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Biomedical subjects

D K Miller

Publications and source records attributed to D K Miller.

At least 91 records · Page 5Linked to original sources
PubMed1992

Impact on caregivers of supporting urinary function in noninstitutionalized, chronically ill seniors.

In a multivariate study of 148 caregivers of chronically ill older persons, 22% of those caring for a continent senior reported that maintaining continence was a burden, and 75% of caregivers of incontinent seniors reported it as burdensome. The burden of maintaining urinary function was associated with lack of social support, time spent providing care, and care receiver's immobility. Caregivers' depressive symptoms were associated with perceived burden from providing care for urinary function, a confused care receiver, and post-stroke support.

Activities of Daily Living↗
PubMed1992

Effects of low levels of lice and internal nematodes on weight gain and blood parameters in calves in central Texas.

The effects of low levels of both biting and sucking lice, a mixed population of nematodes, and a combination of all these parasites were evaluated in calves held in a barn with no environmental controls in central Texas. Observations at 122 sites on each animal for 16 wk consecutively in 1987 revealed that the largest numbers of all louse species [Haematopinus eurysternus (Nitzsch). Linognathus vituli (L.), and Bovicola bovis (L.)] occurred 3-7 wk after infestation. In 1988 L. vituli populations decreased rapidly after the 3rd wk and B. bovis remained fairly constant for 20 wk consecutively. Average nematode egg counts increased to approximately 300 eggs per gram of feces in 1987 and approximately 600 eggs per gram of feces in 1988. The nematodes Ostertagia ostertagia, Haemonchus placei, Oesophagostomum radiatum, Cooperia spp., and Trichostrongylus spp. were present at the end of the study in both years as determined by necropsy. No significant differences in erythrocyte count, mean cell volume, hematocrit, hemoglobin concentration, leukocyte counts, or serum albumin concentration were detected. However, significant increases in total serum protein concentration and serum globulin levels in calves harboring both groups of parasites were observed. Mean weight gain in calves infested with lice and nematodes was 11.4 and 10 kg less than that of uninfested controls during 16 wk in 1987 and 20 wk in 1988, respectively.

Animals↗
PubMed1992

Osteomyelitis caused by Mycobacterium haemophilum: successful therapy in two patients with AIDS.

OBJECTIVE: Difficulties involved in diagnosis and response to antimicrobial therapy are described in detail for two cases of biopsy-proven osteomyelitis caused by Mycobacterium haemophilum in AIDS patients. SETTING: Two large, private teaching hospitals in New York City, New York, USA. PATIENTS, PARTICIPANTS: A 31-year-old woman with previous diagnoses of candida esophagitis and peripheral neuropathy (patient 1), and a 37-year-old man with Kaposi's sarcoma (patient 2). INTERVENTIONS: One patient was treated with a combination of rifampin, ethambutol, clofazimine, and ciprofloxacin, while the other received rifampin, ciprofloxacin and doxycycline. Both patients also received a short course of intravenous amikacin. MAIN OUTCOME MEASURES: Disease activity was monitored clinically by observing resolution of skin ulcers, lymphadenopathy, and pain and swelling in areas affected by osteomyelitis. RESULTS: Both patients experienced complete resolution of signs and symptoms of M. haemophilum infection. Patient 1 was treated for 17 months and remains well after 10 months without therapy. Patient 2 shows no evidence of infection after 14 months of therapy. CONCLUSIONS: M. haemophilum infection must be considered in the differential diagnosis of osteomyelitis in AIDS patients, although specialized culture techniques are required to isolate and identify this pathogen. Excellent clinical response can be achieved with oral antimicrobial therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Efficacy of two formulations of albendazole against liver flukes in cattle.

Albendazole (10 mg/kg of body weight) was administered as a drench suspension or as a feed additive to 24 cattle with naturally acquired infections of Fasciola hepatica and Fascioloides magna. Cattle were euthanatized 16 to 30 days after treatment, and the number of viable flukes was counted. Viable F hepatica and F magna were decreased by 91.4% and 70.6% for drench administration and by 82.9% and 71.9% for the feed additive treatment, respectively. There was no significant difference between the efficacy of the 2 formulations in decreasing viable fluke numbers, compared with untreated controls.

Administration, Oral↗
PubMed1991

Opinions about management of geriatric syndromes given by internal medicine residents in two programs.

Internal medicine residents in two programs providing different amounts of training in geriatrics were surveyed in 1988 regarding their opinions about the management of four geriatric problems and two traditional internal medicine problems. The residents generally agreed that geriatric problems were legitimate concerns in a general internal medicine practice but demonstrated less confidence in the management of geriatric problems than in the management of traditional problems. Residents from the program that provided more extensive training in geriatrics evidenced greater support for nondiscriminatory care of elderly diabetics; otherwise there was no convincing evidence of differences between the two programs. The authors conclude that educational efforts in geriatrics need to target trainees' confidence in the management of geriatric problems.

