Monitoring Blood Pressure Research Articles

Ambulatory Blood Pressure Monitoring versus Office Blood Pressure Monitoring to Identify the True Hypertension Status of Living Kidney Donors.

Ambulatory blood pressure monitoring (ABPM) is a reliable modality and is preferred over office blood pressure monitoring (OBPM) for detecting hypertension. However, despite its advantages, the utilization of 24-h ABPM in evaluating living kidney donors has not been universally adopted by transplant centers, partly because of the lack of data about the utility of ABPM. This study aimed to identify patients with masked and white-coat hypertension, thereby ensuring appropriate identification of their true hypertension status and assessments of the risk to donors. This study included 73 potential living kidney donors. BP was measured in the office using a standardized protocol as well as by ABPM. Detailed clinical and biochemical parameters were assessed. Target organ damage was assessed in all the donors by assessing proteinuria, hypertensive retinopathy, and echocardiography. Out of the 73 donors, 64.4% were females and 35.6% were males. The average age of individuals in our donor population was 42.0 ± 11.28 years. In total, 31.5% were detected to be hypertensive by OBPM. With ABPM, only 21.9% of donors were hypertensive. The overall prevalence of white-coat hypertension was 30.4%; that of masked hypertension was 6.0%. In donors diagnosed as hypertensive by OBPM, three individuals were identified as having target organ damage. However, two additional donors who were initially missed as hypertensive using OBPM had target organ damage. OBPM overestimated the prevalence of hypertension compared with ABPM. ABPM is the better modality in terms of diagnosing white coats and masked hypertension. ABPM also more reliably correlates with target organ damage than OBPM.

Foot Massage dan Latihan Range of Motion Dapat Mengatasi Gangguan Mobilitas Fisik pada Lansia dengan Stroke

Introduction: the elderly are part of the growth process. One of the problems that often occur in the elderly with stroke cases is a decrease in physical mobility. This can be overcome by nursing interventions providing food massage and range of motion exercises. Method: with a case study approach. The research sample was one post-stroke patient who experienced a decrease in muscle strength. by giving foot massage and ROM exercises for 15-30 minutes 2 times a day in the morning and evening for 6 days. Results: there were complaints, weakness in the right extremity, selurred speech, difficulty walking asymmetrical mouth. Nursing interventions identify physical tolerance for movemen. Monitor blood pressure before starting mobilization and ambulation. Implementation facilitates changing positions as comfortable as posibble, providing foot massage and range of montion exercises. Evaluation TTV: 120/90 mmHg, N: 90x/minutes, R: 22x/minutes, S:36.0ᵒC efter being given foot massage and range of montion exercises whit a duration of 15-3o minutes 2 tamies a day in the morning dan evening for 6 days showed that the client eperianced an increase in muscle strength from a score of 2 to 3. Conclusion: giving food massage and range of motion can increase muscle strength. It is hoped that nurses can provide this intervention as a companion to non-pharmacological therapy to overcome physical problems in patients with stroke

Comparison of Blood Pressure in Hypertensive Patients with Monotherapy and Combination Antihypertensive Therapy

Background: Hypertension is a cardiovascular risk factor that is closely related to the patient's systolic and diastolic blood pressure profile. Objective: This study aims to determine the comparison of systolic and diastolic blood pressure profiles using antihypertensives in patients with cardiovascular risk factors. Method: Conducted in the period August-December 2021 on 83 patients who met the inclusion criteria, namely outpatients diagnosed with hypertension with cardiovascular risk factors, adult patients over 18 years of age, a medical record sheet, and a written prescription in full. Data analysis used the Kruskal Wallis test. Results: Shows a p value of 0.02 < 0.05 that there is a difference in systolic and diastolic blood pressure when using antihypertensive monotherapy or combination. The use of antihypertensive monotherapy is able to achieve the target of reducing systolic and diastolic blood pressure, namely amlodipine by -42.4mmHg/-11.7mmHg. Meanwhile, the combination antihypertensive that provides maximum results is a combination of 2 drugs, namely Candesartan + Hydrochlorthiazide which produces a reduction of -42.64 mmHg/-16.09 mmHg; a combination of 3 drugs: Amlodipine + Candesartan + Hydrochlorthiazide resulted in a reduction of -49 mmHg/-19.1 mmHg. Conclusion: There are differences in the profile of reducing systolic and diastolic blood pressure when using monotherapy and combination antihypertensives. The choice of monotherapy and combination can provide benefits in reducing blood pressure, tolerability and the level of compliance with the drugs consumed. Rational dose selection and drug selection in hypertensive patients is an important part in achieving successful therapy and preventing drug related problems, so pharmacists need to always monitoring blood pressure profiles as a form of monitoring the effectiveness of existing antihypertensive drugs consumed by patients.

