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Biomedical subjects

Douglas K Miller

Publications and source records attributed to Douglas K Miller.

At least 19 recordsLinked to original sources
PubMed2006

Challenges in transitional care between nursing homes and emergency departments.

OBJECTIVE: To obtain opinions of knowledgeable professionals involved in the emergency care of nursing home (NH) residents. DESIGN: Structured focus group interviews. PARTICIPANTS: Five provider categories, including NH staff, NH physicians and nurse practitioners, emergency medical services (EMS) providers, emergency department (ED) nurses, and ED physicians. SETTING: Two NHs, 2 EDs, and a county-wide EMS system. ANALYSIS: Audiotaped discussions were transcribed and analyzed independently by 2 authors. RESULTS: Themes included barriers to providing high-quality care, data needed when residents are transported in both directions between EDs and NHs, and possible solutions to improve care. Communication problems were the most frequently cited barrier to providing care. Residents are often transported in both directions without any written documentation; however, even when communication does occur, it is often not in a mode that is useable by the receiving provider. ED personnel need a small amount of organized, written information. When residents are released from the ED, NH personnel need a verbal report from ED nurses as well as written documentation. All groups were optimistic that communication can be improved. Ideas included use of (1) fax machines or audiotape cassette recorders to exchange information, (2) an emergency form in residents' charts that contains predocumented information with an area to write in the reason for transfer, and (3) brief NH-to-ED and ED-to-NH transfer forms that are accepted and used by local NHs and EDs. CONCLUSION: The transitional care of NH residents is laden with problems but has solutions that deserve additional development and investigation.

Emergency Service, Hospital↗
PubMed2006

Neighborhood conditions and risk of incident lower-body functional limitations among middle-aged African Americans.

The authors investigated the association between observed neighborhood conditions and lower-body functional limitations (LBFLs) using data from 563 subjects of the African-American Health Study. This population-based cohort received in-home evaluations. Five items involving LBFL were obtained at baseline (2000-2001) and 3 years later. Subjects were considered to have LBFL if they reported difficulty on at least two of the five tasks. The external appearance of the block the respondent lived on was rated during sample enumeration by use of five items (rated excellent, good, fair, or poor). Of 563 subjects with 0-1 LBFL at baseline, 15% and 14% lived in neighborhoods with 4-5 and 2-3 fair/poor conditions, respectively. Logistic regression adjusting for propensity scores showed that persons who lived in neighborhoods with 4-5 versus 0-1 fair/poor condition were 3.07 times (95% confidence interval: 1.58, 5.94) more likely to develop two or more LBFLs. The odds ratio was 2.24 (95% confidence interval: 1.07, 4.70) when living in neighborhoods with 2-3 conditions versus 0-1 fair/poor condition. Odds ratios for individual neighborhood characteristics varied from 3.45 (fair/poor street conditions) to 2.01 (fair/poor noise level). Sensitivity analyses showed the robustness of the findings. Poor neighborhood conditions appear to be an independent contributor to the risk of incident LBFLs in middle-aged African Americans.

Black or African American↗
PubMed2006

Prescribing to older ED patients.

The purpose of this article is to assist emergency physicians in selecting safe and effective drug therapy for seniors. Because safer alternatives exist, medications on the Beers list of potentially inappropriate medications should generally be avoided. We also review risks associated with several classes of medications: nonsteroidal anti-inflammatory drugs, benzodiazepines, and anticholinergic medications. They are associated with adverse outcomes when taken by older adults and should be used with caution. We also address the use of opioid medications in seniors. Although they are not without risk, opioids are generally safe with slow titration, precautions, and a bowel regimen to prevent constipation. Prescribers should also consider the need for estimating creatinine clearance when prescribing medications that require dosage adjustment in the setting of renal insufficiency. Two areas in need of research are identifying the proper dosing and safety of medications in seniors and prescribing with electronic decision support to assist in prescribing decisions.

Aged↗
PubMed2006

Test-retest reliability of subclinical status for functional limitation and disability.

