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Biomedical subjects

T Myers

Publications and source records attributed to T Myers.

At least 73 records · Page 4Linked to original sources
PubMed1986

An approach to the assessment of learning needs for physician-managers.

In recent years physicians have become increasingly involved in the decision-making and policy-making processes in hospitals and other health service organizations. Consequently, there is a growing awareness of the need for specialized education programs for physicians who have managerial responsibilities. While education programs in management for physicians have been available in Britain and the United States for a number of years, relatively few programs have existed in Canada. Typically, physicians who have assumed administrative positions either within the medical staff organization or within the hospital's management structure have received no formal training in management. This article examines reasons for the increased demand for management education for physicians in Canada, specific needs of physicians in the area of management education, and the assessment of needs for management education programs.

Canada↗
PubMed1986

An analysis of context and alcohol consumption in a group of criminal events.

The aim of this analysis was to demonstrate the importance of examining the context of alcohol consumption with regard to a criminal event. The paper explores information which was part of a larger study of alcohol use by violent and non-violent offenders. Data were collected by interview from the offenders and correlated with other reports. Earlier findings of the study which have been reported suggested that level of consumption was associated with the type of offence. In this paper a more complex drinking/drinking context and crime relationship is shown to exist. The circumstances at the time of the crime were related more to the level of alcohol consumption than to the violent or non-violent nature of the crime. Type of beverage, companionship and time of day were found to be particularly good indicators of the amount of alcohol consumed.

Alcohol Drinking↗
PubMed1983

Cause-and-effect relationship between motilin and migrating myoelectric complexes.

We investigated the cause-and-effect relationship between plasma motilin levels and migrating myoelectric complexes (MMCs). Each dog was implanted with a set of eight bipolar electrodes on the small intestine. Premature phase IIIs were initiated by morphine bolus injections. Plasma samples were assayed for motilin and gastrin. All spontaneous and morphine-initiated phase IIIs were associated with peaks of plasma motilin, which always occurred after phase IIIs had started in the proximal duodenum. The plasma motilin level decreased consistently during phase I and started to increase again only after phase II had started in the duodenum. Either a meal or somatostatin infusion disrupted MMC cycling, but morphine boluses overcame this disruption and initiated phase IIIs that propagated distally. The phase IIIs thus initiated were associated with peaks in plasma motilin levels. In contrast, bolus injections of motilin did not initiate phase IIIs during the fed state or during somatostatin infusion. Our findings suggest that endogenous motilin does not initiate spontaneous MMCs. Instead, MMC contractions release motilin. The physiological role of motilin, thus released, may be to act as an endocrine agent to coordinate secretory and motor events with the start of phase III activity in the upper small intestine.

Animals↗
PubMed1980

Cerebroarthrodigital syndrome: a newly recognized formal genesis syndrome in three patients with apparent arthromyodysplasia and sacral agenesis, brain malformation and digital hypoplasia.

We describe three patients with a complex syndrome of apparent arthromyodysplasia, dyscephaly, sacral agenesis, and hypoplastic digitis. Cause is unknown, but an environmental cause is suspected on the basis of ergotamine exposure in one case and diazoxide intake in another, together with suggestive similarities to anomalies seen in animals treated with these drugs and to calves with the Australian hydranencephaly/arthrogryposis syndrome caused by Akebane or Aino virus. Pathogenetically the primary defect may be a neural tube-neural crest dysplasia with multiple secondary and tertiary manifestations and deformities.

Arthrogryposis↗
PubMedDate not supplied

Extended clinical support with an implantable left ventricular assist device.

Clinical evaluations are under way of an intracorporeal (abdominally positioned) pulsatile left ventricular assist device (LVAD) that is capable of providing support for extended periods (greater than 30 days) in patients awaiting heart transplantation. The LVAD, developed by Thermo Cardiosystems Inc. (Woburn, MA), has uniquely textured blood contacting surfaces and requires only minimal antithrombotic therapy. It has been used at the Texas Heart Institute as a bridge to transplantation in 11 patients, including 2 who are currently receiving support. Four patients required extended LVAD support (35-132 days); of those, three are doing well at 1.5, 8.5, and 13 months, respectively, after transplantation, and one died of liver failure 49 days after transplantation. The LVAD was operated in a fixed-rate mode to maintain pump flows at 4-8 L/min, resulting in stabilization of hemodynamic and secondary organ function in all patients. Blood chemistry and hematologic values returned to normal during LVAD support in three of four patients. Postoperative anticoagulation was gradually reduced over the course of the trials. The two most recent patients (35 and 132 days) received only oral dipyridamole (75 mg X 3/day) and aspirin (80 mg/day) after the early recovery period (four-six days), resulting in normal prothrombin and partial thromboplastin times. Plasma hemoglobin levels remained within acceptable limits, and there was no evidence of thromboembolism. Blood contacting surfaces were coated with a thin, adherent, biologically derived lining. The initial results indicate that the intracorporeal LVAD, with textured blood contacting surfaces, can effectively support the failing heart for extended periods (greater than 30 days) with minimal antithrombotic therapy.