California↗
PubMed1991

Abnormal eating attitudes and body image in older undernourished individuals.

An anorexia nervosa-like syndrome has been reported in older persons. To gain additional insight into this condition, a questionnaire designed to assess the severity of eating disorders (the EAT-26) was administered to 183 male outpatients. Thirty-four subjects were found to be undernourished by midarm circumference measurement and 21 by weight adjusted for age-sex-height. Approximately 60% of malnourished subjects acknowledged inappropriate self-control around food, up to 26% described other unsuitable eating attitudes, and 3% to 52% evidenced various forms of distorted body image. They scored high on EAT-26 Oral Control subscale but low to normal on Dieting and Bulimia and Food Preoccupation subscales. These results indicate that abnormal eating attitudes and body image occur in an important minority of undernourished elderly males, but the pattern of abnormalities differs from that seen in classical anorexia nervosa. This association deserves additional investigation, with special attention to the psychopathology producing high Oral Control responses and to females as well as males. In the meantime, clinicians need to consider anorexia-like attitudes when caring for malnourished seniors.

Aged↗
PubMed1991

Acute upper gastrointestinal bleeding in elderly persons.

We have seen that UGI bleeding is a serious and apparently growing problem for seniors. Of special concern in the older patient are the frequency with which serious peptic disease presents silently, the limitation frequently imposed on adequate pain relief from NSAIDs, and the higher complication rates from most of the causes of UGI bleeding. Care of the elderly would be enhanced by research focused on defining those older patients most at risk of experiencing NSAID-induced peptic complications, improved methods for preventing or treating NSAID-induced ulceration that are well tolerated and cost-effective, and better regimens for preventing the recurrence of ulcers and UGI bleeding in these patients. In regard to the last, future investigation of the role of H. pylori, methods for successfully eliminating the organism, and the effect of eradication on patients' subsequent course may be particularly helpful.

Age Factors↗
PubMed1990

Correlation between expression of 5-lipoxygenase-activating protein, 5-lipoxygenase, and cellular leukotriene synthesis.

Previous studies involving transfection of cDNAs for 5-lipoxygenase-activating protein (FLAP) and 5-lipoxygenase into osteosarcoma cells have shown that both these proteins are essential for leukotriene synthesis (Dixon, R. A. F., Diehl, R. E., Opas, E., Rands, E., Vickers, P. J., Evans, J. F., Gillard, J. W., and Miller, D. K. (1990) Nature 343, 282-284). In the present study we show that FLAP is present in a variety of cells known to produce leukotrienes, but is absent from a number of cells which do not synthesize leukotrienes. Furthermore, differentiation of the human promyelocytic HL-60 cell line towards granulocytic cells following exposure to dimethylsulfoxide is associated with the concurrent induction of both FLAP and 5-lipoxygenase and an increased capacity to synthesize leukotrienes. Cellular leukotriene synthesis in this system is functionally dependent on FLAP as shown by its inhibition by the leukotriene biosynthesis inhibitor MK-886, a compound which specifically binds to FLAP.

5-Lipoxygenase-Activating Proteins↗
PubMed1990

Identification and isolation of a membrane protein necessary for leukotriene production.

Several inflammatory diseases, including asthma, arthritis and psoriasis are associated with the production of leukotrienes by neutrophils, mast cells and macrophages. The initial enzymatic step in the formation of leukotrienes is the oxidation of arachidonic acid by 5-lipoxygenase (5-LO) to leukotriene A4. Osteosarcoma cells transfected with 5-LO express active enzyme in broken cell preparations, but no leukotriene metabolites are produced by these cells when stimulated with the calcium ionophore A23187, indicating that an additional component is necessary for cellular 5-LO activity. A new class of indole leukotriene inhibitor has been described that inhibits the formation of cellular leukotrienes but has no direct inhibitory effect on soluble 5-LO activity. We have now used these potent agents to identify and isolate a novel membrane protein of relative molecular mass 18,000 which is necessary for cellular leukotriene synthesis.

Affinity Labels↗
PubMed1990

Requirement of a 5-lipoxygenase-activating protein for leukotriene synthesis.

