Semiautomatic Device Research Articles

Abdominal fat and blood pressure in healthy young children.

High blood pressure (BP) and obesity are well known risk factors for cardiovascular diseases. Both risk factors exert an influence early in life, and BP is related to body weight. However, the effect of abdominal fat accumulation on BP in childhood is still unclear. We aimed to determine the relation between visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and BP in young children. In 862 healthy 5-year-old children of the Wheezing-Illnesses-Study-Leidsche-Rijn birth cohort, VAT and SAT were measured ultrasonographically. SBP and DBP were measured in sitting and supine postures using a semi-automatic oscillometric device. General linear regression analyses were performed to assess associations between abdominal fat and BP adjusted for confounders. Further explanatory models were run to explore if associations with localized abdominal fat distributions were independent of measures of overall body adiposity. Each millimeter increase in VAT was related to 0.17 mmHg (95% confidence interval: 0.08; 0.3) and 0.11 mmHg (0.02; 0.2) higher sitting SBP and DBP, respectively. These associations remained after additional adjustment for BMI (SBP: 0.14 mmHg/mm, 0.05; 0.2; DBP: 0.11 mmHg/mm, 0.02; 0.2), waist circumference (SBP: 0.16 mmHg/mm, 0.06; 0.3; DBP: 0.12 mmHg/mm, 0.03; 0.2) or early life growth (SBP: 0.16 mmHg/mm, 0.07; 0.3; DBP: 0.115 mmHg/mm, 0.03; 0.2). Associations between VAT and supine SBP and DBP were, respectively, 0.14 mmHg/mm (0.06; 0.2) and 0.08 mmHg/mm (0.004; 0.2), which remained after further explanatory analyses. SAT was not associated to SBP or DBP. Independent of body size, children with more VAT have higher BP, especially when measured in sitting posture.

The Invention of A Semi-Automatic Pill Sorting Device for Re-using Pills in the Hospital Pharmacy

Automatic tablet dispensing & packing system (ATDPS) is becoming essential in the drug management field of the hospital pharmacy and the local pharmacy. The ATDPS device automatically sorts, distributes, and packages in connection with the order communication system (OCS) or electronic medical record (EMR). In the process of using the ATDPS, some pre-packaged drugs cannot be applied to the patient. Such drugs are re-used after disassembling the packaging. However, many problems such as drug contamination, breakage, and mixing with other drugs can arise during the drug re-using process. Therefore, automation is urgently required in the drug re-using process. Automatic sorting device has not yet been introduced to the domestic pharmacy. The aim of this study was to develop a semi-automatic pills sorting device (SPSD) for the purpose of cost-saving, enhancing operation efficiency, and reducing medication errors. The proposed SPSD is affordable and efficient with potential for use in the pharmacy to help drug management. [Key words] Hospital pharmacy, Discrimination, Automatic device, Pills 의료기관 조제실의 정제 재사용을 위한 반자동 정제분류기 개발에 대한 연구 천영주, 김정태, 임성실 가톨릭대학교 약학대학 임상약학 연구실, 강동경희대학교병원 약제부 The Invention of A Semi-Automatic Pill Sorting Device for Re-using Pills in the Hospital Pharmacy Young Ju Cheon, Jung Tae Kim, and Sung Cil Lim The Catholic University of Korea, College of Pharmacy, 43, Jibong-ro, Wonmi-gu, Bucheon, 14662, Korea, Department of Pharmacy, Kyunghee University Hospital at Gang-dong, 892, Dongnamro, Gangnam-gu, Seoul, 05278, Korea 투고일자 2016.6.2; 심사완료일자 2016.6.23; 게재확정일자 2016.6.30 �교신저자 임성실 Tel:02-2164-6595 E-mail:lim5@catholic.ac.kr Original Article

Safety and efficacy of Ovaleap® (recombinant human follicle-stimulating hormone) for up to 3 cycles in infertile women using assisted reproductive technology: a phase 3 open-label follow-up to Main Study

