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Biomedical subjects

W A Miller

Publications and source records attributed to W A Miller.

At least 91 records · Page 5Linked to original sources
PubMed1986

Minus-strand initiation by brome mosaic virus replicase within the 3' tRNA-like structure of native and modified RNA templates.

An RNA-dependent RNA polymerase (replicase) extract from brome mosaic virus-infected barley leaves has been shown to initiate synthesis of (-) sense RNA from (+) sense virion RNA. Initiation occurred de novo, as demonstrated by the incorporation of [gamma-32P]GTP into the product. Sequencing using cordycepin triphosphate to terminate (-) strands during their synthesis by the replicase generated sequence ladders that confirmed that copying was accurate, and that initiation occurred very close to the 3' end. The precise site of initiation was further defined by testing the replicase template activity after stepwise removal of 3'-terminal nucleotides. Whereas removal of the terminal A did not decrease template activity, removal of the next nucleotide (C-2) did. Thus, initiation almost certainly occurs opposite the penultimate 3'-nucleotide (C-2) in vitro. The structure of the double-stranded replicative form of RNA isolated from brome mosaic virus-infected leaves was consistent with such a mechanism occurring in vivo, in that it lacked the 3'-terminal A found on virion RNAs. The specific site of (-) strand initiation and normal template activity were retained for RNAs with as many as 15 to 30 A residues added to the 3' end. However, only limited oligonucleotide 3' extensions can be present on active templates. In order to assess the 5' extent of sequences required for an active template, a 134-nucleotide-long fragment of brome mosaic virus RNA, corresponding to the tRNA-like structure, was generated. This RNA had high template activity, but a shorter 3' (85-nucleotide) fragment was inactive. RNAs with various heterologous sequences 5' to position 134 also showed high template activity. Thus, the 3'-terminal tRNA-like structure common to all four brome mosaic virus virion RNAs contains all of the signals required for initiation of replication, and sequences 5' to it do not play a role in template selection.

Base Sequence↗
PubMed1986

Plasma protein fraction and albumin use: the effect of medical staff education.

A 6-week audit evaluating the use of plasma protein fraction and albumin was conducted and study data demonstrated that these colloids were being inappropriately prescribed. The P & T Committee decided to use educational rather than restrictive methods to improve colloid prescribing. Follow-up audits were performed, one immediately following staff education and another 1 year after the first audit. Although the educational actions employed in this drug utilization review appeared to have an immediate impact, the effect was not sustained long-term, indicating the need for periodic medical staff education. Methods of effective educational intervention as reported in the literature are discussed.

Colloids↗
PubMed1986

Evaluating the impact of education by a clinical pharmacist on antibiotic prescribing and administration in an acute care state psychiatric hospital.

An antibiotic utilization review program was implemented by a clinical pharmacist in an acute care state psychiatric facility. Antibiotic utilization was concurrently audited in 61 antibiotic orders, written for 48 patients, in order to determine antibiotic prescribing and administration practices and problems. Interventions, consisting of educational presentations, problem-solving meetings, and distribution of written educational materials, were provided by a clinical pharmacist to improve antibiotic prescribing and administration practices. A second audit of 68 antibiotic orders written for 47 patients was concurrently audited after completion of the interventions. When prescribing problems were detected, the clinical pharmacist made recommendations to the prescribing physician. Statistically significant changes in the use of culture and sensitivity tests, appropriate dosage regimens, correct antibiotic administration, and selection of cost-effective therapy were found after all educational interventions were provided. A positive trend not resulting in statistical significance was noted for documentation of infectious disease and selection of appropriate antibiotic agents. This study demonstrates a drug utilization review role for clinical pharmacist's involvement in the acute care psychiatric facility, and illustrates one method by which clinical pharmacists can provide educational programs to improve nonpsychotropic drug prescribing and administration in this setting.

Adolescent↗
PubMed1985

Developing an effective P&T Committee, Part I.

Many challenges confront P & T Committees when trying to promote rational drug therapy that is not only safe and efficacious but cost-effective as well. Strategies are discussed for implementing successful P & T policies, including techniques for establishing a well-functioning formulary. New directions are proposed for P & T Committees to respond to our changing health care environment.

Formularies, Hospital as Topic↗
PubMed1985

Developing an effective P & T Committee, Part 2.

The changes in health care have had a direct impact on the functions of the P & T Committee. P & T Committee members must be prepared to face new issues, especially concerning cost-effective drug therapy. Formulary admissions and use of nonformulary agents are discussed. The role of the P & T Committee in relation to the various hospital committees, the roles of physicians and pharmacists, and the role of the pharmacy director as manager are identified. Advice regarding standardization of therapy and drug-dosing policies is provided.

Drug Therapy↗
PubMed1984

Incidence and significance of a deletion of chromosome band 13q14 in patients with retinoblastoma and in their families.

