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Miller DG. Legislative/regulatory update from the International Academy of Compounding Pharmacists. INTERNATIONAL JOURNAL OF PHARMACEUTICAL COMPOUNDING 2012; 16:476-478. [PMID: 23259363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Miller DG. Legislative/Regulatory Update from the International Academy of Compounding Pharmacists. INTERNATIONAL JOURNAL OF PHARMACEUTICAL COMPOUNDING 2012; 16:300-302. [PMID: 23050389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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van Rensburg R, Beyer I, Yao XY, Wang H, Denisenko O, Li ZY, Russell DW, Miller DG, Gregory P, Holmes M, Bomsztyk K, Lieber A. Chromatin structure of two genomic sites for targeted transgene integration in induced pluripotent stem cells and hematopoietic stem cells. Gene Ther 2012; 20:201-14. [PMID: 22436965 PMCID: PMC3661409 DOI: 10.1038/gt.2012.25] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Achieving transgene integration into preselected genomic sites is currently one of the central tasks in stem cell gene therapy. A strategy to mediate such targeted integration involves site specific endonucleases. Two genomic sites within the MBS85 and CCR5 genes [AAVS1 and CCR5 zinc finger nuclease (CCR5-ZFN) site, respectively] have recently been suggested as potential target regions for integration as their disruption has no functional consequence. We hypothesized that efficient transgene integration maybe affected by DNA accessibility of endonucleases and therefore studied the transcriptional and chromatin status of the AAVS1 and CCR5 sites in eight human induced pluripotent stem (iPS) cell lines and pooled CD34+ hematopoietic stem cells. Matrixchromatin immunoprecipitation (ChIP) assays demonstrated that the CCR5 site and surrounding regions possessed a predominantly closed chromatin configuration consistent with its transcriptionally inactivity in these cell types. In contrast, the AAVS1 site was located within a transcriptionally active region and exhibited an open chromatin configuration in both iPS cells and hematopoietic stem cells. To show that the AAVS1 site is readily amendable to genome modification, we expressed Rep78, an AAV2-derived protein with AAVS1-specific endonuclease activity, in iPS cells after adenoviral gene transfer. We showed that Rep78 efficiently associated with the AAVS1 site and triggered genome modifications within this site. On the other hand, binding to and modification of the CCR5-ZFN site by a zinc-finger nuclease was relatively inefficient. Our data suggest a critical influence of chromatin structure on efficacy of site-specific endonucleases used for genome editing.
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Miller DG. The International Academy of Compounding Pharmacists stepping up efforts to remedy problems caused by the U.S. Drug Enforcement Administration's "constructive transfer" policy. INTERNATIONAL JOURNAL OF PHARMACEUTICAL COMPOUNDING 2012; 16:94-96. [PMID: 23050319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Miller DG. Legislative/regulatory update from the International Academy of Compounding Pharmacists. INTERNATIONAL JOURNAL OF PHARMACEUTICAL COMPOUNDING 2012; 16:50-52. [PMID: 23050311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Schartman JP, Coney JM, Hornik JH, Miller DG. Pegaptanib octasodium for the treatment of diabetic macular edema. Expert Opin Pharmacother 2011; 12:1317-1323. [PMID: 21548719 DOI: 10.1517/14656566.2011.579902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Wells HS, Youmans JB, Miller DG. TISSUE PRESSURE (INTRACUTANEOUS, SUBCUTANEOUS, AND INTRAMUSCULAR) AS RELATED TO VENOUS PRESSURE, CAPILLARY FILTRATION, AND OTHER FACTORS. J Clin Invest 2006; 17:489-99. [PMID: 16694596 PMCID: PMC434805 DOI: 10.1172/jci100976] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Wells HS, Miller DG, Drake BM. THE VALIDITY OF RAPID DETERMINATIONS OF THE OSMOTIC PRESSURE OF PROTEIN SOLUTIONS. J Clin Invest 2006; 14:1-6. [PMID: 16694265 PMCID: PMC424646 DOI: 10.1172/jci100642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Wells HS, Youmans JB, Miller DG. A FORMULA AND NOMOGRAM FOR THE ESTIMATION OF THE OSMOTIC PRESSURE OF COLLOIDS FROM THE ALBUMIN AND TOTAL PROTEIN CONCENTRATIONS OF HUMAN BLOOD SERA. J Clin Invest 2006; 12:1103-17. [PMID: 16694185 PMCID: PMC435967 DOI: 10.1172/jci100561] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Youmans JB, Wells HS, Donley D, Miller DG, Frank H. THE EFFECT OF POSTURE (STANDING) ON THE SERUM PROTEIN CONCENTRATION AND COLLOID OSMOTIC PRESSURE OF BLOOD FROM THE FOOT IN RELATION TO THE FORMATION OF EDEMA. J Clin Invest 2006; 13:447-59. [PMID: 16694221 PMCID: PMC436005 DOI: 10.1172/jci100597] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
