Auswahl der wissenschaftlichen Literatur zum Thema „Dyspnea observation scales“

Abstract Background: Dyspnea, like pain, can cause major suffering in intensive care unit (ICU) patients. Its evaluation relies on self-report; hence, the risk of being overlooked when verbal communication is impaired. Observation scales incorporating respiratory and behavioral signs (respiratory distress observation scales [RDOS]) can provide surrogates of dyspnea self-report in similar clinical contexts (palliative care). Methods: The authors prospectively studied (single center, 16-bed ICU, large university hospital) 220 communicating ICU patients (derivation cohort, 120 patients; separate validation cohort, 100 patients). Dyspnea was assessed by dyspnea visual analog scale (D-VAS) and RDOS calculated from its eight components (heart rate, respiratory rate, nonpurposeful movements, neck muscle use during inspiration, abdominal paradox, end-expiratory grunting, nasal flaring, and facial expression of fear). An iterative principal component analysis and partial least square regression process aimed at identifying an optimized D-VAS correlate (intensive care RDOS [IC-RDOS]). Results: In the derivation cohort, RDOS significantly correlated with D-VAS (r = 0.43; 95% CI, 0.29 to 0.58). A five-item IC-RDOS (heart rate, neck muscle use during inspiration, abdominal paradox, facial expression of fear, and supplemental oxygen) significantly better correlated with D-VAS (r = 0.61; 95% CI, 0.50 to 0.72). The median area under the receiver operating curve of IC-RDOS to predict D-VAS was 0.83 (interquartile range, 0.81 to 0.84). An IC-RDOS of 2.4 predicted D-VAS of 4 or greater with equal sensitivity and specificity (72%); an IC-RDOS of 6.3 predicted D-VAS of 4 or greater with 100% specificity. Similar results were found in the validation cohort. Conclusions: Combinations of observable signs correlate with dyspnea in communicating ICU patients. Future studies in noncommunicating patients will be needed to determine the responsiveness to therapeutic interventions and clinical usefulness.

Dyspnea is a common, distressing symptom of cardiopulmonary and neuromuscular diseases and is defined as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.” However, Japanese intensive care units (ICUs) do not routinely screen for dyspnea, as no validated Japanese version of the Respiratory Distress Observation Scale (RDOS) is available. Therefore, we aimed to translate the English version of this questionnaire into Japanese and assess its validity and reliability. To translate the RDOS, we conducted a prospective observational study in a 12-bed ICU of a universal hospital that included 42 healthcare professionals, 10 expert panels, and 128 ventilated patients. The English version was translated into Japanese, and several cross-sectional web-based questionnaires were administered to the healthcare professionals. After completing the translation process, a validity and reliability evaluation was performed in the ventilated patients. Inter-rater reliability was evaluated using Cohen’s weighted kappa coefficient. Criterion validity was ascertained based on the correlation between RDOS and the dyspnea visual analog scale. The area under the receiver operating characteristic curve analysis was used to evaluate the ability of the RDOS to identify patients with self-reported dyspnea. The average content validity index at the scale level was 0.95. Data from the 128 patients were collected and analyzed. Cohen’s weighted kappa coefficient and the correlation coefficient between the two scales were 0.76 and 0.443 (95% confidence intervals 0.70–0.82 and 0.23–0.62), respectively. For predicting self-reported dyspnea, the area under the receiver operating characteristic curve was 0.81 (95% confidence interval 0.67–0.97). The optimal cutoff used was 1, with a sensitivity and specificity of 0.89 and 0.61, respectively. Our findings indicated that the Japanese version of the RDOS is acceptable for face validity, understandability, criterion validity, and inter-rater reliability in lightly sedated mechanically ventilated patients, indicating its clinical utility.

