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At least 19 recordsLinked to original sources

PubMed1997

Medication therapy in ambulatory medical care. National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 1992.

OBJECTIVES: This report describes medications provided or prescribed during ambulatory medical care visits in 1992. Total ambulatory care medication therapy combines data from office-based physicians, hospital outpatient departments (OPD's), and hospital emergency departments (ED's). Drug therapy is described along three dimensions: number of drugs provided or prescribed (drug mention), whether a visit had any drugs mentioned (drug visit), and average number of drugs mentioned per 100 visits (drug mention rate). Utilization in ambulatory care settings is compared in terms of patient, drug, provider, and visit characteristics. METHODS: Annual use of medication therapy was determined using data collected in the 1992 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS). NAMCS includes office visits to nonfederal physicians principally engaged in office practice. The target universe of NHAMCS includes visits to ED's and OPD's of non-Federal, short-stay, or general hospitals. Sample data were weighted to produce annual estimates. Drug mentions are defined as the number of drugs mentioned on the patient record from. RESULTS: An estimated 1.1 billion medications were provided or prescribed at ambulatory care visits in 1992. The setting with the greatest percent of visits with medication therapy was the ED; OPD's had the lowest percent with medications. Patients at the ED were provided more pain relief type drugs. The rate of drug mentions and percent of visits with medications were significantly higher in OPD clinics of general medicine and pediatrics compared with other types of OPD clinics. In office-based settings, physicians specializing in cardiovascular diseases were most likely to prescribe medications. Also, cardiovascular-renal type drugs accounted for the largest percent of office-based drug mentions. Visits with illness diagnoses are most likely to receive medication therapy. Trend data comparing 1980 to 1992 office-based mentions showed significant changes on several characteristics: single-ingredient drug status, physician specialty, and patient age. CONCLUSIONS: The profile of patients using office- and hospital-based ambulatory care settings are quite different as is the case-mix of conditions. These differences play an important role in medications utilized. The aging of the U.S. population from 1980 to 1992 appeared to have significant effects on several drug mention characteristics.

Adolescent↗

PubMed1998

Differential effects of antihypertensive drugs with differing pharmacological properties on the basal ambulatory blood pressure. Japanese Ambulatory Pressure-ANtihypertensive Effects SEarching study group.

To investigate how antihypertensive drugs with different pharmacological properties affect ambulatory blood pressure (BP) the JAPANESE Study Group developed a database of clinic and ambulatory BPs before and after antihypertensive treatment of patients throughout Japan. Drugs evaluated were nilvadipine (n = 195; b.i.d, 4-8 mg/day), amlodipine (n = 75; q.d., 2.5-10 mg/day), lisinopril (n = 80; q.d., 10-20 mg/day) and bisoprolol (n = 49; q.d., 5-10 mg/day). The relationship between basal ambulatory BP and the hypotensive effect on ambulatory BP during treatment was examined. All antihypertensive drugs significantly decreased both clinic BP and ambulatory BP. The hypotensive effect determined by measurement of clinic BP was significantly greater than that determined by ambulatory BP. The hypotensive effect was positively correlated with basal ambulatory BP. However, there was a quantitative difference in this characteristic among the drugs. The critical daytime systolic ambulatory BP below which a hypotensive effect was not observed was extrapolated to 128, 127 and 124 mm Hg with nilvadipine, amlodipine and bisoprolol, respectively, while that with lisinopril was 97 mm Hg. The slope of the correlation coefficient between basal daytime ambulatory systolic BP and hypotensive effect with lisinopril was significantly smaller than those with the other drugs (P < 0.0001). The slope for the relationship between night-time ambulatory systolic BP and the hypotensive effect with bisoprolol was the steepest (P < 0.0001). Antihypertensive drugs with different pharmacological properties exhibited differing hypotensive effects on the basal ambulatory BP. Such differences in efficacy of the drugs on the basal ambulatory BP may reflect adverse effects of the drugs and the prognosis of hypertension.

