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Worrall AP, Connolly MJ, Kelly C, O'Connor-Byrne N, Keeling A, Glavey S, Rajab H, Naughton P. Benign gynaecological pathology causing vascular-compressed. Ir Med J 2024; 117:891. [PMID: 38259222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
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Kluger MT, Skarin M, Collier J, Rice DA, McNair PJ, Seow MY, Connolly MJ. Steroids to reduce the impact on delirium (STRIDE): a double-blind, randomised, placebo-controlled feasibility trial of pre-operative dexamethasone in people with hip fracture. Anaesthesia 2021; 76:1031-1041. [PMID: 33899214 DOI: 10.1111/anae.15465] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 01/18/2023]
Abstract
Neuro-inflammation may be important in the pathogenesis of postoperative delirium following hip fracture surgery. Studies have suggested a potential role for steroids in reducing postoperative delirium; however, the potential efficacy and safety of pre-operative high-dose dexamethasone in this specific population is largely unknown. Conducting such a study could be challenging, considering the multidisciplinary team involvement and the emergency nature of the surgery. The aim of this study was to assess feasibility and effectiveness of dexamethasone given as early as possible following hospital admission for hip fracture, to inform whether a full-scale trial is warranted. This single-centre, randomised, double-blind, placebo-controlled study randomly allocated 79 participants undergoing hip fracture surgery to dexamethasone 20 mg or placebo pre-operatively. Eligibility and recruitment rates, timing of the intervention and adverse events were recorded. Incidence and severity of postoperative delirium were assessed using the 4AT delirium screening tool and the Memorial Delirium Assessment Scale. Postoperative pain, length of stay and mortality were also assessed. The eligibility rate for inclusion was 178/527 (34%), and 57/178 (32%) of eligible patients presented to hospital when no researcher was available (e.g. after-hours, weekends, public holidays). Recruitment was limited mainly by ethical limitations (not including patients with impaired cognition) and lack of weekend staffing. Median (IQR [range]) time from emergency department admission to drug administration was 13.3 (5.9-17.6 [1.8-139.6]) hours. There was a significant difference in delirium severity scores, favouring the dexamethasone group: median (IQR [range]) 5 (3-6 [3-7]) vs. 9 (6-13 [5-14]) in the placebo group, with the probability of superiority effect size being 0.89, p = 0.010. Delirium incidence did not differ between groups: 6/40 (15%) in the dexamethasone group vs. 9/39 (23%) in the placebo group, relative risk (95%CI) 0.65 (0.22-1.65), p = 0.360). A larger randomised controlled trial is feasible and ideally this should include people with existing cognitive impairment, seven days-a-week cover and a multicentre design.
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Affiliation(s)
- M T Kluger
- Department of Anaesthesiology and Peri-operative Medicine, Waitematā DHB, Auckland, New Zealand.,Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - M Skarin
- Department of Anaesthesiology and Peri-operative Medicine, Waitematā DHB, Auckland, New Zealand
| | - J Collier
- Department of Anaesthesiology and Peri-operative Medicine, Waitematā DHB, Auckland, New Zealand
| | - D A Rice
- Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand
| | - P J McNair
- Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand
| | - M Y Seow
- Department of Orthopaedic Surgery, Waitematā DHB, Auckland, New Zealand
| | - M J Connolly
- Department of Geriatric Medicine, University of Auckland and Waitematā DHB, Auckland, New Zealand
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Vuong JS, Garrett JJ, Connolly MJ, York AR, Gross RE, Devergnas A. Head mounted telemetry system for seizures monitoring and sleep scoring on non-human primate. J Neurosci Methods 2020; 346:108915. [PMID: 32822694 DOI: 10.1016/j.jneumeth.2020.108915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
Radio telemetry systems are a useful way to continuously monitor broad electrical neuronal activity in behaving animals. It can also be used to study sleep disturbances or monitor seizure activity. Many different telemeter styles are available, but the more versatile and cost-efficient ones are the head mounted systems. They permit long-term recordings and allow more flexibility in the recordings. However, there are currently no such system available for non-human primate (NHP). In fact, the choices for NHP telemetry solutions are very limited. Here, we present a chronically implantable 3D printed chamber specifically designed to accommodate a rodent head-mounted system (RodentPACK) onto a NHP's head. We recorded EEG signal for more than a year, confirmed quality of the signal, and the ability to use the data to monitor sleep activity. We also used two of our epileptic animals to validate the embedded alarm system for real time seizure monitoring. While initially not designed for NHP, but with a minimum number of adaptions, this telemeter is in fact perfectly suitable for NHP experiments. Since early medical intervention during seizures is critical to avoid status epilepticus and to save the animal's life, real time seizures monitoring is becoming a safety requirement in many NHP studies. This method refines the current seizure monitoring methods for NHP and creates a flexible telemetry solution.
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Affiliation(s)
- J S Vuong
- Yerkes National Primate Research Center, Emory University, Atlanta, United States; Tufts University School of Medicine, United States
| | - J J Garrett
- Yerkes National Primate Research Center, Emory University, Atlanta, United States
| | - M J Connolly
- Yerkes National Primate Research Center, Emory University, Atlanta, United States; Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, United States
| | - A R York
- Yerkes National Primate Research Center, Emory University, Atlanta, United States
| | - R E Gross
- Department of Neurology, School of Medicine, Emory University, United States; Department of Neurological Surgery, Emory University School of Medicine. Atlanta, GA, United States
| | - A Devergnas
- Yerkes National Primate Research Center, Emory University, Atlanta, United States; Department of Neurology, School of Medicine, Emory University, United States.
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Peri K, Broad JB, Hikaka J, Boyd M, Bloomfield K, Wu Z, Calvert C, Tatton A, Higgins AM, Bramley D, Connolly MJ. Study protocol: older people in retirement villages. A survey and randomised trial of a multi-disciplinary invention designed to avoid adverse outcomes. BMC Geriatr 2020; 20:247. [PMID: 32680465 PMCID: PMC7367387 DOI: 10.1186/s12877-020-01640-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 07/03/2020] [Indexed: 12/02/2022] Open
Abstract
Background There is increasing interest among older people in moving into retirement villages (RVs), an attractive option for those seeking a supportive community as they age, while still maintaining independence. Currently in New Zealand there is limited knowledge of the medical, service supports, social status and needs of RV residents. The objective of this study is to explore RV facilities and services, the health and functional status of RV residents, prospectively study their healthcare trajectories and to implement a multidisciplinary team intervention to potentially decrease dependency and impact healthcare utilization. Methods All RVs located in two large district health boards in Auckland, New Zealand were eligible to participate. This three-year project comprised three phases: The survey phase provided a description of RVs, residents’ characteristics and health and functional status. RV managers completed a survey of size, facilities and recreational and healthcare services provided in the village. Residents were surveyed to establish reasons for entry to the village and underwent a Gerontology Nurse Specialist (GNS) assessment providing details of demographics, social engagement, health and functional status. The cohort study phase examines residents’ healthcare trajectories and adverse outcomes, over three years. The final phase is a randomised controlled trial of a multidisciplinary team intervention aimed to improve health outcomes for more vulnerable residents. Residents who triggered potential unmet health needs during the assessment in the survey phase were randomised to intervention or usual care groups. Multidisciplinary team meetings included the resident and support person, a geriatrician or gerontology nurse practitioner, GNS, pharmacist and General Practitioner. The primary outcome of the randomised controlled trial will be first acute hospitalization. Secondary outcomes include all acute hospitalizations, long-term care admissions, and all-cause mortality. Discussion This paper describes the study protocol of this complex study. The study aims to inform policies and practices around health care services for residents in retirement villages. The results of this trial are expected early 2020 with publication subsequently. Trial registration Australia and New Zealand Clinical Trials Registry: ACTRN12616000685415. Registered 25.5.2016. Universal Trial Number (UTN): U111–1173-6083.
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Affiliation(s)
- K Peri
- School of Nursing, University of Auckland, Private Bag 92 019, Auckland, 1142, New Zealand
| | - J B Broad
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - J Hikaka
- Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - M Boyd
- School of Nursing, University of Auckland, Private Bag 92 019, Auckland, 1142, New Zealand.,Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - K Bloomfield
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand.,Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - Z Wu
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - C Calvert
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand.,Auckland District Health Board, Private Bag 92 024, Auckland Mail Centre, Auckland, 1142, New Zealand
| | - A Tatton
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand.,Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - A-M Higgins
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - D Bramley
- Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - M J Connolly
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand. .,Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand.
