A ten year review of colomycin.
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Administration, Inhalation↗
Biomedical subjects
F Duncan-Skingle
Publications and source records attributed to F Duncan-Skingle.
Do Nottingham Health Profile scores change over time in cystic fibrosis?
We have previously shown that the Nottingham Health Profile (NHP) shows good correlation with physiological scores in an adult cystic fibrosis (CF) population when assessing health status (HS). The aim of this study was to determine whether the NHP can detect change in HS over time. Patients attending an adult CF clinic were studied at the time of their 'annual review' appointment. HS was assessed by the NHP and an 'in house' CF-specific score was used. FEV1% predicted, FVC% predicted, FEV1/FVC ratio, and body mass index (BMI) were calculated. The patients were then studied at subsequent annual review appointments. Change over time was calculated for each parameter and the relationship between change in HS and change in physiological parameters was examined using Spearman's rank correlation. Initial (t1), NHP scores were obtained from 204 patients, median age 26 years (range 16-56 years). Follow-up scores were obtained from 152 patients (t2). The mean rate of change in FEV1 was -8.6 (261) ml yr-1 or -0.2 (6.9)% predicted yr-1. The only dimension of the NHP which showed a significant change over time was emotion, which showed a small improvement in score (score at t1 = 11.3, score at t2 = 8.1, P = 0.02). There was a significant deterioration in the CF-specific total score (t1 = 4.4, t2 = 4.7, P = 0.008). There were no significant correlations between change in physiology and change in NHP scores. There was no overall difference in change in NHP scores between the patients whose FEV1 declined at > 4% predicted yr-1 and those who did not. In conclusion, although the NHP correlates well with one-off physiological parameters, there is poor correlation between change in NHP scores and change in physiological parameters over time.
Adolescent↗
Home-use nebulizers: a potential primary source of Burkholderia cepacia and other colistin-resistant, gram-negative bacteria in patients with cystic fibrosis.
Inhalation of aerosols contaminated with gram-negative bacteria generated from home-use nebulizers used by cystic fibrosis (CF) patients may be a primary route for bacterial colonization of the lung. Burkholderia cepacia was isolated from 3 of [corrected] 35 home-use nebulizers, and Stenotrophomonas maltophilia was isolated from 4 of 35 home-use nebulizers. Sputum cultures for two patients whose nebulizers were contaminated with B. cepacia did not yield the organism. However, DNA macrorestriction analysis by pulsed-field gel electrophoresis confirmed that one of two strains of B. cepacia recovered from the nebulizer of a third patient was also present in the sputum of that patient. Although Pseudomonas aeruginosa was isolated from 34 patients, none of the nebulizers were positive for the organism. Sixty-nine percent of nebulizers were contaminated, and up to 16 different environmental colistin-resistant, gram-negative species were identified. The heaviest contamination was found beneath the chamber atomizer. A questionnaire survey showed that the majority of patients (28 of 34) were receiving nebulized colistin and/or gentamicin. Patients who followed recommended instructions for good nebulizer hygienic practice and paid particular attention to drying had minimal or no contamination of their nebulizers.
Adult↗
Quality of life in adults with cystic fibrosis.
BACKGROUND: Cystic fibrosis is an inherited condition with a high mortality and morbidity. The aims of this study were to assess quality of life in a population of adults with cystic fibrosis, to compare quality of life with published scores from a healthy population and other patient groups, and to examine the relation between quality of life and other measured clinical variables. METHODS: Patients over 16 years of age attending an adult cystic fibrosis outpatient clinic were surveyed at a time when they were clinically stable. A self-complete questionnaire was administered which comprised the Nottingham Health Profile (NHP) together with six additional questions related to cystic fibrosis. RESULTS: Completed questionnaires were obtained from 240 subjects (100 women) of median age 26 years (range 16-56). Mean (SD) forced expiratory volume in one second (FEV1) was 49 (26)% predicted, forced vital capacity (FVC) was 68 (26)% predicted, and the FEV1:FVC ratio was 59 (16)%. In this cross sectional study different patterns of perceived quality of life were seen in men and women. In part 1 of the NHP there was an age related trend compared with norms in men, with more distress/disability in the dimensions of emotion, sleep, and social isolation in the older age groups. In women there was no age related trend in the degree of distress/disability compared with norms. The mean score was different from norms in the dimensions of pain, emotion and sleep. For the patients with cystic fibrosis as a whole the scores in part 1 were comparable with published scores of patients with minor non-acute conditions. Scores in part 2 of the NHP for men were different from norms in six of the seven areas of daily living (all except home life). For women the scores were different from norms in the areas of looking after the home, social life, hobbies, and holidays. There were correlations between several of the quality of life dimensions and other measured variables such as FEV1, breathlessness score, and the time spent on home treatment. CONCLUSIONS: Men and women with cystic fibrosis have different patterns of perceived quality of life, and there is an age related trend of perceived quality of life in men in some dimensions. Quality of life scores in this group, as assessed by the NHP, are similar to those reported in subjects with minor non-acute conditions.
Activities of Daily Living↗
Home treatment of patients with cystic fibrosis using the 'Intermate': the first year's experience.
Home treatment of patients with cystic fibrosis has many attractions and is becoming increasingly popular. The investigators have studied the use, results and costs of the first year of operation of a home-care intravenous antibiotic service using the 'Intermate' infusion device in a prospective study using questionnaires, spirometric and weight measurements. Ninety-three patients received 166 courses of intravenous antibiotics in full or in part at home during 1991. The average length of treatment was 12.5 days and on average 70% of the treatment was given at home. The mean percentage predicted FEV1 and FVC improved after treatment and the mean improvement was not significantly different to that produced by hospital treatment. Breathlessness, sputum volume, appetite, ability to sleep, mood, energy and overall well-being, as assessed by questionnaire, showed significant improvements after home treatment. The median time spent mixing and administering drugs was 10-19 hours and visiting the hospital was 7-12 hours. The median number of days of lost income to patients or their carers was 0 days. The majority of the patients were extremely satisfied with the treatment and supervision that they received. Using the home care service, 1442 inpatient days were saved. The investigators conclude that home care using 'Intermates' improves a patient's lung function and quality of life.
Adolescent↗
The management of cystic fibrosis.
Cystic fibrosis is a chronic, life-threatening inherited disease which poses severe physical, psychological and social problems for the sufferer and his or her family. Frances Duncan-Skingle and Fiona Foster present an overview of recent developments in the clinical management of this distressing condition.
Cystic Fibrosis↗
Cystic fibrosis: managing nutrition.
A crucial part of the management of patients with cystic fibrosis is ensuring that dietary requirements are met, and therefore weight gain and growth are achieved. The author outlines the nutritional problems faced by this client group and suggests how they may be overcome. She argues that optimum nutrition contributes not only to an improved standard of health, but also to the overall quality of life of patients with cystic fibrosis.
Child↗
Cystic fibrosis: improving quality of life (continuing education credit).
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Adolescent↗