Interest in electronic distribution of health physics.
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Computer Communication Networks↗
Biomedical subjects
K L Miller
Publications and source records attributed to K L Miller.
Diabetes insipidus.
Diabetes insipidus (DI), an acute or chronic condition, results from either of two situations: An inadequate secretion of antidiuretic hormone (ADH) from the posterior pituitary gland or an insufficient renal response to adequate levels of ADH. Characterized by massive urinary output despite progressive serum hyperosmolality, hypernatremia, and dehydration, DI can be life-threatening if not promptly diagnosed and appropriately managed. Individuals with renal disease, surgical patients, and persons with cerebral trauma are at risk to develop this condition.
Acute Disease↗
Evaluating a pediatric pain management research utilization program.
Research-based pain assessment and management innovations are not fully utilized in clinical nursing practice. Thus children continue to suffer despite strategies that could eliminate or significantly reduce their pain. An educational program was developed and implemented to integrate state-of-the-art pain assessment and management strategies into the clinical practice of pediatric nurses. This article reports on evaluation of the research utilization process during development and implementation of the program. The program included formal classes, development of instruments for pain assessment and documentation, ongoing consultation on pain management strategies, and designation of a unit-based staff nurse liaison. Findings illuminated the process through which nursing staff on one unit came to learn about new ideas, try those ideas in their clinical practice, re-invent certain strategies to better meet their needs, and, ultimately, to adopt innovations deemed helpful in their work.
Adult↗
Keeping the care in nursing care: our biggest challenge.
Although caring is the essence of nursing practice, many nurses are concerned that their ability to care is being compromised by the tumultuous changes occurring in the current healthcare environment. The author explores the challenge of caring in nursing practice, reviews what recent research has shown us about caring in nursing and identifies what we as nurse executives can do to enhance our own caring skills and the caring expertise of clinical nurse colleagues.
Adult↗
Bactericidal/permeability-increasing protein and lipopolysaccharide (LPS)-binding protein. LPS binding properties and effects on LPS-mediated cell activation.
We have previously shown that human bactericidal/permeability-increasing protein (BPI) is able to inhibit serum-dependent lipopolysaccharide (LPS)-mediated activation of human monocytes and neutrophils in vitro, and to counteract the lethal effects of LPS challenge in vivo. Lipopolysaccharide-binding protein (LBP) is a serum protein which participates in LPS-mediated activation of cells (Tobias, P. S., Mathison, J., Mintz, D., Lee, J. D., Kravchenko, V., Kato, K., Pugin, J., and Ulevitch, R. J. (1992) Am. J. Respir. Cell. Mol. Biol. 7, 239-245). We have proposed that BPI functions in a negative feedback loop which opposes this activation (Marra, M. N., Wilde, C. G., Collins, M. S., Snable, J. L., Thornton, M. B., and Scott, R. W. (1992) J. Immunol. 148, 532-537). We have now cloned and expressed recombinant forms of human BPI and LBP. Here we demonstrate that purified recombinant human LBP can replace the serum requirement for both LPS binding to human monocytes and LPS-mediated secretion of tumor necrosis factor alpha from these cells. These activities of LBP are inhibited by a neutralizing anti-CD14 monoclonal antibody. We further demonstrate that purified recombinant human BPI can inhibit LBP-mediated LPS binding to cells and their subsequent activation. Comparison of the LPS binding properties of BPI and LBP in enzyme-linked immunosorbent type assays and in the Limulus amebocyte lysate assay suggest that BPI has a stronger affinity for LPS than does LBP. Direct competition between BPI and LBP for LPS may explain the inhibition by BPI of the proinflammatory effects of LBP in the presence of LPS.
Acute-Phase Proteins↗
The nuclear reactor accident at Three Mile Island.
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Accidents↗
Physicians' practices in screening for the development of diabetic nephropathy and the use of glycosylated hemoglobin levels.
OBJECTIVE: To compare outpatient screening of diabetic patients for nephropathy and measurement of glycosylated hemoglobin (GHb) levels to published American Diabetes Association (ADA) guidelines. RESEARCH DESIGN AND METHODS: We reviewed charts from 157 diabetic patients followed for 27 months at the University of Washington's primary care clinics. The number of screening urinalyses, 24-h urine measurements, and GHb measurements were obtained. From these values, the frequency of screening tests, normalized by patient-year, could be compared with the ADA guidelines. RESULTS: Forty-two percent of the patients received at least one urinalysis, and 5% had 24-h urine measurements. There were 0.48 urinalyses and 0.05 24-h urine measurements per patient-year. Of 14 type I diabetes patients, 5 had a urinalysis and 1 received a 24-h urine measurement. At least one GHb was measured for 85% of patients, and there were 1.66 GHb measurements per patient-year. Only 29% of patients received GHb concentrations as recommended by ADA guidelines. CONCLUSIONS: Diabetic patients at this institution are not screened for nephropathy and do not receive GHb measurements according to the ADA guidelines. Because of recent advancements in the treatment of diabetic nephropathy and the results of the Diabetes Control and Complications Trial (DCCT), further efforts are needed for educating primary care physicians about standards of care of patients with diabetes.
