Search PubMed⌕ Search

Biomedical subjects

M L Wheeler

Publications and source records attributed to M L Wheeler.

At least 19 recordsLinked to original sources
PubMed1992

Diabetes patient education programs. Quality and reimbursement.

To inform health-care providers and third-party carriers of the national quality assurance systems in place for diabetes education programs and the health professionals who provide education services and to indicate the need for consistent reimbursement of essential outpatient diabetes education services. The components of an independent quality assurance mechanism were examined and a survey was conducted to determine reimbursement coverage of ADA recognized programs. A national program to evaluate whether programs meet national standards is in place. Many ADA approved programs were reimbursed and official recognition helped in the process of attaining reimbursement. Insurance coverage decisions made by third-party carriers, however, were inconsistent and largely unpredictable. Outpatient education and follow-up for diabetes is an integral component of care. These services need to be more clearly defined to enable appropriate coding and coverage decisions to be made by third-party payors.

Blue Cross Blue Shield Insurance Plans↗
PubMed1990

Metabolic response to oral challenge of hydrogenated starch hydrolysate versus glucose in diabetes.

Our objective was to determine whether 1) hydrogenated starch hydrolysates (HSHs), bulking/sweetening agents used in hard candies, produce a diminished postmeal glycemic response relative to glucose in individuals with and without diabetes and 2) any diminished glycemia is secondary to altered carbohydrate absorption. This study followed a randomized double-blind crossover design and was performed in 12 individuals with diabetes (6 non-insulin dependent, 6 insulin dependent) and 6 nondiabetic individuals. Each group consisted of 3 men and 3 women, none with known neuropathy. After an overnight fast, each subject was challenged with 50 g of glucose, HSH 5875 (7% sorbitol/60% maltitol), and HSH 6075 (14% sorbitol/78% hydrogenated maltooligosaccharides)/1.73 m2 of body surface area in random order on 3 successive days. Individuals with diabetes were maintained on continuous subcutaneous insulin infusion throughout the study to achieve prechallenge glucose levels between 4.5 and 6.7 mM. For all groups, the order of plasma glucose responses over 5 h postchallenge was glucose greater than HSH 6075 greater than HSH 5875, P less than 0.001 (glucose vs. HSH). Pooled data for all groups for areas under the curve confirmed that HSH 6075 resulted in greater glycemia than HSH 5875 (P less than 0.05). This was reflected in the order of C-peptide responses seen in the nondiabetic and non-insulin-dependent groups (glucose greater than HSH 6075 greater than HSH 5875, P less than 0.001). Breath H2 after glucose was low, whereas HSH 5875 greater than HSH 6075 (P = 0.003). Gastric distress was noticed with all products.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Diet and exercise in noninsulin-dependent diabetes mellitus: implications for dietitians from the NIH Consensus Development Conference.

Noninsulin-dependent diabetes mellitus is a major health problem, highly correlated with obesity and, therefore, overeating. Diet continues as the cornerstone of therapy, with oral hypoglycemic agents or insulin added, if needed, to maintain normal blood glucose values. The diet prescription should be implemented in stages, with caloric restriction the first priority, as weight loss itself diminishes hyperglycemia to or toward normal. Combinations of foods and even different processing or cooking of the same food may produce different glucose responses. These factors minimize the role of the glycemic index in overall diabetes management. Foods with high soluble fiber content may diminish glucose elevations after meals; however, high-fiber foods appear to be less important for the obese diabetic person than adhering to a calorie-restricted diet and achieving weight loss. Attempts should be made to alter life-style within an acceptable degree for any given patient to encourage weight reduction. For example, although exercise may have a small but transient direct effect in lowering blood glucose and insulin resistance, it can be considered an adjunct to decreased calorie diets for weight reduction. Finally, it appears prudent to prevent or reverse obesity, especially in individuals with a family history of diabetes, in the hope that the onset of diabetes may be prevented or postponed.

Adipose Tissue↗
PubMed1987

Exchange lists: revised 1986.

