Youtube as a source of information on "Manual Blood Pressure Measurement"

Objectives: The aim of the study is to evaluate the quality and reliability of videos on manual blood pressure measurement on Youtube. Patients and Methods: In January 2021, the first 100 videos found as a result of a search with the keywords 'manual blood pressure measurement' on Youtube were watched and evaluated. According to exclusion criteria, 75 videos were included in the study. Duplicate videos, irrelevant videos, and videos in languages other than English were excluded from the study. Each video was scored according to the questions prepared based on the guidelines. The GQS score and the 'Reliability' score were used to assess the quality of the videos. Results: According to the checklist prepared according to the hypertension consensus report, the mean score of the videos was 8.33 ± 2.1. When the videos were evaluated according to their sources, the average score of the videos of the health sites was 9±2.5, the average score of the videos of the individual health workers was 8.66±1.8, the average score of the videos of the unidentified people was 7.54±2.1. Conclusion: Manual blood pressure measurement videos on Youtube have little educational value. Videos of health websites should be preferred for education.

Comparison of the manual blood pressure record with ambulatory blood pressure monitoring in young patients found to be hypertensive during routine medical examination before induction to high altitude areas

Background: Ambulatory blood pressure monitoring (ABPM) measurements has been found to be superior to Outpatient Department (OPD) blood pressure measurements (OBPM) for predicting clinical outcomes. There have been various indications of ABPM like to exclude white coat hypertension, evaluation of symptomatic hypotension and hypertension, pregnancy induced hypertension etc. We studied use of ABPM in evaluation of young subjects who were found to be hypertensive in OBPM.Methods: This prospective study was performed at Command Hospital, Kolkata, India from December 2017 to November 2019.This study had a total of 100 subjects. All patients were young healthy individuals and found to have high blood pressure (BP) readings during routine examination done before induction to high altitude areas (>9000 feet). All subjects who were found to be hypertensive in OBPM were evaluated with 24 hours ABPM at least one week after cessation of all medications. Data expressed as the mean±SD. Comparisons of (a) the peripheral hospital mean systolic and diastolic BP over 01 week and (b) 24 hours mean ABPM. Results: In the study, the Mean Systolic BP was 143.33±11.82 with corresponding ABPM 123.92±13.17 which is statistically significant. The mean diastolic BP was 87.30±7.20 mm with corresponding ABPM as 71.55±4.11 MAP in manual blood pressure is 125.55 mm and 103.6 mm in ABPM. The results are highly significant.Conclusions: The study concludes that automated BP recordings may provide a more accurate estimate of a patient's BP status and may prevent unnecessary labelling of young patients as hypertensive.

A Web-based, Smartphone-enabled Algorithm for Calculating Blood Pressure Remotely using Photoplethysmogram (PPG) Waveforms: Observational Study (Preprint)

BACKGROUND The current gold standard instrument for measuring blood pressure is a mercury-filled sphygmomanometer with a cuff and stethoscope. However, this is not convenient or feasible for remote monitoring and virtual care. HeartBeat Technologies Ltd. developed a novel approach to measuring blood pressure remotely after an initial blood pressure reading using the conventional measurement method. Using a finger pulse oximeter, a photoplethysmogram wave (PPG) is transmitted by Bluetooth to a smartphone or tablet. An application called MediBeat on the smartphone transmits the PPG to a server where a proprietary algorithm analyzes it to calculate the person’s current blood pressure level and sends the level back to the smartphone and the device of the individual’s healthcare provider. OBJECTIVE This study sought to determine whether the HeartBeat algorithm calculates blood pressure as accurately as required by the European Society of Hypertension International Protocol revision 2010 (ESH-IP2) for validation of blood pressure measuring devices. METHODS The ESH-IP2, modified to conform to a more recent international consensus statement, was followed. The ESH-IP2 establishes strict guidelines for the conduct and reporting of any validation of any device to measure blood pressure, including using the gold standard manual blood pressure instrument as a comparator and specific required accuracy levels for low, medium and high ranges of blood pressure readings. The consensus statement requires a greater number of study participants for each of the blood pressure ranges. The validation of the accuracy of the algorithm was conducted in conjunction with a Contec CMS50EW pulse oximeter and a Samsung Galaxy XCover 4 smartphone. RESULTS The differences between the HeartBeat-calculated and the manually-measured blood pressures did not meet the ESH-IP2 standards for accuracy for either systolic or diastolic blood pressure measurements. There was no discernible pattern in the inaccuracies in the HeartBeat-calculated measures. CONCLUSIONS The current version of the HeartBeat algorithm, implemented in combination with the MediBeat application, the specific pulse oximeter and the Android smartphones, is not accurate for use in the general population. CLINICALTRIAL This study was registered with ClinicalTrials.gov (ClinicalTrials.gov ID: NCT04082819).

