***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Despite widespread use of the automated blood pressure ( BP ) device ( IVAC model 4200 , IVAC Corporation , San Diego , Calif ) , there is little formal validation in the literature on its accuracy . OBJECTIVE To assess the accuracy of the IVAC 4200 device , both under st and ardized conditions and as routinely used by ward staff , compared with the true indirect BP measured by mercury manometer ( MM ) . METHODS One hundred forty-five stable in patients were r and omly selected for BP measurements by 3 r and omly ordered protocol s : ( 1 ) MM performed by certified investigators , ( 2 ) IVAC 4200 BP performed by trained investigators ( research automated [ RA ] ) , and ( 3 ) IVAC 4200 BP performed by ward personnel ( ward automated [ WA ] ) . RESULTS For RA compared with MM ( " true " indirect BP ) , 59 % of systolic and 54 % of diastolic readings were within 5 mm Hg and 83 % of systolic and 86 % of diastolic were within 10 mm Hg for a British Hypertension Society grade C for both . For WA compared with MM , 40 % of systolic and 50 % of diastolic readings were within 5 mm Hg and 70 % of systolic and 80 % of diastolic readings were within 10 mm Hg for British Hypertension Society grade s D and C , respectively . The presence of arrhythmias and /or low K5 values ( fifth phase of Korotkoff sounds < 30 mm Hg ) significantly increased the inaccuracy for diastolic values . Inappropriate cuff selection significantly increased inaccuracy of systolic BP ( WA vs MM ) . CONCLUSIONS The IVAC 4200 yields subst and ard estimates of systolic and diastolic BP even under st and ardized , thus optimum conditions . The presence of arrhythmias or low K5 values and the selection of inappropriate cuff size by the ward staff also contributed to inaccuracy In addition to its ease of use and degree of independence from the subjectivity inherent in measurements made with the mercury sphygmomanometer ( HgS ) , automated blood pressure measurement instruments ( ABPMI ) obviate the use of mercury-containing instrumentation and the attendant environmental issues . Thus , they have been widely used in healthcare facilities worldwide . Most evaluations of ABPMI have focused on their compliance with established international protocol s , and there has been a paucity of studies examining their performance in actual use in healthcare facilities . The purpose of this study was to evaluate the ABPMI used in our institution -- a large , urban , tertiary-care teaching hospital in the northeastern United States -- under routine conditions . This device , the Dinamap ProCare 400 Monitor , was compared to HgS ( considered the " gold st and ard " for non-invasive blood pressure measurement ) with respect to key analytical variables , i.e. , precision of measurements and correlation within a large ( n=300 ) sample of patients . Several sources of observer bias with HgS were detected . Precision varied among parameter ( systolic blood pressure [ SBP ] ; diastolic blood pressure [ DBP ] ; and mean arterial pressure [ MAP ] ) and level ( normotensive , moderately hypertensive , and severely hypertensive ) . Correlation and regression suggested a strong association between the methods and Bl and -Altman analysis indicated an acceptably small systematic error ( bias ) but greater r and om error than that demonstrated by previous evaluations with international test protocol s. We recommend that healthcare facilities evaluate ABPMI under actual conditions and that formal protocol s be established for these evaluations under routine conditions of patient care Objective Inaccurate blood pressure measurement has serious implication s for both the patient and the health service . It results in inappropriate treatment and underestimation of clinical risk . Few automated devices have been shown to be accurate when compared with mercury sphygmomanometery . The DINAMAP ProCare has been developed to be accurate compared with an auscultatory st and ard . We used the International Protocol of the European Society of Hypertension to assess the accuracy of this device in an adult population . Methods Thirty-eight participants were recruited from outpatient clinics and staff at Groote Schuur Hospital , Cape Town , RSA . Of these , 33 participants who fulfilled the requirements of the International Protocol were selected for final analysis . Demographic data were obtained