Bronchial thermoplasty increases airway volume measured by functional respiratory imaging.

BACKGROUND: The purpose of this study was to use CT scanning with computational fluid dynamics to evaluate the mechanisms by which Bronchial Thermoplasty (BT) improves asthmatic symptoms. METHODS: The study was conducted in a university teaching hospital, experienced in performing BT. Imaging studies were performed before, and after, BT of the left lung, and prior to treatment of the right lung, which therefore acted as a control. On each occasion, two high-resolution CT scans were performed, one at full inspiration (TLC) and the other at Functional Residual Capacity (FRC). The study protocol was offered to 10 patients, all of whom met the definition of severe asthma, despite high dose inhaled corticosteroids and dual long acting bronchodilators. RESULTS: Significant increases in airway luminal volume were observed on the treated side, compared with control, at both full inspiration (by 27%) and at FRC (by 17%). The ratio of distal airway volume to lung volume significantly increased on the treated side. The change in airway volume with inspiration from FRC increased by 48% on the treated side compared to 5% in the control lung, suggesting treatment increased airway distensibility. No effect was observed on airway wall thickness, nor air trapping. There was a trend towards correlation between the improvement in airway volume at TLC and improvement in symptoms. CONCLUSION: This study demonstrates that BT increases the luminal airway volume on the treated side compared to the control lung. We suggest that this is an important link between the airway smooth muscle atrophy demonstrated pathologically, and the improvement in symptoms observed clinically.

Body mass index as a predictor of survival in adults with cystic fibrosis referred for lung transplantation.

BACKGROUND: The timing of referral and listing for lung transplantation in adults with cystic fibrosis is influenced by many factors including pulmonary function, body mass index (BMI), sex, and patient and physician choice. This study aimed to analyze the effect of these variables on waiting list and postoperative mortality rates. In particular, low BMI is suggested to portend a poor outcome after transplantation. METHODS: All patients with cystic fibrosis referred to our institution (n = 92) between 1989 and 1996 were reviewed, and the effect on survival of BMI, sex, and other covariates was analyzed by use of Cox proportional hazards regression. RESULTS: Forty-five transplantations were undertaken with a mean waiting time of 226 days (range 1 to 678). Fifteen of the 62 listed patients died before transplantation with a mean time to death of 160 days (range 8 to 533). Fifteen patients died after transplantation. BMI at the time of listing predicted waiting list mortality (P < .05). Female sex tended to increase waiting list mortality rates, such that the combination of BMI less than 18 kg/m2, and female sex was associated with a 21% 1-year waiting list survival without transplantation. Age, forced expiratory volume in 1 second, sex, BMI, and date of transplantation did not predict postoperative survival. CONCLUSION: Patients with cystic fibrosis (particularly women) referred for lung transplantation with a BMI less than 18 kg/m2 are at high risk of death over the next 12 months. With this in mind, they should not be denied transplantation unduly while attempts are made to increase weight, especially because pretransplantation BMI does not influence posttransplantation survival.

The relationship between sociotropy/autonomy and patterns of symptomatology in the depressed elderly.

This study examined the relationship between the personality constructs of sociotropy and autonomy and clinical symptoms of depression among 80 elderly people reporting to a range of psychiatric services for the treatment of depression. These investigations provided support for the association of sociotropy to a hypothesized pattern of clinical symptomatology, but no support for the relationship of autonomy to its hypothesized pattern of symptoms. Future investigations on elderly depressive people needs to accommodate the clinical patterns more typical of this population. Research on the relationship between depression and personality would benefit from empirically derived symptom profiles. It may also need to take into account the influence of personality on changes in symptoms over and between episodes of depression.

A brief sensitive screening instrument for depression in late life.

Data collected with the depression scale (DEP) of the Brief Assessment Scale (BAS) at interviews with 811 elderly subjects were analysed to determine which of its 21 individual items could be selected to produce a short screening scale for depression which would have less than 10 items and a Cronbach's alpha above 0.8. Eight items which fulfilled these requirements were selected to form the Even Briefer Assessment Scale for Depression (EBAS DEP). The validity of the scale was assessed against psychiatric diagnoses made on a subset of 211 subjects. The EBAS DEP had a sensitivity and specificity for a diagnosis of a DSM-III-R mood disorder (depressed) of 0.91 and 0.72, respectively. The EBAS DEP could be useful as a brief screen for depression in busy hospital and primary care settings where a full assessment of mood for every patient is impractical. The EBAS DEP is presented, together with instructions for its use, to enable independent study of its reliability and validity in other populations.

"Medical records--legal implications for the hospital.".

There are compelling legal reasons for the hospital to maintain an effective medical record service. This article is concerned to highlight those reasons and to provide guidelines to hospitals and associated health professionals as to what constitutes a sufficient and proper medical records service.

Compulsory admission of the mentally ill: adequacy of documentation.

The issues that are involved in the compulsory detention and treatment of persons with mental illness are complex. There has been an improvement in the adequacy of documentation of such persons in the first five years of operation of the new South Australian Mental Health Act, 1976-1977. However, an appreciable proportion of documents still do not appear to comply adequately with the statutory requirements. This may be related not only to shortcomings in the medical documentation, but also to ambiguities and possible overlapping in the criteria for compulsory detention and treatment.