Pain, depression, and fatigue as a symptom cluster in advanced cancer

Context

Pain, depression, and fatigue are common symptoms in cancer populations. They often coexist and have been suggested as a specific symptom cluster. Systemic inflammation (SI) may be a possible common mechanism.

Objective

This study examined whether pain, depression, and fatigue exist as a symptom cluster in advanced cancer patients with cachexia and might be related to the presence of SI.

Methods

Secondary data analysis was undertaken of two clinical trials in patients with cancer cachexia (n = 654). Pain, depression, and fatigue were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. Plasma C-reactive protein (CRP) was measured as a marker of SI in a subgroup (n = 436). Multivariate analysis and a series of regression analyses were undertaken relating pain, depression, fatigue, and CRP.

Results

Pain, depression, and fatigue clustered, with between two and four times as many patients having all three symptoms as would be expected if the symptoms only coexist by chance (P < 0.001). CRP was not related to the symptom cluster. There was a strong relationship between the pattern of symptoms and physical functioning (P < 0.001).

Conclusion

Pain, depression, and fatigue is an identifiable symptom cluster in a cohort of cachexic cancer patients and is associated with reduced physical functioning.     

Bandura's exercise self-efficacy scale: Validation in an Australian cardiac rehabilitation setting

Background

Despite the established benefits of cardiac rehabilitation (CR) in improving health outcomes for people with cardiovascular disease, adherence to regular physical activity at recommended levels remains suboptimal. Self-efficacy has been shown to be an important mediator of health behaviour, including exercise.

Objectives

To assess the psychometric properties of Bandura's exercise self-efficacy (ESE) scale in an Australian CR setting.

Design

Validation study.

Setting

Cardiac rehabilitation.

Participants

One hundred and ten patients (Mean: 60.11, S.D.: 10.57 years).

Methods

Participants completed a six-minute walk test (6MWT) and Bandura's exercise self-efficacy scale at enrolment and on completion of a 6-week CR program.

Results

Bandura's ESE scale had a single factor structure with high internal consistency (0.95), and demonstrated no floor or ceiling effects. A comparison of ESE scores by distance walked on 6MWT indicated those who recorded more than 500 m at baseline had significantly higher ESE scores (Mean: 116.26, S.D.: 32.02 m) than those patients who only achieved up to 400 m on the 6MWT at baseline (Mean: 89.94, S.D.: 29.47 m) (p = 0.044). A positive and significant correlation between the change in scores on the ESE scale and the change in the 6MWT distance (r = 0.28, p = 0.035) was seen.

Conclusions

The ESE scale was a robust measure of exercise self-efficacy over the range of patients attending this outpatient cardiac rehabilitation program. Interventions to improve self-efficacy may increase CR patient's efficacy for regular physical activity.     

Effectiveness of community-based rehabilitation after traumatic brain injury for 489 program completers compared with those precipitously discharged

Altman IM, Swick S, Parrot D, Malec JF. Effectiveness of community-based rehabilitation after traumatic brain injury for 489 program completers compared with those precipitously discharged.

Objective

To evaluate outcomes of home- and community-based postacute brain injury rehabilitation (PABIR).

Design

Retrospective analysis of program evaluation data for treatment completers and noncompleters.

Setting

Home- and community-based PABIR conducted in 7 geographically distinct U.S. cities.

Participants

Patients (N=489) with traumatic brain injury who completed the prescribed course of rehabilitation (completed-course-of-treatment [CCT] group) compared with 114 who were discharged precipitously before program completion (precipitous-discharge [PD] group).

Intervention

PABIR delivered in home and community settings by certified professional staff on an individualized basis.

Main Outcome Measures

Mayo-Portland Adaptability Inventory (MPAI-4) completed by means of professional consensus on admission and at discharge; MPAI-4 Participation Index at 3- and 12-month follow-up through telephone contact.

Results

Analysis of covariance (CCT vs PD group as between-subjects variable, admission MPAI-4 score as covariate) showed significant differences between groups at discharge on the full MPAI-4 (F=82.25; P<.001), Ability Index (F=50.24; P<.001), Adjustment Index (F=81.20; P<.001), and Participation Index (F=59.48; P<.001). A large portion of the sample was lost to follow-up; however, available data showed that group differences remained statistically significant at follow-up.