BackgroundOvaleap® (follitropin alfa), a recombinant human follicle-stimulating hormone intended for use in controlled ovarian stimulation in women undergoing assisted reproductive technologies (ART), showed therapeutic equivalence to Gonal-f® in a multinational, multicenter, randomized, controlled, assessor-blind phase 3 Main Study. The current study examined safety, including immunogenicity, and efficacy of Ovaleap® in an open-label, uncontrolled, follow-up treatment period of up to 2 additional treatment cycles in patients who did not become pregnant in the phase 3 Main Study.MethodsPatients with negative biochemical or clinical pregnancy in the phase 3 Main Study, regardless of treatment group (ie, Ovaleap® or Gonal-f®), were eligible to participate. Patients received Ovaleap® (Merckle Biotec GmbH, Ulm, Germany) for up to 2 additional cycles, administered using a reusable semi-automated pen device. The primary objective was the assessment of safety, including adverse events (AEs), ovarian hyperstimulation syndrome (OHSS), and anti-drug antibodies. Tolerability, patient satisfaction with the Ovaleap® pen device, and efficacy outcomes (as evaluated in the Main Study) were also assessed.ResultsOne hundred forty-seven patients were included in cycle 2, and 61 patients were included in cycle 3. In cycles 2 and 3, 10.9 % (16/147) and 6.6 % (4/61) of patients experienced treatment-emergent AEs (TEAEs), respectively. Three serious TEAEs (ie, appendicitis, OHSS, and borderline ovarian tumor) were reported and successfully resolved. The OHSS TEAE was the only OHSS reported in the study (0.7 % [1/147]). Positive findings on anti-drug antibody assays in 6 serum samples did not show neutralizing activity or clinical relevance in biochemical pregnancy rate. No hypersensitivity reaction occurred. Most patients reported “very good”/“good” local tolerability. All patients were “very confident”/“confident” about dose accuracy and correctness of the injection. They all found use of the pen “very convenient”/“convenient” and were all “very satisfied”/“satisfied” with the pen device. Efficacy outcomes were consistent with the phase 3 Main Study.ConclusionsThese findings further support the safety, including immunogenicity, and efficacy of Ovaleap® for stimulation of follicular development in infertile women undergoing ART. The findings support continued use of Ovaleap® for multiple cycles or a switch to Ovaleap® if pregnancy is initially not achieved with Gonal-f®.Trial registrationEudraCT number: 2009-017674-20. Current controlled trials register number: ISRCTN74772901.

A Wide-Field Fluorescence Microscope Extension for Ultrafast Screening of One-Bead One-Compound Libraries Using a Spectral Image Subtraction Approach.

The increasing involvement of academic institutions and biotech companies in drug discovery calls for cost-effective methods to identify new bioactive molecules. Affinity-based on-bead screening of combinatorial one-bead one-compound libraries combines a split-mix synthesis design with a simple protein binding assay operating directly at the bead matrix. However, one bottleneck for academic scale on-bead screening is the unavailability of a cheap, automated, and robust screening platform that still provides a quantitative signal related to the amount of target protein binding to individual beads for hit bead ranking. Wide-field fluorescence microscopy has long been considered unsuitable due to significant broad spectrum autofluorescence of the library beads in conjunction with low detection sensitivity. Herein, we demonstrate how such a standard microscope equipped with LED-based excitation and a modern CMOS camera can be successfully used for selecting hit beads. We show that the autofluorescence issue can be overcome by an optical image subtraction approach that yields excellent signal-to-noise ratios for the detection of bead-associated target proteins. A polymer capillary attached to a semiautomated bead-picking device allows the operator to efficiently isolate individual hit beads in less than 20 s. The system can be used for ultrafast screening of >200,000 bead-bound compounds in 1.5 h, thereby making high-throughput screening accessible to a wider group within the scientific community.

