heart rate monitor. The percent of heart rates 25% above resting heart rate, an index of physical activity heart rate (PAHR-25 index), was found to have the highest within-day (0.92) and between-day (0.81) reliabilities. The Spearman-Brown prophecy formula indicated that only 9.3 h of observation would be needed to maintain a within-day reliability of 0.90. The percentage of heart rates 50% above resting heart rate (PAHR-50) was found to have slightly lower within-day (0.88) and between-day (0.56) reliability. Principal components analysis revealed that the PAHR-25 and PAHR-50 indicies only had one component throughout the day. The PAHR-25 and PAHR-50 indicies were weakly correlated with age, suggesting that they may be good indicators of relative PAHR. Male children had higher (P < or = 0.025) PAHR-25 index scores than females. There were no gender or ethnic differences in the PAHR-50 index.

Black or African American↗

PubMed1996

The Cleveland Clinic rotodynamic pump program.

The Cleveland Clinic Foundation has developed a unique rotodynamic blood pump for future use as a permanent implant. This pump is small (2.5 x 2.5 inches) and requires an electric input power of 7 watts to produce 5 L/min of blood flow against 100 mm Hg at 3,000 rpm. Initial in vivo testing has confirmed in vitro function and shown low hemolysis. Endurance bench testing has exceeded 12 months of continuous function. This pump is the basis of an innovative ventricular assist system in which power is supplied by a tranocutaneous electrical transmission system, and pacer technology is used for both control logic and telemetry functions. The resulting system will be completed and tested under an NHLBI contract during the next 5 years.

Cardiac Pacing, Artificial↗

PubMed1997

Accuracy of detection of clinically important dysrhythmias with and without a dedicated monitor watcher.

BACKGROUND: Although dedicated monitor watchers are used in many progressive care units with telemetry monitors, this costly practice has not been evaluated. OBJECTIVE: To compare the accuracy of detection of clinically important dysrhythmias with and without a dedicated monitor watcher. METHODS: On a 26-bed cardiac progressive care unit, documentation of four categories of dysrhythmias during a 7-week period when a monitor watcher was present was compared with that during a 7-week period when no monitor watcher was present. The Hewlett-Packard CareVue Clinical Event Review, a full-disclosure system, was used as the gold standard. RESULTS: Accuracy of detection of nonsustained ventricular tachycardia, supraventricular tachycardia, and pauses was significantly better with a monitor watcher than without. Although the detection of life-threatening rhythms was correct a higher percentage of the time with a monitor watcher, the difference was not significant. CONCLUSIONS: The efficiency and quality of patient care can be enhanced by using a dedicated monitor watcher. The results of this study raise the question of whether improved accuracy of detection of dysrhythmias results in better outcomes for patients.

Arrhythmias, Cardiac↗

PubMed1997

Effect of dedicated monitor watchers on patients' outcomes.

BACKGROUND: In 55% of progressive care units, someone is assigned to watch the cardiac monitors at all times, but the effect of this practice on patients' outcomes has not been examined. OBJECTIVE: To evaluate the effect of continual observation of telemetry units by a monitor watcher on mortality, frequency of transfer to a critical care unit, and the occurrence of five life-threatening dysrhythmias. METHODS: Data for this quasi-experimental study were collected on 1185 patients for a 9-month period in 1993 when the cardiac progressive care unit had a monitor watcher and on 1198 patients for a 9-month period in 1994 when the unit had no monitor watcher. RESULTS: We found no significant differences in mortality, frequency of transfer to a critical care unit, or the occurrence of three of the five dysrhythmias examined. The presence of a monitor watcher was associated with significantly fewer episodes of sustained ventricular tachycardia but more bradyarrhythmias. For both sustained ventricular tachycardia and bradyarrhythmias, the monitor watcher variable remained in the final multivariate logistic regression models. CONCLUSIONS: The presence of a monitor watcher was not associated with lower rates of most adverse outcomes evaluated; however, fewer episodes of sustained ventricular tachycardia occurred when a monitor watcher was present. Sustained ventricular tachycardia is life-threatening, disturbing to the patient, and may result in a longer hospital stay while medical therapy is being adjusted. The results of this study support the use of a monitor watcher to prevent sustained ventricular tachycardia.

Adult↗

PubMed1976

[Methods and technique of investigations in the course of sport activities of children (author's transl)].

In order to carry out investigations in the course of sport activities of children an efficient telemetering device is essential, which can also be used on children. The Kinderspital Salzburg has developed a telemetry system in cooperation with the Technische Versuchs- und Forschungsanstalt der Technischen Hochschule Wien and the Messerschmitt-Bölkow-Blohm-Werke München. For the first time in this field a Pulse Code Modulation (P.C.M.) System was utilized, implying high accuracy on data transmission and recovery as required for scientific examinations. The children's physical capacity is determined on a bicycle ergometer, and the performance measured in this fashion is then compared with the performance achieved in sport.

Blood Pressure Determination↗

PubMed1997

The advanced Combi 40+ cochlear implant.