OBJECTIVE: Subclinical status for functional limitation and disability help explain pathways to difficulties with functional limitation and disability, but data on their measurement stability are minimal. We evaluated the reproducibility of measuring subclinical status in a random subset of 92 community-dwelling St. Louis African Americans aged 49 to 65 years old. METHODS: We examined test-retest reliability of subclinical status using Fried's measurement method of changing either the frequency or method of task performance for five functional limitations, three basic activities of daily living (ADLs), and four instrumental ADLs, as well as summary scales reflecting these three constructs. We also performed sensitivity analyses of test-retest interval and alternative definitional approaches (using only method, only frequency, or both). RESULT: Weighted kappas for individual tasks across three performance levels (high functioning, subclinical status, and task difficulty) indicated moderate agreement for one task and substantial agreement for 11 tasks. Intraclass correlation coefficients for the three scales demonstrated outstanding agreement. The most reproducible definition of subclinical status involved the either/or method. DISCUSSION: Excellent test-retest reproducibility was demonstrated in this population-based sample of late middle-aged African Americans using Fried's method of measuring subclinical status.

Activities of Daily Living↗
PubMed2006

Cross-sectional and longitudinal risk factors for falls, fear of falling, and falls efficacy in a cohort of middle-aged African Americans.

PURPOSE: The purpose of this study is to cross-sectionally and longitudinally identify risk factors for falls, fear of falling, and falls efficacy in late-middle-aged African Americans. DESIGN AND METHODS: We performed in-home assessments on a probability sample of 998 African Americans and conducted two annual follow-up interviews. Multiple logistic regression modeled the associations with falls (any fall or injurious fall) during 2 years prior to the baseline interview, and baseline fear of falling and falls efficacy with 2-year prospective risks for falling and fear of falling. RESULTS: The most consistent association for all outcomes was depressive symptoms. Age was associated with increased risk of prior and prospective falls. Lower-body functional limitations were associated with prior falls, baseline fear of falling, and low falls efficacy, whereas low ability with one-leg stands prospectively predicted fear of falling. The greatest prospective risk for incident falls was having had a prior fall (odds ratio = 2.51), and the greatest prospective risk for fear of falling was having been afraid of falling at baseline (odds ratio = 8.14). IMPLICATIONS: Falls, fear of falling, and low falls efficacy are important issues for late-middle-aged as well as older persons. Interventions should focus on younger adults and attend especially to lower-body function and depressive symptoms as well as building self-efficacy for safe exercise, dealing with falls risks, and managing falls themselves.

Accidental Falls↗
PubMed2006

Reliability and validity of observer ratings of neighborhoods.

OBJECTIVES: The objectives were to examine the validity and reliability of a five-item neighborhood measurement scale. METHODS: Respondents were enrolled from two catchment areas: a poor inner city and a heterogeneous suburban area. Items combine for a total score of 5 (best) to 20 (worst). The authors compared scales across catchment areas and respondent ratings and assessed interviewer effects and retest reliability. RESULTS: Suburban neighborhood scale scores were 3 points lower (higher socioeconomic status, SES) than the inner-city scores. There was a strong relationship between scores and participants' neighborhood ratings. The retest correlation was substantial (.81), but only two of five items achieved kappas above .75. In regression models, interviewer experience and residence and individual interviewers contributed to different ratings, although there was still a marked difference between catchment areas. DISCUSSION: Observer ratings of neighborhoods show promise as a measure of neighborhood SES, despite problems with interviewer effects. Future work should improve objective criteria for ratings.

Catchment Area, Health↗
PubMed2005

Development of a high-capacity homogeneous fluorescent assay for the measurement of leukotriene B4.

Current immunoassays for the measurement of leukotriene B(4) (LTB(4)) typically utilize an enzyme-linked immunosorbent assay (ELISA) format that requires multiple incubations and washing steps and often expensive immunoassay kits. We have developed a bead-based, mix and read, indirect fluorescence-linked immunosorbent assay utilizing fluorometric microvolume assay technology (FMAT). The assay employs a monoclonal anti-LTB(4) antibody-coated onto goat antimouse antibody coupled polystyrene beads and an AlexaFluor-647-coupled LTB(4) ligand. Because the FMAT measurement is made only in the portion of the well volume containing the settled beads coated with AF647-LTB(4), the free label in the solution is not measured. Similarly, substances present in plasma that interfere with other immunoassays are largely ignored. The assay is robust (Z=0.8; S/N=250) and can be measured in the presence of relatively high concentrations of dimethyl sulfoxide or serum. It is inexpensive (<0.10 dollars/assay) and amenable to robotics and has a sensitivity comparable to that of the most sensitive ELISA assays; the concentration of LTB(4) giving 50% inhibition (IC(50)) was ca. 55pg/ml. Cross-reactivity in the FMAT assay was comparable to that of the ELISA assay with significant cross-reactivity found only with 20-hydroxy LTB(4) and 12-epi LTB(4). Measurements of LTB(4) determined by FMAT were equivalent to those measured by standard ELISA in samples of ionophore-stimulated human neutrophils or whole blood.