Adult↗
PubMedDate not supplied

Clinical responses to ventricular assistance versus transplantation in a series of bridge to transplant patients.

Hemodynamic and peripheral organ responses to ventricular assistance were compared with transplantation in a cohort of patients bridged with the HeartMate 1000 IP left ventricular assist device (LVAD) (Thermo Cardiosystems Inc., Woburn, MA). The study population included 27 patients that were supported an average of 102 days (range, 15-324 days). Two hepatic (total bilirubin and serum glutamic oxaloacetic transaminase [SGOT]) and two renal (creatinine and blood urea nitrogen [BUN]) parameters were measured: 1) before LVAD insertion, 2) 30 and 60 days during ventricular assistance, 3) before transplantation while still on the VAD, and 4) 30 and 60 days after transplantation. Total bilirubin values were significantly greater just before LVAD implant (2.3 mg/dl) than before transplantation (0.7 mg/dl). Although there was no difference after 30 days of either treatment, the total bilirubin values were greater at 60 days after transplantation (1.1 mg/dl) than at an equivalent time on the LVAD (0.6 mg/dl). The SGOT values were also significantly reduced before transplantation. No differences at 30 and 60 days after either procedure were noticed. Creatinine and BUN values were greater before LVAD implant (1.7 and 37 mg/dl) than before transplantation (1.2 and 19 mg/dl). The creatinine values were also greater after transplantation at 30 and 60 days (2.0 and 1.6 mg/dl) than at comparable intervals after LVAD implantation (1.0 and 1.2 mg/dl), presumably as a result of the use of immunosuppressive drugs. End organ function was markedly improved while on the device, enhancing the physiologic status of the patients before transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Exercise capacity recovers slowly but fully in patients with a left ventricular assist device.

Left ventricular assist devices (LVAD) are used increasingly as bridges to cardiac transplantation. The typical LVAD candidate is a bedridden, critically ill, New York Heart Association (NYHA) Class IV patient with congestive heart failure (CHF) who is dependent upon intravenous, inotropic, and, in many cases, intra-aortic balloon support. The LVAD provides the potential for pre transplant rehabilitation by allowing the patient to become ambulatory, and by improving muscle tone, muscle mass, and nutritional status before transplantation. However, whether the abnormal exercise capacity of these patients improves after implantation has not been elucidated. The purpose of the present study was to evaluate the exercise capacity of patients with CHF after LVAD implantation (n = 10) using peak oxygen consumption during maximal exercise (MVO2), and comparing the results with those of a group of NYHA Class III patients with CHF (n = 14). After 2 months of implantation, MVO2 of the patients with LVAD was 12.8 +/- 0.3 ml/kg/min, which was comparable to that of the NYHA Class III patients with CHF (12.5 +/- 0.5 ml/kg/min). Four of 10 patients with LVAD were monitored for more than 5 months when MVO2 rose to 15.4 +/- 1.0 ml/kg/min (p < 0.05 vs NYHA Class III). In conclusion, the exercise capacity of patients with LVAD recovers slowly but significantly after 5 months of implantation, promising the potential for complete recovery from heart failure in patients supported with an LVAD.

Adult↗
PubMedDate not supplied

Retrospective analysis of infection in patients undergoing support with left ventricular assist systems.

Infection is a problem in patients undergoing support with left ventricular assist systems. To better understand the nature of this problem, we retrospectively analyzed data on 56 patients supported by the HeartMate (Thermo Cardiosystems, Inc, Woburn, MA) left ventricular assist system. Infection was defined as fever > 38 degrees C, white blood count > 12,000 cells/ml, and a need for antimicrobial therapy. Of the 56 patients, 25 (41%) had an infection. Device related infections (as determined by positive culture from driveline, housing, or inflow or outflow tract) occurred in eight patients (14.3%). The most common sites of infection were the respiratory system (42.4%), the central venous catheter (27.8%), and blood (18.3%). Of the positive cultures, 84% were bacterial and 16% fungal. There were no positive viral cultures. Positive cultures from left ventricular assist system related sites made up only 8.7% of the total. All but one of the patients with device related infections survived to transplantation. The long-term survival rate for patients in this group after transplantation was 77.8%. Two patients required surgical revision of the driveline because of infection. Both were free of infection postoperatively. Patients who stayed in the intensive care unit for longer periods had a greater risk of infection (uninfected, 35 days; infected, 78 days). In conclusion, although infection is a problem in patients undergoing support with left ventricular assist systems, it does not preclude survival to transplantation or alter the survival rate after transplantation.

Adolescent↗