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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

"Substituted judgment," in which surrogate decisionmakers approximate patients' wishes, has been recommended for decision making for mentally incapacitated patients. To test understanding of patients' preferences by potential surrogate decisionmakers, we studied primary care physicians' (n = 105) and spouses' (n = 90) predictions of elderly outpatients' (n = 258) preferences for cardiopulmonary resuscitation (CPR) and CPR plus ventilator (CPR + V), assuming three baseline health states: current health, stroke, and chronic lung disease. Although more than three-quarters of physicians and spouses surveyed believed their predictions of patients' preferences were accurate, the accuracy of physicians' and spouses' predictions did not exceed that expected due to chance alone in 5 of 6, and 3 of 6 decisions, respectively. Physicians significantly underestimated patients' preferences for resuscitation in the stroke and chronic lung disease scenarios (p less than .01), and significantly overestimated them in the current health/CPR decision (p less than .05). Spouses overestimated patients' preferences for resuscitation in all decisions, significantly so in the three CPR + V decisions (p less than .05). These results suggest physicians and spouses often do not understand elderly outpatients' resuscitation preferences. Under these circumstances they are unlikely to provide accurate substituted judgments.
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PMID:Physicians' and spouses' predictions of elderly patients' resuscitation preferences. 341 31

To compare circulatory changes during dynamic and isometric exercise in patients with chronic lung disease, vascular pressures and cardiac output were measured in pulmonary and systemic circulation. The patients, mainly chronic bronchitics, were divided according to pulmonary vascular resistance (PVR): six patients with PVR below 120 dyn.s.cm-5, and 17 with PVR above this value. Exercise was performed using the legs, in a supine position, at low load. Oxygen consumption increased, on average, from 270 ml/min at rest, to 340 ml/min during isometric exercise, and 585 ml/min during dynamic exercise. Isometric exercise produced an increase in systemic artery pressure similar to that of dynamic exercise, but other vascular changes were of much smaller magnitude: pulmonary artery pressure increased by 4 mmHg with isometric exercise, and by 14 mmHg during dynamic exercise, on average; for cardiac output, these changes were 0.8 and 3.3 l/min, respectively. The pressure/flow relationship in the pulmonary circulation was comparable for both types of exercise. Changes in filling pressures in relation to stroke volume were more marked in the group of patients with elevated pulmonary vascular resistance. Changes in wedge pressure and in right atrial pressure were remarkably parallel for patients with normal as well as with high pulmonary vascular resistance.
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PMID:Cardiovascular changes during isometric and dynamic exercise in chronic lung disease. 358 16

Initial evaluation of 22 patients with cystic fibrosis (CF) on entry into a trial of home oxygen therapy was used to elucidate the possible effects of poor nutritional status on exercise performance in CF. The patients had advanced lung disease (mean FEV1, 36 percent predicted) and all had a stable resting PaO2 less than or equal to 65 mm Hg. Nutritional status was determined by calculating weight as a percentage of ideal for height (Wt/Ht) for each subject. Exercise testing consisted of a progressive exercise test on a cycle ergometer to measure maximum work capacity (Wmax), and a steady state test at 50 percent of baseline Wmax. During the steady state test, cardiac output (Q) and stroke volume (SV) were computed by the indirect Fick (CO2) method. Wmax, SV, Q and lung function results are expressed as percent predicted. Mean (+/- SD) Wmax was 58 +/- 15 percent predicted. Wmax correlated with both FEV1 and Wt/Ht, but FEV1 and Wt/Ht were not related. During steady state exercise, 12 of 22 patients had a SV less than 80 percent predicted. SV correlated with Wt/Ht, but not with lung function. Thirteen of the 22 patients had a Wt/Ht less than or equal to 90 percent and were considered malnourished. When compared with the well-nourished patients (Wt/Ht greater than 90%), these malnourished subjects had significantly lower mean values for Wmax%, SV% and Q% predicted, but not for lung function parameters. We conclude that: in patients with CF and advanced lung disease, nutritional status plays a significant role in determining exercise capacity; lower exercise tolerance of malnourished patients is an independent effect, as nutritional status and lung function were not related; and malnourished patients with CF have an altered cardiac performance on exercise testing which is due to a reduced SV rather than an impaired heart rate response.
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PMID:Effects of nutritional status on exercise performance in advanced cystic fibrosis. 374 50

