Activity Domain Scores Research Articles

MP84-12 PATIENT-REPORTED QUALITY OF LIFE AND CONVALESCENCE AFTER MINIMALLY INVASIVE KIDNEY CANCER SURGERY

Abstract Objective To better characterize recovery after minimally invasive kidney surgery, we present a study describing patient-reported health-related quality of life (HRQOL) following minimally invasive radical nephrectomy (RN) and partial nephrectomy (PN). Methods Patients who underwent minimally invasive PN or RN for renal cancer were invited to enroll in a prospective, patient-reported HRQOL study using the Convalescence and Recovery Evaluation (CARE) instrument and Short Form-12. Patients completed questionnaires at baseline, 2, 4, 8, and 12 weeks after surgery. Mixed repeated measures model were used to assess time effect on HRQOL scores and predictors of scores within each surgery groups. Results One hundred seventy-seven patients were included in the study: 50 had RN and 127 had PN. At 2 weeks, both groups had significant decreases in Overall CARE, as well as the Pain, Gastrointestinal, and Activity domain scores which remained slightly below baseline at 4 weeks. At 4 weeks only 50% of patients in both the RN and PN cohorts returned to baseline overall CARE score. By 12 weeks 82% returned to baseline overall CARE score in the RN group while 76% of patients did so in the PN group. Conclusion Convalescence after minimally invasive renal surgery can often extend beyond 4 weeks post-treatment in PN and RN subjects. This information may be used to provide more accurate preoperative counseling in an attempt to improve overall patient satisfaction.

Clinical benefits of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease.

To evaluate the benefits of home-based pulmonary rehabilitation (PR) in patients with severe and very severe chronic obstructive pulmonary disease (COPD). Randomized clinical trial involving 58 patients. Pulmonary function, quality of life evaluated by the Saint George Respiratory Questionnaire, breathlessness evaluated by the London Chest Activity of Daily Living Scale, and exercise tolerance evaluated by 6-minute walk distance were assessed at baseline and at 12 weeks. The program consisted of 2 weekly visits by a physiotherapist in the first 2 weeks, followed by visits twice a month, as well as weekly telephone calls. Training included breathing and stretching exercises and strength exercises (upper and lower limbs), along with endurance training, including walking, stair climbing, cycling, and treadmill walking, depending on available patient resources. The treatment group (TG; n = 23) and control group (CG; n = 18) completed the study. Following the intervention, no statistically significant differences were found in pulmonary function in the TG and CG. The TG exhibited statistically significant differences in the activity domain (P = .008), impact domain (P < .001), and total scores of the Saint George Respiratory Questionnaire (P < .001). In addition, the TG demonstrated statistically significant differences in all domains of the London Chest Activity of Daily Living Scale and no differences were observed in the CG after 12 weeks. There was a statistically significant difference in the 6-Minute Walk Distance in the TG after rehabilitation (P = .008). This study offers evidence that home-based PR promotes benefits in the quality of life, breathlessness in activities of daily living, and exercise capacity in patients with severe and very severe COPD. Home-based PR must be considered as part of the treatment for patients who live far from hospitals even in severe COPD.

Increased Body Mass Index Negatively Affects Patient Satisfaction After a Posterior Fusion and Instrumentation for Adolescent Idiopathic Scoliosis

Study DesignRetrospective. Summary of Background DataPrevious studies have reported the correlation of body mass index (BMI) with non-spine surgical outcomes; however, only a few reviewed the correlation of BMI to outcomes after spine surgery. ObjectivesTo review the influence of preoperative BMI on the follow-up clinical and functional outcomes after posterior-only fusion (PSF) and instrumentation for adolescent idiopathic scoliosis in a larger patient cohort. MethodsRetrospective review of a consecutive series of patients treated with PSF for adolescent idiopathic scoliosis from 2002 to 2009 at a single institution. There were 3 categories: underweight (UW), normal weight (NML), and overweight (OW). Percent correction of the major curve was collected at 2 years postoperatively and patient outcome scores were analyzed preoperatively and at 2 years postoperatively. Differences between groups were analyzed using analysis of variance, with p < .05. ResultsA total of 459 patients at an average age of 15.0 years (range, 10.0–21.3 years) treated with PSF instrumentation were included. At 2 years, all groups achieved and maintained equal percent correction with no differences between groups. Regarding preoperative Scoliosis Research Society (SRS) outcome scores, OW patients reported more pain than NML (p = .002) and UW patients (p < .001) despite less reported activity than for the NML (p = .033) and UW groups (p = .005). The total SRS score was also lower in the OW patients compared with NML (p = .009) and UW patients (p = .002). At 2 years, the OW group reported more pain than the UW (p = .031) and NML groups (p = .018), lower mental scores (p = .011) and lower SRS total scores (p = .005) than the NML group. ConclusionsAt follow-up, preoperative overweight adolescents reported more pain and lower mental, activity, and appearance domain scores after surgery than UW and NML patients despite equal percent curve correction. This information may help the surgeon with preoperative counseling of OW patients by stressing that their own assessment of outcome is influenced by BMI, which may help promote a healthy weight management program in this patient group.

