Preliminary survey report on the clinical validation of in-use electronic sphygmomanometers in China / 中华心血管病杂志

Objective: To explore the percentage of in-use electronic sphygmomanometers independently validated clinically in China. Methods: We conducted a cross-sectional survey and Beijing, Shenzhen, Shijiazhuang, Datong, and Shihezi were selected according to the geographical location and economic level. In each site, one tertiary hospital, two community health centers, and 20 families with electronic sphygmomanometers in use were chosen. The information of electronic sphygmomanometers including brand, model, manufacturer and production date were obtained by the trained staff. Ten electronic sphygmomanometers from each hospital, five electronic sphygmomanometers from each community health center, and one electronic sphygmomanometer from each family were surveyed, and the user's subjective judgment results and judgment basis on the accuracy of the electronic sphygmomanometer measurement were collected. We searched six registration websites (Medaval, Stride BP, dabl Educational Trust, British and Irish Hypertension Society, American Medical Association and Hypertension Canada) and two research databases (PubMed and CNKI) for the clinical validation status of each electronic sphygmomanometer. Results: A total of 200 electronic sphygmomanometers were investigated in this study, of which only 29.0% (58/200) passed independent clinical validation. When stratified by users, the percentage of being clinical validated was 46.0% (23/50) for electronic sphygmomanometers in hospitals, 42.0% (21/50) for those in community health centers and 14.0% (14/100) for those in home use, respectively, and the proportions between the three groups were significantly difference (P<0.001). Doctors in tertiary hospitals and community health service centers judged the accuracy of electronic sphygmomanometers mainly on the basis of "regular correction" (41.0% (41/100)) and "comparison with other electronic sphygmomanometers" (20.0% (20/100)), while among home users, 41.0% (41/100) were not clear about the accuracy of electronic sphygmomanometers, and 40.0% (40/100) made the judgment by "comparison with the devices in hospitals". Conclusion: The clinical validation of in-use electronic sphygmomanometers in China is low. Most of users, including healthcare professionals, are not aware of clinical validation of electronic sphygmomanometers.

A non-contact continuous blood pressure measurement method based on video stream / 生物医学工程学杂志

Hypertension is the primary disease that endangers human health. A convenient and accurate blood pressure measurement method can help to prevent the hypertension. This paper proposed a continuous blood pressure measurement method based on facial video signal. Firstly, color distortion filtering and independent component analysis were used to extract the video pulse wave of the region of interest in the facial video signal, and the multi-dimensional feature extraction of the pulse wave was preformed based on the time-frequency domain and physiological principles; Secondly, an integrated feature selection method was designed to extract the universal optimal feature subset; After that, we compared the single person blood pressure measurement models established by Elman neural network based on particle swarm optimization, support vector machine (SVM) and deep belief network; Finally, we used SVM algorithm to build a general blood pressure prediction model, which was compared and evaluated with the real blood pressure value. The experimental results showed that the blood pressure measurement results based on facial video were in good agreement with the standard blood pressure values. Comparing the estimated blood pressure from the video with standard blood pressure value, the mean absolute error (MAE) of systolic blood pressure was 4.9 mm Hg with a standard deviation (STD) of 5.9 mm Hg, and the MAE of diastolic blood pressure was 4.6 mm Hg with a STD of 5.0 mm Hg, which met the AAMI standards. The non-contact blood pressure measurement method based on video stream proposed in this paper can be used for blood pressure measurement.

Hipertensión arterial en paciente de raza negra: a propósito de un caso / Hypertension in a black patient: a purpose of a case

Hypertension in black patients is usually more frequent and associated with higher morbidity and mortality. Due to demographic changes in the Chilean population, dealing with this group of patients has become more frequent. The case of a young Haitian patient with severe hypertension and target organ damage is presented.

Oscillometric blood pressure measurement in a neonatal intensive care unit: a cross-sectional study

OBJECTIVE: The study aimed to evaluate how neonatal blood pressure measurement with the oscillometric method is performed by a nursing team, including patient preparation, documentation, materials, and equipment. METHOD: This cross-sectional study was conducted in a neonatal intensive care unit (NICU) through direct observation of procedures performed by nursing staff. A systematic script was used for observation and documentation of the procedure, patient reparation, and handling of equipment. The results were analyzed through inferential statistics. RESULTS: In a total of 150 observations, 60% or more of steps were classified as correct in 13 of the 26 target items. There was no difference between RNs and nurse technicians concerning the procedure´s success rate (p = 0.3933). Blood pressure measurement was obtained in the first attempt, according to the procedure´s adequacy (p <0.0001). CONCLUSION: Published recommendations for oscillometric blood pressure measurement were not followed completely. Continuing education should focus on routine procedures to ensure essential aspects of care.

Orthostatic changes in blood pressure and survival in elderly cardiopaths

SUMMARY OBJECTIVE: The objective of this study was to analyze the association between orthostatic changes in blood pressure and mortality in elderly cardiopath patients. METHODS: A cohort of 455 elderly cardiopath patients, monitored at a referral outpatient cardiology clinic in Pernambuco, Brazil, from October 2015 to July 2018. The exposure groups were formed according to their orthostatic changes in blood pressure following the requirements of the Brazilian Guidelines for Hypertension. RESULTS: Orthostatic hypotension was present in 46 patients (10.1%), 91 had orthostatic hypertension (20%), and 318 had no orthostatic alterations (69.9%). There were 52 deaths during follow-up. The results demonstrated that there was no statistically significant association between orthostatic hypotension and overall mortality (HR 1.30; 95%CI 0.53-3.14; p=0.567) nor between orthostatic hypertension and overall mortality (HR 0.95; 95%CI 0.65-1.39; p=0.34). Survival in relation to the exposure groups presented no statistically significant difference (p=0.504). CONCLUSION: There was a low frequency of orthostatic hypotension and a mild high frequency of orthostatic hypertension when compared with previous studies, and no association was observed with overall mortality or with the survival time of elderly patients with heart disease.

