# Procedure for Clinic measurements

This document provides a summary of the Standard Operation Procedure (SOP) for taking physical measurements at the Our Future Health in-person appointment, which standardises our practices across multiple sites. This has guided the staff to deliver a good participant experience while also collecting good quality data.

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### Procedure for Clinic measurements <a href="#standard-operating-procedure-sop" id="standard-operating-procedure-sop"></a>

{% hint style="info" %}
The following is a summary of the Standard Operating Procedure (SOP) and not all detailed steps are included.
{% endhint %}

#### **What is the aim of a SOP?**

Staff should aim to follow the same order of measurements for each appointment. Participants can decline having one or more assessments done and still participate in the research programme.

#### **Were there any changes to the SOP?**

Currently, there are two versions of the SOP. In the Clinic measurements tables, a version indicator has been added.

* version 1 ("v1") includes the original set of measurements (height, weight, waist circumference, and up to two readings for heart rate, systolic and diastolic blood pressure)
* version 2 ("v2") includes records where appointments included the additional heart rhythm and third readings for heart measurements (heart rate and rhythm, systolic and diastolic blood pressure) in accordance with specific criteria

***

### Version 1 of the SOP <a href="#version-1.1" id="version-1.1"></a>

1. **At the start of each individual assessment**

* Confirm that the participant is willing to proceed.

2. **Heart measurements**

Device: Omron 3 BP monitor or Omron HBP 1320

Measures recorded: systolic blood pressure (SBP; mmHg) and diastolic blood pressure (DBP; mmHg), heart rate (bpm) and heart rhythm (regular/irregular)

* Inform the participant that you will be taking their blood pressure measurement twice. Confirm that the participant is willing to proceed.
* The participant must sit with their feet flat on the ground, toes pointing forward and their back upright.
* Carefully wrap a fully deflated cuff of the appropriate size snugly around the participant’s upper arm ensuring that they position the arm to be level with their heart.
* Read the systolic and diastolic values, and heart rate and record as first reading.
  * *Heart rhythm is measured but not recorded.*
* Repeat the measurements a minute later on the same arm and record as second reading.

3. **Height measurement**

Device: Marsden HP-250P stadiometer

Measures recorded: Height (cm)

* Confirm that the participant is happy for you to measure their height.
* Ask participant to remove heavy clothes, hats, and shoes.
* Ask the participant to stand tall and look straight ahead.
* Lower the head plate until it touches the crown of the participant’s head.
* Read the height in centimetres (cm) and record the measurement to the nearest cm. (If needed, deduct the estimated height of the shoe from their height).
  * *Where it is not possible or the participant is unwilling to remove their shoes, measure the height, estimate the height of the shoes (at the heel), and deduct this from their height.*

4. **Weight measurement**

Device: SECA875 scales

Measures recorded: Weight (kg)

* Confirm that the participant is happy for you to measure their weight.
* Ask the participant to stand on the scale.
* Read the weight in kilograms (kg) and record the measurement, with one decimal place.
  * *Where not appropriate to remove shoes and clothes, weigh participant with them then estimate the weight of the excess clothes (between 1 and 2kg and deduct this weight from the weight displayed on the scales.*

5. **Waist circumference measurement**

Measures recorded: Waist circumference (cm)

* Confirm that the participant is happy for you to measure their waist circumference.
* Ask the participant to stand. Measure waist circumference on bare skin or on minimal internal clothing.
* Place a tape measure around the middle, between the bottom of the participant’s ribs and the top of their hips. This will be just above the belly button.
* Take the reading (in cm) where the tape measure ends meet and record to the nearest cm.

6. **Point of Care Testing (POCT)\***

Device: *Mission*® Cholesterol monitoring system (ACON)

Measures recorded: Total Cholesterol (TC; mmol/L), High-density lipoprotein (HDL; mmol/L), Low-density lipoprotein (LDL; mmol/L), Triglycerides (mmol/L)

* Explain to the participant that this test involves a finger prick blood test to measure the different levels of cholesterol in their blood. Confirm that the participant is willing to proceed.
* Clean the finger to be used for obtaining the sample (avoiding the index finger and thumb) using an alcohol wipe and leave to dry.
* Firmly press the lancing device against the side of the chosen finger and push the release button to prick the fingertip.
* Wipe off the first blood with a cotton wool ball.
* Use the provided pipette to draw the blood (second drop) to the fill line.
* Release the blood from the pipette onto the Specimen Application Area of the test device.
* The device will start analysing the sample immediately. The results may take a few minutes; please proceed to next step. You will be able to record the results after the blood draw.

\*Please note that data on POCT cholesterol measurements is currently not included in the latest data release, but is planned for a future release.

7. **Blood sample**

* Two 6mL EDTA blood samples are taken from a vein during the appointment.

