Veinplicity versus heat treatment for vein dilation: A randomised cross-over study

Background: Peripheral intravenous cannulation is one of the most common invasive procedures for hospitalised patients. Patients with difficult venous access require special measures to facilitate cannulation. Veinplicity applies mild electrical stimulation to forearm veins to aid vessel dilation. To assess this new technique, we compared its effect on the veins to that of standard heat treatment. Methods: In all, 20 volunteers were randomised to receive either application of heat packs to the forearm and later stimulation with Veinplicity or the same two treatments in reverse order. Ultrasound measurements of the basilic, cephalic and brachial veins were taken at intervals during and after treatment and compared with baseline values. Results: The mean maximum vein diameter increase from baseline was significantly higher with Veinplicity than with heat packs (49.94% ± 23.55% vs 36.26% ± 23.09%, p = 0.021). In addition, the mean duration of the dilatory effect was significantly longer with Veinplicity than with heat packs (9.7 ± 3.9°min vs 4.9 ± 2.2°min, p < 0.001). Conclusion: Veinplicity dilates forearm veins more effectively and for a longer time than commonly used heat packs. This new treatment option appears to be a valuable addition to the vascular access toolkit, with the potential to improve first-attempt cannulation rates and spare patients from discomfort, pain and iatrogenic vessel trauma.

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Prevalence of difficult venous access and associated risk factors in highly complex hospitalised patients

Journal of Clinical Nursing ◽

10.1111/jocn.13750 ◽

2017 ◽

Vol 26 (23-24) ◽

pp. 4267-4275 ◽

Cited By ~ 27

Author(s):

Victoria Armenteros-Yeguas ◽

Lucía Gárate-Echenique ◽

Maria Aranzazu Tomás-López ◽

Estíbaliz Cristóbal-Domínguez ◽

Breno Moreno-de Gusmão ◽

...

Keyword(s):

Risk Factors ◽

Venous Access ◽

Hospitalised Patients ◽

Associated Risk Factors ◽

Difficult Venous Access

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EXPERIENCE WITH SUBCUTANEOUS TRASTUZUMAB USED IN RUSSIAN FEDERATION

Medical Council ◽

10.21518/2079-701x-2017-14-40-45 ◽

2017 ◽

pp. 40-45

Author(s):

E. V. Lubennikova ◽

I. P. Ganshina ◽

A. N. Lud ◽

D. V. Komov ◽

I. V. Kolyadina ◽

...

Keyword(s):

Breast Cancer ◽

Venous Access ◽

Similar Efficacy ◽

Central Vein ◽

Her2 Positive ◽

Intravenous Chemotherapy ◽

Her2 Positive Breast Cancer ◽

To Receive ◽

Difficult Venous Access ◽

Positive Breast Cancer

The HannaH study showed that neoadjuvante-adjuvant subcutaneous and intravenous trastuzumab have similar efficacy and tolerability in patients with early HER2-positive breast cancer. The analysis of the results of the subcutaneous and intravenous trastuzumab usage in Russian population showed the favorable association between tpCR anf EFS. tpCR achiviement is associated with clinical benefit in HER2 positive breast cancer. For patients with difficult venous access who do not require intravenous chemotherapy currently, Subcutaneous trastuzumab allows to receive effective treatment without the risk of complications, which involves catheterization of a Central vein.

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Serum thyrotropin-receptor autoantibodies levels after I therapy in Graves' patients: effect of pretreatment with methimazole evaluated by a prospective, randomized study

Acta Endocrinologica ◽

10.1530/eje.0.1510467 ◽

2004 ◽

pp. 467-474 ◽

Cited By ~ 18

Author(s):

VA Andrade ◽

JL Gross ◽

AL Maia

Keyword(s):

