Relationship between fatigue and nutritional status in patients receiving radiation therapy to treat lung cancer.

PURPOSE/OBJECTIVES: To describe the relationship between fatigue and nutritional status in patients receiving radiation therapy for lung cancer. DESIGN: Prospective, observational study. SETTING: Radiation therapy department of a large mid-western cancer center. SAMPLE: 45 adults with primary cancer of the lung receiving outpatient primary or adjuvant radiation therapy. METHODS: Measurements taken before radiation therapy, at week four of treatment, and at completion included the Piper Fatigue Scale, prealbumin levels, and weights. MAIN RESEARCH VARIABLE: Fatigue, nutritional status. FINDINGS: Weight loss over the course of treatment was significant but did not correlate with fatigue; fatigue did not change significantly during the measurement period. CONCLUSIONS: Fatigue and nutrition are major problems for patients with lung cancer, but nutritional changes do not correlate with fatigue. An increase in fatigue during radiation therapy was not identified. IMPLICATIONS FOR NURSING PRACTICE: Nurses should continue efforts to intervene with the problems of nutrition and fatigue. The study should be repeated using different fatigue Instruments and with other cancer populations.

Long-term survival and health status after prolonged mechanical ventilation after cardiac surgery.

OBJECTIVE: To determine hospital mortality, weaning from mechanical ventilation, long-term survival, and functional health status in patients receiving > or =7 days of mechanical ventilation after cardiac surgery. DESIGN: Retrospective chart review and prospective patient interviews. SETTING: A university-affiliated, tertiary care medical center. PATIENTS: A total of 124 patients that received > or =7 days of mechanical ventilation after cardiac surgery. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Hospital and long-term death, liberation from mechanical ventilation, and functional health status. MEASUREMENTS AND MAIN RESULTS: A total of 19 (15%) patients died in hospital. Of the 105 survivors, 104 (99%) were completely weaned from mechanical ventilation. Patients who died in the hospital were more likely to have had a preoperative stroke or to have a new postoperative stroke, more likely to have postoperative renal failure, and less likely to have chronic obstructive pulmonary disease. Kaplan-Meier survival was 59% at 5 yrs and expected median survival was 6.2 yrs. Patients who died anytime after discharge were more likely to have preoperative renal dysfunction or stroke, took longer to be weaned from mechanical ventilation and to be discharged, and were more likely to have postoperative complications such as stroke or renal dysfunction. Also, they were more likely to be too debilitated to walk or eat. By multivariate analysis, admitting creatinine, aortic valve surgery, number of ventilator days, and discharged on tube feedings remained significant predictors of mortality. A total of 40 of 53 survivors were interviewed. Participants were similar to nonparticipants (p > .10 for all characteristics). A few (16%) had limitations of their activities of daily living (eating, dressing, bathing), and most had limitations of moderate activity (60%) and vigorous activity (94%). Only 36% could climb stairs or walk uphill without limitations, 54% could walk a block, and 41% had no limitations in house or job work. Half the participants had no body pain; 38% had moderate and 4% severe pain. Most (59%) described their general health as good to excellent. Only 10% said it was poor. CONCLUSION: Patients' chances of being liberated from mechanical ventilation are excellent. Their long-term survival and health status are good.

Assessment of U.S. helicopter emergency medical services' planning and preparedness for disaster response.

INTRODUCTION: Helicopter emergency medical services (HEMS) roles in disaster response vary significantly from routine operation, and as reported in the literature, such responses have not been without difficulty. We identified nine criteria (written policy, triage and incident command training disaster drill participation, ground and air communications plan, critical incident stress management, annual review, policy sharing) that may significantly affected an air medical program's disaster preparedness, response, and recovery. Of these criteria, a written policy is considered of primary importance. METHODS: A written survey was developed and mailed in July 1995 to 187 U.S. rotor-wing members of the Association of Air Medical Services. The survey was designed to identify the programs that had a written policy and fulfilled the guideline criteria, had a written policy and partially fulfilled the criteria, or did not have a written policy. RESULTS: Surveys were returned from 104 (56%) programs. Of the 103 qualifying respondents, 16 (16%) meet the criteria, 55 (53%) partially met the criteria, and 32 (31%) did not have written policies. CONCLUSION: Most U.S. HEMS programs have not fully addressed disaster preparedness, response, and recovery. HEMS disaster response guidelines should be established, and these criteria should be incorporated.

Variables predicting reintubation after cardiac surgical procedures.

BACKGROUND: This study sought to determine patient characteristics, processes of care, and intermediate outcomes as predictors of reintubation after cardiac surgical procedures. METHODS: We performed a retrospective case-control study that included all patients undergoing cardiac surgical intervention who required reintubation and an equal number of control patients not requiring reintubation. Putative risk factors were analyzed univariately by chi2, Fisher exact, Student's t, or Mann-Whitney tests. A logistic regression model was developed using data from patients requiring reintubation for cardiorespiratory reasons. RESULTS: Of the 1,000 consecutive patients reviewed, 41 (4.1%) required reintubation (30 [3%] for cardiorespiratory reasons and 11 [1.1] for unplanned operations). Univariate predictors of reintubation (p<0.05) were older age, chronic obstructive pulmonary disease, New York Heart Association functional class IV, preoperative renal failure, lower arterial oxygen tension, insertion of intraaortic balloon pump, longer time in the operating room, longer duration of cardiopulmonary bypass times, positive fluid balance, postoperative renal failure, and worse pulmonary mechanics. Patients requiring reintubation also required a longer initial period of mechanical ventilation (median, 16.3 versus 6.0 hours; p<0.05). Excellent prediction was found with a model consisting of four variables: operating room time, respiratory rate, vital capacity, and chronic obstructive pulmonary disease. CONCLUSIONS: Patients who required reintubation were sicker and had worse respiratory function and more comorbidity. Prompt extubation did not contribute to reintubation. Patients identified as having a high risk for reintubation should be followed up closely, and interventions should be directed to treating the problems leading to reintubation.