8. **Repeat implausible measurements**

* Blood pressure and heart rate must be repeated during the appointment if they are implausible and if *at least* *one* of the following criteria are met:
  * **Systolic blood pressure** readings 1 and 2 are either both greater than or equal to 160 mmHg or both less than 90 mmHg.
  * **Heart rate** readings 1 and 2 are either both greater than 100 bpm or both less than 60 bpm.
* Repeat the heart measurements and replace the recording of one of the implausible measurements.

***

### Version 2 of the SOP <a href="#version-2.1" id="version-2.1"></a>

1. **At the start of each individual assessment**

* Confirm that the participant is willing to proceed.

2. **Height measurement**

Device: Marsden HP-250P stadiometer

Measures recorded: Height (cm)

* Confirm that the participant is happy for you to measure their height.
* Ask participant to remove heavy clothes, hats, and shoes.
* Ask the participant to stand tall and look straight ahead.
* Lower the head plate until it touches the crown of the participant’s head.
* Read the height in centimetres (cm) and record the measurement to the nearest cm. (If needed, deduct the estimated height of the shoe from their height).
  * *Where it is not possible or the participant is unwilling to remove their shoes, measure the height, estimate the height of the shoes (at the heel), and deduct this from their height.*

3. **Weight measurement**

Device: SECA875 scales

Measures recorded: Weight (kg)

* Confirm that the participant is happy for you to measure their weight.
* Ask the participant to stand on the scale.
* Read the weight in kilograms (kg) and record the measurement, with one decimal place.
  * *Where not appropriate to remove shoes and clothes, weigh participant with them then estimate the weight of the excess clothes (between 1 and 2kg and deduct this weight from the weight displayed on the scales.*

4. **Waist circumference measurement**

Measures recorded: Waist circumference (cm)

* Confirm that the participant is happy for you to measure their waist circumference.
* Ask the participant to stand. Measure waist circumference on bare skin or on minimal internal clothing.
* Place a tape measure around the middle, between the bottom of the participant’s ribs and the top of their hips. This will be just above the belly button.
* Take the reading (in cm) where the tape measure ends meet and record to the nearest cm.

5. **Heart measurements**

Device: Omron 3 BP monitor or Omron HBP 1320

Measures recorded: systolic blood pressure (SBP; mmHg) and diastolic blood pressure (DBP; mmHg), heart rate (bpm) and heart rhythm (regular/irregular)

* Inform the participant that you will be taking their blood pressure measurement twice. Confirm that the participant is willing to proceed.
* The participant must sit with their feet flat on the ground, toes pointing forward and their back upright.
* Carefully wrap a fully deflated cuff of the appropriate size snugly around the participant’s upper arm ensuring that they position the arm to be level with their heart.
* Read the systolic and diastolic values, heart rate and heart rhythm and record as first reading.
* Repeat the measurements a minute later on the same arm and record as second reading.

6. **Point of Care Testing (POCT)\***

Device: *Mission*® Cholesterol monitoring system (ACON)

Measures recorded: Total Cholesterol (TC; mmol/L), High-density lipoprotein (HDL; mmol/L), Low-density lipoprotein (LDL; mmol/L), Triglycerides (mmol/L)

* Explain to the participant that this test involves a finger prick blood test to measure the different levels of cholesterol in their blood. Confirm that the participant is willing to proceed.
* Clean the finger to be used for obtaining the sample (avoiding the index finger and thumb) using an alcohol wipe and leave to dry.
* Firmly press the lancing device against the side of the chosen finger and push the release button to prick the fingertip.
* Wipe off the first blood with a cotton wool ball.
* Use the provided pipette to draw the blood (second drop) to the fill line.
* Release the blood from the pipette onto the Specimen Application Area of the test device.
* The device will start analysing the sample immediately. The results may take a few minutes; please proceed to next step. You will be able to record the results after the blood draw.

\*Please note that version 2 of the SOP was amended to no longer include POCT cholesterol measurements after 23-12-2024. Data on POCT cholesterol measurements is not included in the latest data release, but is planned for a future release.&#x20;

7. **Blood sample**

* Two 6mL EDTA blood samples are taken from a vein during the appointment.

8. **Third reading heart measurements (if needed)**

* Blood pressure, heart rate, and heart rhythm measurements must be repeated at the end of the appointment if *at least* *one* of the following criteria are met:
  * **Systolic blood pressure** readings 1 and 2 are either both greater than or equal to 160 mmHg or both less than 90 mmHg.
  * **Heart rate** readings 1 and 2 are either both greater than 100 bpm or both less than 60 bpm
  * **Heart rhythm** readings 1 and 2 are both “irregular”.
* Repeat the heart measurements and record as third reading.

9. **Second point of care test (if needed)**

* The point of care test for Cholesterol must be repeated at the end of the appointment if one of the following criteria is met:
  * Total Cholesterol reading is ≥ 7.5 mmol/L and participant is < 30 years of age.
  * Total Cholesterol reading is ≥ 9.0 mmol/L and participant is ≥ 30 years of age.