Melhorando o controle da pressão arterial com a adoção da automedição da pressão arterial ­ AMPA / Improving blood pressure control with blood pressur self-measurement ­ BPSM

A Automedição da Pressão Arterial (AMPA) tem ganho interesse ultimamente e sua prática pode contribuir para o diagnóstico e seguimento da hipertensão arterial. Em nosso meio, devido a dificuldades de realização da Monitorização Residencial da Pressão Arterial (MRPA) e da indisponibilidade da Monitorização Ambulatorial da Pressão Arterial (MAPA) na maioria dos serviços, a AMPA, que difere dos métodos supracitados, tem uso disseminado em nosso país. Assim, nos parece importante discorrer sobre esse método, tão utilizado e tão pouco estudado. Neste trabalho vamos descrever os métodos de medida de pressão arterial, auscultatório e oscilométrico, além de listar vantagens e desvantagens da medida da pressão arterial no consultório, comparando-as com AMPA. Vamos também fazer um alerta sobre a necessidade de que o paciente receba orientações para a medida da pressão e, por fim, citar as Diretrizes Brasileiras e Europeias no que tange à menção que elas fazem a esse método (AU).

Blood Pressure Self-Measurement (BPSM) has gained interest lately and its practice can contribute to the diagnosis and follow-up of arterial hypertension. In Brazil, due to difficulties in carrying out Home Blood Pressure Monitoring (HBPM) and the unavailability of Ambulatory Blood Pressure Monitoring (ABPM) in most facilities, AMPA, which differs from the aforementioned methods, has widespread use in our country. Therefore, it seems important to discuss this method, which is largely used and poorly studied. In this paper, we will describe the methods for measuring blood pressure, auscultatory and oscillometric, in addition to listing the advantages and disadvantages of measuring blood pressure in the office, comparing them with AMPA. We will also make an alert about the need for the patient to receive guidance on blood pressure measurement and, finally, we will cite the Brazilian and European Guidelines regarding the mention they make about this method (AU).

Miniature Non-invasive Blood Pressure Measurement and Verification System / 中国医疗器械杂志

Mercury sphygmomanometer based on traditional auscultation method is widely used in primary medical institutions in China, but a large amount of blood pressure data can not be directly recorded and applied in scientific research analysis, meanwhile auscultation data is the clinical standard to verify the accuracy of non-invasive electronic sphygmomanometer. Focusing on this, we designed a miniature non-invasive blood pressure measurement and verification system, which can assist doctors to record blood pressure data automatically during the process of auscultation. Through the data playback function,the software of this system can evaluate and verify the blood pressure algorithm of oscillographic method, and then continuously modify the algorithm to improve the measurement accuracy. This study introduces the hardware selection and software design process in detail. The test results show that the system meets the requirements of relevant standards and has a good application prospect.

Comparison of wrist watch type device (GT-103) and oscillometric device for blood pressure measurement following the AAMI/ESH/ISO standards

Background@#Cuffless devices have been studied and developed in the past and in recent years products that employ photoplethysmography became available in the market. However, the vast majority of available product’s accuracy have not yet been studied.@*Objective@#The main objective of this study was to compare a wristwatch device GT 103 to an oscillometric blood pressure device Omron HEM 7120 using the standards set by Association for the Advancement of Medical Instrumentation (AAMI) / The European Society of Hypertension (ESH) Working Group on Blood Pressure / International Organization for Standardization (ISO).@*Methods@#This is a cross sectional study involving blood pressure measurements of 85 individuals using the test device (GT 103) and the reference device (Omron HEM 7120). Demographic characteristics such as age, arm circumference, diagnosis of hypertension, and treatment status were also reported. Sequential blood pressure measurements followed the prescribed steps of AAMI/ESH/ ISO. Paired measurements were statistically treated using the Paired T test. Mean differences of the paired measurements are reported in mean±SD, and proportions of blood pressure differences at ±5mmHg, ±10mmHg, and ±15mmHg are also reported.@*Results@#The mean SBP difference of GT 103 and Omron 7120 was 1.5±20.5mmHg which is not significant (p=0.25) and mean DBP difference of 3±12.6 which is significant (p=0.00017). The result is in accordance with the criterion 1 of ANSI/AAMI/ISO 81060–2:2013 standard requirements (≤5±8 mmHg), but did not fulfil the criterion 2 which requires an SD of less than or equal to 6.47 for SBP and less than or equal to 6.90 mmHg for DBP. The proportion of paired blood pressure readings within ±5mmHg, ±10mmHg, and ±15mmHg were 19.61%, 36.08%, 45.1% for SBP and 30.98%, 56.07%, 69.8% for DBP. This shows that SBP and DBP measurements did not meet the requirement of AAMI/ESH/ISO.@*Conclusions and Recommendations@#This study showed that GT 103 did not fulfill the requirements for acceptable device accuracy. The use of the device for blood pressure measurement is still not recommended by the researcher. Future studies of other similar devices can be done to ensure accuracy of blood pressure measurement.

