This ordinance conquer interpret the pathophysiology of the sickness mode continuous counterlocomotive pulmonary sickness (COPD). It conquer weigh how this sickness affects an singularal appearing at the biological, psychical and gregarious aspects. It conquer conclude this by referring to a enduring who was admitted to a medical parry with an exacerbation of COPD. Furtherbalance with stay of Gibbs mould of pondering (as cited in Bulman & Schutz, 2004) it conquer evince how an cupel altered an locality. In harmony with the Nursing and Midwifery Conclave, (NMC) Code of Administrative Spend (NMC, 2005) touching safeguarding enduring counsel no names or attributes conquer be profaned.
Consequently throughquenched the ordinance the enduring conquer be referred to as John. John is a 57 year ancient lord who has been married to Mavis ce span years. John was admitted to the parry with rigorous astoundedness cough and extravagant sputum evolution. By appearing through John’s referablees it was discovered this was an exacerbation of COPD.
To apprehend John’s qualification it is adapted to appear at how the recognized respiratory scheme efforts.
The exercise of the respiratory Scheme is to afford the substantiality with oxygen and abstract carbon dioxide (Marieb, 2004). According to Waugh and Grant (2004) it so accelerations observe substantiality latitude and eject growth introduce from the substantiality. The Respiratory scheme consists of the hole, nasal indentation, pharynx, larynx, trachea, bronchi and the lungs (Seeley, Stephens & Tate, 2000). Soul enters through either the hole or nose which humidifies and cleans the soul. (Cohen & Wood, 2000) merging into a base chamber warnmined the oropharynx (Watson, 2000). Soul then leaves to the pharynx, a weak, funnel-shaped tube that enravishments soul to the larynx (Waugh & Grant, 2004). The soul enters the larynx which is threadd with mucous membrane and apportionance to the trachea, which is cemed of semi-circular cartileldership rings. The cimperil membrane of the trachea contains hsoul cells and mucous cells which pitffull dissecticles and sweeps them toparry the bronchi. The bronchi are so threadd with mucous membrane and ringed with cartileldership (Marieb, 2004).
Each bronchus is threadd with mucous membrane. (Martini, 2000) and extends into a lung where it subdivides ceming inferiorer bronchioles (Watson, 2000). Bronchioles cimperil with the alveoli which are the exerciseal units ce fog recopy and are infiltratey, juicy and enfolded by capillaries (Clancy & McVicar 2001). Inhaled soul travels through these airways to the alveoli. Arrange is pumped quenched of the kernel through the pulmonary arteries to the capillaries embracing the alveoli. (Shaw, 2005) The oxygen of the inhaled soul diffuses quenched of the alveoli into the arrange, occasion carbon dioxide in the arrange moves into the alveoli to be exhaled (Tortora & Grabowskie, 2003). The oxygen-rich arrange is returned to the kernel through the pulmonary veins.
The lungs can spread and retrench withquenched attrition during lively ascribeffectual to the pleura, a infiltratey membranous building (Tamir, 2002). The visceral pleura circumvent the lungs, occasion the parietal pleura thread the respect of the thoracic indentation. These pleura are separated by a inferior limpid-filled interinterspace warnmined the pleural indentation. Disinfectant requires effort and antecedently the lungs can beseem balancejoyed, a consluxuriance differ must use attribute. The flexible properties of the lung apportion disinfectant to use attribute balance efficiently and the limpid in the pleural indentation serves as a lubricant that apportions the lungs to slide resisting the chest respect (Marieb, 2004).
John referableified the staff that he was diagnosed with COPD twelve months gone by his unconcealed practitioner (G.P.). He external that he repeatedly went to his G.P. as he had been pathos astounded, which was decent worse and was bestow entire day, balance so when he exercised. This astoundedness he biblical was accompanied by a cough alongside sputum evolution. John’s G.P inquired if he steamd and how manifold, John cognizant him he has steamd encircling 30 cigarettes a day ce 42 years. The teacher then gave John a lung exercise cupel using a spirometer. John was referableified by his GP that he had COPD which, John was cognizant, was twain continuous bronchitis and emphysema (National Lung Bloom Order Program, 2005).
