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Biomedical subjects

K Murphy

Publications and source records attributed to K Murphy.

At least 109 records · Page 6Linked to original sources
PubMed1998

Stent revascularization for atherosclerotic renal artery stenosis. 1-year clinical follow-up.

Patients who had undergone stent revascularization of renal artery stenosis for poorly controlled hypertension, preservation of renal function, or both were monitored to assess the procedure's effect upon subsequent renal function and blood pressure control. At 1-year follow-up, systolic and diastolic blood pressures had significantly decreased (166 +/- 26 to 156 +/- 25 mmHg and 86 +/- 14 to 80 +/- 13 mmHg, respectively; P < 0.05), and creatinine levels decreased or remained stable in approximately two thirds of the patients. Renal artery stent revascularization appears to have a beneficial effect upon blood pressure control and a nondeleterious effect upon renal function in the majority of patients.

Aged↗
PubMed1998

Molecular biology of septic shock.

Septic shock is a complex pathophysiologic state which often leads to multiple organ dysfunction, multiple organ failure, and death. This review summarizes current views on the molecular biology of three aspects of septic shock: recognition of bacterial invasion and induction of the cytokine response; genetic variability among humans and their predispositions toward pathologic inflammatory responses; and the signal transduction mechanisms which account for the transfer of molecular signals from cytokine receptors on the plasma membrane to cytokine-responsive genes in the nucleus. In particular, the review summarizes the pathway involved in tumor necrosis factor signaling through nuclear factor-kappaB, and elucidates the molecular signals involved in inflammatory responses and apoptosis.

Apoptosis↗
PubMed1997

Pharmacoeconomic comparison of treatments for the eradication of Helicobacter pylori.

BACKGROUND: Patients with Helicobacter pylori-induced duodenal ulcer should have their infection eradicated. The optimal choice of antibiotic therapy, however, is less clear. OBJECTIVE: To evaluate costs and outcomes of treatment with 8 antibiotic regimens with documented activity against H pylori vs maintenance therapy with histamine2-receptor antagonists (H2RA). METHODS: A meta-analysis for 119 studies enrolling 6416 patients to determine aggregate eradication rates. The complexity of each regimen was used to determine the anticipated compliance rate and actual effectiveness. A decision analytic model with Monte Carlo simulation determined annual costs and health outcomes. RESULTS: Average annual total costs of testing for H pylori infection and antibiotic treatment ranged from $223 to $410 and prevented ulcer recurrence in 70% to 86% of patients. The H2RA maintenance therapy cost $425 and prevented recurrence in 72% of patients. The lowest costs and recurrence rates were achieved by 3 regimens: standard triple therapy (a combination of bismuth subsalicylate, metronidazole, and tetracycline hydrochloride) for 14 days ($223, with 18% recurrence); a combination of clarithromycin, metronidazole, and a proton pump inhibitor for 7 days ($235, with 15% recurrence); and standard triple therapy with a proton pump inhibitor for 7 days ($236, with 14% recurrence). CONCLUSION: Treatment with any regimen resulted in lower costs compared with H2RA maintenance therapy. Three antibiotic regimens had consistently lower costs and better outcomes: standard triple therapy for 14 days, metronidazole, clarithromycin, and a proton pump inhibitor for 7 days, and standard triple therapy plus a proton pump inhibitor for 7 days.

Anti-Bacterial Agents↗
PubMed1997

Recombinant human 92-kDa type IV collagenase/gelatinase from baculovirus-infected insect cells: expression, purification, and characterization.

Human 92-kDa type IV collagenase/gelatinase (MMP9) has been expressed in insect cells and secreted into the cell medium via a baculovirus expression system. The expression level of the proenzyme from Trichoplusia ni cells was estimated to be > = 300 mg/L of cell medium. The recombinant protein was purified in a single step using heparin-affinity chromatography with an overall yield of ca. 70%. The purified zymogen could be activated in vitro using 4-aminophenylmercuric acetate to yield an active protease. Kinetic analysis of the activated recombinant enzyme demonstrates that this material is comparable to activated MMP9 from natural human sources. The recombinant enzyme provides a useful source of protein for a variety of biochemical and biophysical studies aimed at elucidating the structure and function of human MMP9.

