ABSTRACr Walking tests, frequently used to document effects of treatment on exercise capacity, have never been standardised. We studied the effects of encouragement on walking test performance in a randomised study that controlled for the nature of the underlying disease, time of day, and order effects. We randomised 43 patients with chronic airflow limitation or chronic heart failure or both to receive or not receive encouragement as they performed serial two and six minute walks every fortnight for 10 weeks. Simple encouragement improved performance (p < 0*02 for the six minute walk), and the magnitude of the effect was similar to that reported for patients in studies purporting to show beneficial effects of therapeutic manoeuvres. Age and test repetition also affected performance. These results demonstrate the need for careful standardisation of the performance of walking tests, and suggest caution in interpreting studies in which standardisation is not a major feature of the study design. Accepted 21 May 1984 ment was given "as necessary." In subsequent experiments using walking tests as measures of exercise capacity encouragement was not held constant. We were concerned that the influence of encouragement might be sufficiently great to rival treatment effects, and therefore we investigated the impact of encouragement on two and six minute walking tests performance in patients with chronic lung and chronic heart disease.
Methods
PATIENTSWe recruited two groups of subjects who experienced fatigue or dyspnoea while performing activities of daily living. The first, with respiratory conditions, attended a regional referral centre for patients with pulmonary problems and had a best recorded forced expired volume in one second (FEVy) less than 70% of the predicted value. The second group, patients with heart failure, who had been referred by local cardiologists, had impaired left ventricular function demonstrated by angiography, radionuclide scanning, or echocardiography. Exclusion criteria for both groups were as follows:(1) limitation of exercise performance as a result of factors other than fatigue or exertional dyspnoea, 818
A clear need for replication and multi-centre trials of reviewed pertinent studies is identified. Relevance to clinical practice. Community nurses should consider using validated screening tools for this focus. Until such time as higher quality evidence is available about other nursing interventions, the reviewers suggest that the prime nursing action should be the identification of whether older persons receiving community nursing care might have a mental health disorder and, if so, then collaborative referral is made to appropriate services.
Encephalocraniocutaneous lipomatosis (ECCL) is a congenital neurocutaneous syndrome that comprises unilateral porencephalic cysts with cortical atrophy; ipsilateral hamartomas of scalp, eyelid, and outer part of the eye; lipomas of the central nervous system (CNS); cranial asymmetry; and characteristic cutaneous lesions. We report on the antenatal and postnatal sonographic and radiologic, and on the postnatal pathologic findings of an infant diagnosed with ECCL at birth. The antenatal sonogram at 28 weeks of gestation showed normal intracranial structures; the sonogram at 38 weeks of gestation showed asymmetry of the cerebral hemispheres and ventriculomegaly. Magnetic resonance imaging at age 6 weeks demonstrated a porencephalic cyst on the left, hemiatrophy of the left cerebrum with cortical dystrophy, and a lipoma in the middle cranial fossa. Histologic findings of the resected cutaneous lesion confirmed the presence of fibrolipoma hamartoma. This case offers a unique insight into the antenatal and postnatal development of the hamartoneoplastic lesions of ECCL, and it highlights the difficulties inherent in the antenatal sonographic diagnosis of hamartoneoplastic syndromes.
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