Human remote mobile medical information collection method based on internet of things and intelligent algorithm / Método de coleta de informações médicas móveis à distância baseado na internet das coisas e no algoritmo inteligente / Métodos de reunión de información sobre telemedicina móvil basados en la red de materia y algoritmos inteligentes

ABSTRACT In the environment of rapid social and economic development, the reform of medical informatization is constantly advancing, and the residents pay more and more attention to their own health status while improving their living standards. The traditional medical service system has some disadvantages in providing real-time, cross regional, long-term and easy-to-operate health services, which has become increasingly inadequate to meet the health needs of users. In order to solve the problem of difficulty in seeing a doctor caused by limited medical resources, and to carry out real-time health monitoring for a large number of groups suffering from chronic diseases and sub-health groups, this study conducted in-depth analysis and experimental exploration on the human remote mobile medical information collection method based on the Internet of things and intelligent algorithm. It established the information collection section by using KbaC clustering algorithm based on ant colony point system which, combined with a comparative study on the health indicators of related groups, has successfully proved that the Internet of things technology and intelligent algorithm for medical information collection and follow-up medical services are of certain positive significance, based on the Internet of things and other related technologies of human remote medical information collection system that can accurately and timely detect the patient's blood pressure, blood sugar and other health data, and then provide corresponding medical services.

RESUMO No ambiente de rápido desenvolvimento do nível social e econômico, a reforma da informatização médica está constantemente avançando, e os residentes prestam cada vez mais atenção ao seu próprio estado de saúde, melhorando ao Mesmo tempo seu padrão de vida. O sistema tradicional de serviços médicos tem algumas desvantagens em fornecer serviços de saúde em tempo real, transfronteiriços, de longo prazo e fáceis de operar, o que vem se tornando cada vez mais inadequado para satisfazer as necessidades de saúde dos usuários. A fim de resolver o problema a da dificuldade em consultar um médico por devido a recursos médicos limitados, e para realizar a monitorização da saúde em tempo real para um grande número de grupos que sofrem de doenças crônicas e subgrupos de saúde, este estudo conduziu uma análise aprofundada e uma exploração experimental sobre o método de coleta de informações médicas móvel à distância humana baseado na Internet das coisas e algoritmo inteligente. Estabeleceu a seção de coleta de informações utilizando o algoritmo de clustering KbaC baseado no sistema de pontos de colônias de formigas que, juntamente com um estudo comparativo sobre os indicadores de saúde dos Grupos conexos, conseguiu provar que a tecnologia da Internet das coisas e o algoritmo inteligente para a coleta de informações médicas e acompanhamento dos serviços médicos têm certa relevância positiva baseada na Internet das coisas e outras tecnologias relacionadas ao sistema de coleta de informações médicas remotas humanas, podendo detectar com precisão e tempo hábil a pressão arterial do paciente, a glicose e outros dados de saúde, e, em seguida, fornecer o serviço médico correspondente.

RESUMEN En un entorno de rápido desarrollo social y económico, la reforma de la informatización médica avanza constantemente y las personas prestan cada vez más atención a su estado de salud mientras mejoran su nivel de vida. El sistema de servicio médico tradicional tiene deficiencias en la prestación de servicios de salud en tiempo real, transregionales, a largo plazo y fáciles de operar, los que se han vuelto cada vez más inadecuados para satisfacer las necesidades de salud de los usuarios. Este estudio realizó un análisis con el objetivo de resolver la dificultad para consultar al médico debido a la limitación de los recursos, y de realizar un seguimiento de la salud en tiempo real de un gran número de grupos que padecen enfermedades crónicas. Dicho trabajo realizó un análisis en profundidad y de exploración experimental acerca del método de recopilación de información médica humana móvil remoto basado en Internet de las cosas y el algoritmo inteligente. Estableció la sección de recopilación de información utilizando el algoritmo de agrupación KbaC basado en el sistema de puntos de colonia de hormigas. Esto, combinado con un estudio comparativo sobre los indicadores de salud de grupos relacionados, ha demostrado con éxito que la tecnología de Internet de las cosas y el algoritmo inteligente para la recopilación y seguimiento de información médica son de importancia positiva, y que pueden detectar de manera precisa y oportuna la presión arterial, el azúcar en sangre y otros datos de salud del paciente, para luego proporcionar la atención médica correspondiente.

Improvement in Semiconductivity On The Measurement Of Blood Pressure After An Educational Intervention In Health Professionals

Abstract Background Measuring blood pressure is a simple method, but it is subject to errors. Objective to evaluate the theoretical and practical knowledge of the steps of blood pressure measurement in health professionals, before and after the educational intervention. Methods The theoretical knowledge questionnaire on indirect blood pressure measurement was used to assess theoretical knowledge; to assess practical knowledge, the simulation strategy was applied in a standardized clinical setting and environment. The assessments were reapplied after one month. For data analysis, descriptive statistics were used. Results 30 health professionals from different categories; 19 of whom were males aged 41 ± 9.4 years and 11 were females aged 35 ± 9.5 years. Improvement was observed in most stages of theoretical and practical knowledge when compared to pre-and post-intervention, with an emphasis on the theoretical stages: "Position of the lower limbs" 2 (6.6%) x 16 (53.3%) and "Forceps with adequate position" 1 (3.3%) x 6 (20%). In the assessment of practical knowledge, it should be highlighted: "Do not speak during the measurement" 6 (20%) x 28 (93.3%) and in the "ideal size clamp" stage 0 (0%) x 5 (16.6 %). Conclusion The theoretical and practical knowledge on the stages of BP measurement by health professionals in this sample was insufficient. However, after the educational intervention, there was an improvement in the technique in most stages. (International Journal of Cardiovascular Sciences. 2020; [online].ahead print, PP.0-0)

Conocimiento de los médicos generales sobre complicaciones obstétricas asociadas a riesgo cardiovascular subsecuente / General practitioners’ knowledge about pregnancy complications associated with long-term cardiovascular risk