Prostate Cancer Biomarker Detection Using a 16-Sensor Electrochemical Microfluidic Immunoarray

A semi-automated multiple biomarker-based diagnostic microfluidic device for on-line capture and detection of prostate cancer biomarkers is described herein. In the United States, the lifetime risk of men developing prostate cancer is 1 in 7. Strategies in detection and staging of prostate cancer include prostate specific antigen (PSA) test, digital rectal exam (DRE) and biopsy. These practices often fall short in terms of sensitivity, specificity and inability to distinguish between aggressive and indolent forms of prostate cancer. Inaccurate sensitivity and specificity can lead to unnecessary treatments that adversely affect the patients’ quality of life. Measurement of small panels of molecular biomarkers in serum holds tremendous potential for cancer diagnostics and personalized therapy. The protein panel includes PSA, CD-14, ERG, GOLM-1, PEDF-1, IGF-1, VEGF-D and IGFBP-3, many of which are thought to be specific for aggressive prostate cancer. The protein analytes are captured from serum samples in a two channel on-line microfluidic chamber by magnetic beads labeled with antibodies and signal transducing elements. Captured analytes are then magnetically separated, washed, and introduced into a two channel detection chamber housing an array of 8 or 16 nanostructured, antibody-labeled electrodes. Ultra-low detection limits in the sub fg ml-1 range was achieved for the protein panel. Using this strategy, 8-16 proteins can be detected simultaneously in 30 minutes. Measurements of the selected biomarker panel will be tested with prostate cancer patient samples in future to assess its diagnostic capability.

A new semiautomatic device with horizontal developing chamber for gradient thin-layer chromatography

ABSTRACTA new semiautomatic device with two types of horizontal developing chamber for gradient thin-layer chromatography (TLC) that does not require special procedure of chromatographic plate preparation was developed. The new device was applied for separation of test mixture of 10 dyes showing general elution problem. In addition, a general equation for determination of relative position, , of solutes chromatographed under conditions of stepwise gradient elution with one void volume of mobile phase in TLC has been applied. A satisfactory agreement between calculated (by computer program) and experimental values of has been obtained. In the article, based on obtained results, the advantages and disadvantages of different devices for gradient elution in TLC are discussed.

非侵襲手指関節可動域半自動検査デバイスにおける療法士の負担軽減のための改良

非侵襲手指関節可動域半自動検査デバイスにおける療法士の負担軽減のための改良

High Efficiency Techniques for the Assessment of Railways Infrastructures and Buildings

Railways managers and owners have to face several challenges to ensure commuters’ safety and durable operation of their costly infrastructures and buildings which contribute tremendously to economic development. Whatever brand new or ancient railways infrastructures are concerned and according to heavy operation constraints and to consequences of any unwanted service disruption, the accurate, periodical and updatable evaluation of the condition of environments, structures and equipment is one of these challenges. The vast potential of contact-free innovative methods based on laser scanning and photogrammetric coverage developed accordingly is illustrated here by three recent real-cases: an ancient but congested railway concourse in Paris, retaining walls and tunnels of a new intercity line where increase in train frequency is already foreseen.Operating principles, technical features and benefits of these innovative methods developed to solve operators’ complex technical issues are described in this paper. Structural condition of ancient truss-girder railway concourse through contact-free deformation measurements, complete tri-dimensional geometry as well as structural condition of long soil nail retaining walls and underground tunnels using a compact laser-scanner and photogrammetric coverage semi-automatic device were successfully surveyed and assessed, providing operators reliable and extensive data.

Dermal Abrasion Experienced as an Adverse Effect of the EZ-IO®

BackgroundIn 2007, an update was released to the pediatric and neonatal septic shock guidelines, which emphasized early use of therapies, specifically, first-hour fluid resuscitation and inotrope therapy. This has led to increased use of intraosseous (IO) access as a source of vascular access. Previously, IO access could be obtained only via a manual IO placement. New semi-automatic devices, such as EZ-IO® (Vidacare, Shavano Park, TX), allow for safer and quicker IO access. Data support the use of semi-automatic devices during the acute resuscitation period. Case ReportThe patient was a 7-month old girl with VACTERL association (Vertebral defects, Anal atresia, Cardiac defects, Tracheo-Esophageal fistula, Renal anomalies, Limb abnormalities) and complex past medical history. The patient experienced a “choking episode,” which led to subsequent apnea and cyanosis. The patient presented in shock to a local pediatric emergency department. After multiple unsuccessful intravenous line attempts, IO access was obtained using the EZ-IO®. Once in the pediatric intensive care unit with venous access, the IO device was removed and the site had “red bulls-eye target shape” damage to the skin, which appeared consistent with the EZ-IO® flange. Why Should an Emergency Physician Be Aware of This?IO device use is increasing due to the most recent pediatric and neonatal septic shock guidelines, which emphasize first-hour fluid resuscitation and inotrope therapy. It is vital that emergency physicians be aware of the adverse effects of semi-automatic IO devices, including dermal abrasion, which has not been reported previously. With proper training and familiarity, it is possible to avoid dermal abrasion as an adverse effect of the semi-automatic IO device.