Choroidal neovascularization (CNV) is a common cause of vision loss in patients <50 years of age. In these patients, CNV is often the result of pathologic myopia, ocular histoplasmosis syndrome, angioid streaks, or idiopathic causes. Rarely, CNV is seen in children, usually in association with inherited macular dystrophies such as Best's disease (vitelliform macular dystrophy) or drusen of the optic nerve. This article discusses the role of optometrists in the detection and management of CNV. Untreated CNV can cause rapid deterioration of central vision and is associated with a poor prognosis. Optometrists may be able to improve the prognosis of younger patients with CNV by recognizing the signs, symptoms, and risk factors for CNV and promptly referring patients with suspected CNV to a retina specialist. They can also help patients by providing long-term support and rehabilitation. Recent treatment advances, such as the availability of verteporfin (Visudyne; Novartis Pharma AG, Basel, Switzerland) therapy, that are applicable to younger patients with CNV have increased the importance of early detection of CNV and prompt referral of patients to a specialist who can treat CNV.
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Miller DG, Crespi B. The evolution of inquilinism, host-plant use and mitochondrial substitution rates in Tamalia gall aphids. J Evol Biol 2003; 16:731-43. [PMID: 14632236 DOI: 10.1046/j.1420-9101.2003.00567.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We used mitochondrial DNA data to infer phylogenies for 28 samples of gall-inducing Tamalia aphids from 12 host-plant species, and for 17 samples of Tamalia inquilinus, aphid 'inquilines' that obligately inhabit galls of the gall inducers and do not form their own galls. Our phylogenetic analyses indicate that the inquilines are monophyletic and closely related to their host aphids. Tamalia coweni aphids from different host plants were, with one exception, very closely related to one another. By contrast, the T. inquilinus aphids were strongly genetically differentiated among most of their host plants. Comparison of branch lengths between the T. coweni clade and the T. inquilinus clade indicates that the T. inquilinus lineage evolves 2.5-3 times faster for the cytochrome oxidase I gene. These results demonstrate that: (1) Tamalia inquilines originated from their gall-inducing hosts, (2) communal (multi-female) gall induction apparently facilitated the origin of inquilinism, (3) diversification of the inquilines has involved rapid speciation along host-plant lines, or the rapid evolution of host-plant races, and (4) the inquilines have undergone accelerated molecular evolution relative to their hosts, probably due to reduced effective population sizes. Our findings provide insight into the behavioural causes and evolutionary consequences of transitions from resource generation to resource exploitation.
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Parker Ward R, Miller DG, Collins KA, DeCara JM, Spencer KT, Mor-Avi V, Lang RM. The effects of harmonic imaging on endocardial visualization during transesophageal echocardiography. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)82515-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Sustained high notes, diminishing gradually from the loudest to the softest phonation within a maneuver called messa di voce, are examined in two contrasting professional tenor voices. Signals of the sound pressure level, electroglottograph, and mean esophageal pressure are recorded, and similar maneuvers by the same subjects are examined stroboscopically. The lyric voice is found to make a gradual diminuendo while maintaining nearly constant posture of the vocal tract together with a phase of complete closure in the glottal cycle. The robust voice, by contrast, passes abruptly from a production of high subglottal pressure and a high closed quotient to one of low pressure and incomplete closure, and the transition is marked by a sudden opening of the previously constricted laryngeal collar. It is proposed that the mode of soft voice production demonstrated by the robust voice be recognized as a distinct register of the singing voice.
