Different COPD Disease Characteristics are Related to Different Outcomes in the 6-minute Walk Test

Abstract

Background: Chronic obstructive pulmonary disease (COPD) can lead to severe disability as the disease advances. The 6-minute walk test (6MWT) is commonly used to measure functional capacity in COPD patients and has three potential outcomes; walking distance, oxygen desaturation, and self-perceived dyspnea assessed by the Borg scale, all reflecting different aspects of COPD. The aim of this study was to identify predictors of all 3 outcomes of 6MWT in patients with COPD. Methods: 370 COPD patients, aged 40–75 yrs, were included from the first phase of the Bergen COPD cohort study. They were examined with spirometry, bioelectrical impedance measurements, 6MWT, Center for Epidemiologic Studies of Depression (CES-D) Scale, Medical Research Council (MRC) dyspnea scale, Charlson index for co-morbidities, self-reported physical activity questionnaire, plasma levels of C-reactive protein (CRP) and arterial blood gases. Results: Significant predictors in the multivariate analyses were sex, age, FEV₁ in% predicted, symptoms of dyspnea (MRC), co-morbidities (Charlson Index) and self-reported physical activity for walking distance, FEV₁ in% predicted and PaO₂ for oxygen desaturation, and body composition, smoking and co-morbidities for self-perceived dyspnea assessed by the Borg scale. Conclusion: Several COPD characteristics have predictive value for the 6MWT, and some COPD characteristics are more strongly related to specific 6MWT outcomes than others.     

睡眠呼吸暂停低通气综合征问卷对阻塞性睡眠呼吸暂停综合征诊断价值

目的 评价阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的流行病学调查表筛查价值.方法 疑似OSAHS的987例患者为研究对象,按照中华医学会呼吸病学分会睡眠学组睡眠呼吸暂停低通气综合征流行病学调查表进行问卷并行多导睡眠监测.将此问卷表进行量化评分,用克隆巴赫信度系数(α系数)进行信度计算,将各相关因素做方差分析及x2检验,筛选出有统计学意义的因素最后做Logistic回归分析.以鼾声中度以上的打鼾及体质量指数≥25 kg/m2为高危,反之为低危,进行敏感性,特异性,假阳性,假阴性,阳性似然比,阴性似然比,阳性预测值等.结果 疑似OSAHS患者987例,其中男800例(81.05％),女187例(18.95％),年龄18～80岁,平均(47±12)岁,平均体质量指数(29±5) kg/m2.＞60岁者156例(15.81％),≤60岁者831例(84.19％).克隆巴赫信度系数(Cronbach'salpha)是0.803,假阳性者20,假阴性者142,真阳性者742,真阴性者83,问卷的敏感性是83.94％,特异性是80.58％,假阳性率19.42％,假阴性率16.06％,阳性似然比4.32,阴性似然比0.20,阳性预测值0.97,阴性预测值0.37,正确率83.59％.结论 该睡眠调查表对OSAHS筛查具有一定意义,可用于临床OSAHS的初筛,尤其适合在社区和基层医院中推广使用.     

Comparative Responsiveness of Verbal and Numerical Rating Scales to Measure Pain Intensity in Patients With Chronic Pain

Verbal rating scale (VRS) and numerical rating scale (NRS) are regularly used to assess and monitor pain in chronic pain patients. Although the NRS has been generally preferred, limited comparative responsiveness evidence was reported. This study compared the responsiveness of VRS and NRS measuring current pain and investigated the influence of different references (ie, worst, least, average, and current pain or their composite) on the NRSs' responsiveness. Two hundred fifty-four chronic pain patients attended a 10-day pain self-management program and were assessed with two 6-point VRSs (assessing current pain) and four 11-point NRSs (assessing worst, least, average, and current pain) at pre- and posttreatment. A patient-reported rating of pain improvement was used as the criterion for standardized response mean and receiver operating characteristic curve analyses. Results showed that the VRSs and NRSs exhibited small responsiveness in all patients, but the magnitude of responsiveness became moderate to large in patients with improved pain. However, in patients with pain improvements, the NRS current pain item and composite score (made up of the 4 pain items) were found to have significantly larger responsiveness and greater discriminatory ability to detect the presence of improvement than other current pain VRSs and the NRSs assessing worst, least, and average pain. Potential implications for clinical practice are discussed.     

