 The
intermittent claudication questionnaire: A patient-assessed condition-specific
health outcome measure.
Reference: J Vasc Surg 2002 Oct;36(4):764-71
INTRODUCTION: As yet, there is no patient-assessed, condition-specific
instrument for the
assessment of health-related quality of life in intermittent claudication. We
evaluated the
intermittent claudication questionnaire (ICQ) for properties required of a
measure of health
outcome. Methods and Results: Interviews with patients with intermittent
claudication and
vascular specialist opinion produced a pool of statements used to itemize a
self-completed ICQ.
This was piloted in 20 patients for practicality and then administered to 124
stable claudicants.
Reliability was assessed through a retest in 63 (51%) patients at 14 days and
analysis of
Cronbach's alpha for internal consistency. Spearman's correlation coefficient
was used to assess
construct validity in comparisons between the ICQ and ankle brachial pressure
index,
treadmill-walking distances, the walking impairment questionnaire, the EuroQol,
and the Short
Form-36. Responsiveness of the ICQ to changes in health was assessed in 60
patients treated
conservatively and 40 patients undergoing angioplasty. The standardized response
mean was
used to identify the most responsive instrument in the study. A 16-item ICQ with
a test-retest
intraclass correlation of 0.95 and Cronbach's alpha of.94 was produced. One
hundred
twenty-one (98%) patients completed the ICQ (mean time, 3.7 minutes). The ICQ
correlated
better with the EuroQol (r = 0.58) and 7 out of 8 subscales of the Short Form-36
(r =
0.33-0.68) compared with the walking impairment questionnaire. The ICQ
demonstrated the
largest standardized response mean in relation to health transition compared
with the other
instruments. CONCLUSIONS: The patient-assessed ICQ is a practical, reliable,
valid, and
responsive measure of patient health-related quality of life in intermittent
claudication.
Oral
supplementation of branched-chain amino acid improves nutritional
status in elderly patients on chronic haemodialysis.
Reference: Nephrol Dial Transplant 2001 Sep;16(9):1856-62
BACKGROUND: Anorexia may be associated with decreased plasma levels of
branched-chain
amino acids (BCAA). In malnourished elderly haemodialysis (HD) patients, oral
BCAA
supplementation may improve anorexia, resulting in improved nutritional status.
METHODS:
Among 44 elderly (age >70 years) patients on chronic HD, 28 patients with low
plasma albumin
concentration (<3.5 g/dl) were classified as the malnourished group; they also
suffered from
anorexia. The other 16 patients did not complain of anorexia and were classified
as the
well-nourished group. We performed a 12-month, placebo-controlled, double-blind
study on the
malnourished group. Fourteen patients each received daily oral BCAA
supplementation (12
g/day) or a placebo in random order in a crossover trial for 6 months. Body fat
percentage, lean
body mass, plasma albumin concentration, dietary protein and caloric intakes,
and plasma amino acid profiles were monitored. RESULTS: Lower plasma levels of
BCAA and lower protein and caloric intakes were found in the malnourished group
as compared to the well-nourished group. In BCAA-treated malnourished patients,
anorexia and poor oral protein and caloric intakes improved within a month
concomitant with the improvement in plasma BCAA levels over the values in
well-nourished patients. After 6 months of BCAA supplementation, anthropometric
indices showed a statistically significant increase and mean plasma albumin
concentration
increased from 3.31 g/dl to 3.93 g/dl. After exchanging BCAA for a placebo,
spontaneous oral
food intake decreased, but the favourable nutritional status persisted for the
next 6 months. In 14
patients initially treated with a placebo, no significant changes in nutritional
parameters were
observed during the first 6 months. However, positive results were obtained by
BCAA
supplementation during the subsequent 6 months, and mean plasma albumin
concentration
increased from 3.27 g/dl to 3.81 g/dl. CONCLUSIONS: Normalization of low plasma
levels of
BCAA by oral supplementation can reduce anorexia and significantly improve
overall nutritional
status in elderly malnourished HD patients.
