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Biomedical subjects

A Moorhouse

Publications and source records attributed to A Moorhouse.

14 recordsLinked to original sources
PubMed2001

A study of live supervisory phone-ins in collaborative family therapy: correlates of client cooperation.

The behavior of five supervisors, 19 trainee family therapists, and 20 clients before, during, and after 88 live supervisory phone-in events was examined in this study to determine the correlates of client cooperation. Following supervisory phone-in conversations, client cooperation was associated exclusively with the presence and quality of the collaborative behavior shown by the therapist. Isomorphism between the behavior of the supervisor and therapist was not associated with subsequent client cooperation, nor was any particular category of supervisor behavior. Surprisingly, isomorphism between the quality of supervisor and therapist behavior preceded those events where client resistance occurred.

Adult↗
PubMed2001

When CPR is not an option.

What is to be learned from this situation? First, although Mr. Lockwood's consent for the DNR order is not needed, there is an obligation to communicate openly and clearly with the family and ensure that Mrs. Lockwood's advance directive is respected. This might mean a DNR order needs to be written. Also, there is an obligation to discuss goals of care with the family. The second lesson is that you should reflect on your employer's CPR policies and practice, and ask the following questions: Do the policy and/or practices support saying "no" in a situation such as Mrs. Lockwood's? Also, how does the policy support staff when there is a request for futile CPR, either from a competent patient or from a patient's family? What are the expectations about communication with the family when there is an advance directive and/or when CPR is found to be futile? Knowing what you ought to do for patients is not sufficient. Often you cannot act on these decisions because of the environment. If the policies are not in accord with the CNA Statement on Resuscitative Interventions, you should collaborate with colleagues to revise the CPR policy and practices. By doing so, you will be meeting your obligation to help foster and support a practice environment that promotes ethical, competent and compassionate nursing care.

Advance Directives↗
PubMed1999

Direct effects of tolbutamide on mitochondrial function, intracellular Ca2+ and exocytosis in pancreatic beta-cells.

Using the whole-cell voltage-clamp method to measure ATP-sensitive K+(KATP) currents, changes in cell capacitance to measure secretion and microfluorimetry to monitor intracellular Ca2+ and mitochondrial function, we have investigated the direct effect of sulphonylureas on exocytosis in pancreatic beta-cells. Tolbutamide (100 microM) and 100 nM 4-beta-12-phorbolmyristate-13-acetate (PMA), which activates the protein kinase C (PKC) isoforms found in beta-cells, potentiated exocytosis in a non-additive manner. These effects were blocked by down-regulation of PKC. Our data support the idea that tolbutamide can potentiate secretion from beta-cells via a PKC-dependent pathway. Because PKC and sulphonylureas can modulate the activity of KATP channels, we explored whether the above effects are caused by inhibition of this channel. PMA increased whole-cell KATP currents but did not affect their sensitivity to tolbutamide. Down-regulation of PKC affected neither the magnitude nor the tolbutamide sensitivity of the KATP current. Both tolbutamide and the mitochondrial uncoupler FCCP (1 microM) mobilized intracellular Ca2+ and prolonged Ca2+ transients elicited by cholinergic mobilization of intracellular Ca2+ stores. Tolbutamide (0.1-0.5 mM), like FCCP, depolarized the mitochondrial membrane potential and activated KATP currents. We suggest that sulphonylureas can directly potentiate exocytosis by impairing mitochondrial function and Ca2+ handling, which ultimately leads to activation of Ca2+-dependent enzymes such as PKC.

Adenosine Triphosphate↗
PubMed1996

The sulphonylurea receptor confers diazoxide sensitivity on the inwardly rectifying K+ channel Kir6.1 expressed in human embryonic kidney cells.

1. We have examined the effects of diazoxide and intracellular ATP (ATPi) on whole-cell currents in HEK293 cells transfected transiently with the inwardly rectifying K+ channel Kir6.1 (uKATP1) or cotransfected with Kir6.1 and the sulphonylurea receptor (SUR1). 2. Kir6.1 currents were unaffected by the K+ channel opener diazoxide or by dialysis with 0.3 mM ATPi. 3. Kir6.1-SUR1 currents increased in amplitude when cells were dialysed with 0.3 mM ATP, but not with 5 mM ATP. This activation may be explained by the loss of endogenous ATP from the cell when the intracellular solution contains 0.3 mM ATP. Kir6.1-SUR1 currents were also activated by diazoxide; this activation was greater with 0.3 mM ATP1 than with 5 mM ATP1. 4. We conclude that SUR1 is required to confer both diazoxide and ATP sensitivity on Kir6.1.

Adenosine Triphosphate↗
PubMed1996

Promiscuous coupling between the sulphonylurea receptor and inwardly rectifying potassium channels.

