Measurement properties of the WHO Disability Assessment Schedule 2.0 for evaluating functional status after inpatient surgery

BACKGROUND

Expert recommendations propose the WHO Disability Assessment Schedule (WHODAS) 2.0 as a core outcome measure in surgical studies, yet data on its long-term measurement properties remain limited. These were evaluated in a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) prospective cohort.

METHODS

Participants were adults (40 years of age or older) who underwent inpatient non-cardiac surgery. The 12-item WHODAS and EQ-5DTM-3L questionnaires were administered preoperatively (in person) and 1 year postoperatively (by telephone). Responsiveness was characterized using standardized response means (SRMs) and correlation coefficients between change scores. Construct validity was evaluated using correlation coefficients between 1-year scores and comparisons of WHODAS scores across clinically relevant subgroups.

RESULTS

The analysis included 546 patients. There was moderate correlation between changes in WHODAS and various EQ-5DTM subscales. The strongest correlation was between changes in WHODAS and changes in the functional domains of the EQ-5D-3L-for example, mobility (Spearman's rho 0.40, 95 per cent confidence interval [c.i.] 0.32 to 0.48) and usual activities (rho 0.45, 95 per cent c.i. 0.30 to 0.52). When compared across quartiles of EQ-5D index change, median WHODAS scores followed expected patterns of change. In subgroups with expected functional status changes, the WHODAS SRMs ranged from 'small' to 'large' in the expected directions of change. At 1 year, the WHODAS demonstrated convergence with the EQ-5D-3L functional domains, and good discrimination between patients with expected differences in functional status.

CONCLUSION

The WHODAS questionnaire has construct validity and responsiveness as a measure of functional status at 1 year after major surgery.

Parallel latent trajectories of mental health and employment earnings among 16- to 20-year-olds entering the US labor force: A 20-year longitudinal study

Introduction

Depression and anxiety-related mental health and employment earnings are complexly intertwined but have rarely been studied as parallel processes.

Objectives

Determine the number of latent parallel trajectories of mental health and employment earnings over two decades among a cohort of American youth entering the labor force, and estimate the association between baseline sociodemographic/health factors and latent trajectory class membership.

Methods

This study included 8,173 participants from the American National Longitudinal Survey of Youth 1997, who were 13–17 years old in 1997. The survey occurred annually until 2011 then biennially until 2017. Mental health was measured eight times using the Mental Health Inventory-5 between 2000–2017. Employment earnings were measured annually between 1998–2017, where participants were 33–37 years old. Latent parallel trajectories were estimated using latent growth modeling. The association between baseline predictors and trajectory membership was explored using multinomial logistic regression.

Results

Four latent trajectory classes were identified: good mental health, high earnings (3% of sample, average 2017 earnings ˜$196,000 USD); good mental health, medium earnings (23%, average 2017 earnings ˜$78,100); good mental health, low earnings (50%, average 2017 earnings ˜$39,500); and poor mental, low earnings (24%, average 2017 earnings ˜$32,000). Multinomial models revealed participants who were younger, female, Black, Hispanic, who had lower socioeconomic status, and had used marijuana at baseline had higher odds of belonging to the poor mental health, low earnings class.

Conclusions

Findings highlight the stagnated, parallel course of poor mental health and earnings, and the influence of gender, race, adolescent socioeconomic status, and health behaviors on these trajectories.

Disclosure

No significant relationships.

Investigating the Effectiveness and Acceptability of Oral Health and Related Health Behaviour Interventions in Adults with Severe and Multiple Disadvantage: Protocol for a Mixed-Methods Systematic Review

Increasing numbers of people in England experience homelessness, substance use, and repeated offending (known as 'severe and multiple disadvantage'; SMD). Populations experiencing SMD often have extremely poor oral health, which is closely inter-linked with high levels of substance use, smoking, and poor diet. This study aims to undertake an evidence synthesis to identify the effectiveness, resource requirements, and factors influencing the implementation and acceptability of oral health and related health behaviour interventions in adults experiencing SMD. Two systematic reviews will be conducted using mixed-methods. Review 1 will investigate the effectiveness and resource implications of oral health and related health behaviours (substance use, smoking, diet) interventions; Review 2 will investigate factors influencing the implementation of such interventions. The population includes adults (≥18 years) experiencing SMD. Standard review methods in terms of searches, screening, data extraction, and quality appraisal will be conducted. Narrative syntheses will be conducted. If feasible, a meta-analysis will be conducted for Review 1 and a thematic synthesis for Review 2. Evidence from the two reviews will then be synthesised together. Input from people with experience of SMD will be sought throughout to inform the reviews. An initial logic model will be iteratively refined during the review.