Amino Acid Sequence↗
PubMed1997

Development of the nursing home Resident Assessment Instrument in the USA.

BACKGROUND: the nursing home Resident Assessment Instrument (RAI) includes a set of core assessment items, known as the Minimum Data Set (MDS), for assessment and care screening and more detailed Resident Assessment Protocols in 18 areas that represent common problem areas or risk factors for nursing home residents. Its primary use is clinical, to assess residents on admission to the nursing home, at least annually thereafter and on any significant change in status and to develop individualized, restorative plans of care. AIM: to describe the content and development of the RAI, including US testing for MDS item reliability and validity of the RAI, and the results of a 4-year evaluation of the effects of its clinical use. CONCLUSIONS: the evaluation found that implementation of the RAI was associated with significant improvements in a variety of measures of process quality, resident functional outcomes and reduced hospitalization. Other uses of the RAI data in the USA-including payment using resident classification systems and, with RAI-based outcome-oriented quality indicators, quality assurance activities-and the status of RAI use in other countries are also summarized.

Aged↗
PubMed1997

Variation in training programmes for Resident Assessment Instrument implementation.

BACKGROUND: this paper provides an overview of the Minimum Data Set/Resident Assessment Instrument (MDS/RAI) training programmes in eight countries where the system has been introduced into nursing homes. Formal education and training in the skills of assessment and care planning of nursing home personnel is reputed to be poor. In response to this problem several researchers and clinicians view MDS/RAI implementation as an opportunity to upgrade staff knowledge in care of elderly people. RESULTS: the courses in the eight countries varied in content and length according to the different goals each interRAI researcher planned when the MDS/RAI was implemented. As expected the greatest differences in training approach were between the USA and other countries. In the USA, where the MDS/RAI was mandated for use in all nursing homes, tens of thousands of professionals had to be oriented to use the system in a relatively short period of time in order to comply with the law. The training programmes therefore tended to be very short compared with those that emerged in countries where the MDS/RAI was freely chosen and implemented.

Aged↗
PubMed1997

Rehabilitation in nursing homes: a cross-national comparison of recipients.

OBJECTIVE: to examine the prevalence of therapy use in nursing homes in selected countries and to describe the characteristics of nursing home residents who receive therapy. DESIGN and SAMPLING: the design of the study is cross-sectional, using Minimum Data Set (MDS) assessments of nursing home residents. The sample includes all nursing home residents in six US states (n = 273491), in Copenhagen, Denmark (n = 3451), Reyjkavik, Iceland (n = 1254), and selected locations in Italy (n = 1089) and Japan (n = 1255). METHOD: we determined who had received physical or occupational therapy treatments in the last 7 days. Demographic and clinical characteristics of recipients were compared relative to other nursing home residents within each country. RESULTS: in the five countries, the prevalence of receiving therapy was 31% (Iceland), 30% Japan), 23% (Denmark), 14% (Italy) and 11% (USA). Substantial proportions of the recipients were over the age of 85, were clinically stable and had been in the nursing home for longer than 90 days. Across all countries, residents with poorer activities of daily living (ADL) scores but good cognitive scores were more likely to receive therapy than other residents. Rehabilitation nursing, an adjunct to therapy, was concentrated on residents with poor ADL scores. CONCLUSIONS: substantial numbers of long-stay residents receive therapy in nursing homes, including those over the age of 85 years and those with cognitive impairment. Hence, future rehabilitation outcome studies can involve these previously understudied patient populations.

Activities of Daily Living↗
PubMed1997

VP7: an attachment protein of bluetongue virus for cellular receptors in Culicoides variipennis.

