Dynamic stability margin using a marker based system and Tekscan: A comparison of four gait conditions

Stability during gait is maintained through control of the center of mass (CoM) position and velocity in relation to the base of support (BoS). The dynamic stability margin, or the interaction of the extrapolated center of mass with the closest boundary of the BoS, can reveal possible control errors during gait. The purpose of this study was to investigate a marker based method for defining the BoS, and compare the dynamic stability margin throughout gait in comparison to a BoS defined from foot pressure sensors. The root mean squared difference between these two methodologies ranged from 0.9 cm to 3.5 cm, when walking under four conditions: plantigrade, equinus, everted, and inverted. As the stability margin approaches −35 cm prior to contralateral heel strike, there was approximately 90% agreement between the two systems at this time point. Underestimation of the marker based dynamic stability margin or overestimation of the pressure based dynamic stability margin was due to inaccuracies in defining the medial boundary of the BoS. Overall, care must be taken to ensure similar definitions of the BoS are utilized when comparing the dynamic stability margin between participants and gait conditions.     

Braden量表预测无创正压通气致鼻面部压疮研究

目的探讨Braden量表与无创正压通气患者鼻面部压疮发生的相关性，为护理干预提供指导，预防压疮的发生。方法采用前瞻性研究设计，入院时对患者进行Braden评分及一般资料调查，入院次日采集空腹血标本进行生化指标检查。对接受无创正压通气治疗的患者，每日进行鼻面部压疮危险的评估。直至患者停机。以发生压疮为因变量，采用单因素及二分类Logistic回归分析其影响因素。结果44例患者中13例（29．5％）发生压疮，发生压疮的患者在Braden量表及其感觉、潮湿、活动、移动及营养维度方面得分均低于未发生压疮者，差异有显著意义。多因素分析中只有Braden评分进入回归方程，评分每增加1分，发生压疮的概率降低19．6％。结论Braden评分可用于无创正压通气患者鼻面部压疮发生风险的评估，可根据评估结果，对易发生压疮的患者采取预防措施，避免不良事件的发生，提高患者使用无创正压通气的依从性。     

Association between presence of pneumonia and pressure ulcer formation following traumatic spinal cord injury

Objective: To determine if the presence of pneumonia and pressure ulcers are associated in individuals with an acute spinal cord injury during acute care and rehabilitation hospitalizations.

Design: Retrospective, secondary analyses of data obtained from the Spinal Cord Injury Model Systems enrolled from 1993 until 2006

Setting: Acute care hospitalization and inpatient rehabilitation facilities

Participants: A cohort of individuals hospitalized in acute care (n?=?3,098) and inpatient rehabilitation (n?=?1,768) was included in the analysis. Frequencies of pressure ulcer formation and episodes of pneumonia were noted in both settings.

Interventions: Not applicable.

Outcome Measures: Pressure ulcer formation and diagnosis of pneumonia

Results: The development of pressure ulcers, including stage I, was 20.3% acute care and 21.1% during in inpatient rehabilitation. Multivariate logistic regression analyses revealed a significant association of pneumonia with occurrence of pressure ulcers (P?≤?0.001, OR?=?2.3 and 2.2 respectively), the American Spinal Injury Association Impairment Scale grades (P?Conclusion: A higher presence of pressure ulcers was found in individuals with pneumonia, after adjusting for injury severity, age, sex, and utilization of mechanical ventilation. Impaired inflammatory response and decreased mobility in individuals with pneumonia may predispose these individuals to develop pressure ulcers. Surveillance and preventive measures for pressure ulcers should be rigorous in individuals with SCI and pneumonia.     

