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Aims and objectives: To evaluate both concordance among those measurements obtained by three different pulse oximeters currently used by nursing professionals in hospital units and the factors which can influence this concordance. Background: Many models of wireless pulse oximeters in the present market do not offer possibility of calibration and, therefore, they do not ensure patients' safety in daily clinical practice. Design: This is a descriptive and cross-sectional study. The sample of patients (140) was selected from such hospital units, and all of them had to fulfil inclusion and exclusion criteria for participation. Methods: The instruments used to carry out this research were a monitor (calibrated), two models of portable wireless pulse oximeters (used for 3 years by the nursing staff, without being calibrated), a tympanic thermometer and a weather meter. The concordance correlation coefficient (CCC) was used to establish the concordance, whereas the Landis-Koch criteria were used to interpret the results. Results: The concordance among the three devices was considered as “good” (CCC: 0.925 and 0.974 (95%)). The CCC (0.925) for saturation measures was regarded as “very good”/”almost perfect,” and the pulse measure was considered as “very good” CCC 0.974, providing in both cases a high level of concordance (CCC > 0.91). Conclusions: The overall concordance as regards pulse and oxygen saturation among the three pulse oximeters analysed is considered as “very good” according to the Landis-Koch criteria. Relevance to clinical practice: There exists a “very good” concordance among two wireless oximeters which have been used by the health staff for 3 years and which did not offer any possibility of calibration and one monitor which belongs to the healthcare institution. This aspect is of crucial importance in daily clinical practice, and it is also relevant to ensure patient’s safety. [ABSTRACT FROM AUTHOR]

Parachute jump is an extreme activity that elicits an intense stress response that affects jumpers’ body systems being able to put them at risk. The present research analysed modifications in blood oxygen saturation (BOS), heart rate (HR), cortisol, glucose, lactate, creatine kinase (CK), muscles strength, cortical arousal, autonomic modulation, pistol magazine reload time (PMRT) and state anxiety before and after an automatic open parachute jump in 38 male Spanish soldiers (25.6 ± 5.9 years). A MANOVA with samples as a fixed factor and Effect Size (ES) were conducted. MANOVA showed (Wilks lambda = .225;F = 5.980;P = .000) a significantly increase in cortisol (6.2 ± 3.2 vs. 8.2 ± 4.3 nmol/l;P = .025; ES = .47), HR (75.0 ± 14.6 vs. 87.4 ± 17.3 bpm;P = .004; ES = .72), lactate (1.8 ± 1.2 vs. 4.4 ± 2.2 mmol · l−1;P = .002; ES = 1.18), sympathetic nervous system and leg strength manifestation after the parachute jump. By contrary BOS, PMRT (55.6 ± 27.6 vs. 48.0 ± 16.7 s;P = .021; ES = .46) and somatic anxiety (SA), evaluated by CSAI2R questionnaire, decreased. An automatic parachute jump increased physiological and cortical response and decreased SA of participants. This stress response can affect the jumpers’ abilities and allow us to have a better understanding of the organism stress response and to improve training for both military and sport parachute jumps. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effects of craniosacral therapy on disability, pain intensity, quality of life, and mobility in patients with low back pain. Design: A single-blinded randomized controlled trial. Patients: Sixty-four patients with chronic nonspecific low back pain (mean age ± SD, 50 ± 12 years; 66% female) who were referred for physical therapy at a clinical unit of the Health Science School of the University of Almeria (Spain). Interventions: Participants were randomly assigned to an experimental group (10 sessions of craniosacral therapy) or a control group (10 sessions of classic massage). Outcome measures: Disability (Roland Morris Disability Questionnaire [RMQ, primary outcome] and Oswestry Disability Index), pain intensity (10-point numeric pain rating scale), kinesiophobia (Tampa Scale of Kinesiophobia), isometric endurance of trunk flexor muscles (McQuade test), lumbar mobility in flexion, hemoglobin oxygen saturation, systolic blood pressure, diastolic blood pressure, hemodynamic measures (cardiac index), and biochemical estimation of interstitial fluid. These outcomes were registered at baseline, after treatment, and 1-month follow-up. Results: No statistically significant differences were seen between groups for the main outcome of the study, the RMQ ( p = 0.060). However, patients receiving craniosacral therapy experienced greater improvement in pain intensity ( p ≤ 0.008), hemoglobin oxygen saturation ( p ≤ 0.028), and systolic blood pressure ( p ≤ 0.029) at immediate- and medium-term and serum potassium ( p = 0.023) level and magnesium ( p = 0.012) at short-term than those receiving classic massage. Conclusions: Ten sessions of craniosacral therapy resulted in a statistically greater improvement in pain intensity, hemoglobin oxygen saturation, systolic blood pressure, serum potassium, and magnesium level than did 10 sessions of classic massage in patients with low back pain. [ABSTRACT FROM AUTHOR]