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Connolly MJ, Hikaka J, Bloomfield K, Broad JB, Wu Z, Boyd M, Peri K, Calvert C, Tatton A, Higgins AM, Bramley D. 83RESEARCH IN THE RETIREMENT VILLAGE COMMUNITY: DOES THE RECRUITED SAMPLE REFLECT THE RESIDENT POPULATION? Age Ageing 2019. [DOI: 10.1093/ageing/afz061.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M J Connolly
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
- Waitemata District Health Board, Auckland, New Zealand
| | - J Hikaka
- Waitemata District Health Board, Auckland, New Zealand
| | - K Bloomfield
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
- Waitemata District Health Board, Auckland, New Zealand
| | - J B Broad
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
| | - Z Wu
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
| | - M Boyd
- School of Nursing, University of Auckland, Grafton, New Zealand
| | - K Peri
- School of Nursing, University of Auckland, Grafton, New Zealand
| | - C Calvert
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - A Tatton
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
- Waitemata District Health Board, Auckland, New Zealand
| | - A -M Higgins
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
| | - D Bramley
- Waitemata District Health Board, Auckland, New Zealand
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Broad JB, Wu Z, Ng J, Arroll B, Connolly MJ, Jaung R, Oliver F, Bissett IP. 79USE OF BIG DATA TO GUIDE RESEARCH DIRECTIONS IN DIVERTICULAR DISEASE OF THE INTESTINES (DDI): PRIMARY CARE MANAGEMENT OF DDI IS COMMON, YET EVIDENCE IS LACKING AND GUIDELINES ARE SILENT. Age Ageing 2019. [DOI: 10.1093/ageing/afz060.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J B Broad
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
| | - Z Wu
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
| | - J Ng
- Institute for Innovation and Improvement, Waitemata District Health Board, Takapuna, New Zealand
| | - B Arroll
- Department of General Practice and Primary Healthcare, School of Population Health, University of Auckland, Tamaki, New Zealand
| | - M J Connolly
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
- Waitemata District Health Board, Takapuna, New Zealand
| | - R Jaung
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - F Oliver
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
| | - I P Bissett
- Department of Surgery, University of Auckland, Auckland, New Zealand
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Connolly MJ, Broad JB, Bish T, Zhang X, Bramley D, Kerse N, Bloomfield K, Boyd M. Reducing emergency presentations from long-term care: A before-and-after study of a multidisciplinary team intervention. Maturitas 2018; 117:45-50. [PMID: 30314560 DOI: 10.1016/j.maturitas.2018.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/20/2018] [Accepted: 08/31/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The complexity of care required by many older people living in long-term care (LTC) facilities poses challenges that can lead to potentially avoidable referrals to a hospital emergency department (ED). The Aged Residential Care Intervention Project (ARCHIP) ran an implementation study to evaluate a multidisciplinary team (MDT) intervention supporting LTC facility staff to decrease potentially avoidable ED presentations by residents. METHODS ARCHIP (conducted in 21 facilities [1,296 beds] with previously noted high ED referral rates) comprised clinical coaching for LTC facility staff by a gerontology nurse specialist (GNS) and an MDT (facility senior nurse, resident's general practitioner, GNS, geriatrician, pharmacist) review of selected high-risk residents' care-plans. A before-after repeated measures analysis was conducted for 9 months before and 9 months after intervention commencement (a 29-month period because of staggered facility enrolment). Modelling was adjusted for time trend, seasonality, facility size, and cluster effect. RESULTS ED admission rate ratio post- versus pre-intervention was 0.75 (95% C.I. 0.63, 0.89, p-value = 0.0008), a 25% reduction in ED presentations post-intervention. A sensitivity model used a shorter, staggered time period centred on intervention start (9 months pre-intervention and 9 months post-intervention) for each facility, and a four-level categorical intervention variable testing intervention effect over time. The sensitivity test showed a 24% reduction in ED presentations in months 1-3 post-intervention (p-value = 0.07), a 34% reduction in months 4-6 (p-value = 0.01), and a 32% reduction in ED presentations in months 7-9 (p-value = 0.03). However, when the higher ED referral rates for 3 months immediately pre-intervention were modelled, the impact of the intervention on ED presentation rates reverted almost to previous levels. KEY CONCLUSIONS A GNS-led MDT outreach intervention, targeted at selected conditions, decreases avoidable ED admissions of high-risk residents from selected facilities.
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Affiliation(s)
- M J Connolly
- Department of Geriatric Medicine, University of Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand.
| | - J B Broad
- Department of Geriatric Medicine, University of Auckland, New Zealand
| | - T Bish
- Waitemata District Health Board, Auckland, New Zealand
| | - X Zhang
- Department of Geriatric Medicine, University of Auckland, New Zealand
| | - D Bramley
- Waitemata District Health Board, Auckland, New Zealand
| | - N Kerse
- School of Population Health, University of Auckland, New Zealand
| | - K Bloomfield
- Department of Geriatric Medicine, University of Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand
| | - M Boyd
- Department of Geriatric Medicine, University of Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand; School of Nursing, University of Auckland, New Zealand
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Connolly MJ, Yohannes AM. The impact of depression in older patients with chronic obstructive pulmonary disease and asthma. Maturitas 2016; 92:9-14. [PMID: 27621232 DOI: 10.1016/j.maturitas.2016.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/07/2016] [Indexed: 11/30/2022]
Abstract
Respiratory diseases are common in older people. However, the impact of comorbid depression in older patients with chronic obstructive pulmonary disease (COPD) and asthma has not been fully explored. This narrative review examines the impact of comorbid depression and its management in COPD and asthma in older adults. The causes of depression in patients with COPD and asthma are multifactorial and include physical, physiological and behavioural factors. Depression is associated with hospital readmission in older adults with asthma and COPD. We focus on the most current literature that has examined the efficacy of pulmonary rehabilitation (PR), cognitive behavioural therapy (CBT) and antidepressant drug therapy for patients with depression in the context of COPD and asthma. Our findings indicate that PR and CBT are beneficial in improving depressive symptoms and quality of life in short-term intervention studies. However, the long-term efficacy of CBT and PR is unknown. To date, the efficacy of antidepressant drug therapy for depression in patients with COPD and asthma is inconclusive. In addition, there has been no clear evidence that antidepressants can induce remission of depression or ameliorate dyspnoea or physiological indices of COPD. Factors that contribute to 'inadequate' assessment and treatment of depression in patients with COPD and asthma may include misconception of the disease by patients and their caregivers and stigma attached to depression. Thus, well-controlled randomized controlled trials are needed.
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Affiliation(s)
- M J Connolly
- Freemasons' Department of Geriatric Medicine, University of Auckland, New Zealand
| | - A M Yohannes
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom.
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Bloomfield K, Vethanayagam N, Spriggs D, Yohannes AM, Connolly MJ. 82FOLLOW-UP AND READMISSION RATES AFTER HOSPITAL ADMISSION FOR CHRONIC CONDITIONS: A MULTI-SITE PILOT OBSERVATIONAL STUDY. Age Ageing 2015. [DOI: 10.1093/ageing/afv116.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bloomfield K, Vethanayagam N, Spriggs D, Yohannes AM, Connolly MJ. 69FOLLOW-UP AND READMISSION RATES AFTER HOSPITAL ADMISSION FOR CHRONIC CONDITIONS: A MULTI-SITE PILOT OBSERVATIONAL STUDY. Age Ageing 2015. [DOI: 10.1093/ageing/afv114.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Connolly MJ, Broad JB, Boyd M, Kerse N, Foster S, Lumley T, Zhang X, Whitehead N. 64 * CLUSTER-RANDOMISED CONTROLLED TRIAL (RCT) OF A MULTIDISCIPLINARY INTERVENTION PACKAGE FOR REDUCING DISEASE-SPECIFIC HOSPITALISATIONS FROM LONG TERM CARE (LTC). Age Ageing 2014. [DOI: 10.1093/ageing/afu131.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Yohannes AM, Willgoss TG, Baldwin RC, Connolly MJ. Depression and anxiety in chronic heart failure and chronic obstructive pulmonary disease: prevalence, relevance, clinical implications and management principles. Int J Geriatr Psychiatry 2010; 25:1209-21. [PMID: 20033905 DOI: 10.1002/gps.2463] [Citation(s) in RCA: 287] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To review evidence regarding the prevalence, causation, clinical implications, aspects of healthcare utilisation and management of depression and anxiety in chronic heart failure and chronic obstructive pulmonary disease. DESIGN A critical review of the literature (1994-2009). FINDINGS The prevalence of depression and anxiety is high in both chronic obstructive pulmonary disease (8-80% depression; 6-74% anxiety) and chronic heart failure (10-60% depression; 11-45% anxiety). However, methodological weaknesses and the use of a wide range of diagnostic tools make it difficult to reach a consensus on rates of prevalence. Co-morbid depression and anxiety are associated with increased mortality and healthcare utilisation and impact upon functional disability and quality of life. Despite these negative consequences, the identification and management of co-morbid depression and anxiety in these two diseases is inadequate. There is some evidence for the positive role of pulmonary/cardiac rehabilitation and psychotherapy in the management of co-morbid depression and anxiety, however, this is insufficient to guide recommendations. CONCLUSIONS The high prevalence and associated increase in morbidity and mortality justifies future research regarding the management of anxiety and depression in both chronic heart failure and chronic obstructive pulmonary disease. Current evidence suggests that multi-faceted interventions such as pulmonary and cardiac rehabilitation may offer the best hope for improving outcomes for depression and anxiety.
