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  1. Book: Pulmonary disorders in the adolescent

    Homnick, Douglas N.

    (Adolescent medicine ; 11,3)

    2000  

    Author's details guest ed.: Douglas N. Homnick
    Series title Adolescent medicine ; 11,3
    Collection
    Keywords Atemwegskrankheit ; Jugend
    Subject Jugend ; Jugendalter ; Jugendlicher ; Teenager ; Atemwegekrankheit ; Atemwege ; Atemwegserkrankung
    Language English
    Size XV S., S. 483 - 704 : graph. Darst.
    Publisher Hanley & Belfus
    Publishing place Philadelphia
    Publishing country United States
    Document type Book
    HBZ-ID HT012866359
    ISBN 1-56053-331-5 ; 978-1-56053-331-3
    Database Catalogue ZB MED Medicine, Health

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  2. Article ; Online: The effect of therapeutic horseback riding on balance in community-dwelling older adults: a pilot study.

    Homnick, Tamara D / Henning, Kim M / Swain, Charlene V / Homnick, Douglas N

    Journal of applied gerontology : the official journal of the Southern Gerontological Society

    2015  Volume 34, Issue 1, Page(s) 118–126

    Abstract: Equine assisted activities (hippotherapy and therapeutic riding) improve balance in patients with disabilities such as cerebral palsy, but have not been systematically studied in older adults, at risk of falls due to balance deficits. We conducted a 10- ... ...

    Abstract Equine assisted activities (hippotherapy and therapeutic riding) improve balance in patients with disabilities such as cerebral palsy, but have not been systematically studied in older adults, at risk of falls due to balance deficits. We conducted a 10-week, single blind, controlled trial of the effect of a therapeutic horseback riding course on measures of balance in community-dwelling adults 65 years and older. Nine riders and six controls completed the trial. Controls were age matched to riders and all participants were recruited from the local community. Both groups showed improvements in balance during the trial, but did not reach statistical significance. Sample size was small, participants had relatively high initial balance scores, and controls tended to increase their physical activities, likely influencing outcomes. No adverse events occurred and the supervised therapeutic riding program appeared to be a safe and effective form of exercise to improve balance in older adults. A power analysis was performed to estimate numbers of participants needed for a larger study.
    MeSH term(s) Accidental Falls ; Aged ; Animals ; Equine-Assisted Therapy/methods ; Exercise Therapy/methods ; Female ; Geriatric Assessment ; Horses ; Humans ; Male ; Pilot Projects ; Postural Balance ; Single-Blind Method
    Language English
    Publishing date 2015-02
    Publishing country United States
    Document type Controlled Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 155897-3
    ISSN 1552-4523 ; 0733-4648
    ISSN (online) 1552-4523
    ISSN 0733-4648
    DOI 10.1177/0733464812467398
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  3. Article: Making airway clearance successful.

    Homnick, Douglas N

    Paediatric respiratory reviews

    2007  Volume 8, Issue 1, Page(s) 40–45

    Abstract: Airway clearance therapy (ACT) requires a substantial time, effort and resource commitment on the part of families and patients with cystic fibrosis (CF). Lack of compliance with caregiver recommendations and adherence to a proposed therapeutic plan ... ...

    Abstract Airway clearance therapy (ACT) requires a substantial time, effort and resource commitment on the part of families and patients with cystic fibrosis (CF). Lack of compliance with caregiver recommendations and adherence to a proposed therapeutic plan occurs more than 50% of the time with ACT and is particularly common in adolescents. There is a large menu of ACT devices and techniques from which to choose. Increasing adherence and compliance requires an effort on the part of the CF team, including regular visits to the CF center, matching the patient to the device or technique based on lifestyle and disease severity, selecting appropriate outcome measures and monitoring adherence and compliance. Successful ACT also requires the CF team to understand individual patient situations, individualize ACT programs and accept a realistic level of patient participation.
    MeSH term(s) Cystic Fibrosis/therapy ; Humans ; Mucociliary Clearance ; Patient Compliance ; Physical Therapy Modalities ; Respiratory Therapy/instrumentation ; Treatment Outcome
    Language English
    Publishing date 2007-03
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2147664-0
    ISSN 1526-0550 ; 1526-0542
    ISSN (online) 1526-0550
    ISSN 1526-0542
    DOI 10.1016/j.prrv.2007.02.002
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  4. Article: Mechanical insufflation-exsufflation for airway mucus clearance.

