Biomedical subjects

J M Gormley

Publications and source records attributed to J M Gormley.

9 recordsLinked to original sources

PubMed1999

Cerebrospinal fluid human immunodeficiency virus type 1 (HIV-1) suppression and efavirenz drug concentrations in HIV-1-infected patients receiving combination therapy.

Efavirenz, a potent inhibitor of human immunodeficiency virus type 1 (HIV-1) reverse transcriptase, is a promising addition to the antiretroviral armamentarium. Efavirenz levels and HIV-1 RNA levels were measured in cerebrospinal fluid (CSF) and plasma of 10 HIV-1-infected patients taking efavirenz, 600 mg daily, in combination with other antiretroviral medications. Efavirenz was detected in the CSF at a mean concentration of 35.1 nM (range, 6. 6-58.9 nM), which was above the IC95 for wild-type HIV-1. The mean CSF-to-plasma ratio was 0.61% (range, 0.26%-0.99%). CSF HIV-1 RNA levels were ascertained in 9 of the patients; all were <400 copies/mL after a mean of 26 weeks on therapy. Eight of the 9 patients had no detectable virus in plasma. These results indicate that efavirenz is present in the CSF at low levels and is effective in suppressing CSF viral levels when used in combination therapy.

Acquired Immunodeficiency Syndrome↗

PubMed1996

Differentiation between dyspnea and its affective components.

This study investigated whether people with chronic obstructive pulmonary disease (COPD) can differentiate distress and anxiety associated with dyspnea from the intensity of dyspnea and the perceived effort of breathing. Fifty-two subjects with COPD rated their perception of the individual components of dyspnea on a 200 mm visual analog scale at rest, after a 6-min walk (6MD), and every 2 min during an incremental treadmill test (ET). Subjects differentiated among the four dyspnea components at the end of the 6MD (p < .0001) and during ET (at rest, p < 0.001; at 75% VO2 max, p < 0.0001; and at end exercise, p < 0.0001). Intensity was significantly related to perceived effort of breathing (p < .0001), as distress was to anxiety (p < .0001), suggesting that each pair measures similar components. Subjects were able to differentiate their affective response to dyspnea from the intensity of the symptom. Measurement of a patient's affective response to dyspnea may improve the selection of specific treatments and validity of outcomes.

Aged↗

PubMed1996

Exercise training decreases dyspnea and the distress and anxiety associated with it. Monitoring alone may be as effective as coaching.

STUDY OBJECTIVE: To determine whether exercise training with coaching is more effective than exercise training alone in reducing dyspnea and the anxiety and distress associated with it and improving exercise performance, self-efficacy for walking, and dyspnea with activities of daily living. DESIGN: Randomized clinical trial of 51 dyspnea-limited patients with COPD assigned to monitored (n = 27) or coached (n = 24) exercise groups. SETTING: Outpatient area of university teaching hospital. INTERVENTION: Both groups completed 12 supervised treadmill training sessions (phase 1) over 4 weeks followed by 8 weeks of home walking (phase 2). The CE group also received coaching during training. MEASUREMENTS: Perceived work of breathing, dyspnea intensity, distress associated with dyspnea, and anxiety associated with dyspnea were rated on a visual analog scale during incremental treadmill testing and after 6-min walks before and after phase 1. Dyspnea with activities of daily living, self-efficacy for walking, state anxiety, and 6-min walks were measured before and after both phases. RESULTS: Dyspnea and the associated distress and anxiety improved significantly for both groups relative to work performed and in relation to ventilation (p < 0.05). There were no significant differences between groups in any outcomes. The phase 1 improvement in laboratory dyspnea was accompanied by improvements in dyspnea with activities of daily living (p < 0.01) and self-efficacy for home walking (p < 0.01) that were sustained during the home phase. CONCLUSIONS: Coaching with exercise training was no more effective than exercise training alone in improving exercise performance, dyspnea, and the anxiety and distress associated with it, dyspnea with activities, and self-efficacy for walking.

