1. bookVolume 6 (2022): Edition 3 (July 2022)
Détails du magazine
License
Format
Magazine
eISSN
2564-615X
Première parution
30 Jan 2017
Périodicité
4 fois par an
Langues
Anglais
Accès libre

A Comprehensive Assessment of The Eight Vital Signs

Publié en ligne: 18 Jul 2022
Volume & Edition: Volume 6 (2022) - Edition 3 (July 2022)
Pages: 133 - 146
Détails du magazine
License
Format
Magazine
eISSN
2564-615X
Première parution
30 Jan 2017
Périodicité
4 fois par an
Langues
Anglais
Abstract

The term “vital sign” has been assigned to various phenomena with the presumptive intent to emphasize their importance in health care resulting in the emergence of eight vital signs with multiple designations and overlapping terms. This review developed a case definition for vital signs and identified and described the fifth through eighth vital signs. PubMed/Medline, Google and biographical databases were searched using the individual Medical Subject Headings (MeSH) terms, vital sign and fifth, vital sign and sixth, vital sign and seventh, and vital sign eighth. The search was limited to human clinical studies written in English literature from 1957 up until November 30, 2021. Excluded were articles containing the term vital sign if used alone without the qualifier fifth, sixth, seventh, or eighth or about temperature, blood pressure, pulse, and respiratory rate. One hundred ninety-six articles (122 for the fifth vital sign, 71 for the sixth vital sign, two for the seventh vital sign, and one for the eighth vital sign) constituted the final dataset. The vital signs consisted of 35 terms, classified into 17 categories compromising 186 unique papers for each primary authored article with redundant numbered vital signs for glucose, weight, body mass index, and medication compliance. Eleven terms have been named the fifth vital sign, 25 the sixth vital sign, three the seventh, and one as the eighth vital sign. There are four time-honored vital signs based on the case definition, and they represent an objective bedside measurement obtained noninvasively that is essential for life. Based on this case definition, pulse oximetry qualifies as the fifth while end-tidal CO2 and cardiac output as the sixth. Thus, these terms have been misappropriated 31 times. Although important to emphasize in patient care, the remainder are not vital signs and should not be construed in this manner.

Keywords

1. Seguin E: The use of the thermometer in clinical medicine. Chicago M J. 1866, 23:193–201. Search in Google Scholar

2. Cushing H: On routine determinations of arterial tension in operating room and clinic. Boston M & S J. 1903, 148:250–256.10.1056/NEJM190303051481002 Search in Google Scholar

3. Yale SH, Tekiner H, Mazza JJ, Yale ES: Confusing terminology in COVID-19: signs, symptoms, and physical findings. Erciyes Med J. 2021, 43 (5):417–418. Search in Google Scholar

4. Yale SH, Tekiner H, Görkem SB, Draves J, Ye F, Yale ES: Clarifying terminology of signs in COVID-19. Erciyes Med J. 2021;43 (6):530–536. Search in Google Scholar

5. Fortmann AL, Spierling Bagsic SR, Talavera L, Garcia IM, Sandoval H, Hottinger A, Philis Tsimikas A: Glucose as the fifth vital sign: a randomized controlled trial of continuous glucose monitoring in a non-ICU hospital setting. Diabetes Care. 2020, 43 (11):2873–2877.10.2337/dc20-1016757642732855160 Search in Google Scholar

6. Mower WR, Sachs C, Nicklin EL, Baraff LJ: Pulse oximetry as a fifth pediatric vital sign. Pediatrics. 1997, 99 (5):681–686.10.1542/peds.99.5.6819113944 Search in Google Scholar

7. Tierney LM Jr, Whooley MA, Saint S: Oxygen saturation: a fifth vital sign?. West J Med. 1997,166:285–286. Search in Google Scholar

8. Mower WR, Myers G, Nicklin EL, Kearin KT, Baraff LJ, Sachs C: Pulse oximetry as a fifth vital sign in emergency geriatric assessment. Acad Emerg Med. 1998, 5 (9):858–865.10.1111/j.1553-2712.1998.tb02813.x9754497 Search in Google Scholar

9. Neff TA: Routine oximetry: a fifth vital sign? Chest. 1988, 94 (2):227. Search in Google Scholar

10. Birnbaum S: Pulse oximetry: identifying its applications, coding, and reimbursement. Chest. 2009, 135 (3):838–841. Search in Google Scholar

11. Branson RD, Mannheimer PD: Forehead oximetry in critically ill patients: the case for a new monitoring site. Respir Care Clin N Am. 2004, 10 (3):359–367.10.1016/j.rcc.2004.04.00315458733 Search in Google Scholar

12. Hafen BB, Sharma S: Oxygen Saturation. (cited 2021 Aug 12). StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. URL: https://www.ncbi.nlm.nih.gov/books/NBK525974/ Search in Google Scholar

13. Popovich DM, Richiuso N, Danek G: Pediatric health care providers’ knowledge of pulse oximetry. Pediatr Nurs. 2004, 30 (1):14–20. Search in Google Scholar

14. Tozzetti C, Adembri C, Modesti PA: Pulse oximeter, the fifth vital sign: a safety belt or a prison of the mind? Intern Emerg Med. 2009, 4:331–332.10.1007/s11739-009-0268-x19526196 Search in Google Scholar

15. Yazdanian H, Mahnam A, Edrisi M, Esfahani MA: Design and implementation of a portable impedance cardiography system for noninvasive stroke volume monitoring. J Med Signals Sens. 2016, 6 (1):47–56.10.4103/2228-7477.175871 Search in Google Scholar

16. Summers RL, Kolb JC, Woodward LH, Galli RL: Diagnostic uses for thoracic electrical bioimpedance in the emergency department: clinical case series. Eur J Emerg Med. 1999, 6 (3):193–199.10.1097/00063110-199909000-0000410622382 Search in Google Scholar

17. Hunter CL, Silvestri S, Ralls G, Bright S, Papa L: The sixth vital sign: prehospital end-tidal carbon dioxide predicts in-hospital mortality and metabolic disturbances. Am J Emerg Med. 2014, 32 (2):160-165.10.1016/j.ajem.2013.10.04924332900 Search in Google Scholar

18. Hollinger M: Called to task for using the term, “fifth vital sign”. RN. 2004, 67 (10):12. Search in Google Scholar

19. Scott T: Why weight should be the fifth vital sign we check. Emerg Nurse. 2017, 24 (10):5.10.7748/en.24.10.5.s128279109 Search in Google Scholar

20. Jellinek M, Murphy JM: Screening for psychosocial functioning as the eighth vital sign. JAMA Pediatr. 2021, 175 (1):13–14.10.1001/jamapediatrics.2020.2005 Search in Google Scholar

