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Biomedical subjects

A McMurray

Publications and source records attributed to A McMurray.

At least 19 recordsLinked to original sources
PubMed2000

Genomic sequence and transcriptional profile of the boundary between pericentromeric satellites and genes on human chromosome arm 10q.

The organization of centromeric heterochromatin has been established in a number of eucaryotes but remains poorly defined in human. Here we present 1025 kb of contiguous human genomic sequence which links pericentromeric satellites to the RET proto-oncogene in 10q11.2 and is presumed to span the transition from centric heterochromatin to euchromatin on this chromosome arm. Two distinct domains can be defined within the sequence. The proximal approximately 240 kb consists of arrays of satellites and other tandem repeats separated by tracts of complex sequence which have evolved by pericentromeric-directed duplication. Analysis of 32 human paralogues of these sequences indicates that most terminate at or within repeat arrays, implicating these repeats in the interchromosomal duplication process. Corroborative PCR-based analyses establish a genome-wide correlation between the distribution of these paralogues and the distribution of satellite families present in 10q11. In contrast, the distal approximately 780 kb contains few tandem repeats and is largely chromosome specific. However, a minimum of three independent intrachromosomal duplication events have resulted in >370 kb of this sequence sharing >90% identity with sequences on 10p. Using computer-based analyses and RT-PCR we confirm the presence of three genes within the sequence, ZNF11/33B, KIAA0187 and RET, in addition to five transcripts of unknown structure. All of these transcribed sequences map distal to the satellite arrays. The boundary between satellite-rich interchromosomally duplicated DNA and chromosome-specific DNA therefore appears to define a transition from pericentromeric heterochromatin to euchromatin on the long arm of this chromosome.

Centromere↗
PubMed2000

Analysis of vertebrate SCL loci identifies conserved enhancers.

The SCL gene encodes a highly conserved bHLH transcription factor with a pivotal role in hemopoiesis and vasculogenesis. We have sequenced and analyzed 320 kb of genomic DNA composing the SCL loci from human, mouse, and chicken. Long-range sequence comparisons demonstrated multiple peaks of human/mouse homology, a subset of which corresponded precisely with known SCL enhancers. Comparisons between mammalian and chicken sequences identified some, but not all, SCL enhancers. Moreover, one peak of human/mouse homology (+23 region), which did not correspond to a known enhancer, showed significant homology to an analogous region of the chicken SCL locus. A transgenic Xenopus reporter assay was established and demonstrated that the +23 region contained a new neural enhancer. This combination of long-range comparative sequence analysis with a high-throughput transgenic bioassay provides a powerful strategy for identifying and characterizing developmentally important enhancers.

Amino Acid Sequence↗
PubMed1999

Cutting edge: homologous recombination of the MHC class I K region defines new MHC-linked diabetogenic susceptibility gene(s) in nonobese diabetic mice.

To localize the MHC-linked diabetogenic genes in the nonobese diabetic (NOD) mouse, a recombinational hotspot from the B10.A(R209) mouse was introduced to the region between the MHC class I K and class II A of the NOD mouse with the recombinational site centromeric to the Lmp2/Tap1 complex by breeding the two strains. Replacement of the NOD region centromeric to the recombinational site with the same region in R209 mice prevented the development of diabetes (from 71 to 3%) and insulitis (from 61 to 15%) in the N7 intra-MHC recombinant NOD mice. Similarly, the replacement of the NOD class II A, E and class I D region with the same region in R209 mice prevented the diseases (diabetes, from 71 to 0%; insulitis, from 61 to 3%). In addition to the MHC class II genes, there are at least two MHC-linked diabetogenic genes in the region centromeric to Lmp2.

Animals↗
PubMed1999

Birthing at home: the resolution of expectations.

OBJECTIVE: To describe the experience of ten couples who have had a home birth in Western Australia. DESIGN, SETTING AND PARTICIPANTS: Using a phenomenological approach, ten parent couples were interviewed and three home-birth videos observed. Of the ten couples, four discussed their first child's home birth. The remaining six couples had three or four children who had been born at home. FINDINGS: The essence of these parents' experiences of home birth was gained through identifying significant statements from transcripts and field notes and clustering these into the four themes of 'constructing the environment'; 'assuming control'; 'birthing'; and 'resolving expectations'. The first two themes were presented in a previous paper (Morison et al 1998). The latter two themes are now presented. The theme 'birthing' was where parents elaborated on their birth beliefs, discussed the actual birth and shared aspects of the relationship between the couple and the midwife. 'Resolving expectations' concerned the process of parents forming expectations, experiencing the reality of birth and then evaluating whether expectations were met. KEY CONCLUSIONS: The development of a supportive relationship between couples and their midwife was essential during this transition to parenthood. Resolving expectations was an essential process that the parents undertook to clarify the meaning of their birth experience, and thereby acknowledge its uniqueness. IMPLICATIONS FOR PRACTICE: The findings are important to midwives' practice as they reveal the value clients place on a shared philosophy about birth. Midwives, in any setting, can reflect on their own birthing beliefs and determine their compatibility with their clients' beliefs.