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Affiliation(s)
- A M Yohannes
- Department of Health Professions, Manchester Metropolitan University, Elizabeth Gaskell Campus, Manchester, UK.
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Atkinson RA, Srinivas-Shankar U, Roberts SA, Connolly MJ, Adams JE, Oldham JA, Wu FCW, Seynnes OR, Stewart CEH, Maganaris CN, Narici MV. Effects of Testosterone on Skeletal Muscle Architecture in Intermediate-Frail and Frail Elderly Men. J Gerontol A Biol Sci Med Sci 2010; 65:1215-9. [DOI: 10.1093/gerona/glq118] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Beghé B, Hall IP, Parker SG, Moffatt MF, Wardlaw A, Connolly MJ, Fabbri LM, Ruse C, Sayers I. Polymorphisms in IL13 pathway genes in asthma and chronic obstructive pulmonary disease. Allergy 2010; 65:474-81. [PMID: 19796199 DOI: 10.1111/j.1398-9995.2009.02167.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) are chronic respiratory diseases involving an interaction between genetic and environmental factors. Interleukin-13 (IL13) has been suggested to have a role in both asthma and COPD. We investigated whether single nucleotide polymorphisms (SNPs) in the IL13 pathway may contribute to the susceptibility and severity of asthma and COPD in adults. METHODS Twelve SNPs in IL13 pathway genes -IL4, IL13, IL4RA, IL13RA1, IL13RA2 and STAT6- were genotyped in subjects with asthma (n = 299) and in subjects with COPD or healthy smokers (n = 992). Genetic association was evaluated using genotype and allele models for asthma severity, atopy phenotypes and COPD susceptibility. Linear regression was used to determine the effects of polymorphism on baseline lung function (FEV(1), FEV(1)/FVC). RESULTS In asthmatics, three IL13 SNPs - rs1881457(-1512), rs1800925(-1111) and rs20541(R130Q) - were associated with atopy risk. One SNP in IL4RA1 [rs1805010(I75V)] was associated with asthma severity, and several IL13 SNPs showed borderline significance. IL13 SNPs rs1881457(-1512) and rs1800925(-1111) were associated with better FEV(1) and FEV(1)/FVC in asthmatics. IL13 SNPs rs2066960(intron 1), rs20541(R130Q) and rs1295685(exon 4) were associated with COPD risk and lower baseline lung function in the recessive model. In females, but not in males, rs2250747 of the IL13RA1 gene was associated with COPD and lower FEV(1). CONCLUSION These data suggest that IL13 SNPs (promoter and coding region) and, to a lesser extent, IL4RA SNPs may contribute to atopy and asthma. We also provide tentative evidence that IL13 SNPs in the coding region may be of significance in COPD susceptibility.
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Affiliation(s)
- B Beghé
- Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Italy
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Firlej L, Kuchta B, Roth MW, Connolly MJ, Wexler C. Structural and phase properties of tetracosane (C24H50) monolayers adsorbed on graphite: an explicit hydrogen molecular dynamics study. Langmuir 2008; 24:12392-12397. [PMID: 18828622 DOI: 10.1021/la802071a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We discuss molecular dynamics (MD) computer simulations of a tetracosane (C24H50) monolayer physisorbed onto the basal plane of graphite. The adlayer molecules are simulated with explicit hydrogens, and the graphite substrate is represented as an all-atom structure having six graphene layers. The tetracosane dynamics modeled in the fully atomistic manner agree well with experiment. The low-temperature ordered solid organizes into a rectangularly centered structure that is not commensurate with underlying graphite. Above T=200 K, as the molecules start to lose their translational and orientational order via gauche defect formation a weak smectic mesophase (observed experimentally but never reproduced in united atom (UA) simulations) appears. The phase behavior of the adsorbed layer is critically sensitive to the way the electrostatic interactions are included in the model. If the electrostatic charges are set to zero (as for a UA force field), then the melting temperature increases by approximately 70 K with respect to the experimental value. When the nonbonded 1-4 interaction is not scaled, the melting temperature decreases by approximately 90 K. If the scaling factor is set to 0.5, then melting occurs at T=350 K, in very good agreement with experimental data.
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Affiliation(s)
- L Firlej
- LCVN, Université Montpellier 2, 34095 Montpellier, France
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Yohannes AM, Baldwin RC, Connolly MJ. Prevalence of depression and anxiety symptoms in elderly patients admitted in post-acute intermediate care. Int J Geriatr Psychiatry 2008; 23:1141-7. [PMID: 18457336 DOI: 10.1002/gps.2041] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Depression and anxiety symptoms are common in medically ill older patients. We investigated the prevalence and predictors of depression and anxiety symptoms in older patients admitted for further rehabilitation in post acute intermediate care. DESIGN Observational cohort study. SETTING An intermediate care unit, North West of England. PARTICIPANTS One hundred and seventy-three older patients (60 male), aged mean (SD) 80 (8.1) years, referred for further rehabilitation to intermediate care. MEASUREMENTS Depression and anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale, and severity of depression examined by the Montgomery Asberg Depression Rating Scale. Physical disability was assessed by the Nottingham Extended ADL Scale and quality of life by the SF-36. RESULTS Sixty-five patients (38%) were identified with depressive symptoms, 29 (17%) with clinical depression, 73 (43%) with anxiety symptoms, and 43 (25%) with clinical anxiety. 15 (35%) of the latter did not have elevated depression scores (9% of the sample). Of those with clinical depression, 14 (48%) were mildly depressed and 15 (52%) moderately depressed. Longer stay in the unit was predicted by severity of depression, physical disability, low cognition and living alone (total adjusted R2 = 0.24). CONCLUSIONS Clinical depression and anxiety are common in older patients admitted in intermediate care. Anxiety is often but not invariably secondary to depression and both should be screened for. Depression is an important modifiable factor affecting length of stay. The benefits of structured management programmes for anxiety and depression in patients admitted in intermediate care are worthy of evaluation.
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Affiliation(s)
- A M Yohannes
- Department of Physiotherapy, Manchester Metropolitan University, Elizabeth Gaskell Campus, Manchester, UK.
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Abstract
OBJECTIVE To examine health behaviour, severity of depression, gender differences and religiosity in older patients admitted to intermediate care for further rehabilitation. DESIGN Cross-sectional survey. PARTICIPANTS A research physiotherapist interviewed 173 older patients (113 female), 60 and older consecutively admitted to intermediate care for rehabilitation, usually after acute care. MEASUREMENTS Religiosity was measured using the Duke University Religion Index, depressive and anxiety symptoms using the Hospital Anxiety Depression Scale, and severity of depression measured by the Montgomery Asberg Depression Rating Scale. Physical disability was assessed by the Nottingham Extended Activities of Daily Living Scale and quality of life measured by the SF-36 questionnaire. RESULTS After controlling for other factors using multiple regression, religious attendance was associated with positive general health perception (t = 1.9, p = 0.05), and inversely associated with number of pack years smoked (t = -2.05, p = 0.04) and severity of illness (Charlson Index), [t = -2.05, p = 0.04]. Intrinsic religious activity was associated with older age (t = 3.06, p < 0.003), female gender (t = 2.52, p = 0. 01), living situation (t = -2.17, p < 0.03) and with less severe depression (t = -2.43, p = 0.01). CONCLUSION In older patients with chronic diseases in intermediate care, religious attendance was associated with positive perceptions of health, less severe illness, and fewer pack years. Intrinsic religious activities were associated with less severe depression and lower likelihood of living alone.