Intrinsic hippocampal activity as a biomarker for cognition and symptoms in schizophrenia.

Identification of biomarkers for cognitive dysfunction in schizophrenia is a priority for psychiatry research. Functional imaging studies suggest that intrinsic "resting state" hippocampal hyperactivity is a characteristic feature of schizophrenia. The relationships between this phenotype and symptoms of the illness, however, are largely unexplored. The authors examined resting hippocampal activity in schizophrenia patients and healthy comparison subjects and analyzed the relationship between intrinsic hippocampal activity and cognitive function in patients as measured by the MATRICS Consensus Cognitive Battery (MCCB). Twenty-eight schizophrenia patients and 28 age-matched healthy comparison subjects underwent functional "resting state" 3-T MR scanning. Hippocampal activity was extracted by group independent component analysis. Correlation analyses were used to examine the relationship between hippocampal activity and MCCB composite and domain scores in patients, as well as between hippocampal activity and positive and negative symptoms. Greater activity of the right hippocampus at rest was observed in patients relative to comparison subjects. In patients, a significant negative correlation was observed between right hippocampal activity and composite MCCB T-score. The correlation was driven by the MCCB domains of attention/vigilance, working memory, and visual learning. Hippocampal activity was positively correlated with negative symptoms. MCCB scores were inversely correlated with negative symptoms. These findings suggest that greater intrinsic hippocampal activity is a characteristic feature of schizophrenia that is broadly associated with cognitive dysfunction, and they support hippocampal activity as a candidate biomarker for therapeutic development.

Effects of self-management education on quality of life of patients with chronic obstructive pulmonary disease

PurposeTo explore the effects of self-management education on the quality of life of patients living with chronic obstructive pulmonary disease (COPD). MethodsEighty-four stable or discharged COPD subjects were recruited from April 2011 to January 2012 following treatment at Beijing Hospital or Peking Union Medical College Hospital. Subjects were divided into an intervention group who underwent self-management education or a control group who received usual care without additional education (n = 42 each). The St George's Respiratory Questionnaire (SGRQ) was used to measure quality of life at three and six months. ResultsSGRQ impact domain scores revealed significant differences between the groups (t = −2.167, p < 0.05) at three months. SGRQ symptom, impact, activity domain and total scores revealed significant differences between groups (t = −3.482 to −2.530, p < 0.05) at six months. ConclusionA nurse-led, simple, structured self-management education program provided an effective method for the management of patients with COPD.

The impact of concurrent granulocyte–macrophage colony-stimulating factor on quality of life in head and neck cancer patients: results of the randomized, placebo-controlled Radiation Therapy Oncology Group 9901 trial

The Radiation Therapy Oncology Group (RTOG) conducted a randomized, placebo-controlled trial evaluating the efficacy of GM-CSF in reducing mucosal injury and symptom burden from curative radiotherapy for head and neck (H&N) cancer. Eligible patients with H&N cancer receiving radiation encompassing ≥50% of the oral cavity or oropharynx received subcutaneous GM-CSF or placebo. Quality of life (QoL) was assessed using the RTOG-modified University of Washington H&N Symptom Questionnaire at baseline 4, 13, 26, and 48weeks from radiation initiation. Of 125 eligible patients, 114 were evaluable for QoL (58 GM-CSF, 56 placebo). Patient demographics, clinical characteristics, and baseline symptom scores were well balanced between the treatment arms. At the end of the acute period (13weeks), patients in both arms reported negative change in total symptom score indicating increase in symptom burden relative to baseline (mean -18.4 GM-CSF, -20.8 placebo). There was no difference in change in total symptom score (p>0.05) or change in mucous, pain, eating, or activity domain scores (p>0.01) between patients in the GM-CSF and placebo arms. Analysis limited to patients treated per protocol or with an acceptable protocol deviation also found no difference in change in total symptom score (p>0.05) or change in domain scores (p>0.01) between treatment arms. Provider assessment of acute mucositis during treatment did not correlate with patient-reported mucous domain and total symptom scores (p>0.05). GM-CSF administered concurrently during head and neck radiation does not appear to significantly improve patient-reported QoL symptom burden.

The relationship between quality of life and demographic variables in hemodialysis patients

Introduction: Quality of life is an important criterion in evaluation of medical treatment and status of health and well-being, contributing to the prediction of mortality rate in hospitals. QOL may be affected by diseases and their related complications. This study aims to investigate the relationship between the quality of life (QOL) of hemodialysis patients and demographic variables. Materials and Methods: In this descriptive analytic study, SF36 questionnaire was used to examine the QOL of 60 hemodialysis patients in Kerman. Results: The mean score of the QOL in hemodialysis patients was 49.83 ± 17.56. The maximum of score was related to the physical activity domain (57.09) and minimum score was given to the vitality domain (43.85). The relationship between quality of life and age, job, literacy and marriage was significant. Conclusion: Our results revealed that the QOF in hemodialysis patients was less that in than normal people. It was shown that these patients need to live a happy life. Therefore, appropriate mental support and instruction on compatibility methods can increase their QOF.

Evaluation of Patient-reported Quality-of-life Outcomes After Renal Surgery

To assess the feasibility of 2 patient-reported health-related quality of life (HRQOL) instruments, Convalescence and Recovery Evaluation (CARE), and SF-12, as tools for evaluating HRQOL outcome consequences after renal surgery, and to determine which domains of these HRQOL instruments are most sensitive to HRQOL outcome effects of renal surgery. Patients completed CARE and SF-12 preoperatively (baseline) and at 2, 4, 12, and 24 weeks after surgery. Clinical data, patient response rate, HRQOL changes over time, and likelihood of patient return to baseline HRQOL were evaluated. Seventy-one patients were enrolled. Sixty patients completed the baseline and at least 1 follow-up set of questionnaires. The CARE pain, gastrointestinal (GI), and activity domain scores and the SF-12 physical composite score (PCS) were sensitive to changes in HRQOL (all P<.05), whereas other domain subscores of these instruments did not change from presurgical baseline to postsurgical follow-up. Postsurgical HRQOL effects detected by the CARE pain, GI, and activity domains, and SF-12 PCS were most evident at 2 weeks (all P<.001). The CARE composite score demonstrated that 74% and 50% of patients returned to within 90% of baseline 4 weeks after radical and partial nephrectomy, respectively. Evaluation of patient-reported HRQOL outcomes after renal surgery is feasible; our findings suggest that the activity, pain, and GI domains of CARE and PCS subscores of the SF-12 are sensitive measures of HRQOL outcome consequences of renal surgery and represent appropriate measures of either care quality or comparative effectiveness analyses of robotic, laparoscopic, and open renal surgery.

Characterization of Hypoactive Sexual Desire Disorder (HSDD) in Men

Little is known about Hypoactive Sexual Desire Disorder (HSDD) in men. To provide the first comprehensive characterization of men diagnosed with HSDD (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision [DSM-IV-TR]) using established patient-reported outcomes (PROs) and new PROs developed in line with U.S. Food and Drug Administration (U.S. FDA) guidance. This 4-week non-treatment study recruited men (N=200) with or without symptoms of low sexual desire and related distress. Men with erectile dysfunction, serum testosterone <300 ng/dL, or depression were excluded. Men completed assessments of sexual desire and sex-related distress and underwent structured clinical interviews for the diagnosis of HSDD. Primary endpoints were scores on the Sexual Desire Inventory (SDI), Male Desire Scale (MDS), Sexual Concerns Inventory-Male (SCI-M), and Sexual Desire Relationship Distress Scale (SDRDS) on day 28, and University of California, Los Angeles (UCLA) Psychosexual Diary on days 21-27. Scores are presented as median (interquartile range). There were no clinically relevant differences in age, serum testosterone, depressive symptomatology, erectile function, concomitant illness, or medication use between men with HSDD (N=109) and men without HSDD (N=91). However, clinically meaningful differences between men with and without HSDD were observed in sexual desire according to SDI score (40.0 [21.0] vs. 65.0 [25.0]) and MDS sexual desire domain score (18.0 [8.0] vs. 31.0 [13.0]), in sex-related distress according to SCI-M score (22.0 [12.0] vs. 6.0 [12.0]) and SDRDS score (36.0 [17.0] vs. 10.0 [16.0]), and in UCLA Psychosexual Diary sexual activity domain score (2.6 [2.7] vs. 4.9 [3.9]) (P<0.0001, for all). Based on a brief structured interview, diagnosis according to DSM-IV-TR criteria for HSDD identified a population of men comparable with men without HSDD in age, serum testosterone, concomitant illness and medication use but distinct in their experience of sexual desire and distress associated with low desire. These controlled data characterize HSDD in men as a distinct sexual dysfunction.

Quality of life for Chinese patients with adolescent idiopathic scoliosis: evaluation of the Chinese version of the Scoliosis Research Society's outcomes instrument 22

Objective To evaluate the health-related quality of life ( HRQL) of patients with adolescent idiopathic scoliosis ( AIS) before treatment. Methods Sixty-two female patients with AIS were evaluated using the Chinese version of Scoliosis Research Society's outcomes instrument 22 ( SRS-22) HRQL questionnaire before treatment. The patients were categorized into thFee groups: a mild deformity group with a major curve Cobb angle less than 30° ( n =14),a moderate deformity group with Cobb angles of 30° to 50° ( n =42), and a severe deformity group with Cobb angles more than 50° ( n =6). Results The severe deformity group scored lowest in the self-image domain.There was,however,no significant difference in the functional activity,pain or mental health domain scores between the three groups. Conclusions The Chinese version of the SRS-22 HRQL questionnaire can be used to assess the HRQL of Chinese AIS patients.AIS patients with a major curve Cobb angle more than 50° have relatively low self-image scores. Key words: Adolescent idiopathic scoliosis ; Assessment ; Quality of life ; Questionnaires

Preoperative Bracing Affects Postoperative Outcome of Posterior Spine Fusion With Instrumentation for Adolescent Idiopathic Scoliosis

STUDY DESIGN.: Multicenter, prospective clinical series. OBJECTIVE.: To investigate the effect of preoperative bracing on postoperative outcome of posterior spine fusion with instrumentation for adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA.: Bracing is the standard of care for adolescent idiopathic scoliosis between 25° and 45°, yet the efficacy of bracing is questionable. It is important to evaluate the effect of bracing on outcomes in the adolescent idiopathic scoliosis population. METHODS.: We reviewed the outcomes of 281 before surgery braced and 328 before surgery nonbraced patients who underwent posterior spine fusion with instrumentation for adolescent idiopathic scoliosis before operation and at 2 years after operation using the Scoliosis Research Society instrument (SRS-30) and the Spinal Appearance Questionnaire. RESULTS.: At 2 years after operation, nonbraced patients demonstrated a greater improvement in the SRS-30 Pain domain score (0.23 vs. 0.08, P < 0.001), more improvement in back pain at rest (26.7% vs. 20.5%, P = 0.0009), and more improvement in back pain in the past 6 months (42.4% vs. 32.6%, P = 0.039) compared to braced patients. Also at 2 years after operation, nonbraced patients reported higher SRS-30 Activity domain scores (4.38 vs. 4.32, P = 0.031), Satisfaction domain scores (4.53 vs. 4.42, P = 0.007), and Total scores (4.27 vs. 4.35, P = 0.036) compared with braced patients. The 2-year Spinal Appearance Questionnaire scores showed that nonbraced patients reported a greater "decrease in importance" than braced patients in having "more even shoulders" (79.4% vs. 70.5%, P = 0.03), "more even hips" (74.6% vs. 71.6%, P = 0.042), and "more even ribs in back" (78.4% vs. 69.5%, P = 0.05). CONCLUSION.: Before surgery braced patients have more pain, lower activity levels, lower satisfaction, and lower total SRS-30 scores at 2 years after operation. Braced patients also have more "spine-specific" appearance concerns compared to nonbraced patients. These results suggest a negative impact of preoperative bracing on outcomes after posterior spinal fusion for adolescent idiopathic scoliosis. This "brace signature" should be taken into account when brace treatment is being considered.

