Patients' perspectives on point-of-care diagnostics and treatment by emergency medical technicians in acute COPD exacerbations: A qualitative study.

BACKGROUND: In Denmark emergency medical technicians transport patients with acute COPD exacerbations to the nearest emergency department. From a clinical and economic perspective, this transport and assessment at the hospital may be inconvenient if the patient is immediately discharged from the emergency department. We established an emergency technical technicians point-of-care diagnostics and treatment program of patients with COPD with use of ultrasound and blood analysis. Patients' perspectives on treatment at home and sense of security are important to qualify clinical practice at home with patients with acute exacerbation. AIM AND OBJECTIVES: To explore patient's and relatives' experience of treatment at home during emergency calls due to COPD in exacerbation and to investigate their attitude to avoid hospitalization as well as experience of stress during point-of-care diagnostics in their own home. METHOD: A qualitative study comprising semi-structured interviews with 16 patients carried out from April 1st, 2019 to March 31st, 2020 in Denmark. Data was analysed inspired by Malteruds' text condensation and informed by Critical Psychology with first person perspective focusing on the patient's views on point-of-care diagnostics and treatment of their COPD in acute exacerbation. RESULTS: The interviews revealed that in order to ensure an experience of quality in the assessment and treatment of patients in their own homes, it was important that the ambulance staff showed great safety and experience in the use of the technical equipment and treatment of dyspnea. It was also of importance that the patients felt confident that their general practitioner followed up on the home treatment initiated. CONCLUSION: Patients' perspectives showed that point-of-care diagnostics and treatment of acute COPD in exacerbation was considered a qualitative offer by the patients and their relatives. At the same time, it was crucial that the emergency medical technicians showed experience and safety in handling shortness of breath as well as the technical equipment. TRIAL REGISTRATION: Approved by the Danish Data Protection Agency Project-ID: 20/24845.

Lipoic acid improves nerve blood flow, reduces oxidative stress, and improves distal nerve conduction in experimental diabetic neuropathy.

OBJECTIVE: To determine whether lipoic acid (LA) will reduce oxidative stress in diabetic peripheral nerves and improve neuropathy. RESEARCH DESIGN AND METHODS: We used the model of streptozotocin-induced diabetic neuropathy (SDN) and evaluated the efficacy of LA supplementation in improving nerve blood flow (NBF), electrophysiology, and indexes of oxidative stress in peripheral nerves affected by SDN, at 1 month after onset of diabetes and in age-matched control rats. LA, in doses of 20, 50, and 100 mg/kg, was administered intraperitoneally five times per week after onset of diabetes. RESULTS: NBF in SDN was reduced by 50%; LA did not affect the NBF of normal nerves but improved that of SDN in a dose-dependent manner. After 1 month of treatment, LA-supplemented rats (100 mg/kg) exhibited normal NBF. The most sensitive and reliable indicator of oxidative stress was reduction in reduced glutathione, which was significantly reduced in streptozotocin-induced diabetic and alpha-tocopherol-deficient nerves; it was improved in a dose-dependent manner in LA-supplemented rats. The conduction velocity of the digital nerve was reduced in SDN and was significantly improved by LA. CONCLUSIONS: These studies suggest that LA improves SDN, in significant part by reducing the effects of oxidative stress. The drug may have potential in the treatment of human diabetic neuropathy.

Localization and expression of ciliary neurotrophic factor (CNTF) in postmortem sciatic nerve from patients with motor neuron disease and diabetic neuropathy.

Ciliary neurotrophic factor (CNTF) is thought to play an important role in the maintenance of the mature motor system. The factor is found most abundantly in myelinating Schwann cells in the adult sciatic nerve. Lack of neuronal growth factors has been proposed as one possible etiology of amyotrophic lateral sclerosis (ALS) and spinal muscular atrophy (SMA). Growth factor replacement therapies are currently being evaluated as a treatment for motor neuron disease. In this report we determined whether the expression of CNTF in sciatic nerve differed in patients with motor neuron disease compared to controls or patients with another form of axonopathy. We identified 8 patients (7 with ALS and 1 with SMA) with motor neuron disease and 6 patients with diabetic motor neuropathy who had autopsy material available. Immunoperoxidase staining showed reduced CNTF expression in nerves of patients with motor neuron disease but not in patients with diabetic motor neuropathy. Decreased CNTF appears be associated with primary motor neuron disease rather than a generalized process of axon loss. This result supports suggestions that CNTF deficiency may be an important factor in the development of motor neuron disease.