A 12-channel cochlear implant (CI) for high-rate pulsatile stimulation strategies is presented. Symmetric biphasic current pulses can be generated up to a maximum pulse repetition rate of 18.18 kpulses/second. The stimulation pulse amplitude can be selected within 1.5 microA-1.5 mA. Data and power are transcutaneously transferred using a single radiofrequency (RF) channel. A fully digital data transfer format is employed at an overall data rate of 600 kBit/second. The implant contains a single mixed analog/digital CMOS-ASIC (Application Specific Integrated Description) for data synchronization and stimulus generation. Stimulation signals are applied via a monopolar intracochlear multichannel electrode. Output capacitors for each channel are employed for safety reasons. A self-calibrating back telemetry system is included for estimating the channel impedances and field distribution along the electrode array. Dimensions of the ceramic package of the implant are only 33.50 x 23.40 x 3.95 mm3.

Cochlear Implantation↗

PubMed1976

The influence of meprobamate on heart rate in the conscious dog.

The effects of meprobamate on heart rate in the unanesthetized dog were compared under two experimental conditions: (1) In the animal equipped with a telemetry device, in which the heart rate was on average 70/min over a 24 hour period, i.v. injection of 20 mg/kg of meprobamate tended to increase heart rate, a dose of 50 mg/kg provoking a significant tachycardia; (2) In the untrained dog restrained on a table, in which the heart rate ranged from 100 to 110/min, i.v. doses of 20 and 30 mg/kg of meprobamate did not lower heart rate, notwithstanding a significant sedative effect whereas a dose of 50 mg/kg provoked tachycardia; atropine-induced cardio-acceleration was not influenced by these doses of meprobamate.

Animals↗

PubMed1976

Automated short range locator system.

A computer operated system is described for determining the location of a subject fitted with a small sensing coil and telemetry transmitter. The system uses the geometric factors inherent in the value of the mutual inductance of a fixed and moveable coil. Results of a two-dimensional system are shown.

Animals↗

PubMed1998

Arrhythmia detection and response in a monitoring technician and pocket paging system.

Technologically advanced telemetry systems have begun to produce alternatives to the need for continuous visual observation of the electrocardiogram (ECG). Few studies have been conducted to determine the efficacy of these systems in the clinical setting. The purpose of this study was to describe two different approaches to communication of arrhythmia events and corresponding nurse response. One approach, on a cardiac medical unit, utilized a monitoring technician to continuously observe ECGs at a central monitoring technician station (MTS) and notify the nurse of changes. The other approach, on a general medical unit, eliminated the use of the monitoring technician and utilized a pocket paging system (PPS). The PPS interfaced with the computerized arrhythmia detection system from the ECG monitor, which directly alerted the nurse to arrhythmia events. A quasi-experimental comparative post-test design was used. The sample consisted of 50 randomly selected, 2-hour observation periods on each unit during a 3-month period. Data collectors recorded the interaction of the monitoring technician with the arrhythmia detection system and the nurse on the MTS unit, or the nurse using the PPS. Results of this study revealed all arrhythmia events activated an alarm by the computerized arrhythmia detection system. Length of time to notify the nurse was within 0 to 1 minute for both systems. This study demonstrated that the PPS is a viable approach to arrhythmia detection and communication in the medical/cardiac patient population.

Arrhythmias, Cardiac↗

PubMed1998

[Motor evacuatory disorders of the digestive tract in the early periods after stomach operations (1. Motor evacuatory disorders of the stomach)].

The method of telemetry was used for studying the motor function of the stomach in 60 patients with ulcer disease before operation and in 48 patients at early terms after truncal vagotomy or resection of the stomach. An analysis of 318 cases of similar operations on the stomach was also made. The states of normo-, hypo- and adynamia were documented. A pronounced inhibition of motility of the stomach and its stump were noted during 14 and more days after vagotomy and resection. Under conditions of hypo- and adynamia the evacuatory function was maintained by the positive gastrointestinal gradient of the basal pressure and the peristaltic "pump" effect of the small intestine. The early light motor evacuatory disorders are always of the functional character and disappear by the 5th day after operation. The evacuatory disorders of the moderate and grave degree were functional in 7 from 9 patients after vagotomy and in 9 from 17 patients after resection of the stomach.

Digestive System↗

PubMed1998

[Evacuatory motor disorders of the digestive tract in the early period after operations on the stomach (2. Evacuatory motor disorders of the small intestine)].

The method of telemetry was used for studying the motor function of the small intestine in 8 volunteers, 15 patients with duodenal ulcer before operation and in 43 patients at early terms after truncal vagotomy or resection of the stomach. During the first three days, irrespective of the kind of operation and of the degree of extraorganic denervation of the digestive tract, the motility of the small intestine has autonomic regimen of regulation, the pathognomic structure of the motor cycle and is characterized by sufficiently high contractility at the expense of frequent and regular generation of the migrating motor complexes. The motility is restored by the 10th-12th day. Functional evacuatory disturbances of a medium and grave degree are due to hypodynamia or transitory adynamia of the small intestine.

