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[[Image:Monitor (medical).jpg|thumb|250px|Display device of a medical monitor as used in [[anesthesia]].]] | |||
In medicine, '''monitoring''' is the observation of a disease, condition or one or several medical parameters over time. | |||
It can be performed by continuously measuring certain parameters by using a '''medical monitor''' (for example, by continuously measuring [[vital sign]]s by a bedside monitor), and/or by repeatedly performing [[medical test]]s (such as [[blood glucose monitoring]] with a [[glucose meter]] in people with [[diabetes mellitus]]). | |||
Transmitting data from a monitor to a distant monitoring station is known as [[telemetry]] or [[biotelemetry]]. | |||
==Classification by target parameter== | |||
Monitoring can be classified by the target of interest, including: | |||
*'''[[Cardiac monitoring]]''', which generally refers to continuous [[electrocardiography]] with assessment of the patients condition relative to their cardiac rhythm. A small monitor worn by an ambulatory patient for this purpose is known as a [[Holter monitor]]. Cardiac monitoring can also involve [[cardiac output]] monitoring via an invasive [[Swan-Ganz catheter]]. | |||
*'''[[Hemodynamic]] monitoring''', which monitors the [[blood pressure]] and [[blood flow]] within the circulatory system. Blood pressure can be measured either invasively through an inserted blood pressure [[transducer]] assembly, or noninvasively with an inflatable blood pressure cuff. | |||
*'''[[Respiratory monitoring]]''', such as: | |||
**[[Pulse oximetry]] which involves measurement of the saturated percentage of [[oxygen]] in the [[blood]], referred to as SpO2, and measured by an [[infrared]] finger cuff | |||
**[[Capnography]], which involves CO<sub>2</sub> measurements, referred to as [[EtCO2]] or end-tidal [[carbon dioxide]] concentration. The respiratory rate monitored as such is called AWRR or [[airway respiratory rate]]) | |||
**Respiratory rate monitoring through a thoracic transducer belt, an ECG channel or via capnography | |||
*'''[[Neurological monitoring]]''', such as of [[intracranial pressure]]. Also, there are special patient monitors which incorporate the monitoring of brain waves ([[electroencephalography]]), gas anesthetic concentrations, [[bispectral index]] (BIS), etc. They are usually incorporated into anesthesia machines. In [[neurosurgery]] intensive care units, brain EEG monitors have a larger multichannel capability and can monitor other physiological events, as well. | |||
*'''[[Blood glucose monitoring]]''' | |||
*'''[[Childbirth#Monitoring|Childbirth monitoring]]''' | |||
*'''[[Body temperature]] monitoring''' through an [[adhesive pad]] containing a [[thermoelectric]] transducer. | |||
===Vital parameters=== | |||
[[File:Maquet Flow-I anesthesia machine.jpg|thumb|An [[anesthetic machine]] with integrated systems for monitoring of several vital parameters, including [[blood pressure]] and [[heart rate]].]] | |||
Monitoring of [[vital parameters]] can include several of the ones mentioned above, and most commonly include at least [[blood pressure]] and [[heart rate]], and preferably also [[pulse oximetry]] and [[respiratory rate]]. Multimodal monitors that simultaneously measure and display the relevant vital parameters are commonly integrated into the bedside monitors in [[critical care unit]]s, and the [[anesthetic machine]]s in [[operating room]]s. These allow for continuous monitoring of a patient, with medical staff being continuously informed of the changes in general condition of a patient. Some monitors can even warn of pending fatal [[cardiac]] conditions before visible signs are noticeable to clinical staff, such as [[atrial fibrillation]] or [[premature ventricular contraction]] (PVC). | |||
{{anchor|monitor}} | |||
==Medical monitor== | |||
A ''medical monitor'' or ''physiological monitor'' is a [[medical device]] used for monitoring. It can consist of one or more [[sensor]]s, processing components, [[display device]]s (which are sometimes in themselves called "monitors"), as well as communication links for displaying or recording the results elsewhere through a monitoring network. | |||
===Components=== | |||
====Sensor==== | |||
Sensors of medical monitors include [[biosensor]]s and mechanical sensors. | |||
====Translating component==== | |||
The translating component of medical monitors is responsible for converting the signals from the sensors to a format that can be shown on the display device or transferred to an external display or recording device. | |||