A method was developed for determining the ratio of cardiopulmonary blood volume to stroke volume, in horses. The radioisotope 99 Tc (technetium 99m pertechnetate) was injected into the jugular vein as a bolus, which was then detected in the right and left ventricles consecutively by a scanning device consisting of a Na I crystal, a collimator, an amplifier and a discriminator. The radiocardiogram (RCG) and the ECG were recorded simultaneously by a two-channel writing device. The ratio of cardiopulmonary blood volume to stroke volume (cardiopulmonary flow index = CPFI) was then determined from the RCG and ECG tracings. Five categories of horses were examined, viz. Thoroughbreds in training, showjumpers in training, horses not in training, horses with cardiovascular disease and horses with chronic lung disease. The mean CPFI of the above categories were respectively 7.0 +/- 0.39, 7.3 +/- 0.45, 6.7 +/- 0.61, 9.8 +/- 1.30 and 6.2 +/- 0.47. The mean CPFI of the subjects with heart disease was significantly greater than the mean values of the other four categories (P less than 0.001). It was concluded that the CPFI was a reproducible physiological parameter in horses and that the value was significantly increased in our series of subjects with heart disease.
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PMID:The ratio of cardiopulmonary blood volume to stroke volume as an index of cardiac function in horses. 609 21

A CO2-rebreathing method for the determination of stroke volume (SV) was evaluated at rest by comparison with the direct Fick technique in 50 randomly selected patients with valvular heart disease. Patients with intracardiac shunts were excluded. Objective criteria for acceptance of a measurement were set to ensure reliable results. Forty-six of the 50 patients fulfilled these criteria. The rebreathing manoeuvre is, in itself, an effort for the patient, leading to a change in steady state which excludes simultaneous comparison with the direct Fick method. Day-to-day variation of the SV measured with the CO2-method was therefore assessed first, and found to be low. Because of this low day-to-day variation, a comparison of stroke volumes measured one day with the CO2-method and next day with the direct Fick technique was found to be acceptable. In the determination of SV in the supine position, there was no significant difference between the two methods (SVCO2 = 5.2 + 0.90 X SVFick, r = 0.90, SDres = 9.4 ml, n = 46), while cardiac output was significantly higher when measured with the CO2 technique than with the direct Fick method (22%, P less than 0.001). Ten of 12 patients with signs of obstructive lung disease managed to produce registrations which fulfilled the criteria of acceptance. The method is well suited for clinical use.
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PMID:Non-invasive determination of effective stroke volume. Evaluation of a CO2-rebreathing method in normal subjects and patients. 640 80

The hemodynamic response to 20 mg diltiazem i.v. was assessed at rest and during bicycle exercise in the supine position in 32 patients with pulmonary hypertension due to chronic obstructive pulmonary disease. The mean arterial pressure decreased significantly at rest by some 8% and by 2% during exercise. The heart rate fell by some 4% at rest, but remained unchanged during exercise. The cardiac index, stroke volume index and pulmonary capillary wedge pressure did not differ significantly at rest, but during exercise the cardiac index increased by 5% and the stroke volume index by 8%; pulmonary wedge pressure was not influenced by diltiazem. The systolic pulmonary artery pressure fell significantly by some 9% at rest and by 10% on maximum exercise; mean pulmonary arterial pressure decreased significantly by some 10% both at rest and during exercise. Right atrial mean pressure rose significantly on average from 4 to 6 mm Hg, while remaining unchanged during exercise. After diltiazem the total body vascular resistance fell by 8% at rest and by 6% during exercise, while pulmonary arteriolar resistance was lowered by 13% (significant) at rest and by 11% (also significant) during exercise. Decrease in pulmonary afterload was more significant in our patients than decrease in peripheral afterload. In 6 of 32 patients there was no improvement in hemodynamic data after administration of diltiazem. These results support the inclusion of calcium channel blockers in the therapeutic regimen of pulmonary hypertension due to chronic lung disease.
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PMID:[Favorable response of pulmonary hypertension in patients with chronic obstructive airway disease treated with diltiazem]. 671 Jan 4

