Obstruction Score Research Articles

CCSP G38A polymorphism environment interactions regulate CCSP levels differentially in COPD.

Impaired airway homeostasis in chronic obstructive pulmonary disease (COPD) could be partly related to club cell secretory protein (CCSP) deficiency. We hypothesize that CCSP G38A polymorphism is involved and aim to examine the influence of the CCSP G38A polymorphism on CCSP transcription levels and its regulatory mechanisms. CCSP genotype and CCSP levels in serum and sputum were assessed in 66 subjects with stable COPD included in a 1-yr observational study. Forty-nine of them had an exacerbation. In an in vitro study, the impact on the CCSP promoter of 38G wild-type or 38A variant was assessed. BEAS-2B cells were transfected by either the 38G or 38A construct, in the presence/absence of cigarette smoke extract (CSE) or lipopolysaccharides (LPS). Cotransfections with modulating transcription factors, p53 and Nkx2.1, identified by in silico analysis by using ConSite and TFSEARCH were conducted. A allele carrier COPD patients had lower serum and sputum CCSP levels, especially among active smokers, and a decreased body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) score. In vitro, baseline CCSP transcription levels were similar between the wild and variant constructs. CSE decreased more profoundly the CCSP transcription level of 38A transfected cells. The opposite effect was observed with p53 cotransfection. LPS stimulation induced CCSP repression in 38A promoter transfected cells. Cotransfection with Nkx2.1 significantly activated the CCSP promoters irrespective of the polymorphism. Circulating CCSP levels are associated with smoking and the CCSP G38A polymorphism. CSE, LPS, and the Nkx2.1 and p53 transcription factors modulated the CCSP promoter efficiency. The 38A polymorphism exaggerated the CCSP repression in response to p53 and CSE.

Impact of an Electronic Medical Record Screening Tool and Therapist-Driven Protocol on Length of Stay and Hospital Readmission for COPD.

In the United States, care for COPD patients is frequently delivered by respiratory therapists (RTs). After implementing a therapist-driven protocol for COPD treatment, we sought to improve identification of COPD patients. We hypothesized that using an electronic medical record screening tool to identify subjects with COPD combined with a therapist-driven protocol would positively impact length of stay (LOS) and readmission rates. Utilizing the electronic medical record to search the provider's admission notes for the terms COPD/Asthma, a report was generated. Subjects already receiving RT services were removed. An RT evaluated identified subjects using a therapist-driven protocol combining clinical assessment and FEV1 to calculate an air-flow obstruction score. Scores ≥7 received 24 h of bronchodilator therapy by RTs. Scores <7 received assessment by RTs but bronchodilator therapy administered by nursing staff. An RT performed medication reconciliation and education for both groups. ICD-9 discharge codes identified primary and secondary diagnoses of COPD. LOS and 30-d readmission rates were measured for a 14-month period. Respiratory-triggered rapid response data were also collected. The pre-intervention period was from December 2013 to June 2014, and the post-intervention period was from July 2014 to January 2015. There were 142 subjects in total, 68 pre-intervention and 74 post-intervention. For primary COPD, mean LOS decreased from 4.37 to 2.96 d (P = .10), and 30-d readmission rates decreased from 13.6 to 6.1%. Respiratory-triggered rapid response data were as follows: The pre-intervention span was from January 2014 to June 2014, and post-intervention was from July 2014 to December 2015. For primary COPD, there were 61 pre-intervention subjects and 63 post-intervention with a decrease in respiratory-triggered rapid responses from 21 pre-intervention (34.4%) to 8 post-intervention (12.7%) (P = .004). For secondary COPD (1,168 pre-intervention, 1,267 post-intervention), there was a change from 318 (27.2%) pre-intervention to 296 (23.4%) post-intervention (P = .03). Utilization of the electronic medical record to identify subjects with likely COPD combined with a therapist-driven protocol directed by RT assessment was associated with a trend toward decreased LOS and reduction in readmission rates. There was a significant reduction of respiratory-triggered rapid responses in subjects with a primary diagnosis of COPD.

Role of nasal problems on positional and nonpositional obstructive sleep apnea.