Characteristics of self-measured home blood pressure in a Nigerian urban community: the NIPREGH study.

We investigated the characteristics of self-measured home blood pressure (HBP) in a randomly selected population of Nigerians living in Abuja, Nigeria. HBP was the average of 28 measurements comprising duplicate morning and evening readings obtained over a 7-day period by the participants using a semiautomated oscillometric device. Blood pressure measured five consecutive times by trained observers using mercury sphygmomanometer was averaged as the office blood pressure (OBP). Among the 337 participants included in the analysis, 46.6% were women and their mean age (SD) 40.3 (11.3). The mean, mean+2 SD and 95th percentile of HBP and OBP were 117/76, 147/96 and 145/93 mmHg and 114/73, 147/97 and 142/73 mmHg, respectively. The corresponding values in normotensive individuals were 113/73, 137/89 and 132/88 mmHg and 108/70, 130/88 and 128/84 mmHg. Morning HBPs were significantly higher than that of the evening, with a mean difference (confidence interval) of 1.8 mmHg (1.1-2.5 mmHg) and 1.9 mmHg (1.4-2.3 mmHg) for systolic and diastolic pressures, respectively (P<0.0001). There is a strong correlation between the office and home systolic (r=0.8, P<0.0001) and diastolic (r=0.7, P<0.0001) pressures. Overall, the HBP values were significantly higher than OBP, with a mean difference (confidence interval) of systolic/diastolic of 3.6 mmHg (2.5-4.6 mmHg)/2.3 mmHg (1.4-3.1 mmHg) (P<0.0001). The HBP/OBP difference was maintained in men and normotensive individuals, but in women and hypertensive participants, there was no significant difference between HBP and OBP. Our findings have shown that self-measured blood pressure is feasible and can be used to evaluate blood pressure outside the clinic environment among Nigerians.

Semiautomated aseptic preparation of patient-individual antineoplastic intravenous solutions: first experiences in a German hospital pharmacy

ObjectivesIn 2013, the PharmaHelp device was introduced to daily patient care at the University Hospital of Heidelberg in order to improve process and staff safety and health. It is a...

P93. Ictal SPECT in patients with REM sleep behavior disorder

Introduction Patients with idiopathic REM sleep behavior disorder (iRBD) have the same phenotype as those with Parkinson and RBD (PD + RBD) and narcolepsy and RBD (nRBD). Little is known if different types of RBD share the same pathways during their nocturnal activities. The aim of the study was to compare ictal SPECT of different types of RBD. Methods Recording was performed as 22 channel video-EEG polysomnography using an IT- Med system l. Ictal and interictal subtraction SPECT was performed after using a semiautomatic SPECT injection device permitting immediate intravenous application of the radioligand ECD with a latency or 10 epochs and complex behavior in REM sleep > 10 epochs. Ictal and interictal reconstructed datasets were subtracted pixelwise from each other, the difference images were coregistered to MRI images. Patients 2 iRBD, 2 with nRBD. 1 iRBD patient had converted to Parkinson’s disease (Hoehn & Yahr 4). Patients fulfilled RBD criteria according to the International Classification of Sleep Disorders 2 (2005). All patients gave their written consent. The study was approved by the Ethical Committee of the Chamber of Physicians of the state of Hessen/Germany. Results All patients independent of their RBD type displayed a similar pattern of activation in the ictal SPECT. The activation included the premotor areas bilaterally, the interhemispheric cleft, the periaqueductal area, the dorsal and ventral pons and the anterior part of the cerebellum. Conclusion The ictal pathway of RBD is the same in iRBD, PD + RBD and nRBD.