Digestive System Diseases↗

PubMed1976

Development of telemetric techniques for use in studies of the electrical activity of the brain.

A telemetry system has been designed to transmit two channels of wideband activity (0.2 Hz-2.5 KHz) recorded from high-impedance microelectrodes in the brains of free-moving cats. Thus, both unit activity and slow-wave field activity are accessible without disruption of the animals' behavior. In addition, circuitry is described that conditions the receiver signals, that dicriminates valid subcarrier signals from receiver noise and that automatically aborts data output in the absence of discriminable subcarrier. This receiver signal processing circuitry thus assures the fidelity of the decoded subcarrier, greatly facilitates further machine processing of the data and frees the experimenter from having to continuously monitor the receiver signals to subjectively edit out noisy data.

Animals↗

PubMed1998

Elderly patients receive less aggressive medical and invasive management of unstable angina: potential impact of practice guidelines.

BACKGROUND: The Agency for Health Care Policy and Research (AHCPR) released a practice guideline on the diagnosis and management of unstable angina in 1994. OBJECTIVE: To examine practice variation across the age spectrum in the management of patients hospitalized with unstable angina 2 years before release of the AHCPR guideline. DESIGN: Retrospective cohort. SETTING: Urban academic hospital. PATIENTS: All nonreferral patients diagnosed as having unstable angina who were hospitalized directly from the emergency department to the intensive care or telemetry unit between October 1, 1991, and September 30, 1992. MEASUREMENTS: Percentage of eligible patients receiving medical treatment concordant with 8 important AHCPR guideline recommendations. RESULTS: Half of the 280 patients were older than 66 years; women were older than men on average (70 vs 64 years; P<.001). After excluding those with contraindications to therapy, patients in the oldest quartile (age, 75.20-93.37 years) were less likely than younger patients to receive aspirin (P<.009), beta-blockers (P<.04), and referral for cardiac catheterization (P<.001). Overall guideline concordance weighted for the number of eligible patients declined with increasing age (87.4%, 87.4%, 84.0%, and 74.9% for age quartiles 1 to 4, respectively; chi2, P<.001). Increasing age, the presence of congestive heart failure at presentation, a history of congestive heart failure, previous myocardial infarction, increasing comorbidity, and elevated creatinine concentration were associated with care that was less concordant with AHCPR guideline recommendations; only age and congestive heart failure at presentation remained significant in the multivariate analysis (odds ratios, 1.28 per decade [95% confidence interval, 1.02-1.61] and 3.16 [95% confidence interval, 1.57-6.36], respectively). CONCLUSIONS: Older patients were less likely to receive standard therapies for unstable angina before release of the 1994 AHCPR guideline. Patients presenting with congestive heart failure also received care that was more discordant with guideline recommendations. The AHCPR guideline allows identification of patients who receive nonstandard care and, if applied to those patients with the greatest likelihood to benefit, could lead to improved health care delivery.

Age Factors↗

PubMed1991

The effect of sleep on the dyskinetic movements of Parkinson's disease, Gilles de la Tourette syndrome, Huntington's disease, and torsion dystonia.

The effect of sleep on the involuntary movements or dyskinesias in Parkinson's disease, Huntington's disease, primary and secondary torsion dystonia, and Gilles de la Tourette syndrome was studied in a total of 52 patients and 10 normal subjects using video electroencephalographic telemetry. Movements typical of the wake pattern were seen occasionally during unequivocal sleep in all but two completed studies, and in each condition reappeared under similar circumstances. The movements were most likely to occur after awakenings or lightenings of sleep, or in stage one sleep. The movements were very rare during the deeper phases of sleep. Those movements that occurred during sleep without awakenings were usually preceded by arousal phenomena and, rarely, by sleep spindles or slow waves. The control group showed normal "semipurposeful" movements under the same conditions during sleep. The rare appearance of the different dyskinesias and normal movements under similar circumstances during sleep could be a result of common effects on the generator systems or changes in the excitability of the final common motor pathway.

Brain↗

PubMed1992

Comparison of the effects of frontal and temporal lobe partial seizures on prolactin levels.

The acute effects of partial (focal) epileptic seizures on serum prolactin levels were studied in two groups of patients: (1) 10 with temporal lobe seizures and (2) 11 with seizures that arose from the frontal lobes, recorded on cable video-electroencephalographic telemetry. Six of the eight complex partial seizures of temporal lobe origin were associated with a marked rise in prolactin levels at 10 minutes after onset (rise in levels, from a mean of 279 to 534 mU/L), compared with a rise in only one of the eight frontal lobe complex partial seizures. None of the five simple partial seizures (two of temporal and three of frontal lobe origin) was associated with a marked rise in prolactin levels. This difference in prolactin response following complex partial seizures of frontal and temporal lobe origin may help in the clinical differentiation of these seizures. A failure of prolactin levels to rise does not, however, exclude a diagnosis of complex partial seizures; thus, this measurement will not help in the clinical differentiation of frontal lobe complex partial seizures from psychogenic attacks.

Adolescent↗