Placement of finger oximeter on the ear: comparison with oxygen saturation values taken from the finger.

Pulse oximetry is widely used to assess oxygen saturation (SpO2) in order to guide patient care and monitor the response to treatment. However, inappropriate oximeter probe placement has been shown to affect the measured oximetry values in healthy and normoxic outpatients. This study evaluated how treatment decisions might be impacted by SpO2 values obtained using a finger probe placed on the pinna of the ear in a cohort of 46 patients receiving non-invasive ventilation compared with values obtained from a probe on the finger and the results of arterial blood gas (ABG) (SaO2) analysis. Bland-Altman analysis was performed to evaluate agreement between the methods. Finger probe saturation was not statistically different from SaO2, with a mean difference of -0.66% (P>0.05). Saturation from the ear was significantly different (-4.29%; P<0.001). Subgroup analysis in hypoxic patients (SaO2<90%) showed a significant difference between ABG SaO2, and finger and ear SpO2. The study provides evidence that placement of a finger probe on the ear is unsafe clinical practice, potentially leading to patient mismanagement.

Diagnosis of occupational asthma from serial measurements of forced expiratory volume in 1 s (FEV1) using the Area Between Curves (ABC) score from the Oasys plotter.

OBJECTIVES: To identify the changes in serial 2-hourly forced expiratory volume in 1 s (FEV1) measurements required to identify occupational asthma (OA) using the Oasys Area Between Curves (ABC) score. METHODS: The ABC score from 2-hourly measurements of FEV1 was compared between workers with confirmed OA and asthmatics without occupational exposure to identify the optimum separation using receiver operator characteristic (ROC) analysis. Separate analyses were made for plots using clock time and time from waking to allow for use in shift workers. Minimum record criteria were ≥6 readings per day, >4 day shifts and >4 rest days (or >9 days for controls). RESULTS: A retrospective analysis identified 22 workers with OA and 30 control asthmatics whose records reached the quality standards. Median FEV1 diurnal variation was 20.3% (IQR 16.1-32.6) for OA and 19.5% (IQR 14.5-26.1) for asthmatic controls. ROC curve analysis identified that a difference of 0.056 L/hour gave a ROC score of 0.821 for clock time and 0.768 for time from waking with a sensitivity of 73% and a specificity of 93% for the diagnosis of OA. CONCLUSIONS: The diagnosis of OA requires objective confirmation. Unsupervised serial FEV1 measurements are more difficult to obtain reliably than measurements of peak expiratory flow, which are likely to remain the standard for general use. A FEV1 ABC score >0.056 L/hour provides a valid cut-off for those who wish to use FEV1 rather than peak expiratory flow.

Advanced roles in respiratory healthcare science: it's not just spirometry.

Respiratory physiologists and clinical scientists are often still regarded as the "spirometry technician". @shakeyjs, @resp_edward, @Breath_to_win and @melaniebryce11 report on the evolving role of healthcare scientists working in respiratory physiology. http://bit.ly/2lQjlsc.

Endovascular Aneurysm Repair May Provide a Survival Advantage in Patients Deemed Physiologically Ineligible for Open Abdominal Aortic Aneurysm Repair.

BACKGROUND: Cardiopulmonary exercise testing (CPET) provides an objective assessment of functional capacity and fitness. It can be used to guide decision making prior to major vascular surgery. The EVAR-2 trial suggested that endovascular aneurysm repair (EVAR) in patients unfit for open repair failed to provide a significant survival advantage over nonsurgical management. The aim of this study is to assess contemporary survival differences between patients with poor CPET measures who underwent EVAR or were not offered surgical intervention. METHODS: A prospectively maintained database of CPET results of patients considered for elective infrarenal aortic aneurysm repair were interrogated. Anaerobic threshold (AT) of <11 mL/min/kg was used to indicate poor physical fitness. Hospital electronic records were then reviewed for perioperative, reintervention, and long-term outcomes. RESULTS: Between November 2007 and October 2017, 532 aortic aneurysm repairs were undertaken, of which 376 underwent preoperative CPET. Seventy patients were identified as having an AT <11 mL/min/kg. Thirty-seven patients underwent EVAR and 33 were managed nonsurgically. All-cause survival at 1, 3, and 5 years for those patients who underwent EVAR was 97%, 92%, and 81%, respectively. For those not offered surgical intervention survival at the same points was 72%, 48%, and 24% [hazard ratio, HR = 5.13 (1.67-15.82), P = 0.004]. Aneurysm-specific survival at 1, 3, and 5 years for those patients who underwent EVAR was 97%, 94%, and 94%, respectively. Survival at the same time points for those not offered surgical intervention was 90%, 69%, and 39%, respectively [HR = 7.48 (1.37-40.82), P = 0.02]. CONCLUSIONS: In this small, retrospective, single-center, nonrandomized cohort, EVAR may provide a survival advantage in patients with poor physical fitness identified via CPET. Randomized studies with current generation EVAR are required to validate the results shown here.

