Laud, Purushottam W.

Dietary salt intake has significant effects on arterial blood pressure and the development of hypertension. Mechanisms underlying salt-dependent changes in blood pressure remain poorly understood. The goal of the present study was to utilize urine samples from the Dietary Approaches to Stop Hypertension (DASH)-Sodium trial and a targeted metabolomic approach to identify associations of urinary metabolites with blood pressure phenotypes on low- or high-sodium intake. We examined urinary levels of metabolites in 103 participants of the DASH-Sodium trial after 30 days on a defined diet containing high sodium (targeting 150 mmol sodium intake per day) or low sodium (50 mmol sodium per day). Systolic or diastolic pressure was 10 or more mmHg higher on the high-sodium intake in 51 of the 103 participants. Targeted chromatography/mass spectrometry analysis was performed in 24-h urine samples for 10 metabolites related to the tricarboxylic acid cycle and 47 amino metabolites. Urinary metabolite levels improved the prediction of classification of blood pressure salt-sensitivity based on race, age and sex. Random forest and generalized linear mixed model analyses identified significant (false discovery rate <0.05) associations between 24 h excretions of β-aminoisobutyric acid, cystine, citrulline, homocysteine and lysine and systolic blood pressure and between cystine and diastolic blood pressure. The differences of 24 h excretion of homocysteine between low- and high-sodium intakes were significantly associated with the differences in diastolic blood pressure. These associations were significant with or without considering demographic factors. Treatment with β-aminoisobutyric acid significantly attenuated high-salt-induced hypertension in Dahl salt-sensitive rats. These findings support the presence of new mechanisms of blood pressure regulation involving metabolic intermediaries.

BACKGROUNDInaccurate or incomplete information in the written portion of the patient handoff, or sign‐out, may be associated with adverse events in hospitalized patients. Little is known about what information providers actually include in written sign‐out documents and how sign‐outs change over time.OBJECTIVES(1) Provide a descriptive analysis of initial and subsequent hospital day‐written sign‐out content, and (2) evaluate the relationship between team workload and sign‐out composition.DESIGNRetrospective review of sign‐out documents from a larger observational study of general medicine patients admitted to housestaff and hospitalist teams at 3 hospitals.MAIN MEASURESThe presence of 13 components of a high‐quality sign‐out. We performed descriptive analyses and compared initial and subsequent day sign‐outs for content.KEY RESULTSWe reviewed 200 patient hospitalizations (200 initial handoffs, 580 subsequent day handoffs). Initial sign‐out entries contained a mean of 7.54 (standard deviation: 2.27) key sign‐out components. Subsequent day sign‐outs contained a higher percentage of certain key elements but had more vague language. The number of elements present in the sign‐out was reduced as patient census increased (r = −0.295, P < 0.01).CONCLUSIONSSign‐out composition changes over time, and is associated with workload. Future interventions to improve quality should take these factors into consideration. Journal of Hospital Medicine 2015;10:534–536. © 2015 Society of Hospital Medicine.