Monitoring Strips Research Articles

Traitement ET Controle Glycemique De 1.200 Diabetiques Inscrits Dans Les Conventions Inami “Diabete”

SummaryWe have studied the characteristics of insulin therapy and home blood glucose monitoring of 1.200 diabetic patients (590 males, 610 females), mainly type I adults (age: 43 ± 19 years, mean ± 1 SD), attending a licensed diabetes center in Belgium which benefits from a National Health Service convention system for providing education and home blood glucose monitoring kits and disposables to diabetic subjects. 50% of these patients were treated with 2 daily insulin injections, while 22% were treated with 3 and 24% witli 4 daily injections. 4% of the subjects were treated with a continuous subcutaneous insulin infusion. Patients treated with four daily injections were younger than those treated with other insul in schemes (p < 0.001). Home blood glucose monitoring strip consumption was 2.2 patient-1 dah-1. The mean HbAic level was 8.63 ± 1.55% [8.54 ± 1.46 in males and 8.72 ± 1.62% in females (NS)]. In more than one third of the subjects treated with injections, HbAic Was lower than 8%. HbA i c was also below 8% in 50% of patients using 1100–1200 strips.year-1.

Assessment Parameters and Indicators in Expert Intrapartal Nursing Decisions

To determine what clinical parameters and indicators expert intrapartal nurses used to assess the severity of fetal stress. A descriptive, qualitative study using tape-recorded interviews from verbal protocols during clinical problem solving. Labor and delivery units of two metropolitan hospitals in the northeastern United States. Eighteen nurses, designated as experts by nurse managers, with an average of 11.3 years of intrapartal experience. The clinical assessment parameters identified by content analysis included duration of stress, fetal reserve status, reversibility of stress, and specific signs of stress. The clinical assessment parameters included whether the disturbing pattern was brief or prolonged, continuous or intermittent, and how rapidly the mother's labor was progressing. Indicators of fetal reserve status were maternal pregnancy health status, gestational age of fetus, and biophysical indicators of fetal status. Reversibility of stress was assessed based on the precipitating factors involved and responsiveness of the fetus to resuscitation. Specific signs of stress included the characteristics of the fetal monitor strip changes, scalp sample results, and amniotic fluid color. Contextual features of clinical problems are key links in the decision-making processes of expert intrapartal nurses. Knowledge elicitation techniques can be used to identify these links.

Medicolegal Ramifications of Electronic Fetal Monitoring During Labor

Fetal heart rate patterns play a significant role in the modern day obstetric care. They also play a significant role in medicolegal allegations of negligence when the fetus suffers injury. Proper interpretation of the fetal monitor tracing is only one factor in the evaluation of the reasonableness of obstetric care. Appropriate care and optimal defense both derive from reasonable interpretation of pertinent clinical data, including the monitor strip, along with timely pursuit of a thoughtful, properly annotated, plan of care.

Chorioamnionitis: Association of Nonreassuring Fetal Heart‐rate Patterns and Interval From Diagnosis toDelivery on Neonatal Outcome

Objective: The purpose of this study was to determine whether selected fetal heart-rate (FHR) patterns and the interval from diagnosis to delivery in pregnancies complicated by chorioamnionitis could predict neonatal outcome. Methods: During a 6-month period, 217 consecutive patients with acute chorioamnionitis were prospectively identified in labor. Following delivery, the fetal monitor strips and hospital courses were reviewed for both the mother and neonate. Multiple logistic regression was used to analyze the presence of a nonreassuring FHR pattern and the effect on neonatal outcome. Fisher exact tests were used to analyze the time intervals from the diagnosis of chorioamnionitis to delivery and their significance on neonatal outcome parameters. Results: The overall incidence of chorioamnionitis in our population was 2.3%. None of the independent variables analyzed following the diagnosis of chorioamnionitis until delivery were significantly associated with an umbilical artery (Ua) pH < 7.20. There were no differences in cord pH, Apgar scores, sepsis, admission to special-care nursery, and oxygen requirements in neonates based on the duration of time from the diagnosis of chorioamnionitis to delivery in our study. None of the newborns had pathologic fetal acidemia (Ua pH < 7.00). None of the FHR patterns we identified after the diagnosis of acute chorioamnionitis were significantly associated with neonates with a Ua pH < 7.20. Conclusions: An interval from diagnosis to delivery of up to 12 h plays little if any role in neonatal outcome.

