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>
Gynecomastia: When is treatment indicated?
BREAST disease diagnosis; CONNECTIVE tissues; GYNECOMASTIA; MAMMOGRAMS
The article presents a case study of a 57-year-old man with gynecomastia which has been clinically evaluated through an algorithmic approach. It notes that a focused history to determine side effects of medication must be conducted if an examination suggests true gynecomastia. It mentions that diagnostic breast radiography is needed for irregular mass outside the connective tissue.
Morcos Roy N; Kizy Thomas
The Journal of Family Practice
2012
2012-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
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>