Standard Monitoring Of Patients Research Articles

Physical inactivity in patients with rheumatoid arthritis: Data from twenty‐one countries in a cross‐sectional, international study

Regular physical activity is associated with decreased morbidity and mortality. Traditionally, patients with rheumatoid arthritis (RA) have been advised to limit physical exercise. We studied the prevalence of physical activity and associations with demographic and disease-related variables in patients with RA from 21 countries. The Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST-RA) is a cross-sectional study that includes a self-report questionnaire and clinical assessment of nonselected consecutive outpatients with RA who are receiving usual clinical care. Frequency of physical exercise (>or=30 minutes with at least some shortness of breath, sweating) is queried with 4 response options: >or=3 times weekly, 1-2 times weekly, 1-2 times monthly, and no exercise. Between January 2005 and April 2007, a total of 5,235 patients from 58 sites in 21 countries were enrolled in QUEST-RA: 79% were women, >90% were white, mean age was 57 years, and mean disease duration was 11.6 years. Only 13.8% of all patients reported physical exercise>or=3 times weekly. The majority of the patients were physically inactive with no regular weekly exercise: >80% in 7 countries, 60-80% in 12 countries, and 45% and 29% in 2 countries, respectively. Physical inactivity was associated with female sex, older age, lower education, obesity, comorbidity, low functional capacity, and higher levels of disease activity, pain, and fatigue. In many countries, a low proportion of patients with RA exercise. These data may alert rheumatologists to motivate their patients to increase physical activity levels.

Expanding quantitative assessment of rheumatoid arthritis in usual care

Reports concerning patients with rheumatoid arthritis are derived primarily from specialized sources, such as randomized clinical trials, clinical cohorts, special clinics, and from a limited number of countries. Most usual rheumatology care is conducted without quantitative assessment of patients. These considerations led to the Quantitative Patient Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST-RA) program, undertaken to promote quantitative assessment of patients with rheumatic diseases in daily clinical practice and to establish a multinational database with a goal of 100 patients in three clinics in each participating country. Between January 2005 and July 2007, the program was established in 22 countries, including 5519 patients, to provide a general overview of patients who receive usual clinical care. Future directions include expanding the program to all consecutive patients at participating sites, and in additional clinics in other countries, with the ultimate...

QUEST-RA: quantitative clinical assessment of patients with rheumatoid arthritis seen in standard rheumatology care in 15 countries

Objective:To conduct a cross-sectional review of non-selected consecutive outpatients with rheumatoid arthritis (RA) as part of standard clinical care in 15 countries for an overview of the characteristics of patients...

Telemedicine for diabetes support in family doctors’ practices: A pilot project

A telemedicine support system for diabetes management was compared with standard monitoring of patients with diabetes. The telemedicine system was composed of two modules: a Patient Unit and a Medical Unit connected by the telecommunication network. The study involved 60 patients of family doctors' practices in the Lower Silesia Region who were diagnosed with diabetes. There was no significant difference in haemoglobin A(1c) between telemonitoring and the traditional group of diabetic patients during the survey. The patients' quality of life slightly improved in the telemonitoring (mean score 3.4) and the traditionally monitored group (mean score 3.2), but there was no significant difference between them. Most of the telemonitoring patients (75%) expressed the desire to continue with telemedicine support and nearly 60% of patients monitored with traditional methods wanted to be included in the telemedicine group. The system seems to be reliable, simple to use and friendly for the patients.

Signal merging and signal fusion to enhance robustness and reduce false alarms during multichannel patient monitoring

It is recognised that false alarms lead to habituation among clinical staff and to distress for patients. The goal of our work is to reduce the number of false alarms produced by a standard patient monitor and to provide early warning of patient deterioration based on multiple vital signs. Two approaches have been used. In the first ('signal merging'), multiple signals are merged in order to produce a more robust derived measure. For example, cardiac and respiratory information are extracted from the electrocardiogram and photoplethysmogram, and are combined to produce more robust estimates of heart and respiration rates. The second ('signal fusion') uses a combination of advanced signal processing methods to 'integrate' multiple vital signs, to develop a global representation of patient status. The hypothesis is that if a monitoring system can identify periods of physiological instability preceding clinically apparent adverse events, then early warning may result in reduced monitoring alarms, prompt treatment and improved outcome. Over a 3-year period at the John Radcliffe hospital in Oxford, UK, we collected noninvasive physiological data for over 24 hours in 150 'high-risk' patients, including the continuous heart rate, respiratory rate, oxygen saturation, temperature and intermittent noninvasive blood pressure. The system was 'trained' to distinguish periods of physiological stability from instability. Two evaluation studies have taken place. The first assessed the signal merging technology during simulated patient transport. Results showed that signal merging gives a more precise estimate of respiration rate than a standard transport monitor, suggesting that signal merging may reduce the number of false alarms caused by external movement. The second study assessed the alarms of a standard patient monitor versus our signal fusion technology. Numerous standard monitor alarms were recorded that did not correspond to physiological events, often due to signal artefact or nonclinical events such as patient movement, but typically these did not trigger an alert from our signal fusion technology. Signal fusion identified physiological events that included atrial fibrillation, elevated blood pressure, extreme distress and oxygen desaturation. The conclusions are that signal merging and fusion techniques may improve robustness, reduce false-positive alarms and potentially provide early warning of adverse physiological events.

