Evaluation of efficacy of priming dose of propofol in reducing induction dose requirements in patients undergoing elective surgeries under general anaesthesia

Background: Priming principle refers to administration of a subanaestheic dose of an agent prior to its actual anaesthetic dose. Propofol is an effective substitute to thiopentone for intravenous induction. The objectives of the study were to evaluate whether priming with propofol would reduce induction of dose, reduce the peri-intubation haemodynamic changes, influence the severity of side effects and influence recall phenomenon.Methods: Sixty patients of ASA Grade 1 and 2, between 18-55 years of age group, of both sexes, were selected on the basis of eligibility criteria and scheduled for elective surgery under general anaesthesia were divided into study and control groups of 30 patients each. The total dose of propofol including the priming (25% of total) dose of propofol, heart rate and blood pressure, baseline (before induction), immediately after intubation, 1 min, 3 min, 5 min after induction, SPO2 (% of oxygen saturation), recall phenomenon and other side effects post operatively were studied.Results: The demographic data were comparable for age, weight and sex in both the groups. Total patients were divided into two groups with 30 patients each. It was observed that total induction dose of propofol was significantly decreased in the study group 72.33±9.53mg compared to control group 115.83±9.00mg. Heart rate was better maintained in study group with minimal post-intubation response. The values of systolic, diastolic and mean blood pressure observed at 1 min after induction also showed significant decrease in control group compared to study group.Conclusions: Propofol produces smooth, rapid, pleasant and safe induction. Priming with propofol can be practiced due to its cost effectiveness and better haemodynamic profile and safety

1. Report No. FHWA/TX-05/0-4420-2 4. Title and Subtitle Techniques for Mitigating Urban Sprawl 2. Government Accession No. 3. Recipient’s Catalog No. 7. Author(s)

Urban sprawl, driven by population and economic growth, is a pressing issue in the U.S., partly because of its contribution to growing levels of vehicle miles traveled (VMT). According to government figures, new development is gobbling up land at an alarming rate of 365 acres per hour (Natural Resources Defense Council 2002). Between 1960 and 1990, the amount of developed land in metro areas more than doubled, while the population grew by less than half (National Resource Defense Council 2001). In response, various efforts to mitigate urban sprawl have been and are being developed and implemented in different contexts and with different intents under the popular umbrella of “smart growth. ” Transportation plays an important role in these efforts. Transportation investments and policies can be used to influence development patterns, and policies that promote more compact development can help to slow the growth in VMT. This report identifies transportation-related and growth-management strategies and policy actions used in smart growth efforts and catalogues them with respect to goals, characteristics, and suitability factors in the form of six matrices, designed as a guide for communities in Texas in the selection of sprawl mitigation techniques appropriate to their specific contexts. The matrices were developed based on a

Overcoming psychological insulin resistance:A practical guide for healthcare professionals

Despite the demonstrated benefits of using insulin, nearly a third of the patients with type 2 diabetes (T2D) are initially reluctant to initiate insulin therapy when it is first recommended by their healthcare provider (HCP). Several studies have documented the reasons for this phenomenon known as psychological insulin resistance (PIR) and also identified actionable strategies for HCPs to assist people with T2D to overcome their PIR. However, most strategies are based on the experiences of HCPs, rather than of patients. Based on findings from a study exploring real-world patient experience around HCP actions for mitigating PIR, we suggest that HCPs use collaborative strategies throughout the course of T2D treatment to 1) explore reasons for PIR, 2) help patients overcome PIR, and 3) follow-up regarding experience with insulin

Overcoming psychological insulin resistance: A practical guide for healthcare professionals

Despite the demonstrated benefits of using insulin, nearly a third of the patients with type 2 diabetes (T2D) are initially reluctant to initiate insulin therapy when it is first recommended by their healthcare provider (HCP). Several studies have documented the reasons for this phenomenon known as psychological insulin resistance (PIR) and also identified actionable strategies for HCPs to assist people with T2D to overcome their PIR. However, most strategies are based on the experiences of HCPs, rather than of patients. Based on findings from a study exploring real-world patient experience around HCP actions for mitigating PIR, we suggest that HCPs use collaborative strategies throughout the course of T2D treatment to 1) explore reasons for PIR, 2) help patients overcome PIR, and 3) follow-up regarding experience with insulin

Identifying solutions to psychological insulin resistance: An international study