Randomized Study ◽

Antithyroid Drugs ◽

131I Treatment ◽

Baseline Values ◽

The Mean ◽

Immunomodulatory Action ◽

To Receive ◽

Hyperthyroid Patients ◽

Clinical Trial Methods

OBJECTIVE: Radioiodine therapy (131I) in hyperthyroid Graves' disease is generally followed by a transitory increase in levels of thyrotropin receptors antibodies (TRAb). Immunosuppressive effects of antithyroid drugs are still a matter of debate. In this study we evaluated the effect of methimazole pretreatment on the TRAb boost induced by 131I. DESIGN: A randomized, prospective clinical trial. METHODS: 61 patients were randomly assigned to receive 131I alone (32 patients) or 131I plus pretreatment with methimazole (30 mg/day; 29 patients). Serum TRAb levels were measured on the day of 131I dosing (D0), and at 1, 3, 6 and 12 months after 131I administration. RESULTS: The mean serum TRAb levels decreased significantly from baseline to D0 in patients treated with methimazole (80.8 vs 48.8 U/l; P<0.05). After 131I treatment, TRAb levels increased at 3 months (48.8 to 60 U/l; 19%) and they were still elevated at 6 months compared with D0 values (99.9 U/l; 105%). Thereafter, TRAb levels decreased to baseline values (47.8 U/l) at 12 months. In hyperthyroid patients, TRAb levels increased significantly from D0 to 1 month (45.0 to 78 U/l; 73%) reaching their highest levels at 3 months (225 U/l; 400%). After this, we observed a progressive decrease to the baseline levels at 12 months (40.0 U/l). The course of TRAb levels after 131I treatment was significantly different between the two groups (P<0.05). Multiple regression analysis identified serum TRAb levels on D0 as independent predictors of TRAb increment after 131I therapy (r2=0.34; P=0.001). A higher increment in serum TRAb levels was associated with hypothyroidism after 1 year of follow-up. CONCLUSION: Methimazole pretreatment attenuates the 131I-induced rise in serum TRAb levels. The effects of methimazole could be attributed to a direct immunomodulatory action or may be due to its effects on the control of hyperthyroidism, which is a known cause of immune dysregulation.

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EXPERIENCE WITH SUBCUTANEOUS TRASTUZUMAB USED IN RUSSIAN FEDERATION

Medical Council ◽

10.21518/2079-701x-2017-14- ◽

2017 ◽

pp. 40-45

Author(s):

E. V. Lubennikova ◽

I. P. Ganshina ◽

A. N. Lud ◽

D. V. Komov ◽

I. V. Kolyadina ◽

...

Keyword(s):

Breast Cancer ◽

Venous Access ◽

Similar Efficacy ◽

Central Vein ◽

Her2 Positive ◽

Intravenous Chemotherapy ◽

Her2 Positive Breast Cancer ◽

To Receive ◽

Difficult Venous Access ◽

Positive Breast Cancer

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The Antiaggressive Action of Combined Haloperidol-Propranolol Treatment in Schizophrenia

European Psychologist ◽

10.1027//1016-9040.5.4.312 ◽

2000 ◽

Vol 5 (4) ◽

pp. 312-325 ◽

Cited By ~ 9

Author(s):

Gadi Maoz ◽

Daniel Stein ◽

Sorin Meged ◽

Larisa Kurzman ◽

Joseph Levine ◽

...

Keyword(s):