Uterine rupture after previous cesarean delivery: Maternal and fetal consequences

The purpose of this study was to identify the risk factors associated with overt, catastrophic uterine rupture and to report maternal and neonatal outcomes. The associated elapsed time window for delivery of an uncompromised neonate was also investigated. A retrospective study with review of charts and monitor strips was performed. Between Jan. 1, 1983, and June 30, 1992, there were 106 cases of uterine rupture at our institution. Of these, seven charts were incomplete and excluded; of the remainder, 28 patients had complete, 13 patients had partial, and 58 patients had no fetal extrusion into the maternal abdomen. Maternal characteristics or intrapartum events were not predictive of the catastrophic extent of uterine rupture. There was one maternal death. Complete fetal extrusion was associated with a higher incidence of perinatal mortality and morbidity. Significant neonatal morbidity occurred when > or = 18 minutes elapsed between the onset of prolonged deceleration and delivery. Neonatal and maternal complications in uterine rupture with complete fetal extrusion were low with prompt intervention.

Fetal heart rate accelerations, fetal movement, and fetal behavior patterns in twin gestations

Previous studies have shown that twins, when monitored simultaneously, show a remarkably high incidence of coincident fetal heart rate accelerations (about 58%). The current study examines synchrony of behavior patterns in twins. We examined 37 fetal monitor strips from 15 sets of twins with simultaneous fetal heart rate and fetal movement recorded by means of Doppler techniques (Toitu MT-430 fetal actocardiograph). The strips were analyzed for coincidence of fetal heart rate accelerations and fetal movement episodes and then conceptually for synchrony of fetal behavior patterns on the basis of descriptions of behavioral states by Prechtl. Thirty-six percent of fetal heart rate accelerations were found to be simultaneous. Forty-three percent of movement epochs were considered simultaneous. We found that twins exhibited synchronous behavior patterns (basically sleep or awake state) 94.7% of the time. Twin-twin interactions are more consistently related than suspected when observation is limited to heart rate alone, and the synchrony and role of fetal behavior states must be considered when twin interactions and behavior are studied.

Evaluating the validity of blood glucose monitoring strip interpretation by experienced users

This study examined interpretations of blood glucose monitoring strips (BGMS) by patients and registered nurses (RNs) experienced in strip use. Visual interpretations of whole and bisected BGMS were compared with readings obtained with a reflectance meter. For whole strips, statistically significant differences were found when mean values of patient interpretations were compared with two of the three RNs and the meter. A significant difference was found between the average meter values and those for a third RN. When bisected strips were interpreted, a significant interaction effect was found between reader and strip condition. The RNs systematically underestimated bisected strips when compared with whole strips, whereas patients consistently underestimated both whole and bisected strips. The findings support the need for development of quality assurance monitors to evaluate users of patient self-care technologies such as BGMS.

A Product Warning Label to Encourage Prepregnancy Control of Diabetes

To the Editor. —Despite physician awareness of the benefits of preconception glycemic control of diabetes mellitus, many diabetic women of childbearing age are either unaware or unmotivated to optimize control of their diabetes before becoming pregnant. The benefits of preconception glycemic control, including a reduction in the risk of fetal anomalies to that of a normal nondiabetic population 1,2 and a significant decrease in the rate of spontaneous abortion 3,4 have been well established. Implementing a plan to encourage universal prepregnancy diabetes control should be a major priority. We propose a straightforward and inexpensive tactic to improve compliance with preconception diabetes control programs: put a warning label regarding pregnancy and birth defects on the equipment that diabetic patients routinely use for their daily care. The devices and supplies to be labeled could include insulin syringes, glucose meters, blood glucose monitoring strips, lancets, finger-pricking devices, and urine glucose test strips. The

