How is heart monitoring performed? How to prepare for monitoring in elementary school

How to prepare for the Mystery Shopping monitoring.

Why do organizations think about conducting Mystery Shopping monitoring? The answer, at first glance, lies on the surface, but is it really so easy to understand why such research is carried out? Meanwhile, the answer to this question is the basis, the foundation for further work, so it is very important to answer it as honestly as possible.
When I ask this question to our potential Clients, I hear varied and sometimes contradictory answers. The answers depend on what stage of its development the organization is at and on how well the initiator of monitoring understands the essence of the Mystery Shopping method. Among the most common motives when deciding whether to be a “Mystery Shopper”:
 Simple curiosity, which boils down to a lengthy question - how does the work of our employees look in the eyes of customers?
 The desire for retribution - to determine which employees are performing poorly and organize a demonstrative purge of the ranks;
 An attempt to keep up with new trends and technologies and a desire for everything to be “like people”; all advanced people have had “Mystery shopping” for a long time, but are we “redheads”?
 The desire for universal well-being to descend - for employees to be highly motivated, and clients as one, satisfied, loyal, and most importantly, permanent;

Hand on heart, I can say that, by and large, the result of the Mystery Shopping study is information. Necessary, well structured information. This information will be enough to satisfy curiosity, but will not be enough to achieve universal well-being.
When thinking about whether to implement “Mystery Shopping” in your organization, you need to answer the question: Are we ready to do something with the information obtained as a result, how will we manage it, who in our company will work in this direction, do we have enough resources? this employee has the authority to “work on mistakes.” If the answer is no, then save your nerves and finances until better times!

So, Mystery Shopping monitoring is aimed primarily at assessing the quality of service. What does it mean? Every organization has an understanding of how employees should work with clients. This understanding results in the creation of a “service standards” document or remains an understanding not captured in the form of the Talmud, to which the work of employees must comply. But, regardless of whether the company has a document regulating the work of employees with clients or not, management definitely has an understanding of how such work should be structured ideally; all that remains is to get this information from them.

As a result of conducting Mystery Shopping monitoring, it is possible to identify which service standards are met by employees and to what extent. Those. a gap will be visible between the desired situation and what is happening in reality.

If at the time when you came up with the idea of ​​introducing Mystery Shopping monitoring, your company does not have prescribed service standards, this is a good reason to develop them. If to create detailed instructions for employees and their implementation there is no time, resources or desire, what to do in this case, we will definitely talk later.

Service standards answer the question of HOW and WHAT employees should do so that customers are satisfied with the service and become regular customers.
“Mystery shopping” helps to understand WHAT is being done and WHAT is not being done by employees to achieve this goal.

As a result of preparatory thoughts about organizing a Mystery Shopper, it is necessary to answer the following questions:

1. Why do we need information about the quality of service in our company?
2. What will we do with this information?
3. Who will work with the information received and does this employee have the authority to implement changes?
4. Do we have written service standards?
5. Are we ready to take on the development and implementation of such standards and do we have the resources for this?

The next step will be to choose a method for organizing Mystery Shopping monitoring - do it yourself or outsource it, i.e. We will involve a professional organization providing the Mystery Shopping service.
To make a choice, you need to imagine how much work remains and what budget is required to implement such a project using the above-mentioned methods of organization.

Full article in the attached file.

If problems arise with the heart, an electrocardiogram is not always informative. Often it is necessary to record the work of the main muscle of the human body for a longer time. For this, Holter heart monitoring is used.
Why Holter ECG is used and in what cases it is necessary, we will explain in this article.

Holter cardiac monitoring (24-hour ECG monitoring) is a method of continuous recording of an electrocardiogram (ECG) over a 24-hour period or longer using wearable cardiac recorders (monitors).

The essence of the study is to permanently record an ECG on a memory card located in the device. After processing this recording on a computer, the functional diagnostics doctor gives a conclusion about the rhythm, its disturbances, ischemic changes, and the presence of pauses.

The method got its name from the name of the scientist who first used long-term ECG recording in 1952.

What is the method used for?

