Search PubMed⌕ Search

Biomedical subjects

C A Miller

Publications and source records attributed to C A Miller.

At least 361 records · Page 20Linked to original sources
PubMedDate not supplied

Learning needs of Oncology Nursing Society members.

The ONS mission is to promote excellence in oncology nursing. In its effort to carry out this mission, ONS has a responsibility to provide high-quality continuing education (CE) for cancer nurses. An important first step in the provision of quality CE is determining learners' needs. The ONS Continuing Education Provider Committee (CEPC) conducted a comprehensive educational needs assessment of the ONS membership during 1988. Preferred content (98 topics were included), level of content needed (basic versus advanced), preferred teaching-learning methods, and items related to the logistics of CE programs (i.e., preferred length, days of week, employer reimbursement) were assessed. Half of the 1988 ONS membership (6,500) was randomly surveyed, with a 30.8% (2,002) return rate. Analysis revealed the five topics of most interest to be oncologic emergencies, pain, critical care of the patient with cancer, legal issues, and advanced nursing practice roles.

Adult↗
PubMedDate not supplied

Hemodynamic effects of a new right ventricular assist device.

A right ventricular assist device (VAD) based on the principle of counterpulsation has been developed at our institution. The device is a valveless, pneumatically actuated, 40 cc, sac-type pump, with a single inlet-outlet port. For right ventricular support, the "Uniport" pump is anastamosed end-to-side to the pulmonary artery. In previous experimental trials, the device has been shown to impart minimal trauma to blood components. In this study, biventricular failure was induced in eight Holstein calves by normothermic ischemia during cardiopulmonary bypass. A Pierce-Donachy left VAD (LVAD) was used for left ventricular support following the ischemic insult. Hemodynamic measurements were obtained throughout the study, and each animal served as its own control. A significant increase in post injury cardiac output (33.5 +/- 11.4%) was obtained with use of the Uniport and LVAD, as compared to use of the LVAD alone (p less than or equal to 0.005). Other hemodynamic parameters of right heart failure, including right atrial pressure (RAP), pulmonary artery pressure (PAP), and left atrial pressure (LAP) were not significantly affected. These data suggest that the Uniport right ventricular assist device significantly improves cardiac output in this model of moderate right ventricular failure. Additional studies are required, however, to optimize pump stroke volume, and to further define the performance envelope of the device.

Animals↗
PubMedDate not supplied

Lipomas of the mesencephalic tectum and rostral pons associated with sleep apnea syndrome.

Two patients with mixed sleep apnea and autopsy-documented lipomas of the mesencephalic tectum and rostral pons are presented. Microscopically, the locus ceruleus was unilaterally invaded by a tumor in one case and may have been compressed in the other. Adipocytes and fibrous tissue were present adjacent to pial surfaces and around small blood vessels within the parenchyma. There was prominent astrogliosis in the adjacent neuropil. Although respiratory control is a complex, multifocal phenomena, these findings raise the possibility that the locus ceruleus or adjacent brain stem regions may be affected in some instances of sleep apnea.

Adult↗
PubMedDate not supplied

Myocardial oxygen consumption. Comparison between left atrial pulsatile synchronous and asynchronous bypass.

This controlled study was undertaken to quantitate the effect of R-wave synchronization (counterpulsation) on myocardial oxygen consumption (MVO2) as reflected by the tension time index (TTI) during pulsatile left atrial to aortic bypass. Pulsatile ventricular assist devices were implanted in eight anesthetized, fully hemodynamically instrumented animals. After baseline measurement of TTI, heart rate, cardiac output, mean aortic and left atrial pressures, pulsatile left atrial to aortic bypass was instituted. Measurements were then continuously recorded during both left atrial pulsatile synchronous (LAPS) and asynchronous (LAPAS) bypass periods of pumping. Heart rate and mean aortic pressure were controlled throughout the experiment. TTI = 1819 +/- 95 mmHg-sec (control); 987 +/- 127 mmHg-sec (LAPAS); and 763 +/- 89 mmHg-sec (LAPS). The results indicate TTI, and therefore MVO2, is reduced significantly from control levels by either LAPS or LAPAS bypass. However, R-wave synchronization (counterpulsation) offers no further benefit in reducing TTI over the less complex LAPAS or full-to-empty mode pumping.

Animals↗
PubMedDate not supplied

Determinants of survival in patients with ventricular assist devices.

