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Biomedical subjects

J Miller

Publications and source records attributed to J Miller.

At least 181 records · Page 10Linked to original sources
PubMed2000

Contraceptive and reproductive risk factors for cervical intraepithelial neoplasia in American Indian women.

OBJECTIVES: To evaluate contraceptive and reproductive risk factors for cervical intraepithelial neoplasia (CIN) in southwestern American Indian women. METHODS: We conducted a clinic-based case-control study. Cases were American Indian women with biopsy-proven CIN I, CIN II or CIN III. Controls were from the same clinics and had normal cervical epithelium. All subjects underwent structured interviews focused on contraceptive and reproductive factors. Laboratory assays included polymerase chain reaction (PCR)-based tests for cervical human papillomavirus (HPV) infection. RESULTS: We enrolled 628 women in the study. The strongest risk factors for CIN II/III included HPV infection (adjusted odds ratio [OR] = 7.9, 95% CI : 4.7-13.2), and low income (OR = 3.1, 95% CI : 1.7-5.7). The use of an intrauterine device (IUD) ever (OR = 3.0, 95% CI : 1.4-6.1) and currently (OR = 4.1, 95% CI : 1.1-14.6), and > or = 3 vaginal deliveries (OR = 5.2, 95% CI : 2.4-11.1) were associated with CIN II/III. History of infertility was also associated with CIN II/III (OR = 2.1, 95% CI : 1.0-4.2). CONCLUSIONS: The data suggest that history of infertility, IUD use and vaginal deliveries were associated with CIN among American Indian women.

Adolescent↗
PubMed2000

Help from our animal friends.

Animal-assisted therapy has gained widespread support and application in the past few decades. Learn its present goals and applications, including those pertinent to critical care.

Adaptation, Psychological↗
PubMed2000

Meter-dosed, inhaled beclomethasone initiated at birth to prevent bronchopulmonary dysplasia.

OBJECTIVE: To examine the hypothesis that meter-dosed, inhaled beclomethasone administered to premature infants, beginning at birth and continuing in a tapering dosage schedule over the first 12 days of life, decreases the occurrence of bronchopulmonary dysplasia (BPD), at 36 wks corrected gestational age. DESIGN: Prospective, randomized, double-blind, placebo-controlled, small pilot clinical trial. SETTING: Tertiary care, neonatal intensive care unit. PATIENTS: Premature low birth weight neonates (<or=1300 g) followed from birth until 36 wks corrected gestational age. INTERVENTIONS: Aerosolized beclomethasone dipropionate was administered in a tapering dosage schedule beginning at birth and extended for the first 12 days of life, utilizing an aerosol spacer chamber and manual hand ventilation. In a subset of the subjects, a cosyntropin stimulation test was conducted on day 13 to ascertain potential hypothalamic-pituitary-adrenal axis suppression. Need for mechanical ventilation/continuous positive airway pressure (CPAP) and/or oxygen was assessed at 30 days of life and 36 wks corrected gestational age in addition to a number of other variables clinically relevant to the development of BPD. MEASUREMENTS AND MAIN RESULTS: In total, 19 placebo-treated and 20 beclomethasone-treated infants completed the study. Inhaled beclomethasone significantly reduced the need for supplemental oxygen at 30 days (p =.005) of life but not at 36 wks corrected gestational age (p =.243). A significantly greater proportion of infants receiving beclomethasone were extubated before 2 wks of age (p =.035), and infants receiving beclomethasone required significantly fewer days of mechanical ventilation (p =.004), but increased days of nasal CPAP as compared with the control group. Although fewer beclomethasone-treated than placebo-treated infants were administered intravenous steroids after 2 wks of age, this difference was not significant. No differences between groups were noted for the diagnoses of retinopathy of prematurity, nosocomial infection, or intraventricular hemorrhage. Similarly, no differences in the cosyntropin stimulation test were ascertained between treated and nontreated infants. No adverse effects were attributable to inhaled beclomethasone. CONCLUSIONS: In this small series, inhaled beclomethasone initiated at birth did not reduce the occurrence of BPD as defined by the continued requirement for supplemental oxygen at 36 wks corrected gestational age. However, inhaled beclomethasone did reduce the need for supplemental oxygen at 30 days of life and appeared to facilitate the transition from intubation/mechanical ventilation to less invasive nasal CPAP, as demonstrated by more frequent extubation before 2 wks of age and decreased total duration of mechanical ventilation in the beclomethasone-treated group. No adverse effects, including adrenal suppression, were noted in infants treated with inhaled beclomethasone. On the basis of the safety and apparent effectiveness of early inhaled beclomethasone in reducing the need for invasive mechanical ventilation and supplemental oxygen during the first month of life in premature infants, a larger clinical trial with greater power is warranted to ascertain if early inhaled beclomethasone can attenuate the occurrence of BPD.

Clinical Trial↗
PubMed2000

Using the American Medical Association physician masterfile to measure physician supply in small towns.