Risk factor profile and achievement of treatment goals among hypertensive patients from the Israeli Blood Pressure Control (IBPC) program--initial cost utility analysis

Aims: Blood pressure (BP) reduction is crucial in reducing cardiovascular morbidity and mortality. The IBPC (Israeli Blood Pressure Control) program was initiated in order to enhance the control of modifiable risk factors among high-risk hypertensive patients under follow-up by general practitioners in Israel. The cost effectiveness of an intervention program is an important factor in the decision-making process of its implementation and therefore was evaluated here. The objective of this evaluation is to estimate the costs, monetary savings and benefits in terms of QALYs (quality-adjusted life years) that would be expected if the program were to be expanded to 100 clinics nationwide, enabling around 14 800 persons to be treated. Methods: Hypertensive patients were screened in 30 general practice clinics, supervised by specialists in family medicine, each seeing 1000-5000 patients; 50-250 hypertensive patients were diagnosed at each participating clinic. BP levels, body mass index (BMI), lipid and glucose levels, as well as target organ damage and medications were recorded for all patients. Results: A total of 4948 (2079, 42% males) were registered. Mean age was 64.8 ± 12 years. After 1 year of follow-up versus baseline, the various parameters were as follows: BP control was achieved in 46.4% vs 29% of all hypertensive patients. LDL control (JNC VI criteria) was achieved in 41.7% vs 31.2% of all patients. Fasting plasma glucose control (glucose 200 mg/dl. Obesity (BMI >30 kg/m[Formula: See Text]) was noted in 36.7% vs 43.8% at baseline. The cost utility analysis of the reduction in risk factors was calculated based on the international dicta applied to the reduction in risk factors as a result of treatment. For 100 clinics nationwide and 14 800 persons to be treated the net saving to health services would be $977 993 and the increase in QALYs would be 602 years. Conclusions: Better risk factor control in hypertensive patients by general practitioners could reduce morbidity and mortality as well as be cost effective.     

康惠尔水胶体敷料在治疗长期卧床老年患者压疮方面的疗效观察与护理

目的：观察长期卧床的老年患者使用康惠尔水胶体敷料治疗压疮方面的疗效。方法收集我科近1年来共42例压疮,采用对照组与观察组的方法,对照组21例,观察组21例,均为长期卧床的老年患者,两组患者通过使用康惠尔水胶体敷料对压疮治疗的观察与护理,以9d为1个疗程,采用统计学分析。结果康惠尔水胶体敷料在治疗压疮方面有显著的疗效,同时便于患者的护理,值得推广使用。     

Acute hemodynamic effects of ethanol in conscious spontaneously hypertensive and normotensive rats

This study investigated the differential hemodynamic effects of small to high doses of ethanol in conscious age-matched spontaneously hypertensive rats (SHRs) and Wistar Kyoto rats (WKYs). Changes evoked by ethanol (0.25, 0.5, or 1 g/kg, i.v.) or equal volume of saline in mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), stroke volume (SV), and total peripheral resistance (TPR) were followed for 90 min in the two rat strains. The baseline MAP (163 +/- 4 vs. 113 +/- 2 mm Hg) of SHRs was significantly (p < 0.05) higher, compared with WKYs due mainly to the presence of an elevated TPR 13.82 +/- 0.12 vs. 2.51 +/- 0.09 mm Hg/ml/min/100 g, p < 0.05) in SHRs. In both rat strains, all doses of ethanol produced immediate increases in MAP at 1 min, after which the MAP responses varied and depended on the rat strain and dose of ethanol used. In WKYs, 0.25 g/kg ethanol had no effect on MAP, but caused significant decreases in CO and SV and increased HR. Ethanol (0.5 and 1 g/kg) produced a short-lived (10 min) and dose-related increase in MAP. The higher dose (1 g/kg) of ethanol elicited significant (p < 0.05) increases in TPR that were counterbalanced by concomitant decreases in CO and SV. In SHRs, the two higher doses (0.5 and 1 g/kg) of ethanol elicited significant (p < 0.05) decreases and increases in MAP, respectively, compared with control (saline-treated) values. The pressor response to the 1 g/kg dose of ethanol was associated with an increase in TPR that achieved a statistical significance (p < 0.05) at 50 and 80 min after ethanol administration. HR was significantly (p < 0.05) reduced by the two higher doses of ethanol, whereas SV and CO were not changed. Blood ethanol concentrations measured 10, 30, and 60 min after ethanol administration were similar in SHRs and WKYs. These findings suggest that acute administration of ethanol to conscious rats elicits hemodynamic responses that are strain- and dose-dependent. In contrast to a short-lived and dose-related pressor response in WKYs, ethanol (0.5 and 1 g/kg) elicited opposite and longer lasting effects on MAP (decreases and increases, respectively) in SHRs. In both rat strains, the pressor response to the higher dose of ethanol was associated with an increase in TPR; an effect that was compromised by a concomitant decrease in CO in WKYs but not SHRs.     

