Background and objective:In patients with COPD, this study evaluated the effect on health-related quality of life (HRQoL) of adding ongoing feedback to a 12-month unsupervised maintenance walking programme. Methods: Participants were randomized to either an intervention group (IG) or control group (CG). Both groups completed the same 2-month supervised, walking training programme followed by a 12-month unsupervised maintenance walking programme. During the maintenance programme, the IG received ongoing feedback (telephone calls, biofeedback and progressive goal setting) and the CG received no feedback. Results: A total of 75 participants completed the study (mean (SD): age 69 (8) years; forced expiratory volume in 1 s (FEV 1 ) 43 (15) % predicted). There was no between-group differences in the magnitude of change in HRQoL when data collected on completion of the 12-month maintenance programme were compared with that collected either before the 2-month supervised programme (mean between-group difference (MD) in total St George's Respiratory Questionnaire change scores: 1 point, 95% CI: −9 to 7) or on completion of the 2-month supervised programme (MD: 4 points, 95% CI −2 to 10). Conclusion: Following a 2-month supervised walking training programme, ongoing feedback was no more effective than no feedback in maintaining HRQoL during a 12-month unsupervised walking programme.
Existing clinical guidelines recommend weight loss for adults with knee osteoarthritis and obesity, but the supporting evidence to date remains inadequate. There is also no pooled data on physical function and quality of life. This study aims to examine the efficacy of weight loss on pain, self-reported disability, physical function and quality of life in adults with knee osteoarthritis and obesity. A systematic database search (from 1990 to June 2017) was conducted, and seven studies were eligible for inclusion. The meta-analyses demonstrated that a 5% to 10% weight loss significantly improved pain (effect size 0.33, 95% confidence intervals 0.17 to 0.48), self-reported disability (effect size 0.42, 95% confidence intervals 0.25 to 0.59) and quality of life (physical) (effect size 0.39, 95% confidence intervals 0.24 to 0.54). The results were based on adults with mean body mass index 33.6 to 36.4 kg m and mild to moderate knee osteoarthritis. Results for physical function were inconclusive due to the lack of eligible studies and incomprehensive outcome measures used.
Missed appointments place a costly and disruptive strain on National Health Service resources in England. One major source of missed appointments appears to be insufficient communication between patients and providers. SMS text messaging shows promise as a simple, cost-effective means of bridging this communications gap. SMS provides an instant and asynchronous means of communication that protects patient privacy. The potential for this technology is balanced, however, by the lack of high-quality evidence to support its use. There is an urgent need for robust evaluation of critical quality, safety, cost implications, and acceptability before the large-scale rollout of SMS-based systems.
Patients with COPD attending PR in Australia have high rates of comorbidity. The number of medications prescribed for these individuals is similar to that seen in other chronic disease states such as chronic heart failure. Pulmonary rehabilitation presents opportunities for clinicians to educate patients on self-management strategies for multiple comorbidities, review medication usage, and discuss strategies aimed at optimizing adherence with medication regimes.
The objective of this study was to derive and validate an equation to estimate the speed for the endurance shuttle walk test (ESWT) using results from the six-minute walk test (6MWT) in patients with chronic obstructive pulmonary disease (COPD). Participants with diagnosed COPD (n ¼ 84) performed two incremental shuttle walk tests (ISWTs) and two 6MWTs. ESWT speed was calculated from the ISWT results using the original published method. An equation was derived, which directly related six-minute walk distance (6MWD) to ESWT speed. The derived equation was validated in a different group of people with COPD (n ¼ 52). There was a strong correlation between average 6MWD and the calculated ESWT speed (r ¼ 0.88, p < 0.001). The ESWT speed (kilometre per hour) was estimated using the following equation: 0.4889 þ (0.0083 Â 6MWD). The mean difference (+limits of agreement) between ESWT speeds was calculated using the original published method and found to be 0.03 (+0.77) km/hour. When the ISWT is not the test of choice for clinicians, the 6MWT can be used to accurately estimate the speed for the ESWT.
An adolescent with autism and intellectual disability presented with severe depression related to menstruation.
Because of the complex medical, psychiatric and ethical issues involved, her care was coordinated by a hospital‐based adolescent medicine unit.
After trials of other therapies over an extended period and interdisciplinary and intersectoral case conferencing, it was decided that hysterectomy was the most appropriate management.
This case highlights the complexity of adolescent health care in a tertiary hospital, the importance of intersectoral cooperation between hospital and community, and the integral role of interdisciplinary care of adolescent patients with chronic conditions.
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