Adult↗

PubMed1999

[Is there equality of nursing care insurance coverage for ambulatory and non-ambulatory clients according to German law?].

UNLABELLED: In nursing insurance according to German legislation, the act of classifying the client into degrees of severity of disablement (0 = none, 1 to 3 = considerable, severe, most severe disablement) by expert assessment is based on legally defined distinct criteria (need for help items). Over and above these criteria, information with regard to the activities of daily life (ADL) is also documented routinely. PURPOSE: Is there a fundamental difference between patients suitable for ambulatory or non-ambulatory nursing care, or are their positive pattern scores for needing help fundamentally different? METHODS: Based on 7,000 electronic records of the assessments for ambulatory, and another 7,000 records for non-ambulatory nursing care, we fed artificial neural networks with all, or subsets, of the available items. Thereafter, in a crossover design, we evaluated the nets' classification competencies on independent validation data, using the ambulatory net for non-ambulatory classification, and vice versa. Weighted kappa (kw) was calculated as an index of performance. RESULTS: The nets trained on ambulatory data uniformly performed slightly better on ambulatory than on non-ambulatory data (kw = 0.78 versus 0.65, all items; 0.68 versus 0.67, only ADL items), whereas the non-ambulatory nets showed no consistent difference in respect of the nature of the input data (kw = 0.76/0.77, and 0.71/0.66). Overall, the nets' classification competence was convincing. CONCLUSION: There are inter-group differences regarding the need for care. The more severely disabled clients are mainly in the non-ambulatory group. But the principles governing the need for care are very similar in both groups. Thus, a uniform assessment procedure with regard to individual patient disability is justified. From the viewpoint of quality control, the results are reassuring.

Ambulatory Care↗

PubMed1998

[Ambulatory surgery in French public hospitals. Present and future. "Public hospitals" group of the French Association of Ambulatory Surgery].

OBJECTIVES: To assess ambulatory surgery practices in France, make an inventory of projects for the creation of ambulatory structures and analyze the perception of different hospital personnel of ambulatory surgery. METHODS: A questionnaire was sent to 541 public hospitals with a surgery unit in France. The first part of the questionnaire was used to record current activity and existing projects for ambulatory surgery. The questionnaire also collected opinions concerning the analysis of difficulties encountered and possibilities offered by ambulatory surgery. RESULTS: Overall participation rate was 59%. Ambulatory surgery was practised in 81% of the hospitals. Sixty-six percent had a projects under consideration, including several at the decision making stage (17%). 1550 ambulatory surgery clinics could be created by the year 2000. In 66% of the cases, the future facility would be integrated into the traditional surgery unit. There was favorable opinion concerning the development of ambulatory surgery clinics in public hospitals in 83% of the cases. Inconveniences suggested generally involved organizational aspects, particularly concerning medical organization. Foreseen obstacles to the development of ambulatory surgery clinics were regulatory procedures, unfavorable exchange rate, insufficient investment funds and the lack of a policy favoring their development. CONCLUSION: The development of ambulatory surgery clinics in public hospitals in France can be expected in the near future. Budgeting and regulatory procedures must however be adapted to promote implementation of the existing projects.

Attitude of Health Personnel↗

PubMed1998

Normal values for ambulatory blood pressure and differences between casual blood pressure and ambulatory blood pressure: results from a Danish population survey.

