The impact of different recovery positions on the perfusion of the lower forearm and comfort : a cross-over randomized controlled trial

Abstract: Background: : International guidelines recommend a side-lying recovery position for unresponsive individuals with normal breathing who do not require cardiopulmonary resuscitation. However, high-certainty evidence about an optimal recovery position is lacking. Recent guidelines recommend a position with the arm extended rather than bent, hypothesizing that venous drainage in the dependent lower arm might be compromised. This cross-over randomized controlled trial aims to evaluate the effect of recovery positions with bent or extended arm on perfusion of the lower forearm and comfort. Methods: : Eight healthy volunteers were placed in each of the recovery positions for 15 min, in random order, with an interval of 15 min in supine position. Various perfusion indices of the dependent arm were assessed by radial artery tonometry, ulnar artery echo doppler, and venous congestion plethysmography, as well as participant discomfort, pain and skin discoloration. Differences in outcomes were analyzed with linear mixed models. Results: : Our study found no statistically significant difference in systolic peripheral arterial pressure in the radial artery, peripheral venous pressure at the back of the hand, oxygen saturation, heart rate, subjective pain and discomfort, when comparing both postures. Participants slightly experienced more skin discoloration in the position with extended arm. Conclusions: : We conclude that, since perfusion of the dependent arm was shown to be similar in both positions, both recovery positions can be used. These conclusions fill a gap in evidence and can further support the treatment recommendations regarding the recovery position in first aid settings

The evolution of hypertension treatment in Belgium, a pharmacoepidemiological study

Objectives The aim of this paper is to study the number of patients treated for hypertension and the evolution in usage of different classes of antihypertensive medication. Methods Data from 1997 to 2009 was extracted from Pharmanet, a nation-wide database of prescriptions of reimbursed medication in Belgium. Results In 2009, 25 % of women and 20 % of men were prescribed at least one antihypertensive drug. Prescription rates rose with age but already 25 % of the population aged between 41 and 60 years were treated. More than 50 % of the Belgians above 60 years took antihypertensive medication. From 1997 to 2009, a rise in absolute prescription rate was observed for all antihypertensive drug classes. Diuretics and beta blockers remain by far the most frequently delivered drugs with stable prescription rates of 30 % over this period. The largest rise is observed for angiotensin II receptor blockers (ARBs), which were only sporadically prescribed in 1997 and now account for 10.5 % of the delivered antihypertensive drugs. A small rise is also noted for angiotensin-converting enzyme inhibitors (ACE-inhibitors) (12.3 % in 1997 vs 15.6 % in 2009). Their success comes at the expense of calcium antagonists, of which the delivered amount declined from 19.8 % in 1997 tot 14.1 % in 2009. A progressive rise in the prescription of fixed combination products is observed (from 15 % in 1997 to 21 % in 2009), and can probably be attributed to their growing availability but also to the recent guidelines, promoting their usage. Conclusion Above age 60, the majority of the Belgians are treated with antihypertensive medication. There is a growing tendency for the use of renin angiotensin aldosterone system (RAAS) blockers and fixed combination products.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Non-invasive technique for assessment of vascular wall stiffness using laser Doppler vibrometry

It has been shown that in cardiovascular risk management, stiffness of large arteries has a very good predictive value for cardiovascular disease and mortality. This parameter is best known when estimated from the pulse wave velocity (PWV) measured between the common carotid artery (CCA) in the neck and femoral artery in the groin, but may also be determined locally from short-distance measurements on a short vessel segment. In this work, we propose a novel, non-invasive, non-contact laser Doppler vibrometry (LDV) technique for evaluating PWV locally in an elastic vessel. First, the method was evaluated in a phantom setup using LDV and a reference method. Values correlated significantly between methods (R <= 0.973 (p <= 0.01)); and a Bland-Altman analysis indicated that the mean bias was reasonably small (mean bias <= -2.33 ms). Additionally, PWV was measured locally on the skin surface of the CCA in 14 young healthy volunteers. As a preliminary validation, PWV measured on two locations along the same artery was compared. Local PWV was found to be between 3 and 20 m s(-1), which is in line with the literature (PWV = 5-13 m s(-1)). PWV assessed on two different locations on the same artery correlated significantly (R = 0.684 (p < 0.01)). In summary, we conclude that this new non-contact method is a promising technique to measure local vascular stiffness in a fully non-invasive way, providing new opportunities for clinical diagnosing