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Affiliation(s)
- A M Yohannes
- Department of Physiotherapy, Manchester Metropolitan University, Elizabeth Gaskell Campus, Manchester, UK.
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Connolly MJ, Roth MW, Gray PA, Wexler C. Explicit hydrogen molecular dynamics simulations of hexane deposited onto graphite at various coverages. Langmuir 2008; 24:3228-3234. [PMID: 18324844 DOI: 10.1021/la703040a] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We present results of molecular dynamics (MD) computer simulations of hexane (C6H14) adlayers physisorbed onto a graphite substrate for coverages in the range 0.5 < or = rho < or = 1 monolayers. The hexane molecules are simulated with explicit hydrogens, and the graphite substrate is modeled as an all-atom structure having six graphene layers. At coverages above about rho congruent with 0.9 the low-temperature herringbone solid loses its orientational order at T(1) = 140 +/- 3 K. At rho = 0.878, the system presents vacancy patches and T(1) decreases to ca. 100 K. As coverage decreases further, the vacancy patches become larger and by rho = 0.614 the solid is a connected network of randomly oriented islands and there is no global herringbone order-disorder transition. In all cases we observe a weak nematic mespohase. The melting temperature for our explicit-hydrogen model is T(2) = 160 +/- 3 K and falls to ca. 145 K by rho = 0.614 (somewhat lower than seen in experiment). The dynamics seen in the fully atomistic model agree well with experiment, as the molecules remain overall flat on the substrate in the solid phase and do not show anomalous tilting behavior at any phase transition observed in earlier simulations in the unified atom (UA) approximation. Energetics and structural parameters also are more reasonable and, collectively, the results from the simulations in this work demonstrate that the explicit-hydrogen model of hexane is substantially more realistic than the UA approximation.
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Affiliation(s)
- M J Connolly
- University of Northern Iowa, Department of Physics, Cedar Falls, Iowa 50614, USA
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Connolly MJ, Lowe D, Anstey K, Hosker HSR, Pearson MG, Roberts CM. Admissions to hospital with exacerbations of chronic obstructive pulmonary disease: Effect of age related factors and service organisation. Thorax 2006; 61:843-8. [PMID: 16928716 PMCID: PMC2104767 DOI: 10.1136/thx.2005.054924] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Exacerbations of chronic obstructive pulmonary disease (COPD) have a high rate of mortality which gets worse with advancing age. It is unknown whether this is due to age related deficiencies in process of care. A study was undertaken in patients with COPD exacerbations admitted to UK hospitals to assess whether there were age related differences in the process of care that might affect outcome, and whether different models of care affected process and outcome. METHODS 247 hospital units audited activity and outcomes (inpatient death, death within 90 days, length of stay (LOS), readmission within 90 days) for 40 consecutive COPD exacerbation admissions in autumn 2003. Logistic regression methods were used to assess relationships between process and outcome at p < 0.001. RESULTS 7514 patients (36% aged > or = 75 years) were included. Patients aged > or = 75 years were less likely to have blood gases documented, to have FEV1 recorded, or to be given systemic corticosteroids. Those admitted under care of the elderly (CoE) physicians were less likely to enter early discharge schemes or to receive non-invasive ventilation when acidotic. Overall inpatient and 90 day mortality was 7.4% and 15.3%, respectively. Inpatient and 90 day adjusted odds mortality rates for those aged > or = 85 years (versus < or = 65 years) were 3.25 and 2.54, respectively. Mortality was unaffected by admitting physician (CoE v general v respiratory). Age predicted LOS but not readmission. Age related deficiencies in process of care did not predict inpatient or 90 day mortality, readmission, or LOS. CONCLUSIONS Management of COPD exacerbations varies with age in UK hospitals. Inpatient and 90 day mortality is approximately three times higher in very elderly patients with a COPD exacerbation than in younger patients. Age related deficiencies in the process of care were not associated with mortality, but it is likely that they represent poorer quality of care and patient experience. Recommended standards of care should be applied equally to elderly patients with an exacerbation of COPD.
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Yohannes AM, Connolly MJ. Effect of dichotomising age in multivariate model analysis. Thorax 2006; 61:548; author reply 548-9. [PMID: 16738050 PMCID: PMC2111223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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Jacobson KL, Connolly MJ, Chen AY, Johnstone PAS. Health literacy and quality of life in an inner city laryngectomy population. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.8191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- K. L. Jacobson
- Rollins Sch of Public Health, Emory Univ, Atlanta, GA; Emory Univ Sch of Medicine, Atlanta, GA
| | - M. J. Connolly
- Rollins Sch of Public Health, Emory Univ, Atlanta, GA; Emory Univ Sch of Medicine, Atlanta, GA
| | - A. Y. Chen
- Rollins Sch of Public Health, Emory Univ, Atlanta, GA; Emory Univ Sch of Medicine, Atlanta, GA
| | - P. A. S. Johnstone
- Rollins Sch of Public Health, Emory Univ, Atlanta, GA; Emory Univ Sch of Medicine, Atlanta, GA
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Yohannes AM, Connolly MJ, Baldwin RC. A feasibility study of antidepressant drug therapy in depressed elderly patients with chronic obstructive pulmonary disease. Int J Geriatr Psychiatry 2001; 16:451-4. [PMID: 11376459 DOI: 10.1002/gps.461] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To examine the acceptability of fluoxetine in elderly depressed patients with chronic obstructive pulmonary disease (COPD). SETTING A university teaching hospital. METHOD Single-blinded (open) study. One hundred and thirty-seven outpatients (69 male) with symptomatic irreversible, moderate to severe COPD were recruited. Major depression was diagnosed using the Geriatric Mental State Schedule. Quality of life was assessed by the Breathing Problems Questionnaire, physical disability by the Manchester Respiratory Activities of Daily Living Questionnaire and severity of depression using the Montgomery Asberg Depression Rating Scale. Exclusion criteria were: use of oral steroids within 6 weeks, acute or chronic confusion, known cancer and known psychosis. RESULTS Fifty-seven patients (42%) (25 males) with a mean age of 72 years (range 60-89 years) were depressed. Fourteen (six male) agreed to undergo therapy with fluoxetine 20 mg/day for 6 months, while 36 (72%) refused antidepressant drug therapy. Only seven subjects completed the trial; of these, four (57%) responded to fluoxetine therapy. Five subjects withdrew because of side-effects. Twenty-two of those who refused treatment (61%) agreed to be interviewed, and of these 19 (86%) were still depressed. CONCLUSION Patient acceptance of fluoxetine was poor. The reasons for refusing treatment varied but were largely due to misapprehension by the patient. Untreated depression became chronic. Offering antidepressants to COPD patients with depression is not an effective strategy. Why this might be so is discussed.
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Affiliation(s)
- A M Yohannes
- Lecturer, Manchester School of Physiotherapy, Manchester Royal Infirmary, Manchester, UK.
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Yohannes AM, Baldwin RC, Connolly MJ. Depression and anxiety in elderly outpatients with chronic obstructive pulmonary disease: prevalence, and validation of the BASDEC screening questionnaire. Int J Geriatr Psychiatry 2000; 15:1090-6. [PMID: 11180464 DOI: 10.1002/1099-1166(200012)15:12<1090::aid-gps249>3.0.co;2-l] [Citation(s) in RCA: 196] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Depressive and anxiety symptoms are common in elderly patients with chronic obstructive pulmonary disease (COPD). However, true prevalence of clinical depression and anxiety is uncertain. We thus aimed to assess prevalence of clinical depression and/or anxiety in elderly COPD patients using the Geriatric Mental State Schedule (GMS) and determine severity of clinical depression by the Montgomery Asberg Depression Rating Scale (MADRS). We also aimed to validate the Brief Assessment Schedule Depression Cards (BASDEC) screening test for depressive symptoms against GMS. SETTING A university teaching hospital. PARTICIPANTS Subjects comprised 137 (69 men) outpatients with COPD, aged 60 - 89 (mean 73) years. Exclusion criteria were acute respiratory exacerbation or use of oral corticosteroid within 6 weeks, known psychosis, acute or chronic confusion. MEASUREMENTS A GMS score > or =3 is diagnostic of clinical depression, and a BASDEC score > or =7 is classed as "case". GMS was taken as gold standard. Severity of depression was assessed by the MADRS: RESULTS Mean (SD) one second forced expiratory volume was 0.89 (0.3) litres. Sixty-two subjects (46%) scored as a "case" on BASDEC and 57 subjects (42%) were identified as clinically depressed on GMS. In the depressed the prevalence of anxiety was 37% and in the non-depressed 5%. BASDEC performed well against GMS, having a sensitivity of 100%; a specificity of 93%; a positive predictive value of 91% and a negative predictive value of 100%. Assessment of severity of depression by MADRS showed that 17 subjects (30%) were mildly depressed, 39 (68%) were moderately depressed and one (2%) was severely depressed. CONCLUSION Clinical depression and anxiety are common in elderly patients with COPD, though clinical anxiety seems mainly confined to those who also suffer clinical depression. Of those depressed, two-thirds scored in the moderately depressed range. BASDEC is a valid screening tool in this patient group.
