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Biomedical subjects

F Miller

Publications and source records attributed to F Miller.

At least 55 records · Page 3Linked to original sources
PubMed1997

When to recommend compulsory versus optional CME programs? A study to establish criteria.

When should remedial continuing medical education (CME) be compulsory for family physicians? When should it be optional? Should it be structured or not? In 1993-1994, the authors addressed this need for criteria by conducting a study that used reports on 14 physicians who had undergone a structured oral interview (SOI) at the College of Physicians of Quebec. (The SOI is a day-long encounter during which two specially trained physician-interviewers present a physician with standardized clinical cases that focus on ten specific aspects of a family physician's competence.) The 14 SOI reports were reviewed by 12 external physician-judges in an attempt to see how consistently they could link the ten aspects of competence, as shown in the reports, to five particular types of recommended remedial CME programs (the strictest being "compulsory program with suspended license" and the most lenient being "simple suggestions for improvement"). There was substantial agreement among the judges when choosing between compulsory and optional programs (kappa = 0.63, p < .05). The main criteria used when recommending an optional program were overall strengths and the quality of clinical reasoning. The same two criteria were also used for recommending a compulsory program, but the judges also considered three additional factors: the physician's ability to recognize his or her limits and how he or she handled referrals and prescribed medications. Many of the criteria used by the judges were based on unique information that came out of observations and interactions during the SOIs, such as quality of argumentation, sustaining a train of thought, sense for the case as a whole, or awareness of one's limits. Finally, the external judges corroborated the decisions previously made by the College of Physicians of Quebec concerning the appropriate CME programs for the 14 physicians.

Attitude of Health Personnel↗
PubMed1997

Visualization of lung cancer with 99Tcm-tetrofosmin imaging: a comparison with 201T1.

We evaluated the usefulness of 99Tcm-tetrofosmin imaging in lung cancer. The study sample comprised 46 patients with lung cancer. Single photon emission tomography was conducted after the intravenous injection of 740 MBq 99Tcm-tetrofosmin and 111 MBq 201T1-chloride. We obtained an uptake ratio (counts per pixel in the lesion/counts per pixel in contralateral normal lung) for each scan to evaluate the degree of uptake in the tumour. Our results demonstrate that 89.1% of the primary lung cancers were visualized by 99Tcm-tetrofosmin and 95.7% by 201T1. The difference between the 201T1 uptake ratio and the 99Tcm-tetrofosmin uptake ratio was significantly greater in squamous cell carcinomas than small cell carcinomas (P < 0.01) and tended to be greater in squamous cell carcinomas than adenocarcinomas (P = 0.093). This study has indicated that 99Tcm-tetrofosmin, like 201T1, is a highly effective agent in the delineation of lung cancer. The difference between the 99Tcm-tetrofosmin and 201T1 uptake ratios might provide further information regarding the histological type of lung cancer.

Adenocarcinoma↗
PubMed1997

Cerebral palsy.

Cerebral palsy is caused by a static lesion to the cerebral motor cortex that is acquired before, at, or within 5 years of birth. Multiple causes for the condition exist and include cerebral anoxia, cerebral hemorrhage, infection, and genetic syndromes. Cerebral palsy is commonly classified according to the type of movement problem that is present (spastic or athetoid) or according to the body parts involved (hemiplegia, diplegia, or quadriplegia). To care for children with cerebral palsy, a team approach is most effective; the team should include the pediatrician and orthopedist, among others. In the nonambulatory patient, good sitting posture, the prevention of hip dislocation (spastic hip disease), and the maintenance of proper custodial care are prime concerns. Careful monitoring and treatment of spastic hip disease and the correction of scoliotic spinal deformity are also important. In the ambulatory patient, the main goal is to maximize function. Computerized gait analysis in patients with complex gait patterns helps to show whether orthotic or surgical treatment is indicated. In this paper, we also review both the proper indications for orthopedic intervention in patients with upper extremity involvement and recent methods to control spasticity, such as selective dorsal rhizotomy and administration of botulinum toxin or intrathecal baclofen.

Cerebral Palsy↗
PubMed1997

Measuring anteversion and femoral neck-shaft angle in cerebral palsy.

Femoral anteversion was measured by computed tomography (CT) in 40 children with cerebral palsy, however an accurate measurement was possible in only 59 of the 80 hips. Flat-surface measurement of anteversion was possible in 72 of 80 hips by CT, and in 36 of 40 hips by ultrasound. A high neck-shaft angle correlated with an inability to measure anteversion by CT. Measuring by ultrasound allowed subjects to be positioned in internal rotation and in this way accurate measurements of neck-shaft angles were obtained.