Patient-Initiated Laboratory Testing: Applauding the Inevitable

THE TREND of direct patient access to health care started insidiously a long time ago. First there were bathroom scales and home thermometers. To these have been added home blood pressure measuring devices and glucose monitoring strips and instruments and a variety of test kits that can be purchased in drugstores and supermarkets. Consumers may currently use such kits to determine if they are pregnant, have occult blood in their stool, have high levels of blood or urine glucose, or have recently ovulated. The popularity of these devices and kits underscores today's consumers' sophistication, willingness to play active roles in their own health care, and desire for convenient alternatives to the traditional mechanisms by which they obtain health data. According to one major market-research firm, sales of home health kits doubled between 1981 and 1986. In 1989, the estimated sales volume was $750 million, and projected 1995 sales exceed $1

Efficacy of flecainide acetate for atrial arrhythmias following coronary artery bypass grafting

The antiarrhythmic efficacy of intravenous flecainide and intravenous digoxin was assessed in 29 patients (26 men), aged 43 to 73 (63 ± 7) years who developed atrial arrhythmias in the first 96 hours after coronary artery bypass grafting. Twenty-seven had atrial fibrillation and 2 had atrial flutter. Patients were entered into the study if the arrhythmia persisted for at least 15 minutes with a ventricular rate >120 beats/min. Fifteen patients were randomized to flecainide (group 1) and 14 to digoxin (group 2). Flecainide was given as a bolus of 1 mg/kg over 10 minutes followed by an infusion of 1.5 mg/kg/hr for 1 hour and then 0.25 mg/kg/hr for the rest of the study period (24 hours). Digoxin was given as 3 bolus doses (0.5 mg followed after 6 and 12 hours by 0.25 mg). In both groups, 10 mg of verapamil was given intravenously after 45 minutes if the arrhythmia persisted with a mean ventricular rate >100 beats/min. The antiarrhythmic efficacy was assessed by 24-hour Holter monitoring and frequent 15-second rhythm strips. Within 45 minutes control of arrhythmia, which was maintained for the rest of the study period, was achieved in 10 of 15 patients in group 1 and 2 of 14 in group 2 (p < 0.01). Nine of 15 reverted to sinus rhythm in group 1 compared to 0 of 14 in group 2 and 1 of 15 remained in arrhythmia with a controlled ventricular rate in group 1 compared to 2 of 14 in group 2. Within 1 hour arrhythmia was controlled in 12 of 15 in group 1 compared to 3 of 14 in group 2 (p < 0.01). Ten of 15 reverted to sinus rhythm in group 1 compared to 0 of 14 in group 2 and 2 of 15 remained in arrhythmia with a controlled ventricular rate in group 1 compared to 3 of 14 in group 2. There were no serious adverse effects. Intravenous flecainide is safe and more effective than intravenous digoxin for recent onset atrial tachyarrhythmias after bypass grafting.

Reliability and reproducibility of nonstress test readings

The nonstress test is commonly used as a test of fetal well-being, despite the fact that both false-positive and false-negative results are known to occur. Although some of the errors are due to biologic variability among fetuses, some may be due to variability of reading the test. The purpose of the present study was to assess the reliability and reproducibility of nonstress test readings. Fifty nonstress test monitor strips were read by five perinatologists on two occasions, for a total of 500 readings. Nonstress tests were read as reactive, equivocal, nonreactive, or technically unsatisfactory. Of the 50 tracings, only 11 had identical readings on all 10 occasions, and readers had different readings for the first and second readings 28% of the time. Estimates of interobserver and intraobserver agreement ranged from 0.41 to 0.55. These results indicate that there is considerable interobserver and intraobserver variability that can be expected to have a serious adverse effect on the sensitivity of the nonstress test.

Short- and long-term effects of transcatheter ablation of the coronary sinus by radiofrequency energy.

