Dyspnea perception in cystic fibrosis patients

We evaluated dyspnea perception in cystic fibrosis patients compared with normal subjects, during an inspiratory resistive loading test and 6-min walk test. We also evaluated the correlation between dyspnea scores induced by resistive loads and by the 6-min walk test. In this prospective, cross-sectional study, 31 patients with cystic fibrosis (≥15 years of age) and 31 age-, gender-, and ethnicity-matched healthy volunteers (20 females and 11 males per group) underwent inspiratory resistive loading, spirometry, and the 6-min walk test. As the magnitude of the inspiratory loads increased, dyspnea scores increased (P<0.001), but there was no difference between groups in dyspnea score (P=0.654). Twenty-six (84%) normal subjects completed all the resistive loads, compared with only 12 (39%) cystic fibrosis patients (P<0.001). Dyspnea scores were higher after the 6-min walk test than at rest (P<0.001), but did not differ between groups (P=0.080). Post-6-min walk test dyspnea scores correlated significantly with dyspnea scores induced by resistive loads. We conclude that dyspnea perception induced in cystic fibrosis patients by inspiratory resistive loading and by 6-min walk test did not differ from that induced in normal subjects. However, cystic fibrosis patients discontinued inspiratory resistive loading more frequently. There were significant correlations between dyspnea perception scores induced by inspiratory resistance loading and by the 6-min walk test. This study should alert clinicians to the fact that some cystic fibrosis patients fail to discriminate dyspnea perception and could be at risk for delay in seeking medical care.

Cálculo de Kt/V em hemodiálise: comparação entre fórmulas

INTRODUÇÃO: A qualidade da diálise oferecida aos pacientes em diálise pode ser mensurada pelo Kt/V, o qual pode ser calculado de diversas maneiras. OBJETIVO: Comparar os resultados de Kt/V obtidos por meio das fórmulas de Lowrie (L) e de Daugirdas (D) com os resultados mensurados pelo monitor de clearence on-line - Online Clearence Monitor (OCM). MÉTODO: Estudo observacional transversal com 59 pacientes em hemodiálise (HD). Os dados foram coletados na mesma sessão de diálise: (ureia pré-diálise e pós-diálise) e o resultado de Kt/V foi obtido pelo OCM da máquina Fresenius 4008S (Fresenius Medical Care AG, Bad Homburg, Alemanha). RESULTADO: Foram analisadas 95 sessões, em que prevaleceu o sexo masculino, 56% (33), com idade média de 57 + 14 anos. A hipertensão arterial com 42% (25), diabetes com 12% (7) e glomerulonefrite com 8% (5) foram as causas mais frequentes da doença renal crônica (DRC). O Kt/V médio obtido pela fórmula de L, de D e pelo OCM foi de 1,31; 1,41 e 1,32, respectivamente. A comparação entre as fórmulas de L e D mostra que há diferença estatística p = 0,008 com a correlação de Pearson de 0,950. Entre D e OCM a diferença também é significativa: p = 0,011 e r = 0,346, provavelmente devido a perda convectiva, avaliada pela equação de D e não observadas por OCM e L. A comparação entre L e OCM não foi significativa p = 0,999 e r = 0,577. CONCLUSÃO: Os dados sugerem que o OCM pode ser utilizado como um norteador para ajuste da dose de diálise em tempo real.

Early changes in serum albumin: impact on 2-year mortality in incident hemodialysis patients

AbstractIntroduction/objective:We evaluated the predictability of early changes in serum albumin (sAlb) on the two-year mortality of incident hemodialysis patients.Methods:Observational, longitudinal retrospective study using the database of Fresenius Medical Care of Latin America. Adult patients starting dialysis from January/2000 to June/2004, from 25 centers were included. Changes in sAlb during the first 3 months on hemodialysis were used as the main predictor. The outcome was death from any cause.Results:1,679 incident patients were included. They were 52 ± 15 years old, 58.7% male and 21.5% diabetic, with a median sAlb of 38 g/L (bromocresol green). 923 patients had sAlb < 38 g/L (Low sAlb Group) and 756 ones had sAlb > 38.0 g/L (Adequate sAlb Group). The mortality was significantly higher in Low sAlb Group (17% vs. 11%, p < 0.001). Early changes in sAlb significantly affected two-year mortality. Factoring the Kaplan Meier curve of Low sAlb Group by the presence of an increase in sAlb uncovered of a statistically significant difference in mortality favoring the ones whose sAlb went up (19% vs. 15%, p = 0.043). Differently, patients from Adequate sAlb Group with a decrease in their sAlb had a statistically higher mortality rate (13% vs. 8%, p = 0.029).Conclusions:Early sAlb changes showed a significant predictive power on mortality at 2 years in incident hemodialysis patients. Those with low initial sAlb may have a better prognosis if their sAlb rises. In contrast, patients with satisfactory initial levels can have a worsening of their prognosis in the case of an early reduction in sAlb.

Fantasiakirjallisuuden muuttuvia tyttöjä

Kirjallisuusarvostelu

Resolución No. 075. Por medio de la cual se decide el recurso de reposición y en subsidio de apelación

Servicios registrales

Resolución No. 084: Por la cual se resuelve un recurso de reposición y en subsidio de apelación

Servicios registrales

Wellspring: an intrinsic case study of community-based education for adults living with cancer /

This paper presents education research as vital to addressing the issues faced by adults living with cancer. This qualitative study looked at philosophies of practice for cancer patient education. It was about understanding how values and beliefs shape the way program planners and managers operationalize their knowledge of adult education and how this has significant impact on meeting the needs of those touched by cancer. Improved technology has extended life expectancy, so that Canadians living with cancer, or even dying with cancer now spend less time in direct medical care. The notion of cancer as simply a medical concern is outdated. This study found that informational and support needs of adults living with cancer are often unmet, ignored or unknown. This research investigated a community-based education initiative that is inviting, accessible, and promotes a sense of hope. More specifically, this case study uncovered factors contributing to the success of Wellspring, a grass-roots cancer patient support centre which has been recognized nationally for its ability to effectively meet the diverse non-medical supportive care needs of as many cancer patients and caregivers as possible. Therefore, Wellspring was selected as a case study. Educating people to take charge of their own lives and supporting them in making informed decisions about their lifestyle choices made Wellspring part of a social action movement that focused on improving social attitudes toward people living with cancer. Results of this descriptive inquiry and philosophical inquiry evolved into data that was used to devise an organic model of community-based education that encompasses Adler's (1993) four dimensions of philosophy within a socio-cultural context.

