Volume 8 Issue 1

Bringing you the news at the heart of healthcare technology

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In recognition of the importance ofABPM, the British HypertensionSociety and the European Society of

Hypertension have both publishedguidelines for the use and interpretationof ABPM in clinical practice.Traditionally, hypertensive patients havebeen assessed using clinic based bloodpressure readings by a Nurse or Doctor.It has been proven that this snapshotapproach to blood pressuremeasurement can give inconsistenciesand over estimate a patient’s bloodpressure by anything up to 30mmHg.

The so called “White Coat Hypertension”phenomenon can lead to elevated bloodpressure due to stress or anxiety and iswell documented. It can lead tounnecessaryprescription ofhypertensivemedicines which

has a profound clinical and financialrelevance to Primary Care and can leadto inappropriate diagnosis and treatment,especially if a patient’s clinic or surgeryblood pressure measurement is on the140/90 threshold. Ambulatory BloodPressure Monitors like the ABPM-05 andAND TM-2430 provide much moreconsistent readings over a 24-hourperiod and give multiple measurementsthroughout the day and night.

Which Monitor?

T he ABPM-04, ABPM-05 orTM-2430 from P.M.S. (Instruments)Ltd are all suitable for professional

clinical use and have beenindependently clinically validated toeither the British Hypertension SocietyProtocol or the European Society ofHypertension Protocol. They all use PCbased software, are easy to programmeand are supplied with rechargeablebatteries and adult and large adult cuffs.The ABPM-04 and ABPM-05 use ourown CardioVisions software whichmeans it is possible to attach reports topopular Clinical Management Systems,such as EMIS and Torex.

The report should include, as aminimum, daytime and night timeaverages, a list of BP data and trendgraph. Normal mean levels for ABPMin adults are daytime 135/85 andasleep 120/70. It is also important toascertain the level of after sales careand service available from a supplier.

continued overleaf

Which Patients Can BenefitFrom Ambulatory BloodPressure Monitoring?

• Borderline/high blood pressure

• White Coat hypertensives

• Resistant hypertensives

• Elderly patients who maybe hypotensive

• Pregnant women

• Diabetic patients

• Patients switching medication

Ambulatory bloodpressure monitorsAn indispensable tool inmanaging hypertension

Monitors require regular servicing andtesting to ensure accuracy and thisshould be available in the U.K. from thesupplier to minimise downtime.

The introduction of 24-hourmonitoring into General Practiceis gaining pace and although itsuse is not yet recommended byNICE, there is a growing body ofevidence that suggests itsintroduction can greatly improvehypertensive management and preventthe unnecessary prescriptionof hypertensive medicationto patients.

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Patients often complain of repeated chest pain orpalpitations at different times of the day but when a 12lead ECG in surgery is undertaken nothing abnormal is

reported. The 12 lead ECG provides a “snapshot ECG” butwhat is really needed is ECG recorded over 24 hours. Theheart typically beats over 100000 times over 24 hours andyou need a device that can rapidly screen out normal andabnormal beats and classify them into different beat groups.

Welcome to CardioMeraThe CardioMera is a compact 24 hour ECG monitorweighing just 49g. It records full disclosure high resolutionECG onto a digital SD memory card. The CardioMera isprogrammed using the same CardioVisions softwareplatform we use with our ABPMs and real time ECGmonitoring ensures optimum electrode positioning andsignal quality before the patient leaves.

When the patient returns, data from the SD card istransferred to the PC where CardioVisions performs analysis

and report generation.

The CardioMera 24 hrECG recorder set withfull ECG analysis(FC1-S012) will classify

beats into different classesincluding normal, ventricular

and supraventricular, before then identifying whether beats fallinto one of over 20 different types including bigeminy,couplets, atrial fibrillation and tachicardias

Reports can be generated automatically by Nurses and thesoftware algorithim is extremely accurate. As with allproducts using our CardioVisions software, reports can beemailed or attached to patients notes if required.

The CardioMera 24 Hour ECG Holter System is proving verypopular with customers and in particular GP practiceslooking to introduce Practice Based Commissioningschemes or ECG screening programmes. It costs £4995 +VAT for a recorder and software licence and £1095 foradditional recorders therafter.

New Product CardioMERA24 Hour ECG Monitoring

PMS INSTRUMENTS

continued from overleaf

Prices start from£1,200 for ABPM-0shown on model.

www.pmsinstruments.co.uk

The latest version of the TM-2655Pnow features a new IrregularHeartbeat Indicator which is

printed if present during a measurement.This alerts the clinician to the existenceof a possible intermittent arrhythmia.

It is discreetenough not toworry the patientbut provides useful

additional information on a patient’sheart rhythm which can be followed upwith an ECG if appropriate. An irregularheartbeat is defined as a heartbeat thatvaries by 25% from the average of allheartbeats during the measurement.

The latest versionwill also give thetotal number ofmeasurementsrecorded by theproduct, a weeklycount and amonthly count

which is useful for audit purposes.

The TM-2655P is used exclusively byG.P. surgeries and is regarded bymany as the “Gold Standard” waitingroom monitor. It has the followingkey features:

• Patients record their own bloodpressure which frees upNurse/Doctor time and allows thepatient to be involved in theirtreatment.

• The slip of paper is handed to theNurse/Doctor or, in some cases,the receptionist.

• The TM-2655P has beenindependently clinically validated foraccuracy, has an AA grade and isfeatured on the British HypertensionSociety website as suitable forprofessional clinical use.

