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Functional Measures (functional + measure)
Selected AbstractsElective gastrostomy, nutritional status and quality of life in advanced head and neck cancer patients receiving chemoradiotherapyANZ JOURNAL OF SURGERY, Issue 10 2009Randall P. Morton Abstract Background:, Chemoradiotherapy for treatment of advanced head and neck cancer (HNC) is used to achieve organ preservation without compromising survival. Because chemoradiotherapy usually impacts adversely on nutritional and functional status, feeding by percutaneous endoscopic gastrostomy (PEG) is often part of the management regimen for these patients, but the presence of a PEG tube can also be associated with reduced quality of life (QOL). This study aimed to examine the factors associated with PEG insertion and the effects of PEG use on QOL and functional outcomes in HNC patients receiving chemoradiotherapy. Method:, Survey of 36 consecutive patients treated by primary chemoradiotherapy for HNC. Patient weight, age, tumour type, details of PEG insertion, feeding regimens and treatment were noted. The survey comprised the Performance Status Scale, the Functional Measure for Swallowing, Nutritional Mode and a self-assessment of QOL. Results:, PEG insertion within 1 month of treatment was associated with smaller fall in body mass index at 12 months than PEG insertion 1 month or more after the start of the treatment (P < 0.05). Body mass index change was inversely correlated with health-related quality of life and significantly related to lower speech and swallowing function scores. Longer PEG duration correlated with poorer performance status and swallowing function (P < 0.01). Longer PEG duration also predicted poorer overall QOL (P < 0.01) and poorer swallowing (P < 0.01) and speech (P < 0.05). Nutritional mode was related to overall QOL (P < 0.01). Conclusions:, Nutritional support for HNC patients undergoing chemoradiotherapy is an essential component of patient care. Early PEG insertion and shorter PEG duration are associated with more favourable QOL-related outcomes. [source] The Effect of Erythropoietin on Exercise Capacity, Left Ventricular Remodeling, Pressure-Volume Relationships, and Quality of Life in Older Patients With Anemia and Heart Failure With Preserved Ejection FractionCONGESTIVE HEART FAILURE, Issue 3 2010Rose S. Cohen MD A prospective, open-label, 3-month study was conducted to evaluate the feasibility and short-term clinical effect of subcutaneous erythropoietin injections in patients with anemia and heart failure with preserved ejection fraction (ejection fraction, 55%±2%). Using a dose-adjusted algorithm to effect a rate of rise in hemoglobin not to exceed 0.4 g/dL,/wk, hemoglobin (10.8±0.3 to 12.2±0.3 g/dL) and red blood cell volume (1187±55 to 1333±38 mL) increased with an average weekly dose of 3926 units. Functional measures increased from baseline (6-minute walk test [289±24 to 331±22 m], exercise time [432±62 to 571±51 s], and peak oxygen consumption [8.2±0.7 to 9.4±0.9 mL/kg/min], all P<.05). End-diastolic volume declined significantly (8% volumetric decrease, 108±3 to 100±3 mL, P =.03), but there were no significant changes in left ventricular mass or estimated left ventricular end-diastolic pressure. Pressure-volume analysis demonstrated a reduction in ventricular capacitance at an end-diastolic pressure of 30 mm Hg without significant changes in contractile state. Congest Heart Fail. 2010;16:96,103. © 2009 Wiley Periodicals, Inc. [source] USING STREAM BIOASSESSMENT PROTOCOLS TO MONITOR IMPACTS OF A CONFINED SWINE OPERATION,JOURNAL OF THE AMERICAN WATER RESOURCES ASSOCIATION, Issue 3 2006Jeffrey Jack ABSTRACT: The processing of waste from confined animal feeding operations (CAFOs) presents a major environmental challenge. Treatment of waste and subsequent land application is a common best management practice (BMP) for these operations in Kentucky, USA, but there are few data assessing the effect of runoff from such operations on aquatic communities. The authors sampled a stream bordering a CAFO with a land application program to determine if runoff from the fertilized fields was adversely affecting stream communities. Water chemistry, periphyton, and macroinvertebrate samples from riffle habitats downstream of the CAFO were compared to samples collected from an upstream site and a control stream in 1999 and 2000. Riffle communities downstream of the fertilized fields had higher chlorophyll a levels than other sites, but there were no significant differences in macroinvertebrate numbers or in biometrics such as taxa richness among the sites. The BMP in place at this site may be effective in reducing this CAFO's impact on the stream; however, similar assessments at other CAFO sites should be done to assess their impacts. Functional measures such as nutrient retention and litter decomposition of streams impacted by CAFOs should also be investigated to ensure that these operations are not adversely affecting stream