21. Perl TM, Price CS: Managing emerging infectious diseases: should travel be the fifth vital sign? Ann Intern Med. 2020, 172 (8):560–561.10.7326/M20-0643 Search in Google Scholar

22. Kaira S, Verma K, Singh Balhara YP: The sixth vital sign in diabetes. J Pak Med Assoc. 2017, 67 (11):1775-1776. Search in Google Scholar

23. Fiore MC: The new vital sign: assessing and documenting smoking status. JAMA. 1991, 266 (22):3183–3184.10.1001/jama.1991.03470220099036 Search in Google Scholar

24. Ahluwalia JS, Gibson CA, Kenney RE, Wallace DD, Resnicow K: Smoking status as a vital sign. J Gen Intern Med. 1999, 14 (7):402–408.10.1046/j.1525-1497.1999.09078.x Search in Google Scholar

25. Miller M: Smoking status should be the fifth vital sign. WMJ. 2000, 99 (3):9–10. Search in Google Scholar

26. Kum-Nji P, Meloy LD, Keyser-Marcus L: The prevalence and effects of environmental tobacco smoke exposure among inner-city children: lessons for pediatric residents. Acad Med. 2012, 87 (12):1772–1778.10.1097/ACM.0b013e318272f5e7 Search in Google Scholar

27. Campbell JN: 1995 Presidential address. Pain Forum 1996, 5 (1):85–88.10.1016/S1082-3174(96)80076-6 Search in Google Scholar

28. American Pain Society Quality of Care Committee: Quality improvement guidelines for the treatment of acute pain and cancer pain. JAMA. 1995, 274 (23):1874–1880.10.1001/jama.1995.035302300600327500539 Search in Google Scholar

29. Kutzen H, Bennett M: Clinicians are encouraged to use HIV patients’ pain as a fifth vital sign. HIV Clin. 2000, 12 (1):1–5. Search in Google Scholar

30. Lafleur KJ: Taking the fifth (vital sign). RN. 2004, 67 (7):30-2, 34-6; quiz 37. Search in Google Scholar

31. Leyva Carmona M, Torres Luna R, Ortiz San Román L, Marsinyach Ros I, Navarro Marchena L, Mangudo Paredes AB, Ceano-Vivas la Calle M; en representación del Grupo Español para el Estudio del Dolor Pediátrico (GEEDP) de la AEP: Documento de posicionamiento del Grupo Español para el Estudio del Dolor Pediátrico (GEEDP) de la Asociación Española de Pediatría sobre el registro del dolor como quinta constante [Position document of the spanish association of paediatrics group for the study of paediatric pain on the recording of pain as fifth vital sign]. An Pediatr (Engl Ed). 2019, 91:58.e1-58.e7.10.1016/j.anpedi.2019.05.00131175071 Search in Google Scholar

32. Rebalance Focus Action Group: A position paper: Screening key indicators in cancer patients—Pain as a 5th vital sign and emotional distress as a 6th vital sign. Canadian Strategy for Cancer Control Bulletin (suppl). 2005, 7:4. Search in Google Scholar

33. Solodiuk JC, Curley MAQ: In defense of routine inpatient pain assessment. Am J Nurs. 2017, 117 (5):11.10.1097/01.NAJ.0000516255.48226.5828448346 Search in Google Scholar

34. Saranteas T, Kostroglou A, Anagnostopoulos D, Giannoulis D, Vasiliou P, Mavrogenis AF: Pain is vital in resuscitation in trauma. SICOT J. 2019, 5:28.10.1051/sicotj/2019028669474431414982 Search in Google Scholar

35. (No author). St. Luke’s makes pain the fifth vital sign, cuts costs. Hosp Peer Rev. 1996, 21 (4):54,59. Search in Google Scholar

36. Campbell JN: The fifth vital sign revisited. Pain. 2016, 157 (1):3–4.10.1097/j.pain.000000000000041326683106 Search in Google Scholar

37. Fitzpatrick JJ: The fifth vital sign: an agenda for nurse educators. Nurs Health Care Perspect. 1999, 20 (2):67. Search in Google Scholar

38. Levy N, Sturgess J, Mills P: Pain as the fifth vital sign and dependence on the numerical pain scale is being abandoned in the US: why? Br J Anaesth. 2018, 120 (3):435–438.10.1016/j.bja.2017.11.09829452798 Search in Google Scholar

39. Lucas CE, Vlahos AL, Ledgerwood AM: Kindness kills: the negative impact of pain as the fifth vital sign. J Am Coll Surg. 2007, 205 (1):101–107.10.1016/j.jamcollsurg.2007.01.06217617339 Search in Google Scholar

40. Kutlutürkan S, Urvaylıoğlu AE: Evaluation of pain as a fifth vital sign: nurses’ opinions and beliefs. Asia Pac J Oncol Nurs. 2019, 7 (1):88–94. Search in Google Scholar

41. Morone NE, Weiner DK: Pain as the fifth vital sign: exposing the vital need for pain education. Clin Ther. 2013, 35 (11):1728–1732.10.1016/j.clinthera.2013.10.001388815424145043 Search in Google Scholar

42. Christ M: Pain: the fifth vital sign. Swiss Med Wkly. 2020, 150:w20215.10.4414/smw.2020.2021532329804 Search in Google Scholar

43. Gallo AM: The fifth vital sign: implementation of the neonatal infant pain scale. J Obstet Gynecol Neonatal Nurs. 2003, 32 (2):199–206.10.1177/088421750325174512685671 Search in Google Scholar

44. Pierucci R: Fetal pain: the science behind why it is the medical standard of care. Linacre Q. 2020, 87:311–6.10.1177/0024363920924877735011632699441 Search in Google Scholar

45. Pozza DH, Azevedo LF, Castro Lopes JM: Pain as the fifth vital sign-A comparison between public and private healthcare systems. PLoS One. 2021, 16:e0259535.10.1371/journal.pone.0259535856573634731211 Search in Google Scholar

46. Ahmed AS, Kim RL, Ramsamooj H, Roberts M, Downes K, Mir HR: Patient perception of pain control (not opiate amount) affects hospital consumer assessment of health-care providers and systems and press Ganey satisfaction scores After orthopaedic trauma. J Am Acad Orthop Surg. 2021, 29 (7):301–309.10.5435/JAAOS-D-20-0006933443382 Search in Google Scholar

47. Alhani F: The effect of programmed distraction on the pain caused by venipuncture among adolescents on hemo-dialysis. Pain Manag Nurs. 2010, 11 (2):85–91.10.1016/j.pmn.2009.03.00520510838 Search in Google Scholar

