Cuff-Less Methods for Blood Pressure Telemonitoring.

Blood pressure telemonitoring (BPT) is a telemedicine strategy that uses a patient\u27s self-measured blood pressure (BP) and transmits this information to healthcare providers, typically over the internet. BPT has been shown to improve BP control compared to usual care without remote monitoring. Traditionally, a cuff-based monitor with data communication capabilities has been used for BPT; however, cuff-based measurements are inconvenient and cause discomfort, which has prevented the widespread use of cuff-based monitors for BPT. The development of new technologies which allow for remote BP monitoring without the use of a cuff may aid in more extensive adoption of BPT. This would enhance patient autonomy while providing physicians with a more complete picture of their patient\u27s BP profile, potentially leading to improved BP control and better long-term clinical outcomes. This mini-review article aims to: (1) describe the fundamentals of current techniques in cuff-less BP measurement; (2) present examples of commercially available cuff-less technologies for BPT; (3) outline challenges with current methodologies; and (4) describe potential future directions in cuff-less BPT development

Blood Pressure Measurement Validation Off the Cuff? Comment on A New Cuffless Device for Measuring Blood Pressure: A Real-Life Validation Study .

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Cuff-Less Methods for Blood Pressure Telemonitoring

Blood pressure telemonitoring (BPT) is a telemedicine strategy that uses a patient's self-measured blood pressure (BP) and transmits this information to healthcare providers, typically over the internet. BPT has been shown to improve BP control compared to usual care without remote monitoring. Traditionally, a cuff-based monitor with data communication capabilities has been used for BPT; however, cuff-based measurements are inconvenient and cause discomfort, which has prevented the widespread use of cuff-based monitors for BPT. The development of new technologies which allow for remote BP monitoring without the use of a cuff may aid in more extensive adoption of BPT. This would enhance patient autonomy while providing physicians with a more complete picture of their patient's BP profile, potentially leading to improved BP control and better long-term clinical outcomes. This mini-review article aims to: (1) describe the fundamentals of current techniques in cuff-less BP measurement; (2) present examples of commercially available cuff-less technologies for BPT; (3) outline challenges with current methodologies; and (4) describe potential future directions in cuff-less BPT development

The Accuracy of Blood Pressure Measurement by Two Cuff-Less Wearable and Portable Health Devices

Introduction: Wearable and portable devices that claim to measure blood pressure without the need of a cuff are becoming increasingly popular among consumers. Given that hypertension is the leading cause for cardiovascular mortality worldwide, a portable technology that allows consumers to easily measure their BP several times a day would be of great value. However, the convenience that portable health technology provides is useless, and even dangerous, if the measurements are inaccurate. Objective: Investigate the accuracy of two popular commercial cuff-less BP device, the Bodimetrics Performance Monitor and Everlast TR10 watch. Methods: A sample of 127 ambulatory patients (\u3e18y) were recruited from the Thomas Jefferson University Hospital Preadmission Testing Center. Following the 2013 ANSI/AAMI/ISO standard protocol for evaluating non-invasive automated sphygmomanometers, four reference and three investigational BP measurements were obtained after a five minute initial rest period. Reference measurements were taken with the validated Cardiocap 5 sphygmomanometer. Results: 85 subjects met inclusion criteria. The average absolute differences (SD) between the Everlast watch and reference were 22.7 (27.4) mmHg for SBP and 6.9 (6.2) mmHg for DBP. The average absolute difference (SD) between the BodiMetrics Performance Monitor and the reference was 5.3 (4.7) mmHg for systolic BP. Discussion: The Everlast fitness watch tested is not accurate enough to be used as BP measurement device. The Bodimetrics device was more accurate, likely due to calibration immediately prior to validation, but even with this advantage the BP device failed to meet accuracy guidelines. Widespread use of this technology likely results in the misclassification of patients’ BP status

Physiological mechanisms mediating the coupling between heart period and arterial pressure in response to postural changes in humans

The upright posture strengthens the coupling between heart period (HP) and systolic arterial pressure (SAP) consistently with a greater contribution of the arterial baroreflex to cardiac control, while paradoxically decreasing cardiac baroreflex sensitivity (cBRS). To investigate the physiological mechanisms that mediate the coupling between HP and SAP in response to different postures, we analyzed the cross-correlation functions between low-frequency HP and SAP fluctuations and estimated cBRS with the sequence technique in healthy male subjects during passive head-up tilt test (HUTT, n = 58), during supine wakefulness, supine slow-wave sleep (SWS), and in the seated and active standing positions (n = 8), and during progressive loss of 1 L blood (n = 8) to decrease central venous pressure in the supine position. HUTT, SWS, the seated, and the standing positions, but not blood loss, entailed significant increases in the positive correlation between HP and the previous SAP values, which is the expected result of arterial baroreflex control, compared with baseline recordings in the supine position during wakefulness. These increases were mirrored by increases in the low-frequency variability of SAP in each condition but SWS. cBRS decreased significantly during HUTT, in the seated and standing positions, and after blood loss compared with baseline during wakefulness. These decreases were mirrored by decreases in the RMSSD index, which reflects cardiac vagal modulation. These results support the view that the cBRS decrease associated with the upright posture is a byproduct of decreased cardiac vagal modulation, triggered by the arterial baroreflex in response to central hypovolemia. Conversely, the greater baroreflex contribution to cardiac control associated with upright posture may be explained, at least in part, by enhanced fluctuations of SAP, which elicit a more effective entrainment of HP fluctuations by the arterial baroreflex. These SAP fluctuations may result from enhanced fluctuations of vascular resistance specific to the upright posture, and not be driven by the accompanying central hypovolemia

The Accuracy of Blood Pressure Measurement by a Smartwatch and a Portable Health Device

