Do clinicians know how to use pulse oximetry? A literature review and clinical implications

Pulse oximerry has become one of the most commonly used tools in the clinical environment for assessing patients' oxygenation status. It is employed almost continuously in critical care areas and frequently in the general ward environment. Although it is a much better tool for determining hypoxia than the human eye, its use is limited if clinicians do not understand relevant physiological principles, such as the oxyhaemoglobin dissociation curve and the inherent limitations of the device. Furthermore, the risk for compromised patient safety is significant if clinicians fail to recognise the potential for false or erroneous readings. This paper explores the research which has examined clinicians' comprehension of pulse oximetry. Fourteen studies examining clinicians' knowledge of pulse oximerry were reviewed. These studies revealed significant knowledge deficits about pulse oximerry amongst nurses, doctors and allied health professionals, all of whom used this technology frequently. Alarmingly, those lacking an adequate understanding of pulse oximerry included senior, experienced clinicians. The studies were limited by their use of convenience sampling and small sample sizes. Further research is needed to better understand the significance of this problem and to examine how principles of pulse oximerry are taught to nurses and other health professionals at the undergraduate and postgraduate levels. Educators and clinicians alike must ensure that a safe level of knowledge for the use of pulse oximerry is maintained in order to ensure that patient outcomes are not compromised.

Maternal and neonatal influences on, and reproducibility of, neonatal aortic pulse wave velocity

Aortic pulse wave velocity (aPWV), a noninvasive measure of vascular stiffness, is an independent predictor of cardiovascular disease both before and in overt vascular disease. Its characteristics in early life and its relationship to maternal factors have hardly been studied. To test the hypothesis that infant aPWV was positively related to maternal anthropometry and blood pressure (BP) at 28 weeks gestation, after adjusting for neonatal anthropometry and BP, 148 babies born in Manchester were measured 1 to 3 days after birth. A high reproducibility of aPWV, assessed in 30 babies within 3 days of birth, was found with a mean difference between occasions of –0.04 m/s (95% CI: –0.08 to 0.16 m/s). Contrary to our hypothesis, a significant inverse relation was found between neonatal aPWV (mean: 4.6 m/s) and maternal systolic BP (mean: 108.9 mm Hg; r=–0.57; 95% CI: –0.67 to –0.45) but not maternal height nor weight. Neonatal aPWV was positively correlated with birth length, birth weight, and systolic BP. In multiple regression, neonatal aPWV remained significantly inversely associated with maternal systolic BP (adjusted ß coefficient: –0.032; 95% CI: –0.040 to –0.024; P<0.001), after adjustment for maternal age, birth weight, length, and neonatal BP (all independently and positively related to aPWV) and for gestational age, maternal weight, and height (unrelated). These results suggest that infant aPWV may be a useful index of infant vascular status, is less disturbing to measure than infant BP, and is sensitive to the gestational environment marked by maternal BP.

Determination of anabolic steroids by differential pulse polarography

Determination of anabolic steroids often requires the use of elaborate techniques such as gas chromatography - mass spectrometry (GC-MS), gas liquid chromatography (GLC) and more recently high performance liquid chromatography (HPLC). Most of these methods employ derivatisation techniques prior to detection which makes them tedious and relatively time consuming. Other methods demand a great deal of skill. A simple and rapid analytical method, based on differential pulse polarography at a dropping mercury electrode has been developed for the determination of various anabolic steroids in a range of commercially available pharmaceutical preparations. Detailed investigation of the electrochemical behaviour of these steroids was made in order to elucidate the electrode processes involved, in addition to optimising the method. Several other analytical methods such as GC-MS, NMR, ultraviolet (UV), infrared (IR) spectroscopy were also used to confirm the products of the chemical and electrochemical reactions. Possible reactions are suggested. Various extraction procedures were examined for separation of selected steroids from the oil-based or pill matrix and their suitability for polarographic determination is discussed.