Background: In healthy subjects, Nordic walking (NW) generates higher oxygen uptake (V˙O2) than standard walking at an equal rate of perceived exertion (RPE). The feasibility and positive outcomes of NW in patients with chronic obstructive pulmonary disease (COPD) have been reported. Objectives: The aim of the current study is to assess the physiological responses and RPE during NW in COPD patients. Methods: In 15 COPD patients [mean (SD) age 67 (9) years] with a forced expiratory volume in the 1st s of 55% (15)], V˙O2, minute ventilation and heart rate were measured with a portable system during the 6-min walking test (6MWT), incremental shuttle walking test (SWT), 6-min NW on solid ground (6mNWground) and 6-min NW on soft dry beach sand (6mNWsand). The RPE using a modified Borg scale was assessed after each test. Results: 6mNWground and 6mNWsand showed a higher V˙O2 plateau compared with the 6MWT and peak V˙O2 measured during SWT [mean (SD) V˙O2 21 (3), 22 (4), 18 (4) and 19 (5) ml·kg-1·min-1, respectively; p < 0.05 each]. However, no differences in RPE were observed among 6mNWground, 6MWT and SWT [modified Borg scale score for dyspnea 4.2 (2.0), 4.1 (1.8) and 4.3 (1.7), respectively; nonsignificant]. However, RPE in 6mNWsand was significantly higher than in all the other exercise protocols [modified Borg scale score for dyspnea 5.2 (2.2); p < 0.05]. Conclusions: In COPD patients, the use of Nordic poles generates higher V˙O2 than standard walking with no differences in the dyspnea score. The results indicate the potential to enhance community-based training programs in these patients. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

BACKGROUND: Increased dead-space fraction is common in patients with persistent acute respiratory distress syndrome (ARDS). We evaluated the changes in the oxygenation and dead-space fraction in patients with persistent ARDS after corticosteroid therapy. METHODS: This was a non-randomized non-placebo, controlled observational study including 19 patients with persistent ARDS treated with corticosteroids. We measured PaO2 /FIO2 and dead-space fraction at days 0, 4, and 7 after corticosteroids treatment (methylprednisolone) initiation. Patients were classified in intermediate group when corticosteroids were initiated between days 8-14 after ARDS onset, and in late group when initiated after 14 days. RESULTS: Mean time from the diagnosis of the ARDS to methylprednisolone treatment was 11 2 days in the intermediate group (10 patients) and 21 8 days in the late group (9 patients). When comparing days 0, 4, and 7 after methylprednisolone treatment, we found an increase in the PaO2 /FIO2 (145 ± 64 mm Hg, 190 ± 68 mm Hg, and 226 ± 84 mm Hg, respectively, P < .001) and a decrease in the physiological dead-space fraction (0.66 ± 0.10, 0.58 ± 0.12, and 0.53 ± 0.11, respectively, P < .001). No differences were found between the intermediate and late groups. CONCLUSIONS: In patients with persistent ARDS, the increase in oxygenation was accompanied by a decrease in the dead-space fraction after a few days of corticosteroid treatment. To confirm potential benefit of corticosteroids on physiological parameters and mortality will require a powered randomized placebo controlled trial. [ABSTRACT FROM AUTHOR]