    Homnick, Douglas N

    Respiratory care

    2007  Volume 52, Issue 10, Page(s) 1296–305; discussion 1306–7

    Abstract: Cough is an important component of airway clearance, particularly in individuals with intrinsic pulmonary disease, weakness of respiratory muscles, or central nervous system disease that impairs breathing. The use of assisted cough to enhance airway ... ...

    Abstract Cough is an important component of airway clearance, particularly in individuals with intrinsic pulmonary disease, weakness of respiratory muscles, or central nervous system disease that impairs breathing. The use of assisted cough to enhance airway clearance in individuals with neuromuscular disease is essential to produce and maintain peak cough flow above a minimum and thereby avoid retained secretions that cause infection, inflammation, and respiratory failure. Periodic insufflation of the lung above a reduced vital capacity is also important, to maintain range of motion of the thoracic cage and avoid progressive respiratory disability. Mechanical insufflation-exsufflation is a therapy in which the device (the CoughAssist In-Exsufflator is the only currently marketed insufflation-exsufflation device) gradually inflates the lungs (insufflation), followed by an immediate and abrupt change to negative pressure, which produces a rapid exhalation (exsufflation), which simulates a cough and thus moves secretions cephalad. Mechanical insufflation-exsufflation is used with patients with neuromuscular disease and muscle weakness due to central nervous system injury. Insufflation-exsufflation decreases episodes of respiratory failure, particularly during upper-respiratory-tract infection, and provides greater success in weaning from mechanical ventilation than do conventional methods. Alternatives to insufflation-exsufflation that can produce sufficient peak cough flow for airway clearance include (1) insufflation to maximum insufflation capacity (via breath-stacking with a bag and mask, a volume ventilator, or glossopharyngeal breathing) followed by a spontaneous cough, and (2) manually assisted cough with an abdominal thrust. The effectiveness of insufflation-exsufflation in patients with obstructive lung disease, such as chronic obstructive pulmonary disease or asthma, and in pediatric patients, is less clear.
    MeSH term(s) Airway Obstruction/etiology ; Airway Obstruction/therapy ; Cough ; Equipment Design ; Humans ; Insufflation/instrumentation ; Insufflation/methods ; Mucus
    Language English
    Publishing date 2007-10
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 603252-7
    ISSN 0020-1324 ; 0098-9142
    ISSN 0020-1324 ; 0098-9142
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Evaluation of serum concentrations achieved with an empiric once-daily tobramycin dosage regimen in children and adults with cystic fibrosis.

    Vandenbussche, Heather L / Homnick, Douglas N

    The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG

    2012  Volume 17, Issue 1, Page(s) 67–77

    Abstract: Objectives: To assess the ability of an empiric once-daily dosing (ODD) tobramycin regimen to achieve desired serum concentrations in patients with cystic fibrosis (CF); to determine an optimal dosage regimen, using pharmacodynamic parameters; and to ... ...

    Abstract Objectives: To assess the ability of an empiric once-daily dosing (ODD) tobramycin regimen to achieve desired serum concentrations in patients with cystic fibrosis (CF); to determine an optimal dosage regimen, using pharmacodynamic parameters; and to evaluate clinical response, adverse effects, and patient/parent satisfaction with ODD.
    Methods: This was a prospective single-center trial in patients with CF who are 5 years of age and older requiring intravenous antibiotics. Tobramycin, 10 mg/kg every 24 hours, was infused over 60 minutes, and two serum concentrations were analyzed using 1-compartment pharmacokinetic modeling. Simulations were performed to identify dosage regimens that maximized desired pharmacodynamic parameters. Other data included demographics, symptoms, spirometry, adverse events, and satisfaction with ODD.
    Results: A total of 14 children and 11 adults completed the study. Empiric doses resulted in mean peak tobramycin concentrations of 28.7 ± 5.5 mg/L and undetectable trough concentrations. Only 42% of patients achieved desired peak serum concentrations (20-30 mg/L) with the empiric regimen. A regimen of 12 mg/kg every 24 hours would achieve modified pharmacodynamic goals with an acceptable peak range of 20 to 35 mg/L. Forced expiratory volume in 1 second improved in 15 of 20 (75%) patients with ODD. Two patients experienced reversible vestibular adverse effects attributed to tobramycin. All patients were satisfied or very satisfied with ODD because of convenience and ease of use.
    Conclusions: An empiric tobramycin regimen of 10 mg/kg every 24 hours did not achieve desired serum concentrations for most patients, although all patients demonstrated clinical improvement. Desired tobramycin concentrations with modified pharmacodynamic goals could be achieved by using an empiric dosage of 12 mg/kg every 24 hours. Prospective evaluation of this regimen with individualized patient monitoring is needed to ensure safety and efficacy and to monitor the effects on microbial resistance patterns.
    Language English
    Publishing date 2012-10-30
    Publishing country United States
    Document type Journal Article
    ISSN 2331-348X
    ISSN (online) 2331-348X
    DOI 10.5863/1551-6776-17.1.67
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Effect of therapeutic horseback riding on balance in community-dwelling older adults with balance deficits.

