Author: Andrew Webb

I am the Managing Director of PMS (Instruments) Ltd a successful UK based medical distribution, service and sales company specialising in cardiovascular equipment.

What Are The Clinical Advantages Of The Atys Systoe?

The Atys SysToe is a ground breaking device designed for the rapid and automatic assessment of toe or finger systolic pressures. Here are some of its key clinical advantages:

  1. Ease of Use: The SysToe is user-independent, meaning it can be operated easily by healthcare professionals without extensive training
  2. Accuracy and Reliability: Utilizing infrared photoplethysmography (PPG) and a patented algorithm, the SysToe provides accurate and reproducible measurements, even in patients with conditions like diabetes or chronic renal failure
  3. Versatility: It can measure pressures as low as 20 mmHg and is suitable for use in various settings, including vascular labs, diabetic units, and general practice
  4. Clinical Validation: The device has been clinically validated, showing good agreement with traditional methods like laser Doppler. It is particularly useful for patients with calcified arteries where other methods might fail
  5. Comprehensive Assessment: The SysToe can calculate the toe brachial index (TBI) or finger brachial index (FBI) when brachial pressure is known, aiding in the diagnosis and monitoring of peripheral arterial disease (PAD) and critical limb ischemia (CLI)
  6. Patient Comfort: The automatic inflation and deflation of the occlusion cuffs ensure a comfortable experience for patients
    These features make the Atys SysToe an invaluable tool for healthcare providers, enhancing the diagnosis and management of vascular conditions with efficiency and precision.

Clinical Paper Validates Meditech ABPM-06 For Use with Children.

A new peer reviewed clinical paper has just been published validating the popular Meditech ABPM-06 ambulatory blood pressure monitor for use with children.  

The objective of the clinical validation published in the journal Blood Pressure Monitoring 29(4):p 198-202, August 2024 was to validate the ABPM-06 in a paediatric population according to the International Organization for Standardization Protocol 81060-2:2018.

Ambulatory blood pressure monitoring (ABPM) devices like the ABPM-06 play a crucial role in diagnosing hypertension, not only in adults but also in paediatric patients

A total of 86 healthy patients, consisting of 34 males and 52 females, aged between 3 and 17 years, were enrolled in the study.

The validation process involved utilizing the same-arm sequence protocol, both in resting positions and during stress testing.

The ABPM-06 performed well in both clinical and ambulatory validations and met the established criteria regarding the mean and SD values of the differences between the device readings and the observed SBP and DBP measurements.

The ABPM-06 Oscillometric device fully adheres to the ISO 81060-2 : 2018 standard requirements for 24-hour ABPM in the paediatric population (ages 3–17 years) and is suitable for use with children and adolescents as well as adults.

The ABPM-06 is available directly from PMS Instruments and we are proud to have been Meditech’s exclusive UK Distributor and Service Centre for over 25 years.

New Cardioline ECG Product Launch

PMS (Instruments) Ltd are proud to introduce the Cardioline range of ECG machines and PC based ECG systems.

There are 4 devices to choose from and they all feature 12 lead ECG acquisition with high quality University of Glasgow protocol interpretive programmes.

The machines feature an on-screen preview of ECG – prior to printing which saves paper.

The Cardioline 100S is a powerful 12 lead Diagnostic Electrocardiograph that optimises ECG workflow thanks to a smart user interface and connectivity to a dedicated ECG management system. It offers quick ECG acquisition for fast and easy operation with accurate measurements and interpretation suitable for adult and paediatric patients.

Powered by battery or mains, it prints out in multiple popular formats. It is easy to clean and disinfect thanks to its flat silicone keyboard.

The touchECG is a next generation PC based ECG allowing a simultaneous view of 12 or 15 lead high quality signals on screen, and continuous acquisition of up to 30 minutes. The high-resolution digital ECG signal is transmitted via Bluetooth to the computer where the touchECG software is installed.

Automatic interpretation and analysis of the ECG is then undertaken using the University of Glasgow algorithm for both adults and children with specific criteria depending on age, gender and race.

The ECG 100L has been designed for portability and ease of use without compromising Cardioline’s recognized quality standards. Using a high resolution 5-inch colour touch screen, as well as dedicated keys for fast operation. A smart user interface guides the user through the different steps necessary to acquire the ECG. Various on-screen messages inform the user of ongoing operations and warn in case of errors for example in case of lead off.

The device is equipped with USB port to export the ECG stored in the device’s memory in a PDF format. The ECG100L is supplied with the 12-lead Glasgow resting ECG interpretation algorithm.

Last but not least is the ECG200L with a similar specification as the ECG100L but with enhanced A4 printing formats which include standard or Cabrera 3, 3+1, 3+3, 6 or 12 channels in automatic mode and 3, 6 or 12 printout channels in continuous mode, as well as printout of the rhythm strip.

Undiagnosed High Blood Pressure – The Silent Killer

According to new estimates produced by The British Heart Foundation, four million people under the age of 65 in the UK are living with untreated high blood pressure with further analysis finding that 1.3 million of these people are under the age of 45. 

As well as significantly raising the risk of heart attack and stroke, it can also be the cause of an increased risk of vascular dementia, raised cholesterol and diabetes.

Getting your blood pressure under control is one of the most important things you can do to reduce your risk of having a heart attack or stroke.

Checking your own blood pressure with an A&D Medical clinically validated BP monitor is an easy and inexpensive way to understand if you are one of the millions of people across the UK living with undiagnosed high blood pressure and giving you the information needed to get the correct treatment and advice.

Taking a blood pressure reading takes less than 5 minutes and can be done in the comfort of your own home not just in a doctor’s surgery or pharmacy.   

Many people assume that high blood pressure is generally associated with older, overweight or unfit people. Though these conditions can lead to a high risk of heart attack and stroke, many people with an active lifestyle can also fall victim to this silent killer.

A considerable number of young people in the UK aged 16 to 24 unknowingly have risky high blood pressure too.

Stessful workplace environments are a major cause of high blood pressure with busy people all too easily putting the issue to the back of their minds.

Ordering an A&D Medical clinically validated BP monitor and getting your blood pressure under control is one of the most important things you can do to reduce your risk of having a heart attack or stroke.

With waiting lists at an all time high and the NHS under more pressure than ever before, acting now could give you the greatest opportunity to receive the life-saving treatmment you may need.

PMS Instruments stock a vast range of blood pressure monitors with different cuffs sizes to suit every individual.

So don’t become a statistic, order yours today and give yourself the best chance of taking the necessary steps to avoid long-term harm.

AliveCor’s KardiaMobile® 6L Recommended by NICE.

The KardiaMobile 6L manufactured by AliveCor and available from PMS Instruments is the first personal ECG device to be recommended for use in psychiatric services in England and Wales to measure cardiac QT intervals.

Following a conditional recommendation from the National Institute for Health and Care (NICE HTE10), the KardiaMobile 6L opens up the opportunity to ease an unmet clinical need for the ‘instant’ measurement and detection of cardiac abnormalities, such as prolonged QT intervals in psychiatric patients who are taking anti-psychotic medications.

Detecting abnormalities in patients within this group is essential as it could prevent severe or even fatal cardiac events. A prolonged QT interval indicates an abnormality detected on an ECG highlighting a disturbance in the conduction of electricity in the lower chamber (ventricles) of the heart. High doses of various antipsychotic medications can trigger prolonged QT intervals

Now, with the availability of the KardiaMobile 6L, having to configure and attach a 12 lead ECG cable to psychiatric patients after asking the patient to partially undress can be a thing of the past.

To record a 6 lead ECG the patient simply places an index finger on each of the two top plates and touches the bottom plate onto the skin of their left leg. Results are instant and can either be stored in a file on a PC or forwarded as a PDF in an email to the patient’s GP.

Testing and monitoring at regular intervals throughout a patient’s treatment, as well as in the acute phase, may be needed so the fact that NICE now recommend using the KardiaMobile 6L, and that operating it is so straight forward is really exciting news!

Say goodbye to applying messy gel and conductive stickers to psychiatric patients and experience the simplicity of using the KardiaMobile 6L. KardiaMobile 6L can be purchased from www.pmsinstruments.co.uk

Cuff Size Matters

Blood pressure monitors with an upper arm cuff provide the most accurate blood pressure readings but using the correct cuff size is really important in order to avoid inaccurate results.

Ensure the cuff is the correct size

If the cuff you use is too small for the arm, your blood pressure reading will be artificially high. If your cuff is too large, you may get a lower-than-actual reading. This is known as miscuffing.

On people with big arms, a large cuff is needed and as a general rule the inflatable bladder in the cuff needs to encircle at least 80% of the arm. The width of the cuff should be at least 40% of the arm circumference.

Measure your arm

To make sure you are using the correct size cuff for your arm place a tape measure around the bicep, at mid-arm to measure the arm circumference in cm. The left arm is typically used.

Typical cuff sizes

Not all blood pressure monitors can use different sizes of cuffs. Check with us first to make sure your digital A&D Medical UA and UM series or Meditech ABPM device can.

Typical cuff size ranges are as follows but can vary by manufacturer. For A&D UA series monitors the following cuff sizes are available.

  • Small fits an upper arm between 16-24 cm
  • Adult fits an upper arm between 22-32 cm
  • Semi-large fits an upper arm between 23-37 cm
  • Wide range fits an upper arm between 22-42 cm
  • Large adult fits an upper arm between 31-45 cm

Wide range cuffs like that supplied with the A&D Medical UA-1020-W are becoming popular with clinicians as one cuff can be used across a wider arm circumference range. This monitor can also use a small cuff.

All A&D Medical and Meditech cuffs have visual range markers to make cuff positioning easier and ensure the correct size is used. When applied correctly the cuff should wrap snugly around the arm with just enough space to slide two fingertips underneath.

One cuff does not fit all and using the correct cuff size is important both for healthcare professionals in a clinical setting and the public when buying monitors for home use.

Identify More Hypertensives With A Waiting Room Blood Pressure Monitor

Guidance on preventing cardiovascular disease (CVD) was originally published in 2019 and was updated this year.  Optimal treatment of AF, high blood pressure and raised cholesterol is highly effective in preventing CVD events.