Personality and prescription drug use/misuse among first year undergraduates

Emerging adults (18-25 year olds) endorse the highest rates of prescription drug misuse. Attending college or university may confer additional risk. Previous research suggests that personality is an important predictor of many addictive behaviours. Four traits have been consistently implicated: anxiety sensitivity, hopelessness, sensation seeking, and impulsivity. Published studies on personality as a predictor of prescription drug abuse are limited, however, by a primary focus on overall prescription drug use, inconsistent operationalisation of misuse, and failure to control for alcohol use. Sample sizes have been small and non-specific. We sought to better understand how personality predicted the overall use, the medically-sanctioned use, and the misuse of prescription sedatives/tranquilizers, opioids, and stimulants. A large (N = 1755) sample of first year Canadian undergraduate students (mean age = 18.6 years; 68.9% female) was used. We predicted that: anxiety sensitivity would be related to sedatives/tranquilizers, hopelessness to opioids, sensation seeking to stimulants, and impulsivity to all three. Save for the impulsivity to opioid use path, predictions were fully supported in our "any use" model. For medically-sanctioned use: anxiety sensitivity predicted sedative/tranquilizers, hopelessness predicted opioids, and impulsivity predicted stimulants. For misuse: anxiety sensitivity (marginally) predicted sedatives/tranquilizers, sensation seeking predicted stimulants, and impulsivity predicted all three. Our models support using personality-matched interventions. Specifically, results suggest targeting anxiety sensitivity for sedative/tranquilizer misuse, sensation seeking for stimulant misuse, and impulsivity for unconstrained prescription drug misuse. Interventions with early coping skills that pertain to all four traits might be useful for preventing prescription drug uptake and later misuse.

Effects of Growth Conditions on Secondary Phases in CZTSe Thin Films Deposited by Co-evaporation

High temperature multi-source co-evaporation has been the most successful approach to fabricate record efficiency Cu(InGa)Se2 devices, yet many groups have been unable to replicate this success when transferring these methods to the Cu2ZnSnSe4 system. The difficulties stem from the dramatic differences in the thermochemical properties which result in decomposition and loss of volatile species, such as Zn and SnSe, at temperatures needed for growth. In co-evaporation, decomposition and element loss must be managed throughout the entire growth process, from the back contact interface to the final terminating surface of the film. The beginning and ending phases of deposition encompass different kinetic regimes suggesting a phased approach to growth may be helpful. A series of depositions with different effusion profiles were used to demonstrate the effects of decomposition during different stages of growth. Secondary phase detection can be challenging in CZTSe, but a combination of SEM imaging and thin cross-section depth profile by EDS were found to best identify and locate the secondary phases that occur during different phases of growth for co-evaporated Cu2ZnSnSe4 films.

Deposition with a uniform incident flux followed by shuttered vacuum cool-down yielded films with a ZnSe phase at the absorber/Mo interface and Cu-rich composition at the surface of the exposed film. Devices from these absorber layers never exceeded conversion efficiencies of 1%. Decomposition at the surface could be prevented by continuing effusion of Se and Sn during the cool-down of the substrate. Resulting films demonstrated more faceted grains as well as significantly improved device performance. Secondary phases that traditionally form at the back contact during the beginning of growth were minimized by decreasing the substrate temperature to 300°C during the initial stages of deposition which reduced the ZnSe formed at the Mo interface. The thermochemical origin of the secondary phases will be discussed and the performance of representative devices will be presented.

Investigation of the male pattern baldness major genetic susceptibility loci AR/EDA2R and 20p11 in female pattern hair loss

BACKGROUND

The aetiology of female pattern hair loss (FPHL) is largely unknown. However, it is hypothesized that FPHL and male pattern baldness (AGA) share common susceptibility alleles. The two major susceptibility loci for AGA are the androgen receptor (AR)/ectodysplasin A2 receptor (EDA2R) locus on the X-chromosome, and a locus on chromosome 20p11, for which no candidate gene has yet been identified.

OBJECTIVES

To examine the role of the AR/EDA2R and 20p11 loci in the development of FPHL using 145 U.K. and 85 German patients with FPHL, 179 U.K. supercontrols and 150 German blood donors.

METHODS

Patients and controls were genotyped for 25 single nucleotide polymorphisms (SNPs) at the AR/EDA2R locus and five SNPs at the 20p11 locus.