OBJECTIVE: To determine normal values for 24 h ambulatory blood pressure in a Danish population and to study the relationship to casual blood pressure. STUDY POPULATION: A random sample of 2656 Danish men and women participated in a population survey. The participants were selected in age groups and were aged 41-42, 51-52, 61-62 or 71-72 years during the survey. METHODS; Casual blood pressure (standard mercury sphygmomanometer) and 24 h ambulatory blood pressure (Takeda TM-2421) were measured successfully in 2082 subjects. All subjects under antihypertensive treatment (247) were excluded, restricting the study population to 1835 participants. RESULTS: Casual and 24 h ambulatory blood pressure were correlated (P < 0.0001) in all age and sex groups. Casual systolic/diastolic blood pressures were 129.6+/-17.8/82.6+/-10.3 for men and 125.1+/-18.2/79.7+/-9.9 mmHg for women. Twenty-four-hour average blood pressures were 130.8+/-14.2/75.3+/-8.6 for men and 122.4+/-14.9/69.6+/-8.3 mmHg for women. A multivariate linear logistic regression model confirmed that a high casual blood pressure (odds ratios 11/7 for systolic/diastolic blood pressure; P=0.001) was the major determinant of a lower ambulatory than casual blood pressure; age and sex were less important. CONCLUSION: The relationship between casual blood pressure on the one hand and the difference in casual and 24 h ambulatory blood pressure on the other hand suggests that ambulatory blood pressure represents a regression towards the mean compared to casual blood pressure. Any definition of an upper normal level of 24 h ambulatory blood pressure that is derived from a correlation between casual and ambulatory measurements will be inaccurate, and must await long-term studies of the relationship between ambulatory blood pressure and subsequent cardiovascular events.

Adult↗

PubMed1999

Ambulatory blood pressure predicts end-organ damage only in subjects with reproducible recordings. HARVEST Study Investigators. Hypertension and Ambulatory Recording Venetia Study.

OBJECTIVE: To determine whether the prediction of target-organ damage varies according to the reproducibility of 24 h blood pressure. SETTING: Seventeen hypertension clinics in northeast Italy. MAIN OUTCOME MEASURES: Correlations of left ventricular mass index and albumin excretion rate with 24 h and office blood pressures in relation to tertiles of ambulatory blood pressure reproducibility. PATIENTS AND METHODS: In 716 consecutive, stage I, hypertensives enrolled in the Hypertension and Ambulatory Recording Venetia Study (HARVEST), ambulatory blood pressure monitoring was performed twice, 3 months apart In all subjects, the albumin excretion rate was measured by radioimmunoassay, and in 567, the left ventricular mass index was assessed by echocardiography. RESULTS: The subjects were divided into tertiles of ambulatory blood pressure consistency (between-monitoring differences, regardless of the sign). In the tertile of subjects with good reproducibility, correlation coefficients of systolic and diastolic ambulatory blood pressure with left ventricular mass and urinary albumin excretion were significant and higher than those of office blood pressure. In contrast, in the two tertiles with poorer reproducibility, the coefficients were barely or not significant for both pressures. The advantage of ambulatory blood pressure over office blood pressure in predicting target-organ damage was no longer present for systolic blood pressure differences greater than 3.8 mmHg and diastolic blood pressure differences greater than 3.1 mmHg. CONCLUSIONS: These data indicate that ambulatory blood pressure is a better predictor of left ventricular mass and urinary albumin excretion than office blood pressure, but only in subjects with good pressure reproducibility. Therefore, the assessment of hypertensive patients should be based on duplicate blood pressure monitorings. Recordings with 24 h systolic and diastolic blood pressure differences greater than 4 and 3 mmHg, respectively, should be considered with caution.

Adolescent↗

PubMed1990

Comparison of propranolol, diltiazem, and nifedipine in the treatment of ambulatory ischemia in patients with stable angina. Differential effects on ambulatory ischemia, exercise performance, and anginal symptoms. The ASIS Study Group.

