Function In Outpatients Research Articles

Nutritional status and long-term mortality in hospitalised patients with chronic obstructive pulmonary disease (COPD)

Patients with chronic obstructive pulmonary disease (COPD) often have difficulties with keeping their weight. The aim of this investigation was to study nutritional status in hospitalised Nordic COPD patients and to investigate the association between nutritional status and long-term mortality in this patient group. In a multicentre study conducted at four university hospitals (Reykjavik, Uppsala, Tampere and Copenhagen) hospitalised patients with COPD were investigated. Patient height, weight and lung function was recorded. Health status was assessed with St. George's Hospital Respiratory Questionnaire. After 2 years, mortality data was obtained from the national registers in each country. Of the 261 patients in the study 19% where underweight (BMI <20), 41% were of normal weight (BMI 20-25), 26% were overweight (BMI 25-30) and 14% were obese. FEV(1) was lowest in the underweight and highest in the overweight group (p=0.001) whereas the prevalence of diabetes and cardio-vascular co-morbidity went the opposite direction. Of the 261 patients 49 (19%) had died within 2 years. The lowest mortality was found among the overweight patients, whereas underweight was related to increased overall mortality. The association between underweight in COPD-patients, and mortality remained significant after adjusting for possible confounders such as FEV(1) (hazard risk ratio (95% CI) 2.6 (1.3-5.2)). We conclude that COPD patients that are underweight at admission to hospital have a higher risk of dying within the next 2 years. Further studies are needed in order to show whether identifying and treating weight loss and depletion of fat-free mass (FFM) is a way forward in improving the prognosis for hospitalised COPD patients.

Influence of age at onset on social functioning in outpatients with schizophrenia

Background and Objectives: There are different factors that have been found to predict disability in schizophrenia. The aim of our study is to evaluate the influence of age at onset on social functioning in schizophrenia in a large sample of schizophrenic outpatients controlling for gender. Methods: Two hundred and thirty-one subjects with schizophrenia (DSM-IV criteria) were randomly selected from a register that included all patients under treatment in five mental health care centers (MHCC) in Spain. Patients were evaluated with a sociodemographic and clinical questionnaire, and the Spanish version of the Living Skills Profile (LSP). Pearson's analyses were performed between age at onset and LSP, and an ANOVA analysis to compare three groups of age at onset (early, middle and late). Gender was introduced as a covariable. Results: Mean age at onset of the total sample was 23 (sd 7.35), with women having a later age at onset than men (women 24.6 (sd 9.1); men 22.2 (sd 5.9) (p<0.05)). The relation between age at onset and social functioning was only significant in the not interpersonal social behavior subscale (p<0.01). Early age at onset was positively related to social contact-communication (p<0.05), not interpersonal social behavior (p<0.05) and total LSP score (p<0.05). When including gender as a covariable, a significant relationship between age at onset and social functioning was found in most of the LSP subscales. Conclusions: Early onset of illness negatively influences psychosocial functioning, especially in the areas of communication, not interpersonal social behaviour and self-care. Female gender positively influences most aspects of social functioning.

Improvement in social functioning in outpatients with schizophrenia with prominent negative symptoms treated with olanzapine or risperidone in a 1 year randomized, open-label trial

General purpose To evaluate the social functioning of schizophrenic outpatients after switching to second-generation antipsychotics. Methodology Multi-center, randomized, open-label, parallel, flexible-dose, 1-year study of schizophrenic outpatients with prominent negative symptoms (defined as a SANS Global score ≥ 10), previously treated with conventional antipsychotics. Patients were randomly assigned (1:1 ratio) to treatment with an initial dose of at least 10 mg/day olanzapine ( N = 120) or at least 3 mg/day risperidone ( N = 115). Dosage could be modified during the study according to clinical criteria. Social functioning was evaluated using the total and subscales scores of the Social Functioning Scale (SFS) (validated Spanish version). Other efficacy measures included the SANS, SAPS, and CGI-S scales. Response was defined in advance as a 30% improvement in the SANS Global score. Results The mean doses during the trial were 12.2 mg/day (S.D. = 5.8) of olanzapine and 4.9 mg/day (S.D. = 2) of risperidone. There were no significant baseline differences in SFS total scores or other relevant clinical variables. At 1 year, olanzapine-treated patients presented a mean improvement in SFS total scores (7.75) that were significantly higher ( p = 0.0028) than for risperidone-treated patients (− 0.92). Treatment with olanzapine resulted in a greater numerical improvement than risperidone in all SFS domains and reached statistical significance in such categories as social engagement or withdrawal ( p = 0.01), independence (performance) ( p = 0.0098), independence (competence) ( p = 0.04), recreational activities ( p = 0.0391), and occupation/employment ( p = 0.0024) in which the greatest difference between the olanzapine and risperidone groups was found (0.86 vs. − 3.06). Significantly more patients treated with olanzapine reached or surpassed the SFS typified total scores corresponding to a functional level that is representative of a sample of stabilized Spanish outpatients with schizophrenia without prominent negative symptoms ( p = 0.0009). Associated factors were treatment with olanzapine and a 30% improvement or more in SANS global score or SAPS global score. Conclusions Long-term treatment with olanzapine was associated with overall greater improvement in social functioning (as measured by SFS) compared to risperidone-treated patients.