The World Bloom Organization (WHO) (2006A) defines COPD as a sickness declare characterized by soulissue withholding that is refereffectual altogether qualifyable. The soulissue withholding is usually twain altereffectual and associated with abrecognized exaggerative vindication of the lungs to provocative dissecticles or foges. John’s continuous bronchitis is defined, clinically, as the govern of a continuous causative cough ce 3 months in each of 2 successive years, supposing other inducements of continuous cough confess been unwavering quenched. (Mannino, 2003). The British lung Instituteation (BLF) (2005) announces that continuous bronchitis is the inflammation and regular scarring of the plaster of the bronchial tubes which is the explication ce John’s dyspnea. The BLF (2005) prize that when the bronchi beseem inflamed short soul is effectual to issue to and from the lungs and uniformly the bronchial tubes confess been austere balance a crave epoch of interval, extravagant mucus is performed. This growthd sputum effects from an growth in the extent and compute of goblet cells (Jeffery, 2001) effecting in John’s extravagant mucus evolution. The plaster of the bronchial tubes beseems thickened and an blistering cough amplifys, (Waugh & Grant 2004) which is an appended symptoms that john is experiencing.
Emphysema affects the parenchyma of the lung through damnation of the scooped respects, imported to beaming extension of soul interspaces distal to the ultimate bronchioles (Sandford, Weir & Pare, 1997). The respects unordered neighboring alveoli violate down, the alveoli ducts enbig and there is mislaying of interstitial flexible employment (Watson, 2000) This effects in distention of the lungs and mislaying of recognized flexible recoil, consequently pitfallping and arrestation of scooped soul (National Emphysema Instituteation, 2006). As alveoli coalesce there is mislaying of demeanor area ce fogeous recopy (Alexander, Fawcett & Runciman, 2004) effecting in short oxygen. This mislaying of area ce fogeous recopy is an appended explication ce John’s dyspnea.
John was referred to the physiotherapist to acceleration mitigate his astoundedness and mucus evolution. Qualifyer Foster & Johnson (2005) enunciate physiotherapists are solution members of the eldershipncy team, can order and imdissect John useful control on how he can breathe comfortably and efficiently. (United Kingdom Government, 2005). Van der Schans, Postma, Koeter & Rubin (1999) insinuate physiotherapists mature John’s mucus enravishment by using lively techniques, shock and postural drainage. Balancebalance they can ground John on substantiality aspecting as this is indispensable with nation with COPD (Gosselink, 2003).
Additionally John was referred to the Occupational Therapist (OT) who assessed his public plane of ratio and then cemulated a program of activities which conquer ameliorate his balancefull controlce and stamina. The OT can so imdissect order to John to mould his qualification with the meanest afflict and disintegration of daily defence (Turner Foster & Johnson 2005). Furtherbalance the National Institute of Bloom and Clinical Excellence (NICE) (2004) applaud enduring with COPD should be regularly asked abquenched their controlce to underuse activities of daily defence and how astounded they beseem when doing these.
John was cognizant that his COPD was haply inducementd by smoking. Kanner (1996) prizes that the superior environmoral content of COPD is tobacco steam. The Global Initiative ce Continuous Counterlocomotive Lung Sickness (GOLD) (2005) assents and declares cigarette smoking is by distant the most magnanimous inducement content ce COPD. This according to the National Kernel Arrange and Lung Institute (NHLBI) (2006) is accordingly smoking irritates the lungs, which inducements the soulways to beseem inflamed and narrowed. Appendedly Verra, Escudier, Lebargy, Bernaudin, De Cremoux & Bigperception (1995) adds that enzymes released accordingly of the inflammation violates dconfess elastin, the protein magnanimous ce structural completeness of the lungs, creating lively soul in and quenched of the lungs balance perplexing (NHLBI, 2006)
Quiescent D’hulst, Maes, Bracke, Demedts, Tournoy, Joos & Brusselle (2005) declares refereffectual full steamrs amplify clinically hintive COPD, which insinuates that genetic contents must differ each singularal’s inducement (WHO, 2006B). John lives to steam although he has subduedly his intake; quiescent NICE (2004) pilotlines insinuate full COPD patents who live to steam should be encouraged to seal, and offered acceleration to do so, at entire qualify accordingly, smoking suspension is the singular most efficient performance to impair the inducement of amplifying COPD and seal its gradation (WHO, 2006B). John was encouraged to seal, impartn control on how to seal, was cognizant abquenched a smoking suspension cluster that he could imply and in adduction offered nicotine patches; quiescent he refused and tancient staff that he would release in his confess interval.
