Change log for Clinic measurements appointment processes
Detailed information about the changes made to the appointment process for collecting clinical measurement data.
Changes made to the appointment process over time
In the data set, the version indicator only tracks updates where new measurements have been added to the appointment process (such as heart rhythm and third readings).
However, additional changes have been made to the following areas that are not currently reflected by the version indicators assigned to the data. These include changes to:
Standard Operating Procedures (SOPs) and instructions used for guidance during the appointment
software used for capturing Clinic measurement data (the Clinical Staff Application; CSA)
hardware used to obtain Clinic measurements
schematic and configuration rules that define the types of data permitted for capture
The following is a list of changes that may be relevant to analysis and, in some cases, should be used to inform researchers' analytical approaches. These updates may impact data consistency, interpretation, and comparability across different data set versions, potentially influencing study outcomes.
Changes that have been made to SOPs
How to perform physical measurements
Up until June 2023, there were minor variations between SOPs for Our Future Health’s different clinic providers. Of note for researchers are the following changes:
Arm selection for blood pressure readings: Until October 2022, staff were instructed to start with the participant’s left arm to take blood pressure measurements. Note that in some circumstances, staff would instead take measurements from the participant’s preferred arm. From October 2022, staff were formally instructed to start with the participant’s preferred arm.
Rest time between blood pressure readings: Until September 2022, the guidance in all appointments was to have the participant rest for 3 minutes after the first blood pressure and heart rate readings, before taking the second readings. From September 2022, the guidance was changed to have participants rest for at least one minute.
Guidance if participant uncomfortable with removing clothing or shoes: Conducted from September 2022 to June 2023, provided instructions for staff to exercise discretion and deduct 1-2 kg from a participant’s weight if they were uncomfortable removing heavy clothing or shoes. Instructions were provided via clinic-specific SOPs (note that certain clinics and sites may have updates to documentation, guidelines and applications at different times).
Guidance on state of participant for blood pressure readings: Implemented from September 2022 to June 2023, instructed staff to ensure that participants are comfortably seated, relaxed, and not in distress before taking blood pressure and heart rate readings. Instructions where provided via site-specific SOPs.
On 15 June 2023, a single "How to perform physical measurements" SOP was created regardless of provider. This 'route agnostic' SOP included the following additions:
Guidance on repeating measurements: Staff were instructed to manually check if third readings for heart measurements were required based on the criteria outlined for systolic blood pressure and heart rate in Do all participants provide every measurement?If third readings were taken due to abnormal systolic blood pressure, and the third reading was closer to normal than either the first or second reading, the staff deleted the most abnormal reading and replaced it with the more normal reading. In this scenario, the heart rate recorded had to be the one associated with that blood pressure. If a third reading was not triggered by systolic blood pressure, but was triggered by abnormal heart rate readings, and if that third heart rate was closer to normal, the staff deleted the most abnormal heart rate reading and replaced it with the more normal reading. In this scenario, the blood pressure readings recorded had to be the ones associated with that heart rate.
Order of appointment: Staff now permitted to use their discretion if the participant has rushed to the appointment or are displaying signs of stress, they can move the heart measurements to the end of the appointment.
Rest time between blood pressure readings: Guidance for all appointments was changed to instruct participants to rest for 1 minute between heart measurement readings, instead of at least 1 minute.
The "How to perform physical measurements" SOP was updated on November 2023 with the following changes:
Guidance on repeating measurements: In addition to the rules above, a new rule was introduced that if staff identified an irregular heart rhythm for the first or second reading (at this stage not recorded in the CSA but just written in the paper proforma if irregular), then a third reading had to be carried out for heart measurements. This third reading for blood pressure and heart rate was only to be recorded in the CSA if 'significantly closer to normal' than the first two readings.
Pregnant participants: A section was introduced with advice for pregnant participants, who, while allowed to attend a clinic appointment at any time during their pregnancy, are advised to wait until 6 weeks post partum if in their second or third trimester.
Guidance on infilling historic measurements: A section was added advising that if a participant is unable to be measured due to, e.g. being in a wheelchair, staff can enter the participant’s self reported historic measurements into the CSA.
Extreme blood pressure cuff sizes: Staff now permitted to switch to the Omron HBP 1320 machine if the participant’s arm is extra small or extra large.
The "How to perform physical measurements" SOP was updated on January 2024 with the following changes:
Order of appointment: Height, weight and waist measurements now instructed to be taken before heart measurements.
Heart rhythm: Updated information on the introduction of heart rhythm being recorded in the CSA.
Guidance on repeating measurements (third heart readings): Updated information describing prompts added to the CSA to flag if third readings are necessary, and, if so, all three readings entered into CSA. Minor change to the heart rate third reading trigger range: < 60 or > 100 ('or equal to' removed).
The "How to perform physical measurements" SOP was updated in December 2024 with the following changes:
POCT cholesterol measurements removed: POCT cholesterol measurements are no longer performed during the Our Future Health clinic appointment. The last available appointments including finger-prick cholesterol testing were on the 23rd December 2024.
Changes to the CSA
The CSA was updated on 2 September 2023 with the following change:
Check your answers screen added: Staff now view a summary page of the measurements recorded and can change if they notice mistakes.
The CSA was updated on 13 November 2023 with the following change:
Height, weight and waist combined on one screen: Staff now able to enter and view all three measurements on the same page.
The CSA was updated on the 24th of December 2024 with the following change:
POCT cholesterol measurements removed: Staff will no longer perform POCT cholesterol measurements and pages to record the measurements have been removed.
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