RESULTS

Analysis of the AR/EDA2R locus revealed no significant association in the German sample. However, a nominally significant association for a single SNP (rs1397631) was found in the U.K. sample. Subgroup analysis of the U.K. patients revealed significant association for seven markers in patients with an early onset (P = 0·047 after adjustment for the testing of multiple SNPs by Monte Carlo simulation). No significant association was obtained for the five 20p11 variants, either in the overall samples or in the analysis of subgroups.

CONCLUSIONS

The observed association suggests that the AR/EDA2R locus confers susceptibility to early-onset FHPL. Our results do not implicate the 20p11 locus in the aetiology of FPHL.

Photoconductive CdS: how does it Affect CdTe/CdS Solar Cell Performance?

Photoconductive CdS (PC-CdS) in CdS/CdTe solar cells from five different sources is investigated using spectral sensitization of apparent quantum efficiency (AQE) and J-V analysis. Red bias light significantly enhances the blue AQE, commonly leading to AQE>1 below 550 nm, and blue bias light enhances the red AQE, but to a much smaller extent. These enhancements are more pronounced with increasing forward bias, after stress and in devices with intentionally Cu-doped CdS. This behavior is observed to some degree in all devices with CdS, but is absent in cells without CdS. These effects are consistent with blue light, either ac monochromatic or dc bias, increasing the CdS conductivity. This causes an increase in the field and depletion width in the CdTe to maintain balanced space charge, leading to increased collection of carriers from the CdTe. The CdS conductivity modulation can also change the AQE due to a change in equivalent circuit resistance. Analysis of J-V data measured with white, blue, red or no light indicates little dependence of series resistance or diode quality factor on the illumination spectrum. Thus, the PC-CdS resistance has little effect on the solar cell J-V performance, but does influence AQE.

Obtaining informed consent from continuing care residents: issues and recommendations

As the number of older adults residing in continuing care facilities increases, mental health professionals will provide more services and conduct more research in this setting. Mental health professionals working with continuing care residents will find themselves regularly challenged by ethical issues, particularly obtaining informed consent. Characteristics of the continuing care setting and residents make obtaining informed consent especially challenging. Mental health professionals must overcome these challenges in order to fulfill the following three requirements of informed consent: (1) the client is competent, (2) the client is provided with sufficient information, and (3) the client has not been coerced and/or the consent is voluntary. This article will examine the issues surrounding the fulfillment of these requirements in a continuing care facility, and will provide suggestions and guidelines that mental health professionals can utilize during the informed consent process.

Barriers to healthy eating in the nursing profession: Part 2

AIM

This is the second of two articles that report on work commissioned by the NHS Executive North West, to explore the perceived barriers to healthy eating within the nursing profession.

METHOD

Observations were made of catering facilities within eight healthcare sites (six acute hospitals, an NHS walk-in centre and an NHS Direct site) across the North West region. Twenty four unstructured interviews were conducted with nurses and three were sampled from each healthcare site.

RESULTS

Four main themes emerged as barriers to healthy eating: availability; variety; distance from catering facilities; and breaks/staffing levels/workload issues

CONCLUSION

Respondents in this study do not consider their working environments to be conducive to healthy eating practices.

Barriers to healthy eating in the nursing profession: Part 1

AIM

The aim of this study commissioned by the NHS Executive North West was to identify the main areas of the nurse's working environment that prevent healthy eating, to ascertain if nurses have enough nutritional knowledge to make informed choices, and to review sources, availability and quality of food provided for nursing staff.

METHOD

A purposive sample size of 126 nurses from across eight healthcare sites in the North West region completed questionnaires.

RESULTS

Shift patterns and failure to take breaks were identified as the two main barriers to healthy eating by respondents. However, satisfaction with food on offer and a supportive environment were also identified as important influences.

CONCLUSION

Several recommendations were made as a result of the study. Ideally, nurses should take regular breaks. Food should carry nutritional labelling and nutritional information should be displayed at healthcare sites in a more imaginative and innovative way. More refrigerated vending machines with a selection of healthier options should be supplied. Packed lunches or plated salads obtainable from restaurants by evening and night-shift nurses should be offered, in addition to a better selection of sandwiches and other food choices outside the hours of 9 am to 5 pm, Monday to Friday. Nurses should be encouraged to drink the recommended amount of eight glasses of water per day (Health and Fitness Tips 2000) by providing adequate water dispensers. The possibility of having separate catering facilities for staff who wish to avoid patients and visitors during breaks should be explored.

