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1.
Br J Anaesth ; 125(1): 25-37, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32475686

RESUMO

BACKGROUND: Finger cuff technologies allow continuous noninvasive arterial blood pressure (AP) and cardiac output/index (CO/CI) monitoring. METHODS: We performed a meta-analysis of studies comparing finger cuff-derived AP and CO/CI measurements with invasive measurements in surgical or critically ill patients. We calculated overall random effects model-derived pooled estimates of the mean of the differences and of the percentage error (PE; CO/CI studies) with 95%-confidence intervals (95%-CI), pooled 95%-limits of agreement (95%-LOA), Cochran's Q and I2 (for heterogeneity). RESULTS: The pooled mean of the differences (95%-CI) was 4.2 (2.8 to 5.62) mm Hg with pooled 95%-LOA of -14.0 to 22.5 mm Hg for mean AP (Q=230.4 [P<0.001], I2=91%). For mean AP, the mean of the differences between finger cuff technologies and the reference method was ≤5±8 mm Hg in 9/27 data sets (33%). The pooled mean of the differences (95%-CI) was -0.13 (-0.43 to 0.18) L min-1 with pooled 95%-LOA of -2.56 to 2.23 L min-1 for CO (Q=66.7 [P<0.001], I2=90%) and 0.07 (0.01 to 0.13) L min-1 m-2 with pooled 95%-LOA of -1.20 to 1.15 L min-1 m-2 for CI (Q=5.8 [P=0.326], I2=0%). The overall random effects model-derived pooled estimate of the PE (95%-CI) was 43 (37 to 49)% (Q=48.6 [P<0.001], I2=63%). In 4/19 data sets (21%) the PE was ≤30%, and in 10/19 data sets (53%) it was ≤45%. CONCLUSIONS: Study heterogeneity was high. Several studies showed interchangeability between AP and CO/CI measurements using finger cuff technologies and reference methods. However, the pooled results of this meta-analysis indicate that AP and CO/CI measurements using finger cuff technologies and reference methods are not interchangeable in surgical or critically ill patients. CLINICAL TRIAL NUMBER: PROSPERO registration number: CRD42019119266.


Assuntos
Pressão Arterial/fisiologia , Determinação da Pressão Arterial/métodos , Débito Cardíaco/fisiologia , Cuidados Críticos/métodos , Assistência Perioperatória/métodos , Análise de Onda de Pulso/métodos , Determinação da Pressão Arterial/instrumentação , Dedos , Humanos
3.
Vasc Health Risk Manag ; 16: 133-142, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32308406

RESUMO

Objective: A new automated and adjustable blood pressure (BP) system has been developed to improve the accuracy of BP measurements on public-use health stations. This self-fitting BP system includes a mechanical cuff that wraps down to the user's arm prior to bladder inflation. The purpose of this study was to validate the adaptable BP system (ABPS) using the current standards from the Association for the Advancement of Medical Instrumentation (AAMI). Methods: The AAMI/ISO 81060:2013 standards for clinical validation of non-invasive automated arterial BP measurement devices were followed precisely using the same arm sequential method. For each participant, BP was measured over multiple trials by trained observers alternating a reference sphygmomanometer with the ABPS. All study requirements were met with 85 qualifying participants, each with 3 valid paired determinations. Results: The mean difference between ABPS BP and reference BP using all 255 paired determinations was -2.4 ± 7.7 mmHg for systolic and 1.7 ± 5.7 mmHg for diastolic. The standard deviation of the averaged paired determinations per participant was 6.3 mmHg for systolic and 5.2 mmHg for diastolic. Arm circumference measurements had a mean error of -2.1 ± 2.4 cm (R2 = 0.87). A new prediction model for arm circumference was validated using a holdout dataset (R2 = 0.94). Conclusion: The results of the study confirm that the ABPS met all benchmarks established by the AAMI. The device accurately measures BP across a wide range of arm circumferences (24-44 cm) and is suitable for use by individuals to self-monitor BP.


