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Biomedical subjects

R M Kaplan

Publications and source records attributed to R M Kaplan.

At least 127 records · Page 7Linked to original sources
PubMed1991

Gender differences in health-related quality of life.

In 1986 the life expectancy at birth was 71.3 years for males and 78.3 years for females--providing a 7-year advantage for women. Although women live longer, it has been reported that they paradoxically experience more physical and psychological illnesses. In this article, we estimate the expected well-years or quality-adjusted life years for men and women in the general population. The data were obtained in a random sample of 1,034 residents of San Diego. The well-life expectancy uses standard life expectancies with adjustments for quality of life. The well-life expectancy for men was 59.8 years; for women, it was 62.7 years. Thus, the quality adjustment had significantly more impact on women (15.6 years) than on men (11.5 years). Age-specific estimates of health-related quality of life suggested a male advantage before age 45 and a female advantage after age 45. The benefits of well-years of life as a public health statistic are discussed.

Adult↗
PubMed1991

Prediction of maximum exercise tolerance in patients with COPD.

Exercise tolerance in patients with COPD is difficult to predict from measurements of lung function. We examined multiple physiologic and psychosocial variables in an attempt to predict exercise performance in a group of patients with COPD enrolled in a clinical trial of pulmonary rehabilitation. A total of 119 patients (FEV1 = 1.41 +/- 0.64 L) were divided randomly into either a study group (group A, n = 58) or validation group (group B, n = 61). Stepwise multiple regression in group A revealed that peak oxygen uptake (peak VO2) was predicted best by the following equation: Peak VO2 (L/min) = (0.0327 x DCO) + (0.0040 x MVV)-(0.0156 x peak-exercise VD/VT) + (0.0259 x resting VE) + 0.848; r = 0.90; SE = 0.233 L/min. This equation was then cross-validated in group B. It demonstrated excellent validity: measured peak VO2 (L/min) = (1.13 x predicted peak VO2)-0.0891; r = 0.90; SE = 0.239 L/min. We conclude that exercise tolerance was predicted reasonably well from measurements of lung function and gas exchange in this group of patients with COPD. However, the variability of the prediction would limit its usefulness in individual patients.

Carbon Dioxide↗
PubMed1991

Maximum intensity exercise training in patients with chronic obstructive pulmonary disease.

We studied high intensity, symptom-limited, endurance exercise training in 52 patients with COPD participating in a pulmonary rehabilitation program. The patients had moderate to severe airway obstruction and reduced exercise tolerance with ventilatory limitation. The target workload for endurance exercise testing was 95 percent of the baseline maximum treadmill work load. At training weeks 1, 4 and 8, they were training at 85, 84, and 86 percent respectively, of baseline maximum. After rehabilitation, there was an increase in maximal treadmill work load, VO2max, and endurance exercise time, and a decrease in perceived symptoms. Patients who did not reach anaerobic threshold (group 2) were able to train at a higher percentage of maximum exercise tolerance than patients who reached anaerobic threshold (group 1). The increase in exercise performance of both groups, however, was similar. We conclude that patients with moderate to severe COPD can perform exercise training successfully at intensity targets which represent higher percentages of maximum than typically recommended in normal individuals or other patients.

Anaerobic Threshold↗
PubMed1991

Measuring the quality of well-being in cystic fibrosis and lung transplantation. The importance of the area under the curve.

The quality of well-being scale (QWB) has been used to measure overall life quality in a number of different clinical conditions, including cystic fibrosis and chronic obstructive pulmonary disease. Evidence supports its validity and reliability in both cross-sectional and longitudinal studies. One of the strengths of the QWB is that it is not organ-specific, so that it can take into account the broad impact of a disease and/or intervention, including unanticipated effects. The well-year of life is a concept that includes both morbidity and mortality: if a disease reduces quality of life by one-half, over a period of two years, that person can be said to have lost one full well-year. As we examine the impact of diseases such as cystic fibrosis, and of interventions such as lung transplantation, it is important to consider changes in overall well-being over time to help individual patients and families make difficult therapeutic choices and to help formulate health policy.

Adult↗
PubMed1991

Effects of alpha-1-acid glycoprotein on the cardiovascular toxicity of nortriptyline in a swine model.

Tricyclic antidepressant toxicity is a frequently encountered and life-threatening problem in emergency medicine. This trial investigated the effect of alpha-1-acid glycoprotein (AAG), an acute phase reactant with a high affinity for basic drugs, on the clinical and pharmacological manifestations of nortriptyline (NT) toxicity. Fourteen pentobarbital-anesthetized swine (10-13 kg) were given a 10-min loading dose followed by a 45-min maintenance infusion of NT to achieve a plasma level of approximately 1000 ng/ml. At the end of the infusion, 7 control (C) animals were given 50 ml of 0.9% saline and 7 AAG animals were given 50 ml of 10% AAG, both over 15 min. Heart rate, QRS duration, QTc interval, blood pressure, temperature, arterial blood gases, albumin, and plasma-free and plasma-bound NT levels were measured at baseline and at every hour for 4 h. One death was noted in the AAG group and none in the C group (p = NS). Mean total NT levels after infusion in the C group was 1240 +/- 1118 ng/ml and in the AAG group 804 +/- 194 ng/ml (p = NS). No significant differences were found in the plasma-free fractions between groups at any time interval. However, significantly shorter QTc intervals were found during treatment with AAG compared to controls (P = 0.02). A trend toward increased systolic blood pressure (p = 0.09) and shorter QRS duration (p = 0.09) was noted during AAG treatment. No significant changes were shown between groups with respect to heart rate, arterial blood gases, or albumin measurements.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

The safety of prehospital naloxone administration by paramedics.

