JP7097678B2 - Monitor management system and biometric information monitor - Google Patents

Description

The present invention relates to a monitor management system for managing a biological information monitor such as a bedside monitor and a biological information monitor.

The biological information monitor can collectively display measured values and waveforms of biological information (for example, electrocardiogram, blood pressure, oxygen saturation, etc.) on the display unit. Examples of biological information monitors include bedside monitors installed and used on the bedside of hospital rooms and central monitors installed and used on nurse stations and the like.

By observing the measured values and waveforms displayed by the biological information monitor, the medical staff (doctors, nurses, etc.) can grasp the patient's condition. Further, since the biological information monitor generally has an alarm function for notifying an abnormality by an alarm sound or the like when an abnormality of a measured value occurs, a medical worker can promptly take appropriate measures in an emergency.

In addition to the above alarm function, the biological information monitor has a function to analyze arrhythmia, a function to display the progress of measured values over a long period (or a long time), or a screen according to the usage environment to be selected and displayed. Various functions such as functions may be added.

Here, the bedside monitor is generally provided with buttons such as "enter bed", "leave bed", "interrupt", and "continue". When the patient enters the bed, the bedside button is operated and the patient name, patient ID, etc. are input, so that the bedside monitor and the patient are linked. When leaving the bed, the exit button is operated, and as a result, the connection between the bedside monitor and the patient is cleared. Further, when the monitoring of biological information is interrupted, the interrupt button is operated, and when the monitoring is resumed, the continuation button is operated. For example, Patent Document 1 describes an operation of entering and leaving the bedside monitor.

Japanese Unexamined Patent Publication No. 2010-0634886

By the way, the patient does not always continue to use one bedside monitor from admission to discharge, and the patient may be transferred to another bedside monitor. Others, such as portable bedside monitors such as trolleys, can be reused in multiple beds.

At this time, if the operation of the bedside monitor is mistaken and the patient information is forgotten to be changed to the patient after the transfer, the patient information and the actual patient will be monitored in different states. Continued monitoring in this state may lead to incidents such as patient death or aggravation.

For example, the following cases can be considered.

<Case 1>
Mr. Ichiro Fukuda is hospitalized in the intensive care unit (ICU) of Hospital A.

He was found lying down at home by his family and was treated by ICU after emergency transportation and emergency surgery.

Mr. Ichiro Fukuda wanted to get into the bed near the nurse station because he was seriously ill among the patients in the ICU, but there was no space, so he went to the farthest bed for the time being, a bedside monitor was attached, and the bedside operation was performed.

The next day, a patient in a bed near the nurse station was transferred to the ward, so Ichiro Fukuda was moved to that bed and a bedside monitor on that floor was attached.

At Hospital A, progress records are recorded in electronic medical records. Normally, the patient ID on the bedside monitor and the patient ID on the electronic medical record are linked, and the data is automatically stored in the electronic medical record from the bedside monitor at regular intervals. It is a mechanism to be sent to.

When the nurse tried to record the progress record in the electronic medical record, it was found that the data of Mr. Ichiro Fukuda was not transmitted on the electronic medical record. When I hurriedly checked the information on the bedside monitor, the name of the previous patient was displayed on the bedside monitor.

When the nurse left the patient on the bedside monitor and changed it to Ichiro Fukuda (that is, Ichiro Fukuda entered the bed) and entered the patient ID correctly, the data was displayed on the electronic medical record. I was sure that.

The cause is that when Mr. Ichiro Fukuda moved to bed, he had to leave the previous patient on the bedside monitor placed at the transfer destination and perform the operation to enter Mr. Fukuda. This was because the continuous operation was performed. This time, nothing happened, but the fact that the patient was a previous patient in setting alarms was regarded as a problem, and it was reported as a case of hiyari hat.

<Case 2>
Hanako Fukuda was hospitalized in the general ward of Hospital B. Hanako had been in the ICU for a while after being treated for her chronic arrhythmia, but moved to the general ward because of the good progress.

In the general ward of Hospital B, the number of beds or bedside monitors, which is smaller than the number of hospital rooms, was used in a reusable manner. The bedside monitor wirelessly sends data to the central monitor. Since it was after heart surgery, I moved the bedside monitor from another room and connected it to Hanako.

