多通道温度测量仪的外文和翻译Word格式文档下载.docx

1、 The provision of a thermoneutral environment is a corner-tone of neonatal care. An accurate method of temperature measurement is required in order that neonatal nurses can provide this care. Glass mercury thermometers, now rarely used in the developed world were once the gold standard. They have ma

2、inly been replaced by many different types of modern thermometers.Methods: This study aims to compare the accuracy and user-acceptability of one electronic and one infrared thermometer （Lightouch Neonate, Exergen Corp,USA; Suretemp 678, Welch Allyn, Beaverton, USA） with traditional glass mercury the

3、rmometry for intermittent temperature measurement on the NICU, using the axilla as the measuring site.Results: The results demonstrate a generally positive performance of the two de-vices tested. The mean （SD） difference between the readings from the Suretemp thermometer and the glass mercury thermo

4、meter was 0.1 （0.25）.The mean difference between the readings from the Lightouch thermometer and the glass mercury thermometer is 0.07 .IntroductionMaintaining the thermoneutral environment for sick and premature newborn infants is a key part of the nurses role on the NICU, as abnormal temperature i

5、s strongly associated with adverse outcome （Bailey and Rose, 2000; CESDI, 2003;Silverman et al., 1958; WHO, 1997）. Obtaining accurate measurement of temperature is an obligatory step in providing thermoneutrality. Temperature of NICU patients may be measured in a variety of sites, including rectum a

6、nd axilla,and using a number of different tools, including glass mercury thermometers and electronic devices, which may in turn check temperature continuously, or as one-off readings. Mercury thermometry is now used rarely in the developed world, except as a comparison for evaluating new devices, as

7、 in this study. This is largely due to concerns about the hazards associated with mercury. Mercury emits a toxic vapour that can be inhaled or absorbed directly through the skin. This vapour may persist for months or years （Blumenthal,1992）. Very premature neonates with their increased skin permeabi

8、lity are a high-risk group for absorbing mercury vapour, especially as the warm environment required for their care facilitates mercury vapourisation （DoH, 1985）. While mercury thermometers have been regarded as the gold standard for measurement of body temperature （Blumenthal, 1992; Pontious et al.

9、, 1994;Sheeran, 1996）, numerous studies identify their inaccuracies （Abbey et al., 1978; Blumenthal,1992; Leick-Rude and Bloom, 1998）. Johnston and Shorten （1991） tested 48 mercury thermometers against a calibrated water bath, nding only ve recording the same temperature. The remaining thermometers

10、varied by as much as 0.8. In place of mercury thermometry, a profusion of devices for spot-check measurement have become available. These utilise electronic, infrared or chemical technology, for use in the tympanic membrane, axilla or rectum. In addition to providing spot-check measurements, some th

11、ermometers may be used in either monitoring or predictive modes. Monitoring mode gives a continuous readout, while predictive mode uses an algorithm to predict temperature based on rate of rise after probe introduction. A number of these devices have been studied previously （Davis, 1993; Greenall et

12、 al., 1997; Johnson et al., 1991; Leick-Rude and Bloom, 1998;Ogren, 1990; Rogers et al.,1991）. Weiss and Richards （1994） studied 142 preterm and term infants. Using a single instrument （IVAC 2080） they measured temperature using different modes and in different sites in the same baby. They found sta

13、tistically significant differences between measurements obtained in the axilla in predictive and monitoring modes, but concluded that the differences seen （0.1-0.2）were not clinically significant. Seguin and Terry （1999） compared axillary temperatures obtained in 28 term and preterm infants using th

14、e Lightouch device （Exergen Corp, USA） in predictive mode with rectal temperature. They found preterm infants in incubators had the least difference between the two readings, mean （SD） 0.09 （0.16）. They concluded this was clinically acceptable. The rectum is now rarely used as a temperature measurin

15、g site. The utility of the axilla as the measuring site, compared to the rectum, was assessed by Jirapaet and Jirapaet （2000）. They measured the temperature of 109 preterm and term infants simultaneously using four different methods. When they compared rectal and axillarytemperature measured using m

16、ercury thermometry they found a mean （95% CI） difference of 0.06（0.03-0.09） and concluded that axillary temperature can be as accurate as rectal. This study compares the accuracy and user-acceptability of one electronic and one infrared thermometer （Lightouch Neonate, Exergen Corp,USA; Suretemp 678,