This study aims to examine the relationship between nasal pathologies and positional (PP) obstructive sleep apnea (OSA) or nonpositional (NPP) OSA. A total of 44 male OSA patients (mean age 48.0±6.8 years; range 31 to 60 years) suffering from nasal obstruction were retrospectively evaluated for nasal obstruction scores, overall apnea hypopnea index (AHI) and AHI in supine and nonsupine positions, daytime sleepiness scores, and body mass index (BMI). Patients were divided into two equal groups as PP group and NPP group. Output parameters were snoring severity index, clinical nasal obstruction score, septal deviation score, conchal hypertrophy score, and allergic rhinitis (AR) score. These parameters were correlated with the type of OSA. Apnea hypopnea index was significantly lower in PP group than in NPP group (p<0.03). Spearman correlation analysis revealed significant negative correlation between AR score and PP (r=-0.40, p<0.0001). Pearson correlation test revealed significant correlation between AHI and BMI (r=0.32, p<0.05). We suggest that AR is not only an important risk factor for OSA, but also patients with AR tend to be NPP OSA patients because of the serious nasal obstruction which already causes an increase in nasal resistance or pharyngeal collapsibility.

Temporal differences in improvement of nasal obstruction between primary and revision septoplasty.

Septoplasty is one of most frequently performed surgeries in otorhinolaryngologic clinics to improve nasal obstruction by correcting nasal septal deformities. Many patients require revision surgery for persistent nasal obstruction. However, the outcomes and sources of revision septoplasty are unclear. We investigated the discrepancy between patient's subjective and objective improvements after septoplasty by comparing primary and revision procedures. Patients who underwent septoplasty from January 2012 to December 2014 were enrolled. All the subjects were questioned regarding subjective nasal symptoms before surgery and 1 month and every 3 months after surgery, with responses rated on a 7-point Likert scale. Nasal endoscopic evaluation and acoustic rhinometry were also performed with the same schedule. One hundred seventy-nine patients were analyzed. Subjective nasal obstruction scores of both the primary (n = 161) and revision (n = 18) groups were significantly improved at 1 month after surgery and showed no difference between the two groups. However, this improvement was sustained to the last follow-up only in the primary group. The symptom improvement rate of the primary group (85.5% [n = 109]) was significantly higher than that of the revision group (58.8% [n = 10]) at the last follow-up. There was no difference in the degree of improvement in objective findings between the two groups, including the difference and the ratio of the minimal cross-sectional area between the wider and narrower sides, and in endoscopic findings, even at the last follow-up. Compared with primary septoplasty, the long-term efficacy of revision septoplasty may not be clear, and there are discrepancies between the subjective and objective outcomes.

Chronic obstructive pulmonary disease prognostic score: A new index.

The evaluation of chronic obstructive pulmonary disease (COPD) has been shifting from spirometry to focus on the patients' overall health. Despite the existence of many COPD prognostic scales, there remains a large gap for improvement, in particular a scale that incorporates the current focus on overall health. We proposed a new prognostic scale (the COPD Prognostic Score) through discussion among the authors based on published studies. Validation was retrospective, using data from the National Emphysema Treatment Trial. The scores ranged from 0-16, where 16 indicated the poorest prognosis. We assigned 4 points each for forced expiratory volume in one second (%predicted), the modified Medical Research Council dyspnea scale, and age; 2 points for the hemoglobin level; and one point each for decreased activity and respiratory emergency admission in the last two years. The validation cohort included 607 patients and consisted of 388 men (73.9%) and 219 women (36.1%), mean age 67 ± 6 years and an average forced expiratory volume in one second (% predicted) of 27 ± 7%. A one-point increase in the score was associated with increased all-cause death, with a hazard ratio of 1.28 (95%CI: 1.21-1.36. P < 0.001). The areas under the receiver operating characteristic curves for two-year and five-year all-cause death for the new scale were 0.72 and 0.66, respectively. These values were higher than those given by the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index and age, dyspnea, airway obstruction (ADO) index. The preliminary validation for a new COPD prognostic scale: the COPD Prognostic Score was developed with promising results thus far. Above mentioned 16-point score accurately predicted 2-year and 5-year all-cause mortality among subjects who suffered from severe and very severe COPD.

