Biomedical subjects

M D Miller

Publications and source records attributed to M D Miller.

244 records · Page 14Linked to original sources

PubMedDate not supplied

The appearance of roofplasties on lateral hyperextension radiographs.

Graft impingement by the roof of the intercondylar notch has recently been implicated as a cause of failure after anterior cruciate ligament reconstruction. Posterior tibial tunnel placement and roofplasties have been advocated to reduce the incidence of graft-roof impingement. Based on our earlier work in this area, we were concerned that lateral hyperextension radiographs, as advocated by Howell and associates to evaluate impingement, did not accurately reflect the extent of roofplasty accomplished intraoperatively. We hypothesized that these radiographs suggested that the grafts were moderately impinged, when, in fact, they were impingement-free. In a cadaver model, we compared radiographs made before and after roofplasty to determine whether there were any resultant changes in the appearance of the intercondylar roof. We found no detectable difference in 70% (14 of 20) of specimens. A second, subtle line superior to the intercondylar line appeared on radiographs in 30% of the specimens. We concluded that postoperative lateral radiographs may fail to show the effect of a roofplasty and can lead to the overdiagnosis of graft-roof impingement.

Anterior Cruciate Ligament↗

PubMedDate not supplied

Opportunities for psychotherapy in the management of dementia.

Demented patients are not usually thought of as candidates for psychotherapy due to their impaired memory, general intellectual decline, and waning ability to use insight. Families often accede to this view by perceiving their dementing relatives as unable to handle emotion-laden issues. This paper will illustrate with clinical examples that many dementing patients can benefit from psychotherapy. Practical suggestions will be outlined for integrating a psychotherapeutic approach into the management of dementia patients and their caregiving family members. The format of this paper will begin with suggested techniques for the initial interview, followed by separate consideration of psychotherapy issues in dementing patients and in caregiving family members.

Adaptation, Psychological↗

PubMedDate not supplied

Longitudinal analysis of nortriptyline side effects in elderly depressed patients.

Forty-five depressed elderly patients were closely monitored in a research setting during treatment with nortriptyline and interpersonal psychotherapy for 7 consecutive months of acute and continuation treatment. Overall, nortriptyline was efficacious and well tolerated in this group. The frequency of somatic complaints measured by the Rating Scale for Side Effects declined by 50% during the acute phase of treatment, suggesting that many somatic complaints that may be attributed to side effects of nortriptyline are actually somatic symptoms of depression. The authors discuss the implications of these findings and offer practical advice for the treating clinician.

Aged↗

PubMedDate not supplied

Early virologic failure and rescue therapy of tenofovir, abacavir, and lamivudine for initial treatment of HIV-1 infection: TONUS study.

BACKGROUND: To assess the efficacy and safety of the triple NRTI combination of abacavir (ABC), lamivudine (3TC), and tenofovir (TDF) in a once-daily regimen. METHOD: 38 HIV-naive patients (pts) were treated in a prospective open-arm study over 48 weeks (W48). Virological failure was defined as never achieving plasma HIV-1 RNA < 400 copies/mL or rebound of > or = 0.7 log10. RESULTS: 12/36 (33%) pts had virologic failure at W24 and 10 additional pts had HIV RNA > 50 copies/mL at W12 or W24. There was a significant association between baseline viral load (VL) and virologic failure in 0%, 29%, and 64% pts with baseline VL levels < 4, 4-5, and > 5 log10 copies/mL, respectively (p = .014). 76% of pts developed K65R and M184V/I mutations by W24, and 19% developed M184V/I alone. At W4, 86% of pts had adequate plasma Cmin for the 3 drugs. 14 pts with K65R and M184V/I were given a rescue therapy with a successful outcome (< 50 copies/mL; median follow-up 48 weeks). CONCLUSION: Convergent genetic pathway to resistance, in conjunction with lower antiretroviral potency, may explain the high rate of selection K65R and M184V mutations. These mutations did not appear to have a negative effect on rescue therapy with a variety of regimens.

Adult↗

PubMedDate not supplied

Colposcopy practice and training in family practice residency programs.