Diabetic Nephropathies↗
Endocrine disorders in critically ill children.
Endocrine disorders in critically ill infants and children can be the manifestation of an existing but previously unrecognized condition, or hormonal derangements precipitated by deleterious effects on endocrine function of a critical illness or its prescribed therapy. To achieve successful resolution of these crises, a general understanding of various endocrine dysfunctions, clinical symptomatology, diagnosis, and medical and nursing management is essential.
Age Factors↗
Immunoglobulin clonality analysis. Resolution of ambiguities in immunofixation electrophoresis results by high-resolution, two-dimensional electrophoretic analysis of paraprotein bands eluted from agarose gels.
This article describes evaluation of the clonality of origin of immunoglobulin (Ig) chains by strategies that include qualitative analysis of paraproteins with high-resolution, two-dimensional electrophoresis (2DE) and silver staining. This approach is helpful in evaluating specimens in which standard immunoelectrophoresis or immunofixation electrophoresis (IFE) techniques do not provide definitive Ig typing results. One method the authors developed involves a "band elution" procedure, in which proteins present in high-resolution agarose gel electrophoresis bands are cut from the agarose gel, eluted with a denaturing buffer, and subjected to 2DE. The microheterogeneity patterns of the Ig light chains, heavy chains, or both are evaluated for their relationship regarding mass, charge, and, by inference, number of genes of origin. When necessary, determination of charge relationships may be aided by urea-mediated carbamylation of lysine residues, which introduces single-charge shifts to the individual protein subunits. Overall, these adjunctive techniques are particularly useful in cases with multiple bands of identical immunologic types (eg, several IgG1 bands) on IFE before and after sulfhydryl reduction (with dithiothreitol or 2-mercaptoethanol). The authors present procedural details and examples of the 2DE band elution patterns of serum and urine samples from four patients with B-cell dyscrasias, including the first reported case of POEMS syndrome with biclonal gammopathy, to the best of their knowledge.
Adult↗
Bovine bone activin enhances bone morphogenetic protein-induced ectopic bone formation.
A 25-kDa homodimeric protein was purified from demineralized bovine bone extract and identified as activin A. The bovine bone activin enhanced formation of ectopic bone in rat subcutis when implanted in combination with partially purified bovine bone morphogenetic protein (BMP-2, BMP-3) in collagen/ceramic carrier. The implants, removed at 14 days, contained markedly elevated levels of alkaline phosphatase activity. Histological examination revealed an extensive formation of woven bone with very little cartilage. In contrast, a combination of transforming growth factor-beta 2 and BMP promoted formation of bone with an abundance of cartilage. The implants with BMP alone exhibited some osteoinductive activity, while the implants with activin alone showed no activity. These results demonstrate that bone is a rich source of activin and that activin plays an important role in modulating bone formation.
Activins↗
Quality assurance and reproducibility of high-resolution two-dimensional electrophoresis and silver staining in polyacrylamide gels.
Qualitative data from high-resolution two-dimensional electrophoresis (2DE) have become clinically useful in immunoglobulin clonality analysis, in resolution of ambiguities in immunofixation typing of paraproteins, and in genetic typing of serum proteins. Since 1986, the authors have been evaluating the College of American Pathologists Reference Preparation for Serum Proteins (RPSP) as a quality control material for 2DE because (1) it is prepared exclusively from pooled human sera, (2) the pool yields a reference pattern of mixed heterozygosity for genetic markers, and (3) RPSP is widely available as a lyophilized preparation that currently serves in the authors' laboratory as a qualitative quality control preparation and that may become a quantitative quality control material or external quality assessment material for 2DE. Using the ISO-DALT 2DE system and silver-staining, the peptide patterns were examined in 11 lots of RPSP and compared with fresh serum and with each other. Consistent differences in the 2DE pattern between RPSP and fresh serum included the presence of freeze-thaw peptides, the presence of degradation spots of apolipoprotein A-I, and the diminution of apolipoprotein spot intensities in RPSP. All lots of RPSP yielded clear identification of the eight serum proteins used for quality control calculations. Run-to-run coefficients of variation for a single lot of RPSP for four parameters of 2DE spot location and gradient reproducibility were comparable with band location reproducibility for the one-dimensional procedures of serum protein electrophoresis and lactate dehydrogenase isoenzyme electrophoresis. It is concluded that the reproducibility, that is, imprecision, of 2DE is the same as one-dimensional clinical electrophoresis techniques and that either RPSP or pooled fresh serum can serve as a satisfactory internal quality control material.