Before carrying out 24-hour ECG monitoring, the patient should be examined by a therapist or cardiologist. This is necessary for correct design referrals for research, clarification of examination details (for example, discontinuation of medications), formulation of the diagnosis.
Daily ECG monitoring reveals:

• type of heart rhythm and heart rate;
• rhythm disturbances (paroxysmal rhythm disturbances, pauses);
• ischemic ECG changes caused by;
• in some models – heart rate variability.

Daily ECG monitoring is used in the following situations:

• diagnosis for complaints of rapid or slow heartbeat, interruptions in heart function, irregular pulse, episodes of dizziness, severe weakness or loss of consciousness, a feeling of cardiac arrest;
• diagnosis of ischemia ( oxygen starvation) myocardium with complaints of pressing, squeezing, burning pain behind the sternum, especially during exercise, before the appointment, complaints of a feeling of a “lump in the throat”, heartburn, episodes of pain in the lower jaw or elbows;
• monitoring the operation of the installed;
• monitoring the patient's condition over time, including monitoring the effectiveness of treatment.

How to prepare for the procedure?

In the morning before the examination, you must take a hygienic shower. Do not lubricate the skin with anything; it should be dry and clean. Men are strongly recommended to shave their chest hair: this will not only eliminate the painful removal of electrodes, but will also significantly improve the quality of the recording.

If you need to purchase batteries for the monitor, you need to pay attention to the markings. Batteries must be alkaline (alkaline), size AA (“finger”) or AAA (“pinky”).

If the adhesive plaster is poorly tolerated, it is advisable to purchase a special hypoallergenic silk-based plaster at the pharmacy. It will help avoid skin irritation.

Before the examination, it is advisable to get enough sleep, usually have breakfast, and take your time to come to the clinic. The patient will be more comfortable if he wears a tight-fitting T-shirt and loose clothing on top, under which the recorder can be hidden. Women are advised to wear a bra.

How is the examination carried out?

The nurse places round disposable electrodes on the front surface of the chest, securing them with adhesive tape. Most often there are 5 - 7 of them. Wires extend from the electrodes to a small device - a recorder. The recorder is hung on the patient’s neck (less often on the belt) in a special case. After turning on the recorder, ECG recording begins. After this there is no need to touch the monitor. You only need to press any buttons on it when you receive such instructions from the nurse, and this is not mandatory.

The patient is given an observation diary. In it, he must indicate the time of night's sleep (what time he went to bed in the evening, what time he got up in the morning). Some clinics recommend that the patient write down all his actions and sensations during the day. In others, it is recommended to perform several loads.

Most often, the patient is recommended to climb the stairs several times during the day until tired (without unnecessary effort), noting the start time of such a climb and indicating his feelings after the load. Such a diary entry will help the doctor determine the connection between ECG changes and stress and complaints.

If during the day the patient felt interruptions in the work of the heart, rapid heartbeat, dizziness or some other complaints, this should also be noted in the diary. There is no need to write in detail, the main thing is to indicate the time of such complaints.

It is worth noting the timing of medications. There is no need to constantly measure and record blood pressure. It is necessary to note the time of meals, rest, and emotional stress, if they somehow changed how you feel.

The patient should sleep as usual, but not lie on his stomach.

When the electrodes come off, you need to reattach them.

The next morning, the patient returns to the office to remove the monitor. After this, the recording is analyzed by a doctor. This process can take several hours, so most often the result is ready the next day.

During the examination, you must not pass through a metal detector in stores, stadiums, etc. You can use a mobile phone and a computer. X-rays or magnetic resonance imaging of any organs should not be performed. An ultrasound examination is possible as long as it does not affect the chest and interfere with recording.

Indications

1. Complaints of episodes of dizziness, loss of consciousness, heart rhythm disturbances.
2. Examination for previous history of hypertrophic cardiomyopathy and other severe heart diseases.
3. , long QT syndrome.
4. Suspicion of asymptomatic myocardial ischemia.
5. Suspicion of sleep apnea syndrome (a special program for apnea analysis is used).
6. Monitoring the operation of the pacemaker.

Contraindications

24-hour ECG monitoring is not indicated for acute inflammatory diseases skin of the chest. There are no other significant limitations to this study. It can be performed at any age and with any concomitant diseases.

What to do after the study?