Assuntos
Braço/irrigação sanguínea , Determinação da Pressão Arterial/instrumentação , Pressão Sanguínea , Hipertensão/diagnóstico , Saúde Pública/instrumentação , Adolescente , Adulto , Idoso , Automação , California , Desenho de Equipamento , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Adulto Jovem
4.
Phys Ther ; 100(6): 1008-1019, 2020 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-32232372

RESUMO

Hypertension (HTN) is among the leading global preventable risk factors for cardiovascular disease and premature mortality. Early detection and effective management of HTN have demonstrated significant reductions in mortality, morbidity rate, and health care costs. Furthermore, screening for HTN by nonphysician health care providers improves detection rates and medical management. As physical therapist practice advances to a more independent care model, physical therapists may serve as the first point of contact into the health care system, thereby necessitating a need for routine blood pressure (BP) monitoring. This is especially relevant in the outpatient physical therapist practice setting, where there is evidence for elevated BP measures among patients, yet omission of routine screening in this setting is well documented. Leading physical therapy professional organizations include statements in their guidelines that suggest that physical therapists have a duty to provide a standard of care that protects the safety and optimizes the overall health of patients under their care. Therefore, it is imperative not only that physical therapists include BP examination into routine practice protocols but that the knowledge and skills to accurately measure and interpret BP at rest and during exercise be integrated into the standard of care. The authors suggest that the profession of physical therapy proactively embrace their potential to address the national and worldwide HTN epidemic through routine assessment of BP, appropriate referral for elevated BP measures, and exploration of HTN management by physical therapists.


Assuntos
Assistência Ambulatorial , Determinação da Pressão Arterial , Hipertensão/diagnóstico , Fisioterapeutas , Assistência Ambulatorial/ética , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/ética , Determinação da Pressão Arterial/instrumentação , Determinação da Pressão Arterial/normas , Calibragem , Tomada de Decisão Clínica , Diagnóstico Precoce , Desenho de Equipamento , Exercício Físico/fisiologia , Terapia por Exercício , Humanos , Hipertensão/terapia , Fisioterapeutas/ética , Postura/fisiologia , Encaminhamento e Consulta , Padrão de Cuidado
5.
J Spec Oper Med ; 20(1): 47-54, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32203606

RESUMO

BACKGROUND: Pressure is an important variable in emergency use limb tourniquet science. This study characterizes one system for measuring tourniquet-applied pressure. METHODS: A neonatal blood pressure cuff bladder was inflated to target pressures over atmospheric. Unconstrained or constrained within 1-inch tubular polyester webbing, the neonatal cuff was placed in a 500mL Erlenmeyer flask. A 3-hole stopper provided connections to flask interior (chamber) and bladder pressure sensors and a 60mL syringe for altering chamber pressure: atmospheric to >1500mmHg absolute to atmospheric. RESULTS: Within a finite range of chamber pressures, the neonatal cuffbased system accurately indicates applied pressure (minimum and maximum 95% confidence interval linear regression slopes of 0.9871 to 0.9953 and y-intercepts of -0.1144 to 2.157). The visually defined linear response ranges for bladder inflation pressures were as follows for unconstrained/ constrained: 100 to 400mmHg unconstrained/450mmHg constrained for 10mmHg, 150 unconstrained/100 constrained to 450mmHg for 12mmHg, 150 to 500mmHg for 15mmHg, 150 to 500mmHg unconstrained/550mmHg constrained for 18mmHg, 150 to 550mmHg for 21mmHg. Below the linear response range, the inflated bladder system indicated higher pressures than chamber pressures. Above the linear response range, the system indicated progressively lower pressures than chamber pressures. CONCLUSIONS: Within the linear response range, the bladder pressure accurately indicates surface-applied pressure.