Resumen Introducción: La enfermedad cardiovascular (ECV) constituye la principal causa de mortalidad en mujeres; la preeclampsia (PE) y la diabetes mellitus gestacional (DMG) están asociadas a incremento en el riesgo de ECV. Objetivo: Evaluar el conocimiento de los médicos generales (MG) sobre complicaciones obstétricas asociadas a ECV. Métodos: Se envió a los MG un cuestionario electrónico anónimo basado en casos, diseñado para evaluar el entendimiento de la influencia de la historia obstétrica en el riesgo cardiovascular a largo plazo y el conocimiento general sobre riesgo de ECV. Resultados: La tasa de respuesta fue de 35 % (161/465). Los participantes reconocieron que la PE y la DMG son factores de riesgo para ECV (98 y 83 %, respectivamente) y reportaron las siguientes estrategias de tamizaje de ECV en mujeres con historial de PE y DMG: monitoreo de presión arterial (PE 100 %, DMG 46 %), cálculo de índice de masa corporal (PE 68 %, DMG 57 %), evaluación del perfil de lípidos (PE 71 %, DMG 57 %), hemoglobina glucosilada (PE 26 %, DMG 92 %) y glucosa en ayuno (PE 28 %, DMG 91 %). Conclusión: Las estrategias de tamizaje para identificar ECV en mujeres con antecedentes de PE y DMG reportadas por los MG fueron variables.

Abstract Introduction: Cardiovascular disease (CVD) is the leading cause of mortality in women; preeclampsia (PE) and gestational diabetes mellitus (GDM) are associated with an increased risk of CVD. Objective: To evaluate general practitioners (GP) knowledge about complicated pregnancies and their association with CVD. Methods: An anonymous case-based electronic questionnaire designed to assess the level of understanding on the influence of a history of pregnancy complications on long-term cardiovascular risk and general knowledge about CVD risk was sent to GPs. Results: The response rate was 35 % (161/465). The participants recognized that PE and GDM are risk factors for CVD (98 and 83 %, respectively), and reported the following CVD screening strategies in women with a history of PE and GDM: blood pressure monitoring (PE 100 %, GDM 46 %), body mass index calculation (PE 68 %, GDM 57 %), lipid profile evaluation (PE 71 %, GDM 57 %), glycated hemoglobin (PE 26 %, GDM 92 %), and fasting glucose (PE 28 %, GDM 91 %). Conclusion: GP-reported screening strategies to identify CVD in women with a history of PE and GDM were variable.

Elaboration and validation of an educational video on blood pressure measurement in screening programs / Producción y validación de video educativo sobre medida de pressão arterial en programas de detección / Construção e validação de vídeo educativo sobre medida da pressão arterial em programas de rastreamento

ABSTRACT Objective: to produce and validate an educational video on the procedure of indirect blood pressure measurement with the oscillometric technique to support actions of blood pressure screening programs in Brazil. Method: a methodological study consisting in three stages: 1) pre-production of a script/storyboard; 2) content validation by a committee of 16 experts recruited according to their degrees and training in the area of interest of the study; and 3) final production, recording and edition of the educational video. For data collection, three validated instruments were used that allowed the video to be assessed as to its functionality, usability, efficiency, relevance, verbal language, audiovisual technique, environment, content and proposed objectives. The analysis of the quantitative variables was performed by calculating absolute and relative frequencies, and the categorical variables were measured using means and standard deviations. Items that obtained a CVI > 0.75 were considered valid. Results: script validation was performed by eight experts and obtained a CVI of 0.93, while the technical assessment of the educational video and storyboard was performed by three experts and obtained a CVI of 0.97. After accepting the experts' suggestions, the educational video was produced and validated by eight experts, who considered the material valid for application (CVI = 0.94). Conclusion: the educational video produced and validated in this study was characterized as an appropriate strategy for teaching the indirect measurement of blood pressure with the oscillometric technique among health professionals who volunteer to participate in blood pressure screening programs in Brazil.

RESUMEN Objetivo: producir y validar un video educativo sobre el procedimiento de medición indirecta de la presión arterial con técnica oscilométrica para apoyar las acciones de los programas de detección de la presión arterial en Brasil. Método: estudio metodológico compuesto por tres etapas: 1) preproducción de un guion / storyboard; 2) validación de contenido por un comité de 16 especialistas reclutados de acuerdo a sus títulos y calificaciones en el área de interés del estudio; 3) producción final, grabación y edición del video educativo. Para la recolección de datos se utilizaron tres instrumentos validados que permitieron evaluar el video en cuanto a su funcionalidad, usabilidad, eficiencia, relevancia, lenguaje verbal, técnica audiovisual, entorno, contenido y objetivos propuestos. El análisis de las variables cuantitativas se realizó mediante el cálculo de frecuencias absolutas y relativas y las variables categóricas se midieron mediante medias y desviaciones estándar. Se consideraron válidos los ítems que obtuvieron un IVC > 0,75. Resultados: el guion fue validado por ocho especialistas y obtuvo un IVC de 0,93, mientras que la evaluación técnica del video educativo y storyboard realizada por tres especialistas obtuvo un IVC de 0,97. Después de aceptar las sugerencias de los especialistas, el video educativo fue producido y validado por ocho especialistas, quienes consideraron el material válido para su aplicación (IVC = 0,94). Conclusión: el video educativo producido y validado en este estudio se caracterizó como una estrategia adecuada para la enseñanza de la medición indirecta de la presión arterial con técnica oscilométrica entre los profesionales de la salud que se ofrecen como voluntarios para participar en los programas de detección de la presión arterial en Brasil.

