Nomogram for exercise capacity in women.
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Energy Metabolism↗
Biomedical subjects
Mariano Rey
Publications and source records attributed to Mariano Rey.
The effectiveness of different combinations of pulmonary rehabilitation program components: a randomized controlled trial.
STUDY OBJECTIVES: To study the short-term and long-term effects of combining activity training or lectures to exercise training on quality of life, functional status, and exercise tolerance. DESIGN: Randomized clinical trial. SETTING: Outpatient pulmonary rehabilitation center. PARTICIPANTS: Forty-three outpatients with COPD. INTERVENTIONS: Patients were randomized to one of three treatment groups: exercise training alone, exercise training plus activity training, and exercise training plus a lecture series. The mean treatment period was 10 weeks. MEASUREMENT: The Chronic Respiratory Disease Questionnaire, the modified version of the Pulmonary Functional Status and Dyspnea Questionnaire, and the COPD Self-Efficacy Scale were administered at baseline, and 6, 12, 18, and 24 weeks from the beginning of the rehabilitation program. The 6-min walk test was used to measure exercise tolerance. RESULTS: Benefits of activity training combined with exercise included less dyspnea (p < or = 0.04) and fatigue (p < or = 0.01), and increased activity involvement (p < or = 0.02) and total functional status (p < or = 0.02) in the short term compared to comparison treatment groups for comparatively older participants. Compared to the lecture series adjunct, the activity training adjunct resulted in significantly higher gains in total quality of life (p = 0.04) maintained at 24 weeks. Significantly worse emotional function and functional status resulted from the lecture series adjunct in the oldest participants (p < or = 0.03). Treatment groups did not differ significantly on exercise tolerance or self-efficacy. CONCLUSIONS: Evidence for additional benefits of activity-specific training combined with exercise was found. A behavioral method emphasizing structured controlled breathing and supervised physical activity was statistically significantly more effective than didactic instruction in facilitating additional gains and meeting participants' learning needs.
Age Factors↗
Medical humanities at New York University School of Medicine: an array of rich programs in diverse settings.
The New York University School of Medicine has a rich tradition of cultivating programs in medical humanities and professionalism. They are drawn from the departments, centers, students, and faculty in the School of Medicine, have linkages throughout the university, and are interwoven into the fabric and culture of the institution. Some are centrally based in the School of Medicine's deans' office, and others are located in individual departments and receive support from the dean's office. This article describes representative programs for medical students and faculty. Curricular initiatives, the fundamental components of medical students' learning, include a course entitled "The Physician, Patient, and Society," a clerkship essay in the Medicine Clerkship, an opportunity for reflection during the medicine clerkship, and a medical humanities elective. In 2002, the Professionalism Initiative was launched to enhance and reflect the values of the medical profession. Its curriculum consists of a series of events that coordinate, particularly, with existing elements of the first-year curriculum (e.g., orientation week, a session during anatomy, a self-assessment workshop, and a peer-assessment workshop). The Master Scholars Program is a group of five, theme-based master societies consisting of faculty and students who share common interests around the society's themes. Programs developed for the societies include colloquia, faculty-led seminars, a mandatory student-mentoring program, and visiting scholars. Finally, the authors describe three high-quality literary publications created at New York University School of Medicine. Each of the initiatives undergoes regular critical examination and reflection that drive future planning.
Clinical Clerkship↗
Mentoring for a new era.