communities. [source] Replacement of dopaminergic medication with subthalamic nucleus stimulation in Parkinson's disease: Long-term observation,MOVEMENT DISORDERS, Issue 4 2009Luigi M. Romito MD Abstract Stimulation of the subthalamic nucleus (STN) is an effective treatment for advanced Parkinson's disease (PD), but the medication requirements after implant are poorly known. We performed a long-term prospective evaluation of 20 patients maintained at stable dopaminergic therapy for 5 years after bilateral STN implants, who were evaluated 6 months, 1 year, 3 years, and 5 years after surgery. We measured, during the entire observation period, the effect of deep brain stimulation on motor and functional outcome measures, the levodopa equivalent daily dose and the total electrical energy delivered. At 5 years, the UPDRS motor score had improved by 54.2% and levodopa equivalent dose was reduced by 61.9%, compared with preimplant. Dopaminergic medication remained stable during the observation period, but energy was progressively increased over time. Rest tremor, rigidity, gait, lower and upper limb akinesia, and total axial score were improved in decreasing order. Postural stability and speech improved transiently, whereas on-period freezing of gait, motor fluctuations and dyskinesias recovered durably. Functional measures did not show improvement in autonomy and daily living activities after STN implant. Chronic STN stimulation allows to replace for dopaminergic medications in the long-term at the expense of an increase of the total energy delivered. This is associated with marked improvement of motor features without a matching benefit in functional measures. © 2008 Movement Disorder Society [source] Changes in mid-to-late latency auditory evoked reponses in the chicken during neural maturationDEVELOPMENTAL PSYCHOBIOLOGY, Issue 1 2010Rebbekah Atkinson Abstract Utilizing the special advantages offered by the protracted maturation of neural circuits in chicken forebrain this study investigates the functional consequence of maturation using auditory evoked response potentials (AERPs) in behaving animals. Repeated measures AERP recordings were undertaken between weeks 1 and 8 posthatch. Quantitative analysis revealed a significant decrease in amplitude of the positive AERP component and a decrease in latency of the negative AERP component with maturation. AERPs were also utilized to investigate perturbed maturation via the induction of chemically induced hypothyroidism. Results from this study showed that the induction of late onset hypothyroidism produces measurable effects on the chicken AERP consistent with perturbation in maturation of neuronal circuits and synapses. This suggests that AERPs may be useful noninvasive functional measures of brain maturation that can be used to study the effects of endogenous or exogenous factors on brain maturation in the chicken. Since human brain also exhibits a protracted maturation period the availability of a well-characterized animal model for protracted brain maturation provides an opportunity to identify molecules, genes and environmental factors that are important in the regulation of maturation. The protracted maturation of neuronal circuits observed in chicken forebrain offers such a model. © 2009 Wiley Periodicals, Inc. Dev Psychobiol 52: 24,34, 2010 [source] Is structure or function a better measure of the effects of water abstraction on ecosystem integrity?FRESHWATER BIOLOGY, Issue 10 2009RUSSELL G. DEATH Summary 1. Assessments of flow abstractions in streams often focus on changes to biological communities and in-stream physical characteristics, with little consideration for changes in ecosystem functioning. It is unclear whether functional indicators of ecosystem health may be useful for assessing the impacts of reduced discharge on small streams. 2. We used weirs and diversions to reduce stream discharge by over 89% in three small New Zealand streams (11,84 L s,1), ranging in water quality from pristine to moderately impaired. 3. We used both structural (benthic invertebrates) and functional (drifting invertebrates, leaf breakdown, coarse particulate organic matter (CPOM) retention and primary productivity) measures of ecosystem integrity to compare responses to water abstraction in before-after, control-impact designed experiments during summer 2005. 4. At the pristine site, the density of invertebrates, taxon richness, Macroinvertebrate Community Index (MCI), Quantitative MCI, percentage of Ephemeroptera, Plecoptera and Trichoptera individuals and percentage of filter-feeders decreased in response to reduced flows. Only taxon richness decreased at the mildly impaired stream, and reduced discharge had no effect on the invertebrate community at the stream with the lowest water quality. 5. We found that reduced discharge had little influence on the breakdown rate of willow leaves in mesh bags over 1 month. Primary productivity was also relatively insensitive to water abstraction. However, CPOM retention increased with decreased flows. Drift propensity of invertebrates increased at two sites but only within the first few days after flow reduction. 