48. Atkinson VJ, Almahdi B: A prospective audit project into the adequacy of pain assessment in the medical and surgical wards in a North London District General Hospital. Br J Pain. 2014, 8:78–83.10.1177/2049463713510288 Search in Google Scholar

49. Azadfard M, Huecker MR, Leaming JM: Opioid Addiction. 2021 Aug 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. Available from: URL:https://pubmed.ncbi.nlm.nih.gov/28846246/ Search in Google Scholar

50. Body R, Foex BA: Optimising well-being: is it the pain or the hurt that matters? Emerg Med J. 2012, 29:91–94.10.1136/emj.2011.111849 Search in Google Scholar

51. Casey G: Pain-the fifth vital sign. Nurs N Z. 2011, 17:24–9. Search in Google Scholar

52. Chanvej L, Petpichetchian W, Kovitwanawong N, Chai-bandit C, Vorakul C, Khunthong T: A chart audit of postoperative pain assessment and documentation: the first step to implement pain assessment as the fifth vital sign in a University Hospital in Thailand. J Med Assoc Thai. 2004, 87 (12):1447–1453. Search in Google Scholar

53. Chapman JE: Rotator cuff repair outcomes are influenced by chronic opioid use. Arthroscopy. 2021, 37 (4):1115–1116.10.1016/j.arthro.2020.12.219 Search in Google Scholar

54. Chen YH, Lin LC, Watson R: Validating nurses’ and nursing assistants’ report of assessing pain in older people with dementia. J Clin Nurs. 2010, 19:42–52.10.1111/j.1365-2702.2009.02950.x Search in Google Scholar

55. Chimenti C, McIntyre J, Noonan B, Woerner L, Bell M, Marchetti C: Pain assessment clinical practice improvement: an educational approach in the home healthcare setting. Home Healthc Now. 2020, 38 (5):254–260.10.1097/NHH.0000000000000893 Search in Google Scholar

56. Chisholm-Burns MA, Spivey CA, Sherwin E, Wheeler J, Hohmeier K: The opioid crisis: Origins, trends, policies, and the roles of pharmacists. Am J Health Syst Pharm. 2019, 76 (7):424–435.10.1093/ajhp/zxy089 Search in Google Scholar

57. Clark CW, Yang JC, Tsui SL, Ng KF, Clark SB: Unidimensional pain rating scales: a multidimensional affect and pain survey (MAPS) analysis of what they really measure. Pain. 2002, 98 (3):241–247.10.1016/S0304-3959(01)00474-2 Search in Google Scholar

58. Cortellazzo Wiel L, Cozzi G, Barbi E: The risks of physicians’ conformism: reflections from the opioid overflow. Ital J Pediatr. 2021, 47 (1):10.10.1186/s13052-021-00967-z781125233451342 Search in Google Scholar

59. Davis L: Pain management and opioid free treatment order sets: an evolving role for pharmacists. Sr Care Pharm. 2020, 35:406–7.10.4140/TCP.n.2020.40632972489 Search in Google Scholar

60. Davis MP, Walsh D: Cancer pain: how to measure the fifth vital sign. Cleve Clin J Med. 2004, 71 (8):625–632.10.3949/ccjm.71.8.62515449757 Search in Google Scholar

61. Devi BC, Tang TS: Documenting pain as the fifth vital sign: a feasibility study in an oncology ward in Sarawak, Malaysia. Oncology. 2008, 74 (Suppl 1):35–39.10.1159/000143216 Search in Google Scholar

62. Douglas M: Pain as the fifth vital sign: will cultural variations be considered? J Transcult Nurs. 1999, 10 (4):285.10.1177/104365969901000401 Search in Google Scholar

63. Farčić N, Barać I, Pačarić S, Lovrić I, Ilakovac V: Acute postoperative pain in trauma patients. Maced J Med Sci 2017, 5 (3):310–315.10.3889/oamjms.2017.067 Search in Google Scholar

64. Fishman SM: Pain as the fifth vital sign: how can I tell when back pain is serious. J Pain Palliat Care Pharmacother. 2005, 19 (4):77–79.10.1080/J354v19n04_13 Search in Google Scholar

65. Fitzcharles MA, Shir Y: New concepts in rheumatic pain. Rheum Dis Clin North Am. 2008, 34 (2):267–283.10.1016/j.rdc.2008.03.005 Search in Google Scholar

66. Foster D, Shi G, Lesser E, Heckman MG, Whalen J, Forte AJ, Wilke BK: A prospective, blinded study comparing in-hospital postoperative pain scores reported by patients to nurses versus physicians. Cureus. 2019, 11 (11):e6122.10.7759/cureus.6122 Search in Google Scholar

67. Gauger EM, Gauger EJ, Desai MJ, Lee DH: Opioid use after upper extremity surgery. J Hand Surg Am. 2018, 43 (5):470–479.10.1016/j.jhsa.2018.02.026 Search in Google Scholar

68. Gerik SM: Pain management in children: developmental considerations and mind-body therapies. South Med J. 2005, 98 (3):295–302.10.1097/01.SMJ.0000154772.49481.53 Search in Google Scholar

69. Gordon DB: Acute pain assessment tools: let us move beyond simple pain ratings. Curr Opin Anaesthesiol. 2015, 28 (5):565–569.10.1097/ACO.0000000000000225 Search in Google Scholar

70. Graf C, Puntillo K: Pain in the older adult in the intensive care unit. Crit Care Clin. 2003, 19 (4):749–770.10.1016/S0749-0704(03)00052-6 Search in Google Scholar

71. Gruber T, Sharma A, Daneschvar H, Estfan B: The Hawthorne effect in the assessment of pain by house staff. Am J Hosp Palliat Care. 2003, 20 (3):231–234.10.1177/104990910302000314 Search in Google Scholar

72. Gulur P, Soldinger SM, Acquadro MA: Concepts in pain management. Clin Pediatr Med Surg. 2007, 24 (2):333–351.10.1016/j.cpm.2007.01.001 Search in Google Scholar

73. Harden RN: Chronic neuropathic pain: mechanisms, diagnosis, and treatment. Neurologist. 2005, 11 (2):111–122.10.1097/01.nrl.0000155180.60057.8e Search in Google Scholar

74. Henry C, Navarro V, Jun A, Annaberdyev S: Measuring the fifth vital sign in cataract surgery patients: is it necessary? Insight. 2006, 31(2):7–9. Search in Google Scholar

