Understanding the accuracy of body temperature measurements in patient triage during cancer treatment: a retrospective audit

Elevated temperature can be the first sign of infection and neutropenic sepsis in patients undergoing chemotherapy or radiotherapy. Most cancer patients are treated as outpatients and are educated to take their temperatures regularly during treatment. Patients who notice a fever or other concerning symptoms at home are advised to contact the hospital triage unit, who use home-measured temperature, along with other clinical information, to decide whether to admit the patient for assessment and treatment. Following concerns from triage nurses at a regional cancer centre that home-measured temperatures were not being accurately reported, the authors carried out a retrospective audit to quantify differences between reported body temperature at home and on arrival at the triage unit. They found that although temperature measurement is correctly used to identify patients needing further assessment, it is often missing when patients call the triage line and/or measured inaccurately. Improvements in temperature measurement, particularly in the home environment, would be likely to optimise patient care in this vulnerable cohort

Self-Screening and Non-Physician Screening for Hypertension in Communities: A Systematic Review.

BACKGROUND: Community-based self-screening may provide opportunities to increase detection of hypertension, and identify raised blood pressure (BP) in populations who do not access healthcare. This systematic review aimed to evaluate the effectiveness of non-physician screening and self-screening of BP in community settings. METHODS: We searched the Cochrane Central Trials Register, Medline, Embase, CINAHL, and Science Citation Index & Conference Proceedings Citation Index-Science to November 2013 to identify studies reporting community-based self-screening or non-physician screening for hypertension in adults. Results were stratified by study site, screener, and the cut-off used to define high screening BP. RESULTS: We included 73 studies, which described screening in 9 settings, with pharmacies (22%) and public areas/retail (15%) most commonly described. We found high levels of heterogeneity in all analyses, despite stratification. The highest proportions of eligible participants screened were achieved by mobile units (range 21%-88%) and pharmacies (range 40%-90%). Self-screeners had similar median rates of high BP detection (25%-35%) to participants in studies using other screeners. Few (16%) studies reported referral to primary care after screening. However, where participants were referred, a median of 44% (range 17%-100%) received a new hypertension diagnosis or antihypertensive medication. CONCLUSIONS: Community-based non-physician or self-screening for raised BP can detect raised BP, which may lead to the identification of new cases of hypertension. However, current evidence is insufficient to recommend specific approaches or settings. Studies with good follow-up of patients to definitive diagnosis are needed.This article presents independent research funded by a National Institute for Health Research Programme Grant RP-PG-1209–10051.This is the final version of the article. It was first available from Oxford University Press via http://dx.doi.org/10.1093/ajh/hpv02

Mixed-methods feasibility study of blood pressure self-screening for hypertension detection.

OBJECTIVE: To assess the feasibility of using a blood pressure (BP) self-measurement kiosk-a solid-cuff sphygmomanometer combined with technology to integrate the BP readings into patient electronic medical records- to improve hypertension detection. DESIGN: A concurrent mixed-methods feasibility study incorporating observational and qualitative interview components. SETTING: Two English general practitioner (GP) surgeries. PARTICIPANTS: Adult patients registered at participating surgeries. Staff working at these sites. INTERVENTIONS: BP self-measurement kiosks were placed in the waiting rooms for a 12-month period between 2015 and 2016 and compared with a 12-month control period prior to installation. OUTCOME MEASURES: (1) The number of patients using the kiosk and agreeing to transfer of their data into their electronic medical records; (2) the cost of using a kiosk compared with GP/practice nurse BP screening; (3) qualitative themes regarding use of the equipment. RESULTS: Out of 15 624 eligible patients, only 186 (1.2%, 95% CI 1.0% to 1.4%) successfully used the kiosk to directly transfer a BP reading into their medical record. For a considerable portion of the intervention period, no readings were transferred, possibly indicating technical problems with the transfer link. A comparison of costs suggests that at least 52.6% of eligible patients would need to self-screen in order to bring costs below that of screening by GPs and practice nurses. Qualitative interviews confirmed that both patients and staff experienced technical difficulties, and used alternative methods to enter BP results into the medical record. CONCLUSIONS: While interviewees were generally positive about checking BP in the waiting room, the electronic transfer system as tested was neither robust, effective nor likely to be a cost-effective approach, thus may not be appropriate for a primary care environment. Since most of the cost of a kiosk system lies in the transfer mechanism, a solid-cuff sphygmomanometer and manual entry of results may be a suitable alternative

Patient experience of home and waiting room blood pressure measurement: a qualitative study of patients with recently diagnosed hypertension