====Display device==== | |||
Physiological data are displayed continuously on a [[Cathode ray tube|CRT]], [[LED]] or [[LCD]] screen as [[data channel]]s along the time axis, They may be accompanied by [[numerical readout]]s of computed parameters on the original data, such as maximum, minimum and average values, pulse and respiratory frequencies, and so on. | |||
Besides the tracings of physiological parameters along time (X axis), digital medical displays have automated [[numeric readout]]s of the peak and/or average parameters displayed on the screen. | |||
Modern medical display devices commonly use [[digital signal processing]] (DSP), which has the advantages of [[miniaturization]], [[portability]], and multi-parameter displays that can track many different vital signs at once. | |||
Old [[analog signal|analog]] patient displays, in contrast, were based on [[oscilloscope]]s, and had one channel only, usually reserved for electrocardiographic monitoring ([[ECG]]). Therefore, medical monitors tended to be highly specialized. One monitor would track a patient's [[blood pressure]], while another would measure [[pulse oximetry]], another the ECG. Later analog models had a second or third channel displayed in the same screen, usually to monitor [[Respiration (physiology)|respiration]] movements and [[blood pressure]]. These machines were widely used and saved many lives, but they had several restrictions, including sensitivity to [[electrical interference]], base level fluctuations and absence of numeric readouts and alarms. | |||
====Communication links==== | |||
Several models of multi-parameter monitors are networkable, i.e., they can send their output to a central ICU monitoring station, where a single staff member can observe and respond to several bedside monitors simultaneously. [[Ambulatory telemetry]] can also be achieved by portable, battery-operated models which are carried by the patient and which transmit their data via a [[wireless]] data connection. | |||
Digital monitoring has created the possibility, which is being fully developed, of integrating the physiological data from the patient monitoring networks into the emerging hospital [[electronic health record]] and digital charting systems, using appropriate [[health care standards]] which have been developed for this purpose by organizations such as [[IEEE]] and [[HL7]]. This newer method of charting patient data reduces the likelihood of human documentation error and will eventually reduce overall paper consumption. In addition, [[automated ECG interpretation]] incorporates diagnostic codes automatically into the charts. Medical monitor's [[embedded software]] can take care of the data coding according to these standards and send messages to the medical records application, which decodes them and incorporates the data into the adequate fields. | |||
Long-distance connectivity can avail for [[telemedicine]], which involves provision of [[health care|clinical health care]] at a distance. | |||
====Other components==== | |||
A medical monitor can also have the function to produce an alarm (such as using audible signals) to alert the staff when certain criteria are set, such as when some parameter exceeds of falls the level limits. | |||
=== Mobile appliances === | |||
An entirely new scope is opened with mobile carried monitors, even such in sub-skin carriage. This class of monitors delivers information gathered in body-area networking ([[Body Area Network|BAN]]) to e.g. [[smart phones]] and implemented [[autonomous agent]]s. | |||
==Interpretation of monitored parameters== | |||
Monitoring of clinical parameters is primarily intended to detect changes (or absence of changes) in the clinical status of an individual. For example, the parameter of [[oxygen saturation]] is usually monitored to detect changes in [[respiratory]] capability of an individual. | |||
===Change in status versus test variability=== | |||
When monitoring a clinical parameters, differences between test results (or values of a continuously monitored parameter after a time interval) can reflect either (or both) an actual change in the status of the condition or a [[test-retest variability]] of the test method. | |||
In practice, the possibility that a difference is due to test-retest variability can almost certainly be excluded if the difference is larger than a predefined "critical difference". This "critical difference" (CD) is calculated as:<ref name=Fraser1989>{{cite pmid|2503170 }}</ref> | |||
<math>CD = K \times \sqrt{CV_a^2 + CV_i^2}</math> | |||
, where:<ref name=Fraser1989/> | |||