John interpreted to the protect that ce the gone-by rare months he has been pathos subdued, can refereffectual condense and has a perceptioncommunication of inducement in everything, he declares he does refereffectual apprehend why he is pathos this performance. Gross (2001) prizes these symptoms could be a mark of dip. According to Kunik, Roundy, Veazey, Souchek, Richardson, Wray & Stanley (2005) manifsenile-antique CODP endurings amplify psychical symptoms in adduction to corporeal complaints. According to Kunik & Densbalance (2002) this is accordingly of the kind of the sickness and the horror of substance astounded. The BLF (2005) assent and prize lively perplexingy can agitate eagerness and dip. Other inducements outward by Ohri & Steiner (2004) grasp substantiality picture, growthd seclusion, perceptioncommunication of gregarious stay, and subdued self-esteem. Kunik et al (2005) narration that dip and eagerness are span to three intervals balance ordinary in COPD endurings than in the unconcealed population and the explication ce this is accordingly of the sustained and perennial pathoss of discomfiture, veiling and accelerationlessness.
John’s unflourishing humor could subdueder his plane of coureldership needed to connurture with his continuous complaint, which, in qualify, could produce his symptoms short allowable. (Singer, Ruchinskas, Riley, Broshek & Barth, 2001) Dip so can carry to growthd injustice of John’s medical symptoms gone pathoss of dip can inducement a singular to be short locomotive, and, in qualify, may exacerbate corporeal retrogradation, which can incense the psychosocially crippling possessions of COPD (Van Ede, Yzermans & Brouwer, 1999). Quiescent a consider by Engstrom, Persson, Larsson, Ryden & Sullivan (1996) institute that attribute of prudenceer is refereffectual hintively unsupposable in endurings with meek to poor COPD, haply ascribeffectual to coping and/or pulmonary coyness magnitude.
John was impartn the qualify to converse to a psychiatrist gone moral bloom specialist can diagnose dip and cater misapply tenor. One tenor that was insinuateed was pulmonary rehabilitation. Mahler (1998) declares these programs bond psychogregarious and demeanoral components. Emery, Leatherman, Burker & MacIntyre (1991) acquiesce and insinuates that it can so correct cognitive exerciseing and psychical good-luck. Studies by Withers, Rudkin & White (1999) re-enunciate this and appearance that planes of eagerness and dip were hintively correctd by pulmonary rehabilitation.
John was 56 when he was diagnosed with COPD. He outward he was ceced to use present solitude from his trade where he assisted in the recover, installation and defence of introduce and sewer threads. This, he prizes was accordingly of the interval past at effort inducementd by his dyspnea. Mavis outward she so had to remark from her dissect interval operation as a cleaner to use prudence of John gone she is his solely prudencer and is unfilled. Their allowance is from conclave benefits and a inferior pension and they declare they are sentence it perplexing to mould on the totality of money they accept. Strassels, Smith, Sullivan, & Mahajan (1987) narrationed that the natural COPD enduring was balance than 65 years ancient and had poor effort mislaying straightly kindred to his or her sickness. Quiescent a consider by Tinkelman & Corsello (2003) indicated that COPD is refereffectual normal a sickness of the antiquated. They declare a big percenteldership of endurings with COPD are uneffectual to effort, and those who do effort overlook days as a effect of their sickness. This locality they prize is of magnanimous affair to the singularal efforter who may imperil his operation as a deduction of extravagant perceptionresidence.
Continuous complaint and disforce are strongly arrange kindred (Taylor & Field 1993) and those in the inferior socio-economic clusters are the most unsupposable. Smoking, the greacupel inducement content ce COPD and peril to occupational contents from manual young operations, such as mining and institutery efforting are coercionemost unorderedst males in the subdueder socio-economic clusters (Parnell, 2000). COPD endurings and their families nurture to be members of this cluster and are repeatedly antiquated as symptoms beseem intrusive in the fifth and sixth decades of prudenceer which is John’s locality. Webb & Tossell (1999) observe that pensions repeatedly ponder an singularal’s arrange and gregarious condition and as a effect balance women, uninhabited manual efforters and ethnic minorities are disproportionately represented in ancient eldership as substance on the margins of want.
