A Comparison of Non-Invasive Blood Pressure Measurement Strategies with Intra-Arterial Measurement.

INTRODUCTION: It is difficult to obtain an accurate blood pressure (BP) measurement, especially in the prehospital environment. It is not known fully how various BP measurement techniques differ from one another. STUDY OBJECTIVE: The study hypothesized that there are differences in the accuracy of various non-invasive blood pressure (NIBP) measurement strategies as compared to the gold standard of intra-arterial (IA) measurement. METHODS: The study enrolled adult intensive care unit (ICU) patients with radial IA catheters placed to measure radial intra-arterial blood pressure (RIBP) as a part of their standard care at a large, urban, tertiary-care Level I trauma center. Systolic blood pressure (SBP) was taken by three different NIBP techniques (oscillometric, auscultated, and palpated) and compared to RIBP measurements. Data were analyzed using the paired t-test with dependent samples to detect differences between RIBP measurements and each NIBP method. The primary outcome was the difference in RIBP and NIBP measurement. There was also a predetermined subgroup analysis based on gender, body mass index (BMI), primary diagnosis requiring IA line placement, and current vasoactive medication use. RESULTS: Forty-four patients were enrolled to detect a predetermined clinically significant difference of 5mmHg in SBP. The patient population was 63.6% male and 36.4% female with an average age of 58.4 years old. The most common primary diagnoses were septic shock (47.7%), stroke (13.6%), and increased intracranial pressure (ICP; 13.6%). Most patients were receiving some form of sedation (63.4%), while 50.0% were receiving vasopressor medication and 31.8% were receiving anti-hypertensive medication. When compared to RIBP values, only the palpated SBP values had a clinically significant difference (9.88mmHg less than RIBP; P < .001). When compared to RIBP, the oscillometric and auscultated SBP readings showed statistically but not clinically significant lower values. The palpated method also showed a clinically significant lower SBP reading than the oscillometric method (5.48mmHg; P < .001) and the auscultated method (5.06mmHg; P < .001). There was no significant difference between the oscillometric and auscultated methods (0.42mmHg; P = .73). CONCLUSION: Overall, NIBPs significantly under-estimated RIBP measurements. Palpated BP measurements were consistently lower than RIBP, which was statistically and clinically significant. These results raise concern about the accuracy of palpated BP and its pervasive use in prehospital care. The data also suggested that auscultated and oscillometric BP may provide similar measurements.

Evaluation of a primary care-oriented brief counselling intervention for obesity with and without orlistat.

OBJECTIVE: There is a significant need for an obesity treatment model suitable for the primary care environment. We examined the effectiveness of a brief counselling intervention alone, in combination with orlistat, and drug-alone in a 12-month randomized-clinical trial at a medical school obesity centre. METHODS: Participants (N = 250) with body mass index (BMI) >or=27 were randomized. Changes in body weight, lipids, blood pressure and serum glucose were examined. Drug adherence and attendance were also evaluated. RESULTS: Completers analysis was conducted on 136 participants with data at baseline, 6 and 12 months and intention-to-treat analyses (ITT) for the total sample. Amongst completers, participants in the drug only (P = 0.012) and drug + brief counselling (P = 0.001) groups lost more weight (mean +/- SD: -3.8 +/- 5.8 kg and -4.8 +/- 4.4 kg, respectively) than participants in the brief counselling only group at 6 months (-1.7 +/- 3.3 kg), but there were no significant group differences at 12 months. ITT model results were similar to completers at 6 months and remained significant at 12 months, but the weight losses were more modest (<3 kg) for both groups receiving orlistat. For brief counselling alone, participants gained weight (1.7 +/- 4.2 kg). Cardiovascular disease (CVD) parameter changes were negligible. CONCLUSIONS: Pharmacotherapy alone or combined with brief counselling resulted in modest weight losses that had minimal impact on cardiovascular parameters, but were greater than brief counselling alone. Whilst brief interventions and primary pharmacotherapy have been suggested as viable treatments for implementation in primary care settings, our study suggests that such minimal interventions provide minimal benefits.

Does metabolic syndrome mitigate weight loss in overweight Mexican American women treated for 1-year with orlistat and lifestyle modification?

AIMS: To investigate the effects of a pharmacotherapy (orlistat) plus lifestyle management (OLM) intervention on weight loss in Mexican American women with and without metabolic syndrome (MS). METHODS: One hundred and seven female participants aged 21-65 years and of Mexican origin were randomized to either OLM or a wait-list control group (WLC) for one year. The lifestyle interventions were tailored to exhibit features of the Mexican culture. Within each group, subjects with MS were compared to those without MS to assess whether its presence mitigates weight loss. Risk factors for MS also were assessed. RESULTS: Participants with MS in the OLM group experienced significant decreases in weight and body mass index (BMI) as compared to participants without MS. Participants with MS in the OLM group and who completed the study lost 9.3+/-7.5 kg (20.5+/-16.5 lb) as compared to participants with MS in the WLC group, who only lost 0.2+/-3.1 kg (0.4+/-6.8 lb). Further, participants with MS in the OLM group who completed the study experienced a 3.1+/-3.9 kg/m2 decrease in BMI whereas participants with MS in the WLC group only experienced a 0.1+/-1.2 kg/m2 decrease in BMI. No changes in other MS risk factors were significant. CONCLUSIONS: Patients with MS experienced significant weight loss and decreases in BMI as a result of a lifestyle and pharmacotherapy intervention.

