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Baseline Study (baseline + study)
Selected AbstractsA prospective baseline study of frail older people before the introduction of an intermediate care serviceHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2005John Young MB MSC FRCP Abstract This paper describes the first part of a two-stage research project designed to investigate the clinical and service outcomes of a comprehensive intermediate care service. It is a baseline study of patients presenting to two elderly care departments as emergencies with the clinical syndromes of falls, incontinence, confusion or poor mobility before the introduction of a city-wide intermediate care service. The outcome measures were: mortality; disability (Barthel Index, BI); social activities (Nottingham Extended Activities of Daily Living); service use; and carer distress (General Health Questionnaire ,28). These were measured at 3, 6 and 12 months after recruitment. Eight hundred and twenty-three patients were recruited (median age = 84 years; proportion of women = 70%; proportion with cognitive impairment = 45%; median BI score = 15). There was a high mortality rate (36%), evidence for incomplete recovery, a gradual decline in independence over 12 months and a high degree of carer stress. There was little use of rehabilitation services (< 5%), about 25% required readmission to hospital by each assessment point and there was a gradual increase in institutional care admissions. These findings support a needs-based argument for a more comprehensive community service for frail older people. [source] The Different Mechanisms Between Late and Very Late Recurrences of Atrial Fibrillation in Patients Undergoing a Repeated Catheter AblationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2006MING-HSIUNG HSIEH M.D. Introduction: The mechanisms of late (<1 year after the ablation) and very late (>1 year after the ablation) recurrences of paroxysmal atrial fibrillation (AF) after catheter ablation have not been reported. Methods and Results: Fifty consecutive patients undergoing a repeated electrophysiologic study to investigate the recurrence of paroxysmal AF after the first ablation were included. Group 1 consisted of 12 patients with very late (26 ± 13 months) and group 2 consisted of 38 patients with late (3 ± 3 months) recurrence of paroxysmal AF. In the baseline study, group 1 had a lower incidence of AF foci from the pulmonary veins (PVs) (67% vs 92%, P = 0.048) and a higher incidence of AF foci from the right atrium (50% vs 13%, P = 0.014) than group 2. In the repeated study, group 1 had a higher incidence of AF foci from the right atrium (67% vs 3%, P < 0.001) and a lower incidence of AF foci from the left atrium (50% vs 97%, P < 0.001), including a lower incidence of AF foci from the PVs (50% vs 79%, P = 0.07) and from the left atrial free wall (0% vs 29%, P = 0.046) than group 2. Furthermore, most of these AF foci (64% of group 1, 65% of group 2) were from the previously targeted foci. Conclusion: The right atrial foci played an important role in the very late recurrence of AF, whereas the left atrial foci (the majority were PVs) were the major origin of the late recurrence of AF after the catheter ablation of paroxysmal AF. [source] Calcium Channel Antagonism Reduces Exercise-Induced Ventricular Arrhythmias in Catecholaminergic Polymorphic Ventricular Tachycardia Patients with RyR2 MutationsJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2005HEIKKI SWAN M.D. Introduction: Recently, gain-of-function mutations of cardiac ryanodine receptor RyR2 gene have been identified as a cause of familial or catecholaminergic polymorphic ventricular tachycardia. We examined the influence of the calcium channel blockers, verapamil and magnesium, on exercise-induced ventricular arrhythmias in patients with RyR2 mutations. Methods and Results: Six molecularly defined catecholaminergic polymorphic ventricular tachycardia patients, all carrying a RyR2 mutation and on ,-adrenergic blocker therapy, underwent exercise stress test four times: at baseline, after verapamil and magnesium sulphate infusions, and finally, without interventions. The number of isolated and successive premature ventricular complexes during exercise ranged from 40 to 374 beats (mean 165 beats) at baseline, and was reduced during verapamil by 76 ± 17% (P < 0.05). Premature ventricular complexes appeared later and at higher heart rate during verapamil than at baseline (119 ± 21 vs. 127 ± 27 min,1, P < 0.05). Magnesium did not inhibit the arrhythmias. Results in the fourth exercise stress test without interventions were similar to those in the first baseline study. Conclusions: This study provides the first in vivo demonstration that a calcium channel antagonist, verapamil, can suppress premature ventricular complexes and nonsustained ventricular salvoes in catecholaminergic polymorphic ventricular tachycardia caused by RyR2 mutations. Modifying the abnormal calcium handling by calcium antagonists might have therapeutic value. [source] Sleep during the Antarctic winter: preliminary observations on changing the spectral composition of artificial lightJOURNAL OF SLEEP RESEARCH, Issue 3 2008GAVIN FRANCIS Summary Antarctic Base personnel live for 3 months in winter with no natural sunlight. This project compared sleep, by actigraphy, during periods of increased exposure to white light or blue enriched light in 2003. The primary aim was to help define the optimum spectral composition and intensity of artificial environmental light. Nine men and one woman (33 ± 7 years, mean ± SD), wore activity and light monitors continuously from 28.2 to 9.10, and kept sleep diaries. Extra light was provided by light boxes (standard white, 5300 K, or prototype blue enriched, 10 000K, Philips Lighting), which were turned on in bedrooms and in communal/work areas approximately 08.00,18.00 hours. After a no-treatment control period, 28.2,20.3, sequential 4,5 week periods of first white, then blue light, were imposed with a further control period 19.9,9.10. A