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Affiliation(s)
- A M Yohannes
- Department of Geriatric Medicine, The Manchester School of Physiotherapy and Department of Old Age Psychiatry, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
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Yohannes AM, Roomi J, Winn S, Connolly MJ. The Manchester Respiratory Activities of Daily Living questionnaire: development, reliability, validity, and responsiveness to pulmonary rehabilitation. J Am Geriatr Soc 2000; 48:1496-500. [PMID: 11083331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVES Because there is no respiratory-specific activities of daily living (ADL) scale for use in older patients, our aim was to design and develop the Manchester Respiratory ADL questionnaire (MRADL) and to assess its validity in older patients with chronic obstructive pulmonary disease (COPD). DESIGN The MRADL is a composite of the most discriminative questions from the Nottingham Extended ADL Questionnaire (NEADL) and the Breathing Problems Questionnaire (BPQ). SETTING A University teaching hospital. PARTICIPANTS Participants were 188 (104 men) COPD out-patients aged 60 to 93 (mean 77) years and 55 (23 men) normal controls (NCs) aged 70 to 90 (mean 78) years. Exclusions were confusion and acute respiratory exacerbation/use of oral corticosteroid within 6 weeks. INTERVENTION A subgroup of COPD subjects completed a pulmonary rehabilitation program (PR) to assess responsiveness of the MRADL to intervention. MEASUREMENTS All subjects completed MRADL and NEADL scales, and 15 COPD subjects (11 men) completed an 8-week PR program. RESULTS Mean (SE) 1-second forced expiratory volume (FEV1) in COPD subjects was 0.94 (0.03) liters, and in NCs it was 1.96 (0.07) liters. MRADL discriminated better between COPDs and NCs than did the NEADL in terms of sensitivity (90% vs 76%; X2 = 4.8, P = .02) and negative predictive value (84% vs 69%; X2 = 4.5, P = .03). MRADL responded to changes during PR: pre versus post mean (SE) score 11.2 (1.1) vs 13.4 (1.1); (t = 3.09; P = .008), but NEADL was unchanged. MRADL showed high consistency (Cronbach alpha 0.91). 95% confidence limits of repeatability were -0.63 to +0.26 (P = .42) for MRADL and -0.53 to +0.26 (P = .50) for NEADL. CONCLUSIONS MRADL is a reliable and valid self-report scale for assessment of physical disability in older COPD patients. It is responsive to pulmonary rehabilitation.
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Affiliation(s)
- A M Yohannes
- Department of Geriatric Medicine, The Manchester School of Physiotherapy, Manchester Royal Infirmary, UK
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Smith HA, Lee SH, O'Neill PA, Connolly MJ. The combination of bedside swallowing assessment and oxygen saturation monitoring of swallowing in acute stroke: a safe and humane screening tool. Age Ageing 2000; 29:495-9. [PMID: 11191240 DOI: 10.1093/ageing/29.6.495] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND dysphagia is common in acute stroke. Accurate detection of the presence or absence of aspiration by bedside swallowing assessment is difficult without objective methods, tending to over-diagnose aspiration. As a result, some patients suffer restricted oral intake unnecessarily. OBJECTIVE we examined the predictive values of pulse oximetry and speech and language therapy bedside swallowing assessment in the detection of aspiration compared with videofluoroscopy. DESIGN a double-blind observational study. SETTING two university teaching hospitals. SUBJECTS we studied 53 patients whose acute strokes were confirmed by computed tomography scan. METHODS Each subject had initial standard bedside swallowing assessment, closely followed by simultaneous and mutually blinded pulse oximetry, swallowing assessment and videofluoroscopy. RESULTS 15 of 53 subjects aspirated. Bedside swallowing assessment and saturation assessment at > or = 2% desaturation gave good sensitivity (80% and 87% respectively), but low positive predictive values (50% and 36% respectively). Both assessments mistook laryngeal penetration for aspiration. Re-analysis with aspiration +/- penetration as a new endpoint improved bedside swallowing assessment positive predictive values to 83% (chi2 =3.59, P=0.032). Sensitivity of saturation assessment was maintained at 86%, positive predictive values of saturation assessment improved to 69% (chi2=6.74, P=0.009). The combination of bedside swallowing assessment and saturation assessment versus aspiration + penetration gave a positive predictive value of 95%. CONCLUSIONS screening by saturation assessments detects 86% of aspirators/penetrators and should be followed immediately by bedside swallowing assessment, as the combination of the two assessments gives the best positive predictive value. For patients with acute stroke, we advocate a 10 ml water-swallow screening test with simultaneous pulse oximetry by suitably trained medical and nursing staff. Use of this screening test would improve dysphagia detection whilst minimizing unnecessary restriction of oral intake in stroke patients.
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Affiliation(s)
- H A Smith
- Department of Speech and Language Therapy, Manchester Royal Infirmary, UK
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Affiliation(s)
- M J Connolly
- Platt Rehabilitation Unit 2, Manchester Royal Infirmary, UK
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Thornton A, Yohannes AM, Baldwin RC, Connolly MJ. Chronic obstructive pulmonary disease and depression: analysis of depressive symptoms. Age Ageing 2000; 29:286-7. [PMID: 10855916 DOI: 10.1093/ageing/29.3.286b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chatterton HJ, Pomeroy VM, Connolly MJ, Faragher EB, Clayton L, Tallis RC. The effect of body position on arterial oxygen saturation in acute stroke. J Gerontol A Biol Sci Med Sci 2000; 55:M239-44. [PMID: 10811154 DOI: 10.1093/gerona/55.4.m239] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Evidence suggests that respiratory function is impaired poststroke. Body position is known to influence respiratory function in normal subjects and those with respiratory pathologies. Its effect on respiratory function after stroke has received little attention. However, one study suggests that some positions used in clinical practice may adversely influence respiratory function. This study therefore aimed to identify resting positions that maintain arterial oxygen saturation (SaO2) at optimal levels, changes in SaO2 during time spent in the test position, and differences in SaO2 among the positions investigated. METHOD A within-subject, two-center clinical study was made. Patients in the first 72 hours following mild to moderately severe stroke were allocated a randomized sequence of four positions. One hour was spent in each position. SaO2 was recorded each minute by pulse oximetry with a finger probe. Mean values for the hour were calculated. RESULTS Mean arterial oxygen saturation values for all patients were >90% for the hour spent in each test position for all patients. There were no changes in arterial oxygen saturation across the hour spent in the test positions (repeated-measures analysis of variance). No differences in arterial oxygen saturation were identified among positions (analysis of covariance). DISCUSSION The saturation levels recorded corresponded to those observed in studies of normal elderly persons. The positions tested may be recommended for use in clinical practice to maintain arterial oxygen saturation in patients in the first 72 hours following mild to moderately severe stroke.
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Affiliation(s)
- H J Chatterton
- The Stroke Association's Therapy Research Unit, Hope Hospital, Salford, UK.
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Loring SH, Leith DE, Connolly MJ, Ingenito EP, Mentzer SJ, Reilly JJ. Model of functional restriction in chronic obstructive pulmonary disease, transplantation, and lung reduction surgery. Am J Respir Crit Care Med 1999; 160:821-8. [PMID: 10471603 DOI: 10.1164/ajrccm.160.3.9808011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Mechanical interactions between lung and chest wall are important determinants of respiratory function. When chest wall expansion during maximal inhalation generates insufficiently negative pleural pressures, the lungs remain functionally underinflated; this may be termed functional restriction. To explore mechanisms and effects of functional restriction in patients with emphysema, and to predict effects of single lung transplantation and lung volume reduction surgery (LVRS), we used a computational model based on standard physiology and measurements from individual patients. The model's lungs, separated by a compliant mediastinum, exhibit flow limitation according to the equal pressure point approach of Mead and coworkers. Pulmonary elastic recoil pressure is characterized by an exponential equation modified to reflect airway closure. Simulated respiratory maneuvers can be specified by variations in flow or pressure at the airway opening or in respiratory muscle activation. Model simulations successfully mimic recordings from individual patients. Input parameter values may then be altered to predict effects of surgical interventions in these same patients. The model simulations show the following. Single lung transplantation in emphysema can cause functional restriction of the normal transplanted lungs, and larger transplanted lungs may perform less well than smaller ones. LVRS improves lung and chest wall function in emphysema, but not in normal states. Surgical reduction of the native emphysematous lung after single lung transplantation can reduce functional restriction of the transplant and thereby improve its function.