Analysis of daily ECG monitoring is a text with many terms, numbers, graphs and images that are difficult to understand for a non-specialist. Therefore, only a doctor can evaluate it correctly. Contact a specialist to clarify the diagnosis, prescribe additional research methods and treatment.

Video on the topic “Holter ECG”

Types of research conducted:

● Daytime video - EEG - monitoring duration 3-6 hours

● Night video - EEG - monitoring duration 12 hours

● 24-hour video - EEG - monitoring duration 24 hours

Long-term video-EEG monitoring (daytime, nighttime, 24-hour) is carried out in a state of wakefulness before and after sleep (active, passive), during sleep, with standard functional tests (rhythmic photostimulation, hyperventilation). The international “10-20” electrode application scheme is used. The format of the study (day, night, daily) is determined by the attending physician.

EEG decoding is carried out within 2-3 days, long-term video EEG monitoring (day, night, daily) - within 4 days (accelerated decoding is possible within 2 days). You will receive a conclusion on the study, a selective printout of EEG curves (separately for wakefulness, sleep and functional tests), as well as a disk with a recording of the entire study (EEG recording synchronized with video streams).

To undergo this examination, hospitalization in a hospital or additional tests, as well as additional certificates or referrals from a doctor are not required.

Read more about the conditions and preparation for video - EEG - monitoring.

Research is carried out around the clock. You need to bring food, pajamas, and slippers with you. Do not forget that covering your child with a blanket while sleeping during the study is highly undesirable. During the examination, the child can move freely around the ward. It is advisable to have an accompanying person with the child who can give detailed description history of the child's illness.

It is also necessary to bring medical documents to the study: previous EEG/video studies - EEG - monitoring: conclusions and printouts of the EEG recording, if available - recording on disk or other electronic media; MRI and/or CT reports and images/discs; extracts from hospitals and/or conclusions of the attending physician (neurologist, epileptologist), data from genetic studies.

What is needed to prepare for video - EEG - monitoring: Video - EEG - monitoring, in addition to long-term recording of wakefulness, must necessarily include recordings during sleep. During night research, this, as a rule, does not cause difficulties; for day research, preparation is necessary - because sleep deprivation: on the eve of the study, it is advisable to significantly reduce the duration of night sleep (go to bed later than the usual bedtime by at least 2 hours and get up in the morning also earlier than the usual time of getting up at least 2 hours), it is very important not to let the child doze off in transport on the way to the study. Also, on the eve of the study, you must wash your hair and do not use hair styling products.

PREPARATION for EEG

The study is carried out as follows: the child sits in a chair for 10-20 minutes (the little one is in the mother’s arms). A cap with a tail of wires is put on the head, the laboratory assistant communicates with the child in the form of an exciting game and carries out the necessary actions (“hide and seek”, “blinking lights”)

* When recording EEG for children (especially preschool age) parents should tell in detail about the methodology for conducting the upcoming study.

* The child must be calm and fed.

* Play with him “astronaut, pilot, diver”, etc.

* Practice putting on a cap (for example, a sports cap) at home

* Learn to breathe deeply with your mother (for example, like a “dog”) - for children from 3 years old.

* It is advisable for parents to have their favorite toy, book, pacifier, and bottle of water with them.

* The study is not carried out in patients with a runny nose or cough.

* The hair on the head must be clean, the skin on the head must not be damaged.

* Children should come for an EEG without earrings.

* The study cannot be performed with hairstyles: American braids, dreadlocks, gel, etc.

* For children under 5 years old, it is advisable to spend time in the first half of the day.

* The clinic performs EEG for children from 0 to 5 years of age in a state of physiological sleep: resting EEG with activation reaction, photostimulation, hyperventilation: EEG with sleep deprivation (cancellation) - performed only as prescribed by a doctor.

* It is also very important, in order to obtain the most complete information about brain function (and not because the child is lying quietly without artifacts), to record EEG in children under 5 years of age in a state of physiological sleep. This condition in children under 5 years of age is most informative for identifying changes in the bioelectrical activity of the brain (dysfunction, immaturity of cortical-subcortical interactions, identifying paroxysmal activity, etc.). Sleep testing is recommended for children at any age in complex diagnostic cases. In case of sleep disturbance and in the presence of convulsions (especially when there are no changes observed during the EEG with a state of wakefulness).

