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Biomedical subjects

P K Miller

Publications and source records attributed to P K Miller.

8 recordsLinked to original sources
PubMed1999

A randomized trial of endoscopic versus open saphenous vein harvest in coronary bypass surgery.

BACKGROUND: The purpose of this study was to determine whether or not endoscopic vein harvest is a reliable, beneficial, and cost-effective method for saphenous vein harvest in coronary bypass surgery (CABG). METHODS: A total of 100 patients having primary CABG were prospectively randomized to either endoscopic (EVH; n = 47) or open saphenous vein harvest (OVH; n = 50). Three patients in the EVH group required both techniques and were excluded from analysis. RESULTS: The groups did not differ in preoperative characteristics, including: age, gender, left ventricular function, height, weight, percent over ideal body weight, incidence of diabetes, peripheral vascular disease, or preoperative laboratory values (creatinine, albumin, or hematocrit). The EVH group had longer vein harvest and preparation times than the OVH group, while the incision length was significantly shorter. There was no difference between groups in mortality, perioperative myocardial infarction, intensive care unit or postoperative length of stay, blood product utilization, or discharge laboratory measures. There was more drainage noted from leg incisions at hospital discharge in the OVH (34%) versus EVH group (8%; p = 0.001), but more ecchymosis in the EVH group. Although there was a trend towards reduced leg incision pain in the EVH group, there was no statistically significant difference in pain or in the quality of life measure at any point in time. There was no difference between groups in readmission to hospital, administration of antibiotics, or incidence of leg infection. While mean hospital charges for the EVH group were approximately $1,500 greater than for OVH, this difference did not reach statistical significance. CONCLUSIONS: EVH is a safe, reliable, and cost-neutral method for saphenous vein harvest. The best indication for EVH may be in patients who are at increased risk for wound infection and in those for whom cosmesis is a major concern.

Aged↗
PubMed1997

Traumatic adult respiratory distress syndrome.

ARDS is the pulmonary manifestation of both direct and indirect insults to the lung. Trauma patients are at particular risk for ARDS from the direct effects of their injuries, as well as from complications that may occur during their hospital courses. ARDS prevention can be enhanced through diverse areas of medical focus. Public health issues addressing trauma prevention, improved understanding and treatment of trauma-related pathophysiology, as well as a better understanding of basic pathophysiology of this disease process will allow refinement and improvement of our management practices. Newer modes of mechanical ventilation may help us to avoid ventilator-induced exacerbation of lung injury. As we define the role of nonconventional therapies, such as anti-inflammatory and anticytokine therapies, our ability to actively interrupt and reverse the progression of the inflammatory cascade will be enhanced. As yet, ARDS continues to be a challenging disease process to both fully understand and successfully treat in our critically ill patients.

Humans↗
PubMed1992

Cutaneous micrographic surgery: Mohs procedure.

Skin cancer is an increasingly serious public health issue that affects a high percentage of the population. Surgical resection is still standard treatment for skin cancer, but for difficult cases, cutaneous micrographic surgery, originally described by Mohs, is our preferred technique because of the routine methodic accuracy for evaluation of the surgical margin, the high rate of oncologic cure, and the tissue-sparing quality of the procedure. We report the Mayo Clinic experience with cutaneous micrographic surgery from July 29, 1986, through June 30, 1991, which consisted of 3,355 cases (principally basal cell and squamous cell carcinoma). Herein we discuss practical concerns about this procedure: duration of the technique, reconstruction, cure rates, tumors best treated by cutaneous micrographic surgery, and cost. In addition, we review the Mayo Clinic multidisciplinary management of difficult skin cancers.

Adult↗
PubMed1992

Focal mucinosis (myxoid cyst). Surgical therapy.

Myxoid cysts typically arise in association with distal interphalangeal joint arthritis. When myxoid cysts become problematic, surgical excision is a standard treatment with a high cure rate and few complications. The origin, anatomy, and alternative medical and surgical treatment options are discussed.

Humans↗
PubMed1991

Diagnostic and therapeutic nail surgery.

The function of the nail unit is as a protective covering over the dorsal distal end of the digit. Some basic disease processes affecting the nail unit and the surgical techniques used for diagnosis and treatment are reviewed.

Anesthesia, Local↗
PubMed1976

Localized muscle fatigue and dynamic balance.

This investigation was designed for the purpose of ascertaining if one muscle group (dorsi flexors, abdominals, plantar flexors, or knee and hip flexors and extensors) could be identified which most significantly affects dynamic balance. The dependent variable was the dynabalometer. Subjects were 100 male volunteers, between the ages of 19 and 25 yr. Subjects were randomly assigned to a control or 1 of 4 treatment groups. Testing was counterbalanced over time and day. Controls had a practice period and 3 performance trials; other Ss had a practice period, localized fatigue of a muscle group followed by 3 performance trials. Analysis of variance indicated a significant difference between treatment groups (F = 312.09, p less than .01). Multiple comparisons of treatment means showed that only one muscle group, the knee and hip flexors and extensors, differed significantly from all other groups (q = 4.75, p less than .01). Results indicate strongly that the knee and hip flexors and extensors can be considered a most important muscle group for performance by ordinary male college students on the dynabalometer.

Adult↗
PubMedDate not supplied

Downsizing. Use intravenous clinicians to maintain quality venous access care.

Many authors demonstrate the cost effectiveness of using intravenous teams to provide quality venous access care. Despite this evidence, many hospitals are dissolving their i.v. teams as a way of cutting costs. This article provides a guide for downsizing while maintaining quality i.v. therapy. The article chronicles events before and after the disbanding of the i.v. team of the San Francisco Veteran's Administration Medical Center. The focus of the article demonstrates how creating two advanced practice positions is instrumental to maintaining quality i.v. care. Quality is defined as line-associated bacteriemia rates and compliance rates to i.v. care standards, remaining unchanged or better after the downsizing of the i.v. team. Line-associated bacteriemia rates are presented in terms of infections per 1000 line days when possible. Compliance percentages are obtained by auditing compliance to site changes, central line policy. The data are provided in chart form, and definitely show a sharp decline in line-associated bacteremias after the advent of the i.v. clinician role. These data provide clear evidence to support the Intravenous Nurses Society position on the role of the intravenous nurse specialist. Conclusions emphasize the need for i.v. nurse clinicians to provide critical care coverage, ongoing educational programs, outcome auditing, and nursing research in vascular access and i.v. therapy.

Cost Savings↗