    Homnick, Douglas N / Henning, Kim M / Swain, Charlene V / Homnick, Tamara D

    Journal of alternative and complementary medicine (New York, N.Y.)

    2013  Volume 19, Issue 7, Page(s) 622–626

    Abstract: Objectives: Falls are an important cause of morbidity in older adults. Equine-assisted activities including therapeutic riding (TR) benefit balance and neuromuscular control in patients with neurological disabilities but have not been systematically ... ...

    Abstract Objectives: Falls are an important cause of morbidity in older adults. Equine-assisted activities including therapeutic riding (TR) benefit balance and neuromuscular control in patients with neurological disabilities but have not been systematically studied in older adults at greater risk for falls due to balance deficits. The effect of an 8-week TR program on measures of balance and quality of life in community-dwelling older adults with established balance deficits was evaluated.
    Design: This was a pretest-post-test single-group trial of a TR program on measures of balance and quality of life.
    Setting: The study was conducted at a Professional Association of Therapeutic Horsemanship (PATH) International Premier riding center.
    Subjects: The subjects comprised 9 adults (5 female, 4 males) with a mean age 76.4 years (range 71-83 years).
    Interventions: This included an 8-week observation period followed by an 8-week TR program consisting of 1 hour per week of supervised horseback riding and an 8-week follow-up period. SUBJECTS received balance testing at weeks 0, 8, 16, and 24 using the Fullerton Advanced Balance Scale (FABS), and quality of life was measured at weeks 8 and 16 using the Rand SF (short form) 36 quality-of-life measure.
    Outcome measures: OUTCOME MEASURES were change in the FABS and Rand SF 36.
    Results: There was no significant difference in balance scores between the start and end of the observation period. There was a significant improvement in the balance score and perception of general health from the start to the end of the intervention period, and no significant difference between the end of the intervention and the end of study, suggesting that improvements may have been sustained.
    Conclusions: TR is a safe activity for older adults with mild to moderate balance deficits and leads to both improvements in balance and quality of life. Longer and larger studies to assess the benefit of equine-assisted activities on improvements in balance and reduction in fall risk are needed.
    MeSH term(s) Aged ; Aged, 80 and over ; Equine-Assisted Therapy/methods ; Female ; Follow-Up Studies ; Humans ; Independent Living ; Male ; Nervous System Diseases/diagnosis ; Nervous System Diseases/rehabilitation ; Neurologic Examination ; Neuromuscular Diseases/diagnosis ; Neuromuscular Diseases/rehabilitation ; Postural Balance ; Quality of Life ; Treatment Outcome
    Language English
    Publishing date 2013-07
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1237383-7
    ISSN 1557-7708 ; 1075-5535
    ISSN (online) 1557-7708
    ISSN 1075-5535
    DOI 10.1089/acm.2012.0642
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: Parent-reported physician diagnosis is an important factor in asthma management: an elementary school survey.

    Homnick, Douglas N / DeJong, Sandra R

    Clinical pediatrics

    2007  Volume 46, Issue 5, Page(s) 431–436

    Abstract: Parent surveys seem to provide sufficient information for asthma case selection. In this study, elementary school children were identified for an asthma education program through a screening questionnaire, followed by a comprehensive family survey. The ... ...

    Abstract Parent surveys seem to provide sufficient information for asthma case selection. In this study, elementary school children were identified for an asthma education program through a screening questionnaire, followed by a comprehensive family survey. The data were analyzed by groups according to those with parent-reported physician diagnosis or no physician diagnosis. Those with an asthma diagnosis had less nighttime symptoms, less family stress, and more asthma follow-up visits, and were prescribed appropriate medications and peak flow meters more often than those students without a physician diagnosis of asthma. A physician commitment to or recognition of an asthma diagnosis is an important factor in subsequent asthma care.
    MeSH term(s) Asthma/diagnosis ; Asthma/drug therapy ; Asthma/therapy ; Child ; Data Collection ; Humans ; Michigan ; Parents ; Physicians ; Schools ; Surveys and Questionnaires
    Language English
    Publishing date 2007-06
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 207678-0
    ISSN 1938-2707 ; 0009-9228
    ISSN (online) 1938-2707
    ISSN 0009-9228
    DOI 10.1177/0009922806297515
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  8. Article: The effect of a first-generation antihistamine on sputum viscoelasticity in cystic fibrosis.

