9,396 research outputs found

    Breathlessness in the elderly during the last year of life sufficient to restrict activity

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    OBJECTIVES: Breathlessness is prevalent in older people. Symptom control at the end of life is important. This study investigated relationships between age, clinical characteristics and breathlessness sufficient to have people spend at least one half a day in that month in bed or cut down on their usual activities (restricting breathlessness) during the last year of life. DESIGN: Secondary data-analysis SETTING: General community PARTICIPANTS: 754 non-disabled persons, aged 70 and older. Monthly telephone interviews were conducted to determine the occurrence of restricting breathlessness. The primary outcome was the percentage of months with restricting breathlessness reported during the last year of life. RESULTS: Data regarding breathlessness were available for 548/589 (93.0%) decedents (mean age 86.7 years (range 71 to 106; males 38.8%). 311/548 (56.8%) reported restricting breathlessness at some time-point during the last year of life but no-one reported this every month. Frequency increased in the months closer to death irrespective of cause. Restricting breathlessness was associated with anxiety, (0.25 percentage point increase in months breathlessness per percentage point months reported anxiety, 95% CI 0.16 to 0.34, P<0.001), depression (0.14, 0.05 to 0.24, P=0.002) and mobility problems (0.07, 0.03 to 0.1, P=0.001). Percentage months of restricting breathlessness increased if chronic lung disease was noted at the most recent comprehensive assessment (6.62 percentage points, 95% CI 4.31 to 8.94, P<0.001), heart failure (3.34, 0.71 to 5.97, P<0.01), and ex-smoker status (3.01, 0.94 to 5.07, P=0.002), but decreased with older age (─0.19, ─0.37 to ─0.02, P=0.03). CONCLUSION: Restricting breathlessness increased in this elderly population in the months preceding death from any cause. Breathlessness should be assessed and managed in the context of poor prognosis

    A Comparison of Competitive-Orientation Measures

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    We compared two sport-specific measures of competitive orientation, the Sport Orientation Questionnaire (SOQ; Gill & Deeter, 1988) and the Competitive Orientation Inventory (COI; Veasley, 1986), and an alternative 4-item version of the COI. Male and female athletes and nonathletes at two small colleges completed questionnaire packets. Competitive-orientation scores were similar to those reported in previous research. The 4-item measure correlated with the COI, and neither of those measures correlated with the SOQ. As in previous studies, males scored higher than females on SOQ competitiveness and win orientation, and athletes scored higher than nonathletes on all SOQ scores. Our results suggest that the SOQ and COI do not assess the same competitive-orientation constructs. The SOQ assesses sport-specific achievement orientation; the COI assesses the relative importance of performance versus outcome. Our 4-item measure is comparable and provides a reasonable substitute for the more complex COI

    Competitive Orientations and Motives of Adult Sport and Exercise Participants

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    Participants in four different adult sport and exercise programs (running club, exercise classes, cardiac rehabilitation program, senior games) completed measures of competitive orientation and participation motivation. Our samples were older and more diverse than samples of previous research, and their competitive orientations and motives were similarly diverse. Multivariate analyses revealed gender and sample differences. Males were higher than females on competitiveness and win orientation, and runners were less win-oriented than other groups, but overall, all groups were similar to previous college-age samples in competitive orientation. Groups varied on specific motives, with females rating fitness, flexibility, affiliation, and appearance higher than males did. Generally, participants were diverse in orientations and motives, and positive about their participation. Research and conceptual models of sport orientation must extend beyond achievement motives to capture the diversity of adult participants. Program directors and instructors who offer activities and approaches to match this diversity will encourage wider participation and provide a more satisfying experience for more participants

    Does bariatric surgery prior to total hip or knee arthroplasty reduce post-operative complications and improve clinical outcomes for obese patients? Systematic review and meta-analysis.

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    AIMS: Our aim was to determine whether, based on the current literature, bariatric surgery prior to total hip (THA) or total knee arthroplasty (TKA) reduces the complication rates and improves the outcome following arthroplasty in obese patients. METHODS: A systematic literature search was undertaken of published and unpublished databases on the 5 November 2015. All papers reporting studies comparing obese patients who had undergone bariatric surgery prior to arthroplasty, or not, were included. Each study was assessed using the Downs and Black appraisal tool. A meta-analysis of risk ratios (RR) and 95% confidence intervals (CI) was performed to determine the incidence of complications including wound infection, deep vein thrombosis (DVT), pulmonary embolism (PE), revision surgery and mortality. RESULTS: From 156 potential studies, five were considered to be eligible for inclusion in the study. A total of 23 348 patients (657 who had undergone bariatric surgery, 22 691 who had not) were analysed. The evidence-base was moderate in quality. There was no statistically significant difference in outcomes such as superficial wound infection (relative risk (RR) 1.88; 95% confidence interval (CI) 0.95 to 0.37), deep wound infection (RR 1.04; 95% CI 0.65 to 1.66), DVT (RR 0.57; 95% CI 0.13 to 2.44), PE (RR 0.51; 95% CI 0.03 to 8.26), revision surgery (RR 1.24; 95% CI 0.75 to 2.05) or mortality (RR 1.25; 95% CI 0.16 to 9.89) between the two groups. CONCLUSION: For most peri-operative outcomes, bariatric surgery prior to THA or TKA does not significantly reduce the complication rates or improve the clinical outcome. This study questions the previous belief that bariatric surgery prior to arthroplasty may improve the clinical outcomes for patients who are obese or morbidly obese. This finding is based on moderate quality evidence. Cite this article: Bone Joint J 2016;98-B:1160-6
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