Blood Protein Electrophoresis↗
Alternatives to estrogen for menopausal symptoms.
It is not within the scope of this chapter to discuss the long-term effects of menopause, such as osteoporosis or heart disease, or to disentangle the complex psychosocial complications and treatments of menopausal mood disorders. All long-term consequences of hypoestrogenism are more amenable to prevention than to cure, as are all the negative consequences of aging. Women should maintain regular physical activity, consume a diet low in fat and high in fiber, ensure adequate calcium intake, and possibly lower animal protein consumption. Moreover, they should know their cholesterol levels and undergo regular physical examinations with an emphasis on health maintenance. Despite the many advantages of estrogen replacement therapy, it is not appropriate for all women. Cultural, personal, and medical considerations may eliminate the use of estrogen, in which case it is important to offer alternative medical advice and direction to minimize bothersome symptoms of menopause and enhance the quality of life.
Adult↗
Obstructing endobronchial bands complicating radiation therapy for lung carcinoma.
A 57-year-old man with small cell lung carcinoma developed benign, obstructing endobronchial bands five months after external beam radiation therapy. We believe that this represents an unusual delayed complication of radiation therapy for airway tumors. An excellent clinical response was obtained after laser ablation of the lesion.
Antineoplastic Combined Chemotherapy Protocols↗
A personal journey through the abyss of depression.
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Depressive Disorder↗
Alterations in erythropoiesis in TGF-beta 1-treated mice.
Chronic treatment of mice with transforming growth factor beta 1 (TGF-beta 1) resulted in a dose-dependent inhibition of erythropoiesis. Following 14 daily s.c. injections of 5 or 25 micrograms of TGF-beta 1, a significant degree of anemia was observed. In addition, erythroid progenitor cells were present in reduced numbers in the bone marrow and spleen. Pluripotent stem cells were present in normal numbers in the bone marrow of mice treated with 25 micrograms of TGF-beta 1. However, significantly elevated levels were present in the peripheral blood. Adequate levels of erythropoietin were present in TGF-beta 1-treated mice. Following suspension of treatment with TGF-beta 1, erythropoiesis was restored, and TGF-beta-treated mice were able to compensate the anemia. One week following treatment, only mice treated with 25 micrograms of TGF-beta 1 continued to show evidence of anemia. However, in contrast to 1 day following treatment, these mice had levels of reticulocytes that were significantly above control values. In addition, erythroid progenitor cells had returned to normal levels in the bone marrow and were present in elevated levels in the spleen in both groups of TGF-beta 1 treated mice. The results provide evidence that the anemia associated with sustained TGF-beta 1 treatment is the result, in part, of a reversible inhibition of the maturation of erythroid progenitor cells.
Anemia↗
Multiple serum protein abnormalities in carbohydrate-deficient glycoprotein syndrome: pathognomonic finding of two-dimensional electrophoresis?
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Adult↗
Diagnostic radiology peer review: a method inclusive of all interpreters of radiographic examinations regardless of specialty.
A proposed method of assessing the quality of diagnostic radiographic examinations includes peer review designed to evaluate physicians, including nonradiologists, involved in the performance and interpretation of such examinations. A pilot project evaluated this system with randomly selected Pennsylvania Blue Shield data files of 10 providers billing for chest radiography interpretations during the second quarter of 1989. Of the 98 chest radiographs reviewed blindly, all inadequately marked radiographs and incomplete written reports were produced by nonradiologists. Technical quality of images obtained by radiologists did not significantly differ from that of images obtained by nonradiologists (P = .189). All five interpretive errors that could have seriously affected the patient's health care were produced by nonradiologists (P = .019). Four of these serious errors were made by providers billing for fewer than 25 radiographs. While administrative and time cost limitations are obvious, this method of peer review encompasses all physicians billing for a particular radiographic service, irrespective of specialty.
Blue Cross Blue Shield Insurance Plans↗