PurposeInterferon (IFN) -based adjuvant therapy in melanoma is associated with significant side effects, which necessitates evaluation of health-related quality of life (HRQOL). Our trial examined the HRQOL effects of adjuvant pegylated IFN-α-2b (PEG-IFN-α-2b) versus observation in patients with stage III melanoma.MethodsA total of 1,256 patients with stage III melanoma were randomly assigned after full lymphadenectomy to receive either observation (n = 629) or PEG-IFN-α-2b (n = 627): induction 6 μg/kg/wk for 8 weeks then maintenance 3 μg/kg/wk for an intended total duration of 5 years. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 was used to assess HRQOL.ResultsAt 3.8 years of median follow-up, for the primary end point, recurrence-free survival (RFS), risk was reduced by 18% (hazard rate = 0.82; P = .01) in the PEG-IFN-α-2b arm compared with observation. Significant and clinically meaningful differences occurred with the PEG-IFN-α-2b treatment arm compared with the observation group, showing decreased global HRQOL at month 3 (−11.6 points; 99% CI, −8.2 to −15.0) and year 2 (−10.5 points; 99% CI, −6.6 to −14.4). Many of the other scales showed statistically significant differences between scores when comparing the two arms. From a clinical point of view, important differences were found for five scales: two functioning scales (social and role functioning) and three symptom scales (appetite loss, fatigue, and dyspnea), with the PEG-IFN-α-2b arm being most impaired.ConclusionPEG-IFN-α-2b leads to a significant and sustained improvement in RFS. There is an expected negative effect on global HRQOL and selected symptoms when patients undergo PEG-IFN-α-2b treatment.

Objective — to assess the effects of ethylmethylhydroxypyridine succinate on cognitive function and clinical and functional status of patients with chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD). Materials and methods. The study was conducted among outpatients at the clinic of the GI «L.T.Mala National Therapy Institute of NAMS of Ukraine». Examinations involved 67 patients with mean age 61.64±9.17 years. Among them, 27 were patients with COPD and IHD combination, 22 patients with isolated COPD, and 18 patients with isolated IHD. According to the study design, during telephone contact 6 months after the start of observation, all patients were administered the drug ethylmethylhydroxypyridine succinate 500 mg per day for 3 months. The evaluation of its effects on cognitive function in patients with COPD and IHD was carried at visit‑2 (after 12 months from the start of observation). All patients underwent general clinical examination, anthropometric measurements, calculation of body mass index, and spirometry before taking ethylmethylhydroxypyridine succinate (at visit‑1) and after three months of taking the drug (visit‑2). To verify the degree of dyspnea intensity, the following scales were used: five‑point scale Mediсal Research Council Dyspnea Scale in Fletcher’s modification (mMRC) and modified 10‑point Borg scale (Borg, 1982). Questionnaire САТ (COPD Assessment Test) was used to assess COPD effects on the well‑being and everyday life of the patient. Physical load tolerance was evaluated based on the 6‑minute walk test. To assess the cognitive status of patients, the Hospital Anxiety and Depression Scale scale (HADS), Generalized Anxiety Disorder test (GAD‑7), and Montreal Cognitive Assessment were used. Results. In patients with COPD, both with concomitant IHD and without it, the manifestations of shortness of breath decreased and the tolerability of physical exertion improved against the background of administration ethylmethylhydroxypyridine succinate 500 mg per day for three months. Patients with isolated IHD demonstrated improved cognitive function and reduced depressive symptoms. The anxiety decrease was observed in patients with IHD with or without concomitant COPD. Conclusions. Ethylmethylhydroxypyridine succinate can be recommended to improve cognitive function in patients with COPD and IHD.

