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Biomedical subjects

D A Gilbert

Publications and source records attributed to D A Gilbert.

At least 19 recordsLinked to original sources
PubMed1999

Medication treatment for the severely and persistently mentally ill: the Texas Medication Algorithm Project.

This article provides an overview of the issues involved in developing, using, and evaluating specific medication guidelines for patients with psychiatric disorders. The potential advantages and disadvantages, as well as the essential elements in the structure of algorithms, are illustrated by experience to date with the Texas Medication Algorithm Project, a public-academic collaboration. Phase 1 entailed assembling research findings on the efficacy of medications for schizophrenic, bipolar, and major depressive disorders. This knowledge was evaluated for its quality and relevance, integrated with expert clinical judgment as well as input by practicing clinicians, family advocates, and patients. Phase 1 (the design and development of the algorithms) was followed by a feasibility test (Phase 2). Phase 3 is an ongoing evaluation comparing the clinical and economic effects of using specific medication guidelines (algorithms) versus treatment as usual in public sector patients with severe and persistent mental illnesses.

Algorithms↗
PubMed1998

High-precision genotyping by denaturing capillary electrophoresis.

Genotyping, as applied to linkage mapping, human identification, or mapping of genetic traits, mandates electrophoretic separation systems that enable a user to identify alleles with high precision to obtain a correct genotype. For 2-bp microsatellites or short tandem repeats (STRs), standard deviations of +/-0.3 nucleotide are required to ensure with 99.7% probability the identity or dissimilarity of tested alleles. A complete system, consisting of commercially available laser-induced fluorescence capillary electrophoresis (ABI PRISM 310) and performance optimized polymer 4 (POP-4), was evaluated for microsatellite separations. POP-4 is a low viscosity polymer for use in uncoated fused microbore silica capillaries. It separates DNA fragments that differ in size by 1 nucleotide up to 250 nucleotides and that differ in size by 2 nucleotides for fragments up to at least 350 nucleotides in length in about 30 min. The presence of denaturants and, more importantly, operation at 60 degrees C was mandatory for high-precision and high-resolution sizing operation. Reproducible separation performance was achieved in excess of 100 injections per capillary with resulting standard deviations in the range of 0.04 to 0.17 nucleotide. Comparative sizing of known CEPH (Centre d'Etudes du Polymorphisme Humaine) samples performed at 22 independent test sites showed the usefulness of the system for genotyping with standard deviations of 0.24 nucleotide, or better.

Chromosome Mapping↗
PubMed1998

Texas Medication Algorithm Project: definitions, rationale, and methods to develop medication algorithms.

BACKGROUND: The Texas Medication Algorithm Project (TMAP), a public-academic collaborative effort, is a 3-phase project to develop, implement, and evaluate medication treatment algorithms for public sector patients with schizophrenia, major depressive disorders, or bipolar disorders. DISCUSSION: This paper, the first in a series describing the activities of the TMAP, focuses on the various definitions and reasons why guidelines have gained popularity. Also discussed are their strengths, the limitations of the various methods used to develop them, and potential barriers to their implementation.

Algorithms↗
PubMed1998

Relational message themes in nurses' listening behavior during brief patient-nurse interactions.

Using a relational message framework, this study examined themes communicated by nurses' listening behavior during brief patient-nurse interactions and whether the pattern of thematic scores reflected a positive patient-nurse relationship. A sample of 126 White college women individually viewed a videotape of six nurses listening to a patient-actress for 25 to 32 seconds. Participants reported what each nurses' listening behavior communicated on a 30-item instrument. Principal axis factoring using a seven-factor solution explained 57.7% to 65.0% of the common variance. Six of the factors proposed in the relational message framework were identified in each interaction: Trust/Receptivity, Depth/Similarity/Affection, Difference, Composure, Dominance or Power, and Formality. In four interactions the pattern of thematic scores suggested communication of a positive patient-nurse relationship. Thus it appears that the communication of positive patient-nurse relationships is not necessarily precluded by the time constraints in contemporary nursing practice.

Adolescent↗
PubMed1997

Developing clinical work processes in a state psychiatric hospital: a case study.