17、 Welch Allyn, Beaverton, USA）with traditional glass mercury thermometry for intermittent temperature measurement on the NICU, using the axilla as the measuring site. The Lightouch thermometer uses an optical device with a cup shaped probe,which detects infrared emissions from the surface of the skin

18、. As there is no temperature device to heat up, it takes less than 1 s to produce a reading. The Suretemp 678 is an electronic thermistor thermometer, which takes 10 s to display a final reading in predictive mode. The trial aim was to determine whether the Lightouch Neonate infrared thermometer or

19、the Suretemp electronic thermometer set to predictive mode, would be accurate alternatives when compared to glass mercury thermometers.MethodsA convenience sample consisting of the population resident on a large regional NICU, during a three-week trial period, was used to obtain the two separate dat

20、a sets. These included babies requiring intensive care, high dependency care and low dependency care. The patient population consisted of term and preterm infants with a variety of medical and surgical conditions. Readings were obtained at the same time, using glass mercury thermometry and one of th

21、e two trial devices. Temperature readings were taken as clinically indicated and all infants present on any area of the NICU were eligible for inclusion.Guidelines were developed so that the same method of temperature measurement would be undertaken by individual nurses, ensuring comparable sets of

22、data would be produced, which differed only by which trial thermometer was used. The mercury thermometer was held in place for five minutes, as recommended by Bliss-Holtz （1995）. The Suretemp thermometer was set to the predictive mode. Either the Suretemp or the Lightouch was placed on the infant un

23、til a reading was obtained. The two readings were then recorded on a trial data sheet. Statistical analyses were produced using the SPSS statistical program. The Bland and Altman （1986） approach for comparing two measurement devices was utilised for individual comparison of each of the trial thermom

24、eters with the glass mercury thermometer. This method of statistical analysis allows comparison of new measurement techniques with established ones to see whether they agree sufficiently for the new to replace the old. Comparison of the readings from each trial thermometer with their respective pair

25、ed glass mercury axillary readings was accomplished by calculating limits of agreement, within which 95%2 standard deviations （SD） of individual differences would fall.Scatter plots were used to display differences in readings for each thermometer. Glass mercury readings minus trial thermometer read

26、ing were plotted on the y-axis and the average of the two readings on the x-axis. A line indicating the level of the mean difference between the readings assists visualisation of the differences between individual readings around the mean. Additional lines indicate2 SD above and below the mean （see

27、Figs. 1 and 2）.If the differences are normally distributed, 95% of the differences should lie between_2 SD of the mean difference （Bland and Altman, 1986; Leick-Rude and Bloom, 1998）. Leick-Rude and Bloom （1998） identify that 95% limits of agreement can represent a large range of differences for som

28、e instruments. Clinically,this could have marked implications, as temperature is often a criterion for deciding whether an infants thermal environment needs adjusting, or whether they require a septic screen. Thus the percentage of readings for each instrument that was within 0.2,0.5and 1 of the gla

29、ss mercury reading was also calculated, as in the study by Leick-Rude and Bloom （1998）.The Pearson product moment correlation co-efficient was also calculated. This measures the strength of a relation between 2 variables. A value of 1 shows perfect positive correlation （Bland and Altman, 1986）.Figur

30、e 1 Suretemp thermometer vs. glass mercury thermometer. Bland-Altman plot. A line indicating the level of the mean difference between the readings allows visualisation of scatter around the mean. Additional lines indicate _2 SD above and below the mean. Figure 2 Lightouch thermometer vs. glass mercu

31、ry thermometer. Bland-Altman plot. A line indicating the level of the mean difference between the readings allows visualisation of scatter around the mean. Additional lines indicate _2 SD above and below the mean.Results Thirty-four infants provided 102 paired readings between the infants own glass

32、mercury thermometer and the Suretemp electronic thermometer.Ninety-seven sets of data were used during the statistical analysis. Five sets of data could not be used either because they were incomplete or because the correct length of time had not been used for temperature measurement with the glass mercury thermometer. Thirty-nine infants provided 101 paired readings between the Lightouch infrared thermometer and glass mercury thermometer. Ninety-two