Abstract Abstract 3438 Poster Board III-326 INTRODUCTION Chemoimmunotherapies like the FCR combination have been shown to increase complete remission rates and progression-free survival in patients with CLL in comparison to chemotherapies without biologicals (Hallek et al., ASH 2008). Until now little is known on HRQOL outcome of CLL patients receiving chemoimmunotherapy. Therefore we assessed the HRQOL in patients with advanced CLL, who were randomized between FC and FCR treatment within an international randomized trial of the German CLL Study Group (GCLLSG). METHODS 817 pts with good physical fitness as defined by a cumulative illness rating scale (CIRS) score of up to 6 and a creatinine clearance (cr cl) ≥ 70 ml/min were enrolled between July 2003 and March 2006. Pts were randomly assigned to receive 6 courses of either FC (N=409; F 25mg/m2 i.v. d1–3 and C 250 mg/m2 i.v. d1–3; q 28 days) or FC plus R (N=408; 375 mg/m2 i.v. d 0 at first cycle and 500 mg/m2 d1 all subsequent cycles; q 28 days). The EORTC C30 questionnaires were sent to all patients included in Germany or Austria at baseline, after 3, 6, 12 months (mo) and then in yearly follow-up (FU). In all other countries questionnaires were handed out to the patients personally on the same time points during their visits in the study center. The analysis of the questionnaires was performed according to the EORTC recommendations (Aaronson et al., 1993). The questionnaire contained a global health scale, five functional scales (physical, role, cognitive, emotional and social), three symptom scales (fatigue, pain, nausea and vomiting) as well as six single items (dyspnea, appetite loss, sleep disturbances, financial impact, constipation and diarrhea). Mean score values of the EORTC scales ranged between 0 and 100. High scores in the functional scales represent good HRQOL, low scores in the symptom scales a low symptom burden. RESULTS HRQOL was evaluated in 763 (93%) of the included patients who completed at least one questionnaire (376 (49%) FC and 387 (51%) FCR treated patients). The compliance rate was significantly higher in those countries, where the questionnaire was handed out personally (96% in other countries versus 92% in Germany and Austria; P=0.013). Pts answering the baseline questionnaire and at least one further questionnaire (444; 58%) were compared to those how did not (319, 42%): pts with only one or a missing baseline questionnaire had a significantly higher CIRS score (1,7 vs 1,4; P=0.007) and more frequently leukocytopenias (24% CTC grade 3 and 4 leukocytopenias vs 13%; P< 0.001). Age, distribution of Binet stages, gender, poor prognostic factors (del(11q) or del(17p), unmutated IgVH) and treatment arms were similar distributed between both groups. There were also no differences in the rate of other toxicities or response rates. A total of 482 questionnaires were available initially, 406 at interim staging, 454 at final staging, 496 after 12 mo FU, 414 after 24 mo FU and 198 after 36 mo FU. A comparison of the two treatment arms at interim or final staging after 3 and 6 months respectively showed no significant difference between both arms with regards to the global health status, functional scales and symptom scales. Dyspnoe was scored significantly higher during FC treatment in comparison to FCR (23 versus 18; P = 0.023). At 12, 24 and 36 months of FU no significant difference between FC and FCR in all functional scales, symptom scales, single item and global health status was found. Both treatment arms showed slight improvement (defined as difference of 5-10 points) of global health status at 12 months FU in comparison to baseline (FC: 62 at baseline vs 68 at FU 12; FCR: 62 vs 70). CONCLUSIONS Although the FCR regimen is associated with a higher rate of cytopenias in patients' perception this increased hematological toxicity does not result in a difference in HRQOL between both treatment arms. After a median observation time of 38 mo the better efficacy of the FCR regimen with regards on response rates and progression-free survival does not yet result in an improved HRQOL. For the final evaluation of HRQOL outcome after chemoimmunotherapy a longer is FU is needed. Disclosures Eichhorst: Roche: Honoraria, Research Funding; Mundipharma: Research Funding; Hospira: Honoraria. Fischer:Roche: Travel Grand; Munipharma: Travel Grand. Fink:Roche: Travel Grand. Fingerle-Rowson:OrthoBiotech: Employment; Roche: Honoraria. Westermann:Roche: Travel Grand. Wendtner:Roche: Honoraria, Research Funding; Mundipharma: Honoraria, Research Funding; BayerSchering: Honoraria, Research Funding; Celgene: Honoraria, Research Funding. Hallek:Roche: Research Funding, Speakers Bureau; Mundipharma: Research Funding, Speakers Bureau.