A dependence on declare benefits may be a deduction if ceced to depart present and prudencers may refereffectual be entitled to benefits in their confess proper. The financial load is growthd by the costs of disforce such as abode alterations and acceleration in the abode or enravishment (Young, 1995). To acceleration John and Mavis a gregarious efforter was concerned who assisted with abode prudence acceleration when John was discharged so Mavis could confess some interval ce herself. Appendedly the OT was concerned and supposing equipment to acceleration John observe his insurrection (Trombly & Radomski 2000).
Although I was cognizant, through consider, other bloom administratives and through protect luxuriance, that smoking can be detrimoral to bloom and can inducement sicknesss such as cancer (Newcomb & Carbone 1992) atherosclerotic sicknesss (McBride, 1992) and COPD (British Thoracic Society, 1997) I was loth to imdissect bloom furtherance and smoking suspension order gone I steam myself. Several studies appearance that I am refereffectual queer in this infiltrateyking. Studies by Dore & Hoey (1998) and Adriaanse, Van Reek, Zandbelt & Evers (1991) appearance that haughty smoking rates unordered some populations of protects may retrench their conqueringness and efficientness as possible caterrs of smoking suspension prudence. An appended consider by Nardini, Bertoletti, Rastelli , Ravelli & Donner (1998) evinced that smoking manners govern the locality of bloom staff toparry enduring counseling abquenched tobacco smoking. I considered that it was refereffectual my attribute and felt sanctimonious if I attempted to imdissect order on sealping smoking. On convocation John my pathoss did refereffectual differ opposing the event that I could look the possessions that COPD had on John’s lively.
Quiescent on spending interval with John and Mavis my locality altered. I realized that if John sealped smoking then his qualification, although his past lung exercise would refereffectual be regained, (Booker, 2005) conquer be slowed dconfess (Osman & Hyland, 2005). I became apprised of the event that I was in a first-rate aspect to cooperate John in observeing his insurrection, to ground and to acceleration ameliorate John’s attribute of prudenceer through bloom promoting and order on smoking suspension. Although John resolute refereffectual to imdissect up this did refereffectual warn me on giving bloom furtherance order on smoking. On converseing to other endurings I took the qualify to converse abquenched sealping smoking although I did refereffectual do this aggressively (Seedhouse, 2004). This cupel with John differd my pathoss touching bloom furtherance and smoking. Although I quiescent affect subordinately sanctimonious, I profess the weight of my aspect and how it can mature endurings and their lives. I prize I apprehend the perplexingies endurings aspect when attempting to release, possibly balance than a prudenceercrave perception steamr. I conquer live to cater smoking suspension order throughquenched my luxuriance and so throughquenched my prudenceer.
In falsification this ordinance has interpreted the pathophysiology of COPD through introducing a enduring. It weighd how this singularal has been unsupposable holistically. Finally it evinced how an cupel encountered altered an judgment with acceleration from a ponderive mould.
Alexander, M. F., Fawcett, J. M., & Runciman, P. J. (Eds.). (2004). Nursing performance hospital and abode – The adult (2nd ed.). Edinburgh: Churchill Defencestone.
Adriaanse, H., Van Reek, J., Zandbelt, L., & Evers, G. (1991). Protects’ smoking worldwide. A critique of 73 surveys on protects’ tobacco decay in 21 countries in the epoch 1959-1988. International Record of Nursing Studies, 28, 361-375.
Booker, R. (2005). Continuous counterlocomotive pulmonary sickness and discerning pilotlines. Nursing test, 19(22).
British Lung Instituteation (2005). COPD. Retrieved March 14, 2006, from http://www.lunguk.org/copd.aspBritish Thoracic Society (1997). BTS pilotlines ce the mouldment of continuous counterlocomotive pulmonary sickness. Thorax, 52(5).
Bulman, C., & Scultz, S. (2004). Ponderive performance in nursing (3rd ed.). Oxford: Blackwell.
Clancy, J., & McVicar, A. (2001). Physiology and dismemberment: a abodeostatic similarity (2nd ed.). London: Arnold.
Cohen, B. J., & Wood, D. L. (2000). Memmler’s the ethnical substantiality in bloom and sickness (9th ed.). Philadelphia: Lippincott Conqueriams & Wilkins.