Bloeddrukmeting anno 2017

Hypertensie (HT) is de belangrijkste omkeerbare cardiovasculaire risicofactor. Een rationele aanpak van HT vereist dat op de eerste plaats de bloeddruk (BD) correct wordt ingeschat. Studies met cardiovasculaire morbiditeit en mortaliteit als eindpunt toonden onweerlegbaar aan dat dit enkel kan wanneer BD buiten een medische omgeving (“out-of-the-office”) gemeten wordt. Meting van de 24 uur ambulante bloeddruk (ABDM) met een draagbare en programmeerbare monitor is in dit opzicht een “conditio sine qua non”. Enkel deze techniek levert correcte en volledige informatie over het cardiovasculaire risico en over de noodzakelijkheid om bloeddrukverlagende geneesmiddelen op te starten of aan te passen. Enkel ABDM geeft de arts informatie over de aanwezigheid van geïsoleerde nachtelijke HT, episoden van hypotensie, of gemaskeerde HT (een normale consultatiebloeddruk maar HT tijdens ABDM). Gemaskeerde HT komt voor bij 15% van de Vlaamse bevolking, maar draagt een risico vergelijkbaar met HT op raadpleging bevestigd door ABPM. Bovendien is ABDM kosteneffectief. Tot besluit, anno 2017 is ABPM noodzakelijk voor de diagnose van HT en het correct voorschrijven van bloeddrukverlagende geneesmiddelen. Tot op heden vond de Belgische ziekteverzekering geen middelen om door terugbetaling de toegang tot ABDM voor iedereen open te stellen.[Blood pressure measurement anno 2017] The rational management of hypertension (HT) inevitably starts with accurate measurement of blood pressure (BP). Event-driven studies overwhelmingly indicated that out-of-the-office BP monitoring is a prerequisite for risk stratification and for identifying the need of initiating or adjusting antihypertensive drug treatment. 24-H ambulatory BP monitoring is the preferred method of BP measurement. It addresses major issues not covered by conventional or automated office BP measurement or home BP monitoring, such as reliably diagnosing nocturnal HT (the window of the day during which BP is most predictive of adverse cardiovascular outcomes), hypotension, or masked hypertension. This last condition affects 15% of the general populations and carries a risk equal to that of HT on both office and out-of-the-office BP measurement. Moreover, 24-h ambulatory BP monitoring is cost-effective. In conclusion, the overall evidence now overwhelmingly shows that ambulatory BP monitoring is mandatory for the proper management of HT. Health care providers should therefore facilitate access to this technique in both primary and specialized care

Bloeddrukmeting anno 2017

The rational management of hypertension (HT) inevitably starts with accurate measurement of blood pressure (BP). Event-driven studies overwhelmingly indicated that out-of-the-office BP monitoring is a prerequisite for risk stratification and for identifying the need of initiating or adjusting antihypertensive drug treatment. 24-H ambulatory BP monitoring is the preferred method of BP measurement. It addresses major issues not covered by conventional or automated office BP measurement or home BP monitoring, such as reliably diagnosing nocturnal HT (the window of the day during which BP is most predictive of adverse cardiovascular outcomes), hypotension, or masked hypertension. This last condition affects 15% of the general populations and carries a risk equal to that of HT on both office and out-of-the-office BP measurement. Moreover, 24-h ambulatory BP monitoring is cost-effective. In conclusion, the overall evidence now overwhelmingly shows that ambulatory BP monitoring is mandatory for the proper management of HT. Health care providers should therefore facilitate access to this technique in both primary and specialized care.SCOPUS: ar.jinfo:eu-repo/semantics/publishe