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Biomedical subjects

B J Make

Publications and source records attributed to B J Make.

At least 19 recordsLinked to original sources
PubMed2001

Quality of life measured with a generic instrument (Short Form-36) improves following pulmonary rehabilitation in patients with COPD.

STUDY OBJECTIVES: The purpose of this study was to evaluate the effects of a 3-week comprehensive pulmonary rehabilitation program on quality of life as measured by the Short Form-36 (SF-36) in patients with COPD. DESIGN AND SETTING: We report on the outcomes of 37 consecutive patients referred for pulmonary rehabilitation at a respiratory specialty medical center. PATIENTS: Thirty-seven patients (mean age, 66 years) with COPD and severe airflow limitation (mean +/- SE FEV(1), 29.6 +/- 1.8% of predicted) were studied. INTERVENTIONS: Rehabilitation consisted of a 3-week pulmonary rehabilitation program incorporating 12 exercise sessions, each of which included bicycle ergometer exercise training, upper-extremity training, strength training, and stretching, along with psychosocial counseling and education. MEASUREMENTS AND RESULTS: The Health Status Index (SF-36) and 6-min walk test were completed before and after rehabilitation. There was an improvement in five of the nine quality-of-life subscales of the SF-36 following pulmonary rehabilitation. Although there was an improvement in functional capacity as measured by the 6-min walk, there was no correlation between improvement in quality of life and improvement in functional capacity. There was no correlation between FEV(1) and improvement in walk distance, but there was a correlation between FEV(1) and improvement in SF-36 physical function and energy/fatigue subscales. CONCLUSION: Health-related quality of life assessed by the SF-36, a general measure of quality of life, improves following an intensive 3-week pulmonary rehabilitation program. Use of the SF-36 allows comparison of the results of pulmonary rehabilitation to therapeutic interventions in patients with other medical disorders.

Aged↗
PubMed1998

Core body temperature is normal in chronic fatigue syndrome.

BACKGROUND: Subjects with chronic fatigue syndrome (CFS) frequently report symptoms of subnormal body temperature and low-grade fever. We conducted a study to determine whether CFS subjects manifest any abnormality of core body temperature (CBT) that might help explain their fatigue. METHODS: Continuous 24-hour recordings of CBT measured every 5 min were performed in 7 subjects meeting the Centers for Disease Control definition of CFS. Three additional groups were studied: normal controls, subjects with seasonal allergy, and subjects with major depression. Subjects (n = 7) in each group were age-, sex-, and weight-matched to the CFS group and had normal basal metabolic rates, thyroid function, and 24-hour urinary free cortisol excretions. CBT was measured with an ingestible radio frequency transmitter pill and a belt-worn receiver-logger. Each pill was factory-calibrated to +/- 0.1 degree C and field-calibrated with a water bath calibration prior to use. RESULTS: The 24-hour mean calibration-adjusted CBTs of each group were not significantly different (control: 37.00 +/- 0.17 degrees C; CFS: 37.04 +/- 0.31 degrees C; allergy: 37.15 +/- 0.18 degrees C; depression: 37.16 +/- 0.18 degrees C). Similarly, the mean peak and trough circadian temperatures were not statistically different. The mean 24-hour profile of CBT for each group showed a similar circadian rhythm. In simultaneously collected blood samples, each group showed a similar circadian profile of serum cortisol with a peak occurring at 08:00. CONCLUSIONS: Subjects with CFS have normal CBT despite frequent self-reports of subnormal body temperature and low-grade fever.

Adult↗
PubMed1998

Improved exercise performance following lung volume reduction surgery for emphysema.

Lung volume reduction surgery (LVRS) for emphysema has been suggested to improve patient lung function and activity. The short-term impact of LVRS on exercise performance was evaluated using maximal and submaximal steady-state exercise testing in 27 patients with severe hypoxemic chronic obstructive pulmonary disease (COPD), along with measurements of patient function, dyspnea, and quality of life. LVRS significantly improved exercise performance, due to ventilatory improvements associated with increased ventilatory reserve, enhanced tidal volume recruitment, and improved alveolar ventilation. Preoperative measurements of ventilatory reserve and dead space ventilation during exercise testing were closely associated with improved exercise performance. Improvements in patient dyspnea, walk distances, and quality of life also occurred following LVRS and were associated with improvements in exercise performance. Surgical mortality from LVRS was low (4%), but short-term all-cause mortality was increased (19%). Short-term mortality was associated with reduced expiratory muscle strength and markedly elevated dead space ventilation. We conclude that LVRS produces significant improvements in exercise performance, dyspnea, and quality of life in selected patients with COPD. Physiologic prediction of patients most likely to survive for an extended period and have significant benefit following LVRS may also be possible.

Adult↗
PubMed1992

Respiratory tract infection complicating transtracheal oxygen therapy.

Transtracheal oxygen is generally well tolerated in patients with chronic hypoxemia. Minor complications are common, but there are few reports of serious respiratory tract infections associated with transtracheal oxygen therapy. We describe four patients with interstitial lung disease who had frequent lower respiratory tract infections requiring hospitalization after initiation of transtracheal oxygen therapy.

Aged↗
PubMed1990

Mechanical ventilation in the home.

