Minu Patel

Subjective fatigue, influencing variables, and consequences in chronic obstructive pulmonary disease

Background: Fatigue is a common symptom of chronic obstructive pulmonary disease (COPD), but little is known about the specific nature of COPD-related fatigue and its impact on daily life. Objectives: To (a) describe characteristics of fatigue in people with COPD and (b) test a theoretically and empirically supported model of the relationships among subjective fatigue, dyspnea, functional performance, anxious and depressed moods, and sleep quality in people with COPD. Methods: A cross-sectional descriptive study was conducted with 130 people with moderate to severe COPD. Measures included the following: a Numerical Rating Scale (NRS) for frequency, intensity, and distress of fatigue and dyspnea; Fatigue Assessment Instrument (FAI); Chronic Respiratory Disease Questionnaire (CRQ); Profile of Mood States (POMS); Pittsburgh Sleep Quality Index (PSQI); Functional Performance Inventory (FPI); and spirometry. Path analysis was used to examine the relationships among variables. Results: Participants reported moderate amounts of fatigue, which was described as situation-specific, had considerable consequences, and was responsive to rest and sleep. Dyspnea was slightly greater than fatigue, as measured by the NRSs (p <.001), and there was a strong relationship between fatigue and dyspnea (r =.74, p < .001). Dyspnea, depressed mood, and sleep quality accounted for 42% of the variance in subjective fatigue. Fatigue, dyspnea, airflow obstruction, and anxious mood accounted for 36% of the variance in functional performance. Conclusions: Fatigue is an important problem that affects performance of daily activities in people with COPD. The relationships or interactions that exist among fatigue and other symptoms are complex.

Soft tissue sarcomas of the adult head and neck

From 1969 to 1983, 53 adult patients with head and neck soft tissue sarcomas were evaluated and treated by the Division of Surgical Oncology at the University of Illinois. The most common anatomic location was the neck (36%), and these patients had the highest 5‐year disease‐free survival rate (67%). Fibrosarcoma was the most common histologic type (26%); patients with aggressive fibromatosis had the longest mean survival time (93 months). The mean overall survival time was 58.7 months, and the disease‐free 2‐year, 5‐year, and 10‐year survival rates were 68%, 54%, and 28%, respectively. Wide excision was the treatment of choice, with adjuvant radiotherapy or chemotherapy, or both, used in selected patients. In all of the long‐term survivors, the tumors were either well‐differentiated or ≤5.0 cm in diameter. It is apparent that aggressive therapy of such tumors can provide good long‐term results.

Effect of auditory, tactile, visual, and vestibular intervention on length of stay, alertness, and feeding progression in preterm infants

This study determined whether an auditory, tactile, visual, and vestibular intervention (ATVV) reduced the length of hospitalization of 37 preterm infants by increasing the proportion of alert behavioral states, thereby improving their feeding progression. Participants comprised 12 infants born between 23 and 26 weeks’gestation with normal head ultrasounds and 25 CNS‐injured infants born between 23 and 31 weeks’gestation. Infants were randomly assigned to the control group (11 males, five females) or study group (seven males, 14 females) at 32 weeks’postconceptional age. ATVV intervention was administered to the study group for 15 minutes, twice daily, 5 days per week, from 33 weeks of age until discharge. The study group demonstrated increased alertness during the first 5 minutes of intervention, which was significantly correlated to length of stay (p<0.05). The proportion of nippled (teat) intake increased significantly faster for the study group (p=0.0001). Infants in the study group were discharged at a mean of 36.54 weeks, 1.6 weeks earlier than control infants (p<0.05). ATVV intervention facilitated increased alertness, faster transition to complete nipple feeding, and decreased length of hospitalization.

Estrogen receptor in malignant melanoma.

The significance of an estrogen binding protein (ER) in malignant melanoma remains controversial. We have prospectively assayed for ER on 141 patients with malignant melanoma and correlated the presence of the ER with known prognostic variables. The overall incidence of ER was 43%. The incidence of ER in males was 38.7% and 50% in females (not significant). There is an increased incidence of ER+ melanoma in women with extremity lesions (P = .08). The disease-free interval (DFI), survival, and recurrent interval were 42.0 +/- 4.0, 52.3 +/- 4.3, 13.7 +/- 1.7 months in ER- patients; 63.7 +/- 11.6, 76.1 +/- 11.4, 26.5 +/- 7.3 months in ER+ patients (1 to 10 fmol/mg cytosol protein), and 69.8 +/- 17.9, 102.7 +/- 27.9, 29.4 +/- 9.9 months in ER+ patients (greater than 10 fmol/mg cytosol); respectively. When ER+ groups were combined, the DFI in women with ER+ lesions was significantly longer than those with ER- tumors (P less than .05). Cox multivariate analysis demonstrated that ER status is a significant variable of survival along with thickness level and nodal status. These observations suggest that ER may be a marker for a more biologically indolent melanoma.