75. Hernandez-Boussard T, Graham LA, Desai K, Wahl TS, Aucoin E, Richman JS, Morris MS, Itani KM, Telford GL, Hawn MT: The fifth vital sign: postoperative pain predicts 30-day readmissions and subsequent emergency department visits. Ann Surg. 2017, 266 (3):516–524.10.1097/SLA.0000000000002372 Search in Google Scholar

76. Holl RM, Carmack J: Complexity of pain, nurses’ knowledge, and treatment options. Holist Nurs Pract. 2015, 29 (6):377–380.10.1097/HNP.0000000000000114 Search in Google Scholar

77. Joel LA: The fifth vital sign: pain. Am J Nurs. 1999, 99 (2):9. Search in Google Scholar

78. Kalkman GA, Kramers C, van Dongen RT, van den Brink W, Schellekens A: Trends in use and misuse of opioids in the Netherlands: a retrospective, multi-source database study. Lancet Public Health. 2019, 4 (10):e498-e505.10.1016/S2468-2667(19)30128-8 Search in Google Scholar

79. Kelly S, Johnson GT, Harbison RD: Pressured to prescribe: the impact of economic and regulatory factors on South-Eastern ED physicians when managing the drug seeking patient. J Emerg Trauma Shock. 2016, 9 (2):58–63.10.4103/0974-2700.179454484356827162437 Search in Google Scholar

80. Kerns RD, Philip EJ, Lee AW, Rosenberger PH: Implementation of the veterans health administration national pain management strategy. Transl Behav Med. 2011, 1 (4):635–643.10.1007/s13142-011-0094-3371767524073088 Search in Google Scholar

81. Kingsnorth S, Joachimides N, Krog K, Davies B, Higuchi KS: Optimal pain assessment in pediatric rehabilitation: implementation of a nursing guideline. Pain Manag Nurs. 2015, 16 (6):871–880.10.1016/j.pmn.2015.07.00926395294 Search in Google Scholar

82. Kozol RA, Voytovich A: Misinterpretation of the fifth vital sign. Arch Surg. 2007, 142 (5):417–419; discussion 419–420.10.1001/archsurg.142.5.41717515482 Search in Google Scholar

83. Krantz MJ, Palmer RB, Haigney MCP: Cardiovascular complications of opioid use. J Am Coll Cardiol. 2021, 77 (2):205–223.10.1016/j.jacc.2020.11.00233446314 Search in Google Scholar

84. Lanser P, Gesell S: Pain management: the fifth vital sign. Healthc Benchmarks. 2001, 8 (6):68-70. Search in Google Scholar

85. Leo RJ, Pristach CA, Streltzer J: Incorporating pain management training into the psychiatry residency curriculum. Acad Psychiatry. 2003, 27 (1):1-11.10.1176/appi.ap.27.1.112824114 Search in Google Scholar

86. Lima EN: Chronic pain and mental health: moving beyond the conceptualization of pain as the fifth vital sign. N C Med J. 2013, 74 (3):229–231. Search in Google Scholar

87. Liu D, Ma J, Zhang Z, Yu A, Chen X, Feng C, Lei W: Management of postoperative pain in medical institutions in Shandong province in China. Medicine (Baltimore). 2016, 95 (6):e2690.10.1097/MD.0000000000002690475389526871800 Search in Google Scholar

88. Lorenz KA, Sherbourne CD, Shugarman LR, Rubenstein LV, Wen L, Cohen A, Goebel JR, Hagenmeier E, Simon B, Lanto A, Asch SM: How reliable is pain as the fifth vital sign? J Am Board Fam Med. 2009, 22 (3):291–298. Search in Google Scholar

89. Lynch M: Pain as the fifth vital sign. J Intraven Nurs. 2001, 24 (2):85–94. Search in Google Scholar

90. Lynch M: Pain: the fifth vital sign - comprehensive assessment leads to proper treatment. Adv Nurse Pract. 2001, 9 (11):28–36. Erratum in: Adv Nurse Pract. 2004, 12 (6):8. Search in Google Scholar

91. Mandell BF: The fifth vital sign: a complex story of politics and patient care. Cleve Clin J Med. 2016, 83 (6):400–401.10.3949/ccjm.83b.0601627281246 Search in Google Scholar

92. Martin KD, Van Buren JP, Wake J, Dawson L: Comparison of visual analog pain score reported to physician vs nurse. Foot Ankle Int. 2018, 39 (3):300–303.10.1177/107110071774058429160755 Search in Google Scholar

93. Mathews L: Pain in children: neglected, unaddressed and mismanaged. Indian J Palliat Care. 2011, 17 (Suppl):S70-73.10.4103/0973-1075.76247314008821811376 Search in Google Scholar

94. McCaffery M, Pasero CL: Pain ratings: the fifth vital sign. Am J Nurs. 1997, 97 (2):15–16.10.1097/00000446-199702000-000109025664 Search in Google Scholar

95. Mehendale AW, Goldman MP, Mehendale RP: Opioid overuse pain syndrome (OOPS): the story of opioids, prometheus unbound. J Opioid Manag. 2013, 9 (6):421–438.10.5055/jom.2013.018524481931 Search in Google Scholar

96. Merboth MK, Barnason S: Managing pain: the fifth vital sign. Nurs Clin North Am. 2000, 35 (2):375–383. Search in Google Scholar

97. Molony SL, Kobayashi M, Holleran EA, Mezey M: Assessing pain as a fifth vital sign in long-term care facilities: recommendations from the field. J Gerontol Nurs. 2005, 31 (3):16–24.10.3928/0098-9134-20050301-0615799633 Search in Google Scholar

98. Nassif GJ, Miller TE: Evolving the management of acute perioperative pain towards opioid free protocols: a narrative review. Curr Med Res Opin. 2019, 35 (12):2129-2136.10.1080/03007995.2019.164600131315466 Search in Google Scholar

99. Neale KL: The fifth vital sign: chronic pain assessment of the adolescent oncology patient. J Pediatr Oncol Nurs. 2012, 29 (4):185–198.10.1177/104345421244538822797680 Search in Google Scholar

100. Nemati MH: The evaluation of the benefits of pain control by patients using PCA pump compared to medicine injection to ease the pain by nurses. J Med Life. 2015, 8 (Spec Iss 4):144–149. Search in Google Scholar

101. Nworah U: From documentation to the problem: controlling postoperative pain. Nurs Forum. 2012, 47 (2):91-99.10.1111/j.1744-6198.2012.00262.x22512766 Search in Google Scholar

102. (No author): Pain as the fifth vital sign. J Am Optom Assoc. 1999, 70 (10):619–620. Search in Google Scholar

