Hemodynamic Monitoring for the Evaluation and Treatment of Shock: What Is the Current State of the Art?

Hemodynamic monitoring has become a fundamental and ubiquitous, if not defining, aspect of critical care medicine practice. Modern monitoring techniques have changed significantly over the past few years and are now able to rapidly identify shock states earlier, define the etiology, and monitor the response to therapies. Many of these techniques are now minimally invasive or noninvasive. Basic hemodynamic monitoring and evaluation usually includes a focused physical examination and static hemodynamic vital signs: temperature, heart rate, respiratory rate, mean arterial pressure, and arterial hemoglobin oxygen saturation, typically measured with pulse photoplethysmography. When available, measurement of urinary output is often included. Advanced hemodynamic monitoring incorporates both noninvasive and invasive continuous hemodynamic monitoring. Noninvasive ultrasound has emerged as a fundamental hemodynamic evaluation tool and its use is now rapidly increasing. Invasive monitoring from arterial and central venous catheters, and occasionally pulmonary artery catheters, provides measurement of arterial pressure, intracardiac filling pressures, arterial and venous blood gases, and cardiac index. Minimally invasive and noninvasive measure of arterial pressure and cardiac output are also possible and often remain as accurate as invasive measures. Importantly, such advanced monitoring provides the foundation for goal-directed therapies for the treatment of shock. When coupled with functional hemodynamic monitoring analyses, these measures markedly extend the diagnostic and therapeutic potential of all monitoring modalities by defining preload reserve, vasomotor tone, cardiac performance, and tissue perfusion.

Attachment anxiety as a mediator of the relationship between interpersonal trauma and posttraumatic symptomatology among college women.

The identification of variables that mediate the relationship between traumatic life events and posttraumatic symptomatology could help elucidate underlying causal mechanisms and improve therapeutic intervention offered to individuals suffering from posttraumatic stress. The authors examined whether adult attachment, as measured by Brennan, Clark, and Shaver's Experiences in Close Relationships Inventory, mediates the relationship between a broad range of traumatic life events and posttraumatic symptomatology. Participants were 224 ethnically diverse college women. Path analysis indicated that attachment anxiety partially mediated the link between intimate partner violence and posttraumatic symptomatology, as well as the link between adolescent or adult sexual victimization and posttraumatic symptomatology. Attachment avoidance, although associated with posttraumatic stress, did not mediate the relationship between traumatic life events and PTSD symptoms.

Attitudes toward physician-assisted suicide among physicians in Vermont.

BACKGROUND: Legislation on physician-assisted suicide (PAS) is being considered in a number of states since the passage of the Oregon Death With Dignity Act in 1994. Opinion assessment surveys have historically assessed particular subsets of physicians. OBJECTIVE: To determine variables predictive of physicians' opinions on PAS in a rural state, Vermont, USA. DESIGN: Cross-sectional mailing survey. PARTICIPANTS: 1052 (48% response rate) physicians licensed by the state of Vermont. RESULTS: Of the respondents, 38.2% believed PAS should be legalised, 16.0% believed it should be prohibited and 26.0% believed it should not be legislated. 15.7% were undecided. Males were more likely than females to favour legalisation (42% vs 34%). Physicians who did not care for patients through the end of life were significantly more likely to favour legalisation of PAS than physicians who do care for patients with terminal illness (48% vs 33%). 30% of the respondents had experienced a request for assistance with suicide. CONCLUSIONS: Vermont physicians' opinions on the legalisation of PAS is sharply polarised. Patient autonomy was a factor strongly associated with opinions in favour of legalisation, whereas the sanctity of the doctor-patient relationship was strongly associated with opinions in favour of not legislating PAS. Those in favour of making PAS illegal overwhelmingly cited moral and ethical beliefs as factors in their opinion. Although opinions on legalisation appear to be based on firmly held beliefs, approximately half of Vermont physicians who responded to the survey agree that there is a need for more education in palliative care and pain management.

Relationship between football playing ability and selected performance measures.

The relationships between football playing ability (FPA) and selected anthropometric and performance measures were determined among NCAA Division I-A football players (N = 40). Football playing ability (determined by the average of coaches' rankings) was significantly correlated with vertical jump (VJ) in all groups (offense, defense, and position groups of wide receiver-defensive back, offensive linemen-defensive linemen, and running back-tight end-linebacker). Eleven of 50 correlations (groups by variables), or 22%, were important for FPA. Five of the 11 relationships were related to VJ. Forward stepwise regression equations for each group explained over half of the criterion variable, FPA, as indicated by the R(2) values for each model. Vertical jump was the prime predictor variable in the equations for all groups. The findings of this study are discussed in relation to the specificity hypothesis. Strength and conditioning programs that facilitate the capacity for football players to develop forceful and rapid concentric action through plantar flexion of the ankle, as well as extension of the knee and hip, may be highly profitable.