The importance of VP7 of bluetongue virus (BTV) in the binding of BTV to membrane proteins of the BTV vector Culicoides variipennis was investigated. Core BTV particles, prepared from whole viruses, lacked outer proteins VP2 and VP5 and had VP7 exposed. More core particles and whole viruses bound to membrane preparations of adults of C. variipennis and KC cells, which were cultured from this vector insect, than to membrane preparations of Manduca sexta larvae. More core particles than whole viruses bound to membrane preparations of adults of C. variipennis and KC cells. Polyclonal anti-idiotypic antibodies (anti-Id), which were made against an antigen-combining region of an anti-BTV-10 VP7 antibody and functionally mimicked VP7, bound more to the membrane preparations of adults of C. variipennis and KC cells, and less to cytosol preparations. In Western overalay analysis, the Culicoides plasma membrane preparation reduced binding of an anti-VP7 monoclonal antibody to VP7. Whole and core BTV particles and the anti-Id bound to a membrane protein with a molecular mass of 23 kDa that was present predominantly in membrane preparations of adults of C. variipennis and KC cells. This protein was present in much lower concentrations in membrane preparations of C6/36 and DM-2 insect cells.

Animals↗
PubMed1997

A commitment to change: revision of HCFA's RAI.

OBJECTIVE: To describe the reliability of new assessment items and their clinical utility as judged by experienced nurse assessors, based on the results from the field test of Version 2.0 of the Resident Assessment Instrument (RAI). DESIGN: Independent dual assessment of residents of nursing facilities by staff nurses using a draft of Version 2.0 of the minimum data set (MDS). SETTING AND PARTICIPANTS: A total of 187 randomly selected residents from 21 nursing homes in seven states volunteered to test Version 2.0 of the MDS. MEASUREMENT: The full array of MDS assessment items included measures in the following areas: Background information, cognitive patterns, communication/hearing, vision, mood and behavior, psychosocial well-being, physical functioning and structural problems, continence, disease diagnoses, health condition, oral/nutritional status, dental status, skin condition, activity pursuit patterns, medications, special treatments and procedures, and discharge potential and overall status. RESULTS: Evaluative data address issues of MDS item utility and reliability. For new items, almost all achieved a reasonably high-weighted Kappa interrater reliability; revised items also surpassed earlier items, and with the updated training materials, even the non-changed items had higher average reliability levels. Based on the success of the field test and the positive response of the industry, Version 2.0 of the RAI has been adopted, and HCFA has initiated a more long-range process to update further the RAI when necessary. CONCLUSION: Findings support the reliability and clinical utility of the new and revised assessment items incorporated by HCFA in Version 2.0 of the MDS.

Activities of Daily Living↗
PubMed1997

Criteria for enrolling dementia patients in hospice.

OBJECTIVE: Because survival time varies greatly, it is difficult for dementia patients to meet a key criterion for eligibility for the Medicare hospice benefit: a 6-month survival time. We have developed criteria for the Medicare hospice benefit that include the characteristics of advanced dementia and related medical complications. The purpose of the study was to determine survival time among dementia patients who met these criteria. Additionally, because the National Hospice Organization (NHO) developed its own guidelines while the study was in progress, we retrospectively examined the application of these guidelines to our sample. DESIGN: Two cohorts of hospice patients were studied longitudinally, each for 2 years. SETTING: Nine Midwestern hospice programs. PARTICIPANTS: Forty-seven patients were enrolled in home hospice and institutional hospice settings. MEASUREMENTS: Survival time consisted of the number of days between enrollment in the hospice program and death or the end of the study. Other measures included Activities of Daily Living, ratings of Appetite, Nourishment, and Mobility, Functional Assessment Staging (FAST), a Medical Complications Checklist, and a care plan concerning the use of medications for acute illness. RESULTS: Our hospice enrollment criteria predicted a median survival time of 4 months and a mean survival time of 6.9 months; 38% of patients survived for more than 6 months. FAST scores and Mobility ratings were significantly related to survival time. However, 41% could not be scored on the FAST as their disease progression was not ordinal. Among patients who could be scored on the FAST and who had reached Stage Seven C, their mean survival time was 3.2 months compared with 18 months among those who could be scored and had not reached this stage and 8.6 months among patients whose disease progression was not ordinal, P < .001. When the palliative care plans were examined, less aggressive care plans resulted in shorter survival times, P < .01. CONCLUSION: Our hospice enrollment criteria identified a group with a median survival time of 4 months and a mean survival time of 6.9 months. Using NHO criteria relying on the FAST allows the identification of a subgroup with very high mortality and a short time until death. Although the FAST can identify a subgroup of appropriate candidates for hospice, sole reliance on this measure might decrease access to hospice care for many dementia patients.