HYT-hypertension in Turkey: a cross-sectional survey on blood pressure control with calcium channel blockers alone or combined with other antihypertensive drugs.

Although improved during the past few years, high blood pressure control still remains an unmet goal of antihypertensive drug treatment. Among different antihypertensive agents, calcium channel blockers (CCBs), either as monotherapy or in combination with other drugs are recommended by several guidelines for initiation and maintenance of antihypertensive treatment. The HYT-HYperTension survey, carried out in Turkey was aimed to assess (a) blood pressure control in hypertensive patients under treatment with dihydropyridine CCBs, either as monotherapy or in combination with other drugs and (b) the prevalence of blood pressure control in subgroups of patients with cardiovascular risk factors (previous cardiovascular disease, diabetes, renal disease, isolated systolic hypertension, visceral obesity, overweight, current smoking habit). More than 7000 hypertensive patients (60.0 % men, mean age 61.2 ± 11.5 years), routinely visited by either a specialist or a non-specialist physician in the Primary Care Units of 26 cities across Turkey, were enrolled in the survey. Only patients treated with dihydropyridine-type CCBs, as mono- or combination therapy were included in the study, whereas individuals treated with non-dihydropyridine-type CCBs or with other drug classes (as monotherapy or combination therapy), were excluded. Demographic data (age, gender, height, weight, waist circumference, current smoker habit), clinical data and drug treatments were collected at each visit. Blood pressure was measured with a semiautomatic device (Omron-M6) with the patient in sitting position and after at least 5 min of rest. Measurements were repeated three times, at intervals of 5 min each other. In the overall survey population blood pressure control (blood pressure <140/90 mmHg) was achieved in 31.7 % of patients and the average systolic and diastolic blood pressure was 145.3/88.2 mmHg. Prevalence of patients treated with dihydropyridine-type CCBs, either as monotherapy or combined with other drugs, was superimposable (51.6 vs 48.4 %, P = NS). Dihydropyridine-type CCBs were more frequently combined with drugs acting on the renin-angiotensin-aldosterone system (86.4 %), particularly with ACE-inhibitors (34.1 %) and angiotensin II receptor antagonists (52.3 %), while in 13.6 % of patients CCBs were combined with diuretics and/or beta-blockers. Diabetes mellitus was detected in 22.7 % of patients, obesity in 41.5 % and history of cardiovascular disease in 23.0 % (coronary artery disease in 19.2 % and stroke in 3.8 %). Blood pressure control was more difficult to be achieved in complicated hypertension, particularly when cigarette smoking, obesity, overweight, visceral obesity and renal disease were associated with hypertension. Taken together these findings provide evidence that dihydropyridine-type CCBs, particularly when combined with ACE-inhibitors or angiotensin II receptors blockers, allow to achieve a blood pressure control better than the one reported in the same geographic area by other treatment strategies based on different combinations of diuretics, beta-blockers, ACE-inhibitors, angiotensin II receptors blockers and calcium channel blockers.

Resources for Blood Pressure Screening Programs in Low Resource Settings: A Guide From the World Hypertension League.

Resources for Blood Pressure Screening Programs in Low Resource Settings: A Guide From the World Hypertension League.

An accurate semiautomated oscillometric blood pressure device for use in pregnancy (including pre-eclampsia) in a low-income and middle-income country population: the Microlife 3AS1-2.

To assess the accuracy of the Microlife 3AS1-2 blood pressure device in pregnancy and pre-eclampsia in a low-resource setting. Prospective validation according to the British Hypertension Society protocol. A total of 45 pregnant women were recruited from Kimberley Hospital (South Africa), of whom 15 had pre-eclampsia. The Microlife 3AS1-2 device achieved an overall B/A grade in pregnancy (including pre-eclampsia), passing the British Hypertension Society protocol requirements and achieving the International Organization for Standardization standard with a mean difference and SD of -3.8 ± 7.3 and -1.5 ± 6.2 mmHg for systolic and diastolic pressures, respectively. The Microlife 3AS1-2 device can be recommended for use in pregnancy, including pre-eclampsia. In addition, it fulfils the requirements stipulated by the WHO for an automated blood pressure device suitable for use in a low-resource setting. This makes it the ideal device for antenatal clinics and primary healthcare facilities in low-income and middle-income countries.