Ten unrelated retinoblastoma patients were studied cytogenetically with high-resolution prophase banding; two had a deletion of chromosome 13, band q14. Neither of the two patients had any of the congenital defects usually associated with 13q14 deletions. In patient A, the deletion was found to be de novo. Patient B was found to be mosaic for the 13q14 deletion with 54% of the lymphocytes examined having the deletion. This study indicates that the 13q14 deletion may occur in a significant portion of all retinoblastoma cases. Esterase D activity and isozymes were studied also. The significance of findings will be discussed.

Carboxylesterase↗
PubMed1984

The effects of gallamine and a mixture of pancuronium and alcuronium on the pressor and plasma catecholamine responses to tracheal intubation.

Tracheal intubation can be accompanied by significant increases in arterial pressure, heart rate and the plasma levels of noradrenaline and adrenaline. The drugs used at induction can enhance or attenuate these responses. In nine patients who had received gallamine, intubation was associated with a 45% rise in mean arterial pressure, a twofold rise in plasma adrenaline and a 49% rise in plasma noradrenaline concentration. When a mixture of pancuronium and alcuronium (in a ratio of 4:10 by weight) was used in ten patients, blood pressure fell 24% after induction and rose 49% after intubation. A 24% rise in plasma noradrenaline in response to intubation was also observed. Compared with pancuronium alone, the use of the mixture attenuates the rise in blood pressure and noradrenaline concentration associated with intubation but does not abolish them. In addition, the mixture was associated with a significant fall in blood pressure between induction and intubation, whereas this was not found with gallamine.

Adult↗
PubMed1984

Medical education provided by a clinical pharmacist: impact on the use and cost of corticosteroid therapy in chronic obstructive pulmonary disease.

The impact of medical education provided by a clinical pharmacist on the use and cost of corticosteroid therapy in acute exacerbations of chronic obstructive pulmonary disease was evaluated. Three separate two-month audits of corticosteroid use were conducted on the pulmonary medicine service (PMS) of a teaching hospital. For the first audit period, no education was given and no clinical pharmacist was on the PMS. During the second audit period, no education was given, but a clinical pharmacist was on-service. For the third audit period, education (brief discussion and a handout) was given to new house staff members by the clinical pharmacist on the PMS. A significant reduction in the mean number of intravenous steroid doses, steroid cost per day, and patient steroid charges per day occurred in the third vs. the first period. Steroid cost per day and patient steroid charges per day were lower in the third period than the second, but the difference was not statistically significant.

Adrenal Cortex Hormones↗
PubMed1984

Drug utilization review of parenteral clindamycin therapy.

A concurrent drug utilization review was conducted to evaluate the appropriateness of parenteral clindamycin use, the incidence of gastrointestinal side effects, and to implement, if necessary, corrective actions to improve parenteral clindamycin use. Criteria for the appropriate use of clindamycin were prepared, reviewed, and approved by the P & T Committee of the City of Memphis Hospital (CMH) and University of Tennessee Medical Center/William F. Bowld Hospital (UTMCH). Forty-five patients were included in the audit. Overall, in 43/45 (96%) of the patients audited, clindamycin use was deemed appropriate. This audit provided the opportunity for positive reinforcement of physician prescribing practices and helped to foster a cooperative, rather than an adversarial relationship, between pharmacists and physicians involved in drug utilization review.

Anti-Bacterial Agents↗
PubMed1983

Densitometry as an aid in amniotic fluid gel acetylcholinesterase analysis.

We have performed gel acetylcholinesterase analysis blindly on 1,300 consecutive amniotic fluid samples sent to our laboratory for alpha-fetoprotein measurement. Faint acetylcholinesterase bands were identified in nine of 1,300 samples, and all of these were associated with pregnancies free of major fetal malformations. Dense acetylcholinesterase bands were identified in four samples, and all were associated with major fetal malformations. Densitometric analysis of acetylcholinesterase bands provided additional objectivity in classifying band density.

Acetylcholinesterase↗
PubMed1983

Light- and electron-microscopic study of the microbial deposits present on the tongue and dentition of macropods.

The dental deposits in the kangaroos and wallabies were similar to human calculus with lysed bacterial cell remnants embedded in previously mineralized areas. The surface of the microbial deposits in contact with the enamel showed: (a) triangular structures 3-5 micron deep and 4-5 micron wide at their base repeating every 4 or 5 micron which probably occupied the remnants of Tomes processes which in macropods do not flatten out; (b) irregular, short (1 micron) projections that probably occupied the inter-prismatic areas. Few organisms were observed on the anterior or dorsal surfaces of the tongues but on the posterior region there was abundant microbial colonization. Large amounts of extracellular matrix were preserved using a fixation technique designed to minimize the loss of water-soluble material. Bacteria were arranged perpendicular to the epithelial cell surfaces and were present on either surface of desquamating epithelial cells. Aqueous fixation erroneously suggested that inter-bacterial and bacterial-epithelial cell adhesion was primarily by fine fibrillar strands.

Animals↗