Exploring the Acceptability and Feasibility of Remote Blood Pressure Measurements and Cognition Assessments Among Participants Recruited From a Safety-Net Emergency Department (Reach Out Cognition): Nonrandomized Mobile Health Trial.

Hypertension is a prevalent cardiovascular risk factor disproportionately affecting Black Americans, who also experience a higher incidence of Alzheimer disease and Alzheimer disease-related dementias. Monitoring blood pressure (BP) and cognition may be important strategies in reducing these disparities. The objective of the Reach Out Cognition study was to explore the feasibility and acceptability of remote cognitive and BP assessments in a predominantly Black, low-income population. Reach Out was a randomized, controlled, mobile health-based clinical trial to reduce BP among patients with hypertension at an emergency department in a safety-net hospital (ie, a US hospital in which 25% of the patients are Medicaid recipients). Upon conclusion of Reach Out, participants were given the option of continuing into an extension phase, Reach Out Cognition, that included Bluetooth-enabled BP monitoring and digital cognitive assessments for 6 months. Digital cognitive assessments were text message-linked online surveys of the Self-Administered Gerocognitive Exam and Quality of Life in Neurological Disorders scale. BP assessments were measured with Bluetooth-enabled BP cuffs paired with an app and the data were manually sent to the research team. Outcomes were feasibility (ie, enrollment and 3- and 6-month completion of digital cognitive and BP assessments) and acceptability of assessments using a 4-item validated survey, ranging from 1 (not acceptable) to 5 (completely acceptable). Of the 211 Reach Out participants, 107 (50.7%) consented and 71 (33.6%) completed enrollment in Reach Out Cognition. Participants had a mean age of 49.9 years; 70.4% were female and 57.8% identified as Black. Among the 71 participants, 51 (72%) completed cognitive assessments at 3 months and 34 (48%) completed these assessments at 6 months. BP assessments were completed by 37 (52%) and 20 (28%) of the 71 participants at 3 and 6 months, respectively. Participants were neutral on the acceptability of the digital cognitive assessments (mean 3.7) and Bluetooth self-measured BP (SMBP) monitoring (mean 3.9). Participants noted challenges syncing the BP cuff to the app, internet connection, and transmitting the data to the research team. Enrollment and assessment completion were low, while acceptability was moderate. Technological advances will eliminate some of the Bluetooth SMBP barriers and offer new strategies for cognitive assessments. Subsequent studies could benefit from offering more comprehensive support to overcome Bluetooth-related hurdles, such as personalized training materials, video conferencing, or in-person research team support. Alternatively, strategies that do not require pairing with an app and passive transmission of data could be considered. Overall, further research is warranted to optimize participant engagement and overcome technological challenges. ClinicalTrials.gov NCT03422718; https://clinicaltrials.gov/study/NCT03422718.