We performed a retrospective review to investigate the safety of prehospital naloxone administration by paramedics as part of a protocol for all patients presenting with an acutely depressed level of consciousness (LOC). The prevalence of naloxone-induced vomiting, seizures, hypotension, hypertension, and cardiac arrest was sought from the prehospital records of 813 patients treated during a 12-month period. The mean age of the treated patients was 42.4 +/- 9.7 years. The initial dose of naloxone was 0.4 to 0.8 mg, and the mean total dose was 0.9 +/- 0.6 mg. No patients lost a pulse within ten minutes of receiving naloxone. Two patients (0.2%) experienced a significant drop in systolic blood pressure, and one patient (0.1%) demonstrated a significant rise in systolic blood pressure within five minutes of naloxone administration. Vomiting occurred in two patients (0.2%), and one patient (0.1%) suffered a tonic-clonic seizure within five minutes of naloxone administration. Of the 813 patients treated, 60 patients (7.4%: mean age, 32.3 +/- 6.7 years) were judged to have an improved LOC after naloxone, with 27 (3.3%) regaining a normal LOC. We conclude that in the above doses, naloxone is safe as part of prehospital protocols for paramedics treating patients with an acutely depressed LOC. However, the vast majority of patients treated empirically with naloxone in the field demonstrated no benefit.

Adult↗
PubMed1990

Manual translaryngeal jet ventilation and the risk of aspiration in a canine model.

STUDY OBJECTIVES: Manual translaryngeal jet ventilation (TLJV) is a safe and effective method of maintaining normal ventilation in apneic subjects. Little data exist on the amount of airway protection afforded with this technique of airway management. We sought to evaluate the risk of aspiration during manual TLJV. SETTING: Data were collected in a laboratory animal model. DESIGN: A prospective, nonrandomized, controlled trial was performed. PARTICIPANTS: Seventeen adult apneic mongrel dogs were enrolled. INTERVENTIONS: Intratracheal Gastrograffin was instilled and radiographic changes assessed during ventilation using a 0 to 3 scale (none to severe). Thirty-six trials were performed, with equal numbers at both 30 degrees and 45 degrees head elevation. The three groups studied were animals without airway protection (control), animals with a cuffed endotracheal tube (tube), and animals with a percutaneous TLJV cannula and a 50-psi oxygen source ventilated at a rate of 20 breaths per minute (jet). MEASUREMENTS AND MAIN RESULTS: Significantly less radiographic evidence of aspiration was noted in the jet and tube groups at 30 degrees and 45 degrees compared with control animals (P = .002 each). At 45 degrees head elevation a trend toward increased aspiration scores in the jet group compared with the tube group (P = .065) was observed. CONCLUSION: In our model, manual TLJV at 20 breaths per minute and an I:E ratio of 1:2 provided protection from aspiration comparable to that observed with a cuffed endotracheal tube at 30 degrees head elevation. At 45 degrees elevation, this protection was diminished.

Animals↗
PubMed1990

Behavior as the central outcome in health care.

A predominant justification for health psychology and behavioral medicine is that behavior or environmental conditions affect a biological process. Thus, many investigators focus attention on the effects of behavior on cell pathology and blood chemistry. This article argues that behavioral outcomes are the most important consequences in studies of health care and medicine. These outcomes include longevity, health-related quality of life, and symptomatic complaints. Traditional measures in biomedical science often have limited reliability and validity. Their validity is demonstrated only through relationships with longevity, role performance, behavioral functioning, and symptomatic experience, and these correlations are often modest. A model is proposed to guide future investigations. Biological, environmental, and psychological variables are included in the model as predictors or mediators of behavioral health outcomes. Recognizing that health outcomes are behavioral directs intervention toward whatever method produces the most health benefit at the lowest cost.

Behavioral Medicine↗
PubMed1990

Experimental evaluation of rehabilitation in chronic obstructive pulmonary disease: short-term effects on exercise endurance and health status.

Randomly assigned 119 adults with chronic obstructive pulmonary disease to an 8-week comprehensive rehabilitation program or to an 8-week education control program. Comprehensive pulmonary rehabilitation included education, physical and respiratory therapy instruction, psychosocial support, and supervised exercise training; education control included biweekly classroom instruction and discussions on respiratory therapy, medical aspects of lung disease, clinical pharmacology, and diet, but no exercise training. Both groups received extensive physiological and psychosocial evaluation before and after the intervention. Six months after enrollment, patients randomly assigned to the rehabilitation program showed significant increases in exercise endurance, whereas patients randomly assigned to control program showed nonsignificant increases. Improvement in self-efficacy was correlated with improvements in exercise endurance.

