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Biomedical subjects

T Murphy

Publications and source records attributed to T Murphy.

At least 55 records · Page 3Linked to original sources
PubMed1999

Outpatient diabetes management of Medicare beneficiaries in four Mississippi fee-for-service primary care clinics.

BACKGROUND: As part of a quality improvement initiative aimed at increasing physician compliance with standards of care for diabetes patients, diabetes practice patterns among Medicare beneficiaries in four primary care clinics were examined in Mississippi. METHODS: Retrospective chart reviews of Medicare beneficiaries with a diagnosis of diabetes were conducted to examine physician compliance with recommended diabetes monitoring services. RESULTS: Fifty-three percent of all beneficiaries did not have a recorded A1c test while 54 percent did not have a recorded foot exam. The percentage without foot exams decreased with quarterly visits. Seventy-two percent and 68 percent of patients had testing for lipids and proteinuria, respectively, although variability in types of testing performed was seen. Seventy-six percent of beneficiaries did not have a referral for a dilated eye exam. CONCLUSIONS: The study has uncovered, within several primary care sites in Mississippi, variable documentation of compliance with many clinically relevant recommendations relating to the care of elderly patients with diabetes. These items can be targeted for improvement as part of a statewide quality improvement initiative for Medicare beneficiaries.

Aged↗
PubMed1998

Midazolam-sufentanil vs sufentanil-enflurane for induction of anaesthesia for CABG surgery.

PURPOSE: To compare the effects of midazolam-sufentanil (Group I) and sufentanil-enflurane (Group II) anaesthesia on myocardial oxygenation and metabolism in patients with preserved ventricular function undergoing CABG surgery. METHODS: Patients randomized to Group I (n = 16) received midazolam 0.3 mg.kg-1 at induction of anaesthesia, 0.15 mg.kg-1 after tracheal intubation, followed by an infusion of 2.5-10.0 micrograms.kg-1.min-1. Supplemental sufentanil (cumulative maximum of 5 micrograms.kg-1) was given for adverse haemodynamic responses. Group II (n = 16) received 5 micrograms.kg-1 sufentanil at induction. Additional sufentanil (maximum 5 micrograms.kg-1), and enflurane (0-3% inspired concentration) were administered for adverse haemodynamic responses. Haemodynamics, myocardial oxygen consumption (MVO2), and lactate extraction were determined at the following times: I) awake (AWA), 2) after induction (IND), and 3) after tracheal intubation (ETT). RESULTS: Systemic haemodynamics and myocardial metabolism were similar at AWA. Heart rate response was attenuated and MVO2 reduced in Group I at IND (P < 0.05). Following AWA, myocardial lactate production (MLP) occurred more frequently in Group II vs Group I patients (9/16 vs 2/16) and at more individual measurement points (Group II: 10/64 vs Group I: 3/64). Myocardial lactate flux demonstrated a deleterious trend in Group II at ETT. CONCLUSIONS: Compared with sufentanil-enflurane, midazolam-sufentanil anaesthesia resulted in comparable and acceptable haemodynamics and myocardial oxygenation in CABG patients.

Analysis of Variance↗
PubMed1998

Continuous quality improvement: status of Canadian health care organizations.

The Canadian Council on Health Services Accreditation (CCHSA) surveyed its client groups to determine how involved they had become in continuous quality improvement (CQI) activities. This was a follow up to a 1992 survey. Most of the participating organizations indicated they had adopted a CQI philosophy. A major factor influencing this decision was the use of the CCHSA's client-centred standards. This article outlines the gains organizations have realized by implementing CQI, and the extent to which organizations have implemented CQI principles, methods and tools. The information from this survey has been used to develop the accreditation program for the year 2000--"The AIM Project: Achieving Improved Measurement."

Accreditation↗
PubMed1998

The Clinical Standards Advisory Group (CSAG) Cleft Lip and Palate Study.

A national study of care and outcomes in children born with a unilateral cleft lip and palate (UCLP) was performed over a 15-month period. Two cohorts of children ('5-year-olds' and '12-year-olds') were examined. There were 57 active cleft teams in the U.K. with 105 consultant orthodontists involved in the care of these children. Only 36 teams could provide basic data such as patients names. Of the patients, 47-51 per cent had neonatal appliances. The dental arch relationships were measured with the Goslon Index and a Five-Year-Old Index, 37-39 per cent of both age groups were either 'poor' or 'very poor'. Seventy per cent of the 12-year-old patients had a Skeletal III relation and 42 per cent of bone grafts were seriously deficient or failed. Dental treatment for active caries was needed by 40 per cent of 5-year-olds and 20 per cent of 12-year-olds. In addition, the training of recently appointed consultant orthodontists involved in the care of these children was scrutinized. As a whole, the results were disappointing with standards of care not significantly raised in the last decade. Recommendations have been made to the Department of Health and the implications for the orthodontic profession are explored. Overall, it seems that fewer orthodontists will need to be involved in a centralized care model for these children.

