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Biomedical subjects

M C Miller

Publications and source records attributed to M C Miller.

At least 109 records · Page 6Linked to original sources
PubMed1987

Computer instruction as part of a course on analytic medicine for first-year students.

The Medical University of South Carolina integrated instruction in information science and computer technology into a required freshman-level course. Analytic and Community Medicine. The advantages of this placement in the curriculum are two-fold. First, the course provides an opportunity to integrate computer methodology with clinically relevant topics such as medical decision-making. This integration enhances the students' view of the computer as a useful tool that can aid the physician in the practice of medicine. Course organizers are convinced that the success of the first offering is attributable to this integration. Second, the instruction comes early in the medical education process and allows the concepts learned to be utilized throughout the students' medical school careers. The degree to which these concepts and methods are actually utilized by students will depend upon the degree of reinforcement of these ideas in the clinical years and residency. Thus, faculty members must act as role models who not only acknowledge the importance of mastering the use of computers in medicine but also manifest those skills.

Community Medicine↗
PubMed1987

Clinical relevance: an issue in biostatistical training of medical students.

Significant trends in teaching biostatistics to medical students include: recognition of the dependence of advancement in the medical sciences upon the quantitative sciences; integration of biostatistics and other disciplines such as epidemiology and community medicine; increased emphasis on clinical relevance through the introduction of such topics as medical decision-making, evaluation of diagnostic test, genetic counselling and evaluating health-science literature; growing emphasis on analytic skills and computer literacy as precipitated by the presence of computer-based patient and medical information systems, expert systems, imaging and signal analysis systems; the emergence of new applications of statistics in health and medicine; and changes in the learning environment, for example emphasis on small-group discussions and problem-solving sessions. The evolution and future directions of biometrical training in medicine as precipitated by these trends, and the response of course directors at the Medical University of South Carolina to the demand for a 'new' curriculum in biostatistics for medical students are described.

Attitude of Health Personnel↗
PubMed1986

The preterm cervix and preterm labor: relative risks, predictive values, and change over time.

The accurate prediction and diagnosis of preterm labor continue to frustrate the clinician. This is partly due to a scarcity of cervical data from the early third trimester. A total of 760 prospective, serial, paired, and blinded pelvic examinations were done at 28 to 34 weeks of gestation for 191 patients without a history of preterm labor. If the cervix was dilated greater than or equal to 1 cm (internal os) or effaced greater than 30%, the relative risk of preterm labor was increased to 1.8 to 4.2. Negative predictive values for cervical status were greater than 92%, but positive predictive values were less than or equal to 18%. Change over time was unusual (dilatation increase greater than or equal to 1 cm or effacement increase greater than or equal to 40%), suggesting that a baseline late second-trimester examination could assist in the early but accurate diagnosis of preterm labor should it be suspected later in gestation. These data suggest that even in the low-risk patient, an early cervical examination could be beneficial.

Cervix Uteri↗
PubMed1986

The effectiveness of the Titan-S sonic scaler versus curettes in the removal of subgingival calculus. A human surgical evaluation.

This study evaluated clinically the effectiveness of hand versus sonic subgingival scaling and root planing in the removal of calculus by visually examining the root surface at the time of periodontal flap surgery. Consideration was given to the method of instrumentation, probing depth, number of roots, and type of tooth surface. Eleven patients with moderate to advanced periodontal disease were evaluated. Four subjects were scaled and root planed with the Titan-S only, four with curettes only, and three with the Titan-S + curettes. At reevaluation 3 to 6 weeks after scaling and root planing, the decision to perform periodontal flap surgery was made based upon probing depth, bleeding upon probing, previous access to the root surface, furcation involvement, and the patient's level of oral hygiene. A full thickness mucoperiosteal flap was elevated to gain access to the root surface and measure the distance from the cementoenamel junction to the residual calculus. A total of 690 surfaces were evaluated surgically. The percentage of surfaces with residual calculus for each method of instrumentation was: Titan-S only (31.9%), curettes only (26.8%), and Titan-S + curettes (16.9%). Overall, 15.7% of the surfaces probing 0 to 3 mm, 29.3% of the surfaces probing 4 to 5 mm, and 44.4% of the surfaces probing 6 to 12 mm had residual calculus.(ABSTRACT TRUNCATED AT 250 WORDS)

Dental Calculus↗
PubMed1985

Preterm rupture of the membranes: combination therapy.