Current role of computed tomography-guided transthoracic needle biopsy of metastatic lung lesions.

As part of the Catania symposium on lung metastasectomy we reviewed our practice of computed tomography (CT)-guided percutaneous transthoracic needle biopsy of pulmonary metastatic lesions with particular emphasis on diagnostic accuracy and nature of complications lesions. 25 patients with metastatic lesions of the lung have been evaluated between May 2010 and February 2014. Inclusion criteria consisted of patients with histologically confirmed, metastatic disease of the lung, those receiving a CT-guided needle biopsy, were at least 18 years of age; and with adequate hepatic, renal and hematological function. We recorded also the size of the sampled lesions, their distance from the pleura, the complications encountered (pneumothorax and thoracostomy tube placement), the cytological diagnosis and the outcome in all the cases. CT-guided percutaneous transthoracic needle biopsy were performed on 23 of 25 patients with suspected lung metastases. 17 males and six females with a mean age of 71.4 years. The mean size of lesions was 4.2 cm (range: 1 to 17 cm). For CT-guided needle biopsy, an 18 gauge semi-automatic needle biopsy device was used. Of 23 biopsies, 20 (87%) yielded a correct diagnosis with specific histological typing for metastasis. Pneumothorax was the most common complication occurring in four cases (5.7%). CT-guided percutaneous transthoracic needle biopsy is a firm, useful and safe technique for the diagnosis of suspected pulmonary metastases as it avoids open biopsy in most cases.

208-POS

Objectives To assess the Microlife 3AS1-2, a semi-automated oscillometric BP device, compared to mercury sphygmomanometry for use in pregnancy and pre-eclampsia in a low resource setting, according to the requirements of the British Hypertension Society (BHS) Protocol and the International Organization of Standardization (ISO). Methods Prospective observational study, using validation methods recommended by the BHS. 45 pregnant women were recruited from Kimberley Hospital, South Africa, of which 15 were pre-eclamptic. 10 women were in their second trimester, 10 were in their third trimester and 10 had an arm circumference >35 cm. All participants provided written consent. Any subject with cardiac arrhythmia or unclear Korotkoff sounds was excluded. Results The Microlife 3AS1-2 device achieved an overall B/A grade in pregnancy (including pre-eclampsia) and passed all the BHS protocol requirements. The device achieved the ISO standard for mean difference and standard deviation (⩽5 ± 8 mmHg) in pregnancy (including pre-eclampsia). Conclusions The Microlife 3AS1-2 device can be recommended for use in pregnancy, including pre-eclampsia, according to BHS and ISO protocols. As well as demonstrating accuracy in a pregnant low-resource population, it also fulfils all of the requirements stipulated by the World Health Organization for an automated device suitable for use in a low-resource setting. This makes it the ideal device for use in antenatal clinics and primary health-care facilities in low- and middle-income countries. Table 1. Results according to the BHS protocol. Grade ⩽5 mmHg ⩽10 mmHg ⩽15 mmHg Mean difference ± SD (mmHg) Pregnancy (n = 30) Systolic BP A 63 86 96 −2.9 ± 7.4 Diastolic BP A 81 93 99 0.3 ± 5.0 Pregnancy (incl. pre-eclampsia (n = 45)) Systolic BP B 58 82 95 −3.8 ± 7.3 Diastolic BP A 70 90 97 −1.5 ± 6.2 Disclosures H.L. Nathan: None. A. de Greeff: None. N.L. Hezelgrave: None. K.E. Duhig: None. L.C. Chappell: None. A.H. Shennan: None.

Microarray analysis of small non-coding RNAs.

Microarray technology has evolved to efficiently profile the expression of RNAs. However, analysis of small non-coding RNAs (ncRNAs) is challenging due to their short length and highly divergent sequences with large variation in GC content leading to very different hybridization properties. To overcome these challenges, LNA-modified oligonucleotides have been used to enhance and normalize the melting temperature (Tm) of capture probes, which allows sensitive profiling of small ncRNAs regardless of their sequence. Here, we describe the isolation and labeling of small non-coding RNAs, as well as their hybridization to microarrays with LNA-modified oligonucleotide probes using a semi-automated hybridization device.

