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Biomedical subjects

O Miller

Publications and source records attributed to O Miller.

At least 19 recordsLinked to original sources
PubMed2001

Urinary tract infection and pyelonephritis.

UTIs are common, potentially severe infections that the emergency physician must manage efficiently and effectively. In most cases, this entity is well recognized, and the clinician will be confident of the correct course. However, in certain populations, complications are common, and the best therapy has yet to be proven. Tailoring the evaluation and treatment to the risk of complications is imperative. With careful evaluation, individualized therapy and close follow-up, the majority of patients can be expected to do well.

Acute Disease↗
PubMed2000

Residual pulmonary hypertension in children after treatment with inhaled nitric oxide: a follow-up study regarding cardiopulmonary and neurological symptoms.

UNLABELLED: Inhaled nitric oxide is a potent vasodilator in acute severe pulmonary hypertension and is increasingly used as rescue treatment in intensive care algorithms aiming at reducing severe hypoxaemia in neonates and children. Although the immediate effects may seem impressive, long-term outcome regarding residual pulmonary hypertension and other sequelae has been studied in only a very few patients. The aim of the present study was to evaluate residual pulmonary hypertension, cardiopulmonary or neurological symptoms in children after treatment with inhaled nitric oxide in severely hypoxaemic and/or pulmonary hypertensive mechanically ventilated children. The study was performed in four paediatric intensive care units in university hospitals in Sweden, Norway and Australia. Patients who had received inhaled nitric oxide as part of their intensive care treatment for severe hypoxaemia and/or pulmonary hypertension, and in whom 6 mo had elapsed since treatment, were included for evaluation. Thus 36 paediatric or neonatal patients were examined for circulatory, respiratory or neurological disorders with clinical examination, echocardiography, chest X-ray and a capillary blood sample. Four patients with congenital heart disease had residual pulmonary hypertension. Nine patients were receiving bronchodilators. Sixteen patients had minor (n = 15) or moderate (n = 1) changes on a chest X-ray. One patient had a possible delay in psychomotor development. CONCLUSIONS: In spite of the severity of their primary illness, we found that the overwhelming majority of the surviving children were asymptomatic and doing well. The few residual circulatory and respiratory symptoms could be related to the initial condition.

Administration, Inhalation↗
PubMed1999

Does public and private religiosity have a moderating effect on depression? A bi-racial study of elders in the American South.

Religious activities are shown to correlate with rates of psychological depression symptoms in a sample of 995 African American and white elderly residents of Nashville. The data, collected in face-to-face interviews, included indicators of both public and private religiosity. Levels of religiosity and perceived social support were higher among the African-American respondents than among others, and among female respondents. Separate regression analyses of the racial groupings, which appeared to have distinctive religious subcultures, generally show that perceptions of social support mediate the relationship between levels of religiosity and symptoms of depression.

Black or African American↗
PubMed1994

Screening for sickle-cell trait in the emergency department.

OBJECTIVE: To determine 1) whether young adult black patients in an emergency department (ED) are familiar with sickle-cell anemia and 2) how many of these patients know their own sickle-cell trait status. DESIGN: Black patients in an ED were interviewed. Women aged 18 to 40 years and men aged 18 to 50 were included. Sickle-cell screening was offered to the patients. SETTING: The ED of a large urban university hospital with an annual census of 50,000, approximately 25% of whom are black. PATIENTS: A convenience sample of 147 black patients presenting to the ED with minor medical conditions. INTERVENTIONS: The subjects were interviewed to determine their knowledge base regarding sickle-cell anemia and to determine how many knew their sickle-cell trait status. The subjects were tested for sickle-cell trait. MEASUREMENTS AND MAIN RESULTS: 98% of the patients had heard of sickle-cell anemia and 73% knew that it was a genetic disorder. Only 31% of the patients knew their sickle-cell status. Women were more likely than men to know their status. Approximately half of the patients who had family histories of the trait or the disease knew their own status. Two of the 47 patients (4%) tested had positive sickle-cell screen results. CONCLUSIONS: Most black patients of childbearing age presenting to the ED have heard of sickle-cell anemia and know that it runs in families, but few know their own trait status. Until access to primary care providers is improved, ED physicians who care for patients at risk for sickle-cell trait have an obligation to ask them about prior screening and either screen them or refer them for screening.

Adult↗
PubMed1994

Influenza and pneumococcal vaccination in the emergency department: is it feasible?