Does Race Influence Health-related Quality of Life and Toxicity Following Proton Therapy for Prostate Cancer?

Objective:This matched-paired analysis explores disparities in health-related quality of life (QOL) and common toxicities between African American (AA) and white patients following proton therapy for prostate cancer at our institution.Materials and Methods:A total of 1536 men with clinically localized prostate cancer were treated from 2006 to 2009 with definitive proton therapy to a median dose of 78 Gy +/− androgen deprivation therapy. A cohort of 92 consecutively treated AA men was matched to a cohort of 92 white men on the basis of National Comprehensive Cancer Network risk category and age. The 2 groups were compared with regard to comorbidities, demographics, and treatment regimen. Differences in genitourinary and gastrointestinal (GI) toxicity according to the Common Terminology Criteria for Adverse Events scale and QOL data from the Expanded Prostate Index Composite 26-question questionnaire were reported.Results:Median follow-up was 2.1 years. Baseline patient and treatment characteristics were similar between the 2 groups with the exception of prostate-specific antigen ≥10 (32% for AAs vs. 20% for whites; P=0.068) and use of androgen deprivation therapy (26% for AAs vs. 21% for whites; P=0.38). No difference in Expanded Prostate Index Composite 26-question sexual summary, urinary incontinence, urinary obstruction, or bowel summary scores was detected between the 2 groups, nor was there a difference in grade 2 or higher GI toxicity (P=0.45). AAs had a statistically nonsignificant higher absolute incidence of late grade 3 genitourinary toxicity (4.4% vs. 0%; P=0.12).Conclusions:After 2 years, there were no disparities in health-related QOL, physician-reported Common Terminology Criteria for Adverse Events GI toxicity, or biochemical relapse. Longer follow-up is needed to confirm these findings.

Rectal Hyposensitivity Is Associated With a Defecatory Disorder But Not Delayed Colon Transit Time in a Functional Constipation Population.

The physiological mechanism of functional constipation (FC) includes defecatory disorders and delayed colon transit. About 18% to 68% constipated patients may have rectal hyposensitivity (RH). We performed this study to investigate the association between RH and functional defecatory disorder (FDD) as well as that between RH and delayed colon transit in FC patients.A total of 218 FC patients were enrolled. The constipation severity instrument (CSI) was used to assess constipation symptoms. High-resolution anorectal manometry (HR-ARM), defecography, balloon expulsion tests, and colon transit studies were performed for each patient. RH was defined as 1 or more sensory threshold pressures raised beyond the normal range based on HR-ARM. We investigated the association between RH and constipation symptoms, and the occurrence of FDD and delayed CTT. Ninety FDD patients completed the initial phase of biofeedback treatment (BFT). We investigated the association between RH and the effect of BFT.Totally 122 (56.0%) patients had RH. The total CSI (49.82 ± 1.09 vs 41.25 ± 1.55, P = 0.023) and obstructive defecation subscale scores (23.19 ± 0.69 vs 17.07 ± 0.90, P < 0.001) were significantly higher in RH than in non-RH patients. No significant difference was observed in slow transit symptoms (21.77 ± 0.72 vs 19.90 ± 0.85, P = 0.121) or abdominal pain (6.85 ± 2.61 vs 5.00 ± 1.04, P = 0.380). The frequency of prolonged CTT was not significantly different between RH and non-RH groups (54.1% vs 58.3%, P = 0.403). RH patients rated more occurrence of FDD (72.1% vs 53.1%, P = 0.014) and dysynergic defecation (79.8% vs 50.2%, P = 0.004) than non-RH patients, whereas no differences were seen for inadequate defecatory propulsion (59.2% vs 55.0%, P = 0.589). After BFT, the proportion of “no effect” was significantly higher in the RH group than in the non-RH group (22.4% vs 9.4%, P = 0.010).RH is associated with obstructive defecation symptoms and the occurrence of FDD. Further studies are needed to detect the mechanism of RH's effect on BFT and FC.

Hepatic venous outflow tract obstruction: treatment outcomes and development of a new prognostic score.

