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Environmental Health Insights 2024Nosocomial pathogens are known to exacerbate morbidity and mortality in contemporary critical healthcare. Hospital fomites, which include inanimate surfaces, have been... (Review)
Review
BACKGROUND
Nosocomial pathogens are known to exacerbate morbidity and mortality in contemporary critical healthcare. Hospital fomites, which include inanimate surfaces, have been identified as "breeding grounds" for pathogens that cause nosocomial infections. This systematic review aimed to deliver incisive insights on nosocomial pathogens in intensive care units (ICUs) and the role of fomites as potential reservoirs for their transmission.
METHOD
An extensive exploration of electronic databases, including PubMed and Scopus, from 1990 to 2023, was carried out between 25 and 29 May 2023, per standard PRISMA guidelines. Information were extracted from articles that reported on fomites in the ICU. Studies that did not quantitatively report the fomite contamination, and those that exclusively took samples from patients in the ICU were excluded from the analysis.
RESULTS
About 40% of the total samples collected on fomites from all the studies yielded microbial growth, with species of being the most predominant. Other prevalent microbes were , , , spp., sp., and sp. The neonatal intensive care unit (NICU) had the highest proportion of contaminated fomites. Among known fomites, the sphygmomanometer exhibited a 100% detection rate of nosocomial pathogens. This included , , coagulase-negative (CoNS), , and Multidrug-resistant (MDR) bacteria, such as methicillin-resistant (MRSA), vancomycin-resistant (VRE), extended-spectrum beta-lactamase (ESBL)-producing , and MDR were commonly isolated on fomites in the ICUs.
CONCLUSION
Many fomites that are readily used in patient care in the ICU harbour nosocomial pathogens. The most common fomite appeared to be mobile phones, sphygmomanometers, and stethoscopes, with being the most common contaminant. Consequently, the need for rigorous disinfection and sterilization protocols on fomites in the ICU cannot be overemphasized. Additionally, heightened awareness on the subject among health professionals is crucial to mitigating the risk and burden of nosocomial infections caused by drug-resistant bacteria.
PubMed: 38828046
DOI: 10.1177/11786302241243239 -
Physiological Measurement Sep 2022: Accurate and reliable blood pressure (BP) measurement is important for the prevention and treatment of hypertension. The oscillometric-based automatic office blood... (Review)
Review
: Accurate and reliable blood pressure (BP) measurement is important for the prevention and treatment of hypertension. The oscillometric-based automatic office blood pressure measurement (AOBPM) is widely used in hospitals and clinics, but measurement errors are common in BP measurements. There is a lack of systematic review of the sources of measurement errors.: A systematic review of all existing research on sources of AOBPM errors. A search strategy was designed in six online databases, and all the literature published before October 2021 was selected. Those studies that used the AOBPM device to measure BP from the upper arm of subjects were included.: A total of 1365 studies were screened, and 224 studies were included in this final review. They investigated 22 common error sources with clinical AOBPM. Regarding the causes of BP errors, this review divided them into the following categories: the activities before measurement, patient's factors, measurement environment, measurement procedure, and device settings. 13 sources caused increased systolic and diastolic BP (SBP and DBP), 2 sources caused the decrease in SBP and DBP, only 1 source had no significant effect on BPs, and the other errors had a non-uniform effect (either increase or decrease in BPs). The error ranges for SBP and DBP were -14 to 33 mmHg and -6 to 19 mmHg, respectively.: The measurement accuracy of AOBPM is susceptible to the influence of measurement factors. Interpreting BP readings need to be treated with caution in clinical measurements. This review made comprehensive evidence for the need for standardized BP measurements and provided guidance for clinical practitioners when measuring BP with AOBPM devices.
Topics: Blood Pressure; Blood Pressure Determination; Humans; Hypertension; Oscillometry; Sphygmomanometers
PubMed: 35952651
DOI: 10.1088/1361-6579/ac890e -
JMIR MHealth and UHealth May 2022In the era of digital health information technology, there has been a proliferation of devices that collect patient-generated health data (PGHD), including consumer... (Review)
Review
BACKGROUND
In the era of digital health information technology, there has been a proliferation of devices that collect patient-generated health data (PGHD), including consumer blood pressure (BP) monitors. Despite their widespread use, it remains unclear whether such devices can improve health outcomes.
OBJECTIVE
We performed a systematic review of the literature on consumer BP monitors that collect PGHD for managing hypertension to summarize their clinical impact on health and surrogate outcomes. We focused particularly on studies designed to measure the specific effect of using a BP monitor independent of cointerventions. We have also summarized the process and consumer experience outcomes.
