Home monitoring

Sadeh A, Lavie P, Scher A, Tirosh E, Epstein R. Actigraphic home-monitoring sleep-disturbed and control infants and young children a new method for pediatric assessment of sleep-wake patterns. Pediatrics 1991 87 494-9. 

Glucose sensors are mainly used to determine blood glucose in clinical chemistry and diabetes home monitoring. The detection limit is around 1 pM and increases by additional diffusion barriers for undiluted whole-blood measurement and in-vivo application. Typical response times are below one min. Screen-printed electrodes are often made for single use. Entrapment of GOD in polyurethane and amperometric indication of hydrogen peroxide may result in a massively stabilized glucose sensor which may be reused more than 1000 times. 

As with WCH and LH, MH is best revealed by monitoring blood pressure either with occasional home monitoring or by wearing an ambulatory device provided by a physician who, for whatever reason, suspects MH. MH is also known in the medical community as reverse white coat hypertension and white coat normotension. This is particularly insidious, since such patients tend to be at even greater risk than are people with more commonly detected hypertension. 

Late in 2004, the American Heart Association advocated home monitoring in its revised guidelines for blood pressure measurements, published in the February 2005 issue of the journal Hypertension. The lead author of that report. Dr. Thomas Pickering of Columbia University in New York, said, We ve found that blood pressure measurements taken by doctors in their offices may actually be unreliable in many patients. For that reason, there is wider acceptance of blood pressure readings taken by patients in their homes, and of ambulatory blood pressure monitoring. ... 

Not only were early home monitors inaccurate, but they were also expensive. Today they are both accurate and inexpensive. They re a great investment in cardiovascular health for you and the entire family. Even children Authorities advocate blood pressure... 

Even though the home monitoring devices are extremely easy to use, technique is important to assure accurate blood pressure measurements. It s best to sit at a table or a desk, wrap the cuff around the arm as directed in the instructions, and relax for a couple of minutes before inflating the cuff. Keep both feet on the floor and try to remain still, since movement can decrease accuracy. Your arm and cuff should be at the same height as your heart. Hit the start button and note your blood pressure. Many machines also measure heart rate. Wait a couple more minutes and repeat the procedure. You ll probably find that the first measurement is higher. 

In fact, recent research published in the May 2006 issue of the American Journal of Hypertension shows that home monitoring is as effective and accurate as the far more expensive and inconvenient method of ABPM. This was the first study to directly compare the two methods. Please consider making a good investment in your heart health by purchasing a home monitoring device. 

Doctor, nurse and patient are faced with a lifetime of collaboration. Compliance is not a one-sided process, and the patients need all the consideration and support they can get. They should learn about their disease and its management, including home monitoring of blood glucose, and about the need for appropriate diet, exercise and avoidance of smoking. 

Improvement in Management Skills. Patients and families should be shown the various types of medications and devices, and the patients should be tested to determine their preferences and ability to use them correctly. The appropriate selection of devices for specific patients cannot be overemphasised. Once the device is selected, patients and families must learn how to use them correctly. On repeat visits, patient ability and competence is checked and re-checked. Peak flow measurement with home monitoring is generally prescribed for those with moderate-to-severe asthma. Self-management is made as simple as possible. 

But we don t need to worry too much yet. Even those of us who feel that too much machinery inside us is undesirable might at least welcome basic internal biosensors and other monitoring devices that can only report information. Failing even that, externally worn biosensors or such devices around the home are certain to be welcomed by us all. The process has already started, and the first significant systems for home monitoring are for patients with chronic disease such as heart disease or diabetes. 

The gluco.se result log book kept by insulin-dependent diabetics who perform home monitoring may at first sight appear to show good and consistent glucose control. This may not always represent the truth. The clinician should determine the true level of control by close questioning and objective assessments such as Hb A,., or fructosamine. 

Circuit breakers in a home monitor the electric current. If there is an overload, the circuit breaker will create an open circuit, stopping the flow of electricity. 

The manufacturer notes that the results of four tyramine challenge studies, together with the results of home monitoring of blood pressure after meals (from 464 patients treated with rasagiline 0.5 or 1 mg daily or placebo without tyramine restrictions), and the lack of reported problems in clini-eal trials without tyramine restriction, indicate that no dietary restrictions are neeessary with rasagiline. No specific details were provided of any of the studies. 

Telemetry communication to and from the implanted device can also be used in the home. In fact, home monitors are available for most ICDs. The home monitor can interrogate a device and provide valuable diagnostic data to clinicians via telephone or Internet uplinks. Although the technology already... 

For those with PROP, home monitoring of urine ketones can be nsed as an indicator of the degree of illness. Moderate to large ketones indicate compromised metabolic control. The age of the child, severity of illness, and comfort level of caregivers dictates the length of time that home treatment can be continued however, caretakers need to be instructed to contact the metabolic team if the child... 

Frequent home monitoring of blood glucose and adjustments in the diet are needed to prevent hypoglycemia and maintain blood glucose >70 mg/dL or 4 mmol/L. 

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