Results of endovascular interventions in hepatic venous outflow tract obstruction (HVOTO) have been reported from limited studies. Treatment outcomes and prognostic scores need further validation. To evaluate treatment outcomes and prognostic scores for hepatic venous outflow tract obstruction in an Indian population. Consecutive patients with hepatic venous outflow tract obstruction diagnosed at a tertiary centre were included. Technical success and clinical response after endovascular interventional therapy were documented. Predictors of survival were assessed with Cox-proportional model. A new score was derived from the factors significant on multivariate analysis and compared with Child-Turcotte-Pugh, model for end-stage liver disease (MELD), Rotterdam prognostic index (PI) and Budd-Chiari syndrome-transjugular intrahepatic portosystemic shunt ( BCS-TIPSS) PI. Three hundred and thirty-four patients (56.6% males), median age 24 (3-62) years were included. Hepatic vein was the commonest site of block-isolated hepatic vonous block in 48%, combined hepatic venous-inferior vena cava block in 46%. Endovascular interventional therapy was performed in 233/334 (70%) with 90% technical success. Clinical response was complete in 166 (71.2%), partial in 58 (24.9%) and no response in nine (3.9%). Majority of cases with HV block did not require TIPSS and could be treated with angioplasty (with/without stenting). On Cox-proportional multivariate analysis, Child class C and response to intervention were independent predictors of outcome and used to derive the All India Institute of Medical Sciences (AIIMS) hepatic venous outflow tract obstruction score. The 5-year survival was 92% (95% CI, 81-97%) for score ≤3, 79% (95%CI, 63-88%) for score >3 and ≤4, and 39% (95% CI, 21-57%) for score >4. The performance of AIIMS hepatic venous outflow obstruction score was superior to other prognostic indices. Advanced Child class and no response to intervention are associated with poor outcomes. The All India Institute of Medical Sciences hepatic venous outflow tract obstruction score predicts survival better than other prognostic scores.

Dry Eye Disease in Patients with Functioning Filtering Blebs after Trabeculectomy.

PurposeThe aim of this study was to analyze dry eye disease (DED) in patients with functioning filtering blebs and to explore the relationship between the morphology of filtering blebs and ocular surface instability.MethodsThis was a cross-sectional, case-comparison study. Seventy glaucomatous patients (70 eyes) with functioning blebs who had undergone trabeculectomy more than 6 months prior (study group) and 35 control subjects (35 eyes) (control group) were included. All subjects completed an ocular symptom questionnaire that referred to the Shihpai Eye Study. Evaluation of meibomian gland obstruction, a tear film break-up time test (TFBUT), fluorescein corneal staining and a Schirmer’s tear test were then performed. Filtering bleb morphology was analyzed using Wuerzburg bleb classification scoring criteria in the study group. The presence of DED was defined as the concomitant presence of TFBUT <10 seconds and the presence of superficial punctate keratitis.ResultsThe patients with functioning blebs presented higher corneal staining scores (P = 0.012) and lower TFBUT values (P = 0.043) than the control group. DED was present in 28/70 patients in the study group and 6/35 patients in the control group (P = 0.018). More patients in the study group complained of dryness (P = 0.001), a gritty or sandy sensation (P < 0.001) and redness (P = 0.048). In the study group, the patients with DED were significantly different from the patients without DED in both TFBUT (P < 0.001) and corneal staining (P < 0.001). More patients in the DED group were likely to report dryness (P = 0.013) and watery or teary eyes (P = 0.012). The differences in meibomian gland obstruction scores between the study and the control group, the DED and the non-DED group were not significant (P = 0.105 and P = 0.077, respectively). The values for microcysts and bleb heights were significantly higher in the DED group (P = 0.040 and P = 0.011, respectively). A Spearman’s rank correlation showed that microcysts were positively correlated with corneal staining (r = 0.270, P = 0.024). Bleb height was negatively correlated with TFBUT (r = -0.299, P = 0.012) and positively correlated with corneal staining (r = 0.275, P = 0.021). The relationships between DED and microcysts and between DED and bleb height were significant (r = 0.247, P = 0.039 and r = 0.307, P = 0.010, respectively).ConclusionDED is relatively common in patients with functioning filtering blebs following trabeculectomy. In DED patients, dryness and watery are common symptoms. Microcysts and bleb height are related to ocular surface instability and DED.