OBJECTIVE: To assess the numbers of high-risk adult patients presenting to the emergency department (ED) who have not been vaccinated against influenza or pneumococcal disease and whether emergency physicians are willing or able to routinely provide vaccination. DESIGN: A survey of patients in the ED considered to be at high risk for morbidity and mortality from influenza or pneumococcal disease; an anonymous, mail-back survey of emergency physicians. SETTING: The ED of a university-affiliated hospital with an annual census of 50,000 patient visits. PARTICIPANTS: A convenience sample of adult patients visiting the ED for any complaint who fulfilled the American Thoracic Society and Centers for Disease Control and Prevention requirements as a high-risk patient requiring vaccination with influenza or pneumococcal vaccine. The physicians surveyed were identified from the membership role of the state chapter of the American College of Emergency Physicians. MEASUREMENTS: 1) Influenza and pneumococcal vaccination rates for high-risk patients presenting to an ED during influenza season; 2) reasons for lack of immunization; 3) patient willingness to be vaccinated in the ED; 4) vaccination practice patterns for ED physicians; and 5) reasons why ED physicians are unwilling to give these vaccines. RESULTS: 212 high-risk patients were surveyed. 57% and 75% of these patients reported not having received the influenza vaccine and the pneumococcal vaccine, respectively. The main reasons for not being immunized included not being informed they needed it, a prior adverse reaction, and procrastination. Of the unvaccinated patients, 54% were willing to be vaccinated in the ED. Of the surveyed ED physicians, 89% and 93% never or rarely gave influenza and pneumococcal vaccines, respectively. 51% of the ED physicians were willing to give the vaccine. Unwillingness stemmed mainly from: 1) the perception that ED physicians are not primary care providers, 2) inadequate time or personnel; and 3) concerns about adverse reactions or medicolegal liability. Only 5% of the physicians reported organized case-finding mechanisms in their EDs. CONCLUSION: Significant numbers of high-risk patients who are unimmunized against influenza and pneumococcal pneumonia present to the ED. There is hesitancy among ED physicians about assuming the primary care task of providing such immunizations. Any attempt to institute a large-scale vaccination program in an ED setting needs to be carefully planned in a way to involve primary care providers and to decrease ED physician concerns and reluctance.

Attitude of Health Personnel↗
PubMed1993

Collaborative efforts: developing clinical experiences for nursing students in public sector settings.

In the present paper we described the Nurse Academic Collaboration Task Force, which was formed in 1989 by the Texas Mental Health and Mental Retardation (TXMHMR) Commissioner in order to facilitate linkages between academia and state facilities. These efforts have led to increased academic collaboration and linkage with facilities. The task force has identified areas of practice opportunities for all levels of student education programs as well as barriers to collaboration. Collaborative strategies may also lead to better nurse recruitment efforts by TXMHMR facilities. Finally, these educational experiences should prepare nurses in varied settings to provide care for individuals with mental retardation.

Communication Barriers↗
PubMed1992

Iron deficiency.

Explore the source record for details and available documents.

Child↗
PubMed1983

Erythropoietin in liver tissue extracts and in liver perfusates from hypoxic rats.

An attempt to evaluate the role of the liver in extrarenal erythropoietin production was made by measuring the content of erythropoietin in homogenates and perfusates from hypoxic rat livers. Extracts from livers from nephric or anephric animals rendered both anemic and hypoxic showed no detectable erythropoietin despite the fact that both plasma and kidney extracts contained large amounts of erythropoietin. This lack of measurable erythropoietin in the liver is not caused by degradation of erythropoietin during the extraction procedure because exogenously added rat erythropoietin was recovered to the same extent from livers or kidney homogenates. More likely, however, it is caused by the fact that extrarenal erythropoietin production accounts for only one-fifth of total erythropoietin production and that the liver mass is about six times that of both kidneys. Consequently, the erythropoietin content of 1 g of liver should be about one-thirtieth of that of 1 g of kidney, an amount that is below the limit of detection of the assay. On the other hand, the 2-h in situ perfusates of livers from similarly stimulated animals contained significant amounts of secreted erythropoietin. It is concluded that the liver participates actively in extrarenal erythropoietin production in the adult rat. However, the small amount expected to be present in tissue homogenates cannot be detected with our current bioassay.

Anemia↗
PubMed1982

Serum erythropoietin levels by radioimmunoassay in polycythaemia.

A radioimmunoassay (RIA) method for erythropoietin (Epo) was developed and validated against the polycythaemic mouse assay. The correlation was good, with a r = 0.94. Several other criteria of specificity were also filled by the RIA, which had a lower detection limit of 5 microU/ml. The mean serum-Epo level in 6 patients with secondary polycythaemia, 50.2 +/- 26.2 microU/ml, was significantly higher than in a group of 11 normal subjects, 28.7 +/- 7.2 microU/ml (P less than 0.0002). However, the Epo level in 31 polycythaemia vera (PV) patients, M = 21.9 +/- 6.6 microU/ml, was not significantly different from normal (P = 0.006). Since previous studies with bioassay of heat-treated and concentrated plasma samples have shown a decreased serum-Epo level in PV, Epo levels were measured before and after heat treatment and concentration of samples from normals and polycythaemics. It was found that the levels of immunoreactive material increased after heat treatment and 40 times concentration in samples from normals and patients with secondary polycythaemias, but decreased in PV. We conclude that the Epo levels in serum in the low range measured by our and previous RIA:s probably are not true Epo levels but are partly due to an unspecific serum effect, that was removed by heat treatment.