Attitude of Health Personnel↗
PubMed1998

Constructing a home birth environment through assuming control.

OBJECTIVE: The purpose of this qualitative study was to describe the experience of couples who have had a home birth. DESIGN, SETTING AND PARTICIPANTS: A phenomenological approach was used to provide an understanding of the human experience of home birth in Western Australia. The research design consisted of a field study, in which 10 parent couples were interviewed and three videos of home births observed. Of the ten couples, four couples spoke of their first baby's home birth and the remaining six couples had three or four children who had been born at home. FINDINGS: The couples' experiences of home birth were gained through identifying significant statements from transcripts and field notes, and clustering these into the following four themes: 'constructing the environment'; 'assuming control'; 'birthing'; and 'resolving expectations'. The themes of 'constructing the environment' and 'assuming control' are described in detail in this paper. 'Constructing the environment' describes how couples adapted the physical environment, and established support to create a positive birth environment. 'Assuming control' discusses exerting control and taking responsibility for the birth. The remaining themes of 'birthing' and 'resolving expectations' are described in a subsequent paper (Morison et al, in press). KEY CONCLUSIONS: The research furnishes an insight into the couples' experience of home birth. The lived experience of birthing at home involved a process where a couple actively created an environment that enabled them to assume control and responsibility for the birth. IMPLICATIONS FOR PRACTICE: The findings are important for midwives in any setting, as they reveal the extent to which some parents value the right to assume control and responsibility for the birth of their baby. Although the physical environment of a home birth cannot be replicated in every setting, issues specific to the birth environment are relevant to all midwives.

Adult↗
PubMed1998

The use of questioning strategies by clinical teachers.

By using questioning and other appropriate teaching strategies, clinical teachers can facilitate the development of critical thinking, decision making and problem solving in students. This study examined clinical teachers' use of questioning and the variations in their use of questioning as a teaching strategy. Although there was a variation in the number of questions asked, predominantly low level questions were asked by 26 clinical teachers at two post-clinical conferences. Based on the findings of this study, it is recommended that clinical teachers are taught how to ask questions, particularly high level questions.

Australia↗
PubMed1998

Unlicensed assistive personnel in the critical care unit: what is their role?

Driven by an economic imperative, the use of unlicensed assistive personnel (UAP) has proliferated in the health care system, however, their use in the critical care (CC) environment remains relatively new. An analysis of the first phase of a mixed method study, in which interviews with 17 CC nurses were conducted in order to provide data upon which to devise a larger survey, provides insight into the potential uses and misuses of these UAP. An examination of the transcripts, field notes, and diagrams and a comparison of the emerging categories to the literature assisted in identifying several themes important to CC nursing practice. Three themes identified in the analysis--ongoing vigilant assessment, quick response and seeing the whole picture--provide evidence that if UAP are asked to complete tasks allocated to them in other areas, CC nurses will be robbed of vital, albeit subtle, aspects of their nursing practice. As reflective practitioners, CC nurses must be wary of giving away tacit features of their role which enable them to synthesise contextual variables with espoused theory and experience, in order to ensure optimal patient care and outcomes.

Adult↗
PubMed1998

Community parenteral therapy project: a pilot study.

The pilot study reported in this paper was devised to develop and compare service delivery models that would achieve the provision of high quality parenteral therapy care to patients in the Gold Coast District Health Service community. All data were collected on 113 patients for a 12-month period, January to December 1996. The study compared the provision of outreach nursing services and contracted nursing services on measures of satisfaction and cost. The study showed that patient and carers indicated a preference for community care, medical officers advocated the benefits of administering parenteral therapies in the community, general practitioners were interested in managing future community parenteral therapies, and contracted (nurse) service providers endorsed the development of a parenteral therapy resource centre. The findings also revealed considerable potential cost savings in community-based care.

Adult↗
PubMed1998

Undertaking research for the benefit of the rural community.