Functional state of the cardiovascular system in children after COVID-19

Introduction. The new coronavirus infection (COVID-19) in children often occurs in a mild, moderate, or asymptomatic. After experiencing COVID-19, some children, as well as adults, had persistent symptoms over more than 12 weeks and could not be explained by alternative diagnoses. These changes are called Post-acute COVID-19 Syndrome (PACS, post-COVID-19 syndrome or post-covid syndrome). Clinical manifestations of post-covid syndrome in children are very diverse, there are combinations of autonomic, psycho-emotional, cognitive and somatic disorders, including disorders of the cardiovascular system. 
 Aim: analysis of changes in the functional state of the cardiovascular system in children in the post-covid period.
 Materials and methods. The study included one hundred thirty one child aged of 5 to 17 years 11 months 29 days (mean age 12 years [9.5; 15]). The observed children were divided into 2 groups: group 1 (main) — children who had a mild new coronavirus infection (n = 76). The comparison group consisted of children who did not have COVID-19, suffered from acute respiratory viral infections of unspecified etiology of a mild course (n = 55). All children were analyzed for medical history, underwent clinical examination, electrocardiographic examination (ECG), echocardiographic examination (ECHO-KG), 24-hour Holter ECG monitoring and 24-hour blood pressure (BP) monitoring.
 Results. Children who have had COVID-19 are significantly more often showed sinus tachycardia (p = 0.025), extrasystole (supraventricular, ventricular) (p = 0.046), atrioventricular blockade of the 2nd degree (p = 0.027) compared with children with ARVI. After undergoing COVID-19, in 19.7% of children an increase in blood pressure was detected, in 15.8% of children there was a significant decrease in blood pressure at night (p = 0.008). In 38.2% of children after COVID-19, there was a decrease in the activity of the parasympathetic division of the nervous system.
 Conclusion. Children who have had a new mild coronavirus infection were shown to undergo a clinical examination with a mandatory assessment of blood pressure, heart rate and an ECG 3 and 6 months after the illness.

Comparison between oral midazolam and inhaled nitrous oxide/oxygen mixture for sedation during ambulatory lower third molar surgery

In dental surgery, patient anxiety is a common concern, potentially impacting pain tolerance. This study compared oral midazolam and nitrous oxide/oxygen (N2O/O2) inhalation as anxiety control methods. We conducted a split-mouth study for lower third molar extractions, assessing anxiety and satisfaction using Corah's scale, modified State-Trait Anxiety Inventory (STAI), and Visual Analogue Scale (VAS). We also monitored blood pressure, heart and respiratory rates, oxygen saturation, and electrocardiogram (ECG) changes non-invasively. Results showed no statistically significant differences in questionnaire-based parameters. However, fewer N2O/O2 group patients were "very anxious" on the modified STAI scale, favoring N2O for future surgeries. Regarding non-invasive blood pressure, midazolam group had higher levels, and N2O group exhibited elevated saturation, but these lacked clinical significance. In conclusion, both anxiolytic medications effectively induced adequate sedation. Questionnaire and multiparameter monitor data revealed minor variations between groups, indicating the suitability of either approach for dental surgery anxiety management.

The history of tourniquet use in limb surgery.

As tourniquets have been present in medicine since almost its conception, understanding and following their development through time is not only an exercise in history but also an insight into the evolution of medical devices over more than two millennia. From simple leather bands wrapped around patients' limbs to the modernised digital devices used widely in surgical theatres globally, tourniquets have undergone tectonic change both in their design and application, moving from battlefields to hospitals. Hence, the aim of this article is to outline the historical development of these devices alongside their present and modern use. The historical development of emergency and surgical tourniquets is chronologically outlined, with particular emphasis on the impact of warfare on their widespread adoption in trauma and emergency medicine and elective surgery. Novel surgical trends and their impact on the future of tourniquet use are evaluated. The development of tourniquets across two millennia has closely reflected both the scientific understanding of human physiology and anatomy as well as technological discoveries and advancements that have reshaped their design and application. Prominent figures in the field of surgery, such as Sushruta, Fabricius Hildanus, John Louis Petit, Joseph Lister, Harvey Cushing and James McEwen, all fundamentally influenced their evolution and helped popularise and modernise them. The views on their use have been controversial and drastically changed across different eras, with data collected from modern warfare serving to embed their use in clinical practice. The historical development of tourniquets since pre-historic times represents an excellent outline of the adaptive nature of medicine, led, firstly, by scientific rigour and discipline and, secondly, by pioneers who serve as catalysts for change and improvement. The modern inflatable cuff tourniquets that are omnipresent in theatres globally will undoubtedly remain the standard of care for the foreseeable future. Tourniquets that can dynamically monitor blood pressure and consequently adjust inflation pressures, as well as ones with inbuilt axonal excitability monitoring, will further improve their safety profile, reduce associated complication rates and represent the next step in the evolution of these devices. Notably, there might be a shift away from tourniquet use altogether, reflected by the wide use of the wide-awake local anaesthesia no-tourniquet technique that has become the new norm in hand surgery.