Adolescent↗
PubMed1997

Predicting readmission to the psychiatric hospital in a managed care environment: implications for quality indicators.

OBJECTIVE: This study examined predictors of hospital readmission to determine whether readmissions can serve as a quality indicator for an inpatient psychiatric service. METHOD: A series of 255 patients consecutively admitted to any of seven psychiatric hospitals in a regional managed care program were followed to determine whether they were readmitted within 6 months of discharge. Case managers assessed patients with the use of a reliable outcome management/decision support system designed for acute psychiatric services. RESULTS: Patients with greater impairment in self-care, more severe symptoms, and more persistent illnesses were more likely to be readmitted than other patients. Suicidal patients were less likely to be readmitted. There was no evidence to suggest that poor hospital outcome or premature discharge was associated with readmission either within 30 days or within 6 months. CONCLUSIONS: Although patients at risk for hospital admission can be identified, it does not appear that the success of the hospital intervention per se influences the likelihood of readmission. Use of readmission rates as quality indicators for hospital care providers is not recommended.

Acute Disease↗
PubMed1997

Revision spine surgery in children with cerebral palsy.

Ten children with neuromuscular scoliosis and pelvic obliquity had revision spinal instrumentations and fusions performed at an average age of 14.7 years. The initial spinal deformity in all children was the result of static encephalopathy with nine children diagnosed as having spastic cerebral palsy without another specific diagnosis and one child diagnosed as also having Noonan syndrome. All 10 children had a revision performed after the first surgery, and two of the 10 children underwent a second revision because of failure of rod cross-links. The indications for revision surgery were symptomatic recurrent deformity, symptomatic pseudoarthrosis, or perforation of one leg of the unit rod through the pelvis. The average time between the first and second surgery was 2.7 years, and from revision to final follow-up was 2.5 years. The goal of providing symptomatic relief and correction of deformity was accomplished in nine of 10 children; however, two of the nine required two revisions. One patient continues to have a residual painful pseudoarthrosis. The two postoperative complications requiring further surgery were related to the failure of rod connectors.

Activities of Daily Living↗
PubMed1996

In vivo targeting of inducible NO synthase with oligodeoxynucleotides protects rat kidney against ischemia.

Gene products of all three distinct nitric oxide synthases are present in the mammalian kidney. This mosaic topography of nitric oxide synthase (NOS) isoforms probably reflects distinct functional role played by each enzyme. While nitric oxide (NO) is cytotoxic to isolated renal tubules, inhibition of NO production in vivo invariably results in the aggravation of renal dysfunction in various models of acute renal failure. We reasoned that the existing ambiguity on the role of nitric oxide in acute renal failure is in part due to the lack of selective NOS inhibitors. Phosphorothioated derivatives of antisense oligodeoxynucleotides targeting a conserved sequence within the open reading frame of the cDNA encoding the inducible NOS (iNOS) were designed to produce a selective knock-down of this enzyme. In vivo use of these antisense constructs attenuated acute renal failure in rats subjected to renal ischemia. This effect was due, at least in part, to the rescue of tubular epithelium from lethal injury. Application of antisense constructs did not affect endothelial NOS, as evidenced by a spared NO release after the infusion of bradykinin during in vivo monitoring with an NO-selective microelectrode. In conclusion, the data provide direct evidence for the cytotoxic effects of NO produced via iNOS in the course of ischemic acute renal failure, and offer a novel method to selectively prevent the induction of this enzyme.

Animals↗
PubMed1996

Using a stent to treat patients with portal hypertension.

This article is based on work undertaken in the radiology department at the Royal Infirmary of Edinburgh, the first centre in the UK to practise transjugular intrahepatic portosystemic stent shunt (TIPSS) insertion. This is an effective treatment for patients with the signs and symptoms of portal hypertension. The author describes the indications for the procedure and details the nursing care of the patient before, during and after the intervention.

Humans↗
PubMed1996

Normal saline i.v. fluid load decreases uterine activity in active labour.

This study was designed to observe the effects of i.v. fluid infusion on uterine activity during normal labour in women receiving an extradural block. Thirty-four women in spontaneous labour at term gestation were allocated randomly and prospectively to one of three i.v. pre-extradural fluid load groups: group A, no fluid load; group B, normal saline 500 ml; and group C, normal saline 1000 ml. Continuous internal measurement of uterine activity was observed before, during and after fluid infusion and extradural block. In groups A and B, uterine activity did not change. In group C, uterine activity decreased after infusion of saline (P < 0.01) and returned to baseline over the next 20 min. Extradural block was not associated with a change in uterine activity. Hypotension was not increased in the group that received no fluid preload.