Cognitive status among patients with chronic obstructive pulmonary disease.

PurposeWe investigated the association between cognitive impairment and chronic obstructive pulmonary disease (COPD), taking into account demographic and clinical variables evaluated during routine practice.Patients and methodsWe performed a post hoc analysis of a cross-sectional study that included subjects with stable COPD. Sociodemographic and clinical information was recorded using the Body mass index, airflow Obstruction, Dyspnea and Exacerbations index and the Charlson comorbidity index. Cognitive performance was studied by the mini-mental state examination, with a score less than 27 indicating clinical impairment. Depressive symptoms, physical activity, and quality of life (EuroQoL-5 dimensions and COPD Assessment Test) were also evaluated.ResultsThe analysis included 940 subjects. The prevalence of cognitive impairment was 39.4%. Multivariate logistic regression models revealed that cognitive impairment was associated with educational level (odds ratio [OR] =0.096, 95% confidence interval [CI] =0.011–0.447) and poorer quality of life measured by the EuroQoL-5 dimensions social tariff (OR =0.967, 95% CI =0.950–0.983). When questionnaires were not included in the analysis, cognitive impairment was associated with educational level (OR =0.063, 95% CI =0.010–0.934), number of exacerbations (OR =11.070, 95% CI =1.450–84.534), Body mass index, airflow Obstruction, Dyspnea and Exacerbations index score (OR =1.261, 95% CI =1.049–1.515), and the Charlson comorbidity index (OR =1.412, 95% CI =1.118–1.783).ConclusionCognitive impairment is common in COPD and is associated with low educational level, higher disease severity, and increased comorbidity. This could have therapeutic implications for this population.

Patient-Reported Quality of Life in Men with Transurethral Resection of the Prostate Undergoing Proton Therapy for Management of Prostate Cancer.

We report on quality of life (QOL) and early toxicity among men with prostate cancer who underwent transurethral resection of the prostate (TURP) before proton therapy. Between 2006 and 2010, 1,289 patients were treated definitively with proton therapy for prostate cancer at our institution and enrolled on a prospective outcomes-tracking protocol. Ninety-six of the men had received a TURP before proton therapy, while 1,193 men had not. Baseline comorbidities, medications, expanded prostate index composite (EPIC) score, international prostate symptom score (IPSS), and CTCAE vs.3 toxicity assessment were collected prospectively. The Kaplan-Meier product limit method was used to estimate freedom from toxicity. Men who had TURP before proton therapy had lower baseline EPIC scores for urinary incontinence, bowel summary, and sexual summary compared with the non-TURP group, but no significant difference in urinary obstructive score was observed. After controlling for baseline scores, there was no significant difference in bowel summary or sexual summary scores between the two groups over time. There were, however, differences for urinary irritation/obstruction scores and urinary incontinence scores favoring those patients who did not have a TURP-like procedure. Toxicity assessment showed that the 2-year and 5-year rates of grade 3 genitourinary toxicity in the pretreatment TURP group were 12.3% and 17.2%, respectively. Pretreatment TURP was associated with both a high incidence of physician-assessed toxicity and inferior patient-reported QOL scores both before and after proton therapy treatment. Studies investigating QOL and toxicity after specific prostate cancer therapies should stratify patients by pretreatment TURP. Longer follow-up is needed to confirm if these differences ever resolve.

The relation between clinical scores and quality-of-life in long-term follow-up.