Aged↗

PubMed1986

Inhibition of high-affinity choline uptake in the rat hippocampus by in vivo injection of phenobarbital in the medial septum.

Barbiturates administered i.p. inhibit the activity in the septal-hippocampal cholinergic pathway as assessed by an inhibition of choline uptake into hippocampal synaptosomes in vitro. The present experiments were designed to determine where in the central nervous system the drugs act to have this effect. Barbiturates and other drugs were injected into selected sites in the awake, freely moving rat via previously implanted cannulas. It was found that phenobarbital, barbital and muscimol injected into the medial septal area inhibited choline uptake in the hippocampus. Pentobarbital was less effective than phenobarbital even when it was tested in the highest amounts that could be applied locally. The data suggest that the barbiturates rapidly leave the site of local injection and that, in the case of pentobarbital, sufficient local concentrations cannot be maintained to achieve a substantial effect. Phenobarbital had a greater effect in the medial than in the lateral septum. The inhibition of choline uptake by phenobarbital was blocked by coadministration of picrotoxin in the medial septum. In contrast, the stimulation of choline uptake in the hippocampus by picrotoxin occurred when it was injected in the lateral septum but not in the medial septum. These data suggest that GABAergic receptor complexes in the medial septal area do not have a tonic inhibitory effect on septal cholinergic neurons. They also suggest there may be other GABAergic receptor complexes in the lateral septum which are tonically active and may influence the medial septal cholinergic neurons by an unknown pathway.

Acetylcholine↗

PubMed1982

High-affinity choline uptake in the hippocampus: its relationship to the physiological state produced by administration of barbiturates and other treatments.

Choline uptake in hippocampal synaptosomes was not inhibited by pentobarbital administration when rats were decapitated immediately upon loss of the righting reflex (3-4 min) even though it was inhibited at later times post-injection, when the rats were still unable to right themselves. Choline uptake was increased when the animals were decapitated at convulsion after an injection of picrotoxin, high doses of bicuculline, or one of the convulsant barbiturates. However, another convulsant barbiturate, as well as strychnine and lower doses of bicuculline, did not increase choline uptake even though the animals also convulsed. Thus loss of righting reflex or convulsion is not directly correlated with changes in choline uptake. At 7 min after injection, levels of pentobarbital in the hippocampus (and other brain regions) were correlated with the degree of inhibition of choline uptake up to about 50% inhibition; however, greater inhibition could not be achieved with much higher brain levels of the drug. Although hippocampal uptake was partially inhibited at 1 h after septal lesions, 3 h after the lesion the inhibition was no longer apparent. Inhibition was almost complete 10-12 days after the lesion. These results suggest that other factors in addition to impulse flow influence choline uptake.

Animals↗

PubMed1982

Inhibition of high affinity choline uptake in the hippocampus: studies on the site of pentobarbital action.

Pentobarbital (pb) administered in vivo results in an inhibition of high affinity choline uptake measured in hippocampal synaptosomes in vitro. The present studies were designed to determine where in the brain the drug acts to cause this effect. Localized injections of pb into the hippocampus did not result in an inhibition of choline uptake in that region. Lesions of the medial septal region (containing the cell bodies of the cholinergic neurons which project to the hippocampus) blocked the ability of peripherally administered pb to inhibit hippocampal choline uptake. However, localized injections of the drug into the medial septum were without effect. These results suggest that pb acts at some other site which sends projections either to the septum or through the septum to the hippocampus. A lesions isolating the septum from most of its connections (anterior, dorsal, ventral and lateral) but not lesioning the fornix-fimbria or the area caudal to the septum failed to block the effect of i.p. pb. Thus, the drug may act at a site which projects into the septum from a caudal region to cause the inhibition of choline uptake in the hippocampus.

Animals↗

PubMedDate not supplied

Dyspnea and the affective response during exercise training in obstructive pulmonary disease.