The crucial role of sustained attention in community functioning in outpatients with schizophrenia

The aim was to explore the pattern of associations between visual cognitive performance and community functioning in a sample of outpatients with schizophrenia participating in a rehabilitation program. Visuo-spatial tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were administered to assess cognitive performances in 88 subjects. The Multnomah Community Ability Scale (MCAS) was used to measure dimensions of community functioning. Our results showed that the sustained attention score was significantly associated with the global community functioning score and with two specific dimensions: “adjustment to living” and “behavioral problems”. No association was found between other cognitive indices and MCAS scores. Since the sustained attention task mainly involves the executive component of working memory, these findings suggest that attentional control processes are limiting factors for community functioning in schizophrenia outpatients. Measures of such processes could serve as key indices of disability in clinical practice. Attention and working memory training may be helpful to improve community functioning in subjects with schizophrenia.

-ornithine $alpha;-ketoglutarate in HIV infection: effects on muscle, gastrointestinal, and immune functions*1

There have been claims that l-ornithine α-ketoglutarate (OKG) exerts anticatabolic, anabolic, and immunomodulating properties. This study aimed at quantifying the effects of OKG on muscle force, body composition, and immune function in outpatients infected with the human immunodeficiency virus (HIV) and presenting weight loss. Forty-six HIV+ patients were included in a double-blind, prospective, randomized, controlled trial for 12 wk (10 g/d of OKG or isonitrogenous placebo and nutritional counseling). Podometry, handgrip strength, step test, triceps skinfold thickness, 50-kHz bioelectrical impedance, 3-d diet record, CD4 cell count, HIV-1 RNA concentration (viral load), and gastrointestinal symptoms were assessed at 0, 4, 8, and 12 wk. At baseline, patients (OKG, n = 22; placebo, n = 24) has similar CD4 counts (338 ± 172 and 310 ± 136 cells/mL), viral load (3.6 ± 1.3 and 3.5 ± 1.3 log10 copies/mL), body mass index (20.0 ± 2.4 and 20.6 ± 3.0 kg/m2), weight loss (9.0 ± 3.12 and 9.4 ± 3.0 kg), and food intake (2509 ± 962 and 2610 ± 808 kcal/d). Twenty-nine patients completed the protocol. Both groups increased their body mass index (P = 0.02 versus baseline) and triceps skinfold thickness (P < 0.01 versus baseline). They showed a similar positive correlation between handgrip strength and fat-free mass. Frequency of gastrointestinal symptoms increased in the OKG group (86% versus 54% in the placebo group, P = 0.025). No other differences were observed between groups. All patients increased their body mass index and triceps skinfold thickness due to food supplementation and diet counseling. Oral OKG failed to improve nutritional, functional, or immunologic status in these weight-losing HIV+ patients and had important gastrointestinal side effects.