IoT-based health care system for emotional and heart rate monitoring

An IoT-based remote health monitoring system helps patient’s especially older adults and non-communicable disease (NCD) patients to get medical assistance or advice without being physically present in the hospital or medical centre. This system provides regular health monitoring from anywhere by having access to the Internet. One of the important elements is the physiological parameters which indicate the health status of the monitored patients. Literature study shows that most of the previous works monitor blood pressure, respiratory rate, temperature, ECG, blood oxygenation, diabetes, and hypertension. There have been little works paid attention to measuring the emotional level of the patient. Therefore, this paper explains the development of an IoT-based health monitoring system that measures the emotional level of the patient apart from other essential physiological parameters. The system consists of a microcontroller, two sensors, a wireless communication module, and an IoT cloud display, focusing on measuring the heart rate, body temperature, SpO2, and emotional level. For the heart rate and body temperature readings, the measurements acquired from the developed system show a close agreement with those of the established brand ROSSMAX with an error of less than 5%. For the emotional level test, there are 83.3% out of twelve subjects agree that the GSR value shows her feeling.

Development of preeclampsia in pregnant women with white-coat hypertension: a systematic review and meta-analysis.

Hypertensive disorders during pregnancy are a significant cause of maternal and perinatal mortality and morbidity worldwide. White coat hypertension (WCH) is a hypertensive disease characterized by an increased clinic blood pressure but normal home or workplace blood pressure. Due to variable prevalence, a subset of women with WCH may be incorrectly diagnosed with chronic hypertension, highlighting the need for accurate diagnosis. Little is known about the role of WCH in pregnancy, but a meta-analysis aims to determine whether WCH increases the likelihood of developing preeclampsia. A systematic review and meta-analysis was conducted to determine whether there is an association between WCH and the incidence of preeclampsia in pregnant women. The search included PubMed, Embase, and Scopus databases until February 2023, using PRISMA guidelines. Pregnant women with apparent office hypertension throughout pregnancy who underwent 24-hour ambulatory blood pressure monitoring or home blood pressure monitoring were included. Meta-analysis was performed using RevMan. This study included 12 studies with a total of 4,672 pregnant women and found that women with WCH have a higher risk of developing preeclampsia compared to normotensive women (RR: 2.29, 95% CI [1.18,4.43], P = 0.01). However, when compared with pregnant women with gestational hypertension or chronic hypertension, women with WCH had a significantly lower risk of developing preeclampsia ((RR: 0.39, [0.20,0.80], p=0.009) and (RR: 0.41, [0.27,0.62], P<0.001), respectively). The study recommends incorporating 24-hour ABPM into clinical practice to differentiate between chronic hypertension and WCH in early pregnancy and focus on special management for those who need it. The findings may guide future research on ABPM's role in diagnosing WCH and its effects on pregnancy outcomes.

Memory-efficient low-compute segmentation algorithms for bladder-monitoring smart ultrasound devices

Post-operative urinary retention is a medical condition where patients cannot urinate despite having a full bladder. Ultrasound imaging of the bladder is used to estimate urine volume for early diagnosis and management of urine retention. Moreover, the use of bladder ultrasound can reduce the need for an indwelling urinary catheter and the risk of catheter-associated urinary tract infection. Wearable ultrasound devices combined with machine-learning based bladder volume estimation algorithms reduce the burdens of nurses in hospital settings and improve outpatient care. However, existing algorithms are memory and computation intensive, thereby demanding the use of expensive GPUs. In this paper, we develop and validate a low-compute memory-efficient deep learning model for accurate bladder region segmentation and urine volume calculation. B-mode ultrasound bladder images of 360 patients were divided into training and validation sets; another 74 patients were used as the test dataset. Our 1-bit quantized models with 4-bits and 6-bits skip connections achieved an accuracy within 3.8% and 2.6%, respectively, of a full precision state-of-the-art neural network (NN) without any floating-point operations and with an 11.5times and 9.0times reduction in memory requirements to fit under 150 kB. The means and standard deviations of the volume estimation errors, relative to estimates from ground-truth clinician annotations, were 5.0pm 33 ml and 6.8pm 29 ml, respectively. This lightweight NN can be easily integrated on the wearable ultrasound device for automated and continuous monitoring of urine volume. Our approach can potentially be extended to other clinical applications, such as monitoring blood pressure and fetal heart rate.

