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Biomedical subjects

K H Miller

Publications and source records attributed to K H Miller.

At least 19 recordsLinked to original sources
PubMed1999

Cardiac surgery's calculated risk.

Nurses can evaluate preoperative risk and place cardiac surgery patients in four risk categories to predict patients' postoperative clinical and nursing resource needs.

Cardiac Surgical Procedures↗
PubMed1998

Factors influencing selected lengths of ICU stay for coronary artery bypass patients.

This study examines factors influencing the length of intensive care unit stay for patients after coronary artery bypass surgery. Profiles of patients with selected lengths of ICU stay were identified for Group 1 (< or =1 day) and Group 2 (> or =2 days). Medical records of 175 patients who had undergone this procedure at an urban teaching hospital were reviewed. Patients who had a 1-day ICU length of stay were younger (mean=62.39, SD=10.88) and had comorbidities such as hypertension. Those patients with an ICU length of stay 2 days or longer were older (mean=68.18, SD=11.84) and had preoperative comorbidities such as congestive heart failure, chronic obstructive pulmonary disease, ejection fraction <50%, and need for an intra-aortic balloon pump. Atrial dysrhythmias, low cardiac output syndrome, renal insufficiency, and respiratory insufficiency were the postoperative complications associated with a prolonged ICU length of stay. Knowledge of the factors influencing selected lengths of ICU stay will enable nurses to choose patients for critical pathways and to anticipate postoperative problems in high-risk patients.

Adult↗
PubMed1996

Diminution of T cells with gamma delta receptor in the peripheral blood of allergic asthmatic individuals.

BACKGROUND: T cells are shown to regulate allergy and asthma. They are heterogeneous by virtue of surface receptor subtypes (alpha beta and gamma delta receptors), however, their pathophysiological roles in asthma are unclear. OBJECTIVE AND METHODS: The present study employed flow cytometric analysis to compare the size of T-cell subsets and eosinophils present in the peripheral blood of healthy, allergic and allergic asthmatic individuals. RESULTS: Current results demonstrated that the percentages of gamma delta T cells declined from 4.1% in healthy to 3.2% in the allergic subjects and to a significantly lower (P = 0.01) 2.4% in allergic asthmatics. The absolute numbers of circulating gamma delta T cells also were diminished in a similar fashion such that healthy individuals had a significantly higher mean cell count (91.8 x 10(3)/mL) than did allergic asthmatics (47.8 x 10(3)/mL) (P = 0.0266). In contrast, alpha beta T cells were comparable in the healthy, allergic, and allergic asthmatic populations (65.3%, 65.8% and 69.4%, respectively); the differences were not statistically significant. On a populational basis, the proportion of individuals having both gamma delta T cells < or = 4.1% and eosinophils > or = 2.1% was the lowest in the healthy population (30.8%), but was elevated in the allergic group (85.7%) as well as in the allergic asthmatic group (86.6%). However, on an individual basis, those who had reduced gamma delta T cells did not have consistently higher eosinophil counts or IgE level. CONCLUSION: It was concluded that no significant correlation existed between the levels between gamma delta T cells and eosinophils or between gamma delta T cells and IgE present in the peripheral blood. This report, for the first time, documents that allergic asthmatics have reduced gamma delta T cells with reciprocally elevated eosinophil numbers in their peripheral circulation. However, it does not indicate that the reduction of gamma delta T cells directly correlates with the predominance of eosinophils of IgE levels in the diseased populations. The pathophysiological role of gamma delta T cells in allergic diseases awaits further exploration.

Adult↗
PubMed1991

Electrical stimulation for dermal wound healing.

The investigations of biologic actions (in vitro, animal, and human) demonstrated several effects that help explain why electrical stimulation works. Based on the latest scientific understanding of the wound healing process, one would expect that a therapy that decreases edema, debrides necrotic tissue, attracts neutrophils and macrophages, stimulates receptor sites for growth factors, stimulates growth of fibroblasts and granulation tissue, increases blood flow, stimulates neurite growth, induces epidermal cell migration, prevents postischemic oxygen radical-mediated damage, inhibits bacteria, and reduces numbers of mast cells ought to be beneficial for wound healing. Numerous human and animal efficacy studies confirm that electrical stimulation of the proper charge, density, and total energy causes dramatically improved healing of dermal wounds. As of this writing, no devices have yet been approved by the FDA for use in wound healing, although several devices approved for other indications are being used for this purpose. One device (the Staodyn Dermapulse) has undergone controlled animal and human testing, and an application requesting approval for treating dermal ulcers has been submitted to FDA. Taken together, the efficacy studies and the "mechanism of action" studies provide compelling, scientific evidence that electrical stimulation is safe and effective for promoting the healing of dermal wounds.

