3M™ Defib-Pads as a Reusable Alternative to Commercial Ultrasound Gel in Resource-Limited Settings.

INTRODUCTION: With point-of-care ultrasound (POCUS) use in austere environments comes the challenge of having an ever-available coupling medium for image generation. Commercial gel has numerous drawbacks that can limit its utility in these settings, and no studies have evaluated the potential for a reusable coupling medium. This study aimed to determine whether 3M™ Defib-Pads could be utilized as a reusable alternative to commercial gel for image generation in resource-limited settings. METHODS: A descriptive, cross-sectional survey of Canadian physicians with POCUS interest was conducted to evaluate the interpretability of various POCUS images in a blinded fashion. Three anatomic regions (cardiac, abdominal, and nerve) were utilized, and image generation from the commercial gel and 7 Defib-Pad conditions were evaluated. These included pads that were 1) newly opened, 2) dirtied then rinsed, 3) air dried, 4) rinsed after being air dried, 5) frozen then thawed, 6) used in double thickness, and 7) used with a probe cover. RESULTS: Compared to commercial gel, 3M™ Defib-Pads performed similarly, with adequate image interpretability of up to 100% in some conditions. The exception was pads that had prolonged air exposure, which produced images that were never interpretable. However, subsequent rinsing of these pads with water resulted in restored image generation. CONCLUSION: 3M™ Defib-Pads were found to produce interpretable POCUS images under multiple environmental stressors and with different modalities of use, suggesting that 3M™ Defib-Pads can perform as a reusable gel alternative in resource-limited settings.

Assessing the Impact of ED Triage Directives on Febrile Oncology Patient Wait Times.

INTRODUCTION: Fever during chemotherapy is a common and potentially severe complication being increasingly evaluated in emergency departments to minimize morbidity and mortality. Streamlining triage of these patients may improve health outcomes and wait times in the health care system. METHODS: A retrospective chart review of febrile patients undergoing chemotherapy was conducted at a local emergency department to assess the impact of nurse-initiated protocols on wait times. RESULTS: We identified 315 patients undergoing current chemotherapy presenting with fever. Of these, 140 (44%) and 87 (28%) were initiated on the sepsis and febrile neutropenia nurse-initiated protocols, respectively. In total, 197 (63%) were admitted. The febrile neutropenia protocol had a shorter wait time from triage to disposition than the sepsis protocol (403 minutes [SD = 23] vs 329 minutes [SD = 19], t = 1.71, P = 0.01). Furthermore, the febrile neutropenia protocol demonstrated shorter times from both triage to lab results reported, in addition to the physician initial assessment in the admitted patient subgroup. DISCUSSION: Decreased wait times from triage associated with the use of a febrile neutropenia protocol could be accounted for by a lower number of lab results required through this protocol in addition to shorter physician assessment times in the admitted population. This study shows that nurse-initiated protocols may influence door-to-antibiotic time for patients undergoing chemotherapy. By having a targeted protocol for the cancer population, health care centers may be able to demonstrate decreased health care expenditure and increased resource availability. Furthermore, as the current population of patients undergoing chemotherapy is at a high risk for neutropenia, prompt management is crucial to minimize mortality.

Isometric exercise training lowers resting blood pressure and improves local brachial artery flow-mediated dilation equally in men and women.

INTRODUCTION: Isometric resistance training has repeatedly shown to be an effective exercise modality in lowering resting blood pressure (BP), yet associated mechanisms and sex differences in the response to training remain unclear. Exploration into potential sex differences in the response to isometric resistance training is necessary, as it may allow for more optimal and sex-based exercise prescription, thereby maximizing the efficacy of the training intervention. PURPOSE: Therefore, we investigated, in normotensives, whether sex differences exist in the response to isometric handgrip (IHG) training. METHODS: Resting BP and endothelium-dependent vasodilation (brachial artery flow-mediated dilation; FMD) were assessed in 11 women (23 ± 4 years) and 9 men (21 ± 2 years) prior to and following 8 weeks of IHG training (four, 2-min unilateral contractions at 30 % of maximal voluntary contraction; 3 days per week). RESULTS: Main effects of time were observed (all P < 0.05), whereby IHG training reduced systolic BP (Δ 8 ± 6 mmHg), diastolic BP (Δ 2 ± 3 mmHg), mean arterial pressure (Δ 4 ± 3 mmHg), and pulse pressure (Δ 5 ± 7 mmHg), accompanied by increases in absolute (Δ 0.09 ± 0.15 mm) and relative (Δ 2.4 ± 4.1 %) brachial artery FMD; however, no significant sex differences were observed in the magnitude of post-training change in any variable assessed (all P > 0.05). CONCLUSION: IHG training effectively lowers resting BP and improves endothelium-dependent vasodilation in men and women, without significant sex differences in the magnitude of response.

Sit, breathe, smile: effects of single and weekly seated Qigong on blood pressure and quality of life in long-term care.

Long-term care (LTC) facilities house individuals with diverse combinations of cognitive and physical impairments, and the practice of Seated Qigong eliminates common exercise barriers. This study hypothesized: 1) a single session would lower blood pressure (BP) and improve quality of life (QOL) in a generalized LTC population, and 2) these responses would be attenuated with chronic (weekly) Seated Qigong practice. Ten residents (6 female; 86 ± 7 years) participated in 1X/week Seated Qigong sessions for 10-weeks. BP and QOL were assessed pre- and post-session at baseline and following 5- and 10-weeks of Qigong. Systolic BP was significantly reduced immediately post-session after 10-weeks of Qigong (P = 0.03), yet unchanged at baseline and after 5-weeks (all P > 0.05). Diastolic BP and QOL remained unchanged (P > 0.05). A session of Seated Qigong elicits a hypotensive response with exposure, supporting the notion that repeated sessions may provide advantageous health benefits.