Pain perception and coping in female tension headache sufferers and headache-free controls.

The purpose of this study was to investigate how headache sufferers and headache-free controls differ in their responses to acute pain. Thirty-three women completed the study (15 headache sufferers and 18 controls). The cold pressor was used to induce pain, and a partially inflated blood pressure cuff was used as a nonpainful comparison task. Headache sufferers reported more discomfort during both tasks; however, the 2 groups did not differ in the number of facial expressions of pain displayed during the tasks. Headache sufferers reported a tendency to catastrophize during both tasks; positive coping did not differ between the 2 groups. These results offer evidence that recurrent tension headache sufferers are more sensitive to both painful and nonpainful stimuli and that they cope differently from controls with these physical stressors.

Effects of 24-hour ambulatory blood pressure monitoring on daily activities.

Compared the self-monitored activities, locations, and postural positions of 28 hypertensives while they wore an alarm watch and then while they wore a 24-hr ambulatory blood pressure monitor (ABPM) to see if wearing the ABPM led to alterations in behavior. Within the limitations of the study (no counterbalancing of order and twice as many ABPM measures as watch measures), we found significant differences in frequency of being at home or in miscellaneous settings, in standing and reclining positions, and in mental, physical and miscellaneous activities between the two occasions.

A controlled comparison of thermal biofeedback and relaxation training in the treatment of essential hypertension: II. Effects on cardiovascular reactivity.

In the course of conducting a controlled comparison of progressive muscle relaxation and thermal biofeedback as possible substitutes for second-stage (sympatholytic) antihypertensive medications, we measured reactivity (heart rate, systolic blood pressure, and diastolic blood pressure) to three different stressors (mental arithmetic, cold pressor, and negative mental imagery) before and after treatment and drug withdrawal. Neither treatment was consistently effective in reducing reactivity across a variety of stressors. Relaxation led to more reductions in some aspect of reactivity than did biofeedback. The modest level of reductions in reactivity were seen more for mental arithmetic and systolic blood pressure.

The USA-USSR collaborative cross-cultural comparison of autogenic training and thermal biofeedback in the treatment of mild hypertension.

We have conducted a cross-cultural (USA and USSR) comparison of thermal biofeedback (TBF) and autogenic training (AT) to a self-relaxation control condition in 59 unmedicated males with mild hypertension. Identical assessment and treatment protocols were carried out in both settings (Albany, New York, and Moscow). Treatments were delivered in small groups on an outpatient basis twice per week for 10 weeks. Results showed comparable, significant (p less than .05), short-term decreases (M = 8.5 mm Hg) in diastolic blood pressure (DBP) for both treatments at both sites. However, the Soviet patients, starting with significantly (p less than .01) higher systolic blood pressures (SBPs), showed significant decreases (M = 12.8 mm Hg) in SBP, whereas the American patients did not change appreciably (M = 4.6 mm Hg). During follow-up, the treated Soviet patients showed significantly (p less than .05) better maintenance of treatment effects, from 3 months to 1 year, than did the American patients. At 1 year, 75% of the treated Soviet patients had DBPs less than 90 mm Hg, whereas only 24% of the American patients had comparable DBPs.

Differences in daily stress, mood, coping, and eating behavior in binge eating and nonbinge eating college women.

This study investigated differences between binge eaters and controls on measures of daily stress, mood, coping, and eating behavior. The same measures were also used to compare binge days to nonbinge days for the binge group. Participants included 20 college women who reported binge eating at least two times per week and 20 women who reported no disturbance in their eating behavior. They were asked to self-monitor their daily stress, coping, mood, and eating behavior for three weeks. Results indicated that the binge group reported more stress and negative mood over the three weeks than the control group. The binge group reported experiencing a similar number of stressful events on binge days as compared to nonbinge days, however, the impact of those events was much greater on binge days. The binge eaters also reported less positive mood and more episodes of eating on binge days. The groups did not differ in the number of coping strategies used. Stress and negative mood appear to be common antecedents for binge eating. The role of coping responses and daily eating behavior (i.e., restraint) on binge eating is somewhat less clear.