Assuntos
Determinação da Pressão Arterial/instrumentação , Extremidades , Pressão , Torniquetes , Humanos , Reprodutibilidade dos Testes
6.
Eur J Vasc Endovasc Surg ; 59(6): 965-971, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32217116

RESUMO

OBJECTIVE: In patients with peripheral arterial disease (PAD), measurements of distal blood pressure form the basis of assessing the severity of the disease along with symptoms and objective findings. The reliability and accuracy of a fully automated bedside device (SysToe) vs. strain gauge plethysmography (SGP) in patients with low toe pressures in a bedside setting in an outpatient clinic of vascular surgery were investigated. METHODS: This was a prospective, single blinded study carried out in compliance with the Standards of Reporting of Diagnostic Accuracy Studies. A total of 94 outpatients with symptomatic PAD in an outpatient vascular surgery clinic were included and had index measurements performed with the automated bedside device in a bedside setting by observers with no training in routine distal pressure measurements. SGP reference measurements were performed in a vascular laboratory. RESULTS: There was agreement between modalities regarding the diagnostic classification of chronic limb threatening ischaemia (CLTI) in 79/94 (84%) patients. For detection of CLTI, Cohen's kappa was 0.57 with a sensitivity of 94%, specificity of 82%, positive predictive value (PPV) 52%, and negative predictive value (NPV) 98%. On average, the automated bedside device underestimated the pressures, compared with the SGP. The mean difference between SGP and SysToe was 9 ± 16 mmHg for right limbs and 10 ± 16 mmHg for left limbs (p < .001). CONCLUSION: The automated bedside device showed a high sensitivity and a high NPV for excluding CLTI. However, the low PPV may result in overdiagnosis. The automated bedside device may function as a screening tool identifying patients in need of further diagnostics with more accurate equipment, for example SGP.


Assuntos
Determinação da Pressão Arterial/métodos , Isquemia/diagnóstico , Doença Arterial Periférica/complicações , Testes Imediatos , Dedos do Pé/irrigação sanguínea , Idoso , Idoso de 80 Anos ou mais , Determinação da Pressão Arterial/instrumentação , Dinamarca , Feminino , Humanos , Isquemia/etiologia , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar , Pletismografia , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
7.
Obesity (Silver Spring) ; 28(4): 718-723, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32096341

RESUMO

OBJECTIVE: In patients with obesity, it was determined what proportion had an arm slant angle (SA) < 83° and which measure best predicted arm conicity. Patient experience with noninvasive blood pressure measurement was evaluated. METHODS: Arm SA was calculated from arm measurements. Linear regression determined whether BMI, weight, or right midarm circumference (MAC) best predicted conicity. Patient experiences were evaluated by survey and conventional content analysis of free-text comments. RESULTS: One hundred participants had a median (interquartile range; range) BMI of 44.1 (39.1-53.1; 31.1-80.8). Thirty-three (33%) had a right arm SA < 83°. Seven (7%) had a right MAC outside the recommended range. BMI, weight, and the right MAC showed low correlation with and explained little of the variation (with age and sex adjustment) in right arm SA (r = -0.29, -0.27, -0.31; P = 0.003, 0.007, 0.002; R2 = 0.09, 0.08, 0.10). Forty-two (42%) reported noninvasive blood pressure measurement caused severe pain, and 30 (30%) reported skin damage. Themes identified in free-text responses were "problems with equipment," "feelings and experiences," and "concerns about accuracy." CONCLUSIONS: Current equipment is inadequate for patients with obesity based on MAC and conicity. Pain and skin damage contributed to negative experiences of these patients.


Assuntos
Braço/anatomia & histologia , Determinação da Pressão Arterial/instrumentação , Pressão Sanguínea/fisiologia , Obesidade/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
8.
Sensors (Basel) ; 20(1)2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31906383

RESUMO

This paper presents a newly-designed and realized Invasive Blood Pressure (IBP) device for the simulation on patient's monitors. This device shows improvements and presents extended features with respect to a first prototype presented by the authors and similar systems available in the state-of-the-art. A peculiarity of the presented device is that all implemented features can be customized from the developer and from the point of view of the end user. The realized device has been tested, and its performances in terms of accuracy and of the back-loop measurement of the output for the blood pressure regulation utilization have been described. In particular, an accuracy of ±1 mmHg at 25 °C, on a range from -30 to 300 mmHg, was evaluated under different test conditions. The designed device is an ideal tool for testing IBP modules, for zero setting, and for calibrations. The implemented extended features, like the generation of custom waveforms and the Universal Serial Bus (USB) connectivity, allow use of this device in a wide range of applications, from research to equipment maintenance in clinical environments to educational purposes. Moreover, the presented device represents an innovation, both in terms of technology and methodologies: It allows quick and efficient tests to verify the proper functioning of IBP module of patients' monitors. With this innovative device, tests can be performed directly in the field and faster procedures can be implemented by the clinical maintenance personnel. This device is an open source project and all materials, hardware, and software are fully available for interested developers or researchers.


