18 research outputs found
Agreement of different reference equations to classify patients with COPD as having reduced or preserved 6MWD
No full textBackground: Interpretation of the six-minute walk distance (6MWD) is enhanced by using recommended reference equations. Whenever possible, the choice of equation should be region-specific. A potential problem is that different equations for the 6MWD may have been developed for the same population, and it may be complicated to choose the most suitable. Objective: To verify the agreement of different reference equations in classifying patients with Chronic Obstructive Pulmonary Disease (COPD) as having reduced or preserved 6MWD. Methods: 159 patients with COPD performed the six-minute walk test according to international standardization. They were classified as having reduced 6MWD if it was below the lower limit of normal. Five Brazilian equations (Iwama; Britto1; Britto2; Dourado; Soares) and the two non-Brazilian equations most cited worldwide (Troosters; Enright) were used. The agreement for patients classified as reduced or preserved 6MWD was verified by Cohen's Kappa (pair-to-pair) analysis. The proportion of patients classified as having reduced walked distance was compared by the Chi-squared test. Results: Agreement between equations varied largely in classifying subjects as having reduced or preserved 6MWD (Kappa: 0.10–0.82). Brazilian equations with the highest agreement were Iwama, Britto1 and Britto2 (Kappa > 0.75). The proportion of patients classified as having reduced 6MWD was statistically similar only between equations in which the agreement was higher than 0.70. Conclusion: Even reference equations from the same country vary considerably in the classification of reduced or preserved 6MWD, and it is recommended that the region-specific ones be used as they give with higher agreement for similar and comparable interpretation of the patients’ functional exercise capacity. Keywords: Pulmonary disease, Chronic obstructive, Exercise tolerance, Exercise test, Walk test, Reference value
Energy expenditure per minute in different activities and body positions and its association with the classification as physically active or inactive in daily life in individuals with COPD
No full textObjective: To describe and compare energy expenditure (EE)/minute walking and in different body postures in individuals with COPD; and to investigate if EE/minute walking is a predictor of their classification as physically active or inactive. Methods: Physical activity (PA) in daily life was objectively assessed using two PA monitors for 7 days and data were analyzed on a minute-by-minute basis. Predominant minutes were separated into walking, standing, sitting, and reclined, and EE/minute (a reflection of PA intensity) was then calculated in each of these four activities and postures. Participants were classified as active and inactive according to the criteria proposed by the American College of Sports Medicine (ACSM). Results: 43 individuals were evaluated (65 +/- 8 years; FEV1 50 +/- 14% predicted). A binary logistic regression model yielded that, regardless of the time spent walking/day, EE/minute walking was a significant predictor of the classification as physically active (OR=18.2 [2 - 165]; p=0.01), together with BMI (OR=0.68 [0.5 - 0.9]; p=0.008) (model: Chi-square = 22.431, p< 0.05; R-2 [Nagelkerke] = 0.556). In the active group, significantly higher EE/minute was observed for walking and standing in comparison both to sitting and reclined. However, in the inactive group, there were significant differences in EE/minute only when comparing walking versus reclined and standing versus reclined. Conclusion: In individuals, with COPD, EE/minute walking is a significant predictor of being classified as physically active, independently of the time spent walking/day. Each additional kilocalorie/minute spent walking increases in 18 times the chances to be classified as physically active in daily life
(A) clinical study of percutaneous cervical radiofrequency cordotomy
No full text의학과/석사[한글]
불인통에 대한 신경외과적 치료로는 1912년 spiller의 제의에 의해 Martin이 척추후궁
을 절제하고 척수의 통각신경로를 직접차단한 이후로 약 50여년간 이 방법이 널리 이용되
어 왔으나 허약한 환자에 있어서는 그 수술적 침습이 너무 크고 이에 따른 후유증과 사망
률의 빈도가 높은 단점이 있었다. 1963년 Sean Mullan이 X-선 투시하에 Strontium-90 rad
ioactive needle을 이용하여 정위법에 의한 신경로절단술을 창안하여 국소마취로도 동통
을 제거할 수 있었다. 그후 1965년 Rosomoff가 단파(radiofrequency)를 이용하므로서 더
욱 개선되었고 보편화 되었다. 환자에게 수술이 주는 큰 부담을 덜을 수 있어 전신상태가
나쁜 고령의 악성질환 말기 환자에게도 단기일의 입원기간을 통해서 X-선 투시, 조직의
전기저항측정, 그리고 전기반응에 의한 생리반응조사등을 이용하여 신경로를 원하는 대로
절단할 수 있어서 앞으로 이 술식의 적응은 신경외과 영역에서 더욱 넓어질 것으로 예상
된다. 저자는 1972년 5월부터 1975년 5월까지 3년간 연세의대 신경외과학교실에서 32명의
각종 불인통환자에게 실시한 총 41예의 단파에 의한 경피 정위 경수 통각로절단술(Rosom
off 방법: 31예, Lin의 방법: 10예)을 중심으로 조사한 결과를 아래와 같이 요약한다.
1. 본 증예의 81%는 악성종양으로 인한 것이였고 나머지 19%는 양성질환에서 기인된 불
인통이였다. 악성병소 발생빈도는 위장관계통, 호흡기계통, 골격계통의 순이였고 양성질
환에서는 절단 신경통에 대한 것이 가장 많았다.
2. 본 술식 적응자들의 연령분포는 40-60대가 63%로 대다수를 차지하고 있었고 남녀의
비는 2:1로서 남자에서 더 많았다.
3. 13예에서는 경수 2-4 cord segment까지 무통역을 만들었고 대상성포진환자 2예에서
는 부분적 무통역을 만들 수 있어서 결과적으로 1예 실패를 제외한 97%에서 제통목적을
달성하였다.
4. 환자의 평균 입원소요시일은 10일이내이었다.
5. 술후 통각과 온도감의 높이 (level)의 차이에는 일정한 규율이 없었고 같은 높이를
유지한 것이 19예, 통각d역 상위가 9예, 온도감 상위가 13예이었다.
6. 술후 지각 level의 하강도 종래의 수술적 방법 (open cordotomy)에 비해 경한 것으
로 인정되었다.
7. 술후 후유증도 비교적 경한 편이였으며 일과성 운동부전이 9예(22%) 이였으나 3주이
내에 다 회복되었다. 배뇨장애도 상당한 수에서 왔으나 (약 20%) 약 2주일내에 도뇨관을
제거할 수 있었고 호흡부전은 호흡기계통질환에서 양측술후 2예, 편측술후 1예에서 병발
하였으나 이것으로 사인이 될 Sleep-induced apnea는 한 예도 없었다. 그러나 F.V.C., M.
B.C., PaO^^2 등은 특히 양측 차단시 술후 상당한 저하를 볼 수 있었으나 이것으로 인해
위험한 정도는 아니였다.
이상의 결과로 보아 본 술식은 비교적 간단하고 X-선 조정, 조직전기저항, 생리적 자극
반응등이 보조조사 등으로서 정확하게 통각로의 차단이 가능하므로 고령과 일반상태가 좋
지못한 말기악성질환 환자들에게도 적응이 되며 수술적 방법(open cordotomy)를 거의 대
치할 것으로 믿어진다.
[영문]
The technique of anterolateral cordotomy for relief of pain was first performed
by Spiller and Martin (1912). It was accepted as the best available method for
long-term relief despite its disadvantages. The procedure often caused weakness of
an extremity or the loss of sphincter control and respiratory impairment associated
with high surgical cervical cordotomy has been well documented.
In 1963, Mullan et al. devised an approach to the cervical spinal cord by
inserting a needle through the neck under roentgenologic control. They introduced a
radioactive needle(Strontium**90) to produce a lesion interrupting the lateral
spinothalamic tract. Mullan and Rosomoff et al. (1965) later simplified the
procedure by using an electrical current to produce the lesion.
The percutaneous method has considerable advantages. The mortality and morbidity
are very small and the technique can be used on any patient up to and including the
terminal state. If the required level is not attained at the first attempt, or if
the level subsequently drops, the procedure is easily repeated. Most patients can
be discharged early after this type of cordotomy.