Abstract Abstract 155 Background Bendamustine is a unique alkylating agent, active as monotherapy and in combination with rituximab for relapsed and refractory indolent non-Hodgkin's lymphoma (NHL). This study compared efficacy and safety of bendamustine-rituximab (BR) with standard treatment regimens of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and rituximab, cyclophosphamide, vincristine, and prednisone (R-CVP) in first-line treatment of patients with indolent NHL or mantle cell lymphoma (MCL). The primary objective was to determine whether the complete response rate for BR was noninferior to R-CHOP/R-CVP (presented separately). The present analysis reports results for quality of life (QOL) as measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30). Methods Previously untreated patients with indolent NHL or MCL were randomized to receive BR (bendamustine 90 mg/m2/day on days 1 and 2; rituximab 375 mg/m2 on day 1 of each 28-day cycle) or R-CHOP/R-CVP (rituximab 375 mg/m2 and vincristine 1.4 mg/m2 (up to maximum 2 mg) on day 1 and prednisone at 100 mg on days 1–5 (of a 21-day cycle), plus either [1] cyclophosphamide 750 mg/m2 and doxorubicin 50 mg/m2 on day 1 or [2] cyclophosphamide 750 mg/m2 or 1000 mg/m2(investigator choice) on day 1. QLQ-C30 was administered at screening (baseline); after cycles 1, 3, 6, 8; and at the end-of-treatment visit. Linear transformation to standardize raw scores was performed. The QLQ-C30 is composed of 5 multi-item functional scales, 1 global health status (GHS)/QOL scale, 3 symptom scales, and 6 single-item measures; all scores could range from 0 to 100. Rising scores for functional scales and GHS/QOL indicate improvement. Rising scores for symptom scales/single items indicate worsening. GHS/QOL score change at last QLQ-C30 administration postbaseline was interpreted using analysis of covariance. Data from the last observation (end-of-treatment visit) were analyzed. Results The 447 enrolled patients were randomly assigned to 1 of the 2 treatments; 224 to BR (NHL n=187, MCL n=36, missing n=1) and 223 to R-CHOP/R-CVP (NHL n=184, MCL n=38, missing n=1). Treatment groups were well matched for demographic and clinical characteristics. Among all randomized patients, mean change in GHS/QOL score from baseline to final visit was significantly higher (indicating relative improvement) for patients treated with BR than those treated with R-CHOP/R-CVP (3.6 vs −5.1 respectively, P=0.0005). For patients with indolent NHL, mean change in GHS/QOL score by final visit was significantly higher in patients treated with BR than those receiving R-CHOP/R-CVP (2.1 vs −6.3, respectively, P=0.0021); in patients with MCL, mean change in GHS/QOL score was numerically higher in the BR group, but the difference was not statistically significant (10.9 vs 1.6, P=0.0654). All randomized patients receiving BR showed greater improvement in QLQ-C30 Emotional Functioning (from baseline to final visit), compared with patients receiving R-CHOP/R-CVP. Mean change from baseline scores (± SEM) for QLQ-C30 for Cognitive, Physical, Role, and Social Functioning scales of the QLQ-C30 decreased (signifying deteriorating effect) in both treatment groups, with patients treated with BR deteriorating less than patients treated with R-CHOP/R-CVP (Figure). For symptom scales/item measures, patients treated with BR showed larger reductions in mean scores from elevated baseline levels (signifying greater improvement), compared with R-CHOP/R-CVP for Appetite Loss (−2.9 for BR vs −1.1 for R-CHOP/R-CVP), Pain (−5.6 vs −1.7), and Constipation (−0.7 vs 1.8). For symptom scales/item measures of Dyspnea, Fatigue, and Financial Difficulties, both treatments showed deteriorating effects, with BR showing less than R-CHOP/R-CVP: Dyspnea (0.8 vs 4.8), Fatigue (0.5 vs 7.2), and Financial Difficulties (0.9 vs 1.3). Patients receiving R-CHOP/R-CVP had larger reductions in mean scores for Insomnia (−2.1 for BR vs −6.7 for R-CHOP/R-CVP), Diarrhea (0.5 vs −1.3), and Nausea and Vomiting (1.8 vs 0.9). Conclusions In this study, BR significantly improved GHS/QOL, compared with R-CHOP/R-CVP treatment, in previously untreated patients with indolent NHL or MCL. In addition, BR provided improved patient QOL scores for most aspects of functioning and symptoms, as measured by the QLQ-C30. Support: Teva Pharmaceutical Industries Ltd. Disclosures: Burke: Spectrum Pharmaceuticals: Consultancy. Off Label Use: Bendamustine is FDA-approved for adults with chronic lymphocytic leukemia or indolent B-cell non-Hodgkin's lymphoma that has progressed during or within six months of treatment with rituximab or a rituximab-containing regimen. Van der Jagt:Celgene: Consultancy, Research Funding, Sponsorship Other; Novartis: Consultancy, Research Funding, Sponsorship, Sponsorship Other; Roche: Consultancy, Sponsorship, Sponsorship Other; Teva: Consultancy, Research Funding; Incyte: Research Funding; Xanthus: Research Funding; Bristol-Myers Squibb: Consultancy. Kahl:Genentech: Membership on an entity's Board of Directors or advisory committees, Research Funding; Roche: Membership on an entity's Board of Directors or advisory committees, Research Funding; Teva: Membership on an entity's Board of Directors or advisory committees. MacDonald:Lundbeck: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees, Research Funding. White:Teva Pharmaceutical Industries Ltd.: Employment. Munteanu:Teva Pharmaceutical Industries Ltd.: Employment. Clementi:Teva Pharmaceutical Industries Ltd.: Employment. Chen:Teva Pharmaceutical Industries Ltd.: Employment. Flinn:Teva: Research Funding.