103. Parvizy S, Tarvirdinasab S, Raznahan R, Aliakbari M: The effect of pain management training in workshop on the knowledge, attitude and self-efficacy of pediatric nurses. J Family Med Prim Care. 2020, 9 (6):2880–2884.10.4103/jfmpc.jfmpc_92_20749179532984143 Search in Google Scholar

104. Pilitsis JG, Fahey M, Custozzo A, Chakravarthy K, Capo-bianco R: Composite score is a better reflection of patient response to chronic pain therapy compared with pain intensity alone. Neuromodulation. 2021, 24 (1):68–75.10.1111/ner.1321232592618 Search in Google Scholar

105. Pinzur MS: The fifth vital sign. Foot Ankle Int. 2013, 34 (11):1605.10.1177/107110071349536624178799 Search in Google Scholar

106. Premkumar J: Pain as the fifth vital sign. Nurs J India. 2006, 97 (10):225–227. Search in Google Scholar

107. Purser L, Warfield K, Richardson C: Making pain visible: an audit and review of documentation to improve the use of pain assessment by implementing pain as the fifth vital sign. Pain Manag Nurs. 2014, 15 (1):137–142.10.1016/j.pmn.2012.07.00724602432 Search in Google Scholar

108. Reid PF: Cobra venom: a review of the old alternative to opiate analgesics. Altern Ther Health Med. 2011, 17 (1):58–71. Search in Google Scholar

109. Rogers MP, Kuo PC: Pain as the fifth vital sign. J Am Coll Surg. 2020, 231 (5):601–602.10.1016/j.jamcollsurg.2020.07.50833491655 Search in Google Scholar

110. Rousseau P: Pain as the fifth vital sign. Arch Surg. 2008, 143 (1):98; author reply 99; discussion 99.10.1001/archsurg.2007.2318209163 Search in Google Scholar

111. Ruoff GE: Assessing pain as the fifth vital sign. Postgrad Med. 2002, 112 (1 Suppl):4–7.10.3810/pgm.2002.07.suppl18.96 Search in Google Scholar

112. Sabesan VJ, Chatha K, Koen S, Dawoud M, Gilot G: Innovative patient education and pain management protocols to achieve opioid-free shoulder arthroplasty. JSES Int. 2020, 4 (2):362–365.10.1016/j.jseint.2020.01.005725688332490427 Search in Google Scholar

113. Sayers M, Marando R, Fisher S, Aquila A, Morrison B, Dailey T: No need for pain. J Healthc Qual. 2000, 22 (3):10–15. Search in Google Scholar

114. Scher C, Meador L, Van Cleave JH, Reid MC: Moving beyond pain as the fifth vital sign and patient satisfaction scores to improve pain care in the 21st Ccntury. Pain Manag Nurs. 2018, 19 (2):125–129.10.1016/j.pmn.2017.10.010587870329249620 Search in Google Scholar

115. Schiavenato M, Craig KD: Pain assessment as a social transaction: beyond the “gold standard”. Clin J Pain. 2010, 26 (8):667–676.10.1097/AJP.0b013e3181e7250720664341 Search in Google Scholar

116. Taylor S, Voytovich AE, Kozol RA: Has the pendulum swung too far in postoperative pain control? Am J Surg. 2003, 186 (5):472–475.10.1016/j.amjsurg.2003.07.02114599609 Search in Google Scholar

117. Tequare MH, Huntzicker JJ, Gidey Mhretu H, Zelelew YB, Abraha HE, Tsegay MA, Gebretensaye KG, Gebre Tesfay D, Sotomayor JG, Nardos R, Yosses MB, Cobbs JE, Schmidt JPL, Weisman W, Breitner LK: Pain management and its possible implementation research in North Ethiopia: a before and after study. Adv Med. 2020:5317352.10.1155/2020/5317352728804732566691 Search in Google Scholar

118. Thomas MA: Pain management - the challenge. Ochsner J. 2003, 5 (2):15–21. Search in Google Scholar

119. Tompkins DA, Hobelmann JG, Compton P: Providing chronic pain management in the “Fifth Vital Sign” era: historical and treatment perspectives on a modern-day medical dilemma. Drug Alcohol Depend. 2017, 173 Suppl 1 (Suppl 1):S11-21.10.1016/j.drugalcdep.2016.12.002577123328363315 Search in Google Scholar

120. Torma L: Pain: the fifth vital sign. Pulse. 1999, 36 (2):16. Search in Google Scholar

121. Woodard D, Van Demark RE Jr: The opioid epidemic in 2017: Are we making progress? S D Med. 2017, 70 (10):467–471. Search in Google Scholar

122. Yuen TS, Irwin MG: The ‘fifth vital sign’. Hong Kong Med J. 2005, 11 (3):145–146. Search in Google Scholar

123. Zhang X, Zhang J, Du Y, Wang M, Gao Y, Zhou L, Lu J, Zhao J: Intravenous analgesia with ultra-high-dose morphine for the treatment of headache and successful withdrawal of morphine: a case report and literature review. Medicine (Baltimore). 2020, 99 (44):e22919.10.1097/MD.0000000000022919759879133126353 Search in Google Scholar

124. Johnson M: BMI: another “vital” sign? NAS Newsletter. 2002, 17 (14):12. Search in Google Scholar

125. Kirk SF, Cramm CL, Price SL, Penney TL, Jarvie L, Power H: BMI: a vital sign for patients and health professionals. Can Nurse. 2009, 105 (1):25–28. Search in Google Scholar

126. Ballas SK: The sixth vital sign: body mass index in patients with sickle cell disease. J Clin Med Res. 2017, 9 (10):889–890.10.14740/jocmr3137w559343828912927 Search in Google Scholar

127. Singer P, Attal-Singer J, Shapiro H: Body mass index and weight change: the sixth vital sign. Isr Med Assoc J. 2008, 10 (7):523–525. Search in Google Scholar

128. Exercise is Medicine: A Global Health Initiative. 2021. America College of Sports Medicine. exerciseismedicine. org, (accessed 14 August 2021). https://www.exerciseis-medicine.org/ Search in Google Scholar

129. Sallis RE: Exercise is medicine and physicians need to prescribe it! Br J Sports Med. 2009, 43 (1):3–4.10.1136/bjsm.2008.05482518971243 Search in Google Scholar

130. Sallis R: Developing healthcare systems to support exercise: exercise as the fifth vital sign. Br J Sports Med. 2011, 45 (6):473–474.10.1136/bjsm.2010.08346921292925 Search in Google Scholar

