Ewing Tester - Autonomic neuropathy testing system
Ewing Tester - Autonomic neuropathy testing system
 EWING TESTER (installed) |
 EWING TESTER (portable) |
- Sympathetic and parasympathetic tests
- Three-channel built-in ECG module
- Automatic management of examination and analysis
- Adult and child version
- Portable and installed version
The simplest way to characterize the autonomic nervous system functions is the reproducible and standardized cardiovascular reflex tests (CRT) described by Ewing. The examination is based on the analysis of the ECG and blood pressure values recorded continuously during the reflex tests. The first group of the reflex tests (fall of the orthostatic blood pressure, handgrip-test) mainly investigate the sympathetic nervous system functions, the others (heart rate response to deep inspiration and expiration, Valsalva maneuver, 30:15 ratio) deal with the operation of the parasympathetic nervous system.
The importance of examining autonomic neuropathy has become clear by now, but its widespread application was hampered by the time-consuming methods of data registration and evaluation. Our company could solve this problem successfully by creating automatic management of the examination at software level with simultaneous evaluation of data.
System
Patient Manager
This system is used to carry out Ewing’s reflex tests (for the examination of cardiovascular autonomic neuropathy) automatically. High level of integration of the system allows for execution of a series of tests – cooperation of the patient provided – by an assistant, even without a physician being present.
The patient file control panel is used for adding new patients to the database and for archiving the recorded data and further notes belonging to the patients. Digital data management provides the possibility to reload previous recordings and the related information at any time.
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Examination of the parasympathetic and sympathetic functions: 30/15 ratio (heart rate response) and decrease in systolic blood pressure upon standing up -
Examination of the parasympathetic function: Heart rate response to the Valsalva maneuver -
Examination of the parasympathetic function: Heart rate response to the Valsalva maneuver
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Examination of the sympathetic function: Handgrip test (rise in diastolic blood pressure upon sustained tension of the hand muscles)
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Examination of the parasympathetic and sympathetic functions: 30/15 ratio (heart rate response) and decrease in systolic blood pressure upon standing up
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Examination of the parasympathetic and sympathetic functions: 30/15 ratio (heart rate response) and decrease in systolic blood pressure upon standing up
The list of NEUROPATHY TESTS (Ewing’s test) provided by this system:
Examination of the parasympathetic functions:
- Heart rate response to deep inspiration and expiration,
- Heart rate response to the Valsalva maneuver,
- 30:15 ratio: heart rate response upon standing up.
Examination of the sympathetic functions:
- Decrease in systolic blood pressure upon standing up,
- Handgrip test: rise in diastolic blood pressure upon sustained tension of the hand muscles.
 Protocol configuration board |
 Text messages for help of measurements |
 Ewing score table |
 Automatic averaged ECG analysis |
 Printed ECG report |
Configuration of the tests can be done in the Protocol board. Beside the basic protocols found in the literature, further protocols applied successfully at the examination facility can be added and used. All protocols can be modified according to the user’s preferences.
The system gives assistance in performing the sympathetic and parasympathetic tests by written instructions and sound signals. Automatic management and evaluation of the test significantly increases the throughput of patient care and results in higher cost-effectiveness.
The score values calculated by the automatic evaluation, running continuously during the tests, are automatically saved in the summarizing Ewing Score Board. The results – after validation by the physician – can be printed out immediately as a medical report.
The system can be used in Ewing and in ECGmode. Switching between the two is done in the software, thus the two examinations can be applied to the same patient consecutively. The integrated standard three-channel ECG of the system can be used for monitoring or for continuous, cycle- or time-based recording. From the saved data, ECG of the patient can be evaluated and printed out as a medical report by only a few mouse clicks.
Parameters calculated automatically:
R-R, Hr, Pmax, Qmax, Rmax, Tmax, ST, PQ, QRS, QT, QTc, T-Te.
Among the different versions, anyone can find the most suitable one according to the character of the examination facility, since the system is available in installed form (AC network powered) or in portable version (long-life battery powered). The battery powered version can operate on the currently available standard computer configurations, resulting in significant cost reduction for the user.