The author has reviewed 41 cordotomies on 32 patients with intractable pain
carried out by the percutaneous radiofrequency procedure at the Neurosurgery
Department of Yonsei University from 1972 to 1975: 31 cases were treated by a
modification of the Rosomoffs technique, 10 cases by Lin's technique.
The following results were obtained.
1. Malignant states comprised 81% of the series, with the gastrointestinal tract
being the predominent primary site, respiratory, bone and breast carcinomas were
the mext most common neoplasms. Non-malignant states comprised 19% of the series:
most common was amputation neuroma. The majority of the patients were in the fourth
to sixth decades of life and males predominated 2:1.
2. In 69%, pain was located in the abdomen, perineum, back or extremity and could
be controlled by thoracic levels of analgesia. The 31% with neck, upper extremity
or thoracic disease required cervical levels of analgesia.
3. Immediate postoperative analgesic levels were obtained at C 2-4 in 13 of 37
cases and at T5-12 in 9 cases. It was relatively neccessary that high levels of
analgesia be achieved for some possible slipping and for metastases of malignancy.
Segmental levels were also sought in 2 cases of herpes coster. One case has been a
failure.
4. Most patients could be discharged 10 days after this type of cordotomy without
pain. Follow-up analgesic levels showed sustained analgesia without change in one
half of the cases and higher or lower from 4 to 6 segments in the remainder.
5. The zones of analgesia and thermesthesia were the same in 19 instances,
analgesia was more extensive in 9 cases and thermesthesia more extensive in 13.
6. The morbidity was gratifyingly small. Nice cases of paresis were seen but all
were temporary, lasting within 3 weeks. Urinary retention occured in 8 cases and
also was transient, the longest period of catheterization being two week. Three
patients had mild respiratory difficulties but did not exhibit the syndrome of
sleep-induced apnea. Death was absent.
7. Following unilateral cordotomy, mean F.V.C., M.V.C. and PaO^^2 were not
lowered. Following cordotomy on the other side (7 cases), there was a significant
reduction in F.V.C., M.V.C. and PaO^^2 values, greater in the 3/9 who became
dyspneic. Three instances of respiratory failure were proved to be the primary
lesions of pulmonary cancer.
8. Electrolyte study showed no distinctive change between pre- and postoperative
states.
In conclusion, percutaneous cervical radiofrequency cordotomy allows easy,
efficient and low-risk relief of pain in an extended range of intractable
conditions, both benign and malignant, with a short period of hospitalization.restrictio
The correlation between quadriceps muscle strength and endurance and exercise performance in patients with COPD
No full textContains fulltext :
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Frequency and functional translation of low muscle mass in overweight and obese patients with COPD
No full textBackground Cut offs for fat-free mass index (FFMI) and appendicular skeletal muscle mass index (ASMI) are available for diagnosing low muscle mass in patients with COPD. This study aimed to investigate: (1) the frequency of low muscle mass (FFMI and ASMI) applying different cut-offs and (2) the functional translation (clinical impact) of low muscle mass, in patients with COPD stratified into BMI categories. Methods Patients with COPD were assessed regarding body composition, exercise capacity, quadriceps muscle strength, symptoms of anxiety and depression, dyspnea and quality of life upon referral to pulmonary rehabilitation. The proportion of patients with low muscle mass was compared among BMI categories. Clinical outcomes between patients with normal and low muscle mass within each BMI category were compared. Results 469 patients with COPD were included for analyses. The frequency of patients classified as low FFMI varied significantly according to the choice of cut-off (32 to 54%; P < 0.05), whereas the frequency of patients with low ASMI was 62%. When applying age-gender-BMI-specific cut-offs, 254 patients (54%) were classified as low FFMI. The choice of the cut-off affected the frequency of patients with low muscle mass in all BMI categories. Overweight and obese patients with low muscle mass were more frequently males and presented worse pulmonary function, exercise capacity and muscle strength compared with overweight and obese patients with normal muscle mass. Conclusions Approximately half of the overweight and obese patients with COPD have low muscle mass when applying age-gender-BMI-specific cut-offs. Low muscle mass is associated with worse functional outcomes in overweight and obese COPD patients.</p
Understanding and Being Understood: Information and Care Needs of 2113 Patients With Confirmed or Suspected COVID-19
