Self-measurement and ambulatory monitoring of blood pressure: a subject's chronobiological perspective.

Population studies show the direct benefit from self-measurement for guiding the treatment of patients with severe hypertension; they also separate groups of children with a positive vs. negative family history of high blood pressure, despite the difficulty of obtaining valid readings during the rest/sleep span, which are needed for a reliable estimation of the circadian parameters. From the viewpoint of preventive maintenance, a 67-year-old woman monitored her blood pressure and heart rate around the clock for 7 days, using concomitantly an ambulatory monitor and a manual instrument. Self-measurement profiles were repeated on several occasions. The results are compared with those of a 62-year-old woman who followed the same initial 7-day protocol. The estimation of the circadian blood pressure pattern differed between the profiles obtained with an ambulatory monitor and by self-measurement. The differences, relatively small in one subject, were much larger for the other subject. Provided the results are chronobiologically analyzed and interpreted in the light of reference limits which are specific to self-measurement series as well as for gender, age and times of sampling, systematic self-measurement of blood pressure may yield a reliable assessment of the circadian variation for some, but not for all, individuals. For those who have been validated in at least one 7-day/24-h profile, occasional automatic ambulatory profiles are tentatively recommended as the main approach, with complementary systematic self-measurement when automatic instruments are scarce. For those with discrepant results, automatic monitoring is invariably recommended.

Cross-validation of a patient classification procedure: an application of the U method.

The objective of this article is to present the methods used for the validation of a patient classification system that was based on the concept of types of care (PCTC system). The PCTC system was developed to improve placement decisions for long-term care patients and also to provide information required for planning in the field of long-term care. A sample of long-term care patients was selected from various institutions/programs and the patients in the sample were assessed and classified by the program practitioners (users) as well as an independent panel (criterion team) composed of a physician, a nurse, and a social worker, using prototype forms specially designed for the project. An objective and empiric classification model was developed by applying discriminant analysis, Bayesian classification procedure, and cluster analysis techniques. The classification validity was evaluated by the use of the R, H, and U methods.

A patient-classification system for long-term care.

A system for patient classification by types of care (referred to in this article as the PCTC system) was developed. The objectives of the system are to improve placement decisions for long-term care patients and to provide information that would be useful for planning and resource allocation in the long-term care field. The PCTC system attempts to resolve placement problems of long-term care patients based on patient care need and a system perspective. A conceptual model based on an assessment/classification/placement sequence is employed. Following a comprehensive assessment of patients' health states and their service requirements, types-of-care classification may be carried out through both subjective/normative and objective/empirical procedures. In an attempt to take into consideration the inherent uncertainty associated with classification procedures, the concept of a PCTC profile is introduced, and to use this profile for making rational placement decisions within environmental constraints, a patient-placement decision model is proposed.