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Biomedical subjects

J E Hodgkin

Publications and source records attributed to J E Hodgkin.

At least 19 recordsLinked to original sources
PubMed1995

Ambulatory monitoring of heart rate and blood pressure during the first week after smoking cessation.

To investigate the timecourse of cardiovascular changes immediately after smoking cessation, 16 subjects wore ambulatory monitors on alternate days during a 1-week residential smoking cessation program. Heart rate was significantly elevated at the time of cessation, then declined steadily until 6 h after cessation, when it reached the level of subsequent nonsmoking days. Systolic and diastolic blood pressures were elevated to a lesser degree for the same period after cessation. The timing of the decline in heart rate and blood pressure was coincident with the timing of an increase in withdrawal symptoms and has implications for laboratory and epidemiologic studies.

Adult↗
PubMed1992

Reversibility of airways injury over a 12-month period following smoking cessation.

In this investigation, we examined changes in exfoliated tracheobronchial cells in sputum in 46 individuals (mean age = 49.2 years; mean packyears = 48.7) who discontinued smoking and 37 individuals (mean age = 54.9 years; mean packyears = 65.2) who continued to smoke over a 12-month period after participation in the St. Helena Hospital and Health Center one-week residential smoking cessation program. Before the beginning of the smoking cessation program, those who went on to quit were not different from those who did not quit with respect to baseline cytomorphology ratings. In those individuals with a minimum of three follow-up tests, results indicated significant reductions from precessation levels in macrophages, pigmented macrophages, and neutrophils after adjustment for differences in age, packyears, and pulmonary function (FEV1/FVC). Over the course of follow-up, quitters, in comparison with nonquitters, also had significantly lower mean levels of columnar cells, mucus, mucous spirals, and metaplasia. These results indicate a consistent effect of smoking cessation on cytomorphology and demonstrate that on cessation, some of the measured elements promptly return toward a more normal pattern.

Forced Expiratory Volume↗
PubMed1990

Pulmonary rehabilitation.

Any COPD patient with symptoms is a candidate for pulmonary rehabilitation. A careful assessment of the individual to determine the patient's precise disease process and needs is essential to outlining an appropriate treatment program. Following the sequence described in the ATS Statement on Pulmonary Rehabilitation included in the appendix to this article provides the best potential for successfully returning the patient to the highest level of function possible. An increase in the availability of pulmonary rehabilitation programs should allow more COPD patients to participate in this process, resulting in an enhanced ability to carry out daily activities, an improved quality of life, and a reduction in the long-term costs of caring for such individuals.

Combined Modality Therapy↗
PubMed1990

Prognosis in chronic obstructive pulmonary disease.

Although many factors have been shown to relate to survival in patients with COPD, the patient's age and baseline postbronchodilator FEV1 are the best predictors of mortality. The presence of mild obstructive airway disease is not indicative of a progressive downhill course and shortened survival. Mortality in patients with a baseline postbronchodilator FEV1 greater than or equal to 50% of predicted was only slightly greater than that of a group of healthy smokers. Investigators attempting to compare survival in patients with COPD should attempt to exclude patients with asthma or asthmatic bronchitis, because these individuals have a much better prognosis than those with typical COPD (emphysema and chronic bronchitis). Patients should be matched closely for age and severity of impairment, because younger individuals and those with milder impairment are likely to live longer. Other factors besides age and baseline FEV1 have been shown to affect survival. Patients who stop smoking are likely to survive longer than those who continue to smoke. The presence of malnutrition has clearly been shown to worsen survival. Further studies will be necessary to determine if corticosteroid therapy can slow down progression of disease in patients with typical COPD. Oxygen therapy improves survival in COPD patients with significant hypoxemia, many of whom also have CO2 retention, polycythemia, and cor pulmonale. There are now multiple studies in the literature suggesting that the type of comprehensive respiratory care provided by pulmonary rehabilitation programs can not only improve the quality of life but also survival in patients with chronic obstructive pulmonary disease.

Humans↗
PubMed1989

Applications of a method for setting air quality standards based on epidemiological data.