Aims: To identify actions of healthcare professionals (HCPs) that facilitate the transition to insulin therapy (IT) in type 2 diabetes (T2D) adults. Methods: Included were T2Ds in seven countries (n = 594) who reported initial IT reluctance but eventually began IT. An online survey included 38 possible HCP actions: T2Ds indicated which may have occurred and their helpfulness. Also reported were delays in IT start after initial recommendation and any period of IT discontinuation. Results: Exploratory factor analysis of HCP actions yielded five factors: “Explained Insulin Benefits” (EIB), “Dispelled Insulin Myths” (DIM), “Demonstrated the Injection Process” (DIP), “Collaborative Style” (CS) and “Authoritarian Style” (AS). Highest levels of helpfulness occurred for DIP, EIB and CS; lowest for AS. Participants who rated DIP as helpful were less likely to delay IT than those who rated DIP as less helpful (OR = 0.75, p = 0.01); participants who rated CS and EIB as helpful were less likely to interrupt IT than those who rated these as less helpful (OR = 0.55, p < 0.01; OR = 0.51, p = 0.01, respectively). Conclusions: Three key HCP actions to facilitate IT initiation were identified as helpful and were associated with more successful initiation and persistence. These findings may aid the development of interventions to address reluctance to initiating IT

Key factors for overcoming psychological insulin resistance:An examination of patient perspectives through content analysis

Objective To understand participant perceptions about insulin and identify key behaviors of healthcare professionals (HCPs) that motivated initially reluctant adults from seven countries (n=40) who had type 2 diabetes (T2D) to start insulin treatment. Research design and methods Telephone interviews were conducted with a subset of participants from an international investigation of adults with T2D who were reluctant to start insulin (EMOTION). Questions related to: (a) participants' thoughts about insulin before and after initiation; (b) reasons behind responses on the survey that were either â € not helpful at all' or â € helped a lot'; (c) actions their HCP may have taken to help start insulin treatment; and (d) advice they would give to others in a similar situation of starting insulin. Responses were coded by two independent reviewers (kappa 0.992). Results Starting insulin treatment was perceived as a negative experience that would be painful and would lead down a â € slippery slope' to complications. HCPs engaged in four primary behaviors that helped with insulin acceptance: (1) showed the insulin pen/needle and demonstrated the injection process; (2) explained how insulin could help with diabetes control and reduce risk of complications; (3) used collaborative communication style; and (4) offered support and willingness to answer questions so that participants would not be â € on their own'. Following initiation, most participants noted that insulin was not â € as bad as they thought' and recommended insulin to other adults with T2D. Conclusions Based on these themes, two actionable strategies are suggested for HCPs to help people with psychological insulin resistance: (1) demonstrate the injection process and discuss negative perceptions of insulin as well as potential benefits; (2) offer autonomy in a person-centred collaborative approach, but provide support and accessibility to address concerns. These findings help HCPs to better understand ways in which they can engage reluctant people with T2D with specific strategies

Randomized Phase 2 Study of ACE-083 in Patients With Charcot-Marie-Tooth Disease

ObjectiveTo determine whether locally acting ACE-083 is safe, well tolerated, and increases muscle volume, motor function, and quality of life (QoL) in adults with Charcot-Marie-Tooth disease (CMT) type 1.MethodsThis phase 2 study enrolled adults with CMT1 or CMTX (N=63). Part 1 was open-label and evaluated safety and tolerability of different dose levels of ACE-083 for use in Part 2. Part 2 was a randomized, placebo-controlled, 6-month study of 240 mg/muscle ACE-083 injected bilaterally in the tibialis anterior muscle, followed by a 6-month, open-label extension in which all patients received ACE-083. Pharmacodynamic endpoints included total muscle volume (TMV; primary endpoint), contractile muscle volume (CMV), and fat fraction. Additional secondary endpoints included 6-minute walk test, 10-meter walk/run, muscle strength, and QoL. Safety was assessed with treatment-emergent adverse events (TEAEs) and clinical laboratory tests.ResultsIn Part 1 (n=18), ACE-083 was generally safe and well tolerated at all dose levels, with no serious AEs, TEAEs ≥Grade 3, or death reported. In Part 2 (n=45 enrolled, n=44 treated), there was significantly greater change in TMV with ACE-083 compared with placebo (LS mean difference: 13.5%; p = 0.0096). There was significant difference between ACE-083 and placebo for CMV and change in ankle dorsiflexion strength. Fat fraction and all other functional outcomes were not significantly improved by ACE-083. Moderate-to-mild injection-site reactions were the most common TEAEs.ConclusionsDespite significantly increased TMV and CMV, patients with CMT receiving ACE-083 in tibialis anterior muscles did not demonstrate greater functional improvement compared with those receiving placebo.Classification of evidenceThis study provides Class II evidence that intramuscular ACE-083 is safe, well tolerated, and increases total muscle volume after 6 months of treatment in adults with CMT1 or CMTX