[Determination of arm circumference for correct measurement of blood pressure. Results of an intervention study]. / La determinación del perímetro braquial para una adecuada medida de la presión arterial. Resultados de un estudio de intervención.

OBJECTIVE: To assess the effectiveness of an intervention to promote standardized arm circumference measurement as way to choose appropriate cuff size to measure blood pressure. PATIENTS AND METHODS: A before-after intervention study was performed in a basic health care area in Barcelona. Doctors, nurses and pharmacy staff participated by filling out an anonymous self-administered questionnaire pre- and post-intervention (3m). Variables included: demographics, type of professional, years since they finished their studies, availability of different cuff sizes, if arm circumference measurement were obtained or not, knowledge about the cutoff values for each cuff size and type of blood pressure monitor. INTERVENTION: The written results were given to the participants and presented in sessions. RESULTS: Pre- and post-intervention: 74.3 and 67.3% answered the questionnaires (P=ns), respectively. Determination of arm circumference varied from 1.3 to 19.1% (P=.009). A total of 37.3% and 44.1% declared that they had 2 or more available cuff sizes (P=ns). Knowledge about the correct measurement of the cuffs was 2.7 to 33.8% regarding the standard cuff size (P=.0198) and 0 to 23.5% for obese subjects (P<.05). When more than one cuff was available, reasons for the choice went from: «making a rough guess¼ or «when velcro stops sticking¼ before and after the intervention. All blood pressure devices in our primary health care center were electronic and automatic as were those of the 9 pharmacies. CONCLUSION: The intervention increased the determination of arm circumference prior to the reading of the blood pressure and the knowledge about the cutoff interval for standard and obese cuff size after intervention. There was greater availability of different sized cuffs. Despite this, the choice of the appropriate cuff size was not made based on arm circumference.

La determinación del perímetro braquial para una adecuada medida de la presión arterial. Resultados de un estudio de intervención / Determination of arm circumference for correct measurement of blood pressure. Results of an intervention study

Objetivo: Evaluar la eficacia de una intervención para promover la determinación del perímetro braquial para seleccionar el manguito adecuado para la toma de la presión arterial. Pacientes y métodos: Estudio de intervención antes-después. Incluyó médicos, enfermeras y personal de oficinas de farmacia de un área básica de salud en Barcelona. Encuesta autoadministrada pre y posintervención (3 m). Variables recogidas: demográficas, tipo de profesional, años desde la finalización de los estudios, disponibilidad de manguitos de diferentes medidas, determinación o no del perímetro braquial, conocimiento o no de los valores de corte para cada manguito y tipo de aparatos de medida. Intervención: entrega de los resultados escritos y presentación en sesiones. Resultados: Pre y posintervención: 74,3 y 67,3% encuestas cumplimentadas (p = ns), respectivamente. La determinación del perímetro braquial varió del 1,3 al 19,1% (p = 0,009). Declararon disponer de 2 o más manguitos de diferente medida el 37,3 y el 44,1% de los encuestados (p = ns). El conocimiento del intervalo de medida correcto de los manguitos fue del 2,7 al 33,8% para el manguito estándar (p = 0,0198) y del 0 al 23,5% para el de obesos (p < 0,05). Cuando disponían de más de un manguito la elección se realizaba por motivos como «a ojo» o «cuando salta el velcro» antes y después de la intervención. La totalidad de los aparatos del centro de atención primaria eran electrónicos automáticos, así como los de 9 farmacias. Conclusión: La intervención aumentó la determinación del perímetro braquial previa a la lectura de la presión arterial y el conocimiento del intervalo de los manguitos estándar y para obesos. Hubo una mayor disponibilidad de manguitos de distinto tamaño. A pesar de ello, la utilización de uno u otro manguito no se realizaba en función de la medida del perímetro braquial

Objective: To assess the effectiveness of an intervention to promote standardized arm circumference measurement as way to choose appropriate cuff size to measure blood pressure. Patients and methods: A before-after intervention study was performed in a basic health care area in Barcelona. Doctors, nurses and pharmacy staff participated by filling out an anonymous self-administered questionnaire pre- and post-intervention (3 m). Variables included: demographics, type of professional, years since they finished their studies, availability of different cuff sizes, if arm circumference measurement were obtained or not, knowledge about the cutoff values for each cuff size and type of blood pressure monitor. Intervention: The written results were given to the participants and presented in sessions. Results: Pre- and post-intervention: 74.3 and 67.3% answered the questionnaires (P = ns), respectively. Determination of arm circumference varied from 1.3 to 19.1% (P = .009). A total of 37.3% and 44.1% declared that they had 2 or more available cuff sizes (P = ns). Knowledge about the correct measurement of the cuffs was 2.7 to 33.8% regarding the standard cuff size (P = .0198) and 0 to 23.5% for obese subjects (P < .05). When more than one cuff was available, reasons for the choice went from: «making a rough guess» or «when velcro stops sticking» before and after the intervention. All blood pressure devices in our primary health care center were electronic and automatic as were those of the 9 pharmacies. Conclusion: The intervention increased the determination of arm circumference prior to the reading of the blood pressure and the knowledge about the cutoff interval for standard and obese cuff size after intervention. There was greater availability of different sized cuffs. Despite this, the choice of the appropriate cuff size was not made based on arm circumference

