Monitoring (medicine) - AbsoluteAstronomy.com

In medicine, monitoring is the evaluation of a disease or condition over time.

It can be performed by continuously measuring certain parameters (for example, by continuously measuring vital signs by a bedside monitor), and/or by repeatedly performing medical test

Medical test

A diagnostic test is any kind of medical test performed to aid in the diagnosis or detection of disease. For example:* to diagnose diseases, and preferably sub-classify it regarding, for example, severity and treatability...

s (such as blood glucose monitoring

Blood glucose monitoring

Blood glucose monitoring is a way of testing the concentration of glucose in the blood . Particularly important in the care of diabetes mellitus, a blood glucose test is performed by piercing the skin to draw blood, then applying the blood to a chemically active disposable 'test-strip'...

in people with diabetes mellitus

Diabetes mellitus

Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced...

).

Transmitting data from a monitor to a distant monitoring station is known as telemetry

Telemetry

Telemetry is a technology that allows measurements to be made at a distance, usually via radio wave transmission and reception of the information. The word is derived from Greek roots: tele = remote, and metron = measure...

or biotelemetry

Biotelemetry

Biotelemetry involves the application of telemetry in the medical field to remotely monitor various vital signs of ambulatory patients.-Application:...

Classification by target parameter

Monitoring can be classified by the target of interest, including:

Cardiac monitoring
Cardiac monitoring
The phrase cardiac monitoring generally refers to continuous monitoring with electrocardiography with assessment of the patients condition relative to their cardiac rhythm. It is different from hemodynamic monitoring, which monitors the pressure and flow of blood within the circulatory system. The...

, 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
Holter monitor
In medicine, a Holter monitor is a portable device for continuously monitoring various electrical activity of the cardiovascular system for at least 24 hours...

.
Hemodynamic monitoring, which monitors the pressure and flow of blood within the circulatory system.
Respiratory monitoring
Respiratory monitoring
Monitoring a patient's respiratory status usually takes place in a hospital setting and may be the primary purpose for a patient being observed or admitted to a medical setting....
Neurological monitoring, such as of intracranial pressure
Intracranial pressure
Intracranial pressure is the pressure inside the skull and thus in the brain tissue and cerebrospinal fluid . The body has various mechanisms by which it keeps the ICP stable, with CSF pressures varying by about 1 mmHg in normal adults through shifts in production and absorption of CSF...

. Also, there are special patient monitors which incorporate the monitoring of brain waves (electroencephalography
Electroencephalography
Electroencephalography is the recording of electrical activity along the scalp. EEG measures voltage fluctuations resulting from ionic current flows within the neurons of the brain...

, gas anesthetic concentrations, bispectral index
Bispectral index
Bispectral index is one of several technologies which purport to monitor depth of anesthesia. BIS monitors are intended to replace or supplement Guedel's classification system for determining depth of anesthesia...

(BIS), etc. They are usually incorporated into anesthesia machines. In neurosurgery
Neurosurgery
Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spine, spinal cord, peripheral nerves, and extra-cranial cerebrovascular system.-In the United States:In...

intensive care units, brain EEG monitors have a larger multichannel capability and can monitor other physiological events, as well.
Blood glucose monitoring
Blood glucose monitoring
Blood glucose monitoring is a way of testing the concentration of glucose in the blood . Particularly important in the care of diabetes mellitus, a blood glucose test is performed by piercing the skin to draw blood, then applying the blood to a chemically active disposable 'test-strip'...

Monitoring of vital parameters can include several of the ones mentioned above. In critical care units of hospital

Hospital

A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....

s, bedside units allow 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

Atrial fibrillation

Atrial fibrillation is the most common cardiac arrhythmia . It is a common cause of irregular heart beat, identified clinically by taking a pulse. Chaotic electrical activity in the two upper chambers of the heart result in the muscle fibrillating , instead of achieving coordinated contraction...

or premature ventricular contraction

Premature ventricular contraction

A premature ventricular contraction , also known as a premature ventricular complex, ventricular premature contraction , ventricular premature beat , or extrasystole, is a relatively common event where the heartbeat is initiated by the heart ventricles rather than by the sinoatrial node, the...