***

### Biometrics Ranges and Proforma <a href="#biometrics-ranges" id="biometrics-ranges"></a>

#### What are the allowed ranges for the measurements?

Each measurement can only be recorded within a certain range. If a staff member tries to record a value outside of these ranges, they are notified of an error and must enter a different value within range. The allowed ranges for each measurement are:

* **Height**: 90-299 cm
* **Weight**: 20-400 kg
* **Waist circumference**: 30-200 cm
* **Systolic blood pressure**: 40-300 mmHg
* **Diastolic blood pressure**: 30-200 mmHg
* **Heart rate**: 20-300 bpm
* **Heart rhythm**: regular or irregular
* **POCT Total cholesterol:** v1: 2.59-10.36 mmol/L; v2: 1.0-19.9 mmol/L
* **POCT HDL cholesterol:** v1: 0.30-2.59 mmol/L; v2: 0.1-9.9 mmol/L
* **POCT LDL cholesterol:** v1: 0.1-15 mmol/L; v2: 0.1-19.9 mmol/L
* **POCT Triglycerides:** v1: 0.56-5.65 mmol/L; v2: 0.1-9.9 mmol/L

#### **What information is provided to the participants during the appointment?**

A proforma was designed as a means to communicate to the participant the results of their measurements. All participants will be provided with printed copies of the proforma. At the end of each appointment, staff will check their answers before submitting them to complete the appointment on the CSA. At this point, we will also require staff to copy the results entered onto the computer onto the proforma. &#x20;

Staff will also have been provided with a staff-facing table with similar recommendations to the proforma (see table below). Staff will have been trained on this table to ensure they understand the proforma document that they provide to the participant. &#x20;

In order to ensure that the recommended guidance associated with the results aligns with those provided broadly by the NHS, all recommendations are based on guidelines from the NHS on hypertension. For lipid levels, all recommendations are based on guidelines from the British Heart Foundation.&#x20;

**Table:** *Summary of the recommendations given to participants based on ranges of physical measurements.*

<table data-full-width="true"><thead><tr><th>Biometric measurement</th><th>Results range</th><th>Recommended action</th><th>Third reading required?</th></tr></thead><tbody><tr><td>Blood pressure: Low</td><td>SBP/DBP &#x3C; 90/60 mmHg</td><td>If the participant does not feel unwell, no action is required. If they do feel unwell, the participant should contact their GP or NHS 111 within 24 hours.</td><td>Yes, if SBP readings 1 and 2 are both &#x3C; 90 mmHg</td></tr><tr><td>Blood pressure: Normal</td><td><p>SBP/DBP</p><p>90/60 to 139/89 mmHg</p></td><td>No action required.</td><td>No</td></tr><tr><td>Blood pressure: High</td><td><p>SBP/DBP</p><p>140/90 to 179/109 mmHg</p></td><td>The participant should have their blood pressure re-checked at a pharmacy within the next week.</td><td>Yes, if SBP readings 1 and 2 are both > 160 mmHg</td></tr><tr><td>Blood pressure: Very high</td><td><p>SBP/DBP</p><p>≥ 180/110 mmHg</p></td><td>The participant should have their blood pressure re-checked at a pharmacy or GP straightaway and no later than within the next 2 days.</td><td>Yes, if SBP readings 1 and 2 are both > 160 mmHg</td></tr><tr><td>Heart rate: Low</td><td>&#x3C; 60 bpm</td><td>The participant should contact their GP if their reading is not normal for them and/or they feel unwell.</td><td>Yes, if readings 1 and 2 are both &#x3C; 60 bpm</td></tr><tr><td>Heart rate: High</td><td>> 100 bpm</td><td>The participant should contact their GP if their reading is not normal for them and/or they feel unwell.</td><td>Yes,  if readings 1 and 2 are both ≥ 100 bpm</td></tr><tr><td>Heart rhythm: Regular</td><td>Regular</td><td>No action required.</td><td>No</td></tr><tr><td>Heart rhythm: Irregular</td><td>Irregular</td><td>The participant should contact their GP or NHS 111 within 24 hours if an irregular heart rhythm is not normal for them.</td><td>Yes, if readings 1 and 2 are both “irregular”</td></tr><tr><td>Total Cholesterol*: At / below target </td><td>≤ 5 mmol/L</td><td>No action required.</td><td>Yes, if reading is &#x3C; 2.5 mmol/L</td></tr><tr><td>Total Cholesterol*: Above target at age 18-30 years</td><td>≥ 7.5 mmol/L</td><td>The participant should inform their GP at their next visit.</td><td>Yes, if reading is ≥ 7.5 mmol/L and participant is &#x3C; 30 years of age</td></tr><tr><td>Total Cholesterol*: Above target at age 30 years and older</td><td>≥ 9.0 mmol/L</td><td>The participant should inform their GP at their next visit.</td><td>Yes, if reading is ≥ 9.0 mmol/L and participant is ≥ 30 years of age</td></tr></tbody></table>

\*Please note that version 2 of the SOP was amended to no longer include POCT cholesterol measurements after 23-12-2024.&#x20;