Over 40% of people with high blood pressure remain undiagnosed and of those diagnosed with high blood pressure, only 67% are optimally managed.

How do we diagnose and manage more effectively?

GP Practices are encouraged to actively screen patients and seek out hidden hypertensives. To the average practice this could mean hundreds of extra appointments for a simple blood pressure measurement.

They need help in the form of the easy to use, clinically validated A&D Medical TM-2657P waiting room blood pressure monitor.

Originally the idea of allowing patients to measure their own blood pressure was greeted with scepticism by some clinicians, but practice managers were quick to see the advantages.

Ideally located in a quiet corner of the waiting room, this type of monitor is designed for professional high volume use and automatically prints a reading, with the date and time, on a small slip of paper.

The patient usually shows this reading to the doctor or nurse at the beginning of the consultation and if the readings are too high or low they can then re-measure. In some practices patients hand results to a member of the reception team, who record it electronically for later review.

For practice managers, they offer good management and effective use of resources freeing clinical staff for other roles where they may be better utilised. Some practices report they ‘save’ up to 100 appointments per month on average.

For patients the feedback is positive and the monitors promote understanding and compliance.

Recently we have been involved in a couple of projects looking to target patients who don’t visit a GP regularly or have access to another healthcare provider. TM-2657P blood pressure monitors have been placed in public access buildings like Libraries and Pharmacies.

They have identified new undiagnosed hypertensives with elevated blood pressure and helped manage existing hypertensive patients promoting medication compliance.

The Smart Choice For Measuring Lung Function At Home

The MIR SmartOne® is a low-cost, home spirometer for self-monitoring that offers a basic level of lung function screening using Bluetooth technology to connect to a smart phone or tablet.

It is ideal for people who would benefit from home assessment of lung function, such as those with asthma, cystic fibrosis or chronic obstructive pulmonary disease (COPD). 

Using the SmartOne® app (iOS or Android) users can record PEF (peak expiratory flow- the maximum speed of the air  exhaled as hard as possible after filling the lungs completely) and FEV1 ( volume of air expelled during the first second of the same exhalation) from the comfort of their own home in real time.

The results can then be emailed electronically as a PDF to a health care professional.

The SmartOne® uses the same bi-directional digital turbine technology found in other MIR spirometers, offering a higher level of performance and accuracy than a conventional peak flow meter. It meets the ATS/ERS 2019 standard as well as ISO 26782 (for Spirometry) and ISO 23747 (for PEF).

In addition to displaying the PEF and FEV1 measurements the app will calculate a Normal Base Line Value based on the users age, weight, origin height and sex.

Three tests are performed per measurement session, after which the SmartOne app automatically selects the highest value and compares it with the users Baseline Value assigning a traffic light colour to it which is then displayed with the test result.

The results are stored in the App making it easy to track trends over a period of time.

By using the SmartOne® on a regular basis changes and patterns can be monitored by the user and their healthcare professional and appropriate treatment taken if needed.

NICE have published a Medtech Innovation Briefing (MIB96) on the SmartOne for measuring lung function which is available on their website.

SysToe, an accurate option for the diagnosis and evaluation of Peripheral Arterial Disease (PAD)

Peripheral arterial disease (PAD) occurs when plaque builds up in the arteries that carry blood to head, organs, and limbs.

Limitations of Ankle Brachial Index (ABI)

The Ankle Brachial Index (ABI) test has been in use for diagnosis and evaluation of peripheral arterial disease (PAD) for over half a century. Nevertheless, it is not without its issues.

  • Training is required before the operator is able to carry out reliable measurements
  • Some patients feel pain in the leg during cuff inflation
  • It takes time to perform the measurement
  • False values can result from medial calcification of the tibial/peroneal arteries which may prevent the measurement of ABI.

Why measure Toe Systolic Pressure?

The toe arteries are affected by medial calcification later than the leg arteries. The toe systolic pressure can be measured to circumvent the problem of medial calcification of the tibial/peroneal arteries.

Toe pressure measurements show a good agreement with ABI and remain measurable and reliable in patients with arterial wall calcification.

Does the measurement of toe systolic pressure using SysToe improve the diagnosis and reliability of diagnosis?

The SysToe is easy to use, quick and fully automatic and not operator dependent. It improves clinical evaluation and follow-up of PAD in every day practice.

SysToe drastically improves the reliability of distal toe pressure measurement, especially in diabetic and chronic renal failure patients, since the measurement of ankle pressure and ankle brachial index may be difficult or impossible in these patients because of medial calcification.

As a fully automated, totally non-invasive and painless (unlike ankle pressure measurement)  technique, systolic toe pressure measurement with SysToe is easily performed outside the Vascular Lab by Diabetologists, Podiatrists and General Practitioners for the follow-up of patients with peripheral arterial disease.

Therefore, the use of more expensive examinations (such as complete duplex Doppler ultrasound of lower limb arteries) can now be reduced. The use of a SysToe can have major clinical care pathway advantages and cost savings as well as saving patient assessment time.

PMS customers use the SysToe for

  • Assessment and diagnosis of peripheral arterial disease
  • Diagnosis of critical limb ischemia
  • Follow up of diabetic patients, patients with chronic renal failure, elderly patients
  • Assessment of healing potential of ulcers

NICE One! KardiaMobile Recommended For AF Detection.

The National Institute for Health and Care Excellence (NICE) have recently published a Medical Technology Guidance report (MTG) 64 featuring the AliveCor KardiaMobile. KardiaMobile is now the first and only NICE recommended personal ECG device for detecting atrial fibrillation in an ambulatory setting.

KardiaMobile is now NICE accredited.

KardiaMobile is recommended for detecting atrial fibrillation (AF) for people with suspected paroxysmal AF, who present with symptoms such as palpitations and are referred for ambulatory electrocardiogram (ECG) monitoring by a clinician.

Why did NICE make this recommendation?

Detecting atrial fibrillation in people with suspected paroxysmal AF usually involves wearing a continuous ECG Holter monitor. KardiaMobile is a portable wireless ECG recorder that can help detect AF.

The NICE committee consisting of a panel of experts looked at published clinical evidence that shows significantly more people had AF detected using the KardiaMobile single-lead device compared with a Holter monitor.

The clinical experts agreed that monitoring with KardiaMobile could increase infrequent AF event detection because it could record an AF event whenever symptoms are presented. 

Cost modelling shows that KardiaMobile is cost saving compared with a Holter monitor by an average of £13.22 per patient over 2 years in people presenting with symptoms such as palpitations. 

This positive recommendation acknowledges AliveCor’s digital innovative technology and empowers patients and doctors to remotely monitor their heart rhythm.

KardiaMobile can support an earlier diagnosis of AF in an ambulatory setting and this recommendation highlights AliveCor’s commitment to the NHS Long Term Plan to reduce the incidence of cardiovascular disease in the UK.

KardiaMobile is the world’s most clinically-validated personal ECG. Unlike traditional ECGs, KardiaMobile provides a compact, patchless and wireless solution that can be used at any time and anywhere.

The user starts a 30-second ECG recording on their smartphone via the Kardia app – by placing two fingers from each hand on each of the two top electrodes – enabling the patient to remotely capture a medical-grade recording of their heart activity. KardiaMobile provides instant detection of AF, bradycardia and tachycardia, which are leading indicators of cardiovascular disease.

KardiaMobile can also detect normal heart rhythm, offering users peace of mind.

This guidance replaces NICE’s earlier medtech innovation briefing on KardiaMobile for the ambulatory detection of atrial fibrillation (MIB232) published in October 2020.

PMS Instruments. Expertise, Experience and Trust for service, calibration and support.

These are the key words our customers associate with PMS Instruments, as well as being the fundamental foundations of our calibration and service department.

Back in 2016 I posted an article with a picture of an A&D Medical TM-2655P waiting room blood pressure monitor that had recorded a staggering 103,366 readings since we originally supplied it in 2004!

Since then, we have calibrated and serviced a number of A&D Medical waiting room blood pressure monitors that have recorded in excess of one hundered thousand readings!

At PMS Instruments as an ISO-9001 Quality Assured company we keep detailed service and calibration records for every item of equipment we service and repair.

What’s the secret of this reliability and low cost of ownership?

I am convinced it is regular, preventative and routine servicing by PMS Instruments which extends the ‘in service’ life of the monitors and prolongs the investment our customers make in their equipment.

How does the service you get from PMS Instruments differ?

The A&D Medical TM-2655P and TM-2657P waiting room blood pressure monitors are specialist instruments, requiring specialist knowledge and test equipment.

With every service and calibration PMS Instruments carries out, each monitor is subjected to an approved individual ISO-9001 quality assured Work Instruction. This comprises a series of up to 70 detailed steps our service engineers must follow, and which the product must pass, in accordance with the manufacturer’s service manuals.

You get so much more from PMS Instruments than the basic 10 minute on site functional test some companies offer.

Our popular Fixed Price Service and Support Plan includes:

  • Annual calibration of your device and detailed calibration certificate issued.
  • Priority unlimited telephone and technical support.
  • Fixed price servicing cost.
  • Fast priority response for all servicing and repairs.
  • 20% discount off non standard service items including pumps
  • Standard service parts and consumables including filters.
  • Replacement of the cotton cuff inner.
  • Supply of premium packing box and material included.
  • Courier collection and return included.
  • Priority turnaround time typically 3-5 working days from receipt of equipment.
  • Inclusive annual service and calibration to manufacturer’s specification.

You get what you pay for…

PMS Instruments’ service and calibration team are certified to ISO-9001 and use only genuine manufacturer approved spare parts.

Depending on the model it can take up to 90 minutes for our Service Engineers to adjust, calibrate and service an A&D Medical waiting room blood pressure monitor and we are the experts at it! Rapid turnaround time means minimum downtime and a full service and calibration certificate is issued.

Not convinced and still want to use another company?

Can the company you use tell you how many readings your waiting room blood pressure monitor has taken during its lifetime? If they can’t schedule your service and calibration with PMS Instruments and we will.

Monitoring Your BP At Home

Monitoring your blood pressure at home and can be a way to feel more in control of your own health and wellbeing. Your GP may even have recommended you take your own BP measurements at home so that you know your numbers.