(PVC).

Instruments

An instrument used for monitoring can be called a medical monitor

Medical monitor

A medical monitor or physiological monitor or display, is an electronic medical device used in medical monitoring that displays the monitored data, and may or may not have the ability to transmit the data on a monitoring network...

, and may have an integrated display that shows the data of interest directly, and/or have the ability to transmit the data to a network or other means of processing, storing or displaying it.

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

Oxygen saturation

Oxygen saturation or dissolved oxygen is a relative measure of the amount of oxygen that is dissolved or carried in a given medium. It can be measured with a dissolved oxygen probe such as an oxygen sensor or an optode in liquid media, usually water.It has particular significance in medicine and...

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:

, where:

K, is a factor dependent on the preferred probability level. Usually, it is set at 2.77, which reflects a 95% prediction interval
Prediction interval
In statistical inference, specifically predictive inference, a prediction interval is an estimate of an interval in which future observations will fall, with a certain probability, given what has already been observed...

, 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_a is the anaytical variation
CV_i is the intra-individual variability

For example, if a patient has a hemoglobin level of 100 g/L, the anaytical variation (CV_a) is 1.8% and the intra-individual variability CV_i 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.

Critical differences for some blood test
Blood test
A blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via fingerprick....

s
Sodium Sodium Sodium is a chemical element with the symbol Na and atomic number 11. It is a soft, silvery-white, highly reactive metal and is a member of the alkali metals; its only stable isotope is 23Na. It is an abundant element that exists in numerous minerals, most commonly as sodium chloride...	3%
Potassium Potassium Potassium is the chemical element with the symbol K and atomic number 19. Elemental potassium is a soft silvery-white alkali metal that oxidizes rapidly in air and is very reactive with water, generating sufficient heat to ignite the hydrogen emitted in the reaction.Potassium and sodium are...	14%
Chloride Chloride The chloride ion is formed when the element chlorine, a halogen, picks up one electron to form an anion Cl−. The salts of hydrochloric acid HCl contain chloride ions and can also be called chlorides. The chloride ion, and its salts such as sodium chloride, are very soluble in water...	4%
Urea Urea Urea or carbamide is an organic compound with the chemical formula CO2. The molecule has two —NH2 groups joined by a carbonyl functional group....	30%
Creatinine Creatinine Creatinine is a break-down product of creatine phosphate in muscle, and is usually produced at a fairly constant rate by the body...	14%
Calcium Calcium Calcium is the chemical element with the symbol Ca and atomic number 20. It has an atomic mass of 40.078 amu. Calcium is a soft gray alkaline earth metal, and is the fifth-most-abundant element by mass in the Earth's crust...	5%
Albumin Albumin Albumin refers generally to any protein that is water soluble, which is moderately soluble in concentrated salt solutions, and experiences heat denaturation. They are commonly found in blood plasma, and are unique to other blood proteins in that they are not glycosylated...	8%
Fasting glucose	15%
Amylase Amylase Amylase is an enzyme that catalyses the breakdown of starch into sugars. Amylase is present in human saliva, where it begins the chemical process of digestion. Food that contains much starch but little sugar, such as rice and potato, taste slightly sweet as they are chewed because amylase turns...	30%
Carcinoembryonic antigen Carcinoembryonic antigen Carcinoembryonic antigen is a glycoprotein involved in cell adhesion. It is normally produced during fetal development, but the production of CEA stops before birth. Therefore, it is not usually present in the blood of healthy adults, although levels are raised in heavy smokers...	69%
Glycosylated hemoglobin Glycosylated hemoglobin Glycated hemoglobin is a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over prolonged periods of time. It is formed in a non-enzymatic glycation pathway by hemoglobin's exposure to plasma glucose...	21%
Hemoglobin Hemoglobin Hemoglobin is the iron-containing oxygen-transport metalloprotein in the red blood cells of all vertebrates, with the exception of the fish family Channichthyidae, as well as the tissues of some invertebrates...	8%
Erythrocytes	10%
Leukocytes	32%
Platelets	25%

Critical differences for other tests include early morning urinary albumin concentration, with a critical difference of 40%.