Assuntos
Determinação da Pressão Arterial/instrumentação , Monitores de Pressão Arterial , Pressão Sanguínea/fisiologia , Monitorização Fisiológica/instrumentação , Determinação da Pressão Arterial/métodos , Calibragem , Desenho de Equipamento , Humanos , Monitorização Fisiológica/métodos , Software
9.
Adv Exp Med Biol ; 1232: 315-322, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893426

RESUMO

We present an unobtrusive cuff-less sphygmomanometer based on contact-type and optical pulse sensors for continuous and minimally invasive monitoring of blood pressure (BP). We developed a cuff-less sphygmomanometer that utilizes the pulse arrival time (PAT) to estimate continuous BP. To assess its accuracy, we recruited 10 healthy subjects in whom we carried out BP studies using the cuff-less sphygmomanometer compared with a standard cuff-type device in a stationary sitting patient. Preliminary results showed that the mean difference (MD) of estimated systolic blood pressure and diastolic blood pressure were 0.96 ± 9.6 (mean ± SD) mmHg and 1.14 ± 7.5 mmHg, respectively, compared to the control. The corresponding correlation between the estimated BP values and controls were 0.78 for systolic blood pressure (p < 0.01) and 0.69 for diastolic blood pressure (p < 0.01); thus, there were significant correlations. These results suggest that the developed cuff-less sphygmomanometer has the potential for continuous BP monitoring. Finally, we conducted a preliminary study of simultaneous monitoring of cuff-less BP and near-infrared spectroscopy to evaluate the potential for assessment of autonomic nervous system functions during mental stress tasks.


Assuntos
Determinação da Pressão Arterial , Esfigmomanômetros , Adulto , Sistema Nervoso Autônomo/fisiologia , Pressão Sanguínea , Determinação da Pressão Arterial/instrumentação , Eletrocardiografia , Frequência Cardíaca , Humanos , Masculino , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/normas , Esfigmomanômetros/normas , Adulto Jovem
10.
Clin Exp Hypertens ; 42(2): 131-138, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30887842

RESUMO

This study aimed to examine the associations between home blood pressure (HBP) and sleep and activity assessed using data obtained via a wristwatch-type pulsimeter with accelerometer (Pulsense®) using original software. We recruited 28 elderlies and 40 employees aged 24-81 years who were not on hypotensive agents and sleeping drugs. Sleep, activity, and HBP were measured consecutively over a 5-7-day period. Body mass index (BMI), base heart rate (HR0), and age showed significant correlation with HBP in a simple and multiple linear regression analysis. HR0 was positively, and log deep sleep duration, negatively correlated with HBP in the adjusted multiple linear regression analysis. Physical and mental activities were negatively correlated with systolic blood pressure (SBP) in a simple linear regression, but high physical and mental activities tend to reduce deep sleep duration. Self-recorded sleep duration had no relationship with HBP. In conclusion, HR0, BMI, age, deep sleep duration, and activity showed relationships with HBP. Using this type of wristwatch and observing daily sleep and activity data with HBP measurement may have important clinical implication.