No full textTo become a proactive and informed partner in postacute coronavirus disease 2019 (COVID-19) management, patients need to have the knowledge, skills, and confidence to self-manage COVID-19-related health challenges. Due to several restrictions and consequently social isolation, online platforms and forums where people can share information and experiences became more popular and influential. Therefore, this study aimed to identify perceived information needs and care needs of members of 2 Facebook groups for patients with COVID-19 and persistent complaints in the Netherlands and Belgium and patients with COVID-19 who registered at a website of the Lung Foundation Netherlands. Besides demographics and clinical characteristics, the degree of satisfaction with care during and after the infection as well as satisfaction with available information were assessed. Open text fields revealed specific information needs which were summarized. Patients with confirmed or suspected COVID-19 perceive various unmet needs varying from specific information needs (eg, information about permanent lung damage) to general needs (eg, being heard and understood). These data lead to several recommendations to improve care for patients with COVID-19 and justify further development of online platforms specifically addressing these unmet needs
The Impact of Post-COVID-19 Syndrome on Self-Reported Physical Activity
No full textBackground: A subgroup of patients recovering from COVID-19 experience persistent symptoms, decreased quality of life, increased dependency on others for personal care and impaired performance of activities of daily living. However, the long-term effects of COVID-19 on physical activity (PA) in this subgroup of patients with persistent symptoms remain unclear. Methods: Demographics, self-reported average time spent walking per week, as well as participation in activities pre-COVID-19 and after three and six months of follow-up were assessed in members of online long-COVID-19 peer support groups. Results: Two hundred thirty-nine patients with a confirmed COVID-19 diagnosis were included (83% women, median (IQR) age: 50 (39-56) years). Patients reported a significantly decreased weekly walking time after three months of follow-up (three months: 60 (15-120) min. vs. pre-COVID-19: 120 (60-240) min./week; p < 0.05). Six months after the onset of symptoms walking time was still significantly lower compared to pre-COVID-19 but significantly increased compared to three months of follow-up (three months: 60 (15-120) min. vs. six months: 90 (30-150) min.; p < 0.05). Conclusions: Patients who experience persistent symptoms after COVID-19 may still demonstrate a significantly decreased walking time six months after the onset of symptoms. More research is needed to investigate long-term consequences and possible treatment options to guide patients during the recovery fromCOVID-19.</p
Severe Fatigue in Long COVID: Web-Based Quantitative Follow-up Study in Members of Online Long COVID Support Groups
No full textBackground: Fatigue is the most commonly reported symptom in patients with persistent complaints following COVID-19 (ie, long COVID). Longitudinal studies examining the intensity of fatigue and differentiating between physical and mental fatigue are lacking.Objective: The objectives of this study were to (1) assess the severity of fatigue over time in members of online long COVID peer support groups, and (2) assess whether members of these groups experienced mental fatigue, physical fatigue, or both.Methods: A 2-wave web-based follow-up study was conducted in members of online long COVID peer support groups with a confirmed diagnosis approximately 3 and 6 months after the onset of infectious symptoms. Demographics, COVID-19 diagnosis, received health care (from medical professionals or allied health care professionals), fatigue (Checklist Individual Strength-subscale subjective fatigue [CIS-Fatigue]; 8-56 points), and physical and mental fatigue (self-constructed questions; 3-21 points) were assessed. Higher scores indicated more severe fatigue. A CIS-Fatigue score >= 36 points was used to qualify patients as having severe fatigue.Results: A total of 239 patients with polymerase chain reaction/computed tomography-confirmed COVID-19 completed the survey 10 weeks (SD 2) and 23 weeks (SD 2) after onset of infectious symptoms, respectively (T1 and T2). Of these 239 patients, 198 (82.8%) were women; 142 (59.4%) had no self-reported pre-existing comorbidities; 208 (87%) self-reported being in good health before contracting COVID-19; and 62 (25.9%) were hospitalized during acute infection. The median age was 50 years (IQR 39-56). The vast majority of patients had severe fatigue at T1 and T2 (n=204, 85.4%, and n=188, 78.7%, respectively). No significant differences were found in the prevalence of normal, mild, and severe fatigue between T1 and T2 (P=.12). The median CIS-Fatigue score was 48 points (IQR 42-53) at T1, and it decreased from T1 to T2 (median change: -2 points, IQR -7 to 3; P<.001). At T1, a median physical fatigue score of 19 points (IQR 16-20) and a median mental fatigue score of 15 points (IQR 10-17) were reported; these scores were lower at T2 for physical but not for mental fatigue (median change for physical fatigue -1 point, IQR -3 to 0, P<.001; median change for mental fatigue 0 points, IQR -3 to 3, P=.52). At the time of completing the follow-up survey, 194/239 (81.2%) and 164/239 (68.6%) of all patients had received care from at least one medical professional and one allied health care professional, respectively.Conclusions: Fatigue in members of online long COVID support groups with a confirmed COVID-19 diagnosis decreases from 10 to 23 weeks after onset of symptoms. Despite this, severe fatigue remains highly prevalent. Both physical and mental fatigue are present. It remains unclear whether and to what extent fatigue will resolve spontaneously in the longer term
Persistent symptoms 3 months after a SARS-CoV-2 infection:the post-COVID-19 syndrome?