METHODS
An information specialist searched PubMed, MEDLINE, and Embase for controlled studies on consumer BP monitors published up to May 12, 2020. We assessed the risk of bias using an adapted 9-item appraisal tool and performed a narrative synthesis of the results.
RESULTS
We identified 41 different types of BP monitors used in 49 studies included for review. Device engineers judged that 38 (92%) of those devices were similar to the currently available consumer BP monitors. The median sample size was 222 (IQR 101-416) participants, and the median length of follow-up was 6 (IQR 3-12) months. Of the included studies, 18 (36%) were designed to isolate the clinical effects of BP monitors; 6 of the 18 (33%) studies evaluated health outcomes (eg, mortality, hospitalizations, and quality of life), and data on those outcomes were unclear. The lack of clarity was due to low event rates, short follow-up duration, and risk of bias. All 18 studies that isolated the effect of BP monitors measured both systolic and diastolic BP and generally demonstrated a decrease of 2 to 4 mm Hg in systolic BP and 1 to 3 mm Hg in diastolic BP compared with non-BP monitor groups. Adherence to using consumer BP monitors ranged from 38% to 89%, and ease of use and satisfaction ratings were generally high. Adverse events were infrequent, but there were a few technical problems with devices (eg, incorrect device alerts).
CONCLUSIONS
Overall, BP monitors offer small benefits in terms of BP reduction; however, the health impact of these devices continues to remain unclear. Future studies are needed to examine the effectiveness of BP monitors that transmit data to health care providers. Additional data from implementation studies may help determine which components are critical for sustained BP improvement, which in turn may improve prescription decisions by clinicians and coverage decisions by policy makers.
Topics: Blood Pressure; Blood Pressure Monitors; Humans; Hypertension; Quality of Life; Sphygmomanometers
PubMed: 35499862
DOI: 10.2196/33261 -
Scientific Reports Mar 2022This study aims to systematically review the diagnostic accuracy of a digital blood pressure measurement device compared to the gold standard mercury sphygmomanometer in... (Meta-Analysis)
Meta-Analysis
This study aims to systematically review the diagnostic accuracy of a digital blood pressure measurement device compared to the gold standard mercury sphygmomanometer in published studies. Searches were conducted in PubMed, Cochrane, EBSCO, EMBASE and Google Scholar host databases using the specific search strategy and filters from 1st January 2000 to 3rd April 2021. We included studies reporting data on the sensitivity or specificity of blood pressure measured by digital devices and mercury sphygmomanometer used as the reference standard. Studies conducted among children, special populations, and specific disease groups were excluded. We considered published manuscripts in the English language only. The risk of bias and applicability concerns were assessed based on the author's judgment using the QUADAS2 manual measurement evaluation tool. Based on the screening, four studies were included in the final analysis. Sensitivity, specificity, diagnostic odds ratio (DOR), and 95% confidence interval were estimated. The digital blood pressure monitoring has a moderate level of accuracy and the device can correctly distinguish hypertension with a pooled estimate sensitivity of 65.7% and specificity of 95.9%. After removing one study, which had very low sensitivity and very high specificity, the pooled sensitivity estimate was 79%, and the specificity was 91%. The meta-analysis of DOR suggests that the digital blood pressure monitor had moderate accuracy with a mercury sphygmomanometer. This will provide the clinician and patients with accurate information on blood pressure with which diagnostic and treatment decisions could be made.
Topics: Blood Pressure; Blood Pressure Determination; Child; Humans; Mercury; Sensitivity and Specificity; Sphygmomanometers
PubMed: 35233077
DOI: 10.1038/s41598-022-07315-z -
The Journal of Family Practice May 2021Obtain greater accuracy in blood pressure measurement with an automated office device. (Comparative Study)
Comparative Study Meta-Analysis
Obtain greater accuracy in blood pressure measurement with an automated office device.
Topics: Adult; Aged; Aged, 80 and over; Automation; Blood Pressure Determination; Blood Pressure Monitoring, Ambulatory; Female; Humans; Hypertension; Male; Middle Aged; Sphygmomanometers; United States
PubMed: 34339363
DOI: 10.12788/jfp.0188 -
European Journal of Pediatrics Jan 2022With the progressive elimination of mercury column devices for blood pressure (BP) measurement in children and adolescents, valid alternatives are needed. Oscillometric... (Meta-Analysis)
Meta-Analysis Review
Blood pressure measurement in pediatric population: comparison between automated oscillometric devices and mercury sphygmomanometers-a systematic review and meta-analysis.