from each participant , followed by nine sequential same-arm measurements , alternating between two trained observers and the device . The last seven readings were analysed according to the guidelines of the International Protocol . Results The ProCare Monitor achieved all the required criteria of the International Protocol by successfully passing phase 1 , phase 2.1 and phase 2.2 of the study protocol . The mean difference ( st and ard deviation ) for systolic and diastolic pressures , respectively , were –2.5 ( 5.4 ) and 0.5 ( 4.5 ) mmHg , which also falls within the passing criteria for the Association for the Advancement of Medical Instrumentation St and ard ( ANSI/AAMI SP-10 ) . Conclusion The DINAMAP ProCare Monitor can be recommended for clinical use in an adult population BACKGROUND Rounding blood pressure ( BP ) to the nearest 10 mmHg ( terminal digit preference ) and selecting for particular values near treatment cut-offs ( number preference ) have both been previously described . Both reduce measurement accuracy , and may have consequences for treatment and survival . AIM To check for number preference in screening for hypertension , and whether this influenced subsequent mortality . DESIGN Prospect i ve case-control screening study . METHODS In the General Practice Hypertensive Study Group ( GPHSG ) , prospect i ve case control study patients ( n=23 574 ) were screened on one occasion for high phase-IV diastolic BP ( DBP4 ) ( > or = 90 mmHg ) . Identified cases were matched with normotensive controls for age , sex , date of screen and ethnic group , and were registered for mortality follow-up ( n=6310 ) . Patients with a high DBP4 had two further readings , and were treated if it remained elevated . RESULTS For DBP4 terminal digit , ' 0 ' was over-represented ( 28.2 % vs. 20 % ) , and the number ' 88 ' was over-represented in both men and women . There was an excess adjusted death rate for females with DBP4 88 - 89 mmHg vs. 90 - 99 mmHg for both cardiovascular ( RR 2.56 , 95%CI 1.43 - 4.56 , p=0.0015 ) and all-cause ( 1.56 , 95%CI 1.06 - 2.29 , p=0.023 ) mortality . For males , the corresponding rates were non-significantly reduced : cardiovascular RR 0.69 , 95%CI 0.42 - 1.14 , p=0.15 ; all-cause RR 0.93 , 95%CI 0.68 - 1.27 , p=0.64 . DISCUSSION The quality of BP measurements should be monitored both in research studies and in clinical practice as part of clinical governance procedures OBJECTIVE Automated blood pressure ( ABP ) devices are ubiquitous at emergency department ( ED ) triage . Previous studies failed to evaluate ABP devices against accepted reference st and ards or demonstrate triage readings as accurate reflections of blood pressure ( BP ) . This study evaluated ED triage measurements made using an ABP device and assessed agreement between triage BP and BP taken under recommended conditions . METHODS A prospect i ve study was conducted at an urban teaching hospital . Patients were enrolled by convenience sampling . Simultaneous automated and manual triage BPs were obtained using one BP cuff with a Y-tube connector . Research assistants were certified in obtaining manual BP as described by the British Hypertension Society ( BHS ) . Patients were placed in a quiet setting , and manual BP was repeated by American Heart Association ( AHA ) st and ards . Data analysis was performed using methods described by Bl and and Altman . The ABP device was assessed using Association for the Advancement of Medical Instrumentation ( AAMI ) and BHS criteria . RESULTS One hundred seventy-one patients were enrolled .  Systolic BP ( sBP ) range was 81 to 218 mm Hg ; diastolic BP ( dBP ) range was 43 to 130 mm Hg . Automated vs. manual sBP difference was 3.8 + /- 11.2 mm Hg ( 95 % confidence interval [ CI ] = 2.1 to 5.4 ) ; dBP difference was 6.6 + /- 9.0 mm Hg ( 95 % CI = -7.9 to -5.2 ) . Manual triage BP vs. AHA st and ard SBP difference was 11.6 + /- 12.8 mm Hg ( 95 % CI = 9.1 to 14.1 ) ; dBP difference was 9.9 + /- 10.4 mm Hg ( 95 % CI = 7.9 to 12.0 ) . The ABP device failed to meet AAMI criteria and received a BHS rating of " D. " Poor operator technique and extraneous patient and operator movement appeared to hamper accuracy . CONCLUSIONS ABP triage measurements show significant discrepancies from a reference st and ard . Repeat measurements following AHA st and ards demonstrate significant decreases in the measured blood pressures Ambulatory