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Biomedical subjects

M L Winningham

Publications and source records attributed to M L Winningham.

12 recordsLinked to original sources
PubMed2001

Strategies for managing cancer-related fatigue syndrome: a rehabilitation approach.

Although technologic advances and insights into the mechanisms of cancer and cancer treatments have resulted in hope of increased survival and even cure in many cancer populations, parallel efforts to promote quality of life through a commitment to rehabilitation and aggressive palliation have lagged. Recent studies have demonstrated fatigue to be the most distressing phenomenon experienced by cancer patients. This article examines fatigue from a rehabilitation perspective. Application of innovations in therapeutic exercise training, diet therapy, sleep therapy, cognitive therapy, and pharmacologic therapy and their attendant rationales are discussed. From clinical as well as research perspectives of palliation and rehabilitation, the manifestations of fatigue are better appreciated if fatigue is conceptualized as a syndrome, namely, cancer-related fatigue syndrome (CRFS). Experience of CRFS by cancer patients, regardless of their diagnosis, stage of disease, treatment regimen, or age, influences all aspects of quality of life and aggravates the experience of other distressing symptoms such as pain, nausea, and dyspnea. Understanding the underlying mechanisms for energy loss and gain, as well as the relationship between the right amount and type of activity and sleep, can lead toward more effective and innovative rehabilitation programs. Development of research based clinical interventions in these areas holds promise for significant improvement in functioning and quality of life for cancer survivors and may constitute valuable rehabilitative techniques that can be adjunctive to standard therapies.

Cognition Disorders↗
PubMed1995

Fatigue and weakness in cancer patients: the symptoms experience.

OBJECTIVES: To distinguish between fatigue and weakness and review symptom management for both and to suggest directions for research and practice. DATA SOURCES: Articles and book chapters pertaining to fatigue and weakness. CONCLUSIONS: Fatigue and weakness are important but long-neglected symptoms, and comparatively little effort has been invested in developing techniques to mitigate these symptoms. Research is needed to differentiate between these concepts, to determine the relation between fatigue and weakness, to delineate their causes, and to develop interventions aimed at the prevention and treatment of these symptoms. IMPLICATIONS FOR NURSING PRACTICE: Early assessment of risk factors, mobility and sensory problems, and usual level of activity will help identify those patients who may benefit from nursing interventions or referrals for occupational or physical therapy. It is important to repeatedly evaluate these symptoms in relation to treatment, situational changes, interventions used to manage other symptoms, and tumor progression. Developing clinical guidelines and intervention strategies will contribute greatly to the functional independence and the quality of life of patients.

Activities of Daily Living↗
PubMed1994

High- vs low-intensity inspiratory muscle interval training in patients with COPD.

This study determined the effect of a high vs low resistive inspiratory muscle interval training protocol on inspiratory muscle strength (PImax), incremental inspiratory threshold loading (Pitl), inspiratory muscle endurance (IE), and 12-minute distance test (12 MD) in severely impaired patients with COPD. We used a double-blind, two-group, repeated-measure design. Group 1 (n = 12) received supervised high resistive loading at approximately 52 percent PImax and group 2 (n = 8) received supervised low resistive loading at approximately 22 percent PImax. All subjects trained three times weekly (progressing from 5 min per session in week 1 to 18 min per session in week 12) for 12 weeks. After three practice sessions, measures of PImax, Pitl, IE, and 12 MD were taken at baseline, at 4-week intervals, and within 72 h of completing the protocol. Group 1 showed significant improvement in all four dependent variables while group 2 improved in Pitl, IE, and 12 MD. The results suggest there is no significant difference between high and low resistive interval training in more severely impaired patients with COPD.

Aged↗
PubMed1994

A nursing rehabilitation program for women with breast cancer receiving adjuvant chemotherapy.

PURPOSE/OBJECTIVES: To examine the effects of a comprehensive rehabilitation program on facilitating physical and psychosocial adaptation of women with breast cancer who are receiving adjuvant chemotherapy. DESIGN: Experimental. SETTING: Breast evaluation clinics of two New England medical centers with comprehensive cancer treatment programs. SAMPLE: 14 women (mean age = 44 years) receiving adjuvant chemotherapy for breast cancer (86% stage II) following surgical treatment. METHODS: Subjects were assigned randomly to the experimental group or the usual care group. Experimental group members began a structured exercise program of walking and attended support group meetings. All subjects were tested before beginning chemotherapy, during the course of chemotherapy, and one month following chemotherapy completion. MAIN RESEARCH VARIABLES: Performance status, physical functioning, psychosocial adjustment, self-concept and body image, and 12 symptoms (e.g., fatigue, nausea, anxiety). FINDINGS: Measures of physical performance, psychosocial adjustment, and symptom intensity revealed improved adaptation in subjects who completed the walking/support group program. CONCLUSIONS: Physical and psychosocial benefits from a modest walking exercise program and a support group are possible for patients receiving adjuvant chemotherapy. IMPLICATIONS FOR NURSING PRACTICE: Although more detailed research is necessary to answer some of the questions raised by this study, implementing the walking program and forming a support group are achievable in an outpatient setting.