But which home BP monitor to buy? There are so many now on the market, available from anywhere from your local supermarket to large online retailers. The options can seem over whelming. It needn’t be.

When choosing a BP monitor we would recommend you check for 3 things 

  1. Has it been clinically validated? This means it has been tested and approved by the British and Irish Hypertension Society (BIHS) and will it provide arcuate and reliable readings.
  2. Is it fully automatic as these are the easiest monitors to use at home.
  3. The cuff fits your arm. Cuffs come in a range of sizes but most monitors are supplied with a standard adult cuff which will fit an arm measuring 22-32cm. The cuff should wrap snugly around your upper arm, with just enough space to slide two fingertips underneath.

You can purchase an additional cuff which will fit your arm if your arm is either smaller or larger than a standard cuff size.

Or look for a monitor with a wider range cuff such as the A&D Medical UA 767S-W which is supplied with a wide ranging cuff which will fit an arm measuring 22-42 cm. For more of the monitors features Click here

The A&D Medical UA 767S + AFib is a popular choice for its proven record of reliability and wide use across the UK with GP surgeries and within the NHS. It also comes with a 5 year warranty. For more of the monitors features Click here 

PMS Instruments can supply you with a BP monitor to suit you, your needs and your budget.

Disposable Hand and Arm Hygienic BP Covers

A&D Medical protective hand and arm covers are specially designed for use with the TM-2655P and TM-2657P waiting room blood pressure monitors.

They demonstrate to your patients that when they use your waiting room blood pressure monitor, you take any safety and hygiene concerns they may have seriously. This gives them the confidence to use the monitor after post COVID lockdown.

They are manufactured from thin polyethylene and cover the upper arm and hand to prevent a patients arm coming in to direct contact with the inside of monitor. These single patient use hygienic arm and hand covers are easy to apply and comfortable to wear.

With a length of 75cm they accommodate most arms and fit an arm circumferences of up to 44cm. Each overarm and hand cover is perforated making them easy to detach. Each batch/bundle of 200 has a convenient attachment string which means the covers can be hung neatly near the waiting room monitor or anywhere keeping the waiting room tidy.

They are designed for single patient use and are easy to apply. Simply pull one over sleeve off, insert your arm fully in to the cover, take a blood pressure measurement, remove the cover and dispose of. They are hygienic and cost effective providing effective protection to a patients arm. Free samples are available from PMS Instruments. Further information is available on our website https://www.pmsinstruments.co.uk/acatalog/A-D-Medical-Arm-and-Hand-Cover-for-TM-2655P-TM-2657P-703.html#SID=42

The ISO 80369-5 BP Cuff Standard

ISO80369-5 was developed as an international standard to prevent cuff connection errors with different types of medical devices that use the same or similar connectors. Whilst connection errors were few and far between they could have fatal consequences.

The US Food & Drug Administration (FDA) reported several real life incidents involving misconnections.

In one a blood pressure cuff was accidentally connected to an Intra Venous (IV) catheter.

A patient had an IV catheter in their arm but no IV fluids had been started. The patient also had an automatic BP cuff fitted on the same arm for continuous monitoring. The BP cuff tubing was disconnected from the blood pressure monitor while the patient went to the bathroom.

When she returned, her spouse accidentally connected the BP cuff tube to the IV catheter and approximately 15 mL of air was delivered to the IV catheter by the blood pressure monitor.

Unfortunately the patient died from a fatal air embolus, despite resuscitation efforts.

As a precaution and so this can’t happen again new ISO connectors are being introduced on blood pressure cuffs to ensure correct device connections, even in complex working environments and avoiding fatal consequences.

Japanese company A&D Medical are one of the first manufacturers of clinically validated digital blood pressure monitors to have introduced ISO-80369-5 connectors to their blood pressure cuffs and monitors.

The latest UA-651SL Plus is compliant with the ISO80369-5 regulation. It features A&D Medicals latest 4th generation Electric Control Exhaust Valve (ECEV) which precisely controls cuff deflation.

This low cost digital monitor can use 4 different cuff sizes for arm sizes ranging between 16cm – 45cm, including small, adult and large cuffs.

In the UA-651SL Plus A&D Medical are one of the few manufacturers to have a model that can use small, adult and large adult cuffs.

It’s important to note that ISO80369-5 cuffs cannot be used with non-compliant ISO80369-5 blood pressure monitors and they are not interchangeable with earlier models.

Pulse Oximeters and COVID-19

NHS England recently updated their guidance to support the remote monitoring, using pulse oximetry, of patients with confirmed or possible COVID-19.

It builds on the COVID Oximetry @home standard operating procedure, as well as the general practice and community health services standard operating procedures which were published last year.

Patients most at risk of poor outcomes are best identified by oxygen levels.

NHS England and NHS Improvement coronavirus have developed a standard operating procedure for using pulse oximeters to monitor oxygen saturation levels and an assessment pathway. Pulse oximeters can help detect asymptomatic presentations of “silent hypoxia” with low oxygen saturation but often with normal heart rate and other obs.

The assessment pathway classifies Oxygen saturation levels in to one of three classifications. Mild where O2 is 95% or higher, moderate where O2 is 93-94% or severe where O2 is 92% or lower. At a severe stage urgent admission to Hospital should be considered.

According to NHS England guidance an ideal blood oxygen level is between 95% and 99% and an ideal heart rate is between 50 and 90 beats per minute (bpm).

The NHS England Annex 2: Remote monitoring COVID-19 diary gives some practical tips on how to use a pulse oximeter correctly. These include

  • Remove any nail polish or false nails and warm your hand if cold.
  • Make sure you have been resting for at least five minutes before taking your measurement.
  • Rest your hand on your chest at heart level and hold still.
  • Pulse oximeters works best on your middle or index finger. It should not be used on your ear.
  • Keep still and keep the pulse oximeter in place for at least a minute, or longer if the reading keeps changing.
  • Record the highest result once the reading has not changed for five seconds.
  • Be careful to identify which reading is your heart rate and which is your oxygen level.

They have also produced a diary card which can be used to record results and any symptoms.

The link for the guidance and diary is below.

https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/06/C0445-remote-monitoring-in-primary-care-annex-2-diary-jan-21-v1.2.pdf

ECG electrodes. Cost Vs Convenience and time.

For many customers price is the only focus when purchasing electrodes for resting 12 lead ECG’s. It’s undoubtedly an important factor but should it be the only criteria considered when purchasing? 

In 2019 The Royal Papworth Hospital under took a trial to compare the cost effectiveness of two different brands of ECG electrodes. Ambu and a Brand Competitor.

Comparison was made between quality of ECG trace, time taken to carry out the ECG procedure, electrode attachment and patient comfort.

During the trial electrodes were placed on patients according to clinical guidelines for a 12 lead ECG recording.

Before the electrodes were applied, if needed, skin preparation was performed to obtain a better electrode-skin contact. The patient’s skin was shaved and cleaned with alcohol wipes and wiped by a gauze swab before the electrodes were placed to obtain an artefact-free ECG.

All filters on the ECG monitor were ‘off’ when recording an ECG. To minimize any noise, all forms of electronic devices that may cause interference were also switched off and patients were advised and encouraged to relax as much as possible to reduce muscle artifact.

Participants were assigned to two groups either using AMBU BlueSensor SU ECG electrodes or Skintact Easitab Resting ECG electrodes (competitor).

The average time it took to take an ECG using the Ambu electrodes was 3.39 minutes. The average time using the competitor Brand was 6.53 minutes. The time includes the preparation of the patient’s skin, shaving where necessary.

When using the Brand Competitor 7 razors were used, none were used with the Ambu electrodes.

The use of wipes and gauze was eight times higher for patients being monitored with the competitor electrodes and 28 additional competitor electrodes were used in comparison with five of the Ambu electrodes.

The average price (including wipes, razors, skin preparations and extra electrodes) of taking an ECG using the competitor electrodes was 57 pence compared to 54 pence using the Ambu electrodes.

The trial concluded that: The Ambu SU is the lower cost electrode when the additional patient preparation, extra electrodes and staff time are considered and that the reduced need for skin preparation improves the patient journey.

KardiaMobile NICE MIB232

This guidance has been updated and replaced by NICE medical technologies guidance 64 published 6th January 2022.

The AliveCor KardiaMobile ECG PMS Instruments distribute has just been recognised by the National Institute for Health and Care Excellence (NICE) for the fast and precise ambulatory detection of atrial fibrillation.

The recently published NICE Medtech Innovation Briefing (NICE MIB232) demonstrates how AliveCor’s technology can support patients and health care professionals, and highlights alignment to the NHS long term plan.

Highlights from the NICE MIB232 report conclude:

  • The published evidence from 11 studies, across 1,218 adult patients, demonstrates that KardiaMobile can detect more cardiac arrhythmias, but can do so faster than standard care.
  • The brief showcases KardiaMobile’s diagnostic accuracy for detection of cardiac arrhythmias with sensitivity ranging between 77.0% and 96.6% and specificity ranging between 76.0% and 99.1%.
  • KardiaMobile is suitable for patients to use with suspected paroxysmal AF, which might not be detected using a standard 12-lead ECG if the person is not in arrhythmia at the time of recording.
  • The convenience of an at-home medical-grade ECG that can be taken at any time of the day increases the diagnostic yield of an arrhythmic episode being detected and recorded.

It was also noted that patients preferred not having electrodes connected to the skin or travel to and from the surgery or hospital especially during the Covid 19 Pandemic.

All six experts involved with the studies described the technology as innovative. With one stating that it had already changed clinical pathways for those with suspected arrhythmia, one that it had potential to change standard of care, and another suggested it could be used in settings, outside of healthcare.

All of the experts thought that this technology had the potential to change standard care in some way (earlier diagnosis, quicker intervention, fewer hospital visits and referrals, fewer strokes) improving both patient outcomes and patient satisfaction.

At a cost of only £82.50 + VAT and ease of use compared to the cost of an ECG event recorder the KardiaMobile ECG could be a cost effective way of diagnosing AF earlier in suspected patients and improving patient outcomes.

