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Biomedical subjects

L Miller

Publications and source records attributed to L Miller.

538 records · Page 30Linked to original sources
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Building an integrated health management system at Honeywell.

The ideal of many a company seriously committed to managing its health care costs is to coordinate all its health-related functions. Honeywell, through a 14-person team representing 10 functions, has come closer to achieving this ideal than most. In the process, the Company saved $27.5 million in 2 years and has expanded its aims well beyond cost containment. How it conceived, staffed and developed its "hybrid" health management organization is described by the Company's Health Systems Director and the author of a recent book detailing Honeywell's many programs.

Cost Control↗
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The Glasgow Coma Scale in intensive care: a study.

This study reviewed neurological assessment and therapeutic intervention records of adult, intubated, sedated and ventilated patients who had sustained a severe cerebral insult. The purpose of the study was to determine whether the Glasgow Coma Scale detected neurological change in the ventilated, sedated patient. In addition the study aimed to establish whether changes to therapeutic intervention took place in response to an alteration in Glasgow Coma Scale parameters. A retrospective analysis of patient observation records was conducted and descriptive statistics presented. The study found that the Glasgow Coma Scale did not predict or correlate with a sustained rise in intracranial perfusion pressure (ICP) in ventilated and sedated patients. Changes in therapeutic intervention appear to be initiated in response to changes in a number of differing parameters. It is suggested that it may not be appropriate to use the Glasgow Coma Scale as a neurological assessment tool in ventilated and sedated patients.

Adolescent↗
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Importance of ventricular arrhythmias in bridge patients with ventricular assist devices.

To evaluate whether bridge to transplant patients with ventricular arrhythmias (VA; fibrillation or tachycardia) are at risk of death before or during ventricular assist device (VAD) support, the records of 28 patients who were supported with VADs for periods of 0.1 to 370 days (mean, 35.3 days) were retrospectively reviewed. VADs were effective in reducing the incidence of VA by 36%; however, patients with ischemic heart disease had a high incidence of VA (44%) during VAD. Only one patient with non-ischemic heart disease (8%) had VA during VAD. All five patients supported with left ventricular assist devices who had VA during support survived. Overall, the occurrence of VA during VAD was not a mortality risk. Since VAs are not predictors of survival, the presence of VA should not influence patient selection. While biventricular assist devices may be necessary in patients with the most severe VA, an LVAD provides excellent support in many patients.

Adolescent↗
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Left ventricular versus left atrial cannulation for the Thoratec ventricular assist device.

In a retrospective study of 28 patients (23 men, 5 women) supported with ventricular assist devices greater than 3 days, the effect of LV cannulation versus LA cannulation on device performance was compared. Patients ranged in age from 12 to 67 years (mean 46 years) and were supported for 3-81 days (mean 15 years). Fifteen patients were supported with left VADs (6 LV and 9 LA), and 13 patients were supported with BVADs (5 LV and 8 LA). The mode of operation 91% of the time was the fill-to-empty mode. Ten data points were taken for each patient. LV cannulation results in higher VAD flow index at decreased preload, lower VAD systolic and vacuum pressures, and shorter diastolic durations. Eleven of the 28 patients survived. Although survival was greater in patients with LV cannulation, survival was more dependent upon reversibility of myocardial damage, eligibility for transplantation, or the development of complications. These data indicate that LV cannulation provides better VAD performance than LA cannulation in the fill-to-empty mode.

Adolescent↗
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Report of the New England Task Force on Reducing Heart Disease and Stroke Risk.

Five years ago, a task force on reducing risk for heart disease and stroke was established by the six New England States. The task force included representatives from State public health departments, academia, the corporate sector, and voluntary organizations. This article is the final report of the task force. Heart disease and cerebrovascular disease are major causes of mortality in the New England region. Heart disease causes nearly 40 percent of all deaths in each of the six States and cerebrovascular disease, 7 percent of the deaths. Major risk factors for ischemic heart disease that have been identified--elevated serum cholesterol, high blood pressure, and cigarette smoking--are caused largely by lifestyle behaviors. Similarly, cerebrovascular disease results largely from uncontrolled high blood pressure, much of which is attributable to unhealthy lifestyle behaviors. In a series of studies evidence has accumulated that the reduction or elimination of these risk factors results in a decline in mortality rates. Many intervention programs have been mounted in the region, but there has been no population-wide effort to attack these risk factors. The task force proposed a broad range of activities for New Englanders at sites in the community and in health facilities. These activities would promote not smoking, exercising regularly, and maintaining desirable levels of serum cholesterol and blood pressure.

Adolescent↗
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Soft tissue coverage for defects on the plantar aspect of the foot.

Coverage of difficult plantar wounds has posed a problem in the weight-bearing foot. Through a greater understanding of the vascular anatomy of the plantar surface of the foot, developments in local flap technique have made it possible to cover such defects. The following manuscript examines these developments.

Foot↗
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Evaluation of efficacy and safety of human insulin (Novo) in the treatment of insulin-dependent diabetes mellitus: a double-blind, multicenter clinical trial.

The safety and efficacy of human insulin (Novo) were evaluated in a double-blind, parallel, multicenter trial in which 47 insulin-dependent diabetic patients were randomly divided into two equal groups and treated with either purified pork or human insulin (Actrapid and Monotard, Novo) for 12 wk. Mean levels of fasting plasma glucose, glycohemoglobin, and daily insulin dosages showed no statistical differences between the two groups, and there was no significant difference in the incidence of hypoglycemic reactions. The results from this clinical trial indicate that human insulin, prepared by enzymatic transpeptidation of pork insulin, appears to be as safe and efficacious as purified pork insulin in the treatment of insulin-dependent diabetes mellitus.

Adolescent↗
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Lack of an effect of dietary saturated fat and cholesterol on blood pressure in normotensives.

The effect on blood pressure (BP) levels of modifying the saturated fat and cholesterol content in the diet was studied in two separate protocols in normotensive volunteers. For 3 months, 19 men and women, aged 14 to 54 years, adhered to a diet that eliminated meat, poultry, eggs, and dairy fat from the subjects' customary nonvegetarian diet, which had included 71 g/day (35%) of dietary fat. The experimental diet reduced the consumption of saturated fat from 21 to 10 g, dietary cholesterol was lowered from 398 to 69 mg per day, but consumption of polyunsaturated fatty acids, carbohydrates, and dietary fiber was unchanged. Body weight and urinary sodium and potassium excretion were not significantly altered. Mean BP before and after the low fat diet was 116/74 and 115/74 mm Hg, respectively. A second double-blind study tested the effect on BP of dietary cholesterol at levels of 155 and 471 mg/day. Seventeen semivegetarian college students consumed one egg per day concealed in desserts for 3 weeks, and identical desserts containing no eggs for an additional 3 weeks. Mean BP at the end of the egg and eggless periods was 108/69 and 107/69 mm Hg, respectively. Thus, in short-term nutritional studies, dietary saturated fat and cholesterol at low-to-moderate levels of intake have no significant effects on BP in normotensive adults.

Adolescent↗