6. Structural measures of ecosystem integrity suggested that the impacts of water abstraction differed among streams of varying water quality, probably because of differences in the sensitivity of invertebrate assemblages in the three streams. In contrast, the three functional measures tested were generally less sensitive to water abstraction impacts, although understanding how stream ecosystems respond to water abstraction clearly requires that both are considered. [source] A Randomized, Controlled Trial of Fall Prevention Programs and Quality of Life in Older FallersJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2007Mau-Roung Lin PhD OBJECTIVES: To compare the effects of three fall-prevention programs (education (ED), home safety assessment and modification (HSAM), and exercise training (ET)) on quality of life (QOL), functional balance and gait, activities of daily living (ADLs), fear of falling, and depression in adults aged 65 and older. DESIGN: A 4-month randomized trial. SETTING: Randomized, controlled trial. PARTICIPANTS: One hundred fifty participants who had experienced a recent fall. MEASUREMENTS: QOL was assessed according to the brief version of the World Health Organization Quality of Life instrument (WHOQOL-BREF), functional balance and gait according to functional reach and Tinetti balance and gait, ADLs according to the Older Americans Resources and Services questionnaire, fear of falling according to a visual analog scale, and depression level according to the Geriatric Depression Scale. RESULTS: The score changes for the ET group were 2.1 points greater on the physical domain (95% confidence interval (CI)=,1.2,5.3), 3.8 points greater on the psychological domain (95% CI=0.7,7.0), and for the WHOQOL-BREF, 3.4 points greater on the social domain (95% CI=0.7,6.1) and 3.2 points greater on the environmental domain (95% CI=0.6,5.7) than for the ED group. The score change for each domain of the WHOQOL-BREF for the HSAM group was greater than that for the ED group, although these results were not statistically significant. The ET group also had greater improvements in functional reach, Tinetti balance and gait, and fear of falling than the ED group. CONCLUSION: The QOL outcome supports the superiority of ET over the other two interventions in older people who have recently fallen. This finding also parallels those gathered from the functional measures. [source] Reduction in Fear of Falling Through Intense Tai Chi Exercise Training in Older, Transitionally Frail AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2005Richard W. Sattin MD Objectives: To determine whether an intense tai chi exercise program could reduce fear of falling better than a wellness education (WE) program in older adults who had fallen previously and meet criteria for transitioning to frailty. Design: Cluster-randomized, controlled trial of 48 weeks' duration. Setting: Ten matched pairs of congregate living facilities in the greater Atlanta area. Participants: Sample of 291 women and 20 men, aged 70 to 97. Measurements: Activity-related fear of falling using the Activities-Specific Balance Confidence Scale (ABC) and the Fall Efficacy Scale at baseline and every 4 months for 1 year. Demographics, time to first fall and all subsequent falls, functional measures, Centers for Epidemiologic Studies Depression Scale, medication use, level of physical activity, comorbidities, and adherence to interventions. Results: Mean ABC was similar in both cohort groups at the time of randomization but became significantly higher (decreased fear) in the tai chi cohort at 8 months (57.9 vs 49.0, P<.001) and at study end (59.2 vs 47.9, P<.001). After adjusting for covariates, the mean ABC after 12 months of intervention was significantly greater in the tai chi group than in the WE group, with the differences increasing with time (mean difference at 12 months=9.5 points, 95% confidence interval=4.8,14.2, P<.001). Conclusion: Tai chi led to a significantly greater reduction in fear of falling than a WE program in transitionally frail older adults. The mean percentage change in ABC scores widened between tai chi and WE participants over the trial period. Tai chi should be considered in any program designed to reduce falling and fear of falling in transitionally frail older adults. [source] The Effects of Staffing on In-Bed Times of Nursing Home ResidentsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2004Barbara M. Bates-Jensen PhD, CWOCN Objectives: To examine the effect of staffing level on time observed in bed during the daytime in nursing home (NH) residents. Design: Descriptive, cross-sectional study. Setting: Thirty-four southern California NHs. Participants: A total of 882 NH residents: 837 had hourly observation data, 777 had mealtime observations, 837 completed interviews, and 817 completed a physical performance test. Measurements: Cross-sectional