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Biomedical subjects

W F Miser

Publications and source records attributed to W F Miser.

At least 19 recordsLinked to original sources
PubMed1998

High-altitude medicine.

As more people enjoy the outdoors, high-altitude illness is increasingly becoming a problem that family physicians across the country must treat. High-altitude illness, which usually occurs at altitudes of over 1,500 m (4,921 ft), is caused primarily by hypoxia but is compounded by cold and exposure. It presents as one of three forms: acute mountain sickness (AMS), high-altitude pulmonary edema (HAPE) and high-altitude cerebral edema (HACE). But high-altitude illness can have many other manifestations. Cardinal symptoms include dyspnea on exertion and at rest, cough, nausea, difficulty sleeping, headache and mental status changes. Treatment requires descent, and gradual acclimatization provides the most effective prevention. Acetazolimide is an effective preventive aid and can be used in certain conditions as treatment.

Acute Disease↗
PubMed1997

Pertussis: an update on primary prevention and outbreak control.

Pertussis is a highly contagious respiratory disease. Infected adolescents and adults with mild illness are the source of potentially life-threatening illness in infants and young children. The incidence of pertussis has been rising steadily in recent years. Primary vaccination is 80 percent effective, but protection is transient. Pertussis can be difficult to diagnose because classic whooping cough is uncommon, disease manifestations are often atypical, and laboratory and radiologic aids are frequently nonspecific. Diagnosis is usually based on the clinical picture, but culture, direct fluorescent antibody tests and serology can be helpful. Antibiotic therapy can decrease the duration and severity of illness, and prevents secondary spread if started early. Effective management of pertussis outbreaks requires early diagnosis and treatment of cases, antibiotic prophylaxis of contacts and accelerated vaccination of susceptible infants and children. Acellular pertussis vaccine preparations have recently been recommended for the entire primary vaccination series.

Adolescent↗
PubMed1997

Army family practice: does our training meet our needs?

OBJECTIVES: (1) To determine the perceived adequacy of residency training for current practice by Army family physicians; (2) to ascertain if differences exist by residency setting: medical center, medical activity, or civilian. METHODS: Surveys were mailed to the 334 family physicians in the Army in 1993. Training in various subject areas was rated as inadequate, adequate, or overly prepared. RESULTS: More than 75% of respondents felt prepared in 76% of general medical subjects (GM) but in only 39% of family medicine subjects (FM). There were no practice management subjects in which more than 75% felt adequately prepared. There were no differences in perceptions of GM or FM training between military- and civilian-trained respondents. CONCLUSIONS: Army and civilian residencies prepare family physicians for the medical aspects of practice. Early training in management subjects could be enhanced. Civilian and Army programs could improve training in family medicine subjects.

Analysis of Variance↗
PubMed1996

Non-clinical roles of Army family physicians in their first post-residency assignment and their level of preparedness for these roles.

A cross-sectional survey of the 1992 and 1993 graduates from Army Family Practice Residencies was done to determine their non-clinical roles and their perceived level of preparedness for these roles. Sixty-nine of the 98 questionnaires mailed (70%) were returned. The non-clinical roles were divided into command, administrative, committee (subdivided into hospital level and department/clinic level), and duties outside of the hospital (subdivided into military and administrative). Twenty-nine (42%) had commands, 58 (84%) had administrative roles, 48 (70%) had hospital committee roles, 53 (77%) had department/clinic committee roles, 54 (78%) had military roles, and 42 (61%) had administrative roles outside of the hospital or clinic. The self-reported level of preparedness, on a five point Likert scale (1 = not at all, 3 = adequately, 5 = superbly), ranged from 2.2 for command to 2.9 for administrative roles outside the hospital. Residents did not feel adequately prepared for their non-clinical roles.

Cross-Sectional Studies↗
PubMed1995

Acute focal bacterial pyelonephritis.

Acute focal bacterial pyelonephritis is a renal inflammatory disease that has similarities to both pyelonephritis and renal abscess. The diagnosis is based on clinical symptoms of pyelonephritis and renal abnormalities detected on radiologic imaging studies (ultrasonography and computed tomographic scanning). Ultrasonographic examination demonstrates mass lesions in the renal cortex that resolve after appropriate antibiotic therapy. Computed tomographic studies reveal localized, wedge-shaped or circular, poorly enhancing, hypodense areas and/or swelling of the superior pole of the kidney. A voiding cystourethrogram should be done to rule out reflux as an underlying cause. Magnetic resonance imaging is not required for diagnosis or follow-up evaluation. Escherichia coli is the most common etiologic agent. All reported cases have responded to conservative therapy with extended courses of oral bactericidal antibiotics. Resolution is typically complete in one to three months. A follow-up evaluation with ultrasonography is required to document resolution.

Acute Disease↗
PubMed1995

Army family physician satisfaction.