Adolescent↗
PubMed1996

Growth factors in subglottic stenosis.

We sought to define the role of fibrogenic peptides in subglottic stenosis (SGS). Biopsy specimens were obtained from patients with stenosis following endotracheal intubation (group 1, n = 5, mean age 5), patients without a history of any precedent trauma, ie. idiopathic stenosis (group 2, n = 3, mean age 40), and those without stenosis (group 3, n = 3, mean age 70). Formalin-fixed biopsy specimens were analyzed following immunohistochemical staining to determine if epidermal growth factor (EGF), platelet-derived growth factor-AA and -BB (PDGF-AA/BB), transforming growth factor-beta 1 and -beta 2 (TGF-beta 1, beta 2), or basic fibroblast growth factor (bFGF) was deposited in these tissues. Blinded analysis revealed TGF-beta 2 and PDGF-AA to be present in seven of eight biopsy specimens from SGS and absent in controls. Staining for PDGF-BB was observed in the mucosa and submucosa and occasionally within vessel walls. Staining of individual growth factors appeared to correlate closely with the presence of granulation tissue. Essentially no bFGF or TGF-beta 1 was observed. Differences were found between patients in groups 1 and 2; tissue from group 1 revealed deposition of EGF and PDGF-BB in submucosa, epithelium, and vasculature. In summary, our experimental findings implicate PDGF and TGF-beta 2, perhaps acting in concert, in mediating the pathologic fibrotic process observed in subglottic stenosis. Epidermal growth factor, in conjunction with TGF-beta and PDGF, may also have a role, but further investigation is needed to more precisely define it.

Adult↗
PubMed1995

Induction of plasmacytomas in genetically susceptible mice with silicone gels.

Silicone gels injected intraperitoneally into strains of mice related to BALB/c develop plasmacytomas in approximately the same numbers and with similar phenotypes as previously obtained with pristane. Silicone gels produce few side effects and are well tolerated for long periods. Silicone gels contain several components that are potentially biologically active: residual vinyl groups and platinum. Microscopic and histological evidence suggests the silicone gel is degraded over a long period of time. Preliminary studies with long chain liquid dimethylpolysiloxanes with viscosities of 1000 cSt and 12,500 cSt have not produced plasmacytomas as yet. The plasmacytomagenic action of the gel appears to be due to the release of liquids from the gel matrix.

Animals↗
PubMed1995

Recurrence of immunoglobulin A-kappa crystalline deposition disease after kidney transplantation.

Cases of immunoglobulin A heavy chain and kappa light chain deposition disease are rare and their clinical presentations vary. We report one patient with histopathologic and clinical findings of a microangiopathic glomerulonephritis due to immunoglobulin A-kappa deposition. Ultrastructural studies revealed highly ordered deposits in the capillary lumen, mesangium, and basement membrane. The disease recurred at 2.5 years after a cadaveric kidney transplantation. Pulse steroid therapy was repeatedly effective in retarding further progression of renal deterioration in this patient.

Female↗
PubMed1995

Frequency of familial dilated cardiomyopathy.

Based on evaluation of 59 probands and their families, we previously demonstrated that over 20% of patients with idiopathic dilated cardiomyopathy (DCM) have familial disease. We acquired 36 additional probands and found familial disease in 24.2% of the 95 probands in this expanded consecutively ascertained cohort. The family history, as reported by the patient and relatives, is often an unreliable indicator of familial disease because patients may be unaware of the significance of a family history of sudden death, arrhythmia or stroke. We demonstrate that careful family history with review of medical records identifies more familial cases than merely asking the patient if there is a family history of DCM. However, even such a careful family history does not identify all familial cases. Some familial cases are identified only by echocardiographic investigation of asymptomatic relatives. We found no clinical attributes of probands, other than family history, which predicted familial disease.

Adolescent↗
PubMed1995

Age and migration percentage as risk factors for progression in spastic hip disease.

Age and migration percentage were evaluated as risk factors for the progression of spastic hip subluxation in patients with cerebral palsy. Three age-groups were defined: group 1 (two to eight years), group 2 (nine to 18 years), and group 3 (over 18 years). Four subluxation groups were defined by migration percentage: group A (< 30 per cent), group B (30 to 60 per cent), group C (60 to 90 per cent), and group D (> 90 per cent). The risk of progression was the same in groups 1A and 2A, and both of these were higher than the risk in group 3A. All group B hips had similar risks for progression, and all group C hips progressed to group D (> 90 per cent migration percentage). Groups 1A, 1B, 2A, 2B and 3B hips need close radiographic follow-up to detect progressive subluxation. All group C hips required surgical treatment for progression to dislocation to be avoided.

Adolescent↗