The reliability of auscultatory measurement of arterial blood pressure. A comparison of the standard and a new methodology

In 48 individuals with a wide range of arm circumferences blood pressure measured indirectly with two different cuffs was compared to direct intraarterial measurements. The two cuffs were a standard size cuff (12 X 35 cm) and a newly developed cuff, containing three rubber bags of different sizes, which automatically selects the appropriately sized bag in relation to arm circumference (Tricuff, Pressure Group AB, Sweden). The Tricuff correctly placed 42 of the 43 patients in the "normotensive" range, ie, diastolic blood pressure less than 90 mm Hg, whereas the standard cuff put only 33 of 44 patients in this range (P less than .005). The discrepancy was not only due to the expected better performance in patients with obese arms, but also in the subgroup of patients with arms in the range 22 to 31 cm, in which group both cuffs would measure blood pressure with a 12 cm wide rubber bag. The number of correctly identified "normotensive" patients was noticeably higher with the Tricuff than with the standard cuff (30/31 v 25/32, P = .053). The better specificity of the new cuff thus offers an improvement over the standard cuff. There are several potential clinical advantages of this, mainly that the risk of erroneously labelling normotensive individuals as hypertensive is reduced.     

Cancer patients' perceptions of quality‐of‐care attributes—Associations with age,perceived health status,gender and education

Aims and objectives

The aim of this study was to explore the associations between patients' gender, education, health status in relation to assessments of patient‐centred quality and individuality in care and trust in nurses for those <65 (working age) and ≥65 years (older people).

Background

Patients' assessments of the quality of care they receive are essential for the development of the provision of patient care and services. Previous studies have revealed age of the patient is associated with their assessment of care quality attributes.

Design

The study employed a cross‐sectional, multicultural comparative survey design.

Methods

The data were collected using questionnaires among hospitalised cancer patients (N = 876, n = 599, 68%) in four European countries: Greece, Cyprus, Sweden and Finland. The data were divided into two subgroups based on age (cut point 65 years) and were analysed statistically.

Results

Cancer patients' age, gender and level of education were not related to their assessments of care quality attributes: person‐centred care quality, individuality in care and trust in nurses. Subgroup analysis of the older adults and those of working age showed clear associations with patients' assessments of quality‐of‐care attributes and perceived health status. The lower the perceived health status, the lower the assessment of care quality attributes.

Discussion

The results suggest that the cancer itself is the strongest determinant of the care delivered, rather than any patient characteristics, such as age, education or gender. Perceived health status, in association with cancer patient assessments of care quality attributes, may be useful in the development of patient‐centred, individualised care strategies alongside a stronger focus on people instead of cancer‐care‐related processes and duties.

Conclusions

Health status was the only factor associated with cancer patients' assessments of care quality attributes. Cancer itself may be the strongest determinant of the care quality perceptions, rather than any patient characteristics.

Relevance to clinical practice

The findings of this study have implications for cancer care professionals in terms of patient assessment and care planning. The measures may be useful in assessing quality of cancer nursing care.     

The effects of simulated obstructive apnea and hypopnea on arrhythmic potential in healthy subjects

Preliminary evidence supports an association between OSA and cardiac dysrhythmias. Negative intrathoracic pressure, as occurring during OSA, may provoke cardiac dysrhythmias. Thus, we aimed to study the acute effects of simulated apnea and hypopnea on arrhythmic potential and measures of cardiac repolarization [QT_C and T _peak to T _end intervals ( $ T_{\text{p}} T_{{{\text{e}}_{\text{c}} }} $ )] in humans. In 41 healthy volunteers, ECG was continuously recorded prior, during and after simulated obstructive hypopnea (inspiration through a threshold load), simulated apnea (Mueller maneuver), end-expiratory central apnea and normal breathing in randomized order. The number of subjects with premature beats was significantly higher during inspiration through a threshold load (n = 7), and the Mueller maneuver (n = 7) compared to normal breathing (n = 0) (p = 0.008 for all comparisons), but not during end-expiratory central apnea (n = 3, p = 0.125). Inspiration through a threshold load was associated with a non-significant mean (SD) increase of the QT_C interval [+5.4 (22.4) ms, 95 %CI ?1.7 to +12.4 ms, p = 0.168] and a significant increase of the $ T_{\text{p}} T_{{{\text{e}}_{\text{c}} }} $ interval [+3.7 (8.9) ms, 95 %CI +0.9 to +6.6 ms, p = 0.010]. The Mueller maneuver induced a significant increase of the QT_C interval [+8.3 (23.4) ms, 95 %CI 0.9 to +15.6 ms, p = 0.035] and the $ T_{\text{p}} T_{{{\text{e}}_{\text{c}} }} $ interval (+4.2 (8.2) ms, 95 %CI +1.6 to +6.8 ms, p = 0.002). There were no significant changes of the QT_C and $ T_{\text{p}} T_{{{\text{e}}_{\text{c}} }} $ intervals during central end-expiratory apnea. These data indicate that simulated obstructive apnea and hypopnea are associated with an increase of premature beats and prolongation of QT_C and $ T_{\text{p}} T_{{{\text{e}}_{\text{c}} }} $ intervals. Therefore, negative intrathoracic pressure changes may be a contributory mechanism for the association between OSA and cardiac dysrhythmias.     