Conclusions

Results provided evidence of the effectiveness of home- and community-based PABIR and that treatment effects were maintained at follow-up.     

The Hyperemesis Impact of Symptoms Questionnaire: Development and validation of a clinical tool

Background

The Hyperemesis Impact of Symptoms Questionnaire is a clinical tool designed to assess holistically the impact of the physical and psychosocial symptoms of hyperemesis gravidarum (HG) on individuals. Its purpose is to aid planning and implementation of tailored care for women with HG. To our knowledge no similar tool exists.

Objective

To assess the validity and reliability of the HIS questionnaire.

Design

As no similar tool exists, we compared the HIS with three tools that reflect its key areas: physical impact (Pregnancy Unique Quantification of Emesis - PUQE score and markers of severity of HG), psychological impact (Hospital Anxiety and Depression Score - HADS) and social impact (SF12 quality of life score).

Setting

A large regional referral, women and children's hospital in the North West of England.

Participants

The HIS was evaluated on 50 women admitted to hospital with HG and 50 women recruited from ante-natal clinic without severe nausea and vomiting of pregnancy and with an uncomplicated pregnancy.

Results

Good criterion validity was demonstrated by strong significant correlations with all three scores (PUQE, r = 0.75, p < 0.001, HADS, depression r = 0.76, p < 0.001, and SF12, mental component r = −0.65, p < 0.001). The HIS showed good internal consistency, Cronbach alpha 0.87, split half 0.80.

Conclusions

There is evidence for the validity and reliability of the HIS to assess the impact of the physical and psychosocial symptoms of HG. Further research is currently underway to establish the clinical utility of the HIS questionnaire in the care of women hospitalised with HG.     

An external focus of attention attenuates balance impairment in patients with Parkinson's disease who have a fall history

Objectives

Studies using young, non-impaired adults have shown that by directing attention to the outcome of movements (external focus) rather than directing attention to the movements involved in a specific skill (internal focus), motor skill acquisition is enhanced. The purpose of this study was to investigate the generalisability of these attentional focus findings to balance in subjects with Parkinson's disease.

Design

Experimental, repeated measures design.

Setting

Physiotherapy research facility.

Participants

Twenty-two subjects diagnosed with idiopathic Parkinson's disease.

Interventions

Subjects were tested under three attentional focus conditions; no instruction, internal focus and external focus.

Main outcome measure

Balance equilibrium scores from three computerised dynamic posturography conditions.

Results

A significant condition x attentional focus interaction was found (F [4, 84] = 2.86, P < 0.05), indicating increased sway with internal focus relative to no focus instructions (control) under the eyes-open condition. More importantly, when only subjects with a history of falls were considered, there was a significant interaction between condition and attentional focus (F [4, 36] = 4.40, P < 0.01). Post hoc tests revealed that the external focus instructions resulted in less sway than both internal focus and no attentional focus instructions under sway-referenced conditions.

Conclusion

These findings support previous research studies on attentional focus. In particular, it was demonstrated that the balance of subjects with Parkinson's disease and a fall history can be enhanced by instructing subjects to adopt an external focus.     

Improving outcome after out-of-hospital cardiac arrest by strengthening weak links of the local Chain of Survival; quality of advanced life support and post-resuscitation care

Background

Survival after out-of-hospital cardiac arrest (OHCA) depends on a well functioning Chain of Survival. We wanted to assess if targeted attempts to strengthen the weak links of our local chain; quality of advanced life support (ALS) and post-resuscitation care, would improve outcome.

Materials and methods

Utstein data from all OHCAs in Oslo during three distinct 2-year time periods 1996-1998, 2001-2003 and 2004-2005 were collected. Before the second period the local ALS guidelines changed with increased focus on good quality chest compressions with minimal pauses, while standardized post-resuscitation care including goal directed therapy with therapeutic hypothermia and percutaneous coronary intervention was added in the third period. Additional a priori sub-group analyses of arrests with cardiac aetiology as well as bystander witnessed ventricular fibrillation/tachycardia (VF/VT) arrests with cardiac aetiology were performed.