Association between body mass and hypotension in dogs under general anaesthesia.

To investigate the association between body mass and hypotension during general anaesthesia in dogs undergoing surgical and diagnostic procedures within a referral hospital. Retrospective evaluation of the anaesthetic records of 1789 dogs was performed. Data on signalment, anaesthetic protocol and physiological variables, including mean arterial pressure, were collected. A multivariable generalised linear model was used to identify associations between explanatory variables, including body mass, and hypotension. In the population studied, increasing body mass (per 10 kg) was significantly associated with decreasing odds of hypotension (odds ratio 0.68; 95% confidence interval: 0.60 to 0.77). Additional variables associated with a decreased odds of hypotension were pre-anaesthetic medication with alpha-2 agonists (odds ratio 0.63; 95% confidence interval 0.48 to 0.82) and increasedbody temperature (per 1°C) during general anaesthesia (odds ratio 0.77; 95% confidence interval 0.67 to 0.88). Brachycephaly (odds ratio 1.72; 95% confidence interval 1.25 to 2.38), ASA physical status classification >3 (odds ratio 2.03; 95% confidence interval 1.16 to 3.56), undergoing a surgical procedure (versus diagnostic) (odds ratio 1.57; 95% confidence interval 1.10 to 2.23) and bradycardia (odds ratio 1.37; 95% confidence interval 1.05 to 1.80) were independently associated with increased odds of hypotension. Dogs of lower body mass and brachycephalic breeds may be at higher risk of hypotension during general anaesthesia or alternatively represent subpopulations in which accurate blood pressure measurement presents a greater challenge. Monitoring blood pressure accurately in these groups requires particular attention and provisions for treating hypotension should be readily accessible.

Effects of Continuous Non-Invasive Blood Pressure Monitoring on Intraoperative Hemodynamics and Postoperative Myocardial Injury in Craniotomy: Comparison Between Groups Based on Self-Control and Propensity Score Matching

Objective: To explore the effect of continuous non-invasive blood pressure monitoring on intraoperative hemodynamics and postoperative myocardial injury in craniotomy. Methods: 120 cases of elective craniotomy were divided into the self-control group (continuous non-invasive blood pressure monitoring and intermittent cuff non-invasive blood pressure monitoring, CNAP group) and propensity score matching group (only intermittent cuff non-invasive blood pressure measurement in previous craniotomy, PSM group); Goal-directed hemodynamic management in CNAP group included heart rate (HR), blood pressure (BP), stroke volume (SV), stroke variability (SVV), and systemic vascular resistance index (SVRI). The main index is to compare the troponin level within 72 hours after operation between the CNAP group and the PSM group; The secondary indicators are the comparison of the hemodynamic conditions between the CNAP group and the PSM at 10 specific time points. Results: The incidence of postoperative myocardial injury in the CNAP group was significantly lower than that in the PSM group (12% vs. 30%, P = 0.01); in the CNAP group hypotensive episodes (6 vs. 3, P = 0.01), positive balance of fluid therapy (700 vs. 500 mL, P &lt; 0.001), more use of vasoactive drugs (29 vs. 18, P = 0.04), more stable hemodynamics medical status (P = 0.03) were recorded. Conclusion: The hemodynamic management strategy based on continuous non-invasive blood pressure monitoring can reduce the incidence of myocardial injury after elective craniotomy and maintain a more stable hemodynamic state.

TELE-ANC model in public sector in India: a feasible option to sustain quality antenatal care