With some preparation, conducting this study will not be difficult: the child arrives with his parents at the time nap(it is important not to let you sleep on the road). Then all that remains is to connect the cap to the device and conduct the examination. If there is a need to come again, which is rare. Parents receive recommendations to wake up the child earlier, take a longer walk with him, and feed him before the examination.

2 - 4 years - 7 hours

4 - 7 years - 6 hours

7 - 10 years - 5 hours

10 years and older less - 4 hours

Requirements for the level of preparation of a 4th grade student Literary reading 1. Know the distinctive features of works of folklore: epics, riddles, tongue twisters, legends, traditions, sayings and proverbs, nursery rhymes, fairy tales, fairy tales. 2. Literary (author's) and folk tales(everyday, magical, about animals). 3. Literary genres: saying, tale, fairy tale, story, play, scientific and artistic work, oral folk art poem fable ballad legend, myth epic story, essay 4. Theme, idea of ​​the work (about children, about the Motherland, about nature, fantasy, etc.) 5. Literary hero (characterize, describe, plot, episode) 6. Finely - expressive means of language: epithet comparison personification hyperbole 7. Reading technique and reading comprehension (120 – 150 words) - determine the topic, structure of the text, main idea work and correlate it with the title; - correlate the main content of the text with illustrations; - establish connections within events; - divide the text into semantic parts and compose a simple retelling; - use types of retelling (selective, brief, detailed) and distinguish between them; - briefly describe the main idea work of art; - describe the heroes of the work (their actions, characters); - express your attitude to the work you read; 8. Reader's horizons: find bibliographic information about the book (author, title page, abstract, table of contents); work with an encyclopedia, dictionary and reference book; know the difference between types of books (reference, educational, popular science) 9. Creative activity students: presentations and short essays on texts literary works; writing riddles, nursery rhymes, sayings, fairy tales; writing reviews about the book you read; Requirements for the level of preparation of a 4th grade student Russian language 1 block “How our language works” 1. Phonetic analysis of the word; 2. Analysis of the word by composition; 3. Preposition, prefix; 4. Morphological characteristics of parts of speech; 5. Main, secondary members of the sentence; 6. The grammatical basis of the sentence; 7. Sentences (types of sentences according to the purpose of the statement and intonation); 8. Homogeneous members of the sentence; 9. Ambiguous words, synonyms, antonyms; 10. Lexical meaning words in the explanatory dictionary. Block 2 “Spelling” 1. Voiced and voiceless consonants; 2. Unpronounceable consonants; 3. Unstressed vowels; 4. Separating ь and ъ sign; 5. Soft sign after hissing nouns at the end; 6. Soft sign after sibilants at the endings of 2nd person singular verbs; 7. Unstressed case endings of nouns and adjectives; 8. Unstressed personal endings of verbs; 9. Adverbs ending in hissing, vowels at the end of adverbs; 10. Punctuation marks at the end of a sentence, a comma between homogeneous members offers. 11. Correcting errors in sentences; 12. Practicing spelling rules. Block 3 “Speech development” Students must distinguish between: - text or non-text. Solve practical and educational problems: - highlight the main idea of ​​the text; - select a title for this text; - correct deformed text; - draw up a text plan, create your own text according to a given plan; - find linguistic means that make the text expressive; - write statements (detailed and concise, selective, with elements of an essay); - write essays (narrative essays, reasoning essays, descriptive essays). Requirements for the level of preparation of a 4th grade student Mathematics Line of arithmetic development: multi-digit numbers (their reading, writing and comparison); four arithmetic operations with numbers within the millions class (including multiplication and division by a three-digit number); properties of actions and their application to calculations. The line of development of the concept of quantity: angle and its designation. Types of angles. types of triangles depending on the size of the angles (acute, rectangular, obtuse). types of triangles depending on the length of the sides (scalene, isosceles, equilateral). exact and approximate values ​​of a quantity (with a deficiency, with an excess). Measurement of length, mass, time, area with a given accuracy. The line of development of logical-mathematical concepts and mathematical relations: complex statements using conjunctions and; or; if, then. Line of algebraic development: expressions with two and three variables are introduced, containing more than one occurrence of the same variable, the values ​​of such expressions are calculated; familiarization with simple equations, finding the root of an equation. Line of the geometric part of the course: geometric figures: flat - polygon, segment, circle, broken line; spatial - ball, cylinder, cone, pyramid, prism; axial symmetry. It is necessary to work on: complex equations (not provided by the program) four arithmetic operations (addition and subtraction within a million, multiplication and division by two-digit and three-digit numbers) properties of actions and their application (combinative, commutative and distributive) solving problems on movement, finding the perimeter, area, one of the sides Requirements for the level of preparation of a 4th grade student The world As a result of studying the course “The World Around us”, students must name (give examples): signs of a living organism; signs characteristic of humans (as opposed to animals); the main organs and systems of human organs and their functions; healthy lifestyle rules; rights of citizens and children in Russia; the main rulers of the Russian state (prince, tsar, first and last emperors); peoples inhabiting Russia; distinguish (correlate): year and century, Arabic and Roman numerals; artificial bodies and natural bodies; good and bad habits; emotional condition and the feelings of others; solve problems in educational and everyday situations: reveal the causes of individual events in the country, the causes of wars, the dates of the main wars in the history of Russia; find out from the text what time this event belongs to; compose a coherent story on the following topics: “Man is a biological being”, “How to be healthy”, “How to develop your memory”, “If trouble happens”, “How man differs from animals”, “Native land”; explain the meaning of the concepts “man is a living organism”, “ healthy image life”, “bad habits”, “state”, “child’s rights”; apply the rules of moral behavior in everyday life; work with geographical and historical maps; complete tasks on the contour map. Need to work out: natural areas our Motherland (where it is located, main features: climate, vegetation, animal world, human occupations) minerals ( appearance, properties: strength, color, application, where they are mined)