A committee composed of members of The American Dietetic Association and the American Diabetes Association has revised Exchange List for Meal Planning. Changes were made, as deemed necessary, on the basis of nutritional recommendations for persons with diabetes as understood in 1986. Major changes include rewriting the text to make it more useful in the education of persons with diabetes; changing the order of the exchange lists to emphasize a high-carbohydrate, high-fiber diet, as well as to better reflect the order of foods in menu planning; adding symbols to foods high in fiber and sodium; changing nutritive values for the starch/bread and fruit lists; adding lists of combination foods, free foods, and foods recommended only for occasional use; developing a data base; and initiating a plan for field testing and evaluation. The committee also developed a simplified meal planning tool, Healthy Food Choices, to be used for initial or "survival" level education. In poster format, foods are grouped by calories into six food groups. Approximate portion sizes of commonly used foods are listed. Blank lines are provided for the nutrition counselor to write in a suggested menu or meal plan for the client. Because the booklet does not use the word "diabetes" specifically, it is appropriate as a general teaching tool.

Diabetes Mellitus↗
PubMed1985

Computer-selected exchange lists approximations for recipes.

A computer program has been developed to aid dietitians and patients in determining the best Exchange Lists for Meal Planning representation for a serving of a recipe. Applying an optimization program to information obtained from a nutrient data base and a recipe file results in a printout of the five best Exchange Lists representations and the macronutrient and caloric content of the recipe serving compared with the Exchange Lists approximate nutrient values for each of the "best fit" solutions. The nutritional analysis of one serving of the recipe (including 26 nutrients), as well as a breakdown by recipe ingredients, is also provided. Analysis of a 10-item recipe takes about 17 minutes of coding, entry, and evaluation time and 6 seconds of mainframe computer time. This program has been used to compute Exchange Lists representations for the recipes in Vol. II of The American Diabetes Association/The American Dietetic Association Family Cookbook.

Computers↗
PubMed1979

Shock and resuscitation. III. Accurate refractometric COP determinations in hypovolemia treated with HALFD.

In 38 critically burned patients with symptomatic hypovolemia being treated by intravenous fluids, the accuracy of colloid oncotic pressure (COP) calculated from the refractometrically-determined serum total protein (TPRI) was compared with COP values determined by a commercially-available clinical oncometer. Sera were obtained randomly from seven patients receiving Ringer's lactate solution, five receiving a hypertonic solution (240 mOsm Na+) and 26 receiving a hypertonic solution containing albumin (12.5 gm/liter, HALFD method). There was poor correlation between COP measure and that calculated from RI in patients receiving colloid-free fluid, but high correlation (r = 0.925) in patients receiving HALFD. There was high correlation (r = 0.951) between measured COP and values calculated from TPRI in patients receiving hypertonic fluid, colloid containing hypertonic fluid, or no fluid:COP = 4.08 (TPRI)--4.61.

Burns↗
PubMed1979

Studies in shock and resuscitation, I: use of a hypertonic, albumin-containing, fluid demand regimen (HALFD) in resuscitation.