Results

ALS was attempted in 454, 449, and 417 patients with OHCA in the first, second and last time period, respectively. From the first to the third period VF/VT arrests declined (40% vs. 33%, p = 0.039) and fewer arrests were witnessed (80% vs. 72%, p = 0.022) and response intervals increased (7 ± 4 to 9 ± 4 min, p < 0.001). Overall survival increased from 7% (first period) to 13% (last period), p = 0.002, and survival in the sub-group of bystander witnessed VF/VT arrests with cardiac aetiology increased from 15% (first period) to 35% (last period), p = 0.001.

Conclusions

Survival after OHCA was increased after improving weak links of our local Chain of Survival, quality of ALS and post-resuscitation care.     

Comparison of the effects of episiotomy and no episiotomy on pain, urinary incontinence, and sexual function 3 months postpartum: A prospective follow-up study

Background

The episiotomy rate has declined worldwide but remains high in several countries such as Taiwan. The effects of episiotomy on women's health should be a constant concern. Few data are available on the effect of episiotomy by validated measures.

Objective

The present study examined the effect of episiotomy on pain, urinary incontinence, and sexual function up to 3 months postpartum.

Design, setting and participants

A prospective follow-up study of 243 women who completed the Taiwanese versions of the Short Form McGill Pain Questionnaire, International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form, Female Sexual Function Index, and a demographic questionnaire after vaginal delivery in a Taiwanese medical center.

Methods

Differences between those who did and did not have an episiotomy were tested using ANCOVA, adjusting for age, parity, newborn weight, and vacuum delivery. The reliability and validity of the measuring instruments were assessed using Cronbach's α coefficient and factor analysis.

Results

Women who delivered without an episiotomy had significantly lower perineal pain scores at weeks 1, 2 and 6 postpartum compared to women who had an episiotomy (p = 0.0065, 0.0391, 0.0497, respectively). Women in the no-episiotomy group had significantly lower non-localized pain scores at week 2 postpartum compared to women in the episiotomy group (p = 0.0438). The mean urinary incontinence score was significantly higher in the episiotomy group 3 months postpartum (p = 0.0293). No significant difference in sexual function score was found between groups.

Conclusions

The results indicate that episiotomy increased pain at weeks 1, 2 and 6 postpartum, and urinary incontinence at 3 months postpartum. Awareness of the relationship between episiotomy and women's health will help health care professionals develop policy and promote the application of restrictive episiotomy.     

Pronociceptive pain modulation in patients with painful chemotherapy-induced polyneuropathy

Context

Several chemotherapy agents induce polyneuropathy that is painful for some patients, but not for others. We assumed that these differences might be attributable to varying patterns of pain modulation.

Objectives

The aim of the present study was to evaluate pain modulation in such patients.

Methods

Twenty-seven patients with chemotherapy-induced polyneuropathy were tested for detection thresholds (cold, warm, and mechanical) in both the forearm and foot, as well as for heat pain threshold, mechanical temporal summation (TS), and conditioned pain modulation (CPM; also known as the diffuse noxious inhibitory control-like effect), which were tested in the upper limbs.

Results

Positive correlations were found between clinical pain levels and both TS (r = 0.52, P = 0.005) and CPM (r = 0.40, P = 0.050) for all patients. In addition, higher TS was associated with less efficient CPM (r = 0.56, P = 0.004). The group of patients with painful polyneuropathy (n = 12) showed a significantly higher warm detection threshold in the foot (P = 0.03), higher TS (P < 0.01), and less efficient CPM (P = 0.03) in comparison to the group with nonpainful polyneuropathy.

Conclusion

The painfulness of polyneuropathy is associated with a “pronociceptive” modulation pattern, which may be primary to the development of pain. The higher warm sensory thresholds in the painful polyneuropathy group suggest that the severity of polyneuropathy may be another factor in determining its painfulness.     