OBJECTIVE: Over the course of their education, medical students must develop an identity that involves a deep understanding of professional principles and the skills to apply these ideals. This task is so important that it cannot be left to informal means and should be cultivated by a structured system that is focused on professionalism. The overall goal of our student-mentoring program is to advance the professional development of our students during the first two years of medical school through regular group meetings with skilled, trained faculty facilitators. DESCRIPTION: We shaped the program to foster meaningful mentoring relationships among students and faculty, facilitate personal reflection, and encourage exploration of larger questions related to professional development. This program has evolved from a model of individual student-faculty pairings that resulted in uneven experiences. It is organized through a new "Master Scholars Program" (MSP), inaugurated in 2001-2002. The MSP features five theme-based societies composed of students and faculty who share interests in the theme (e.g., bioethics/human rights, health policy/public health, arts/humanities in medicine, biomedical/health sciences, medical informatics/biotechnology). Approximately once per month, eight students and two faculty members from each society meet over lunch for student-led discussions on topics related to their own professional development. In the first session, structured exercises enable students to get to know one another and brainstorm a curriculum for the year. In subsequent sessions, student pairs lead discussions on topics of interest to the group ranging from "the role of medical professionals in the aftermath of the World Trade Center attacks" to "balancing careers in medicine with family." A list of each group's discussion topics is posted on an electronic bulletin board to inform others. Two faculty mentors lead each group to ensure continuity and diversity over the two-year course of their meetings. A total of 57 out of 78 (73%) attended workshops to learn about the program and enhance their facilitation skills. Professional behaviors are explicitly emphasized in the materials outlining expectations of both students and faculty. Students are expected to attend, participate in and lead discussions, be constructive, respectful, and supportive, and accept/act on constructive feedback. Mentors are to facilitate the group's process, and provide feedback and guidance about the students' ideas and passions and the challenges they encounter. The faculty mentors will contribute descriptive material for the dean's letter on each student. We assessed student understanding of the definition of professionalism prior to the mentoring program and will follow up at regular intervals. Formative evaluation of the program includes surveys and focus groups with students and faculty to assess the effectiveness of the group process in accomplishing the stated goals of the program. DISCUSSION: Our medical school has committed resources, and our faculty and students have given thought, energy, and enthusiasm, to our mentoring program. This innovative new model has the potential to deepen and enrich the culture of medicine by providing a forum and skills for students to reflect on their own professional development and interact in a meaningful way with committed and skilled faculty who share similar interests.
Education, Medical, Undergraduate↗
A new functional status outcome measure of dyspnea and anxiety for adults with lung disease: the dyspnea management questionnaire.
PURPOSE: To develop and psychometrically test the Dyspnea Management Questionnaire (DMQ), a new multidimensional measure of dyspnea in adults with chronic obstructive lung disease. PARTICIPANTS: Eighty-five participants were recruited with diagnoses of chronic obstructive pulmonary disease (COPD, n = 73) and asthma (n = 12). The total sample was predominately female (65%) and married (34%), with 64.9% white and a mean age of 75 years (SD = 9.6, n = 76), diagnosed with pulmonary disease 4.8 years ago (SD = 4.4), 32% requiring the use of supplemental oxygen. Participants were also African American (29.9%), Asian (2.6%), and Hispanic (2.6%); n = 77. METHODS: An initial item pool of 74 items was drawn for the DMQ aided by qualitative interview data, literature review, and pilot testing with 3 adults with COPD. Several analyses were used to reduce the item pool. An interdisciplinary panel of 12 experts evaluated the content validity of the DMQ items. To evaluate test-retest reliability, respondents with stable COPD (n = 26) completed the questionnaire twice within a mean interval of 18 days (SD = 7.17). The DMQ was compared with the Medical Outcomes Study 12-Item Short-Form (SF-12) Health Survey, the Seattle Obstructive Lung Disease Questionnaire, and the Hospital Anxiety and Depression Scale. RESULTS: The resulting DMQ is a 30-item scale that measures 5 conceptually derived dimensions: dyspnea intensity, dyspnea-related anxiety, fearful activity avoidance, self-efficacy for activity, and satisfaction with strategy use. It has a 7-point Likert-type scale and third Flesch-Kincaid reading grade level. A panel of 12 experts supported the content validity of the DMQ. It showed high internal consistency (alpha = .87 to .96) and test-retest reliability over 2.5 weeks (intraclass correlation coefficient = 0.71 to 0.95). Dyspnea intensity, dyspnea-related anxiety, and fearful activity avoidance subscales of DMQ-30 and composite score were moderately to highly correlated with 3 Seattle Obstructive Lung Disease Questionnaire dimensions (r = 0.44-0.83), Medical Outcomes Study 12-Item Short-Form scales (r = 0.41-0.57), and Hospital Anxiety and Depression Scale-Anxiety (r = -0.59 to -0.65). Two of DMQ's subscales, self-efficacy for activity and satisfaction with strategy use, correlated mildly with Seattle Obstructive Lung Disease Questionnaire (r = 0.28 and 0.27, respectively). Some very low correlations for DMQ-30's satisfaction with strategy use compared with the Medical Outcomes Study 12-Item Short-Form provided preliminary support for its divergent construct validity. The DMQ-30 discriminated adults with COPD requiring supplemental oxygen from those not requiring it. CONCLUSIONS: The DMQ addresses the need for a more comprehensive, multidimensional assessment of dyspnea, especially for anxious patients with COPD, in order to better guide the appropriate application of dyspnea management interventions and measure pulmonary rehabilitation outcomes. The DMQ can help add insights into the benefit of adjunctive therapies such as psychoeducation, controlled breathing strategies, and cognitive-behavioral approaches in pulmonary rehabilitation for anxious patients with COPD.
Aged↗