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Biomedical subjects

M Dwyer

Publications and source records attributed to M Dwyer.

At least 19 recordsLinked to original sources
PubMed1997

[Sex offenders in legal treatment and their relatives: results of family therapy sessions].

Members of the family of origin and spouses have been invited to take part in a cognitive-behavioral treatment programme for incarcerated sexual offenders to support the offender. Offenders arranged appointments with their spouses, mother, fathers and the therapist. A one-year follow-up reveals considerable change in denying and minimisation of responsibility, forcefullness and degree of sexual intrusiveness of both the offenders and the spouses. Both groups showed a better understanding for and a more positive attitude to the offenders' sexuality. Furthermore, both groups showed a significant increase in applying concepts of relapse prevention.

Adult↗
PubMed1996

Do the ward notes reflect the quality of end-of-life care?

OBJECTIVES: To study the accuracy of reviewing ward notes (chart review) as a measure of the quality of care rendered to patients with "Do Not Resuscitate" (DNR) orders. DESIGN: We reviewed the charts of 19 consecutive, competent inpatients with DNR orders for evidence that the staff addressed a broad range of patient care needs called Concurrent Care Concerns (CCCs), such as withholding treatments other than resuscitation itself, and attention to patient comfort needs. We then interviewed the patient, consultant physician, house officer, and primary nurse and compared the ward notes with the understandings of these staff members. SETTING: The medical service of an urban university medical centre. RESULTS: The average number of documented CCCs addressed per DNR order was 1.1. The ward notes generally agreed with the perceptions of patients, house officers, and nurses (% agreement with notes = 79%, 77%, and 82%; kappa = 0.43, 0.40, 0.50). Consultant physicians' understandings were poorly reflected in the ward notes (% agreement = 59%; kappa = 0.18). They overestimated attention to CCCs compared with the notes (P < 0.0001) and with other observers (P < 0.0001). CONCLUSION: Chart review for attention to CCCs accurately reflects the understandings of patients, house officers, and nurses, but consultant physicians report more attention to CCCs than is recorded in the ward notes or understood by other observers. Better communication regarding end-of-life care plans should be encouraged.

Advance Care Planning↗
PubMed1995

Knowledge, confidence, and attitudes regarding medical ethics: how do faculty and housestaff compare?

BACKGROUND: It has been suggested that faculty members' inadequate knowledge of and unfavorable attitudes toward ethics may present barriers to effective education in ethics for house officers. METHOD: To test this hypothesis, the authors administered a questionnaire assessing the knowledge, confidence, and attitudes regarding ethics of the 73 house officers and 73 full-time faculty members in the Department of Medicine at the Georgetown University Medical Center in 1992-93. Statistical analysis of the responses was performed using chi-square, two-tailed t-tests, and linear regression. RESULTS: Fifty-five house officers (75%) and 57 faculty (78%) responded. The knowledge scores were similarly low for both groups (53% correct for the faculty and 50% for the house officers). However, the faculty were significantly more confident than the house officers regarding ability to address ethical issues (mean ratings of 3.9 vs 3.4 on a scale from 1, very low, to 5, very high; p = .0001). Seventy-five percent of the faculty and 65% of the house officers believed that ethics training should be mandatory during residency. CONCLUSION: The attitudes of the faculty per se do not appear to represent a barrier to teaching ethics. However, the gap between the faculty members' confidence and knowledge could interfere with their abilities to model and teach ethics to house officers.

Academic Medical Centers↗
PubMed1991

Ventricular fibrillation complicating endomyocardial biopsy of a cardiac allograft.

Transvenous endomyocardial biopsy remains the most useful diagnostic aid in assessing rejection in the transplanted heart. Although invasive, the complications associated with endomyocardial biopsy are few, and the procedure is generally regarded as safe. We report a case of apparent ventricular fibrillation complicating transvenous endomyocardial biopsy. Histologic section revealed evidence of moderate acute rejection. This case represents the first report of a life threatening ventricular dysrhythmia following routine endomyocardial biopsy in a cardiac transplant recipient.

Cardiomyopathy, Dilated↗
PubMed1991

Cloning and characterization of the gene for an additional extracellular serine protease of Bacillus subtilis.