With the progressive elimination of mercury column devices for blood pressure (BP) measurement in children and adolescents, valid alternatives are needed. Oscillometric devices provide a replacement without mercury, are fully automated, and have excellent reliability among evaluators. Here, the goal was to test the accuracy of automatic blood pressure monitor devices compared to the mercury sphygmomanometer for BP measurement in children and adolescents. Electronic databases are EMBASE, MEDLINE (PubMed), SCOPUS, and Web of Science. We selected 8974 potentially eligible articles and two authors independently. We separately reviewed 370 full papers. Potentially eligible articles were selected according to the following criteria: (a) articles published in Portuguese, English, and Spanish; (b) screening of titles; (c) screening of abstracts; and (d) retrieval and screening of the full article to determine whether it met the inclusion criteria. We included 45 articles for analysis, 28 of which were selected for meta-analysis. The systolic BP measured by automatic blood pressure monitors presents 1.17 mmHg on average (95% CI 0.85; 1.48); for diastolic BP, it produced -0.08 mmHg (95% CI -0.69; 0.54) compared with a mercury sphygmomanometer. There is high heterogeneity between studies (> 90%) in the meta-analysis, partly explained by the device model, study environment, and observer training. Only articles that reported BP measurement by both methods were included.Conclusion: Automatic blood pressure monitors have strong measurement validity when compared with the mercury column. Thus, these can be safely used in blood pressure measurements of children and adolescents in clinical and epidemiological studies. What is Known: •The "gold standard" for indirect BP measurement is the mercury sphygmomanometer. •The accuracy of the automatic device is critical to any blood pressure measurement method. What is New: •Oscillometric or automatic devices can be a suitable alternative to auscultation for initial screening, consistent with current pediatric guidelines. •The automatic devices compared to the mercury column have a good validity of measurements, which can be used in blood pressure measurements of children and adolescents in clinical and epidemiological settings, provided that international protocols are followed.
Topics: Adolescent; Blood Pressure; Blood Pressure Determination; Blood Pressure Monitors; Child; Humans; Hypertension; Mercury; Reproducibility of Results; Sphygmomanometers
PubMed: 34272985
DOI: 10.1007/s00431-021-04171-3 -
Blood Pressure Monitoring Feb 2020This study aimed to identify whether automated oscillometric blood pressure monitor (AOBPM) is a reliable blood pressure (BP) measurement tool in geriatric patients with... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This study aimed to identify whether automated oscillometric blood pressure monitor (AOBPM) is a reliable blood pressure (BP) measurement tool in geriatric patients with atrial fibrillation (AF) with high variability in BP and to evaluate whether it can be applied in practice.
METHODS
Electronic searches were performed in databases including MEDLINE, EMBASE, the Cochrane Library, and CINAHL by using the following keywords: 'atrial fibrillation,' 'atrial flutter, 'blood pressure monitor', 'sphygmomanometer.' The QUADAS-2 was applied to assess the internal validity of selected studies. Meta-analysis was performed using RevMan 5.3 program.
DESIGN
Systematic review.
RESULTS
We identified 10 studies, including 938 geriatric patients with AF. We compared with the previously used BP measurement method (mainly office) and AOBPM, and the patients with AF were divided into the AF-AF (atrial fibrillation rhythm continued) and AF-SR groups (sinus rhythm recovered). The difference in the systolic BP was -3.0 mmHg [95% confidence interval (CI): -6.58 to 0.59] and -1.62 (95% CI: -6.08 to 2.84) mmHg in the AF-AF and AF-SR groups, respectively. The difference in the diastolic BP was 0.17 (95% CI: -2.90 to 3.25) mmHg and -0.23 (95% CI: -5.11 to 4.65) mmHg, respectively.
CONCLUSION
This review showed that the BP difference from AOBPM compared with the auscultatory BP method was less than 5 mmHg in the elderly with AF. This difference is acceptable in clinical practice. However, AOBPM compared with invasive arterial BP in the diastolic BP was a difference of 5 mmHg or more, and so its accuracy cannot be assured.