Cardiovascular responses to physical and psychological stress in female alcoholics with transitory hypertension after early abstinence

BACKGROUND: Male alcoholic patients with acute withdrawal hypertension have shown exaggerated cardiovascular reactivity to stress after 3 to 4 weeks of abstinence, although resting blood pressures (BP) had returned to normal. Studies of this nature, however, have not been extended to women. METHODS: In this study, 32 alcohol-dependent women, abstinent for 4 weeks, were compared with 16 healthy controls on cardiovascular hemodynamics during rest and in response to 2 moderately aversive stressors: isometric handgrip and a speech task. The alcoholics were placed according to withdrawal BP into transitory hypertensive (tHT; n = 16; BP >or=140/90 mm Hg) and normotensive (NT; n = 16; BP <140/90 mm Hg) subgroups. RESULTS: During stress testing, the transitory hypertensive women had increased diastolic BP (p < 0.01), a higher peripheral resistance index (p < 0.05), and a reduced cardiac efficiency index (p < 0.03) relative to the normotensive and control subjects. CONCLUSIONS: This cardiovascular pattern suggests that both cardiac and vascular functions were altered adversely in the transitory hypertensives. In contrast to men examined in previous studies, the transitory hypertensive women had no exaggeration of BP reactivity, but instead showed sustained alterations of resting cardiovascular function in relation to chronic alcohol consumption. Although the pattern of cardiovascular dysregulation seems to be different in female alcoholics than in males, it is consistent with studies showing that cardiovascular effects in women are more severe than in men and emerge at a lower threshold level of chronic drinking.     

Regional distribution of action potential abnormalities induced by subacute right ventricular pressure overload

Right ventricular pressure overload of 3 days' duration was established in cats by banding of the pulmonary artery. To characterize the regional distribution of the resulting electrophysiologic changes, the right ventricular free wall, adjacent pulmonary outflow tract and septum were mounted in tissue bath and examined by conventional microelectrode techniques. Abnormal action potentials, identified by a negative shift of the voltage level of phase 2 with a corresponding accentuation of phase 1, were recorded from sites contiguous to the tricuspid valve and pulmonary outflow tract and in limited adjacent areas. No abnormal action potentials were recorded on the septal surface, apical end of the free wall, or at any right ventricular location in normal or sham-operated cats. Abnormal potentials could be recorded from sites sampled 5 cell layers deep in the endocardium. The number and extent of distribution of cells demonstrating altered action potentials correlated best with increased right ventricular wet weight at time of sacrifice. Abnormal cells responded to epinephrine or elevated extracellular calcium by a shift in plateau voltage towards zero and by an increase in action potential duration prior to usual plateau shortening. Responsiveness of these cells to agents which influence slow inward current suggests pressure overload-induced changes in the cell membrane that limit or otherwise affect availability of calcium. Regional distribution of plateau potential abnormalities may reflect differential physical stress within the myocardium provoked by sudden pressure overload.     

Predictive ability of the EVARUCI scale and COMHON index for pressure injury risk in critically ill patients: A diagnostic accuracy study

Background

Hospital-acquired pressure injuries are a costly and largely preventable complication occurring in a variety of acute care settings. Patients admitted to the intensive care unit are at greater risk of developing pressure injuries.