[projectstatistics]_[4m2f]

1: Introduction
We are a group of physiotherapy students from Nanyang Polytechnic collecting data to determine the correlation between oral temperature and axilla temperature.
Goh Chun Kiat (090401H)
Stephanie Wong Shu Yun (095861F)
Sarah Lim Min (095848R)
Kelvin Leong Ying Kit (096765N)
Alan Tan Kian Hoe (095856Z)

Rationalise why you choose your variable
Rationalise why you choose your variable
It is clinically important to maintain a constant internal core temperature in humans in order for a stable environment to allow chemical reactions to take place at the optimum temperature. Homeostasis is therefore important to ensure efficient functioning of the body & also to facilitate recovery in sick patients. Therefore, monitoring a patient's body temperature accurately is an important component of capturing any changes and to administer the proper treatment to maintain a constant internal environment.


Clark M. Blatteis, "Body Temperature", Physiology and Pathophysiology of Temperature Regulation, Chapter 2: 14 - 22

State the importance of your study
The decision of which route to use for measuring core temperature in the hospitals (especially the intensive care units) remains a tough & controversial cookie to crack. Protocol differs between hospitals, or even within the departments in a hospital itself.



While there exist studies done regarding the difference between rectal, infrared tympanic and nasopharyngeal pathways in the ICU setting (Cronin & Wallis, "Temperature taking in the ICU: Which route is best?", Australian Critical Care, Volume 13, Issue 2 (May 2000): 59 - 64), there are far lesser research on the differences between oral & axillary temperature (more commonly done on patients outside of the ICU who are more likely to resist the more invasive methods used in the ICU). We hope that this pilot study would be able to help us visualise the data-collection process and understand better the basis of a clinical research.


What is the hypothesis?
We hypothesise that axillary temperature shows a high correlation to oral temperature. The null hypothesis would therefore be that the axillary temperature shows a low correlation to oral temperature.


Variables
Dependent variable: Axilla temperature
Independent variable: Oral temperature

Conceptualisation
Axillary temperature: The body temperature as recorded by a clinical thermometer placed under the armpit
Oral temperature: The body temperature as recorded by a clinical thermometer placed in the mouth

Operationalisation
Temperature: Clinical thermometer
Position: Under the tongue for oral, under the armpit for axilla

Safety & Hygiene

Usage of sleeves at mercury bulb
Alcohol swaps to clean mercury bulb after every individual reading
Gloves to be worn at all times when handling the thermometer

Other factors that can affect the data collected

Weather on the day of data collection
Extra heat generated due to friction

2: Literature Review
List of research & supporting documents reviewed
Cronin and Wallis, "Temperature taking in the ICU: Which route is best?", Australian Critical Care, Volume 13, Issue 2 (May 2000): 59 - 64

Review

In the Intensive Care Unit, nasopharygeal temperature measurements and rectal temperature measurements showed significant positive correlations.

Intermittent rectal probes are replaceable by infrared tympanic thermometry for intubated patients.

Abstract

Temperature measurement in an intensive care environment requires accurate estimation of core temperature via reliable equipment. Intermittent rectal probes were routinely used to measure core temperature in all extubated patients admitted to the Intensive Care Unit (ICU) which was the setting for this project. The nursing and medical staff identified various problems associated with this practice and a quality improvement project was implemented to compare temperatures recorded using three different routes: rectal, infrared tympanic and nasopharyngeal. Forty-nine patients were included in the study.

Nasopharyngeal temperature measurements were recorded for all intubated patients and rectal temperature measurements were recorded for all extubated patients. During data collection, infrared tympanic temperature measurements were recorded at the same time as all other temperature measurements. The main comparison was between the rectal route and the infrared tympanic route because of the problems with the rectal probes that had been identified by staff. The results indicated statistically significant correlations between temperatures measured at the different sites. These results confirmed previous literature and the ICU involved in this study replaced rectal temperature measurement via intermittent probe insertion with infrared tympanic thermometry for the measurement of core temperature in extubated patients.

Deepti Chaturvedi et al, "Comparison of Axillary Temperature with Rectal or Oral Temperature and Determination of Optimum Placement Time in Children", Indian Pediatrics, Vol. 41 (Jun 2004): 600 - 603

Review

There is a good correlation between axillary temperature and oral or rectal temperature recorded by the conventional mercury in glass thermometer.