A method for setting air quality standards for long-term cumulative exposures of a population based on epidemiological studies has been developed. It uses exposure estimates interpolated from monitoring stations to zip code centroids, each month applied to zip code by month residence histories of the population. Two alternative cumulative exposure indices are used--hours in excess of a threshold, and the sum of concentrations above a threshold. The indices are then used with multiple logistic regression models for the health outcome data to form dose response curves for relative risk, adjusting for covariates. These curves are useful for determination of at what exposure amounts and threshold levels, effects which have both statistical and public health significance begin to occur. The method is applied to a ten year follow-up of a sub cohort of 7,343 members of the National Cancer Institute-funded Adventist Health Study. Up to 20 years of residence history was available. Analysis for prevalence of symptoms was conducted for four air pollutants--total oxidants, sulfur dioxide, nitrogen dioxide, and total suspended particulates. For each pollutant, cumulated exposures were calculated above each of five different thresholds. Statistically significant effects were noted for total suspended particulates, total oxidants, sulfur dioxide, past and passive smoking.

Air Pollution↗
PubMed1987

The National Institutes of Health Intermittent Positive Pressure Breathing trial--pathology studies. III. The diagnosis of emphysema.

In an attempt to predict the severity of emphysema in patients with moderately severe and severe chronic air-flow obstruction, antemortem pulmonary function data, including spirometry, subdivisions of lung volumes, diffusing capacity (transfer factor) for carbon monoxide, and elastic recoil were assessed in 46 patients who were autopsied during the National Institutes of Health Intermittent Positive Pressure Breathing Clinical Trial and we compared these to the morphologic severity of emphysema. The severity of emphysema was graded by the panel grading method using whole lung, paper-mounted (Gough-Wentworth) sections and the mean linear intercept (Lm). The FEV1 and FEF25-75 of the FVC, the DLCO, the diffusing capacity for carbon monoxide, and subdivisions of lung volumes showed significant but low order correlations with the emphysema score and Lm. Total lung capacity, determined by plethysmography, was better related to emphysema in this study than in others in which TLC was measured by helium dilution. Volume-pressure data fitted to the exponential equation (V = A - Be-KP) yielded a low order, but a significant relationship between Lm and the exponential constant (K), but not between K and the panel emphysema score. We conclude that the recognition of the presence and severity of emphysema continues to require a multivariate approach including clinical history, assessment of air-flow obstruction via routine spirometry, radiologic assessment of the lung with emphasis on total lung capacity, and evaluation of the diffusing capacity for carbon monoxide.

Biomechanical Phenomena↗
PubMed1986

Prognosis in chronic obstructive pulmonary disease.

We recruited 985 patients with COPD but without hypoxemia or other serious disease, treated them in a standard fashion, and followed them closely for nearly 3 yr. At the time of recruitment the patients were carefully characterized as to symptom severity, lung function, exercise tolerance, and quality of life, and studies of lung function were repeated during follow-up. Overall mortality was 23% in 3 yr of follow-up. Patient age and the initial value of the FEV1 were the most accurate predictors of death; when FEV1 before bronchodilator was used, the response to bronchodilators was directly related to survival, but this relationship became nonsignificant when postbronchodilator FEV1 was used as a primary predictor. After adjustment for age and FEV1, mortality was related positively to TLC, resting heart rate, and perceived physical disability, and related negatively to exercise tolerance. These relationships, though significant, were relatively weak. When standardized for age and FEV1, mortality in the present series was less than that of a previous series (4), and the same as that of hypoxemic patients with COPD who received continuous home O2 therapy. Changes in FEV1 with time averaged -44 ml/yr, but the standard deviation was large. Patients with low initial values of FEV1 showed relatively little further decline, probably indicating a survivor effect. In patients with well-preserved initial FEV1, rate of decline correlated negatively with bronchodilator response, symptomatic wheezing, and psychological disturbances.

Adult↗
PubMed1986

United States audit of asthma therapy.