RESUMO Objetivo: produzir e validar um vídeo educativo sobre o procedimento da medida indireta da pressão arterial com técnica oscilométrica para apoiar ações de programas de rastreamento da pressão arterial no Brasil. Método: estudo metodológico composto por três etapas: 1) pré-produção de um roteiro/storyboard; 2) validação de conteúdo por um comitê de 16 especialistas recrutados conforme suas titulações e capacitações na área de interesse do estudo; 3) produção final, gravação e edição do vídeo educativo. Para a coleta dos dados foram utilizados três instrumentos validados que permitiram avaliar o vídeo quanto à sua funcionalidade, usabilidade, eficiência, relevância, linguagem verbal, técnica audiovisual, ambiente, conteúdo e objetivos propostos. A análise das variáveis quantitativas foi realizada por cálculo de frequências absolutas e relativas e as variáveis categóricas foram mensuradas por meio de média e de desvio padrão. Foram considerados válidos os itens que obtiveram IVC > 0,75. Resultados: a validação do roteiro foi realizada por oito especialistas e obteve um IVC de 0,93, enquanto a avaliação técnica do vídeo educativo e do storyboard foi realizada por três especialistas e obteve um IVC de 0,97. Após acatadas as sugestões dos especialistas, o vídeo educativo foi produzido e validado por oito especialistas, os quais consideraram o material válido para aplicação (IVC= 0,94). Conclusão: o vídeo educativo produzido e validado neste estudo foi caracterizado como estratégia adequada para o ensino da medida indireta da pressão arterial com técnica oscilométrica entre profissionais da saúde que se voluntariarem a participar de programas de rastreamento da pressão arterial no Brasil.

Pressão arterial sistólica em cães anestesiados: concordância entre mensurações por dois métodos não invasivos / Systolic blood pressure in anesthetized dogs: agreement between measurements by two noninvasive monitors

The oscillometric monitor is a noninvasive method used for measuring blood pressure in dogs and cats. Despite widely used, there is a large variability in the accuracy of oscillometric monitors, which may also be influenced by the location of the blood pressure cuff. The Doppler ultrasound is another non-invasive method that was shown to measure blood pressure with good accuracy and precision in small animals. The present study aimed to determine the agreement between systolic arterial pressure (SAP) measured by the Prolife P12 oscillometric monitor with 2 cuff locations and the Doppler ultrasound in anesthetized dogs. Dogs scheduled for routine anesthetic procedures were included in the study, which was carried out in 2 phases. In Phase 1, SAP values measured by the Doppler were compared with those measured by the Prolife P12 monitor with the cuff placed at the thoracic limb for both methods. In Phase 2, SAP values measured by the Doppler were compared with those measured by the Prolife P12 monitor, with the cuff placed at the thoracic limb for the Doppler and at the base of the tail for the P12. The cuff width corresponded to approximately 40% of limb or tail circumference. On all occasions, 3 consecutive measurements of SAP were recorded, followed by a single measurement of SAP by the P12, and then other 3 measurements were performed with the Doppler. The arithmetic mean of the 6 SAP measurements with the Doppler was compared with the SAP value measured by the P12 monitor (paired measurements). Agreement between SAP values measured by the Doppler and the P12 monitor was analyzed by the Bland Altman method for calculation of the bias (Doppler - P12) and standard deviation (SD) of the bias. The percentages of differences between the methods with an error ≤ 10 mmHg and ≤ 20 mmHg and Pearson's correlation coefficients were also calculated. Results were compared with the criteria from the American College of Veterinary Internal Medicine (ACVIM) for validation of noninvasive blood pressure methods. A total of 33 dogs were included in Phase 1 and 15 were included in Phase 2. During Phases 1 and 2, 179 and 87 paired measurements were recorded, respectively. Most of the measurements were recorded during normotension (SAP = 90-130 mmHg): 113/179 in Phase 1 and 52/87 in Phase 2. The bias (± SD) for Phases 1 and 2 were -2.7 ± 14.1 mmHg and 7.2 ± 25.8 mmHg. The percentages of differences ≤ 10 mmHg and ≤ 20 mmHg were: Phase 1, 61% and 83%; Phase 2, 41% and 70%. Correlation coefficients were 0.81 and 0.67 for Phases 1 and 2, respectively. According to the ACVIM criteria, maximum values accepted for bias are 10 ± 15 mmHg, the percentages of differences ≤ 10 mmHg and ≤ 20 mmHg should be ≥ 50% and ≥ 80%, respectively, and the correlation coefficient should be ≥ 0.9. When the blood pressure cuff was placed at the thoracic limb, SAP values measured by the P12 monitor met most of the ACVIM criteria, demonstrating good agreement with SAP values measured by the Doppler. The only requirement not met was the correlation coefficient which was 0.81 whereas the recommended is ≥ 0.9. Conversely, when the cuff was placed at the base of the tail, SAP values measured by the P12 monitor did not meet most of the ACVIM criteria indicating that, in anesthetized dogs, SAP measurements with the P12 monitor should be performed with the cuff placed at the thoracic limb. One limitation of this study was that most measurements fell in the normotensive range and the results should not be extrapolated for hypotensive and hypertensive conditions. In conclusion, the Prolife P12 oscillometric monitor demonstrated good agreement with SAP values measured by the Doppler and provides acceptable values in normotensive anesthetized dogs.(AU)

Guideline on optimal blood pressure range for Chinese oldest old / 中华预防医学杂志

Hypertension is a major problem of public health that endangers the health of the oldest old. However, the current guidelines for hypertension management do not uniformly diagnose hypertension among the oldest old, nor recommend a normal blood pressure range, which is not convictive enough to support the decision making to the prevention of blood pressure-related adverse events. This guideline gives guiding opinions on optimal blood pressure range for the Chinese oldest old, which applies to the staff of medical and health institutions at all levels nationwide to evaluate the blood pressure levels of the oldest old. It includes the sections of general principles, methods and standards of blood pressure evaluation, measurement conditions, specifications of blood pressure measurement, implementation approaches, etc. The guideline has important directive significance for improving the blood pressure management and decision-making level of the Chinese oldest old.