Introduction: ET is a chronic myeloproliferative neoplasm (MPN) characterized by thrombocytosis and an increased risk for thrombotic and hemorrhagic events. ET can be associated with substantial symptom burden, impaired quality of life (QoL), and reduced survival. PRO data pertaining to the impact of ET on QoL and symptom burden in these pts are limited. The ongoing Myelofibrosis and Essential Thrombocythemia Observational STudy (MOST) was designed to collect data about the demographics, disease burden, PROs, and management of pts with ET or myelofibrosis (MF) in clinical practices throughout the United States. This analysis describes PROs from pts with ET enrolled in MOST. Methods: MOST is a longitudinal, multicenter, noninterventional, prospective, observational study (NCT02953704). Eligible adults with ET were ≥60 years of age, had a history of thrombotic events, or were receiving ET-directed therapy. PROs were collected in conjunction with usual-care visits approximately every 6 months over a planned observation period of 36 months. Patient-reported symptom burden was assessed with the disease-specific MPN Symptom Assessment Form Total Symptom Score (MPN-SAF TSS), composed of 10 items (fatigue, early satiety, abdominal discomfort, inactivity, concentration problems, night sweats, itching, bone pain, fever [>100oF], weight loss). The MPN-SAF numbness/tingling item was also included in the questionnaire but was not included in the TSS calculation. Symptom severity was graded from 0 (absent) to 10 (worst imaginable), with a possible TSS ranging from 0 to 100. Health-related QoL was evaluated with the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30 v3.0), composed of 5 functional scales, 3 symptom scales, 6 additional single-symptom items, and a global health/QoL scale. For functional and global health/QoL scales, higher scores indicate higher functioning and better global health/QoL, respectively. For symptom scales/items, higher scores indicate greater symptom burden. High-risk pts and low-risk pts receiving ET-directed therapy (excluding aspirin only) with baseline PRO data were included in this analysis. Data were summarized with descriptive statistics. Results: The MOST study enrolled 1234 pts with ET between Nov 29, 2016 and March 29, 2019 at 124 sites. Of these pts, 794 qualified for this analysis (data cut-off date, June 17, 2019); median age was 70 (range, 19-93) years, 80% were ≥60 years of age, 68% were women, 90% were white, 42% were working full or part-time, and 4% had a documented family history of MF, ET, or polycythemia vera. The majority of pts (87%) had high-risk ET. At enrollment, 768 pts completed the MPN-SAF. Mean (SD) TSS was 17.1 (15.6); 33% of pts had TSS ≥20. Women had higher mean (SD) TSS than men (18.5 [15.8] vs 14.2 [14.9]) and had higher mean individual symptom scores, except for weight loss and fever. The highest mean (SD) individual symptom scores were fatigue (3.4 [2.7]), numbness/tingling (2.3 [3.0]), inactivity (2.3 [2.8]), and early satiety (2.3 [2.7]) (Fig A). The most frequently reported severe symptoms (ie, score ≥7) were fatigue (17% [127/746]), numbness/tingling (14% [107/767]), and inactivity (11% [86/762]). At enrollment, 794 pts completed the EORTC QLQ-C30. The highest mean (SD) symptom scale scores (score ≥15) were fatigue (29.6 [25.8]), insomnia (28.6 [30.6]), pain (22.1 [27.9]), dyspnea (17.2 [25.5]), and constipation (15.7 [25.2]) (Fig B). The mean (SD) global health status/QoL score was 72.7 (21.9); functional scores ranged from 79.9 (21.9) for emotional functioning to 85.2 (24.1) for social functioning (Fig C). The average functional scale scores and symptom scale scores indicate higher functioning and less symptom burden, respectively, in men vs women. Conclusion: Pts with ET experienced a high symptom burden; fatigue was the most common and highest in severity. Symptom burden and quality of life scores in the current study were similar to prior reports (Emanuel J Clin Oncol 2012; Scherber Blood 2011). Women reported higher symptom burden than men in both the MPN-SAF and EORTC QLQ-30. Of note, numbness/tingling, which is not included in the MPN-SAF TSS calculation, was one of the most frequently reported severe symptoms for pts with ET in MOST. Future analyses from this trial will continue to increase understanding of the symptom burden and its impact on QoL in pts with ET. Disclosures Ritchie: Celgene, Incyte, Novartis, Pfizer: Consultancy; Genentech: Other: Advisory