Anemia, Aplastic↗
PubMed1982

Erythropoietin production in response to anemia or hypoxia in the newborn rat.

Erythropoietin production in response to hypoxic-hypoxia is markedly reduced in the newborn when compared to the adult rat. This response improves steadily with age and reaches adult values at about 4 wk. When animals of the same age are stimulated with anemic-hypoxia, considerably higher levels of erythropoietin are found. The erythropoietin level is proportional to the degree of anemia and independent of the age of the animal. Extraction of erythropoietin from tissue homogenates revealed a parallelism between the plasma and kidney erythropoietin content, while no erythropoietin could be extracted from liver tissue at any age. The lack of response to hypoxia in the newborn appears to be related to the high hemoglobin oxygen affinity during the neonatal period, which facilitates oxygen loading. Newborn rats have a very low intraerythrocytic concentration of 2-3 DPG and a marked shift to the left in the oxygen hemoglobin dissociation curve that slowly increases to adult values at 4 wk of age. The response to anemia on the other hand, appears to be normal and not affected by age or by hemoglobin oxygen affinity. These studies suggest that the newborn rat, when properly stimulated, is able to produce normal amounts of erythropoietin, most likely renal in origin.

Anemia↗
PubMed1980

The biogenesis of erythropoietin.

Aerobic living demands a constant supply of oxygen at the cellular mitochondrial level. Numerous interlocking feedback mechanisms insure the constancy of this supply by adapting the supply lines to changes in the intra and extracellular milieu. Among these mechanisms is the feedback circuit which, triggered by an intracellular decrease in oxygen supply, initiates the production of a polypeptide hormone, erythropoietin, which in turn augments the production of an oxygen carrier, the hemoglobin-containing red cell. The biogenesis of this hormone is an important biologic process which is being studied intensively and slowly unravelled.

Animals↗
PubMed1979

Plasma erythropoietin in polycythemia.

Erythropoietin titers of plasma cannot be used to differentiate polycythemia vera from secondary polycythemia since the limit of sensitivity of our current bioassay technics is 50 mU, considerably higher than levels found in normal subjects and in patients with polycythemia. However, erythropoietin is relatively heat stable, and since abundant plasma is available from therapeutic phlebotomies it is possible to prepare and assay highly concentrated, erythropoietin-containing extracts. In 35 normal subjects, erythropoietin levels ranged from less than 5 mU/ml (the limit of sensitivity) to 18 mU/ml with a mean of 7.8 mU/ml. In 21 patients with proved polycythemia vera, the levels were less than 5 mU/ml in all. In 41 patients with suspected secondary polycythemia or polycythemia of unknown origin, the levels ranged from less than 5 to 3,000 mU/ml. Three of the 11 patients with levels less than 5mU/ml were subsequently shown to have polycythemia vera. These results suggest that this refinement of the routine bioassay for erythropoietin may be of clinical importance in the differential diagnosis of polycythemia.

Erythropoietin↗
PubMed1979

Erythropoietin levels in uremic nephric and anephric patients.

Erythropoietin titers were measured in anemic nephric and anephric patients undergoing chronic hemodialysis by utilizing a plasma concentration technique. In eight out of 11 anephric patients studied, decreased but detectable levels of erythropoietin were found, suggesting that extrarenal erythropoietin plays a role in the regulation of red cell production in anephric patients. In 14 nephric uremic patients, erythropoietin production was found to be more variable, with one group of eight patients having erythropoietin levels in the range for normal nonanemic individuals (3.9 to 15 mU/ml), and a second group of six patients with erythropoietin higher than normal (greater than 15 mU/ml). Both groups were found to be equally anemic, indicating that in the second group the bone marrow is less responsive to erythropoietin. The severity of secondary hyperparathyroidism was found to be higher in this second group, suggesting a role of PTH in the bone marrow unresponsiveness. A good correlation between biological and immunological erythropoietin activities was found in the plasma from normal subjects and uremic nephric and anephric patients.

Animals↗
PubMed1976

The 5' leads to 3' polarity of the Xenopus Ribosomal RNA precursor molecule.

Evidence is presented that in Xenopus laevis the 18S rRNA sequence is proximal to the 5' end of the rRNA precursor molecule and the 28S secquence is proximal to the 3' end. This assignment was made by digesting amplified ribosomal gene transcription complexes with EcoRI restriction endonuclease and spreading the cleaved transcription complexes for electron microscopy. From the known location of the EcoRI cutting sites within the transcribed region and the length of nascent chains on the cleaved transcription complexes, it was possible to make an unambiguous assignment of polarity.

Animals↗