Medida indireta da pressão arterial em membros inferiores: revisão integrativa / Indirect blood pressure measurement in lower limbs: an integrative review

Introdução: A medida indireta da pressão arterial nos membros superiores, em determinadas situações, pode ser contraindicada, como em casos de utilização de cateteres vasculares, presença de linfedema, Trombose Venosa Profunda (TVP) ou fístulas arteriovenosas. Assim, um local alternativo para a medida da pressão arterial pode ser os membros inferiores, mais especificamente a coxa, a panturrilha ou o tornozelo. Objetivo: Sintetizar o conhecimento sobre a medida indireta da pressão arterial nos membros inferiores. Método: Trata-se de uma revisão integrativa da literatura. A estratégia de busca utilizou os seguintes descritores controlados: Ankle, Arterial Pressure, Blood Pressure, Blood Pressure Determination, Blood Pressure Measurement, Leg, Lower Extremity, Lower limb, Thigh. Sendo adaptada e realizada a busca no mês de junho de 2020, sem limite de período de publicação, em seis bases de dados eletrônicas: Academic Search Premier, CINAHL, Embase, PubMed, LILACS, Scopus e Web of Science. Foram identificadas 3.047 referências, das quais 1.523 duplicatas. Assim, do total de 1.524 citações, 1.478 foram excluídas após a leitura de título e resumo. Dessa forma, 46 estudos primários foram elegíveis para a leitura na íntegra, sendo 34 estudos excluídos, pois não respondiam à questão de pesquisa ou eram estudos de revisão. Adicionalmente, foi realizada a busca manual (handsearching) nas referências dos estudos primários incluídos, a qual resultou na inclusão de 11 estudos primários. A amostra final da revisão foi constituída por 23 estudos primários. Resultados: Os estudos foram analisados e integrados em três categorias temáticas: 1) comparação de valores de PA; 2) comparação de métodos de medida da PA; e 3) recomendações de especialistas. Utilizou-se a classificação de hierarquia dos níveis de evidência para estudos de intervenção proposta por Melnik-Fineout (2010), resultando em 18 estudos classificados como nível de evidência VI e cinco como nível de evidência VII. Quanto às características dos estudos, todos foram publicados no idioma inglês (n=23), sendo 21 publicados pela comunidade médica e dois por profissionais não médicos - um engenheiro e um enfermeiro. Conclusão: A medida da pressão arterial nos membros inferiores pode ser realizada tanto com aparelho aneroide quanto oscilométrico. Na coxa, a literatura enfatiza que se deve utilizar o manguito grande (18 centímetros de largura) e no tornozelo o manguito padrão (12 centímetros de largura), com o paciente em posição supina ou prona. Os valores de diferença média da pressão arterial sistólica encontrados na perna ou no braço variaram de 11,2 a 36,5 milímetros de mercúrio quando comparados nos estudos analisados. Tais resultados sugerem que o tornozelo e a coxa são alternativas viáveis quando a medida indireta da pressão arterial não pode ser realizada no braço, entretanto, não devem ser utilizadas como substitutas devido à discrepância dos valores encontrados e suas importâncias na prática clínica. Nos casos em que o membro inferior for a única opção disponível, a medida da pressão arterial preferencialmente deve ser realizada no tornozelo, dado que, na coxa, há relatos de desconforto e dor, o que pode influenciar nos valores de pressão arterial encontrados

Introduction: The indirect measurement of blood pressure in the upper limbs, in certain situations, may be contraindicated, as in cases of use of vascular catheters, presence of lymphedema, Deep Vein Thrombosis (TVP - Trombose Venosa Profunda) or arteriovenous fistulas. Thus, an alternative location for measuring blood pressure may be the lower limbs, more specifically the thigh, calf or ankle. Objective: To synthesize the knowledge about the indirect measurement of blood pressure in the lower limbs. Method: This is an integrative review of the literature. The search strategy used the following controlled descriptors: Ankle, Arterial Pressure, Blood Pressure, Blood Pressure Determination, Blood Pressure Measurement, Leg, Lower Extremity, Lower Limb, Thigh. The search was adapted and performed in June 2020, with no publication period limit, in six electronic databases: Academic Search Premier, CINAHL, Embase, Pubmed, LILACS, Scopus and Web of Science. 3,047 references were identified, of which 1,523 were duplicates. Thus, out of a total of 1,524 citations, 1,478 were excluded after reading the title and abstract. Thus, 46 primary studies were eligible for reading in their entirety, and 34 studies were excluded because they did not answer the research question or were review studies. Additionally, a handsearching was performed in the references of the primary studies included, which resulted in the inclusion of 11 primary studies. The final sample of the review consisted of 23 primary studies. Results: The studies were analyzed and integrated into three thematic categories: 1) comparison of blood pressure values; 2) comparison of blood pressure measurement methods; and 3) expert recommendations. The classification of hierarchical levels of evidence was used for intervention studies proposed by Melnik-Fineout (2010), resulting in 18 studies classified as evidence level VI and five as evidence level VII. As for the characteristics of the studies, all were published in the English language (n=23), 21 published by the medical community and two by non-medical professionals - an engineer and a nurse. Conclusion: The measurement of blood pressure in the lower limbs can be performed with both aneroid and oscillometric apparatus. In the thigh, the literature emphasizes that one should use the large cuff (18 centimeters wide) and in the ankle the standard cuff (12 centimeters wide), with the patient in supine or prone position. The mean difference of systolic blood pressure found in the leg or arm ranged from 11.2 to 36.5 millimeters of mercury when compared in the studies analyzed. These results suggest that the ankle and thigh are viable alternatives when indirect blood pressure measurement cannot be performed on the arm, however, they should not be used as substitutes due to the discrepancy of the values found and their importance in clinical practice. In cases where the lower limb is the only available option, the measurement of blood pressure should preferably be performed on the ankle, given that, on the thigh, there are reports of discomfort and pain, which may influence the blood pressure values found

