The effect of microdialysis needle trauma on cutaneous vascular responses in humans.

Microdialysis enables in-depth mechanistic study of the cutaneous circulation in humans. However, whether the insertion or presence of the microdialysis fiber (MDF) affects the skin circulation or its responses is unknown. We tested whether the cutaneous vascular response to whole body heating (WBH) was affected by MDF or by pretreatment with ice (part 1) or local anesthesia (LA; part 2). Eleven subjects participated, 9 in part 1 and 8 in part 2 (5 participated in both). In both parts, four sites on the forearm were selected, providing untreated control, MDF only, ice or LA only, and combined MDF plus ice or LA. A tube-lined suit controlled whole body skin temperature, which was raised to approximately 38 degrees C for WBH. Skin sites were instrumented with laser-Doppler flow probes. Data were expressed as cutaneous vascular conductance (CVC). Baseline levels were not different among sites (P > 0.05). In part 1, the internal temperature for the onset of vasodilation was higher (P > 0.05) with MDF with or without ice pretreatment than at untreated control sites (control 36.6 +/- 0.1 degrees C, Ice 36.5 +/- 0.1, MDF 36.8 +/- 0.1 degrees C, and Ice+MDF 36.8 +/- 0.1 degrees C). Peak CVC during WBH was decreased (P < 0.05) by MDF (control 73 +/- 7 vs. MDF 59 +/- 6% of maximal CVC). Ice (73 +/- 6% of maximal CVC) or Ice+MDF (69 +/- 6% of maximal CVC) did not affect (P > 0.05) peak CVC compared with control. In part 2, the temperature threshold for the onset of vasodilation was increased by MDF with or without LA treatment and by LA alone (P < 0.05; control 36.6 +/- 0.1 degrees C, MDF 36.7 +/- 0.1 degrees C, LA 36.8 +/- 0.1 degrees C, and LA+MDF 36.8 +/- 0.1 degrees C). Peak CVC was decreased by MDF (control 69 +/- 6% of maximal CVC vs. MDF 58 +/- 8% of maximal CVC; P < 0.05). LA only (65 +/- 10% of maximal CVC) or MDF in the presence of LA (73 +/- 12% of maximal CVC) did not affect (P > 0.05) peak CVC compared with control. Thus LA or MDF increases the temperature threshold for the onset of vasodilation. MDF alone decreases the peak vasodilator response in CVC to WBH; however, this attenuation did not occur if ice or LA is used before MDF placement. Ice or LA alone do not affect the peak response in CVC to WBH. How those treatments prevent or reverse the effect of MDF placement is presently unclear.

Effects of 8 weeks sustained follow-up after a nurse consultation on hypertension: a randomised trial.

BACKGROUND: The prevalence of hypertension is high, but the overall control rate is low. Poor control of, hypertension is associated with a number of diseases, such as stroke, heart and renal failure, and high, mortality rates. Studies have shown the separate effects of nurse clinics and telephone follow-up on, blood pressure control, but the incremental effect of combining the two interventions is unknown. OBJECTIVES: This study examines whether there is an incremental effect on blood pressure control when using a nurse clinic combined with telephone follow-up. METHODS: This was a randomised controlled trial. The primary outcome measure was blood pressure reading. The secondary outcome measures included adherence to home blood pressure monitoring, exercise, diet, medication, and satisfaction with care. RESULTS: There were no significant differences in the baseline measures between the control and study groups. Significant differences were found at 8 weeks after intervention was initiated between groups in, systolic blood pressure (control -7.97 vs study -19.03, t=2.35, p=0.022, CI 1.66-20.47) and diastolic, blood pressure (control -3.72 vs study -11.68, t=3.02, p=0.004, CI 2.68-13.24). Other variables with a significant between-group differences (p<0.05) were blood pressure control rate, adherence, to home blood pressure monitoring, exercise and satisfaction with care. Further analysis using, regression showed that home blood pressure monitoring is the most significant predictor for improved, systolic blood pressure. CONCLUSIONS: This study showed that nurse clinics have positive effects on blood pressure control and adherence to healthy lifestyle, but telephone follow-up after such clinics augments the effects of the clinic consultation. This combined mode of services is worth considering for other chronic disease, management programmes.