Rating Scales ◽

Double Blind ◽

Propranolol Group ◽

Schizophrenic Patients ◽

Propranolol Treatment ◽

Simultaneous Decrease ◽

The Mean ◽

Haloperidol Treatment ◽

To Receive ◽

Drug Free

Psychopharmacological interventions for managing aggression in schizophrenia have thus far yielded inconsistent results. This study evaluates the antiaggressive efficacy of combined haloperidol-propranolol treatment. Thirty-four newly admitted schizophrenic patients were studied in a controlled double-blind trial. Following a 3-day drug-free period and 7 days of haloperidol treatment, patients were randomly assigned to receive either haloperidol-propranolol or haloperidol-placebo for eight consecutive weeks. Doses of medications were adjusted as necessary; biperiden was administered if required. Rating scales were applied to assess aggression, anger, psychosis, depression, anxiety and extrapyramidal symptoms. The mean daily dose of haloperidol was 21 mg (SD = 6.4) in the research group and 29 mg (SD = 6.9) in the controls. Mean and maximal daily doses of propranolol were 159 mg (SD = 61) and 192 mg (SD = 83), and of placebo, 145 mg (SD = 50) and 180 mg (SD = 70), respectively. Compared with the controls, the scores for the research patients decreased significantly from baseline, particularly after 4 weeks of treatment, for some dimensions of anger, psychosis, anxiety, and neuroleptic-induced parkinsonism. A tendency for reduced aggression was shown in the combined haloperidol-propranolol group for some dimensions but not others. These patients also required significantly less biperiden. The tendency toward elevated antiaggressive effect of combined haloperidol-propranolol treatment compared to haloperidol alone may be explained by a simultaneous decrease in aggression, psychotic symptomatology, and anxiety.

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DMSA-scintigraphy in paediatrics: Is the evaluation of the geometric mean necessary for the calculation of the differential renal function?

Nuklearmedizin ◽

10.1055/s-0038-1625921 ◽

2001 ◽

Vol 40 (04) ◽

pp. 107-110 ◽

Cited By ~ 1

Author(s):

B. Roßmüller ◽

S. Alalp ◽

S. Fischer ◽

S. Dresel ◽

K. Hahn ◽

...

Keyword(s):

Renal Function ◽

Geometric Mean ◽

Region Of Interest ◽

Posterior View ◽

Renal Abnormality ◽

Anterior View ◽

Differential Renal Function ◽

The Mean ◽

The Right ◽

To Receive

SummaryFor assessment of differential renal function (PF) by means of static renal scintigraphy with Tc-99m-dimer-captosuccinic acid (DMSA) the calculation of the geometric mean of counts from the anterior and posterior view is recommended. Aim of this retrospective study was to find out, if the anterior view is necessary to receive an accurate differential renal function by calculating the geometric mean compared to calculating PF using the counts of the posterior view only. Methods: 164 DMSA-scans of 151 children (86 f, 65 m) aged 16 d to 16 a (4.7 ± 3.9 a) were reviewed. The scans were performed using a dual head gamma camera (Picker Prism 2000 XP, low energy ultra high resolution collimator, matrix 256 x 256,300 kcts/view, Zoom: 1.6-2.0). Background corrected values from both kidneys anterior and posterior were obtained. Using region of interest technique PF was calculated using the counts of the dorsal view and compared with the calculated geometric mean [SQR(Ctsdors x Ctsventr]. Results: The differential function of the right kidney was significantly less when compared to the calculation of the geometric mean (p<0.01). The mean difference between the PFgeom and the PFdors was 1.5 ± 1.4%. A difference > 5% (5.0-9.5%) was obtained in only 6/164 scans (3.7%). Three of 6 patients presented with an underestimated PFdors due to dystopic kidneys on the left side in 2 patients and on the right side in one patient. The other 3 patients with a difference >5% did not show any renal abnormality. Conclusion: The calculation of the PF from the posterior view only will give an underestimated value of the right kidney compared to the calculation of the geometric mean. This effect is not relevant for the calculation of the differntial renal function in orthotopic kidneys, so that in these cases the anterior view is not necesssary. However, geometric mean calculation to obtain reliable values for differential renal function should be applied in cases with an obvious anatomical abnormality.

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Implantation depth and its influence on complications after TAVI with self-expanding valves

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-021-02275-3 ◽

2021 ◽

Author(s):

Philipp Breitbart ◽

Jan Minners ◽

Manuel Hein ◽

Holger Schröfel ◽

Franz-Josef Neumann ◽

...