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Affiliation(s)
- S H Loring
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Division of Pulmonary Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Abstract
OBJECTIVES Increased bronchial responsiveness is a feature of symptomatic asthma, and it predicts the onset of wheezing. We have investigated the relationship between bronchial responsiveness and age in a population sample with an age range of 45 to 86 years. DESIGN Cross-sectional population survey. SETTING Population of Central Manchester, UK. PARTICIPANTS An age-stratified random sample of white adults aged > or = 45 years old and living in Central Manchester. They were recruited from their primary care physician (general practitioner) lists. Patients with confusion and patients who were housebound were excluded. MEASUREMENTS Respondents to a mail questionnaire were invited to attend a methacholine bronchial challenge performed using the Newcastle dosimeter method. Respondents with ischemic heart disease or respondents taking oral steroids, beta-blockers, or anticholinergic medication were excluded. RESULTS Of the 783 subjects contacted, 92.3% of the subjects responded, and 508 subjects returned enough information for us to deduce their suitability for the bronchial challenge. Of the 395 suitable subjects, 247 subjects participated (62.5% of those invited; 31.5% of the study population), and 208 participants completed the bronchial challenge. Participants were slightly younger than nonparticipants, but they were otherwise representative of the population. Increased bronchial responsiveness (provocative dose of methacholine causing a 20% fall in FEV1 < or = 200 microg) was present in 71 (34.1%) participants. Stepwise multiple regression analysis showed weak, independent, positive associations between bronchial responsiveness and age, and between bronchial responsiveness and the total immunoglobulin E level. There was an independent negative relationship between bronchial responsiveness and the airways caliber (expressed as standardized residuals; R2 = 0.29). CONCLUSIONS We have found a high prevalence of increased bronchial responsiveness in this inner-city population of older adults. Bronchial responsiveness showed a weak independent positive association with age.
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Affiliation(s)
- D S Renwick
- University Department of Medicine for the Elderly, Barnes Hospital, Manchester, UK
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Renwick DS, Connolly MJ. Do respiratory symptoms predict chronic airflow obstruction and bronchial hyperresponsiveness in older adults? J Gerontol A Biol Sci Med Sci 1999; 54:M136-9. [PMID: 10191841 DOI: 10.1093/gerona/54.3.m136] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Respiratory symptoms are common in older adults. In young populations the predictive value of such symptoms for chronic airflow obstruction and bronchial hyperresponsiveness is low. We investigated whether symptoms predict airflow obstruction and bronchial responsiveness in adults aged 45-86 years. METHODS An age-stratified random sample of white adults aged 45 years and older was obtained from family doctor lists in Central Manchester, UK, and sent a respiratory symptoms questionnaire (exclusions: housebound, confused). Responders were invited to participate in a methacholine challenge (Newcastle dosimeter method; exclusions: ischemic heart disease, oral steroids, anticholinergic or beta-blocker medication). RESULTS Of 783 eligible subjects, 723 responded (response rate 92.3%). Symptoms were reported by 53.8%. Methacholine challenge was completed by 208 subjects. Sixty-five (26.4%) had chronic airflow obstruction, of whom 76.6% reported respiratory symptoms. Bronchial hyperresponsiveness (PD20 < or = 100 micrograms) was present in 26.0% of subjects overall, and in 36.8% of symptomatic and 14.6% of asymptomatic subjects (p < .001). Of those with bronchial hyperresponsiveness, 26.4% were asymptomatic. Predictive values of symptoms for chronic airflow obstruction and bronchial hyperresponsiveness were low. CONCLUSIONS Respiratory symptoms, chronic airflow obstruction, and bronchial hyperresponsiveness were all common in this adult population sample. However, the predictive value of symptoms for airflow obstruction/bronchial hyperresponsiveness was low. It was concluded that respiratory symptoms do not identify adults with airflow obstruction or bronchial hyperresponsiveness. Investigation by spirometry and peak flow monitoring is necessary to guide appropriate management.
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Affiliation(s)
- D S Renwick
- University Department of Medicine for the Elderly, Barnes Hospital, Manchester, UK
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Abstract
The roles of the carotid arterial baroreceptor reflex and of vagally mediated mechanisms during positive end-expiratory pressure (PEEP) were determined in pentobarbital-anesthetized dogs with isolated carotid sinuses. Spontaneously breathing dogs were placed on PEEP (5-10 cmH2O) with the carotid sinus pressure set to the systemic arterial pressure (with feedback) or to a constant pressure (no feedback). Right atrial volume was measured with a conductance catheter. With carotid baroreceptor feedback before bilateral cervical vagotomy, total peripheral resistance increased (P < 0.01) and mean arterial pressure decreased (-9.8 +/- 4.3 mmHg) in response to PEEP. With no feedback after vagotomy, mean arterial pressure decreased to a greater extent (-45 +/- 6 mmHg, P < 0.01), and total peripheral resistance decreased (P < 0.05) in response to PEEP. In contrast, cardiac index decreased similarly during PEEP (P < 0.01) for all baroreceptor and vagal inputs. This response comprised a decrease in the passive phase of right ventricular filling (P < 0. 01) that was not matched by the estimated increase in active right atrial output. Although the carotid baroreceptor reflex and vagally mediated mechanisms elicit vasoconstriction to compensate for the effects of PEEP on the arterial pressure, these processes fail to defend cardiac output because of the profound effect of PEEP on the passive filling of the right ventricle.
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Affiliation(s)
- S S Blevins
- American University of the Caribbean School of Medicine, Cupecoy, St. Maarten, Netherland Antilles
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Abstract
Although often regarded as a disease of childhood, asthma is common in elderly people. Although recent figures show a decline over the past few years in the number of asthma deaths in children and younger adults, the same is not true of older adults, in whom most asthma deaths occur. Differences between asthma in young and old patients are seen not only in response to treatment. The nonspecific presentation of asthma in elderly adults means that the diagnosis of asthma is difficult to make. In addition, research suggests that physicians are reluctant to use spirometry and measurement of reversibility when investigating respiratory symptoms in old people. This leads to a tendency to label breathless or wheezy elderly patients as having chronic obstructive pulmonary disease (COPD) rather than asthma. In turn, patients with a diagnosis of COPD are less likely to be treated with bronchodilators and corticosteroids. Treatment guidelines for the management of asthma in children and younger adults may need to be adapted when applied to older patients. Reduced perception of bronchoconstriction may lead to underuse of bronchodilators prescribed 'as required'. The bronchodilator response to beta2-agonists is attenuated as part of the normal aging process, and other groups of bronchodilator medications should be considered. Inhaler technique can be a particular problem in elderly patients with asthma, requiring careful choice of inhaler device. However, the frequent presence of multiple pathology and multiple medication in this age group enhances the risk of adverse effects from oral preparations, and so the inhaled route should be preferred wherever possible. Underestimation of the severity of an acute exacerbation of asthma by both patient and doctor has been suggested as a contributory factor to poor outcome in older people. Since the cardiovascular responses to hypoxia and bronchoconstriction tend to diminish with increasing age, objective measures of asthma severity (peak flow monitoring and blood gas estimation) are essential in this age group.