board; Tolero: Other: Advisory board; Pfizer: Other: Advisory board, travel support; agios: Other: Advisory board; Celgene: Other: Advisory board; Jazz Pharmaceuticals: Research Funding; Celgene, Novartis: Other: travel support; AStella, Bristol-Myers Squibb, Novartis, NS Pharma, Pfizer: Research Funding; Ariad, Celgene, Incyte, Novartis: Speakers Bureau. Al-Janadi:Incyte: Honoraria, Other: Travel, Accommodations, Expenses, Research Funding; Celgene: Honoraria, Other: Travel, Accommodations, Expenses, Research Funding, Speakers Bureau; Genentech/Abbvie: Honoraria, Other: Travel, Accommodations, Expenses, Speakers Bureau; Genentech/Roche: Honoraria, Other: Travel, Accommodations, Expenses, Speakers Bureau; Gilead Sciences: Consultancy, Honoraria, Other: Travel, Accommodations, Expenses; Sandoz-Novartis: Consultancy, Honoraria; Alexion Pharmaceuticals: Consultancy, Honoraria, Other: Travel, Accommodation, Expenses, Research Funding, Speakers Bureau; Takeda: Consultancy, Honoraria, Other: Travel, Accommodations, Expenses, Research Funding, Speakers Bureau; MEI Pharma: Research Funding; Seattle Genetics: Consultancy, Honoraria, Other: Travel, Accommodations, Expenses. Colucci:Incyte: Employment, Equity Ownership. Kalafut:Incyte: Employment, Equity Ownership. Paranagama:Incyte: Employment, Equity Ownership. Mesa:Genotech: Research Funding; Promedior: Research Funding; Sierra Onc: Consultancy; Celgene: Research Funding; AbbVie: Research Funding; Novartis: Consultancy; La Jolla Pharma: Consultancy; CTI Biopharma: Research Funding; Samus: Research Funding; Incyte: Research Funding.

Introduction. Wearable or home electronic devices with the function of transmitting information at a distance are used for the purpose of remote dynamic monitoring of the condition of patients. Aim. To determine the effectiveness of the use of "new" criteria for assessing the health status of patients with broncho-obstructive diseases in order to monitor remotely. Material and methods. 28 patients with broncho-obstructive diseases who were admitted for inpatient treatment were examined. Most of them had comorbidities, mainly cardiovascular pathology. A general clinical examination and special research methods were performed: an interactive survey using the respiratory module of the Electronic Polyclinic program, remote monitoring of vital signs using a smart watch and a mobile application for recording and transmitting information, a 6-minute walk test with simultaneous recording of vital signs with using a smart watch, a questionnaire and a scale for assessing the usability of the System usability scale system. The analysis of the results was performed by using the Statistica 13.0 software package. Results and discussion. Interactive survey corresponded to the severity of dyspnea according to the mMRC and Borg scales. The 6-minute walk test showed a significant limitation of physical activity and an increase in heart rate. The deep sleep phase has been limited. The CRP index averaged 7.78±8.48 µg/l. More than 85% of patients expressed their willingness to continue observation. The results of the correlation analysis demonstrated a direct relationship with the patient's physical activity assessment and the results of the 6-minute walk test, and an inverse relationship with the 6-minute walk test result and the patients' age, severity of respiratory failure and CRP concentration. The duration of deep sleep is inversely correlated with the SpO2 value. Our studies made it possible to compare the obtained data with the results of traditional methods of examining a patient, to confirm the position that the physical activity of a patient with broncho-obstructive disease is connected with indicators of the function of external respiration, and also that the total duration of sleep of COPD patients mainly consists of light sleep with a decrease in the duration of deep sleep. An inverse relationship was found with the duration of deep sleep and the concentration of CRP and the value of SpO2. The described monitoring system allows you to timely adjust the treatment regimen, reduce the number of hospitalizations, the risk of exacerbation or death.Conclusion. Additional instrumental control of vital parameters increases the efficiency of the system of long-term remote monitoring of patients with broncho-obstructive diseases. the indicators represent the severity of the symptoms of the disease and the degree of violations of the indicators of the function of external respiration.

