Publications by authors named "Sarah Bernard"

30 Publications

  • Page 1 of 1

Oximetry neither to prescribe long-term oxygen therapy nor to screen for severe hypoxaemia.

ERJ Open Res 2021 Oct 18;7(4). Epub 2021 Oct 18.

Research Center, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec, Canada.

Background And Objective: Transcutaneous pulse oximetry saturation ( ) is widely used to diagnose severe hypoxaemia and to prescribe long-term oxygen therapy (LTOT) in COPD. This practice is not based on evidence. The primary objective of this study was to determine the accuracy (false positive and false negative rates) of oximetry for prescribing LTOT or for screening for severe hypoxaemia in patients with COPD.

Methods: In a cross-sectional study, we correlated arterial oxygen saturation ( ) and in patients with COPD and moderate hypoxaemia (n=240) and calculated the false positive and false negative rates of at the threshold of ≤88% to identify severe hypoxaemia (arterial oxygen tension ( ) ≤55 mmHg or <60 mmHg) in 452 patients with COPD with moderate or severe hypoxaemia.

Results: The correlation between and was only moderate (intra-class coefficient of correlation: 0.43; 95% confidence interval: 0.32-0.53). LTOT would be denied in 40% of truly hypoxaemic patients on the basis of a >88% ( false negative result). Conversely, LTOT would be prescribed on the basis of a ≤88% in 2% of patients who would not qualify for LTOT ( false positive result). Using a screening threshold of ≤92%, 5% of severely hypoxaemic patients would not be referred for further evaluation.

Conclusions: Several patients who qualify for LTOT would be denied treatment using a prescription threshold of saturation ≤88% or a screening threshold of ≤92%. Prescription of LTOT should be based on measurement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1183/23120541.00272-2021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8521391PMC
October 2021

Outcomes after transperitoneal laparoscopic ureteronephrectomy for the treatment of primary renal neoplasia in seven dogs.

Vet Surg 2021 Jul 7;50 Suppl 1:O108-O115. Epub 2021 Jul 7.

Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada.

Objective: To describe the perioperative characteristics and outcomes in dogs that underwent transperitoneal laparoscopic ureteronephrectomy (TLU) for primary renal neoplasia.

Study Design: Short case series.

Animals: Seven client-owned dogs.

Methods: Medical records were reviewed and data extracted regarding perioperative characteristics and animal outcomes. TLU was performed using a single-port + 1 or multiple port techniques. Hemostatic clips or a vessel-sealing device were used for occlusion of renal hilar vessels. The ureter was occluded and transected close to the ureterovesicular junction and the tumor was placed in a specimen retrieval bag for extraction from the abdomen.

Results: Preoperative contrast enhanced computed tomography (CECT) was performed in 6/7 dogs. Median estimated tumor volume measured from abdominal CECT removed by TLU was 32.42 cm (interquartile range [IQR] 14.76-94.85). Median surgery time for TLU was 90 minutes (IQR 85-105). In one dog, elective conversion to open laparotomy was performed due to large tumor size. Median time to discharge was 31 hours (IQR 24-48). No major perioperative complications occurred and all dogs survived to discharge. Progression free survival in four dogs was 422 days (IQR 119-784).

Conclusion: TLU was performed for the extirpation of modest sized primary renal tumors with acceptable perioperative outcomes and a low complication rate.

Clinical Relevance: TLU may be considered for the treatment of selected cases of primary renal neoplasia in dogs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/vsu.13675DOI Listing
July 2021

Enhance Access to Pulmonary Rehabilitation with a Structured and Personalized Home-Based Program-: Protocol for Real-World Setting.

Int J Environ Res Public Health 2021 06 6;18(11). Epub 2021 Jun 6.

Healthcare Department, Nippon Gases Portugal, 4470-177 Maia, Portugal.

Home-based models represent one of the solutions to respond to the poor accessibility of pulmonary rehabilitation (PR) services in patients with chronic respiratory disease (CRD). The main goal of this protocol is to present the implementation of the first nationwide home-based PR program--in Portugal and the strategies to assess its benefits in patients with CRD. The program consists of 2 phases: a 12-week intensive phase and a 40-week maintenance phase (total: 52 weeks, 1 year). The intervention in both phases is composed of presential home visits and phone-call follow ups, including exercise training and the self-management educational program Living Well with COPD. Dyspnea, impact of the disease, emotional status, and level of dyspnea during activities of daily living are used as patient-reported outcomes measures. A one-minute sit-to-stand test is used as a functional outcome, and the number of steps as a measure of physical activity. To ensure safety, fall risk and the cognitive function are assessed. Data are collected at baseline, at 12 weeks, at 26 weeks and at 52 weeks. This is the first nationwide protocol on enhancing access to PR, providing appropriate responses to CRD patients' needs through a structured and personalized home-based program in Portugal.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph18116132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8201276PMC
June 2021

Randomized Trial of Nocturnal Oxygen in Chronic Obstructive Pulmonary Disease.

N Engl J Med 2020 09;383(12):1129-1138

From Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, QC (Y.L., F.S., S.B., F.M.), Centre Hospitalier Affilié Universitaire de Trois-Rivières, Trois-Rivières, QC (F.C.), Mount Sinai Hospital, McGill University (M.B.), and Montreal Chest Institute, Research Institute of the McGill University Health Centre and McGill University (J.B.), Montreal, Centre Intégré de Santé et de Services Sociaux de Laval, Laval, QC (B.P.), and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A.) - all in Canada; Hospital Pedro Hispano-Unidade Local de Saúde de Matosinhos, Matosinhos (P.S.), and Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia (M.G.) - both in Portugal; and Hospital Universitario de Getafe, Getafe (A.A.F.), and Hospital Galdakao, Servicio Vasco de Salud-Osakidetza, Bizkaia (C.E.) - both in Spain.

Background: Long-term oxygen therapy improves survival in patients with chronic obstructive pulmonary disease (COPD) and chronic severe daytime hypoxemia. However, the efficacy of oxygen therapy for the management of isolated nocturnal hypoxemia is uncertain.