131. Sallis RE, Baggish AL, Franklin BA, Whitehead JR: The call for a physical activity vital sign in clinical practice. Am J Med. 2016, 129 (9):903–905.10.1016/j.amjmed.2016.05.00527235007 Search in Google Scholar

132. Cowan RE: Exercise is medicine initiative: physical activity as a vital sign and prescription in adult rehabilitation practice. Arch Phys Med Rehabil. 2016, 97 (9 Suppl):232–237.10.1016/j.apmr.2016.01.040 Search in Google Scholar

133. Rozanski A, Arnson Y, Gransar H, Hayes SW, Friedman JD, Thomson LEJ, Dey D, Berman DS: Associations among self-reported physical activity, coronary artery calcium scores, and mortality risk in older adults. Mayo Clin Proc Innov Qual Outcomes. 2020, 4 (3):229–237.10.1016/j.mayocpiqo.2020.02.005 Search in Google Scholar

134. Diaz A, Laufer, MR, Breech LL Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. American Academy of Pediatrics Committee on Adolescence; American College of Obstetricians and Gynecologists Committee on Adolescent Health Care. Pediatrics. 2006, 118 (5):2245–2250. Search in Google Scholar

135. Naz MSG, Rostami Dovom MR, Tehrani FR. The menstrual disturbances in endocrine disorders: a narrative review. Int J Endocrinol Metab. 2020, 18 (4):e106694.10.5812/ijem.106694 Search in Google Scholar

136. Douw G, Schoonhoven L, Holwerda T, et al. Nurses’ worry or concern and early recognition of deteriorating patients on general wards in acute care hospitals: a systematic review. Crit Care. 2015, 19 (1):230.10.1186/s13054-015-0950-5 Search in Google Scholar

137. Douw G, Huisman-de Waal G, van Zanten AR, van der Hoeven JG, Schoonhoven L: Nurses’ worry as predictor of deteriorating surgical ward patients: a prospective cohort study of the Dutch-Early-Nurse-Worry-Indicator-Score. Int J Nurs Stud. 2016, 59:134–40.10.1016/j.ijnurstu.2016.04.006 Search in Google Scholar

138. Romero-Brufau S, Gaines K, Nicolas CT, Johnson MG, Hickman J, Huddleston JM: The fifth vital sign? Nurse worry predicts inpatient deterioration within 24 hours. JAMIA Open. 2019, 2 (4):465–470.10.1093/jamiaopen/ooz033 Search in Google Scholar

139. Naito AS, Sakuma Y, Kinoshita H, Ito T, Mimatsu S, Tarumi A, Kiyohara E, Morita T: Screening using the fifth vital sign in the electronic medical recording system. Jpn J Clin Oncol. 2017, 47 (5):430–433.10.1093/jjco/hyx020 Search in Google Scholar

140. Morita T, Fujimoto K, Namba M, Kiyohara E, Takada S, Yamazaki R, Taguchi K: Screening for discomfort as the fifth vital sign using an electronic medical recording system: a feasibility study. J Pain Symptom Manage 2008, 35 (4):430–436.10.1016/j.jpainsymman.2007.05.013 Search in Google Scholar

141. Fraser GL, Riker RR: Monitoring sedation, agitation, anal-gesia, and delirium in critically ill adult patients. Crit Care Clin. 2001, 17 (4):967–987.10.1016/S0749-0704(05)70189-5 Search in Google Scholar

142. Alford JW, Fadale PD: Evaluation of postoperative bupiva-caine infusion for pain management after anterior cruciate ligament reconstruction. Arthroscopy. 2003, 19 (8):855–861.10.1016/S0749-8063(03)00734-5 Search in Google Scholar

143. Rendell M, Saiprasad S, Trepp-Carrasco AG, Drincic A: The future of inpatient diabetes management: glucose as the sixth vital sign. Expert Rev Endocrinol Metab. 2013, 8 (2):195–205. 10.1586/eem.13.110.1586/eem.13.130736179 Search in Google Scholar

144. Dionigi F, Milani R, Garcia-Etienne CA, Praticò V, Riboni G, Della Valle A, Ferrari A, Grasso D, Lasagna A, Pedrazzoli P, Klersy C, Politi P, Sgarella A, Manna S, Conti C: The institution of a Multi-disciplinary Italian Breast Unit: reflections of the first psychosocial research study results on distress and quality of life. Breast J. 2019;25 (4):678–681.10.1111/tbj.1324431127684 Search in Google Scholar

145. Bultz BD, Carlson LE: Emotional distress: the sixth vital sign in cancer care. J Clin Oncol. 2005, 23 (26):6440–6441.10.1200/JCO.2005.02.325916155033 Search in Google Scholar

146. Carlson LE, Groff SL, Maciejewski O, Bultz BD: Screening for distress in lung and breast cancer outpatients: a randomized controlled trial. J Clin Oncol. 2010, 28 (33):4884–4891.10.1200/JCO.2009.27.369820940193 Search in Google Scholar

147. Bultz BD, Waller A, Cullum J, et al.: Implementing routine screening for distress, the sixth vital sign, for patients with head and neck and neurologic cancers. J Natl Compr Canc Netw. 2013, 11 (10):1249–1261.10.6004/jnccn.2013.014724142826 Search in Google Scholar

148. Fitch MI, Ashbury F, Nicoll I: Reflections on the implementation of screening for distress (sixth vital sign) in Canada: key lessons learned. Support Care Cancer. 2018, 26 (12):4011–4020.10.1007/s00520-018-4278-y29858691 Search in Google Scholar

149. Miller AH, Ancoli-Israel S, Bower JE, Capuron L, Irwin MR: Neuroendocrine-immune mechanisms of behavioral comorbidities in patients with cancer. J Clin Oncol. 2008, 26 (6):971–982.10.1200/JCO.2007.10.7805277001218281672 Search in Google Scholar

150. Tavani CA, LeRoy P: Suffering: a sixth vital sign? Del Med J. 2005, 77 (10):411–412. Search in Google Scholar

151. Bultz BD, Travado L, Jacobsen PB, Turner J, Borras JM, Ullrich AW: 2014 President’s plenary international psycho-oncology society: moving toward cancer care for the whole patient. Psychooncology. 2015; 24 (12):1587–1593.10.1002/pon.384425963279 Search in Google Scholar

152. Bultz BD, Carlson LE: Emotional distress: the sixth vital sign - future directions in cancer care. Psychooncology. 2006, 15 (2):93–95.10.1002/pon.102216444764 Search in Google Scholar

153. Chaturvedi SK, Venkateswaran C: New research in psychooncology. Curr Opin Psychiatry. 2008, 21 (2):206–210.10.1097/YCO.0b013e3282f4928918332672 Search in Google Scholar