INTRODUCTION: As numbers of family physicians decrease in the Army, the Army needs to know how satisfied they are with being family physicians and military officers. What variables are associated with these satisfactions? METHODS: This was a cross-sectional mailed survey of Army family physicians (N = 334). The response rate was 82% (N = 274). The survey included questions with a Likert scale and was analyzed using Kruskal-Wallis, one-way analysis of variance, and logistic regression. RESULTS: Ninety-two percent were satisfied with being family physicians and 74% were satisfied with being military officers. The variables associated with satisfaction were rank (positively associated) and percent time in patient care (negatively associated). CONCLUSIONS: Army family physicians are more satisfied with being family physicians than they are with being military officers. They are, however, satisfied with both professions. The Army, as an organization, may want to explore how its system of rewards interplay with rank and amount of time in patient care to make them predictive of satisfaction.

Adult↗
PubMed1995

Injuries and illnesses incurred by an army ranger unit during Operation Just Cause.

Detailed knowledge of anticipated casualties is essential for the medical officer preparing to support a mission. To accurately describe the injuries inflicted upon the 2/75th Ranger Battalion involved in Operation Just Cause, 471 (75.5%) Rangers were personally interviewed. The average Ranger was 23 years old, an E-4 with 3 years of active duty service, and in a good to excellent fitness category. The majority went into battle with little sleep or food. Injuries forced 9.5% out of combat, and limited another 9.9%. The overall unit casualty rate was 35%, with 217 Rangers suffering 281 injuries. Most of the injuries were musculoskeletal (sprains) and non-surgical, with 90% occurring during the insertion. The lower extremity, particularly the ankle, was the most frequently injured area. It is hoped that this study will assist those who are planning to support future, similar nighttime parachute operations.

Adult↗
PubMed1992

The content of outpatient family practice care in an Army community hospital: one physician's three-year experience.

The purpose of this pilot study was to describe the 3-year experience of ambulatory medical care provided by one family physician in an Army community hospital. Data collected at each outpatient visit included the patient's age, race, gender, problems actively addressed, and procedures. There were 7,895 outpatient visits, representing 3,665 patients and 2,292 families. Of the 13,158 problems recorded, the 10 most frequent were pregnancy care, general medical examination, alcohol and tobacco use, hypertension, depression/anxiety, contraception, otitis media, acute upper respiratory infection, vaginitis, and headache. Further studies should be done to validate this pilot study.

Ambulatory Care↗
PubMed1992

Outcome of infants born with nuchal cords.

BACKGROUND: The effect of a nuchal cord on the outcome of delivery is controversial. The purposes of this study were to investigate the frequency of nuchal cords and determine the effect that nuchal cords have on the neonate. METHODS: In a retrospective, case-control study, 706 consecutive infant deliveries in a community hospital were evaluated. Sixteen deliveries that were complicated by the umbilical cord entangled around an extremity or by a prolapsed cord were excluded from further analysis. The study group consisted of the 167 deliveries (23.7%) complicated by a nuchal cord. The remaining 523 deliveries were used as the control group. RESULTS: There were no significant differences found in maternal age, race, parity, prepregnancy weight, or amount of weight gain between the mothers of the infants in the two groups. Fetal bradycardia and variable decelerations in fetal heart rate occurred almost twice as often in the nuchal cord group (18.6% as compared with 9.6%, P less than .01). Despite this finding, there was no significant difference in the number of operative deliveries or in Apgar scores at 1 and 5 minutes between the two groups. There were no perinatal deaths associated with nuchal cords. Infants born with nuchal cords weighed less than those in the control group (3345 g compared with 3468 g, P less than .01). There were also significantly fewer large-for-gestational-age and macrosomic infants born in the nuchal cord group. Complications such as jaundice, hypoglycemia, sepsis, and respiratory problems were not increased in the postnatal period because of a nuchal cord. CONCLUSIONS: This study suggests that nuchal cords are common and are rarely associated with significant morbidity or mortality in neonates.

Adult↗
PubMed1987

Variant forms of asthma.

Asthma is an important cause of morbidity in children, and prompt diagnosis and treatment are essential. Asthma has a wide variety of clinical manifestations. Chest pain variant asthma is an important subset of cough variant asthma. A high index of suspicion is required to make the diagnosis. Wheezing is not always present in asthma. Another manifestation, such as chronic cough or chest pain, may be the sole presenting complaint.

Adolescent↗
PubMedDate not supplied

The use of alternative health care by a family practice population.

BACKGROUND: This study examined the characteristics of family practice patients using alternative medicine, the problems that led them to use it, and their satisfaction with its use. METHODS: A confidential questionnaire was mailed to 250 randomly selected adults enrolled in a large military family practice clinic, with a final response rate of 71 percent. RESULTS: More than 28 percent of patients used some form of alternative medicine. The typical user was 30 to 49 years old, female, white, and well educated. Common methods used were chiropractic (64 percent), massage therapy (36 percent), herbal therapy (32 percent), and acupuncture (16 percent). The most common problems for which patients sought alternative care were back pain (56 percent), other musculoskeletal pain (22 percent), and stress or other psychosocial problems (20 percent). Fewer than one half were satisfied with their alternative health care, although 82 percent reported at least some improvement in their conditions. Most (63 percent) had not told their family physician of their use of alternative health care. CONCLUSIONS: A substantial number of family practice patients are using alternative medicine. Although most derive some benefit, most are not satisfied with the results. Reasons for this disparity between satisfaction and effectiveness of alternative medicine deserve further study.

Adolescent↗