Keyword(s):

Characteristic Curve ◽

Fusion Imaging ◽

Paravalvular Leakage ◽

Conduction Disturbances ◽

Transcatheter Aortic Valve ◽

Transcatheter Heart Valve ◽

Implantation Depth ◽

The Mean ◽

Valve Implantation ◽

To Receive

AbstractPrior studies in patients with transcatheter aortic valve implantation (TAVI) demonstrated an influence of transcatheter heart valve (THV) position on the occurrence of new conductions disturbances (CD) and paravalvular leakage (PVL) post TAVI in balloon-expandable valves (BEV). Purpose of this study was to investigate the THV implantation depth and its influence on the occurrence of CD and PVL in self-expanding valves (SEV). We performed fusion imaging of pre- and post-procedural computed tomography angiography in 104 TAVI-patients (all with Evolut R) to receive a 3-D reconstruction of the THV within the native annulus region. The THV length below the native annulus was measured for assessment of implantation depth. Electrocardiograms pre-discharge were assessed for conduction disturbances (CD), PVL was determined in transthoracic echocardiography. The mean implantation depth of the THV in the whole cohort was 4.3 ± 3.0 mm. Using the best cut-off of ≥ 4 mm in receiver operating characteristic curve analysis (sensitivity 83.3%, specificity 60.0%) patients with lower THV position developed more new CD after TAVI (68.2 vs. 23.7%, P < 0.001). A deep THV position was identified as the only predictor for new CD after TAVI (odds ratio [CI] 1.312[1.119–1.539], P = 0.001). The implantation depth showed no influence on the grade of PVL (r = 0.052, P = 0.598). In patients with TAVI using the Evolut R SEV, a lower THV positioning (≥ 4 mm length below annulus) was a predictor for new conduction disturbances. In contrast, implantation depth was not associated with the extent of PVL. Graphic abstract Prostheses positions of self-expanding valves and their influence on the occurrence of new conduction disturbances and the grade of paravalvular leakage after TAVI.

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Ethnicity and outcomes in patients hospitalised with COVID-19 infection in East London: an observational cohort study

BMJ Open ◽

10.1136/bmjopen-2020-042140 ◽

2021 ◽

Vol 11 (1) ◽

pp. e042140

Author(s):

Vanessa J Apea ◽

Yize I Wan ◽

Rageshri Dhairyawan ◽

Zudin A Puthucheary ◽

Rupert M Pearse ◽

...

Keyword(s):

Premature Death ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Organ Support ◽

Invasive Ventilation ◽

Black Patients ◽

Hospitalised Patients ◽

Observational Cohort ◽

The Impact ◽

To Receive

ObjectiveTo describe outcomes within different ethnic groups of a cohort of hospitalised patients with confirmed COVID-19 infection. To quantify and describe the impact of a number of prognostic factors, including frailty and inflammatory markers.SettingFive acute National Health Service Hospitals in east London.DesignProspectively defined observational study using registry data.Participants1737 patients aged 16 years or over admitted to hospital with confirmed COVID-19 infection between 1 January and 13 May 2020.Main outcome measuresThe primary outcome was 30-day mortality from time of first hospital admission with COVID-19 diagnosis during or prior to admission. Secondary outcomes were 90-day mortality, intensive care unit (ICU) admission, ICU and hospital length of stay and type and duration of organ support. Multivariable survival analyses were adjusted for potential confounders.Results1737 were included in our analysis of whom 511 had died by day 30 (29%). 538 (31%) were from Asian, 340 (20%) black and 707 (40%) white backgrounds. Compared with white patients, those from minority ethnic backgrounds were younger, with differing comorbidity profiles and less frailty. Asian and black patients were more likely to be admitted to ICU and to receive invasive ventilation (OR 1.54, (95% CI 1.06 to 2.23); p=0.023 and OR 1.80 (95% CI 1.20 to 2.71); p=0.005, respectively). After adjustment for age and sex, patients from Asian (HR 1.49 (95% CI 1.19 to 1.86); p<0.001) and black (HR 1.30 (95% CI 1.02 to 1.65); p=0.036) backgrounds were more likely to die. These findings persisted across a range of risk factor-adjusted analyses accounting for major comorbidities, obesity, smoking, frailty and ABO blood group.ConclusionsPatients from Asian and black backgrounds had higher mortality from COVID-19 infection despite controlling for all previously identified confounders and frailty. Higher rates of invasive ventilation indicate greater acute disease severity. Our analyses suggest that patients of Asian and black backgrounds suffered disproportionate rates of premature death from COVID-19.