Celebrating Meditech’ s 30 Year Anniversary

2020 is a memorable year and not just because of the COVID-19 pandemic. It also marks the 30th year in business of one of our key partners, Meditech.

Established in Hungary in 1990 Meditech have established a reputation for quality, accuracy and reliability in the design and manufacture of professional cardiovascular medical devices. From small beginnings their Distributor reseller network now covers 5 continents and I am proud to say PMS have been their exclusive UK and Ireland Distributor and Service Partner for over 20 years.

We sold our first Meditech product the Elite PC based ECG back in 1997. The E-Lite was one of the world’s first “plug and play” cost effective 12-lead resting ECG systems. It was popular with GP surgeries and pioneered the use of computers in the recording of ECG’s helping to start the trend for paperless ECG’s.

Next up was the ABPM-04 24 hour ambulatory blood pressure monitor introduced in 2003. This product really put Meditech on the map. Clinically validated to the demanding British Hypertension Society accuracy protocol it launched with the first generation CardioVisions analysis software fully compatible with Windows XP.

With thousands of ABPM-04’s sold worldwide it has become a classic ABPM renowned for its reliability that is still available to this day.

Several of the original monitors we sold over 17 years ago are still in regular use!

Other product milestones include

2000 Merlin ECG Event watch
2000 CardioTens combined ABPM and ECG Event monitor
2003 CardioClip 7 day looping ECG recorder
2004 CardXplore combined ABPM and Holter ECG recorder
2007 ABPM-05
2007 CardioMera 24 Hour Holter ECG
2017 CardiUP3!/12! Second generation Holter ECG
2019 ABPM-06

The latest ABPM-06 is the result of 30 years of product design, engineering precision and of course customer feedback that sets Meditech apart from competitors.

On behalf of everyone at PMS I would like to offer congratulations to the team at Meditech for the achievements and innovations over the last 30 years. We are looking forward to many more.

Life Goes On

It’s very easy to forget that life, although not as we knew it, is still going on. Covid 19 has dominated our lives for the last 6 months and it looks set to continue that way for at least the next 6.

Many GP surgeries have put a temporary hold on offering 24 hour ABPM services

Some are using waiting room BP monitors in place of face to face measurements. Others are not using them at all to reduce the number of patients in the waiting room.

Some are not using the waiting room at all requesting that their patients wait outside the surgery until called directly into the consulting room.

There are so many different ways and we are all trying to provide the best service we can during these strange unprecedented times.

Now could be the perfect time to get your Surgeries BP monitors serviced, if they are not currently being used, so they are ready for when things return to a more normal service.

Some surgeries have decided to wait until they feel comfortable in offering monitoring again.

Either way however you are dealing with the current pandemic we will continue to offer service and calibration of A&D Medical waiting room BP monitors, Meditech ABPM monitors and ECG monitors.

I am pleased to report that for the 27th year running we recently passed the ISO9001 quality standard audit. We are registered to provide repairs and support services for a range of specialised medical instruments.

With us you can be assured that when your monitors are serviced they go through a  comprehensive assessment of up to 70 tests carried out by our own manufacturer trained engineers.

As all monitors are collected and returned by our courier the engineer does not have to enter your premises, therefore maintaining all of your existing covid-19 safety measures.

Despite the Pandemic we are maintaining our fast turnaround time which remains at 3-5 working days. All it to takes to arrange is a quick call or email to us and we will do the rest.

Nothing is normal right now but life does go on and you can be assured we are still here offering you our support and service.

Cleaning Blood Pressure Equipment and Cuffs During COVID-19

As customers start to get ready for the new normal we’ve been receiving a number of calls and emails regarding the safe cleaning of blood pressure cuffs, including 24 hour ABPM cuffs.

Our advice is to use a disinfectant from a reputable brand which complies to the BS EN 14476 standard as this will ensure the spray is effective against a range of viruses including Coronavirus.

Different disinfectants have different contact times, the time the surface must remain wet for the product to be effective. If the solution is not left wet on the surface for the directed time it may not work as effectively.

Before disinfecting cuffs ensure they are dirt and grease free otherwise this may make the disinfectant less effective.

If you are using old style Meditech woven cloth material cuffs we recommend you upgrade to the new hygienic wipe style. ERKA and A&D Medical also have wipe able cuffs in their range.

Purchasing additional cuffs could also provide further protection by leaving time between patient uses.

Even before the outbreak of Covid-19 our TiDi blood pressure cuff barriers were popular. Since the outbreak they have become indispensable for many customers.

Intended for single patient use they are manufactured in latex free FABRICEL tissue fused with a leak proof polyethylene film. They wrap around the patients arm and the cuff is applied over the top ensuring the blood pressure cuff never comes in to direct contact with the skin.

They can be used with all ABPM, digital and manual blood pressure cuffs and are thin enough not to affect measurements. 

They are available in 3 sizes

Adult (TID916114)- 300 barriers are supplied in 6 boxes of 50.

Large Adult (TID916115)- 150 barriers are supplied in 3 boxes of 50.

Paediatric (TID916113)- 300 barriers are supplied in 6 boxes of 50.

For waiting room BP monitors the same disinfectant complying with BS EN 14476 can be used. Single use protective overarm sleeves (AND093) protect the TM-2655P and TM-2657P inner from dirt and liquid and from coming into direct patient contact. Manufactured from latex free polythene they are 40cm long and fit an arm circumference of 38cm.

Moving Matters During COVID-19

The last few weeks since lockdown on the 23rd March have changed the way we all work and like all businesses PMS Instruments have had to adapt. As a NHS Supply Chain partner we were assigned key supplier status from day one and whilst adopting Government guidance have remained open throughout.

The initial surge in orders we received tested the resilience of my staff, manufacturing supply chain partners as well as our own procedures and processes but we also had another challenge.

We were committed to relocating our Offices.

As any business knows finding suitable business premises can be a real test. We had been in our existing building in Maidenhead since 1982 and weathered a number of changes over the last 38 years in terms of technology, the local area, society and the NHS.

We had responded to these challenges in a positive and pragmatic way but when the Royal Borough of Windsor and Maidenhead announced plans to redevelop the building we occupied as part of their regeneration plans for the town, there was no option but to relocate.

After a great deal of time and effort I identified new larger offices that would meet our requirements for expansion in Wokingham and by the end of January terms were agreed.

Moving a business established in the same building for nearly 40 years is similar to moving house but I can confirm it’s 1000 times more stressful!

There’s a lot more to consider and take in to account. If you move home, don’t have any Broadband or a functioning phone for a week it’s an inconvenience but not the end of the world. If PMS moved without any of these it would restrict our ability to support the NHS at a time of national emergency.

Surely it’s all just down to careful planning right? Well that’s what I thought until Covid-19 and lockdown on 23rd March and our carefully laid plans went out of the window.

By the end of March we were ready to move but struggling to get key infrastructure like IT and comms installed. It seemed the whole world was in lockdown and they were.  

So we waited…and waited…and waited. Then we moved and it was worth it.

Due to an incredible effort from PMS staff, our office refurbishment company, legal and surveying team, comms, IT and removal company we have now moved to our new offices.

My personal thanks to all those involved directly and indirectly and most importantly thanks to our customers for their support and understanding over this period.

FDA Guidance Allows Use of KardiaMobile 6L to Measure QTc in COVID-19 Patients

The KardiaMobile 6L – the world’s only six-lead personal ECG – is now cleared for use in the measurement of a patient’s QTc and detection of potentially dangerous QT prolongation.

A prolonged QTc can lead to a potentially fatal side effect, called drug-induced sudden cardiac death (DI-SCD) linked with the use of several medicines now being used in the treatment of COVID-19.

The QTc is a heart rate corrected interval that reflects the integrity of the heart’s electrical recharging system. Abnormal prolongation of the QTc can stem from congenital long QT syndrome, many disease states, electrolyte abnormalities, and over 100 FDA-approved medications that have the potential for unwanted QT prolongation.

Patients with a prolonged QTc are at greater risk of their hearts going into a potentially dangerous arrhythmia called Torsades de Pointes which can lead to sudden cardiac arrest and even worse, sudden cardia death.

With the global pandemic of COVID-19, several drugs being used off-label to treat COVID-19 which have the potential for unwanted QT prolongation and worse, DI-SCD.

With the KardiaMobile 6L a patient’s QTc can be obtained without exposing clinical staff to affected patients which helps to conserve personal protection equipment (PPE) and thereby expand the capacity of strained medical resources.

Healthcare professionals can now use KardiaMobile 6L to collect a six-lead ECG (Lead I, II, III, aVR, aVL, aV), and then use manual tools to calculate QT duration allowing them to make assessments with respect to patient medication.

Lead I I-ECGs could detect AF more accurately than a manual pulse check

A new study which looks at Lead-I ECG for detecting atrial fibrillation in patients with an irregular pulse using single time point testing has been published in Health Technology Assessment Volume: 24, Issue: 3 January 2020 https://doi.org/10.3310/hta24030

This study aimed to assess whether or not the use of lead-I ECGs in GP surgeries could benefit patients and offer good value for money to the NHS.

The objective was to assess the diagnostic test accuracy, clinical impact and cost-effectiveness of using single time point lead-I ECG devices for the detection of AF in people presenting to primary care with relevant signs or symptoms, and who have an irregular pulse compared with using manual pulse palpation (MPP) followed by a 12-lead ECG in primary or secondary care.

The study found that if GPs were to routinely use lead-I ECG devices, including the AliveCor KardiaMobile, people with suspected AF could receive treatment while waiting for the AF diagnosis to be confirmed by a 12-lead ECG.

The study found that using a manual pulse check followed by a lead-I ECG offers better value for money when compared with a manual pulse check followed by a 12-lead ECG. This is mostly because patients with AF can begin treatment earlier when a GP has access to a lead-I ECG device.

The report also stated that the AliveCor KardiaMobile lead –I ECG is the most cost-effective option in a full incremental analysis.

Review of the Meditech ABPM-06

It’s not that often that Meditech introduce a new ABPM. The last one, the ABPM-05 was introduced in 2007 the year the iPhone was launched. When they do it’s worth the wait.

