A novel method of continuous measurement of head of bed elevation in ventilated patients

Objective We developed a novel pressure transducer-based method of continuous measurement of head of bed elevation. Following validation of the method we hypothesized that head of bed angles would be at or above 30 ° among mechanically ventilated patients throughout the day due to a hospital-wide initiative on ventilator-associated pneumonia prevention and standardized electronic order entry system to keep head of bed at an angle of 30 ° or greater. Design and setting Prospective observational study in university hospital intensive care units. Patients and participants Twenty-nine consecutive mechanically ventilated patients with no contraindications for semirecumbency. Measurements and results We acquired 113 pairs of measurements on unused beds for validation of the method at angles between 3 ° and 70 °. Correlation between transducer and protractor was fitted into a linear regression model (R ² = 0.98) with minimal variation of data along the line of equality. Bland–Altman analysis showed a mean difference of 1.6 ° ± 1.6 °. Ninety-six percent of differences were within 2 SD from the mean. This method was then used among 29 intubated patients to collect head of bed data over a 24-h period for 3 consecutive days. Contrary to our hypothesis, all patients had head of bed angles less than 30 °. Conclusions Our results suggest that this method could be used with high reliability and patients in our institution were not kept even at 30 °. The results are in accord with those of a recent study which found that continued maintenance of previously suggested head of bed angles was difficult to attain clinically. This may lead us to reevaluate methods studying the impact of head of bed elevation in VAP prevention.     

Hopelessness depression in depressed inpatients: Symptomatology,patient characteristics,and outcome

This exploratory study examined the association between level of hopelessness and specific depression symptomatology, patient characteristics, and treatment outcome. Results from 80 unipolar depressed inpatients suggested that high-hopelessness patients could be discriminated from low-hopelessness patients on hypothesized symptoms of depression, characterized by retarded initiation of voluntary responses (a motivational symptom) and sad affect (an emotional symptom). Moreover, high-hopelessness patients could be discriminated from patients low in hopelessness on the patient characteristics of greater suicidal ideation, social dysfunction, and cognitive dysfunction. Finally, compared to low-hopelessness patients, depressed inpatients high in hopelessness exhibited a poorer outcome to pharmacological and cognitive-behavioral treatment interventions.This research was supported by National Institute of Mental Health grants MH-35945 and MH 44778. Preparation of this article was supported by a grant from the National Alliance for Research on Schizophrenia and Depression. Portions of this article were presented at the 26th annual convention of the Association for Advancement of Behavior Therapy, Boston, November 1992.     

Improved Recovery of Erectile Function in Younger Men after Radical Prostatectomy: Does it Justify Immediate Surgery in Low-risk Patients?

Background

Although active surveillance is increasingly used for the management of low-risk prostate cancer, many eligible patients are still nonetheless subject to curative treatment. One argument for considering surgery rather than active surveillance is that the probability of postoperative recovery of erectile function is age dependent, that is, patients who delay surgery may lose the window of opportunity to recover erectile function after surgery.