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Biomedical subjects

N Munro

Publications and source records attributed to N Munro.

At least 19 recordsLinked to original sources
PubMed2005

Improving glucose management: ten steps to get more patients with type 2 diabetes to glycaemic goal.

Despite increasingly stringent clinical practice guidelines for glycaemic control, the implementation of recommendations has been disappointing, with over 60% of patients not reaching recommended glycaemic goals. As a result, current management of glycaemia falls significantly short of accepted treatment goals. The Global Partnership for Effective Diabetes Management has identified a number of major barriers that can prevent individuals from achieving their glycaemic targets. This article proposes 10 key practical recommendations to aid healthcare providers in overcoming these barriers and to enable a greater proportion of patients to achieve glycaemic goals. These include advice on targeting the underlying pathophysiology of type 2 diabetes, treating early and effectively with combination therapies, adopting a holistic, multidisciplinary approach and improving patient understanding of type 2 diabetes. Implementation of these recommendations should reduce the risk of diabetes-related complications, improve patient quality of life and impact more effectively on the increasing healthcare cost related to diabetes.

Blood Glucose Self-Monitoring↗
PubMed2003

Recurrent osteoid osteoma of the lunate: a case report and review of the literature.

Osteoid osteoma is a benign tumour of bone that rarely localises in the carpal bones. Its treatment by curettage and bone grafting is considered to be curative and its recurrence is thought to be rare. We report a case of an osteoid osteoma of the lunate, which recurred seven years after the initial operation. Recurrent osteoid osteoma of the lunate bone has not been reported in the literature. We present this case report for its atypical presentation and diagnostic difficulty and also to alert the readers of the possibility of an osteoid osteoma as a cause of the chronic unexplained wrist pain in young adults.

Adult↗
PubMed2002

Is multidisciplinary learning effective among those caring for people with diabetes?

The role of multi-professional learning for those providing clinical services to people with diabetes has yet to be defined. Several assumptions are generally made about education in the context of multi-professional settings. It is argued that different professions learning together could potentially improve professional relationships, collaborative working practices and ultimately standards of care. Greater respect and honesty may emerge from a team approach to learning with a commensurate reduction in professional antagonism. Personal and professional confidence is reportedly enhanced through close contact with other professionals during team-based learning exercises. We have examined current evidence to support multidisciplinary learning in the context of medical education generally as well as in diabetes education. Previous investigation of available literature by Cochrane reviewers, aimed at identifying studies of interprofessional education interventions, yielded a total of 1042 articles, none of which met the stated inclusion criteria. Searches involving more recent publications failed to reveal more robust evidence. Despite a large body of literature on the evaluation of interprofessional education, studies generally lacked the methodological rigour needed to understand the impact of interprofessional education on professional practice and/or health care outcomes. Nevertheless, planners continue to advocate, and endorse, joint training between different groups of workers (including nurses, doctors and those in professions allied to medicine) with the objective of producing an integrated workforce of multidisciplinary teams. Whilst the concept of multi-professional learning has strong appeal, it is necessary for those responsible for educating health care professionals to demonstrate its superiority over separate learning experiences.

Costs and Cost Analysis↗
PubMed2000

Single-strand conformation polymorphism analysis by capillary and microchip electrophoresis: a fast, simple method for detection of common mutations in BRCA1 and BRCA2.

As a result of intensive studies on hereditary breast and ovarian cancers, two breast cancer susceptibility genes, BRCA1 and BRCA2, have been identified. In each gene, a small number of specific mutations have been found at relatively high frequency in certain ethnic populations. The mutations, 185delAG and 5382insC in BRCA1 and 6174delT in BRCA2, have been identified as common mutations in the Ashkenazi Jewish population, with a combined frequency of 2.0 to 2.5%. Women who have one of the above three common mutations are at a high risk of developing breast or ovarian cancer. Consequently, accurate and cost-effective detection of these three mutations may have important implications for risk assessment in susceptible women and men. In this report, we describe a fast and simple capillary electrophoresis (CE)-based method using a polymer network for screening the three common mutations in BRCA1 and BRCA2. Fluorescent dye-labeled primers (6-FAM-tagged) were used to amplify three DNA fragments of 258, 296, and 201 bp for detection of the 185delAG, 5382insC, and 6174delT mutations, respectively. After the PCR products were denatured, a single-strand conformation polymorphism (SSCP) profile could be obtained for each mutation in less than 10 min by CE in a polymer network. We demonstrate the potential provided by translating this assay to the microchip format where the SSCP analysis is complete in 120 s, representing only a fraction of the reduction in analysis time that can be achieved with microchip technology. The speed and simplicity of the SSCP methodology for detection of these mutations make it attractive for use in the clinical diagnostic laboratory.

BRCA1 Protein↗
PubMed2000

Assessing validity in written tests of general practice - exploration by factor analysis of candidate response patterns to paper 1 of the MRCGP examination.

OBJECTIVE: To investigate the content validity of Paper 1 of the MRCGP examination. METHOD: Exploratory factor analysis was carried out on candidate responses to Paper 1 of the May and October MRCGP examination in 1998. Contribution of each test question across factors was assessed using a pattern matrix of the oblique rotation. Common dimensions and variations between factor sets were identified. Key testing areas were then matched against the 'domains of competence' intended to be assessed by Paper 1 (as defined within the examination blueprint matrix). RESULTS: Whilst critical appraisal, disease prevention/evidence-based medicine and clinical management emerged as areas tested consistently, content variation was observed between factor sets extracted from both sittings. In addition, some overlap, in terms of domains tested, was seen among other assessment instruments used within the examination. CONCLUSION: Paper 1 conforms to the majority of its stated intentions. However, further development of techniques for investigating validity will be required in order to minimize content variation between both sittings of the examination as well as to help more closely define areas of competence to be tested by Paper 1 of the MRCGP examination.

Education, Medical, Undergraduate↗
PubMed2000

Pulmonary challenges in neurotrauma.

Traumatic injury to the central nervous system presents a formidable clinical challenge to any practitioner. Part of that challenge is to anticipate the pulmonary sequelae that may occur in this patient population. Direct pulmonary trauma commonly occurs with CNS injury and requires immediate treatment to prevent further compromise of the patient's condition. Neurologic deficits can then be compounded by complications such as ARDS and aspiration pneumonia that can be minimized if not prevented. The nurse is a key health care professional who can implement these interventions and effect better patient outcomes.

Brain Injuries↗
PubMed1999

Acousto-optical deflection-based laser beam scanning for fluorescence detection on multichannel electrophoretic microchips.

Laser beam scanning driven by an acousto-optical deflector (AOD) is presented for multimicrochannel laser-induced fluorescence (LIF) detection during microchip-based electrophoresis. While fast laser beam scanning for LIF detection on capillary or microchannel arrays can been achieved with galvanometric scanning or a translating stage, it can also be accomplished by using acoustic waves to deflect the laser beam in a manner that is dependent on the acoustic frequency. AOD scanning differs from other approaches in that no moving parts are required, and the scan frequency is faster than conventional approaches. Using a digital/analog (D/A) converter to provide addressing voltages to a voltage/frequency converter, rapidly changing the frequency input to the AOD allows the laser beam to be addressed accurately on a microchip. With the ability to change the frequency on the nanosecond time scale, scanning rates as high as 30 Hz for Windows-based LabView programming are possible, with much faster scan rates achievable if a microprocessor-embedded system is utilized. In addition to spatial control, temporal control is easily attainable via raster scanning or random addressing, allowing for the scanning process to be self-aligning. Since the D/A output voltages drive the scanning of the laser beam over all channels, the software can define addressing voltages corresponding to the microchannel centers and, subsequently, fluorescence data can be collected from only those locations. This method allows for flexible, high-speed, self-align scanning for fluorescence detection in capillary or microchip electrophoresis and has the potential to be applied to a number of applications.

Acoustics↗
PubMed1998

Creating a general practice national minimum data set: present possibility or future plan?

AIM: To assess the feasibility of implementing the recommendations of the New Zealand National Minimum Data Set working party in computerised general practices. METHOD: Doctors from 12 computerised general practices belonging to the Royal New Zealand College of General Practitioners' Dunedin Research Unit Computer Network participated in the study (five Dunedin practices, four in rural Otago and Southland, and three in Christchurch). A three-month sample of data was extracted from practice computers and evaluated for completeness and compliance to the national minimum data set structure. Rates of recording practice identifier, provider, patient identifiers, sex, ethnicity, government subsidy eligibility, consultation identifier and date, prescriptions and Read codes were calculated for each practice. RESULTS: Apart from data recorded automatically by computers, there was a wide range in the extent of missing data. Of the data requiring manual computer entry, patient demography and subsidy eligibility were most comprehensively recorded (date of birth 99.9%, sex 99.6%, eligibility to subsidies 98.5%). Data with little immediate clinical or management relevance were poorly recorded (Read codes 32.4% and ethnicity 5.0%). CONCLUSIONS: It is possible to derive a common minimum data set from different computerised general practices. However some data elements will be missing unless suitable education and support are provided for the doctors and other staff members who record patient information.

Data Collection↗
PubMed1998

The big glitch.

Explore the source record for details and available documents.

Bankruptcy↗
PubMed1995

Neuroendocrine responses to d-fenfluramine and insulin-induced hypoglycemia in chronic fatigue syndrome.

Chronic fatigue syndrome (CFS) is a disorder characterized by severe physical and mental fatigue and fatiguability of central rather than peripheral origin. We hypothesized that CFS is mediated by changes in hypothalamopituitary function and so measured the adrenocorticotrophic hormone (ACTH), cortisol, growth hormone, and prolactin responses to insulin-induced hypoglycemia, and the ACTH, cortisol, and prolactin responses to serotoninergic stimulation with dexfenfluramine in nondepressed CFS patients and normal controls. We have shown attenuated prolactin responses to hypoglycemia in CFS. There was also a greater ACTH response and higher peak ACTH concentrations (36.44 +/- 4.45 versus 25.60 +/- 2.78 pg ml), whereas cortisol responses did not differ, findings that are compatible with impaired adrenal cortical function. This study provided evidence for both pituitary and adrenal cortical impairment in CFS and further studies are merited to both confirm and determine more precisely their neurobiological basis so that rational treatments can be evolved.

Adrenocorticotropic Hormone↗
PubMed1994

Toxicity of the organophosphate chemical warfare agents GA, GB, and VX: implications for public protection.

The nerve agents, GA, GB, and VX are organophosphorus esters that form a major portion of the total agent volume contained in the U.S. stockpile of unitary chemical munitions. Congress has mandated the destruction of these agents, which is currently slated for completion in 2004. The acute, chronic, and delayed toxicity of these agents is reviewed in this analysis. The largely negative results from studies of genotoxicity, carcinogenicity, developmental, and reproductive toxicity are also presented. Nerve agents show few or delayed effects. At supralethal doses, GB can cause delayed neuropathy in antidote-protected chickens, but there is no evidence that it causes this syndrome in humans at any dose. Agent VX shows no potential for inducing delayed neuropathy in any species. In view of their lack of genotoxicity, the nerve agents are not likely to be carcinogens. The overreaching concern with regard to nerve agent exposure is the extraordinarily high acute toxicity of these substances. Furthermore, acute effects of moderate exposure such as nausea, diarrhea, inability to perform simple mental tasks, and respiratory effects may render the public unable to respond adequately to emergency instructions in the unlikely event of agent release, making early warning and exposure avoidance important. Likewise, exposure or self-contamination of first responders and medical personnel must be avoided. Control limits for exposure via surface contact of drinking water are needed, as are detection methods for low levels in water or foodstuffs.

Animals↗
PubMed1993

The stability of binocular fixation during reading in adults and children.

The authors recorded the binocular eye-movements of children and adults while they read single words appropriate for their reading ability. Normal data were obtained from nine- to 11-year-old primary-school children and adults, because very little is known about changes in binocular vergence during reading. These normal data were compared with those from poor readers of the same age who had passed or failed the Dunlop Test. On average, normal children made larger vergence errors while they fixated words than did adults. There were no differences between the groups of children, therefore the authors conclude that poor vergence control during reading fixations is not the immediate cause of the non-word error effect found among children who fail the Dunlop Test.

Adult↗
PubMed1992

Effect of Pseudomonas aeruginosa rhamnolipids on mucociliary transport and ciliary beating.

Pseudomonas aeruginosa rhamnolipid causes ciliostasis and cell membrane damage to rabbit tissue, is a secretagogue in cats, and inhibits epithelial ion transport in sheep tissue. It could therefore perturb mucociliary clearance. We have investigated the effect of rhamnolipid on mucociliary transport in the anesthetized guinea pig and guinea pig and human respiratory epithelium in vitro. Application of rhamnolipid to the guinea pig tracheal mucosa reduced tracheal mucus velocity (TMV) in vivo in a dose-dependent manner: a 10-microgram bolus caused cessation of TMV without recovery; a 5-micrograms bolus reduced TMV over a period of 2 h by 22.6% (P = 0.037); a 2.5-microgram bolus caused no overall changes in TMV. The ultrastructure of guinea pig tracheal epithelium exposed to 10 micrograms of rhamnolipid in vivo was normal. Application of 1,000 micrograms/ml rhamnolipid had no effect on the ciliary beat frequency (CBF) of guinea pig tracheal rings in vitro after 30 min, but 250 micrograms/ml stopped ciliary beating after 3 h. Treatment with 100 micrograms/ml rhamnolipid caused immediate slowing of the CBF (P less than 0.01) of human nasal brushings (n = 7), which was maintained for 4 h. Mono- and dirhamnolipid had equivalent effects. The CBF of human nasal turbinate organ culture was also slowed by 100 micrograms/ml rhamnolipid, but only after 4 h (CBF test, 9.87 +/- 0.41 Hz; control, 11.48 +/- 0.27 Hz; P less than 0.05, n = 6), and there was subsequent recovery by 14 h.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