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Affiliation(s)
- D S Renwick
- Department of Geriatric Medicine, Cornwall Healthcare Trust, Camborne/Redruth Community Hospital, Redruth, England
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Roomi J, Yohannes AM, Connolly MJ. The effect of walking aids on exercise capacity and oxygenation in elderly patients with chronic obstructive pulmonary disease. Age Ageing 1998; 27:703-6. [PMID: 10408664 DOI: 10.1093/ageing/27.6.703] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND high walking frames may improve exercise capacity in young patients with chronic obstructive pulmonary disease (COPD). We have assessed the effect of Zimmer, rollator and gutter frames on 6-min walking distance and on arterial oxygenation during exercise in elderly patients with COPD. METHODS 27 out-patients (15 men) aged 70-82 (mean 75) years were recruited. Exclusions comprised: COPD exacerbation or oral steroid use within 6 weeks, confusional state, participation in a pulmonary rehabilitation programme and exercise limitation by other diseases. Subjects completed 6-min walk tests unaided and with the three frames on four separate days in random order 30 min after nebulized salbutamol (5 mg) and ipratropium (0.5 mg) and were accompanied by an investigator blinded to results of all other walk tests undertaken. Oxygen saturation (SaO2) was monitored by finger probe during exercise. Grouped t-tests were used to compare distances and reductions in SaO2. RESULTS Unaided, the mean (SEM) 6-min walk distance was 210 (16) m and fall in oxygen saturation was 6.0 (1.1)%. Use of a rollator frame did not significantly affect either of these values. Using the Zimmer frame reduced the mean distance to 165 (13) m (t=5.2, P < 0.001 vs unaided walk) with an SaO2 fall similar to that recorded during the unaided walk. Using the gutter frame increased the mean distance to 234 (150) m (t=3. 1, P=0.004 vs unaided walk) and reduced the fall in SaO2 to 3.7 (0.8)% (t=2.3, P=0.03 vs unaided walk). CONCLUSIONS gutter frames improve exercise capacity and SaO2 during exercise in elderly COPD patients who remain symptomatic on optimal therapy, whereas unwheeled Zimmer frames have a deleterious effect in such patients.
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Affiliation(s)
- J Roomi
- Department of Medicine, Bolton Royal Infirmary, UK
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Abstract
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity in old age. It leads to reduced quality of life (QoL), but the factors that contribute to this are less understood. There is no consensus on measurement of QoL in elderly COPD patients. We assessed (a) factors predicting QoL in elderly COPD out-patients and (b) specificity (SP), sensitivity (SEN), positive and negative predictive values (PPV and NPV) and repeatability of two disease-specific QoL instruments, the Chronic Respiratory Disease Questionnaire (CRQ) and the Breathing Problems Questionnaire (BPQ) in elderly people. All subjects also completed an ADL measure [Nottingham Extended ADL (NEADL)] and a measure of psychological well-being [Brief Assessment of Depression Cards (BASDEC)] as well as a 6-min walk test. Subjects comprised 96 (56 men) elderly out-patients with irreversible COPD aged 70-93 years (mean 78) who were clinically stable for > or = 6 weeks. Controls were 55 (23 men) aged 71-90 years (mean 78) with normal lung function. All were cognitively intact. Mean FEV1/FVC in COPD subjects was 45.5 (SE = 1.4)% and for controls was 71.4 (SE = 1.3)%. Repeatability was good for both BPQ and CRQ with no significant difference. There were no significant differences in specificity and positive predictive values between the two questionnaires but BPQ performed better than CRQ with regard to sensitivity (P = 0.02) and NPV (P < 0.001). A multiple regression analysis was used to identify variables that best predicted BPQ and CRQ in COPD subjects. For BPQ predictive values were NEADL (P < 0.0001); BASDEC (P < 0.0001); age (P < 0.0001); 6-min walk distance (P = 0.001); body mass index (P < 0.05); resting oxygen saturation (P < 0.05); and household composition (living alone or with relatives, P = 0.05). In contrast only the following predicted CRQ: NEADL, BASDEC and resting oxygen saturation. Sixteen per cent of the variance in BPQ was accounted for by NEADL score, 9% by BASDEC, 4% by age and 3% by 6-min walk distance (total r2 = 0.70). It was concluded that: (1) BPQ provides more valid assessment than CRQ of QoL in elderly COPD subjects; (2) severity of disease in terms of its impact on QoL is not predicted by lung function tests; (3) the most important determinants of QoL are ADL score and emotional status.
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Affiliation(s)
- A M Yohannes
- Department of Geriatric Medicine, University of Manchester, Barnes Hospital, Cheadle, U.K
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Abstract
BACKGROUND We compared uptake of hospital and community-based support in elderly people disabled by chronic obstructive pulmonary disease (COPD), normal controls (NCs) and patients with Parkinsons disease, stroke, amputation, or arthritis (disabled controls; DCs). METHODS There were 65 subjects (35 men) aged 70-93 years (mean 78) with COPD, 55 NCs [23 men; age range 71-90 years (mean 78)] and 53 DCs [27 men; age range 70-92 years (mean 78)]. Patients with COPD and DCs were outpatients with Nottingham extended activities of daily living (NEADL) score < 16. NCs came from a community survey. Subjects with COPD were clinically stable. All were cognitively intact. RESULTS Mean NEADL scores (and range) were: 10.2 (3-15) for patients with COPD, 9.4 (3-15) for DCs (t=1.14, P=0.26) and 19.0 (11-21) for NCs. There was no difference in meals-on-wheels, district nurse or hospital or physiotherapy provision between patients with COPD and NCs, but those with COPD received more home care (P < 0.01). DCs received more home care (P=0.04), more district nurse input (P < 0.001) and more physiotherapy (P < 0.0001) than those with COPD. CONCLUSIONS Despite moderate or severe disability, elderly patients with COPD receive little statutory domiciliary support. Reasons for this need further exploration.
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Affiliation(s)
- A M Yohannes
- Department of Geriatric Medicine, University of Manchester, Barnes Hospital, Cheadle, Cheshire, UK
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Abstract
INTRODUCTION Depression is common in both young adults and elderly people with chronic obstructive pulmonary disease (COPD). METHODS We compared the prevalence of depressive symptomatology in elderly outpatients with stable disabling COPD with that in healthy controls and age-matched patients with other disabilities, and also assessed the relation between degree of disability, quality of life and depressive symptoms. The subjects were 96 older people with COPD [56 men; aged 70-93 (mean 78) years], 55 normal controls [23 men; aged 70-90 (mean 78) years] and 53 disabled controls [27 men; aged 70-92 (mean 78) years]. Exclusion criteria were acute respiratory exacerbation or use of oral steroids in the last 6 weeks, known previous psychiatric disorder and acute or chronic confusion. RESULTS Mean (and SD) values for 1-s forced expiratory volume (FEV1) were 51 (20) % in COPD subjects, 107 (24) % in normal controls and 82 (13)% in disabled controls. Forty-four subjects with COPD (46%), six normal controls (11%) and 14 disabled controls (26%) scored in the 'caseness' range for depressive ideation on the Brief Assessment Schedule Depression Cards (BASDEC) screening questionnaire. A multiple regression analysis was performed for the COPD group to identify factors predictive of BASDEC score. Predictive variables were total quality of life score [P<0.0001], Chronic Respiratory Questionnaire and level of activities of daily living (Nottingham extended activities of daily living scale) [P = 0.001]. Spirometry results and exercise tolerance (6-min walk distance) did not help predict BASDEC score (R2 = 0.50). CONCLUSIONS Depressive symptoms are common in elderly patients with COPD; prevalence and/or severity of depressive symptoms may be greater in those who are most disabled.
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Affiliation(s)
- A M Yohannes
- Department of Geriatric Medicine and Psychiatry for the Elderly, Manchester Royal Infirmary, Oxford Road, Manchester, UK
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Abstract
BACKGROUND the relationships between atopy and chronic airflow obstruction and bronchial hyperresponsiveness in adults are unclear. We measured airways calibre (FEV1), bronchial responsiveness, eosinophil count and total serum IgE in a random population sample of adults aged 45 years or older. METHODS Caucasian adults (n = 783) were selected from the practice lists of local general practitioners using random number tables. Responders to a postal questionnaire were invited to attend for venous blood sampling and methacholine challenge (Newcastle dosimeter method). FINDINGS the questionnaire response rate was 92.3% (723 subjects); 62.5% of subjects invited to attend did so. Attenders were slightly younger than the whole study population, but otherwise representative. Methacholine challenge was completed by 208 subjects. Geometric mean IgE level was higher in current smokers; both IgE and eosinophils were raised in subjects reporting asthma. Multiple regression showed a negative independent relationship between age- and sex-standardized eosinophils and baseline FEV1 and a positive relationship between standardized IgE score and level of bronchial responsiveness. Separate analysis of subjects aged <65 and > or =65 years showed that these relationships were only significant in older subjects. INTERPRETATION airways calibre and level of bronchial responsiveness are associated with measures of atopy in older adults. Atopy should not be overlooked as a factor in elderly patients with asthma or chronic airflow obstruction.
