Respiratory Muscle Overloading and Dyspnoea During Bronchoconstriction in Asthma: Protective Effects of Fenoterol

Whether, and to what extent, β₂-agonists protect against respiratory muscle overloading and breathlessness during bronchoconstriction remains to be defined in patients with asthma. In a double blind placebo-controlled study, 100 μg of fenoterol were administered to six stable asthmatics before a bronchial provocation test, performed by inhaling doubling concentrations of histamine from a Devilbiss 646 nebulizer. We recorded breathing pattern (tidal volume V_T, inspiratory time T_I, total time of the respiratory cycle T_TOT), inspiratory capacity (IC), dynamic pleural pressure swing (P_plsw), total lung resistance (R_L) and FEV₁. V_Twas expressed both in actual values and as % of IC. Changes in V_T(%IC) during histamine inhalation reflected changes in dynamic end-inspiratory lung volume (EILV). P_plswwas expressed as % of maximal (the most negative in sign) pleural pressure, obtained under control conditions during a sniff manoeuvre (P_plsn). P_plsw(%P_plsn) is an index of inspiratory muscle effort. The test ended when the concentration of histamine which caused a decrease in FEV₁of ≥40% post-saline was reached. Dyspnoea rating was scored by a modified Borg scale. At the ultimate degree of bronchoconstriction (UDB) with histamine: (i) decrease in FEV₁was similar after placebo and fenoterol, while increase in R_Lwas lower after fenoterol (P<0.005); (ii) V_T(%IC) increased less after fenoterol (P<0.027); (iii) increases in P_plsw(%P_plsn) was lower after fenoterol (P<0.001); (iv) ΔBorg (from saline) was lower (P<0.01) after fenoterol; (v) differences in ΔBorg, from placebo to fenoterol, related to concurrent changes in V_T(%IC) (r²=0.67). In conclusion, at UDB 100 μg of fenoterol produced a beneficial effect on the degree of inspiratory muscle loading and breathlessness, an effect greater than it would be expected from measuring FEV₁alone.     

Contributing to research via biobanks: what it means to cancer patients

Context and objective Biobanks have become strategic resources for biomedical and genetic research. The aim of the present empirical qualitative study was to investigate how patients with cancer perceive and experience the process of donation to biobanks, focussing on the subjective meanings associated with their decisions when they are asked in a routine context to agree to their own biological specimens being used for research projects. Design A qualitative study, using semi‐structured interviews to explore in depth the reasons why patients with cancer agree to participating in biobanking. Participants Nineteen patients (aged 28–82 years) being treated for colorectal cancer or leukaemia at a French cancer centre participated in this study. Results Contributing to biobanks was experienced here as a rewarding and empowering individual experience because of the psychological issues involved, such as feelings of hope associated with research, because it makes the relationship with researchers and clinicians less asymmetrical, revalorization of otherwise ‘wasted’ tissue, and also as an act of solidarity and reciprocity, which makes patients part of a community. Discussion and conclusion Patients seem to regard contributing to biobanks as an act of benevolence, which they are motivated to perform because of societal welfare considerations as well as the hope of subjective benefits. Knowledge about the patients’ perspective and of the psychological rewards associated with tumour donation should be taken into account by physicians and caregivers discussing this topic with their patients.     

Comparison of Cardiovascular Risk Assessment Algorithms to Determine Eligibility for Statin Therapy: Implications for Practice in Canada

Background

New lipid management guidelines in the United States have created controversy regarding risk assessment using the new Pooled Cohort Equations (PCE) which might overestimate cardiovascular risk and identify an excessive number of patients as new candidates for statin therapy.

Methods

We compared the Framingham Risk Score (FRS) used in Canada with PCE, the FRS version used in Adult Treatment Panel III (ATP III), Reynolds Risk Score (RRS), and Systematic Coronary Risk Evaluation (SCORE) using patient profile simulation of 10 cohorts of 100,000 each (total n = 1,000,000 for each comparison). Patients with diabetes, established cardiovascular disease, or family history of premature cardiovascular disease were not considered, mimicking uncomplicated primary prevention. Analyses were performed separately for men and women and for black individuals when feasible.

Results

SCORE (high-risk version) was most concordant with FRS in men, whereas PCE was most concordant in black women. Compared with FRS, all other algorithms except SCORE (high-risk version) identified more simulations as low risk. Reclassification from low FRS to a higher risk was not seen using RRS or ATP III and seen in < 5% of simulations using PCE, affecting predominantly black subject simulations.

Conclusions

Choice of risk calculator leads to systematic differences in risk categorization that can influence eligibility for lipid-lowering therapy. Compared with FRS, an isolated switch to PCE, RRS, or ATP III is unlikely to lead to substantial reclassification from low to higher risk categories in Canada.     

Canadian Cardiovascular Society Guidelines for the Diagnosis and Management of Stable Ischemic Heart Disease

This overview provides a guideline for the management of stable ischemic heart disease. It represents the work of a primary and secondary panel of participants from across Canada who achieved consensus on behalf of the Canadian Cardiovascular Society. The suggestions and recommendations are intended to be of relevance to primary care and specialist physicians with an emphasis on rational deployment of diagnostic tests, expedited implementation of long- and short-term medical therapy, timely consideration of revascularization, and practical follow-up measures.     