Vasopressin for cardiac arrest: meta-analysis of randomized controlled trials

Background

Prior meta-analyses-reported results of randomised controlled trials (RCTs) published between 1997 and 2004 failed to show any vasopressin-related benefit in cardiac arrest. Based on new RCT-data and a hypothesis of a potentially increased vasoconstricting efficacy of vasopressin, we sought to determine whether the cumulative, current evidence supports or refutes an overall and/or selective benefit for vasopressin regarding sustained restoration of spontaneous circulation (ROSC), long-term survival, and neurological outcome.

Methods

Two reviewers independently searched PubMed, EMBASE, and Cochrane Database for RCTs assigning adults with cardiac arrest to treatment with a vasopressin-containing regimen (vasopressin-group) vs adrenaline (epinephrine) alone (control-group) and reporting on long-term outcomes. Data from 4475 patients in 6 high-methodological quality RCTs were analyzed. Subgroup analyses were conducted according to initial cardiac rhythm and time from collapse to drug administration (T_DRUG) < 20 min.

Results

Vasopressin vs. control did not improve overall rates of sustained ROSC, long-term survival, or favourable neurological outcome. However, in asystole, vasopressin vs. control was associated with higher long-term survival {odds ratio (OR) = 1.80, 95% confidence interval (CI) = 1.04-3.12, P = 0.04}. In asystolic patients of RCTs with average T_DRUG < 20 min, vasopressin vs. control increased the rates of sustained ROSC (data available from 2 RCTs; OR = 1.70, 95% CI = 1.17-2.47, P = 0.005) and long-term survival (data available from 3 RCTs; OR = 2.84, 95% CI = 1.19-6.79, P = 0.02).

Conclusions

Vasopressin use in the resuscitation of cardiac arrest patients is not associated with any overall benefit or harm. However, vasopressin may improve the long-term survival of asystolic patients, especially when average T_DRUG is <20 min.     

The impact of an education program on hand hygiene compliance and nosocomial infection incidence in an urban Neonatal Intensive Care Unit: An intervention study with before and after comparison

Background

Nosocomial bloodstream infections are a major cause of morbidity and mortality in neonatal intensive care units. Appropriate hand hygiene is singled out as the most important measure in preventing these infections. However, hand hygiene compliance among healthcare professionals remains low despite the well-known effect on infection reduction.

Objectives

We studied the effectiveness of a hand hygiene education program on the incidence of nosocomial bloodstream infections.

Design

Observational study with two pretests and two posttest measurements and interrupted time series analysis.

Setting

A 27 bed level IIID neonatal intensive care unit in a teaching hospital in the Netherlands.

Participants

Healthcare professionals who had physical contact with very low birth weight (VLBW) infants.

Methods

The study was conducted during a period of 4 years. Medical and nursing staff followed a problem-based education program on hand hygiene. Hand hygiene practices before and after the education program were compared by guided observations. The incidence of nosocomial infections in VLBW infants was compared. In addition, numbers of nosocomial bloodstream infections per day-at-risk in very low birth weight infants were analyzed by a segmented loglinear regression analysis.

Results

During 1201 observations hand hygiene compliance before patient contact increased from 65% to 88% (p < 0.001). Median (interquartile range) drying time increased from 4 s (4-10) to 10 s (7-14) (p < 0.001).The proportion of very low birth weight infants with one or more bloodstream infections and the infection rate per 1000 patient days (relative risk reduction) before and after the education program on hand hygiene intervention decreased from 44.5% to 36.1% (18.9%, p = 0.03) and from 17.3% to 13.5% (22.0%, p = 0.03), respectively.At the baseline the nosocomial bloodstream infections per day-at-risk decreased by +0.07% (95% CI −1.41 to +1.60) per month and decreased with −1.25% (95% CI −4.67 to +2.44) after the intervention (p = 0.51). The level of instant change was −14.8% (p = 0.48).

Conclusions

The results are consistent with relevant improvement of hand hygiene practices among healthcare professionals due to an education program. Improved hand hygiene resulted in a reduction in nosocomial bloodstream infections.     

Cognitive determinants of pain and disability in patients with chronic whiplash-associated disorder: A cross-sectional observational study

Objective

To delineate the relative extent to which specific cognitive factors are related to levels of pain and disability in patients with chronic whiplash-associated disorder.