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Affiliation(s)
- D S Renwick
- University of Manchester Department of Geriatric Medicine, Barnes Hospital, Cheadle, Cheshire, UK
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Yohannes AM, Roomi J, Connolly MJ. Predictors of Functional Disability in Elderly Patients with Chronic Obstructive Pulmonary Disease. Physiotherapy 1997. [DOI: 10.1016/s0031-9406(05)65764-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Bronchial challenge with methacholine or histamine is associated with a reduction in arterial oxygen tension, which can be appreciable. In this study, oxygen saturation was monitored during methacholine challenge in subjects with and without respiratory disease, over a wide age range, in order to identify factors predicting a large fall in saturation during the challenge. Two hundred and twenty subjects aged 24-86 years were included, comprising 15 healthy adult volunteers, and 205 adults from a random sample of the local adult population taking part in a survey of bronchial responsiveness. Subjects with ischaemic heart disease or baseline FEV1 < 60% predicted were excluded. Methacholine challenge was performed by the Newcastle Dosimeter technique; oxygen saturation (SaO2) was monitored using a pulse oximeter and finger probe. Of the 220 subjects, 27% were current smokers and 39.5% were ex-smokers; 26% reported asthma or bronchitis. Mean baseline FEV1 was 100% predicted; mean baseline saturation was 97%. Mean fall in saturation was 3.2% (range 0-17.5%). Multiple regression analysis revealed that fall in saturation during methacholine challenge is related to baseline FEV1, baseline SaO2, log of total methacholine dose inhaled, and fall in FEV1 during challenge. Change in saturation was not related to subject age, smoking history, reported asthma or bronchitis, or the presence of respiratory symptoms. Methacholine challenge produces a significant fall in oxygen saturation, but this is not greater in subjects who are old or have low baseline saturation.
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Affiliation(s)
- D S Renwick
- Department of Geriatric Medicine, University of Manchester, UK
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Affiliation(s)
- M J Connolly
- Department of Geriatric Medicine, University of Manchester, Barnes Hospital, Cheadle, Cheshire
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Abstract
BACKGROUND Obstructive airways disease adversely affects quality of life, although relationships between quality of life and lung function have been shown to be weak. The relationships between the results of a quality of life questionnaire, spirometric tests, and methacholine bronchial challenge were investigated in a population sample of middle aged and elderly people. METHODS A random population sample of the white population of Central Manchester, UK were contacted by post. Respondents were invited to undergo bronchial challenge with methacholine (Newcastle dosimeter method) and to complete the St George's Respiratory Questionnaire. This self-completed questionnaire quantifies quality of life as three component scores, with higher scores indicating greater impairment of quality of life. RESULTS Two hundred and twenty seven subjects aged 45-86 years completed the St George's Questionnaire and performed spirometric tests; 190 completed the methacholine challenge. All quality of life scores were higher in subjects with a forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) of < 65%, indicating impaired quality of life in subjects with airways obstruction. There was no relationship between quality of life and age. Multiple regression analysis showed independent relationships between quality of life scores and both baseline FEV1 and bronchial responsiveness. However, the amount of variation in quality of life attributable to variation in FEV1 or bronchial responsiveness was less than 10%. Subgroup analysis indicated that the quality of life score was independently associated with bronchial responsiveness and not FEV1 in subjects aged < 65 years, but with baseline FEV1 and not bronchial responsiveness in older subjects. CONCLUSIONS Obstructive airways disease significantly impairs quality of life in adults. The reduction in quality of life in these patients is related to both baseline pulmonary function and non-specific bronchial responsiveness. The impact of airways obstruction on quality of life does not decrease with advancing age.
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Affiliation(s)
- D S Renwick
- University of Manchester, Department of Geriatric Medicine, Barnes Hospital, Cheshire, UK
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Connolly MJ. Publishing research supported by the tobacco industry. It's folly to allow the enemy access to your camp. BMJ 1996; 312:774. [PMID: 8605473 PMCID: PMC2350478 DOI: 10.1136/bmj.312.7033.774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abstract
BACKGROUND Chronic airways obstruction is common in adults and the elderly. To investigate the possibility that older adults with obstructive airways disease frequently do not receive appropriate treatment, the respiratory symptoms, medication use, and pulmonary function were studied in a random sample of white adults aged over 45 living in central Manchester, UK. METHODS A postal questionnaire survey was performed on 783 men and women aged 45 years and over selected from GP lists by random number tables. Subjects completing the questionnaire were invited to attend for pulmonary function testing and methacholine challenge (Newcastle dosimeter method). RESULTS The questionnaire response rate was 92.3% (723 subjects). The mean age of the population was 66.1 years and 57.2% were women; 29.2% were current smokers and 37.3% were ex-smokers. Asthma or bronchitis was reported by 30.0%. Two hundred and forty seven representative subjects attended for pulmonary function testing and spirometric evidence of chronic airways obstruction was found in 26.4%. Respiratory symptoms were reported by 76.6% of subjects with chronic airways obstruction; 55.0% had features which may predict potential improvement on treatment (increased non-specific bronchial responsiveness or significant bronchodilator reversibility). However, only 55.4% of subjects with airways obstruction had received a diagnosis of asthma or chronic bronchitis and only 36.9% were using inhaled bronchodilators or steroids. CONCLUSIONS Chronic airways obstruction is very common in adults in this inner city population, but is frequently overlooked. Most subjects with chronic airways obstruction are not receiving appropriate treatment.
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Affiliation(s)
- D S Renwick
- Department of Geriatric Medicine, University of Manchester, UK
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Roomi J, Johnson MM, Waters K, Yohannes A, Helm A, Connolly MJ. Respiratory rehabilitation, exercise capacity and quality of life in chronic airways disease in old age. Age Ageing 1996; 25:12-6. [PMID: 8670523 DOI: 10.1093/ageing/25.1.12] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Respiratory rehabilitation improves exercise capacity and quality of life in younger patients but is untried in the aged. We aimed to: (a) assess repeatability of the 6-minute walk test, factors affecting it and its relation to quality of life in elderly patients with chronic obstructive airways disease (COAD); (b) assess compliance of such patients with an intensive respiratory rehabilitation protocol; (c) pilot the assessment of the effect of respiratory rehabilitation on the 6-minute walk test in these patients. Seventeen subjects with stable, symptomatic COAD were recruited, 15 (six men), 70-89 (mean 76) years, completed the study. Mean (standard deviation) 1-second forced expiratory volume (FEV1) = 49 (5)% predicted. Six-minute walk tests were repeated single-blind, 2-10 days apart. Quality of life was measured using Guyatt respiratory questionnaire. Patients underwent 12 weeks incremental respiratory rehabilitation (x4/day step-ups, unweighed arm raises, inflating balloons). Baseline 6-minute walk was repeatable and was correlated with the log Guyatt dyspnoea score (r = 0.65, p = 0.006). In multiple regression neither age nor FEV1 predicted walk distance: body mass index, maximal expiratory mouth pressure; calorie intake. Mean (SEM) 6-minute walk distance after-rehabilitation was greater than baseline (p = 0.003). Elderly patients with COAD tolerate intensive respiratory rehabilitation and a controlled, blinded study is needed.
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Affiliation(s)
- J Roomi
- Department of Geriatric Medicine, University of Manchester, Barnes Hospital, Kingsway, Cheadle, Cheshire, UK
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Abstract
BACKGROUND Lymphocytes of normal elderly subjects and young asthmatics display dysfunctional beta-adrenoceptors. If beta-adrenoceptor dysfunction were found in senescent airways, it might help explain the pathogenesis of late onset asthma. METHODS The bronchodilatory effects of albuterol after methacholine-provoked bronchoconstriction were compared in 17 healthy young (age 20 to 36 years) and 17 healthy elderly (age 60 to 76 years) volunteer subjects. Albuterol was inhaled via dosimeter (initially 7.8 micrograms, doubling every 7.5 min) with forced expiratory flow at 50% vital capacity (FEF50) measured prior to each dose. Albuterol sensitivity was expressed as the cumulative logarithm of the area under the FEF50 recovery curve (AUC); a greater AUC meant lower sensitivity. On another study day, spontaneous recovery from methacholine was assessed similarly. RESULTS There was no intergroup difference in spontaneous recovery. Despite lower methacholine doses provoking similar (35%) FEF50 falls in elderly subjects, albuterol AUC was greater in elderly subjects (6,552%.min.microgram) than young subjects (3,922%.min microgram; p = 0.03). Multiple regression showed that AUC and age were related (p = 0.02). CONCLUSION Airway beta 2-adrenoceptor responsiveness is diminished in old age, suggesting that airway beta-adrenoceptor dysfunction may be implicated in late-onset asthma.
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Affiliation(s)
- M J Connolly
- Clinical Pharmacology and Gerontology Research Unit, Department of Veterans Affairs Medical Center, Boise, ID 83702, USA
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