While variations observed in the approach to treatment among specialists in the United States may be partly related to differences in the types of patients seen, the differences are more likely related to a varied level of awareness among the specialties regarding new concepts of asthma therapy. A heightened awareness in the US of the results of therapeutic interventions often tried in other countries for years prior to their introduction in the US can benefit asthma patients by hastening the adoption of therapeutic advances by physicians in this country. Education of physicians and their patients is essential to improving the quality of life and survival in asthma patients. Physicians must inform patients and their families of the critical importance of prophylactic care and aggressive early intervention at the first sign of an exacerbation in order to once again achieve a declining mortality rate in individuals with asthma.

Administration, Inhalation↗
PubMed1986

Organization of a pulmonary rehabilitation program.

In order for pulmonary rehabilitation to be successful, the organization of the program must be carefully planned. If a program seems feasible, based on an initial study, attention must be given to proper team structure, space needs, and services to be provided. A well thought out marketing plan is crucial to the success of the program, and of course obtaining maximal reimbursement is critical.

Health Facility Environment↗
PubMed1984

COPD prevalence in nonsmokers in high and low photochemical air pollution areas.

The prevalence of respiratory symptoms, as ascertained by questionnaire, was evaluated in 6,666 nonsmokers who had lived for at least 11 years in either a high photochemical pollution area (4,379 individuals) or a low photochemical pollution area (2,287 individuals). Of these, 5,178 had never smoked, and none was currently smoking. The risk estimate for "definite" COPD, as defined in this study, was 15 percent higher in the high pollution area (p = 0.03), after adjusting for sex, age, race, education, occupational exposure, and past smoking history. Past smokers had a risk estimate 22 percent higher than never smokers (p = 0.01). Multivariate analysis showed a significant effect of air pollution on the prevalence of "definite" COPD which univariate analysis failed to demonstrate.

Adult↗
PubMed1980

Incidence of metabolic alkalemia in hospitalized patients.

Analysis of 13,430 arterial blood samples demonstrated that metabolic alkalemia was the most common acid-base disturbance encountered in the hospital setting, being present in 51% of patients with abnormal acid-base status. Respiratory alkalemia was encountered in 29%, respiratory acidemia in 27%, and metabolic acidemia in only 12%. Evaluation of those blood gases with metabolic alkalemia, using 95% confidence-limit bands for acid-base disturbances, showed that the metabolic alkalemia was pure in 70% of the cases, mixed with respiratory acidemia in 18%, and combined with respiratory alkalemia in 12%. The adverse effects of alkalemia may be subtle but often significant. Alveolar hypoventilation in response to metabolic alkalemia, without evidence of primary respiratory disease, was more frequent than is generally suspected. This hypoventilation often directly results in hypoxemia, as well as atelectasis with worsened ventilation/perfusion match-up. Alkalemia shifts the oxyhemoglobin dissociation curve to the left, increasing hemoglobin's affinity for oxygen, thus, limiting oxygen release at the tissue level. The presence of metabolic alkalemia makes it more difficult to wean patients from assisted ventilation. A clearer understanding of the frequency and significance of metabolic alkalemia should lead to more appropriate therapy to prevent or correct this acid-base disturbance and should result in a decreased morbidity and mortality in critically ill patients.

Acidosis↗
PubMed1979

Preoperative evaluation of pulmonary function.

Respiratory problems are a major cause of postoperative complications. Detection of the patient with subtle chronic obstructive pulmonary disease is essential to lessen the risk of respiratory complications in the postoperative period. In the patient with known chronic obstructive pulmonary disease, it is important to determine not only whether a lung lesion such as a neoplasm can be completely resected, but also whether the patient's cardiorespiratory reserve is adequate to allow the proposed lung resection. Detection of the patient at increased risk as well as evaluation of the ability to withstand surgery is discussed.

Carbon Dioxide↗
PubMed1975

Respiratory care warrants studies for cost-effectiveness.

The need for careful cost-effectiveness studies in the field of RCS is apparent. Salaries consume most of the cost, and overtrained and expensive personnel may be saturating the work force. Costs for consumable and nonconsumable supplies have not risen out of proportion to general economic inflationary indixes. Close examination is needed of therapeutic modalities that are expensive and that stand on shaky scientific ground. However, the short-term experience of the medical center's multidisciplinary respiratory rehabilitation program has demonstrated that such programs can be worth the costs involved.

California↗