*''K'', is a factor dependent on the preferred probability level. Usually, it is set at 2.77, which reflects a 95% [[prediction interval]], in which case there is less than 5% probability that a test result would become higher or lower than the critical difference by test-retest variability in the absence of other factors. | |||
*''CV<sub>a</sub>'' is the anaytical variation | |||
*''CV<sub>i</sub>'' is the [[intra-individual variability]] | |||
For example, if a patient has a hemoglobin level of 100 g/L, the anaytical variation (''CV<sub>a</sub>'') is 1.8% and the intra-individual variability ''CV<sub>i</sub>'' is 2.2%, then the critical difference is 8.1 g/L. Thus, for changes of less than 8 g/L since a previous test, the possibility that the change is completely caused by test-retest variability may need to be considered in addition to considering effects of, for example, diseases or treatments. | |||
{|class="wikitable" | |||
|+ Critical differences for some [[blood test]]s<ref name=Fraser1989/> | |||
|- | |||
| [[Sodium]] || 3% | |||
|- | |||
| [[Potassium]] || 14% | |||
|- | |||
| [[Chloride]] || 4% | |||
|- | |||
| [[Urea]] || 30% | |||
|- | |||
| [[Creatinine]] || 14% | |||
|- | |||
| [[Calcium]] || 5% | |||
|- | |||
| [[Albumin]] || 8% | |||
|- | |||
| [[Fasting glucose]] || 15% | |||
|- | |||
| [[Amylase]] || 30% | |||
|- | |||
| [[Carcinoembryonic antigen]] || 69% | |||
|- | |||
| [[C-reactive protein]] || 43%<ref>[http://www.acb.org.uk/Nat%20Lab%20Med%20Hbk/CRP.pdf C‐reactive protein (serum, plasma)] from The Association for Clinical Biochemistry and Laboratory Medicine. Author: Brona Roberts. Copyrighted 2012</ref> | |||
|- | |||
| [[Glycosylated hemoglobin]] || 21% | |||
|- | |||
| [[Hemoglobin]] || 8% | |||
|- | |||
| [[Erythrocytes]] || 10% | |||
|- | |||
| [[Leukocytes]] || 32% | |||
|- | |||
| [[Platelets]] || 25% | |||
|- | |||
|colspan=2|<small>Unless otherwise specified, then reference for critical values is ''Fraser 1989''</small><ref name=Fraser1989/> | |||
|} | |||
Critical differences for other tests include early morning urinary albumin concentration, with a critical difference of 40%.<ref name=Fraser1989/> | |||
==Techniques in development== | |||
{{Unreliable sources|date=October 2011}} | |||
The development of new techniques for monitoring is an advanced and developing field in [[smart medicine]], biomedical-aided [[integrative medicine]], [[alternative medicine]], [[Personalized medicine|self-tailored]] [[preventive medicine]] and [[predictive medicine]] that emphasizes monitoring of comprehensive medical data of patients, people at risk and healthy people using advanced, smart, minimally [[Invasiveness of surgical procedures|invasive]] [[Biomedical engineering|biomedical devices]], [[biosensors]], [[lab-on-a-chip]] (in the future [[nanomedicine]]<ref>{{cite web|url=http://positivefuturist.com/archive/345.html|title=Healthcare 2030: disease-free life with home monitoring nanomedince|publisher=Positivefuturist.com}}</ref><ref>{{cite web|url=http://www.technologyreview.com/business/21047/|title=Nanosensors for Medical Monitoring.|publisher=Technologyreview.com}}</ref> devices like [[nanorobots]]) and advanced [[Artificial intelligence|computerized]] [[medical diagnosis]] and early warning tools over a short clinical interview and [[medical prescription|drug prescription]]. | |||
As [[biomedical research]], [[nanotechnology]] and [[nutrigenomics]] advances, realizing the human body's [[self-healing]] capabilities and the growing awareness of the limitations of [[Health intervention|medical intervention]] by chemical [[drugs]]-only approach of old school medical treatment, new researches that shows the enormous damage medications can cause,<ref>{{cite web|url=http://www.mindfreedom.org/kb/psychiatric-drugs/antipsychotics/neuroleptic-brain-damage|title=Brain Damage Caused by Neuroleptic Psychiatric Drugs|publisher=Mindfreedom.org}}</ref><ref>{{cite web|url=http://www.livestrong.com/article/202044-medications-that-can-cause-nerve-damage/|title=Medications That Can Cause Nerve Damage|publisher=Livestrong.com}}</ref> researchers are working to fulfill the need for a comprehensive further study and personal continuous [[clinical monitoring]] of health conditions while keeping legacy medical intervention as a last resort. | |||
In many medical problems, drugs offer temporary relief of symptoms while the [[Functional medicine|root]] of a medical problem remains unknown without enough data of all our [[biological system]]s<ref name=Hyman>{{cite book |last= Hyman|first= Mark |title=The UltraMind Solution: Fix Your Broken Brain by Healing Your Body First |publisher= Scribner |date=December 2008 |isbn= 978-1-4165-4971-0}}</ref> | |||