Derived equation could be used to calculate rectal or oral temperature from axillary temperature.

The placement time of the thermometer should be 3 minutes, 4 minutes and 6 minutes for rectal, oral and axillary temperature recordings respectively.

Abstract

Axillary site is commonly used for temperature recording in children as it is safe and convenient. However, conflict remains regarding its accuracy and there is no universally accepted equation to predict the core temperature from axillary temperature(1,2). Few studies done in this regard have used improper methodology like use of electronic or uncalibrated thermometers and unsatisfactory data analysis(1). The thermometer placement time required to accurately reflect the stabilized body temperature is also unclear and varies between seconds to 15 minute in various studies(2-6). The present study was done to compare the axillary temperature with rectal or oral temperature in children and to find out the optimum placement time at these sites for conventional mercury in glass thermometer.

Rakesh Lodha et al, "Is axillary temperature an appropriate surrogate for core temperature", The Indian Journal Of Pediatrics, Volume 67, Number 8 (August, 2000): 571 - 574.

Review
Axillary temperature was an acceptable and more comfortable substitute for oral temperature in children.

Abstract
The ideal technique for measuring temperature should be rapid, painless, reproducible and accurately reflect the core temperature. While axillary temperature is commonly used because of convenience and safety, there are conflicting reports about its accuracy. To determine whether axillary temperature can act as a surrogate for oral/rectal temperatures, a prospective comparative study was conducted. The axillary and rectal temperatures (Group 1: infants < 1 year age) and axillary and oral temperatures (Group 2: children 6–14 years age) were compared using mercury-in-glass, thermometers. Various tests of agreement were applied to the data obtained. Rectal and axillary temperatures for infants agreed well; the mean difference (95% limits of agreement) between the two being 0.6°C (−0.3°C, 1.4°C). Similarly, the mean difference (95% limits of agreement) between oral and axillary measurements for children aged 6–14 years was observed to be 0.6°C (−0.4°C, 1.4°C). Axillary temperature appears to be an acceptable alternative to rectal/oral temperature measurements in children.

3: Methodology
How was the data collection done?
The data was collected at a air-conditioned area (Nanyang Polytechnic School of Health Sciences Blk J Room 204) over a period of 2 hours using the MedTecs VT-801BW Clinical Thermometer. Subjects were advised the day before to abstain from exercise for the 4 hours before the temperature taking.

How did you gather the samples?
The subjects were selected via a group of physiotherapy students via random selection of both genders ages 19 - 35.
A short questionnaire was presented prior to obtaining the temperature to ensure that they are not having any signs & symptoms of acute infections during the time of data collection or in the previous week. They were also briefed upon their privacy entitlement & that there would be no need for anonymity due to the unbiased nature of the experiment (a collection of data rather than an experiment of effect).

What did you use to measure?
To measure the oral temperature, subjects were seated while we inserted the thermometer into the oral cavity. The thermometer must be placed under the tongue. At any point in time the subject was not allowed to touch the thermometer. Same goes for the measurement of the axillary temperature but this time under the armpit. Recording of the data was done by another group member for efficiency.

The standardised way of placing the thermometer in the oral cavity (under the tongue held by the teeth)

Taking the oral temperature for a subject (subject was aware and gave permission to use photo)

Temperature as measured by the themometer

The standardised way of placing the thermometer at the axilla

Thermometer was cleaned by swabbing with alcohol swabs between the oral and axilla measurement and between subjects.

How often did we measure?
3 measurements were taken at the oral cavity & 3 measurements were taken at the axilla with the averages calculated for each component for data analysis in SPSS. This is to minimise discrepancies due to human or systemic error that might interfere with interference of the results.

Any rejection?
There was no rejection of data. The subjects also volunteered out of their own free will.

4: Statistical Analysis & Results
Show the raw data


The images above are the data collected on Friday, 18th June 2010.
The 1st image is the details of each variable.
The 2nd image is the data collected.