The goal of this study was to describe the magnitude, direction and sources of error of the American Medical Association's (AMA) masterfile (MF) in estimating physician supply in small towns. A random sample of nonmetropolitan towns in the United States was selected, and physicians with AMA MF (MFMDs) addresses in these towns were listed. Local pharmacists were asked to confirm or disconfirm the identities and locations of practice for the listed physicians and to add any unlisted physicians who were there. We took pharmacist confirmed or identified local source physicians (LSMDs) to be the "gold standard." The sample of 57 towns yielded 1,341 potential physician names. In these towns, there were 377 physician listings only from the MF, 188 only from local pharmacists, and 776 from both sources. About 80 percent of physicians identified by local informants were also listed on the MF; only 67 percent of physicians listed on the MF were identified by local informants as currently practicing in the town where they were listed. The error in these measures declined with increasing town size. The aggregate ratio of MFMDs to LSMDs was 1.20, ranging from 1.10 to 1.28 across size classes of towns. Given the persistence of local shortages of physicians, despite a national oversupply, accurate measurement of physician supply should be a priority of rural health care planners and advocates. Although the MF is the most comprehensive available national physician database, reliance on it alone to make local estimates of physician supply might lead one to believe that there are 20 percent more physicians in small rural communities than are actually there. Local pharmacists can be valuable informants about rural physician availability and their in- and out-migration.

American Medical Association↗
PubMed2000

Cardiac output during exercise by the open circuit acetylene washin method: comparison with direct Fick.

An open-circuit (OpCirc) acetylene uptake cardiac output (QT) method was modified for use during exercise. Two computational techniques were used. OpCirc1 was based on the integrated uptake vs. end-tidal change in acetylene, and OpCirc2 was based on an iterative finite difference modeling method. Six subjects [28-44 yr, peak oxygen consumption (VO(2)) = 120% predicted] performed cycle ergometry exercise to compare QT using OpCirc and direct Fick methods. An incremental protocol was repeated twice, separated by a 10-min rest, and subsequently subjects exercised at 85-90% of their peak work rate. Coefficient of variation of the OpCirc methods and Fick were highest at rest (OpCirc1, 7%, OpCirc2, 12%, Fick, 10%) but were lower at moderate to high exercise intensities (OpCirc1, 3%, OpCirc2, 3%, Fick, 5%). OpCirc1 and OpCirc2 QT correlated highly with Fick QT (R(2) = 0.90 and 0.89, respectively). There were minimal differences between OpCirc1 and OpCirc2 compared with Fick up to moderate-intensity exercise (<70% peak VO(2)); however, both techniques tended to underestimate Fick at >70% peak VO(2). These differences became significant for OpCirc1 only. Part of the differences between Fick and OpCirc methods at the higher exercise intensities are likely related to inhomogeneities in ventilation and perfusion matching (R(2) = 0.36 for Fick - OpCirc1 vs. alveolar-to-arterial oxygen tension difference). In conclusion, both OpCirc methods provided reproducible, reliable measurements of QT during mild to moderate exercise. However, only OpCirc2 appeared to approximate Fick QT at the higher work intensities.

Acetylene↗
PubMed2000

Erythromycin and position facilitated placement of postpyloric feeding tubes in burned patients.

BACKGROUND: One of the main difficulties encountered in enteral nutrition in critically ill patients is the impaired gastric emptying: while the small bowel is ready the stomach is still 'lazy'. This paper describes a simple bedside method for postpyloric feeding tube placement, using a gastric prokinetic agent, erythromycin, and patient positioning. METHODS: In eight critically ill, burned patients a gastric feeding tube was placed in a reverse Trendelenburg, right lateral decubitus position. A dose of 250 mg of erythromycin was administered intravenously. RESULTS: In 13 out of 14 attempts, the tube passed into the duodenum, a success rate of 92%. CONCLUSIONS: Combining the prokinetic effects of erythromycin with proper patient positioning allows a rapid bedside transpyloric placement of feeding tubes.

Adult↗
PubMed2000

Collaborative partnership for culture care: enhancing health services for the Arab community.

The purpose of this study was to discover perceptions, experiences, and patterns of health care behavior among Arab Americans in an urban Midwestern area of the United States and then to discover perceptions and experiences of health care providers related to culturally competent care. The goal of the study was to generate findings that would provide the basis for implementing system-wide changes to include culturally competent care. A qualitative focus group methodology was used to discover the care patterns and perceptions of Arab Americans and the local health care providers. The nurse researchers conducted 10 focus groups. Six themes were identified, including the unique caring behaviors of Arab families, the complexity of the health care system to Arab Americans, communication gaps, the diversity of perceptions of cultural competency, obstacles to accessibility of care, and workforce diversity issues.

Adolescent↗
PubMed2000

Current treatment practice in immunosuppression.

New drugs have recently been added that may eventually replace the two-decade dominance of cyclosporin in solid organ transplantation. This cornerstone of immunosuppression was introduced by Borel [1] and Calne [2] in the mid-70s. In 1989, Starzl et al., after 2 years of preclinical experimentation, introduced tacrolimus (originally designated as FK506 by the Fujisawa Pharmaceutical Company of Japan) as a potent immunosuppressant for liver transplants [3]. Also, in recent years, a variety of novel purine and pyrimidine biosynthesis inhibitors have been tested for transplantation therapy. The leading agent which appears to be replacing the 35-year position occupied by azathioprine is the semi-synthetic morpholinoethyl ester of mycophenolic acid (MPA), mycophenolate mofetil (MMF), introduced by Allison [4] and Sollinger [5], and developed by the Syntex Corporation (now Roche Pharmaceuticals). Others, affecting different intra- or intercellular messages amplifying immunity, are in the pipeline.

Antibodies↗