There is a lot of thought that goes into the design and features customers really want in a new monitor. As well as good design it is important the technical elements are addressed so that the 30 year plus reputation for reliability and accuracy that Meditech have and customers from around the world expect, is maintained.

We’re proud that Meditech chose PMS Instruments and the UK as their first launch partner for the new ABPM-06 so what’s it really like to wear, use and operate?

First impressions are good. It’s got the same familiar look as the ABPM-05 which means it’s compact and light.

It uses the same size and type of wipeable cuffs which means users of the old ABPM-04 and ABPM-05 can use their existing cuffs interchanging between units. The cuffs are durable and easy to wipe clean which is important for patient hygiene.

One major improvement is the type of PC interface cable the new ABPM-06 is supplied with. The old ABPM-04 and ABPM-05 used either a serial interface or USB optoelectronic fibre optic cable which was unique to Meditech. Although repairable these old cables are expensive to replace or purchase new.

As customers frequently want to use their ABPM in more than one treatment room the new ABPM-06 is now supplied with a standard mini USB A mini to USB B PC cable. This resolves any potential cable comms issues as there is only one way the cable will go in.

Meditech have taken the wise decision to integrate the ABPM-06 into their popular CardioVisions analysis software rather than offer a completely new software platform. This means the look and feel of the software, programming, downloading and printing will be familiar to users of the old ABPM-04 and ABPM-05 with no new software to learn.

Programming the ABPM-06 takes seconds and key patient information like name, date of birth and ID is retained in the monitor so there is no doubt who has worn the monitor.

In the interests of customers I have worn a new ABPM-06 twice now and found the monitor comfortable and unobtrusive throughout.

I programmed the monitor to record every 30 minutes during the day and hourly during the night as recommended by the latest NICE guideline NG136.

Of the 40 readings taken over 24 hours all were successful with no errors. I was aware of the monitor going off at night but the new SleepWell® function added to the new AA grade algorithm meant the device wasn’t uncomfortable and the measurement inflation and deflation time was quick.

Downloading the results took seconds and the automatic text reporting, trend graph and presentation of key metrics like average daytime reading value are clear.

Feedback from new and existing customers who have purchased the ABPM-06 since we introduced it has been very positive. For a free demonstration, loan or for more information just call or email us.

Save time and money one measurement at a time

At around £1,500.00 is the A&D TM-2657P waiting room blood pressure still worth the money?

Self patient blood pressure measurement devices like the A&D TM-2657P are not new and there are now several hundred in use in the UK since they were first introduced by PMS Instruments 17 years ago in 2002.

Sited in the waiting room, for many Practices they are an integral part of their long term medical conditions clinics allowing them to work smarter, not harder, whilst helping patients take ownership of their conditions and play a more active role in their treatment.

A number of GP practices have adapted established protocols whereby patients pass their blood pressure results to the reception team and are then advised as to whether there is a need for further clinical follow up.

The protocol needs to be easy to follow and comprehensive to ensure that the receptionist is taking no responsibility for a clinical decision. When implemented correctly, after suitable training the process works very well.

Why is all this relevant to Primary Care and the NHS?

When this type of service is introduced anecdotal evidence from PMS Instruments GP customers suggests that waiting room BP monitors are used by up to 240 patients every month and only 80 of them require any further intervention. This represents a potential “saving” of over 160 face to face GP clinical appointments. 

Let’s do some maths!

According to NHS England, the average GP appointment costs £30 so in the example above that’s a saving of £4800 to the NHS every month.

So the payback period in terms of time saved and the initial £1500 cost of the monitor is established but what are the other benefits?

It’s about time.

According to a report published in Pulse in August 2019, over half of GPs have said the average waiting time for non-urgent appointments at their practice is now over two weeks.

Anything that can help reduce this must be a good thing and waiting room blood pressure monitors like the TM-2657P can.  

With the protocol above Doctors and nurses who want to monitor a patient’s blood pressure ask the patient to use the waiting room BP monitor and they only need to see a Doctor if their readings move out of an agreed range. Patients can do this at any time the practice is open freeing up valuable appointment time.

Nurses who run chronic disease clinics can also ask patients to monitor their blood pressure before coming to their clinic. Apart from saving nursing time it gives an immediate focus to the consultation.

Public Health England and NHS England have agreed ambitions and a goal over a 10 year period to improve the detection and treatment of high blood pressure with the following targets

  • 80% of the expected number of people with high BP are diagnosed by 2029
  • 80% of the total number of people diagnosed with high BP are treated to target as per NICE guidelines by 2029

How do we achieve these objectives when Primary Care is already overstretched?

In this instance the technology, in the form of waiting room BP monitors, already exists we just need to encourage wider adoption and not be afraid to adopt new approaches.

Time is money as the saying goes and the A&D TM-2657P saves time and money one measurement at a time.

ERKA The Original Aneroid?

With an established reputation for quality, Erka has been developing and manufacturing sphygmomanometers as well as stethoscopes since 1889.

The ERKA name has a worldwide reputation and represents a guarantee of quality for services and quality goods that are designed, produced and Made in Germany. 130 years of experience means the highest precision, trust and innovation and are just some of the reasons why so many consumers purchase.

PMS Instruments have been their UK Distributor since 2001.

Designed for manual blood pressure measurement the ERKA Switch Comfort Aneroid Sphygmomanometer offer outstanding quality, precision and ease of use as standard.

The sensitive deflation screw valve of the ERKA Switch allows the user to make precise adjustments to the deflation speed.

The innovative design of the SWITCH allows the device to be switched from a right-handed to a left-handed device in a single step.

Buy with confidence direct from PMS Instruments an official authorised Distributor or via the NHS Supply Chain NPC code FFE1244.

Features include

•             Shock resistant to AAMI SP10

•             Special tempered copper-beryllium membrane

•             Easy to read 56 mm diameter polycarbonate head

•             Weight without cuff 120g

•             Latex free, DEHP free, PVC free single tube cuff

•             Manufactured in Germany for precision

•             5 year warranty after registration

•             Wide range of cuff sizes available

The New Meditech ABPM-06

PMS Instruments are pleased to announce the UK launch of the new ABPM-06 24 hour ABPM.

The ABPM-06 is the latest generation premium ambulatory blood pressure monitor from Meditech, technology leaders worldwide in the manufacturing of ambulatory blood pressure monitors since 1990.

It builds on the near 30 year plus reputation and experience of Meditech’ s engineers and maintains the tradition of reliability and accuracy that thousands of customers around the world have come to expect.

The ABPM-06 has all the features customers like in the ABPM-04 and ABPM-05 plus some important new innovations

  1. AA grade Independent clinical validation to 3 separate protocols
  2. Built in voice recording (max 8 x 15 seconds)
  3. Free, all-inclusive software packages
  4. Unique SleepWell® function
  5. Dual valve system for patient safety
  6. Proven technology and long-life reliability

With both the ABPM-04 and ABPM-05 patients could trigger additional measurements by pressing a button. This feature is retained but with the ABPM-06 they can now also record up to 8 x 15 second voice memos.

For the first time patients can now record voice memos of symptoms during the recording for example if they are feeling dizzy and give detailed feedback to their Doctor over the monitoring period. This voice memos are downloaded and stored with the recording on the PC.

The ABPM-06 is A/A clinically validated to the ESH-IP, BIHS and AAMI protocols so accuracy is assured. The extended measurement range gives the doctor a more precise BP profile and overnight dipping and morning surges can easily be identified.

Meditech have designed a unique SleepWell® function to disturb the patient as little as possible during the night. The ABPM-06 won’t repeat failed readings unless necessary. This helps avoid measurements being taken uncomfortably close together.

The ABPM-06 comes with a standard USB cable. Cuff compatibility with earlier versions is maintained.

As you would expect the ABPM-06 is supplied with the popular CardioVisions analysis software which provides detailed automatic reporting and textual analysis.

For existing customers there is no new software to learn. Demonstrations are available and you can buy with confidence direct from PMS Instruments, the exclusive UK and Ireland Meditech authorised distributor since 1997.

KardiaMobile 6L-Different but the same

Since we launched the KardiaMobile 6L last week we’ve seen phenomenal interest in the new product which has the potential to be a real game changer in the diagnosis of Atrial Fibrillation as well as potentially other arrhythmias.

It’s important to point out that both products use the same clinically proven AI technology but the KardiaMobile provides 6 times more of it!

For instance both versions of the KardiaMobile will display and record a Premature Ventricular Contraction (PVCs) but now with KardiaMobile 6L Cardiologists can identify where they originate from in the heart.

As well as recording 30 seconds of 6 Lead ECG (Lead I, Lead II, Lead III, aVR, aVL and aVF) ECG in real time it can also be set to record Lead 1 only so it offers the best of both worlds! You can buy yours from our Web site

KardiaMobile 6L KardiaMobile
CE Marked and FDA cleared 6 lead
personal ECG 		CE Marked and FDA cleared 1 lead personal ECG
Detects Atrial Fibrillation, Bradycardia, Tachycardia, and Normal Sinus Rhythm Detects Atrial Fibrillation, Bradycardia, Tachycardia, Normal Sinus Rhythm
Increased ability to identify cardiac arrhythmias such as atrial flutter, heart block and PVCs Clinically proven AI- technology
Clinically proven AI-technology Most widely-used 1-lead personal ECG in the world
Select single or 6-lead ECG, depending on patients’ unique remote monitoring needs  
£149 + VAT £99 + VAT

New NICE Hypertension Guideline NG136

NICE have today published their Hypertension in Adults guidance NG136 which replaces CG127.

This provides updated guidance on the diagnosis of hypertension and measuring blood pressure. Although there are some changes since 2011, the recommendation that ABPM should be used as a preferred method of diagnosis still stands. 

“Based on the evidence in the previous guideline and the committee’s experience and knowledge, it was agreed that ABPM remains the gold standard for the accurate measurement of blood pressure in primary care. ABPM has therefore been retained as the preferred method for the diagnosis of hypertension.” NG136 recommendations 1.2.1 to 1.2.5 &1.2.8

Although this recommendation was made in 2011 there is still a large variation in practice. NICE have suggested that new resources and training are needed. NG136 recommendations 1.2.1 to 1.2.5 &1.2.8

Meditech’s CardioVisions may be a solution to the training aspect. CardioVisions software works with both Meditech’s ABPM-04 and ABPM-05. Supplied by PMS Instruments it supports Windows 7, 8 &10 and is very easy to use. With colour coded trend graphs, flexible programming and data retrieval. Patient’s results are automatically classified from normal to stage 2 Hypertension.   