Introduction: Hypertension is a leading cause of mortality. Proper blood pressure (BP) control can be achieved by lifestyle modification, pharmacotherapy, and frequent measurements. With the growing popularity of cuffless blood pressure monitors, it is important to independently validate their accuracy. Objective: We evaluated two cuffless blood pressure monitors, The Everlast TR10 fitness watch and the BodiMetrics Performance Monitor, for their accuracy and precision in BP measurements. Methods: Using a protocol derived from the ANSI/AAMI/ISO 2013 standard for evaluating automated sphygmomanometers, we measured the blood pressures of 85 patients recruited from the Thomas Jefferson University Hospital Preadmission Testing Center with two experimental devices and a validated automated sphygmomanometer cuff. We compared the mean absolute differences in measurements between the investigational and reference devices. Comparisons were analyzed with Spearman correlation and T-test, p\u3c0.05. Results: The BodiMetrics Performance Monitor SBP measurements correlated well with the reference SBP measurements (ρ = 0.88, P \u3c 0.01), whereas the Everlast TR10 fitness watch did not (SBP: ρ = -0.19, P \u3c 0.01; DBP: ρ = -0.01, P \u3c 0.01). The BodiMetrics performance monitor reported a hypertensive BP (≥140 mm Hg) for 80% of the hypertensive reference SBP measurements, whereas the Everlast watch measured no hypertensive BP values for any of the hypertensive reference SBP or DBP measurements. Discussion: The Everlast fitness watch and BodiMetrics Performance Monitor are not accurate enough to use for blood pressure monitoring. Use of these devices will likely result in misclassifying patients with hypertension as normotensive, which is a public health concern

Accuracy of Vital Signs Measurements by a Smartwatch and a Portable Health Device: Validation Study.

BACKGROUND: New consumer health devices are being developed to easily monitor multiple physiological parameters on a regular basis. Many of these vital sign measurement devices have yet to be formally studied in a clinical setting but have already spread widely throughout the consumer market. OBJECTIVE: The aim of this study was to investigate the accuracy and precision of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and oxygen saturation (SpO2) measurements of 2 novel all-in-one monitoring devices, the BodiMetrics Performance Monitor and the Everlast smartwatch. METHODS: We enrolled 127 patients (\u3e18 years) from the Thomas Jefferson University Hospital Preadmission Testing Center. SBP and HR were measured by both investigational devices. In addition, the Everlast watch was utilized to measure DBP, and the BodiMetrics Performance Monitor was utilized to measure SpO2. After 5 min of quiet sitting, four hospital-grade standard and three investigational vital sign measurements were taken, with 60 seconds in between each measurement. The reference vital sign measurements were calculated by determining the average of the two standard measurements that bounded each investigational measurement. Using this method, we determined three comparison pairs for each investigational device in each subject. After excluding data from 42 individuals because of excessive variation in sequential standard measurements per prespecified dropping rules, data from 85 subjects were used for final analysis. RESULTS: Of 85 participants, 36 (42%) were women, and the mean age was 53 (SD 21) years. The accuracy guidelines were only met for the HR measurements in both devices. SBP measurements deviated 16.9 (SD 13.5) mm Hg and 5.3 (SD 4.7) mm Hg from the reference values for the Everlast and BodiMetrics devices, respectively. The mean absolute difference in DBP measurements for the Everlast smartwatch was 8.3 (SD 6.1) mm Hg. The mean absolute difference between BodiMetrics and reference SpO2 measurements was 3.02%. CONCLUSIONS: Both devices we investigated met accuracy guidelines for HR measurements, but they failed to meet the predefined accuracy guidelines for other vital sign measurements. Continued sale of consumer physiological monitors without prior validation and approval procedures is a public health concern

Vitamin D3 Supplementation at 5000 IU Daily for the Prevention of Influenza-like Illness in Healthcare Workers: A Pragmatic Randomized Clinical Trial.

Vitamin D supplementation has been shown to reduce the incidence of acute respiratory infections in populations at risk. The COVID-19 pandemic has highlighted the importance of preventing viral infections in healthcare workers. The aim of this study was to assess the hypothesis that vitamin D3 supplementation at 5000 IU daily reduces influenza-like illness (ILI), including COVID-19, in healthcare workers. We conducted a prospective, controlled trial at a tertiary university hospital. A random group of healthcare workers was invited to receive 5000 IU daily vitamin D3 supplementation for nine months, while other random healthcare system workers served as controls. All healthcare workers were required to self-monitor and report to employee health for COVID-19 testing when experiencing symptoms of ILI. COVID-19 test results were retrieved. Incidence rates were compared between the vitamin D and control groups. Workers in the intervention group were included in the analysis if they completed at least 2 months of supplementation to ensure adequate vitamin D levels. The primary analysis compared the incidence rate of all ILI, while secondary analyses examined incidence rates of COVID-19 ILI and non-COVID-19 ILI. Between October 2020 and November 2021, 255 healthcare workers (age 47 ± 12 years, 199 women) completed at least two months of vitamin D3 supplementation. The control group consisted of 2827 workers. Vitamin D3 5000 IU supplementation was associated with a lower risk of ILI (incidence rate difference: -1.7 × 1

Coccydynia Treated with Dorsal Root Ganglion Stimulation

Coccydynia can be difficult to resolve with conventional treatment options. Dorsal root ganglion (DRG) stimulation has recently emerged as a treatment for chronic pain, but its application has not been described in the context of coccydynia. We used DRG stimulation treatment in a patient suffering from intractable coccyx pain. At long-term follow-up, the patient experienced a decrease in pain intensity and improvement in function, without any complications. DRG stimulation may be a treatment modality for coccydynia refractory to other approaches