Techniques in development

The development of new techniques for monitoring is an advanced and developing field in smart medicine, biomedical-aided integrative medicine

Integrative medicine

Integrative medicine or integrative health is the combination of the practices and methods of alternative medicine with conventional medicine. The term is relatively recent, and is mainly promoted by proponents of alternative therapies in the west...

, alternative medicine

Alternative medicine

Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....

, self-tailored

Personalized medicine

Personalized medicine is a medical model emphasizing in general the customization of healthcare, with all decisions and practices being tailored to individual patients in whatever ways possible...

preventive medicine

Preventive medicine

Preventive medicine or preventive care refers to measures taken to prevent diseases, rather than curing them or treating their symptoms...

and predictive medicine

Predictive medicine

Predictive medicine is a rapidly emerging field of medicine that entails predicting disease and instituting preventive measures in order to either prevent the disease altogether or significantly decrease its impact upon the patient...

that emphasizes monitoring

Monitoring (medicine)

In medicine, monitoring is the evaluation of a disease or condition over time.It can be performed by continuously measuring certain parameters , and/or by repeatedly performing medical tests .Transmitting data from a monitor to a distant...

of comprehensive medical data of patients, people at risk and healthy people using advanced, smart, minimally invasive

Invasiveness of surgical procedures

There are three main categories which describe the invasiveness of surgical procedures. These are: non-invasive procedures, minimally invasive procedures, and invasive procedures ....

biomedical devices

Biomedical engineering

Biomedical Engineering is the application of engineering principles and design concepts to medicine and biology. This field seeks to close the gap between engineering and medicine: It combines the design and problem solving skills of engineering with medical and biological sciences to improve...

, biosensors, lab-on-a-chip

Lab-on-a-chip

A lab-on-a-chip is a device that integrates one or several laboratory functions on a single chip of only millimeters to a few square centimeters in size. LOCs deal with the handling of extremely small fluid volumes down to less than pico liters. Lab-on-a-chip devices are a subset of MEMS devices...

(in the future nanomedicine

Nanomedicine

Nanomedicine is the medical application of nanotechnology. Nanomedicine ranges from the medical applications of nanomaterials, to nanoelectronic biosensors, and even possible future applications of molecular nanotechnology. Current problems for nanomedicine involve understanding the issues related...

devices like nanorobots) and advanced computerized

Artificial intelligence

Artificial intelligence is the intelligence of machines and the branch of computer science that aims to create it. AI textbooks define the field as "the study and design of intelligent agents" where an intelligent agent is a system that perceives its environment and takes actions that maximize its...

medical diagnosis

Medical diagnosis

Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...

and early warning tools over a short clinical interview and drug prescription

Medical prescription

A prescription is a health-care program implemented by a physician or other medical practitioner in the form of instructions that govern the plan of care for an individual patient. Prescriptions may include orders to be performed by a patient, caretaker, nurse, pharmacist or other therapist....

.

As biomedical research

Biomedical research

Biomedical research , in general simply known as medical research, is the basic research, applied research, or translational research conducted to aid and support the body of knowledge in the field of medicine...

, nanotechnology

Nanotechnology

Nanotechnology is the study of manipulating matter on an atomic and molecular scale. Generally, nanotechnology deals with developing materials, devices, or other structures possessing at least one dimension sized from 1 to 100 nanometres...

and nutrigenomics

Nutrigenomics

Nutrigenomics is the study of the effects of foods and food constituents on gene expression. It is about how our DNA is transcribed into mRNA and then to proteins and provides a basis for understanding the biological activity of food components...

advances, realizing the human body's self-healing

Self-healing

Self-healing is a phrase applied to the process of recovery , motivated by and directed by the patient, guided often only by instinct. Such a process encounters mixed fortunes due to its amateur nature, although self-motivation is a major asset...

capabilities and the growing awareness of the limitations of medical intervention

Health intervention

A health intervention is an effort to promote good health behaviour such as physical exercise or to prevent bad health behaviours, e.g. promoting tobacco smoking cessation or discouraging the use of illicit drugs or excessive drinking....

by chemical drugs

DRUGS

Destroy Rebuild Until God Shows are an American post-hardcore band formed in 2010. They released their debut self-titled album on February 22, 2011.- Formation :...