. Our body is equipped with sub-systems for the purpose of maintaining balance and self healing functions. Intervention without sufficient data might damage those healing sub systems.<ref name=Hyman/> Monitoring medicine fills the gap to prevent diagnosis errors and can assist in future medical research by analyzing all [[data acquisition|data]] of many patients. | |||
[[File:CapsuleEndoscope.jpg|thumb|right|160px|[[Given Imaging]] [[Capsule endoscopy]]]] | |||
===Examples and applications=== | |||
The development cycle in medicine is extremely long, up to 20 years, because of the need for U.S. [[Food and Drug Administration]] (FDA) approvals, therefore many of monitoring medicine solutions are not available today in conventional medicine. | |||
[[File:PASCAL tonometer.jpg|thumb|The PASCAL Dynamic Contour Tonometer. A monitor for detection of increased [[intraocular pressure]].]] | |||
;Blood glucose monitoring | |||
:[[In vivo]] [[blood glucose monitoring]] devices can transmit data to a computer that can assist with daily life suggestions for [[Lifestyle (sociology)|lifestyle]] or [[nutrition]] and with the [[physician]] can make suggestions for further study in people who are at risk and help prevent [[diabetes mellitus type 2]] .<ref>{{cite web|url=http://www.biomedcentral.com/1471-2458/10/15|title=Blood glucose testing and primary prevention of diabetes mellitus type 2 - evaluation of the effect of evidence based patient information.|publisher=BMC Public health}}</ref> | |||
;Stress monitoring | |||
:Bio sensors may provide warnings when stress levels signs are rising before human can notice it and provide alerts and suggestions.<ref>{{cite web|url=http://ieeexplore.ieee.org/xpl/freeabs_all.jsp?arnumber=1213626|title="Stress monitoring using a distributed wireless intelligent sensor system".|publisher=IEEE}}</ref> | |||
;Serotonin biosensor | |||
:Future [[serotonin]] biosensors may assist with [[mood (psychology)|mood]] disorders and [[depression (mood)|depression]].<ref>{{cite web|url=http://www.architalbiol.org/aib/article/view/347|title=Using biosensors to detect the release of serotonin from taste buds during taste stimulation.|publisher=Archives Italiennes de Biologie}}</ref> | |||
;Continuous blood test based nutrition | |||
:In the field of [[evidence-based nutrition]], a [[lab-on-a-chip]] [[implant (medicine)|implant]] that can run 24/7 [[blood test]]s may provide a continuous results and a coumputer can provide nutritaion suggestions or alerts. | |||
;Psychiatrist-on-a-chip | |||
:In clinical brain sciences [[drug delivery]] and in vivo [[Bio-MEMS]] based [[biosensor]]s may assist with preventing and early treatment of mental disorders | |||
;Epilepsy monitoring | |||
:In [[epilepsy]], next generations of [[long-term video-EEG monitoring]] may predict [[epileptic seizure]] and prevent them with changes of daily life activity like [[sleep]], [[stress (biology)|stress]], [[nutrition]] and [[mood (psychology)|mood]] management.<ref>{{cite journal|pmid=21035403|title=Evaluating the use of prolonged video-EEG monitoring to assess future seizure risk and fitness to drive.|publisher= | doi=10.1016/j.yebeh.2010.09.026|volume=19|issue=4|date=December 2010|author=Kamel JT, Christensen B, Odell MS, D'Souza WJ, Cook MJ|journal=Epilepsy Behav|pages=608–11}}</ref> | |||
;Toxicity monitoring | |||
:Smart biosensors may detect toxic materials such [[Mercury (element)|mercury]] and [[lead]] and provide alerts.<ref>{{cite web|url=http://www.crcnetbase.com/doi/abs/10.1201/9781420019506.ch19|title=Multiarray Biosensors for Toxicity Monitoring and Bacterial Pathogens|publisher=CRC}}</ref> | |||
== See also == | |||
* [[Medical equipment]] | |||
* [[Medical test]] | |||
* [[Nanoelectromechanical system]] (NEMS) | |||
* [[Functional medicine]] | |||
==References== | |||
{{Reflist}} | |||
== Further reading == | |||
* ''Monitoring Level of Consciousness During Anesthesia & Sedation '', Scott D. Kelley, M.D., ISBN 978-0-9740696-0-9 | |||
* ''Healthcare Sensor Networks: Challenges Toward Practical Implementation'', Daniel Tze Huei Lai (Editor), Marimuthu Palaniswami (Editor), Rezaul Begg (Editor), ISBN 978-1-4398-2181-7 | |||
* ''Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics (Contemporary Cardiology)'', William B. White, ISBN 978-0-89603-840-0 | |||
* ''Physiological Monitoring and Instrument Diagnosis in Perinatal and Neonatal Medicine'', Yves W. Brans, William W. Hay Jr, ISBN 978-0-521-41951-2 | |||