Drepa-Opia: A Pilot Study to Determine the Predictive Factors of Morphine Use and Consumption in Hospitalized Adult Patients with Sickle Cell Disease

Abstract

The aim of this study was to evaluate the clinical, biological and genetic factors that could be associated with the use and dose of morphine during hospitalization for vaso-occlussive crisis (VOC) in adults with sickle cell disease. Ninety-nine hospitalizations for acute VOC (58 sickle cell disease patients aged 18 to 60?years, one to six hospitalizations each) were recorded; we investigated the associations between qualitative and quantitative opioid requirements and several biological, clinical, epidemiological and genetic parameters. Visual analog pain scale (VAS) was the only independent predictor of the qualitative need for morphine (mean value of 8.5 vs. 6.1 for the 77 hospitalizations that required morphine). A higher total administered morphine dose, which relates mainly to the overall crisis severity, was associated with a lower hemoglobin (Hb) level at entry. The mean daily morphine dose, which is more influenced by the individual sensitivity to morphine, was not influenced by the studied genetic parameters [sickle cell disease type, α-thalassemia (α-thal) status, UGT2B7 and ABCB1 genotypes] but a very slight negative association was found with the total bilirubin (BIL) level at entry. Our study demonstrated that physicians are often reluctant to prescribe morphine in sickle cell disease as a VAS of 6 corresponds to the usual threshold of administration in other instances. Total Hb at entry was also associated for the first time with higher total morphine consumption and could be used in a predictive VOC severity score. These results have to be confirmed and completed on larger cohorts.     

Beginning Steps to Recovery

This study examines two treatment interventions for patients in the pre-recovery stage of addiction. Patients in the Psychoeducation group, compared to the Recovery-oriented group, demonstrated greater duration in treatment and agreement with the first three steps of the Twelve Steps, measured by a Steps Questionnaire. The study is based on a new model for stage of recovery, which compliments the Twelve Step recovery model and includes eight "Beginning Steps" as a pre-requisite to becoming "recoveryready."     

脑卒中危险因素与大脑胆碱能通路损伤的相关性

目的:探究脑卒中的危险因素与大脑胆碱能通路损伤的相关性。方法:连续纳入符合入组标准的患者102例,收集患者人口学特征和脑卒中危险因素(年龄、高血压病史、糖尿病史、吸烟史、既往卒中史等),头颅MRI评估胆碱能通路高信号评分(CHIPS),利用多元线性回归法分析脑卒中危险因素与CHIPS的相关性。结果:在脑卒中危险因素中,既往卒中史与CHIPS呈正相关(B=12.58,P=0.01)。结论:既往卒中史可能是导致大脑胆碱能通路损伤的独立危险因素。     

CONTROL OF THE PINE BARK BEETLE (HYLASTES ATER) AT MT. BURR,SOUTH AUSTRALIA

This endemic beetle caused damage to the second rotation crop ot Pinus radiata at Mt. Burr, described by Boomsma and Adams (1943).

As an outcome of the investigations then made, a suggestion naturally arose that has since been tried, simplified, and regularly practised with entirely satisfactory results. Slash areas to be planted in winter are completely felled before mid-summer and burned in autumn.     

Measuring barriers to adherence: validation of the problematic experiences of therapy scale

Abstract

Purpose: To present the psychometric properties of the Problematic Experiences of Therapy Scale (the PETS), a brief measure to assess self-reported perceived barriers to adherence to physical rehabilitative therapy. Methods: Participants (study 1: n?=?128, study 2: n?=?227) taking part in trials of rehabilitative exercises completed the PETS and adherence questions at 12 weeks. Participants in study 2 were also asked about maintained adherence at 6-month follow-up. Results: Principal component analysis identified a four-factor structure relating to symptoms, uncertainty, doubts and practical problems. Cronbach’s alphas ranged between 0.84 and 0.96 for study 1 and study 2. Correlations between factors varied, ranging between ?0.22 and ?0.53 for study 1, and 0.12 and 0.36 for study 2. Adherence was associated with all subscales at 12 weeks, and with the symptoms and doubts subscales at 6-months. Conclusions: The PETS is a valid and reliable measure that can be used to assess participants' perceived reasons for non-adherence to a home-based rehabilitative therapy. It can be easily incorporated into treatment trials and as subscales were associated with reported adherence and maintained adherence, it provides potentially valuable indicators of reported barriers to adherence or might be used in clinical practice to facilitate conversations about adherence.

• Implications for Rehabilitation

• Low levels of adherence are commonly reported among people with chronic conditions who are required to undertake self-managed, home-based rehabilitation, yet patient-perceived barriers to adherence are rarely measured.

• The Problematic Experiences of Therapy Scale (the PETS) is a brief self-report measure that assesses the extent to which respondents perceive that they have been prevented from carrying out an intervention by common and plausible reasons.

• A patient-centered approach to reasons for non-adherence could facilitate conversations about adherence and identify areas in which the respondent may benefit from additional support or interventions to aid adherence.