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Am Fam Physician. 2002;66(5):904

ATS Guidelines for the Six-Minute Walk Test

The Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories of the American Thoracic Society (ATS) has issued a position statement on guidelines for the six-minute walk test (6MWT). The statement appears in the March 2002 issue of the American Journal of Respiratory and Critical Care Medicine.

According to the ATS, the most popular clinical exercise tests in order of increasing complexity are stair climbing, a 6MWT, a shuttle-walk test, detection of exercise-induced asthma, a cardiac stress test, and a cardiopulmonary exercise test. The ATS states that the 6MWT is easy to administer, better tolerated, and more reflective of activities of daily living than the other tests. Because most activities of daily living are performed at submaximal levels of exertion, the test may better reflect the functional exercise level for daily physical activities.

The 6MWT can be used to measure the response to medical interventions in patients with moderate to severe heart or lung disease, as well as a one-time measure of functional status of patients and a predictor of morbidity and mortality.

The ATS points out that the test should be performed in a location where a rapid, appropriate response to an emergency is possible. A crash cart should be within easy access, and a telephone or other device should be in place to enable a call for help. Physicians are not required to be present during all tests. The physician ordering the test or a supervising laboratory physician may decide whether physician attendance at a specific test is required. However, the person administering the test should be certified in cardiopulmonary resuscitation (CPR) with a minimum of Basic Life Support by an American Heart Association-approved CPR course. Finally, if patients are receiving chronic oxygen therapy, oxygen should be given at their standard rate or as directed by a physician or a protocol.

Most 6MWTs can be done before and after intervention, and the primary question to be answered after both tests have been completed is whether the patient has experienced a clinically significant improvement. With a good quality-assurance program, with patients tested by the same technician, and after one or two practice tests, short-term reproducibility of the distance walked in the 6MWT can be excellent.

ACOG Opinion Paper on Vaginal Agenesis

The Committee on Adolescent Health Care of the American College of Obstetricians and Gynecologists (ACOG) has issued an opinion paper on nonsurgical diagnosis and management of vaginal agenesis. ACOG Committee Opinion No. 274 appears in the July 2002 issue of Obstetrics and Gynecology.

According to the ACOG opinion paper, vaginal agenesis is an uncommon, but not rare, condition. It occurs once in every 4,000 to 10,000 females. The most common cause of vaginal agenesis is congenital absence of the uterus and vagina, which is also referred to as müllerian aplasia, müllerian agenesis, or Mayer-Rokitansky-Küster-Hauser syndrome. The condition usually can be managed nonsurgically with the use of successive dilators if it is correctly diagnosed and the patient is sufficiently motivated.

Besides correct diagnosis, effective management also includes evaluation for associated congenital, renal, or other anomalies and careful psychologic preparation of the patient before any treatment or intervention. The ACOG committee recommends that nonsurgical creation of the neovagina should be the first-line approach. If surgery is preferred, a number of approaches are available and described in the Committee Opinion; the most common is the Abbe-McIndoe operation.

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