Episodes of transient myocardial ischemia during ambulatory activities are common in patients with stable coronary artery disease and who are often asymptomatic. Selection of therapy for episodes of asymptomatic ischemia is limited by a lack of direct comparative studies. To determine the most effective monotherapy for patients with stable angina and a high frequency of asymptomatic ischemic episodes, propranolol-LA (mean daily dose, 293 mg), diltiazem-SR (mean daily dose, 350 mg), nifedipine (mean daily dose, 79 mg) were each compared with placebo, each for 2 weeks, in a randomized, double-blinded, crossover trial. Entry criteria were a positive exercise treadmill test during placebo therapy characterized by 1.0 mm or more ST segment depression and angina pectoris, and six or more episodes of transient ST segment depression of 1.0 mm or more on a 48-hour ambulatory electrocardiogram. One hundred ninety-four patients were screened, 63 were eligible and received randomized therapy, of which 56 patients completed at least two of the four treatment periods and were included in an intent-to-treat analysis. Fifty patients completed all four treatment phases and were included in the protocol-completed analysis. Anti-ischemia efficacy was assessed by 48-hour ambulatory electrocardiographic monitoring, exercise treadmill tests, and anginal diaries. Ninety-four percent of all episodes of ambulatory ischemia were asymptomatic. Compared with placebo, only propranolol was associated with a marked reduction in all manifestations of asymptomatic ischemia during ambulatory electrocardiographic monitoring (2.3 versus 1.0 episodes/24 hr; mean duration of ischemia per 24 hours, 43.6 versus 5.7 minutes; both p less than 0.0001). Diltiazem's reduction of the frequency of episodes compared with placebo (2.3 versus 1.9 episodes/24 hr) was associated with a trend (p = 0.08) in the protocol-completed analysis and with a significant reduction in the intent-to-treat analysis (p = 0.03). Nifedipine had no significant effect on any measured variable of ambulatory ischemia. The dosages of medication used may have been excessive for some patients, and a more beneficial effect may have been evident at a lower dose. In contrast to the marked effects of the active agents on ambulatory asymptomatic ischemia, the effects on exercise performance and angina pectoris were slight. The active agents modestly improved treadmill exercise duration time until 1 mm ST segment depression (3%), and only propranolol and diltiazem had significant effects. Only diltiazem significantly prolonged the total exercise time. Anginal frequency was significantly decreased by both propranolol and diltiazem.(ABSTRACT TRUNCATED AT 400 WORDS)

Angina Pectoris↗

PubMed2001

Ambulatory heart rate is underestimated when measured by an ambulatory blood pressure device.

OBJECTIVE: To test the validity of ambulatory heart rate (HR) assessment with a cuff ambulatory blood pressure (ABP) monitor. DESIGN: Cross-instrument comparison of HR measured intermittently by a cuff ABP monitor (SpaceLabs, Redmond, Washington, USA), with HR derived from continuous electrocardiogram (ECG) recordings (1) in a controlled laboratory experiment and (2) during long-term recording in a true naturalistic setting. PARTICIPANTS: Six normotensive subjects participated in the laboratory study. A total of 109 male white-collar workers underwent ambulatory monitoring, of which 30 were mildly hypertensive. METHODS: Four different laboratory conditions (postures: lying, sitting, standing, walking), repeated twice, were used to assess the short-term effects of cuff inflation on the HR. To test the actual ambulatory validity, participants simultaneously wore a continuous HR recorder and the ABP monitor from early morning to late evening on 2 workdays and one non-workday. Diary and vertical accelerometery information was used to obtain periods of fixed posture and (physical) activity across which HR from both devices was compared. RESULTS: Laboratory results showed that the ABP device reliably detected HR during blood pressure measurement, but that this HR was systematically lower than the HR directly before and after the blood pressure measurement. The ambulatory study confirmed this systematic underestimation of the ongoing HR, but additionally showed that its amount increased when subjects went from sitting to standing to light physical activity (2.9; 4.3 and 9.1 bpm (beats/min), respectively). In spite of this activity-dependent underestimation of HR, the correlation of continuous ECG and intermittent ABP-derived HR was high (median r= 0.81). Also, underestimation was not different for normotensives and mild hypertensives. CONCLUSIONS: A direct effect of cuff inflation leads to the underestimation of ongoing HR during cuff-based ABP measurement. Additional underestimation of HR occurs during periods with physical activity, probably due to behavioural freezing during blood pressure measurements. HR underestimation was not affected by hypertensive state. When its limitations are taken into account, ABP-derived ambulatory HR can be considered a reliable and valid measure.

Adult↗

PubMed1999

Task force IV: Clinical use of ambulatory blood pressure monitoring. Participants of the 1999 Consensus Conference on Ambulatory Blood Pressure Monitoring.