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Abstract
High myopia, or pathologic myopia, usually refers to a condition in which individuals have greater than 6 diopters of myopia or an axial length greater than 26 to 27 mm. The natural history of choroidal neovascularization in high myopia is variable, and reports to date have some conflicting information, but analysis shows fairly poor final visual outcomes. This outcome complicates recommendations for treatment and must be considered in future studies aimed at managing this disease.
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Miller DG, Brayton SV, Boyles WT. Chemical oxygen demand analysis of wastewater using trivalent manganese oxidant with chloride removal by sodium bismuthate pretreatment. WATER ENVIRONMENT RESEARCH : A RESEARCH PUBLICATION OF THE WATER ENVIRONMENT FEDERATION 2001; 73:63-71. [PMID: 11558305 DOI: 10.2175/106143001x138705] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Current chemical oxygen demand (COD) analyses generate wastes containing hexavalent and trivalent chromium, mercury, and silver. Waste disposal is difficult, expensive, and poses environmental hazards. A new COD test is proposed that eliminates these metals and shortens analysis time, where trivalent manganese oxidant replaces hexavalent chromium (dichromate). A silver catalyst is not required. Optional pretreatment removes chloride via oxidation to chlorine using sodium bismuthate, eliminating the need for mercury. Sample aqueous and solid components are separated for chloride removal, then recombined for total COD measurement. Soluble and nonsoluble COD can be determined separately. Digestion at 150 degrees C is complete in 1 hour. Results are determined by titration or by spectrophotometric reading. Test wastes contain none of the metals regulated for disposal under the Resource Conservation and Recovery Act. Results are shown for selected organic compounds and various wastewaters. Statistical comparisons are made with dichromate COD and biochemical oxygen demand (BOD5) test values.
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Kash KM, Ortega-Verdejo K, Dabney MK, Holland JC, Miller DG, Osborne MP. Psychosocial aspects of cancer genetics: women at high risk for breast and ovarian cancer. SEMINARS IN SURGICAL ONCOLOGY 2000; 18:333-8. [PMID: 10805955 DOI: 10.1002/(sici)1098-2388(200006)18:4<333::aid-ssu8>3.0.co;2-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In the past five years the advent of cancer genetic testing has created concern about the negative psychosocial sequelae of genetic counseling and testing. Research indicates that the women most likely to seek genetic testing are anxious about carrying a gene mutation and developing breast cancer. Women who are at high risk have poor knowledge and the expectation of being a gene-mutation carrier. High levels of distress have been shown to interfere with decision-making about genetic testing. Further, individuals who decline genetic testing may be at increased risk for depressive symptoms even more than those who are found to be gene-mutation carriers. There is great concern that inappropriate candidates will seek genetic testing. Improved education and access to genetic counseling are essential to help women make appropriate decisions about genetic testing. Strategies for the prevention of breast and ovarian cancer are explored, and methods to reduce the adverse psychosocial effects of decision-making about genetic testing and preventive treatment strategies are suggested.
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Martidis A, Miller DG, Ciulla TA, Danis RP, Moorthy RS. Corticosteroids as an antiangiogenic agent for histoplasmosis-related subfoveal choroidal neovascularization. J Ocul Pharmacol Ther 1999; 15:425-8. [PMID: 10530703 DOI: 10.1089/jop.1999.15.425] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to evaluate the role of corticosteroids in managing subfoveal choroidal neovascularization (CNV) secondary to the presumed ocular histoplasmosis syndrome. The cases of eighteen patients with histoplasmosis-related subfoveal CNV treated with corticosteroids were reviewed. Ten patients received oral prednisone for 4 to 6 weeks, and eight received a single sub-Tenon's injection of triamcinalone. Visual acuity outcomes were analyzed along with side effect profiles. At two-week follow-up, the prednisone group showed a median improvement in Snellen visual acuity of +2.0 lines, while the triamcinalone group remained essentially stable with a 0.5 line median loss. At treatment end (4 to 6 weeks), both groups showed no significant change in median acuity at 0.0 and -1.0 lines, respectively. Median final vision at 3 months also remained essentially stable at -0.5 lines for each group. Three patients reported anxiety, all of whom were taking prednisone 80 mg daily. Two patients reported increased appetite and weight gain on regimens of prednisone 80 and 100 mg daily. There were no adverse effects reported in the other patients receiving oral prednisone or in any patient receiving sub-Tenon's triamcinalone. The results suggest a beneficial effect of corticosteroids in stabilizing subfoveal CNV secondary to ocular histoplasmosis. In this small series, oral prednisone resulted in a short-term improvement in visual acuity, which stabilized over longer follow-up. The sub-Tenon's triamcinalone group achieved similar final stabilization without the initial improvement. Corticosteroids may be particularly valuable in managing neovascularization in patients who are awaiting interventions currently under development, in preventing recurrence after subfoveal surgery, or in treating non-surgical candidates. Further study is warranted to define the precise role of corticosteroids in this condition.