L-ornithine α-ketoglutarate in HIV infection: effects on muscle, gastrointestinal, and immune functions

Objectives There have been claims that l-ornithine α-ketoglutarate (OKG) exerts anticatabolic, anabolic, and immunomodulating properties. This study aimed at quantifying the effects of OKG on muscle force, body composition, and immune function in outpatients infected with the human immunodeficiency virus (HIV) and presenting weight loss. Methods Forty-six HIV + patients were included in a double-blind, prospective, randomized, controlled trial for 12 wk (10 g/d of OKG or isonitrogenous placebo and nutritional counseling). Podometry, handgrip strength, step test, triceps skinfold thickness, 50-kHz bioelectrical impedance, 3-d diet record, CD4 cell count, HIV-1 RNA concentration (viral load), and gastrointestinal symptoms were assessed at 0, 4, 8, and 12 wk. Results At baseline, patients (OKG, n = 22; placebo, n = 24) has similar CD4 counts (338 ± 172 and 310 ± 136 cells/mL), viral load (3.6 ± 1.3 and 3.5 ± 1.3 log 10 copies/mL), body mass index (20.0 ± 2.4 and 20.6 ± 3.0 kg/m 2), weight loss (9.0 ± 3.12 and 9.4 ± 3.0 kg), and food intake (2509 ± 962 and 2610 ± 808 kcal/d). Twenty-nine patients completed the protocol. Both groups increased their body mass index ( P = 0.02 versus baseline) and triceps skinfold thickness ( P < 0.01 versus baseline). They showed a similar positive correlation between handgrip strength and fat-free mass. Frequency of gastrointestinal symptoms increased in the OKG group (86% versus 54% in the placebo group, P = 0.025). No other differences were observed between groups. Conclusions All patients increased their body mass index and triceps skinfold thickness due to food supplementation and diet counseling. Oral OKG failed to improve nutritional, functional, or immunologic status in these weight-losing HIV + patients and had important gastrointestinal side effects.

Depression and pulmonary function in outpatients with asthma

The purpose of this study was to examine the relation between depression, anxiety and pulmonary function in asthmatics. Thirty-eight adult asthmatic patients underwent psychometric evaluation with the DSSI/sAD questionnaire, filled in an asthma questionnaire and underwent spirometry. The majority of patients suffered from mild-persistent asthma. Twenty-six reported symptoms of anxiety and 25 reported symptoms of depression. A statistically significant reduction in FEV 1 and FEV 1/FVC values was observed in asthmatic patients with symptoms of depression. The mean value of FEV 1 was 81.84(±20.83) in patients without symptoms and 63.73(±17.99) in patients with symptoms of depression. The mean values of FEV 1/FVC were 0.85(±0.11) and 0.75(±0.10), respectively. These findings indicate a high frequency of depression and anxiety in adult asthmatic patients. A biological linkage between depression and impaired pulmonary function is proposed.

A new concept of a multidisciplinary wound healing center and a national expert function of wound healing.

An independent, multidisciplinary wound healing center in an accepted national expert function of wound healing is the optimal way to improve prophylaxis and treatment of patients with problem wounds. A clinical perspective analysis. An independent, multidisciplinary wound healing center focusing on all types of problem wounds, organized as a university hospital department, and integrated in an expert function in the national health care organization of Denmark. Patients with all types of problem wounds referred to and treated in the center during the first years of its existence provided a model for a new multidisciplinary structure for treatment of wound patients in the health care system. During the first 3 years of the fully functioning wound healing center, a total of 23 802 patient consultations were performed in the outpatient clinic, and 1014 patients with problem wounds were hospitalized in the inpatient ward. The surgical concept of the center has resulted in improved healing rates in patients with leg ulcers and decreased rates of major amputations. The outpatient function has resulted in a decrease in the number of patients transported in beds to the center. This structure provides better opportunities for basic and clinical research as well as for establishing expert education for all types of health care personnel. The center's structure has been the background for establishing an expert function in wound healing, allowing the wound healing area area to be fully integrated in the Danish National Health Care System. Overall, the concept and structure of the center have enhanced the knowledge and understanding of wound problems and increased the status of wound healing and patient care. Establishing multidisciplinary centers integrated into an accepted national expert function of wound healing is an optimal way to improve the clinical outcome of prophylaxis and treatment of all types of problem wounds. This model, with minor adjustments, may be applicable for both industrialized and developing countries.

Prevalence of impaired cognitive functioning in outpatients with chronic liver disease

Prevalence of impaired cognitive functioning in outpatients with chronic liver disease

Differential functioning of outpatients and residents of a domestic violence shelter on the Abuse Disability Questionnaire.

Consistent with prediction, scores on the Abuse Disability Questionnaire were significantly greater for 64 residents than 80 outpatients at a domestic violence shelter. This finding lends additional support to the questionnaires' validity.