Activities of Daily Living↗
PubMed1997

A survey of grief and bereavement in nursing homes: the importance of hospice grief and bereavement for the end-stage Alzheimer's disease patient and family.

OBJECTIVES: To determine the prevalence of grief and bereavement services in nursing homes. To highlight the importance of grief and bereavement as provided in the Medicare hospice benefit for the end-stage Alzheimer's Disease (AD) patient and family residing in long-term care facilities. DESIGN: Telephone survey of nursing homes. PARTICIPANTS: One hundred twenty-one nursing homes in the Lower Peninsula of the state of Michigan. MEASUREMENTS: The facilities were asked questions about on-site grief and bereavement services, services routinely offered by licensed hospice agencies. RESULTS: Fifty-five percent of the homes sent sympathy cards after the patients death. Ninety-nine percent of the facilities surveyed did not provide materials to the family or primary caregiver on the grieving process or bereavement after the death. None of the facilities sent a letter after the patients death informing them of local, community or on-site bereavement support group meetings. Seventy-six percent of the homes were not able to offer a referral to a counseling or psychiatric professional when bereavement intervention was deemed appropriate. Fifty-four percent of the homes usually went to the funeral home or the funeral of a patient who died it their facility. Ninety-eight percent of the nursing homes neither visited, made phone calls, nor provided written communication (i.e., bereavement newsletter) to the family members after the patients death. CONCLUSION: The study demonstrated few grief and bereavement services for families of patients residing in long-term care facilities. Because grief and bereavement is part of the career of most Alzheimer's caregivers, access to the Medicare hospice benefit should be encouraged for families of patients with end-stage Alzheimer's Disease residing in nursing facilities.

Alzheimer Disease↗
PubMed1997

Cerebral areas associated with motor control of speech in humans.

We have defined areas in the brain activated during speaking, utilizing positron emission tomography. Six normal subjects continuously repeated the phrase "Buy Bobby a poppy" (requiring minimal language processing) in four ways: A) spoken aloud, B) mouthed silently, C) without articulation, and D) thought silently. Statistical comparison of images from conditions A with C and B with D highlighted areas associated with articulation alone, because control of breathing for speech was controlled for; we found bilateral activations in sensorimotor cortex and cerebellum with right-sided activation in the thalamus/caudate nucleus. Contrasting images from conditions A with B and C with D highlighted areas associated with the control of breathing for speech, vocalization, and hearing, because articulation was controlled for; we found bilateral activations in sensorimotor and motor cortex, close to but distinct from the activations in the preceding contrast, together with activations in thalamus, cerebellum, and supplementary motor area. In neither subtraction was there activation in Broca's area. These results emphasize the bilaterality of the cerebral control of "speaking" without language processing.

Adult↗
PubMed1996

Reversibility of T helper 1 and 2 populations is lost after long-term stimulation.

Commitment of T helper 1 (Th1) or Th2 populations developing during an immune response to a pathogen, or an inappropriate immune response to an allergen or autoantigen, may determine the difference between health and chronic disease. We show that strongly polarized Th1 and Th2 populations assessed by immunoassay are heterogeneous using flow cytometry to detect single cells producing interferon gamma (IFN-gamma) and interleukin 4 (IL-4). Th1 populations arising after 1 wk of stimulation in IL-12 plus anti-IL-4 antibodies could convert to Th2 cells when restimulated in IL-4. Th2 populations resulting from stimulation for 1 wk in IL-4 could give rise to Th1 cells upon restimulation in IL-12 plus anti-IL-4. In contrast, the cytokine profiles of long-term Th1 and Th2 populations arising originally from repeated stimulation in IL-12 or IL-4 appeared more homogeneous and were not reversible, although IL-4 dramatically reduced the number of IFN-gamma-producing Th1 cells. This may explain previous reports that Th1 cells can be converted to Th2 cells.