Thirty minutes after wearing the bedside monitor, the family came to visit, but the family pointed out that "the name displayed on the instrument is not the daughter's name."

When the nurse confirmed, the patient's name was different as pointed out. Upon examination, it was the name of the previous patient to whom the bedside monitor was attached.

Hospital B did not collect data from the bedside monitor or cooperate with other systems, and operated only with the bedside monitor and the central monitor. In addition, the progress record was entered on paper by visually observing the monitor. Therefore, I used to reuse it without entering the name on the bedside monitor, but it seemed that someone had entered the name and it remained, and I was operating without noticing it.

The present invention has been made in consideration of the above points, and the patient who is associated with the bedside monitor due to carelessness or erroneous operation when entering or leaving the bed and the bedside monitor are actually attached. Provided is a monitor management system and a biometric information monitor that can prevent the patient from remaining different from the patient.

One aspect of the monitor management system of the present invention is
Biometric information measurement unit and
At least, an operation unit that accepts patient entry and exit, interruption and continuation of monitoring,
The biological information stored before the monitoring interruption due to the interruption operation of the operation unit is compared with the biological information measured by the biological information measurement unit after the monitoring is resumed by the continuous operation of the operation unit, and the monitoring is interrupted. A judgment unit that determines whether the previous patient and the patient after resuming monitoring are the same patient,
When the determination unit obtains a determination result that is not the same patient, a notification unit that notifies this fact and a notification unit.
Equipped with
After notifying that the determination result of not being the same patient has been obtained by the notification unit, the patient waits for the operation unit to perform the exit operation and the bed entry operation, and the biological information is provided on condition that these operations are performed. Resume measurement and recording .

One aspect of the biological information monitor of the present invention is
Biometric information measurement unit and
At least, an operation unit that accepts patient entry and exit, interruption and continuation of monitoring,
The biological information stored before the monitoring interruption due to the interruption operation of the operation unit is compared with the biological information measured by the biological information measurement unit after the monitoring is resumed by the continuous operation of the operation unit, and the monitoring is interrupted. A judgment unit that determines whether the previous patient and the patient after resuming monitoring are the same patient,
When the determination unit obtains a determination result that is not the same patient, a notification unit that notifies this fact and a notification unit.
Equipped with
After notifying that the determination result of not being the same patient has been obtained by the notification unit, the patient waits for the operation unit to perform the exit operation and the bed entry operation, and the biological information is provided on condition that these operations are performed. Resume measurement and recording .

According to the present invention, the patient associated with the bedside monitor and the patient actually attached to the bedside monitor remain different due to carelessness or erroneous operation when entering or leaving the bed. You will be able to prevent that.

Schematic diagram showing the overall configuration of the monitor management system according to the embodiment Block diagram showing the basic configuration of the monitor management system of the embodiment The figure which shows the limb lead electrocardiogram The figure which shows the relationship between the pressure waveform of the central venous pressure (FIG. 4A) and the electrocardiogram (FIG. 4B). Diagram showing the relationship between arterial pressure and electrocardiogram A flowchart for explaining the operation of the embodiment.

Hereinafter, embodiments of the present invention will be described with reference to the drawings.

FIG. 1 is a schematic diagram showing an overall configuration of a monitor management system according to an embodiment of the present invention. The monitor management system 100 is arranged in a hospital or the like.

The monitor management system 100 has a plurality of bedside monitors 101, 102, 103, a central monitor 110, and servers 120, 130, which are connected by a LAN (Local Area Network). The connection between the bedside monitors 101, 102, 103 and the central monitor 110 is not limited to a wired connection by LAN, and may be connected by, for example, wirelessly. Further, in FIG. 1, three examples of bedside monitors 101, 102, and 103 are shown, but the number of bedside monitors is not limited to this.

The bedside monitors 101, 102, and 103 measure biometric information such as the patient's electrocardiogram, heart rate, blood pressure, and respiratory rate, respectively, and display the biometric information on the display in the form of numerical values or waveforms. The central monitor 110 receives the biological information measured by the bedside monitors 101, 102, 103 from the bedside monitors 101, 102, 103, and displays and records it on the display. The bedside monitors 101, 102, 103 and the central monitor 110 also have various functions such as alarm output, but the description thereof is omitted here.