monitoring of blood pressure  can improve clinical trials in two ways , first , by the identification and exclusion of those patients in whom the blood pressure is raised only in the clinic environment and second , by improving the repeatability of blood pressure estimations . In 75 subjects the st and ard deviation of the difference in diastolic pressure between two clinic readings taken a month apart was 12.3 mmHg . On ambulatory monitoring this fell to 6.3 mmHg . Since the number of subjects needed in a trial is related to the square of the st and ard deviation of the difference , the improved repeatability leads to a substantial reduction in the number of subjects needed . However , to achieve an adequate repeatability , at least 20 blood pressure readings are required per day BACKGROUND Automated devices are widely available in the community for people to measure their  blood pressure .  We assessed the accuracy and reproducibility of a br and of community-based automated device against the st and ard mercury sphygmomanometer . METHODS Same-arm pairs of blood pressure readings were obtained with the Vita-Stat 90550 automated device , a sphygmomanometer and the Omron HEM-705CP automated device in r and om order on volunteers in 3 community pharmacies using a modified protocol for evaluating blood pressure devices . Comparison of readings between the Omron device and the sphygmomanometer served as a positive control of how well a laboratory-vali date d automated device could perform in the community . Both the Association for the Advancement of Medical Instrumentation ( AAMI ) and British Hypertension Society ( BHS ) criteria were used to assess the accuracy and reproducibility of readings . RESULTS The mean blood pressure reading and st and ard error ( SE ) of the mean for the 108 volunteers ( 66 women and 42 men ) was 133/77 ( SE 2/1 ) mm Hg with the Vita-Stat device , 131/77 ( SE 2/1 ) mm Hg with the Omron device and 129/76 ( SE 2/1 ) mm Hg with the sphygmomanometer . The mean difference in readings was 4.4/1.0 ( st and ard deviation [ SD ] 9.4/6.2 ) mm Hg between the Vita-Stat device and the sphygmomanometer and 1.6/0.6 ( SD 9.3/6.4 ) mm Hg between the Omron device and the sphygmomanometer . Neither automated device met the AAMI accuracy criteria for the systolic readings . The BHS grade s were C/A ( systolic unacceptable/diastolic acceptable ) for each automated device . According to the BHS analytical criterion , all devices achieved acceptable reproducibility grade s. INTERPRETATION Neither automated device met the AAMI or BHS criteria for accuracy while in use in the community , and neither performed as well in the community as in the laboratory BACKGROUND Although they have been marketed widely , few data about the diagnostic accuracy of blood pressure monitors are available . METHODS Repeated measurements of blood pressures in 85 patients were performed in r and om sequence with two oscillometric blood pressure monitors around the upper arm ( Visomat OZ2 ) and the wrist ( Omron R3 ( and with a st and ard sphygmomanometer . The oscillometric blood pressure monitors were vali date d according to protocol s of the British Hypertension Society ( BHS ) and the American Association for the Advancement of Medical Instrumentation ( AAMI ) . Subsequently , sensitivity and specificity of these monitors for the diagnosis of hypertension or exclusion of the possibility of its presence in a general medical outpatient population were calculated . RESULTS Sphygmomanometric readings exceeded oscillometric blood pressure measurements by 3.7+/-7.5/4.8+/-5.6 mmHg ( systolic/diastolic ) for the upper arm and 5.7+/-6.2/6.8+/-6.8 mmHg for the wrist . Deviations occurred in both directions and were higher for blood pressures in the hypertensive range . Oscillometric blood pressure measurements at the upper arm , but not at the wrist , satisfied validation criteria of BHS and AAMI protocol s. Optimal sensitivity and specificity for the diagnosis of hypertension , defined as blood pressure > 140/90 mmHg with a st and ard sphygmomanometer , was achieved with blood pressure limits of 133/82 mmHg for the Visomat OZ and 131/80 mmH 
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However , in most cases the oscillometric device appears sufficiently accurate for clinical use , the exceptions being use with hypertensive patients , patients with arrhythmia and after trauma .