Assessment of HRV after maximal exercise in trained postmenopausal women.

Increased parasympathetic tone achieved with endurance training may provide cardioprotection after menopause. To compare heart rate variability (HRV) from rest through maximal exercise and recovery in trained postmenopausal women. Thirty-six postmenopausal women who self-reported training at either moderate (MOD; 3-5.9 METS; 58.9+/-4.4 year) or vigorous (VIG; >6 METS; 59.7+/-5.2 year) intensities participated. HRV was measured for 5 min in the supine position, in the last minute of the VO2max test and after 2 min of active recovery. HRV in MOD and VIG was compared using a factorial ANOVA with repeated measures on time. MOD and VIG responded similarly over the three time periods for root mean square of sequential deviations (rMSSD), and high (HF) and low frequency (LF) power (p>0.05). Maximal exercise lowered rMSSD (3.3+/-0.08 vs. 1.2+/-0.06) and lnLF (4.1+/-0.05 vs. 3.3+/-0.13) and increased lnHF (3.3+/-0.14 vs. 4.0+/-0.10; p<0.01) from resting. However, active recovery restored lnHF (3.3+/-0.11) and lnLF (4.1+/-0.08) from maximal values (p<0.01). Our findings suggest that moderate and vigorous exercise training may enhance HRV recovery following one bout of maximal exercise in older women.

Communication skills for telehealth interactions.

Telehealth technologies provide a challenging new home care approach. Through the use of cameras, video display services, and telephone lines, nurses can interact with patients located several miles away. In delivering services from a distance, the ease of equipment operation and installation, picture, and voice quality are important. Of equal importance are the nurse's communication skills in conducting telehome visits.

Creating a functional environment.

Staff at this facility found that redesigning a common area not only improves the facility's appearance, but actually raises residents' level of independence and functioning.

Mexiletine effects on theophylline disposition.

The effect of mexiletine administration on steady-state plasma theophylline concentrations was studied in eight normal healthy men in a prospective open label nonrandomized two-way crossover trial. Repeated doses of 300 mg of sustained-release theophylline were given every 12 hours for 9 days. Mexiletine hydrochloride, 200 mg every 8 hours, was given for five consecutive doses starting on the morning of day 6. Mexiletine increased theophylline levels in all subjects. Mean predose (trough) levels rose from 8.1 +/- 0.1 microgram.ml-1 to 13.4 +/- 0.6 micrograms.ml-1 and AUC(0-12) from 96.8 +/- 9.1 to 160.2 +/- 3.7 micrograms.ml-1.hr. Plasma clearance was reduced by mexiletine from 44.7 +/- 5.1 to 25.4 +/- 1.2 ml.hr-1. Both N-demethylated metabolites of theophylline were decreased by 60% by mexiletine, whose levels remained within its therapeutic range. Theophylline levels returned to pre-mexiletine values when this drug was discontinued. Mexiletine reduces theophylline clearance and increases its plasma concentration by inhibiting N-demethylation of theophylline. Plasma theophylline levels should be monitored when mexiletine is added.

Efficacy of oral mexiletine therapy at a 12-h dosage interval.

The antiarrhythmic effectiveness and safety of 12-h oral administration of mexiletine were evaluated in adult outpatients with a baseline hourly rate of PVCs of 30 or higher who had initially shown at least a 50 percent reduction of this rate when treated with mexiletine at an 8-h dosage interval. Doses were titrated on the basis of 24-h Holter monitoring for both 8- and 12-h intervals. Seventeen of 26 patients showed PVC reductions after 8-h treatment. Fifteen of these 17 patients reached the goal reduction of greater than or equal to 50 percent in the hourly PCV rate with 12-h dosing. Hour-by-hour analysis disclosed a consistent degree of PVC suppression throughout both 8- and 12-h dose intervals. No increase in the incidence of adverse effects was associated with conversion to the 12-h regimen.

Long-term treatment with transdermal clonidine in mild hypertension.

Long-term antihypertensive treatment by once-weekly application of transdermal clonidine patches, in doses equivalent to 0.1, 0.2, 0.3 mg of clonidine daily, was evaluated in an open trial of 41 patients with baseline seated diastolic blood pressures of 90 to 103 mmHg. In all the patients, seated diastolic blood pressure was reduced to less than 90 mmHg with transdermal clonidine alone at the end of a dose titration phase of two to six weeks. Thirty-two patients successfully completed at least 22 months of therapy; three patients withdrew because of lack of efficacy and six because of adverse events. In the second treatment year 14 patients required a concomitant diuretic. Mean reductions in seated diastolic blood pressure from baseline values were statistically significant (P less than 0.0001) at all study intervals. The incidence of patient withdrawals resulting from the development of contact dermatitis at the patch application site was 5%; skin irritation not requiring withdrawal occurred in 13 patients during the first year of treatment and in two during the second. The incidence of dry mouth (in 7%) and drowsiness (in 10%) was lower than has been reported during oral clonidine therapy (40% and 35%). The results suggest that transdermal clonidine may be beneficial for the maintenance therapy of many patients with mild hypertension.

Social support and alternatives to institutionalization for the at-risk elderly.

Selected findings are reported from a follow-up study conducted to determine what happened to persons aged 65 or older who were referred for evaluation to an urban Geriatric Evaluation Service (GES) but who were not approved by the GES for admission to a mental hospital. Reasons given for the referral included both physical and behavioral problems. The alternatives to institutionalization were based upon the nature of the available social support system, and the functional health status. The family provided most of the care for its aged ill, and the adult children provided most of the social support. In the absence of support by adult children, other relatives gave the necessary care, which included a wide range of services such as personal care, housekeeping, cooking, running errands, transporting, and the important service of just being present or available. Community services were used infrequently. The majority of the subjects were in the "poor health" category and required supervision or care for impaired mobility, one or more physical health problems, and sometimes for mental confusion or disorientation.

A Geriatric Evaluation Service: follow-up survey.

A survey was conducted to determine the community resources used by the urban elderly when long-term care in a mental hospital was deemed inappropriate by a Geriatric Evaluation Team. The follow-up study of 112 elderly subjects showed that there are alternatives to institutionalization for the majority of elderly persons referred to a geriatric evaluation and screening service. The natural support system (family members) proved to be of significant value, and more than half of the subjects had daily contact with some other person. Available community services, however, were used infrequently.