The feasibility and efficiency of ventilation by high-frequency oscillation (HFO) were examined in animals with diffuse hemorrhagic lung disease. Twenty-four hours after injection with 0.12 ml/kg oleic acid, 11 spontaneously breathing rabbits had a mean (+/- SD) arterial O2 partial pressure (PaO2) of 65 +/- 16 Torr and arterial CO2 partial pressure (PaCO2) of 38 +/- 7 Torr [inspired fractional O2 concentration (FIO2) of 0.21]. Following paralysis animals were ventilated using a high-frequency oscillator for periods of 20 min followed by three successive hyperinflations to prevent atelectasis. Maintaining a constant mean airway pressure (MAP) of 6 cmH2O and fresh gas flow (FGF) of 2 1/min (FIO2 = 0.21), all combinations of frequency (5, 10, 20, and 30 Hz) and stroke volume (Vs) 2.6, 5.0, and 8.9 ml) were tested. At each frequency, an increase in Vs tended to lower mean PaCO2. At each Vs, CO2 elimination appeared maximal at 20 Hz, an effect attributable to decreasing effective Vs with increasing frequency. With constant Vs, MAP, and frequency, increasing FGF from 1 to 2 or 61/min decreased mean PaCO2 (P less than 0.05). With constant Vs, frequency, and FGF, increases in MAP from 2 to 10 cmH2O increased mean PaO2 (P less than 0.05). HFO, coupled with periodic hyperinflation, supports satisfactory gas exchange in rabbits with oleic acid lung injury. The efficiency of gas exchange is improved by independent increases in Vs, FGF, MAP, or frequency.
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PMID:Ventilation by high-frequency oscillation in rabbits with oleic acid lung disease. 678 64

To assess left ventricular (LV) response to supine bicycle exercise, we studied 10 normal (group 1). 10 patients with coronary artery disease (CAD) (group 2), 12 patients with severe obstructive lung disease (COPD) (group 3), and eight patients with both CAD and COPD (group 4) by gated equilibrium radionuclide angiography. Most individuals in all groups also had pulmonary catheter-obtained measurements of LV filling pressures during exercise. Normal individuals increased their ejection fraction (EF) during exercise by increasing stroke volume (SV) and reducing end-systolic volume (ESV) without changing end-diastolic volume (EDV); pulmonary artery (PAP) and wedge (PAW) pressures were unaltered. CAD patients (group 2) showed no change in EF with increased EDV, ESV, SV, and PAW. COPD patients (group 3) exhibited decreases in EDV, ESV, and SV, accounting for abnormal EF responses in 6 of 12; PAW was unchanged and the marked elevation of PAP correlated with reduced EDV. Group 4 patients (CAD plus COPD) had abnormal EF responses with increased EDV and ESV without change in SV. Thus an abnormal LV function response to exercise in COPD patients may be multifactorial, thereby indicating the possible need for therapeutic modalities in addition to those employed in alleviating pulmonary parenchymal disease.
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PMID:Evaluation of left ventricular function in chronic pulmonary disease by exercise gated equilibrium radionuclide angiography. 721 69

Echocardiograms were obtained in 10 normal patients and in 11 patients with respiratory insufficiency due to chronic obstructive lung disease (8) and to thoracic poliomyelitis (3). Only the eight patients with obstructive lung disease had paradoxic pulse. No patient had pericardial disease. The left ventricular internal dimension, stroke volume, and the mitral valve E-F slope and D-E excursion were measured. The inspiratory to expiratory ratio of each measurement was significantly lower in patients with obstructive lung disease than in normal subjects. The patients with thoracic poliomyelitis demonstrated almost no respiratory change in these measurements. The magnitude of the change in the measured factors probably relates to the degree of negativity of intrathoracic pressure during respiration. The inspiratory reduction of mitral valve motion and left ventricular internal dimension is not specific to tamponade but may be seen in patients who exhibit paradoxic pulse due to other conditions.
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PMID:Echocardiographic observations of paradoxic pulse without pericardial disease. 741 66

This study investigated the effects of specific health conditions on perceived quality of life in retirement as measured by dimensions of retirement satisfaction. Respondents were 252 men and 199 women who participated in the retirement substudy of an ongoing epidemiological investigation of people age 65 and over in two rural Iowa counties. Retirement satisfaction was measured by the Retirement Descriptive Index, which assesses satisfaction with activities and work, finances, health, and people. Pulmonary disease was a predictor of dissatisfaction with health for both sexes. Pulmonary disease and heart attack were the strongest predictors of dissatisfaction with health for men, followed closely by stroke. Arthritis was the strongest predictor of dissatisfaction with health for women. Implications for social work practice are discussed.
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PMID:Health conditions and perceived quality of life in retirement. 755 23


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