EZ-IO® intraosseous device implementation in German Helicopter Emergency Medical Service

BackgroundIntraosseous access (IO) is a rapid and safe alternative when peripheral venous access is difficult. Our aim was to summarize the first three years experience with the use of a semi-automatic IO device (EZ-IO®) in German Helicopter Emergency Medical Service (HEMS). MethodsIncluded were all patients during study period (January 2009–December 2011) requiring an IO access performed by HEMS team. Outcome variables were IO rate, IO insertion success rates, site of IO access, type of EZ-IO® needle set used, strategy of vascular access, procedure related problems and operator's satisfaction. ResultsIO rate was 0.3% (348/120.923). Overall success rate was 99.6% with a first attempt success rate of 85.9%; there was only one failure (0.4%). There were three insertion sites: proximal tibia (87.2%), distal tibia (7.5%) and proximal humerus (5.3%). Within total study group IO was predominantly the second-line strategy (39% vs. 61%, p<0.001), but in children<7 years, in trauma cases and in cardiac arrest IO was more often first-line strategy (64% vs. 28%, p<0.001; 48% vs. 34%, p<0.032; 50% vs. 29%, p<0.002 respectively). Patients with IO access were significantly younger (41.7±28.7 vs. 56.5±24.4 years; p<0.001), more often male (63.2% vs. 57.7%; p=0.037), included more trauma cases (37.3% vs. 30.0%; p=0.003) and more often patients with a NACA-Score≥5 rating (77.0% vs. 18.6%; p<0.001). Patients who required IO access generally presented with more severely compromised vital signs associated with the need for more invasive resuscitation actions such as intubation, chest drains, CPR and defibrillation. In 93% EZ-IO® needle set handling was rated “good”. Problems were reported in 1.6% (needle dislocation 0.8%, needle bending 0.4% and parafusion 0.4%). ConclusionsThe IO route was generally used in the most critically ill of patients. Our relatively low rate of usage would indicate that this would be compatible with the recommendations of established guidelines. The EZ-IO® intraosseous device proved feasible with a high success rate in adult and pediatric emergency patients in HEMS.

Ambulatory blood pressure monitoring is ready to replace clinic blood pressure in the diagnosis of hypertension: con side of the argument.

The San Francisco experience with Perloff and Sokolow was the starting point for the clinical application of ambulatory blood pressure (ABP) measurement. Using a semiautomatic device, the superiority of ABP to office measurement was demonstrated in the relationship with hypertension-induced organ damage1 and in the risk for cardiovascular events.2 This seminal study impelled an issue with the largest production and impact in the field of hypertension in recent decades, boosting research and having an enormous influence on daily clinical practice. Initially restricted to specialized clinics, ABP monitoring (ABPM) has largely expanded to primary care in many countries. Similarly, scientific production has increased extraordinarily. The number of articles that include 24-hour ABPM in the title or abstract has grown exponentially from the beginning of the 1990s to ≈600 articles per year. Fifty years on from the pioneering work, ABPM is now considered a keystone in hypertension management. Several guidelines and consensus have been published with recommendations for the monitoring process, reference values, and clinical and research use.3–6 Recently, the ESH-ESC 2013 guidelines7 upgraded the importance of out-of-office BP measurement for hypertension management, and the NICE guidelines8 recommend that, “If the clinic BP is 140/90 mm Hg or higher, offer ABPM to confirm the diagnosis of HTN.” Likewise, the Canadian Education Program in Hypertension9 recommended, “At visit 2 for the assessment of hypertension, patients without macrovascular target organ damage, diabetes mellitus, or CKD but with BP lower than 180/110 mm Hg, should undergo further evaluation using repeated office BP, ABPM or home monitoring.” Moreover, a recent full document10 and a summary11 from the European Working Group on BP Monitoring updated the information available and emphasized fundamentals and recommendations. More recent guidelines in hypertension management from the American Heart Association12 and from …