Exercise-based interventions and health-related quality of life in intermittent claudication: a 20-year (1989-2008) review.

Peripheral arterial disease (PAD) is a chronic, progressive disease with significant cardiovascular risk. Symptoms include pain in leg muscles on walking, relieved by rest (intermittent claudication). Treatment aims to maintain or improve quality of life (QoL) by minimising ischaemic symptoms and preventing progression to vascular occlusion. Management strategies include exercise-based interventions. Research from 1989 to 2008 was systematically reviewed to identify the QoL impact of exercise-based interventions in patients with intermittent claudication. Twenty-three studies were identified. Five were randomized controlled trials. Studies were summarized in terms of exercise interventions, QoL measures used and QoL findings. The majority used a generic QoL instrument; most commonly the Short Form Health Survey (SF-36). Eleven studies reported beneficial effects on the SF-36 Physical Functioning scale. Some also reported positive effects on the scales of Bodily Pain, Role-Physical, Vitality, General Health and the Physical Component Score. In seven studies, a disease-specific measure was used. In six of these, both generic and disease-specific questionnaires were used. Disease-specific measures demonstrated greater improvements across a range of QoL domains. Greater use of disease-specific measures and an extended follow-up period may enable a more definitive picture to emerge regarding effects of exercise on QoL in intermittent claudication

Quality of Life and Functional Capacity following Peripheral Arterial Disease Exercise Programme

Peripheral arterial disease (PAD) is a manifestation of generalised atherosclerotic disease in which the arterial lumen becomes progressively narrowed by atherosclerotic plaques. This results in reduced blood flow to the tissues causing pain on exercise, relieved by rest (Intermittent Claudication [IC]). As PAD is a chronic, progressive disease with a significant cardiovascular and cerebrovascular risk burden it has a considerable impact on functional capacity and quality of life (QOL). Current evidence suggests that 27 million people in Europe and North America have PAD1. The main aim of treatment is maintenance or improvement in quality of life by eliminating ischaemic symptoms and preventing progression to vascular occlusion. The use of patient-based measures of treatment effect including functional capacity and disease-specific quality of life questionnaires has been recommended

An exercise programme for patients with intermittent claudication: randomised trial of health outcomes and cost analysis

As peripheral arterial disease (PAD) is a chronic, progressive disease with a significant cardiovascular and cerebrovascular risk burden, it has a considerable impact on functional capacity and quality of life (QoL). Exercise programmes result in significant improvements in walking distances but these correlate poorly with patient-reported functioning and QoL and the long-term outcomes are unknown. The aim of this study was to assess the long-term (one year) effects of participation in a 12-week supervised exercise programme for patients with intermittent claudication (IC). Primary outcome measures were the effects on disease-specific aspects of quality of life, functional capacity and cardiovascular risk factors. Secondary outcome measures were the effects on generic aspects of quality of life and a cost analysis of the exercise intervention. Patients were recruited from the Vascular Clinics (Beaumont Hospital) and randomly allocated to a Control (n= 16) or an Exercise (n=28) group. Data regarding cardiovascular risk factors, functional capacity (Walking Impairment Questionnaire WIQ), disease-specific QoL (Intermittent Claudication Questionnaire ICQ) and generic QoL (SF-36) were collected at baseline, 12 weeks and one year. Costs of participation in the exercise programme were measured. The final numbers available for analysis at 12 weeks were 31 (Exercise n=17 and Control n=14) and at one year were 30 (Exercise n=17 and Control n=13). At 12 weeks, there was a trend towards improved QoL in both groups, greater in the Exercise group (p=.066) and a trend towards improvement in functional capacity (WIQ Stair-climbing p=.093) in the Exercise group. At one year, improvements in the Exercise group (although reduced from those recorded immediately following completion of the exercise programme) were maintained from baseline. Scores in the Control group at one year reflected a continuing deterioration in QoL and functional capacity. There were no significant changes in cardiovascular risk factors. Cost associated with the exercise intervention were calculated. The implications for clinical practice and service delivery within the Irish healthcare system are discussed

Recruitment to clinical trials of exercise: challenges in the peripheral arterial disease population.

OBJECTIVES: To describe recruitment to a randomised controlled trial of a 12-week (twice-weekly) supervised exercise programme for patients with peripheral arterial disease (PAD). PAD is a chronic, progressive disease with a significant cardiovascular and cerebrovascular risk burden, and exercise is an effective primary management approach. METHOD: Potential patients were identified from the Non-Invasive Vascular Laboratory records and invited to participate in the study. On successful completion of an incremental treadmill exercise test, patients were allocated at random to a control (usual care) or an exercise group. RESULTS: Between November 2006 and June 2009, 548 patients were identified. Of the 156 patients who met the inclusion criteria, 40 (26%) declined to participate. Of the 71 patients who underwent exercise testing, 23 (32%) did not complete the test. The final enrolment number was 44 (44/156; 28%). Eleven patients (11/28; 39%) subsequently withdrew from the exercise programme. CONCLUSION: Recruitment to clinical trials of exercise presents significant challenges in the PAD population due to the presence of co-existing cardiovascular and cerebrovascular disease, a reluctance to exercise due to leg pain, and an acceptance of reduced mobility as part of ageing. Early identification in primary care before the onset of significant comorbidity may ameliorate some of these issues