Fluorometry↗
PubMed2005

Novel ketal ligands for the glucocorticoid receptor: in vitro and in vivo activity.

A novel series of selective ligands for the human glucocorticoid receptor is described. Structure-activity studies focused on variation of B-ring size, ketal ring size, and ketal substitution. These analogs were found to be potent and selective ligands for GR and have partial agonist profiles in functional assays for transactivation (TAT, GS) and transrepression (IL-6). Of these compounds, 27, 28, and 35 were evaluated further in a mouse LPS-induced TNF-alpha secretion model. Compound 28 had an ED(50) of 14.1 mg/kg compared with 0.5 mg/kg for prednisolone in the same assay.

Animals↗
PubMed2005

Novel heterocyclic glucocorticoids: in vitro profile and in vivo efficacy.

A series of novel ligands for the glucocorticoid receptor containing two heterocycles were synthesized. These compounds were investigated for a dissociative profile using transrepression and transactivation assays. Several compounds were tested in vivo and showed the ability to reduce inflammation in a mouse.

Animals↗
PubMed2005

Supportive-affective group experience for persons with life-threatening illness: reducing spiritual, psychological, and death-related distress in dying patients.

BACKGROUND: Attention to psycho-socio-spiritual needs is considered critical by patients with life-threatening illnesses and their caregivers. Palliative care interventions that address these needs--particularly spirituality--are lacking. OBJECTIVE: To evaluate the effects of an innovative program to address psycho-socio-spiritual needs in patients with life-threatening illnesses. DESIGN: A group intervention entitled Life-Threatening Illness Supportive-Affective Group Experience (LTI-SAGE) was developed for reducing patient spiritual, emotional, and death-related distress. SETTING/SUBJECTS: African American and Caucasian patients (n = 69) from two hospitals in St. Louis, Missouri, with life-threatening medical conditions (cancer; human immunodeficiency virus/acquired immune deficiency syndrome [HIV/AIDS]; geriatric frailty; liver, kidney, pulmonary, or cardiovascular disease) were randomly assigned to intervention or control groups. Intervention patients participated in a maximum of 12 LTI-SAGE groups over a 12-month period. Control patients received standard care. MEASUREMENTS: Outcome measures were depression symptoms, anxiety, spiritual well-being, and death-related emotional distress. RESULTS: After attrition, 51 (73.9%) patients completed the trial. At the end of the trial, after factoring in compliance, intervention patients had significantly fewer depression symptoms and death-related feelings of meaninglessness and significantly better spiritual well-being than did control patients. CONCLUSIONS: The use of the LTI-SAGE model for enhancing the end-of-life illness experience is promising.

Analysis of Variance↗
PubMed2005

The future (history) of socioeconomic measurement and implications for improving health outcomes among African Americans.

Socioeconomic status (SES) has powerful and complex impacts on health, and understanding the relationship between SES and health is essential for long-term improvements in the health of populations. In addition, in the United States, the impact of SES on health is inextricably intertwined with racial and ethnicity status and the historical development and maintenance of health disparities. Most of the literature documenting this relationship has focused on individual-level socioeconomic factors. There are sound theoretical reasons and some empirical support to suggest that socioeconomic resources at both individual and neighborhood levels have strong influences on health outcomes such as disease, disability, and mortality. However, these relationships have been inadequately examined to date. In this article, the term "ecological SES" will be used to denote SES at geographic group levels. As the United States attempts to achieve the goals of the Department of Health and Human Services' Healthy People 2010 program, understanding ecological SES and its impacts on health will be crucial. We review the theory, some of the empirical evidence, and likely future for the measurement and use of a broader approach to SES and offer a specific research paradigm for examining these issues. We focus in particular on one racial-ethnic group that experiences health disparity, that is, African Americans. We use our ongoing project investigating physical frailty in urban African Americans to illustrate the importance of a multilevel approach to understanding the impacts of socioeconomic resources on health and the potential implications for efforts to prevent or reverse frailty.