* ''Medical Nanotechnology and Nanomedicine (Perspectives in Nanotechnology)'', Harry F. Tibbals, ISBN 978-1-4398-0874-0 | |||
==External links== | |||
*[http://ieeexplore.ieee.org/xpl/freeabs_all.jsp?arnumber=4571045 ''Monitoring medicine intake in the networked home: The iCabiNET solution''], [[IEEE Xplore]], Issue Date: Jan. 30 2008-Feb. 1 2008, pp. 116 – 117 | |||
*[http://www.cs.umd.edu/hcil/iHealth/personal_device.htm ''Personal Medical Monitoring Devices''], The University of Maryland | |||
{{Intensive care medicine}} | |||
{{Anesthesia}} | |||
[[Category:Medicine]] | |||
[[Category:Health care]] | |||
[[Category:Evidence-based medicine]] | |||
[[Category:Nanomedicine]] | |||
[[Category:Technology forecasting]] | |||
[[Category:Medical equipment]] | |||
[[Category:Intensive care medicine]] | |||
[[Category:Anesthesia]] | |||
[[Category:Cardiology]] | |||
[[Category:Neurology]] | |||
[[Category:Respiratory system procedures]] | |||
[[Category:Surgery]] | |||
[[Category:Traumatology]] | |||
[[Category:Health informatics]] |
Revision as of 15:11, 12 March 2013
In medicine, monitoring is the observation of a disease, condition or one or several medical parameters over time.
It can be performed by continuously measuring certain parameters by using a medical monitor (for example, by continuously measuring vital signs by a bedside monitor), and/or by repeatedly performing medical tests (such as blood glucose monitoring with a glucose meter in people with diabetes mellitus).
Transmitting data from a monitor to a distant monitoring station is known as telemetry or biotelemetry.
Classification by target parameter
Monitoring can be classified by the target of interest, including:
- Cardiac monitoring, which generally refers to continuous electrocardiography with assessment of the patients condition relative to their cardiac rhythm. A small monitor worn by an ambulatory patient for this purpose is known as a Holter monitor. Cardiac monitoring can also involve cardiac output monitoring via an invasive Swan-Ganz catheter.
- Hemodynamic monitoring, which monitors the blood pressure and blood flow within the circulatory system. Blood pressure can be measured either invasively through an inserted blood pressure transducer assembly, or noninvasively with an inflatable blood pressure cuff.
- Respiratory monitoring, such as:
- Pulse oximetry which involves measurement of the saturated percentage of oxygen in the blood, referred to as SpO2, and measured by an infrared finger cuff
- Capnography, which involves CO2 measurements, referred to as EtCO2 or end-tidal carbon dioxide concentration. The respiratory rate monitored as such is called AWRR or airway respiratory rate)
- Respiratory rate monitoring through a thoracic transducer belt, an ECG channel or via capnography
- Neurological monitoring, such as of intracranial pressure. Also, there are special patient monitors which incorporate the monitoring of brain waves (electroencephalography), gas anesthetic concentrations, bispectral index (BIS), etc. They are usually incorporated into anesthesia machines. In neurosurgery intensive care units, brain EEG monitors have a larger multichannel capability and can monitor other physiological events, as well.
- Blood glucose monitoring
- Childbirth monitoring
- Body temperature monitoring through an adhesive pad containing a thermoelectric transducer.
Vital parameters
Monitoring of vital parameters can include several of the ones mentioned above, and most commonly include at least blood pressure and heart rate, and preferably also pulse oximetry and respiratory rate. Multimodal monitors that simultaneously measure and display the relevant vital parameters are commonly integrated into the bedside monitors in critical care units, and the anesthetic machines in operating rooms. These allow for continuous monitoring of a patient, with medical staff being continuously informed of the changes in general condition of a patient. Some monitors can even warn of pending fatal cardiac conditions before visible signs are noticeable to clinical staff, such as atrial fibrillation or premature ventricular contraction (PVC).
<monitor>...</monitor>
Medical monitor
A medical monitor or physiological monitor is a medical device used for monitoring. It can consist of one or more sensors, processing components, display devices (which are sometimes in themselves called "monitors"), as well as communication links for displaying or recording the results elsewhere through a monitoring network.
Components
Sensor
Sensors of medical monitors include biosensors and mechanical sensors.