Post-COVID syndrome is characterized by the persistence of nonspecific disabling symptoms, even several months after the resolution of the infection, with clinical characteristics similar to fibromyalgia (FM) and a prevalence of 31%. We evaluated the effectiveness of physical exercise, in association with L-acetyl-carnitine (ALC) therapy, in patients with Post-COVID syndrome, on musculoskeletal pain, dyspnea, functional capacity, quality of life, and depression. We conducted an observational case-control study on patients with Post-COVID syndrome. The patients were randomly divided into two groups: a treatment group that received rehabilitation treatment in combination with ALC 500 mg therapy; a control group that received only rehabilitation treatment. Patients were assessed at the time of recruitment (T0) and one month after the end of therapy (T1), with the administration of rating scales: NRS, Barthel Dyspnea Index (NPI), 12-Item Short Form Survey (SF-12) scale, Fibromyalgia Impact Questionnaire (FIQ), and Patient Health Questionnaire (PHQ-9). The treatment group showed statistically higher variations in pain scores, quality of life, and depression. No statistically significant differences between the two groups emerged regarding changes in dyspnea and functional capacity scores. Combining exercise with ALC is a promising and effective treatment in the management of Post-COVID syndrome, especially for musculoskeletal pain, depression, and quality of life.

Bien pire que la douleur, la dyspnée chez les patients de réanimation placés sous ventilation mécanique est à l'origine d'une souffrance majeure, d'une sensation terrifiante d'asphyxier (mourir asphyxié) sans pouvoir ni la contrôler (powerlessness), ni lui échapper, ni même la signaler aux soignants (helplessness). Elle participe à la survenue du syndrome de stress post-traumatique des patients. L'absence d'attention portée par les soignants à la dyspnée des patients et les difficultés des patients à communiquer avec les soignants leurs symptômes sont à l'origine d'un enjeu de soins crucial, conceptualisé sous le terme « d'invisibilité » de la dyspnée, qui demeure au quotidien une souffrance non-évaluée et non traitée. Cette thèse de science, propose une approche transversale de l'observation de la souffrance respiratoire d'une « autre personne » afin d'apporter des éléments de réponses à la problématique de l'invisibilité de la dyspnée des patients. Une approche pédagogique suggère que le niveau d‘empathie des soignants influence leur capacité à ressentir ce qu'éprouvent les patients et à estimer l'intensité de la dyspnée des patients. Une approche clinique a permis le développement et la validation d'une échelle observationnelle de dyspnée la MV-RDOS permettant de fortement suspecter la dyspnée chez les patients placés sous ventilation mécanique et non-communicant. Enfin, dans une approche fondamentale, ces investigations proposent pour la première fois une description des expressions faciales associées à la dyspnée induite en laboratoire (sujets sains) ainsi qu'une méthode intelligente de reconnaissance faciale automatique des principales expressions faciales de dyspnée. Ces travaux de thèse ouvrent des pistes de développement d'outils de surveillance continue de la souffrance respiratoire des patients de réanimation afin de restaurer la « visibilité » de la dyspnée et mieux la soulager
Much worse than pain, dyspnea in intensive care unit (ICU) patients receiving mechanical ventilation is a major cause of suffering, conveying a terrifying sensation of an asphyxial threat, without being able to control it (powerlessness), or escape it, or even report it to caregivers (helplessness). It participates independently in the onset of post-traumatic stress syndrome in survivors of ICU stay. The lack of attention paid by caregivers to patients' dyspnea and the difficulty patients have in communicating their symptoms with caregivers are at the origin of a crucial care issue, conceptualized under the term "invisibility" of dyspnea, which remains an under-assessed and an under-treated suffering in daily practice. This science thesis proposes a transversal approach to observing the respiratory suffering of “another person” in order to provide elements of response to the problem of the invisibility of patients' dyspnea. An educational approach suggests that caregivers' level of empathy influences their ability to feel what patients are experiencing and to estimate the intensity of patients' dyspnea. A clinical approach allowed the development and validation of an observational dyspnea scale, the MV-RDOS, making it possible to strongly suspect dyspnea in noncommunicative, mechanically ventilated patients. Finally, in a fundamental approach, these investigations provide an original description of the facial expressions associated with dyspnea as well as an intelligent method for automatic facial recognition of the main facial expressions of dyspnea. This thesis work opens avenues for developing tools for continuous monitoring of respiratory suffering in the ICU in order to restore the “visibility” of dyspnea and better relieve it

Abstract When a person with advanced dementia develops respiratory symptoms, infection, pulmonary embolism, and heart failure are considerations. Pneumonia often has a high mortality rate and high symptom burden. While a decision to focus on palliative treatment is often appropriate, even with prior discussions families may experience considerable distress. Dyspnea can usually be controlled with opioids, typically morphine. Other symptoms, such as reduced oral intake and dehydration, pain, fever, and neuropsychiatric symptoms, are also discussed. The need for careful symptom monitoring, preferably with observation scales, and swift interventions to alleviate the symptom burden is highlighted. Family support and guidance on a daily basis are important treatment foci.