Sex: sex of respondent
ot: oral temperature (degrees celcius)
at: axilla temperature (degrees celcius)
aot: average oral temperature (degrees celcius)
aat: average axilla temperature (degrees celcius)

Draw the necessary appropriate plots for the data values




The scatter plot and above data shows the following :

- There is a linear association between BP readings before and after exercise
- The Pearson’s R of 0.953 indicates a high positive relationship
- The Approx. Sig. Column indicates a p-value (0.000) of less than 0.05, suggesting that the relationship is significant.


From the table above, Pearson's r value is 0.953. This shows that there is a positive and strong relationship between oral and axilla temperature. The p value is 0.00, which is <>

Compute the value of the correlation coefficient

5: Conclusion
Did it support or reject your hypothesis?
From our calculations, there is a positive, very strong, and significant relationship between axilla & oral temperature.

The null hypothesis is rejected.

In addition to our findings, and with reference to the available literature that supports our hypothesis (Deepti Chaturvedi et al, "Comparison of Axillary Temperature with Rectal or Oral Temperature and Determination of Optimum Placement Time in Children", Indian Pediatrics, Vol. 41 (Jun 2004): 600 - 603)
), we can conclude that a person's oral temperature has a strong correlation to the axilla temperature.

6: Conclusion
Introduction and Methodology
Coming up with the suitable hypothesis, variables, concepts was a breeze. We proceeded to discuss about the most suitable literary article which relates most to our subject and set up the blog.

Data Collection
30 subjects were a lot to handle. There was the distribution and collection of questionnaires, measurement and recording of data to be done. Thus to make the data collection session as organised and efficient as possible, our team split tasks and showed true team spirit.

Data Analysis and Conclusion
This is where we find it the most grueling. Tabulation of data in the form of data took almost a day to finish due to the many readings and the uncertainty of whether we have set the correct parameters to analyse or if we have used the wrong analysis. We had to double-check many times to ensure that the right set of data is keyed into SPSS. After that step, we were not sure on how to go about interpreting the statistical test results. Thus there was a lot of understanding to do our our part. We greatly appreciate the presence of the Statistics manual to help us maneuver this hurdle with more grace.

Overall
It was a very memorable experience for all of us especially working with each other for the first time. There's bound to be uphills and downhills but most importantly when the going gets tough, the tough gets going and it was teamwork which pulled us through. We have learned to be tediously meticulous (to the decimal point) in order not to let any human error (i.e. carelessness) come in the way of our data collection. We have also tasted a slice of how professional clinical research is like whether it is our cup of tea or not. In all, the process of the entire mini-research has given us much insight, whether related to the study of Statistics or the methods of research, and these can be applied to other aspects of our professional & personal lives.

Introduction and Methodology
Coming up with the suitable hypothesis, variables, concepts was a breeze. We proceeded to discuss about the most suitable literary article which relates most to our subject and set up the blog. That was not a wonderful start for all of us, admittingly, because the process of reviewing literature and deciding which is useful to our research proves daunting.

Data Collection
30 subjects were a lot to handle. There was the distribution and collection of questionnaires, measurement and recording of data to be done. Thus to make the data collection session as organised and efficient as possible, our team split tasks and showed true team spirit.

Data Analysis and Conclusion
This is where we find it the most grueling. Tabulation of data in the form of data took almost a day to finish due to the many readings and the uncertainty of whether we have set the correct parameters to analyse or if we have used the wrong analysis. We had to double-check many times to ensure that the right set of data is keyed into SPSS. After that step, we were not sure on how to go about interpreting the statistical test results. Thus there was a lot of understanding to do our our part. We greatly appreciate the presence of the Statistics manual to help us maneuver this hurdle with more grace.

Overall
It was a very memorable experience for all of us especially working with each other for the first time. There's bound to be uphills and downhills but most importantly when the going gets tough, the tough gets going and it was teamwork which pulled us through. We have learned to be tediously meticulous (to the decimal point) in order not to let any human error (i.e. carelessness) come in the way of our data collection. We have also tasted a slice of how professional clinical research is like whether it is our cup of tea or not. In all, the process of the entire mini-research has given us much insight, whether related to the study of Statistics or the methods of research, and these can be applied to other aspects of our professional & personal lives.

Did it support or reject your hypothesis?
From our calculations, there is a positive, very strong, and significant relationship between axilla & oral temperature.

The null hypothesis is rejected.