O uso de metodologias ativas no ensino das etapas da medida indireta da pressão arterial / The use of active methodologies as teaching strategies on blood pressure measurement

A utilização de metodologias ativas junto ao ensino da medida indireta da pressão arterial tem sido tema ainda pouco discutido na literatura, sobretudo quando trata-se de cursos de graduação nas diferentes áreas da saúde. Alguns cursos de graduação não trazem em seus currículos de forma explicita tal conteúdo. Por se tratar de procedimento tão importante na prática clínica em diferentes áreas do conhecimento, é que este estudo foi desenvolvido. O objetivo deste estudo foi avaliar o conhecimento teórico e prático da medida indireta da pressão arterial por meio de metodologias ativas entre estudantes de graduação dos cursos de Fisioterapia e Medicina. Para tanto realizou-se um estudo quase experimental, desenvolvido em uma universidade privada, no ano de 2020, na cidade de Franca- SP. Que avaliou o conhecimento teórico da medida indireta da PA, pré intervenção educativa, entre estudantes, onde utilizou-se a plataforma de aprendizagem e ensino online, denominada como KAHOOT, com a elaboração de um Quiz, composto por treze questões, realizado em sala de aula, onde os estudantes respondiam por meio do acesso ao aplicativo KAHOOT IT. Imediatamente após a avaliação teórica, realizou-se a avaliação do conhecimento prático da medida indireta da PA entre os participantes, com o uso da simulação realística por meio do Objective Structured Clinical Examination (OSCE). Os estudantes foram encaminhados para os laboratórios de simulação, composto por uma mesa, duas cadeiras, uma pia, sabonete e papel toalha para higienização das mãos, uma fita métrica inextensível, um esfigmomanômetro automático da marca OMRON® HEM-7200, com dois tamanhos de manguito disponíveis, além de um ator, previamente orientado a ficar sentado com as pernas e braços cruzados, e fazer somente o que o examinador lhe solicitasse. Como instrumento de avaliação, utilizouse um checklist, composto por trinta e três itens referentes as etapas da medida indireta da PA, com opções de: S= sim, fez; N= não fez e NA = não se aplica. Após avaliação teórica e prática, realizou-se, em sala de aula, a intervenção educativa onde utilizou-se o recurso da Sala de Aula Invertida denominada: "CONHECIMENTO TEÓRICO-PRÁTICO SOBRE A MEDIDA INDIRETA DA PRESSÃO ARTERIAL", com duração de 4 horas, apresentada no formato de slides seguida de debates e simulação prática para melhor fixação do aprendizado. Após quinze dias da intervenção educativa, os estudantes foram submetidos a reavaliação por meio do KAHOOT e OSCE. As análises descritivas foram realizadas por meio de frequência absoluta e relativa, média e desvio padrão. Para as variáveis que não apresentaram normalidade na distribuição das respostas, utilizou-se o teste de Wilcoxon, na comparação pré e pós intervenção educativa, sobre o conhecimento teórico e prático dos estudantes referentes a medida indireta da PA. O nível de significância de 5% (p<0,05) foi considerado. O estudo obteve aprovação do Comitê de Ética em pesquisa, e aprovado sob o parecer número: 28446920.4.0000.5495. Participaram 81 estudantes, sendo 40 do curso de Fisioterapia, idade média de 21,50+2,20 anos e 41 de Medicina, idade média de 23,13+4,28 anos, matriculados no 5º período de graduação. Os resultados obtidos na avaliação teórica, por meio do KAHOOT, mostraram diferença significativa no total dos itens de acertos (p<0,001), sendo que somente na etapa "posição do paciente" não foi observado diferença estatística (p=0,227) quando comparados pré e pós intervenção educativa. Na análise do conhecimento prático, a partir do checklist utilizado no OSCE, evidenciou melhora significativa após a intervenção educativa em todas as etapas analisadas (p<0,001). Com base nos resultados, este estudo permitiu avaliar o conhecimento teórico e prático da medida indireta da PA, pré e pós intervenção educativa, por meio de metodologias ativas entre estudantes de graduação dos cursos de Fisioterapia e Medicina e pode despertar de forma positiva no âmbito da literatura, o anseio de outros pesquisadores, na tentativa de replicar esta metodologia a fim de proporcionar uma melhoria no ensino, ainda no processo de graduação. Desta maneira, as estratégias de metodologias ativas que envolveram o processo de ensino aprendizagem do conhecimento do procedimento da medida indireta da PA, foi adequado para esta população e acredita-se que o mesmo pode ser readaptado e aplicado em diferentes populações, com o intuito de representar um grande avanço na produção no meio acadêmico, com promoção de melhoria do seu potencial metodológico. Os estudantes são os maiores beneficiários de todos os esforços possíveis na busca e obtenção de melhorias no aprendizado, visto que realizar a medida correta da PA, promoverá, indiscutivelmente, acerto no controle, diagnóstico e tratamento dos pacientes.