Scanning electron microscopy of Leucochloridiomorpha constantiae during development from metacercaria to adult.

Scanning electron microscopy revealed that the tegument of Leucochloridiomorpha constantiae metacercariae was marked with interconnected longitudinal and transverse ridges. Alteration of the ridges began within 1 hr after implantation into the chick coelom. Ridges were completely lost by the 4th hr, leaving a smooth tegument. Body shape altered from that of a tapered metacercaria to a plump, rounded adult within 3 days, and was accompanied by doubling of the acetabular diameter. Papillae, present in both the metacercaria and adult, were located on the suckers, genital orifice, and body surface. The microtopography of the tegument consisted of knoblike protuberances that gave the surface a cobblestonelike appearance. Tegumental knobs in te vicinity of the genital pore contained minute, rounded inclusions.

Histochemistry and ultrastructure of the metacercarial cyst of Bolbogonotylus corkumi (Trematoda: Cryptogonimidae).

Histochemical and ultrastructural studies were conducted on the metacercarial cyst of the cryptogonimid trematode Bolbogonotylus corkumi from the muscle tissue of fantail darters Etheostoma flabellare. The metacercarial cyst consisted of an outer host capsule and an inner parasite cyst. The host capsule was composed of an outer region of fibroblasts, collagen, macrophages, and unidentified cells, and an inner region containing degenerating cells. The parasite cyst was thin, homogenous, and noncellular in nature. The host capsule stained strongly for connective tissue and proteins and moderately for lipids, nucleic acids, nonspecific esterase activity, and acid and alkaline phosphatase activities. The parasite cyst stained intensely for acid mucopolysaccharides and moderately for acid phosphatase activity. A thick glycocalyx occurred between the parasite cyst and metacercarial tegument.

Histochemistry and ultrastructure of the metacercarial cysts of blackspot trematodes Uvulifer ambloplitis and Neascus pyriformis.

Cysts of Uvulifer ambloplitis from green sunfish, Lepomis cyanellus, and Neascus pyriformis from red shiners, Notropis lutrensis, were studied with light-level histochemistry and scanning and transmission electron microscopy. Cysts of both species are bilayered, consisting of an outer host capsule and an inner parasite cyst; the space between these layers is filled with a viscous material. The outer portion of the host capsule of both species is composed of fibrocytes, melanin granules, and collagen fibrils, and the inner portion of layers of flattened fibrocytes. The parasite cyst of U. ambloplitis is formed of 2 layers, an outer dense layer and an inner light layer, whereas the parasite cyst of N. pyriformis is made of 3 layers. A thin outer light-staining layer is present in addition to the 2 layers observed in U. ambloplitis. Results of histochemical staining were the same for both species. The host capsule stained positively for proteins and neutral and acid mucopolysaccharides. The viscous material was positive for neutral and acid mucopolysaccharides but not for proteins. The parasite cyst gave a strong positive reaction for neutral mucopolysaccharides but was negative for acid mucopolysaccharides and proteins.

Erectile dysfunction in men with chronic medical illness.

This study examined interrelationships of psychosocial variables found in a psychological evaluation for erectile disorder in 75 male veterans with chronic medical illness. Patients whose partners participated in the evaluation were compared with those whose partners were not involved, and agreement on measures between patients and partners was examined. Finally, a principal components analysis was performed to assess the primary dimensions underlying the variance in mental health and sexual functioning variables. Five factors were identified, accounting for 65.5% of the variance. Results of these analyses are discussed in order to obtain an understanding of the interrelationship between behavioral, psychological, and interpersonal variables in the onset and course of sexual dysfunction.

Thermal biofeedback treatment of mild hypertension. A comparison of effects on conventional and ambulatory blood pressure measures.