An electrocardiogram cannot always detect cardiac pathologies. After all, the study is carried out for a short time and in a state of rest of the patient. 24-hour cardiac monitoring allows the patient to wear a device to record the activity of the main organ. The patient must know the rules for conducting this type of examination and fully comply with them.

Description of the method

Scientist Norman Holter was the first to develop and apply this technique, hence the name - Holter monitoring (or 24-hour heart monitoring). The patient must carry a small mobile recording device (recorder) with him at all times. Special bipolar leads are attached to the chest at the base and apex of the heart.

The entire diagnostic procedure consists of continuously recording heart rhythms, as when taking a cardiogram. The main difference is the duration of daily monitoring. During an ECG, 10-15 seconds are enough to record cardiac capabilities, but this data is often not enough to make an accurate diagnosis. Some pathologies appear periodically, during physical activity or, conversely, only at night.

Indications for testing

In cardiology, the method has been used for more than half a century and allows obtaining reliable data when a simple electrocardiogram does not detect disturbances in the functioning of the heart. There are quite a lot of cases when it is necessary to seek help from this particular diagnostic option. Daily heart monitoring not only reveals various abnormalities, but also allows you to evaluate the performance of the pacemaker.

Indications for using a Holter study include:

• Recent myocardial infarction.
• Heart rhythm disturbances (arrhythmia, tachycardia, angina).
• The patient complains of periodic pain and tingling in the heart area.
• Chronic heart failure.
• Silent ischemia.
• Dizziness of unknown etiology.
• Sudden shortness of breath.
• Chronic circulatory failure.
• Evaluation of the effect of certain medications on cardiac activity.
• Control study after completing a course of therapy.
• Examination before and after surgery.
• Changes in blood pressure.
• Feeling of suffocation and chest pain.

Diagnostics are mandatory for persons whose activities involve a high degree of responsibility (pilots, divers, crane operators, industrial climbers).

Types of examination

Depending on the indications, the doctor must select a specific type of study using the Holter method. Currently, full-scale diagnostics are more often used, in which a device for daily heart monitoring operates on permanent basis within 24 or 48 hours. If necessary, the period can be extended to three days. In the first day alone, the device records up to 120,000 heartbeats. An electrocardiogram allows you to record no more than 50 beats in a short period of time.