limited baseline study in 2002 (no interventions) similarly measured light and activity in seven men and one woman (30 ± 7 years). Daily light exposure in winter (lux, mean ± SD) was doubled in 2003 (maximum 1039 ± 281, average 64 ± 21), compared to 2002 (572 ± 276 and 30 ± 11), P < 0.05 and P < 0.01, with no differences between white and blue light. There were no major differences in sleep between light conditions in 2003. A delay in sleep timing was found in midwinter compared to control (2003, bedtime, P < 0.05, sleep start, P < 0.05, sleep end, P < 0.01) and sleep fragmentation increased (P < 0.05). Sleep efficiency was slightly higher during all blue light periods compared to all white periods (P < 0.05). The use of higher intensity light of suitable spectral composition is proposed. [source] Auditory-evoked potentials in general anesthesia monitoring: baseline study of availability in relation to hearing function in awake statusACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2005L. De Siena Background:, It has been confirmed that middle latency auditory-evoked potentials are good indicators of the hypnotic level in patients undergoing general anesthesia. The focal point for the evocation of auditory-evoked potentials is the presence of a serviceable hearing function. The aim of the study was to evaluate the limit of hearing loss above which the test could not be applied. Methods:, To determine the limit of applicability of the technique, 100 subjects were studied. Twenty of them were normally hearing and 80 were affected by sensorineural hearing loss of various degrees. Each subject was submitted to pure tone audiometry, to determine hearing threshold, and then, in awake status, to auditory-evoked potentials recording using acoustic stimuli of 85 dB HL. Results:, All the 20 normally hearing subjects showed a reliable auditory-evoked potentials. Among the 80 subjects affected by hearing loss, only five had no potentials. These five subjects presented a pure tone audiometry threshold greater than 85 dB HL. Conclusion:, The study demonstrated that middle latency auditory-evoked potentials recorded using an A-Line® (software version 1.4) AEP monitor (Danmeter, Odense, Denmark) can be carried out even in presence of hearing loss if the pure tone threshold is less than 85 dB HL. [source] Cross-sectional and longitudinal construct validity of the Saint George's Respiratory Questionnaire in patients with IPFRESPIROLOGY, Issue 6 2008Shouchun PENG Background and objective: This study was performed to confirm the cross-sectional and longitudinal construct validity of the Saint George's Respiratory Questionnaire (SGRQ) for the measurement of health-related quality of life (HRQoL) in patients with IPF. Methods: Sixty-eight patients with IPF responded to the SGRQ and pulmonary function tests (PFT), dyspnoea testing, arterial blood gas analysis, 6-min walk tests (6MWT) and high-resolution computed tomography were performed in a baseline study. A follow-up study was performed on 45 of these patients. Results: In the baseline study HRQoL as measured by the SGRQ was substantially impaired in IPF patients, especially in symptoms and activity domains. A significant decline in HRQoL was observed in the activity domain during follow up. TLC and changes in TLC showed the most significant inverse correlations with each SGRQ domain (r < ,0.3, P < 0.05). In a stepwise multiple regression analysis, TLC contributed most significantly to each SGRQ component baseline score. Similar results were also observed during follow up. There was a significant correlation between total CT scores and each component of the SGRQ (r > 0.3, P , 0.001). Changes in ground-glass opacity on CT (CT-alv) were also correlated with changes in each SGRQ domain (r > 0.3, P , 0.001). Stepwise multiple regression analysis showed that interstitial opacity on CT (CT-fib) contributed to variation in the baseline activity score, and that changes in CT-alv independently contributed to overall changes in the SGRQ domains during follow up. The dyspnoea score, and changes in the dyspnoea score, correlated significantly with the SGRQ sores, with the exception of the symptoms score, in both the baseline and follow-up studies. Conclusions: HRQoL as assessed by the SGRQ showed good cross-sectional and longitudinal construct validity in patients with IPF. However, additional studies are required to analyse the reliability and responsiveness so that the SGRQ can be used in patients with IPF. [source] Temporal alterations in brain water diffusivity in neonatal meningitisACTA PAEDIATRICA, Issue 9 2009Gyanendra K Malik Abstract Aim:, To compare changes in apparent diffusion coefficient (ADC) in neonatal meningitis using serial diffusion-weighted imaging (DWI). Method:, Thirty neonates with meningitis and 12 age/sex-matched controls were studied using DWI. ADC was quantified by placing region of interest(s) on periventricular white matter during acute illness and again at 21 days. Three groups of patients were studied: those with normal findings on both conventional MRI and DWI, those with abnormal DWI only and those with abnormal conventional MRI as well as DWI. Neurodevelopment assessment was performed in controls and patients at 3 months using Indian adaptation of Bayley scales of infant development (BSID) kit. Results:, Patients with neonatal meningitis with normal imaging (n = 8) showed no significant difference in ADC compared to controls. Patients showing abnormality only on DWI (n = 10) and on both conventional magnetic resonance imaging (MRI) as well as DWI (n = 12) had significantly reduced ADC (p = 0.001) than controls at baseline study. Follow-up study showed no significant differences in ADC in controls compared to any patient group. Significantly reduced neurodevelopmental scores were observed in patient groups compared to controls. Conclusion:, We conclude that quantitative ADC may detect meningitis-induced hypoxia early in brain parenchyma, which may be associated with abnormal motor and mental development. [source] | ||||||||||