Niagara Region Hospital fonds, 1941-2003, n.d. (non-inclusive)

The fonds contains materials relating to The St. Catharines General Hospital, from 1941-2003 (non-inclusive). The materials included are meeting minutes, reports, media releases and correspondence media packages and some photographs. There are also a few short books put together on the history of the Mack Training School for Nurses and the Shaver Hospital. Material within folders has retained its original order. Many of the folders contain more than one type of material, for example media releases, clippings, correspondence etc. The most prominent form of material within the folder is what dictates the folder title. Sub-series within a series have been arranged alphabetically. Folders within a sub-series have been arranged chronologically.

Intellectual property rights and the campaign for access to essential medicines : the advocacy role assumed by Médecins Sans Frontières

Non-governmental organizations and transnational networks have been increasingly successful a t gaining influence within issue areas traditionally controlled by the state. In many instances, non-state actors have been instrumental in forcing issues onto the global agenda, have aided in the development or transformation of global regimes, and have participated in securing state compliance for the adoption of new international norms. This paper argues that, consistent with social constructivist theory, ideas are important in influencing state preferences and change may be possible when certain factors are present. I f non-state actors can influence states, it is meaningful to understand how this happens. This paper focuses on a campaign led by Medecins Sans Frontieres that began in the late 1990s to acquire affordable medicines for patients in developing states that could not afford patented drugs. The campaign reached a measure of success in that member states of the World Trade Organization re-negotiated contested terms and meanings within the trade agreement for intellectual property rights and allowed concessions that would benefit lower income states. What factors contributed to the success of the campaign? And what were the most important factors - the issue, the actors or the mechanisms used?

National Intelligencer Vol. XIII, No. 1984- June 8, 1813

The Intelligencer was an American newspaper that was established, in 1800, in Washington by Samuel Harrison Smith, a young Jeffersonian- Republican from Philadelphia. The paper was a supporter of the Jefferson and Madison administrations until 1810 when it was sold to Joseph Gales Jr. from North Carolina. In 1812 William Seaton joined Gales as a publishing partner. This paper made significant contributions to the nation and wielded considerable influence in political circles during its publication. It has been praised for its "high standard of journalistic excellence and high intellectual level of its contents". (William E. Ames , National Intelligencer: Washington's Leading Political Newspaper) The Intelligencer was, until 1810, named the National Intelligencer, and Washington Advertiser. It was a tri-weekly paper and had a peak circulation of 6, 000. Publication was suspended in 1869.

National Intelligencer Vol. XIII, No. __91- June 24, 1813

The Intelligencer was an American newspaper that was established, in 1800, in Washington by Samuel Harrison Smith, a young Jeffersonian- Republican from Philadelphia. The paper was a supporter of the Jefferson and Madison administrations until 1810 when it was sold to Joseph Gales Jr. from North Carolina. In 1812 William Seaton joined Gales as a publishing partner. This paper made significant contributions to the nation and wielded considerable influence in political circles during its publication. It has been praised for its "high standard of journalistic excellence and high intellectual level of its contents". (William E. Ames , National Intelligencer: Washington's Leading Political Newspaper) The Intelligencer was, until 1810, named the National Intelligencer, and Washington Advertiser. It was a tri-weekly paper and had a peak circulation of 6, 000. Publication was suspended in 1869.

National Intelligencer Vol. XIII, No. 1993- June 29, 1813

The Intelligencer was an American newspaper that was established, in 1800, in Washington by Samuel Harrison Smith, a young Jeffersonian- Republican from Philadelphia. The paper was a supporter of the Jefferson and Madison administrations until 1810 when it was sold to Joseph Gales Jr. from North Carolina. In 1812 William Seaton joined Gales as a publishing partner. This paper made significant contributions to the nation and wielded considerable influence in political circles during its publication. It has been praised for its "high standard of journalistic excellence and high intellectual level of its contents". (William E. Ames , National Intelligencer: Washington's Leading Political Newspaper) The Intelligencer was, until 1810, named the National Intelligencer, and Washington Advertiser. It was a tri-weekly paper and had a peak circulation of 6, 000. Publication was suspended in 1869.

National Intelligencer, 10 November 1812 (vol. 13, no. 1895) - Newspaper

The Intelligencer was an American newspaper that was established in Washington by Samuel Harrison Smith, a young Jeffersonian-Republican from Philadelphia. The paper was a supporter of the Jefferson and Madison administrations until 1810 when it was sold to Joseph Gales Jr. from North Carolina. In 1812 William Seaton joined Gales as a publishing partner. The paper made significant contributions to the nation and wielded considerable influence in political circles during its publication

Elisha B. Sherwood letter, February 26, 1845

Elisha Barber Sherwood (1810-1905) was a Presbyterian minister. He began his career as a minister in the Church at Wilson, Niagara County, N.Y., subsequently becoming pastor at various churches in New York, Michigan, and Missouri. He is the author of Fifty Years on the Skirmish Line, a review of his ministerial work.