Methods: We designed this double-blind, placebo-controlled, randomized trial to determine, in patients with COPD who have nocturnal arterial oxygen desaturation without qualifying for long-term oxygen therapy, whether nocturnal oxygen provided for a period of 3 to 4 years would decrease mortality or the worsening of disease such that patients meet current specifications for long-term oxygen therapy. Patients with an oxygen saturation of less than 90% for at least 30% of the recording time on nocturnal oximetry were assigned, in a 1:1 ratio, to receive either nocturnal oxygen or ambient air from a sham concentrator (placebo). The primary outcome was a composite of death from any cause or a requirement for long-term oxygen therapy as defined by the Nocturnal Oxygen Therapy Trial (NOTT) criteria in the intention-to-treat population.

Results: Recruitment was stopped prematurely because of recruitment and retention difficulties after 243 patients, of a projected 600, had undergone randomization at 28 centers. At 3 years of follow-up, 39.0% of the patients assigned to nocturnal oxygen (48 of 123) and 42.0% of those assigned to placebo (50 of 119) met the NOTT-defined criteria for long-term oxygen therapy or had died (difference, -3.0 percentage points; 95% confidence interval, -15.1 to 9.1).

Conclusions: Our underpowered trial provides no indication that nocturnal oxygen has a positive or negative effect on survival or progression to long-term oxygen therapy in patients with COPD. (Funded by the Canadian Institutes of Health Research; INOX ClinicalTrials.gov number, NCT01044628.).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1056/NEJMoa2013219DOI Listing
September 2020

Relieving exertional dyspnea during the 3-min constant speed shuttle test in patients with COPD with indacaterol/glycopyrronium tiotropium: the RED trial.

Ther Adv Respir Dis 2020 Jan-Dec;14:1753466620939507

Centre de pneumologie, Institut universitaire de cardiologie et de pneumologie de Québec, 2725 chemin Ste-Foy, QC G1V 4G5, Canada.

Background: Exertional dyspnea is a cardinal feature of chronic obstructive pulmonary disease (COPD) and a major cause of activity limitation. Although dual bronchodilation is more effective than bronchodilator monotherapy at improving resting pulmonary function, it is unclear to which extent this translates into superior relief of exertional dyspnea.

Methods: We conducted a randomized controlled, double-blind, cross-over trial comparing indacaterol 110 µg/glycopyrronium 50 µg once daily (OD) with tiotropium 50 µg OD in patients with moderate to severe COPD and resting hyperinflation (functional residual capacity >120% of predicted value). The primary outcome was Borg dyspnea score at the end of a 3-min constant speed shuttle test after 3 weeks of treatment. Secondary outcomes included changes in Borg dyspnea score after the first dose of study medication, expiratory flows and lung volumes. Statistical analysis was conducted using a cross-over analysis of variance model with repeated measurements.

Results: A total of 50 patients with COPD and a mean forced expiratory volume in 1 s of 54 ± 11% (mean ± SEM) predicted participated in the cross-over phase of the trial. Compared with baseline, there was a decrease in dyspnea after the first dose of medication with indacaterol/glycopyrronium [mean -1.00, 95% confidence interval (CI) -1.49 to -0.52] but not with tiotropium alone (mean -0.36, 95% CI -0.81 to 0.08). The reduction in dyspnea after the first dose was statistically significant between the two treatments (mean difference of -0.64, 95% CI -1.11 to -0.17). Despite indacaterol/glycopyrronium providing further bronchodilation and lung deflation throughout the trial, the reduction in dyspnea was not sustained at 3 weeks of treatment (mean between-treatment difference at 3 weeks of 0.09, 95% CI -0.44 to 0.61).

Conclusion: In comparison with bronchodilator monotherapy, indacaterol/glycopyrronium provided greater immediate exertional dyspnea relief, although this difference was not sustained after 3 weeks of therapy despite evidence of further bronchodilation and lung deflation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1753466620939507DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361488PMC
September 2021

Reliability of Home Nocturnal Oximetry in the Diagnosis of Overlap Syndrome in COPD.

Respiration 2020;99(2):132-139. Epub 2020 Jan 29.

Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec, Canada,

Background: Chronic obstructive pulmonary disease (COPD) and sleep apnea are common conditions and often coexist. The proper diagnosis of sleep apnea may affect the management and outcome of patients with COPD.

Objective: To determine the accuracy of home nocturnal oximetry to distinguish between nocturnal oxygen desaturation related to COPD alone or to sleep apnea in patients with moderate-to-severe COPD who have significant nocturnal hypoxemia with cyclical changes in saturation.

Methods: This study involved a comparison of home nocturnal oximetry and laboratory-based polysomnography (PSG) in patients with moderate-to-severe COPD considered for inclusion in a trial of nocturnal oxygen therapy. All of the patients had significant nocturnal oxygen desaturation (defined as ≥30% of the recording time with a transcutaneous arterial oxygen saturation <90%) with cyclical changes in saturation suggestive of sleep apnea.

Results: PSG was obtained in 90 patients; 45 patients (mean age = 68 years, SD = 8; 71% men; mean forced expiratory volume in 1 s [FEV1] = 50.6% predicted value, SD = 18.6%; data from 41 patients) fulfilled the criteria for sleep apnea (mean apnea-hypopnea index = 32.6 events/h, SD = 19.9) and 45 patients (mean age = 69 years, SD = 8; 87% men; mean FEV1 predicted value 44.6%, SD = 15%) did not (mean apnea-hypopnea index = 5.5 events/h, SD = 3.8). None of the patients' characteristics (including demographic, anthropometric, and physiologic measures) predicted the diagnosis of sleep apnea according to PSG results.

Conclusion: The diagnosis of sleep apnea in patients with moderate to severe COPD cannot rely on nocturnal oximetry alone, even when typical cyclical changes in saturation are seen on oximetry tracing. When suspecting an overlap syndrome, a full-night, in-laboratory PSG should be obtained.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000505299DOI Listing
April 2021

Quantification of permethrin resistance and kdr alleles in Florida strains of Aedes aegypti (L.) and Aedes albopictus (Skuse).

PLoS Negl Trop Dis 2018 10 24;12(10):e0006544. Epub 2018 Oct 24.

Mosquito and Fly Research Unit, United States Department of Agriculture, Agricultural Research Service, Center for Medical, Agricultural, and Veterinary Entomology, Gainesville, FL, United States of America.