Assuntos
Determinação da Pressão Arterial/instrumentação , Pressão Sanguínea/fisiologia , Hipertensão/fisiopatologia , Acelerometria , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Determinação da Pressão Arterial/métodos , Índice de Massa Corporal , Feminino , Frequência Cardíaca/fisiologia , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/psicologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Análise de Regressão , Sono/fisiologia , Adulto Jovem
12.
Anaesthesia ; 75(1): 37-44, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31556454

RESUMO

The inflationary non-invasive blood pressure monitor (iNIBP™) uses a new measurement method, whereby the cuff is slowly inflated whilst simultaneously sensing oscillations, to determine the diastolic blood pressure first and then the systolic pressure. It may measure blood pressure more quickly than the conventional non-invasive blood pressure monitor. We studied 66 patients undergoing general anaesthesia, comparing the time taken to measure the blood pressure between the two monitors at times when there were marked changes (increases or decreases by 30 mmHg or greater) in the systolic blood pressure. The median (IQR) [range]) time was significantly longer for the non-invasive blood pressure monitor (38.8 (31.5-44.7) [18.0-130.0] s) than for the iNIBP (14.6 (13.7-16.4) [11.5-35.5] s), p = 0.001, 95%CI for difference 22-25 s). We also studied 30 volunteers to evaluate the accuracy of the iNIBP, comparing it with the mercury sphygmomanometer. There was good agreement between the two monitors, with a mean difference of 0 (95% limit of agreement -12 to 11) mmHg for the systolic blood pressure. We also compared the degree of pain during cuff inflation between the automated non-invasive blood pressure and iNIBP monitors. Pain was significantly more for the non-invasive blood pressure monitor (22 of 30 volunteers had less pain with the iNIBP). We have shown that the iNIBP measured the blood pressure quicker than the conventional non-invasive blood pressure monitor and the speed of measurement was not significantly affected by marked changes in the blood pressure.


Assuntos
Determinação da Pressão Arterial/instrumentação , Determinação da Pressão Arterial/métodos , Estudos Cross-Over , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Fatores de Tempo
13.
Rev Bras Enferm ; 72(suppl 3): 162-169, 2019 Dec.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31851249

RESUMO

OBJECTIVE: to compare blood pressure values obtained by auscultatory and oscillometric methods in different gestational periods, considering cuff width. METHOD: it is a cross-sectional and quasi-experimental study approved by the Research Ethics Committee. The sample consisted of 108 low-risk pregnant women. Blood pressure measurements were performed in gestational periods of 10-14, 19-22 and 27-30 weeks. RESULTS: The oscillometric device presented values similar to the auscultatory method in systolic blood pressure, but overestimated diastolic blood pressure. Underestimation of blood pressure occurred when using the standard width cuff rather than the correct width cuff in both measuring methods. CONCLUSION: Verification of brachial circumference and use of adequate cuffs in both methods are indispensable to obtain reliable blood pressure values in pregnant women. We recommend performance of additional studies to evaluate diastolic blood pressure overestimation by the Microlife 3BTO-A.


Assuntos
Determinação da Pressão Arterial/instrumentação , Oscilometria/instrumentação , Gestantes , Adulto , Auscultação/instrumentação , Auscultação/métodos , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/normas , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Pessoa de Meia-Idade , Oscilometria/métodos , Oscilometria/normas , Gravidez
14.
Am J Vet Res ; 80(12): 1067-1073, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31763937

RESUMO

OBJECTIVE: To compare results of a commercially available device for oscillometrically measured blood pressure (OBP) with invasively measured blood pressure (IBP) in awake and anesthetized dogs. ANIMALS: 19 adult dogs (mean ± SD body weight, 17.8 ± 7.5 kg). PROCEDURES: Blood pressures were measured in dogs while they were awake and anesthetized with isoflurane. The OBP was recorded on a thoracic limb, and IBP was simultaneously recorded from the median caudal artery. Agreement between OBP and IBP was evaluated with the Bland-Altman method. Guidelines of the American College of Veterinary Internal Medicine (ACVIM) were used for validation of the oscillometric device. RESULTS: In awake dogs, mean bias of the oscillometric device was -11.12 mm Hg (95% limits of agreement [LOA], -61.14 to 38.90 mm Hg) for systolic arterial blood pressure (SAP), 9.39 mm Hg (LOA, -28.26 to 47.04 mm Hg) for diastolic arterial blood pressure (DAP), and -0.85 mm Hg (LOA, -40.54 to 38.84 mm Hg) for mean arterial blood pressure (MAP). In anesthetized dogs, mean bias was -12.27 mm Hg (LOA, -47.36 to 22.82 mm Hg) for SAP, -3.92 mm Hg (LOA, -25.28 to 17.44 mm Hg) for DAP, and -7.89 mm Hg (LOA, -32.31 to 16.53 mm Hg) for MAP. The oscillometric device did not fulfill ACVIM guidelines for the validation of such devices. CONCLUSIONS AND CLINICAL RELEVANCE: Agreement between OBP and IBP results for awake and anesthetized dogs was poor. The oscillometric blood pressure device did not fulfill ACVIM guidelines for validation. Therefore, clinical use of this device cannot be recommended.