D’hulst, A., Maes, T., Bracke, K., Demedts, L Tournoy, K., Joos G., & Brusselle G. (2005). Cigarette steam-induced pulmonary emphysema in scid-mice is the assumed immune scheme required?. Respiratory Inquiry, 6(147).
Dore, K., & Hoey, J. (1998). Smoking performances, information and localitys touching smoking of university hospital protects. Canadian Record of Public Bloom, 4(79).
Emery, E. F., Leatherman, N. E., Burke, E. J., & MacIntyre, N. R. (1991). Psychical quenchedcomes of a pulmonary rehabilitation program. American garden of chest physicians, 42(7).
Engstrom, C., Persson, L., Larsson, S., Ryden, A., & Sullivan, M. (1996). Exerciseal condition and well-mannered-mannered substance in continuous counterlocomotive pulmonary sickness with heed to clinical parameters and smoking: a picturesquely and proportionately consider. Thorax, 51(30).
Gosselink, R. (2003). Controlled lively and dyspnea in endurings with continuous counterlocomotive pulmonary sickness. Record of rehabilitation inquiry and amplifyment, 40(5).
Global Initiative ce Continuous Counterlocomotive Lung Sickness (2005). Global diplomacy ce the individuality, mouldment, and obstruction of continuous counterlocomotive pulmonary sickness. Retrieved February 19, 2006, from http://www.goldcopd.com/Guidelineitem.asp?l1=2&l2=1&intId=989Gross, R. (2001). Psychology: the expertness of will and demeanor (4th ed.). London: Hodder and Stoughton.
Jeffery, P. K. (2001). Remodeling in asthma and continuous counterlocomotive lung sickness. American Record of Respiratory and Critical Prudence Medicine , 164(28).
Kanner, R. (1996). Present eldershipncy in continuous counterlocomotive pulmonary sickness: a critique of the lung bloom consider effects. Medical Clinics of North America, 80(4).
Kunik, M., & Densmore, D. (2002). Dip and COPD. Geriatrics, 7(4).
Kunik, M., Roundy, K., Veazey, C., Souchek, J., Richardson, P., Wray, N., & Stanley, M. (2005). Surprisingly haughty superiority of eagerness and dip in continuous lively disorders. American garden of chest physicians, 127(4).
Mahler, D. A. (1998). Pulmonary rehabilitation. Chest , 113(26).
Mannino, D. M. (2003). Continuous counterlocomotive pulmonary sickness: specification and epidemiology. Respiratory prudence record, 48(12).
Marieb, E. (2004). Ethnical dismemberment & physiology. San Francisco: Pearson Order.
Martini, F. (2000). Indispensables of dismemberment and physiology. New Jersey:
McBride, P. E. (1992). The bloom deductions of smoking. Cardiovascular sicknesss. Medical Clinics of North America, 76(2).
Nardini, S., Bertoletti , R., Rastelli, V., & Ravelli, L., & Donner, C. (1998). Singularal smoking manner and locality toparry smoking unordered the bloom staff of a unconcealed hospital. Monaldi Archive ce Chest sickness, 53(1).
National Emphysema Instituteation (2006). COPD – What is it?. Retrieved March 11, 2006, from http://emphysemafoundation.org/copdcbro.jsp#COPDWhatNational Kernel Arrange and Lung Institute (2006). What Inducements COPD?. Retrieved March 8, 2006, from http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_Causes.htmlNational Institute ce Bloom and Clinical Excellence (2004). Mouldment of continuous counterlocomotive pulmonary sickness in adults in chief and unimportant prudence. Retrieved February 12, 2006, from http://www.nice.org.uk/pdf/CG012_niceguideline.pdfNational Lung Bloom Order Program (2005). What is COPD? Retrieved March 19, 2006, from http://www.nlhep.org/lung_copd.htmlNewcomb, P. A., & Carbone, P. P. (1992). The bloom deductions of smoking: Cancer. Medical Clinics of North America, 76(2).
Nursing & Midwifery conclave. (2004). Code of administrative spend. London: Nursing & Midwifery conclave.
Ohri, C., & Steiner, M. (2004). COPD: the sickness and perception refuse tenor. Hospital pharmacist, 11.
Osman, L. M., & Hyland, M. E. (2005). Enduring needs and medication styles in COPD. The European Respiratory Society, 14(7).
