PREDICTING WALKING-INDUCED OXYGEN DESATURATIONS in COPD PATIENTS: A STATISTICAL MODEL.
PREDICTING WALKING-INDUCED OXYGEN DESATURATIONS IN COPD PATIENTS: A STATISTICAL MODEL.
Filed under: Rehab Centers
Respir Care. 2013 Jan 29;
Crisafulli E, Iattoni A, Venturelli E, Siscaro G, Beneventi C, Cesario A, Clini EM
BackgroundOxygen desaturation during walking can have important consequence on prognosis of COPD patients. However, a standard 6-minute walking test (6MWT) useful to detect walking desaturators (WD(+)), can be difficult to execute in some settings of COPD management, as in the community health care service. Aim of our study was to validate and evaluate the accuracy of a newly composed score of risk of oxygen desaturation during walking in COPD patients: the Walking Desaturation Score-WDS.MethodsData on symptomatic COPD inpatients admitted for rehabilitation (derivation cohort) and outpatients referred to the local community health service (validation cohort) were recorded. By pulse-oximetry oxygen saturation (SpO(2)) was monitored during 6MWT to obtain minimal values (SpO(2) nadir); patients were thus divided into WD(+)or non-desaturators (WD(-)). By a regression analysis model we have assigned a weighted score proportional to the measured percentage of explained variance for each variable. Risk estimate was computed by odds ratio (OR). A Receiver Operating Curve (ROC) analysis and a Hosmer-Lemeshow (HL) goodness of fit test were then performed to measure discrimination and calibration of WDS.ResultsBaseline characteristics in derivation (n=435, WD(+) 74%) and validation (n=238, WD(+) 37%) cohorts were different. Resting arterial oxygen saturation-SO(2), arterial partial pressure of oxygen-PaO(2) and forced expiratory volume in the 1(st) second-FEV(1) % pred. were the variables predicting walking desaturation. The proportion of WD(+) patients (and OR estimate) gradually increased according to WDS (range 0 to 6) and associated categories of desaturation risk (low 0-1 in total score of WDS, high 2-3, and very high 4-6) (X(2)0.001). A considerable predictive discrimination (area under curve-AUC 0.90, 95% CI 0.86 to 0.93, P< 0.001) and calibration (HL X(2) 1.31, P=0.859) values have been shown.ConclusionsWDS accurately predicts and classifies the risk of walking desaturation in COPD patients. HubMed – rehab
Pulsed electromagnetic fields on postmenopausal osteoporosis in southwest China: A randomized, active-controlled clinical trial.
Filed under: Rehab Centers
Bioelectromagnetics. 2013 Jan 29;
Liu HF, Yang L, He HC, Zhou J, Liu Y, Wang CY, Wu YC, He CQ
A randomized, active-controlled clinical trial was conducted to examine the effect of pulsed electromagnetic fields (PEMFs) on women with postmenopausal osteoporosis (PMO) in southwest China. Forty-four participants were randomly assigned to receive alendronate or one course of PEMFs treatment. The primary endpoint was the mean percentage change in bone mineral density of the lumbar spine (BMDL), and secondary endpoints were the mean percentage changes in left proximal femur bone mineral density (BMDF), serum 25OH vitamin D3 (25(OH)D) concentrations, total lower-extremity manual muscle test (LE MMT) score, and Berg Balance Scale (BBS) score. The BMDL, BMDF, total LE MMT score and BBS score were recorded at baseline, 5, 12, and 24 weeks. Serum concentrations of 25(OH)D were measured at baseline and 5 weeks. Using a mixed linear model, there was no significant treatment difference between the two groups in the BMDL, BMDF, total LE MMT score, and BBS score (P???0.05). For 25(OH)D concentrations, the effects were also comparable between the two groups (P???0.05) with the Mann-Whitney’s U-test. These results suggested that a course of PEMFs treatment with specific parameters was as effective as alendronate in treating PMO within 24 weeks. Bioelectromagnetics. © 2013 Wiley Periodicals, Inc.
HubMed – rehab
European Stroke Organisation Recommendations to Establish a Stroke Unit and Stroke Center.
Filed under: Rehab Centers
Stroke. 2013 Jan 29;
Ringelstein EB, Chamorro A, Kaste M, Langhorne P, Leys D, Lyrer P, Thijs V, Thomassen L, Toni D,
In the recent Helsingborg declaration, acute organized stroke unit care was described as the backbone of the chain of care for all European stroke victims. Access to stroke units is, however, still limited. To improve the availability and the quality of affordable stroke care, the European Stroke Organisation (ESO) has appointed an ESO Stroke Unit Certification Committee to define the requirements and criteria for official certification as ESO Stroke Units and ESO Stroke Centres based on scientific evidence from randomized controlled trials, clinical practice guidelines, and expert consensus. Important features of modern stroke care include the presence of a dedicated stroke unit ward, a multiprofessional team approach, a comprehensive stroke unit organization, including emergency room organization, adherence to diagnostic and therapeutic time-windows, early swallowing diagnostics and therapy, intravenous thrombolytic therapy, periods of automated monitoring, access to decrompressive craniectomy and intraarterial thrombolysis, early mobilization and rehabilitation, supported discharge and basic aftercare with treatment of risk factors and poststroke prevention. The Committee defined the target population, the necessary infrastructure, technical equipment, diagnostic pathways, therapeutic interventions, nursing care, and multiprofessional rehabilitation. The definitions also cover the hospital environment characteristics and the stroke unit’s interactions with other departments. Quality indicators for benchmarking are presented. Although the ESO Stroke Unit’s requirements are largely evidence-based, expert consensus is also included where evidence was unavailable. These recommendations of the ESO task force should stimulate hospitals in Europe to apply for ESO certification. Fulfilling of the criteria will be checked by on-site visits.
HubMed – rehab
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