The biometric information obtained by the bedside monitors 101, 102, 103 is stored in the servers 120, 130. The server 120 is a server of the filing system, and the server 130 is a server of the core system. In the example of the figure, the case where the biometric information is stored in the server 120 of the filing system and the server 130 of the core system is shown, but the number of servers may be one, and a large number of patients may be stored in the central monitor 110, for example. In the case of a system provided with a large-capacity storage unit capable of storing the biological information of the above, the servers 120 and 130 can be omitted.

FIG. 2 is a block diagram showing a basic configuration of the monitor management system 100 of the embodiment. The monitor management system 100 includes a biological information measurement unit 201, an operation unit 202, a biological information storage unit 203, a determination unit 204, and a notification unit 205. In the present embodiment, the biometric information measuring unit 201, the operating unit 202 and the determination unit 204 are mounted on the bedside monitors 101, 102 and 103, the biometric information storage unit 203 is mounted on the servers 120 and 130, and the notification unit 205 is mounted. It is mounted on the bedside monitors 101, 102, 103 and the central monitor 110. The biological information measurement unit 201, the operation unit 202, the biological information storage unit 203, the determination unit 204, and the notification unit 205 may all be mounted on the bedside monitors 101, 102, 103.

The biological information measuring unit 201 is mounted on the bedside monitors 101, 102, 103, and measures biological information such as an electrocardiogram, a heart rate, a blood pressure, and a respiratory rate of a patient. The measured biological information is stored in the biological information storage unit 203. Specifically, the operation unit 202 is a touch panel of the bedside monitors 101, 102, 103. Buttons such as "enter bed", "leave bed", "interruption", and "continue" are displayed on the touch panel, and medical staff such as doctors and nurses can touch these buttons to operate the bedside monitor 101. , 102, 103 can perform the floor entry operation, the floor exit operation, the interruption operation, and the continuation operation.

Incidentally, the biological information measuring unit 201 starts measuring the biological information when the bed entry operation is performed. Further, the biological information measuring unit 201 ends the measurement of the biological information when the interruption operation or the leaving operation is performed. When the bedside operation is performed, the bedside monitors 101, 102, and 103 clear the patient information set in the bedside operation. Even if the interruption operation is performed, the bedside monitors 101, 102, and 103 continue to hold the patient information set in the bedside operation without clearing it. The biometric information measuring unit 201 resumes the measurement of biometric information when the continuous operation is performed after the interrupted operation is performed.

The determination unit 204 inputs the biological information stored from the biological information storage unit 203 before the monitoring is interrupted, specifically, before the interruption operation by the interrupt button is performed, from the biological information storage unit 203. Further, the determination unit 204 inputs the biological information measured by the information measurement unit 201 when the monitoring is resumed, specifically, when the continuation operation by the continuation button is performed and the monitoring is resumed. Then, the determination unit 204 compares the biological information stored in the biological information storage unit 203 before the monitoring interruption with the biological information measured by the biological information measurement unit 201 after the monitoring is resumed, and before the monitoring interruption. Determine if the patient and the patient after resumption of monitoring are the same patient.

When the determination unit 204 determines that the patient before the interruption of monitoring and the patient after resumption of monitoring are not the same patient, the determination unit 204 notifies the medical staff via the notification unit 205. Specifically, the notification unit 205 is a display unit or a voice output unit of the bedside monitors 101, 102, 103. This allows the healthcare professional to know from the alarm that the patient before the interruption of monitoring and the patient after resumption of monitoring are likely not the same patient (that is, the patient is likely to be mistaken). As a result, the medical staff can match the names and IDs of the patients on the bedside monitors 101, 102, and 103 with the patients who are currently measuring the biometric information by appropriately performing the exit operation and the bed entry operation. Can be done.

Next, the determination process by the determination unit 204 will be described.

The determination unit 204 of this embodiment is
(I) Extremity lead electrocardiogram (I, II, III, aVR, aVL, aVF)
(Ii) Central venous pressure (CVP)
(Iii) The determination is made using any one or two or more of the arterial pressures.