Recent outbreaks of locally transmitted dengue and Zika viruses in Florida have placed more emphasis on integrated vector management plans for Aedes aegypti (L.) and Aedes albopictus Skuse. Adulticiding, primarily with pyrethroids, is often employed for the immediate control of potentially arbovirus-infected mosquitoes during outbreak situations. While pyrethroid resistance is common in Ae. aegypti worldwide and testing is recommended by CDC and WHO, resistance to this class of products has not been widely examined or quantified in Florida. To address this information gap, we performed the first study to quantify both pyrethroid resistance and genetic markers of pyrethroid resistance in Ae. aegypti and Ae. albopictus strains in Florida. Using direct topical application to measure intrinsic toxicity, we examined 21 Ae. aegypti strains from 9 counties and found permethrin resistance (resistance ratio (RR) = 6-61-fold) in all strains when compared to the susceptible ORL1952 control strain. Permethrin resistance in five strains of Ae. albopictus was very low (RR<1.6) even when collected from the same containers producing resistant Ae. aegypti. Characterization of two sodium channel kdr alleles associated with pyrethroid-resistance showed widespread distribution in 62 strains of Ae. aegypti. The 1534 phenylalanine to cysteine (F1534C) single nucleotide polymorphism SNP was fixed or nearly fixed in all strains regardless of RR. We observed much more variation in the 1016 valine to isoleucine (V1016I) allele and observed that an increasing frequency of the homozygous V1016I allele correlates strongly with increased RR (Pearson corr = 0.905). In agreement with previous studies, we observed a very low frequency of three kdr genotypes, IIFF, VIFF, and IIFC. In this study, we provide a statewide examination of pyrethroid resistance, and demonstrate that permethrin resistance and the genetic markers for resistance are widely present in FL Ae. aegypti. Resistance testing should be included in an effective management program.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1371/journal.pntd.0006544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6218098PMC
October 2018

Adherence to long-term oxygen therapy in patients with chronic obstructive pulmonary disease.

Chron Respir Dis 2019 Jan-Dec;16:1479972318767724. Epub 2018 Apr 9.

Centre de recherche, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec, Canada.

Long-term oxygen therapy (LTOT) has beneficial effects on survival in patients with chronic obstructive pulmonary disease (COPD) and severe hypoxemia at rest. Two landmark trials suggested that these benefits depend on the time of exposure to oxygen. Patients are usually prescribed LTOT for at least 15-18 hours/day. The primary objective of this study was to determine the average daily exposure to supplemental oxygen in patients with severely hypoxemic COPD who were newly prescribed LTOT and the proportion of patients who were adherent to their prescription. The secondary objective was to identify predictors of compliance to LTOT. We performed a retrospective observational study of patients newly registered in a regional home oxygen program in Quebec, Canada, between July 1, 2013, and December 31, 2014. Daily exposure to oxygen was objectively measured from the concentrator's counter clock. From 196 patients registered in the program during the study period, 115 contributed to the analysis. Most patients ( n = 84; 73%) were prescribed oxygen for ≥18 hours/day. Overall, the 115 patients were exposed to home oxygen for 17.8 hours/day; 60% of the patients were compliant according to our definition. Increasing age and ambulatory oxygen utilization predicted adherence to oxygen therapy. Adherence to home oxygen therapy is suboptimal. Behavioral and psychological interventions to improve compliance to LTOT should be investigated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1479972318767724DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6302966PMC
April 2020

Response of the Formosan Subterranean Termite to Neighboring Con-Specific Populations After Baiting With Noviflumuron.

J Econ Entomol 2017 04;110(2):575-583

Department of Entomology and Nematology, Ft. Lauderdale Research and Education Center, University of Florida, Institute of Food and Agricultural Sciences, 3205 College Avenue, Ft. Lauderdale, FL 33314

Coptotermes formosanus Shiraki are economically important subterranean termites, particularly in the Southeastern United States where they are considered invasive. Where two C. formosanus populations met, aggressive encounters resulted in blockages in tunnels, but reinvading termites unblocked obstructions or constructed new tunnels. Experiments in planar arenas in which one population of C. formosanus was baited resulted in elimination of baited termites and subsequent reinvasion of territory by neighboring termites. Territories held by unbaited neighboring termites increased significantly, nearly doubling after reinvasion. Reinvading termites consumed baits left by baited colonies and were eliminated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jee/tow317DOI Listing
April 2017

Multi-center, randomized, placebo-controlled trial of nocturnal oxygen therapy in chronic obstructive pulmonary disease: a study protocol for the INOX trial.

BMC Pulm Med 2017 01 9;17(1). Epub 2017 Jan 9.

Centre de recherche, Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), 2725 Chemin Ste-Foy, Québec, Québec, G1V 4G5, Canada.

Background: Long-term oxygen therapy (LTOT) is the only component of the management of chronic obstructive pulmonary disease (COPD) that improves survival in patients with severe daytime hypoxemia. LTOT is usually provided by a stationary oxygen concentrator and is recommended to be used for at least 15-18 h a day. Several studies have demonstrated a deterioration in arterial blood gas pressures and oxygen saturation during sleep in patients with COPD, even in those not qualifying for LTOT. The suggestion has been made that the natural progression of COPD to its end stages of chronic pulmonary hypertension, severe hypoxemia, right heart failure, and death is dependent upon the severity of desaturation occurring during sleep. The primary objective of the International Nocturnal Oxygen (INOX) trial is to determine, in patients with COPD not qualifying for LTOT but who present significant nocturnal arterial oxygen desaturation, whether nocturnal oxygen provided for a period of 3 years decreases mortality or delay the prescription of LTOT.

Methods: The INOX trial is a 3-year, multi-center, placebo-controlled, randomized trial of nocturnal oxygen therapy added to usual care. Eligible patients are those with a diagnosis of COPD supported by a history of past smoking and obstructive disease who fulfill our definition of significant nocturnal oxygen desaturation (i.e., ≥ 30% of the recording time with transcutaneous arterial oxygen saturation < 90% on either of two consecutive recordings). Patients allocated in the control group receive room air delivered by a concentrator modified to deliver 21% oxygen. The comparison is double blind. The primary outcome is a composite of mortality from all cause or requirement for LTOT. Secondary outcomes include quality of life and utility measures, costs from a societal perspective and compliance with oxygen therapy. The follow-up period is intended to last at least 3 years.

