Sources of Error in Office Blood Pressure Measurement
bias; Blood Pressure; end-digit preference; global burden; hypertension; Hypertension; mercury; Patient Positioning; Prehypertension; prevalence
October 2019 Update
PURPOSES: To evaluate 2 commonly overlooked sources of error in measuring blood pressure (BP) in the office, improper patient positioning and frequency of terminal digit bias (TDB) using manual and automated (BP) devices. METHODS: BPs recorded by 3 nurses using manual and automated devices were analyzed for TDB. In the next part of the study, 294 patients were recruited and tested with each patient's BP measured twice in the table position and compared with BP measured in the chair position. To eliminate concern for position sequence, a randomized controlled trial was initially conducted. RESULTS: Significant TDB for the digit zero was identified in BPs measured by all nurses using a manual device. No such bias was identified for any nurse when measuring BP with an automated device. For the positional study, the randomized controlled study showed no significant sequencing effect therefore the sequence of table then chair BP measurements was adopted. Significant BP lowering was observed in 128 patients (42.7%) in the chair compared with the table position. Misclassification of prehypertension and hypertension would have occurred in 15.3% and 16% of patients, respectively, when BP was recorded in the table instead of the chair position. CONCLUSIONS: Significant TDB was identified for all nurses when using a manual but not an automated device. Patient positioning on the examination table resulted in elevations of systolic and diastolic BPs.
Morcos Roy N; Carter Kimbroe J; Castro Frank; Koirala Sumira; Sharma Deepti; Syed Haroon
Journal of the American Board of Family Medicine: JABFM
2019
2019-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3122/jabfm.2019.05.190085" target="_blank" rel="noreferrer noopener">10.3122/jabfm.2019.05.190085</a>
Getting the hypertension Dx right: Patient positioning matters.
AMERICAN Heart Association; BLOOD pressure; HYPERTENSION; LOGISTIC regression analysis; PATIENT positioning; SPHYGMOMANOMETERS
Taking blood pressure with the patient seated on the edge of an exam table led to misclassification of prehypertension or hypertension in 13.2% of patients.
Morcos Roy N; Carter Kimbroe J; Castro Frank; Yu Nathan; Jordan Cary; Macabobby Thomas D; Rodriguez Angelina
The Journal of Family Practice
2018
2018-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
On the Importance of Accurate Inputs and Assumptions for Screening Mammography Modeling.
Carter Kimbroe J; Castro Frank; Morcos Roy N
AJR. American journal of roentgenology
2018
2018-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2214/AJR.18.19749" target="_blank" rel="noreferrer noopener">10.2214/AJR.18.19749</a>
Insights Into Breast Cancer Screening: A Computer Simulation of Two Contemporary Screening Strategies.
Female; Humans; *Computer Simulation; *Practice Guidelines as Topic; American Cancer Society; Biopsy/economics/statistics & numerical data; breast cancer; Breast Neoplasms/*diagnostic imaging; Cost-Benefit Analysis; cost-effectiveness acceptability curves; Early Detection of Cancer/economics/methods; False Positive Reactions; mammography screening; Mammography/economics/*statistics & numerical data; Mass Screening/*methods; Medical Overuse/economics; mixed interval screening; Monte Carlo method; Monte Carlo Method; Unnecessary Procedures/economics
OBJECTIVE: The debate over the value of screening mammography is rekindled with each new published study or guideline. Central to the discussion are the uncertainties about screening benefits and harms and the criteria used to assess them. Today, the magnitude of benefits for a population is less certain, and the evolving concept of harm has come to encompass false-positives (FPs), unnecessary biopsies, overdiagnosis, and overtreatment. This study uses a Monte Carlo computer simulation to study the balance of benefits and harms of mammographic breast cancer screening for average-risk women. MATERIALS AND METHODS: This investigation compares the American Cancer Society's 2015 mixed annual-biennial guideline with the U.S. Preventive Services Task Force's 2016 fixed biennial guideline. Screening strategies are compared using cost-effectiveness acceptability curves, an economic analysis describing uncertainty in evaluating costs and health outcomes. Strategy preference is examined under changing assumptions of willingness to pay for a quality-adjusted life-year. Additionally, comparative effectiveness analysis is performed using FP screens and unnecessary biopsies per life-year gained. Alternative scenarios are compared assuming a reduced mortality benefit of screening. RESULTS: In general, results using both cost-effectiveness and clinical measures indicate that American Cancer Society's 2015 mixed annual-biennial guideline is preferred. Assuming decreases in the mortality benefit of mammography, no screening may be reasonable. CONCLUSION: The use of a mixed annual-biennial strategy for population screening takes advantage of the nonuniformity of occurrence of mammography benefits and harms over the duration of screening. This approach represents a step toward improving guidelines by exploiting age dependencies at which benefits and harms accrue.