Activities of Daily Living↗
PubMed1991

Walking program for people with cancer. Getting started.

Having the energy to maintain functional independence and social roles is an important component of quality of life in cancer patients. Unnecessary bedrest and prolonged sedentarism can contribute significantly to the development of fatigue and may result in rapid and potentially irreversible losses in energy and functioning. Walking is an important self-care activity that can counter some of the debilitating effects of disease, treatment, and inactivity. Research on exercise for ambulatory cancer patients has been limited to moderate intensity, interval, supervised exercise programs on cycle ergometers. However, lower intensity walking can be used as a self-care intervention for individuals or groups. Cancer patients often ask questions about what kind, frequency, duration, and intensity of exercise they should perform. By teaching self-care techniques, such as keeping a walking diary and pulse monitoring to regulate activity, nurses can help patients develop safe activity practices. I also present guidelines and precautions related to safe exercising by ambulatory patients during and after treatment for cancer.

Adult↗
PubMed1988

Effects of two methods of preoxygenation on mean arterial pressure, cardiac output, peak airway pressure, and postsuctioning hypoxemia.

Our purpose was to determine which method of preoxygenation (ventilator versus manual resuscitation bag [MRB]) produced minimal changes in mean arterial pressure (MAP), cardiac output (CO), and peak airway pressure and prevented postsuctioning hypoxemia in patients after coronary artery bypass graft surgery. Three lung inflation breaths at F10(2) 1.0 were delivered at 12 and 14 cc/kg of lean body weight via ventilator or MRB, followed by 10 seconds of continuous endotracheal suctioning. This sequence was repeated three times. The MRB produced a greater (12 mm Hg) increase in MAP than the ventilator (9 mm Hg), which was not statistically significant (p less than 0.09). MRB caused a larger increase to CO than the ventilator, but this was not statistically significant (p less than 0.10). The MRB generated significantly (p less than 0.000) higher mean airway pressures (45 mm Hg) than the ventilator (23 mm Hg); the larger the volume the higher the pressure. Both methods effectively prevented postsuctioning hypoxemia; the larger the volume the higher the PaO2.

Blood Pressure↗
PubMedDate not supplied

Effects of aerobic interval training on cancer patients' functional capacity.

The effect of a 10-week aerobic interval-training cycle ergometer protocol on the functional capacity (VO2Lmax) of 45 women receiving chemotherapy for treatment of Stage II breast cancer was studied. Subjects were stratified by baseline functional capacity (+/- 1 MET) and randomized to experimental (EX), placebo (PL), and control (CO) groups. EX subjects completed a 10-week, 3 times/week exercise training program; PL subjects participated in 10 weeks of nonaerobic stretching and flexibility exercises; the CO group maintained normal activities. The EX group showed significant, p less than .05, improvement on pre- to posttest VO2Lmax as well as workload and test time compared to the PL and CO groups. The interval-training exercise intervention was effective in improving the functional capacity of Stage II breast cancer patients on adjuvant chemotherapy.

Antineoplastic Agents↗
PubMedDate not supplied

Effect of aerobic exercise on body weight and composition in patients with breast cancer on adjuvant chemotherapy.

This study examined the effect of a supervised, aerobic exercise program on change in body weight and composition (multi-site subcutaneous skinfold measures, percent body fat, and lean body weight) of women undergoing adjuvant chemotherapy for breast cancer. Stage II patients with breast cancer (N = 24) were randomized to an exercise treatment group (EG, n = 12) and a control group (CG, n = 12). The EG participated in the individualized Winningham Aerobic Interval Training (WAIT) exercise program with exertional levels set at 60%-85% of maximal heart rate for 20-30 minutes, 3 times per week, for 10-12 weeks. The CG received no exercise treatment, but were asked to continue with their daily activities. Subjects were asked to maintain their customary eating patterns throughout their participation. Data were analyzed using covariate analysis, adjusting for age and pre-test values. Comparisons of pre- and post-test results indicated that exercise had a moderating effect on gain in body fat and altered the subcutaneous body fat profile in both obese (OB) and nonobese (NOB) subjects. Exercising OB subjects showed a greater increase in lean body weight than NOB subjects, indicating an increase in muscle tissue. Results from this study may be useful in designing safe and effective weight-control programs for patients with breast cancer on chemotherapy.

Adult↗
PubMedDate not supplied

Quantifying the minimum discard sample required for accurate arterial blood gases.

The purpose of this study was to determine the minimum amount of discard sample required to remove all heparinized normal saline from an indwelling arterial catheter to obtain an accurate arterial blood gas (ABG) sample. The pH and partial pressure of oxygen (PO2) and carbon dioxide (PCO2) were adjusted to known values prior to the onset of the study. The discard sample size ranged from zero to 5 cubic centimeters (cc), increasing at 0.5-cc increments. Twenty-nine sets of 11 consecutive discard/ABG samples, totaling 319 ABG specimens, were drawn over 20 minutes. Based on the data, a 2-cc discard is sufficient to guarantee accurate blood gases when withdrawing blood from an arterial catheter with a 1-cc dead space volume.

Blood Gas Analysis↗