data collected from participants at each NH site included direct observations (hourly and mealtime), resident interviews, medical record review, and physical performance tests. Results: In multivariate analyses, staffing level remained the strongest predictor of time observed in bed after controlling for resident functional measures (odds ratio=4.89; P=.042). Residents observed in bed during the daytime in more than 50% of hourly observations were observed also to experience increased daytime sleeping (P<.001) and less social engagement (P=.026) and consumed less food and fluids during mealtimes than those observed in bed in less than 50% of observations, after adjusting for resident function (P<.001). Conclusion: In this sample of NHs, resident functional measures and NH staffing level predicted observed time in bed according to hourly observations, with staffing level the most powerful predictor. Neither of these predictors justifies the excessive in-bed times observed in this study. Staff care practices relevant to encouraging residents to be out of bed and resident preferences for being in bed should be examined and improved. Practice recommendations regarding in-bed time should be considered, and further research should seek to inform the development of such recommendations. [source] A Demonstration of a Presurgical Behavioral Medicine Evaluation for Categorizing Patients for Implantable Therapies: A Preliminary StudyNEUROMODULATION, Issue 4 2008Kimberly Gardner Schocket PhD ABSTRACT Objectives., The aim of the current study was to evaluate the potential efficacy of a presurgical behavioral medicine evaluation screening algorithm with patients undergoing evaluation for implantable pain management devices. Methods., Sixty patients were evaluated for prognostic recommendations regarding outcomes from surgery for spinal cord stimulators and intrathecal pumps. Diagnostic interviews, review of medical charts, and psychosocial and functional measures were used in the initial evaluation. Results., Patients were classified into one of four prognostic groups, from low to increasing risks: Green, Yellow I, Yellow II, and Red. The Green group showed the most positive biopsychosocial profile, while the Red groups showed the worst profiles. Conclusions., This preliminary study suggests that the presurgical behavioral medicine evaluation algorithm may be an effective method for categorizing patients into prognostic groups. Psychological and adverse clinical features appear to have the most power in the classification of such patients. [source] Axonal loss and myelin in early ON loss in postacute optic neuritisANNALS OF NEUROLOGY, Issue 3 2008Alexander Klistorner PhD Objective To investigate the relation between retinal nerve fiber layer (RNFL) thickness and latency and amplitude of multifocal visual-evoked potentials (mfVEPs) in the postacute stage of optic neuritis in patients with early or possible multiple sclerosis. Method Thirty-two patients with clinical diagnosis of unilateral optic neuritis and magnetic resonance imaging lesions typical of demyelination and 25 control subjects underwent mfVEP and optical coherence tomography imaging. Results Although there was significant reduction of RNFL thickness in the affected eyes (18.7%), a considerably larger decrease was observed for the amplitude of the mfVEPs (39.8%). Latency of the mfVEPs was also significantly delayed in optic neuritis eyes. In fellow eyes, the amplitude of mfVEPs was significantly reduced and the latency prolonged, but RNFL thickness remained unaltered. RNFL thickness correlated highly with the mfVEP amplitude (r = 0.90). There was also strong correlation between optical coherence tomography measure of axonal loss and mfVEP latency (r = ,0.66). Interpretation Although our findings demonstrate strong associations between structural and functional measures of optic nerve integrity, the functional loss was more marked. This fact, together with amplitude and latency changes of the mfVEPs observed in clinically normal fellow eyes, may indicate greater sensitivity of mfVEPs in detecting optic nerve abnormality or the presence of widespread inflammation in the central nervous system, or both. The significant correlation of the mfVEP latency with RNFL thickness suggests a role for demyelination in promoting axonal loss. Ann Neurol 2008 [source] Measuring function in rheumatoid arthritis: Identifying reversible and irreversible componentsARTHRITIS & RHEUMATISM, Issue 9 2006Daniel Aletaha Objective Measurement of physical function at one point in time cannot distinguish impairment caused by the active disease process from chronic irreversible impairment. We aimed to dissect these two components of functional limitation in rheumatoid arthritis (RA) by using the disability index of the Health Assessment Questionnaire (HAQ) as the measure of function. Methods We performed a secondary analysis of data from 6 contemporary clinical trials of RA (2,763 patients). Patients in whom remission was achieved