Combined Modality Therapy↗
PubMed1990

Correct positioning of an endotracheal tube using a flexible lighted stylet.

Endotracheal intubation is not without complications, among the most serious of these being misplacement of the endotracheal (ET) tube. Unrecognized esophageal placement is a lethal complication, but even when placed in the trachea, ET tubes can be displaced distally and enter a mainstem bronchus. Correct positioning of an ET tube is usually defined as the placement of the tube within the trachea approximately 5 cm above the carina. Chest x-ray is the most common and a reliable method of demonstrating correct positioning, particularly in ICU patients. Using transillumination by means of a flexible stylet (lightwand), we investigated whether transillumination could position an ET tube consistently within 5 +/- 2 cm of the carina. Ten human cadavers of varied weight and body habitus were intubated under direct vision and 10 ml of a radiopaque dye was injected down the tube as a marker for the carina. A premeasured flexible lighted stylet was then inserted into the inplace tube so that the bulb was positioned at the tube's distal opening. The brightest transilluminated glow produced by the bulb was then positioned at the sternal notch. A chest x-ray was taken and the distance of the tube tip from the carina was calculated. In each case the tube tip could be placed consistently at a level 5 +/- 1 cm from the carina by observing the maximal transilluminated glow at the sternal notch. We conclude that transillumination of the neck using a flexible lighted stylet can accurately and consistently position an ET tube at an appropriate distance above the carina.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1990

Nursing home utilization in adults: a prospective population-based study.

Rates of nursing home utilization between 1972 and 1986 were determined for 1,302 men and women living in an upper-middle-class community in Southern California. Leading diagnostic reasons for admission were dementia, cancer, and stroke, and the leading nondiagnostic reason for admission was an inability to carry out activities of daily living. In this cohort, rates of nursing home utilization increased with age. Women at all ages used nursing homes at a higher rate than men, although their probability of survival once admitted was greater. Admission rates were higher over time or prior to death than when observed cross-sectionally. Rates were highest in the year prior to death but declined at time of death.

Adult↗
PubMed1990

Attendance at health promotion programs: baseline predictors and program outcomes.

As part of a family cardiovascular health promotion project, 111 Mexican-American and 95 Anglo-American families with fifth- or sixth-grade children were assigned to either a primary prevention program involving 18 sessions or to a control condition. This article evaluates predictors of attendance at the year long sequence of sessions in the intervention group. In addition it considers the relationship between attendance and program outcomes. Low baseline scores on physical activity and cardiovascular fitness measures were associated with higher attendance for both children and adults. High initial health knowledge and self-motivation were also associated with attendance. Multiple regression analysis showed that adult attendance was significantly predicted by a model including completion of a three-day food record, low exercise, higher socioeconomic status, family adaptability, and self-motivation. Attendance was correlated with greater knowledge gains and larger reductions in blood pressure. The results indicate that motivated families who are in greater need of conditioning attended more sessions in a health promotion program.

Adult↗
PubMed1990

A comparative study of the psychosocial assets of adults with cystic fibrosis and their healthy peers.

Psychosocial assets of 37 adults with cystic fibrosis (CF) and 46 of their healthy peers were assessed by mailed questionnaire. Major sociodemographic variables did not differ significantly between the two groups, nor did indices of emotional social support, social network density, self-esteem, or current life satisfaction. This study revealed adults with CF to function on a par with their healthy peers in nearly all respects, a finding at odds with those from uncontrolled studies and which suggests to us that many previous conclusions about the psychosocial health of adults with CF have been unwarranted. Future psychosocial studies involving patients with CF should include control groups and inferences about the effect of these patients' physical illness on their psychosocial health should not be made in the absence of normative data.

Adaptation, Psychological↗
PubMed1990

Quality of well-being before and after antibiotic treatment of pulmonary exacerbation in patients with cystic fibrosis.

General quality of life has only recently been measured with an objective tool in patients with cystic fibrosis (CF), and there have been no reported attempts to document changes in patients' overall well-being over time, as patients deteriorate or respond to intervention. We applied the Quality of Well-Being scale (QWB) in 28 patients with CF before and after a two-week course of oral ciprofloxacin used to treat pulmonary exacerbations. There were significant correlations between changes in QWB and various pulmonary function test results; QWB vs FEV1: r = 0.4, p less than 0.03; QWB vs FVC: r = 0.5, p less than 0.01; and QWB vs SaO2: r = 0.4, p less than 0.05. Thus, the QWB can track changes in general well-being in CF patients over a brief time and detect changes associated with pulmonary exacerbation and its treatment.

Attitude to Health↗
PubMed1989

Prevalence of the use of unconventional remedies for arthritis in a metropolitan community.

Of 1,811 individuals sampled in a metropolitan community, 382 reported having a musculoskeletal complaint. Eighty-four percent of them had used an unconventional remedy within the previous 6 months. Most individuals used inexpensive, unharmful remedies such as exercise, prayer, and relaxation. This study indicates that people with musculoskeletal disorders often use unconventional remedies, but raises questions regarding the seriousness of this problem.

Arthritis↗