Preterm rupture of the membranes poses perhaps the greatest threat to perinatal survival. Unfortunately, the literature leaves us in a quandry as to the management of the problem. At the Medical University of South Carolina for the past 3 years, aspects of both active and passive management have been used. Vaginal pool phospholipid analysis, the use of corticosteroids whenever appropriate, and tocolysis (in an attempt to gain 48 hours) were used in 96 consecutive patients with premature rupture of the membranes between 26 and 36 weeks' gestation. Decisions about delivery were dictated by spontaneous onset of labor and/or evidence of chorioamnionitis. This regimen prolonged gestation an average of 4.6 days. Maternal and neonatal infectious morbidity was uncommon. Clinical chorioamnionitis was diagnosed in 5.2% of mothers, and only 8.5% of all neonates had evidence of serious infection. Respiratory distress syndrome was seen in 12.8% of neonates. There were only three perinatal deaths, and most babies (92.5%) were discharged without residual problems (average hospital stay, 18.1 days). A detailed analysis of the group by gestational age categories will be presented.

Adolescent↗
PubMed1985

Sympathetic regulation of cerebral blood flow during reflex hypertension.

The cerebral circulatory effects of physiological stimulation of the sympathetic nervous system have been examined in the present study. In lightly anesthetized rabbits, reflex sympathetic activation was provoked by bilateral sinus deafferentation and vagotomy. Regional cerebral blood flow (CBF) was measured by the [14C]-ethanol technique and compared in paired brain structures following unilateral superior cervical ganglionectomy. Two subgroups of hypertensive rabbits were statistically distinguished. In the first (19 of 28 rabbits), CBF in the innervated hemisphere was little modified by hypertension but there was a significant side-to-side difference in CBF between the hemispheres. In the second group (9 rabbits) CBF was markedly increased by the systemic hypertension, and little difference was noted between innervated and denervated hemispheres. We demonstrate that, during acute hypertension, the superior cervical system contributes to cerebrovascular autoregulation; this contribution varies according to the brain region studied. In a subgroup of animals, little sympathetic activity could be evidenced, and it is hypothesized that in these rabbits a vasodilatory system was activated that counteracted the myogenic, autoregulatory responses.

Animals↗
PubMed1984

Effect of gestational age and birth weight on tobramycin kinetics in newborn infants.

The effects of gestational age and birth weight on tobramycin kinetics were studied in 26 newborn infants with presumed or proven bacterial sepsis during the first week of postnatal age. The infants received tobramycin, 2.5 mg/kg intravenously every 12 h. Group A consisted of nine patients 28 to 30 weeks of gestational age; group B had 11 patients greater than 30 to less than or equal to 34 weeks of gestational age; and group C had six patients greater than 34 to less than or equal to 40 weeks of gestational age. Steady-state peak serum concentrations of tobramycin averaged 6.5, 7.2 and 7.1 mg/l in groups A, B and C; the corresponding trough concentration averaged 2.0, 2.3 and 1.3 mg/l. The frequency of tobramycin trough serum concentration above 2 mg/l was 44% in group A, 45% in group B and 0% in group C. Total body clearance of tobramycin averaged 1.04, 1.13 and 1.28 ml/min/kg; apparent volume of distribution averaged 0.84, 0.81 and 0.61 l/kg; and elimination half-life averaged 9.3, 8.9 and 5.6 h in groups A, B and C. Group M consisted of seven infants with 1.0-1.25 kg birth weight; group N had six infants 1.26-1.50 kg birth weight; group O had seven infants 1.51-2.0 kg birth weight; and group P had six infants 2.1-3.5 kg birth weight. Steady-state peak serum concentration of tobramycin averaged 5.7, 7.3, 7.8 and 7.1 mg/l; and the trough serum concentration averaged 2.2, 2.4, 1.9 and 1.3 mg/l in groups M, N, O and P.(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Weight↗
PubMed1983

Analytic procedures for evaluating health care. Statistical control charts.