A cost-effective method for the automatic quantitative analysis of fibroblastic colony-forming units

A great deal of the work characterizing stromal cell precursors in the bone marrow has been performed using the fibroblastic colony-forming unit (CFU-f) assay. However, the assay is limited in its usefulness by the necessity for manual colony counting which means that assay quantitation is highly subjective, time consuming, and much information regarding the colony size is lost. To rectify this, we have developed a computer-automated method for the analysis of CFU-f. Bone marrow cells were cultured at low density and treated with either prostaglandin E(2) (PGE(2)), basic fibroblast growth factor (bFGF), or dexamethasone, and colony formation was assessed by staining with methylene blue. After staining, the dishes were photographed over a light box using a digital camera and the image was then analyzed using Bioimage "Intelligent Quantifier" image analysis software which automatically locates and quantifies each individual colony. The data can then be imported to a spreadsheet program and processed. We have shown that this system can accurately identify, assign coordinates, and quantitate each individual colony. Colony numbers obtained with this method and manually counting showed a linear relationship with a correlation coefficient of 0.99. In addition, using the colony intensity and surface area data, the colony size can be calculated. With this methodology, we have shown that dexamethasone, PGE(2), and bFGF can all modulate total cell numbers in bone marrow stromal cells (BMSC) cultures but modulating both colony number and colony size.

Eliminating needless testing in intensive care--an information-based team management approach

OBJECTIVE

To determine if the application of an information-based management system in adult intensive care units (ICU) can produce sustained decreases in the use of laboratory resources and costs.

DESIGN

Interventional study with prospective data collection on consecutive patients admitted during three time periods.

SETTING

A 10-bed adult surgical ICU and an eight-bed adult medical ICU in a tertiary care hospital.

PATIENTS

All patients admitted to an ICU during a 7-month baseline period (n = 647), a 1-yr intervention period (n = 1236), and a 2-yr follow-up period (n = 2349).

INTERVENTIONS

Using a management database to track the use of 123 laboratory investigations during the baseline period, nine frequently ordered investigations (determination of blood gases, glucose, potassium, electrocardiogram, chest radiograph, sodium, chloride, complete blood count with differential, and serum osmolality) were targeted for reduction. Specific policies were developed by a multidisciplinary committee within the ICU to reduce the utilization of these laboratory, radiology, and cardiology tests. The policies were applied to all patients admitted during the 1-yr intervention period and during the 2-yr follow-up period.

MEASUREMENTS AND MAIN RESULTS

A 25% reduction was observed in the frequency of all 123 monitored tests during the intervention period. The most dramatic reductions occurred in the nine targeted tests (range 19% to 46%) (p < .001). There were significant reductions in only 13 of the untargeted 114 investigations during this period. Potential annual cost savings were > $150,000 Canadian. No increases in ICU mortality rate, length of stay, or cost of medication were observed, and the reductions in the frequency of targeted tests were maintained during the 2-yr follow-up period.

CONCLUSIONS

Application of an information-based multidisciplinary management system in the ICU can produce marked and sustained reductions in unnecessary testing in a cost-effective manner. Although rationing of intensive care services may be necessary, reducing needless testing can be a safe and effective cost-containment strategy in the ICU.

Couple therapy as a treatment for depression: II. The effects of relationship quality and therapy on depressive relapse

This study investigated the effects of behavioral couple therapy, cognitive-behavioral therapy, and their combination on female depression 6 and 12 months after therapy ended. We predicted that couples receiving a behavioral couple treatment would be less likely to relapse than those receiving a cognitive-behavioral treatment for the depressed spouse alone. Relapse rates, however, did not discriminate between treatments at any follow-up point. Reductions in husband and wife dysphoria and increases in wife facilitative behavior during therapy predicted recovery. Moreover, high rates of husbands' facilitative behavior at posttest were associated with wife recovery and predicted low levels of depression at the 1-year follow-up.

Couple therapy as a treatment for depression: II. The effects of relationship quality and therapy on depressive relapse

This study investigated the effects of behavioral couple therapy, cognitive-behavioral therapy, and their combination on female depression 6 and 12 months after therapy ended. We predicted that couples receiving a behavioral couple treatment would be less likely to relapse than those receiving a cognitive-behavioral treatment for the depressed spouse alone. Relapse rates, however, did not discriminate between treatments at any follow-up point. Reductions in husband and wife dysphoria and increases in wife facilitative behavior during therapy predicted recovery. Moreover, high rates of husbands' facilitative behavior at posttest were associated with wife recovery and predicted low levels of depression at the 1-year follow-up.