Discussion: The benefits of LTOT have been demonstrated whereas those of nocturnal oxygen therapy alone have not. The INOX trial will likely determine whether supplemental oxygen during sleep is effective in reducing mortality, delaying the need for LTOT and improving health-related quality of life in patients with COPD who desaturate overnight.

Trial Registration: Current Controlled Trials ISRCTN50085100 ; ClinicalTrials.gov NCT01044628 (date of registration: January 6, 2010).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12890-016-0343-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223547PMC
January 2017

Higher Charlson Comorbidity Index scores do not influence Functional Independence Measure score gains in older rehabilitation patients.

Australas J Ageing 2016 Dec 12;35(4):236-241. Epub 2016 Sep 12.

Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.

Aim: To assess the effect of age-adjusted Charlson Comorbidity Index (CCI) score on Functional Independence Measure (FIM) score gain in older rehabilitation patients.

Methods: This prospective cohort study observed 306 older rehabilitation patients admitted to a secondary hospital between February and April 2015. Groups were compared using CCI score cut-offs of ≤4, 5-6 and ≥ 7.

Results: Complete FIM data were available for 280 patients. The mean age-adjusted CCI score was 5.59 ± 1.96. An age-adjusted CCI score ≤4 correlated with higher FIM scores at admission P = 0.015, and discharge P = 0.002, but not with a greater gain in FIM score P = 0.067. There were no significant between-group differences in mortality, hospital transfers or length of stay.

Conclusion: The Charlson age-comorbidity index was not a prognostic marker for FIM gain. Age and comorbidity alone are not barriers to the rehabilitation of older patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ajag.12351DOI Listing
December 2016

Eligibility for home oxygen programs and funding across Canada.

Can Respir J 2015 Nov-Dec;22(6):324-30. Epub 2015 Aug 25.

Background: In Canada, although medical insurance is generally universal, significant differences exist in the provision of home oxygen therapy across the country.

Objective: To systematically compare the terms of reference for home oxygen across Canada, with a focus on the clinical inclusion criteria to the programs.

Methods: The authors searched the terms of reference of the 10 Canadian provinces and three territories, focusing on general eligibility criteria for home oxygen (including blood gas criteria, and eligibility criteria for ambulatory and nocturnal oxygen), and compared the eligibility criteria to the widely accepted criteria of the Nocturnal Oxygen Therapy Trial (NOTT) trial, the clinical recommendations of the Canadian Thoracic Society and the results of Cochrane reviews.

Results: The terms of reference for nine provinces were retrieved. All jurisdictions have similar criteria for long-term oxygen therapy, with slight differences in the thresholds of prescription and the clinical criteria defining 'pulmonary hypertension' or 'cor pulmonale'. The use of oxyhemoglobin saturation as a criterion for funding is inconsistent. All nine provinces fund nocturnal oxygen, all with different clinical criteria. Funding for portable oxygen widely varies across provinces, whether the ambulatory equipment is offered to patients on long-term oxygen therapy or to those who have isolated exercise-induced desaturation. The terms of reimbursement are very heterogeneous.

Conclusions: Heterogeneity exists in the criteria for eligibility to home oxygen programs and funding across Canada. Terms of prescription and reimbursement of oxygen are not necessarily supported by available evidence from the current literature in several Canadian jurisdictions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4676395PMC
http://dx.doi.org/10.1155/2015/280604DOI Listing
September 2016

Utility Scores In Patients With Oxygen-Dependent COPD: A Case-Control Study.

COPD 2015 16;12(5):510-5. Epub 2015 Mar 16.

a Centre de Recherche, Hôpital Laval , Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval , Québec , Canada.

Background: Utility measures that summarize the health-related quality of life of an individual using a single number usually between 0 (death) and 1 (full health) are useful to quantify the benefits of health care interventions in terms of quality-adjusted life years (QALYs) and to help prioritizing limited health resources from cost-effectiveness analyses among patients with different health conditions.

Objective: To determine utility scores in patients with oxygen-dependent chronic obstructive pulmonary disease (COPD).

Methods: Patients with oxygen-dependent COPD (the cases) were matched, on a 1:2 basis, to COPD controls according to gender, age (± 5 years) and FEV1 (±5% predicted). Utility scores were obtained from the SF-6D, a measure derived from the SF-36.

Results: From a cohort of 102 patients with oxygen-dependent COPD, 68 (42 men; mean age: 71 years; mean FEV1: 35% predicted) were successfully matched with 136 controls. We found clinically and statistically significant differences in mean utility scores between cases (0.588 ± 0.071) and controls (0.627 ± 0.085; p = 0.001). The same differences were observed in men and women.

Conclusion: Oxygen-dependence adds to the burden of disease in terms of quality of life. These utility scores may be useful in cost-utility analyses involving patients with oxygen-dependent COPD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/15412555.2014.995290DOI Listing
July 2016

Use of medication for challenging behaviour in people with intellectual disability.

Br J Psychiatry 2014 Jul;205(1):6-7

Gyles Glover, MSc, MD, FRCPsych, FPPH, Co-Director, Learning Disabilities Team, Public Health England; Sarah Bernard, MD, FRCPsych, DRCOG, Child and Adolescent Learning Disability Service, South London and Maudsley NHS Foundation Trust; David Branford, PhD, FRPharmS, FCMHP, Chairman, English Pharmacy Board, Royal Pharmaceutical Society; Anthony Holland, MPhil, MRCP, FRCPsych, Diploma in Clinical Genetics, Health Foundation Chair in Learning Disabilities, Academic Department of Psychiatry, University of Cambridge; Andre Strydom, MSc, PhD, MRCPsych, Reader in Intellectual Disabilities, Mental Health Sciences Unit, University College London, UK.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1192/bjp.bp.113.141267DOI Listing
July 2014

Obesity in chronic obstructive pulmonary disease: is fatter really better?

Can Respir J 2014 Sep-Oct;21(5):297-301. Epub 2014 May 2.