We have purified a minor extracellular serine protease from a strain of Bacillus subtilis bearing null mutations in five extracellular protease genes: apr, npr, epr, bpr, and mpr (A. Sloma, C. Rudolph, G. Rufo, Jr., B. Sullivan, K. Theriault, D. Ally, and J. Pero, J. Bacteriol. 172:1024-1029, 1990). During purification, this novel protease (Vpr) was found bound in a complex in the void volume after gel filtration chromatography. The amino-terminal sequence of the purified protein was determined, and an oligonucleotide probe was constructed on the basis of the amino acid sequence. This probe was used to clone the structural gene (vpr) for this protease. The gene encodes a primary product of 806 amino acids. The amino acid sequence of the mature protein was preceded by a signal sequence of approximately 28 amino acids and a prosequence of approximately 132 amino acids. The mature protein has a predicted molecular weight of 68,197; however, the isolated protein has an apparent molecular weight of 28,500, suggesting that Vpr undergoes C-terminal processing or proteolysis. The vpr gene maps in the ctrA-sacA-epr region of the chromosome and is not required for growth or sporulation.

Amino Acid Sequence↗
PubMed1990

Surgery for refractory epilepsy.

Over a six-year period, 130 patients with medically intractable epilepsy were assessed for possible surgical treatment. Initial assessment comprised full neurological and neuropsychological examination, computed tomographic and magnetic resonance imaging brain scanning, and simultaneous video and surface plus sphenoidal electroencephalographic (EEG) recordings of typical seizures. Forty-one patients (32%) underwent further video and EEG recordings of their seizures with depth (intracerebral) or strip (subdural) electrodes. After these assessments 46 patients (35%) underwent surgery, and follow-up for six months to six years is reported in 41 patients. Of 30 patients who underwent temporal lobe surgery, 21 (70%) are free of seizures and four have had significant seizure reduction, meaning that 83% benefited from surgery. Optimal results were obtained for complex partial seizures when depth electrode recordings were obtained and when abnormal tissue was removed. Six extratemporal resections abolished seizures in two patients, and four others showed worthwhile improvement. Five patients underwent corpus callosotomy, resulting in a worthwhile improvement in three and modest improvement in two patients. No deaths or major complications occurred. It is concluded that surgical intervention can be beneficial for up to 30% of patients with medically intractable epilepsy, and referral of these patients to an appropriate institution is encouraged.

Brain↗
PubMed1990

Bioavailability of a new sustained-release theophylline capsule in fasted and non-fasted healthy subjects: single and multiple dosing studies.

Eighteen healthy, non-smoking, adult volunteers participated in single and multiple dose three-way crossover studies to evaluate a sustained-release, pellet-filled capsule of theophylline, Austyn. The effect of food on the bioavailability of the sustained-release capsule was investigated by administering 300 mg single doses of Austyn, with a high-fat meal and without food and a divided 300 mg dose of the reference product Elixophyllin elixir, given after fasting. Plasma theophylline concentrations were measured by fluorescence polarization immunoassay (FPIA) which had been validated against HPLC. The single dose study data showed that there were no significant differences (n = 18, ANOVA, p greater than 0.05) between the three regimens with respect to AUC0-infinity values (mg h l-1), (mean +/- SD); Elixophyllin fasting = 97.1 +/- 33.7, Austyn with food = 90.9 +/- 31.3, Austyn fasting = 91.2 +/- 33.8. Similarly, multiple dosing with rapid-release Nuelin tablets, Austyn capsules, and sustained-release Theo-Dur tablets demonstrated that there were no significant differences between regimens with respect to AUC0-24h, AUC0-12h, and AUC12-24h values calculated from the steady-state concentrations (5th day, 24 h sampling). However, the percentage fluctuation at steady-state over the total blood sampling period was significantly less for treatment with the sustained-release capsule. Austyn, compared with the sustained-release tablet, Theo-Dur (Austyn = 36.7 +/- 13.7 per cent, Theo-Dur = 53.1 +/- 14.1 per cent). The results of the single and multiple dose studies indicate that Austyn capsules demonstrate complete bioavailability, and good controlled release characteristics not influenced by concomitant intake of a high-fat meal and with no evidence of dose dumping.

Adult↗
PubMed1988

Evaluation of serum testosterone and luteinizing hormone levels in sex offenders.

Testosterone levels were analyzed in a group of nonviolent sex offenders and compared to normal controls; the offenders had significantly lower levels (P = 0.0016). This finding differs from reports of violent offenders who have been shown to have higher testosterone levels than normals, but concurs with a previous study done at the University of Minnesota, Department of Family Practice and Community Health, which found nonviolent sex offenders to have significantly lower testosterone levels than normals. Luteinizing hormone levels were in the normal range for both groups.