The Texas Department of Mental Health and Mental Retardation applied the continuous quality improvement (CQI) concept of work process to the delivery of clinical services in each of its eight state psychiatric hospitals. Two different clinical processes were involved: (1) individualized psychiatric treatment and (2) medical treatment. The processes were then benchmarked against national leaders in the delivery of public psychiatric hospital services. This case study demonstrates the applicability of the work process concept to a clinical environment where it can function as a management tool that can significantly improve the quality and efficiency of services provided to individual patients.

Hospitals, Psychiatric↗
PubMed1996

High frequency oscillations in the activity of phosphotyrosine phosphatase in murine erythroleukaemic cells: action of insulin and hexamethylene bisacetamide.

We have previously reported oscillations in the activities of the phosphoamino acid phosphatases in murine erythroleukaemic cells. In keeping with our predictions we now show that the phosphotyrosine phosphatase activity rhythm has a much shorter period than originally seemed the case, being of the order of 10 min and probably less. The periodic changes show evidence of rhythmic modulation of mean, period and amplitude as with all other cellular oscillations studied. Insulin decreases the frequency of the rhythm while the inducer of differentiation, hexamethylene bisacetamide (HMBA) decreases its amplitude. Current ideas on phosphorylation dynamics in relation to metabolism and mitosis may need to be revised in the light of the observations.

Acetamides↗
PubMed1996

Independent high-frequency oscillations in the amounts of individual isozymes of lactate dehydrogenase in HL60 cells.

Early studies, using kinetic methods, suggested that the isozyme pattern of lactate dehydrogenase in various cells oscillated with time. More recent electrophoretic studies on murine erythroleukaemic cells (which exhibit only one isozyme) indicated very high frequency variations (period 2 min or less) in the amount of the lone active isozyme. We now show that in HL60 cells, the activity stain intensities of the two major isozyme bands both oscillate but the temporal variations are distinct. As with other cellular rhythms, each of the two periodicities seem to be modulated in cyclic fashion with respect to period, amplitude and mean levels, the periods of both the primary and modulating rhythms being of the order of 10-15 min or probably much less.

Activity Cycles↗
PubMed1996

Distinct, very high frequency oscillations in the activity and amount of active isozyme of lactate dehydrogenase in murine erythroleukaemic cells and a cell-free system.

Electrophoretic and kinetic determinations of the activity of lactate dehydrogenase in murine erythroleukaemic (MEL) cells, sampled at 1 min intervals, reveal distinct oscillations in the activity and amount of active isozyme. Both oscillations have periods in the range of 2-6 min (probably less) and both appear to be rhythmically modulated with respect to period, amplitude and mean. The oscillations also occur in cell-free systems, a fact which throws doubt on the value of studies where it is assumed that such preparations have constant composition.

Activity Cycles↗
PubMed1996

The role of colpocleisis with urethral lengthening in transsexual phalloplasty.

OBJECTIVE: Transsexual surgery is an unique area of rarely performed surgery. This study examines factors that have significance in the prevention of major morbidity in this unusual surgery. The role of the gynecologist in the psychologic, endocrine, and operative management is presented. STUDY DESIGN: Initial operations were complicated by fistulas at the urethra-to-phallus anastomosis site. After reviewing these complications, we modified our approach to include a two-stage procedure allowing for healing before microsurgery and sparing of the anterior vaginal wall during vaginal hysterectomy and colpocleisis. By sparing the anterior vaginal wall, we were able to better extend the urethra for later phallus attachment. RESULTS: Using the two-stage procedure at colpocleisis allowed a significant reduction in the fistula rate. (p = 0.0087) with the effective elimination-fistulas, the use of stiffeners during phalloplasty for better functional results is possible. CONCLUSION: Extending the urethra during colpocleisis allows for better healing and significantly decreased fistula formation. Proper blood supply for microvascular surgery and adequate tissue for the anastomosis site contribute to better results.

Female↗
PubMed1996

QI as resolution to a major lawsuit.