Background: Overweight⁄obesity is associated with longer survival in chronically ill patients, a phenomenon referred to as the 'obesity paradox'.

Objective: To investigate whether the obesity paradox in patients with chronic obstructive pulmonary disease (COPD) is due to fat accumulation or confounding factors.

Methods: A total of 190 patients with stable COPD who underwent a mean (± SD) follow-up period of 72±34 months were enrolled. Anthropometry, pulmonary function tests, midthigh muscle cross-sectional area obtained using computed tomography (MTCSACT), arterial blood gas and exercise testing data were measured at baseline. Patients were categorized into two subgroups according to body mass index (BMI) <25 kg⁄m2 or ≥25 kg⁄m2 (normal and overweight⁄obese, respectively).

Results: Seventy-two patients (38%) died during the follow-up period. Survival tended to be better in the overweight⁄obese patients but this difference did not reach statistical significance. Overweight⁄obese patients had better lung function and a larger MTCSACT than those with normal BMI (P<0.001). Overweight⁄obese patients also had a significantly higher peak work rate than patients with normal BMI (P<0.001). PaO2 and PaCO2 were not significantly different in the two groups. When adjusted for PaCO2, peak work rate and MTCSACT, the tendency for improved survival in overweight⁄obese patients disappeared. In fact, when these variables were considered in the survival analysis, patients with lower BMI tended to have better survival.

Conclusion: These results suggest that important confounders, such as hypercapnia, exercise capacity and muscle mass, should be considered when interpreting the association between increased BMI and survival in patients with COPD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2014/181074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4198232PMC
June 2015

Commentary: RCT of optimal dose methylphenidate in children and adolescents with severe ADHD and ID--a reply to Arnold (2013).

J Child Psychol Psychiatry 2013 Jun;54(6):703-4

The commentary by Arnold (2013) raises a number of interesting issues and speculations about the action of methylphenidate in children with intellectual disability (ID) and associated neurodevelopmental disorders, such as autism spectrum disorders. In our article (Simonoff et al., 2013), we were careful to stick closely to the statistical analysis plan drawn up (and approved by the Data Monitoring Committee) during data collection and prior to any exploratory analysis. However, a number of the issues raised by Arnold warrant further response, with the aim of clarifying the lessons that can reasonably be drawn for clinical practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jcpp.12098DOI Listing
June 2013

Validation of a new questionnaire with generic and disease-specific qualities: the McGill COPD Quality of Life Questionnaire.

Can Respir J 2012 Nov-Dec;19(6):367-72

University of Ottawa, The Ottawa Hospital, The Otta Hospital Research Institute, Ottawa, Ontario.

Background: A validated health-related quality of life questionnaire in chronic obstructive pulmonary disease (COPD) with advantages of both generic- and disease-specific questionnaires is needed to capture patients' perspectives of severity and impact of the disease. The McGill COPD questionnaire was created to include these advantages in English and French. It assesses three domains: symptoms, physical function and feelings with 29 items (12 from the 36-item Short-Form Health Survey with 17 from the previously developed COPD-specific module).

Objective: To evaluate the psychometric properties of this newly developed hybrid questionnaire in subjects with COPD.

Methods: Data from a multicentre, prospective cohort study involving four hospitals with COPD subjects undergoing pulmonary rehabilitation were used. Patient evaluations included health-related quality of life (the new McGill COPD questionnaire, the St Georges Respiratory Questionnaire and the 36-item Short-Form Health Survey) and pulmonary function tests pre-and postrehabilitation. Reliability, validity and responsiveness were tested.

Results: The study included 246 COPD subjects (111 females) with a mean age of 66 years, 87% ex- and 8% current smokers (mean 61 pack-years) and mean forced expiratory volume in 1 s of 1.12 L (Global initiative for chronic Obstructive Lung Disease stages: 2, 27%; 3, 33%; and 4, 37%). Missing data were <2% and floor and ceiling effects were <5%. Internal consistency (Cronbach's alpha) was 0.68 to 0.82. Test-retest reliability (intracorrelation coefficients) ranged from 0.74 to 0.96 for the subscales, and 0.95 for the total score. Correlation with the St George's Respiratory Questionnaire was moderately high (r=-0.88 [95% CI -0.91 to -0.84]), consistent with the a priori hypothesis for convergent validity. The effect size was 0.33 (pre-postrehabilitation mean score difference = 6), suggesting a small to moderate change.

Conclusions: The new McGill COPD questionnaire showed high internal consistency, test-retest reliability, validity and moderate responsiveness in COPD subjects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2012/914138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3603761PMC
June 2013

The mental health needs of children and adolescents with learning disabilities.

Curr Opin Psychiatry 2012 Sep;25(5):353-8

Locum Consultant in Child and Adolescent Psychiatry, South London and Maudsley NHS Foundation Trust, South London and Maudsley NHS Foundation Trust, London, UK.

Purpose Of Review: To provide an update on the mental health needs of children and adolescents with learning disabilities, by examining salient studies published predominantly in the last 12-18 months.

Recent Findings: There have been further articles published supporting the findings of earlier landmark studies demonstrating an increased prevalence of mental health disorders in young people with learning disabilities. These articles suggest higher rates of comorbidity than were previously recognized. There are few published studies pertaining to the effectiveness of psychological and pharmacological treatments, although there is a recognition that the latter are more routinely and perhaps inappropriately administered. Antipsychotics are the most commonly prescribed group of medications and, despite a lack of evidence, continue to be prescribed more to address challenging behaviours rather than in the treatment of an identified psychiatric disorder. Reviews examining services and policies in other countries further highlight that the health and social care needs of individuals with learning disabilities are receiving more attention, with a shared vision that services should be inclusive and preferably community based.

Summary: Although there is improved knowledge of the rates of mental health disorders in young people with learning disabilities, in clinical practice these mental health needs continue to be underrecognized and untreated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/YCO.0b013e3283566843DOI Listing
September 2012

Randomized controlled double-blind trial of optimal dose methylphenidate in children and adolescents with severe attention deficit hyperactivity disorder and intellectual disability.

J Child Psychol Psychiatry 2013 May 7;54(5):527-35. Epub 2012 Jun 7.

Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, London, UK.

Background: Attention deficit hyperactivity disorder is increased in children with intellectual disability. Previous research has suggested stimulants are less effective than in typically developing children but no studies have titrated medication for individual optimal dosing or tested the effects for longer than 4 weeks.

Method: One hundred and twenty two drug-free children aged 7-15 with hyperkinetic disorder and IQ 30-69 were recruited to a double-blind, placebo-controlled trial that randomized participants using minimization by probability, stratified by referral source and IQ level in a one to one ratio. Methylphenidate was compared with placebo. Dose titration comprised at least 1 week each of low (0.5 mg/kg/day), medium (1.0 mg/kg/day) and high dose (1.5 mg/kg/day). Parent and teacher Attention deficit hyperactivity disorder (ADHD) index of the Conners Rating Scale-Short Version at 16 weeks provided the primary outcome measures. Clinical response was determined with the Clinical Global Impressions scale (CGI-I). Adverse effects were evaluated by a parent-rated questionnaire, weight, pulse and blood pressure. Analyses were by intention to treat.

Trial Registration: ISRCTN 68384912.

Results: Methylphenidate was superior to placebo with effect sizes of 0.39 [95% confidence intervals (CIs) 0.09, 0.70] and 0.52 (95% CIs 0.23, 0.82) for the parent and teacher Conners ADHD index. Four (7%) children on placebo versus 24 (40%) of those on methylphenidate were judged improved or much improved on the CGI. IQ and autistic symptoms did not affect treatment efficacy. Active medication was associated with sleep difficulty, loss of appetite and weight loss but there were no significant differences in pulse or blood pressure.

Conclusions: Optimal dosing of methylphenidate is practical and effective in some children with hyperkinetic disorder and intellectual disability. Adverse effects typical of methylphenidate were seen and medication use may require close monitoring in this vulnerable group.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1469-7610.2012.02569.xDOI Listing
May 2013

Combining both generic and disease-specific properties: development of the McGill COPD quality of life questionnaire.

COPD 2011 Aug 5;8(4):255-63. Epub 2011 Jul 5.

The University of Ottawa, the Ottawa Hospital, the Ottawa Hospital Research Institute, Canada.

Unlabelled: Presently, a generic and a disease-specific questionnaire are often co-administered to capture the different domains of quality of life in chronic obstructive pulmonary disease (COPD) subjects. A health-related-quality of life (HRQL) questionnaire in COPD combining both generic and disease-specific properties is needed.

Objective: To develop a new, hybrid-HRQL questionnaire, the McGill-COPD-questionnaire, with qualities of both generic and disease-specific instruments. Using pre-defined criteria, we selected items from the SF-36 to complement the items from a COPD-specific-module to create the new hybrid-HRQL-questionnaire. Domains were identified via confirmatory factor analysis. The McGill COPD questionnaire is available in English and French; it assesses three domains: symptoms, physical-function and feelings, has 29 items: 17 from the COPD-specific-module and 12 from the SF-36. The symptom sub-scale has 6 items, all from the COPD-specific-module; the feelings sub-scale has 10 items, 5 each from COPD-specific-module and SF-36 and the physical-function sub-scale has 13 items, 6 from COPD-specific-module and 7 from SF-36. The McGill COPD questionnaire was developed using a novel method of combining items from the SF-36 and a COPD-specific-module. Thus, this new questionnaire has items from a generic-questionnaire and a disease-specific-module and, hence, is promising to be a stand alone quality-of-life questionnaire for COPD subjects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/15412555.2011.578600DOI Listing
August 2011

Fatigue in COPD: prevalence and effect on outcomes in pulmonary rehabilitation.

Chron Respir Dis 2011 23;8(2):119-28. Epub 2011 Mar 23.

Mount Sinai Hospital Center, Montreal, Canada.

Patients with chronic obstructive pulmonary disease (COPD) complain of dyspnea and fatigue. We sought to estimate the prevalence of high fatigue in this population and to determine whether individuals with high fatigue had a different response to pulmonary rehabilitation. This observational study was embedded within a randomized trial. Participants underwent 3 months of pulmonary rehabilitation including education and exercise training. We divided 251 individuals into low and high fatigue groups using population normal scores of the SF-36 vitality domain. Baseline data included spirometry, 6-minute walk distance (6MWD), peak exercise capacity, constant workrate cycling endurance time, and questionnaires including the St. George's and Chronic Respiratory questionnaires (SGRQ, CRQ). The response to pulmonary rehabilitation was evaluated using changes in these measures at 3 months and 1 year after entry. High fatigue was present in 97/251 (39%) of patients. High fatigue patients were younger, had more depressive symptoms, greater dyspnea and poorer SGRQ scores (p < 0.01). They also had lower 6MWD, endurance times, and peak volume of oxygen consumption (VO(2); p < 0.05). Patients in both groups improved similarly in their dyspnea, the 6MWD and endurance time. High-fatigue patients had greater improvements in both the CRQ fatigue (by 0.74 more points) and the SGRQ scores (by 6.0 points; p < 0.01), with clinically significant gains maintained at 1 year. This study suggests that high levels of fatigue is a common feature in patients with COPD. They have a lower exercise capacity and a lower health status. However, they benefit from pulmonary rehabilitation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1479972310396737DOI Listing
October 2011

Dihydropyranone formation by ipso C-H activation in a glucal 3-carbamate-derived rhodium acyl nitrenoid.

J Org Chem 2011 Apr 7;76(7):2240-4. Epub 2011 Mar 7.

Department of Chemistry, Barnard College, 3009 Broadway, New York, New York 10027, USA.

By using (N-tosyloxy)-3-O-carbamoyl-D-glucal 10, which removes the need for a hypervalent iodine(III) oxidant, we provide evidence for rhodium nitrenoid-mediated ipso C-H activation as the origin of a C3-oxidized dihydropyranone product 3. This system may be especially susceptible to such a pathway because of the ease of forming a cation upon hydride transfer to the rhodium-complexed acyl nitrene.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1021/jo101599qDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3064709PMC
April 2011

The impact of obesity on walking and cycling performance and response to pulmonary rehabilitation in COPD.