Quality of Life of Patients With Tongue Cancer 1 Year After Surgery

To study the changes and factors affecting the quality of life (QOL) of patients with tongue cancer 1 year after primary surgery. A total of 289 consecutive patients with tongue cancer who had undergone primary surgery from 2003 to 2008 at our hospital were recruited. Patient QOL was evaluated using the University of Washington Quality of Life Questionnaire, version 4. Statistical analysis was conducted using a paired-samples t test and multiple stepwise linear regression with Statistical Package for Social Sciences, version 11.5 (SPSS, Chicago, IL). At 1 year after surgery, the appearance, activity, speech, swallowing, shoulder function, salivary, and taste domain scores were significantly lower than the preoperative scores (P < .05). However, the pain, anxiety, and mood scores were significantly better 1 year after surgery (P < .05). The overall QOL had increased greatly 1 year after surgery but did not reach the pretreatment level. Multiple stepwise linear regression analysis showed that the main factors affecting QOL were radiotherapy, advanced clinical stage (P < .05), socioeconomic status, and patient age. Radiotherapy, advanced clinical stage (P < .05), socioeconomic status, and age (P < .05) were independently associated with QOL. The patients with tongue cancer who have been diagnosed and treated early might have a better QOL. A greater socioeconomic status can also improve the QOL of patients with tongue cancer after primary surgery.

Perfil do nível de atividade física na vida diária de pacientes portadores de DPOC no Brasil

To evaluate characteristics of physical activities in daily life in COPD patients in Brazil, correlating those characteristics with physiological variables. Physical activities in daily life were evaluated in 40 COPD patients (18 males; 66 + or - 8 years of age; FEV(1) = 46 + or - 16 % of predicted; body mass index = 27 + or - 6 kg/m(2)) and 30 healthy age- and gender-matched subjects, using a multiaxial accelerometer-based sensor for 12 h/day on two consecutive days. We also assessed maximal and functional exercise capacity, using the incremental exercise test and the six-minute walk test (6MWT), respectively; MIP and MEP; peripheral muscle force, using the one-repetition maximum test and the handgrip test; quality of life, using the Saint George's Respiratory Questionnaire (SGRQ); functional status, using the London Chest Activity of Daily Living questionnaire; and dyspnea sensation, using the Medical Research Council (MRC) scale. Mean walking time/day was shorter for COPD patients than for the controls (55 + or - 33 vs. 80 + or - 28 min/day; p = 0.001), as movement intensity was lower (1.9 + or - 0.4 vs. 2.3 + or - 0.6 m/s(2); p = 0.004). The COPD patients also tended to spend more time seated (294 + or - 114 vs. 246 + or - 122 min/day, p = 0.08). Walking time/day correlated with the 6MWT (r = 0.42; p = 0.007) and maximal workload (r = 0.41; p = 0.009), as well as with age, MRC scale score and SGRQ activity domain score (-0.31 < or = r < or = -0.43; p < or = 0.05 for all). This sample of Brazilian patients with COPD, although more active than those evaluated in studies conducted in Europe, were less active than were the controls. Walking time/day correlated only moderately with maximal and functional exercise capacity.

Fatores associados à diferença clinicamente significativa da qualidade de vida relacionada à saúde após condicionamento físico em pacientes com DPOC

To identify factors associated with the minimal clinically important difference (MCID) for health-related quality of life (HRQoL) after physical conditioning in patients with COPD. Thirty-five patients were submitted to a 12-week program of physical conditioning (strength training plus low-intensity aerobic exercise). Body composition, incremental treadmill test results, endurance treadmill test results, six-minute walk test results, peripheral muscle strength, MIP, baseline dyspnea index (BDI) and Saint George's Respiratory Questionnaire (SGRQ) scores were assessed at baseline and after the program, thus allowing the variations (Delta) to be calculated. The MCID for HRQoL was defined as a reduction of > 4% in the SGRQ total score. Subjects who responded to the program, achieving the MCID for HRQoL, were allocated to the responders (R) group (n = 24), and the remainder were allocated to the non-responders (NR) group (n = 11). The values obtained for the following variables were significantly higher in group R than in group NR (p < 0.05): FEV1 (1.48 + or - 0.54 L vs. 1.04 + or - 0.34 L); VEF1/FVC (47.9 + or - 11.7% vs. 35.5 + or - 10.7%); PaO2 (74.1 + or - 9.7 mmHg vs. 65.0 + or - 8.9 mmHg); and DeltaBDI, expressed as median and interquartile range (2.0 [0.0-3.5] vs. 0.0 [0.0-1.0]). The DeltaBDI correlated significantly with the DeltaSGRQ symptoms domain score, activity domain score and total score (r = 0.44, 0.60 and 0.62, respectively, p < 0.01 for all). After logistic regression, only DeltaBDI remained as a predictor of MCID for HRQoL. Achieving the MCID for HRQoL after physical conditioning is associated with dyspnea reduction in COPD patients. Therefore, there is a need to develop treatment strategies designed to interrupt the dyspnea-inactivity-dyspnea cycle in such patients.

