• Clinical and Experimental Pediatrics
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• v.54 no.11
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• pp.463-469
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• 2011

Purpose: To validate the Dinamap ProCare 200 blood pressure (BP) monitor against a mercury sphygmomanometer in children 7 to 18 years old in accordance with the 2010 International Protocol of European Society of Hypertension (ESH-IP2) and the British Hypertension Society (BHS) protocol. Methods: Forty-five children were recruited for the study. A validation procedure was performed following the protocol based on the ESH-IP2 and BHS protocols for children and adolescents. Each subject underwent 7 sequential BP measurements alternatively with a mercury sphygmomanometer and the test device by trained nurses. The results were analyzed according to the validation criteria of ESH-IP2. Results: The mean (${\pm}SD$) difference in the absolute BP values between test device and mercury sphygmomanometer readings was $1.85{\pm}1.65$ mmHg for systolic BP (SBP) and $4.41{\pm}3.53$ mmHg for diastolic BP (DBP). These results fulfilled the Association for the Advancement of Medical Instrumentation criterion of a mean${\pm}$SD below $5{\pm}8$ mmHg for both SBP and DBP. The percentages of test device-observer mercury sphygmomanometer BP differences within 5, 10, and 15 mmHg were 96%, 100%, and 100% for SBP, and 69%, 92%, and 100% for DBP, respectively, in the part 1 analysis; both SBP and DBP passed the part 1 criteria. In the part 2 analysis, SBP passed the criteria but DBP failed. Conclusion: Although the Dinamap ProCare 200 BP monitor failed an adapted ESH-IP2, SBP passed. When comparing BP readings measured by oscillometers and mercury sphygmomanometers, one has to consider the differences between them, particularly in DBP, because DBP can be underestimated.

• Journal of Biosystems Engineering
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• v.33 no.6
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• pp.438-445
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• 2008

The purpose of this study was to develop a measurement model based on PLS (Partial least square) method for blood pressures. Measurement system for blood pressure signals consisted of pressure sensor, va interface and embedded module. A mercury sphygmomanometer was connected with the measurement system through 3-way stopcock and used as reference of blood pressures. The blood pressure signals of 20 subjects were measured and tests were repeated 5 times per each subject. Total of 100 data were divided into a calibration set and a prediction set. The PLS models were developed to determine the systolic and the diastolic blood pressures. The PLS models were evaluated by the standard methods of the British Hypertension Society (BHS) protocol and the American Association for the Advancement of Medical Instrumentation (AAMI). The results of the PLS models were compared with those of MAA (maximum amplitude algorithm). The measured blood pressures with PLS method were highly correlated to those with a mercury sphygmomanometer in the systolic ($R^2=0.85$) and the diastolic blood pressure ($R^2=0.84$). The results showed that the PLS models were the effective tools for blood pressure measurements with high accuracy, and satisfied the standards of the BHS protocol and the AAMI.

• Journal of Sensor Science and Technology
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• v.16 no.1
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• pp.44-51
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• 2007

A hybridized simulator for generating blood pressure waveform is proposed to study the remedy and/or evaluation of the conventional sphygmomanometer utilizing the oscillometric method which is widely applied. The blood pressure of a flowing fluid was controlled for the blood vessel's condition caused by a rhythmical and periodical contraction/relaxation because of the special excitatory and conductive system of the heart. In this study, a hybridized controller composed of the PI feedback controller and the feedforward controller. The inverse dynamics function is proposed to operating the control valve while the pressure is applied in an oil pressure tank. The proposed hybrid simulator reproducing the blood pressure waveform in an artificial blood vessel has kept the control performance consistent over all range. Based on these results, the proposed simulators could be applied to the development and compensation of the non invasive sphygmomanometer type as well as to study the characteristics of the blood pressure and blood vessel.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.5 no.1
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• pp.95-106
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• 1998

The purpose of this study was to compare direct and three indirect blood pressure measurements in adults and to compare among three indirect blood pressure measurements in adults. One direct(intraarterial) and three indirect(using a mecury sphygmomanometer, a aneroid type sphygmomanometer and an automatic auscultatory device) methods of blood pressure measurement were compared in adult patients who had an arterial line. The subjects for this study consisted of 29 patients in K medical center, B medical center, B hospital and M hospital in Pusan. The data was collected from October 1, 1992 to June 30, 1993. The collected data was analysed with the SPSS program, frequency, percentage, mean, S.D., t-test, ANOVA. The results of this study were as follows : 1) There was a significant difference in the systolic BP when using the direct and three indirect measurements(P<0.05). 2) There was no overall significant difference in the diastolic BP when using the direct and three indirect measurements. 3) There was no significant difference in the SBP and DBP among the three indirect measurements.