BMC Pulm Med 2010 Nov 6;10:55. Epub 2010 Nov 6.

Centre de recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada.

Background: We examined the influence of overweight and obesity on pulmonary function, exercise tolerance, quality of life and response to pulmonary rehabilitation in COPD.

Methods: 261 patients with COPD were divided into three groups: normal body mass index (BMI), overweight and obese. Baseline and post rehabilitation pulmonary function, 6-min walking test (6MWT), endurance time during a constant workrate exercise test (CET) and St. George's Respiratory Questionnaire (SGRQ) scores were compared between all three classes of BMI.

Results: At baseline, obese and overweight patients had less severe airflow obstruction compared to normal BMI patients. There was no baseline difference in CET performance or SGRQ scores across BMI classes and 6MWT was reduced in the presence of obesity (p < 0.01). Compared to baseline, post-rehabilitation 6MWT, CET performance and SGRQ scores improved significantly in each group (p < 0.01), but 6MWT was still significantly lower in the presence of obesity.

Conclusions: Walking, but not cycling performance was worse in obese patients. This difference was maintained post rehabilitation despite significant improvements. Weight excess may counterbalance the effect of a better preserved respiratory function in the performance of daily activities such as walking. However, obesity and overweight did not influence the magnitude of improvement after pulmonary rehabilitation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1471-2466-10-55DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2987952PMC
November 2010

Effects of written action plan adherence on COPD exacerbation recovery.

Thorax 2011 Jan 30;66(1):26-31. Epub 2010 Oct 30.

Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

Background: The effects of written action plans on recovery from exacerbations of chronic obstructive pulmonary disease (COPD) have not been well studied. The aims of this study were to assess the effects of adherence to a written action plan on exacerbation recovery time and unscheduled healthcare utilisation and to explore factors associated with action plan adherence.

Methods: This was a 1-year prospective cohort study embedded in a randomised controlled trial. Exacerbation data were recorded for 252 patients with COPD who received a written action plan for prompt treatment of exacerbations with the instructions to initiate standing prescriptions for both antibiotics and prednisone within 3 days of exacerbation onset. Following the instructions was defined as adherence to the action plan.

Results: From the 288 exacerbations reported by 143 patients, start dates of antibiotics or prednisone were provided in 217 exacerbations reported by 119 patients (53.8% male, mean age 65.4 years, post-bronchodilator forced expiratory volume in 1 s (FEV(1)) 43.9% predicted). In 40.1% of exacerbations, patients adhered to their written action plan. Adherence reduced exacerbation recovery time with statistical (p=0.0001) and clinical (-5.8 days) significance, but did not affect unscheduled healthcare utilisation (OR 0.94, 95% CI 0.49 to 1.83). Factors associated with an increased likelihood of adherence were influenza vaccination, cardiac comorbidity, younger age and lower FEV(1) as percentage predicted.

Conclusions: This study shows that adherence to a written action plan is associated with a reduction in exacerbation recovery time by prompt treatment. Knowing the factors that are associated with proper and prompt utilisation of an action plan permits healthcare professionals to better focus their self-management support on appropriate patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/thx.2009.127621DOI Listing
January 2011

Protecting group and solvent control of stereo- and chemoselectivity in glucal 3-carbamate amidoglycosylation.

Org Lett 2009 Apr;11(7):1527-30

Department of Chemistry, Barnard College, 3009 Broadway, New York, New York 10027, USA.

In the Rh(2)(OAc)(4)-catalyzed amidoglycosylation of glucal 3-carbamates, anomeric stereoselectivity and the extent of competing C3-H oxidation depend on the 4O and 6O protecting groups. Acyclic protection permits high alpha-anomer selectivity with further improvement in less polar solvents, while electron-withdrawing protecting groups limit C3-oxidized byproducts. Stereocontrol and bifurcation between alkene insertion and C3-H oxidation reflect an interplay of conformational, stereoelectronic, and inductive factors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1021/ol900126qDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684990PMC
April 2009

Effects of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial.

Ann Intern Med 2008 Dec;149(12):869-78

Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval and Centre Hospitalier Universitaire Associé, Québec City, Québec, Canada.

Background: Home-based rehabilitation is a promising approach to improve access to pulmonary rehabilitation.

Objective: To assess whether self-monitored, home-based rehabilitation is as effective as outpatient, hospital-based rehabilitation in patients with chronic obstructive pulmonary disease (COPD).

Design: Randomized, multicenter, noninferiority trial.

Setting: 10 academic and community medical centers in Canada.

Patients: 252 patients with moderate to severe COPD.

Intervention: After a 4-week education program, patients took part in home-based rehabilitation or outpatient, hospital-based rehabilitation for 8 weeks. They were followed for 40 weeks to complete the 1-year study.

Measurements: The primary outcome was the change in Chronic Respiratory Questionnaire dyspnea subscale score at 1 year. The primary analysis took a modified intention-to-treat approach by using all patients who provided data at the specified follow-up time, regardless of their level of adherence. The analysis used regression modeling that adjusted for the effects of center, sex, and baseline level. All differences were computed as home intervention minus outpatient intervention.

Results: Both interventions produced similar improvements in the Chronic Respiratory Questionnaire dyspnea subscale at 1 year: improvement in dyspnea of 0.62 (95% CI, 0.43 to 0.80) units in the home intervention (n = 107) and 0.46 (CI, 0.28 to 0.64) units in the outpatient intervention (n = 109). The difference between the 2 treatments at 1 year was small and clinically unimportant. The 95% CI of the difference did not exceed the prespecified noninferiority margin of 0.5: difference in dyspnea score of 0.16 (CI, -0.08 to 0.40). Most adverse events were related to COPD exacerbations. No serious adverse event was considered to be related to the study intervention.

Limitation: The contribution of the educational program to the improvement in health status and exercise tolerance cannot be ascertained.

Conclusion: Home rehabilitation is a useful, equivalent alternative to outpatient rehabilitation in patients with COPD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7326/0003-4819-149-12-200812160-00006DOI Listing
December 2008

A computational study of chlorocarbene additions to cyclooctyne.

J Org Chem 2008 Nov 1;73(21):8537-44. Epub 2008 Oct 1.

