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Biomedical subjects

L M Harvill

Publications and source records attributed to L M Harvill.

18 recordsLinked to original sources
PubMed2001

Durability of eversion carotid endarterectomy: comparison with primary closure and carotid patch angioplasty.

OBJECTIVES: Despite numerous studies in which various methods for arteriotomy closure after carotid endarterectomy (CEA) have been addressed, the optimum surgical technique to reduce complications and late carotid restenosis has yet to be firmly established. The purpose of this study was to prospectively compare the results of the eversion CEA technique with those of conventional CEA with either primary closure or carotid patch angioplasty, and to determine under clinical conditions whether eversion CEA influences the results and restenosis rate. PATIENTS AND METHODS: Over a 3-year period, 322 CEAs performed on 296 consecutive patients were concurrently evaluated. This study included 118 eversion CEAs, 97 CEAs with primary closure, and 107 CEAs with patch angioplasty. There were no differences in demographics, in surgical indications, or in the severity of carotid disease (not significant [NS]). The choice of CEA technique was not randomized because of technical considerations and surgeon preference. After entry into the protocol, no patients were excluded or withdrawn. Carotid restenosis was defined as a > 60% lumen reduction at the CEA site with established duplex ultrasonography criteria. RESULTS: The mean operative time for eversion CEA was 31 minutes, for CEA-primary closure it was 39 minutes, and for CEA-patch angioplasty it was 46 minutes (P <.01). The operative mortality rate for eversion CEA was 0.8% (1 patient), for CEA-primary closure it was 1.0% (1 patient), and for CEA-patch angioplasty it was 2.8% (3 patients) (NS). The postoperative stroke rate was 0.8% after eversion CEA, 1.0% after CEA-primary closure, and 2.8% after CEA-patch angioplasty (NS). The combined stroke and death rate in each group was thus 0.8% for eversion CEA (1 stroke-death), 1% for CEA with primary closure (1 stroke-death), and 5% for CEA with patch angioplasty (1 stroke-death, 2 fatal myocardial infarctions, and 2 nonfatal strokes) (NS). Transient ischemic attacks occurred in 2.5% after eversion CEA, in 5.2% after CEA-primary closure, and in 2.9% with CEA-patch angioplasty (NS). The mean clinical follow-up for all three groups was 23 months (range, 6-42 months) (NS). The restenosis rate was 1.7% after eversion CEA, 9.3% after CEA-primary closure, and 6.5% after CEA-patch angioplasty (P <.05). CONCLUSIONS: This prospective, nonrandomized clinical study indicates that eversion CEA is an effective surgical option comparable to conventional CEA with either primary arteriotomy closure or carotid patch angioplasty. No differences were found between eversion CEA and these more widely accepted CEA closure techniques with respect to operative morbidity and mortality. These data indicate, however, that eversion CEA has a lower restenosis rate than conventional CEA closure techniques and thus superior long-term durability.

Aged↗
PubMed1999

Demographic changes in tuberculosis: high risk groups.

We conducted a statistical analysis of all verifiable tuberculosis (TB) cases in Tennessee from 1990 through 1996 to determine the demographic changes in TB. We studied variables, including age, sex, race, site of the disease, and possible impact of known risk factors such as human immunodeficiency virus (HIV) infection, homelessness, foreign birth, and residency in extended care facility. The percentage increase in all such categories, except in the nursing home population, had a statistically significant increase. Unlike national epidemiologic findings, foreign-born TB comprised less than 1% of the total cases. Association of HIV as a co-infection increased from 16 (2.7%) in 1990 to 41 (8.1%) in 1996. These findings will have significant impact on TB control measures and the clinical practice of TB cases in Tennessee and other areas of the southeastern US.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Improved control of type 2 diabetes mellitus: a practical education/behavior modification program in a primary care clinic.

BACKGROUND: This study was done to determine the efficacy and ease of administration of education/behavior modification classes, provided by a nurse and a dietitian in a primary care clinic for improving control of type 2 diabetes mellitus. METHODS: Patients were divided randomly into two groups. Eighteen patients completed 6 months of structured, office-based classes, and 20 similar patients served as control subjects. All were patients of the same group practice and had their usual office visits. Glycemic control, lipid levels, body weight, knowledge about diabetes, medication requirements, and symptoms were monitored during the 6 months, with follow-up at 12 months. RESULTS: At the end of 6 months, the intervention group had significant reductions in mean fasting blood glucose, glycosylated hemoglobin, total cholesterol, and low-density lipoprotein cholesterol (LDL-C) values. Their mean body weight was significantly reduced at 12 months, and their knowledge of diabetes was improved. Control patients had significant improvement only in glycosylated hemoglobin and body weight at 6 months. Minimal physician time was required. CONCLUSION: The education/behavior modification program was clinically worthwhile, and it was easy to administer.

Aged↗
PubMed1996

Extrapulmonary tuberculosis in Tennessee: lessons from the last decade.