    Homnick, Douglas N / Marks, John H / Rubin, Bruce K

    Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine

    2007  Volume 20, Issue 1, Page(s) 45–49

    Abstract: Tenacious airway secretions are responsible for much of the lung damage in cystic fibrosis (CF). Label warnings on potential secondary effects of some antihistamines include possible drying or thickening of lower airway secretions, suggesting that they ... ...

    Abstract Tenacious airway secretions are responsible for much of the lung damage in cystic fibrosis (CF). Label warnings on potential secondary effects of some antihistamines include possible drying or thickening of lower airway secretions, suggesting that they are detrimental to individuals with airway disease. We studied the effects of cyproheptadine hydrochloride (CH) on sputum weight, viscoelasticity, and transportability in CF patients participating in a pilot trial of CH as an appetite stimulant to assure no potential adverse secondary effects on mucus clearance. Sixteen clinically stable subjects were randomized to receive either CH (2 mg QID for 1 week followed by 4 mg QID for 11 weeks) or placebo. Sputum was obtained by voluntary forced cough and expectoration prior to starting CH or placebo and at 4 weeks. Viscoelasticity was measured by rheometry and cough transportability by simulated cough machine. Sufficient paired sputum for rheologic analysis was obtained on four placebo and seven CH subjects and for cough transportability analysis on three placebo and six CH subjects. Weight on all specimens was obtained prior to both analyses. There were no significant differences in sputum weight wet, measures of mucus viscoelasticity (rheology), or cough transportability of mucus between baseline and 4 weeks in patients on placebo or CH. From this limited study, CH, a first-generation antihistamine, appears to have no adverse effects in sputum viscoelasticity or cough transportability in CF patients.
    MeSH term(s) Adolescent ; Adult ; Appetite Stimulants/administration & dosage ; Appetite Stimulants/therapeutic use ; Child ; Cough/physiopathology ; Cyproheptadine/administration & dosage ; Cyproheptadine/therapeutic use ; Cystic Fibrosis/physiopathology ; Double-Blind Method ; Elasticity ; Forced Expiratory Volume/physiology ; Histamine H1 Antagonists/administration & dosage ; Histamine H1 Antagonists/therapeutic use ; Humans ; Mucociliary Clearance/drug effects ; Mucus/drug effects ; Pilot Projects ; Placebos ; Rheology ; Sputum/drug effects ; Sputum/physiology ; Viscosity
    Chemical Substances Appetite Stimulants ; Histamine H1 Antagonists ; Placebos ; Cyproheptadine (2YHB6175DO)
    Language English
    Publishing date 2007
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 645084-2
    ISSN 0894-2684
    ISSN 0894-2684
    DOI 10.1089/jam.2006.0593
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article: Long-term trial of cyproheptadine as an appetite stimulant in cystic fibrosis.

    Homnick, Douglas N / Marks, John H / Hare, Karyl L / Bonnema, Sally K

    Pediatric pulmonology

    2005  Volume 40, Issue 3, Page(s) 251–256

    Abstract: Appetite stimulants have been used to help overcome decreased appetite and malnutrition in children and adults with various chronic illnesses, including cystic fibrosis (CF). Stimulants have included megestrol acetate (MA), cyproheptadine hydrochloride ( ... ...