• Clinical and Experimental Pediatrics
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• v.65 no.2
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• pp.73-80
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• 2022

A mercury sphygmomanometer (MS) has been the gold standard for pediatric blood pressure (BP) measurements, and diagnosing hypertension is critical. However, because of environmental issues, other alternatives are needed. Noninvasive BP measurement devices are largely divided into auscultatory and oscillometric types. The aneroid sphygmomanometer, the currently used auscultatory method, is inferior to MS in terms of limitations such as validation and regular calibration and difficult to apply to infants, in whom Korotkoff sounds are not audible. The oscillometric method uses an automatic device that eliminates errors caused by human observers and has the advantage of being easy to use; however, owing to its measurement accuracy issues, the development of an international validation protocol for children is important. The hybrid method, which combines the auscultatory and electronic methods, solves some of these problems by eliminating the observer bias of terminal digit preference while maintaining measurement accuracy; however, the auscultatory method remains limited. As the age-related characteristics of the pediatric group are heterogeneous, it is necessary to reconsider the appropriate BP measurement method suitable for this indication. In addition, the mobile application-based BP measurement market is growing rapidly with the development of smartphone applications. Although more research is still needed on their accuracy, many experts expect that mobile application-based BP measurement will effectively reduce medical costs due to increased ease of access and early BP management.

• Journal of Sensor Science and Technology
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• v.17 no.2
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• pp.87-94
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• 2008

Blood pressure (BP), one of the most important vital signs, is used to identify an emergency state and reflects the blood flow characteristics of the cardiovascular system. The conventional noninvasive method of measuring BP is inconvenient because patients must wear a cuff on their arm and the measurement process takes time. This paper proposes an algorithm for estimating the BP using the pulse transit time (PTT) of the photoplethysmography (PPG) and pressure pulse from finger at the same time as a more convenient way to measure the BP. After recording the electrocardiogram (ECG), measuring the pressure pulse, and performing PPG, we calculated the PTT from the acquired signals. Then, we used a multiple regression analysis to measure the systolic and diastolic BP indirectly. Comparing the BP measured indirectly using the proposed algorithm and the real BP measured with a sphygmomanometer, the systolic pressure had a mean error of ${\pm}3.240$ mmHg and a standard deviation of 2.530 mmHg, while the diastolic pressure had a satisfactory result, i.e., a mean error of ${\pm}1.807$ mmHg and a standard deviation of 1.396 mmHg. These results are more superior than existing method estimating blood pressure using the one PTT and satisfy the ANSI/AAMI regulations for certifying a sphygmomanometer i.e., the measurement error should be within a mean error of ${\pm}5$ mmHg and a standard deviation of 8 mmHg. These results suggest the possibility of applying our method to a portable, long-term BP monitoring system.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.3 no.1
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• pp.96-107
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• 1996

Automated blood pressure monitors have gained acceptance in many clinical settings with the increasing demand, the accurate BP measuring devices reguire the need for validation. We have evaluated the Dinamap 8100, an oscillometric automated blood pressure monitor, using the Mercury sphygmomanometer as a reference. Comparison of sphygmomanometers was conducted 60 patients (30-Normotensive group, 30-Hypertensive group at Seoul National University Hospital. Two trained observers took measure blood pressure(systolic/diastolic) at the same time using the Dinamap 8100 on one arm and the Mercury on the other. For each measurement, the device was randomly selected from a group of devices repetively used for the experiment. Mean readings for systolic pressure with the Dinamap 8100 in normotensive group were lower(mean difference ; 4.26mmHg) than the Mercury type. Mean readings for systolic pressure with the Dinamap 8100 in hypertensive group were lower(mean difference ; 9.05mmHg) than the Mercury type. Mean readings for diastolic pressure with the Dinamap 8100 in normotensive group were lower (mean difference ; 7.46mmHg) than the Mercury type. Mean readings for diastolic pressure with the Dinamap 8100 in hypertensive group were lower(mean difference ; 9.03mmHg) than the Mercury type. We have found that blood pressure readings with the Dinamap 8100 were lower than those with the Mercury type. we are using the Mercury type in clinics, although it has observer bias and terminal digit preference. But the Dinamap 8100 is readily portable, simple to use, and capable of preventing observer bias and terminal digit preference. The Dinamap 8100 is acceptable for blood pressure determination in subjects who are normotensive or hypertensive ones.

• Quality Improvement in Health Care
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• v.3 no.1
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• pp.94-103
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• 1996

Background : Blood pressure is an important indicator in diagnosis and assessing treatment of a patient. Clinical staffs use blood pressure on the assumption that measured value is accurate and reliable. However, whether measured blood pressure is accurate has been rarely investigated in Korea. Objectives : The aims of this study are to evaluate clinical staffs' knowledge and technique as well as accuracy of sphygmomanometer. Also the program to improve the measurement is developed. Methods : Seventy-three registered nurses were asked nine multiple choice questions including Korotkoff sound, cuff size, and deflation rate. Simultaneously characteristics of nurses were examined, age, working place, duration of employment and academic degree. A testing videotape(Standardizing Measurement Video-Tutored Course) was used for evaluating the accuracy of measurement. Testees were to read and record the 12 cases of blood pressure measurement, watching a falling mercury column and hearing Korotkoff sounds. After 10 minutes' education, they were again tested with the same cases. Additionally, 83 mercury sphygmomanometers were checked to find defects such as inaccurate calibration and zero setting, leaky bladder, etc. Results: For the knowledge testing correct response rate was 41.1%. They were the lowest in selecting the proper cuff size and Korotkoff sound. In examining accuracy of blood pressure with videotape, nurses had 67.7% correct response rate. The correct response rate was significantly improved by a session of education. About 23% of sphygmomanometers was without discernable defects. Conclusion : The knowledge and skill of clinical staffs along with the accuracy of equipment have to be improved. A properly designed education program would contribute to the accuracy improvement of blood pressure measurement. Also, more concerns should be given to the precision and maintenance of equipment.

• Korean Circulation Journal
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• v.54 no.5
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• pp.270-287
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• 2024

Background and Objectives: Blood pressure (BP) measurement using an auscultatory sphygmomanometer is recommended for diagnosing hypertension in children. As mercury sphygmomanometers (MSs) are banned owing to environmental concerns, it is crucial to determine the accuracy of mercury-free sphygmomanometers to replace them. We analyzed the accuracy of these devices to guide the National Survey selection. Methods: BP was measured thrice each with MS, auscultatory device (AD), and oscillometric device (OD) in 104 participants aged 10-18 using the National Survey data. The difference in BP was defined as the difference between MS and other devices. The BP differences, correlations, and influencing factors were analyzed. The frequencies of hypertension were also compared. Results: Systolic BP (SBP) and diastolic BP (DBP) differences between MS and AD were 0.88±3.36 mmHg and 0.63±3.95 mmHg, and those between MS and OD were 0.43±5.83 mmHg and 4.57±6.89 mmHg, respectively. The absolute error of <10 mmHg for DBP between MS and OD was 76%. The concordance correlation coefficient between MS and AD was 0.94 for SBP and 0.90 for DBP, and 0.81 and 0.67, respectively for MS and OD. Arm circumference negatively correlated with BP differences except for SBP between the MS and OD. The frequency of hypertension was not different between MS and AD but was underestimated by OD. Conclusions: AD correlated well with MS, while OD did not, especially for DBP. The superiority of AD over OD suggests AD as a possible alternative for MS in the National Survey.

• Tuberculosis and Respiratory Diseases
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• v.52 no.2
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• pp.156-165
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• 2002

Background: A tracheal stenosis is caused by mucosal ischemic injury related to a high cuff pressure ($P_{cuff}$) of the endotracheal tube. In contrast, aspiration of the upper airway secretion and impaired gas exchange due to cuff leakage is related to a low $P_{cuff}$. To prevent these complications, the $P_{cuff}$ should be kept appropriately because the appropriate $P_{cuff}$ appears to change according to the patient's daily respiratory mechanics. However, the constant cuff volume($V_{cuff}$) has frequently been instilled to the cuff balloon on a daily basis to maintain the optimal $P_{cuff}$ instead of monitoring the $P_{cuff}$ directly at the patients' bedside. To address the necessity of continuous $P_{cuff}$ monitoring, the change in the $P_{cuff}$ was evaluated at various $V_{cuff}$ levels on a daily basis in patients with long-term mechanical ventilation. The utility of mercury column sphygmomanometer for the continuous monitoring $P_{cuff}$ was also investigated. Method: The change in $P_{cuff}$ according to the increase in $V_{cuff}$ was observed in 17 patients with prolonged endotracheal intubation for mechanical ventilation for 2 week or more. This maneuver measured the change in $P_{cuff}$ daily during the mechanical ventilation days. In addition, the $P_{cuff}$ measured by mercury column sphygmomanometer was compared with the $P_{cuff}$ measured by an automatic cuff pressure manager. Results : There were no statistically significant changes of $P_{cuff}$ during more than 14 days of intubation for mechanical ventilation. However the $V_{cuff}$ required to maintain the appropriate $P_{cuff}$ varied from 1.9 cc to 9.6 cc. In addition, the intra-individual variation of the $P_{cuff}$ was observed from 10 $cmH_2O$ to 46 $cmH_2O$ at constant 3 cc $V_{cuff}$. The $P_{cuff}$ measured by the bedside mercury column sphygmomanometer is well coincident with that measured by the automatic cuff pressure manager. Conclusion: Continuous monitoring and management of the $P_{cuff}$ to maintain the appropriate $P_{cuff}$ level in order to prevent cuff related problems during long-term mechanical ventilation is recommended. For this purpose, mercury column sphygmomanometer may replace the specific cuff pressure monitoring equipment.