Marital therapy as a treatment for depression

The purpose of this study was to compare cognitive-behavioral therapy (CT; n = 20), behavioral marital therapy (BMT; n = 19), and a treatment combining BMT and CT (CO; n = 21) in the alleviation of wives' depression and the enhancement of marital satisfaction. BMT was less effective than CT for depression in maritally nondistressed couples, whereas for maritally distressed couples the two treatments were equally effective. BMT was the only treatment to have a significant positive impact on relationship satisfaction in distressed couples, whereas CO was the only treatment to enhance the marital satisfaction of nondistressed couples. On marital interaction measures CO was the only treatment to significantly reduce both husband and wife aversive behavior and to significantly increase wife facilitative behavior.

Marital therapy as a treatment for depression

The purpose of this study was to compare cognitive-behavioral therapy (CT; n = 20), behavioral marital therapy (BMT; n = 19), and a treatment combining BMT and CT (CO; n = 21) in the alleviation of wives' depression and the enhancement of marital satisfaction. BMT was less effective than CT for depression in maritally nondistressed couples, whereas for maritally distressed couples the two treatments were equally effective. BMT was the only treatment to have a significant positive impact on relationship satisfaction in distressed couples, whereas CO was the only treatment to enhance the marital satisfaction of nondistressed couples. On marital interaction measures CO was the only treatment to significantly reduce both husband and wife aversive behavior and to significantly increase wife facilitative behavior.

The effects of methoxamine and epinephrine on survival and regional distribution of cardiac output in dogs with prolonged ventricular fibrillation

This study compares the effects of methoxamine, a pure alpha 1-agonist, and epinephrine on cerebral and myocardial blood flow, central hemodynamics, and survival in a randomized placebo-controlled fashion during prolonged ventricular fibrillation (VF) in a canine model. Twenty-four anesthetized and ventilated adult mongrel dogs were instrumented for regional blood flow determinations using radio-labeled microspheres. The dogs were randomized to receive either 20 mg of methoxamine as a single intravenous bolus or repeated boluses of 0.02 mg/kg of epinephrine, 0.2 mg/kg of epinephrine, or normal saline solution placebo beginning at three minutes following induction of VF and initiation of closed chest cardiac massage (CCCM). Organ blood flow measurements were determined during normal sinus rhythm and after five and 20 minutes of VF. All six dogs receiving methoxamine were successfully resuscitated in contrast to only one in each of the epinephrine-treated groups and none of the dogs receiving placebo (p less than .01). Although epinephrine was associated with significantly higher blood pressures than placebo during cardiopulmonary resuscitation (CPR), blood pressures achieved with methoxamine were significantly higher than those observed in the other three treatment groups (p less than .001). Cerebral blood flow was significantly higher with both methoxamine and high-dose epinephrine (p less than .05). Mean left and right ventricular myocardial flows were highest with methoxamine but this did not achieve statistical significance. In contrast, organ flows measured in the animals receiving the lowest dose of epinephrine were not significantly higher than those associated with placebo. Cardiac output after 20 minutes of CPR was significantly lower with high-dose epinephrine than with methoxamine or placebo (p less than .05). Our results suggest that methoxamine significantly improves regional cerebral blood flow and survival during CPR and although high-dose epinephrine is associated with comparable improvements in regional cerebral blood flow, this treatment is associated with deterioration in central hemodynamics during prolonged VF and does not enhance survival.

Early predictors of mortality for hospitalized patients suffering cardiopulmonary arrest

Few if any prearrest or intraarrest variables have been identified as highly predictive of inhospital mortality following cardiopulmonary arrest. A total of 310 consecutive patients requiring advanced cardiac life support during the calendar years 1985 and 1986 were reviewed with respect to eight specific variables. These included age, diagnosis, location, mechanism of the event, duration of resuscitation, whether the event was witnessed or unwitnessed, the initial observed rhythm and medications administered. A total of 37.1 percent of the patients were successfully resuscitated, but only 9.7 percent survived until discharge. Factors strongly associated with inhospital mortality included unwitnessed events (p = 0.0316), the need for epinephrine (p = 0.0003), identification of electromechanical dissociation or asystole as initial rhythms (p = 0.0000), and cardiac vs respiratory mechanism of arrest (p = 0.0000).

