EXT B1 Form

EXT B1 Form and Dictionary

EXT B1 Form

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EXT B1 Form

Variable / Field Name Field Label Choices, Calculations, OR Slider Labels
b1_adcid_ext Site: 39 ADCID
b1_ptid_ext Subject ID:PTID
b1_visitdate_ext Form Date: (Y-M-D)
b1_visitnum_ext Visit number: 1 (Initial visit), 2 and up (Follow up visit) VISITNUM
b1_initials_ext Examiner's initials: INITIALS
ext_b1_ent_date Data Entry Date: (Y-M-D)
ext_b1_ent_by Data Entry By:
b1_admin_st Administered Status 1, 1 Yes | 95, 95 - No, Physical problem | 96, 96 - No, Cognitive/behavior problem | 97, 97 - No, Other problem | 98, 98 - No, Verbal refusal | 99, 99 - Not Administered
ext_b1_ht Height (cm)
ext_b1_inch HT(inch) roundup(([ext_b1_ht]/2.54), 1)
ext_b1_wt Weight (kg)
ext_b1_lbs WT(lbs) roundup(([ext_b1_wt]*2.2), 0)
ext_b1_symp1 Lightheadedness or dizziness 1, 1 Yes
ext_b1_symp1_com Comments
ext_b1_symp2 Fainting or near-fainting 1, 1 Yes
ext_b1_symp2_com Comments
ext_b1_symp3 "Graying" of vision or blurry vision 1, 1 Yes
ex1_b1_symp3_com Comments
ext_b1_symp4 Clammy skin or sweating 1, 1 Yes
ext_b1_symp4_com Comments
ext_b1_symp5 Imbalance 1, 1 Yes
ext_b1_symp5_com Comments
ext_b1_symp6 Pallor
(paleness)
 1, 1 Yes
ext_b1_symp6_com Comments
ext_b1_symp7 Chest pain
(uncommon)
 1, 1 Yes
ext_b1_symp7_com Comments
ext_b1_symp8 Headache
(uncommon)
 1, 1 Yes
ext_b1_symp8_com Comments
ext_b1_symp9 Shortness of breath
(uncommon)
 1, 1 Yes
ext_b1_symp9_com Comments
ext_b1_symp10 Other symptom(s) 1, 1 Yes
ext_b1_symp10_com Comments
instructions
  1. Do not obtain a standing blood pressure if the participant is unable to stand safely.
  2. Instruct the participant on the process of, and rationale for, orthostatic blood pressure measurement.
  3. Record the type and brand of blood pressure monitor.
  4. Ask the participant to lie supine on the examination table with the head flat or nearly flat for a 3 full minutes. You may use a low pillow for comfort.
  5. Record the systolic blood pressure, diastolic blood pressure, and pulse. Take the blood pressure first. If the pulse is obtained manually, record for a full 60 seconds.
  6. Help the participant to stand. Observe carefully for signs that might indicate a large pressure drop. Ask the participant if he/she feels comfortable or all right. If there is concern at any point, have the participant sit or lie down, take the blood pressure and pulse if it is safe to do so, and discontinue the procedure.
  7. The participant should stand unassisted, but the participant may place his/her hand on the examination table if needed to improve stability, or use a cane or walker for the same purpose. Ideally, the participant should support very little of his/her weight on the table, cane, or walker. These are intended for stability. If the participant agrees, you may lightly support him/her by placing your hand lightly on the shoulder or upper arm. Discontinue the procedure if greater support is needed.
  8. We prefer that the participant stand still. However, the participant may shift his/her weight and move his/her feet but should not walk about the room or march in place.
  9. Measure the blood pressure and pulse after the participant has stood for 1 minute. Support the forearm at heart level when taking the blood pressure.
  10. Repeat the blood pressure and pulse measurements at 3 minutes.
  11. Assist the participant back to chair.
  12. Never hesitate to call the research physician or another health care professional, if urgent.
b1_sbp_s3_ext Systolic BP
b1_dbp_s3_00_ext Subject diastolic blood pressure, supine at 3 minutes
b1_dbp_s3_ext Diastolic BP
b1_pulse_00_ext Subject pulse, supine at 3 minutes
b1_pul_s3_ext Pulse (per min)
ext_b1_s3_com Comments
b1_sbp_u1_ext Systolic BP
b1_dbp_u1_00_ext Subject diastolic blood pressure, upright at 1 minute
b1_dbp_u1_ext Diastolic BP
b1_pul_u1_00_ext Subject pulse, upright at 1 minute
b1_pul_u1_ext Pulse (per min)
ext_b1_u1_comm Comments
b1_sbp_u3_ext Systolic BP
b1_dbp_u3_00_ext Subject diastolic blood pressure, upright at 3 minutes
b1_dbp_u3_ext Diastolic BP
b1_pul_u3_00_ext Subject pulse, upright at 3 minutes
b1_pul_u3_ext Pulse (per min)
ext_b1_u3_com Comments
ext_b1_oth_00 =======================================================================================================
ext_b1_oth Other (specify)
ext_b1_mon_type Blood pressure monitor type/brand