Black or African American↗
PubMed2005

Inner city, middle-aged African Americans have excess frank and subclinical disability.

BACKGROUND: Healthy People 2010 seeks to decrease or eliminate the health disparities experienced by disadvantaged minority groups. METHODS: African American Health (AAH) is a population-based panel study of community-dwelling African Americans born between 1936 and 1950 from two strata. The first encompasses a poor, inner city area, and the second involves a suburban population with higher socioeconomic status. The authors recruited 998 participants (76% recruitment). Frank disability was assessed for 25 tasks and defined as inability or difficulty performing that task. Subclinical disability was assessed for 12 tasks and defined as no difficulty but a change in either manner or frequency of task performance. Frank disability prevalences were compared with national data for community-dwelling non-Hispanic white persons (NHW) and African American persons in the same age range. RESULTS: Compared with the suburban sample, the inner city group had a higher prevalence of frank disability for all 25 tasks (p<.05 for 16) and subclinical disability for 11 of the 12 tasks (p<.05 for 5). Both strata had more frank disability compared with the national NHW population. The inner city area had higher frank disability proportions than did the national African American sample, whereas the suburban group had similar disability levels. CONCLUSIONS: The AAH inner city group experiences more frank disability than other populations of African Americans and NHWs. The increased prevalence of subclinical disability in the inner city group compared with the suburban group suggests that the disparity in frank disability will continue. These findings indicate that African Americans living in poor inner city areas in particular need intensive and targeted clinical and public health efforts.

Black or African American↗
PubMed2005

Fear of falling and related activity restriction among middle-aged African Americans.

BACKGROUND: The prevalence of fear of falling and related activity restriction, and their joint distribution with falls and falls efficacy, have been inadequately addressed in population-based studies of middle-aged and African-American groups. METHODS: The African American Health project is a population-based panel study of 998 African Americans born in 1936-1950 from two areas of metropolitan St. Louis (an impoverished inner-city area and a suburban area). Fear of falling, fear-related activity restriction, and 24 frailty-related covariates were assessed during in-home evaluations in 2000-2001. RESULTS: We found that 12.6% of participants reported having fear of falling without activity restriction, 13.2% had fear of falling with activity restriction, and 74.2% had no fear of falling. Neither fear of falling nor fear-related activity restriction varied significantly across three birth cohorts (1946-1950, 1941-1945, and 1936-1940). Lack of overlap of these two phenomena with having a fall in the past 2 years and low falls efficacy was considerable. When examined across three groups (no fear, fear without activity restriction, and fear with activity restriction), a consistent pattern of decreasing health status and social, emotional, and physical functioning was demonstrated. CONCLUSIONS: In this population-based sample of 49- to 65-year-old African Americans, fear of falling and fear-related activity restriction were surprisingly common and not well explained by prior falls or low falls efficacy. These phenomena were already evident by age 49-55. Further study is warranted, including detailed qualitative investigations examining the timing, precursors, and consequences of fear of falling and fear-related activity restriction in minority and majority populations.

Accidental Falls↗
PubMed2005

Further evidence for the importance of subclinical functional limitation and subclinical disability assessment in gerontology and geriatrics.

OBJECTIVE: The objectives of this work were to determine the prevalence of self-reported subclinical status for functional limitation and disability at baseline and assess their independent effects on the onset of functional limitation and disability 1-2 years later. METHODS: Nine hundred ninety-eight African American men and women 49-65 years old in St. Louis, MO, received comprehensive in-home evaluations at baseline and two annual telephone follow-ups. Outcome measures included walking a half-mile, climbing steps, stooping-crouching-kneeling, lifting or carrying 10 lbs., and doing heavy housework. RESULT: The baseline prevalence of subclinical status was 26.4% for walking a half-mile, 26.8% for climbing steps, 39.0% for stooping-crouching-kneeling, 29.1% for lifting or carrying 10 lbs., and 22.7% for doing heavy housework. The adjusted odds ratios for the task-specific subclinical status measure at baseline on developing difficulty 1-2 years later were 1.68 (p < .05) for walking a half-mile, 4.46 (p < .001) for climbing steps, 2.48 (p < .001) for stooping-crouching-kneeling, 2.51 (p < .001) for lifting or carrying 10 lbs., and 2.22 (p < .001) for doing heavy housework. Performance tests (tandem stand, chair stands, and preferred gait speed) did not have consistent independent effects on the onset of functional limitation or disability. CONCLUSION: The subclinical status measures were the main predictors of the onset of difficulty in all tasks and functions 1-2 years later. Interventions to reduce frailty should focus on self-reported subclinical status as an early warning system.