BACKGROUND: Dyspnea (SOB), dyspnea-related anxiety (DA), and exercise performance have been shown to improve after exercise training in patients with Chronic Obstructive Pulmonary Disease (COPD). However, there are no published descriptions of the changes in dyspnea intensity or dyspnea-related anxiety during or across the exercise training sessions. OBJECTIVES: To describe and compare the differences in the patterns of change in SOB, DA, and exercise performance during 12 exercise training sessions with and without nurse coaching. METHODS: Forty-five dyspnea-limited patients with COPD were randomly assigned to nurse-monitored (ME) or nurse-coached exercise (CE). SOB and DA were rated on a 200 mm VAS every 2 minutes during each of 12 treadmill training sessions. RESULTS: Warm-up, peak, cool-down, mean SOB, and peak SOB/stage remained constant over the exercise sessions, with increasing exercise performance for both groups over the 12 sessions (p < .001). There was a significant difference in the pattern of mean SOB over time between the ME and CE group (p < . 05). Mean, peak DA, and peak DA/stage showed a rapid decrease within the first 4 sessions (p < . 05) with no significant differences between the groups. Warm-up and cool-down DA remained constant. There were large intra- and inter-subject variations in the rating of dyspnea and dyspnea-related anxiety within and across sessions. CONCLUSIONS: As theoretically proposed, both groups significantly decreased their DA over the training sessions. This decrease was early in the sessions and was not accompanied by a decrease in the SOB. In contrast, subjects maintained a nearly constant mean and peak SOB with increasing exercise performance, suggesting that people may have a dyspnea threshold above which they are unable to tolerate greater dyspnea. Description of the changes in dyspnea and the affective response during training need to be expanded, while studying the type and timing of strategies to enhance the improvement in dyspnea and dyspnea-related anxiety.

Aged↗

PubMedDate not supplied

Accuracy of recall of dyspnea after exercise training sessions.

BACKGROUND: Although clinicians often rely on patients' retrospective reporting of dyspnea, it is not known if dyspnea scores recalled after exercise are equivalent to dyspnea scores during exercise. The objective of this study was to determine whether patients could accurately recall after exercise the maximum ratings of the intensity of dyspnea and the anxiety associated with it that they experienced during exercise. METHODS: Forty-nine patients with chronic obstructive pulmonary disease (COPD) (forced expiratory volume in 1 second 0.92 +/- 0.23 L) participating in a randomized clinical trial of the impact of coached versus monitored exercise training on dyspnea rated dyspnea intensity (shortness of breath [SOB]) and dyspnea-related anxiety (DA) on a visual analog scale every 2 minutes during treadmill exercise. After each of 12 training sessions each subject was asked to rate the worst level of the two sensations that they recalled having experienced during exercise. RESULTS: For the groups as a whole, actual maximum scores for SOB and DA during exercise were highly correlated with recalled maximum values after exercise (r > or = 0.85, P < 0.0001) and the average differences were small (0-10.9 mm on a 200-mm scale). However, individual variation was substantial, limiting predictability for individual ratings. CONCLUSIONS: After exercise, patients with COPD as a group can accurately recall the worst SOB and DA that they experienced during exercise. This finding supports the further study and use of retrospective symptom ratings as a method for dyspnea assessment during exercise training in pulmonary rehabilitation.

Aged↗

PubMedDate not supplied

Desensitization and guided mastery: treatment approaches for the management of dyspnea.

Dyspnea is a frequent and distressing symptom for people with cardiopulmonary disease. Activity tolerance with presumably less dyspnea has been shown to increase after patients have been exposed to higher than usual dyspnea in a safe, monitored environment. Authors have suggested this decrease in dyspnea with activity may be due to a process of "desensitization" to the anxiety associated with the shortness of breath. The use of desensitization for other symptoms and phobias has evolved over time from an exposure-anxiety approach to a coping-mastery paradigm, labeled by some as guided mastery. This article reviews selected research studies that have used desensitization and guided mastery to treat other symptoms and phobias. Components of these two approaches are described and clinical strategies incorporating the two techniques with pulmonary patients during exercise-induced dyspnea are presented. A conceptual model that relates the two treatment approaches to the perception of the symptom and health outcomes is proposed.

Adaptation, Psychological↗