Design

Cross-sectional observation study.

Setting

Three secondary care physiotherapy departments in the Greater Manchester region of the UK.

Participants

All patients with chronic whiplash-associated disorder referred to the participating departments were invited to take part in the study. In total, 124 patients were invited to participate, and 63 (51%) agreed to do so. Complete data were available for 55 (44%) of those invited to participate in the study.

Main outcome measures

Pain and disability, as assessed by the Neck Disability Index.

Results

Cognitive factors were strongly related to levels of disability (R² change = 0.39, P < 0.001). Specifically, greater catastrophising (β = 0.41, P < 0.01) and lower functional self-efficacy beliefs (β = −0.47, P < 0.001) were significantly related to greater levels of disability. Significant univariate correlations were seen between the cognitive factors and current pain intensity. However, no significant associations were seen between the cognitive factors and current pain intensity in the multivariate analysis.

Conclusions

Interventions which aim to reduce catastrophising and enhance functional self-efficacy beliefs should be included alongside conventional physiotherapy interventions when treating patients with chronic whiplash-associated disorder.     

The effectiveness of music in relieving pain in cancer patients: A randomized controlled trial

Objectives

To examine effects of sedative music on cancer pain.

Design

A randomized controlled trial.

Settings

Two large medical centers in Kaoshiung City, in southern Taiwan.

Participants

126 hospitalized persons with cancer pain.

Methods

Participants were randomly assigned to an experimental (n = 62) or a control group (n = 64), with computerized minimization, stratifying on gender, pain, and hospital unit. Music choices included folk songs, Buddhist hymns (Taiwanese music), plus harp, and piano (American). The experimental group listened to music for 30 min; the control group rested in bed. Sensation and distress of pain were rated on 100 mm VAS before and after the 30-min test.

Results

Using MANCOVA, there was significantly less posttest pain in the music versus the control group, p < .001. Effect sizes were large, Cohen's d = .64, sensation, d = .70, distress, indicating that music was very helpful for pain. Thirty minutes of music provided 50% relief in 42% of the music group compared to 8% of the controls. The number needed to treat (NNT) to find one with 50% sensation relief was three patients. More patients chose Taiwanese music (71%) than American music (29%), but both were liked and effective.

Conclusions

Offering a choice of familiar, culturally appropriate music was a key element of the intervention. Findings extend the Good and Moore theory (1996) to cancer pain. Soft music was safe, effective, and liked by participants. It provided greater relief of cancer pain than analgesics alone. Thus nurses should offer calming, familiar music to supplement analgesic medication for persons with cancer pain.     

Decreased plasma levels of soluble receptor for advanced glycation endproducts (sRAGE) in patients with nonalcoholic fatty liver disease

Objectives

Levels of soluble receptor for advanced glycation endproducts (sRAGE) have been linked to several components of the metabolic syndrome. We tested the hypothesis that plasma levels of sRAGE may be associated with non-alcoholic fatty liver disease.

Design and methods

We enrolled subjects with definite nonalcoholic steatohepatitis (NASH, n = 40), borderline NASH (n = 8), simple fatty liver (n = 9) and healthy controls (n = 14). Plasma levels of sRAGE were measured by ELISA.

Results

Concentrations of sRAGE were significantly lower in patients with definite NASH (1080 ± 392 pg/mL, P < 0.01) and borderline NASH (1050 ± 278 pg/mL, P < 0.05) compared to controls (1480 ± 387 pg/mL). Levels of sRAGE were significantly and inversely correlated with ALT (r = − 0.30, P < 0.05) and AST (r = − 0.23, P < 0.05).

Conclusion

Plasma levels of sRAGE are significantly reduced in definite and borderline NASH.     

Detrended fluctuation analysis predicts successful defibrillation for out-of-hospital ventricular fibrillation cardiac arrest

Aims

Repeated failed shocks for ventricular fibrillation (VF) in out-of-hospital cardiac arrest (OOHCA) can worsen the outcome. It is very important to rapidly distinguish between early and late VF. We hypothesised that VF waveform analysis based on detrended fluctuation analysis (DFA) can help predict successful defibrillation.