BACKGROUND: The potential growth of colposcopy as a family medicine procedural skill is directly related to the training currently offered to family practice residents. To define whether these skills are being adequately offered to physicians who want to perform this procedure for their patients, a study was designed to investigate the current status of colposcopy practice and training in family practice residency programs. METHODS: A 16-item survey sent to 356 family practice residency directors in the United States included items concerning colposcopy practice, training, educational programs and strategies, colposcopy coordinator educational background, and colposcopic resource materials and equipment. RESULTS: Surveys were returned from 204 (57 percent) family practice residencies. Colposcopy was performed at 45 percent of the residencies that responded. Ninety-six percent of the respondents who did not perform colposcopy believed colposcopy is a procedure that should be performed by family physicians. Clinical teaching and supervision was the most common method of resident training (74 percent). Colposcopy training coordinators were usually family physicians (72 percent), primarily trained by gynecologists. Assistance with implementing a colposcopy training program was requested by 85 percent of those programs presently not performing colposcopy. CONCLUSIONS: This study indicates that there are opportunities for further development of colposcopy practice and training in family practice residencies.

Attitude of Health Personnel↗

PubMedDate not supplied

Medical student attitudes toward elderly patients: effects of social attractiveness.

The purpose of this study was to determine if medical students' attitudes toward the elderly can be modified through social attractiveness cues in the form of descriptions of abilities and photographs of the patients. The results indicated that students were most personally and professionally attracted to the mentally alert patient, and they were most personally attracted to the patient whose photograph was included in the medical record. Furthermore, inclusion of previous and current photographs had a mediating effect on attitude formation and the formation of stereotypes. These results suggest that presenting social attractiveness information may be useful in countering negative perceptions of the elderly.

Age Factors↗

PubMedDate not supplied

Quantitative evaluation of the stability and delivery of interleukin-1B by infusion.

The stability and delivery of IL-1 beta has been characterized in a polypropylene based syringe pump infusion system and in polyvinyl chloride based infusion bags, at concentrations ranging from 100 ng/mL to 1 microgram/mL. At higher concentrations (1 microgram/mL), minimal drug loss was observed in both systems. At low doses (100 ng/mL) in the syringe-pump system, the addition of 1% human serum albumin was necessary to prevent significant drug absorption to the polypropylene drug reservoir.

Adsorption↗

PubMedDate not supplied

A decentralized clerkship: strategies for standardizing content and instruction.

Course decentralization in a required family medicine clerkship occurred because additional teaching and clinical resources were needed to meet the educational goals and objectives of an entire class of medical students. The decentralized teaching effort, which consisted of a variety of practice models, had the potential for an inconsistent exposure to the required educational content of the clerkship. Course monitoring and evaluation also was difficult because of the logistics of the various teaching sites. In order to minimize inconsistent content exposure, efforts to standardize course requirements occurred through criterion-based faculty and teaching site selection, initial faculty development, and provision of appropriate library resources. Continuous standardization consisted of required periodic faculty development, frequent evaluation of faculty and teaching sites, and comparative studies of student performance. Standardization of some of the students' patient care experience resulted from the use of predetermined list of required clinical encounters. A computer assisted evaluation of students' patient experience log defined the actual student patient care population at various teaching sites and compared this to course requirements. Deficits in patient care experiences were addressed by providing either the appropriate patient encounters or alternative experiences through print, audiovisual, or teaching sessions.

Clinical Clerkship↗

PubMedDate not supplied

A system for assessing clerkship experience using a logbook and microcomputers.

Family Medicine clerkships emphasizing ambulatory care often require multiple teaching sites. Continuous assessment of actual student clinical experiences may not occur because the task of collecting and analyzing the necessary data may be expensive and time-consuming. However, the decreasing price of microcomputers and available software has provided teaching programs with inexpensive and effective tools to perform this task. The Department of Family Medicine at the Medical College of Georgia recently developed and implemented a microcomputer based information management system for use in assessing program and student clinical experiences in a required family medicine clerkship. This system, which uses logbooks as an information source, is able to monitor and provide information which is used to insure that the student's actual clinical experiences are consistent with the goals and objectives of the clerkship.

Ambulatory Care↗

PubMedDate not supplied

An intradepartmental teaching effort at a medical university.

Over a period of four years, 693 third-year medical students were offered the opportunity to receive half of their required internal medicine clerkship clinical experience by rotating on a well-established family medicine inpatient service in a university hospital. This learning experience was designed and evaluated by the physician and behavioral science faculty of the department of family medicine. The family medicine inpatient experience provided the student with a greater number of individual patient encounters and a greater variety of clinical problems than an internal medicine experience. Scores on an internal medicine national board test showed no statistical difference between those students who completed a traditional internal medicine clerkship and those receiving a portion of their internal medicine experience by rotating on a family medicine inpatient service. The success of this student experience was a significant factor in the eventual acquisition of curriculum time for a third-year required family medicine clerkship.

Clinical Clerkship↗