The fragmentary type of survey involves continuous or periodic (event) recording. In the first option, recording the state of the heart begins from the moment the patient feels the symptoms of the pathology. To do this, he just needs to press a button on the device. The method is suitable even for cases where the patient has fainted. With daily heart monitoring in a fragmentary manner, the device will record the state of the heart some time before the patient can press the button after regaining consciousness.

The second type of fragmentary examination is necessary for patients in whom signs of cardiac disorders are observed quite rarely. A miniature device for recording information can be worn on the wrist. It is more convenient to use than one that still needs to be attached to the chest when symptoms are detected.

What does 24-hour heart monitoring show?

The Holter device detects any dysfunction of the heart in a variety of situations, not just at rest. This helps to detect the factor causing deviations.

Cardiac arrhythmia, which is characterized by a sudden appearance and disappearance, can be recorded exclusively by 24-hour cardiac monitoring. How is the examination carried out in this case? The most reliable result will be shown by a full-scale study. Thanks to this method, premature contractions of various parts of the heart, paroxysmal tachycardia (a sharp increase in the number of heart beats), and atrioventricular block (failure in the transmission of electrical impulses) are detected.

Carrying out the procedure

In order to obtain valuable and reliable information, it is necessary to correctly attach the electrodes to the chest. The wires coming from them are connected to a small recording device. The recorder itself is small in size and can be attached to a belt. Daily cardiac monitoring should be carried out even during sleep, so the patient must ensure that the device is connected.

Throughout the diagnosis, the patient leads a normal lifestyle, goes to work, and rests. You will also need to keep a diary where the following events that affect the functioning of the heart are recorded:

1. Morning awakening time.
2. Eating foods that can change your heart rate (coffee, strong tea, chocolate).
3. Any physical activity (jogging, climbing stairs).
4. Emotional stress.
5. Taking medications.
6. Bedtime time.

Sometimes doctors specifically prescribe certain actions for the patient, which he must perform and record the time in a diary.

Holter monitoring in pediatrics

Sometimes situations arise when daily heart monitoring for a child is prescribed by doctors (pediatrician, cardiologist) or sports coaches. The reason for this may be the need for a simple examination, for example, for more serious and heavy loads during training, or suspicion of a heart disease. For children, the device does not cause any discomfort and is attached in the same way as in the case of diagnosing the heart function of an adult.

The recorder can be worn around your neck or hidden in your pocket. All wires will be hidden under clothing. The child should maintain a normal daily routine, attend school or kindergarten, walk outside. The device will record the work of the heart under different loads. The method allows you to determine possible deviations in the form of arrhythmia, bradycardia, tachycardia.

Patient preparation

No special preparatory actions are required to prepare for Holter monitoring. An exception is the preliminary manipulations that a man must perform. In order for the device to record true readings, it is necessary to shave the hair from the chest in the place where the electrodes will be attached. This will ensure proper adhesion to the skin.

Patients are interested in what 24-hour heart monitoring looks like and whether any discomfort is felt. There is no need to worry about this, since the electrodes are fixed on an area of ​​skin that has been previously lubricated with a special gel. The method does not cause any painful or unpleasant sensations.

TO general recommendations This includes taking a shower, because on the days of diagnosis, hygiene procedures will be limited. The functionality of the recorder may be somewhat affected by radio devices or a working microwave oven. The patient also needs to sleep on his back (or side) so as not to disturb the placement of the electrodes.

24-hour heart monitoring: what should not be done during the study?

The use of the recording device requires careful handling. Some manipulations can damage it or distort the results of diagnosing cardiac activity. To avoid negative consequences, you must first of all prevent the device from coming into contact with liquid. The mechanism will not withstand the shower test, so during the examination you will have to forget about water procedures for the upper body.

Patients are strictly prohibited from increasing physical activity without a doctor’s prescription! This can lead to serious consequences in the form of a heart attack, surges in blood pressure, and stroke.

The Holter device should be protected from direct exposure sun rays, electromagnetic waves. This can significantly affect the final result of cardiac monitoring. You should choose the right clothing while wearing the device. It is advisable not to wear tight clothes and avoid synthetic material that does not allow air to pass through well. The electrodes will quickly move away from a wet surface.