NICE NG136 also suggests that the initial cost of using ABPM’s is outweighed by the long term benefits of accurate diagnosis and subsequent treatment. NG136 recommendations 1.2.1 to1.2.5 &1.2.8

A new guide line is the recommendation of the use of ABPM for a patient with a clinic blood pressure reading of 140/90 to180/120 to confirm hypertension.

“If clinic blood pressure is between 140/90 mmHg and 180/120 mmHg, offer ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension”. NG136 1.2.3

In addition there is a recommendation for the use of ABPM for patients with white-coat effect Hypertension

“Consider ABPM or HBPM, in addition to clinic blood pressure measurements, for people with hypertension identified as having a white-coat effect or masked hypertension (in which clinic and non-clinic blood pressure results are conflicting).” NG136 1.4.18

Meditech are on the list of validated blood pressure monitoring devices provided on the British and Irish Hypertension Society’s website.

New AliveCor KardiaMobile 6L And The Diagnostic Power Of Six Leads

The ECG has come a long way since Nobel prize winning Willem Einthoven invented the first practical electrocardiogram (ECG or EKG) in 1895. The 3 lead string galvanometer also known as the Einthoven galvanometer he introduced in 1901 was 7 metres long, required 5 operators and weighed over 270 kiliograms!

Although the original “Einthoven triangle” configuration which refers to the imaginary inverted equilateral triangle centered on the chest and the points being the standard leads on the arms and leg was chosen largely for convenience it is still in use today.

I wonder what Einthoven would make of the new AliveCor KardiaMobile 6L PMS Instruments have launched today?

Things have definitely come on in the 159 years since he was born.

The new AliveCor KardiaMobile 6L records a six lead 30 second clinically validated ECG using a smartphone or tablet and App.

At 9cm long and weighing 24 g the KardiaMobile 6L has two electrodes on the top and one on the bottom.

The two electrodes on the top are for your fingers, and the one on the bottom to contact the skin of your left leg.

To record a 6 lead ECG hold the KardiaMobile 6L in your hands, placing your fingers on the front electrodes then touch the third electrode to the skin of your left knee or ankle. It’s that easy.

Why six leads?

The 2 fingers and left leg configuration allow the KardiaMobile 6L to record Lead I, II, II, aVL, aVR, and aVF ECG leads which are known as the frontal plane leads recording vertical and lateral electrical forces. By looking at the axis through the heart each of the individual 6 leads records the ECG from a slightly different perspective giving 6 times more information than the original KardiaMobile 1 Lead.

That’s 6 more times data for the KardiaMobile App and for your Doctor to analyse and providing more visibility into certain arrhythmias that are leading indicators of cardiovascular disease

For example with the 6 leads of ECG data the KardiaMobile 6L records it could be possible to identify if there is any deviation of axis out of the normal range in the frontal plane and if P waves are present.

With the launch of the KardiaMobile 6L six really is better than one!

Detecting Irregular Heartbeats (IHB)/AFib Using A&D’s Latest Blood Pressure Monitors.

A&D have a long history and pedigree in pioneering innovation and the development of blood pressure monitors with leading edge functions. With over 40 years of patient-focused thinking it has made them one of the leading blood pressure manufacturers in the world. Their latest clinically validated digital monitors feature a new 2nd generation IHB/AFib algorithm to detect an irregular rhythm during a measurement. 

It is currently available in the latest 2019 versions of the UA-767S AFib+ and UA-767S-W AFib+ from leading distributor PMS Instruments and will be available in more models soon.

It’s the latest development of an Irregular Heartbeat (IHB) detector and algorithm originally pioneered by A&D in 2014. With this feature as well as the existing World Health Organisation (WHO) blood pressure classification index introduced in 2003, A&D monitors really are at the Heart of Healthcare Technology.  

Why is the detection of Atrial Fibrillation important?

AFib is an irregular heart beat that can lead to strokes and other heart related conditions.

The NHS long term plan (NHSLTP) recently published ambitious targets for Atrial Fibrillation (AFib) and high Blood Pressure detection over the next 10 years.

For Atrial Fibrillation the targets are

That 85% of the expected number of people with AF are detected by 2029

That 90% of people with AF who are known to be at high risk of stroke to be adequately anti-coagulated by 2029.

The A&D UA 767S Afib+ and UA-767S-W Afib+ with %IHB/AFib detection could help with these aims.

The monitors classify the %IHB into 4 different grades showing how often an IHB has been detected during the measurement and illustrated by an icon.

0% no indication

1 – 9% grade 1

10 – 24% grade 2

25 – 100% grade 3

This feature is for monitoring purposes only and we recommend contacting your doctor if the grade is high.  

This new feature has been clinically validated and published in the Journal of Clinical Hypertension J Clin Hypertens. 2017;19:1143–1147 Tomoyuki Kabutoya et al. The paper concludes that the new algorithm had high diagnostic accuracy for detecting AF and a low false-positive rate.

Kardia Mobile ECG App now detects Bradycardia and Tachycardia

The latest update of the AliveCor Kardia mobile ECG app for Apple iOs and Android devices now includes 2 new FDA-cleared, medical-grade ECG detectors, Bradycardia and Tachycardia.

This brings the total to 4 clinically relevant detectors including automatic instant analysis for Bradycardia, Tachycardia, Atrial Fibrillation, and Normal ECGs.

What is Bradycardia?

Kardia Instant Analysis Bradycardia indicates that atrial fibrillation is not detected in the ECG, and the heart rate is less than 50-beats per minute, which is slower than normal for most people. The normal range for heart rate depends on your age and physical condition. A heart rate of less than 50-beats per-minute can be normal for healthy adults, athletes and during sleep.

What is Tachycardia?

Kardia Instant Analysis Tachycardia indicates that atrial fibrillation is not detected in the ECG, and the heart rate is faster than 100 beats per minute. This can be normal with stress or physical activity. The normal range for heart rate depends on your age and physical condition. The most common form of tachycardia is sinus tachycardia, which is a normal increase in heart rate.

While Bradycardia (heart rate less than 50 beats per minute) and Tachycardia (heart rate higher than 100 beats per minute) are often nonthreatening, these arrhythmia’s can be indicative of heart disease or other health conditions, such as thyroid disease.

A slow or fast heart rate may be asymptomatic, or cause symptoms such as dizziness or shortness of breath. Kardia Mobile users will now be able to detect these arrhythmias and use the insight to inform conversations with their doctor.

Beyond the patient-doctor relationship, Kardia Mobile also provides peace of mind by diminishing the number of unclassified readings that users may receive. 

The latest Basic version of the App now also allows multiple ECG’s to be stored on the mobile device.

Kardia Mobile Recommended In UK Accident & Emegency Departments

The latest clinical validation study on the AliveCor Kardia Mobile ECG has just been published in The Lancet. The study was funded by research awards from Chest, Heart and Stroke Scotland (CHSS) and the British Heart Foundation (BHF).

Whilst previous clinical studies have concentrated on the AliveCor’s use to detect Atrial Fibrillation (AFib) in Community Pharmacy and Primary Care settings this latest multi-centre trial looked at patients presenting to Accident and Emergency Departments with palpitations and pre-syncope but with no obvious cause at their initial consultation. 

The multi-centre, randomised controlled trial included 243 patients recruited over an 18 month period from 10 prestigious centres across the UK including Hospitals in Edinburgh, Reading, London, Exeter, Plymouth, Chesterfield, Leicester and Nottingham.

What was the problem the researchers identified?

It is estimated that Palpitations and pre-syncope are together responsible for 300,000 annual Accident and Emergency Department attendances in the United Kingdom (UK) alone. However diagnosis of the underlying rhythm is difficult as many patients are fully recovered by the time they attend Hospital and their ECG is normal.

What was the outcome?

Use of the AliveCor Kardia Mobile ECG smartphone-based event recorder in Accident and Emergency units was five times more effective at detecting heart rhythm problems than standard tests and should be used in all Accident and Emergency units, researchers say.

Use of the Kardia Mobile ECG also increased the number of patients diagnosed with cardiac arrhythmia.

The Study participation survey and questionnaire demonstrated the Kardia Mobile was well received and liked by patients with the majority agreeing or strongly agreeing the Kardia Mobile was easy to use.

The £99 Kardia Mobile ECG recorder also cut the cost of diagnosis by more than £900 per patient and cut the time taken to diagnose by more than three weeks.

A copy of the paper can be accessed using the following link

M.J. Reed, N.R. Grubb, C.C. Lang, et al., Multi-centre Randomised Controlled Trial of a Smartphone-based Event Recorder Alongside Standard Car…, , https://doi.org/10.1016/j.eclinm.2019.02.005

Cardiovascular disease a national call to action

The fight begins against the nation’s biggest killer. Prevention is better than cure.

That’s the message from the latest guidance jointly released today by Public Health England and NHS England.

They have agreed ambitions and a goal over a 10 year period to improve the detection and treatment of (A) atrial fibrillation, (B) high blood pressure and (C) high cholesterol the A-B-C of major causes of cardiovascular disease (CVD) in England.

It is estimated CVD costs the wider economy £15.8 billion per year and causes 1 in 4 deaths.

It’s well known that many people are living with undiagnosed CVD or if diagnosed it is badly managed. These conditions often carry no symptoms meaning millions of people are unaware they are at risk and in need of treatment. It is believed that over 5 million are currently living with undiagnosed high blood pressure in England alone.

Today CVD causes 1 in 4 deaths in England or 1 every 4 minutes. In 2016 heart disease was the leading cause of death for men and the second biggest for women after dementia.

The NHS long term plan (NHSLTP) has the ambition to prevent 150,000 cases of Strokes, heart attacks and dementia over the next 10 years.