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Svec JG, Schutte HK, Miller DG. On pitch jumps between chest and falsetto registers in voice: data from living and excised human larynges. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 1999; 106:1523-31. [PMID: 10489708 DOI: 10.1121/1.427149] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The paper offers a new concept of studying abrupt chest-falsetto register transitions (jumps) based on the theory of nonlinear dynamics. The jumps were studied in an excised human larynx and in three living subjects (one female and two male). Data from the excised larynx revealed that a small and gradual change in tension of the vocal folds can cause an abrupt change of register and pitch. This gives evidence that the register jumps are manifestations of bifurcations in the vocal-fold vibratory mechanism. A hysteresis was observed; the upward register jump occurred at higher pitches and tensions than the downward jump. Due to the hysteresis, the chest and falsetto registers can be produced with practically identical laryngeal adjustments within a certain range of longitudinal tensions. The magnitude of the frequency jump was measured as the "leap ratio" F0F:F0C (fundamental frequency of the falsetto related to that of the chest register) and alternatively expressed as a corresponding musical interval, termed the "leap interval." Ranges of this leap interval were found to be different for the three living subjects (0-5 semitones for the female, 5-10 and 10-17 for the two males, respectively). These differences are considered to reflect different biomechanical properties of the vocal folds of the examined subjects. A small magnitude of the leap interval was associated with a smooth chest-falsetto transition in the female subject.
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Miller DG, Tiwari R, Pathak S, Hopwood VL, Gilbert F, Hsu TC. DNA repair and mutagen sensitivity in patients with triple primary cancers. Cancer Epidemiol Biomarkers Prev 1998; 7:321-7. [PMID: 9568788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The purpose of this study was to measure DNA repair capacity and mutagen sensitivity in patients who have had three or more primary forms of cancer. It was hypothesized that, if abnormalities in DNA repair and mutagen sensitivity were cancer susceptibility factors, such findings would be seen with regularity in individuals with multiple primary cancers. DNA repair capacity was measured by determining repair of UV-irradiated plasmid DNA (pCMVCAT) transfected into peripheral blood lymphocytes. Results from 18 patients and a like number of age- and sex-matched controls demonstrated a significant difference in DNA repair capacity (P < 0.0001; odds ratio = 14). Mutagen sensitivity was measured by determining the mean number of chromatid breaks per cell after in vitro exposure to either bleomycin or 4-nitroquinoline-1-oxide. The difference in mean bleomycin- or 4-nitroquinoline-1-oxide-induced mutagen sensitivity between cases and controls was not statistically significant. Fourteen of the 18 patients had positive family histories of cancer; in 10, the history was compatible with cancer susceptibility syndromes. Although the numbers were small, there was no suggestion in this study that treatment or the presence of cancer was the cause of the DNA repair abnormalities encountered. These findings support the concept of diminished DNA repair capacity as an underlying feature in the development of a mutator phenotype.
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Miller DG, Sulter AM, Schutte HK, Wolf RF. Comparison of vocal tract formants in singing and nonperiodic phonation. J Voice 1997; 11:1-11. [PMID: 9075171 DOI: 10.1016/s0892-1997(97)80018-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The skilled use of nonperiodic phonation techniques in combination with spectrum analysis has been proposed here as a practical method for locating formant frequencies in the singing voice. The study addresses the question of the degree of similarity between sung phonations and their nonperiodic imitations, with respect to both frequency of the first two formants as well as posture of the vocal tract. Using magnetic resonance imaging (MRI), linear predictive coding (LPC), and spectrum analysis, two types of nonperiodic phonation (ingressive and vocal fry) are compared with singing phonations to determine the degree of similarity/difference in acoustic and spatial dimensions of the vocal tract when these phonation types are used to approximate the postures of singing. In comparing phonation types, the close similarity in acoustic data in combination with the relative dissimilarity in spatial data indicates that the accurate imitations are not primarily the result of imitating the singing postures, but have instead an aural basis.