Methods

Electrocardiogram (ECG) recordings of VF signals from automated external defibrillators (AEDs) were obtained for subjects with OOHCA in Taipei city. To examine the time effect on DFA, we also analysed VF signals in subjects who experienced sudden cardiac death during Holter study from PhysioNet, a publicly accessible database. Waveform parameters including root-mean-squared (RMS) amplitude, mean amplitude, amplitude spectrum analysis (AMSA), frequency analysis as well as fractal measurements including scaling exponent (SE) and DFA were calculated. A defibrillation was regarded as successful when VF was converted to an organised rhythm within 5 s after each defibrillation.

Results

A total of 155 OOHCA subjects (37 successful and 118 unsuccessful defibrillations) with VF were included for analysis. Among the VF waveform parameters, only AMSA (7.61 ± 3.30 vs. 6.30 ± 3.13, P = 0.028) and DFAα2 (0.38 ± 0.24 vs. 0.49 ± 0.24, P = 0.013) showed significant difference between subjects with successful and unsuccessful defibrillation. The area under the curves (AUCs) for AMSA and DFAα2 was 0.63 (95% confidence interval (CI) = 0.52-0.73) and 0.65 (95% CI = 0.54-0.75), respectively. Among the waveform parameters, only DFAα2, SE and dominant frequency showed significant time effect.

Conclusions

The VF waveform analysis based on DFA could help predict first-shock defibrillation success in patients with OOHCA. The clinical utility of the approach deserves further investigation.     

Factors associated with recurrence of venous leg ulcers: A survey and retrospective chart review

Background

Chronic venous leg ulcers have a significant impact on older individuals’ well-being and health care resources. Unfortunately after healing, up to 70% recur.

Objective

To examine the relationships between leg ulcer recurrence and physical activity, compression, nutrition, health, psychosocial indicators and self-care activities in order to provide information for preventive strategies.

Design

Survey and retrospective chart review.

Settings

Two metropolitan hospital and three community-based leg ulcer clinics.

Subjects

A sample of 122 community living patients with leg ulcer of venous aetiology which had healed between 12 and 36 months prior to the survey.

Methods

Data were collected from medical records on demographics, medical history and previous ulcer history and treatments; and from self-report questionnaires on physical activity, nutrition, psychosocial measures, ulcer recurrences and history, compression and other self-care activities. All variables clinically or statistically significantly associated with recurrence at the bivariate level were entered into a logistic regression model to determine their independent influences on recurrence.

Results

Median follow-up time was 24 months (range 12-40 months). Sixty-eight percent of participants had recurred. Bivariate analysis found recurrence was positively associated with ulcer duration, cardiac disease, a body mass index ≤ 20, scoring as at risk of malnutrition and depression; and negatively associated with increased physical activity, leg elevation, wearing Class 2 (20-25 mmHg) or Class 3 (30-40 mmHg) compression hosiery, and higher self-efficacy scores. After adjusting for all variables, an h/day of leg elevation (OR = 0.04, 95% CI = 0.01-0.17), days/week in Class 2 or 3 compression hosiery (OR = 0.53, 95% CI = 0.34-0.81), Yale Physical Activity Survey score (OR = 0.95, 95% CI = 0.92-0.98), cardiac disease (OR = 5.03, 95% CI = 1.01-24.93) and General Self-efficacy scores (OR = 0.83, 95% CI = 0.72-0.94) remained significantly associated (p < 0.05) with recurrence.

Conclusions

Results indicate a history of cardiac disease is a risk factor for recurrence; while leg elevation, physical activity, compression hosiery and strategies to improve self-efficacy are likely to prevent recurrence.     

Minimizing pre- and post-defibrillation pauses increases the likelihood of return of spontaneous circulation (ROSC)

Background

The three-phase model of ventricular fibrillation (VF) arrest suggests a period of compressions to “prime” the heart prior to defibrillation attempts. In addition, post-shock compressions may increase the likelihood of return of spontaneous circulation (ROSC). The optimal intervals for shock delivery following cessation of compressions (pre-shock interval) and resumption of compressions following a shock (post-shock interval) remain unclear.

