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Biomedical subjects

C P Green

Publications and source records attributed to C P Green.

At least 19 recordsLinked to original sources
PubMed2000

Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure.

OBJECTIVES: To create a valid, sensitive, disease-specific health status measure for patients with congestive heart failure (CHF). BACKGROUND: Quantifying health status is becoming increasingly important for CHF. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a new, self-administered, 23-item questionnaire that quantifies physical limitations, symptoms, self-efficacy, social interference and quality of life. METHODS: To establish the performance characteristics of the KCCQ, two distinct patient cohorts were recruited: 70 stable and 59 decompensated CHF patients with ejection fractions of <40. Upon entry into the study, patients were administered the KCCQ, the Minnesota Living with Heart Failure Questionnaire and the Short Form-36 (SF-36). Questionnaires were repeated three months later. RESULTS: Convergent validity of each KCCQ domain was documented by comparison with available criterion standards (r = 0.46 to 0.74; p < 0.001 for all). Among those with stable CHF who remained stable by predefined criteria (n = 39), minimal changes in KCCQ domains were detected over three months of observation (mean change = 0.8 to 4.0 points, p = NS for all). In contrast, large changes in score were observed among patients whose decompensated CHF improved three months later (n = 39; mean change = 15.4 to 40.4 points, p < 0.01 for all). The sensitivity of the KCCQwas substantially greater than that of the Minnesota Living with Heart Failure and the SF-36 questionnaires. CONCLUSIONS: The KCCQis a valid, reliable and responsive health status measure for patients with CHF and may serve as a clinically meaningful outcome in cardiovascular research, patient management and quality assessment.

Activities of Daily Living↗
PubMed1999

When seniors relocate.

Where we will live and die as we age is a dilemma that each of us faces. With the population of seniors growing at an unprecedented rate, decisions about where to live are evoking considerable attention from families, the health care system and the business community. Most seniors hope to live in their own homes as long as possible, and many manage to do just that; however, deliberations about maintaining or securing affordable, appropriate housing for their elderly members remain a necessary part of all families' developmental work. All families have to face the if, when and how of housing shifts for their senior members.

Aged↗
PubMed1998

Review of available instruments and methods for assessing quality of life in anti-anginal trials.

Collection of patient-centred health status is a method for quantifying patient outcome in the context of clinical trials for the treatment of coronary artery disease (CAD). Traditional clinical trial end-points, such as morbidity and mortality, fail to adequately measure the health-related outcomes of disease states for which death is a rare occurrence. Health-related quality of life (QOL) and functional status surveys allow measurement of the general, and/or disease-specific, health-related limitations experienced by patients. Measures of patient preference, in turn, quantify the effects these health-related limitations have on the overall value patients ascribe to their current health state. Together, these outcomes measures may provide a more accurate appraisal of the benefit conferred by treatment. Currently, selection of the appropriate outcomes measures and methodological approaches for a clinical trial is complicated by the lack of consensus on a single quality of life measure for use with patients with (CAD). This article outlines the use of QOL measures in anti-anginal trials done to date and summarises the approaches currently available for assessing QOL, including the differences between psychometric and preference-based techniques, and general and disease-specific health measures. In conclusion, a framework is provided for selecting the appropriate instruments and methodology in the context of the clinical trial.

Angina Pectoris↗
PubMed1995

Persistent increase in plasma and urinary leukotrienes after acute asthma.

Leukotrienes may mediate bronchoconstriction in asthma. Cysteinyl leukotriene production rises in vivo after allergen challenge, but few reports describe leukotriene concentrations in clinical asthma or in children. Using high performance liquid chromatography/radioimmunoassay, plasma and urinary leukotrienes in asthmatic children (aged 5-10 years) were measured during an acute exacerbation (peak expiratory flow (PEF) < 65%, n = 10) and one month later (PEF 74-169%, n = 9), and in non-atopic normal children (aged 1.3-13.2 years). In the asthmatics, geometric mean (95% confidence interval) plasma leukotriene B4 (LTB4) was 746 pg/ml (398 to 1403) acutely and 1026 pg/ml (662 to 1593) in remission, compared with 369 pg/ml (167 to 728) in the normal children (n = 14). Plasma cysteinyl leukotrienes were low or undetectable, but urinary leukotriene E4 (LTE4) was higher in the asthmatics during an acute episode (210 pmol/mmol creatinine, 101 to 454) and at follow up (179 pmol/mmol, 110 to 293), compared with the normal children (98 pmol/mmol, 81 to 118, n = 41). This persistent increase in plasma LTB4 and urinary LTE4 concentrations one month after a severe asthmatic episode suggests leukotriene production is related to chronic inflammation rather than to acute bronchoconstriction.

Acute Disease↗
PubMed1992

Sputum cysteinyl-leukotriene levels correlate with the severity of pulmonary disease in children with cystic fibrosis.

Sputum samples from 13 children with cystic fibrosis (CF) were analyzed for leukotrienes (LTs) LTB4, LTC4, LTD4, and LTE4. Distribution of LTB4 appeared to be normal, and of cysteinyl-LTs log normal. Total cysteinyl-LT levels, of which on average 75% was LTE4, were nearly 10 times higher than in earlier studies. Log LTE4 and total cysteinyl-LT levels correlated with the overall severity of pulmonary disease assessed by Chrispin-Norman chest radiograph score (Log LTE4: r = 0.701, r2 = 49.1%, P = 0.008. Log total cysteinyl-LTs: r = 0.715, r2 = 51.1%, P = 0.006). There was no apparent relationship between LTB4 levels and Chrispin-Norman chest radiograph score, nor between the level of any of the LTs and age or organism cultured from sputum. These findings suggest that the cysteinyl-LTs may be involved in the pathophysiology of pulmonary disease in CF.