in the trials, based on a simplified disease activity index, were identified. In an individual patient, HAQ scores at trial entry represented both reversible and irreversible impairments, while HAQ scores at the time of RA remission represented the mostly irreversible component, and the difference between these corresponded to the component related to disease activity. We tested the concept that the HAQ has a reversible and an irreversible component by associating the HAQ score during remission with 2 measures associated with the degree of accrued damage: duration of RA and radiographic severity. Results Among patients in whom clinical remission was achieved (n = 295), average HAQ scores despite clinical remission increased progressively with the duration of RA, from 0.19 (<2 years of RA) to 0.36 (2,<5 years) to 0.38 (5,<10 years) to 0.55 (,10 years) (P < 0.001). The reversibility of HAQ scores decreased with the duration of RA (median 100%, 83.3%, 81.9%, and 66.7%, respectively; P < 0.001). Findings were similar in patients subgrouped by quartile of radiographic scores. Conclusion Differences in the sources of functional limitations should be considered in the interpretation of functional measures, and in their use for prediction and in cost analyses. [source] 4432: Comparison of the two domains of visual optics: the aberrometric domain and the straylight domainACTA OPHTHALMOLOGICA, Issue 2010TJTP VAN DEN BERG Purpose The ocular point-spread-function defines the functional problem originating from optical defects in the eye. Aberrations as well as scatter degrade the psf. How do these two types of defect differ with respect to their effect on the psf, and on functional measures? Methods Literature models for different aspects of the optical irregularities in the eye media, in particular Thibos et al. JOSA A 2002 for the aberration structure and Van den Berg et al. VR 1999 for small particle scattering, were used to delineate their effects on the psf. The Thibos et al. model was extrapolated to allow inclusion of the high orders of aberration not normally included in aberrometry, but potentially visible with double pass. With respect to the visual function counterparts, straylight (C-Quant from Oculus) outcomes were compared to visual acuity and contrast sensitivity in 2400 subjects. Results As a reference the full scale psf standard model of Vos et al. CIE 1999 was used. The modeled aberration structures of the eye proved to predict the central part of the psf up till about 0.3 degrees if extreme high orders were included. For angles >1 degree predicted values were far below the actual values of the psf. Small particle scattering was essential to predict the psf for angles above 1 degree. Conclusion In the assessment of disturbances to the optical media two domains must be discriminated: the aberration domain and the small particle domain, with corresponding parts (small angle vs large angle) to the psf. Straylight typically originates from irregularities of size 10 micrometer and below, as opposed to aberrations originating from refractile humps and bumps extending over 100 micrometer and more. Straylight has independent value. [source] Choroidal blood flow and retinal ganglion cell function in early glaucomaACTA OPHTHALMOLOGICA, Issue 2009D MARANGONI Purpose To assess subfoveal choroidal blood flow in patients with early manifest glaucoma (EMG) and to compare blood flow with functional measures of retinal ganglion cell (RGC) integrity. Methods Subfoveal choroidal blood flow was determined by confocal, real-time laser Doppler flowmetry in 25 EMG patients (<-6 dB Humphrey mean deviation, age range: 42-64 years, visual acuity: 0.8-1.0) and in 20 age-matched controls. All patients had a therapeutically (topical beta-blockers with or without a prostaglandin) controlled intraocular pressure (IOP <20 mmHg). Subfoveal choroidal blood volume (ChBVol), velocity (ChBVel) and flow (ChBF) were determined as the average of three 60 sec recordings with changes in the DC < 10% between the recordings (DC measures the intensity of the light scattered by the tissue and red blood cells in the illuminated volume). In all patients and controls pattern electroretinograms (PERGs) were recorded according to a standardized protocol. Results In EMG patients, average ChBVel and ChBF were reduced by 31 and 35%, respectively (p <0.01) compared to control values. No significant difference in ChBVol was found between the two groups. PERG amplitudes were reduced by 40% (p <0.01) in EMG patients compared to controls. No correlation was found between anyone of the choroidal flow parameters and PERG data or IOP values. Conclusion The results suggest a significant alteration of subfoveal choroidal hemodynamics in EMG patients, involving both ChBVel and ChBF. These changes do not appear to be associated with the severity of functional retinal ganglion cell loss. Our findings may have implications for the pathophysiology of early glaucomatous damage and its treatment. [source] | ||||||||||