Translating component
The translating component of medical monitors is responsible for converting the signals from the sensors to a format that can be shown on the display device or transferred to an external display or recording device.
Display device
Physiological data are displayed continuously on a CRT, LED or LCD screen as data channels along the time axis, They may be accompanied by numerical readouts of computed parameters on the original data, such as maximum, minimum and average values, pulse and respiratory frequencies, and so on.
Besides the tracings of physiological parameters along time (X axis), digital medical displays have automated numeric readouts of the peak and/or average parameters displayed on the screen.
Modern medical display devices commonly use digital signal processing (DSP), which has the advantages of miniaturization, portability, and multi-parameter displays that can track many different vital signs at once.
Old analog patient displays, in contrast, were based on oscilloscopes, and had one channel only, usually reserved for electrocardiographic monitoring (ECG). Therefore, medical monitors tended to be highly specialized. One monitor would track a patient's blood pressure, while another would measure pulse oximetry, another the ECG. Later analog models had a second or third channel displayed in the same screen, usually to monitor respiration movements and blood pressure. These machines were widely used and saved many lives, but they had several restrictions, including sensitivity to electrical interference, base level fluctuations and absence of numeric readouts and alarms.
Communication links
Several models of multi-parameter monitors are networkable, i.e., they can send their output to a central ICU monitoring station, where a single staff member can observe and respond to several bedside monitors simultaneously. Ambulatory telemetry can also be achieved by portable, battery-operated models which are carried by the patient and which transmit their data via a wireless data connection.
Digital monitoring has created the possibility, which is being fully developed, of integrating the physiological data from the patient monitoring networks into the emerging hospital electronic health record and digital charting systems, using appropriate health care standards which have been developed for this purpose by organizations such as IEEE and HL7. This newer method of charting patient data reduces the likelihood of human documentation error and will eventually reduce overall paper consumption. In addition, automated ECG interpretation incorporates diagnostic codes automatically into the charts. Medical monitor's embedded software can take care of the data coding according to these standards and send messages to the medical records application, which decodes them and incorporates the data into the adequate fields.
Long-distance connectivity can avail for telemedicine, which involves provision of clinical health care at a distance.
Other components
A medical monitor can also have the function to produce an alarm (such as using audible signals) to alert the staff when certain criteria are set, such as when some parameter exceeds of falls the level limits.
Mobile appliances
An entirely new scope is opened with mobile carried monitors, even such in sub-skin carriage. This class of monitors delivers information gathered in body-area networking (BAN) to e.g. smart phones and implemented autonomous agents.
Interpretation of monitored parameters
Monitoring of clinical parameters is primarily intended to detect changes (or absence of changes) in the clinical status of an individual. For example, the parameter of oxygen saturation is usually monitored to detect changes in respiratory capability of an individual.
Change in status versus test variability
When monitoring a clinical parameters, differences between test results (or values of a continuously monitored parameter after a time interval) can reflect either (or both) an actual change in the status of the condition or a test-retest variability of the test method.
In practice, the possibility that a difference is due to test-retest variability can almost certainly be excluded if the difference is larger than a predefined "critical difference". This "critical difference" (CD) is calculated as:[1]
, where:[1]
- K, is a factor dependent on the preferred probability level. Usually, it is set at 2.77, which reflects a 95% prediction interval, in which case there is less than 5% probability that a test result would become higher or lower than the critical difference by test-retest variability in the absence of other factors.
- CVa is the anaytical variation
- CVi is the intra-individual variability
For example, if a patient has a hemoglobin level of 100 g/L, the anaytical variation (CVa) is 1.8% and the intra-individual variability CVi is 2.2%, then the critical difference is 8.1 g/L. Thus, for changes of less than 8 g/L since a previous test, the possibility that the change is completely caused by test-retest variability may need to be considered in addition to considering effects of, for example, diseases or treatments.
