Smoking status as a vital sign

OBJECTIVE: We conducted this study to determine if a smoking status stamp would prompt physicians to increase the number of times they ask, advise, assist, and arrange follow-up for African-American patients about smoking-related issues. DESIGN: An intervention study with a posttest assessment (after the physician visit) conducted over four 1-month blocks. The control period was the first 2 weeks of each month, while the following 2 weeks served as the intervention period. SETTING: An adult walk-in clinic in a large inner-city hospital. PARTICIPANTS: We consecutively enrolled into the study 2,595 African-American patients (1,229 intervention and 1, 366 control subjects) seen by a housestaff physician. INTERVENTIONS: A smoking status stamp placed on clinic charts during the intervention period. MAIN RESULTS: Forty-five housestaff rotated through the clinic in 1-month blocks. In univariate analyses, patients were significantly more likely to be asked by their physicians if they smoke cigarettes during the intervention compared with the control period, 78.4% versus 45.6% (odds ratio [OR] 4.28; 95% confidence interval [CI] 3.58, 5.10). Patients were also more likely to be told by their physician to quit, 39.9% versus 26.9% (OR 1.81; 95% CI 1.36, 2.40), and have follow-up arranged, 12.3% versus 6.2% (OR 2.16; 95% CI 1.30, 3.38). CONCLUSIONS: The stamp had a significant effect on increasing rates of asking about cigarette smoking, telling patients to quit, and arranging follow-up for smoking cessation. However, the stamp did not improve the low rate at which physicians offered patients specific advice on how to quit or in setting a quit date.     

The reliability of respiratory quotient measurements

A graphical analysis is presented which allows the assessment of confidence in the measurement of the respiratory quotient in an open-circuit metabolic chamber as a function of an organism's metabolic rate, the chamber ventilation, the magnitude of the respiratory quotient and the sensitivity of the gas analyzers.     

Quality of life as a vital clinical sign

Hypertension is a significant public health problem in the United States. Despite this, many patients fail to seek or comply with treatment, owing to potential adverse effects on the patient's quality of life (QOL). This paper reports on the development and evaluation of an instrument for evaluating the QOL of black patients who are being treated for hypertension. The scale proved highly reliable (Cronbach's alpha = 0.949), and correlated well with lengthier instruments for assessing QOL. Results are presented from administration of the questionnaire to 998 patients.     

老年高血压患者胃镜检查时生命体征的监测分析

目的观察老年高血压患者胃镜检查时心率、血压、血氧饱和度、心电图等变化,探讨高血压患者行胃镜检查的安全性。方法分析老年高血压患者及血压正常患者胃镜检查时心率、血压、血氧饱和度、心电图的变化,并进行比较。结果高血压组与对照组的心率于胃镜检查中均较检查前升高（P〈0．05）,组间比较亦有统计学差异（P〈0．01）。2组收缩压和舒张压检查中与检查前相比均有升高,血氧饱和度均有不同程度的下降（P〈0．05）,但组间比较无统计学差异。2组于检查中均有心律失常发生,但无危险性心律失常。结论血压、心率控制在安全范围内,老年高血压患者行胃镜检查是安全的。     

Measuring pain as the 5th vital sign does not improve quality of pain management

BACKGROUND: To improve pain management, the Veterans Health Administration launched the "Pain as the 5th Vital Sign" initiative in 1999, requiring a pain intensity rating (0 to 10) at all clinical encounters. OBJECTIVE: To measure the initiative's impact on the quality of pain management. DESIGN: We retrospectively reviewed medical records at a single medical center to compare providers' pain management before and after implementing the initiative and performed a subgroup analysis of patients reporting substantial pain (> or =4) during a postimplementation visit. PARTICIPANTS: Unique patient visits selected from all 15 primary care providers of a general medicine outpatient clinic. MEASUREMENTS: We used 7 process indicators of quality pain management, based on appropriately evaluating and treating pain, to assess 300 randomly selected visits before and 300 visits after implementing the pain initiative. RESULTS: The quality of pain care was unchanged between visits before and after the pain initiative (P>.05 for all comparisons): subjective provider assessment (49.3% before, 48.7% after), pain exam (26.3%, 26.0%), orders to assess pain (11.7%, 8.3%), new analgesic (8.7%, 11.0%), change in existing analgesics (6.7%, 4.3%), other pain treatment (11.7%, 13.7%), or follow-up plans (10.0%, 8.7%). Patients (n=79) who reported substantial pain often did not receive recommended care: 22% had no attention to pain documented in the medical record, 27% had no further assessment documented, and 52% received no new therapy for pain at that visit. CONCLUSIONS: Routinely measuring pain by the 5th vital sign did not increase the quality of pain management. Patients with substantial pain documented by the 5th vital sign often had inadequate pain management.     

The feasibility and reliability of capillary blood pressure measurements in the fingernail fold

Capillary blood pressure is an essential parameter in the study of the (patho-)physiology of microvascular perfusion. Currently, capillary pressure measurements in humans are performed using a servo-nulling micropressure system containing an oil-water interface, which suffers some drawbacks. In addition, the effect of the preparation of the skin and the presence of the tip of the pipette in the capillary during the measurement on microcirculatory perfusion has never been described. Therefore, we assessed the feasibility of capillary pressure measurements using an alternative micropressure system using an air-water interface (900 A, WPI) and examined the effect of the measurement on local microcirculation. In 19 healthy male volunteers the apex of capillaries in the eponychium of the fourth finger was punctured, after skin peeling, by a micropipette connected to a servo-nulling micropressure system. Red blood cell velocity (RBCV) was assessed after peeling during the measurement and at an adjacent area. Mean capillary pressure (in 16/19 volunteers) was 20.5 +/- 3.7 mm Hg (systolic 26.2 +/- 5.6 mm Hg, diastolic 17.6 +/- 3.9 mm Hg). RBCV was not significantly different before (0.52 mm/s) and during the measurement (0.51 mm/s) and at an adjacent area (0.51 mm/s). Capillary pressure can be measured well with the alternative setup used without hampering capillary flow, while the pressures obtained are in agreement with the results reported previously by other investigators.     

Blood glucose levels should be considered as a new vital sign indicative of prognosis during hospitalization

Background and aimsThe measurement of vital signs is an important part of clinical work up. Presently, measurement of blood glucose is a factor for concern mostly when treating individuals with diabetes. Significance of blood glucose measurement in prognosis of non-diabetic and hospitalized patients is not clear.MethodsA systematic search of literature published in the Electronic databases, PubMed and Google Scholar was performed using following keywords; blood glucose, hospital admissions, critical illness, hospitalizations, cardiovascular disease (CVD), morbidity, and mortality. This literature search was largely restricted to non-diabetic individuals.ResultsBlood glucose level, even when in high normal range, or in slightly high range, is an important determinant of morbidity and mortality, especially in hospitalized patients. Further, even slight elevation of blood glucose may increase mortality in patients with COVID-19. Finally, blood glucose variability and hypoglycemia in critically ill individuals without diabetes causes excess in-hospital complications and mortality.ConclusionIn view of these data, we emphasize the significance of blood glucose measurement in all patients admitted to the hospital regardless of presence of diabetes. We propose that blood glucose be included as the “fifth vital sign” for any hospitalized patient.