No full textBackground: Many patients with COVID-19 did not require hospitalisation, nor underwent COVID-19 testing. There is anecdotal evidence that patients with “mild” COVID-19 may complain about persistent symptoms, even weeks after the infection. This suggests that symptoms during the infection may not resolve spontaneously. The objective of this study was to assess whether multiple relevant symptoms recover following the onset of symptoms in hospitalised and nonhospitalised patients with COVID-19. Methods: A total of 2113 members of two Facebook groups for coronavirus patients with persistent complaints in the Netherlands and Belgium, and from a panel of people who registered on a website of the Lung Foundation Netherlands, were assessed for demographics, pre-existing comorbidities, health status, date of symptoms onset, COVID-19 diagnosis, healthcare utilisation, and the presence of 29 symptoms at the time of the onset of symptoms (retrospectively) and at follow-up (mean±SD 79±17 days after symptoms onset). Results: Overall, 112 hospitalised patients and 2001 nonhospitalised patients (confirmed COVID-19, n=345; symptom-based COVID-19, n=882; and suspected COVID-19, n=774) were analysed. The median number of symptoms during the infection reduced significantly over time (median (interquartile range) 14 (11–17) versus 6 (4–9); p<0.001). Fatigue and dyspnoea were the most prevalent symptoms during the infection and at follow-up (fatigue: 95% versus 87%; dyspnoea: 90% versus 71%). Conclusion: In previously hospitalised and nonhospitalised patients with confirmed or suspected COVID-19, multiple symptoms are present about 3 months after symptoms onset. This suggests the presence of a “post-COVID-19 syndrome” and highlights the unmet healthcare needs in a subgroup of patients with “mild” or “severe” COVID-19.</p
Care Dependency in Non-Hospitalized Patients with COVID-19
No full textBackground: A large sample of "mild" COVID-19 patients still experience multiple symptoms months after being infected. These persistent symptoms are associated with many clinically relevant outcomes, including poor health status and impaired functional status. To date, no information is available about care dependency. Therefore, we aimed to explore the level of care dependency and the need for assistance with personal care in non-hospitalized COVID-19 patients. Methods: Members of two Facebook groups for COVID-19 patients with persistent complaints in The Netherlands and Belgium, and from a panel of people who registered at a website of the Lung Foundation Netherlands, were assessed for demographics, pre-existing comorbidities, health status, and symptoms. In addition, patients were asked about their dependence on others for personal care before and after the infection. The level of care dependency was assessed with the Care Dependency Scale (CDS) in members of the Belgian Facebook group (n= 210). Results: The data of 1837 non-hospitalized patients (86% women; median (IQR) age: 47 (38-54)) were analyzed. Only a small proportion of patients needed help with personal care before COVID-19, but the care need increased significantly after the infection (on average 79 +/- 17 days after the onset of symptoms; 7.7% versus 52.4%, respectively;p<0.05). The patients had a median (IQR) CDS score of 72 (67-75) points, and 31% of the patients were considered as care-dependent (CDS score</p