The assessment of pain is particularly difficult in critical patients unable to self-report or with cognitive impairment. In such cases, the use of scales which evaluate pain through patient behaviour is important. To compare the behavioural responses to pain, measured on the Critical-Care Pain Observation Tool (CPOT) scale, and the physiological responses prior to, during and after the positioning procedure in patients with invasive mechanical ventilation. We also sought to analyse whether there are differences in the CPOT scores between medical and surgical patients, and between conscious and unconscious patients. Pain scores were evaluated in 96 patients. The data gathering was carried out 1 min before, during and 10 min after the turning by means of the CPOT scale which includes four behavioural indicators, each indicator scored from 0 to 2. Likewise, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR) and arterial oxygen saturation (SpO) were recorded. The total mean score on the CPOT scale prior to the positioning procedure was 0·27; during turning it was 1·93 and 0·10 after the procedure ( p < 0·05). Facial expression was the indicator that increased most with reference to the baseline situation, followed by body movements; compliance with the ventilator, and finally, muscle tension. There were also slight variations in these physiological variables during the turning procedure ( p < 0·05). The total mean score on the CPOT scale during the turning of surgical patients was 2·02 and 1·80 for medical patients ( p = 0·162). The observation of the patient's behaviour during the turning and the physiological changes produced allow professionals to objectify pain in critical patients with verbal communication difficulties. Moreover, our results also highlight the need to administer of additional analgesia before a painful procedure, particularly in post-surgical patients. The good measurement qualities of the CPOT scale obtained during a painful procedure recommend its use in intensive care units (ICUs) for adult patients with artificial ventilation. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) patients are very sensitive to changes in pulmonary mechanics and central ventilation control during sleep and may develop significant gas exchange alterations with increased hypoxemia and hypercapnia. Oxygen therapy improves nocturnal desaturation but can worsen hypoventilation. Objectives: To analyze the prevalence of nocturnal hypoventilation (NHV) in hypercapnic COPD patients and to determine predictive factors for this phenomenon. Methods: This was a prospective multicenter study which enrolled 80 clinically stable COPD patients with hypercapnic respiratory failure who fulfilled the conventional criteria for long-term oxygen therapy (LTOT). All patients had undergone pulmonary function testing, blood gas analysis, and respiratory polygraphy. Arterial blood gas samples were obtained while patients were awake and during sleep. NHV was considered when an increase in PaCO2 >10 mm Hg was observed in any nocturnal arterial blood gas sample as compared to the awake levels. Results: Seventeen patients (21%) developed NHV. NHV was associated with the values of BMI, hemoglobin, hematocrits, DLCO, and PaO2 reached after oxygen administration. In the logistic regression analysis BMI (OR 1.26, 95% CI 1.068-1.481; p = 0.006) and the diurnal increase of PaO2 after O2 (OR 0.89, 95% CI 0.807-0.972; p = 0.010) were the variables that best discriminated with a sensitivity of 82% and a specificity of 78%. Conclusions: NHV is a relatively common finding in stable hypercapnic COPD patients undergoing LTOT and it is related to a higher BMI and lower PaO2 after oxygen administration. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The aims of this study were to assess the physical activity and aerobic fitness of a group of university students (n=399) and to evaluate their risk for cardiovascular disease. Leisure-time physical activity, body composition, systolic and diastolic blood pressure, and maximal oxygen uptake ([image omitted] ) were assessed. During leisure time, the majority (53.5%) of female students were found to be sedentary, while the majority of male students (49.6%) were found to be active (P<0.001). Active students, both males (P<0.05) and females (P<0.05), had higher absolute and relative [image omitted] values than their sedentary counterparts. No statistically significant differences were found in anthropometric or blood pressure values according to the different physical activity classification levels. In contrast, relative [image omitted] was negatively associated with percentage body fat (males: P<0.01; females: P<0.01) and body mass index (males: P<0.01; females: P<0.01). We also found a negative association between relative [image omitted] and systolic (males: P<0.05; females: P<0.01) and diastolic blood pressure (males: P<0.01; females: P<0.01). The present results indicate that poor physical fitness, evaluated in terms of relative [image omitted] , is associated with a higher risk of cardiovascular disease in university students. This is a cause for concern, especially for male studentsp, since their aerobic capacity was found to be rather low. [ABSTRACT FROM AUTHOR]

Previous studies have shown that actuate stress have a negative effect on working memory, visio-spatial ability and symptoms of disassociation. We conducted the present research with the aim of to analyse the effect of experience and training in psychophysiological response, attention and memory of soldiers in combat. Variables of blood lactate, blood glucose, blood oxygen saturation, body temperature, heart rate, lower body muscular strength manifestation, autonomic modulation, cortical arousal, cognitive and somatic anxiety, and memory by a post mission questionnaire were analysed before and after a combat simulation in 49 soldiers of Spanish Army. Combat simulation produced a significant increase (p < 0.05) in blood lactate, blood glucose, blood oxygen saturation, rated perceived exertion, heart rate, cognitive and somatic anxiety. Significant increase in low frequency domain and significant decrease in high frequency domain of the heart rate variability was found in experienced and highly trained soldiers. The percentage of correct response in the post mission questionnaire indicated that elements better remembered were those related with soldier integrity and considered as a possible life threat, Significant differences in the post mission questionnaire by experience and training was also found. Correlation analysis showed that higher psychophysiological activation correlated positively with cognitive impairment and lower memory. As a conclusion, higher experienced soldiers presented higher physiological activation as well as cognitive and memory impairment than lower experienced soldier after a combat simulation and memory function was modulated by the stimulus nature. [ABSTRACT FROM AUTHOR]

Soldiers´ training and experience can influence the outcome of the missions, as well as their own physical integrity. The objective of this research was to analyze the psycho-physiological response and specific motor skills in an urban combat simulation with two units of infantry with different training and experience. Material and Methods: psychophysiological parameters -Heart Rate, blood oxygen saturation, glucose and blood lactate, cortical activation, anxiety and heart rate variability-, as well as fine motor skills were analyzed in 31 male soldiers of the Spanish Army, 19 belonging to the Light Infantry Brigade, and 12 to the Heavy Forces Infantry Brigade, before and after an urban combat simulation. Results and Conclusion: A combat simulation provokes an alteration of the psycho-physiological basal state in soldiers and a great unbalance in the sympathetic-vagal interaction. The specific training of Light Infantry unit involves lower metabolic, cardiovascular, and anxiogenic response not only previous, but mainly after a combat maneuver, than Heavy Infantry unit’s. No differences were found in relation with fine motor skills, improving in both cases after the maneuver. This fact should be taken into account for betterment units´ deployment preparation in current theaters of operations. [ABSTRACT FROM AUTHOR]

Question In adults with severe acute respiratory distress syndrome (ARDS), what is the efficacy of early prone positioning compared with supine positioning? Methods Design Randomized controlled trial (Proning Severe ARDS Patients [PROSEVA] study). ClinicalTrials.gov NCT00527813. Allocation Concealed.* Blinding Blinded* {patients, outcome assessors, data analysts, and safety committee}†. Follow-up period 90 days. Setting 26 intensive care units (ICUs) in France and 1 in Spain. Patients 474 adults (mean age 59 y, 68% men, mean Sepsis-related Organ Failure Assessment [SOFA] score 10.0) who had severe ARDS (confirmed as severe after 12 to 24 h of mechanical ventilation in the ICU) and were treated with mechanical ventilation for < 36 hours before randomization. Exclusion criteria included contraindication for prone positioning; use of inhaled nitric oxide, almitrine bismesylate, or extracorporeal membrane oxygenation before inclusion; lung transplantation; burns on > 20% of body surface; chronic respiratory failure requiring oxygen therapy or noninvasive ventilation; or prone positioning before inclusion. Eligibility was confirmed after a 12- to 24-hour stabilization period. Intervention Placement in prone position for ≥ 16 consecutive h/d for ≥ 28 days (n = 240) or supine, semirecumbent position (n = 234) during mechanical ventilation. Prone positioning began within 1 hour after randomization and was stopped if there was improvement in oxygenation when in the supine position for ≥ 4 hours, > 20% decrease in PaO2-FIO2 ratio during 2 consecutive prone sessions relative to the ratio in the supine position, or a complication during a prone session. Patients in the prone group could be returned to the prone position from the supine position if criteria for oxygen saturation level and/or PaO2 were met. Outcomes Mortality at 28 days. Secondary outcomes included mortality, successful extubation, and complications at 90 days. Patient follow-up 98% (intention-to-treat analysis). Main results Early prone positioning reduced mortality at 28 and 90 days and increased successful extubation compared with supine positioning (Table). Fewer cardiac arrests occurred in the prone group than in the supine group (6.8% vs 14%, P < 0.05); groups did not differ for other adverse events. Conclusion In adults with severe acute respiratory distress syndrome, early prone positioning for 16 h/d reduced mortality compared with supine positioning. [ABSTRACT FROM AUTHOR]