The concern for quality of health care motivates evaluation programs designed to monitor the health care system, patient outcome, and provider expertise. An array of audit methods and instruments for evaluating professional and institutional performance has been developed. Although evaluation is viewed by many as the basis for accountability and improvement of health care, few are aware that most existing evaluation programs are really data-collecting systems. Very little if any, analysis of the data is done with the objective of optimizing the system. The "sampling with intervention" procedures often used to monitor the health care delivery system are primarily directed toward the individual patient while the system and provider continue to operate in the established mode. This article outlines analytic procedures for interpreting evaluation data generated by quality control and audit systems. Five common univariate statistical quality control charts are described.

Data Collection↗
PubMed1983

Monitoring simultaneously two or more indices of health care. Multivariate quality control procedures.

Often the data collected in a health care evaluation program consist of a number of indices, each of which represents a different component of a health care process. The question, "Is the health care process in control," to be answered effectively, must be answered in terms of the effect of the several indices considered jointly rather than in terms of each variable considered separately. This article describes the nature of the problem of monitoring jointly several indices of health care and presents two quality control methods, the control ellipse and Hotelling's T2, which are applicable to the multivariable setting. The discussion focuses on the case of monitoring simultaneously two related indices of health care, and extension of the two techniques to more than two indices is discussed briefly.

Factor Analysis, Statistical↗
PubMed1982

A behavioral response of swine to a 60-Hz electric field.

It has been shown that rats, given the choice, will spend more time out of a 60-Hz electric field than in it at field strengths greater than or equal to 75 kV/m. This paper describes research to examine the relevance of these data to a different species, the pig. Miniature pigs that had been exposed to a 60-Hz electric field at 30 kV/m for 20 h/day, 7 days/week for as long as 6 months, were tested for their preference for the presence or absence of the field during a 23.5-h period. Similar to earlier results with rats, miniature pigs spent more time out of the electric field than in it during the sleeping period.

Animals↗
PubMed1982

Electromyographic feedback: effects on voluntary muscle contractions in normal subjects.

To evaluate the efficacy and function of EMG feedback (FB) in muscle reeducation, voluntary muscle contractions with and without EMG FB were compared under controlled experimental conditions in normal human subjects (n=10). Each subject was instructed to produce 12 sustained, 30-second contractions of the left abductor hallucis muscle, 6 contractions in each of 2 sessions. For all subjects, EMG FB was provided in half of the trials, alternating with nonfeedback (NFB) trials. A ranking task was included to measure ability to discriminate contractions in the target muscle. EMG activity was significantly greater during muscle contractions attempted with EMG FB; this was due to increased motor unit recruitment early in the course of the trials, a positive response in normal subjects similar to that in paretic subjects in our previous study. Performance on the ranking task also indicated that subjects had little perceptual awareness of their muscle contractions. Our findings suggest that the positive response to EMG FB was due to the precise information it provided concerning small, poorly discriminated muscle contractions.

Biofeedback, Psychology↗
PubMed1982

Maternal risk factors in infants with very low birth weight.

To determine whether maternal risk factors associated with the delivery of very low birth weight infants under 1501 g are different from those associated with low birth weight infants of 1501 to 2500 g, prenatal data on 12,247 deliveries were evaluated. The sample contained 302 very low birth weight infants. Maternal race, age, height, weight, gravidity, parity, past pregnancy performance, and pregnancy complications were analyzed. Factors related to very low birth weight but not to low birth weight infants were previous abortions, previous fetal deaths, and hypertensive vascular disease. Race, maternal height, and prepregnancy weight were not related to very low birth weight but were associated with an increase in low birth weight. There was no significant difference in the rate of very low birth weight or low birth weight by maternal age from 14 to 40 years. These results contradict the concept of a uniform set of predisposing factors for birth of all infants weighing 2500 g or less.

Abortion, Spontaneous↗
PubMed1981

Comparison of media for substance abuse education in rural communities.

A study was done in Orangeburg County, South Carolina, to compare the effectiveness of the various mass media, television, radio, and newspaper, for the dissemination of educational material about substance abuse. Effectiveness of the media in reaching certain subpopulations defined by race, sex, income, age, and population density was also examined. It was found that the radio medium was generally less effective than the others. Furthermore, it was found that Blacks and Whites differed in the extent to which they were reached by radio and television.

Health Education↗