The old adage prevention is better than cure is the mantra and Health Secretary Matt Hancock is on record as saying

“Prevention is at the heart of our vision for improving the health of the nation, empowering people to stay healthy, not just treating them when they’re ill. Millions of people are needlessly at risk of heart attacks or strokes when it could be prevented. So I want to help more people take the time out to protect their future health and get checked.”

These are the ambitions for Atrial Fibrillation (AFib) and Blood Pressure.

Atrial Fibrillation

  • 85% of the expected number of people with AF are detected by 2029
  • 90% of people with AF who are known to be at high risk of stroke to be adequately anti-coagulated by 2029.

Blood Pressure

  • 80% of the expected number of people with high BP are diagnosed by 2029
  • 80% of the total number of people diagnosed with high BP are treated to target as per NICE guidelines by 2029

How do we achieve these objectives when Primary Care is already overstretched?

By using the NHS Health Check to support early diagnosis and management can encourage people to make healthy life style choices such as eating well, reducing alcohol and taking more exercise is one approach.

New technology and new approaches can also help.

I’ve written previously on this Blog about opportunistic screening in different settings including community settings. Pharmacists for instance are already using new technologies and products like the AliveCor Kardia Mobile ECG and A&D UA-767 S blood pressure monitor with AFib + technology to actively and opportunistically identify at risk patients.

Already used extensively throughout the NHS the Kardia Mobile ECG monitor is clinically validated and automatically detects AFib in 30 seconds. Its quick uses a smartphone App and costs under £99.

Published today the CVD goals and ambitions Public Health England and NHS England hope to achieve by 2029 should be welcomed. If made a reality, the prospects of millions of at risk people will be transformed for the good.

PMS Instruments Receives Gold Trusted Service Award 2019

PMS Instruments have won the Feefo Gold Service award, an independent seal of excellence that recognises businesses for delivering exceptional experiences, as rated by real customers.

Created by Feefo, Trusted Service is awarded only to those businesses that use Feefo to collect genuine reviews and insights. Those that meet the high standard, based on the number of reviews they have collected, and their average rating, receive the award. A badge of honour, this accreditation remains unique, as it is based purely on the interactions with real customers. As all reviews are verified as genuine, the accreditation is a true reflection of a business’ commitment to outstanding service.

PMS Instruments met the criteria of collecting sufficient positive reviews between January 1st 2018 and December 31st 2018, with a Feefo service rating of between 4.5 and 5.0.

We’re thrilled to receive this award from Feefo. It recognises how hard we’ve been working to give great experiences to all our customers, who are the most important judges of what we do. We’re committed to delivering the highest quality of service, so it’s important for us to listen, understand and respond to all our customers. Feefo enabled us to consistently improve throughout 2018 and now we’re looking forward to another successful year ahead.”

Congratulating PMS Instruments on winning this year’s award, Matt West, CEO at Feefo, commented: “The Trusted Service award has always been about recognising those companies that excel beyond the norm. This year we’ve seen many remarkable businesses leveraging the full potential of Feefo to provide outstanding levels of experience for their customers – and rightly being awarded our most prestigious accreditation. I’m looking forward to the continual success of the businesses that work in partnership with us throughout 2019.”

New Fixed Price Service Package.

We are pleased to announce the introduction of new Fixed Price Service Plans for selected A&D Medical and Meditech devices including the Meditech ABPM-04/ABPM-05 and A&D TM-2655P/TM-2657P waiting room blood pressure monitors.

PMS Instruments are an approved A&D Medical and Meditech service and repair centre and our new Fixed Price Service Plan includes:-

  • 12 months priority software telephone and remote technical support
  • 12 months remote assist training and installation where applicable
  • Fixed price servicing cost including labour and service parts
  • Fast priority response for all servicing and repairs
  • Loan equipment (subject to availability)
  • FREE preventative maintenance and calibration check
  • Up to 70 point test procedure verifies equipment accuracy, patient safety and reliability
  • Fully insured courier collection and return included
  • Priority turnaround time typically 3-5 working days from receipt of equipment
  • Inclusive annual service and calibration to manufacturer’s specification
  • ISO-9001 Quality Assured service centre and Practice Index approved supplier
  • No need to pay to get this equipment serviced by 3rd party

We use genuine manufacturer approved spare parts, and adhere to recommended preventative and service procedures.

For pricing and to protect your equipment investment and ensure it is accurate, safe and reliable act today by calling 01628 773233 or email support@pmsinstruments.co.uk

Just one call or email is all it takes and we will do the rest.

Improving the AF clinical pathway with the Kardia Mobile

Clinical Background

1.4 million people in the UK have atrial fibrillation; that’s 2.4% of the population. It’s known that in the 45 – 65 age group over 80% of people will suffer from the condition.

Public Health England (PHE) believes almost half a million people with AF remain undiagnosed. AF is known to be a direct cause of a third of all strokes and consequently 2,000 premature deaths per year. Early diagnosis could help avoid this.

AF and AF-related illness costs the National Health Service over £2.2 billion annually – a cost that is expected to rise as the incidence of AF increases due to the ageing population.

Current Clinical Pathway

The current clinical pathway varies according to each GP surgery and CCG but generally it can be a lengthy and costly process to achieve a definitive diagnosis.

The process typically begins with a manual pulse check and then auscultation, a 5 or 12 lead ECG in the surgery is followed by a 24 hour ECG tape or seven day Holter recording which then has to be analysed. With a positive (or indecisive) test, the patient is then referred to a cardiologist. If a diagnosis of AF is confirmed, the patient is then referred back to the GP for anticoagulant therapy.

PHE estimates that 2,000,000 people in the UK have Atrial Fibrillation and that the cost per patient using the current pathway is £1,305 without interventional procedures. This includes three GP visits, 12 lead ECG and Holter recordings, and outpatient costs.

The cost reduction achieved by using Kardia Mobile is significant. Assuming the patient requires two GP visits and a Kardia Mobile is provided for each patient, the cost is £189 rising to £352 if a patient is also sent for a 12 lead ECG. The minimum saving is therefore in the region of £950 per patient.

The cost to the NHS of screening the population with the current pathway is prohibitive. Kardia Mobile makes it possible.

Cost £ Of Current Pathway

First GP visit (incl. ECG test) £81
Outpatients £230
24 hr ECG £163
7 day Holter test £163
Outpatients and decision £230
Implantable loop recorder (ILP) £4021-£4556
Second GP visit £45
Total £1305 with ILR £5861

Cost £ When Using Kardia Mobile

First GP visit (incl. ECG test) £81
GP Supplies Kardia Mobile £99
Second GP visit £81
Total £189

Therefore using the AliveCor Kardia Mobile is a faster, simpler and more effective pathway.

Added Benefits. Early diagnosis of AF in 30 seconds

 In surgery, the GP or the nurse can use the Kardia Mobile for a quick check when a patient presents with palpitations, fast heart rate or irregular rhythm.

The presence of AF can be immediately identified. Due to its simplicity, speed of use and low cost, Kardia Mobile can routinely be used to screen patients for AF and become part of the protocol for health checks in key age groups.

It can also be used to screen newly registered patients, in the well woman/well man NHS health checks and to form part of the routine in flu clinics.

As AF may be transient in nature, a test in the GP’s surgery may still not reveal the presence of the condition. A doctor can then issue a Kardia device to the patient for home use to make a recording when he or she experiences symptoms.

Kardia Mobile will also provide a simple ECG rhythm strip recording with heart rate when used during home visits.

The Cost/Benefit Analysis Of Using The Kardia Includes

  •  Reduction in the number of ECG tests, 24 hour tapes and 7 day Holter recordings.
  • Reduction in the number of GP appointments and outpatient appointments.
  • Savings to the NHS through early diagnosis of AF and prevention of stroke.

Why Is There A Need For The Systoe Toe Pressure Measurement System?

Clinical situation

Peripheral arterial disease (PAD) is when the arteries, in this case, to the legs, become fully or partially blocked. This blockage most commonly occurs due to atherosclerotic (cholesterol) plaques.

Arterial blood brings oxygen and nutrients to the muscles of the legs, and when blocked may result in pain in the legs, also called intermittent claudication. Intermittent claudication is typically described as pain in the patient’s calf after walking a distance that goes away when the patient rests.

In advanced peripheral arterial disease, the patient may have pain in the legs at rest, and may develop leg ulcers and gangrene.

When a patient is first seen and suspected of having PAD, the underlying diagnosis is usually not difficult if a proper history and physical examination is performed.

For this purpose the Ankle brachial index (ankle systolic pressure/brachial systolic pressure) is usually measured.

Why is there a need for the Systoe?

Limitations of Ankle Brachial Index (ABI)

In the case of diabetic patients, old patients and renal failure patients, medial calcification (deposit of calcium on the middle part of the artery wall) of the tibial/peroneal arteries may prevent the measurement of the ABI pressure.

ABI measurement is impossible in

  • 15 %  of diabetic patients at the time of the diagnosis.
  • 20 % of the diabetic patient present a PAD
  • 30 % after 15 years

Weitz et al. Circulation. 1996; 94: 3026-3049

As the toe arteries are affected by medial calcification later than the leg arteries, the toe systolic pressure can be measured to circumvent the problem of medial calcification of the tibial/peroneal arteries. Toe pressures are a clinical indicator. For clinical purposes a normal Toe brachial Index (TBI = toe systolic pressure/brachial systolic pressure) is considered to be higher than 0.7

For any value less than that, the patient will be found to have some occlusive disease proximal to the recording site.

A major advantage of TBI is its use following the progress of disease and after any form of intervention.

The Atys SysToe can also be used in the following circumstances

  • Triage patients before referral to vascular specialist
  • Opportunistic Screening and follow up after intervention
  • Wound and Ulcer healing

The Atys SysToe is a fully automatic clinically validated device that gives consistent readings which are not operator dependent. Using the SysToe clinicians can quickly determine whether a patient does or doesn’t have PAD without necessarily referring to a specialist Ultrasound Dept saving time and money

Why Buy A Clinically Validated Blood Pressure Monitor?

The sales team at PMS often get asked the same questions from customers wanting to purchase a blood pressure monitor. Questions like which one would you recommend and which is the best one we sell will depend on the features a user is looking for and their budget.

One question we are always happy to answer is “What does clinical validation mean?”