Department of Chemistry, Barnard College, 3009 Broadway, New York, New York 10027, USA.

Dichloro- and phenylchlorocarbene (CCl2 and PhCCl) add to cyclooctyne via a barrierless process (MP2/6-311+G*, B3LYP/6-311+G*, B3LYP/6-31G*) to yield the expected corresponding cyclopropene adducts. A three-dimensional potential energy surface (PES) for CCl2 addition to cyclooctyne (B3LYP/6-31G*) shows the formation of the cyclopropene product and also possible formation of a vinylcarbene. Residing in a shallow energy well, the vinylcarbene easily rearranges to the cyclopropene product, or to an exocyclic vinyl bicyclo[3.3.0]octane. Although the calculated three-dimensional PES indicates possible dynamic control of the cyclooctyne-chlorocarbene system through the putative formation of a vinylcarbene (in addition to the expected cyclopropene), additional calculations and preliminary experimental work show paths through the vinylcarbene to be unlikely. If the additions of chlorocarbenes to cyclooctyne are controlled by reaction dynamics, we predict that the vast majority of the reactions proceed via traditional carbene cycloaddition with only a very minor amount of products formed from the alternative pathway.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1021/jo801736xDOI Listing
November 2008

A Canadian, multicentre, randomized clinical trial of home-based pulmonary rehabilitation in chronic obstructive pulmonary disease: rationale and methods.

Can Respir J 2005 May-Jun;12(4):193-8

Centre de rechereche, Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval, Sainte-Foy, Canada.

Background: Pulmonary rehabilitation remains largely underused. Self-monitored, home-based rehabilitation is a promising approach to improving the availability of pulmonary rehabilitation.

Objective: To report the rationale and methods of a trial comparing the effectiveness of self-monitored, home-based rehabilitation with hospital-based, outpatient rehabilitation in patients with chronic obstructive pulmonary disease (COPD).

Study Design: A parallel-group, randomized, noninferiority, multicentre trial will be performed with 240 patients with moderate to severe COPD.

Intervention: Patients will be randomly assigned to conventional, supervised, hospital-based outpatient rehabilitation or self-monitored, home-based rehabilitation. Both interventions will include a standardized, comprehensive self-management program, in addition to the hospital-based outpatient or home-based exercise program. After the three-month intervention, patients in both groups will be encouraged to continue exercising at home. Patients will be assessed monthly with telephone interviews and in person at enrollment, three months and 12 months.

Outcomes: The dyspnea domain of the Chronic Respiratory Questionnaire (CRQ) at 12 months is the primary outcome variable. Secondary outcome variables include total and domain-specific CRQ scores; exercise tolerance and activity of daily living; health service use over the one-year study period; and direct and indirect costs of COPD treatment.

Analysis: An intent-to-treat approach will be used as the primary analysis. The primary analysis will focus on the change in the CRQ dyspnea score using a two-sided t distribution based on 95% CIs. The same approach will be used for secondary continuous outcome variables.

Conclusion: The present trial will address two unresolved issues in pulmonary rehabilitation for patients with COPD: the short-term and long-term effectiveness of home-based pulmonary rehabilitation strategies. The authors will also determine if home-based pulmonary rehabilitation can reduce health service use (eg, hospitalizations and emergency visits) and if it can be done at a lower cost than the traditional hospital-based outpatient pulmonary rehabilitation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2005/606378DOI Listing
September 2005

Cell adhesion to fibrillin-1 molecules and microfibrils is mediated by alpha 5 beta 1 and alpha v beta 3 integrins.

J Biol Chem 2003 Sep 13;278(36):34605-16. Epub 2003 Jun 13.

United Kingdom Centre for Tissue Engineering, School of Biological Sciences, University of Manchester, United Kingdom.

Fibrillins are the major glycoprotein components of microfibrils that form a template for tropoelastin during elastic fibrillogenesis. We have examined cell adhesion to assembled purified microfibrils, and its molecular basis. Human dermal fibroblasts exhibited Arg-Gly-Asp and cation-dependent adhesion to microfibrils and recombinant fibrillin-1 protein fragments. Strong integrin alpha 5 beta 1 interactions with fibrillin ligands were identified, but integrin alpha v beta 3 also contributed to cell adhesion. Fluorescence-activated cell sorting analysis confirmed the presence of abundant alpha 5 beta 1 and some alpha v beta 3 receptors on these cells. Adhesion to microfibrils and to Arg-Gly-Asp containing fibrillin-1 protein fragments induced signaling events that led to cell spreading, altered cytoskeletal organization, and enhanced extracellular fibrillin-1 deposition. Differences in cell shape when plated on fibrillin or fibronectin implied substrate-specific alpha 5 beta 1-mediated cellular responses. An Arg-Gly-Asp-independent cell adhesion sequence was also identified within fibrillin-1. Adhesion and spreading of smooth muscle cells on fibrillin ligands was enhanced by antibody-induced beta1 integrin activation. A375-SM melanoma cells bound Arg-Gly-Asp-containing fibrillin-1 protein fragments mainly through alpha v beta 3, whereas HT1080 cells used mainly alpha 5 beta 1. This study has shown that fibrillin microfibrils mediate cell adhesion, that alpha 5 beta 1 and alpha v beta 3 are both important but cell-specific fibrillin-1 receptors, and that cellular interactions with fibrillin-1 influence cell behavior.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1074/jbc.M303159200DOI Listing
September 2003

Respite Care for Children with Severe Intellectual Disability and their Families: Who Needs It? Who Receives It?

Child Adolesc Ment Health 2002 May;7(2):66-72

Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.

Need for, and receipt of, respite care services were examined in a representative sample of 103 5-11-year-old children with severe intellectual disability and their families. Children for whom respite care was wanted had significantly more severe disabilities and behaviour problems than those whose parents felt they did not need it; their parents also reported significantly higher levels of stress. However, among those who wanted respite care, none of these factors appeared relevant to whether or not they had received it. The results suggest the need for greater account to be taken of the severity of the child's behaviour problems and intellectual disabilities in the allocation of respite care services, and also for measures to improve the supply of respite care placements capable of managing children with more challenging behaviour.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/1475-3588.00013DOI Listing
May 2002
-->