Estudio transversal comparativo de las fórmulas CKD-EPI y MDRD-4 a partir de la historia clínica informatizada de Atención Primaria de Barcelona / A comparative, cross-sectional study of the CKD-EPI and MDRD-4 equations from the Primary Care computerized clinical history of Barcelona

Antecedentes: La prevalencia de enfermedad renal crónica (ERC) en España supera el 7%. Su diagnóstico precoz puede ayudar a frenar la evolución. En Atención Primaria (AP) se calcula el filtrado glomerular estimado (FGe) mediante fórmulas basadas en la creatinina plasmática(CrP).Objetivos: Comparar los FG e según las fórmulas MDRD-4 y CKD-EPI a partir de la historia clínica informatizada (HCI) y la clasificación de ERC en una población de AP. Material y métodos: Estudio transversal. Se incluyó a pacientes de 20-99 años, asignados a centros de AP de Barcelona, con CrP entre julio de 2008 y junio de 2010. Se obtuvieron losdatos de la HCI. Se calculó el FGe mediante CKD-EPI y MDRD-4.Resultados: Se estudió a un total de 447.140 personas: 58,7% mujeres, 56,6 (DE 18,8) años. El 32,5% con diagnóstico de hipertensión arterial, 11% con diabetes mellitus y 9,3% con enfermedad cardiovascular asociada. La CrP media fue 0,89 (0,28) mg/dL, FGe por MDRD-4 de 80,59(21,04) mL/min/1,73 m2y por CKD-EPI de 85,03 (21,13) mL/min/1,73 m2. La CKD-EPI, respecto a MDRD-4, clasificó el 2,3% de los pacientes en estadios menos avanzados de ERC, el 96,8% en el mismo y el 0,9% en más avanzados. El índice kappa fue de 0,87. En números absolutos clasificó en estadios 3b-4-5 (posible derivación a nefrología) a 958 pacientes más, con 691 personas >69 años en estadio 3b.Conclusiones: Utilizar una u otra fórmula puede variar el FGe. La CKD-EPI tiende a clasificar enestadios más avanzados en > 69 años. El uso de cada fórmula puede hacer cambiar el número y tipo de derivaciones a nefrología

Background: The prevalence of chronic kidney disease (CKD) in Spain is higher than 7%. Its early diagnóstico can help to delay its progression. Glomerular filtration rate (GFR) based on serum creatinine (SC) is calculated in primary care (PC) to identify CKD. Objectives: To compare GFR by MDRD-4 and CKD-EPI equations obtained from clinical records(CR) and to compare the classification of CKD in a primary care population. Material and methods: A cross-sectional study was performed, including patients 20-99 years old, assigned to primary care centers of Barcelona, with a SC recorded between July 2008 and June 2010. Data were obtained from the CRs. GFR was calculated from MDRD-4 and CKD-EPI equations. Results: A total of 447,140 persons were studied (58.7% females, 56.6 [SD 18.8] years old).Of these 32.5% were diagnosed of hypertension, 11.0% diabetes and 9.3% had some associated cardiovascular disease. SC 0.89 (0.28) mg/dL (78.7 [SD 24.8] mol/L), GFR being 80.59(21.04) mL/min/1.73 m2by MDRD-4, and 85.03 (21.13) mL/min/1.73 m2by CKD-EPI. CKD-EPI compared to MDRD-4 classified 2.3% of patients in less advanced stages of CKD, 96.8% in the same stage and 0.9% in more advanced stages. Kappa coefficient: 0.87. In absolute numbers, CKD-EPI classified in 3b-4-5 stages (candidates for referral to nephrology) 958 patients more,691 of them being patients > 69 years old and stage 3b.Conclusions: Using one equation or another could vary the estimation of GFR. CKD-EPI tends to classify patients older than 69 into more advanced stages. Each equation can change the number and type of referral to nephrology (AU)