Many customers are familiar with the CE mark on consumer electrical items.

Medical devices like blood pressure monitors must also have a CE mark by law. The CE mark means that, provided you use it correctly, the device will work properly and is safe but doesn’t mean it will necessarily give accurate readings or that it is clinically validated.

Whether you are going to record your blood pressure at home or in a clinical setting surely accuracy is the whole point of buying a monitor in the first place!

When a manufacturer like Meditech or A&D Medical state their product is “clinically validated” it means an independent validation of the device has been performed by a professional group

The most common validation protocols are the British and Irish Hypertension Society (BIHS), formerly British Hypertension Society, the European Society of Hypertension International Protocol (ESH-IP), and the Association for the Advancement of Medical Instrumentation (AAMI).

While each of the protocols may have many similarities, there are some differences in their testing requirements. In many cases, however, a product that passes one protocol may also satisfy the criteria of other protocols as well. Recently, the AAMI, ESH, and ISO experts agreed to develop a single universally acceptable standard (AAMI/ESH/ISO), which will replace all previous protocols.

Often, the clinical validation report is published in a peer-reviewed journal like Blood Pressure Monitoring.  Publication in a peer-reviewed journal is essential because of the rigorous review processes a clinical validation must go through to make sure there are no protocol violations and the chosen validation protocol has been adhered to.

The time and conditions demanded by the various protocols are extremely difficult to fulfil as a large number of subjects have to be recruited, a wide range of blood pressures are required and it can be difficult to recruit skilled staff . They can also be expensive.

There is a great overview of the detailed process involved from the Working Group on Blood Pressure Monitoring of the European Society of Hypertension here.

For these reasons not every blood pressure manufacturer will conduct a clinical validation.

PMS Instruments only distribute blood pressure monitors from manufacturers that do. Clinical validation provides so much more than a CE mark!

Whether you are a healthcare professional, or someone looking to keep a check on their blood pressure at home a clinically validated blood pressure monitor from Meditech or A&D Medical gives you the confidence to know you’re using a reliable, accurate device to make a clinical decision.

A&D Medical clinical validation studies

Validation of the A&D UM-211 device for office blood pressure measurement according to the European Society of Hypertension International Protocol revision 2010
Fania, Claudio; Albertini, Federica; Palatini, Paolo
Blood Pressure Monitoring, October 2017,22(5):302-305

Validation of the A&D UM-201 device for office blood pressure measurement according to the European Society of Hypertension International Protocol Revision 2010
Fania, Claudio; Albertini, Federica; Palatini, Paolo
Blood Pressure Monitoring, August 2017,22(4):234-237

Validation of the fully automated A&D TM-2656 blood pressure monitor according to the British Hypertension Society Protocol (equivalent to TM-2657P)
Zeng, Wei-Fang; Liu, Ming; Kang, Yuan-Yuan; Li, Yan; Wang, Ji-Guang
Blood Pressure Monitoring, August 2013,18(4):223-226

Validation of the A&D BP UA-651 device with a wide-range cuff for home blood pressure measurement according to the European Society of Hypertension International Protocol revision 2010
Benetti, Elisabetta; Fania, Claudio; Palatini, Paolo
Blood Pressure Monitoring, June 2015,20(3):164-167

Validation of the A&D BP UA-651 device for home blood pressure measurement according to the European Society of Hypertension International Protocol revision 2010
Benetti, Elisabetta; Fania, Claudio; Palatini, Paolo
Blood Pressure Monitoring, February 2014,19(1):50-53

Validation of the A&D UA-1020 upper-arm blood pressure monitor with six different-shaped or different-sized cuffs according to the British Hypertension Society protocol
Zeng, Wei-Fang; Kang, Yuan-Yuan; Liu, Ming; Li, Yan; Wang, Ji-Guang
Blood Pressure Monitoring, October 2013,18(5):272-277

Validation of the A&D UA-1020 upper-arm blood pressure monitor for home blood pressure monitoring according to the British Hypertension Society Protocol
Zeng, Wei-Fang; Kang, Yuan-Yuan; Liu, Ming; Li, Yan; Wang, Ji-Guang
Blood Pressure Monitoring, June 2013,18(3):177-181

Validation of A&D UA-778 blood pressure monitor in children
Narogan, Marina V.; Narogan, Marina I.; Syutkina, Elena V.
Blood Pressure Monitoring, October 2009,14(5):228-231

Validation of A&D UA-85X device for blood pressure measurement
Bonso, Elisa; Ragazzo, Fabio; Palatini, Paolo
Blood Pressure Monitoring, December 2008,13(6):339-341

Validation of A&D TM-2430 upper-arm blood pressure monitor for ambulatory blood pressure monitoring in children and adolescents, according to the British Hypertension Society protocol
Yip, Gabriel Wai-Kwok; So, Hung-Kwan; Li, Albert Martin; Tomlinson, Brian; Wong, Sik-Nin; Sung, Rita Yn-Tz
Blood Pressure Monitoring, April 2012,17(2):76-79

Validation of the A&D UM-101 professional hybrid device for office blood pressure measurement according to the International Protocol
Stergiou, George S.; Giovas, Periklis P.; Gkinos, Charilaos P.; Tzamouranis, Dimitris G.
Blood Pressure Monitoring, February 2008,13(1):37-42

Meditech clinical studies

Reproducibility of 24-h ambulatory blood pressure and measures of autonomic function
Morrin, Niamh M.; Stone, Mark R.; Henderson, Keiran J.
Blood Pressure Monitoring, June 2017,22(3):169-172
Brief Report

Obstructive sleep apnea increases systolic and diastolic blood pressure variability in hypertensive patients
Shi, Jing; Piao, Jingyan; Liu, Bin; Pan, Yujiao; Gong, Yongtai; Deng, Xianzhu; Sun, Weiyan; Lu, Shuang; Li, Yue
Blood Pressure Monitoring, August 2017,22(4):208-212
Clinical Methods and Pathophysiology

The influence of physical training status on postexercise hypotension in patients with hypertension: a cross-sectional study
Imazu, Alexandre A.; Goessler, Karla F.; Casonatto, Juliano; Polito, Marcos D.
Blood Pressure Monitoring, August 2017,22(4):196-201
Clinical Methods and Pathophysiology

Clinical practice of ambulatory versus home blood pressure monitoring in hypertensive patients
Paolasso, Jorge A.; Crespo, Florencia; Arias, Viviana; Moreyra, Eduardo A.; Volmaro, Ariel; Orías, Marcelo; Moreyra, Eduardo Jr
Blood Pressure Monitoring, December 2015,20(6):303-309
Clinical Methods and Pathophysiology

The association of night-time systolic blood pressure with ultrasound markers of subclinical cardiac and vascular disease
O’Flynn, Anne Marie; Ho, Emily; Dolan, Eamon; Curtin, Ronan J.; Kearney, Patricia M.
Blood Pressure Monitoring, February 2017,22(1):18-26
Clinical Methods and Pathophysiology

Myocardial ischemia during everyday life in patients with arterial hypertension: prevalence, risk factors, triggering mechanism and circadian variability
Uen, Sakir; Un, Ismail; Fimmers, Rolf; Vetter, Hans; Mengden, Thomas
Blood Pressure Monitoring, August 2006,11(4):173-182

Development of normative ambulatory blood pressure data in children: Marianne Soergel and the Arbeitsgruppe Pädiatrische Hypertonie
Blood Pressure Monitoring, June-August 1999,4(3):121-126

Making ambulatory blood pressure monitoring accessible in pharmacies
James, Kirstyn; Dolan, Eamon; O’Brien, Eoin
Blood Pressure Monitoring, June 2014,19(3):134-139

Simultaneous recording of blood pressure and ST-segment with combined, triggered ambulatory 24-h devices
Uen, Sakir; Vetter, Hans; Mengden, Thomas
Blood Pressure Monitoring, February 2003,8(1):41-44

Silent myocardial ischaemia in treated hypertensives with and without left ventricular hypertrophy
Stojanovic, Milos M.; O’Brien, Eoin; Lyons, Simon; Stanton, Alice V.
Blood Pressure Monitoring, February 2003,8(1):45-51

The twenty year wait has been worth it!

The new A&D Medical TM-2440 and TM-2441 Ambulatory Blood Pressure Monitors are now available to pre-order from lead distributor PMS Instruments. They replace the old TM-2430 which PMS originally introduced in 1998.

Engineered in Japan, they are the 4th generation of A&D ABPM monitor PMS Instruments have launched in the UK and easily the most advanced to date. Both new models have a number of new innovative premium features.

With the launch of 2 new ABPM monitors at once the twenty year wait has been worth it!

The A&D TM-2440 Classic abpm comes as standard with fast measurement time, silent operation and with a world first in an A&D ABPM, IHB (Irregular Heart Beat) analysis technology.

This ground breaking technology pioneered by A&D in 2001 is now used worldwide assisting in the opportunistic detection of arrhythmias – which include AFib (or Atrial Fibrillation). It features Oscillometric waveform measurement analysis and with the new analysis software you can check the waveform record for each measurement.

The TM-2441 Premium ABPM with it’s all in one design concept offers the clinician and patient complete flexibility, providing Ambulatory (ABPM), Home (HBPM), Office (OBP), Automatic Night Blood Pressure (ANBP), and Automatic Self Blood Pressure (ASBP) measurement/monitoring in one device.

In addition to the Irregular Heart Beat analysis technology, it records environmental factors including Activity using a built in Accelerometer, Temperature and Air Pressure. The new TM-2441 provides additional more insightful view of the patient beyond just blood pressure recording and heart rate information – helping build a better picture for clinical decision making.

Both models for the first time are available with 4 different cuff sizes small, adult, large adult and extra-large adult with sizes fitting an arm circumference from 15-22cm right up to 36-50cm.

The new AND Analysis software allows PDF reports to be exported to popular clinical management systems like EMIS and SystmOne and is compatible with the old TM-2430.

The TM-2440/TM-2441 feature both USB and Bluetooth communication, use just 2 AA batteries and at just 120g, the TM-2440 is one of the smallest, lightest ABPM monitors on the market.

To discuss competitive upgrades or arrange a demonstration or trial call us today.