This paper discusses the importance of disseminating clinical research findings to improve nursing practice and, ultimately, the health of rural Australia. It is argued that nursing in all settings must be practised within the context of changing healthcare trends. Currently, these changes include the restructuring of health services toward a greater emphasis on community-based services, a redirection of the focus of care toward population health rather than hospital-based service provision, multidisciplinary clinical decision-making with the community as partner, and the need for all health professionals to maintain fiscal and clinical accountability. To chart the process and outcomes of care in these changing circumstances requires ongoing, systematic research. The global movement toward evidence-based healthcare practice is thus timely and necessary. In order to provide a foundation for evidence-based practice that will demonstrate quality, efficiency, effectiveness and community acceptability, employers must address both infrastructure and educational needs. Educators must be responsive to changes in the organisation and finding of care. Also both groups must work collaboratively toward ensuring dissemination of research information that will make a difference to patient and community outcomes. The key to success is ongoing communication between employers, educators, practitioners in the field, community members and professional organisations so that research findings can be analysed in simple language that increases utility and that provides a forum for valuing information from all sources.

Australia↗
PubMed1998

Family health and health services utilisation in Belmont, Western Australia: a community case study.

This case study was designed to examine the self-defined health needs of families in one urban Western Australian community. We conducted 157 family interviews to examine the relationship between family sociodemographic variables and patterns of use of health services, which included services used within the previous 12 months, and what the family needed and wanted from these services. Questions covered perceptions of health, family health concerns and the role of the family health guardian. Quantitative analysis included frequencies, cross-tabulations, chi-squared tests and multiple regression analysis. Open-ended responses were categorised and analysed for common themes. Approximately 80 per cent of participants had used one or more health services during the previous 12 months and, despite 35.9 per cent of families having at least one family member with a long-standing illness, disability or infirmity, most (82.1 per cent) considered the family healthy. The correlational analysis revealed several associations. Predictably, younger persons reported higher health ratings and older persons had more health concerns. Larger families reported better perceived levels of health. Higher utilisation rates were recorded for families with children, who tended to use the general practitioner for general care and medication, whereas one-parent families used hospital and specialist care more often, and 98.7 per cent reported satisfaction with services. What they needed and wanted from their health service providers was 'full disclosure' and 'not being talked down to', and for specialists especially to be approachable and impart information simply and honestly.

Adult↗
PubMed1996

The reduction of radiation mucositis by selective decontamination antibiotic pastilles: a placebo-controlled double-blind trial.

The aim of this study was to see if antibiotic pastilles could reduce radiation mucositis, pain, dysphagia and weight loss in patients undergoing radical radiotherapy for head and neck cancer. A total of 275 patients with T1-T4 tumours entered the study; 136 were allocated to suck four times daily a pastille containing amphotericin, polymyxin and tobramycin. The remaining 139 patients received an identical placebo. In all, 54 patients were unevaluable (24 active, 30 placebo). Bacteriological monitoring was carried out before and twice weekly during treatment. Both arms of the study were well balanced for T and N stage, age, sex and radiation dose (60 Gy). There was a slight imbalance in the site of disease which had no substantive effect on the results. The primary study end point was the percentage of patients who developed intermediate or thick pseudomembranes. No statistically significant difference was found in this end point, with 36% of patients in the active arm developing this type of membrane compared with 48% in the placebo arm (P = 0.118). The estimated odds ratio (placebo/active) of developing an intermediate or thick pseudomembrane was 1.59 (95% CI 0.89-2.82). However a more sensitive test comparing the worst recorded mucositis grade between the two arms was statistically significant (P = 0.009). This indicated that the active pastilles had a beneficial effect, but the magnitude was probably smaller than the trial was designed to detect. There was a reduction in mucositis distribution (P = 0.002), mucositis area (P = 0.028), dysphagia (P = 0.006) and weight loss (P = 0.009) in the active arm. There was a clear tendency for patients with positive cultures for aerobic Gram-negative bacteria (AGNB) (P = 0.003) and yeasts (P = 0.026) during treatment to have more severe mucositis. The active pastilles reduced the percentage of patients with yeast cultures (P = 0.003) but had less effect on AGNB. The benefit derived from the pastilles should materially increase patient tolerance to radical radiotherapy for head and neck cancer.

Adult↗
PubMed1996

Couples' experiences of infertility: a phenomenological study.

If nurses are to work effectively with families in contemporary society, their practice activities must be appropriately informed. Families exposed to new technologies, such as in vitro fertilization (IVF) require care that is sensitive to their particular experience. Infertile couples have been the subject of a substantial body of research, however, most studies to date focus on the physiological effects of infertility and do not take into account the context in which the experience takes place, or the meanings that people assign to this experience. The purpose of this study was to examine in-depth the experience of couples undergoing IVF treatment for infertility. A phenomenological approach was adopted for the study. A purposive sample of six couples was selected for interview. Data were generated from taped interviews and the researcher's observational field notes. Data analysis was in accordance with the procedure outlined by Colaizzi (1978). Interview responses were categorized by examining the participants' transcripts and identifying significant statements and meanings. Themes which emerged from the statements were then identified, and cross-case comparisons were made to confirm or modify these themes. Four key themes emerged from the data: life changes; powerlessness; hope-disappointment cycle; and social isolation. All couples undergoing infertility treatment experienced life changes which included: lifestyle changes, various physical and emotional changes, and changes in their relationships. There was a perceived loss of control over many aspects of their lives. Couples also described a cycle, alternating feelings of hope and disappointment. Most of the couples reported feelings of social isolation associated with being infertile, that were intensified by having to deal with the inappropriate responses of others. Findings from this study will add to the knowledge base on infertility, and contribute to recommendations for improving the way nurses guide, counsel, and support infertile couples.

Adult↗
PubMed1995

Ulcerative skin reaction from subcutaneous infusion of isotonic methotrimeprazine and diamorphine.

We report an ulcerative skin reaction resulting from a subcutaneous infusion of isotonic methotrimeprazine and diamorphine. Skin reactions are a recognized side effect of this treatment, although they are reduced by the use of the isotonic formulation of methotrimeprazine. Frank ulceration has not been previously reported. It occurred in our patient despite low doses of diamorphine and methotrimeprazine, an isotonic formulation, and a short infusion time.

Adult↗
PubMed1994

Filgrastim fails to improve haemopoietic reconstitution following myeloablative chemotherapy and peripheral blood stem cell rescue.

The morbidity of high-dose chemotherapy has been considerably reduced by the use of autologous peripheral blood progenitor cell reinfusion. Most studies have used myeloid colony-stimulating factors after stem cell reinfusion, making it difficult to determine the relative contribution of each of these variables to the early recovery of blood cells. The financial implications of colony-stimulating factor use are an area of concern as dose intensification in chemosensitive malignancies is increasingly employed. We have studied 19 consecutive patients receiving high-dose chemotherapy with and without filgrastim (Amgen, granulocyte colony-stimulating factor, G-CSF) after stem cell infusion to examine its effect on the kinetics of blood cell recovery, the complications of myelosuppression and the associated costs. Analysis of the two treatment groups reveals that administration of filgrastim 10 micrograms kg-1 day-1 following stem cell reinfusion does not further accelerate haemopoietic recovery, fails to reduce the incidence of neutropenic fever or antibiotic usage and significantly increases the cost of the procedure. The results of this study do not support the routine use of filgrastim after high-dose chemotherapy and peripheral blood stem cell reinfusion.

Adolescent↗
PubMed1993

An evaluation of comparative strategies for teaching breast self-examination.

This study compared the effects of three alternative methods of breast self-examination (BSE) instruction (booklet, film and group discussion, individual teaching) on nurses' personal BSE practice. A pre-test and follow-up questionnaire were administered to a convenience sample of 166 nurses from Western Australian hospitals. The results demonstrated that each method of BSE instruction produced a significant improvement in the technique of BSE (P < 0.0001). However, the nurses involved in the film and discussion had the greatest improvement in BSE proficiency. Findings were analysed in terms of the Health Belief Model. The variables 'barriers to action' and 'perceived susceptibility' (in this case, to breast cancer) were found to be predictive of BSE practice; 'perceived barriers' at pre-test and 'perceived susceptibility' at follow-up. The incidence of BSE was significantly higher in the older nurses. A reminder to practise BSE was significantly associated with an effective BSE technique. Implications for nursing practice are discussed.

Adult↗
PubMed1992

Expertise in community health nursing.

This article reports on a study of expertise in community health nursing. The objective of the study was to develop a model of expertise derived from identification of the characteristics and factors influencing clinical expertise in community health nurses (CHNs) practicing in district nursing, school health, and child health. Participant observations, individual interviews, and written retrospective accounts of clinical episodes were analyzed from 37 nurses (10 novices within the first year of community practice and 27 experts identified by peers and colleagues). The data identified the expert as someone in whom the following characteristics operate synchronously: knowledge; empathy; appropriate communication; holistic understanding; an ability to get right to the problem at hand; and self-confidence in her or his perceptions, judgments, and intervention strategies. The findings suggest that there is a combination of factors which influences the development of expertise. These include educational factors, personal factors, and experience. These factors are incorporated into the model of expertise. The data also suggest that, in order to educate for expert levels of practice, the educational process must be designed to stimulate the learner's perceptual as well as analytic abilities. This can best be achieved through clinical practice opportunities and through demonstrations and case studies which stimulate inferential and intuitive thinking in students.

Australia↗