Gagné’s 9 Events of Instruction With Active Learning: Teaching Student Pharmacists How to Measure Blood Pressure

As the scope of practice for pharmacists expands to include rendering physical assessment procedures, colleges and schools of pharmacy are increasingly incorporating various assessment skills into the curriculum. Pharmacy practice faculty are increasingly tasked with teaching and assessing learners on professional competency in entrustable professional activities and skills such as manual blood pressure measurement. Manual measurement using a sphygmomanometer and a stethoscope is considered the gold standard with regard to evaluating blood pressure. As pharmacy faculty begin to develop courses on physical assessment, a step-by-step, evidence-based andragogic/pedagogic method for designing, planning, instructing, and assessing learner proficiency is essential. The principles and techniques of active learning are frequently discussed and increasingly incorporated into the curricular and teaching philosophies of colleges and schools of pharmacy. However, the practical application of andragogic/pedagogic principles toward lesson planning and curation of active learning is infrequently discussed. In this article, we aim to illustrate a deliberate approach to designing and operationalizing active learning for auscultatory manual blood pressure measurement within the framework of Gagné’s 9 events of instruction. For each design and instruction step, we propose user-friendly, high-impact operational practices derived empirically from education science, experience, and observations. Schematically, the approach described is intended to also facilitate instructor metacognition and knowledge building of applied andragogy/pedagogy through pre hoc, ad hoc, and post hoc reflection. Pragmatically, the approach accommodates active learning lesson planning, promotes transparency of teaching and learning, and is generalizable and applicable toward the instruction of various physical assessment procedures within the health professions.

Accuracy of student paramedics when measuring adult respiratory rate: a pilot study

IntroductionAbnormal respiration rate (RR) is commonly undervalued in the out-of-hospital environment despite its use as a predictive marker for physiological decline. The need for paramedicine students to manually measure RR is therefore important. The aims of the study were: 1) to determine the accuracy of manually measured RR when performed by second-year paramedicine students on healthy volunteers in a simulated environment; and 2) to provide data to inform design of a larger study.MethodsThis pilot study utilised a prospective double-blinded observational design, in which neither the participants nor the healthy volunteers knew the specific aim of the study. Paramedicine students manually recorded RR along with a range of vital signs including non-invasive manual blood pressure, heart rate, oxygen saturation, temperature and 4-lead electrocardiogram on healthy volunteers. Capnography was used as the gold standard to confirm observed respiratory rates. Intra-class correlation was used to assess agreement between manual RR and capnography.ResultsThirty-six complete sets of data were recorded. There was strong agreement between paramedicine student and capnography measurements (ICC 0.77; 95% CI 0.54–0.88). Accuracy of paramedicine students to measure RR of the opposite gender showed no statistical difference when female students (F=0.05, p=0.83) or male students (F=0.04, p=0.84) measured.ConclusionThe manual RR measured by paramedicine students agreed well with capnography irrespective of the gender of the patient or paramedicine student. These data suggest the two measurements could be used interchangeably, although the difference between statistical and clinical significance should be further investigated.

Blood Pressure Measurement Error in Children: Lessons in Measurement Reliability

Background and PurposeBlood pressure measurement represents the pressure exerted during heart ejection and filling. There are several ways to measure blood pressure and a valid measure is essential. The purpose of this study was to evaluate the approach to noninvasive blood pressure measurement in children.MethodsBlood pressure measurements were taken using the automatic Phillips MP30 monitor and compared against Welch Allyn blood pressure cuffs with Medline manual sphygmomanometers.ResultsA total of 492 measurements were taken on 82 subjects, and they demonstrated comparability between automatic and manual devices.ConclusionsAlthough our study indicated acceptable agreement between automatic and manual blood pressure measurement, it also revealed measurement error remains a concern, with sample size, study protocol, training, and environment all playing a role.

Masked hypertension incidence and risk factors in a prospective cohort study

Aims Masked hypertension may affect up to 30% of the general population and is associated with a high cardiovascular disease risk. No previous study has examined the incidence of masked hypertension and its risk factors. The study aim was to determine the incidence of masked hypertension and to examine its related risk factors. Methods This is a cohort study including 1836 initially normotensive participants followed up on average for 2.9 years. Blood pressure was measured using Spacelabs 90207. Manual blood pressure was defined as the mean of the first three readings taken at rest. Ambulatory blood pressure was defined as the mean of the next readings recorded every 15 minutes during daytime working hours. Masked hypertension incidence at follow-up was defined as manual blood pressure less than 140 and less than 90 mmHg and ambulatory blood pressure at least 135 or at least 85 mmHg. Generalised estimating equations were used. Results The cumulative incidence of masked hypertension was 10.3% and was associated with male gender (relative risk (RR) 1.51, 95% confidence interval (CI) 1.18–1.94), older age (RR40–49 years 1.56, 95% CI 1.16–2.11, RR≥50 years 1.50, 95% CI 1.06–2.10), higher education (RRcollege 1.31, 95% CI 1.03–1.65), body mass index (RR≥27 1.43, 95% CI 1.11–1.85), smoking (RR 1.51, 95% CI 1.09–2.010) and alcohol intake (RR≥6/week 1.65, 95% CI 1.13–2.03). Conclusion The present study is the first to identify risk factors for the incidence of masked hypertension. Current guidelines for hypertension detection recommend ambulatory blood pressure in patients with an elevated blood pressure reading at the clinic. As it is impractical to measure ambulatory blood pressure in all normotensive patients, factors identified in the present study should be considered for the screening of at-risk individuals and for primary prevention of masked hypertension.