Serum creatine kinase is an unreliable predictor of ectopic pregnancy.

OBJECTIVE: To compare serum creatine kinase (CK) values in patients with ectopic pregnancy vs patients with threatened miscarriage or normal pregnancy. METHODS: An observational case-control study was performed at an urban teaching hospital. Pregnant women with a quantitative beta-hCG obtained for suspicion of ectopic pregnancy were evaluated. Excluded were cases with recent trauma, i.m. injections, surgery, or history of heart, liver, or muscle disease. The serum beta-hCG and CK values were recorded and compared between groups with 1-way ANOVA and Tukey's multiple comparison procedure at the overall 0.05 level. RESULTS: The 15 ectopic, 28 threatened miscarriage, and 21 normal pregnancy cases were of similar gestational ages (p = 0.2), ranging from 3 to 12 weeks. Although the CK values for ectopic pregnancy (88.8 +/- 33.6 IU/L) exceeded those for threatened miscarriage (65.9 +/- 59.0 IU/L) and normal pregnancy (56.0 +/- 38.1 U/L) (p = 0.02), there was significant overlap between groups. CK values were at or above a cutoff of 74 IU/L in 80% (95% confidence interval: 52-96%) of ectopic pregnancies, 25% (11-45%) of threatened miscarriages, and 14% (3-36%) of normal pregnancies. CONCLUSIONS: Although the ectopic pregnancy population is characterized by a higher mean CK than are patients with threatened miscarriage or a normal pregnancy, a significant overlap in CK values makes use of this serum marker unreliable for detecting ectopic pregnancy.

Effects of simulated mouth-to-mouth ventilation during external cardiac compression or active compression-decompression in a swine model of witnessed cardiac arrest.

STUDY OBJECTIVE: To assess the effects of simulated mouth-to-mouth (MTM) ventilation on blood gases, gas exchange, and minute ventilation during external cardiac compression (ECC) or active compression-decompression (ACD) in a swine model of witnessed cardiac arrest and bystander CPR. METHODS: Twenty swine were anesthetized, intubated, ventilated with room air, and monitored for aortic and right atrial pressure and blood gas sampling. After 1 minute of ventricular fibrillation cardiac arrest, ECC or ACD was manually performed at a rate of 100 per minute for 12 minutes. Animals in the room air group had their endotracheal tubes open to air, whereas those in the MTM group were mechanically ventilated with a gas mixture of 16% oxygen and 4% carbon dioxide. Arterial and venous PO2, PCO2, and pH values; oxygen consumption (VO2); carbon dioxide production (VCO2); and minute ventilation (VE) were measured at baseline and 1, 5, 9, and 13 minutes after induction of cardiac arrest. RESULTS: MTM ventilation did not alter arterial or venous PO2 values in comparison with room air but did result in higher arterial PCO2 values at 5 and 9 minutes (although the mean PCO2 was 40 mm Hg or less [5.3 kPa] in all groups) and significant central venous hypercarbic acidosis at 9 and 13 minutes. Arterial PO2 values were greater in the ACD than the ECC groups at 5, 9, and 13 minutes, although all groups maintained acceptable PO2 (mean values > or = 60 mm Hg [8.0 kPa]) through 9 minutes of CPR and through 13 minutes in all but the ECC-room air group. PCO2 values were lower in the ACD groups beyond 1 minute, with the ACD-room air group showing extreme hyperventilation (mean PCO2 < or = 20 mm Hg [2.7 kPa]). MTM ventilation resulted in negative VO2 and VCO2 for the first few minutes, reflecting changes in pulmonary gas stores. As equilibrium was approached, VO2 and VCO2 approached zero in all groups, reflecting low cardiac output. MTM ventilation did not improve VE over room air at any time during ACD. It did improve VE during ECC, but only at the 12th interval. CONCLUSION: In this swine model of witnessed CPR, simulated MTM ventilation was not beneficial for blood gases, gas exchange, or ventilation during ECC or ACD CPR.

Bone loss and bone turnover in diabetes.

There have been conflicting reports about the effect of diabetes on bone density. In 1978, we studied 109 patients, 46 with type I and 63 with type II diabetes; approximately 12 years later we restudied 35 of the 66 surviving patients. In the original study, radial bone density did not differ significantly between patients with either type of diabetes but was significantly lower than in nondiabetic control subjects. In eight osteopenic patients, bone formation rate and other histological indexes of osteoblast recruitment and function were markedly depressed compared with those in nondiabetic control subjects. In patients remeasured approximately 2.5 years (41 patients) and approximately 12.5 years (35 patients) after baseline, bone loss had continued at the expected rate in patients with type I diabetes, with maintenance of the same deficit, but was slower than expected in patients with type II diabetes, such that the initial deficit had been completely corrected. In six of the eight patients who had undergone bone biopsy, one with type I and five with type II diabetes, the mean bone mineral density z-score of the spine and femoral neck approximately 12 years later was > 0 and in one subject was significantly higher than normal at both sites. Based on these data and on previous studies, we propose that in patients with diabetes, low bone formation retards bone accumulation during growth, metabolic effects of poor glycemic control lead to increased bone resorption and bone loss in young adults, and low bone turnover retards age-related bone loss.(ABSTRACT TRUNCATED AT 250 WORDS)