Assuntos
Anestesia/veterinária , Determinação da Pressão Arterial/instrumentação , Monitores de Pressão Arterial/veterinária , Oscilometria/veterinária , Animais , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/normas , Monitores de Pressão Arterial/normas , Cães , Feminino , Membro Anterior , Masculino , Oscilometria/instrumentação , Oscilometria/normas , Vigília
15.
Sensors (Basel) ; 19(23)2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31766391

RESUMO

Fiber Bragg grating (FBG) sensors fabricated in silica optical fiber (Silica-FBG) have been used to measure the strain of human arteries as pulse wave signals. A variety of vital signs including blood pressure can be derived from these signals. However, silica optical fiber presents a safety risk because it is easily fractured. In this research, an FBG sensor fabricated in plastic optical fiber (POF-FBG) was employed to resolve this problem. Pulse wave signals were measured by POF-FBG and silica-FBG sensors for four subjects. After signal processing, a calibration curve was constructed by partial least squares regression, then blood pressure was calculated from the calibration curve. As a result, the POF-FBG sensor could measure the pulse wave signals with an signal to noise (SN) ratio at least eight times higher than the silica-FBG sensor. Further, the measured signals were substantially similar to those of an acceleration plethysmograph (APG). Blood pressure is measured with low error, but the POF-FBG APG correlation is distributed from 0.54 to 0.72, which is not as high as desired. Based on these results, pulse wave signals should be measured under a wide range of reference blood pressures to confirm the reliability of blood pressure measurement uses POF-FBG sensors.


Assuntos
Determinação da Pressão Arterial/instrumentação , Pressão Sanguínea/fisiologia , Frequência Cardíaca/fisiologia , Plásticos/química , Algoritmos , Calibragem , Humanos , Análise dos Mínimos Quadrados , Fibras Ópticas , Fenômenos Físicos , Reprodutibilidade dos Testes , Processamento de Sinais Assistido por Computador/instrumentação
16.
Artigo em Inglês | MEDLINE | ID: mdl-31703325

RESUMO

Blood pressure cuffs (BP cuffs) have been implicated in some nosocomial outbreaks. We compared the efficacy of an ethanol-based hand sanitizer (EBHS) with a detergent/disinfectant for the disinfection of BP cuffs. The inner sides of 30 BP cuffs were sampled for bacterial culture. Then, the same area was divided into halves. One half was disinfected by a detergent/disinfectant and the other was disinfected by an EBHS. The bacterial count decreased significantly with both disinfectants (p < 0.0001 compared with before disinfection). The bacterial count decrease seemed greater with the EBHS compared with the detergent/disinfectant, but the difference was not significant. Therefore, within the limits of a single application, the EBHS was an efficacious means of BP cuff disinfection. However, the repeated exposure to emollients contained in EBHS may require further studies before validating these results.


Assuntos
Determinação da Pressão Arterial/instrumentação , Desinfetantes/farmacologia , Desinfecção/métodos , Etanol/farmacologia , Higienizadores de Mão/farmacologia , Bactérias/efeitos dos fármacos , Bactérias/crescimento & desenvolvimento , Carga Bacteriana , Pressão Sanguínea
17.
Presse Med ; 48(11 Pt 1): 1319-1328, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31732365

RESUMO

Since 2016, the French Society of Hypertension has warned about the decline in the management of high blood pressure in France: stagnation, or even decreased number of people who know their blood pressure level, take a treatment and are controlled. These results are lower than those observed in many other countries. Blood pressure is measured with an old method in the doctor's office. Accepted, simple and cost-effective, this method is currently unavoidable for reasons of feasibility and social habit. It has been used in observational and intervention studies that are the basis of the medical reasoning for screening, treatment and drug control of hypertension. In practice, it is too often poorly applied and unpredictable. It is now necessary to measure blood pressure in mmHg using a validated oscillometric automatic device coupled to a specific upper arm cuff adapted to the arm circumferences for the diagnosis and monitoring of high blood pressure in the doctor's office and at home. The auscultatoric measurement is only recommended if any doubt about the reliability of the electronic measurement. Blood pressure measurement is basically performed on both arms to detect asymmetry and then on the arm with the highest blood pressure. It is performed in sitting or lying position after a few minutes of rest without speaking and without having smoked and then in standing position to diagnose orthostatic hypotension, especially in elderly, diabetic and multi-medicated subjects. The blood pressure measurement during the consultation must be repeated and include at least 3 consecutive measurements at one minute intervals. The average of the last 2 measurements determines the blood pressure level. It is recommended to perform BP measurements outside the medical environment for the diagnosis and monitoring of hypertension; Home BP measurement is preferred to ambulatory blood pressure measurement for practical reasons unless otherwise specified. The home blood pressure measurement should include three measurements in the morning at breakfast and three measurements in the evening before bedtime at one minute intervals for at least three days. Prior training must be provided. In treated hypertensive patients, a masked hypertension should be considered as an uncontrolled hypertension and antihypertensive therapy adapted accordingly. The measurement of central BP pressure (aorta) should be limited to clinical research.


Assuntos
Determinação da Pressão Arterial/normas , Consenso , Determinação da Pressão Arterial/instrumentação , Determinação da Pressão Arterial/métodos , Monitorização Ambulatorial da Pressão Arterial , França , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Sociedades Médicas , Fatores de Tempo
18.
IEEE Trans Biomed Circuits Syst ; 13(6): 1690-1699, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31670678

RESUMO

This work presents a mixed-signal physical-compu-tation-electronics for monitoring three vital signs; namely heart rate, blood pressure, and blood oxygen saturation; from electrocardiography, arterial blood pressure, and photoplethysmography signals in real-time. The computational circuits are implemented on a reconfigurable and programmable signal-processing platform, namely field-programmable analog array (FPAA). The design leverages the core enabling technology of FPAA, namely floating-gate CMOS devices, and an on-chip low-power microcontroller to achieve energy-efficiency while not compromising accuracy. The custom physical-computation-electronics operating in CMOS subthreshold region, performs low-level (i.e., physiologically-relevant feature extraction) and high-level (i.e., detecting arrhythmia) signal processing in an energy-efficient manner. The on-chip microcontroller is used (1) in the programming mode for controlling the charge storage at the analog-memory elements to introduce patient-dependency into the system and (2) in the run mode to quantify the vital signs. The system has been validated against digital computation results from MATLAB using datasets collected from three healthy subjects and datasets from the MIT/BIH open source database. Based on all recordings in the MIT/BIH database, ECG R-peak detection sensitivity is 94.2%. The processor detects arrhythmia in three MIT/BIH recordings with an average sensitivity of 96.2%. The cardiac processor achieves an average percentage mean error bounded by 3.75%, 6.27%, and 7.3% for R-R duration, systolic blood pressure, and oxygen saturation level calculations; respectively. The power consumption of the ECG, blood-pressure and photo-plethysmography processing circuitry are 126 nW, 251 nW and 1.44 µW respectively in a 350 nm process. Overall, the cardiac processor consumes 1.82 µW.