Quality-of-life and severity scores are both popular measures in medicine. For deep venous obstruction, the VEINES-QOL/Sym and venous clinical severity score (VCSS) are widely used. Combining a patient-reported outcome with a clinical severity score should give a more sensitive outcome for treatment results. To establish and compare their suitability for deep venous disease, we compared the outcomes of both scores in a group of patients who were interventionally treated for deep venous disease. The venous clinical severity scores and VEINES-QOL/Sym scores of a group of patients who had received interventional treatment for deep venous obstruction more than 12 months ago were compared at T0 and T12. Both the Spearman's rho and Pearson's r show a very weak, negative correlation (statistically significant (p ≤ 0.05)), between the venous clinical severity score and VEINES-QOL at T12 and between the venous clinical severity score and the VEINES-SYM at both T0 and T12. T0 VCSS-VSYM: rho = -0.219 (p = 0.052), r = -0.236 (p = 0.037), T12 VCSS-VQOL: rho = -0.459 (p = 0.007), r = -0.379 (p = 0.030), T12 VCSS-VSYM: rho = -0.463 (p = 0.007), r = -0.432 (p = 0.012). This negative correlation was not statistically (p ≥ 0.05) confirmed for T0 VCSS-VSYM. The physician-scored venous clinical severity score of patients treated for deep venous obstruction does not correlate well with their self-reported quality-of-life and symptom scores.

Endoscopic septoplasty: Learning curve

AimsThe aim of the current study was to report the learning curve for endoscopic septoplasty for a senior surgeon already trained in endonasal sinus surgery. Material and methodsFrom November 2011 to September 2012, 100 patients were prospectively included and grouped in 5 consecutive groups of 20 by date of surgery. The primary endpoint was operative time. Intra- and postoperative complications and functional assessment were also analyzed. ResultsOperative time decreased with the surgeon's experience and became stable after 60 procedures. Operative time saving was about 10min per 20 procedures. Mean operative time was stable between groups 4 (21.1±9.6min) and 5 (19.2±8.2min). There was a 2% rate of conversion to conventional surgery for technical problems. The number of procedures free of accidental mucosal lesion increased and became stable after 40 procedures. There was a 4% rate of residual postoperative perforation. Nasal Obstruction and Septoplasty Effectiveness (NOSE) score improved postoperatively in each group (P<0.05). ConclusionAfter 60 endoscopic septoplasty procedures, a senior surgeon masters the surgical technique with satisfactory operative times, and a decreasing rate of intra- and postoperative complications.

Assessment of nasal airway patency during pregnancy and postpartum period: correlation between subjective and objective techniques.

This study aims to determine the physiological changes in a pregnant woman's nasal airway, the frequency of pregnancy rhinitis, and the correlation among anterior rhinoscopy (AnR), anterior rhinomanometry (ARM), and subjective nasal obstruction score as she progresses through pregnancy into the postpartum period (PPP). Twenty non-smoking healthy pregnant women aged 19-35 (average 27.5±4.7) without a history of either respiratory allergy or chronic nasal or sinus problems were included in the study. Detailed history taking, AnR, and ARM were performed by the same ear nose and throat specialist at each trimester and postpartum second week. From then on, the participants scored, subjectively, morning levels of nasal obstruction (0= none, 1= slight, 2= moderate, 3= severe, 4= total obstruction). The AnR scores were low and the ARM findings were in normal range in the first trimester. Increasing AnR scores through pregnancy and decreasing AnR scores at PPP were statistically significant. Similarly, the ARM findings increased through pregnancy and decreased to normal levels at PPP; however, these changes among trimesters and PPP were not statistically significant. Anterior rhinomanometry and AnR are useful tools in the determination of nasal physiological changes as pregnancy progresses to PPP.

Development and Validation of a Morphologic Obstructive Sleep Apnea Prediction Score: The DES-OSA Score.