Introduction: Prenatal care is one of the most widely used preventive strategies in healthcare. Despite rapid advances in medical practice over a century, obstetric care remains ‘traditional’. It is resource intensive with heavy footfall in public sector antenatal OPD leading to compromise in quality of care. Therefore, hybrid ‘TELE-ANC model’ is a feasible option to sustain quality care in limited resource setting. We assessed feasibility of this model in reducing ‘in-person visits’ in terms of provider, process and recipient and determined barriers and facilitators to implementation and robustness of process in delivering the model. Methods: Single center prospective feasibility study, composed of 50 low-risk women within 20 weeks of pregnancy; recruited from outpatient obstetric department. Model had 5 in-person and 4 virtual visits. During in-person visits; history, general and systemic examination, ANC investigations and ultrasounds were done and clubbed; counseling and treatment were advised. During virtual visit, patients monitored blood pressure, pulse, weight and fetal movements at home. Pictures of prescription were sent on patients’ phones with records maintained by provider. Patients and provider filled detailed Satisfaction Performa after each virtual visit and last antenatal visit which were measured through Likert scale. Results: Each pregnant woman on an average made 5 physical and 5 virtual visits (one extra than proposed 4 in the model). Each patient saved approximately 10 productive hours and 700 Rupees during their antenatal period. Doctor was able to implement services readily. Adequacy to conduct virtual visits, successful decision making, technical issues faced, ease and safety of process and overall improvement in access to healthcare and positive change, demonstrates high levels of Provider satisfaction score of &gt;80% overall. There was high patient satisfaction score of 80 to 90% in areas assessed i.e., satisfaction with the care received, doctor-patient rapport, knowledge about pregnancy, convenience of self-monitoring and ability to contact provider during emergencies. Nearing term, patients had satisfaction score of 85-90% overall in ability to express, continuation of visits post COVID, reduction in overall cost and time, desire for such a model in future and positive change. Minimal technological barriers were identified which did not adversely impact the quality of care. It is ‘Good’ in terms of its robustness. 96% of patients desired hybrid model as mode of future antenatal care. Discussion: Due to rapid increase in use of telehealth during COVID-19 pandemic, we were encouraged to test feasibility of a reduced in-person visit hybrid model; ‘The TELE-ANC model’ in a tertiary care public hospital. It is feasible in delivering an efficient antenatal care with additional advantages of lower cost, greater doctor-patient rapport, increased patient’s productivity, increased patient satisfaction, better continuity of care, better time management and increased provider engagement and satisfaction. It has potential to be standard care model for antenatal services in future leading to a more flexible and patient centered care

Nocturnal Blood Pressure Estimation from Sleep Plethysmography Using Machine Learning.

Elevated nocturnal blood pressure (BP) is a risk factor for cardiovascular disease (CVD) and mortality. Cuffless BP assessment aided by machine learning could be a desirable alternative to traditional cuff-based methods for monitoring BP during sleep. We describe a machine-learning-based algorithm for predicting nocturnal BP using single-channel fingertip plethysmography (PPG) in healthy adults. Sixty-eight healthy adults with no apparent sleep or CVD (53% male), with a median (IQR) age of 29 (23-46 years), underwent overnight polysomnography (PSG) with fingertip PPG and ambulatory blood pressure monitoring (ABPM). Features based on pulse morphology were extracted from the PPG waveforms. Random forest models were used to predict night-time systolic blood pressure (SBP) and diastolic blood pressure (DBP). Our model achieved the highest out-of-sample performance with a window length of 7 s across window lengths explored (60 s, 30 s, 15 s, 7 s, and 3 s). The mean absolute error (MAE ± STD) was 5.72 ± 4.51 mmHg for SBP and 4.52 ± 3.60 mmHg for DBP. Similarly, the root mean square error (RMSE ± STD) was 6.47 ± 1.88 mmHg for SBP and 4.62 ± 1.17 mmHg for DBP. The mean correlation coefficient between measured and predicted values was 0.87 for SBP and 0.86 for DBP. Based on Shapley additive explanation (SHAP) values, the most important PPG waveform feature was the stiffness index, a marker that reflects the change in arterial stiffness. Our results highlight the potential of machine learning-based nocturnal BP prediction using single-channel fingertip PPG in healthy adults. The accuracy of the predictions demonstrated that our cuffless method was able to capture the dynamic and complex relationship between PPG waveform characteristics and BP during sleep, which may provide a scalable, convenient, economical, and non-invasive means to continuously monitor blood pressure.