Sodium | 3% |
Potassium | 14% |
Chloride | 4% |
Urea | 30% |
Creatinine | 14% |
Calcium | 5% |
Albumin | 8% |
Fasting glucose | 15% |
Amylase | 30% |
Carcinoembryonic antigen | 69% |
C-reactive protein | 43%[2] |
Glycosylated hemoglobin | 21% |
Hemoglobin | 8% |
Erythrocytes | 10% |
Leukocytes | 32% |
Platelets | 25% |
Unless otherwise specified, then reference for critical values is Fraser 1989[1] |
Critical differences for other tests include early morning urinary albumin concentration, with a critical difference of 40%.[1]
Techniques in development
Template:Unreliable sources The development of new techniques for monitoring is an advanced and developing field in smart medicine, biomedical-aided integrative medicine, alternative medicine, self-tailored preventive medicine and predictive medicine that emphasizes monitoring of comprehensive medical data of patients, people at risk and healthy people using advanced, smart, minimally invasive biomedical devices, biosensors, lab-on-a-chip (in the future nanomedicine[3][4] devices like nanorobots) and advanced computerized medical diagnosis and early warning tools over a short clinical interview and drug prescription.
As biomedical research, nanotechnology and nutrigenomics advances, realizing the human body's self-healing capabilities and the growing awareness of the limitations of medical intervention by chemical drugs-only approach of old school medical treatment, new researches that shows the enormous damage medications can cause,[5][6] researchers are working to fulfill the need for a comprehensive further study and personal continuous clinical monitoring of health conditions while keeping legacy medical intervention as a last resort.
In many medical problems, drugs offer temporary relief of symptoms while the root of a medical problem remains unknown without enough data of all our biological systems[7] . Our body is equipped with sub-systems for the purpose of maintaining balance and self healing functions. Intervention without sufficient data might damage those healing sub systems.[7] Monitoring medicine fills the gap to prevent diagnosis errors and can assist in future medical research by analyzing all data of many patients.
Examples and applications
The development cycle in medicine is extremely long, up to 20 years, because of the need for U.S. Food and Drug Administration (FDA) approvals, therefore many of monitoring medicine solutions are not available today in conventional medicine.
- Blood glucose monitoring
- In vivo blood glucose monitoring devices can transmit data to a computer that can assist with daily life suggestions for lifestyle or nutrition and with the physician can make suggestions for further study in people who are at risk and help prevent diabetes mellitus type 2 .[8]
- Stress monitoring
- Bio sensors may provide warnings when stress levels signs are rising before human can notice it and provide alerts and suggestions.[9]
- Serotonin biosensor
- Future serotonin biosensors may assist with mood disorders and depression.[10]
- Continuous blood test based nutrition
- In the field of evidence-based nutrition, a lab-on-a-chip implant that can run 24/7 blood tests may provide a continuous results and a coumputer can provide nutritaion suggestions or alerts.
- Psychiatrist-on-a-chip
- In clinical brain sciences drug delivery and in vivo Bio-MEMS based biosensors may assist with preventing and early treatment of mental disorders
- Epilepsy monitoring
- In epilepsy, next generations of long-term video-EEG monitoring may predict epileptic seizure and prevent them with changes of daily life activity like sleep, stress, nutrition and mood management.[11]
- Toxicity monitoring
- Smart biosensors may detect toxic materials such mercury and lead and provide alerts.[12]
See also
References
43 year old Petroleum Engineer Harry from Deep River, usually spends time with hobbies and interests like renting movies, property developers in singapore new condominium and vehicle racing. Constantly enjoys going to destinations like Camino Real de Tierra Adentro.
Further reading
- Monitoring Level of Consciousness During Anesthesia & Sedation , Scott D. Kelley, M.D., ISBN 978-0-9740696-0-9
- Healthcare Sensor Networks: Challenges Toward Practical Implementation, Daniel Tze Huei Lai (Editor), Marimuthu Palaniswami (Editor), Rezaul Begg (Editor), ISBN 978-1-4398-2181-7
- Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics (Contemporary Cardiology), William B. White, ISBN 978-0-89603-840-0
- Physiological Monitoring and Instrument Diagnosis in Perinatal and Neonatal Medicine, Yves W. Brans, William W. Hay Jr, ISBN 978-0-521-41951-2
- Medical Nanotechnology and Nanomedicine (Perspectives in Nanotechnology), Harry F. Tibbals, ISBN 978-1-4398-0874-0
External links
- Monitoring medicine intake in the networked home: The iCabiNET solution, IEEE Xplore, Issue Date: Jan. 30 2008-Feb. 1 2008, pp. 116 – 117
- Personal Medical Monitoring Devices, The University of Maryland
Template:Intensive care medicine Template:Anesthesia
- ↑ 1.0 1.1 1.2 1.3 1.4 Template:Cite pmid
- ↑ C‐reactive protein (serum, plasma) from The Association for Clinical Biochemistry and Laboratory Medicine. Author: Brona Roberts. Copyrighted 2012
- ↑ Template:Cite web
- ↑ Template:Cite web
- ↑ Template:Cite web
- ↑ Template:Cite web
- ↑ 7.0 7.1 20 year-old Real Estate Agent Rusty from Saint-Paul, has hobbies and interests which includes monopoly, property developers in singapore and poker. Will soon undertake a contiki trip that may include going to the Lower Valley of the Omo.