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Oxygen saturation improved with nitrate-based nutritional formula in patients with COVID-19

Journal of International Medical Research ◽

10.1177/03000605211012380 ◽

2021 ◽

Vol 49 (4) ◽

pp. 030006052110123

Author(s):

Sergej M. Ostojic ◽

Aleksandra Milovancev ◽

Patrik Drid ◽

Alexandros Nikolaidis

Keyword(s):

Oxygen Saturation ◽

Patient Reported Outcomes ◽

Case Series ◽

Potassium Nitrate ◽

Open Label ◽

Patient Reported ◽

Baseline Values ◽

Study Participants ◽

To Receive ◽

Test Result

In this open-label case series trial, we evaluated the effects of a nitrate-based nutritional formula on oxygen saturation (SpO2) and patient-reported outcomes in individuals with coronavirus disease 2019 (COVID-19). Five adult patients (three men and two women, age 39.6 ± 6.9 years) with a positive COVID-19 test result, breathing difficulties, and SpO2 ≤95%, who were free from other pulmonary and cardiovascular conditions, were recruited for this study. Participants were assigned to receive a multi-component nutritional formula (containing 1200 mg of potassium nitrate, 200 mg of magnesium, 50 mg of zinc, and 1000 mg of citric acid) every 4 hours during the 48-hour monitoring period. In all participants, SpO2 improved immediately after administration of the nutritional formula, from 1 to 7 percentage points (mean increase 3.6 ± 2.7 points; 95% confidence interval 0.3 to 7.0). SpO2 remained above baseline values throughout the monitoring interval, with values persisting over threshold values (>92%) for all patients and at each time point during the 48 hours. No patients reported any side effects of the intervention. These promising and rather unexpected results call for immediate, well-sampled, mechanistic randomized controlled trials to validate our findings.

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Comparison of the Quality of Life of Patients with Breast or Colon Cancer with an Arm Vein Port (TIVAD) Versus a Peripherally Inserted Central Catheter (PICC)

Current Oncology ◽

10.3390/curroncol28020141 ◽

2021 ◽

Vol 28 (2) ◽

pp. 1495-1506

Author(s):

Brent Burbridge ◽

Hyun Lim ◽

Lynn Dwernychuk ◽

Ha Le ◽

Tehmina Asif ◽

...

Keyword(s):

Quality Of Life ◽

Cancer Patients ◽

Well Being ◽

Venous Access ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Access Device ◽

The Mean ◽

Venous Access Device

Introduction: Venous access is a crucial element in chemotherapy delivery. It remains unclear whether cancer patients prefer a port to a peripherally inserted central catheter (PICC). Our study aimed to assess cancer patients’ satisfaction with their venous access device and to compare the quality of life (QoL) of subjects with a PICC to those with a port. Methods: In this prospective cohort study, EORTC QLQ-C30, and a locally developed quality of life survey (QLAVD), designed to assess satisfaction with venous access devices, were administered to breast or colorectal cancer patients over a one-year period following the device insertion. Mixed effects models were used to assess changes on mean scores at different time points. Results: A total of 101 patients were recruited over a three-year period, (PICC group, n = 50; port group, n = 51). Survey response rates for months one and three were 72% and 48%, respectively. Overall, no significant differences were noted between the two groups in relation to EORTC QOL. At three months, the mean pain scores were 3.5 ± 2.3 for the port and 1.3 ± 0.75 for PICC (<0.001). The mean score for a negative effect of the venous access device on psychosocial well-being was 6.0 ± 4.1 for PICC and 3.0 ± 2.7 for the port (p = 0.005). Complications related to PICCs occurred in 38% patients versus 41% with a port (p > 0.24). Conclusions: Although subjects with a port experienced more pain during the device insertion or access for chemotherapy, it had a smaller negative impact on psychosocial scores than the PICC. No significant differences in complications rates were observed between the two devices.

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