Allergens↗
PubMed1996

Control of breathing in man; insights from the 'locked-in' syndrome.

Control of breathing was studied in a patient with a lesion in the ventral pons; no volitional behaviour, including voluntary breathing acts, was possible (locked-in syndrome, LIS). Spontaneous breathing via a tracheostomy maintained a normal PETCO2 of 39-40 mmHg. Variability of ventilatory parameters awake was similar to that seen in five tracheostomized control subjects during stage IV sleep but much smaller than during resting wakefulness. Emotion associated with laughter caused disturbances of breathing. The ventilatory response to CO2 was normal and was associated with 'hunger for air' when the PETCO2 was 49-50 mmHg. Mechanical ventilation to reduce PETCO2 by as little as 1 mmHg resulted in apnoea when the ventilator was disconnected; breathing resumed when PETCO2 crossed the threshold of 39-40 mmHg. These results demonstrate the functional dependence of the human medullary respiratory oscillator on a threshold level of PCO2 in the absence of cortico-bulbar input, even during wakefulness. The absence of such input may explain the regularity of breathing.

Adult↗
PubMed1996

Site of facilitation of diaphragm EMG to corticospinal stimulation during inspiration.

The electromyographic response of the diaphragm to (a) transcutaneous electrical stimulation (TCES) of the spinal cord at C5 and above, (b) transcranial magnetic stimulation (TMS) over the motor cortex and (c) transcutaneous electrical stimulation of the phrenic nerve in the neck (TPNS), was recorded in six normal subjects at the antero-lateral chest wall. The compound motor evoked potentials (cMEPs) recorded in response to both TMS and TCES were facilitated to a similar extent during volitional inspiration; this facilitation was greater than any change seen in response to TPNS with inspiration. The results show that facilitation of the response in the diaphragm to TMS during volitional inspiration is due to increased excitability at synapses associated with the spinal motoneurone pool, but they do not exclude a component due to increased higher centre excitability. We conclude that it is unsafe to assign a cortical contribution to 'automatic' inspiration on the sole basis of facilitation of the electromyographic response in the diaphragm to TMS.

Adult↗
PubMed1996

Development, testing, and validation of two scales measuring nursing home management of subjects with mental disorder.

This paper describes the development, testing, and validation of summary scales measuring nursing processes commonly used in caring for elderly nursing home residents with cognitive, mood, and behavior problems, or other markers of mental disorder. Data were obtained from a cross-sectional study of 1017 residents from a proportionate random sample in Delaware nursing facilities, to determine the prevalence of mental disorders and to describe distinguishing characteristics and treatments. An exploratory factor analysis was performed on 11 frequently encountered nursing management strategies as applied to 808 subjects with some indicator of mental disorder. Two factors emerged, which were subsequently conceptualized as separate scales (composed of six and five elements, respectively) that measure the basic approaches termed Encouragement and Control. Alpha reliability levels determined internal consistency for each scale. Cognitive, behavioral, and mood correlates were identified for each scale using multiple regression. Replication and validation were achieved when similar findings were obtained using a random sample of 290 residents at Hebrew Rehabilitation Center for Aged, a 725-bed long-term care facility in Boston. LISREL analyses confirmed the presence of at least two dimensions in behavior management strategies. The identification of these approaches is significant in providing non-pharmacologic and non-restraint alternatives to managing elderly residents with symptom distress.

Aged↗
PubMed1996

Adults with attention deficit hyperactivity disorder: assessment and treatment considerations.

Attention Deficit Hyperactivity Disorder (ADHD) has, historically, been viewed as a childhood disorder which would be outgrown by adulthood. More recent findings have established that the disorder often persists into adult-hood in a significant number of those diagnosed as children. Due to increased awareness and media attention being focused on ADHD in adults, greater numbers of adults are seeking evaluation and treatment for this disorder. The symptoms of ADHD are common to a variety of other psychiatric disorders including learning disabilities, so clinicians need to update their knowledge of assessment, treatment, and differential diagnosis issues regarding this often misunderstood disorder. This article discusses some current methods used in the assessment and treatment of adults with ADHD.

Attention Deficit Disorder with Hyperactivity↗