Topics: Aged; Arterial Pressure; Atrial Fibrillation; Blood Pressure Determination; Blood Pressure Monitors; Female; Humans; Male; Oscillometry; Reproducibility of Results
PubMed: 31714346
DOI: 10.1097/MBP.0000000000000414 -
Blood Pressure Monitoring Dec 2019A mercury sphygmomanometer has been considered a gold standard for measuring blood pressure. However, by the Minamata Convention on Mercury, the traditional mercury... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
A mercury sphygmomanometer has been considered a gold standard for measuring blood pressure. However, by the Minamata Convention on Mercury, the traditional mercury sphygmomanometer is being replaced by an automated oscillometric device. This study aimed to provide scientific evidence to determine whether an automated oscillometric device can replace a mercury sphygmomanometer and if it is applicable in routine practice.
METHODS
MEDLINE, EMBASE, the Cochrane Library, and CINAHL were searched on 4 May 2018. Studies comparing blood pressure measurements between automated oscillometric devices and mercury sphygmomanometers were included. Study characteristics were abstracted using the evidence table, and random-effects meta-analyses were conducted.
RESULTS
Data were compiled from 24 studies comprising 47 759 subjects. The results of meta-analysis showed that automated oscillometric devices measured lower than mercury sphygmomanometers for both systolic blood pressure (mean differences -1.75 mmHg, 95% confidence intervals: -3.05 to -0.45, I = 91.0%) and diastolic blood pressure (mean differences -1.20 mmHg, 95% confidence intervals: -2.16 to -0.24, I = 95.0%). In sub-group analyses by manufacturer, BpTRU measured lower than the mercury sphygmomanometer and OMRON showed no difference compared to the mercury sphygmomanometer for both systolic and diastolic blood pressure, but the results differed depending on the devices.
CONCLUSION
As a result of this review, the difference in blood pressure between the mercury sphygmomanometer and the automated oscillometric device was within 5 mmHg, but the heterogeneity between the studies was very high. The automated oscillometric devices showed differences in blood pressure results according to the manufacturer and product type.
Topics: Blood Pressure; Blood Pressure Determination; Humans; Hypertension; Mercury; Oscillometry; Reproducibility of Results; Sphygmomanometers
PubMed: 31658107
DOI: 10.1097/MBP.0000000000000412 -
JAMA Pediatrics Dec 2019Reliable estimates of the prevalence of childhood hypertension serve as the basis for adequate prevention and treatment. However, the prevalence of childhood... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Reliable estimates of the prevalence of childhood hypertension serve as the basis for adequate prevention and treatment. However, the prevalence of childhood hypertension has rarely been synthesized at the global level.
OBJECTIVE
To conduct a systematic review and meta-analysis to assess the prevalence of hypertension in the general pediatric population.
DATA SOURCES
PubMed, MEDLINE, Embase, Global Health, and Global Health Library were searched from inception until June 2018, using search terms related to hypertension (hypertension OR high blood pressure OR elevated blood pressure), children (children OR adolescents), and prevalence (prevalence OR epidemiology).
STUDY SELECTION
Studies that were conducted in the general pediatric population and quantified the prevalence of childhood hypertension were eligible. Included studies had blood pressure measurements from at least 3 separate occasions.
DATA EXTRACTION AND SYNTHESIS
Two authors independently extracted data. Random-effects meta-analysis was used to derive the pooled prevalence. Variations in the prevalence estimates in different subgroups, including age group, sex, setting, device, investigation period, BMI group, World Health Organization region and World Bank region, were examined by subgroup meta-analysis. Meta-regression was used to establish the age-specific prevalence of childhood hypertension and to assess its secular trend.
MAIN OUTCOMES AND MEASURES
Prevalence of childhood hypertension overall and by subgroup.
RESULTS
A total of 47 articles were included in the meta-analysis. The pooled prevalence was 4.00% (95% CI, 3.29%-4.78%) for hypertension, 9.67% (95% CI, 7.26%-12.38%) for prehypertension, 4.00% (95% CI, 2.10%-6.48%) for stage 1 hypertension, and 0.95% (95% CI, 0.48%-1.57%) for stage 2 hypertension in children 19 years and younger. In subgroup meta-analyses, the prevalence of childhood hypertension was higher when measured by aneroid sphygmomanometer (7.23% vs 4.59% by mercury sphygmomanometer vs 2.94% by oscillometric sphygmomanometer) and among overweight and obese children (15.27% and 4.99% vs 1.90% among normal-weight children). A trend of increasing prevalence of childhood hypertension was observed during the past 2 decades, with a relative increasing rate of 75% to 79% from 2000 to 2015. In 2015, the prevalence of hypertension ranged from 4.32% (95% CI, 2.79%-6.63%) among children aged 6 years to 3.28% (95% CI, 2.25%-4.77%) among those aged 19 years and peaked at 7.89% (95% CI, 5.75%-10.75%) among those aged 14 years.