Influência dos parâmetros funcionais respiratórios na qualidade de vida de pacientes com DPOC

To determine the quality of life of COPD patients by using the Medical Outcomes 36-item Short-Form Survey (SF-36) and the Saint George's Respiratory Questionnaire (SGRQ), correlating the scores with respiratory function parameters. This was a cross-sectional study involving 42 COPD patients. We used the SGRQ (a specific questionnaire) and the SF-36 (a general questionnaire), together with their component summaries, in order to determine the quality of life of these patients. The functional profile was assessed by means of spirometry, arterial blood gas analysis and the six-minute walk test. Of the 42 patients, 30 (71.4%) were male and 12 (28.6%) were female. The mean age of the patients was 65.4 +/- 8.0 years. The mean physical component summary and mean mental component summary scores were 37.05 +/- 11.19 and 45.61 +/- 15.65, respectively. The physical component summary correlated significantly with FEV(1) in L/s (r = 0.38; p = 0.012). There was a correlation between the SGRQ total score and FEV(1) (r = -0.50; p < 0.01). The SGRQ activity domain showed negative correlations with all respiratory function parameters. The multiple regression analysis showed that only FEV(1) correlated significantly with the SGRQ total score, as well as with the activity domain score (r= -0.32; p = 0.04 and r = -0.34; p = 0.03, respectively). In COPD patients, a decline in FEV(1) is associated with poorer quality of life, as evaluated using the SGRQ.

Quality-of-life outcomes after surgical correction of pectus excavatum: a comparison of the Ravitch and Nuss procedures

PurposeThe purpose of this study was to compare clinical and health-related quality-of-life (HRQL) outcomes within a group of patients treated for pectus excavatum (PE). MethodsA retrospective 3-year review of patients undergoing Nuss or Ravitch correction of PE was performed. Health-related quality-of-life assessment was performed using the Child Health Questionnaire (CHQ-CF87) and the 17-item Pectus Excavatum Evaluation Questionnaire, and results were compared between groups and with age-matched CHQ-CF87 normative data. ResultsForty-three patients (39 males; 91%) underwent surgery; 19 (44%) by Nuss procedure. Duration of postoperative opioid analgesia and length of hospital stay (LOS) were significantly longer in Nuss patients. The overall survey response rate was 53%. The groups differed significantly in the CHQ on one item (Change in Health). On the Pectus Excavatum Evaluation Questionnaire, Nuss patients reported being “less bothered” by the appearance of their chest. Compared to Australian age-matched norms, the aggregate PE sample showed better scores for family activity domain and worse scores in mental health, general health perceptions, change in health, bodily pain, and self-esteem. ConclusionsPatients undergoing surgery for PE by either Nuss or Ravitch procedure have similar clinical and HRQL outcomes, but as a group have poorer HRQL scores than age-matched population norms.

Long-acting beta2-agonists for poorly reversible chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is characterised by partially reversible airflow limitation. Many patients have little reversibility to short acting bronchodilators, but long acting bronchodilators are frequently advocated. To determine the effectiveness of long acting beta-2 adrenoceptor agonists (LABAs) in COPD patients demonstrating poor reversibility to short-acting bronchodilators. The Cochrane Airways Group Specialised Register was searched ('all years' to 2005) along with the reference lists from identified randomised controlled trials (RCTs). All RCTs comparing inhaled LABAs (salmeterol or formoterol) with placebo in the treatment of patients with stable, poorly reversible COPD. Studies were a minimum of four weeks in duration. Two authors independently performed data extraction and study quality assessment. If we required additional data, we contacted authors and pharmaceutical companies sponsoring the identified RCTs. Twenty-three published and unpublished studies (6061 participants) were included in the review. There was a significant change in forced expiratory volume in 1 second (FEV1) in favour of salmeterol 50 mcg twice daily (BID) of 51 mls (95% confidence intervals (CI) 32 to 70), end of study morning peak expiratory flow (PEF) 14.89 L/min (95% CI 10.86 to 18.91). Supplemental short-acting bronchodilator usage was reduced by just under one puff per day. There were significant differences in the total, activity and impact domain scores of the St George's respiratory questionnaire in favour of salmeterol 50 mcg BID. Findings from other health status measurements and symptom scores were conflicting. There was no significant difference in exercise tolerance. The number of participants experiencing exacerbations was significantly reduced with salmeterol 50 mcg treatment compared with placebo (numbers needed to treat to benefit 21). This review shows that the treatment of patients with COPD with salmeterol 50 mcg produces modest increases in lung function. There were varying effects for other important outcomes such as health related quality of life or reduction in symptoms. However, there was a consistent reduction in exacerbations which may help people with COPD who suffer frequent deterioration of symptoms prompting healthcare utilisation. The strength of evidence for the use of salmeterol 100 mcg, formoterol 12 mcg, 18 mcg, 24 mcg was insufficient to provide clear indications for practice.