Challenges Associated with the use of Smartwatches for out of Clinic Blood Pressure Monitoring Among Expectant Mothers in a Developing Country: A Case study of Nakuru County Kenya

Pre-eclampsia is a leading cause of maternal mortality globally and more so in developing countries. The condition, if detected early, can be prevented to avert death and suffering. This early detection has become easier with the development of devices such as smartwatches with BP sensors which have enhanced the practice of Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM). However, most of these devices and monitoring practices have not been widely adopted in developing countries due to the high cost of devices and the lack of institutionalization of the ABPM and HBPM in healthcare systems. This study sought to examine the use of low-cost smartwatches, a mobile application, and a support system for the implementation of ABPM and HBPM among expectant mothers in Nakuru county, Kenya. A total of 34 expectant mothers were involved in the study over 8 months. A total of 967 readings were collected with only 3 out of the 34 mothers managing to take at least 71 readings during the period of the study. The study established that the use of low-specification phones that were incompatible with the mobile application, failure of the smartwatches to work appropriately, difficulties in getting mothers who met the inclusion criteria under 20 weeks gestation, poor adherence to the data collection, and loss of the devices negatively impacted the quality and consistency of BP monitoring among the expectant mothers. The study therefore recommends the use of more robust devices such as cuff BP readers and the inclusion of community health volunteers in the early identification of pregnant mothers from the community and subsequent follow-up for ABPM and HBPM.

Accuracy of oscillometric-based blood pressure monitoring devices: impact of pulse volume, arrhythmia, and respiratory artifact.

An oscillometric waveform (OMW) envelope-based blood pressure (BP) monitoring device is widely used to monitor blood pressure and prevent hypertension and adverse cardiovascular events. At present, all primary care physicians and clinicians widely recommend oscillometric-based BP devices. The consumer selects the device based on their own decision, without knowing whether the device is validated or not, resulting in over- or under-treatment of hypertension. It is imperative that each device must comply with international protocols. In this study, we have investigated the accuracy of inflation and deflation-based oscillometric BP monitoring devices in the case of sinus rhythm (SR). Since different health conditions of the patient affect the oscillometric waveform, which can affect the device's accuracy, in such cases, many BP monitors are skeptical of succeeding in the norms of international protocols. Therefore, this study also aims to calculate the accuracy of these devices in various health conditions and measure the effect of pulse volume, arrhythmia, and respiratory artifact on it using a non-invasive blood pressure (NIBP) simulator. We found that the oscillometric BP devices failed to measure the correct blood pressure in several clinical conditions.

Monitoring blood pressure and cardiac function without positioning via a deep learning-assisted strain sensor array.

Continuous and reliable monitoring of blood pressure and cardiac function is of great importance for diagnosing and preventing cardiovascular diseases. However, existing cardiovascular monitoring approaches are bulky and costly, limiting their wide applications for early diagnosis. Here, we developed an intelligent blood pressure and cardiac function monitoring system based on a conformal and flexible strain sensor array and deep learning neural networks. The sensor has a variety of advantages, including high sensitivity, high linearity, fast response and recovery, and high isotropy. Experiments and simulation synergistically verified that the sensor array can acquire high-precise and feature-rich pulse waves from the wrist without precise positioning. By combining high-quality pulse waves with a well-trained deep learning model, we can monitor blood pressure and cardiac function parameters. As a proof of concept, we further constructed an intelligent wearable system for real-time and long-term monitoring of blood pressure and cardiac function, which may contribute to personalized health management, precise and early diagnosis, and remote treatment.