Catheter ablation of left-sided atrioventricular accessory pathways through the coronary sinus by direct-current shock may be complicated by rupture and thrombosis of the coronary sinus and injury to the coronary arteries. This study examined short and long-term effects of radiofrequency catheter ablation of the coronary sinus in 20 closed-chest dogs to determine whether this technique is feasible for potential interruption of left-sided accessory pathways. Single-pulsed radiofrequency energy (750 kHz, 85-293 J) was delivered to three sites in the distal and middle coronary sinus between the distal (1) or the proximal electrodes (2 or 3) of a standard 6 French quadripolar catheter and a chest-wall patch electrode. Single-pulsed radiofrequency energy (78-293 J) was also applied to two sites near the ostium of the coronary sinus with the proximal (4) or the distal (1) electrode of the same catheter. Coronary artery and levophase coronary sinus angiograms obtained before and immediately after ablation, as well as before killing, showed intact vascular structures in all dogs. Right atrial, pulmonary arterial, and aortic pressures measured in three dogs did not change significantly at the time of energy delivery. No significant changes were found in atrioventricular nodal refractoriness and conduction. None of the dogs had significant rhythm disturbances during and after ablation as evaluated by ambulatory electrocardiographic monitoring and periodic rhythm strips at follow-up. Ten dogs were killed 1-7 days after ablation, three dogs were killed at 4 weeks, three dogs at 6 weeks, two dogs at 8 weeks, and two dogs at 12 weeks. Discrete lesions ranging in size from 3 x 3 to 8 x 10 mm2 in surface area and 0.5-4.5 mm in depth were found in the coronary sinus with most of the lesions extending to the left atrial and left ventricular myocardium. There was neither rupture of the coronary sinus nor occlusion of the coronary arteries. Mural thrombus was found in the coronary sinus on five acute lesions in two dogs, but none was noted on the chronic lesions, which was characterized by chronic granulation tissue and fibrosis. Two dogs in the study during chronic conditions had damage to branches of the underlying coronary artery that showed necrotizing arteritis and arterial sclerosis. Conduction system studies in four dogs showed some chronic inflammatory and fibrotic changes. Similar discrete lesions were found in situ in the coronary sinus of four postmortem human hearts with radiofrequency catheter ablation.(ABSTRACT TRUNCATED AT 400 WORDS)

Effect of maternal magnesium sulfate treatment on fetal heart rate variability.

The effect of maternal magnesium sulfate treatment on fetal heart rate variability (FHRV) was evaluated by comparing the maternal serum magnesium level drawn during labor to the degree of FHRV seen concurrently on fetal rate heart monitor strips. The records of 57 patients treated with intravenous magnesium sulfate for hypertensive disorders of pregnancy were studied. Fetal heart rate variability was measured by both subjective assessment and objective measurement. The difference in beats/min between the average high and low fetal heart rates, at the time the magnesium level obtained, was used as the objective measurement. Labor records were reviewed and neonatal outcome recorded. Data from individual patients not treated with analgesics were analyzed separately in addition. Statistical methods used included analysis of variance, Student's t-test, and Chi square analysis. The range of magnesium levels was 2.3-7.4 mEq/L. Thirty-four women had single determinations of magnesium levels and 23 had multiple determinations. Statistical analysis showed no significant change in FHRV with increasing maternal magnesium levels. In addition, no significant effect of maternal magnesium level on FHRV was noted in the group that did not receive meperidine, morphine, or epidural anesthesia. Neonatal outcome, assessed by Apgar scores, did not vary with maternal magnesium level. We conclude that maternal magnesium sulfate treatment, in the therapeutic ranges normally obtained, does not significantly affect fetal heart rate variability.

Fetal heart monitor strip documentation: examining cost and benefit.

Fetal heart monitor strip documentation: examining cost and benefit.

Fetal heart rate patterns in infants in whom necrotizing enterocolitis develops: a preliminary report.

Perinatal changes in fetal heart rate (FHR) were monitored in infants in whom necrotizing enterocolitis (NEC) developed. Eleven of 16 monitoring strips indicated severe FHR changes consistent with perinatal hypoxia, two indicated mild changes, two indicated tachycardia alone, and only one was normal. Severe variable FHR decelerations indicating umbilical cord compression occurred in four cases, persistent late FHR decelerations occurred in two cases, persistent late and severe variable FHR decelerations occurred in two cases, prolonged bradycardia occurred in two cases, and bradycardia with persistent late FHR decelerations occurred in one case. These findings confirm that NEC does occur in infants with perinatal hypoxia and indicate that intestinal ischemia may occur before delivery and after delivery from hypoxia and acidosis from lung disease, exchange transfusion, or sepsis. Perinatal monitoring may become an important determinant in identifying the infant in whom NEC will develop.