Risk Stratification and Selection for Statin Therapy: Going Beyond Framingham

Decisions for statin therapy in the primary prevention of atherosclerotic cardiovascular disease are generally made using the 10-year Framingham Risk Score (FRS). Even when a family history of premature cardiovascular disease is taken into account, there is often ambiguity about the need for statin therapy for patients with a 10-year FRS of 5%-19% and low-density lipoprotein cholesterol <3.5 mmol/L. Current Canadian dyslipidemia guidelines recommend consideration of a diversity of other factors, including biochemical measurements and imaging studies to help determine whether the calculated FRS might be misleadingly low and whether statin therapy might, therefore, be prudent. However, efficient use of the plethora of secondary factors makes this decision process itself potentially ambiguous. This brief summary provides a practical approach for using clinical information, basic biochemical tests, and more specialized tests, such as carotid ultrasound and coronary artery calcium scoring, to identify groups of patients at greater risk for atherosclerotic cardiovascular disease than suggested by the FRS.     

Recombinant human erythropoietin in very elderly patients with myelodysplastic syndromes: results from a retrospective study

Myelodysplastic syndromes (MDS) are common in elderly patients. Recombinant human erythro-poietin (rHuEPO) has been widely used to treat anemia in lower risk MDS patients, but few data are known about rHuEPO treatment in the very elderly patient group. In order to investigate the role of rHuEPO treatment in terms of response, overall survival (OS), and toxicity in a very elderly MDS patient group, 93 MDS patients treated with rHuEPO when aged ≥80 years were selected among MDS cases enrolled in a retrospective multicenter study by the cooperative group Gruppo Romano Mielodisplasie (GROM) from Jan 2002 to Dec 2010. At baseline, median age was 82.7 (range 80–99.1) with a median hemoglobin (Hb) level of 9 g/dl (range 6–10.8). The initial dose of rHuEPO was standard (epoetin alpha 40,000 IU/week or epoetin beta 30,000 IU/week) in 59 (63.4 %) pa-tients or high in 34 (36.6 %) (epoetin alpha 80,000 IU/week) patients. We observed an erythroid response (ER) in 59 (63.4 %) patients. No thrombotic event was reported. Independent predictive factors for ER were low transfusion requirement before treatment (p?=?0.004), ferritin <200 ng/ml (p?=?0.017), Hb >8 g/dl (p?=?0.034), and a high-dose rHuEPO treatment (p?=?0.032). Median OS from rHuEPO start was 49.3 months (95 % CI 27.5–68.4) in responders versus 30.6 months (95 % CI 7.3–53.8) in resistant patients (p?=?0.185). In conclusion, rHuEPO treatment is safe and effective also in the very elderly MDS patients. However, further larger studies are warranted to evaluate if EPO treatment could be worthwhile in terms of quality of life and cost-efficacy in very old patients.     

Who are you talking to? The role of addressee identity in utterance comprehension

Experimental evidence suggests that speaker and addressee quickly adapt to each other from the earliest moments of sentence processing, and that interlocutor-related information is rapidly integrated with other sources of nonpragmatic information (e.g., semantic, morphosyntactic, etc.). These findings have been taken as support for one-step models of sentence comprehension. The results from the present event-related potential study challenge this theoretical framework providing a case where discourse level information is integrated only at a late stage of processing, when morphosyntactic analysis has been already initiated. We considered the case of Basque allocutive agreement, where information about addressee gender is encoded in verbal inflection. Two different types of Basque grammatical violations were presented together with the corresponding control conditions: one could be detected based on a morphosyntactic mismatch (person agreement violation), while the other could be detected only if the addressee's gender was considered (allocutive violation). Morphosyntactic violations elicited greater N400 effects followed by P600 effects, while allocutive violations elicited only P600 effects. These results provide new constraints to one-step accounts as they represent a case where speakers do not immediately adjust to the addressee's perspective. We propose that the relevance of discourse-level information might be a crucial variable to reconcile the dichotomy between one- and two-step models.     

Connecting experiences of community shared responsibility and collective competence to the well-being of adults in military families

Drawing from the social organization theory of action and change, the role of community-capacity elements (shared responsibility and collective competence) for military members' and their civilian spouses' well-being is examined. With data from 266 active-duty military families, military members and their spouses are classified by theory-based community-capacity type. A path analysis examines associations between community types, elements of military context (rank and transitions), and dimensions of well-being (anxiety, depressive symptoms, self-efficacy, life satisfaction). There were few variations in community capacity across rank and transitions. For military members' and their civilian spouses, community types were differentially associated with well-being, particularly in disengaged and synergetic communities. Well-being was generally highest for those in synergistic communities (high shared responsibility and collective competence) and lowest in disengaged communities (low shared responsibility and collective competence). Findings inform intervention and prevention efforts seeking to activate communities as a mechanism for fostering well-being.