Abstract-Blood Pressure (BP) measurement without using a cuff is an interesting goal especially during Exercise Stress Test. Conventional methods like Cuff-based blood pressure measurement is not accurate enough due to high motion artifacts. High blood pressure during exercise test will cause pain and discomfort during inflation of cuff as well. Many researches have been conducted and shown Pulse Arrival Time (PAT), can be used in blood pressure estimation. This paper proposes a new calibration method for blood pressure estimation during exercise stress test that increases the quality of estimation. Besides PAT and heart rate, estimated blood pressure of previous stage is added as another input parameter. This technique increases the correlation coefficients between real and estimated blood pressures. We also show that by using ΔPAT, ΔHR instead of PAT and HR quality of estimation improves.

IntroductionWidespread inappropriate antibiotic prescribing by healthcare professionals in the hospital setting is a great concern that may cause many undesirable consequences. Adherences to antibiotic guidelines have proven to be a simple and effective intervention to guide the choice of appropriate empiric antibiotic regimens and reduce the unnecessary variations in the practice among practitioners. The objective of this study was to evaluate the prescription patterns of empiric antibiotic therapy in relation to treatment guidelines and the economic burden of discordance with guidelines in a major referral Iranian university hospital.MethodHospital records of hospitalized patients with empiric antibiotic prescription, from September 2016 to February 2017 were reviewed. The process consisted of comparing empiric antimicrobial administration with institutional guidelines for each patient by a clinical pharmacist and an infectious disease specialist to evaluate the appropriate utilization of antibiotics. Adherence to guideline, the cost of antibiotics usage for each patient and the excess cost consequent from discordance with guideline was calculated.ResultsThe most inappropriate prescribed antibiotics were carbapenems and aminoglycosides. Overall guideline adherence was 27.8%. Frequency of antibiotic usage incompatibility with the guidelines on the basis of dosing interval, duration of therapy and drug indication were 31.46%, 29.44% and 19.36%, respectively. General surgery and internal medicine wards had the least and the most inappropriate antibiotic administration, respectively. Totally antibiotic usage cost was 578,959.39 USD (24,316,294,800 Iranian Rials, IRR) for 6 months, which the excess costs of inappropriate antibiotic prescribing, was 471,319.69 USD (19,795,427,225 IRR). The estimated annual excess cost is 942,639.38 USD (39,590,854,450 IRR).ConclusionIn this research, physicians’ adherence with guidelines for empiric antibiotic therapy was low which was led to 471,319.69 USD excess costs. These results urge institution policy makers to develop guidelines to ensure active dissemination and implementation of them to decrease inappropriate antibiotic usage.

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