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Biomedical subjects

C K Wells

Publications and source records attributed to C K Wells.

47 records · Page 3Linked to original sources
PubMed1985

Sustained-release theophylline reduces dyspnea in nonreversible obstructive airway disease.

Although orally administered theophylline has been prescribed widely in patients with nonreversible airway obstruction, symptomatic benefit has not been established. To assess the effects of orally administered theophylline on dyspnea, we performed a randomized, double-bind, crossover, placebo-theophylline clinical trial in 12 ambulatory male patients with moderate to severe nonreversible airway obstruction. Dyspnea was rated using 2 clinical indexes based on 3 components affecting breathlessness: functional impairment, magnitude of task that evokes dyspnea, and the associated magnitude of effort. Dyspnea and physiologic parameters were measured on 4 occasions: at baseline, 4 wk after initial treatment, a second baseline after a 2-wk washout period, and 4 wk after the second medication. For the 12 patients, mean age (+/- SD) was 60 +/- 7 yr, forced expiratory volume in one second was 1.36 +/- 0.67 L (mean, 40% of predicted), and arterial oxygen tension was 71 +/- 10 mmHg. During the treatment phase, all patients had a therapeutic theophylline blood level (range, 12 to 19 micrograms/ml). Theophylline significantly decreased the components of functional impairment (p = 0.02) and magnitude of task (p = 0.02) relating to dyspnea, as well as the overall dyspnea rating (p = 0.01). There were no significant differences between placebo and theophylline therapy for spirometry, arterial blood gas tensions, and the 12-min walking distance. Thus, sustained-release theophylline significantly reduced dyspnea in these ambulatory patients with moderate to severe nonreversible airway obstruction without altering lung function, gas exchange, or exercise performance.

Administration, Oral↗
PubMed1984

The measurement of dyspnea. Contents, interobserver agreement, and physiologic correlates of two new clinical indexes.

To improve the clinical measurement of dyspnea, we developed a baseline dyspnea index that rated the severity of dyspnea at a single state and a transition dyspnea index that denoted changes from that baseline. The scores in both indexes depend on ratings for three different categories: functional impairment; magnitude of task, and magnitude of effort. At the baseline state, dyspnea was rated in five grades from 0 (severe) to 4 (unimpaired) for each category. The ratings for each of the three categories were added to form a baseline focal score (range, 0 to 12). At the transition period, changes in dyspnea were rated by seven grades, ranging from -3 (major deterioration), to +3 (major improvement). The ratings for each of the three categories were added to form a transition focal score (range, -9 to +9). In 38 patients tested with respiratory disease, interobserver agreement was highly satisfactory for both indexes. The baseline focal score had the highest correlation (r = 0.60; P less than 0.001) with the 12-minute walking distance (12 MW), while significant, but lower, correlations existed for lung function. For the transition focal score, there was a significant correlation only with the 12 MW (r = 0.33; p = 0.04). These results indicate that dyspnea can receive a direct clinical rating that provides important information not disclosed by customary physiologic tests.

Aged↗
PubMed1984

Comorbid and clinical determinants of prognosis in endometrial cancer.

In cancers of the lung, larynx, rectum, and breast, the patients' initial clinical manifestations and comorbid diseases have shown important prognostic distinctions that are not evident in the customary systems of anatomic staging. This study was done to see whether the same phenomena occurred for cancer of the endometrium. In 142 consecutive cases of endometrial carcinoma, strikingly high five-year survival rates were found in women who had no symptoms attributable to the cancer or whose only symptoms might have been caused either by concomitant uterine or cervical disease or by replacement estrogen therapy. A distinct decline in survival was associated with systemic symptoms and with major comorbid ailments. Estimation of prognosis and evaluation of therapy can be improved with a new composite staging system, formed by combining the new clinical categories and the standard morphologic stages of the International Federation of Gynecology and Obstetrics (FIGO) system.

Adenocarcinoma↗
PubMed1977

A new clinical taxonomy for rating change in functional activities of patients with angina pectoris.

The treatment of patients with angina pectoris is commonly evaluated according to such indexes as the frequency of anginal attacks, quantity of supplemental nitroglycerin, and exercise performance in an ergometric laboratory test. None of these indexes demonstrates the clinical change in ordinary functional limitations that may have been the major reason why a patient sought medical help. The New York Heart Association ratings of functional capacity do not refer to different types of activity and the four categories of the scale are too coarse to show distinct changes that can occur while a patient retains the same rating. A new taxonomy has been devised for rating transitions in functional capacity as noted in three different kinds of functional performance: occupation, customary activities, and sporadic activities. The ratings of change in these three activities can be combined into single global rating. When applied to conventional questionaire data for 309 patients in a randomized double-blind therapeutic trial, the new classifications showed a statistically significant superiority, in each type of functional transition and in the global ratings, for patients receiving timolol maleate rather than placebo. By augmenting the conventional information used for therapeutic evaluation, the new taxonomic indexes can expand the scientific scope of antianginal treatment. Data derived from history-taking can be just as statistically significant as "harder" forms of information, while simultaneously being more pertinent for the clinical challenge of choosing and evaluating the agents used in patient care.

Activities of Daily Living↗