Sulphonylureas are a class of drugs widely used to treat non-insulin-dependent diabetes mellitus. These drugs act by binding to a sulphonylurea receptor (SUR) in the pancreatic beta-cell membrane which inhibits an ATP-sensitive potassium (K-ATP) channel and thereby stimulates insulin secretion. There has been much debate as to whether SUR and the K-ATP channel are the same or separate proteins, whether SUR confers ATP-sensitivity on an ATP-insensitive pore-forming subunit, and whether sulphonylureas can also modulate other types of K-channel. We show here that SUR itself does not possess intrinsic channel activity but that it endows sulphonylurea sensitivity on several types of inwardly-rectifying K-channels. It does not necessarily confer ATP-sensitivity on these channels.

ATP-Binding Cassette Transporters↗
PubMed1993

Needlestick injuries: the shock and reality.

It has been a typically busy Saturday night in the emergency department. Then, near midnight, a trauma casualty was admitted and an incident occurred that would occupy Suzanne Smith's thoughts for months to come. When starting an intravenous line on this patient, Suzanne spiked herself with a needle. Later the patient was taken to the intensive care unit and placed on a ventilator. Suzanne was overcome with fear that she might have contracted AIDS. Her fears intensified when she learned that the patient, Mr. Norman, was a heroin addict.

Fear↗
PubMed1993

User fees: fair cost containment or a tax on the sick?

The federal government's reduction in transfer payments for health and education, in combination with a severe recession, has put provincial and territorial health ministries, health professionals and hospital administrators under immense financial pressure. In response, user fees are being discussed as one way to maintain medicare. Yet, charging levies for health services presents numerous ethical problems. User fees would end the universality of and accessibility to health care for many Canadians. Hence, they would constitute an unfair tax on the sick and the poor. The hardest hit would be the elderly, children, women, aboriginal people, the disabled and the chronically ill.

Cost Control↗
PubMed1989

Spatial variations of the 3 micron emission features within UV-excited nebulae: photochemical evolution of interstellar polycyclic aromatic hydrocarbons.

We have obtained 3 microns spectra at several positions in the Orion Bar region and in the "Red Rectangle," the nebula surrounding HD 44179. The recently discovered weak emission features at 3.40, 3.46, 3.51, and 3.57 microns (2940, 2890, 2850, and 2800 cm-1) are prominent in the Orion Bar region. The 3.40 microns and 3.51 microns features increases in intensity relative to the dominant 3.29 microns (3040 cm-1) feature when going from the ionized to the neutral zone across the Orion Bar. However, only a weak and rather broad 3.40 microns feature is present at the position of HD 44179. These spectra demonstrate that some of the 3 microns emission components vary independently of each other and in a systematic way within UV-excited nebulae. This spatial variation is discussed in terms of the UV excitation and photochemical evolution of polycyclic aromatic hydrocarbons and related molecular structures. The spatial behavior of the weak emission features can be understood qualitatively in terms of hot bands of the CH stretch and overtones and combination bands of other fundamental vibrations in simple PAHs. An explanation in terms of emission by molecular sidegroups attached to the PAHs is less straightforward, particularly in the case of the Red Rectangle and other evolved mass-losing objects. We estimate PAH sizes of 20-50 carbon atoms based on the susceptibility of PAHs to destruction by the far ultraviolet fields present in the Orion Bar and the Red Rectangle; the size range is similar to independent estimates made previously.

Astronomical Phenomena↗
PubMedDate not supplied

An integrated model of discharge planning for acutely-ill elderly patients.

Prior research has demonstrated that current discharge-related practices present resource-related and ethical problems for all those involved. The purpose of this 9-month qualitative study was to develop a more resource efficient and compassionate discharge planning model for acutely-ill, elderly patients. The focus group interviewing method was used to elicit 99 participants' perceptions of an ideal approach to discharge planning. Focus group participants included professionals from acute-care hospitals and community organizations. Telephone interviews were also completed with 25 patients and 6 family members. Themes identified in the analysis revealed that an ideal approach to discharge planning would incorporate seven elements. According to participants, the approach is ideal because it potentially addresses both resource utilization and ethical issues. Program evaluation of the model is underway in order to determine its effectiveness.

Acute Disease↗
PubMedDate not supplied

Organizational support of the clinical nurse specialist role: a nursing research and professional development directorate.

Administrative support is essential for optimal utilization of the Clinical Nurse Specialist (CNS) resource. It has been linked to successful role implementation, role efficacy and job satisfaction. The article addresses how a Nursing Research and Professional Development Directorate (NRPD) provides administrative support of the CNS role. The impact of the directorate on the role functions of practitioner, consultant, educator and researcher is delineated. Specific challenges to the CNS role and organizational benefits are described. A model of organizational support of the CNS, based on the concepts of collaboration and peer mentorship, is proposed. The model emphasizes mutual goal setting to achieve both organizational and professional objectives.

Humans↗