The relationship among three measures of social functioning in outpatients with schizophrenia.

Deficits in social functioning are a defining characteristic of schizophrenia. Several instruments have been developed to measure social functioning in this population, but there has been little study of the correlation among different instruments. We used the Social Functioning Scale (SFS), the Multnomah Community Ability Scale (MCAS), and the Quality of Life Interview (QOLI) to evaluate 72 stable outpatients with schizophrenia. Results of canonical analyses indicate a significant but limited relationship between each set of measures. The largest overlap was between the QOLI and the SFS (R2c = .597) with less shared variance found between the SFS and the MCAS (R2c = .520) and between the MCAS and the QOLI (R2c = .335). Although the instruments share some common content. the instruments measure different aspects of social functioning. A consensus is needed about how to define and measure social functioning in this population.

The influence of trazodone treatment on cognitive functions in outpatients with major depressive disorder

Eight patients suffering from major depression were treated with trazodone 150 or 200 mg bid (non-responders) over 5 weeks, preceded and followed by a placebo week. Cognitive functioning was tested in the morning at the end of each treatment week. Before trazodone treatment commenced, patients' cognitive performance was compared with non-depressed controls. The depressed group showed significantly slower reaction times on the memory scanning test, but did not differ from the control group on five other tests including word learning, Critical Flicker/Fusion frequency (CFF), vigilance, tracking and divided attention. CFF threshold decreased significantly during trazodone treatment. CFF returned to its initial baseline level at the end of the placebo withdrawal. During the trazodone treatment period, recall from long-term memory of a previously learnt word list significantly improved, but at the end of the placebo withdrawal period memory performance returned to its initial baseline level. These results indicated that the subchronic influence of trazodone on cognitive functions is at least of a two-dimensional nature: decreased CFF threshold can be interpreted in terms of lowered CNS arousal, whereas a higher cognitive function, memory, improved, possibly related to the relief of depressive symptoms. Copyright © 1999 John Wiley & Sons, Ltd.

The influence of trazodone treatment on cognitive functions in outpatients with major depressive disorder

The influence of trazodone treatment on cognitive functions in outpatients with major depressive disorder

Neurocognitive deficits and social functioning in outpatients with schizophrenia: A two year follow-up

Neurocognitive deficits and social functioning in outpatients with schizophrenia: A two year follow-up

Ratings of social functioning in outpatients with schizophrenia: Patient self-report versus caregiver assessment

Patients with schizophrenia often have deficits in day-to-day functioning that are central to their disability. The ability of patients to rate their own social functioning, however, has not been established. In this study we examined the concordance between the ratings on the Social Functioning Scale of 58 outpatients with schizophrenia and their caregivers. We found a high level of overall concordance between the self and informant ratings. Items measuring the frequency of behaviors were among those with the highest concordance, while ratings of ability or social skill showed lower correlations. On only nine of 73 items did patients rate themselves significantly higher than did caregivers. There was no difference in concordance between family and nonfamily caregivers. These findings indicate that outpatients with schizophrenia can provide self-report ratings that are consistent with the ratings of their caregivers.

Neurocognitive deficits and social functioning in outpatients with schizophrenia

Previous studies suggest that neurocognitive factors may contribute to the reduced social functioning of patients with schizophrenia. To assess this relationship, we administered a battery of neurocognitive tests and independently assessed symptoms (PANSS) and social functioning (SFS) in 88 stable outpatients with schizophrenia. We found a significant correlation between neurocognitive and social functioning variables. Patients' performance on aphasia, spatial organization and visual spatial tasks was correlated with their competence at activities of daily living, frequency of social activities and total social functioning. Regression analyses of each social functioning scale revealed different symptom and neurocognitive predictors. Patients' overall social functioning was best predicted by a combination of negative symptoms and aphasia. The results support the potential use of interventions to reduce patients' cognitive deficits as a means to improve their social outcomes.