Bronchial asthma is a chronic respiratory disease of heterogeneous nature, manifested by paroxysmal but reversible bronchoconstriction. The aim of this work is to identify nursing problems of a child with bronchial asthma and determine nursing interventions based on ICNP® guidelines. In the study the fallowing research methods were used: individual case study, interview, observation, measurement, documentation analysis, scales, and nursing process. The research subject is a patient 17 years and 7 months old admitted to the children’s hospital on an emergency basis with suspected pneumonia of unknown etiology and an exacerbation of asthma. History: runny nose, cough for 3 weeks, and periodic dyspnea for 2 weeks. On admission to the hospital: weakness, difficulty climbing stairs, expiratory dyspnea, headache, pallor, decreased appetite, nausea, and vomiting. On physical examination: weakened alveolar murmur over the lung fields, expiratory wheezes, furrows, moist rales, reddened throat. As a result of treatment, the patient’s condition improved. She was discharged home with the recommendation: systematic medication, avoidance (of noxious agents and human concentrations), overheating, hypothermia, oral rehydration, oral hygiene, an easy-to-digest diet, blood count control in 1-2 months and follow-up at the Pulmonology Clinic. During hospitalization, the child was diagnosed with biological, psychological, and social problems, which were solved by the diagnostic, care and therapeutic, educational activities of the nurse. Education about the disease (symptoms and treatment) was required by the patient’s mother. The prevalence of asthma imposes an obligation to implement educational activities in educational institutions, since comprehensive education of parents and teachers improves the emotional state of a child with asthma.

Background: Neuromuscular involvement has been identified in acute and early stages of severe COVID-19. Guillain-Barre syndrome and variants, rhabdomyolysis and prone position-related neuropathy represent early complications. Mononeuritis multiplex is rarely a post-infectious complication. Objectives: Characterization of patients with mononeuritis multiplex after severe COVID-19. Methods, design and setting: We performed a retrospective observational study of clinical, laboratorial and neurophysiological aspects of nine Brazilian patients with mononeuritis multiplex after severe COVID-19 at the Division of Neuromuscular Diseases, Federal University of São Paulo (UNIFESP), São Paulo, Brazil. Results: Nine patients (4 male, 5 female) had mean age at diagnosis of 60.6 years. 78% had at least one risk factor for severe COVID-19. Dyspnea, cough, fever, headache, anosmia, odynophagia, and myalgia were the most common SARS-CoV-2 symptoms. Most patients had large length of stay in intensive care (35.8 days), with orotracheal intubation and the need of prone positioning and tracheostomy. 44% had venous or arterial thromboembolic complications. Mononeuritis multiplex symptoms started after 45.7 days (23-71) of first COVID-19 symptoms. Sensorimotor multifocal axonal mononeuritis multiplex was the most common pattern (78%) with moderate to severe (89%) and lower limb-dominant compromise (67%). 33% with LANSS pain scale >12 and 67% with high fatigue scores on Fatigue Severity Scale. Two patients developed moderate titles of positive antinuclear antibody for nuclear membrane compounds (titin) during diagnostic work-up. Three patients were treated with oral corticosteroids with moderate disease control. Conclusions: Mononeuritis multiplex may be a late neuromuscular complication after severe COVID-19. Vasculitis and endotheliopathy seem to mediate its pathophysiology.