Weight loss with meal replacement and meal replacement plus snacks: a randomized trial.

OBJECTIVE: To evaluate whether snacking would improve weight loss and weight maintenance in overweight individuals within the context of a structured meal replacement (MR) weight loss program. DESIGN: A prospective 24 week, 2 (snacking vs nonsnacking) x 2 (MR vs meal replacement augmented with snacks (MRPS)) randomized trial. Participants were instructed to limit their total daily intake to 1200 (women) or 1500 (men) kcals. Those receiving the MR program were instructed not to snack while those in the MRPS program were told to snack three times per day. SUBJECTS: A total of 100 participants were block-randomized, based on prestudy snacking status (high vs low), to receive a standard meal replacement program (MR) or MRPS. MEASUREMENTS: Weight, height, blood pressure, lipid fractions, glucose, and insulin were assessed at the baseline, 12-, and 24 weeks. RESULTS: Completers analysis at 24 weeks demonstrated a significant time effect (F(1,46)=44.6, P<0.001), indicating that all participants lost significant amounts of weight regardless of group assignment. An intention-to-treat model resulted in similar results. By week 24, the average weight loss across groups was 4.6 kg. There also were significant improvements across all groups among completers for systolic blood pressure (P=0.047), cholesterol (P=0.001), LDL (P=0.001), glucose (P=0.004), and insulin (P=0.001) at week 12, and glucose (P=0.001) and insulin at week 24 (P=0.003). CONCLUSIONS: Our results suggest that a participant's preferences for snacking did not affect their response to treatment. Snackers and nonsnackers responded equally well whether they received a standard meal replacement program or one augmented with snacks.

Psychological, nutritional, and energy expenditure differences in college females with anorexia nervosa vs. comparable-mass controls.

This is the first study to examine psychological and behavioral variables in nonhospitalized college females with subclinical anorexia nervosa (AN) as compared to healthy college females of comparable body mass (i.e., body mass index (BMI)<19). Participants who met all DSM-IV [Diagnostic and statistical manual of mental disorders, 4th ed. (1994). Washington, DC: APA.] criteria for AN-restrictive type (except for BMI<17.5; n=11) and control participants (n=15) with comparable body mass completed psychological, nutritional, and exercise assessments. Results suggested that those with AN evidenced more general psychopathology, more eating disorder symptoms, more dieting, more compulsive exercise, and less consumption of calories compared to participants in the control group. There was no difference in macronutrient consumption. There was no significant difference in expenditure of energy, despite differences in reports of compulsive exercise. Given similar body mass, this suggests that the women with AN were experiencing an energy deficit consistent with the disorder's defining features of "fear of gaining weight or becoming fat" and provides us with more understanding of individuals with AN in their natural environment.

Interactions between model proteins and deoxyribonucleic acids.

Interactions between DNA and model proteins, poly(L-Lys(m)L-Ala(n)), where m + n = 100%, have been investigated using thermal denaturation and circular dichroism (CD). All complexes of DNA with these proteins precipitate in a small range of input ratios, protein to DNA, with the midpoints of all precipitation curves close to a 1:1 ratio of lysine to phosphate. The melting temperature of model protein-bound DNA regions decreases slightly as the alanine content of the model protein is increased, which can be explained as a result of insufficient charge neutralization of phosphates by lysine residues in the model proteins. In the free state, these model proteins possess varying amounts of alpha helix, random coil, or a mixture of these two, depending upon the relative lysine/alanine content. When bound to DNA, the CD of the complex shows a substantial increase in alpha-helical structure for those model proteins with 40-60% alanine, while there is no significant change in alpha-helical structure when the percent alanine is either substantially higher or lower (i.e., 81 or 19% alanine). Only those complexes formed with model proteins having 40-60% alanine undergo a drastic transition from a B-type CD to an A-type in the presence of intermediate ionic strength (0.2 M NaCl, for example). Poly(Lys19Ala81)-DNA complexes show a slight transition toward A-type CD at 0.4 M NaCl or higher. Apparently other factors, in addition to alanine and alpha-helical content, must be responsible for this B leads to A transition. At the other extreme of lysine/alanine ratio, with high lysine content, poly(Lys81Ala19) or polylysine, the presence of NaCl produces a B leads to psi transition. The possible significance of these differences in response to the binding of these model proteins is discussed.