154. Dégi CL: In search of the sixth vital sign: cancer care in Romania. Support Care Cancer. 2013, 21(5):1273–1280.10.1007/s00520-012-1657-723151651 Search in Google Scholar

155. Fitch MI, Howell D, McLeod D, Green E: Screening for distress: responding is a critical function for oncology nurses. Can Oncol Nurs J. 2012, 22 (1):12–30. Search in Google Scholar

156. Groff S, Holroyd-Leduc J, White D, Bultz BD: Examining the sustainability of Screening for Distress, the sixth vital sign, in two outpatient oncology clinics: a mixed-methods study. Psychooncology. 2018, 27 (1):141–147.10.1002/pon.438828128894 Search in Google Scholar

157. Henry M, Trickey B, Huang LN, Cohen SR: How is cancer recently portrayed in Canadian newspapers compared to 20 years ago? Support Care Cancer. 2012, 20 (1):49–55.10.1007/s00520-010-1049-921132331 Search in Google Scholar

158. Holland JC, Bultz BD, National comprehensive Cancer Network: The NCCN guideline for distress management: a case for making distress the sixth vital sign. J Natl Compr Canc Netw. 2007, 5 (1):3–7.10.6004/jnccn.2007.0003 Search in Google Scholar

159. Lazenby M: The international endorsement of US distress screening and psychosocial guidelines in oncology: a model for dissemination. J Natl Compr Canc Netw. 2014, 12 (2):221–227.10.6004/jnccn.2014.002324586084 Search in Google Scholar

160. LeBlanc TW, Kamal AH: Assessing psychological toxicity and patient-reported distress as the sixth vital sign in cancer care and clinical trials. AMA J Ethics. 2017, 19 (5):460–466.10.1001/journalofethics.2017.19.5.stas1-170528553903 Search in Google Scholar

161. Maher NG, Britton B, Hoffman GR: Early screening in patients with head and neck cancer identified high levels of pain and distress. J Oral Maxillofac Surg. 2013, 71 (8):1458–464.10.1016/j.joms.2013.02.00923611602 Search in Google Scholar

162. McLeod DL, Morck AC, Curran JA: A pan-Canadian web-based education program to support screening for distress: evaluation of outcomes. Palliat Support Care. 2014, 12 (1):15-23.10.1017/S147895151300007223942172 Search in Google Scholar

163. Murthy RS: Lessons of being a patient: Personal thoughts about psycho-oncology in India. Mens Sana Monogr. 2016, 14 (1):171–186.10.4103/0973-1229.154532517961528031630 Search in Google Scholar

164. Smith SK, Loscalzo M, Mayer C, Rosenstein DL: Best practices in oncology distress management: beyond the screen. Am Soc Clin Oncol Educ Book. 2018, 38:813–821.10.1200/EDBK_20130730231391 Search in Google Scholar

165. Stapleton SJ, Valerio TD, Astroth K, Woodhouse S: Distress during radiation therapy: assessment among patients with breast or prostate cancer. Clin J Oncol Nurs. 2017, 21 (1):93–98.10.1188/17.CJON.93-9828107334 Search in Google Scholar

166. Suppa CH, Linton JC: Psychosocial oncology services in West Virginia. W V Med J. 2009, 105 Spec No:12–15. Search in Google Scholar

167. Thomas BC, Bultz BD: The future in psychosocial oncology: screening for emotional distress--the sixth vital sign. Future Oncol. 2008, 4 (6):779–784.10.2217/14796694.4.6.77919086844 Search in Google Scholar

168. Thomas BC, NandaMohan V, Nair MK, Pandey M: Gender, age and surgery as a treatment modality leads to higher distress in patients with cancer. Support Care Cancer. 2010, 19 (2):239–250. Search in Google Scholar

169. Thomas BC, Nandamohan V, Nair MK, Robinson JW, Pandey M: Screening for distress (the sixth vital sign) in a global recession: sustainable approach to maintain patient-centered care. Future Oncol. 2009, 5 (5):727–738.10.2217/fon.09.4319519211 Search in Google Scholar

170. Waller A, Garland SN, Bultz BD: Using Screening for Distress, the sixth vital sign, to advance patient care with assessment and targeted interventions. Support Care Cancer. 2012, 20 (9):2241–2246.10.1007/s00520-012-1506-822674058 Search in Google Scholar

171. Waller A, Williams A, Groff SL, Bultz BD, Carlson LE: Screening for distress, the sixth vital sign: examining self-referral in people with cancer over a one-year period. Psychooncology. 2013; 22 (2):388–395. Search in Google Scholar

172. LaVance MS, Fairchild R, Rosado RJ: Turning the table: depression screening as the 6th vital sign. J Nurs Pract. 2015, 11 (2):199–206.10.1016/j.nurpra.2014.10.026 Search in Google Scholar

173. UT Southwest https://www.utsouthwestern.edu/education/medical-school/departments/psychiatry/research/center/vital-sign6/ (accessed 4 October 2022). Search in Google Scholar

174. Splaine M: Thinking about thinking: why cognition should be the sixth vital sign. MD Advis. 2019, 12 (3):19–20. Search in Google Scholar

175. Voyer P, Champoux N, Desrosiers J, Landreville P, Mc-Cusker J, Monette J, Savoie M, Carmichael PH, Richard H, Richard S: RADAR: a measure of the sixth vital sign? Clin Nurs Res. 2016, 25 (1):9–29. Search in Google Scholar

176. Tamune H, Yasugi D: How can we identify patients with delirium in the emergency department?: A review of available screening and diagnostic tools. Am J Emerg Med. 2017, 35 (9):1332–1324.10.1016/j.ajem.2017.05.02628571901 Search in Google Scholar

177. Bellelli G, Trabucchi M: Delirium as the sixth vital sign. J Am Med Dir Assoc. 2008, 9 (4):279; author reply 279–280.10.1016/j.jamda.2007.08.01418457806 Search in Google Scholar

178. Flaherty JH, Rudolph J, Shay K, Kamholz B, Boockvar KS, Shaughnessy M, Shapiro R, Stein J, Weir C, Edes T: Delirium is a serious and under-recognized problem: why assessment of mental status should be the sixth vital sign. J Am Med Dir Assoc. 2007, 8 (5):273–275.10.1016/j.jamda.2007.03.00617570303 Search in Google Scholar

179. Bierman AS: Functional status: the six vital sign. J Gen Intern Med. 2001, 16 (11):785–786.10.1111/j.1525-1497.2001.10918.x149529311722694 Search in Google Scholar

