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Biomedical subjects

D D Miller

Publications and source records attributed to D D Miller.

352 records · Page 20Linked to original sources
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A gender-specific hazard-based clinical and noninvasive coronary risk scoring system for patients with suspected coronary artery disease.

OBJECTIVE: An outpatient-based scoring system was developed for at-risk patients with coronary artery disease based on data derived from the clinical history and noninvasive testing results for the prediction of an adverse event, the development of risk subsets, and the evaluation of the appropriateness of utilization patterns in an ambulatory care patient population. METHOD: This was a hospital-based cohort study. From a population of 3,795 consecutively tested patients, 872 with suspected coronary artery disease were enrolled from a midwestern university tertiary medical center from 1988 to 1989. RESULTS: Multivariable Cox modeling was used to develop scoring weights with scores ranging from -1.6 to 8.5 points. Significant multivariable disease predictors of cardiac death or myocardial infarction were use of nitroglycerin or insulin, ST-T wave changes, female gender, left ventricular hypertrophy, and a reversible thallium 201 defect. Receiver operating characteristics curves by use of the hazard score were comparable by gender. A probability threshold of .30 for cardiac death or myocardial infarction yielded a cut point of acceptable sensitivity and specificity for prompting medical management decisions. Below this threshold, the rate of follow-up diagnostic testing was 16.9% for women and 57.8% for men (p=.00001). Above this threshold, the rate of follow-up diagnostic testing was 40.6% for women and 64.3% for men (p= .04). CONCLUSION: Use of cardiac diagnostic services and cardiac event-free survival varies by gender in patients screened by noninvasive testing. For men at low risk of cardiac death or myocardial infarction, a statistically greater use of follow-up diagnostic testing was reported, thus reflecting more aggressive treatment and overuse of services for men as compared with women.

Aged↗
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Failure of ketanserin, a serotonin inhibitor, to prevent spontaneous or ergonovine-induced attacks of variant angina.

Six patients hospitalized with active variant angina were treated for 3 days with the serotonin antagonist ketanserin after a 3 day control period on no medication. The number of variant angina episodes per patient per day was 1.52 +/- 1.42 during the control period and 2.05 +/- 2.30 during ketanserin therapy (p = NS). Ergonovine was administered in incremental doses of 0.0125 mg to 0.4 mg in the control period, during intravenous ketanserin administration and after 3 days of oral treatment. All 6 patients developed ST elevation during all 3 ergonovine tests. The ergonovine dose at which ST elevation developed was similar in each of the 3 periods. It is concluded that ketanserin is of no value in the treatment of variant angina and that both spontaneous and ergonovine-induced coronary spasm in man are unlikely to be mediated by a serotonergic mechanism.

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Tocolytic therapy for the prevention of preterm labor.

The focus on treatment for preterm labor lies in risk screening, assessment, patient education, and the use of various tocolytic drug regimens. In years past, preterm labor patients were treated in the hospital with IV tocolytic drug therapies. However, patients can now receive oral subcutaneous tocolytics while remaining in their own homes. Modern technology allows for some women to be monitored daily for changes in uterine contraction activity without hospitalization. Nurses play an integral role in providing home care and education to these patients who comply with lifestyle changes to prolong the pregnancy toward term gestation.

Drug Monitoring↗
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Schizophrenia: its etiology and impact.

Schizophrenia is a devastating illness that can impair all aspects of a patient's life. Although positive psychotic symptoms such as hallucinations and delusions are often emphasized, the negative symptoms of the disease prevent patients from functioning in society and limit their ability to hold a job, attend school, or form friendships. Since schizophrenia is most likely to develop between ages 15 and 25 years, its effects are felt throughout a person's life. Much research has been conducted on the etiology of the disorder, but no single cause has been identified. Most likely, it is the result of a combination of genetic, environmental, and neuropathologic factors. The costs of schizophrenia are high. These patients occupy about 25% of hospital beds. They are paid approximately 10% of Social Security benefit days, as they are often too ill to work. Given the high costs of hospital care, any pharmacologic or psychosocial therapy that can prevent hospitalization will play an important role in the treatment of these patients.

Antipsychotic Agents↗