Background Out-of-office blood pressure (BP) measurement is advocated to confirm hypertension diagnosis. However, little is known about how primary care patients view and use such measurement.Aim To investigate patient experience of out-of-office BP monitoring, particularly home and practice waiting room BP measurement, before, during, and after diagnosis.Design and setting A cross-sectional, qualitative study with patients from two UK GP surgeries participating in a feasibility study of waiting room BP measurement.Method Interviewees were identified from recent additions to the practice hypertension register. Interviews were recorded, transcribed, and coded thematically.Results Of 29 interviewees, 9 (31%) and 22 (76%) had used the waiting room monitor and/or monitored at home respectively. Out-of-office monitoring was used by patients as evidence of control or the lack of need for medication, with the printed results slips from the waiting room monitor perceived to improve ‘trustworthiness’. The waiting room monitor enabled those experiencing uncertainty about their equipment or technique to double-check readings. Monitoring at home allowed a more intensive and/or flexible schedule to investigate BP fluctuations and the impact of medication and lifestyle changes. A minority used self-monitoring to inform drug holidays. Reduced intensity of monitoring was reported with both modalities following diagnosis as initial anxiety or patient and GP interest decreased.Conclusion Home and practice waiting room measurements have overlapping but differing roles for patients. Waiting room BP monitors may be a useful out-of-office measurement modality for patients unwilling and/or unable to measure and record their BP at home

The HIM (Health for Izhevsk Men) trial protocol

BACKGROUND: Russia is one of the very few industrialised countries in the world where life expectancy has been declining. Alcohol has been implicated as a major contributor to the rapid fluctuations observed in male life expectancy since 1985 that have been particularly marked among working-age men. One approach to reducing the alcohol problem in Russia is 'brief interventions' which seek to change views of the personal acceptability of excessive drinking and to encourage self-directed behaviour change. There is limited understanding in Russia of the salience and applicability of Motivational Interviewing (MI), a well-defined brief intervention commonly used to target alcohol-related behaviour, but MI may have important potential for success within the Russian context. METHODS/DESIGN: The study will be an individually randomised two-armed parallel group exploratory trial. The primary hypothesis is that a brief adaptation of MI will be effective in reducing self-reported hazardous drinking at 3 months. The secondary hypothesis is that it will be effective in reducing self-reported past week beverage alcohol consumption, alcohol dependence and related problems at 3 months and at 12 months. MI will also be effective at 12 months in reducing self-reported hazardous drinking, alcohol dependence and related problems, proxy reported hazardous drinking, and recent alcohol use as indicated by bio-markers. Participants are drawn from the Izhevsk Family Study II, with eligibility determined based on proxy reports of hazardous drinking in the past year. All participants undergo a health check, with MI subsequently delivered to those in the intervention arm. Signed consent is obtained from those in the intervention arm at this point. Both groups are then invited for 3 and 12 month follow ups. The control group will not receive any additional intervention. TRIAL REGISTRATION: ISRCTN82405938

Measurement and fusion of non-invasive vital signs for routine triage of acute paediatric illness

Serious illness in childhood is a rare occurrence, but accounts for 20% of childhood deaths. Early recognition and treatment of serious illness is vital if the child is to recover without long-term disability. It is known that vital signs such as heart rate, respiratory rate, temperature, and oxygen saturation can be used to identify children who are at high risk of serious illness. This thesis presents research into the development of a vital signs monitor, designed for use in the initial assessment of unwell children at their first point of contact with a medical practitioner. Child-friendly monitoring techniques are used to obtain vital signs, which can then be combined using data fusion techniques to assist clinicians in identifying children with serious illness. Existing normal ranges for heart rate and respiratory rate in childhood vary considerably, and do not appear to be based on clinical evidence. This thesis presents a systematic meta-analysis of heart rate and respiratory rate from birth to 18 years of age, providing evidence-based curves which can be used to assess the degree of abnormality in these important vital signs. Respiratory rate is particularly difficult to measure in children, but is known to be predictive of serious illness. Current methods of automated measurement can be distressing, or are time-consuming to apply. This thesis therefore presents a novel method for estimating the respiratory rate from an optical finger sensor, the pulse oximeter, which is routinely used in clinical practice. Information from multiple vital signs can be used to identify children at risk of serious illness. A number of data fusion techniques were tested on data collected from children attending primary and emergency care, and shown to outperform equivalent existing scoring systems when used to identify those with more serious illness.</p

Measurement and fusion of non-invasive vital signs for routine triage of acute paediatric illness

Serious illness in childhood is a rare occurrence, but accounts for 20% of childhood deaths. Early recognition and treatment of serious illness is vital if the child is to recover without long-term disability. It is known that vital signs such as heart rate, respiratory rate, temperature, and oxygen saturation can be used to identify children who are at high risk of serious illness. This thesis presents research into the development of a vital signs monitor, designed for use in the initial assessment of unwell children at their first point of contact with a medical practitioner. Child-friendly monitoring techniques are used to obtain vital signs, which can then be combined using data fusion techniques to assist clinicians in identifying children with serious illness. Existing normal ranges for heart rate and respiratory rate in childhood vary considerably, and do not appear to be based on clinical evidence. This thesis presents a systematic meta-analysis of heart rate and respiratory rate from birth to 18 years of age, providing evidence-based curves which can be used to assess the degree of abnormality in these important vital signs. Respiratory rate is particularly difficult to measure in children, but is known to be predictive of serious illness. Current methods of automated measurement can be distressing, or are time-consuming to apply. This thesis therefore presents a novel method for estimating the respiratory rate from an optical finger sensor, the pulse oximeter, which is routinely used in clinical practice. Information from multiple vital signs can be used to identify children at risk of serious illness. A number of data fusion techniques were tested on data collected from children attending primary and emergency care, and shown to outperform equivalent existing scoring systems when used to identify those with more serious illness.</p