Phase 1 of the Trials of Hypertension Prevention was conducted in 2182 adults, aged 35-54 y, with diastolic blood pressure of 80-89 mm Hg to test the feasibility and blood pressure-lowering effects of seven nonpharmacologic interventions (weight loss, sodium reduction, stress management, and supplementation with calcium, magnesium, potassium, and fish oil). At 6 and 18 mo, weight loss and sodium reduction were well-tolerated and produced significant declines in systolic and diastolic blood pressures (-2.9/-2.4 and -2.1/-1.2 mm Hg for weight loss and sodium reduction, respectively, at 18 mo). None of the other interventions lowered blood pressure significantly at either the 6- or 18-mo follow-up visits. These results suggest that both weight loss and sodium reduction provide an effective means to prevent hypertension. The long-term effects of both of these interventions are being tested in phase 2 of the trial.
Inhibition of the non-weight-bearing quadriceps was studied in ten patients with chronic knee effusions. The muscles were tested with the knees both flexed and extended, before and after joint aspiration. More inhibition was seen when the knees were extended (p less than 0.005). There was no relationship between muscle inhibition and the size of effusion, pain experienced during contraction or the extent of weakness. Aspiration of joints did not reduce the amount of inhibition. Acute effusions have previously been shown to cause muscle inhibition, even when pain-free, and we suggest that the known changes in the compliance of chronically effused joints are responsible for the observed differences in the effect of acute and chronic effusions.
Introduction
There is limited data regarding the typical characteristics of COVID-19 patients requiring interfacility transport or the clinical capabilities of the out-of-hospital transport clinicians required to provide safe transport. The objective of this study is to provide epidemiologic data and highlight the clinical skill set and decision-making needed to transport critically ill COVID-19 patients.
Methods
A retrospective chart review of Persons Under Investigation for COVID-19 transported during the first six months of the pandemic by Johns Hopkins Lifeline was performed. Patients who required interfacility transport and tested positive for SARS-CoV-2 RNA by PCR assay were included in the analysis.
Results
Sixty-eight patients (25.4%) required vasopressor support, 35 patients (13.1%) were pharmacologically paralyzed, 15 (5.60%) were prone, and one (0.75%) was receiving an inhaled pulmonary vasodilator. At least one ventilator setting change occurred for 59 patients (22.0%) and ventilation mode was changed for 11 patients (4.10%) during transport.
Conclusions
The safe transport of critically ill patients with COVID-19 requires experience with vasopressors, paralytic medications, inhaled vasodilators, prone positioning, and ventilator management. The frequency of initiated critical interventions and ventilator adjustments underscores the tenuous nature of these patients and highlights the importance of transport clinician reassessment, critical thinking and decision-making.
Objectives
Data regarding the characteristics of patients who are morbidly and super obese, and the resources they use in nonbariatric hospital settings are limited. The aims of our study were to explore the frequency of inpatient admissions of patients who are morbid (body mass index [BMI] ≥ 40 kg/m2) and super obese (BMI ≥ 50 kg/m2), their specific characteristics, and to identify their utilization of hospital services and resources, 30-day readmission rates, safe patient handling equipment, and patient clinical outcomes.
Methods
We conducted a retrospective chart review of adult patients hospitalized at our institution (n = 1670) who are morbidly obese or super obese. We collected and compared data regarding the characteristics of patients, the services and resources used, the use of any special handling equipment, and patient clinical outcomes.
Results
After accounting for confounding variables, wound care and occupational therapy services were more likely to be required for the patients who are super obese (odds ratio [OR] = 1.49, P = 0.04) than for those who are morbidly obese (odds ratio [OR] = 1.36, P = 0.02). Use of safe patient handling devices was twice as likely for the super obese group (OR = 2.09, P < 0.01). There was no difference in mortality rates between the two patient groups (P = 0.81); patients who are super obese had higher odds of prolonged hospital stay by 32% (P = 0.009).
Conclusions
This study provides an understanding of the characteristics of patients with BMI of 40 kg/m2 or greater who are admitted to the hospital, the resources and services use, and their clinical outcomes. There is also a need to develop an organizational protocol to ensure safe handling using the right devices and activation of appropriate consult services.
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