We have reevaluated and clinically tested the current concepts of shock and resuscitation on a logical, physiological, and physical basis. We have considered the currently accepted resuscitation paradigm which is based upon the thesis that early rapid resuscitation of "lost" fluid volume is mandatory and that adequacy of resuscitation can be evaluated by central venous pressure, PAP, PAWP, pulse rate, blood pressure, and/or urine volume. Such methods also accept as natural concomitants that capillary beds are "damaged by injury"; that they "leak" salt, fluid, and albumin; and that these are expected occurrences which are injury-related. We have also examined and clinically evaluated the thesis that MAP is a primary reflector of the relationships between volume and the size of the currently available functional vascular space. (Currently available functional vascular space is mediated through the baroreceptor (stretch receptor)/neuroendocrine mechanisms.) Under this hypothesis, fluid resuscitation comprises infusion of a volume per unit time given so as to replete currently measurable fluid losses and to normalize and/or sustain MAP and the normal osmolar and oncotic relationships at the capillary/tissue interface while holding hydrostatic pressure at normal. Using burn injury as a model, we compared statistically homogeneous, randomly selected groups of burn patients who were resuscitated using a hypotonic fluid (130 mOsm/liter) alone (group R: 7 patients), hypertonic fluid (240 mOsm/liter) alone group H: 5 patients), or the hypertonic fluid containing albumin (12.5 g/liter) (group A: 7 patients). The results indicate that significantly smaller volumes of fluid were needed to resuscitate the patients in group A with a significantly more rapid normalization of physical, physiological, and biochemical parameters. We conclude that the physically and physiologically appropriate method of resuscitation, demonstrated in burn injury, comprises the use of a fluid given at a rate: (1) to maintain mean arterial and hydrostatic pressures within normal range; (2) that delivers a volume per unit time which does not exceed the capacity of the currently available functional vascular space; (3) that replaces concurrent measurable fluid losses; (4) that is hypertonic (to normalize capillary/tissue osmotic gradients); and (5) that contains colloid (to normalize capillary/tissue osmotic gradients); and (5) that contains colloid (to normalize capillary/tissue oncotic gradients). We further conclude that salt, fluid, and colloid loss into the interstitium during resuscitation frequently is due to the rate delivered and/or the physical nature of the fluid used and not to capillary bed damage outside the zone of injury.

Adult↗
PubMed1979

Studies in burns, XVI: The effect of surgical trauma on metabolic heat production.

As part of an ongoing study of the naturally-occurring skin lipid ethyl linoleate as an adjunct for reducing post-burn hypermetabolism and hyperevaporation, we have conducted a series of evaluations of metabolic heat production (M) using a clinical partitional calorimeter. In this article, we describe the metabolic chamber and its use in evaluating the change in M in pre- and postoperative patients. We determined that dry heat losses (radiation and convection) comprise the major components of heat loss in the "normal" and traumatized individual with intact skin. In the post-operative state, metabolic heat production increases significantly above the preoperative levels, the percentage of change being accurately described by a first order exponential equation. In the postoperative patient, possibly because of a physiologic shift in source of metabolic substrate, stored heat increases significantly. These data may be useful in allowing approximate correction of the metabolic heat equation when studying the burn patient where no "control" is attainable and where some approximation of the contribution of "pure" trauma must be made.

Adult↗
PubMed1978

Shock and resuscitation. II: Volume repletion with minimal edema using the "HALFD"(Hypertonic Albuminated Fluid Demand) regimen.

A hypertonic albuminated fluid demand regimen (HALFD) for resuscitation has been used in burn patients since January 1, 1976. The effects of the HALFD method were compared with hypertonic fluid and Ringer's lactate resuscitation. Specific attention was directed to fluid, colloid, and volume changes. Resuscitation was guided by maintaining the mean arterial pressure between 60 to 110 torr, and urine volume at 30 to 50 ml/hr. Patients treated with the HALFD method fared significantly better clinically, needed less fluid, had less weight gain and plasma leak, and experienced slower plasma volume repletion than those treated more traditionally. We conclude that the HALFD method is a physically and physiologically appropriate paradigm for resuscitating the volume-depleted patient.

Adult↗
PubMed1975

Studies in burns: XIV, Heling in burn wounds treated with Ethyl Linoleate alone or in combination with selected topical antibacterial agents.