Occupational status and bronchoprovocative factors in relation to health-related quality of life in patients with COPD. A cross-sectional study in general practice

Objective:To investigate (1) associations between occupational status, work-related airway symptoms and quality-of-life and (2) the relationship between quality-of-life and bronchial symptoms due to common provocative exposure (e.g., domestic dust exposure, smog) in patients with chronic obstructive pulmonary disease (COPD) in general practice.Design:Secondary analyses on baseline data from the COOPT study, a randomised controlled trial investigating the effectiveness of fluticasone and N-acetylcysteine in COPD. Patients were subdivided into four groups according to their occupational status: ‘paid employment’; ‘no paid employment’; ‘incapacitated for work’; and ‘retired’. Quality-of-life was assessed by Chronic Respiratory Questionnaire (CRQ). This questionnaire measures four domains of health status, i.e. ‘activity’, ‘emotions’, ‘fatigue’, and ‘mastery’. Susceptibility to exposure to common bronchoprovocative factors was assessed with an ad hoc questionnaire. Between-group differences in CRQ scores and associations between CRQ scores and work-related airway symptoms were analysed using univariate and multivariate techniques. Results: 320 COPD patients were included (mean age 59.4 [SD 9.6] years, FEV1 %predicted 60.5 [SD 18.8]). Univariate analysis revealed differences in FEV1 %predicted between occupational status subgroups (p<0.001): paid work 65.3% (SD 16.7), no paid work 58.5% (18.7), incapacitated for work 64.1% (SD 20.5) and retired 54.8% (SD 18.1). Multivariate analysis showed that patients incapacitated for work had statistically significant lower CRQ total, activity, fatigue and mastery domain scores compared with patients in paid employment. In those employed (n=93), severity of work-related airway symptoms correlated with the CRQ total score (r=−0.48, p<0.001). Univariately, patients susceptible to many common bronchoprovocative factors had a lower total CRQ score (r=−0.42, p<0.001).Conclusion:In patients with COPD, quality-of-life may depend on susceptibility to common bronchoprovocative factors. COPD patients who are incapacitated for work show equal severity of airflow limitation, but worse quality-of-life compared with patients in paid employment.

Choline acetyltransferase activity and cognitive domain scores of Alzheimer's patients

Choline acetyltransferase activity and cognitive domain scores of Alzheimer's patients

Choline acetyltransferase activity and cognitive domain scores of Alzheimer’s patients ☆

Choline acetyltransferase activity and cognitive domain scores of Alzheimer’s patients. Item scores from the Mattis Dementia Rating Scale (MDRS) and the Mini-Mental State Examination (MMSE) from 389 patients with probable Alzheimer’s disease were submitted to principal component analysis with orthogonal rotation. The optimal solution identified four factors that reflected the cognitive domains of attention/registration, verbal fluency/reasoning, graphomotor/praxis and recent memory. A subgroup of patients was identified for whom both the MDRS and the MMSE had been administered within the 12 months before death. Scores were assigned to these patients for the four factors. These cognitive-domain scores were then correlated with postmortem choline acetyltransferase (ChAT) activity in the medial frontal cortex, inferior parietal cortex, and hippocampus. ChAT activity in both the medial frontal and the inferior parietal cortex significantly correlated with scores on the graphomotor/praxis factor. Medial frontal ChAT also correlated significantly with the attention/registration scores. Hippocampal ChAT correlated significantly only with recent memory scores. These results are consistent with current animal research regarding the effect of selective cholinergic lesions on behavior.