Improved arthritic knee health in a pilot RCT of phytotherapy.

Although practitioner-prescribed 'western' herbal medicine (phytotherapy) is a popular complementary therapy in the UK, no clinical studies have been reported on patient-orientated outcomes. The objective of this pilot study was to investigate the effects of phytotherapy on symptoms of osteoarthritis of the knee. A previous study of Chinese herbal medicine for the treatment of irritable bowel syndrome, published in the Journal of the American Medical Association, acted as a model in the development of the protocol of this investigation. Twenty adults, previously diagnosed with osteoarthritis of the knee, were recruited from two Inner London GP practices into this randomized, double-blind, placebo-controlled, pilot study carried out in a primary-care setting. All subjects were seen in consultation three times by a herbal practitioner who was blinded to the randomization coding. Each subject was prescribed treatment and given lifestyle advice according to usual practice: continuation of conventional medication where applicable, healthy-eating advice and nutrient supplementation. Individualized herbal medicine was prescribed for each patient, but only dispensed for those randomized to active treatment-- the remainder were supplied with a placebo. At baseline and outcome (after ten weeks of treatment), subjects completed a food frequency questionnaire and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee health and Measure Yourself Outcome Profile (MYMOP) wellbeing questionnaires. Subjects completing the study per protocol (n = 14) reported an increased intake of wholegrain foods (p = 0.045) and oily fish (p = 0.039) compared to baseline, but no increase in fruit and vegetables and dairy products intakes. There was no difference in the primary outcome measure of knee health assessed as the difference in the mean response (baseline-week 10) in WOMAC score between the two treatment groups. However, there was, compared with baseline, improvement in the active group (n = 9) for the mean WOMAC stiffness sub-score at week 5 (p = 0.035) and week 10 (p = 0.060) but not in the placebo group (n = 5). Furthermore, for the active, but not the placebo group, the mean WOMAC total and sub-scores all showed clinically significant improvement (> or = 20%) in knee symptoms at weeks 5 and 10 compared with baseline. Moreover, the mean MYMOP symptom 2 sub-score, mostly relating to osteoarthritis (OA), showed significant improvement at week 5 (p = 0.02) and week 10 (p = 0.008) compared with baseline for the active, but not for the placebo group. This pilot study showed that herbal medicine prescribed for the individual by a herbal practitioner resulted in improvement of symptoms of OA of the knee.

'They look like my kind of people'--perceptions of smoking images in youth magazines.

Ten years ago research showed that pro-smoking images were prevalent in British youth magazines, whereas there was little coverage of smoking and health. Since then there has been a great expansion in the number of youth magazines, and particularly those aimed at young men. Titles such as FHM and Loaded, which did not exist at the time of the previous research, are now market leaders. New qualitative and quantitative research has therefore been conducted to examine the prevalence and impact of smoking images in this revitalised youth style magazines market. This paper presents the findings of the qualitative element of this research, which examined British first year students' perceptions of the pro-smoking imagery found in the magazines and explored the relationship between this and their own smoking images and identities. The research found that: (a) this imagery was perceived to be, on the whole, attractive, sociable and reassuring; (b) that it supported young people's perceptions of smoking and reinforced their smoker identities; and (c) that it has the potential to be more powerful than advertising imagery.