Child↗
PubMed1992

Prevention of exercise induced asthma by inhaled salmeterol xinafoate.

The effect of inhaled salmeterol xinafoate, a long acting beta 2 agonist, on exercise induced asthma was studied in a double blind, crossover, and placebo controlled trial. Thirteen asthmatic children with a fall of at least 15% in their forced expiratory volume in one second (FEV1) after a standard exercise test on a motorised treadmill, on separate days performed the same test 1, 5, and 9 hours after a single dose of 50 micrograms salmeterol or placebo. FEV1 was measured before treatment, and before and for 30 minutes after each exercise test. After placebo the number of children with exercise induced asthma was: 10 at 1 hour, 11 at 5 hours, and 12 at 9 hours. Salmeterol prevented exercise induced asthma in all 13 children studied, at 1, 5, and 9 hours. Mean maximum falls in FEV1 after exercise were at 1 hour: salmeterol 2.7% and placebo 24.6%, 5 hours: salmeterol 5.3% and placebo 22.7%; and 9 hours: salmeterol 3.4% and placebo 26.6%. After salmeterol the mean increase in FEV1 was 17.8% at 1 hour, 19.6% at 5 hours, and 19.2% at 9 hours. Inhaled salmeterol prevents exercise induced asthma and produces significant bronchodilatation for at least 9 hours.

Administration, Inhalation↗
PubMed1991

Human cytotoxic T cell responses to vaccinia virus vaccination.

Recombinant vaccinia viruses have been proposed as live virus vectors in man to generate both specific humoral and cellular immune responses. The generation of such responses following revaccination was followed in five normal volunteers. All five showed elevated (35- to 6500-fold) vaccinia virus-specific IgG by 14 days post-vaccination, following uncomplicated vaccination by dermal scarification. Four of the five had elevated total serum immunoglobulins with increased spontaneous and pokeweed mitogen-induced immunoglobulin production. Major histocompatibility complex class I-restricted vaccinia virus-specific cytotoxic T lymphocytes (CTLs) were not detected either directly, from peripheral blood mononuclear cells, or following secondary in vitro stimulation, even by limiting dilution analysis. These studies would suggest that vaccination with recombinant vaccinia viruses may provide an insufficient stimulus to the generation of CTLs in vivo.

Adult↗
PubMed1991

Clinical considerations. Midlife daughters and their aging parents.

1. As North America ages, complex parent care issues are becoming part of the lives of already busy midlife daughters. 2. The midlife daughter involved in parent care is at risk for becoming a "hidden patient" in the health-care system. 3. Group intervention with midlife daughters helps them to anticipate and avoid the stress of elder care to learn coping skills and to access support.

Adult↗
PubMed1990

Leukotrienes in the sputum and urine of cystic fibrosis children.

1. Leukotrienes (LTs) are potent pro-inflammatory mediators with actions relevant to the pathophysiology of cystic fibrosis (CF), including increased mucus production, bronchoconstriction, leucocyte chemotaxis, and increased vascular permeability. We have therefore investigated the potential role of LTs in children with CF. Leukotriene E4 levels were assessed in the urine of 30 normal (N) children (aged 1.3-12.7 years) and 30 CF children (1.6-14.3 years). Sputum from 13 of the CF children was analysed from LTB4, LTC4, LTD4, and LTE4. LTs were separated by reversed-phase h.p.l.c. and quantitated by radioimmunoassay. 2. Urinary LTE4 levels were log normally distributed, with geometric mean values (95% confidence intervals) of N: 88.4 (71.3-111) pmol mmol-1 creatinine (n = 30), and CF: 112 (70.6-177) pmol mmol-1 creatinine (n = 30; P greater than 0.05). Of the CF subjects, 33% had urinary LTE4 levels above 200 pmol mmol-1 creatinine, compared with 3.3% of the N children. 3. In sputum, mean (+/- s.e. mean) LT concentrations were (pmol g-1), LTB4: 44.3 +/- 10.8, LTC4: 4.9 +/- 1.3, LTD4: 1.8 +/- 0.9, and LTE4: 67.7 +/- 18.9 (n = 13). 4. Urinary LTE4 levels correlated significantly with sputum LTE4 levels (r = 0.673, P = 0.012), and with sputum levels of total cysteinyl-LTs (r = 0.660, P = 0.014). 5. In conclusion, total cysteinyl-LT content in sputum is 10-fold higher than previously reported, consisting primarily (91%) of LTE4. The high levels of LTE4 and LTB4 in sputum suggest involvement of LTs in the pathophysiology of CF. Urinary LTE4 levels may prove useful as a marker for cysteinyl-LT production in sputum.

Adolescent↗
PubMed1987

Multiple role women: the real world of the mature RN learner.

The last quarter of this century is revealing exciting changes in university nursing education. With the endorsement of the BSN as entry to practice has come an unprecedented demand for university education for mature RN learners. Because of their personal, educational, and professional histories, their lack of familiarity with the university community, and their complex lives, these women present a unique challenge to university educators. Effective teaching of this large population of students is contingent upon educators' appreciation of them as mature female learners who lead busy lives and experience "academic shock" as part of their transition to becoming a baccalaureate graduate.

Adult↗
PubMed1983

Skeletons in the closet: exploring personal family background as a prerequisite for family nursing.

A nurse's family background, values and experiences will either positively or negatively affect the kind of care he or she gives. This depends on whether the nurse either has explored his/her background and uses it as a valuable resource or fails to see that it may affect care or even be a restriction to quality care. An individual can take specific steps to use family background as a potent and valuable resource. This paper describes a collection of self-directed and group exercises developed at the University of British Columbia School of Nursing that can be used to explore family background and hence use it more positively.

Adult↗