Novel
risk factors for peripheral arterial disease in young women.
Reference: Am J Med 2002 Oct 15;113(6):462-7
To investigate traditional and novel risk factors (homocysteine and C-reactive
protein levels, and
exposure to infections) for peripheral arterial disease in young women.In a
multicenter,
population-based, case-control study, 212 young women (mean [+/- SD] age, 48.2
+/- 7.0
years) with peripheral arterial disease and 475 healthy control women (mean age,
45.5 +/- 8.1
years) completed a standardized questionnaire and provided blood samples.
Peripheral arterial
disease was angiographically confirmed if a stenotic lesion (more than 50%
reduction of the
lumen) was present in at least one major peripheral artery. Hyperhomocysteinemia
was defined
as a nonfasting plasma homocysteine level exceeding the 90th percentile of the
control group.
History of infectious diseases was determined by questionnaire.Elevated
C-reactive protein levels were associated with an increased likelihood of
peripheral arterial disease (odds ratio [OR] = 3.9; 95% confidence interval
[CI]: 1.8 to 8.5 for women in the third quartile; OR = 3.1; 95% CI:
1.4 to 6.8 for women in the fourth quartile; both comparisons with women in the
first quartile).
Hyperhomocysteinemia was not associated with a significantly increased risk of
peripheral arterial disease (OR = 1.6; 95% CI: 0.9 to 3.0). A history of
chickenpox, shingles, mumps, pneumonia, chronic bronchitis, peptic ulcer, or
periodontitis was independently related to peripheral arterial disease, with
adjusted odds ratios varying from 1.7 (95% CI: 1.0 to 3.1) for mumps to 3.4 (95%
CI: 1.5 to 7.7) for peptic ulcer. The risk of peripheral arterial disease
increased with the number of these infections; exposure to five or more
infections increased the odds 3.7-fold (95% CI: 1.7 to 8.2). This association
was not affected by the level of C-reactive protein.Our results do not support a
strong relation between homocysteine and peripheral arterial disease in young
women. However, an elevated C-reactive protein level and several types of
symptomatic infection were associated with peripheral arterial disease.
Effects
of supine intermittent compression on arterial inflow to the lower limb
Reference: Arch Surg 2002 Nov;137(11):1269-73
HYPOTHESIS: Intermittent pneumatic compression will affect the arterial blood
flow in the
lower limb at moderate pressure, without requiring dependency. DESIGN:
Before-after trial.
SETTING: Vascular ultrasound unit of a university hospital. PATIENTS: A
volunteer sample of
19 healthy subjects without symptoms or history of vascular disease and 17
patients with
peripheral arterial disease were studied. Six patients and 1 healthy volunteer
were not included in the study group because of measurement difficulties or
refusal when approached.
INTERVENTIONS: Common femoral artery blood flow velocities were measured with
Doppler
ultrasound during 10 minutes of intermittent compression of the calf and thigh
at 60 mm Hg, while the subject was supine. The data were collected every 5
seconds from 4 minutes before to 4 minutes after the therapy period, and toe
temperatures were also measured with an infrared
radiometer. MAIN OUTCOME MEASURES: Resting to postcompression percentage
increases in flow velocity were measured, along with more representative
measures of the total
flow change during the intermittent compression period. RESULTS: On compression,
the blood
flow velocity decreased slightly (15% in healthy subjects and 6% in patients)
and increased on
release (21% and 29%, respectively). Overall, blood flow did not decrease during
therapy as
expected (increases of 1% and 2%, respectively), and the toes of the patients
warmed (by 2.2
degrees C). CONCLUSIONS: This work confirms the initial hypothesis in both
subject groups.
There appears to be physiological justification for investigating intermittent
compression as a
therapy for patients with intermittent claudication and rest pain in the supine
position as well as
seated.
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Volume
5, Number 12: December 2002