High-intensity inspiratory muscle training in patients with chronic obstructive pulmonary disease and severely reduced function.

PURPOSE This study examined the effects of inspiratory muscle training (IMT) with high-intensity inspiratory pressure loads on respiratory muscle performance and exertional dyspnea. METHODS This was a randomized single-blind clinical trial. Twenty-seven patients with chronic obstructive pulmonary disease (18 men, 9 women) with severe to very severe airflow obstruction and severely limited functional performance were assigned randomly to an IMT group (n = 12) or an educational control group (n = 15). The IMT group trained with a threshold loaded device for 30 minutes a day for 16 weeks using interval training techniques. Training was initiated with inspiratory pressure loads equal to 30% of maximal inspiratory pressure (Plmax) and increased as tolerated to 60% of Plmax. Dependent variables were measured before and after 4 months of IMT: inspiratory muscle strength (Plmax), respiratory muscle endurance (discontinuous incremental threshold loading test [DC-ITL]), dyspnea (Chronic Respiratory Disease Questionnaire [CRQ]), and the Borg Category-Ratio Scale ratings of perceived breathing difficulty (RPBD) at equal loads during the DC-ITL. RESULTS In the IMT group, Plmax increased from 64 +/- 15 to 75 +/- 17 cm H2O (P < .05), performance on the DC-ITL test increased from a maximal load of 37 +/- 12 to 53 +/- 13 cm H2O (P < .05), RPBD decreased from 5.5 +/- 2.5 to 3.8 +/- 2.6 for equal loads on the DC-ITL (P < .05) and the CRQ Dyspnea Scale improved from 18.1 +/- 5.1 to 22.4 +/- 5.2 (P < .05). CONCLUSIONS Inspiratory muscle training at high-intensity loads significantly improved inspiratory muscle strength, respiratory muscle endurance, and respiratory symptoms during daily activities and respiratory exertion.

Church‐based education: An outreach program for African Americans with hypertension

The goals of this education outreach demonstration study were to prepare a cadre of registered nurses (RN) as Church Health Educators (CHE), and to test the efficacy of a hypertension (HBP) education and support program in African American (AA) churches for persons with HBP in managing blood pressure (BP). In this two-phase study, RNs were prepared as CHEs in phase 1 and a convenience sample of 97 subjects with HBP was taught by the CHEs in phase 2. The interventions content included the bases of HBP and HBP management strategies, and was taught in eight 1-hour sessions. Using a pre-test-post-test design, data on knowledge, social support and BP were collected at baseline (pre), post-intervention (post1) and 3 months post-intervention (post2). Major findings include: (1) there was a significant increase in knowledge scores from pre to post1 and post2 (P < or = 0.0001; F = 95.08; df = 1.79); (2) education, age and number of years with HBP explained 49% of the variance associated with HBP knowledge; (3) systolic BP (SBP) and mean arterial BP (MAP) significantly decreased from pre to post1 and post2 (SBP-p < or = 0.0001, F = 18.35, df = 1.91; MAP-p < or = 0.0001, F = 17.80, df = 1.86); (4) DBP significantly decreased from pre to post1 only (p < or = 0.008, F = 17.48, df = 1.91); and (5) relationships were found between social support and DBP, and social support and MAP. Issues that emerged from this study with implications for outreach programming include recruitment and retention, randomization, selective sampling, intervention design and use of volunteers.