Pulse-lavage brushing followed by hydrogen peroxide-gauze packing for bone-bed preparation in cemented total hip arthroplasty : a bovine model

To compare the effectiveness of pulse-lavage brushing followed by hydrogen peroxide-gauze packing with either technique alone or normal-saline irrigation in bone-bed preparation for cemented total hip arthroplasty. 44 fresh-frozen ox femoral canals were prepared for cemented total hip arthroplasty using 4 techniques: normal-saline irrigation, pulse-lavage brushing, hydrogen peroxide-soaked gauze packing, and a combination of the latter 2 techniques. The maximum tensile pull-out force required to separate the prosthesis from the femoral canal was measured as an indicator of the strength of the cement-bone interface. The mean pull-out force to separate the prosthesis from the femoral canal was significantly higher in specimens prepared with pulse-lavage brushing followed by hydrogen peroxide-soaked gauze packing or pulse-lavage brushing alone than those prepared with normal-saline irrigation or hydrogen peroxide-soaked gauze packing alone 300(p<0.001). Pulse-lavage brushing is more effective at cleansing the femoral canal and increasing mechanical strength at the cement-bone interface than preparation with normal-saline irrigation or hydrogen peroxide-soaked gauze packing.

An approximate numerical technique for characterizing optical pulse propagation in inhomogeneous biological tissue

An approximate numerical technique for modeling optical pulse propagation through weakly scattering biological tissue is developed by solving the photon transport equation in biological tissue that includes varying refractive index and varying scattering/absorption coefficients. The proposed technique involves first tracing the ray paths defined by the refractive index profile of the medium by solving the eikonal equation using a Runge-Kutta integration algorithm. The photon transport equation is solved only along these ray paths, minimizing the overall computational burden of the resulting algorithm. The main advantage of the current algorithm is that it enables to discretise the pulse propagation space adaptively by taking optical depth into account. Therefore, computational efficiency can be increased without compromising the accuracy of the algorithm.

Laguerre Runge-Kutta-Fehlberg method for simulating laser pulse propagation in biological tissue

An efficient algorithm for solving the transient radiative transfer equation for laser pulse propagation in biological tissue is presented. A Laguerre expansion is used to represent the time dependency of the incident short pulse. The Runge–Kutta– Fehlberg method is used to solve the intensity. The discrete ordinates method is used to discretize with respect to azimuthal and zenith angles. This method offers the advantages of representing the intensity with a high accuracy using only a few Laguerre polynomials, and straightforward extension to inhomogeneous media. Also, this formulation can be easily extended for solving the 2-D and 3-D transient radiative transfer equations.

Low actuation-voltage shift in MEMS switch using ramp dual-pulse

This paper proposes a ramp dual-pulse actuation-voltage waveform that reduces actuation-voltage shift in capacitive microelectromechanical system (MEMS) switches. The proposed waveform as well as two reported waveforms (dual pulse, and novel dual-pulse) are analyzed using equivalent-circuit and equation models. Based on the analysis outcome, the paper provides a clear understanding of trapped charge density in the dielectric. The results show that the proposed actuation-voltage waveform successfully reduces trapped charge and increases lifetime due to lowering of actuation-voltage shift. Using the proposed actuation-voltage waveform, the membrane reaches a steady state on the electrode faster.

The effect of known cardiovascular risk factors on carotid-femoral pulse wave velocity in school-aged children: a population based twin study

Childhood cardiovascular risk factors affect vascular function long before overt cardiovascular disease. Twin studies provide a unique opportunity to examine the influence of shared genetic and environmental influences on childhood cardiovascular function. We examined the relationship between birth parameters, markers of adiposity, insulin resistance, lipid profile and blood pressure and carotid-femoral pulse wave velocity (PWV), a validated non-invasive measure of arterial stiffness in a healthy cohort of school-aged twin children. PWV was performed on a population-based birth cohort of 147 twin pairs aged 7-11 years. Fasting blood samples, blood pressure and adiposity measures were collected concurrently. Mixed linear regression models were used to account for twin clustering, within- and between-twin pair associations. There were positive associations between both markers of higher adiposity, insulin resistance, elevated triglycerides and PWV, which remained significant after accounting for twin birth-set clustering. There was a positive association between both diastolic and mean arterial blood pressure and PWV in within-pair analysis in dizygotic, but not monozygotic twins, indicating genetic differences evident in dizygotic not monozygotic twins may affect these associations. Increased blood pressure, triglycerides and other metabolic markers are associated with increased PWV in school-aged twins. These results support both the genetic and environmental contribution to higher PWV, as a marker of arterial stiffness, and reiterate the importance of preventing metabolic syndrome from childhood.