Animals↗
PubMed1980

Immunoprotein deposition in the cornea.

A 63-year old woman had bilateral, multi-level corneal deposits distributed as fine, discrete crystals and in dense, deep geographic patches. She had a long history of sero-positive rheumatoid arthritis. Autopsy revealed an unsuspected lymphoproliferative disorder and immune-complex disease. Histologic examination of the eyes revealed eosinophilic, PAS-positive, noncollagenous deposits in the cornea at all levels and also in the ciliary processes, pars plana, and choroid. Stains for gold, amyloid, and acid mucopolysaccharides were negative. Immunoperoxidase stains were positive for IgG most strongly, and also for IgA, kappa and lambda light chains. Transmission electron microscopy showed needle-like electron-dense extracellular particles which we presume are immunoglobulins.

Cornea↗
PubMed1978

Sexual adjustment after lower extremity amputation.

Sexual adjustment following lower extremity amputation was evaluated by interviewing 60 adults with recent amputations, 39 men and 21 women, after they had become independent in ambulation with a prosthesis. Among the men, 77% reported a substantial decrease in the frequency of sexual intercourse following amputation, while only 38% of the women reported a decrease. The decreased frequency was greater for nonmarried men than for married men, greater for men with above-knee amputations than for men with below-knee amputations, and greater for male amputee patients in whom phantom phenomena persisted compared to those in whom phantom phenomena no longer existed. The decreased frequency of intercourse for male amputee patients was unrelated to the patient's age, education, and etiology of amputation. There was no significant change in other aspects of sexual activity, including oral-genital relations, masturbation, homosexuality, and extramarital relations.

Adolescent↗
PubMedDate not supplied

From silencing the self to action: experiences of women living with HIV/AIDS.

Feminist literature has demonstrated that women often maintain behaviors that support silencing of their voices. The critical issue is whether the silencing experience is (a) a destructive process of burying feelings and needs, (b) a protective strategy to preserve personal and professional relationships which they value, (c) a coping mechanism to divorce themselves from an androcentric/ethnocentric health care culture, or all of these. The transition from silence to action may be a process of reacting to a threat to self (i.e., HIV/AIDS diagnosis) where gender normative behaviors become irrelevant and self-advocacy becomes paramount for survival. Alternatively, the transition may be a conscious process of gaining insight into past behaviors that have been learned and culturally supported and making purposeful changes. Data for this study were extracted for secondary analysis from data from a larger study on experiences and needs of persons living with HIV/AIDS. Data were obtained from transcripts from three focus groups (N = 14 women) and six individual interviews. Women ranged in age from 21 to 55; 9 were European American, 7 were African American, and 4 were Latina American. Data were content analyzed and organized using four categories proposed by Jack (1991): (a) externalized self-perception, (b) care as self-sacrifice, (c) silencing the self, and (d) the divided self. Data supported that women with HIV/AIDS reported all four categories of silencing behaviors, particularly early in the HIV trajectory. For some women, an HIV/AIDS diagnosis ignited them to speak for themselves and to shape their own lives based on feelings and needs. For others, peer or professional support or both was the catalyst for the transition from silence to action. Findings suggest interventions that would assist women in judging themselves by internal versus external standards, putting their own needs before the perceived needs of others, expressing themselves toward action rather than avoidance, and feeling comfortable expressing anger.

Adaptation, Psychological↗
PubMedDate not supplied

Decreasing diagnostic blood loss for patients in critical care units.

Several studies have investigated the problem of diagnostic blood loss for patients in critical care units. This research analysis categorizes these studies according to common themes, evaluates their methodologies, and synthesizes the findings. The author recommends research-based strategies that nurses can use to reduce patients' blood loss and the risk of complications such as nosocomial anemia.

Anemia↗
PubMedDate not supplied

Risk classification, clinical outcomes, and the use of nursing resources for cardiac surgery patients.

Several studies have used risk classification models to examine the effect of preoperative risk factors on operative morbidity and mortality. However, previous research has not linked risk classification models to factors such as frequency of postoperative complications, length of intensive care unit stay, mortality, and the use of nursing resources. This article reports on significant differences in clinical outcomes and hours of nursing care by risk classifications.

Aged↗
PubMedDate not supplied

Students' decisions to select HIV services for clinical experiences.

The ever-growing numbers of persons living with HIV/AIDS emphasizes the need for highly trained healthcare professionals to care for this population. Understanding why nursing and medical students would choose HIV services for clinical rotations, and the impact of those clinical experiences on their future professional practice, is key to recruiting healthcare providers to care for this population.

Adult↗