Studies of the efficacy, in terms of burned wound healing, of a mixture of Ethyl Linoleate (ethyl 9-12 (cis, cis) octadecadienoate) with alpha-1-histidine, alpha-tocopherol, and TBHQ (hELate) was undertaken in 12 swine. The species was selected so as to study an animal with skin anatomy similar to the human. Statistically significantly greater healing occurred in 730 C/7sec contact burns (20% BSA) treated with hELate than in untreated burns in pigs. Further, there was no contracture noted in the hELate treated lesions, while marked contracture occurred in the untreated burns. Additionally, we noted that there was a proportional increase in weight gain amongst swine studied as their burn lesions epithelialized. In order to evaluate the compatibility of hELate with selected, currently-used topical antibacterial agents, 154 rabbits with 20% 730 C/7 sec contact burns were studied. The lipid was applied (0.01 ml/cm2 burn) at 1 hour postburning; the topical agent was applied at 2 hours post-burn and every 24-hours. All animals were washed once daily. hELate was applied only once. We found no statistical difference in the number of subjects healed or in the mortality between animals treated with hELate alone and those treated with the agent plus Gentamycin cream, Neosporin cream, and silver sulfadiazine 1% in Unibase USP (compounded at Medical College of Georgia specifically and only for this study.) We suggest that Ethyl Linoleate agent (hELate) may be used safely in combination with selected antibacterial substances. Further, these selected combinations seem to be non-toxic and appear to allow the calorie-saving and healing effects of the lipid to proceed unimpeded.

Administration, Topical↗
PubMed1975

Studies in burns. XIII. Effects of a topical lipid on burned subjects and their wounds.

We evaluated ethyl linoleate (ethyl, (9, 12)-cic, cis-octadecadienoate), a naturally occurring cutaneous water-holding lipid, for its water-holding metabolic, healing and toxic properties in groups of unburned and burned rabbits and its toxic potentials in this species and mice. The lipid appears to reduce evaporative water loss in full-thickness burned rabbits. Associated with this effect is a proportional and related lowering of metabolic heat production. The topical application of the lipid at any time after burn appears to be associated with a significant healing in lesions that, histologically at least, would be interpreted as fullthickness. The material is highly toxic if applied daily to mice or rabbits. The details of the toxic effect (s) are being studied. The commerical-grade material (75 percent pure) contains a derivative of ricinoleci acid and chronic exposure of the EL to air may result in the formation of peroxides and epoxides. These materials exert well-defined toxicity. The obvious potential uses of this agent in treating human burn lesions need not be emphasized, but it does need to be stated categorically that, at present, (Feb 1974), the toxicity has not been defined enough for use except in experiments.

Administration, Topical↗
PubMed1975

Nutrient menu planning for clinical research centers. Control by computer.

A computer program has been developed for the dietetic service of the Clinical Research Center at the University of Florida. Presently, it is used in menu planning and nutrient analysis for selective, controlled-nutrient diets and for constant diets. The program is able to compute food weights for a patient-selected daily menu which would satisfy up to twenty-three nutrient constraints and which may be optimized with respect to one or more of these. The principal benefit of the program is a saving in the dietetian's time in calculating the nutrient content of the diet and in planning diets with several constrained nutrients. It is also being used as a teaching resource for dietetic interns and dietetic trainees.

Computers↗
PubMedDate not supplied

Evaluation of computer-based diet education in persons with diabetes mellitus and limited educational background.

A study was conducted to determine whether computer-based techniques for meal planning and diet education could be an effective supplement to diabetes diet counseling in a group of inner-city subjects with limited educational background. Sixteen individuals with diabetes mellitus who were newly referred to an inner-city outpatient diet clinic and who demonstrated ninth-grade reading ability were given computer-based nutritional education. They received meal planning information through use of individualized computer-planned menus and education about the diabetes diet by computer-assisted instruction (CAI) combined with an interactive videodisc system (VIDEO). Total contact time was 180 min of CAI/VIDEO, 50 min of dietitian/patient education, and 20 min of dietitian/patient computer time (the last function could have been performed by a clerk). At the end of 4 wk, the group performance was improved in Exchange Lists knowledge (P less than 0.001), recognition of foods containing concentrated carbohydrate (P less than 0.05), and reduction of reported fat intake (P less than 0.05). In addition, average group weight declined by 4.6 lb (P less than 0.005). No improvement was found in food-measuring skills or in calorie-consumption compliance during a standardized buffet lunch. It appears that computer-based techniques are an acceptable supplement to traditional methods of education in this patient group and can improve the effectiveness of diabetes education programs without a significant increase in dietitian time.

Adult↗