Dose‐Ranging Study of a New, Once‐Daily Diltiazem Formulation for Patients with Stable Angina

A double-blind safety and efficacy dose-ranging study was conducted with a new, once-daily, extended-release (XR) diltiazem hydrochloride formulation (Dilacor XR, Rhône-Poulenc Rorer, Collegeville, PA) in 189 patients with chronic stable angina pectoris. After a 2-week placebo lead-in phase, the patients were randomly assigned to 1 of 4 once-daily, fixed-dose treatment groups: placebo, XR diltiazem 120 mg, 240 mg, or 480 mg. Extended-release diltiazem, at 240-mg and 480-mg once-daily doses, significantly improved (P < .05) total exercise time during treadmill exercise tolerance testing after 2 weeks of treatment when assessed 24 hours after the previous dose. These increasing doses of XR diltiazem were associated with incremental improvements in exercise tolerance. Outpatient function, as assessed by frequency of anginal attacks, nitroglycerin use, and ambulatory electrocardiogram (Holter, Scole Engineering Culver City, CA) monitoring of ischemic events, was also improved by XR diltiazem. This extended-release diltiazem formulation can be clinically titrated within the 120- to 480-mg dosing range, permitting effective once-daily administration for treating chronic stable angina.

Nutritional depletion in relation to respiratory and peripheral skeletal muscle function in out-patients with COPD

Although increasing attention has been paid to nutritional aspects in chronic obstructive pulmonary disease (COPD), limited information is available regarding the prevalence and consequences of nutritional depletion in a random out-patient COPD population. We studied body composition in relation to respiratory and peripheral skeletal muscle function in 72 COPD patients (mean (SD) forced expiratory volume in one second (FEV1) 53 (15) % predicted), who came to the lung function laboratory for routine lung function measurements. Patients were characterized by the degree of body weight loss and fat-free mass depletion. According to this definition, 14% of the group suffered from both loss of body weight and depletion of fat-free mass, whereas 7% had one of these conditions. We found that tissue depletion was concomitant with lower values for respiratory and peripheral skeletal muscle strength (46.0 (27.2) vs 77.1 (29.8) kg), and a significantly lower transfer coefficient for carbon monoxide (KCO 64.9 (16.2) vs 81.9 (24.5) % pred). Stratification by KCO (< 60% vs > 80%) also revealed significantly lower values for fat-free mass and higher values for intrathoracic gas volumes, total lung capacity (TLC) and residual volume (RV) in the group with a KCO < 60% pred. Analysis of covariance, taking fat-free mass as covariate, indicated an independent contribution of KCO on maximal inspiratory mouth pressure (PImax) but not on peripheral skeletal muscle strength. It is concluded that a substantial number of COPD out-patients suffer from nutritional depletion, preferentially affecting peripheral skeletal muscle function.

Cognitive remediation in schizophrenia: is it time yet?

Considerable effort has been directed toward identifying and conceptualizing information-processing deficits in schizophrenia and other psychotic disorders. The impressive gains in this field have made meaningful contributions to our understanding of the etiology and course of these disorders. This article considers whether the time is ripe to move beyond identification of these deficits to remediation of them. This move is far from a simple matter; it requires careful attention to theoretical frameworks and to the criteria for selecting certain cognitive deficits, among many, for remediation. A sparse and somewhat dated literature suggests that certain types of cognitive remediation, at least when defined in a narrow sense, are feasible with schizophrenic patients. This literature can reasonably justify continuing investigations on a modest scale. Specific questions for further studies include the following. 1) Which cognitive models provide a framework to guide cognitive interventions? 2) Which specific functions or levels of information processing should be targeted by cognitive interventions? 3) Are cognitive interventions effective? 4) Does the remediation of basic cognitive deficits generalize? A major strength of this area of investigation is the testability of the questions. Several research designs are tentatively suggested.

Psychological Outcomes of a Pulmonary Rehabilitation Program

This study assessed physiologic, psychological, and cognitive functioning in outpatients with COPD. Sixty-four subjects, 53 to 82 years of age, participated in the 30-day exercise rehabilitation program. The program consisted of exercise, education and psychosocial counselling. Participants were assessed prior to beginning the program and at the end of 30 days. Assessments at both times included physiologic functioning (bicycle ergometry testing, pulmonary function tests, 12-min walk), psychological well-being (anxiety, depression, psychiatric symptoms, perceived well-being) and an abbreviated neuropsychological test battery. Results indicate significant improvement in physical endurance and pulmonary function, significant reductions in symptoms of depression and anxiety, and improvement in measures of general well-being and neuropsychological functioning. The study suggests that exercise rehabilitation of older adults with COPD contributes not only to improvements in physical functioning and endurance, but also to enhanced cognitive functioning and psychological well-being. (Chest 1991; 100:613-17)