PubMed Health⌕ Search

Biomedical subjects

E H Miller

Publications and source records attributed to E H Miller.

50 records · Page 3Linked to original sources
PubMedDate not supplied

A randomized, controlled trial of cefoperazone vs. cefamandole-tobramycin in the treatment of putative, severe infections with gram-negative bacilli.

Cefoperazone was compared with the combination of cefamandole and tobramycin in a prospective, randomized study of putative, severe, gram-negative bacillary infections. We attempted to exclude patients with granulocytopenia or infections due to Pseudomonas species. A total of 118 isolates (94 gram-negative bacilli and 24 gram-positive cocci) caused infection in 99 of the 120 patients studied. Cefoperazone (16 micrograms/ml) was active against 93% of the organisms tested; cefamandole (16 micrograms/ml) and/or tobramycin (4 micrograms/ml) was active against 95%. Infection was cured or improved in 77% of cefoperazone-treated patients and 81% of cefamandole-tobramycin-treated patients. Bacteremia was cured or improved in 61% of cefoperazone-treated patients and in 63% of cefamandole-tobramycin-treated patients. Adverse reactions included five cases of probable antibiotic-associated nephrotoxicity in the cefamandole-tobramycin group; there were no such cases in the cefoperazone group. One patient given cefoperazone plus eight other drugs became granulocytopenic, but the condition resolved when all medications were stopped. This analysis suggests that cefoperazone alone may be as effective as cefamandole plus tobramycin in the treatment of severe infections with gram-negative bacilli and is less nephrotoxic. The role of cefoperazone in patients with granulocytopenia or infections due to Pseudomonas aeruginosa was not evaluated.

Adolescent↗
PubMedDate not supplied

The implementation of bedside bladder ultrasound technology: effects on patient and cost postoperative outcomes in tertiary care.

RESEARCH PROBLEM: The purpose of this study was to determine the effect of ultrasound assessment of bladder volume on patient and cost outcomes for patients needing postoperative catheterization. RESEARCH METHODS: Prospective descriptive and quasi-experimental designs were used with patients having general surgery (N = 50) and patients having orthopaedic surgery (N = 103), respectively. Four outcomes were measured: number of catheterizations over the hospitalization period, infection rates, cost, and patient and provider satisfaction. RESULTS: Accuracy of the technology ranged from .76 to .97 (p = .01). Catheterizations were avoided in 38% (in the "Due to Void" category) and in 81% (in the "Void with Residual" category) of patients in the general surgery group. Patients in the orthopaedic surgery group having ultrasound experienced 1.68 and the standard catheterization group, 1.96 catheterizations, throughout hospitalization. This difference was not statistically significant. UTI rates from admission to 30 days after discharge were 4% and 13% of patients in the ultrasound and standard orthopaedic groups, respectively, and 17% of patients in the general surgical population. Based on acquisition catheter cost, approximately 3 years of ultrasound machine use would be needed to recover the acquisition cost for each machine. The satisfaction rate with the technology was 93% of patients and 97% of nurses. In postoperative patients, bedside bladder ultrasound is accurate, is effective in decreasing numbers of catheterizations, reduces cost over time, and provides high patient and provider satisfaction.

Adult↗
PubMedDate not supplied

Forefoot conditions in dancers: part I.

The conditions occurring in the dancer's forefoot can be divided into five categories. The three categories presented in Part I of our study include those conditions occurring from poor training, those from chronic forefoot stresses, and those of static deformity. Five hundred dancers were observed for both symptomatic and asymptomatic forefoot conditions. It is most important that a young dancer have at least three years training before dancing en pointe. Many skeletal changes in a dancer's foot occur from use and should not be interpreted as injuries. Static forefoot deformities tend to appear in dancers at a younger age than the general population but seldom require corrective surgery.

Adolescent↗
PubMedDate not supplied

Forefoot conditions in dancers: part II.

Conditions in the dancer's forefoot can be divided into five categories. Part II of our study presents two categories: acute conditions of the forefoot and conditions which masquerade as forefoot problems. Five hundred dancers were studied. Of those, some had conditions including muscle spasm, soft tissue trauma, fractures, dislocations, and abscesses, and were treated accordingly. The general health of the dancer was an important factor in treatment as well as difficulty in diagnosing the injury. Prolonged periods of healing were expected but did not prevent the return to dance class and rehearsal. The highly motivated, goal-oriented dancer often did not complain of systemic disease or pain and this prevented diagnosis until triggering tendons or muscle paralysis made it obvious. Such a sequence gave rise to prolonged convalescence or termination of the dancer's career.

Abscess↗
PubMedDate not supplied

Improving pain management after total joint replacement surgery.

PURPOSE: To test the effects of implementing evidence-based postoperative pain management content and strategies on patient, provider (nurse and physician), and fiscal outcomes. SAMPLE: 118 patients, 57 before and 61 after implementation, having total knee replacement (TKR) (54%) and total hip replacement (THR) (45%), and 28 orthopaedic nurses. METHODS: A research utilization approach with a pretest/posttest design was used. Independent variables (interventions) included evidence-based pain management content, education of care providers and patients, and system changes at the point of care. Dependent variables (outcomes) were patient perception of the postoperative pain experience, provider practice patterns, and length of stay (LOS). FINDINGS: The hypotheses of decreased provider use of meperidine and increased use of hydromorphone, i.v. route, pain plans of care, and nurse knowledge were supported. LOS was significantly reduced. The patient hypotheses decreased pain intensity and side effects and increased satisfaction and function were not supported. CONCLUSION: Methodical implementation of evidence-based pain management information changed practice and fiscal outcomes. Improvement in the patient perception of pain management was more difficult to achieve.

Adult↗