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Antani MR, Beyth RJ, Covinsky KE, Anderson PA, Miller DG, Cebul RD, Quinn LM, Landefeld CS. Failure to prescribe warfarin to patients with nonrheumatic atrial fibrillation. J Gen Intern Med 1996; 11:713-20. [PMID: 9016417 DOI: 10.1007/bf02598984] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine how often warfarin was prescribed to patients with nonrheumatic atrial fibrillation in our community in 1992 when randomized trials had demonstrated that warfarin could prevent stroke with little increase in the rate of hemorrhage, and to determine whether warfarin was prescribed less frequently to older patients-the patients at highest risk of stroke but of most concern to physicians in terms of the safety of warfarin. DESIGN Cross-sectional study. Appropriateness of warfarin was classified for each patient based on the independent judgments of three physicians applying relevant evidence and guidelines. SETTING Two teaching hospitals and five community-based practices. PATIENTS Consecutive patients with nonrheumatic atrial fibrillation (n = 189). MEASUREMENTS AND MAIN RESULTS Warfarin was prescribed to 44 (23%) of the 189 patients. Warfarin was judged appropriate in 98 patients (52%), of whom 36 (37%) were prescribed warfarin. Warfarin was prescribed to 11 (14%) of 76 patients aged 75 years or older with hypertension, diabetes mellitus, or past stroke, the group at highest risk of stroke. In a multivariable logistic regression model controlling for appropriateness of warfarin and other patient characteristics, patients aged 75 years or older were less likely than younger patients to be treated with warfarin (odds ratio 0.25; 95% confidence interval 0.10, 0.65). CONCLUSIONS Warfarin was prescribed infrequently to these patients with nonrheumatic atrial fibrillation, especially the older patients and even the patients for whom warfarin was judged appropriate. These findings indicate a substantial opportunity to prevent stroke.
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Beyth RJ, Antani MR, Covinsky KE, Miller DG, Chren MM, Quinn LM, Landefeld CS. Why isn't warfarin prescribed to patients with nonrheumatic atrial fibrillation? J Gen Intern Med 1996; 11:721-8. [PMID: 9016418 DOI: 10.1007/bf02598985] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the opinions of selected physicians in our community about use of warfarin for patients with nonrheumatic atrial fibrillation, and to determine the relation of the physicians' opinions to their practices. DESIGN Survey of physicians, using eight hypothetical clinical vignettes to characterize physicians' opinions about use of warfarin in patients with nonrheumatic atrial fibrillation, according to patient age, risk of bleeding, and risk of stroke. SETTING Two teaching hospitals and five community-based practices. PARTICIPANTS Eighty physicians who cared for 189 consecutive patients with nonrheumatic atrial fibrillation. MEASUREMENTS AND MAIN RESULTS The survey response rate was 73%. Nearly all responding physicians (90%) recommended warfarin for at least one vignette. However, physicians recommended warfarin less often for vignettes depicting 85-year-old patients than for matched vignettes depicting 65-year-old patients (odds ratio [OR] 0.03; 95% confidence interval [CI] 0.01, 0.08), and less often for cases with specified risk factors for bleeding than for matched cases without the risk factors (OR 0.01; 95% CI 0.004, 0.03); warfarin was recommended more often for cases with a recent stroke than for matched cases without this history (OR 8.2; 95% CI 3.6, 18). In practice, warfarin was prescribed more often (p < or = .05) by physicians reporting good personal experience and by those who had favorable opinions about its use. However, even physicians with good experience and favorable opinions did not prescribe warfarin to half of their patents for whom warfarin was independently judged appropriate. CONCLUSIONS Physicians' opinions frequently opposed warfarin for older patients with nonrheumatic atrial fibrillation, and for those with bleeding risk factors. Physicians' opinions, as well as other barriers to warfarin therapy, most likely contribute to its infrequent prescription.
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