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Biomedical subjects

Mark D Miller

Publications and source records attributed to Mark D Miller.

66 records · Page 4Linked to original sources
PubMed2002

Combined pharmacotherapy and psychotherapy as maintenance treatment for late-life depression: effects on social adjustment.

OBJECTIVE: This study examined the effects of maintenance treatment for late-life depression on social adjustment. The authors hypothesized that elderly patients recovering from depression would have better social adjustment with medication and interpersonal psychotherapy than with medication or psychotherapy alone. METHOD: Patients aged 60 and older recovering from recurrent major depression were randomly assigned to one of four treatments: nortriptyline and interpersonal psychotherapy, nortriptyline and clinic visits, placebo and psychotherapy, or placebo and clinic visits. The Social Adjustment Scale was administered every 3 months until illness recurrence. Combined treatment was compared to monotherapy on scores over 1 year among patients who remained in recovery (N=49). RESULTS: Patients receiving nortriptyline and interpersonal psychotherapy maintained social adjustment, which declined in those receiving monotherapy. CONCLUSIONS: Treatment of late-life depression with nortriptyline and psychotherapy is more likely to maintain social adjustment than treatment with either alone. Combination therapy improves not only duration but quality of wellness.

Age Factors↗
PubMed2002

Vascular risk associated with a posterior approach for posterior cruciate ligament reconstruction using the tibial inlay technique.

This study evaluated the risk to the popliteal artery associated with the tibial inlay technique in posterior cruciate ligament (PCL) reconstruction. Barium was injected into the femoral arteries of eight fresh-frozen cadaveric knees and anteroposterior (AP) radiographs were obtained. Dissection of the fascia overlying the gastrocnemius muscle, identification of the interval between the medial head of the gastrocnemius and the semimembranosus, and lateral retraction of the medial head of the gastrocnemius (the Burks and Schaffer approach) was performed. Subsequently, a bicortical screw was placed from posterior to anterior through the tibia as is performed in the tibial inlay technique. A second AP radiograph was obtained. The distance from the center of the screw to the edge of the popliteal artery was measured using digital calipers. The closest any screw came to the popliteal artery was 18.1 mm, and the average distance was 21.1 mm (21.1 +/- 4.6 mm, range: 18.1-31.7 mm). When this distance was calculated as a percentage of the tibial plateau width, the smallest value was 19.2% (24% +/- 4.9%, range: 19.2%-35.1%). A posterior approach for a tibial inlay PCL reconstruction procedure appears safe with respect to the popliteal artery.

Aged↗
PubMedDate not supplied

Intra-articular migration of a sutureless arthroscopic rotator cuff fixation device.

Rotator cuff tears are a common orthopaedic condition. Recent new advances in arthroscopic equipment and devices has allowed many rotator cuff tears to be repaired arthroscopically. Some of these newer devices allow sutureless repair of rotator cuff tears. We report a case of failure in intra-articular migration of such a fixation device. Displacement of the device was noted 4 months after surgery on magnetic resonance arthography. The device was removed arthroscopically with no long-term sequelae. Nevertheless, it is important to recognize that these devices have the potential for intra-articular migration. Due diligence is required in placing these devices. As with all arthroscopic procedures, there appears to be a learning curve associated with the use of sutureless rotator cuff repair fixation devices.

Aged↗
PubMedDate not supplied

Anterior capsular shift volume reduction: an in vitro comparison of 3 techniques.

The anterior capsular shift is a well-established procedure for correction of capsular redundancy. Several different techniques have been developed to reduce capsular volume via a shift or capsulorrhaphy. The purpose of this study was to compare volume reduction objectively among 3 popular capsular shift techniques. Twenty-four fresh-frozen human cadaver shoulders were assigned to one of three groups: a lateral (humeral)-based T-capsular shift (group A), a medial (glenoid)-based T-capsular shift (group B), or a central vertical capsular shift (group C). Initial capsular volume was measured by repeated injection of a viscous fatty acid sulfate solution and recorded for each specimen. A predetermined capsular shift procedure was performed on each cadaver, and repeated measurements were made. All 3 procedures resulted in a significant reduction in capsular volume. The lateral (humeral)-based T-capsular shift resulted in the most reduction (48.9%). This reduction was statistically greater than for the glenoid-based shift (36.8% volume reduction) and approached statistical significance for the vertical shift (40.3% volume reduction, P =.12). Repeated measurements confirmed that the injection technique was valid and reproducible. The lateral (humeral)-based capsular shift results in the most volume reduction and should be considered the preferred procedure for patients with excessive capsular redundancy.

Adult↗
PubMedDate not supplied

Impact of 2003 power outages on public health and emergency response.