A case of making a judgment using a limb-guided electrocardiogram will be described. As shown in FIG. 3, P wave, Q wave, R wave, S wave, and T wave appear on the electrocardiogram. The P wave indicates the excitatory process of the atrium, the QRS complex indicates the excitement of both the left and right ventricles, and the T wave indicates the repolarization of the ventricular muscle. In the present embodiment, the determination is performed using the PR interval [ms], the QRS interval [ms], the QT interval [ms], and / or the QRS axis [ms]. The determination may be made using all of these four parameters, or the determination may be made using any one or more of them. Of course, the more parameters used for the determination, the higher the accuracy of the determination. The determination unit 204 determines whether or not the patient is the same patient based on how similar these parameters are before the interruption of monitoring and after the resumption of monitoring.

Since the height of the waveform of the electrocardiogram varies greatly depending on the position where the electrodes are attached, the height of the waveform is not used in this embodiment, but the time interval is used for the determination. However, if it is the ratio of the height of the waveform, it is considered that the fluctuation of the height of the waveform due to the change of the electrode attachment position can be ignored. You may use it. As described above, in making the determination, it is important to use a parameter that is less affected by the electrode attachment position.

Further, in order to reduce the influence of the heart rate in the excited state and the sedated state, for example, the ratio of the PR interval and the RT interval may be used for the determination.

Next, a case where the determination is made using the central venous pressure (CVP) will be described. FIG. 4 shows the relationship between the pressure waveform of central venous pressure (FIG. 4A) and the electrocardiogram (FIG. 4B). The A wave of the pressure waveform (peak of right atrial contraction) corresponds to the P wave (atrial contraction) of the electrocardiogram, and the C wave of the pressure waveform (tricuspid valve closure) corresponds to the QRS wave (ventricular contraction) of the electrocardiogram. The waveform V wave (the three-pointed valve opens) corresponds to the electrocardiogram T wave (start of ventricular dilation). Thus, the electrocardiogram and central venous pressure are related to each other. Therefore, for example, it may be determined whether or not the patients are the same based on the AC interval, the CV interval, or the correlation between the AC interval and the CV interval in the central venous pressure before and after the monitoring is interrupted. That is, it is determined whether or not the patients are the same patient based on how similar the AC interval, the CV interval, or the ratio of the AC interval and the CV interval is before the monitoring is interrupted and after the monitoring is resumed.

Further, as shown in FIG. 5, since the arterial pressure is also related to the electrocardiogram, the arterial pressure may be used to determine whether or not the patient is the same patient. For example, it is determined whether or not the patients are the same based on the correlation between the systolic and diastolic ratios in the arterial pressure before and after the monitoring is interrupted. That is, it is determined whether or not the patients are the same based on how similar the ratio between the systole and the diastole is before the interruption of monitoring and after the resumption of monitoring.

FIG. 6 is a flowchart for explaining the operation of the present embodiment.

In step S1, the bedside monitor 101, 102, 103 is used to enter the bed using the operation unit 202. Specifically, the medical staff touches the "enter bed" button on the touch panel, and then the patient name and patient ID are input.

When the bed-entry process in step S1 is completed, various biological information is measured by the biological information measuring unit 201 of the bedside monitors 101, 102, 103 in step S2, and the biological information is stored by the biological information storage unit 203 in step S3. To.

The measurement and storage in steps S1 and S2 are continued until the "interruption" button is operated in the following step S4, and when the "interruption" button is operated, the process proceeds to step S5 and the biometric information by the biometric information measuring unit 201 is operated. Suspend the measurement.

When the "continue" button is operated in the following step S6, the biometric information is measured by the biometric information measuring unit 201 in step S7, and the biometric information is stored by the biometric information storage unit 203 in step S8. That is, the measurement and storage of biological information are resumed.

In step S9, the determination unit 204 measured the biological information measured before the interruption (that is, the biological information stored before the interruption of the measurement in step S5) and the biological information measured after the restart (that is, measured after step S7). It is determined whether or not the biometric information) belongs to the same patient.

When the determination unit 204 determines that the biological information does not belong to the same patient, the monitor management system 100 moves from step S9 to step S10, and the notification unit 205 issues a notification (alarm) notifying that the patient is not the same patient. On the other hand, when the determination unit 204 determines that the biological information belongs to the same patient, the monitor management system 100 returns from step S9 to step S2 and repeats the measurement and storage of the biological information.

In the example of FIG. 6, after the notification in step S10 is given, the process returns to step S2. However, after the notification is given, the patient waits for the medical staff to perform the exit operation and the entry operation. However, it may be configured to restart the measurement and storage of biological information after confirming that these operations have been performed.