In addition to our findings, and with reference to the available literature that supports our hypothesis (Deepti Chaturvedi et al, "Comparison of Axillary Temperature with Rectal or Oral Temperature and Determination of Optimum Placement Time in Children", Indian Pediatrics, Vol. 41 (Jun 2004): 600 - 603), we can conclude that a person's oral temperature has a strong correlation to the axilla temperature.

Draw the necessary appropriate plots for the data values





Compute the value of the correlation coefficient

How was the data collection done?
The data was collected at a air-conditioned area (Nanyang Polytechnic School of Health Sciences Blk J Room 204) over a period of 2 hours using the MedTecs VT-801BW Clinical Thermometer. Subjects were advised the day before to abstain from exercise for the 4 hours before the temperature taking.

How did you gather the samples?
The subjects were selected via a group of physiotherapy students via random selection of both genders ages 19 - 35.
A short questionnaire was presented prior to obtaining the temperature to ensure that they are not having any signs & symptoms of acute infections during the time of data collection or in the previous week. They were also briefed upon their privacy entitlement & that there would be no need for anonymity due to the unbiased nature of the experiment (a collection of data rather than an experiment of effect).

What did you use to measure?
To measure the oral temperature, subjects were seated while we inserted the thermometer into the oral cavity. The thermometer must be placed under the tongue. At any point in time the subject was not allowed to touch the thermometer. Same goes for the measurement of the axillary temperature but this time under the armpit. Recording of the data was done by another group member for efficiency.

Equipment

1. 2 MedTecs VT-801BW Clinical Thermometers (one for oral, another for axilla)
2. Alcohol swabs

The standardised way of placing the thermometer in the oral cavity (under the tongue held by the teeth)

Taking the oral temperature for a subject (subject was aware and gave permission to use photo)

Temperature as measured by the themometer

The standardised way of placing the thermometer at the axilla

The thermometer was swabbed between subjects with the alcohol swabs available.

How often did we measure?
3 measurements were taken at the oral cavity & 3 measurements were taken at the axilla with the averages calculated for each component for data analysis in SPSS. This is to minimise discrepancies due to human or systemic error that might interfere with interference of the results.

Any rejection?
There was no rejection of data. The subjects also volunteered out of their own free will.

List of research & supporting documents reviewed

Rationalise why you choose your variable
It is clinically important to maintain a constant internal core temperature in humans in order for a stable environment to allow chemical reactions to take place at the optimum temperature. Homeostasis is therefore important to ensure efficient functioning of the body & also to facilitate recovery in sick patients. Therefore, monitoring a patient's body temperature accurately is an important component of capturing any changes and to administer the proper treatment to maintain a constant internal environment.


Clark M. Blatteis, "Body Temperature", Physiology and Pathophysiology of Temperature Regulation, Chapter 2: 14 - 22

State the importance of your study
The decision of which route to use for measuring core temperature in the hospitals (especially the intensive care units) remains a tough & controversial cookie to crack. Protocol differs between hospitals, or even within the departments in a hospital itself.



While there exist studies done regarding the difference between rectal, infrared tympanic and nasopharyngeal pathways in the ICU setting (Cronin & Wallis, "Temperature taking in the ICU: Which route is best?", Australian Critical Care, Volume 13, Issue 2 (May 2000): 59 - 64), there are far lesser research on the differences between oral & axillary temperature (more commonly done on patients outside of the ICU who are more likely to resist the more invasive methods used in the ICU). We hope that this pilot study would be able to help us visualise the data-collection process and understand better the basis of a clinical research.


What is the hypothesis?
We hypothesise that axillary temperature shows a high correlation to oral temperature. The null hypothesis would therefore be that the axillary temperature shows a low correlation to oral temperature.


Variables
Dependent variable: Axilla temperature
Independent variable: Oral temperature

Conceptualisation
Axillary temperature: The body temperature as recorded by a clinical thermometer placed under the armpit
Oral temperature: The body temperature as recorded by a clinical thermometer placed in the mouth

Operationalisation
Temperature: Clinical thermometer
Position: Under the tongue for oral, under the armpit for axilla

Safety & hygiene

Usage of sleeves at mercury bulb
Alcohol swaps to clean mercury bulb after every individual reading
Gloves to be worn at all times when handling the thermometer

Other factors that can affect the data collected

Weather on the day of data collection
Extra heat generated due to friction