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C Miller

Publications and source records attributed to C Miller.

At least 379 records · Page 21Linked to original sources
PubMed1993

The electronic medical record: a definition and discussion.

The health care industry has had limited success in achieving some degree of an EMR in the past several years, and the industry has the potential to move even farther in the next decade. As standards begin to emerge and technologies conform to those standards, the industry will begin to see the evolution of a totally electronic patient record. Standard interfaces and hardware platforms, with software products designed to meet a standardized market need, will become more prevalent. Multifunction workstations, voice recognition, and other technological advancements will simplify the data-entry process for clinicians. Legal statutes that support automated records will be established and accepted by the courts, and optical disk image processing systems will take off as the storage medium of choice for the next generation. Because the EMR can provide the benefits outlined here, the health care industry must work together to ensure the success of this vision. As leaders in the health care information management arena, we need to participate in the realization of this ideal for the betterment of our patients, our health care organizations, and the entire health care delivery system.

Data Display↗
PubMed1993

A clinical case study: moving toward an automated patient record.

Automation of patient records is a concept that has slowly evolved into practical application during the last decade within the health care environment. Although limited progress has been made as far as standardizing automated record content and data exchange industrywide, we can be encouraged by individual hospital progress as illustrated by the Washington Hospital. This organization was successful in visualizing its goal, thoroughly planning its strategy, involving key players in the design, and following a methodical, purposely slow implementation plan to ensure system success. Benefits, both financial and intangible, have been achieved and recognized both within the organization and by those facilities that have been privy to its success first hand. Facilities contemplating automation of their patient record can be encouraged by Washington's example and the relentless pursuit of its vision for the automated patient record.

Cost-Benefit Analysis↗
PubMed1993

Consenting to DNR: critical care nurses' interactions with patients and family members.

OBJECTIVE: To investigate the process of consenting to do-not-resuscitate status from the perspective of critical care nurses who have been involved with patients and/or family members during their decision. METHOD: A network sample of 22 critical care nurses, with at least 1 year's experience in a critical care unit and self-reported multiple experiences with the do-not-resuscitate consent process, participated in the study. Semistructured, formal interviews were used to collect data. All interviews were tape recorded and transcribed verbatim. The grounded theory method was used to collect and analyze data. RESULTS: The analysis revealed a core category: consenting to do-not-resuscitate status. Integrated into the process were intervening conditions that further explained the process: the meaning of "do not resuscitate," the importance of time/timing in the process, the nurse's role and conflict issues that arose during the process of consenting to do-not-resuscitate status. CONCLUSIONS: The theoretical model developed in this study provides a framework to describe the role of critical care nurses in the do-not-resuscitate process. In addition, a description of the categories provides information for nurses, especially novice nurses, to consider when caring for patients and families who are in the process of making decisions concerning resuscitation.

Adult↗
PubMed1993

P53 mutations in human cancer.

A 53,000 dalton protein called p53, was noted to be mutated in human cancer in 1987. Further studies have shown that p53 is a tumor suppressor gene which may be one of the most frequently altered genes in cancer of all types. These alterations include interactions with viral antigens, coding mutations and inactivating rearrangements. Accumulating evidence suggests that p53 acts by binding DNA and activating transcription. Expression of p53 after transfection with a constitutive promotor, blocks cellular proliferation and leads to an apoptotic cell death. In normal cells, p53 expression is induced by irradiation; this has led to the hypothesis that p53 acts to inhibit replication during genetic repair. Cells which lack p53 are more prone to develop amplification. Mice lacking p53 are born normal but develop cancer after a lag of months, this suggests that p53 is not an initiating mutation in cancer, but probably a late event.

Codon↗
PubMed1993

Hepatitis C in liver allografts.

Recurrent or intercurrent hepatitis C represents significant problems in patients with liver transplants and must be differentiated from hepatic allograft rejection and other conditions affecting allografts. Often, the currently available anti-hepatitis C virus (HCV) tests are not helpful in the differential diagnosis, because preexisting anti-HCV may persist after transplantation or its development may be delayed. We determined the presence of HCV RNA by the reverse double polymerase chain reaction in biopsy specimens of liver allografts from nine patients with acute or chronic hepatitis of uncertain origin and from three patients with cellular allograft rejection. The NS3 region sequences of HCV were detected in seven of nine liver allograft biopsy specimens 6 weeks to 20 months after transplantation. Hepatitis C virus RNA was not detected in two patients. One of these patients was anti-HCV positive, showing mild acute hepatitis 5 weeks after transplantation. Anti-HCV was present in three patients with detectable HCV RNA in the liver but was absent from four other patients with HCV RNA. These findings suggest that HCV is a major cause of acute and chronic hepatitis following liver transplantation, that detection of HCV RNA by polymerase chain reaction in the liver biopsy specimen represents a reliable method for the diagnosis of hepatitis C in liver allografts, and that in some patients HCV may be acquired during transplantation while in others it may represent a recurrent infection.

Hepacivirus↗
PubMed1993

Biliary cystadenocarcinoma arising in a liver with fibropolycystic disease.

Intrahepatic cholangiocarcinoma associated with fibropolycystic disease of the liver and biliary cystadenocarcinoma are rare tumors that are considered distinct entities. We present a case of a malignant tumor with features of hepatic cystadenocarcinoma arising in a background of fibropolycystic disease.

Bile Duct Neoplasms↗
PubMed1993

Benign schwannoma of the liver.

We report a case of benign schwannoma presenting as a rapidly enlarging liver mass in a 67-year-old man and review the literature on nerve sheath tumors of the hepatobiliary system. Such tumors, which may occur in patients with and without neurofibromatosis, are very uncommon in the liver. The case reported herein, to our knowledge, is the first well-documented benign schwannoma of the liver occurring in a patient without neurofibromatosis.

Aged↗
PubMed1992

Escherichia coli genes involved in cell survival during dormancy: role of oxidative stress.

When Escherichia coli cells reach stationary phase of growth, specific gene products are synthesized that protect cells while dormant. "Aged" cells may remain viable in cultures for years. For example, agar cultures stored for 38 years still had more than 10(5) viable cells/ml. However, when specific mutants were cultured, the population of these mutants dropped sharply after 4-10 days. This defect is termed "Stationary-Phase-Death". Each mutant strain was hypersensitive to near-ultraviolet radiation and other oxidative agents. Bovine catalase rescued many of the mutants from death in dormancy, suggesting that specific gene products protect "aged" cells against oxidative damage.

Escherichia coli↗