180. Richardson J, Letts L, Chan D, Officer A, Wojkowski S, Oliver D, Moore A, McCarthy L, Price D, Kinzie S: Monitoring physical functioning as the sixth vital sign: evaluating patient and practice engagement in chronic illness care in a primary care setting--a quasi-experimental design. BMC Fam Pract. 2012, 13:29.10.1186/1471-2296-13-29335502022471378 Search in Google Scholar

181. Studenski S, Perera S, Wallace D, Chandler JM, Duncan PW, Rooney E, Fox M, Guralnik JM: Physical performance measures in the clinical setting. J Am Geriatr Soc. 2003, 51 (3):314–322.10.1046/j.1532-5415.2003.51104.x12588574 Search in Google Scholar

182. Bortone I, Sardone R, Lampignano L, Castellana F, Zupo R, Lozupone M, Moretti B, Giannelli G, Panza F: How gait influences frailty models and health-related outcomes in clinical-based and population-based studies: a systematic review. J Cachexia Sarcopenia Muscle. 2021, 12 (2):274–297.10.1002/jcsm.12667806136633590975 Search in Google Scholar

183. Fritz S, Lusardi M: White paper: “walking speed: the sixth vital sign”. J Geriatr Phys Ther. 2009, 32 (2):46–49. Erratum in: J Geriatr Phys Ther. 2009, 32 (3):110. Search in Google Scholar

184. Lusardi M: Is walking speed a vital sign? absolutely. Top Geriatr Rehabil. 2012, 28 (2):67–76.10.1097/TGR.0b013e31824385a4 Search in Google Scholar

185. Middleton A, Fritz SL, Lusardi M: Walking speed: the functional vital sign. J Aging Phys Act. 2015, 23 (2):314–322.10.1123/japa.2013-0236425489624812254 Search in Google Scholar

186. Younce AB, Hinton D, Haynes DD, Berg J: Patient safety: make fall risk the sixth vital sign. Nursing. 2011;41(4):62–64.10.1097/01.NURSE.0000395307.68539.6421403511 Search in Google Scholar

187. Holl RM: Bowel movement: the sixth vital sign. Holist Nurs Pract. 2014;28 (3):195–197.10.1097/HNP.000000000000002424722614 Search in Google Scholar

188. Nursing care of dyspnea: The 6th vital sign in individuals with chronic obstructive pulmonary disease (COPD). National Guideline Clearinghouse. Archived from the original on 2009-01-17. https://bpgmobile.rnao.ca/guideline-content/20. (Accessed 18 September 2021). Search in Google Scholar

189. Heinrich C: Health literacy: the sixth vital sign. J Am Acad Nurse Pract. 2012, 24 (4):218–223.10.1111/j.1745-7599.2012.00698.x22486837 Search in Google Scholar

190. Dunn DJ: The sixth vital sign: health literacy assessment. Fla Nurse. 2010, 58 (2):12. Search in Google Scholar

191. World Health Organization: IMAI District Clinician Manual: hospital care for adolescents and adults. Geneva, Switzerland: WHO, 2011. http://www.who.int/hiv/pub/imai/imai2011/en/ (accessed 4 July 2021). Search in Google Scholar

192. Cummings MJ, Goldberg E, Mwaka S, et al.: The sixth vital sign: HIV status assessment and severe illness triage in Uganda. Public Health Action. 2017, 7 (4):245–250.10.5588/pha.17.0045575377629584800 Search in Google Scholar

193. Joseph AC: Is urinary incontinence as the sixth vital sign part of your practice? Urol Nurs. 2009, 29 (3):146. Search in Google Scholar

194. Joseph AC: Continence: the sixth vital sign? Am J Nurs. 2003, 103 (7):11. Search in Google Scholar

195. Rundio AA: SBIRT-the new sixth vital sign? A policy perspective. J Addict Nurs. 2012, 23 (3):208–209.10.1097/JAN.0b013e31826eb32724335740 Search in Google Scholar

196. Biedrzycki BA: Could fatigue become the sixth vital sign? ONS News. 2003, 18 (4):4–5. Search in Google Scholar

197. Amen K: Cancer-related fatigue: the sixth vital sign? ONS Connect. 2007, 22 (8 Suppl):17–18. Search in Google Scholar

198. Given B: Cancer-related fatigue: a brief overview of current nursing perspectives and experiences. Clin J Oncol Nurs. 2008, 12 (5 Suppl):7–9.10.1188/08.CJON.S2.7-918842519 Search in Google Scholar

199. Piper BF, Borneman T, Sun VC, Koczywas M, Uman G, Ferrell B, James RL: Cancer-related fatigue: role of oncology nurses in translating National Comprehensive Cancer Network assessment guidelines into practice. Clin J Oncol Nurs. 2008, 12 (5 Suppl):37–47.10.1188/08.CJON.S2.37-47377658718842523 Search in Google Scholar

200. Fawcett J: Advancing evidence-based nursing practice through explicit theory-testing research: focus on the sixth vital sign, fatigue. J Adv Nurs. 2010, 66 (12):2603. Search in Google Scholar

201. Rosenow EC: Patients’ understanding of and compliance with medications: the sixth vital sign? Mayo Clin Proc. 2005, 80:983–987.10.4065/80.8.98316092574 Search in Google Scholar

202. Magid KP, Ho M: The 7th vital sign: why we should care about mediation adherence?. American College of Cardiology. 2016. https://www.acc.org/latest-in-cardiology/articles/2016/06/30/06/42/the-7th-vital-sign. (accessed 28 May 2021] Search in Google Scholar

203. Cedars MI, Taymans SE, DePaolo LV, Warner L, Moss SB, Eisenberg ML: The sixth vital sign: what reproduction tells us about overall health. Hum Reprod Open. 2017 (2):hox008.10.1093/hropen/hox008627664730895226 Search in Google Scholar

204. Klonoff DC, Shang T, Zhang JY, Cengiz E, Mehta C, Kerr D: Digital connectivity: the sixth vital sign. J Diabetes Sci Technol. 2021:19322968211015241.10.1177/1932296821101524133980049 Search in Google Scholar

205. Berke EM: Geographic information systems (GIS): recognizing the importance of place in primary care research and practice. J Am Board Fam Med. 2010, 23 (1):9–12.10.3122/jabfm.2010.01.090119317447020051537 Search in Google Scholar

206. Davenhall B: Place: the seventh vital sign. Virtual Mentor. 2014, 16 (2):135–137.10.1001/virtualmentor.2014.16.02.msoc1-140224553335 Search in Google Scholar

Articles recommandés par Trend MD

Planifiez votre conférence à distance avec Sciendo