Biomedical subjects
G A Traver
Publications and source records attributed to G A Traver.
Measures of symptoms and life quality to predict emergent use of institutional health care resources in chronic obstructive airways disease.
Thirty subjects with severe chronic obstructive airways disease participated in a study to identify differences in symptoms and life quality between those with high and low emergent use of institutional health care resources. Emergent use was defined as care obtained through unscheduled, nonroutine methods of access to health care providers. There were 15 subjects in each group; the groups had similar sex distribution and were not significantly different for percent predicted forced expiratory volume in 1 second (mean 29.8%), use of home oxygen (15 of 30 subjects), or prevalence of CO2 retention (nine of 30). Symptoms and life quality were measured by using three paper and pencil tests, the Bronchitis-Emphysema Symptom Checklist, the Sickness-Impact Profile, and the Katz Adjustment Scale for relatives. Findings demonstrated consistently more symptoms and impairment of life quality in the "high emergent" group. The differences reached statistical significance for irritability, anxiety, helplessness, nervousness, peripheral sensory complaints, alienation, social interaction, and emotional behavior. Discriminant analysis provided a prediction formula that yielded 80% correct prediction for the two groups.
The course and prognosis of different forms of chronic airways obstruction in a sample from the general population.
We examined the course and prognosis in subjects selected from the general population who had chronic airflow obstruction at the time of their enrollment in a longitudinal epidemiologic study. Mortality and the rate of change in lung function were analyzed in relation to the initial clinical characteristics of the subjects. Twenty-seven subjects with symptoms and signs of asthma (Group I) had a higher survival rate and a much lower rate of decline in pulmonary function than the 45 subjects in Group III, whose clinical characteristics were more compatible with an emphysematous form of chronic obstructive pulmonary disease (COPD). The 10-year mortality among subjects in Group III (non-atopic smokers without a history of asthma) was close to 60 percent, whereas it was only 15 percent in Group I (atopic subjects or nonsmokers with known asthma). The mean overall rate of decline in forced expiratory volume in one second was 70 ml per year in Group III but less than 5 ml per year in Group I. Forty-five patients (Group II) who did not clearly fit into either Group I or III had intermediate values for survival and decline in pulmonary function. Previous data on mortality from COPD and the rate of progression of the condition, although compatible with our findings in patients who had an emphysematous form of disease, are not applicable to those with an asthmatic-bronchitic form. Better control of the progression of asthmatic bronchitis with therapy may explain its more favorable prognosis.
Methodological considerations of epidemiological diagnoses in respiratory diseases.
Since epidemiological research depends extensively on questionnaire responses, a comparison of such responses with a standardized medical evaluation was conducted. It was found that standardized questionnaires do well in comparison for certain kinds of information on chronic conditions. However, clinical evaluations will elicit more information, specifically of a milder nature. It was concluded that standardized epidemiological questionnaires are satisfactory for survey of chronic conditions.
Maximal expiratory flows after postural drainage.
Flows measured from maximal expiratory flow-volume (MEFV) curves were used to evaluate the efficacy of postural drainage in improving ventilatory function acutely. Maximal expiratory flow-volume curves were obtained for 9 cystic fibrosis subjects and 10 subjects with chronic bronchitis before and 5, 15, and 45 min after a 30-min session of postural drainage with percussion, vibration, and coughing. Forced vital capacity (FVC) was significantly increased 45 min after drainage for the combining group. Flows at high lung volumes were different for the 2 subgroups. Subjects with cystic fibrosis demonstrated a significant increase in peak expiratory flow rates 45 min after drainage and an increase in forced expiratory volume in one sec at all time intervals. The subjects with chronic bronchitis had a decreased peak expiratory flow rate 5 min after drainage, but by 45 min, it had returned to baseline. There was no significant change in one-sec forced expiratory volume at any time interval for the chronic bronchitis subgroup. Changes in flows at low lung volumes were similar for the 2 subgroups. Forty-five min after drainage there was an increase in flow rates near 50 per cent of FVC. Flows near 25 per cent of FVC were increased 15 and 45 min after drainage. This study demonstrated that postural drainage with coughing resulted in significant improvement in flows at low lung volumes. Changes in flows at high lung volumes were less consistent.
Predictors of mortality in chronic obstructive pulmonary disease. A 15-year follow-up study.
The relative usefulness of various initial findings in predicting survival is reported for 200 patients with chronic obstructive pulmonary disease who have been followed for approximately 15 years. After 5 years of follow-up, subjects 62 or more years of age showed a poorer survival rate than younger subjects. After controlling for age, the per cent predicted forced expiratory volume in 1 sec after administration of bronchodilator was the best indicator of prognosis. In subjects less than 65 years of age, the presence or absence of cor pulmonale further improved the prediction of subsequent mortality. Regardless of initial findings, however, there was wide individual variability in prognosis, and factors relating to this variability remain obscure. No difference in survival rate was noted between the 178 male patients who were enrolled in Chicago 15 years ago and the 100 similarly impaired men enrolled in Tucson approximately 7 years ago.
[1. Assessment of thorax and lungs].
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Living with chronic respiratory disease.
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Editorial: Nurse practitioner programs.
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The danger of hypostatic pneumonia.
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The nurse's role in clinical testing of lung function.
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Symposium on care in respiratory disease. Forward.
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Respiratory care. Roles of allied health professionals.
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Assessment of thorax and lungs.
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Respiratory insufficiency--pulmonary physiology and the nursing assessment.
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Respiratory insufficiency--nursing intervention.
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Asthma update. Part I. Mechanisms, pathophysiology, and diagnosis.
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Asthma update. Part II. Treatment.
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