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News briefs from the journal Chest, December 2005

American College of Chest Physicians

A diet rich in omega-3 fatty acids, such as those found in fish, canola oil, and walnuts, can have anti-inflammatory effects and improve the exercise capacity for patients with chronic obstructive pulmonary disease (COPD). For two years, Japanese researchers followed 32 patients with COPD on an omega-3 fatty acid-rich diet (treatment group) and 32 patients with COPD on a non-omega-3 fatty acid-rich diet (nontreatment group). Every three months, dyspnea scores, levels of inflammatory mediators, and exercise capacity were recorded. Overall, results showed that dyspnea scores and exercise capacity significantly improved and inflammatory mediators significantly decreased for patients in the treatment group, while there was no significant change in the nontreatment group. Researchers suggest that nutritional support with an omega-3 fatty acid-rich diet is a safe and practical method for treating COPD. The study appears in the December issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.

Shorter work shifts for hospital fellows and resident physicians do not compromise continuity of patient care, shows a new study. Researchers at Mayo Clinic College of Medicine compared outcomes between traditional long hours of continuous care, with a 14-hour work-shift model in a medical intensive care unit (MICU) over a five-week pilot period. During the nonpilot periods, which included two months prior to and two months after the pilot, residents and fellows worked six days a week and were on in-house call (28 to 30 continuous hours) once every fourth night, averaging 73.3 duty hours weekly. During the pilot program, residents and fellows worked in 14-hour shifts, averaging 61.3 duty hours and 65.3 duty weekly hours, respectively. When patient care outcomes were compared, results showed no significant differences in the observed MICU and hospital mortality rates and lengths of stay. Although researchers conclude that a 14-hour sift model is a feasible option for housestaff rotation in the MICU, potential harms and benefits that may arise from long duty-hours with continuous care versus shorter shift models with less continuous care will need to be further evaluated. The study appears in the December issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.

A new study shows that caregivers of patients residing in institutions suffer from depression more than caregivers of patients residing at home. Researchers from Case Western University, Cleveland, OH, followed 211 caregivers of patients who received more than three days of mechanical ventilation. Of the caregivers, 163 were enrolled in an eight-week disease management intervention program, consisting of individualized case management services from an advanced practice nurse. All caregivers were assessed at patient's hospital discharge and two months later for depression and for burden related to physical health, disrupted schedule, financial concerns, lack of family support, physical health concerns, and self esteem. Researchers found that caregivers of patients in institutions reported higher depression, lack of family support, and greater health problems than did caregivers of patients living at home. At discharge, 50.2 percent of caregivers reported symptoms of depression and more than half were still depressed two months later. The disease management program had no significant impact on the majority of variables. However, at two months, 54 percent of caregivers in the disease management group had no or mild depression, as compared to 34.5 percent of the control group. Overall, spouses were at highest risk for depression but reported the lowest sense of burden from lack of family support. Researchers conclude that further research needs to be conducted on interventions aimed at reducing depression for this caregiver population. The study appears in the December issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.


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