CONCLUSIONS AND RELEVANCE
This study provides a global estimation of childhood hypertension prevalence based on blood pressure measurements in at least 3 separate visits. More high-quality epidemiologic investigations on childhood hypertension are still needed.
Topics: Child; Global Health; Humans; Hypertension; Prevalence
PubMed: 31589252
DOI: 10.1001/jamapediatrics.2019.3310 -
JBI Database of Systematic Reviews and... Oct 2019The objective of this systematic review was to synthesize the best available research evidence on the effectiveness of flavonoid-rich fruits in the treatment of... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The objective of this systematic review was to synthesize the best available research evidence on the effectiveness of flavonoid-rich fruits in the treatment of hypertension.
INTRODUCTION
Hypertension is a serious public health concern as it contributes to a significant burden of disease, leading to millions of deaths globally. Complementary therapies including flavonoids have generated interest in assisting the treatment of hypertension. Flavonoids are a type of polyphenol abundant in fruits and a growing body of evidence suggests antihypertensive effects of the flavonoids due to their antioxidant properties. To date, no systematic review has been performed to collate the evidence on the effects of flavonoid-rich fruits on hypertension in adults.
INCLUSION CRITERIA
This systematic review included randomized controlled trials (RCTs) that compared the administration of any type of flavonoid-rich fruit or equivalent supplement with a placebo or other intervention in adults with hypertension. Trials that measured blood pressure using objective outcome measures such as a manual mercury sphygmomanometer were included. Studies that did not specify the flavonoid component of the fruit or fruit supplement were excluded from the review. Secondary outcomes, including change in weight, blood glucose level, triglycerides and total blood cholesterol levels, were also assessed.
METHODS
A three-step search was undertaken, including a comprehensive search of the MEDLINE, Embase, Cochrane Trials (CENTRAL) and CINAHL databases, in September 2018. We also searched Dissertation Abstracts International, ProQuest Dissertations and Theses, MedNar and ClinicalTrials.gov to identify unpublished studies. The title and abstracts of the studies were reviewed by two independent reviewers against the inclusion/exclusion criteria. The methodological quality of the potential studies for inclusion were assessed using the critical appraisal checklist for randomized controlled trials as recommended by JBI. Data were pooled in a statistical meta-analysis model. Subgroup-analysis according to type of intervention and length of intervention period was performed. Where statistical pooling was not possible, the findings have been presented in a narrative form.
RESULTS
Fifteen randomized controlled trials involving 572 participants were included in the review. The subclasses of flavonoids assessed included: anthocyanins, naringin, narirutin and flavan-3-ols. The overall methodological quality of the trials was high. Six trials investigated the effect of the flavonoid intervention on blood pressure within four weeks. Meta-analysis of four of the trials demonstrated no effect of flavonoids on systolic or diastolic blood pressure when compared to placebo (systolic mean difference = -1.02, 95% confidence interval [CI] -3.12, 1.07; p = 0.34, I = 0%; diastolic mean difference = -0.90, 95% CI -2.10, 0.31; p = 0.15, I = 0%). Similarly, pooled results from two crossover RCTs with two-timed dosed interventions in a 24-hour period demonstrated no effect on a reduction in diastolic blood pressure (p = 0.38) but did reveal evidence of a reduction in systolic blood pressure (p = 0). Six trials assessed blood pressure following the flavonoid intervention at more than four weeks follow-up. Meta-analysis of five of the trials demonstrated evidence of no effect on either systolic blood pressure (mean difference = -0.95, 95%CI -3.58, 1.68; p = 0.478, I = 0%) or diastolic blood pressure (mean difference = 0.86, 95%CI -1.11, 2.82; p = 0.393, I = 0%).
CONCLUSIONS
The findings of this systematic review should be interpreted with caution, given that the results are obtained from single-center trials with small sample sizes. Flavonoids have no effect on systolic and diastolic blood pressure. Further robust RCTs using sample sizes based on power calculations are needed to provide evidence for the use of flavonoid-rich fruits for the management of hypertension.
Topics: Blood Glucose; Body Weight; Flavonoids; Fruit; Humans; Hypertension; Lipids; Randomized Controlled Trials as Topic
PubMed: 31464854
DOI: 10.11124/JBISRIR-D-19-00050