Leukotrienes, the biologically active metabolites of arachidonic acid, have been implicated in a variety of inflammatory responses, including asthma, arthritis and psoriasis. Recently a compound, MK-886, has been described that blocks the synthesis of leukotrienes in intact activated leukocytes, but has little or no effect on enzymes involved in leukotriene synthesis, including 5-lipoxygenase, in cell-free systems. A membrane protein with a high affinity for MK-886 and possibly representing the cellular target for MK-886 has been isolated from rat and human leukocytes. Here, we report the isolation of a complementary DNA clone encoding the MK-886-binding protein. We also demonstrate that the expression of both the MK-886-binding protein and 5-lipoxygenase is necessary for leukotriene synthesis in intact cells. Because the MK-886-binding protein seems to play a part in activating this enzyme in cells, it is termed the five-lipoxygenase activating protein (FLAP).

5-Lipoxygenase-Activating Proteins↗
PubMed1990

Effects of horn fly and house fly (Diptera: Muscidae) larvae on the development of parasitic nematodes in bovine dung.

Laboratory studies were conducted to determine the effects of horn fly, Haematobia irritans (L.), and house fly, Musca domestica L., larvae on the development of a mixed population of parasitic nematodes in compressed and crumbled bovine dung. Fresh dung (100 g per sample) from a single calf passing trichostrongyle type eggs was infested with 150 horn fly or 150 house fly eggs. After 14-15 d, more horn flies and house flies had emerged from the compressed dung than from the crumbled dung, but more third stage parasitic nematode larvae were recovered from the crumbled dung containing either fly species than from dung containing no flies.

Animals↗
PubMed1990

Progress in the development of a nutritional risk index.

The development of a 16-item nutritional risk index (NRI) is chronicled from its inception through its application in three studies designed to assess its reliability and validity. Study I involved a survey of 401 community-dwelling elderly in St. Louis, Missouri who were interviewed at baseline, 4-5 mo later, and 1 yr later. Study II involved a cross-sectional survey of 377 male outpatients attending two clinics at the St. Louis Veterans Administration Medical Center. Study III involved a cross-sectional survey of 424 community-dwelling elderly in Houston, Texas. Internal consistency reliability coefficients ranged between 0.47 and 0.60, and test-retest reliability coefficients ranged between 0.65 and 0.71. Validity was established by using the NRI to predict the use of health services, as well as by correlating it with a variety of anthropometric, laboratory, and clinical markers of nutritional status. The utility of the NRI for future applications is discussed.

Aged↗
PubMed1990

Formal geriatric assessment instruments and the care of older general medical outpatients.

To improve identification of cognitive, affective, gait, and nutritional problems in older medical outpatients, non-physician clinic personnel administered formal geriatric assessment tools to 183 medical outpatients age 70 years and older. Definite impairments were demonstrated in 7% to 23% of patients (depending on the function being assessed), and borderline abnormal results were common as well. Overall, 56% of patients had at least one meaningful impairment identified. Few of these problems had been recognized before the survey. Assessment required 10 to 15 minutes of interviewer time per patient (approximately 22 minutes for each problem newly uncovered). A simple education and information intervention led to physicians addressing the newly identified problem in 30% to 55% of cases. These results suggest that formal geriatric assessment instruments provide an efficient mechanism for case finding in older medical outpatients. Further studies are necessary to determine whether such interventions will lead to improved outcomes in older medical outpatients.

Aged↗
PubMed1990

The effect of prescribed daily dose frequency on patient medication compliance.

The objective of this study was to determine the relationship between prescribed daily dose frequency and patient medication compliance. The medication compliance of 105 patients receiving antihypertensive medications was monitored by analyzing data obtained from special pill containers that electronically record the date and time of medication removal. Inaccurate compliance estimates derived using the simple pill count method were thereby avoided. Compliance was defined as the percent of days during which the prescribed number of doses were removed. Compliance improved from 59.0% on a three-time daily regimen to 83.6% on a once-daily regimen. Thus, compliance improves dramatically as prescribed dose frequency decreases. Probably the single most important action that health care providers can take to improve compliance is to select medications that permit the lowest daily prescribed dose frequency.

Antihypertensive Agents↗
PubMed1989

Clinical validation of a nutritional risk index.

This research assessed the clinical validity of a nutritional risk index (NRI). Subjects were 377 male veterans, aged 55+, attending general medicine and geriatric outpatient clinics. Data were collected by personal interviews, anthropometric measurements, laboratory assay of nutritional parameters, three-day food records, and medical record reviews. Although the results showed that the NRI correlated significantly with only two nutritional measures (body mass index, total energy intake), critical values or threshold levels of NRI were identified that significantly discriminated low risk from high risk patients on four nutritional parameters (body mass index, total energy intake, laboratory risk, and medications risk). It was concluded that the NRI is a valid measure of health status and contains a nutritional dimension.

Aged↗