Activities of Daily Living↗
PubMed2005

Cognitive ability and physical performance in middle-aged African Americans.

OBJECTIVES: To investigate the association between cognitive ability and physical performance in a population-based sample of middle-aged African Americans. DESIGN: Cross-sectional study, 2000/2001. SETTING: St. Louis, Missouri. PARTICIPANTS: Nine hundred ninety-eight African Americans born between 1936 and 1950. MEASUREMENTS: Cognitive function was measured using the Mini-Mental State Examination (MMSE) and the Animal Naming Test of verbal fluency. Physical performance was measured using eight tests: chair stand, semitandem stand, tandem stand eyes open, tandem stand eyes closed, one-leg stand, usual gait speed, grip strength, and peak expiratory flow. RESULTS: There was a statistically significant and monotonic (progressively worsening) trend of the eight physical performance measures across cognitive tertiles in all eight MMSE analyses and five of eight Animal Naming analyses, controlling for age, sex, education, geographic area, depressive symptoms, and comorbid conditions. CONCLUSION: The association between physical performance and cognitive function appears robust. The results extend previous reports for adults aged 65 and older to a measure of verbal fluency and to a population-based sample of African Americans aged 49 to 65. Further research is needed to disentangle the temporal sequence and identify potential interventions to prevent declines in function.

Black or African American↗
PubMed2005

Reproducibility of physical performance and physiologic assessments.

UNLABELLED: We evaluate the test-retest stability of physical performance and physiologic assessments used in epidemiologic research. METHOD: Eighty subjects aged 50 to 65 were randomly selected from a probability sample of African Americans for test-retest assessments 5 to 45 days after baseline. Physical performance assessments included grip strength, chair stands, gait speed, and four standing-balance measures. Physiologic assessments included systolic and diastolic blood pressure, height, weight, body fat, and peak expiratory flow. RESULTS: Intraclass correlations coefficients (ICCs) were .81 for grip strength, .72 for chair stands, .56 for gait speed, .60 for one-leg stand, .52 for semitandem stand, .58 for tandem stand with eyes closed, and .27 for tandem stand with eyes open. Except for blood pressure (ICCs of .51 and .55 for systolic and diastolic), the physiologic assessments had ICCs > .89. DISCUSSION: Additional interviewer training may improve the reproducibility of the tandem stand with eyes open.

Aged↗
PubMed2005

Retest reliability of self-reported function, self-care, and disease history.

BACKGROUND: Exposures and outcomes frequently are measured by self-reports in epidemiologic studies. However, compared with objective data based on physiologic or laboratory tests, self-reports may suffer from lower accuracy and reliability. In addition, few reports examine reliability in population subgroups, such as black adults. METHODS: The authors examined the retest reliability of common self-reports concerning self-care, function, and chronic conditions in a random subsample of 92 middle-aged black subjects from a larger cohort of 998 subjects in St. Louis, Missouri. Subjects completed in-home interviews between September 2000 and July 2001. MEASURES: Function and self-care measures included 7 basic activities of daily living, 8 instrumental activities of daily living, and 9 items based on the Nagi physical performance scale. Chronic conditions included a list of 11 common diseases and conditions and the 7 items of the Rose Angina protocol. Item level agreement was measured by kappa and scale level agreement was measured by intraclass correlation coefficients. RESULTS: Function and self-care items demonstrated highly variable agreement with 7 items failing to reach even moderate (kappa = 0.40) levels of agreement. Scale reliability was better, and intraclass correlation coefficients ranged from 0.75 to 0.95. Self-reported chronic conditions all achieved at least moderate agreement, except for angina based on the Rose protocol. CONCLUSIONS: This study provides evidence that summary measures of function and a number of chronic conditions and diseases are reliable based on self-reports from urban black adults.

Activities of Daily Living↗