In conclusion, extrapulmonary TB remains a significant fraction of the total TB cases in Tennessee. During the last few years, the percentage of extrapulmonary TB in Tennessee has been on the increase. Understanding these changes in the epidemiology of extrapulmonary TB will help the clinician in making a prompt diagnosis, leading to appropriate therapy. Understanding the changing trends at the national level may aid state health departments in reorganizing disease control programs, thus, facilitating the eradication of TB and other communicable diseases in Tennessee.

AIDS-Related Opportunistic Infections↗
PubMed1995

Underutilization of isoniazid chemoprophylaxis in tuberculosis contacts 50 years of age and older. A prospective analysis.

STUDY OBJECTIVES: To examine the utilization of chemoprophylaxis for tuberculosis in certain high-risk groups, ie, infected contacts 50 years and older, and to study the safety of isoniazid (INH) preventive therapy in such persons. DESIGN: From 1987 to 1992, two-part questionnaires were sent to each of the regional health offices within the 95 counties of Tennessee to document cases of purified protein derivative skin test conversion or reaction among close contacts of new patients with active tuberculosis. Infected contacts 50 years and older were included in the study. METHODS: Data collected from these questionnaires were grouped according to age, sex, race, liver functions test (LFT), and whether chemotherapy was completed. Reasons for early discontinuation were also recorded. High values of LFTs were classified in the various groups as either twofold elevation or greater than threefold elevation. RESULTS: Of the 829 responses for persons fitting the criteria for INH chemoprophylaxis, 415 began treatment; 249 (60%) of those completed the full course (9 months) and 166 stopped prematurely. Of the 414 persons (50%) who did not start preventive therapy, 233 (56.5%) respondents listed age as the reason. No patients started on a regimen of therapy developed hepatitis. Of those completing therapy, 6.9% had a rise in liver enzyme values but remained asymptomatic for hepatitis. Liver enzyme level elevation was significantly higher among patients who discontinued therapy, particularly white women, than those who completed the full course. Asymptomatic liver enzyme level elevation (> or = 3 times normal value), private practitioners' preferences, and patients arbitrarily stopping therapy were the leading reasons for incomplete INH preventive therapy. CONCLUSION: We conclude that 30% of tuberculosis-infected contacts deserving chemoprophylaxis were actually provided the full benefit of INH preventive therapy, indicating underutilization of this prevention strategy, particularly in contacts older than 50 years.

Age Distribution↗
PubMed1994

Investigation of the influence of acetylsalicylic acid on the steady state of long-term therapy with theophylline in elderly male patients with normal renal function.

The risk inherent in the clinical control of patients with theophylline is widely recognized. Elderly patients may present an additional risk because of altered pharmacokinetics and the use of concomitant medication. Acetylsalicylic acid has been proposed for primary and secondary prevention of myocardial infarction and possible strokes. This investigation was undertaken to determine if concomitant administration of acetylsalicylic acid in elderly patients would alter steady-state levels of theophylline. A population of smoking male patients older than 60 years of age under long-term control of chronic obstructive pulmonary disease (COPD) with theophylline were evaluated for a baseline period of 3 days. Serum levels were measured at 6:00 AM and 6:00 PM. An enteric-coated acetylsalicylic acid preparation, 650 mg by mouth, was added to the daily slow-release theophylline, 6:00 AM hour dose regimen for 4 weeks. The serum levels of theophylline and salicylates were measured at 6:00 PM after dosing and at 6:00 AM the following day, at weekly intervals for 4 weeks. Urine specimens collected before administration of medication at 6:00 AM were analyzed for salicylates to further confirm dosage compliance. All volunteers continued to be clinically controlled throughout the treatment period and no symptoms of either overdose or underdose of either medication occurred. Plateau or trough theophylline serum levels did not change significantly during the salicylate treatment period. Salicylate serum levels did show during treatment self-induced metabolism. It is concluded that in elderly male patients, a daily concomitant therapeutic salicylate regimen does not alter steady-state serum theophylline levels and therefore does not per se necessitate the assay of theophylline blood levels in elderly patients.

Aged↗
PubMed1994

Regional differences in bone density of young men involved in different exercises.

In this cross-sectional, retrospective study, the bone mineral content (BMC) and density (BMD) of the whole skeleton, upper limbs, lower limbs, femoral neck, and lumbar vertebrae were measured using dual photon absorptiometry and the results compared in healthy young males involved in: weight-lifting, running, cross-training, or recreational exercises. When adjusted for body weight, the upper limb BMD was highest in those engaged solely in weight-lifting (mean 1.021, SE 0.019, and 95% CI 0.981-1.061) and lowest in runners (mean 0.908, SE 0.019 and 95% CI 0.869-0.946). These differences were significant (P = 0.0004). There were no significant differences in upper limb BMD between weight-lifters and cross-trained athletes and between runners and those engaged in recreational exercises. Significant differences in BMD were observed between weight-lifters and recreational athletes (P = 0.001) and between cross-trained athletes and runners (P = 0.03). No other significant differences were observed. These data suggest that healthy, young, adult males reporting a history of intensive weight-lifting had significantly greater bone mass of the upper limb bones than those reporting a history of non-weight-lifting exercises. These results imply a specific versus generalized effect of mechanical load on bones of the skeleton.