Bone Transplantation↗
PubMed1997

Structure and transcription of the gene for translation elongation factor 1 subunit alpha of zebrafish (Danio rerio).

The zebrafish gene for translation elongation factor 1 alpha (EF1 alpha) was isolated from a phage Lambda genomic library and sequence and structure determined. One gene copy of EF1 alpha per haploid set of chromosomes was found and no processed pseudogenes. A highly active promoter region was localized to a 277 bp PstI/PvuII fragment beginning 240 bp upstream from the tsp, but no transcription enhancing, or silencing activity was observed within 1 kbp upstream, or downstream from the promoter. Expression of EF1 alpha appears to be developmentally regulated.

Animals↗
PubMed1997

Nitric oxide activates skeletal and cardiac ryanodine receptors.

The endothelial-derived relaxing factor, nitric oxide (NO.) has been shown to depress force in smooth and cardiac muscles through the activation of guanylyl cyclase and an increase in cGMP. In fast skeletal muscle, NO (i.e. NO-related compounds) elicits a modest decrease in developed force, but in contracting muscles NO increases force by a mechanism independent of cGMP. We now demonstrate an alternative mechanism whereby NO triggers Ca2+ release from skeletal and cardiac sarcoplasmic reticulum (SR). NO delivered in the form of NO gas, NONOates (a class of sulfur-free compounds capable of releasing NO), or S-nitrosothiols (R-SNO) oxidized or transnitrosylated regulatory thiols on the release channel (or ryanodine receptor, RyR), resulting in channel opening and Ca2+ release from skeletal and cardiac SR. The process was reversed by sulfhydryl reducing agents which promoted channel closure and Ca2+ reuptake by ATP-driven Ca2+ pumps. NO did not directly alter Ca(2+)-ATPase activity but increased the open probability of RyRs reconstituted in planar bilayers and inhibited [3H]-ryanodine binding to RyRs. The formation of peroxynitrite or thiyl radicals did not account for the reversible R-SNO-dependent activation of RyRs. Ca2+ release induced by nitric oxide free radicals (NO.) was potentiated by cysteine providing compelling evidence that NO. in the presence of O2 formed nitrosylated cysteine followed by the transnitrosation of regulatory thiols on the RyR to activate the channel. These findings demonstrate direct interactions of NO derivatives with RyRs and a new fundamental mechanism to regulate force in striated muscle.

Animals↗
PubMed1997

Preconditioning during warm blood cardioplegia.

OBJECTIVE: Preconditioning describes the cardioprotective effects of multiple brief episodes of warm ischemia. The purpose of the study was to determine whether warm ischemia, during the intermittent delivery of warm blood cardioplegia, would induce preconditioning during cardioplegia arrest. METHODS: Dogs, 15, were randomized to a preconditioning protocol or to serve as controls. The control group received 60 min of continuous warm blood cardioplegia (WBC) followed by 30 min of warm arrested ischemia. The preconditioned group were arrested with WBC and then underwent three consecutive cycles consisting of 10 min of warm ischemia followed by 10 min of reperfusion. Reperfusion was provided by a continuous infusion of WBC. The preconditioning protocol was followed by 30 min of warm arrested ischemia. Myocardial functional recovery was assessed before cardiopulmonary bypass and cardioplegia arrest and again 30, 60 and 90 min after the arrest. Pressure-volume loops were used to measure the maximum elastance of the left ventricle (Emax), diastolic compliance, and used to calculate preload recruitable stroke work area. RESULTS: Myocardial functional recovery was better preserved after 30 min of warm arrested ischemia in those animals that had been preconditioned. CONCLUSION: Preconditioning may be induced when warm blood cardioplegia is delivered intermittently during cardioplegia arrest.

Animals↗
PubMed1997

Meiotic crossing over between nonhomologous chromosomes affects chromosome segregation in yeast.

Meiotic recombination between artificial repeats positioned on nonhomologous chromosomes occurs efficiently in the yeast Saccharomyces cerevisiae. Both gene conversion and crossover events have been observed, with crossovers yielding reciprocal translocations. In the current study, 5.5-kb ura3 repeats positioned on chromosomes V and XV were used to examine the effect of ectopic recombination on meiotic chromosome segregation. Ura3 random spores were selected and gene conversion vs. crossover events were distinguished by Southern blot analysis. Approximately 15% of the crossover events between chromosomes V and XV were associated with missegregation of one of these chromosomes. The missegregation was manifest as hyperploid spores containing either both translocations plus a normal chromosome, or both normal chromosomes plus one of the translocations. In those cases where it could be analyzed, missegregation occurred at the first meiotic division. These data are discussed in terms of a model in which ectopic crossovers compete efficiently with normal allelic crossovers in directing meiotic chromosome segregation.