ARTERIAL HYPERTENSION AMONG MEDICAL WORKERS. ANALYSIS. EVALUATION

The aim. To examine the impact of individual medical and social factors, including work experience, lifestyle and living conditions, excess body weight, metabolic syndrome, types of circadian rhythms of blood pressure, and heredity, on the frequency of arterial hypertension (hypertensive disease - HD) formation.&#x0D; Materials and methods. The study involved the collection of anamnestic data, conducting interviews, performing objective examinations, and monitoring blood pressure in 391 medical workers, predominantly from therapeutic, surgical, and intensive care backgrounds. The obtained data were statistically processed using probability assessment criteria, risks assessed through odds ratio (OR), and ROC analysis.&#x0D; The results. The study revealed that only 33% of medical workers have a normal body weight. The risk of developing hypertensive disease (HD) is 3.24 times higher in the group with excess body weight and 8.72 times higher in the group with obesity compared to the examined subjects with normal body weight (p&lt;0.0001). Daily blood pressure monitoring results showed a statistically significant difference in 12 out of the 21 studied parameters (p&lt;0.05) between patients with HD, with and without metabolic syndrome. This indicates that the presence of metabolic syndrome affects the severity of hypertensive disease. Additionally, a statistically significant difference (p&lt;0.05) was observed in the distribution of circadian rhythm types of blood pressure between groups with and without hypertension. It was established that there is a predominance of unfavorable types of circadian blood pressure rhythm in medical worker groups experiencing high professional psycho-emotional stress (78.1-85.5%). Recognizing the risk factors for HD occurrence in medical workers can significantly enhance the effectiveness of a comprehensive hypertensive disease prevention program, leading to reduced blood pressure levels and a lower frequency of complications.&#x0D; Conclusions. It has been established that excess body weight is a risk factor for the development of hypertensive disease (HD) in medical personnel. The presence of metabolic syndrome has been proven to affect the severity of the hypertensive disease course. There is a certain association between disruptions in circadian blood pressure rhythms, professional psycho-emotional stress, and the development of arterial hypertension in medical workers of certain specialties. The prognostically significant threshold level of work experience for the formation of a group at an increased risk of developing HD is 11 years.

PPG Signals-Based Blood-Pressure Estimation Using Grid Search in Hyperparameter Optimization of CNN-LSTM.

Researchers commonly use continuous noninvasive blood-pressure measurement (cNIBP) based on photoplethysmography (PPG) signals to monitor blood pressure conveniently. However, the performance of the system still needs to be improved. Accuracy and precision in blood-pressure measurements are critical factors in diagnosing and managing patients' health conditions. Therefore, we propose a convolutional long short-term memory neural network (CNN-LSTM) with grid search ability, which provides a robust blood-pressure estimation system by extracting meaningful information from PPG signals and reducing the complexity of hyperparameter optimization in the proposed model. The multiparameter intelligent monitoring for intensive care III (MIMIC III) dataset obtained PPG and arterial-blood-pressure (ABP) signals. We obtained 75,226 signal segments, with 60,180 signals allocated for training data, 12,030 signals allocated for the validation set, and 15,045 signals allocated for the test data. During training, we applied five-fold cross-validation with a grid-search method to select the best model and determine the optimal hyperparameter settings. The optimized configuration of the CNN-LSTM layers consisted of five convolutional layers, one long short-term memory (LSTM) layer, and two fully connected layers for blood-pressure estimation. This study successfully achieved good accuracy in assessing both systolic blood pressure (SBP) and diastolic blood pressure (DBP) by calculating the standard deviation (SD) and the mean absolute error (MAE), resulting in values of 7.89 ± 3.79 and 5.34 ± 2.89 mmHg, respectively. The optimal configuration of the CNN-LSTM provided satisfactory performance according to the standards set by the British Hypertension Society (BHS), the Association for the Advancement of Medical Instrumentation (AAMI), and the Institute of Electrical and Electronics Engineers (IEEE) for blood-pressure monitoring devices.

Staff perspectives on the influence of patient characteristics on alarm management in the intensive care unit: a cross-sectional survey study

BackgroundHigh rates of clinical alarms in the intensive care unit can result in alarm fatigue among staff. Individualization of alarm thresholds is regarded as one measure to reduce non-actionable alarms. The aim of this study was to investigate staff’s perceptions of alarm threshold individualization according to patient characteristics and disease status.MethodsThis is a cross-sectional survey study (February-July 2020). Intensive care nurses and physicians were sampled by convenience. Data was collected using an online questionnaire.ResultsStaff view the individualization of alarm thresholds in the monitoring of vital signs as important. The extent to which alarm thresholds are adapted from the normal range varies depending on the vital sign monitored, the reason for clinical deterioration, and the professional group asked. Vital signs used for hemodynamic monitoring (heart rate and blood pressure) were most subject to alarm individualizations. Staff are ambivalent regarding the integration of novel technological features into alarm management.ConclusionsAll relevant stakeholders, including clinicians, hospital management, and industry, must collaborate to establish a “standard for individualization,” moving away from ad hoc alarm management to an intelligent, data-driven alarm management. Making alarms meaningful and trustworthy again has the potential to mitigate alarm fatigue – a major cause of stress in clinical staff and considerable hazard to patient safety.Trial registrationThe study was registered at ClinicalTrials.gov (NCT03514173) on 02/05/2018.