If the "continue" button is not operated in step S6, the process proceeds from step S6 to step S11, and it is determined whether or not the "get out" button has been operated. If the "Get out of bed" button is not operated in step S11, the process proceeds from step S11 to step S5 to maintain the measurement interrupted state. That is, after the "suspend" button is operated in step S4, the bedside monitors 101, 102, and 103 maintain the measurement suspension state until the "continue" button or the "get out" button is operated. .. On the other hand, when the "get out" button is operated in step S11, the process moves from step S11 to step S12 to clear the patient information currently set in the bedside monitors 101, 102, 103.

As described above, according to the present embodiment, the biological information stored in the biological information storage unit 203 before the monitoring is interrupted, and the biological information measured by the biological information measuring unit 201 after the monitoring is resumed, By providing a determination unit 204 to determine whether the patient before the interruption of monitoring and the patient after resuming monitoring are the same patient, the bedside monitor is inadvertently or erroneously operated when entering or leaving the bed. It will be possible to prevent the patient associated with the bedside monitor from remaining different from the patient who is actually attached to the bedside monitor.

The above-described embodiment is merely an example of the embodiment of the present invention, and the technical scope of the present invention should not be construed in a limited manner by these. That is, the present invention can be implemented in various forms without departing from its gist or its main features.

In the above-described embodiment, the case where the notification unit 205 for notifying the determination result of not being the same patient is obtained by the determination unit 204 has been described, but the configuration without the notification unit 205 is also used. good. For example, when the patient's name and ID and the patient's biological information are stored in advance in the bedside monitors 101, 102, 103, servers 120, 130, etc., and the determination unit 204 obtains a determination result of not being the same patient. The patient may be configured to search for a patient to which the bedside monitors 101, 102, 103 are currently attached based on the biological information, and automatically set the bedside monitors 101, 102, 103 to the patient.

Further, the biological information to be compared by the determination unit 204 may be the biological information immediately before the interruption of monitoring and the biological information immediately after the restart of monitoring, for example, the average value of the biological information for a predetermined period before the interruption of monitoring. , It may be the average value of biometric information for a predetermined period after resuming monitoring. In particular, immediately after resuming monitoring, it is highly possible that the patient has just moved his / her body, and there is a high possibility that the biological information is in a state of large fluctuation. Therefore, in particular, as the biological information after resuming monitoring, it is preferable to use the average value of the biological information for a predetermined period after resuming monitoring, or the biological information after a predetermined period has elapsed after resuming monitoring.

Further, in the above-described embodiment, the case where the determination is made based on the limb-guided electrocardiogram, the central venous pressure (CVP), and the arterial pressure has been described, but the determination may be made using biological information other than these. .. In short, among the biological information measured by the bedside monitors 101, 102, 103, the determination may be made using the biological information that can identify an individual with a high probability. Here, the probability that an individual can be identified differs depending on the site where the system is used, and in consideration of this, it is preferable to configure the configuration so that which biometric information is used can be changed.

Incidentally, the reason why the electrocardiogram is used in the above-described embodiment is that, for example, although the pulse changes even in the same person, the change in the electrocardiogram waveform itself is small if the person is the same person. In addition to the biological information exemplified in the above-described embodiment, preferred biological information to be used for determination is, for example, carbon dioxide concentration in exhaled breath. In addition, it is considered that biological information on the way of breathing (lung restraint / function) can also be used for personal identification.

In addition, if the individual identification process is performed by comprehensively using a plurality of biological information, the individual can be identified more accurately. An example is shown below. The plurality of biometric information stored in advance before the interruption of monitoring is compared with the plurality of biometric information after resumption of monitoring. The determination unit 204 calculates whether or not the patient is the same patient for each biological information from the threshold value of the difference programmed in advance. If it is determined that the patient is different, +1 point will be given. Then, (total points / number of biometric information) is calculated from the number of biometric information used for comparison and the total points, and if this calculated value is equal to or greater than the specified value, the patient is considered to be a different patient. Depending on what value this specified value is set to, the sensitivity to be regarded as a different patient can be changed. For example, the larger the specified value is from 0 → 0.25 → 0.5 → 0.75, the smaller the sensitivity of treating different patients.