Chromosome Aberrations↗
PubMed1997

Clinical evaluation of difco ESP culture system II for growth and detection of mycobacteria.

The reliability of the ESP Culture System II (ESP II; Difco Laboratories, Detroit, Mich.), a continuously monitoring mycobacterial culture system, was evaluated by comparing its performance with the BACTEC TB 460 (BACTEC TB) and Middlebrook 7H11/7H11 selective agar systems. A total of 2,283 specimens of all types (70.7% were respiratory specimens) were cultured; 149 (6.5%) yielded mycobacteria. The most common species recovered were Mycobacterium avium complex (MAC, 73 isolates) and Mycobacterium tuberculosis complex (MTBC, 53 isolates). The recovery rates by individual system were 87, 81, and 65% for ESP II, BACTEC TB, and Middlebrook agar, respectively, for all mycobacteria; the recovery rates were 89, 92, and 89%, respectively, for MTBC. For liquid plus solid medium system combinations, recovery rates for all mycobacteria and for MTBC, respectively, were 91 and 94% for ESP II plus Middlebrook agar and 85 and 96% for BACTEC TB plus Middlebrook agar. The difference between the recovery rates of all mycobacteria by ESP II and by BACTEC TB was not significant, whereas for the individual species, the only significant difference was recovery of more isolates of MAC by ESP II. For those isolates recovered in the individual systems, mean times to detection of all mycobacteria, MTBC, and MAC, respectively, were 13.1, 15.5, and 10.9 days for ESP II; 14.4, 16.6, and 12.1 days for BACTEC TB; and 17.8, 18.3, and 18.8 days for Middlebrook agar. ESP II is a reliable, nonradiometric, less labor-intensive alternative to BACTEC TB for growth and detection of mycobacteria, but as with other liquid culture methods, ESP II should be used in combination with a solid medium, not as a stand-alone system.

Bacterial Typing Techniques↗
PubMed1997

Fluvoxamine in the treatment of obsessive-compulsive disorder and related conditions.

The mainstay of the pharmacologic treatment of obsessive-compulsive disorder (OCD) is a 10- to 12-week trial of a potent serotonin reuptake inhibitor (SRI) at an adequate dose. Double-blind, placebo-controlled trials have established the anti-obsessive-compulsive (OC) efficacy of five different SRIs. One of the most thoroughly studied of these SRIs is fluvoxamine, the focus of this article. Fluvoxamine's pharmacologic and pharmacokinetic properties, its efficacy, and guidelines for its clinical use in OCD and related disorders are briefly reviewed. Potential drug-drug interactions are discussed and placed in clinical perspective. The management of common SRI-induced side effects is also addressed. Recent comparative studies suggest that fluvoxamine may be equivalent in efficacy to clomipramine, yet better tolerated. Fluvoxamine shows promise in the treatment of several so-called OC-spectrum disorders, but additional controlled trials are needed.

Adolescent↗
PubMed1996

Thalidomide inhibits TNF response and increases survival following endotoxin injection in rats.

Sepsis is a leading cause of death following major trauma and complicated abdominal surgery. Tumor necrosis factor-alpha (TNF) is believed to be a central mediator in the inflammatory response syndrome. Numerous methods of blunting the TNF response in sepsis have been attempted with suggestion of increased survival and decreased organ injury. Thalidomide, shown in vitro to selectively inhibit TNF production, has been used clinically in states of chronic TNF elevation with encouraging results. In this study, we examined the effect of thalidomide administration in a rat model of acute septic shock. Femoral artery cannulation was performed and baseline TNF measured. Dose response was determined by giving varying doses of thalidomide by gavage. Rats were injected intraarterially with endotoxin and serial samples drawn. TNF was measured by ELISA. For survival, thalidomide was given by gavage and endotoxin injected intraperitoneally. Serum TNF elevation occurred after endotoxin injection with peak levels at 90 min. Thalidomide treated rats had lower TNF levels at all time points (P = <0.01 at 90 and 120 min), with the inhibition being dose dependent. Survival in treated rats exceeded that of untreated rats (53% vs 19%, P = <0.05) at 48 and 72 hr. In conclusion, we found that thalidomide administration leads to increased survival following acute endotoxemia, which may be due to the observed TNF inhibition.

Analysis of Variance↗
PubMed1996

Intraductal carcinoma associated with invasive carcinoma of the breast. A comparison of the two lesions with implications for intraductal carcinoma classification systems.