Recruitment to Exercise Programmes: Challenges in the Peripheral Arterial Disease Population

Current evidence suggests that 27 million people in Europe and North America have peripheral arterial disease (PAD). Although only 3% of patients with intermittent claudication (IC) require amputation, a significant number will require hospital admission and other surgical intervention for IC and associated cardiac and cerebrovascular complications. An important aim of exercise therapy in the peripheral arterial disease population is to decrease cardiovascular risk factors and consequent morbidity and mortality. Several studies have demonstrated that exercise programmes result in significant improvements in walking distances but the long-term benefits are unknown. A randomised controlled trial is currently being conducted in Beaumont Hospital to determine the effects of a supervised exercise programme on quality of life, risk factor modification and morbidity and mortality in patients with PAD

The prevalence of violence encountered by community physiotherapists in Ireland.

The Health and Safety Authority of Ireland has recognised violence towards health workers as an occupational hazard. However no research examining the issue of violence against physiotherapists in Ireland exists. The aim of this study was to establish the prevalence of violence encountered by community physiotherapists in Ireland and to identify any influential factors. A descriptive cross-sectional questionnaire was distributed to all 103 members of the Chartered Physiotherapists in Community Care (CPCC) group. Topic sections were: personal details and area of work, incidents of violence, reporting of incidents, workplace provisions and referrals. The majority of respondents (94%) reported that they felt safe in their job as a community physiotherapist. However 73% (n=51) had experience of violent incidents whilst working in the community. All of these physiotherapists experienced verbal aggression and ten had also experienced physical assault. The fact that the physiotherapist was seen as a representative of the health system was the most common reason given for the aggression. Of the 51 physiotherapists who had experienced any incident of violence, only 17 (33%) had reported it to a member of staff. Only 24 physiotherapists (34%) had received specific training or education on how to deal with violent work situations

Chemotherapy induced peripheral neuropathy: the modified total neuropathy score in clinical practice.

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) is a common, potentially reversible side effect of some chemotherapeutic agents. CIPN is associated with decreased balance, function and quality of life (QoL). This association has to date been under-investigated. AIMS: To profile patients presenting with CIPN using the modified Total Neuropathy Score (mTNS) in this cross-sectional study and to examine the relationship between CIPN (measured by mTNS) and indices of balance, quality of life (QoL) and function. METHODS: Patients receiving neurotoxic chemotherapy regimens were identified using hospital databases. Those who did not have a pre-existing neuropathy were invited to complete mTNS, Berg Balance Scale (BBS), timed up and go (TUG), and FACT-G QoL questionnaire. mTNS scores were profiled and also correlated with BBS, TUG and FACT-G using Spearmans correlation coefficient. RESULTS: A total of 29 patients undergoing neurotoxic chemotherapy regimens were tested. The patients mTNS scores ranged between 1 and 12 (median = 5), indicating that all patients had clinical evidence of neuropathy on mTNS. No significant correlations were found between mTNS and BERG (r = -0.29), TUG (r = 0.14), or FACT-G (r = 0.05). CONCLUSIONS: This study found a high prevalence of CIPN in patients treated with neurotoxic chemotherapy regimens. The mTNS provided a clinically applicable, sensitive screening tool for CIPN which could prove useful in clinical practice. mTNS did not correlate with BBS, TUG or FACT-G in this sample, possibly due to relatively mild levels of CIPN and consequent subtle impairments which were not adequately captured by gross functional assessments

Morphometric affinities and direct radiocarbon dating of the Toca dos Coqueiros’ skull (Serra da Capivara, Brazil)

The biological variation of the earliest skeletons of South America has been intensely debated for the last two centuries. One of the major research constraints has been the limited number of available samples dating to the early Holocene. We here present the first direct radiocarbon-date for the early Holocene human skeleton from Toca dos Coqueiros (Serra da Capivara, Brazil), also known as “Zuzu” (8640 ± 30 BP; 9526–9681 cal years BP). We performed craniometric analyses using exclusively samples from Brazil, to revisit the sex of the skeleton, and to discuss the evolutionary processes involved in the occupation of the continent. The sex of the individual was estimated as a female when compared to late and early Holocene individuals, but as a male when compared only to the early Holocene series. We also found that Zuzu presents the strongest differences with the late Holocene Guajajara individuals, located nearby, and the strongest similarities with the early Holocene series from Lagoa Santa, attesting for solid biological affinities among early Holocene individuals from Brazil, as well as a moderate level of morphological variation among them. This suggests that the early individuals were part of the same heterogeneous lineage, possibly a different one from which late Holocene populations diverged.Fil: Menendez, Lumila Paula. Universidad de Viena; Austria. Universitat Bonn; AlemaniaFil: López Sosa, María Clara. Universitat Bonn; AlemaniaFil: Monteiro da Silva, Sergio Francisco Serafim. Universidade Federal de Pernambuco; BrasilFil: Martin, Gabriela. No especifíca;Fil: Pessis, Anne Marie. No especifíca;Fil: Guidon, Niède. No especifíca;Fil: Solari, Ana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Intérêts du dosage sérique de la procalcitonine dans la leptospirose

BESANCON-BU Médecine pharmacie (250562102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF