Biomedical subjects
M Gorman
Publications and source records attributed to M Gorman.
"Telestroke" : the application of telemedicine for stroke.
BACKGROUND: Time is of the essence for effective intervention in acute ischemic stroke. Efforts including stroke teams that are "on call" around-the-clock are emerging to reduce the time from emergency room arrival to evaluation and treatment. SUMMARY OF COMMENT: Based on the results of the NINDS rt-PA Stroke Trial, which demonstrated both clinical effectiveness in reducing neurological deficits and disability and cost savings to health care systems, many community hospitals and managed-care organizations are exploring methods to enhance and expedite acute stroke care in their local communities. Only a small fraction of acute stroke victims is currently treated with thrombolytics (<1.5% nationally), and few benefit from the expertise and experience of the stroke teams. It is essential to develop new paradigms to improve acute stroke care in all settings, rural and urban. Rapid linkages to expert stroke care can help the underserved areas. Telemedicine for stroke, "Telestroke, " uses state-of-the-art video telecommunications that may be a potential solution and may maximize the number of patients given effective acute stroke treatment across the country and across the world. Telestroke could facilitate remote cerebrovascular specialty consults from virtually any location within minutes of attempted contact, adding greater expertise to the care of any individual patient. This model also has the potential to enhance patient entry into clinical trials. Telestroke would enhance stroke education through the use of Internet-based interactives for health-care professionals and patients. Education would be facilitated through the creation of telecommunication-linked classes providing interactive information on stroke care and prevention to places where they are otherwise not available. Health-care professionals will gain experience and expertise through the interaction with a remote expert--telementoring. Telestroke provides an excellent medium for data collection and an unprecedented opportunity for quality assurance. Monitoring of an entire tele-interaction can offer real-time assessments, which can then be analyzed in-depth at a later date for unique insights into health-care delivery. Prehospital use of telemedicine for stroke is already being piloted, linking patients in the ambulance to the emergency department. Legal and economic parameters must be established for telemedicine in the areas of reimbursement, liability, malpractice insurance, licensing, and credentialing. Issues of protection of privacy and confidentiality, informed consent, product liability, and industry standards must be addressed to facilitate the use of this new and potentially useful technology. CONCLUSIONS: Computer-based technology can now be used to integrate electronic medical information, clinical assessment tools, neuroradiology, laboratory data, and clinical pathways to bring state-of-the-art expert stroke care to underserved areas.
Results of aortic valve replacement for aortic stenosis with relatively low transvalvular pressure gradients.
Fifty-two patients with low gradient critical aortic stenosis who underwent aortic valve replacement were found to have a perioperative mortality of 11% and an 8-year actuarial survival of only 29%. No hemodynamic variables, including valvular resistance, predicted long-term outcome, and the only clinical variable that predicted long-term survival was the absence of coronary artery disease.
Aspergillus fungal mass detected by transesophageal echocardiography.
Cardiac fungal infections have become more prevalent and are being diagnosed with increasing frequency. The most common infective organism is Candida albicans, followed by Aspergillus fumigatus and Cryptococcus. Cardiac involvement is usually associated with endocarditis, myocarditis, pericarditis, or intracardiac fungal mass. Early diagnosis is imperative, as these patients have poor outcome once there is cardiac involvement. In this report we describe a patient in whom an intracardiac mass was detected with transesophageal echocardiography and confirmed to be aspergillus fungal ball at surgery.
What to do when your patient uses illicit drugs.
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Are needle-exchange programs really helpful?
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Pain management needs of patients with HIV or AIDS who also have a history of chemical dependency.
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Validation of an automated up-timer for measurement of mobility in older adults.
OBJECTIVE: To test the reliability, validity and utility of an "up-timer", an automated device to measure time spent standing and walking. DESIGN: Repeat measurement of mobility one week apart in a convenience sample. SETTING: Hostel and nursing homes in Melbourne. PARTICIPANTS: 26 hostel and 24 nursing home residents (aged 70-99 years) participated. They were mobile, with or without the use of walking aids or personal assistance. OUTCOME MEASURES: "Up-time" (measured with the up-timer); functional activity (measured with the Barthel Index, Functional Independence Measure, Timed Up & Go, and Human Activity Profile); and disability (measured by the Rapid Disability Rating Scale). RESULTS: The test-retest reliability of the up-timer was high (Pearson's r = 0.84; P < 0.001). Pearson's correlation between the up-timer results and results of functional and disability measures ranged from r = 0.47 to r = 0.55. The functional measures correlated more highly among themselves (r = 0.79 to r = 0.92). The performance-based Timed Up & Go test had moderate levels of correlation with both the up-timer and the functional measures. Use of the device was well accepted by both participants and staff. CONCLUSIONS: The up-timer is a practical, objective and reliable means of measuring mobility. The useful information it provides is different from, but overlaps with, that obtained from subjective observation or self report. It will complement existing subjective and performance-based measures of activity and mobility.
Expressed sequences from conidial, mycelial, and sexual stages of Neurospora crassa.
In the Neurospora Genome Project at the University of New Mexico, expressed sequence tags (ESTs) corresponding to three stages of the life cycle of the filamentous fungus Neurospora crassa are being analyzed. The results of a pilot project to identify expressed genes and determine their patterns of expression are presented. 1,865 partial complementary DNA (cDNA) sequences for 1,409 clones were determined using single-pass sequencing. Contig analysis allowed the identification of 838 unique ESTs and 156 ESTs present in multiple cDNA clones. For about 34% of the sequences, highly or moderately significant matches to sequences (of known and unknown function) in the NCBI database were detected. Approximately 56% of the ESTs showed no similarity to previously identified genes. Among genes with assigned function, about 43.3% were involved in metabolism, 32.9% in protein synthesis and 8.4% in RNA synthesis. Fewer were involved in defense (6%), cell signalling (3.4%), cell structure (3.4%) and cell division (2.6%).
Use of store and forward technology for vascular nursing teleconsultation service.
Accurate assessment is critical in planning appropriate therapeutic management of a patient with a vascular wound. However, several factors may inhibit wound assessment by trained professionals or subspecialists. Multiple co-morbidities and lack of transportation and finances contribute to problems with access to specialty clinics for both rural and urban patients with vascular disease. To assess the application of telemedicine in meeting the needs of rural patients with vascular disease, the vascular nurse clinician of a regional medical network was incorporated into a telemedicine research project that used a still-image transmission system known as the Picasso telephone, which allows a diagnostic quality image to be transmitted over a regular telephone line. Telephone consultation between sender and receiver occurs simultaneously at the time of image transmission. Because images can be collected and stored for future reference, this technology is commonly called "store and forward" technology. The application of advanced technology in a rural health care environment has the potential to reduce costs for both patient and managed care insurance plans, allow for expert consultation from distant centers, and promote collegiality and learning among professionals.
Helping patients to quit smoking.
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The structure and functions of the HAP1/Ref-1 protein.
The HAP1/Ref-1 (hereafter referred to as HAP1) protein is a nuclear enzyme that apparently performs two distinct roles in the cellular defense against oxidative stress. One well-established role is in the repair of a variety of lesions induced in DNA either by spontaneous hydrolysis or by reactive oxygen species (ROS). This function has been characterized in great detail and the roles played by individual active site amino acid residues have been defined. The second role, which was identified only relatively recently and is still not characterized in detail, is to regulate the DNA binding activity of a group of nuclear factors. This second role proceeds via the modification of the oxidation/reduction (redox) state of a cysteine residue in the target protein, although the mechanism by which this is achieved remains to be elucidated. In this article, we shall review the latest knowledge on the relationship between structure and the dual functions of HAP1, and we will seek to explain in detail the roles played by several individual amino acid residues in the catalytic function of the HAP1 protein.
Identification of intermittent ordered patterns as heteroclinic connections.
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Effects of pancreatic spasmolytic Polypeptide (PSP) on epithelial cell function.
Trefoil peptides are expressed near endodermal ulcerations and may modulate epithelial repair. The trefoil pancreatic spasmolytic polypeptide (PSP) was tested for growth activity in vitro on epithelial cells and in vivo following intragastric or intravenous infusion in parenterally fed intact rats. Ion transport was assessed as changes in short-circuit current in rat intestine and adenocarcinoma cells in Ussing chambers. PSP stimulated growth of MCF-7 and Colo-357 cells, but only in the presence of extracellular glutathione (GSH). The effect was attenuated by GSH depletion with buthionine sulphoximine, even in GSH-containing media. When GSH-reduced PSP was carboxymethylated with iodoacetic acid, it still depended on extracellular GSH for its growth effect. Intestinal epithelial proliferation in rats was not affected by either intravenous or intraluminal infusion. PSP had no effect on basal or stimulated ion flux in rat jejunum or epithelial monolayers. The peptide did not compete with 125I-labeled epidermal growth factor for its receptor. [14C]Iodoacetamide treatment of PSP, followed by prolonged tryptic digestion yielded predominantly a 14C-labeled tetrapeptide fragment containing Cys1O4, with a lesser quantity of a 14C-labeled 15-amino-acid peptide containing Cys95 (molar ratio 15:1). GSH may predominantly reduce the Cys6-Cys1O4 terminal disulphide bond in PSP. We conclude that some epithelia may exhibit a growth response to PSP if extracellular GSH is present. Reduction of PSP by GSH is not necessary for this response, suggesting that the trefoil receptor or its signal transduction is GSH sensitive. PSP could assist wound healing by interactions with epithelial cells exposed concurrently to a local high GSH concentration.
Ratcheting motion of concentric rings in cellular flames.
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Alcoholic patients: keeping hope alive.
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The five phases of behavioral change.
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