Specification
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EWING TESTER (installed) |
EWING TESTER (portable) |
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Program run on Windows-based 64-bit OS |
Program run on Windows-based OS |
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Standard 3-ch ECG recording |
Standard 3-ch ECG recording |
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Screen speed: 5, 10, 25 or 50 mm/sec |
Screen speed: 5, 10, 25 or 50 mm/sec |
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Displayed amplitude range: 5, 10, 20 or 50 mm/mV |
Displayed amplitude range: 5, 10, 20 or 50 mm/mV |
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Each input is defibrillator proof |
Each input is defibrillator proof |
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3-lead monitoring: real-time ECG curve monitoring and recording or review of stored records |
3-lead monitoring: real-time ECG curve monitoring and recording or review of stored records |
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Pressure sensor to perform measurements of neuropathy |
Pressure sensor to perform measurements of neuropathy |
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Measuring range of the pressure sensor: 0-200 mm Hg |
Measuring range of the pressure sensor: 0-200 mm Hg |
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Manual and automatic mode |
Manual and automatic mode |
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Continuous ECG monitoring with heart rate display |
Continuous ECG monitoring with heart rate display |
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Baseline drift correction |
Baseline drift correction |
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AC power noise filtering algorithm (50/60Hz) |
AC power noise filtering algorithm (50/60Hz) |
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Muscle motion (tremble, tremor) filtering algorithm |
Muscle motion (tremble, tremor) filtering algorithm |
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Digital sampling |
Digital sampling |
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Sampling frequency: 1000 sample/sec/channel |
Sampling frequency: 1000 sample/sec/channel |
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EWING TESTER (installed) built-in BP module |
EWING TESTER (installed) built-in BP module |
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Configuration and measurement controlled by the software |
Configuration and measurement controlled by the software |
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Blood pressure measurement of infants, children and adults |
Blood pressure measurement of infants, children and adults |
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Oscillometric measurement |
Oscillometric measurement |
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Maximal cuff pressure is 300 mm Hg for adults and 150 mm Hg for infants |
Maximal cuff pressure is 300 mm Hg for adults and 150 mm Hg for infants |
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Real-time measuring, recording, or reviewing the stored data |
Real-time measuring, recording, or reviewing the stored data |
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Pressure measuring ranges for adults: systolicpressure25-280mm Hg,diastolicpressure10-220mm Hg Pressure measuring ranges for infants: systolicpressure20-150 mm Hg,diastolicpressure5-110mm Hg |
Pressure measuring ranges for adults: systolicpressure25-280mm Hg,diastolicpressure10-220mm Hg Pressure measuring ranges for infants: systolicpressure20-150 mm Hg,diastolicpressure5-110mm Hg |
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Manual and automatic mode |
Manual and automatic mode |
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Measurement frequency in automatic mode: 1, 2, 3, 4, 5, 10, 15, 30, 60, 90 min |
Measurement frequency in automatic mode: 1, 2, 3, 4, 5, 10, 15, 30, 60, 90 min |
How can it help?
Cardiovascular autonomic neuropathy (CAN) often occurs in patients with diabetes, liver disease, autoimmune disease, in regular alcohol consumers, but can also occur in people suffering from metabolic syndrome. The importance of CAN is based on the complications threatening the quality of life and life expectancy of the patients. CAN is the most commonly examined form of autonomic nervous system dysfunctions, which is explained – beyond its clinical importance – by the easily performable and reproducible testing methods. The involvement of the autonomic nervous system may also affect cardial electrical activity, including ventricular repolarization. Its signs may also manifest as pathological changes of the surface ECG QT interval. Variable degree of damage in the adrenergic innervation of the myocardium results in the inhomogeneity of sympathetic influence, which can lead to inhomogeneous QT prolongation. Inhomogeneous prolongation of the QT interval, that is, of ventricular repolarization, may predispose to ventricular tachyarrhythmias. Increased QT dispersion is – besides silent myocardial infarction – an important risk factor of sudden cardiac death which can be traced back to malignant ventriculararrhythmia and is common in diabetic patients.
Assessment of the autonomic nervous system functions can be done most easily by the reproducible and properly standardized cardiovascular reflex tests (CRTs) described by Ewing. The examination is based on analysis of the ECG and blood pressure values recorded continuously during the reflex tests. One group of the reflex tests (orthostatic hypotension, handgrip strength test) mainly investigates sympathetic nervous system functions, while others (heart rate response to deep inspiration and expiration, Valsalva maneuver, 30:15 ratio) characterizes the functioning of the parasympathetic nervous system.
The importance of examining autonomic neuropathy has been generally recognized by now. Widespread application of this method was hampered because the methods of registration and evaluation of data were time-consuming. Our company has solved this problem successfully by automating the management of the examination at software level, and enabling simultaneous evaluation of data. Quick and easily identifiable data management provided by the software offers new ways in following-up patients with chronic diseases. Furthermore, this system can be perfectly applied in prevention, since cost-effectiveness and shorter examination time makes it suitable for health status surveys in large populations.
Available models
You find details by clicking on the product code.
Media
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