PHARMACOTHERAPIES FOR ALCOHOL ABUSE: Withdrawal and Treatment

Pharmacologic management of alcoholism is only one part of the management of both alcohol dependence and withdrawal, which also includes the provision of a calm, quiet environment; reassurance; ongoing reassessment; attention to fluid and electrolyte disorders; treatment of coexisting addictions and common medical, surgical, and psychiatric comorbidities; and referral for ongoing psychosocial and medical treatment. For further discussion of these topics, the reader is referred to previously published sources. A survey of alcoholism treatment programs revealed that although benzodiazepines were the most commonly used drugs, standardized monitoring of patients' withdrawal severity was not common practice, and a significant minority of clinicians were using a variety of other drugs, some not known to prevent or treat the complications of withdrawal. Treatment should be based on the available evidence (Working Group on Pharmacological Management of Alcohol Withdrawal: American Society of Addiction Medicine Committee on Practice Guidelines: Pharmacological management of alcohol withdrawal: An evidence-based practice guideline. Unpublished draft, 1997). Patients with significant symptoms, patients with complications such as seizures or delirium tremens, and patients at higher risk for complications of alcohol withdrawal should receive benzodiazepines, particularly chlordiazepoxide, diazepam, or lorazepam, because of their safety and documented efficacy in preventing and treating the most serious complications of alcohol withdrawal. These drugs may be dosed on a fixed schedule for a predetermined number of doses on a tapering schedule over several days, or they may be administered by front-loading. An alternative approach for selected patients without seizures or acute comorbidity is symptom-triggered therapy, which individualizes treatment and decreases the duration and dose of medication administration. With either of the regimens, patients should have their withdrawal severity monitored until symptoms are resolving. Once withdrawal from alcohol is safely completed, the focus should turn to helping to prevent relapse. Disulfiram may be useful in highly motivated subsets of patients and when compliance-enhancing strategies are used. Naltrexone is useful in the broader population of patients entering treatment for alcohol dependence. These pharmacologic interventions should be given in the context of ongoing psychosocial support. There is substantial evidence that pharmacologic management of alcohol abuse and dependence is effective. As would be predicted from alcohol's myriad cellular effects, no panacea exists for alcoholism. For alcohol withdrawal, however, although treatment regimens have only recently been refined, evidence for effective treatment of symptoms and prevention of complications with benzodiazepines has been available for decades. Within the last decade, effective treatments, including naltrexone, have been shown to reduce alcohol intake in alcohol-dependent persons. Given the prevalence and cost of alcohol-related problems, all effective therapies (including pharmacologic treatments) should be considered to treat alcohol abuse and dependence.

Continuous measurement of systemic vascular resistance.

We have successfully linked a standard patient monitor system (Hewlett Packard M1166A-A66) with the Baxter Edwards Critical-Care Swan Ganz Intellicath continuous cardiac output catheter and the Vigilance continuous cardiac output monitor system to produce continuous values of systemic vascular resistance. Six cases are presented in which marked changes in indexed systemic vascular resistance were observed as a result of clinical interventions. The continuous derivation of systemic vascular resistance has much potential as a diagnostic and research tool as well as allowing rapid accurate assessment of the response of patients to therapy.

Standard postoperative monitoring of patients after primary resection of colon and rectum cancer

The goal of monitoring after primary treatment of any solid tumor, including colon and rectum carcinoma, is to help the patient. The general parameters include prevention of secondary tumors or precancers (because most patients with solid tumors are at greater risk than the general population for second tumors of the same histology), the cure of symptomatic or asymptomatic tumor recurrences, and the palliation of symptomatic tumor recurrences. Additional rationale for more stringent follow-up is somewhat dependent upon the venue of patient care, including the necessity for more frequent studies if the patient happens to be in a protocol in which disease-free survival and/or patterns of recurrence are being investigated. Keeping these parameters in mind, most prevalent follow-up plans remain empiric and probably are not justifiable, on the basis of either cost-effective analysis or real benefit to the patient.