Further, in the above-described embodiment, when the determination unit 204 obtains a determination result that is not the same patient (that is, when there is a high possibility that the patient is mistaken), the bedside monitors 101, 102, and 103 are used. Although the alarm notification is performed to notify that, the central monitor 110 or the server 120 of the filing system may also be notified of the determination result, and the central monitor 110 or the server 120 of the filing system may also be notified of the alarm.

Further, in the above-described embodiment, the case where the bedside monitor is provided with the determination unit 204 for determining whether the patient before the interruption of monitoring and the patient after resumption of monitoring are the same patient, but this determination is not always the case. It is not necessary to perform it on the bedside monitor, and it may be performed on a monitor other than the bedside monitor such as a central monitor or a transport monitor (that is, a portable biometric information monitor), and the result may be sent to the bedside monitor. In this case, the monitor management system compares the biometric information acquisition unit with the biometric information stored before the monitoring is interrupted and the biometric information acquired by the biometric information acquisition unit after the monitoring is resumed, and the monitoring is interrupted. It suffices to have a determination unit for determining whether the previous patient and the patient after resuming monitoring are the same patient.

Further, the present invention is not limited to the bedside monitor, but can be applied to a biological information monitor that requires operations such as bedside operation, bedside operation, interruption operation, and continuous operation.

INDUSTRIAL APPLICABILITY The present invention can be widely applied to a biological information monitor and a monitor management system that require operations such as bed entry operation, bed exit operation, interruption operation, and continuous operation.

100 Monitor management system 101, 102, 103 Bedside monitor 110 Central monitor 120, 130 Server 201 Biometric information measurement unit 202 Operation unit 203 Biometric information storage unit 204 Judgment unit 205 Notification unit

Claims (6)

Biometric information measurement unit and
At least, an operation unit that accepts patient entry and exit, interruption and continuation of monitoring,
The biological information stored before the monitoring interruption due to the interruption operation of the operation unit is compared with the biological information measured by the biological information measurement unit after the monitoring is resumed by the continuous operation of the operation unit, and the monitoring is interrupted. A judgment unit that determines whether the previous patient and the patient after resuming monitoring are the same patient,
When the determination unit obtains a determination result that is not the same patient, a notification unit that notifies this fact and a notification unit.
Equipped with
After notifying that the determination result of not being the same patient has been obtained by the notification unit, the patient waits for the operation unit to perform the exit operation and the bed entry operation, and the biological information is provided on condition that these operations are performed. Resume measurement and recording of
Monitor management system. The determination unit makes the determination by comparing the electrocardiogram stored before the monitoring interruption due to the interruption operation of the operation unit with the electrocardiogram measured after the monitoring is resumed by the continuous operation of the operation unit .
The monitor management system according to claim 1 . The determination unit is the average value of the biological information for a predetermined period after the restart of the monitoring by the continuous operation of the operation unit, or the operation unit as the biological information after the monitoring is restarted by the continuous operation of the operation unit . Comparison is performed using biometric information after a predetermined period has elapsed after resuming monitoring by continuous operation .
The monitor management system according to claim 1 or 2 . Biometric information measurement unit and
At least, an operation unit that accepts patient entry and exit, interruption and continuation of monitoring,
The biological information stored before the monitoring interruption due to the interruption operation of the operation unit is compared with the biological information measured by the biological information measurement unit after the monitoring is resumed by the continuous operation of the operation unit, and the monitoring is interrupted. A judgment unit that determines whether the previous patient and the patient after resuming monitoring are the same patient,
When the determination unit obtains a determination result that is not the same patient, a notification unit that notifies this fact and a notification unit.
Equipped with
After notifying that the determination result of not being the same patient has been obtained by the notification unit, the patient waits for the operation unit to perform the exit operation and the bed entry operation, and the biological information is provided on condition that these operations are performed. Resume measurement and recording of
Biological information monitor. The determination unit makes the determination by comparing the electrocardiogram stored before the monitoring interruption due to the interruption operation of the operation unit with the electrocardiogram measured after the monitoring is resumed by the continuous operation of the operation unit.
The biological information monitor according to claim 4. The determination unit is the average value of the biological information for a predetermined period after the restart of the monitoring by the continuous operation of the operation unit, or the operation unit as the biological information after the monitoring is restarted by the continuous operation of the operation unit. Comparison is performed using biometric information after a predetermined period has elapsed after resuming monitoring by continuous operation.
The biological information monitor according to claim 4 or 5.

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