Torsades de pointes: occurrence in myocardial ischaemia as a separate entity. Multiform ventricular tachycardia or not?

Torsades de pointes (Tdp) were evaluated with respect to aetiology, morphology and response to treatment in 16 patients admitted to the CCU. Analysis was based on monitor strip charts and conventional 12 lead ECGs. Underlying disease was total AV block in four patients, acute myocardial ischaemia in nine patients, with acute ventricular aneurysms in four patients; one patient had chronic ventricular aneurysm, one idiopathic hypokalaemia, and one was on quinidine therapy. Heart rate was less than 30 beats min−1 in patients with total AV block and above 90 beats min−1 in six out of 12 patients with basic sinus rhythm. QT prolongation was not present in six patients with acute myocardial ischaemia. Tdp were always initiated by PVCs either falling on the downslope of the T wave of the preceding normal beat or shortly after it in the range of a U wave. Coupling intervals in a run of Tdp were variable in most patients, with an increase in eight patients and a decrease in five patients. In patients with total AV block Tdp could be controlled by increasing the heart rate through pacemaker stimulation. Patients in sinus rhythm (heart rate above 60 beats min−1) received antiarrhythmic drugs: propafenon was effective in 80% (eight out often patients). Ten patients were long-term survivors. Outcome of the acute stage of the disease seemed to be determined by underlying myocardial function. Differentiation between Tdp and multiform ventriadar tachycardia (i.e. VT with torsion of QRS complexes occurring in acute myocardial ischaemia) seems unnecessary to us, since morphological features were similar in both groups with the exception of QT prolongation, which was absent in six out of nine patients with acute myocardial ischaemia. Propafenon was active in patients without as well as with QT prolongation.

Pseudoarrhythmia Caused by Temporary Transvenous Pacemaker

THE INTERPRETATION of arrhythmias on a 12-lead scalar electrocardiogram or on a monitoring strip can frequently be a difficult task. Essential to the interpretation is a good-quality stable baseline without artifacts. We are dependent on proper electrode placement, faultless technical assistance, and quality equipment. Unfortunately, artifacts are not uncommon in full 12-lead scalar ECGs because the equipment must fulfill American Heart Association standards of a wide frequency response range from 0.05 to 100 hertz. With this wide frequency range, the scalar ECG is subject to motion artifacts from respiration, arm movement, muscle tremors such as parkinsonism, and high-frequency electrical signals such as 60-Hz interference. Fortunately, bedside monitors are provided with a low- and high-frequency cutoff that eliminates most artifact. Our patient had a temporary transvenous pacemaker that caused an unusual ventricular pseudoarrhythmia during monitoring. This points out the need for caution in interpretation and treatment of a patient with an

Critical magnetic fields of Cu-Pb-Cu proximity-effect sandwiches studied by acoustic surface waves

The temperature dependence of the surface-wave attenuation in Cu-Pb-Cu sandwiches, in the absence of a magnetic field, agrees well with the BCS expression. We compare the temperature dependence of the parallel and perpendicular critical fields with expressions derived from the Ginzburg-Landau theory. We get satisfactory agreement, provided that for the thinner specimens we take the mean free paths in the proximity-effect sandwich to be somewhat smaller than the values found for monitor strips. This implies that some interdiffusion between the Pb and the Cu is taking place.

Equilibrium potentials of isolated metal areas during electron beam bombardment polymerization

The value of equilibrium potential reached by an isolated metal thin film under electron bombardment was examined as the accelerating voltage of the electron gun was varied between about 100 and 500 V. The measurements were taken with and without earthing the film between readings. The effect on the equilibrium potential of variations in the past history of the metal film, the thickness of polymer coating, the partial pressure of organic monomer and the electron beam current were found. The use of monitor strips of materials different from, or having a different past history from the target metal was investigated. A qualitative explanation of the results is suggested and the implications with regard to thin film device fabrication are discussed and illustrated.