Obstructive sleep apnea (OSA) is a common and underdiagnosed entity that favors perioperative morbidity. Several anatomical characteristics predispose to OSA. We developed a new clinical score that would detect OSA based on the patient's morphologic characteristics only. Patients (n = 149) scheduled for an overnight polysomnography were included. Their morphologic metrics were compared, and combinations of them were tested for their ability to predict at least mild, moderate-to-severe, or severe OSA, as defined by an apnea-hypopnea index (AHI) >5, >15, or >30 events/h. This ability was calculated using Cohen κ coefficient and prediction probability. The score with best prediction abilities (DES-OSA score) considered 5 variables: Mallampati score, distance between the thyroid and the chin, body mass index, neck circumference, and sex. Those variables were weighted by 1, 2, or 3 points. DES-OSA score >5, 6, and 7 were associated with increased probability of an AHI >5, >15, or >30 events/h, respectively, and those thresholds had the best Cohen κ coefficient, sensitivities, and specificities. Receiver operating characteristic curve analysis revealed that the area under the curve was 0.832 (95% confidence interval [CI], 0.762-0.902), 0.805 (95% CI, 0.734-0.876), and 0.834 (95% CI, 0.757-0.911) for DES-OSA at predicting an AHI >5, >15, and >30 events/h, respectively. With the aforementioned thresholds, corresponding sensitivities (95% CI) were 82.7% (74.5-88.7), 77.1% (66.9-84.9), and 75% (61.0-85.1), and specificities (95% CI) were 72.4% (54.0-85.4), 73.2% (60.3-83.1), and 76.9% (67.2-84.4). Validation of DES-OSA performance in an independent sample yielded highly similar results. DES-OSA is a simple score for detecting OSA patients. Its originality relies on its morphologic nature. Derived from a European population, it may prove useful in a preoperative setting, but it has still to be compared with other screening tools in a general surgical population and in other ethnic groups.

Identifying obstructive sleep apnea after stroke/TIA: evaluating four simple screening tools

ObjectiveDespite its high prevalence and unfavorable clinical consequences, obstructive sleep apnea (OSA) often remains underappreciated after cerebrovascular events. The purpose of our study was to evaluate the clinical utility of four simple paper-based screening tools for excluding OSA after stroke or transient ischemic attack (TIA). Patients/MethodsSixty-nine inpatients and outpatients with stroke or TIA during the past 180 days completed the 4-Variable screening tool (4V), STOP-BAG questionnaire (ie, STOP-BANG questionnaire without the neck circumference measurement), Berlin questionnaire, and the Sleep Obstructive apnea score optimized for Stroke (SOS). They subsequently underwent objective testing using a portable sleep monitoring device. Cutoffs were selected to maximize sensitivity and exclude OSA (AHI ≥ 10) in ≥10% of the cohort. ResultsThe mean age was 68.3 ± 14.2 years and 47.8% were male. Thirty-two patients (46.4%) were found to have OSA. Male sex, body mass index (BMI), and atrial fibrillation were independent predictors of OSA. Among the screening tools, the 4V had the greatest area under the curve (AUC) of 0.688 (p = 0.007); the sensitivity was 96.9% for a cutoff of <6. The STOP-BAG also significantly detected OSA with an AUC of 0.677 (p = 0.012); the sensitivity was 93.8% for a cutoff of <2. Scores on the 4V and STOP-BAG were significantly correlated with the AHI. ConclusionsThe 4V and STOP-BAG questionnaire may aid clinicians with ruling out OSA within 180 days of stroke/TIA. Due to the atypical presentation of poststroke/TIA OSA, these tools are only moderately predictive; objective testing should still be used for OSA diagnosis in this population.

Home nursing care with the self-care model improves self-efficacy of patients with chronic obstructive pulmonary disease.

This study was carried out as an intervention study to determine the effect of nursing care provided at home with the self-care model on the self-efficacy of patients with chronic obstructive pulmonary disease in northern Turkey. The study sample totaled 106 patients with chronic obstructive pulmonary disease divided into two groups. The intervention group and the control group each included 53 patients. To collect data, the patient data sheet, Orem's self-care model-based data collection form, symptom evaluation form, Medical Research Council dyspnea scale, and the chronic obstructive pulmonary disease self-efficacy scale (CSES) were used. The nursing care applied for the intervention group consisted of four visits, two during the first month and two for the next 2 months. An educational guidebook was distributed to the intervention group during the first visit, and at all visits, education, care, and supervision were provided according to the care plan. All data were analyzed with the number, percentage, χ(2) -test, Kruskal-Wallis H test, Wilcoxon rank sum test, and Mann-Whitney U-test. The dyspnea level measured at the last visit for the control group was high compared with the intervention group (P < 0.05). The chronic obstructive pulmonary disease self-efficacy scale scores for subscale dimensions at the last visit and the general score for the intervention group were high compared with the first visit scores (P < 0.05). According to the study results, home nursing care based on the Orem's self-care model is effective in improving self-efficacy of patients with chronic obstructive pulmonary disease.