Assuntos
Determinação da Pressão Arterial/instrumentação , Eletrocardiografia/instrumentação , Fotopletismografia/instrumentação , Sinais Vitais/fisiologia , Sistemas Computacionais , Diagnóstico Precoce , Voluntários Saudáveis , Humanos , Dispositivos Lab-On-A-Chip , Semicondutores , Processamento de Sinais Assistido por Computador/instrumentação , Dispositivos Eletrônicos Vestíveis
19.
Sensors (Basel) ; 19(20)2019 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-31635394

RESUMO

This paper presents an intelligent system designed to increase the treatment adherence of hypertensive patients. The architecture was developed to allow communication among patients, physicians, and families to determine each patient's rate assertion of medication intake time and their self-monitoring of blood pressure. Concerning the medication schedule, the system is designed to follow a predefined prescription, adapting itself to undesired events, such as mistakenly taking medication or forgetting to take medication on time. When covering the blood pressure measurement, it incorporates best medical practices, registering the actual values in recommended frequency and form, trying to avoid the known "white-coat effect." We assume that taking medicine precisely and measuring blood pressure correctly may lead to good adherence to the treatment. The system uses commercial consumer electronic devices and can be replicated in any home equipped with a standard personal computer and Internet access. The resulting architecture has four layers. The first is responsible for adding electronic devices that typically exist in today's homes to the system. The second is a preprocessing layer that filters the data generated from the patient's behavior. The third is a reasoning layer that decides how to act based on the patient's activities observed. Finally, the fourth layer creates messages that should drive the reactions of all involved actors. The reasoning layer takes into consideration the patient's schedule and medication-taking activity data and uses implicit algorithms based on the J48, RepTree, and RandomTree decision tree models to infer the adherence. The algorithms were first adjusted using one academic machine learning and data mining tool. The system communicates with users through smartphones (anytime and anywhere) and smart TVs (in the patient's home) by using the 3G/4G and WiFi infrastructure. It interacts automatically through social networks with doctors and relatives when changes or mistakes in medication intake and blood pressure mean values are detected. By associating the blood pressure data with the history of medication intake, our system can indicate the treatment adherence and help patients to achieve better treatment results. Comparisons with similar research were made, highlighting our findings.


Assuntos
Determinação da Pressão Arterial/métodos , Hipertensão/patologia , Adesão à Medicação , Algoritmos , Anti-Hipertensivos/uso terapêutico , Determinação da Pressão Arterial/instrumentação , Computação em Nuvem , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/psicologia , Acesso à Internet , Smartphone , Dispositivos Eletrônicos Vestíveis
20.
IEEE Trans Biomed Circuits Syst ; 13(6): 1535-1544, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31613778

RESUMO

This paper presents a flexible multi-functional physiological sensing system that provides multiple noise-immune readout architectures and hybrid-sensing capability with an analog pre-processing scheme. The proposed multi-functional system is designed to support five physiological detection methodologies of piezo-resistive, pyro-resistive, electro-metric, opto-metric and their hybrid, utilizing an in-house multi-functional e-skin device, in-house flexible electrodes and a LED-photodiode pair. For their functional verification, eight representative physiological detection capabilities were demonstrated using wearable device prototypes. Especially, the hybrid detection method includes an innovative continuous measurement of blood pressure (BP) while most previous wearable devices are not ready for it. Moreover, for effective implementation in the form of the wearable device, post-processing burden of the hybrid method was much reduced by integrating a proposed analog pre-processing scheme, where only simple counting process and calibration remain to estimate the BP. This multi-functional sensor readout circuits and their hybrid-sensing interface are fully integrated into a single readout integrated circuit (ROIC), which is designed to implement three readout paths: two electrometric readout paths and one impedometric readout path. For noise-immune detection of the e-skin sensor, a pseudo-differential front-end with a ripple reduction loop is proposed in the impedometric readout path, and also state-of-the-art body-oriented noise reduction techniques are adopted for the electrometric readout path. The ROIC is fabricated in a CMOS process and in-house e-skin devices and flexible electrodes are also fabricated.


Assuntos
Determinação da Pressão Arterial/instrumentação , Impedância Elétrica , Eletrodos , Humanos , Dispositivos Eletrônicos Vestíveis
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