BACKGROUND: In 1991, in response to a lawsuit filed in 1974, the Texas Department of Mental Health and Mental Retardation (TXMHMR) became the first major state agency in Texas to implement a systemwide effort to implement quality improvement (QI) in its Quality System Oversight (QSO) program. QSO: The QSO approach includes a uniform internal hospital management structure focusing on teams and data-based decision making; the development of uniform work processes for each of the issues cited in the lawsuit; and a uniform set of procedures for determining compliance, including the establishment of numeric targets for which each hospital is accountable. CASE STUDY: At one TXMHMR hospital, patient records in a monthly random sample were below the performance target. Data showed that approximately 40% of the patients leave the hospital (many for a community mental health center) before a treatment plan (at 14 days) is developed. Based on a team's recommendations, a uniform assessment package is being developed for use by all TXMHMR hospitals and community mental health centers. THE NEXT STEP: In 1994, again in response to external pressures to improve quality, TXMHMR used a simplified version of the Malcolm Baldrige National Quality Award criteria for organizational self-assessment. Two pilot sites have developed action plans for improving performance as indicated on the self-assessments. SUMMARY AND CONCLUSIONS: The QSO program, put into place as a result of a lawsuit, provides a structure and database for TXMHMR to efficiently and effectively manage the performance of all hospitals in the system. All but one of the eight hospitals have exited, or are close to exiting, the lawsuit.

Affective Symptoms↗
PubMed1995

Ageing, oscillations and efficiency.

The phenomenon of ageing still defies understanding. Theoretical studies have indicated that glycolysis is more efficient at maintaining a high ATP/ADP ratio when oscillating at its resonant frequency. Earlier, it was proposed that the differentiated state results from the establishment of a stable pattern of temporal organisation. It is now suggested that ageing involves a decrease in efficiency due to the detuning of oscillating glycolysis as a result of frequency locking with other cellular oscillations in the differentiated state.

Adenosine Diphosphate↗
PubMed1995

Approach to genotyping errors caused by nontemplated nucleotide addition by Taq DNA polymerase.

Thermostable DNA polymerases can catalyze nontemplated addition of a nucleotide to the 3' end of amplification products. This presents a potential source of error in genotyping studies employing Taq DNA polymerase to amplify microsatellite loci. Although the activity is marker specific, experimental variation is often seen in the degree of modification. Consequently, for a given microsatellite marker, an allele may be inconsistently identified as either the unmodified or modified amplification product. Full automation of high-throughput genotyping has been hampered by the need for manual editing of data because of this source of allele misidentification. In this study we estimate a 1% to 3% error rate attributable to nontemplated nucleotide addition in the ABI PRISM genotyping system. We present a PCR-based strategy to minimize this source of error.

Alleles↗
PubMed1995

Elderly residents: perceptions of nurses' comforting touch.

1. Elderly nursing home residents often feel unwanted or unloved because of a lack of physical contact with others or their caregivers' inability to communicate love and belonging. 2. In a study of 25 elderly nursing home residents, it was found that those who were subjected to comforting touch by their nurses perceived an increased feeling of affection and immediacy. 3. The conscious and intentional use of comforting touch by nurses and caregivers to elderly nursing home residents should be encouraged because of its beneficial effect of conveying love and belonging.

Aged↗
PubMed1994

Oscillatory variations in the amount of protein extractable from murine erythroleukemia cells: stimulation by insulin.

The amount of protein extractable from murine erythroleukemia (MEL) cells varies in an oscillatory manner at high frequency and high amplitude as it does for several other cell lines. Moreover, the rhythm appears to be modulated in periodic fashion with respect to the mean, period and amplitude. The phenomenon thus seems to be universal and fundamental. Time series analyses support the view that several periodicities contribute to the observed protein rhythm. Insulin affects the dynamics as it does for both morphological and phosphorylation oscillations. Caution is necessary in the interpretation of 'specific activities' of cellular components and in electrophoretic studies wherein equal amounts of protein are applied to the wells in an effort to correct for random errors.

Animals↗
PubMed1994

Insulin stimulation of high frequency phosphorylation dynamics in murine erythroleukemia cells.

The phosphorylation potentials of two proteins (M(r) 81 kDa and 63 kDa) in extracts of murine erythroleukemic (MEL) cells both vary in an oscillatory manner, sometimes changing by as much as 100-fold in 10 min. Direct analysis of the temporal changes indicates the existence of periodic modulation of the frequencies, amplitudes and mean levels of the two rhythms. In both cases, periodogram analyses, by two methods, confirm the presence of several oscillations having periods in the range 20-100 min which tend to occur in (pseudo) periodic bursts. Insulin has been found to enhance these oscillations in a manner comparable with its effect on rhythmic variations in cell morphology. Despite the marked similarity in the behaviour of the two proteins, no particular phase relationship existed between the two temporal variations, suggesting differences between the underlying driving forces.

Activity Cycles↗