Carter Kimbroe J; Castro Frank; Morcos Roy N
AJR. American journal of roentgenology
2018
2018-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2214/AJR.17.18484" target="_blank" rel="noreferrer noopener">10.2214/AJR.17.18484</a>
Simulation of breast cancer screening: quality assessment of two protocols.
*Clinical Protocols; *Computer Simulation; *Practice Guidelines as Topic; Adult; American Cancer Society; Breast Neoplasms/*diagnosis/epidemiology; Breast Self-Examination/*standards; Female; Health Care; Humans; Mammography/*standards; Mass Screening/*standards; Middle Aged; Neoplasm Staging; Quality Assurance; Time Factors; United States
Healthcare professionals must make breast cancer screening decisions without the help of clear answers in current medical knowledge. This study used computer simulation to evaluate two screening protocols. The American Cancer Society (ACS) protocol comprising self-breast examination, professional breast examination and annual mammography was evaluated versus annual mammography alone. The effective frequency of mammography and the cost in the ACS protocol doubles the cost of mammography alone. Breast self-examination and clinical breast examination contributes to increased cost without any added health effects. These study results could be applied by healthcare professionals to assist their decision making for breast cancer screening.
Carter Kimbroe J; Castro Frank; Kessler Edward; Erickson Barbara A
Journal for healthcare quality : official publication of the National Association for Healthcare Quality
2004
2004-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1945-1474.2004.tb00534.x" target="_blank" rel="noreferrer noopener">10.1111/j.1945-1474.2004.tb00534.x</a>
A computer model for the study of breast cancer.
*Computer Simulation; Breast Neoplasms/epidemiology/mortality/*pathology; Female; Humans; Incidence; Life Expectancy; Lymphatic Metastasis; Neoplasm Metastasis; SEER Program; Software; United States/epidemiology
A computer model was designed as a relational database to assess breast cancer screening in a cohort of women where the growth and development of breast cancer originates with the first malignant cell. The concepts of thresholds for growth, axillary spread, and distant sites are integrated. With tumor diagnosis, staging was performed that includes clinical and sub-clinical states. The model was parameterized to have staging characteristics similar to data published by the Surveillance, Epidemiology, and End-Results (SEER) Program. Validation was accomplished by comparing simulated staging results with non-SEER sources, and simulated survival with independent clinical survival data.
Carter Kimbroe J; Castro Frank; Kessler Edward; Erickson Barbara
Computers in biology and medicine
2003
2003-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0010-4825(03)00003-9" target="_blank" rel="noreferrer noopener">10.1016/s0010-4825(03)00003-9</a>
The relation of breast cancer staging to screening protocol compliance: a computer simulation study.
*Computer Simulation; *Models; *Patient Compliance; Adult; Breast Neoplasms/*pathology; Clinical Protocols; Female; Humans; Mammography; Mass Screening/standards; Middle Aged; Neoplasm Staging/*methods; Theoretical
A computer model based on relational database techniques was used to analyze the relationship between staging and population compliance to a breast cancer screening protocol. Stage distribution data permitted estimates of compliance to the protocol. This relationship followed the equation y=5.83e-2.44x where y was compliance and x was disease stage. Application of this equation to SEER and NCDB data estimated that the levels of compliance never exceeded 16 percent. Results indicated increasing clinical Stage IV disease as population compliance decreased. As the clinical staging increased there was increased sub-clinical Stage IV disease. With regular screening, simulation suggested that mortality would decrease.
Castro Frank; Carter Kimbroe J; Kessler Edward; Erickson Barbara A; Kseibi Samer A
Computers in biology and medicine
2005
2005-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.compbiomed.2003.12.006" target="_blank" rel="noreferrer noopener">10.1016/j.compbiomed.2003.12.006</a>