The use of active methodologies in the teaching of indirect blood pressure measurement has been a topic that is still little discussed in the literature, especially when it comes to undergraduate courses in different areas of health. Some undergraduate courses do not explicitly include such content in their curricula. Because it is such an important procedure in clinical practice in different areas of knowledge, this study was developed. The aim of this study was to evaluate the theoretical and practical knowledge of indirect blood pressure measurement using active methodologies among undergraduate students of Physiotherapy and Medicine courses. To this end, a quasi-experimental study was carried out at a private university in 2020 in the city of Franca-SP. That evaluated the theoretical knowledge of the indirect BP measurement, pre educational intervention, among students, where the online learning and teaching platform, called KAHOOT, was used, with the elaboration of a Quiz, composed of thirteen questions, carried out in a classroom. Class, where students responded by accessing the KAHOOT IT app. Immediately after the theoretical evaluation, the practical knowledge of the indirect BP measurement was carried out among the participants, using realistic simulation using the Objective Structured Clinical Examination (OSCE). The students were sent to the simulation labs, consisting of a table, two chairs, a sink, soap and paper towels for hand hygiene, an inextensible measuring tape, an OMRON® HEM-7200 automatic sphygmomanometer, with two sizes of cuff available, in addition to an actor, previously instructed to sit with his legs and arms crossed, and do only what the examiner asked. As an assessment tool, a checklist was used, consisting of thirty-three items referring to the steps of the indirect BP measurement, with options: S = yes, it did; N = did not and NA = does not apply. After theoretical and practical evaluation, an educational intervention was carried out in the classroom, using the Inverted Classroom resource called: "THEORETICAL-PRACTICAL KNOWLEDGE ABOUT THE INDIRECT MEASUREMENT OF BLOOD PRESSURE", lasting 4 hours, presented in slide format followed by debates and practical simulation for better learning fixation. After fifteen days of the educational intervention, the students were submitted to reevaluation through KAHOOT and OSCE. Descriptive analyzes were performed using absolute and relative frequency, mean and standard deviation. For variables that did not show normal response distribution, the Wilcoxon test was used, in the comparison before and after educational intervention, on the theoretical and practical knowledge of students regarding indirect BP measurement. The significance level of 5% (p <0.05) was considered. The study was approved by the Research Ethics Committee, and approved under opinion number: 28446920.4.0000.5495. 81 students participated, 40 of whom were in the Physiotherapy course, with an average age of 21.50 + 2.20 years and 41 of Medicine, with an average age of 23.13 + 4.28 years, enrolled in the 5th graduation period. The results obtained in the theoretical evaluation, using the KAHOOT, showed a significant difference in the total number of correct answers (p <0.001), and only in the "patient position" stage was there no statistical difference (p = 0.227) when compared before and post educational intervention. In the analysis of practical knowledge, from the checklist used in the OSCE, it showed significant improvement after the educational intervention in all the analyzed stages (p <0.001). Based on the results, this study made it possible to evaluate the theoretical and practical knowledge of the indirect BP measurement, pre and post educational intervention, through active methodologies among undergraduate students of the Physiotherapy and Medicine courses and can awaken positively within the scope of literature, the desire of other researchers, in an attempt to replicate this methodology in order to provide an improvement in teaching, even in the graduation process. In this way, the strategies of active methodologies that involved the teaching process learning the knowledge of the procedure of indirect BP measurement, was suitable for this population and it is believed that it can be readapted and applied in different populations, in order to represent a major advance in production in academia, promoting the improvement of its methodological potential. Students are the greatest beneficiaries of all possible efforts in the pursuit and improvement of learning, since performing the correct BP measurement will undoubtedly promote success in the control, diagnosis and treatment of patients.

Programas de rastreamento da pressão arterial: relato de experiência / Blood pressure screening programs: a case report / Programas de detección de la presión arterial: un informe de experiencia

Objetivo: relatar a experiência da construção e implementação de Programas de Rastreamento da Pressão Arterial realizados no Brasil entre os anos de 2015 e 2018. Método: relato de experiência conduzido em cinco municípios brasileiros, por meio das etapas: elaboração, cooperação, recrutamento, desenvolvimento, planejamento, treinamento, divulgação, execução e análise. Resultados: para a implementação do rastreamento foram estabelecidas parcerias com instituições públicas e privadas. Estudantes e profissionais de saúde receberam capacitação para realizar a medida da pressão arterial, preencher o instrumento de coleta de dados e orientar os participantes. Um cronograma foi elaborado para atender aos locais, datas, horários, recursos humanos e insumos necessários para a realização das atividades. Os indicadores prevalência, conhecimento, tratamento e controle da hipertensão arterial compuseram a análise descritiva dos dados coletados. Conclusão: os procedimentos metodológicos apresentados neste estudo são capazes de sustentar a construção e a implementação de programas sistematizados de rastreamento da pressão arterial no Brasil.

Objective: To report on the experience of developing and implementing Blood Pressure Screening Programs carried out in Brazil from 2015 to 2018. Method: A case report conducted in five Brazilian cities, covering the following stages: Elaboration, cooperation, recruitment, development, planning, training, dissemination, execution, and analysis. Results: Partnerships with public and private institutions were established for the implementation of the screening. Students and healthcare providers were trained to measure blood pressure, fill out the data collection instrument, and orient the participants. A schedule was prepared to address the locations, dates, times, human resources, and supplies needed to carry out the activities. The indicators prevalence, knowledge, treatment, and hypertension management comprised the descriptive analysis of the collected data. Conclusion: The methodological procedures presented in this study are capable of supporting the development and implementation of systematized blood pressure screening programs in Brazil.

Objetivo: reportar la experiencia de construcción e implementación de Programas de Detección de la Presión Arterial realizada en Brasil entre 2015 y 2018. Método: informe de experiencia realizado en cinco municipios brasileños, a través de los pasos: elaboración, cooperación, reclutamiento, desarrollo, planificación, capacitación, difusión, ejecución y análisis. Resultados: para la implementación del seguimiento se establecieron alianzas con instituciones públicas y privadas. Se capacitó a estudiantes y profesionales de la salud para medir la presión arterial, completar el instrumento de recolección de datos y orientar a los participantes. Se elaboró ​​un cronograma para conocer los lugares, fechas, horarios, recursos humanos e insumos necesarios para realizar las actividades. Los indicadores de prevalencia, conocimiento, tratamiento y control de la hipertensión arterial comprendieron el análisis descriptivo de los datos recolectados. Conclusión: los procedimientos metodológicos presentados en este estudio pueden apoyar la construcción e implementación de programas de detección sistemático de la presión arterial en Brasil.