Objective

To define optimal pre- and post-defibrillation compression pauses for out-of-hospital cardiac arrest (OOHCA).

Methods

All patients suffering OOHCA from VF were identified over a 1-month period. Defibrillator data were abstracted and analyzed using the combination of ECG, impedance, and audio recording. Receiver-operator curve (ROC) analysis was used to define the optimal pre- and post-shock compression intervals. Multiple logistic regression analysis was used to quantify the relationship between these intervals and ROSC. Covariates included cumulative number of defibrillation attempts, intubation status, and administration of epinephrine in the immediate pre-shock compression cycle. Cluster adjustment was performed due to the possibility of multiple defibrillation attempts for each patient.

Results

A total of 36 patients with 96 defibrillation attempts were included. The ROC analysis identified an optimal pre-shock interval of <3 s and an optimal post-shock interval of <6 s. Increased likelihood of ROSC was observed with a pre-shock interval <3 s (adjusted OR 6.7, 95% CI 2.0-22.3, p = 0.002) and a post-shock interval of <6 s (adjusted OR 10.7, 95% CI 2.8-41.4, p = 0.001). Likelihood of ROSC was substantially increased with the optimization of both pre- and post-shock intervals (adjusted OR 13.1, 95% CI 3.4-49.9, p < 0.001).

Conclusions

Decreasing pre- and post-shock compression intervals increases the likelihood of ROSC in OOHCA from VF.     

Perfluorocarbon induced intra-arrest hypothermia does not improve survival in a swine model of asphyxial cardiac arrest

Background

Pulseless electrical activity is an important cause of cardiac arrest. Our purpose was to determine if induction of hypothermia with a cold perfluorocarbon-based total liquid ventilation (TLV) system would improve resuscitation success in a swine model of asphyxial cardiac arrest/PEA.

Methods

Twenty swine were randomly assigned to control (C, no ventilation, n = 11) or TLV with pre-cooled PFC (n = 9) groups. Asphyxia was induced by insertion of a stopper into the endotracheal tube, and continued in both groups until loss of aortic pulsations (LOAP) was reached, defined as a pulse pressure less than 2 mmHg. The TLV animals underwent asphyxial arrest for an additional 2 min after LOAP, followed by 3 min of hypothermia, prior to starting CPR. The C animals underwent 5 min of asphyxia beyond LOAP. Both groups then underwent CPR for at least 10 min. The endpoint was the resumption of spontaneous circulation maintained for 10 min.

Results

Seven of 9 animals achieved resumption of spontaneous circulation (ROSC) in the TLV group vs. 5 of 11 in the C group (p = 0.2). The mean pulmonary arterial temperature was lower in total liquid ventilation animals starting 4 min after induction of hypothermia (TLV 36.3 ± 0.2 °C vs. C 38.1 ± 0.2 °C, p < 0.0001). Arterial pO₂ was higher in total liquid ventilation animals at 2.5 min of CPR (TLV 76 ± 12 mmHg vs. C 44 ± 2 mmHg; p = 0.03).

Conclusion

Induction of moderate hypothermia using perfluorocarbon-based total liquid ventilation did not improve ROSC success in this model of asphyxial cardiac arrest.     

Influence of reduction in the elution times on HPLC glycohaemoglobin results

Objectives

To compare HPLC methods with short and long elution times for HbA1c measurement in blood.

Methods

Comparison between G7-Tosoh (1.2 min); Bio-Rad-Variant-II-Turbo (1.3 min) and Arkray-HA-8160 (2.9 min).

Results

Passing-Bablok regression equations were: Y = 0.17 + 0.96X; Y = − 0.39 + 1.01X; Y = − 0.40 + 1.0X and the means of the differences using Bland-Altman Plot were 0.02; − 0.34; 0.32 for HA-8160/G7-Tosoh, HA-8160/Variant-II-Turbo and G7-Tosoh/Variant-II-Turbo, respectively.

Conclusions

Faster elution methods had no problems on reproducibility of results obtained by slower elution methods.