Real-time RT-PCR for the determination of topoisomerase II mRNA level in leukaemic cells

We developed a real-time RT-PCR assay for the quantification of topoisomerase II (topo II) mRNA level. It was applied on peripheral leukaemic cells from 23 patients with acute myelogenous leukaemia (AML) and 23 with chronic lymphocytic leukaemia (CLL). RNA template dilutions from 0.25 to 25ng per reaction were used as standard curves for topo IIalpha, beta and the internal control 18S rRNA. About 57% (26/46) and 26% (12/46) of the specimens had detectable topo IIbeta and alpha mRNA, respectively. The correlation between these two factors was rho=0.7 and P=0.0001. No relationship between topo IIalpha or beta mRNA level and response to chemotherapy was found in AML patients (n=19 assessable for response).Our method is rapid and convenient for quantification of topo IIalpha and beta mRNA levels, and could be suitable for investigation in a larger population.     

Royal naval physician Sir John Jamison (1776-1844), Scurvy and Sweden's medico-surgical institute

As a direct consequence of Sweden's devastating losses in its war with Russia in 1808-9, an institute for the training of military surgeons was established in Stockholm in December 1810. This establishment soon became known as the Karolinska Institute and is the forerunner of today's eponymous institution. This paper records the nature of the British assistance that led indirectly to the founding of this institute. This aid took the form of a report into the high morbidity and mortality rates due to scurvy which were sustained by the Swedish Fleet in Carlscrona in the summer of 1808. This report, written by John Jamison, Fleet Physician to the Baltic Command of Sir James Saumarez, was used by the Stockholm medical authorities as part of their campaign for improved training of military medical personnel. Whilst Jamison's report did not in itself lead to the establishment of the Stockholm medico-surgical institute, it was undoubtedly important, and serves both as an example of Anglo-Swedish relations during the Napoleonic era and a reminder of the ravages of scurvy.     

How to handle informed consent in longitudinal studies when participants have a limited understanding of the study

Empirical findings from a Swedish longitudinal screening study show that many of the research subjects had a limited understanding of the study. Nevertheless they were satisfied with the understanding they had and found it sufficient for informed continued participation. Were they wrong? In this paper, it is argued that the kind of understanding that is morally required depends partly on the kind of understanding on which the research subjects want to base their decisions, and partly on what kind of knowledge they lack. Researchers must ensure that the information process is not flawed and that participants receive the information they want. To achieve this, new information efforts may be needed. Researchers must also ensure that research subjects have knowledge about aspects of importance to them. Lack of understanding may, however, be the result of conscious choices by research subjects to disregard some of the information because it is not important to them. Such choices should normally be respected.     

Information and informed consent in a longitudinal screening involving children: a questionnaire survey

This empirical study explores participants' perceptions of information and understanding of their children's and their own involvement in a longitudinal screening, the ABIS Study. ABIS (All Babies In Southeast Sweden) is a multicentre, longitudinal research screening for Type 1 diabetes and multifactorial diseases involving 17 005 children and their families. For this study, a random selection of mothers was made, using perinatal questionnaire serial numbers from the ABIS study. In total, 293 of these mothers completed an anonymous questionnaire (response rate 73.3%). Our findings from the questionnaire indicate a marked difference between the reported satisfaction with and understanding of the information provided on the one hand and the significant lack of knowledge of some of the aims and methods of the ABIS screening on the other, namely concerning high-risk identification of involved children, potential prevention and future questionnaires. Two questions evoked by our results are: (1) what information is required for participants in longitudinal studies involving children? and (2) how do we ensure and sustain understanding, and thus in a prolonging, informed consent in these studies? This study underlines the importance of an increased understanding of the ethical issues that longitudinal research on children raise and the need to discuss how information and informed consent strategies should be analysed and designed in longitudinal studies.