OBJECTIVE: To reach a consensus on the clinical use of ambulatory blood pressure monitoring (ABPM). METHODS: A task force on the clinical use of ABPM wrote this overview in preparation for the Seventh International Consensus Conference (23-25 September 1999, Leuven, Belgium). This article was amended to account for opinions aired at the conference and to reflect the common ground reached in the discussions. POINTS OF CONSENSUS: The Riva Rocci/Korotkoff technique, although it is prone to error, is easy and cheap to perform and remains worldwide the standard procedure for measuring blood pressure. ABPM should be performed only with properly validated devices as an accessory to conventional measurement of blood pressure. Ambulatory recording of blood pressure requires considerable investment in equipment and training and its use for screening purposes cannot be recommended. ABPM is most useful for identifying patients with white-coat hypertension (WCH), also known as isolated clinic hypertension, which is arbitrarily defined as a clinic blood pressure of more than 140 mmHg systolic or 90 mmHg diastolic in a patient with daytime ambulatory blood pressure below 135 mmHg systolic and 85 mmHg diastolic. Some experts consider a daytime blood pressure below 130 mmHg systolic and 80 mmHg diastolic optimal. Whether WCH predisposes subjects to sustained hypertension remains debated. However, outcome is better correlated to the ambulatory blood pressure than it is to the conventional blood pressure. Antihypertensive drugs lower the clinic blood pressure in patients with WCH but not the ambulatory blood pressure, and also do not improve prognosis. Nevertheless, WCH should not be left unattended. If no previous cardiovascular complications are present, treatment could be limited to follow-up and hygienic measures, which should also account for risk factors other than hypertension. ABPM is superior to conventional measurement of blood pressure not only for selecting patients for antihypertensive drug treatment but also for assessing the effects both of non-pharmacological and of pharmacological therapy. The ambulatory blood pressure should be reduced by treatment to below the thresholds applied for diagnosing sustained hypertension. ABPM makes the diagnosis and treatment of nocturnal hypertension possible and is especially indicated for patients with borderline hypertension, the elderly, pregnant women, patients with treatment-resistant hypertension and patients with symptoms suggestive of hypotension. In centres with sufficient financial resources, ABPM could become part of the routine assessment of patients with clinic hypertension. For patients with WCH, it should be repeated at annual or 6-monthly intervals. Variation of blood pressure throughout the day can be monitored only by ABPM, but several advantages of the latter technique can also be obtained by self-measurement of blood pressure, a less expensive method that is probably better suited to primary practice and use in developing countries. CONCLUSIONS: ABPM or equivalent methods for tracing the white-coat effect should become part of the routine diagnostic and therapeutic procedures applied to treated and untreated patients with elevated clinic blood pressures. Results of long-term outcome trials should better establish the advantage of further integrating ABPM as an accessory to conventional sphygmomanometry into the routine care of hypertensive patients and should provide more definite information on the long-term cost-effectiveness. Because such trials are not likely to be funded by the pharmaceutical industry, governments and health insurance companies should take responsibility in this regard.

Antihypertensive Agents↗

PubMed1987

The ambulatory care parameter: a structured approach to quality assurance in the ambulatory care setting.

Assessing the quality of ambulatory care is difficult because practitioners see patients for only a short time and because the goals of care are not always clearly defined. The ambulatory care department of Methodist Hospital of Indiana, Inc, has developed a system, called ambulatory care parameters, that helps ambulatory health care professionals sort through the complexities of ambulatory care. The ten parameters provide a framework for evaluating the care provided.

Ambulatory Care↗

PubMed1995

A consensus view on the technique of ambulatory blood pressure monitoring. The Fourth International Consensus Conference on 24-Hour Ambulatory Blood Pressure Monitoring.