The coronary artery bypass experience : gender differences

OBJECTIVE The primary purpose of this study was to examine differences between women and men on physical, social and psychological domains of health quality of life before, 1 month after, and 3 months after coronary artery bypass surgery. DESIGN A prospective, longitudinal design was used. SETTING The study was conducted at a Midwestern, 500-bed community hospital with an ongoing cardiothoracic surgical program. PARTICIPANTS Forty pairs of women and men matched on age within 5 years and body surface area within 0.1m 2. INSTRUMENTS The physical, social and psychological domains of health quality of life were assessed using the following instruments: Ferrans and Powers Quality of Life Index, Specific Activity Scale, Symptom Scale, Profile of Mood States, Overall Health Rating Index, and Personal Resource Questionnaire. RESULTS Both women and men improved on physical and psychological measures following coronary artery bypass surgery. Compared with men, women reported more shortness of breath and depression and lower ratings of activity, vigor, and overall health. Measures of social support yielded little information. CONCLUSIONS Despite matching for age and body surface area, women did not have as favorable an outcome after surgery as men. Continued research needs to further examine the interaction of physical outcomes and depression in women after coronary artery bypass surgery.

RESPIRATORY MUSCLE STRENGTH IN OLDER ADULTS

Gender-related effects and two measures of muscularity, handgrip strength and fat-free mass (FFM), were examined to determine their relationship to respiratory muscle strength. Subjects were 101 healthy older adults. In 75 subjects, the magnitude of learning effect was examined over four weekly sessions. Maximal inspiratory pressure (PImax) was lower with increasing age in women, and maximal expiratory pressure (PEmax) was lower with increasing age in both genders. The PEmax correlated with handgrip strength and FFM in men only. Performance of PImax plateaued by the third visit in both men and women. Performance of PEmax plateaued by the third measure in women and was unchanged across four measurements for men.

Inspiratory muscle training in patients with chronic obstructive pulmonary disease

The effects of 6 months of muscle training with an inspiratory pressure load equal to 30% of the maximal inspiratory pressure (PImax) was compared with sham training with a light inspiratory pressure load. In this double-blind randomly assigned study, 67 patients with chronic obstructive pulmonary disease were followed for 6 months. Both groups demonstrated improvements in performance of PImax, respiratory muscle endurance time for breathing against an inspiratory pressure load equal to 66% of PImax, 12-minute distance walk, and dyspnea. The treatment group did not demonstrate significant effects beyond those observed in the control group. Improvements in performance were related to improved coordination of the inspiratory muscles and desensitization to dyspnea.

Heart rate variability in preterm brain-injured and very-low-birth-weight infants.

Heart rate variability (HRV) reflects the complex interplay of the sympathetic and parasympathetic innervation of the heart. Developmental maturation of the fetus and newborn results in predictable alterations in the neural cardiac control of heart rate. Furthermore, patterns of HRV are closely correlated to clinical outcome in several pathologic situations. The first aim of this study was to characterize the maturational patterns of HRV in a group of developmentally at-risk newborns (those with severe hemorrhagic or ischemic brain injury and extremely immature, low-birth-weight infants). Secondly, we sought to determine whether a correlation exists between HRV and length of hospital stay, diagnosis of cerebral palsy, and neurodevelopmental test scores at 1-year corrected age. Time domain indices of HRV were computed longitudinally from 32 to 37 weeks of corrected gestational age in 19 very low birth weight, preterm infants. Among the 19 infants studied, 7 infants had no evidence of brain injury, 7 infants had periventricular leukomalacia (PVL), 3 infants had grade III/IV intraventricular hemorrhage (IVH), and 2 infants had both IVH and PVL. Neurologic injuries were documented using ultrasound and neurodevelopmental progress was followed through 1 year of corrected gestational age. A multivariate repeated measures analysis was performed to determine the relationship between the type of perinatal brain injury and neurodevelopmental status at 1 year of corrected gestational age. The type of perinatal brain injury was highly correlated to specific patterns of HRV with multivariate regression models producing adjusted r2 values ranging from 0.63 to 0.99. The type of perinatal brain injury was highly correlated to the developmental outcome measures (p < 0.0000) with PVL patients having the lowest neurodevelopmental scores, IVH patients having the highest scores, and noninjured infants having midrange, grossly normal values. Using ANOVA, HRV was correlated to outcome, but individual comparisons revealed statistical significance only for the noninjured group (p < 0.04). However, multivariate models, which characterized outcome within each brain injury group, were highly significant (adjusted r 2 ranged from 0.23 to 0.89). In summary, the type of perinatal brain injury determined the pattern of HRV and HRV was highly correlated to length of hospital stay and neurodevelopmental function assessed at 1 year of corrected gestational age.