-only approach of old school medical treatment, new researches that shows the enormous damage medications can cause, researchers are working to fulfill the need for a comprehensive further study and personal continuous clinical monitoring

Clinical monitoring

Clinical monitoring - Oversight and administrative efforts that monitor a participant's health during a clinical trial. The government and other clinical trial funding agencies require data and safety monitoring boards to oversee clinical trials...

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

Functional medicine

Functional medicine is a form of Western alternative medicine unrelated to the Western biomedical approaches.It focuses on treating individuals who may have bodily symptoms, imbalances and dysfunctions...

of a medical problem remains unknown without enough data of all our biological system

Biological system

In biology, a biological system is a group of organs that work together to perform a certain task. Common systems, such as those present in mammals and other animals, seen in human anatomy, are those such as the circulatory system, the respiratory system, the nervous system, etc.A group of systems...

s
. 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. Monitoring medicine fills the gap to prevent diagnosis errors and can assist in future medical research by analyzing all data

Data acquisition

Data acquisition is the process of sampling signals that measure real world physical conditions and converting the resulting samples into digital numeric values that can be manipulated by a computer. Data acquisition systems typically convert analog waveforms into digital values for processing...

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

Food and Drug Administration

The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...

(FDA) approvals, therefore many of monitoring medicine solutions are not available today in conventional medicine.

Glaucoma

In glaucoma

Glaucoma

Glaucoma is an eye disorder in which the optic nerve suffers damage, permanently damaging vision in the affected eye and progressing to complete blindness if untreated. It is often, but not always, associated with increased pressure of the fluid in the eye...

patients, high intraocular pressure

Intraocular pressure

Intraocular pressure is the fluid pressure inside the eye. Tonometry is the method eye care professionals use to determine this. IOP is an important aspect in the evaluation of patients at risk from glaucoma...

(IOP) can slowly damage the optic nerve and lead to blindness

Blindness

Blindness is the condition of lacking visual perception due to physiological or neurological factors.Various scales have been developed to describe the extent of vision loss and define blindness...

. An advanced IOP continuous monitoring device can help the patients to learn which daily activity is best for low IOP values.

Blood glucose monitoring

In vivo

In vivo is experimentation using a whole, living organism as opposed to a partial or dead organism, or an in vitro controlled environment. Animal testing and clinical trials are two forms of in vivo research...

blood glucose monitoring

Blood glucose monitoring

devices can transmit data to a computer that can assist with daily life suggestions for lifestyle or nutrition

Nutrition

Nutrition is the provision, to cells and organisms, of the materials necessary to support life. Many common health problems can be prevented or alleviated with a healthy diet....

and with the physician

Physician

A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

can make suggestions for further study in people who are at risk and help prevent diabetes mellitus type 2

Diabetes mellitus type 2

Diabetes mellitus type 2formerly non-insulin-dependent diabetes mellitus or adult-onset diabetesis a metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. Diabetes is often initially managed by increasing exercise and...

Stress monitoring

Bio sensors may provide warnings when stress levels signs are rising before human can notice it and provide alerts and suggestions.

Serotonin biosensor

Future serotonin

Serotonin

Serotonin or 5-hydroxytryptamine is a monoamine neurotransmitter. Biochemically derived from tryptophan, serotonin is primarily found in the gastrointestinal tract, platelets, and in the central nervous system of animals including humans...

biosensors may assist with mood

Mood (psychology)

A mood is a relatively long lasting emotional state. Moods differ from emotions in that they are less specific, less intense, and less likely to be triggered by a particular stimulus or event....

disorders and depression

Depression (mood)

Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless...