    Abstract Appetite stimulants have been used to help overcome decreased appetite and malnutrition in children and adults with various chronic illnesses, including cystic fibrosis (CF). Stimulants have included megestrol acetate (MA), cyproheptadine hydrochloride (CH), cannabinoids, hydrazine sulfate, anabolic hormones, and growth hormone. Many of these, including MA, have substantial side effects and may not be suitable for prolonged use. We previously studied the effects of CH on weight gain in a short-term (12 week) trial in CF with good results compared to placebo. Side effects were few, and weight gain was significant. In this study, we sought to determine the effects of CH over a longer term in order to assess its suitability for prolonged use. Sixteen CF children and adults enrolled in the original short-term study subsequently entered this study, and 12 completed the 9-month trial. All patients receiving placebo in the original short-term study received CH 4 mg up to four times a day in the long-term study continuation, and those receiving CH in the short-term study continued on the drug. No pill counts were done, and patients were queried at quarterly visits as to their CH use. Anthropometrics and spirometry were also done quarterly, and antibiotic use was quantified. Subjects who had changed from placebo (CH2 group) gained weight significantly over 3-6 months, and those continuing on CH (CH1 group) generally maintained previously gained weight over the duration of the study. Select spirometric measures improved in both groups but not significantly, and side effects were mild. CH appears to be an effective appetite stimulant in CF, and generally maintains its effect over time with an acceptable side-effect profile.
    MeSH term(s) Adolescent ; Age Factors ; Appetite Stimulants/therapeutic use ; Body Composition/drug effects ; Body Weight/drug effects ; Cyproheptadine/therapeutic use ; Cystic Fibrosis/drug therapy ; Female ; Gastrointestinal Agents/therapeutic use ; Humans ; Male ; Sleep Stages/drug effects
    Chemical Substances Appetite Stimulants ; Gastrointestinal Agents ; Cyproheptadine (2YHB6175DO)
    Language English
    Publishing date 2005-09
    Publishing country United States
    Document type Clinical Trial ; Controlled Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 632784-9
    ISSN 1099-0496 ; 8755-6863
    ISSN (online) 1099-0496
    ISSN 8755-6863
    DOI 10.1002/ppul.20265
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article: Pulmonary function and sputum production in patients with cystic fibrosis: a pilot study comparing the PercussiveTech HF device and standard chest physiotherapy.

    Marks, John H / Hare, Karyl L / Saunders, Robert A / Homnick, Douglas N

    Chest

    2004  Volume 125, Issue 4, Page(s) 1507–1511

    Abstract: Study objective: To compare the PercussiveTech HF (PTHF) device (Vortran Medical Technology 1; Sacramento, CA) to standard manual chest physiotherapy (CPT) with respect to acute changes in pulmonary function, sputum production, and pulse oximetry in ... ...

    Abstract Study objective: To compare the PercussiveTech HF (PTHF) device (Vortran Medical Technology 1; Sacramento, CA) to standard manual chest physiotherapy (CPT) with respect to acute changes in pulmonary function, sputum production, and pulse oximetry in patients with cystic fibrosis (CF).
    Design: Randomized crossover.
    Setting: University-affiliated, community-based CF center.
    Participants: Ten clinically stable patients with CF (age range, 10 to 21 years; mean age, 15.3 years) with Shwachman scores from 55 to 95 (mean 75).
    Interventions: Two treatment regimens were used: 2.5 mg of albuterol delivered via updraft nebulizer followed by standard CPT, and 2.5 mg of albuterol delivered via the PTHF device without CPT.
    Results: Outcome measures included pulmonary function test (PFT) results 4 h after treatment and quantitative sputum production during the 4 h after treatment. Pulse oximetry was performed during treatment. A patient satisfaction questionnaire was administered at the end of the study. No PFT parameters were significantly changed 4 h after CPT or PTHF, although there was a trend to decreasing residual volume after both treatments. There was a trend for more sputum production after PTHF compared to CPT, but this did not reach statistical significance. There were no episodes of hemoglobin-oxygen desaturation during or after either treatment. One patient had minor hemoptysis after CPT. No adverse effects occurred after PTHF. Eight patients found the PTHF device easy to use, and six patients would prefer the PTHF device to CPT.
    Conclusions: The PTHF device appears to be a safe and effective method of airway clearance in CF patients in this small pilot study.
    MeSH term(s) Adolescent ; Adult ; Aerosols ; Albuterol/administration & dosage ; Bronchodilator Agents/administration & dosage ; Child ; Cross-Over Studies ; Cystic Fibrosis/physiopathology ; Cystic Fibrosis/therapy ; Female ; Humans ; Lung/physiopathology ; Male ; Oximetry ; Patient Satisfaction ; Percussion ; Pilot Projects ; Respiratory Function Tests ; Respiratory Therapy/methods ; Sputum/metabolism ; Treatment Outcome ; Ventilators, Mechanical
    Chemical Substances Aerosols ; Bronchodilator Agents ; Albuterol (QF8SVZ843E)
    Language English
    Publishing date 2004-04
    Publishing country United States
    Document type Clinical Trial ; Comparative Study ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 1032552-9
    ISSN 1931-3543 ; 0012-3692
    ISSN (online) 1931-3543
    ISSN 0012-3692
    DOI 10.1378/chest.125.4.1507
    Database MEDical Literature Analysis and Retrieval System OnLINE

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