Adult↗
PubMed1991

Relationship between blood groups and behavior patterns in men who have had myocardial infarction.

Consistent correlations have been found between physical dysfunctional states and blood factors. Some of these disorders have possible psychosomatic components (eg, duodenal ulcer, myocardial infarction). This study focused on the relationship between blood types and various indices of behavior patterns (eg, type A behavior scores, anger ratings) in young patients who had had an initial myocardial infarction. Patients with blood type O scored significantly higher on type A behavior scales and related indices than those having blood type A. Those with blood group B responded on several scales between those with types A and O. We discuss the utility of blood groupings in future research in the prediction of myocardial infarction, methodologic limitations, the relationship of these results to temperament studies, Jenkins Activity Survey subtest patterns, anti-H reactivity pattern, and hypotheses relating blood factors and behavioral traits in patients with psychosomatic disorders.

ABO Blood-Group System↗
PubMed1989

Phenotypic characteristics of Branhamella catarrhalis strains.

Isolates of Branhamella catarrhalis from 13 patients with pneumonia, 6 patients with tracheobronchitis, and 8 patients who were colonized with the organism were studied with respect to susceptibility to the bactericidal action of normal human serum (NHS), glass slide hemagglutination (HA) of group O human erythrocytes, beta-lactamase production, and susceptibility to selected antimicrobial agents and laboratory drugs. A total of 18 of 27 isolates were serum resistant, 22 of 27 produced HA, and 21 of 27 were beta-lactamase positive. Statistically significant correlations were found between susceptibility to NHS and susceptibility to trypsin (r = +0.47; P = 0.01) and between susceptibility to NHS and HA (r = -0.48; P = 0.009). Significant correlations were also observed among several pairs of antimicrobial drugs. Analysis of variance showed that mean ampicillin MICs correlated with isolate group (r = -0.49; P = 0.03) in that the pneumonia isolates had higher MICs. Some phenotypic characteristics appeared to be independent of each other. These data suggest that important differences exist among clinically significant B. catarrhalis strains and that these differences may be due to differences in the cell wall envelope of the organism.

Blood Bactericidal Activity↗
PubMed1984

Self-assessment of need, relevance and motivation to learn as indicators of participation in continuing medical education.

This study examined the validity of using physicians' self-assessed needs, relevance and motivation to learn about clinical topics as a means for setting objectives and priorities for continuing medical education (CME) programmes. In an initial survey family doctors were asked to rate their need, relevance and motivation to learn about 120 different clinical topics. Eight months later, the same population was sent a second mail survey asking respondents to indicate if they had learned about a set of sixteen topics taken from the initial survey and, if so, in what kind of learning activities. Eight of the sixteen topics were highly rated and eight were low rated in the initial survey. In terms of actual participation of family doctors, self-assessed motivation to learn exhibited a strong positive relationship with actual participation. Both self-assessed need and relevance were negative to only moderately positive in their association with actual participation. This evidence contributed to the value of using self-assessed motivation as an indicator of future participation of family doctors in CME and questioned the value of using self-assessed need and relevance as indicators of future patterns of participation.

Education, Medical, Continuing↗
PubMed1980

The evaluation of a training program for improving residents' teaching skills.

As a response to the growing recognition of the need for improvement in medical instructional practices, a training program on teaching skills for resident physicians in the East Tennessee State University College of Medicine was implemented. The program consisted of 13 weekly, one-hour, small-group sessions attended by 20 residents. The microteaching method was utilized for practicing instructional techniques. Significant gains in teaching performance and in attitude toward participating in a teaching skills program were demonstrated, on the basis of videotaped teaching performances and a written questionnaire, indicating that short training programs can assist physicians in the process of instructional improvement.

Attitude of Health Personnel↗
PubMedDate not supplied

Long-term effects of strokes on bone mass.

The purpose of the study was to determine the long-term effects of muscle weakness secondary to strokes on the bone mineral content of the hemiparetic limb. Patients who had experienced single recent strokes were studied. The bone mineral content of each limb was measured by Dual Energy X-ray Absorptiometry using the region of interest analysis program. Muscle strength of each muscle group was ranked using the Oxford scale, and the mean was calculated for each limb. Bone and muscle parameters were measured within seven days after the stroke and repeated thereafter at monthly intervals for up to 6 mo. A repeated measures analysis of variance, Newman-Keuls pair-wise comparisons, and orthogonal contrasts were done for each parameter. Significance levels were set at P < 0.05. Sixteen patients were included in this study. Demineralization was more pronounced in the upper than lower limbs. Demineralization of bones on the paralyzed side started during the first month after the stroke and gradually progressed. By the fourth month, the bone mineral content decreased by a mean of 9.3% (P = 0.01) and 3.7% (P = 0.01) in the upper and lower limbs, respectively, for the 11 patients followed for 4 mo. In the patients we followed for more than 4 mo, there was no further significant mineral loss. No change in bone mineral content was observed in the healthy nonparetic limbs. In conclusion, after a stroke, bone demineralization occurs in the paralyzed side and reaches its maximum within 3 to 4 mo. Arms are affected more than legs.

Absorptiometry, Photon↗