Continuous blood test based nutrition

In the field of evidence-based nutrition, a lab-on-a-chip

Lab-on-a-chip

implant

Implant (medicine)

An implant is a medical device manufactured to replace a missing biological structure, support a damaged biological structure, or enhance an existing biological structure. Medical implants are man-made devices, in contrast to a transplant, which is a transplanted biomedical tissue...

that can run 24/7 blood test

Blood test

A blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via fingerprick....

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

Drug delivery

Drug delivery is the method or process of administering a pharmaceutical compound to achieve a therapeutic effect in humans or animals. Drug delivery technologies modify drug release profile, absorption, distribution and elimination for the benefit of improving product efficacy and safety, as well...

and in vivo Bio-MEMS

Bio-MEMS

Bio-MEMS is an abbreviation of biological microelectromechanical systems and refers to a special class of microelectromechanical systems where biological matter is manipulated to analyze and measure its activity under any class of scientific study. This class of devices belongs to one of the areas...

based biosensor

Biosensor

A biosensor is an analytical device for the detection of an analyte that combines a biological component with a physicochemical detector component.It consists of 3 parts:* the sensitive biological element A biosensor is an analytical device for the detection of an analyte that combines a biological...

s may assist with preventing and early treatment of mental disorders

Epilepsy monitoring

In epilepsy

Epilepsy

Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...

, next generations of long-term video-EEG monitoring

Long-term video-EEG monitoring

Long-term video-EEG monitoring, also known as video telemetry, is a diagnostic technique used in certain patients with epilepsy or seizures. It involves the inpatient hospitalization of the patient for a period of time, typically days to weeks, during which they are continuously monitored and...

may predict epileptic seizure and prevent them with changes of daily life activity like sleep

Sleep

Sleep is a naturally recurring state characterized by reduced or absent consciousness, relatively suspended sensory activity, and inactivity of nearly all voluntary muscles. It is distinguished from quiet wakefulness by a decreased ability to react to stimuli, and is more easily reversible than...

, stress

Stress (biology)

Stress is a term in psychology and biology, borrowed from physics and engineering and first used in the biological context in the 1930s, which has in more recent decades become commonly used in popular parlance...

, nutrition

Nutrition

Nutrition is the provision, to cells and organisms, of the materials necessary to support life. Many common health problems can be prevented or alleviated with a healthy diet....

and mood

Mood (psychology)

A mood is a relatively long lasting emotional state. Moods differ from emotions in that they are less specific, less intense, and less likely to be triggered by a particular stimulus or event....

management.

Toxicity monitoring

Smart biosensors may detect toxic materials such mercury

Mercury (element)

Mercury is a chemical element with the symbol Hg and atomic number 80. It is also known as quicksilver or hydrargyrum...

and lead

Lead

Lead is a main-group element in the carbon group with the symbol Pb and atomic number 82. Lead is a soft, malleable poor metal. It is also counted as one of the heavy metals. Metallic lead has a bluish-white color after being freshly cut, but it soon tarnishes to a dull grayish color when exposed...

and provide alerts.

External links

Monitoring medicine intake in the networked home: The iCabiNET solution, IEEE Xplore
IEEE Xplore
IEEE Xplore is a scholarly research database that indexes, abstracts, and provides full-text for articles and papers on computer science, electrical engineering and electronics. The database mainly covers material from IEEE and IET. The IEEE Xplore database contains over two million...

, Issue Date: Jan. 30 2008-Feb. 1 2008, pp. 116 – 117
Personal Medical Monitoring Devices, The University of Maryland

The source of this article is wikipedia, the free encyclopedia. The text of this article is licensed under the GFDL.

Classification by target parameter

Instruments

Interpretation of monitored parameters

Change in status versus test variability

Techniques in development

Examples and applications

See also

Further reading

External links