This review, based on the Fourth International Consensus Conference on Ambulatory Blood Pressure Monitoring (Leuven, Belgium, 1994), deals with the technical aspects of ambulatory blood pressure monitoring. Ambulatory blood pressure monitoring by noninvasive intermittent techniques is widely used despite artifacts due to cuff size, movement, body position, short-term blood pressure variability, and interference with sleep. The performance of the currently available monitors under truly ambulatory conditions and during exercise remains a matter of debate, as are the procedures required to validate portable monitors under these circumstances. There is general agreement that whenever a monitor is to be used in special populations, such as older subjects or pregnant women, or in special conditions, such as exercise, a specific demonstration of its accuracy in these defined subgroups or conditions is warranted. Whether the auscultatory or oscillometric method is preferred remains controversial because each technique has specific advantages and disadvantages and because both can provide accurate results. Most experts in the field strongly believe that manufacturers should disclose the algorithms of their devices and that they should specify all changes made to the hardware and software of a previously validated monitor. Finally, the development of the volume-clamp method, which makes continuous noninvasive registration of blood pressure at the finger possible in both stationary and ambulatory conditions, opens new perspectives in research, in particular in relation to short-term blood pressure variability.

Adult↗

PubMedDate not supplied

[The geriatric team in ambulatory (mobile) rehabilitation. Results of a longitudinal study on the effects of ambulatory rehabilitation].

This article describes the experiences obtained in a study of ambulatory (mobile) rehabilitation with stroke patients. The patients had been treated in a rehabilitation clinic before. The ambulatory rehabilitation, which lasted 18 months, served to maintain and further develop the previous success of in-patient rehabilitation. On the one hand, the research project provided empirical evidence for the success of ambulatory rehabilitation. On the other hand, the experiences obtained through this research project indicate that the success of an ambulatory rehabilitation concept is dependent on optimal co-operation among members of the rehabilitation team (physicians, psychologists, physical therapists, occupational therapists, speech therapists, and nursing staff). In relation, the institutional conditions for effective ambulatory rehabilitation are only met when physicians in private practice, who are responsible for the co-ordination of rehabilitation services, are supported by physicians in regard to time-consuming home visits, and when sufficient numbers of physical therapists, occupational therapists, and speech therapists in private practice are available. Unfortunately, these conditions are not fulfilled in many regions of Germany.

Activities of Daily Living↗

PubMedDate not supplied

Concordance of the ambulatory medical record and patients' recollections of aspects of an ambulatory new-patient visit.

The ambulatory medical record should provide an accurate account of what took place during an outpatient visit. If it does not, the record cannot be used to judge many aspects of the quality of care, including physician-patient communication. The author evaluated the accuracy of the ambulatory medical record by comparing the results of structured telephone interviews with 40 patients following new-patient visits with audits of the medical records. The evaluation focused on chief complaint and the patient's understanding of the diagnosis, medications and follow-up arrangement. The 95% confidence intervals of concordance rates between interview and audit were [1, 0.68] or better for all measures except understanding of diagnosis [0.73, 0.37]. The generally good rate of concordance between the ambulatory medical record and patient recollection for important indices of physician-patient communication suggests that the ambulatory medical record can be used to evaluate that aspect of ambulatory patient care.

Adult↗

PubMed1996

Conventional and ambulatory blood pressure measurement in older patients with isolated systolic hypertension:second progress report on the ambulatory blood pressure monitoring project in the Syst-Eur trial.

OBJECTIVES: To compare clinic and ambulatory blood pressure measurement and the reproducibility of these measurements in older patients with isolated systolic hypertension.PATIENTS: A total of 477 patients aged >/= 60 years with isolated systolic hypertension on clinic measurement were monitored during the placebo run-in phase of the Syst-Eur trial. METHODS: The time-weighted 24 h blood pressure, clock time day and night blood pressure, the cumulative sum-derived crest and trough blood pressure and the high and low blood pressure levels of the square-wave model were computed. The daily alteration between the high and low blood pressure spans was quantified using the clock time day-night difference, the cumulative sum-derived circadian alteration magnitude, the Fourier amplitude and the difference between the high and low blood pressure levels of the square-wave model. RESULTS: The daytime ambulatory systolic blood pressure was, on average, 21 mmHg lower than the clinic blood pressure, whereasthe diastolic blood pressure was, on average, similar with both techniques of measurement. In the 132 patients who underwent repeat measurements, clinic blood pressure levels and the parameters describing the difference betgween the daily high and low blood pressure spans were equally reproducible. However, both were less reproducible than the ambulatory blood pressure levels. The repeatability coefficients, expressed as percentages of near maximum variation, were 50 and 51% for the clinic systolic and diastolic blood pressures, 30 and 33% for the mean 24 h systolic and diastolic blood pressures and between 44 and 54% for the parameters describing the daily alteration between the high and low blood pressure spans. CONCLUSION: In older patients with isolated systolic hypertension, clinic and ambulatory systolic blood pressure may differ greatly; the prognostic significance of this difference remains to be elucidated. Furthermore, the level of blood pressure in these patients is more reproducible by ambulatory measurement than it is by clinic measurement.