Parnell, H. (2000). Respiratory sickness: Caring ce the prudencers of continuous lung sickness sufferers in the aggregation. Retrieved February 23, 2006, from http://www.jcn.co.uk/journal.asp?MonthNum=05&YearNum=2001&Type=backissue&Arti
cleID=346Seedhouse, D. (2004). Bloom furtherance: philosophy, harm, and performance (2nd ed.). Chichester: J. Wiley.
Seeley, R.R., Stephens, T. D., & Tate, P. (2000). Dismemberment and physiology (5th ed.). USA: McGraw- Hill haughtyer order.
Sandford, A. J., Weir, T. D., & Pare, P. D. (1997). Genetic inducement contents ce continuous counterlocomotive pulmonary sickness. European Respiratory Record , 10(42).
Shaw, L. (2005). Dismemberment and physiology. Cheltenham: Nelson ThornesSinger, H., Ruchinskas , R., Riley, K., Broshek, D., & Barth, J. (2001). The psychical impression of end-steldership lung sickness. American garden of chest physicians, 120(4).
Strassels, S. A., Smith, D. H., Sullivan, S. D., & Mahajan, P. (1987). The costs of treating COPD in the United Declares. American garden of chest physicians, 119(9).
Tamir, E. (2002). The ethnical substantiality made mere : a pilot to dismemberment, physiology, and sickness. Edinburgh: Churchill Defencestone.
Taylor, S., & Field, D. (Eds.). (1993). Sociology of bloom and bloom prudence: an presentation ce protects (3rd ed.). London: Blackwell-mannered Scientific Publications.
Tinkelman, O., & Corsello, P. (2003). Continuous counterlocomotive pulmonary sickness: the impression occurs antecedent than we infiltrateyk. American Record of Mouldd Prudence, 9(6).
Tortora, G. J., & Grabowski, S. R. (2003). Principals of dismemberment and physiology. New York: HarperCollins Garden Publishers.
Turner, A., Foster, M., & Johnson, S. E. (2005). The performance of occupational therapy: an presentation to the tenor of corporeal dysexercise (5th ed.). London: Churchill Defencestone.
Trombly, C. A., & RadomskI, M. V. (Eds.). (2000). Occupational therapy ce corporeal dysexercise . Philadelphia: Lippincott Conqueriams & Wilkins.
United Kingdom government (2005). Memorandum by the Chartered Society of Physiotherapy. Retrieved March 9, 2006, from http://www.publications.parliament.uk/pa/cm200506/cmselect/cmhealth/485/485we23.htmVan Ede, L., Yzermans, C. J., & Brouwer, H. J. (1999). Superiority of dip in endurings with continuous counterlocomotive pulmonary sickness: a schemeatic critique. Thorax, 17(4).
Van der Schans , C. P., Postma, D. S., Koeter, G. H., & Rubin, B. K. (1999). Physiotherapy and bronchial mucus enravishment. European Respiratory Record, 13(8).
Verra, F., Escudier, E., Lebargy, F., Bernaudin, J. F., De Cremoux, H., & Bignon. J. (1995). Ciliary unnaturalities in bronchial epithelium of steamrs, ex- steamrs, and perceptionsmokers. American Record of Respiratory Critical Prudence Medicine, 151.
Watson , R. (2000). Dismemberment and physiology ce protects . Edinburgh: Bailliere Tindall.
Waugh, A., & Grant, A. (2004). Ross and Wilson dismemberment and physiology in bloom and bloom prudence. (9th ed.). Edinburgh; New York: Churchill Defencestone.
Webb, R., & Tossell, D. (1999). Gregarious Issues ce Prudencers: Inlands Positive Performance (2nd ed.). London: Arnold.
World Bloom Organization. (2006A).COPD: A specification. Retrieved February 21, 2006, from http://www.who.int/respiratory/copd/definition/en/index.htmlWorld Bloom Organization. (2006B). COPD: Inducements. Retrieved February 19, 2006, from http://www.who.int/respiratory/copd/causes/en/index.htmlWithers, N. J., Rudkin, S. T., & White RJ, R. J. (1999). Eagerness and dip in rigorous
continuous counterlocomotive pulmonary sickness: the possessions of pulmonary rehabilitation. Record of Cardiopulmonary Rehabilitation, 19(6).
Young, P. (1995). Mastering gregarious success (3rd ed.). London: Macmillan Press.