Adult↗
PubMed1987

Selection criteria for surgery in patients with refractory epilepsy.

Between February 1983 and August 1986, 53 patients underwent inpatient evaluation at the Neuropsychiatric Institute, Prince Henry Hospital to determine their suitability for epilepsy surgery. The patients were first continuously monitored with a video camera during surface and sphenoidal electrode telemetry. During this phase, clinical, radiological, neuropsychological and psychosocial evaluations were performed and intracarotid sodium amylobarbitone injections were used to lateralise language and memory function. Following this evaluation, 30 patients were considered not suitable for further investigation. Six patients were able to have definitive surgery without further evaluation while 17 required depth electrode studies. These patients had flexible wires inserted into their frontal and temporal lobes under stereotactic guidance and video recording and depth electrode telemetry was continued until typical seizures were characterised. These studies led to a further 9 operations; one patient was suitable for operation but deferred surgery. When the original 53 patients were classified according to seizure type, the outcome was as follows. 1. Twelve patients had classical complex partial seizures (CPSs) only and 5 of these had temporal lobe surgery. 2. Five had CPSs with motor accompaniments and 3 of these had temporal lobe surgery. 3. Seven had CPSs and generalised seizures; one had temporal lobe and another frontal lobe surgery. 4. Four had partial simple seizures with secondary generalisation and 3 had cortical excisions (2 frontal, 1 occipital lobe) surgery. 5. Twenty-two patients had mixed seizure disorder; one had lesion excision and one had corpus callosum section in 2 stages. 6. Three patients were non-epileptic.

Adolescent↗
PubMed1986

Solubilization of native actin monomers from human erythrocyte membranes.

Up to 50% of the actin in erythrocyte membranes can be solubilized at low ionic strength in a form capable of inhibiting DNAse I, in the presence of 0.4 mM ATP and 0.05 mM calcium. In the absence of calcium and ATP, actin is released but is apparently rapidly denatured. Solubilization of G-actin increases with temperature up to 37 degrees C. At higher temperatures, actin is released rapidly but quickly loses its ability to inhibit DNAse I.

Actins↗
PubMed1981

A new temperate phage of streptomyces venezuelae: morphology, DNA molecular weight and host range of SV2.

A new, narrow host range temperate phage, SV2, was isolated from soil. It lysogenized and lysed strains of Streptomyces venezuelae and seemed to be specific for this species. In general morphology, the virions were typically lambdoid, but had unusually ringed tails similar to those of some rare phages isolated from hosts belonging to different bacterial genera. The molecular weight of double-stranded linear SV2 DNA, estimated at about 24 X 10(6), was lower than the published values for other Streptomyces phages.

Bacteriophages↗
PubMed1978

Effect of hospitalization on weight of psychiatric patients.

The hypothesis that patients hospitalized for long periods and receiving psychotrophic drugs increase in weight is tested, and it was discovered that women patients were somewhat heavier than their 'standard' weights. This, however, was not due to hospitalization or drug effects. Contrary to expectation, the ratio of observed/'standard' weight frequently observed in affective disorder patients, we discovered puzzling higher mean ratios in men with this illness. This paper shows that small research projects can be carried out by nurses who are actively involved in patient care. It also demonstrates that small scale investigations, replicating locally some other research, testing its validity in a different setting are eminently worthwhile.

Adult↗
PubMedDate not supplied

Wegener's granulomatosis presenting with sclerokeratitis diagnosed by antineutrophil cytoplasmic autoantibodies (ANCA).

A 23-year-old male presented with bilateral sclerokeratitis. He reported recent bronchitis, sinusitis, dyspnea on exertion, hemoptysis, arthralgias and myalgias. Wegener's granulomatosis was diagnosed by a positive antineutrophil cytoplasmic autoantibody (ANCA) test and a nasal and subglotic biopsy showing granulomatous inflammation. Treatment with cyclophosphamide, systemic corticosteroids and trimethoprim/sulfamethoxazole resulted in resolution of the sclerokeratitis and remission of the disease.

Adult↗
PubMedDate not supplied

A guide to the Harvard referencing system.

This article explains how to reference an academic work using the Harvard system. Instructions comply with the relevant British standards, i.e. BS 5605:1990, BS 1629:1989 and BS 6371:1983. The importance of referencing in an approved manner is discussed and problem areas such as joint authors, corporate authorship and unpublished works are examined. The issue of second-hand references that are not addressed by the standards is also explained.

Authorship↗