Several studies have produced results suggesting that thermal biofeedback treatment is effective in lowering the blood pressure (BP) of individuals with both mild and moderate essential hypertension. This study used thermal biofeedback to treat 9 unmedicated individuals with mild hypertension. Subjects underwent 24-hour ambulatory BP monitoring both prior to and following the thermal biofeedback treatment regimen. Four of the subjects were considered treatment successes using standard office blood pressure assessments as the success-fail criteria. However, 24-hour ambulatory BP measures showed a markedly different pattern of results, with several subjects who were considered successes under conventional assessment techniques showing an increase in 24-hour ambulatory BP from pre- to posttreatment. There was a significant decrease in diastolic blood pressure for all subjects as measured by the ambulatory method. There was also a significant decrease in systolic and diastolic standing home blood pressure. The implications of these results are discussed.

An experimental analysis of facilitated communication.

We evaluated the authorship of messages produced through facilitated communication by 7 adults with moderate or severe mental retardation and their facilitators. The clients had been reported to be communicating fluently through facilitated communication. We controlled the facilitators' access to information to be communicated in two evaluation formats, naming pictures and describing activities. In both formats we conducted three conditions: (a) the facilitator and client had access to the same information, (b) the facilitator did not have access to the picture or activity, and (c) the facilitator was given false information about the picture or activity. The results showed that the clients typed the correct answer only when the facilitator had access to the same information, never typed the correct answer when the facilitator had no information or false information, and typed the picture or activity presented to the facilitator when it was different from the one experienced by the client. These results provide unequivocal evidence for facilitator control of typing during facilitated communication.

The comparison of individuals with tension-type headache and headache-free controls on frontal EMG levels: a meta-analysis.

For many years, the dominant theory of tension-type headache has been that individuals who suffer from these headaches have elevations in electromyographic (EMG) activity at rest or during stressful life experiences. This theory has come under increasing attack in recent years. Although the research that is relevant to the controversy has been reviewed previously using box score and voting methods, no one has analyzed the relevant data using a statistical approach. This study used meta-analysis to summarize the studies that have directly compared individuals with tension-type headache to headache-free control subjects on measures of frontal EMG at baseline and during rest. Twenty-three studies were included in the analysis. The overall effect size was .395; however, there was heterogeneity of effect size. Several potential moderator variables were investigated. Perhaps the most interesting moderator variable was whether the studies clearly stated that subjects were headache-free during assessment. This group of studies produced a nonsignificant effect size that had homogeneity of effects. Several interpretations of the results are presented.

The comparison of individuals with recurrent tension-type headache and headache-free controls in physiological response, appraisal, and coping with stressors: a review of the literature.

It is widely accepted that stress plays an important role in the experience of tension-type headache. This article reviews the literature in which individuals with recurrent tension-type headache are compared to headache-free controls in the experience and appraisal of stress, psychophysiological response to stress, and coping with stress. A modified and extended version of the transactional model of stress as it might apply to tension-type headache is used to organize the relevant literature. In summary, there is evidence to suggest that individuals with recurrent tension-type headache experience more stressful events and are more sensitive and have a lower threshold to pain. There are some suggestions that headache sufferers may use different coping strategies for stress and pain. There is little evidence of differences in physiological responses to stressful events. The shortcomings of this body of literature are addressed and directions for future research are identified.

Subjective stress and coping in recurrent tension-type headache.

Subjects with tension-type headache and headache-free control subjects completed two mental stressor tasks, solving anagrams and mental arithmetic. During the experimental session, measures of heart rate, muscle tension, and subjective stress ratings were recorded. In addition, all subjects completed a week-long series of questionnaires which monitored headache activity in addition to frequency and intensity of stressful life events. Recurrent tension headache sufferers were found to have higher levels of depression and trait anxiety. Headache and control subjects were not found to respond differently to stressors presented in the laboratory based on measures of EMG, heart rate, or subjective stress ratings, nor were there differences in reports of coping. However, diary questionnaires revealed that headache subjects experienced stressful events more frequently than headache-free controls. Headache subjects also rated these events as causing more stress.