Journal Article↗

PubMed2000

Randomized controlled trial of ambulatory oxygen and an ambulatory ventilator on endurance exercise in COPD.

In a prospective, randomized study we examined the effect of (i) ambulatory oxygen and (ii) a portable, inspiratory pressure support (IPS) device on the endurance shuttle walk test (ESWT) in patients with severe chronic obstructive pulmonary disease (COPD). Ten outpatients [median (range) FEV1 0.60 l(0.35, 1.45)] performed the ESWT under five test conditions: baseline walk (no assistance), IPS at 14 cmH2O from a portable ventilator (the HIPPY, Friday Medical, U.K.), sham IPS (< 8 cmH2O), ambulatory oxygen at 2 l min(-1), and sham oxygen (carrying the portable oxygen cylinder and breathing air). There were significant improvements in the ESWT with ambulatory oxygen, but a negative effect with the HIPPY device [mean (SD) time: baseline 172 (48) sec; oxygen 242 (62) sec; HIPPY 84 (35) sec]. The ESWT appeared sensitive to the effect of cylinder weight although differences in endurance capacity were not significant [sham oxygen 151 (45) sec]. The ESWT was sensitive to the acute application of oxygen, demonstrating a beneficial effect on endurance performance in patients with severe COPD. The ESWT could form the basis of a standardized assessment for ambulatory oxygen.

Aged↗

PubMed1994

Relation between physical training and ambulatory blood pressure in stage I hypertensive subjects. Results of the HARVEST Trial. Hypertension and Ambulatory Recording Venetia Study.

BACKGROUND: This study was undertaken to assess whether ambulatory blood pressure (BP) in a population of stage I hypertensive individuals was lower in the subjects performing regular exercise training. METHODS AND RESULTS: The study was carried out in 796 young hypertensive patients (592 men) who had never been treated who took part in the HARVEST trial. The diagnosis of stage I hypertension was made on the basis of six office BP measurements. Subjects underwent noninvasive 24-hour ambulatory BP monitoring, 24-hour urine collection for catecholamine assessment, and echocardiography (n = 457). They were classified as exercisers if they reported at least one session of aerobic sports per week and as nonexercisers if they did not engage regularly in sports activities. Age (P < .0001), body mass index (P = .002), 24-hour heart rate (P < .0001), alcohol intake (P = .02), smoking (P = .02), and norepinephrine output (P = .04) were lower in the active (n = 153) than the inactive (n = 439) men. Physically active men exhibited a lower 24-hour and daytime diastolic BP than the inactive men, while there were no group differences in office BP or in nighttime diastolic BP and in ambulatory systolic BP. The between-group ambulatory diastolic BP difference remained statistically significant after adjustment for age, body mass index, alcohol intake, and smoking (P < .0001). Of the nonexercisers, 46.2% were confirmed hypertensives, compared with only 26.8% of the exercisers (P < .0001), on the basis of daytime diastolic BP. Echocardiographic left ventricular dimensional and functional indexes were similar in the two groups of men. Similar findings were shown by the 16 women who engaged in aerobic sports. CONCLUSIONS: These data suggest that participation in aerobic sports may attenuate the risk of hypertension in young subjects whose office BP is in the stage I hypertensive range at office measurement.

Adolescent↗

PubMed2006

Ambulatory arterial stiffness index derived from 24-hour ambulatory blood pressure monitoring.

We hypothesized that 1 minus the slope of diastolic on systolic pressure during 24-hour ambulatory monitoring (ambulatory arterial stiffness index [AASI]) might reflect arterial stiffness. We compared AASI with established measures of arterial stiffness and studied its distribution in Chinese and European populations. We used 90207 SpaceLabs monitors and the SphygmoCor device to measure AASI, central and peripheral pulse pressures, the central (CAIx) and peripheral (PAIx) systolic augmentation indexes, and aortic pulse wave velocity. In 166 volunteers, the correlation coefficient between AASI and pulse wave velocity was 0.51 (P<0.0001). In 348 randomly recruited Chinese subjects, AASI correlated (P<0.0001) with CAIx (r=0.48), PAIx (r=0.50), and central pulse pressure (r=0.50). AASI increased with age and mean arterial pressure but decreased with body height. Both before and after adjustment for arterial wave reflections by considering height and heart rate as covariates, AASI correlated more (P<0.0001) closely with CAIx and PAIx than 24-hour pulse pressure. Among normotensive subjects, the 95th percentile of AASI was 0.55 in Chinese and 0.57 in 1617 Europeans enrolled in the International Database on Ambulatory Blood Pressure Monitoring. The upper boundary of the 95% prediction interval of AASI in relation to age ranged from 0.53 at 20 years to 0.72 at 80 years. In conclusion, AASI is a new index of arterial stiffness that can be easily measured under ambulatory conditions. Pending additional validation in outcome studies, normal values of AASI are probably <0.50 and 0.70 in young and older subjects, respectively.

Adolescent↗

PubMed2005

Ambulatory teaching: do approaches to learning predict the site and preceptor characteristics valued by clerks and residents in the ambulatory setting?

BACKGROUND: In a study to determine the site and preceptor characteristics most valued by clerks and residents in the ambulatory setting we wished to confirm whether these would support effective learning. The deep approach to learning is thought to be more effective for learning than surface approaches. In this study we determined how the approaches to learning of clerks and residents predicted the valued site and preceptor characteristics in the ambulatory setting. METHODS: Postal survey of all medical residents and clerks in training in Ontario determining the site and preceptor characteristics most valued in the ambulatory setting. Participants also completed the Workplace Learning questionnaire that includes 3 approaches to learning scales and 3 workplace climate scales. Multiple regression analysis was used to predict the preferred site and preceptor characteristics as the dependent variables by the average scores of the approaches to learning and perception of workplace climate scales as the independent variables. RESULTS: There were 1642 respondents, yielding a 47.3% response rate. Factor analysis revealed 7 preceptor characteristics and 6 site characteristics valued in the ambulatory setting. The Deep approach to learning scale predicted all of the learners' preferred preceptor characteristics (beta = 0.076 to beta = 0.234, p < .001). Valuing preceptor Direction was more strongly associated with the Surface Rational approach (beta = .252, p < .001) and with the Surface Disorganized approach to learning (beta = .154, p < 001) than with the Deep approach. The Deep approach to learning scale predicted valued site characteristics of Office Management, Patient Logistics, Objectives and Preceptor Interaction (p < .001). The Surface Rational approach to learning predicted valuing Learning Resources and Clinic Set-up (beta = .09, p = .001; beta = .197, p < .001). The Surface Disorganized approach to learning weakly negatively predicted Patient Logistics (beta = -.082, p = .003) and positively the Learning Resources (beta = .088, p = .003). Climate factors were not strongly predictive for any studied characteristics. Role Modeling and Patient Logistics were predicted by Supportive Receptive climate (beta = .135, p < .001, beta = .118, p < .001). CONCLUSION: Most site and preceptor characteristics valued by clerks and residents were predicted by their Deep approach to learning scores. Some characteristics reflecting the need for good organization and clear direction are predicted by learners' scores on less effective approaches to learning.

Adult↗