Despite advances in the application of mechanical ventilation as a short-term, life-saving technique, intensive care units are increasingly faced with patients who cannot be weaned from ventilatory assistance and who require mechanical ventilation as a long-term, life-supporting necessity. Because of limited resources in health care facilities for the management of chronic ventilator-assisted individuals, home care has become an important option. With careful selection of appropriate candidates, home care for ventilator-assisted individuals can result in not only decreased respiratory symptoms, reduction in hospitalization, and improved physiologic measures, but also an improved quality of life with substantial survival and a reduction in the costs of medical care.

Home Care Services↗
PubMed1989

Transtracheal oxygen decreases inspired minute ventilation.

Although patients using transtracheal oxygen (TTO2) frequently report decreased dyspnea and improved exercise tolerance, the mechanism for these effects is unknown. We hypothesized that these patients might have decreased inspired minute ventilation (VI), and this might be one mechanism for their decreased dyspnea and improved exercise tolerance. The effects of TTO2 on VI were studied in seven patients with chronic hypoxemia; two had chronic obstructive lung disease and five had severe restrictive disorders. VI, exhaled minute ventilation (VE), respiratory rate (RR), tidal volume (VT), earlobe O2 saturation (O2 sat), and arterial blood gases were measured while patients received varying amounts of oxygen either transtracheally or by mouth to achieve equivalent degrees of oxygenation. With TTO2 VI was reduced compared to VI with mouth O2 at similar levels of PaO2. As TTO2 flow rate increased, VI decreased; at 6 L/min O2 delivered transtracheally, mean VI was reduced by 54 +/- 7.0%. Reduction in VI was due to decreased VT; RR did not change. To determine if air delivered transtracheally decreased VI, five patients were studied while receiving air transtracheally or by mouth. With transtracheal air, VI was significantly less than VI obtained while breathing air by mouth. We conclude that VI is decreased when oxygen or air is delivered directly into the trachea and that VI decreases as transtracheal flow increases. This effect is not due solely to changes in oxygenation. Decreased dyspnea and improved exercise tolerance in patients using TTO2 may be due to decreased VI and decreased inspiratory work of breathing.

Adult↗
PubMed1988

Criteria for establishing units for chronic ventilator-dependent patients in hospitals.

These guidelines were developed by the American Association for Respiratory Care in response to a request by the Health Care Financing Administration for professional assistance in defining criteria for establishment of demonstration units for management of chronic ventilator-dependent patients in hospitals. Although the exact method by which these demonstration units (3 to 5 in number) will be selected has not been announced, these guidelines will have an important role in assuring that appropriate sites are chosen and that patient selection and data collection are adequate to document the possible benefits of such units.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1986

Dyssynchronous breathing during arm but not leg exercise in patients with chronic airflow obstruction.

Some patients with chronic airflow obstruction experience dyspnea with mild arm exercise but not with more-intense leg exercise. To investigate why these patients have limited endurance during arm exertion, we studied ventilatory responses to exercise with unsupported arms in 12 patients with chronic airflow obstruction (mean [+/- SD] forced expiratory volume in one second, 0.68 +/- 0.28 liters). Unloaded leg cycling was also studied for comparison. In the five patients who had the most severe airflow obstruction, arm exercise was limited by dyspnea after 3.3 +/- 0.7 minutes, and dyssynchronous thoracoabdominal breathing developed. In the other seven patients, arm exercise was limited by the sensation of muscle fatigue after 6.1 +/- 2.0 minutes (P less than 0.05), and dyssynchronous breathing did not occur. None of the 12 patients had dyssynchronous breathing during unloaded leg cycling. Maximal transdiaphragmatic pressure, a measure of diaphragmatic fatigue, declined similarly after arm and leg exercise in both groups. During unsupported arm work, the accessory muscles of inspiration help position the torso and arms. We hypothesize that the extra demand placed on these muscles during arm exertion leads to early fatigue, an increased load on the diaphragm, and dyssynchronous thoracoabdominal inspirations. This sequence may contribute to dyspnea and limited endurance during upper-extremity exercise.

Adult↗
PubMed1986

Long-term management of ventilated-assisted individuals: the Boston University experience.

In the 4 1/2 years beginning in January 1981, the University Hospital at the Boston University Medical Center admitted 46 ventilator-assisted individuals to its Respiratory Care Center and discharged 38 of them to their homes with ventilators. Of the 46 admitted, 23 had COPD and 23 had neuromuscular or skeletal disorders. All the latter were successfully sent home, and 15 of the 23 with COPD went home. At follow-up in 1985, of the 38 patients managed at home for periods of 1 to 51 months, 30 were surviving and 4 with COPD and 4 with neuromuscular disorders had died. One died immediately after discharge, one who had amyotrophic lateral sclerosis lived 9 months at home before dying, and the other 6 lived at home a year or more before dying. These results were made possible by an inpatient facility that had the goal of improving the quality of life of ventilator-assisted persons. This was done by the use of portable ventilators on motorized wheelchairs, by the use of traditional rehabilitation techniques, and by encouraging and training patients to become independent and responsible for their own personal and respiratory care. The hospital-based Respiratory Care Center is staffed by a team from physical therapy, occupational therapy, respiratory therapy, rehabilitation nursing, social service, psychiatry, rehabilitation medicine, and otolaryngology. A pulmonary physician directs the program and a respiratory nurse specialist is co-director and oversees its daily operation. The rehabilitation process has six stages: Stage 1 is stabilization, Stage II is evaluation, Stage III is rehabilitation planning, Stage IV is rehabilitation training, Stage V is discharge planning.(ABSTRACT TRUNCATED AT 250 WORDS)

Boston↗