Mechanical ventricular assist devices (VADs) have led to survival in patients who develop postcardiotomy cardiogenic shock (PCCS) refractory to conventional therapies. To elicit determinants of survival, the authors reviewed records of 26 patients at our institution who required Pierce-Donachy VADs for PCCS. Thirteen patients were weaned from ventricular assistance (50%), nine (34.6%) achieved long-term survival, and 17 died. Survivors and those that died were equivalent in terms of age, sex, NYHA class, type of operation, and preoperative hemodynamics. Ventricular assist pumping was established earlier in survivors (P = 0.006) although aortic cross-clamp and total cardiopulmonary bypass times were equivalent between the groups. The development of biventricular failure was significantly associated with the inability to wean from mechanical circulatory assistance. Despite an equal incidence of biventricular failure, survivors had milder forms of this entity and all patients with severe biventricular failure requiring a biventricular assist device failed to wean and ultimately died (N = 5). Of all complications, inadequate cardiac output was a significant determinant of weaning. Perioperative myocardial infarction and renal failure were found to be univariate determinants of survival. Inadequate cardiac output and biventricular failure preclude weaning from mechanical circulatory assistance. Survival is associated with the expeditious establishment of assist pumping, and with the avoidance of irreversible perioperative myocardial injury and renal failure.

Acute Kidney Injury↗
PubMedDate not supplied

Recent changes in selected local health departments: implications for their capacity to guarantee basic medical services.

Local public health departments traditionally have been supported as providers of preventive care and, in some jurisdictions, as guarantors of other essential services to vulnerable populations that usual providers do not reach. In the 1980s, the responsibility for allocating federal grants for public health shifted to the states, and those funds were reduced by about 20 percent. These circumstances, coupled with a deep recession, raised questions about the capacity of public health agencies to guarantee basic medical services for their constituent populations. Comparing information obtained in 1978-1979 with that obtained in 1982-1983 from 15 local health departments geographically dispersed throughout the United States, we found that, in the aggregate, the capacity of the departments to provide and guarantee personal health services had diminished. These departments had maintained what a panel of experts judged to be notable personal health services programs in the late 1970s. However in 1982-1983 (with some exceptions) the departments as a group had smaller budgets and staffs than they'd had four years earlier, had undergone extensive turnovers in leadership, found their relationships with the private sector increasingly strained, experienced a greater demand for their services, accentuated income-producing services, and were realigning themselves politically to interact more with state and local governments than with federal agencies. One department ceased to function as a guarantor of care; the capacity of four others to fulfill this role was jeopardized. The resourcefulness and adaptability of the remaining departments enabled them to continue to guarantee basic medical care for their service populations.

Community Health Services↗
PubMedDate not supplied

CT patterns in histopathologically complex cavernous hemangiomas.

Computed tomographic (CT) studies were correlated with microscopic findings in 10 histologically verified cavernous hemangiomas in nine patients. In four of the 10 lesions, two or more distinct types of cerebrovascular malformations were identified histopathologically. These included arteriovenous malformations, venous malformations, and telangiectasis. Such coexistence of various types of cerebrovascular malformations has been reported rarely. In each of the four combined lesions, there was evidence of recent or old hemorrhage. The CT findings were nonspecific and were similar to those seen in a variety of intracranial pathologic conditions.

Adult↗
PubMedDate not supplied

Ischemic chiasmal syndrome and hypopituitarism associated with progressive cerebrovascular occlusive disease.

Two interesting patients are described with unique clinical and radiographic manifestations of progressive bilateral stenosis-occlusion of the distal internal carotid arteries. Their clinical presentations, ischemic chiasmal syndrome and hypopituitarism, are extremely rare, despite extensive occlusion of the circle of Willis. In one of these patients, the configuration of collateral vessels around the optic chiasm on computed tomography (CT) was so rounded and discrete that it actually had an appearance suggesting a pituitary tumor or an aneurysm. In the second patient, a pseudoaneurysm and a very large intracerebral hematoma with a ring of contrast enhancement were the radiographic manifestations.

Adult↗
PubMedDate not supplied

Relationships between public and private providers of health care.

Fifteen local health departments that were identified as notable for their involvement in rendering personal health care were intensively studied along with their communities. Interviews with local medical care leaders and practitioners provided much of the study data. Three patterns characterized the relationships between the health departments and private providers in the communities. In one pattern, there were dual or parallel systems of care, both public and private, which were self-contained, with little planned linkage between them. In another pattern, the public and private sectors were interactive, relying on each other in deliberate ways for the exchange of services. In a third pattern, termed accommodative, the private and public sectors, although maintaining service separation, planned with each other for the establishment of complementary programs that would be responsive to community needs. Provision of health services of high repute was associated with all three of these patterns. Although tensions were not absent between public and private providers in the study communities, a climate of mutual support and good will appeared to characterize their relationships. In none of the health departments selected as outstanding, was an atmosphere of conflict with the private medical community reported.

Community Health Services↗