Effect of simple and radical hysterectomy on quality of life – analysis of all aspects of pelvic floor dysfunction

ObjectiveThe impact of simple and radical hysterectomy on all aspects of pelvic floor dysfunctions was evaluated in current study. Study designThis retrospective cohort study included 142 patients; 58 women (40.8%) who have undergone simple, 41 (28.8%) radical hysterectomy, and 43 (30.2%) women without any surgical intervention to serve as the control group. The validated versions of the Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), Pelvic Floor and Incontinence Sexual Impact Questionnaire (PISQ-12), Wexner Incontinence Scale score and pelvic organ prolapse quantification (POP-Q) system were used in detailed evaluation of pelvic floor dysfunction. One-way ANOVA and Pearson's chi square tests were performed in statistical analysis. ResultsIt was found that there were significant differences in irritative and obstructive scores of UDI-6 between Type III hysterectomy group and Type I hysterectomy group. In addition, patients of Type I hysterectomy had significant higher irritative and obstructive scores than the control group. Type III hysterectomy had the most significant deteriorating effect on sexual life, based on scores of PISQ-12 compared to both Type I hysterectomy group and control group. ConclusionHysterectomy results in detrimental effects on the quality of life (QoL) regarding all aspects of pelvic floor functions especially in women of radical hysterectomy. Urinary dysfunctional symptoms like urgency, obstruction and especially sexual problems are more bothersome and difficult to overcome. The impact of hysterectomy on QoL should be investigated as a whole and may be more profound than previously thought.

Effects of Sediment Removal on Prairie Pothole Wetland Plant Communities in North Dakota

ABSTRACT This study assessed the effects of sediment removal on Prairie Pothole Region wetland plant communities in North Dakota in order to determine if this management tool improves vegetation structure that benefits wildlife. Three categories of seasonal wetlands were evaluated: reference condition, converted cropland, and excavated. Vegetation surveys were conducted in the wet meadow and shallow marsh zones of 39 seasonal wetlands located in Benson, Eddy, Towner, and Wells Counties, North Dakota. Visual obstruction readings were taken at various heights in order to assess habitat quality. There were no geographic differences in the reference wetland plant communities. However, there were significant treatment differences between the plant communities of the wet meadow and shallow marsh zones. In general, excavated wetlands showed vegetation trends similar to reference wetlands, whereas the converted cropland wetlands tended to be more cattail-choked. Visual obstruction scores and mean percent cover of...

Effects of oral prednisolone and fluticasone nasal spray in the management of nasal polypi

Background : Nasalpolyp presents a significant challenge in management due to its frequent recurrences. This study focuses on a medical model of combined local and systemic therapy for efficacy. Aims: Evaluation of a combined therapy, oral prednisolone, and fluticasone propionate nasal spray in the management of nasal polypi. Materials and Methods: This study was carried out in a tertiary care hospital in northeast India during a period of 18 months from 2010 to 2011. The recruitment of patients was done for 13 months and follow-up done for 3 months. The diagnosis made on the basis of physical examination, diagnostic nasal endoscopy, and radiological findings. The patients were evaluated for effects of combined treatment with fluticasone propionate nasal spray and oral prednisolone and followed up for 3 months. Descriptive statistics and analysis were carried out wherever applicable and P < 0.05 was considered statistically significant. Results: Altogether 67 patients were enrolled in this study. The most common presentation was observed in males in the fourth decade. With our modality, 98.5% showed a reduction in nasal obstruction score after treatment, and 83.6% showed a reduction in nasal discharge symptom score. Sixty patients (89.6%) showed a reduction in hyposmia symptom score after treatment and 68.7% showed a reduction in facial pain symptom score after treatment. Nasal polyp size was found to be significantly reduced after treatment, and no patients developed any adverse effects during or following the treatment initiation except mild burning sensation with fluticasone nasal spray (three patients) which subsided after a few days. Conclusion: We found that a 3-week course of combined oral prednisolone and fluticasone-propionate nasal spray is effective in decreasing polyp size and improving nasal symptoms for nasal polyposis, without sustained adverse effects.