My blog: http://www.primaboinca.com/view_profile.php?userid=5889534 - ↑ Template:Cite web
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- ↑ One of the biggest reasons investing in a Singapore new launch is an effective things is as a result of it is doable to be lent massive quantities of money at very low interest rates that you should utilize to purchase it. Then, if property values continue to go up, then you'll get a really high return on funding (ROI). Simply make sure you purchase one of the higher properties, reminiscent of the ones at Fernvale the Riverbank or any Singapore landed property Get Earnings by means of Renting
In its statement, the singapore property listing - website link, government claimed that the majority citizens buying their first residence won't be hurt by the new measures. Some concessions can even be prolonged to chose teams of consumers, similar to married couples with a minimum of one Singaporean partner who are purchasing their second property so long as they intend to promote their first residential property. Lower the LTV limit on housing loans granted by monetary establishments regulated by MAS from 70% to 60% for property purchasers who are individuals with a number of outstanding housing loans on the time of the brand new housing purchase. Singapore Property Measures - 30 August 2010 The most popular seek for the number of bedrooms in Singapore is 4, followed by 2 and three. Lush Acres EC @ Sengkang
Discover out more about real estate funding in the area, together with info on international funding incentives and property possession. Many Singaporeans have been investing in property across the causeway in recent years, attracted by comparatively low prices. However, those who need to exit their investments quickly are likely to face significant challenges when trying to sell their property – and could finally be stuck with a property they can't sell. Career improvement programmes, in-house valuation, auctions and administrative help, venture advertising and marketing, skilled talks and traisning are continuously planned for the sales associates to help them obtain better outcomes for his or her shoppers while at Knight Frank Singapore. No change Present Rules
Extending the tax exemption would help. The exemption, which may be as a lot as $2 million per family, covers individuals who negotiate a principal reduction on their existing mortgage, sell their house short (i.e., for lower than the excellent loans), or take part in a foreclosure course of. An extension of theexemption would seem like a common-sense means to assist stabilize the housing market, but the political turmoil around the fiscal-cliff negotiations means widespread sense could not win out. Home Minority Chief Nancy Pelosi (D-Calif.) believes that the mortgage relief provision will be on the table during the grand-cut price talks, in response to communications director Nadeam Elshami. Buying or promoting of blue mild bulbs is unlawful.
A vendor's stamp duty has been launched on industrial property for the primary time, at rates ranging from 5 per cent to 15 per cent. The Authorities might be trying to reassure the market that they aren't in opposition to foreigners and PRs investing in Singapore's property market. They imposed these measures because of extenuating components available in the market." The sale of new dual-key EC models will even be restricted to multi-generational households only. The models have two separate entrances, permitting grandparents, for example, to dwell separately. The vendor's stamp obligation takes effect right this moment and applies to industrial property and plots which might be offered inside three years of the date of buy. JLL named Best Performing Property Brand for second year running
The data offered is for normal info purposes only and isn't supposed to be personalised investment or monetary advice. Motley Fool Singapore contributor Stanley Lim would not personal shares in any corporations talked about. Singapore private home costs increased by 1.eight% within the fourth quarter of 2012, up from 0.6% within the earlier quarter. Resale prices of government-built HDB residences which are usually bought by Singaporeans, elevated by 2.5%, quarter on quarter, the quickest acquire in five quarters. And industrial property, prices are actually double the levels of three years ago. No withholding tax in the event you sell your property. All your local information regarding vital HDB policies, condominium launches, land growth, commercial property and more
There are various methods to go about discovering the precise property. Some local newspapers (together with the Straits Instances ) have categorised property sections and many local property brokers have websites. Now there are some specifics to consider when buying a 'new launch' rental. Intended use of the unit Every sale begins with 10 p.c low cost for finish of season sale; changes to 20 % discount storewide; follows by additional reduction of fiftyand ends with last discount of 70 % or extra. Typically there is even a warehouse sale or transferring out sale with huge mark-down of costs for stock clearance. Deborah Regulation from Expat Realtor shares her property market update, plus prime rental residences and houses at the moment available to lease Esparina EC @ Sengkang - ↑ Template:Cite web