Intraductal carcinoma (DCIS) is a useful marker for predicting which women will develop a recurrent breast malignancy. The authors examined 150 consecutive, mammographically detected, T1 invasive carcinomas associated with DCIS to study the DCIS and compare it to its associated invasive carcinoma. Intraductal carcinoma nuclear grades were assigned to each duct on a scale of 1 to 3. The percentage of DCIS ducts that were involved by each grade was quantitated into quartiles for cases with more than one DCIS nuclear grade. The predominant architectural pattern corresponding to each DCIS nuclear grade was recorded. Ninety-two percent of the 150 invasive carcinomas were of ductal type, 4% were tubular, and the remainder were various other subtypes. Nine percent of the DCIS cases were nuclear grade 1. The remaining 91% of cases were almost evenly distributed between mixed DCIS nuclear grades 1 and 2 (19%), pure DCIS nuclear grade 2 (24%), mixed DCIS nuclear grade 2 to 3 (25%), and pure DCIS nuclear grade 3 (22%). Two percent of cases were a mixture of DCIS nuclear grades 1 and 3 or 1, 2, and 3. All pure DCIS nuclear grade 1 or mixed 1 and 2 were associated with well or moderately differentiated invasive carcinomas, whereas the majority (61%) of the pure DCIS nuclear grade 3 cases were associated with poorly differentiated invasive carcinomas. There was no relation between the DCIS architectural pattern and the invasive carcinoma grade. In general, the DCIS nuclear grade correlates with the grade of the invasive carcinoma. Unlike DCIS architecture, nuclear grade heterogeneity within DCIS associated with invasive carcinoma is minimal. DCIS classification systems based on nuclear grade have merit because there is little variation in nuclear grade within a given patient's lesion.

Breast Neoplasms↗
PubMed1996

Measuring the cost of palliative radiotherapy.

Economic evaluations can be useful in decision making regarding allocation of scarce health care resources such as radiation therapy. However, assessment of treatment efficacy must be performed in addition to economic evaluations if proper resource allocation decisions are to be made. Economic evaluations cannot and should not relapse properly conducted clinical trials-particularly in the area of palliative care.

Costs and Cost Analysis↗
PubMed1996

Zebrafish translation elongation factor EF1 alpha mRNA: sequence and secondary structures.

We have determined the complete sequence of the translation elongation factor EF1 subunit alpha (EF1 alpha) mRNA of zebrafish, and the 3'-untranslated sequence of EF1 alpha mRNA of halibut. The 5'-untranslated leader sequence of the EF1 alpha mRNA starts with a polypyrimidine tract. This feature is shared with the mRNAs for ribosomal proteins, where it affects the utilization of mRNA by ribosomes. However, the secondary structures of these leader sequences may differ. 5'-Polypyrimidine tracts of vertebrate EF1 alpha mRNAs participate in the formation of stable stem-loop structures, whereas those of 15 randomly chosen mRNAs for ribosomal proteins do not. This difference may provide a basis for differential control of translation for the two classes of mRNA. The 3'-untranslated sequences of vertebrate EF1 alpha mRNA have diverged little during evolution. Analyses of sequence and putative secondary structures suggest that both sequence-specific interactions and secondary structures may have contributed to sequence conservation.

Amino Acid Sequence↗
PubMed1995

The HIV information project for transfusion recipients a decade after transfusion.

OBJECTIVE: To gather information on which to base decisions about a general notification program for pediatric patients a decade after their receiving transfusions. DESIGN: The physicians of a cohort of 1793 patients who underwent cardiac surgery were sent letters asking them to contact and counsel patients identified from cardiovascular surgery and blood bank databases about their risk for human immunodeficiency virus (HIV) infection. Questionnaires were used to collect data about physicians' HIV practices; telephone interviews were conducted to collect information about patients' and parents' knowledge and attitudes about HIV and transfusions. Because of unexpected media interest, questionnaires and interviews were modified to include questions about the source of information. The HIV-testing status of patients reported by physicians was anonymously cross-referenced with specimens received by the Laboratory Services Branch, Ontario Ministry of Health, Toronto. SETTING: A large Canadian pediatric tertiary care hospital in Toronto. PARTICIPANTS: Seven hundred ninety-three patients undergoing cardiopulmonary bypass between 1980 and 1985. RESULTS: The HIV Information Project successfully reached most (approximately 75%) of this cohort and, with the help of the media, many other at-risk transfusion recipients. The information was new for many; almost all informed wanted to undergo testing. The seroprevalence of this group that received multiple transfusions was, at minimum, 8.5 patients in 1000. Six previously unsuspected HIV-seropositive cases were diagnosed. CONCLUSIONS: Although we had assumed that most patients receiving transfusions would be aware of their risk for HIV infection, our results indicate that, even a decade after the transfusion, many recipients were not aware of the risk and wanted to undergo testing. Testing identified asymptomatic infected patients.

Acquired Immunodeficiency Syndrome↗