Syringes versus minibags as an intravenous admixture system: a comparison of cost and nursing preference

The implementation of centralized intravenous admixture programs in Canadian hospitals has been hindered by the high costs associated with such programs. The most popular system uses minibags as an admixture base but other less expensive alternatives are being investigated. This study examines the material and labour costs associated with preparing admixtures in either minibags or polypropylene syringes. The minibag admixtures were administered by nursing staff using secondary medication administration sets. Standard volume-control sets were used for diluting and administering the intravenous admixtures supplied in syringes. The results indicated a major cost advantage for the syringe-based program. Furthermore, evaluation of the two systems by nursing staff indicated a strong preference for the syringe-based system.

Effect of indomethacin on arterial oxygenation in critically ill patients with severe bacterial pneumonia

The effect of indomethacin (1 mg/kg) on gas exchange was studied in ten patients with hypoxaemic respiratory failure precipitated by bacterial pneumonia. Mean arterial oxygen tension (PaO2) improved significantly (79 +/- 16 mm Hg to 98 +/- 20 mm Hg) but the response varied between patients: five showed substantial responses (27-42 mm Hg), three lesser responses (7-9 mm Hg), and two no response. Similar changes were found in the alveolar-arterial oxygen gradient and the ratio of PaO2 to fractional inspired oxygen concentration. In two responders studied further, PaO2 had fallen to baseline values 4-6 h later and a repeat indomethacin challenge again increased PaO2 by greater than 25 mm Hg with concomitant changes in pulmonary shunt. There were no significant changes in the other gas-exchange or haemodynamic variables measured and there was no clear reason for the variability in response to indomethacin. These results suggest a role for products of the cyclo-oxygenase pathway of arachidonic acid metabolism in the pathogenesis of hypoxaemia in patients with severe bacterial pneumonia.

Hemodynamic management in clinical acute hypoxemic respiratory failure. Dopamine vs dobutamine

We investigated short-term hemodynamic effects of dopamine and dobutamine in eight patients with acute hypoxemic respiratory failure. We tested the hypothesis that for a similar increase in cardiac output, left ventricular filling pressure (pulmonary capillary wedge pressure [PCWP]) would increase with dopamine and decrease with dobutamine. Dopamine increased cardiac output (p less than 0.05), stroke volume (p less than 0.05), and PCWP (p less than 0.01). Cardiac output increased almost 20 percent when PCWP increased 50 percent with dopamine. In contrast, despite a mean 30 percent increase in cardiac output with dobutamine (p less than 0.01), PCWP decreased. In six of these patients, left ventricular end-diastolic volumes and end-systolic volumes were measured using scintigraphic techniques. In all patients, end-diastolic volume increased with dopamine (p less than 0.05); and in four of six, end-systolic volume increased. In contrast, with dobutamine, in five of six patients, end-diastolic volume decreased; and in all six patients, end-systolic volume decreased. There was a small increase in intrapulmonary shunt with both drugs. We conclude that if an inotropic agent is required to increase cardiac output in patients with acute hypoxemic respiratory failure, dobutamine is probably preferred over dopamine.

Effects of dopamine on cardiopulmonary function and left ventricular volumes in patients with acute respiratory failure

We investigated cardiopulmonary effects of dopamine in patients with acute respiratory failure. Specifically, we wished to test the hypothesis that left ventricular filling pressure (Pcwp) would increase when cardiac output (CO) increased with dopamine. Dopamine (range, 5.5 to 20 micrograms/kg/min) increased blood pressure (BP) (p less than 0.001) Pcwp, CO, and stroke volume (SV) (p less than 0.005). Mean Pcwp increased (p less than 0.005) 45% with dopamine, from 11 to 16 mmHg. Qs/Qt increased with dopamine in association with an increase in mixed venous O2 tension, and arterial O2 tension remained constant. In 8 of these patients, left ventricular end-diastolic volume (LVEDV) and end-systolic volume (ESV) were measured using scintigraphic techniques. The LVEDV increased (p less than 0.01) in each patient after the administration of dopamine, and the mean change was from 134 to 163 ml. Although BP and LV afterload increased in each patient, there was no consistent change in LVESV after dopamine administration, i.e., ESV decreased in 1 patient, remained constant in 3, and increased in 4. Accordingly, because afterload increased in all patients and ESV did not, dopamine probably increased contractility. Because EDV increased in all patients, we concluded that the increase in SV with dopamine is explained by a combination of inotropic and peripheral vascular effects.