INTRODUCTION: In 2003, a major power outage occurred in the midwest and northeast United States affecting some 50 million people. The power outages affected multiple systems in state and local municipalities and, in turn, affected public health. METHODS: Semi-structured interviews were conducted using open-ended questionnaires, with a convenience sample of state- and locally selected subject matter experts from Ohio, Michigan, and New York. Respondents were interviewed in groups representing one of five areas of interest, including: (1) emergency preparedness; (2) hospital and emergency medical services; (3) municipal environmental systems; (4) public health surveillance and epidemiology; and (5) psychosocial and behavioral issues. The reported positive and negative impacts of the power outage on public health, medical services, and emergency preparedness and response were documented. Responses were categorized into common themes and recommendations were formulated. RESULTS: The amount of time that the respondents' locations were without power ranged from <1 hour to 52 hours. Many common themes emerged from the different locations, including communications failures, alternate power source problems, manpower and training issues, and psychosocial concerns. There was minimal morbidity and mortality reported that could be attributed to the event. CONCLUSION: Power outages negatively impacted multiple municipal infra-structures, and affected medical services, emergency response, and public health efforts. Previous federal funding positively impacted public health and emergency response capabilities. Recommendations were made based upon the common themes identified by the respondents. Recommendations may assist state and local health departments, medical service providers, and emergency responders in planning for future power outage problems.

Disaster Planning↗
PubMedDate not supplied

Differences between children and adults: implications for risk assessment at California EPA.

The California legislature enacted a law requiring the California Environmental Protection Agency (Cal/EPA) Office of Environmental Health Hazard Assessment (OEHHA) to evaluate whether our risk assessment methodologies are adequately protective of infants and children. In addition both OEHHA and the California Air Resources Board must examine whether the Ambient Air Quality Standards set for criteria air pollutants and the health values developed for air toxics are adequately protective of infants and children. We have initiated a program to look at potential differences in response to toxicants between children and adults. We are evaluating this issue from the perspective of exposure differences as well as toxicokinetic and toxicodynamic differences between children and adults. Data on specific chemicals are rather limited. As a result, we will be pooling information to determine whether there are generic differences between children and adults that may be applicable to risk assessment in general or to risk assessment of specific classes of compounds. This paper discusses the rationale for approaching the issue of determining whether our risk assessment methods are adequate for infants and children and includes a discussion of some of the available information on both qualitative and quantitative differences in response to toxicants between children and adults or immature and mature laboratory animals. We provide examples of differences between children and adults in absorption, metabolism, and excretion of toxicants as well as qualitative differences in toxic response.

Adult↗
PubMedDate not supplied

Effect of cerebrovascular risk factors on depression treatment outcome in later life.

OBJECTIVE: The vascular depression hypothesis posits that depression can arise in late life from cerebrovascular damage and that depression arising this way has a different clinical presentation and is more chronic and treatment-resistant than early-onset depression. This study tested the relationship of cerebrovascular risk factors (CVRF) to clinical presentation and treatment outcome in 156 subjects enrolled in a long-term maintenance treatment study of late-life recurrent major depression. METHODS: CVRF scores were generated with the Probability of Stroke Risk Profile. Subjects with the highest one-third of scores were designated High CVRF, and their baseline clinical presentation and treatment outcomes were compared with the remaining subjects. RESULTS: In the High-CVRF group, a greater proportion of subjects had first-onset depression after age 60. However, high CVRF score, late onset of depression, and their interaction had no effect on time-to-remission, need for adjunctive medication, or increased risk for recurrence during 3-year follow-up. Furthermore, high CVRF score and late onset of depression did not predict the associated clinical features of vascular depression, such as psychomotor retardation and lack of insight, previously described in the literature. CONCLUSION: Optimism about the outcome of late-life depression treatment should not be diminished by the presence of high cerebrovascular risk.

Age of Onset↗
PubMedDate not supplied

The value of maintenance interpersonal psychotherapy (IPT) in older adults with different IPT foci.

OBJECTIVE/METHODS: The authors examined recurrence rates of major depression in elderly subjects with different foci of interpersonal psychotherapy (IPT), who were treated for up to 3 years with either monthly maintenance IPT and pill placebo or with monthly clinical management and pill placebo. RESULTS: Among subjects with an IPT focus on role conflict, a greater proportion of those treated with maintenance-IPT survived for 3 years without recurrence than those treated with placebo/clinical management. Median time to recurrence was 68.9 weeks in IPT-treated patients versus 16.3 weeks for patients in clinical management. Subjects with an IPT focus on abnormal grief or role transition demonstrated no effect differential for maintenance IPT and pill-placebo on recurrence prevention over supportive clinical management and pill-placebo. CONCLUSION: If replicated in a larger sample, these findings have important implications for ongoing case-management decisions.

Aged↗