Return to work after spinal cord injury: a Singaporean pilot community-based rehabilitation program.

STUDY DESIGN: Retrospective analysis of data collected as part of a pilot program. OBJECTIVES: The primary objective of our study was to document the return-to-work rate of individuals with SCI who participated in a community-based interdisciplinary vocational rehabilitation program. The secondary objectives were to assess changes in their levels of community integration and functional independence. SETTING: A community-based rehabilitation center in Singapore. METHODS: Participants were individuals with SCI between 21 and 55 years. They identified return to work as a rehabilitation goal, and were certified fit to undergo rehabilitation by their physicians. Primary outcome was the return-to-work rate at discharge from the program. Secondary outcomes were community integration and functional independence, measured by the Community Integration Questionnaire (CIQ) and the Spinal Cord Independence Measure III (SCIM-III), respectively. We summarized participants' clinical and socio-demographic characteristics descriptively, and used inferential statistics to compare pre- and postprogram scores for secondary outcome measures. RESULTS: Thirty-nine participants were included for this study. Thirty-two completed the program, of which 84% (n = 27) reported returning to work. Participants who completed the program had mean change in total CIQ and SCIM-III scores of 7 (95% CI, 5-8) and 11 (95% CI, 7-15), respectively. There were differences (p < 0.05) between pre- and postprogram scores for both secondary outcome measures. CONCLUSIONS: Our findings suggest that our vocational rehabilitation program facilitated participants with SCI in Singapore to return to work and was beneficial to enhance their levels of community integration and functional independence. Future interventional studies are recommended to estimate the efficacy of such programs.

Observations on the physiological interactions between obesity and asthma.

To explore whether asthma and obesity share overlapping pathogenic features, we examined the impact of each alone, and in combination, on multiple aspects of lung function. We reasoned that if they influenced the lungs through similar mechanisms, the individual physiological manifestations in the comorbid state should interact in a complex fashion. If not, then the abnormalities should simply add. We measured specific conductance, spirometry, lung volumes, and airway responsiveness to adrenergic and cholinergic agonists in 52 normal, 53 asthmatic, 52 obese, and 53 asthmatic and obese patients using standard techniques. Six-minute walks were performed in subsets from each group. Asthma significantly lowered specific conductance and the spirometric variables while increasing airway reactivity and residual volume. Obesity also reduced the spirometric variables as well as total lung capacity and functional residual capacity. Residual volume, specific conductance, and airway responsivity were unaltered. With comorbidity, the disease-specific derangements added algebraically. Features that existed in isolation appeared unchanged in the combination, whereas shared ones either added or subtracted depending on the individual directional changes. Synergistic interactions were not observed. Body mass index weakly correlated with spirometry and lung volumes in asthma, but not with specific conductance or bronchial reactivity. Exercise performance did not aid in differentiation. Our findings indicate asthma and obesity appear to influence the respiratory system through different processes.

Newly identified obstructive sleep apnea in hospitalized patients: analysis of an evaluation and treatment strategy.

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) case finding in hospitalized patients occurs commonly. In some institutions, the wait time to polysomnography (PSG) may be long. We investigated the impact of a protocol utilizing autoadjusting continuous positive airway pressure (CPAP) for early initiation of therapy in hospitalized patients suspected of having OSA. METHODS: A retrospective chart review of patients with likely OSA (oxygen desaturation index > or =10 desaturations per hour with symptoms of OSA) hospitalized between 1999 and 2004 was performed. Subjects were split into intervention and control groups. The intervention group (n=62) underwent autoadjusting CPAP titration while hospitalized and were discharged on fixed CPAP. The control group subjects (n=62) had no autoadjusting CPAP titration and were discharged without CPAP (90% on nocturnal oxygen). Both groups then had a follow-up PSG. RESULTS: The 2 groups were matched for baseline characteristics, admission diagnoses, and oximetry parameters. There were no significant differences in time to PSG or apnea-hypopnea index at PSG. In the intervention group, autoadjusting CPAP improved, but did not normalize, oximetry parameters. No significant differences were found in length of hospital stay or in number of urgent care visits, emergency department visits, or hospital readmissions pending PSG. Compared with PSG-determined CPAP pressures, autoadjusting CPAP underestimated the pressure in 60% of the intervention group, whereas 21% required bilevel positive airway pressure for optimal control. CONCLUSIONS: Compared with oxygen support or no therapy, an autoadjusting CPAP-titration protocol did not improve short-term outcomes in hospitalized patients with symptoms suggestive of OSA. Autoadjusting CPAP may underestimate optimal treatment settings.

[Granulometry and measurement of a aerosol drug deposit (fusafungine) in normal and pathological airways]. / Granulométrie et mesure du dépôt d'un aérosol médicamenteux (fusafungine) dans les voies aériennes normales et pathologiques.

We measured with a laser velocimeter granulometric deposit of an aerosol anti-infectious agent, fusafungin, administered with a controlled inhalator. Total drug deposit was determined on the basis of a granulometric spectrum of the polydispered aerosol (mass mean aerodynamic diameter (MMAD) = 2.8 +/- 1.7 microns) and dispersion in the airways was estimated using the Stahlhofen model. We first compared deposits obtained with oral inhalation in 19 normal subjects and 20 patients with chronic obstructive lung disease. Total deposit in the airways of patients with chronic obstructive lung disease (82%) was not significantly different from that in normal subjects (85%). Estimated dispersion in normal airways was 27% in the alveoles, 8.4% in the tracheobronchic region and 23.5% in the extrathoracic regions. We then compared deposits after nasal inhalation in 22 normal subjects and 21 patients with rhinitis: nasal deposit was significantly greater in patients with rhinitis (54.5%) than in controls (44.7%). We conclude that such an inhalator can be adapted for local treatment of ENT infections and upper respiratory infections. Deposit is not modified in case of obstructive bronchopathy.