• The monitor is supplied with a stand,security cable, paper, patientinstruction card and a comprehensive2 year warranty.

• The monitor automatically adjusts tothe patients arm circumference andwill accommodate large arms.

• It will allow you to record patient’sblood pressure when they first arrive,or switch medication again savingclinical consultation time.

• It gives fast, accurate, reliable,repeatable measurements and isdesigned for high volume use forexample when screening at flu clinics.

Many practices use it when operating a‘drop in’ clinic where a patient does notneed to make an appointment for routineblood pressure screening.These results arereviewed later byclinical staff andan appointmentis only made if apatient’s bloodpressure is high orlow. Some practicessave up to 100appointmentsper week!

New Irregular Heartbeat Feature OnTM-2655P Waiting Room MonitorThe original just got better!

The UM-101independentclinical validation

The UM-101A Mercury FreeManual Sphygmomanometerhad an independent clinical

validation published recently in thejournal Blood Pressure Monitoringvol 13 No 1 Feb 2008.

The authors of the papercommented that “In fact, the deviceappeared to be nearly perfect andmore accurate than recentlyvalidated oscillometric devices”.

The UM-101 has the look and feelof a traditional mercurysphygmomanometer without anyof the disadvantages or Health andSafety issues.

The UM-101 allows the user torecord manual blood pressuresaccurately using theKorotkoff auscultatorytechnique with astethoscope. The large,easy-to-read LCDdisplay mimics thefalling of a mercurycolumn and can beviewed from multipleangles. The UM-101Acosts £99 + deliveryand VAT and a standmodel the UM-101Bis also available.

Regular pulse

The distance between the spikes are the same size.The pulse is regular.

Does your pulse beat regularly?

Irregular pulse

The intervals between the pulse beats vary.The pulse is irregular.

Chair not included.

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P.M.S (Instruments) Ltd, Waldeck House, Waldeck Road,Maidenhead, Berkshire SL6 8BRTel: 01628 773233 Fax: 01628 770562E-mail: sales@pmsinstruments.co.uk

PMS INSTRUMENTS

For moreinformation visit

www.pmsinstruments.co.uk

DABL Educational websiteThe ABPM-05 and UM-101 are nowrecommended for clinical use on theDABL Educational website. The DABLwebsite www.dableducational.org isupdated regularly and provides listingsof different types of blood pressuremonitors and their validation status.

Can I attach patients ECGsusing Elite?

The latest version of the Elite ECGsoftware 6.92, available free fromwww.pmsinstruments.co.uk will allowyou to record electronically and thenattach Elite ECG files to popular thirdparty clinical management systemslike EMIS and SystemOne. ECG files

need to be stored on a network driveaccessable to all users and are then“attached” to a patients notes.

Anyone wanting to view theattachments will need to have the Elitesoftware installed which takesseconds. Unlike some systems, whichjust create a picture of the ECG, withElite you have complete control of therecord and can take measurementsand reprint as if you had just recordedthe ECG. No more paper ECGs justhigh resolution electronic ECGs. TheElite costs £1195 plus delivery and VAT.

Is there a network version ofCardioVisions?There is a network version availablebut at additional cost. For customerswanting to share ABPM or 24 hourECG recordings, we recommend thePersonal Edition is installed. Patientreports can be exported to a networkdrive and attached to a patient’s noteseither as a Rich Text File, in whichcase CardioVisions does not need tobe installed on all PCs, or aCardioVisions format where it does.

What is the largest size cuffavailable for the ABPM-04and ABPM-05?Using the correct cuff size with anyblood pressure monitor is essential. Acuff that is too large will produce areading that is lower than the correctblood pressure; a cuff that is too smallgives a measurement that is higher.With your arm hanging at the side ofyour body, measure the circumferenceof your upper arm at the midpointbetween shoulder and elbow.

There are practical limitations on the sizeof cuff available for the ABPM-04 andABPM-05. The largest cuff size currentlyavailable will fit an arm from 32-42cm.

Larger cuff sizes areavailable for our monitorsthat are manually inflated.The UM-101A which costs£99 plus delivery and VAThas a cuff available thatwill measure an arm from41 to 66cm. These cost£30 including connectorsand inflation bulb.

Other News And Tips

Occasionally the ABPM-04 /05 may report an error duringmeasurement. The table below lists the error codeswhich may be displayed on the recorder LCD. They can

easily be viewed from CardioVisions.

Don’t forget when logged in as the administrator you cannotprogramme the recorder or access data!

Do your batteries need replacing?Two sets of rechargeable batteriesare supplied with the ABPM-04 andABPM-05. These monitors briefly display the battery voltageafter you put the last battery in. With fully charged rechargeablebatteries the voltage in the ABPM-04 should be >5.1 volts andwith the ABPM-05 it should be >2.5 volts.

CardioVisions Error Codes For The ABPM-04/ABPM-05Code Explanation Code Explanation

1 Aborted measurement 31 Cuff missing or loose

2 Manually interrupted 32 Cuff tubing clogged

3 Batteries rundown 33 Cuff leaking or loose

4 Batteries changed 34 Cuff not on arm

8 Pressure limit exceeded

9 Temporary disturbance 90,99 Device error

All product descriptions and prices are believed to be correct at the time of printing. We reserve the right to alter or amend prices, products and or descriptions at any time.© P.M.S. (Instruments) Ltd 2008.

If you need replacement batteries please call our sales line on01628 773233.

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