Search PubMed⌕ Search

Biomedical subjects

M Muller

Publications and source records attributed to M Muller.

At least 199 records · Page 11Linked to original sources
PubMed1995

Participative management in health care services.

The need and demand for the highest-quality management of all health care delivery activities requires a participative management approach. The purpose with this article is to explore the process of participative management, to generate and describe a model for such management, focusing mainly on the process of participative management, and to formulate guidelines for operationalization of the procedure. An exploratory, descriptive and theory-generating research design is pursued. After a brief literature review, inductive reasoning is mainly employed to identify and define central concepts, followed by the formulation of a few applicable statements and guidelines. Participative management is viewed as a process of that constitutes the elements of dynamic interactive decision-making and problem-solving, shared governance, empowerment, organisational transformation, and dynamic communication within the health care organisation. The scientific method of assessment, planning, implementation and evaluation is utilised throughout the process of participative management. A continuum of interactive decision-making and problem-solving is described, the different role-players involved, as well as the levels of interactive decision-making and problem-solving. The most appropriate decision-making strategy should be employed in pro-active and reactive decision-making. Applicable principles and assumptions in each element of participative management is described. It is recommended that this proposed model for participative management be refined by means of a literature control, interactive dialogue with experts and a model case description or participative management, to ensure the trustworthiness of this research.

Decision Making, Organizational↗
PubMed1995

A marketing strategy for a nursing college.

The objective of this study is to explore and describe a marketing strategy for a nursing college. An explorative and descriptive research design, within the context of a nursing college and affiliated hospitals, was followed. A literature study of marketing models was undertaken and the Delphi-method was utilised to determine the contribution of marketing staff and the possible content of a marketing strategy for a nursing college. The results were utilised to describe guidelines for such a strategy, consisting of marketers/marketing agents, target market, product, price, promotional activities, place and market research. Recommendations include the planning, implementation and evaluation of strategy, inservice training for potential marketing agents, inclusion of marketing as part of the formal education of tutors and nurse managers, as well as an impact study of the scholar as the main consumer.

Advertising↗
PubMed1995

[A staff development model in psychiatric nursing].

The nursing service manager is accountable for the quality of nursing care delivered in the nursing service. It is therefore important that the nursing service manager facilitates staff development in the nursing service. It is not only the nursing service manager's responsibility to make provision for staff development--the nurse also has a responsibility in this regard. He/she should purposefully make an effort to keep up to date with the latest developments. This article focuses on the co-responsibility of the psychiatric nurse and nursing service manager regarding staff development. A model for staff development is described, in accordance with the guidelines of Dickoff, James & Wiedenbach for theory development. An inductive approach was primarily followed to describe the provisional model, after which a literature study was employed to refine and purify the model. This model was exposed to expert evaluation, after which the final model for staff development of psychiatric nurses was described. Recommendations include the testing of certain hypotheses and utilisation of this model in psychiatric nursing practice.

Humans↗
PubMed1995

[Nursing leadership in perspective].

South Africa is currently in the process of political change, which places great demands on all service sectors. To meet these demands effectively, will require dynamic leadership on all levels of service industries. The nursing profession in South Africa has produced several significant leaders, of whom Sister Henriëtta Stockdale and Professor Charlotte Searle are prime examples. However, research reports indicate that the profession is currently undergoing a crisis with regard to nursing service management. It is assumed that the nursing profession of South Africa is experiencing a leadership crisis. It seems as if there are not sufficient new leaders to replace those who retire from the profession--which means that leadership development is inadequate in the profession. Only a few South African research projects have been undertaken with regard to leadership in the nursing profession. However, the process of leadership practice in nursing has never been researched in South Africa. In this paper a provisional model is presented for leadership practice in nursing, which is developed and based on a Judeo-Christian-philosophical approach. The dimensions and assumptions of nursing leadership practice will be discussed, whereafter the dynamics of nursing leadership will be highlighted. Finally the process of leadership will be described by suggesting four leadership actions, each with its own principles, prerequisites and assumptions. It is recommended that this provisional model be exposed to reliability and validity control measures, to develop a final model for nursing leadership.

Health Services Needs and Demand↗
PubMed1994

Two silencing sub-domains of v-erbA synergize with each other, but not with RXR.

The thyroid hormone receptor (TR) and the retinoic acid receptor (RAR) induce gene expression in the presence of specific ligand and repress transcription in the absence of hormone. This repression is mediated by an active silencing mechanism rather then by interference with DNA binding activators. V-erbA, a variant form of TR which is unable to bind hormone, represents a constitutive repressor. Here we show, using fusion proteins with the GAL4 DNA binding domain, that the minimal silencing domain of v-erbA extends from amino acids 389 to 632 and that internal deletions within this domain retain at least some repression function. Co-transfection experiments of different deletion mutants indicate that the silencing domain is composed of at least two sub-domains which are non-functional when tested individually. When combined in a heterodimeric complex, they synergize such that silencing activity is regained. In contrast to the retinoic acid receptor the retinoid X receptor does not contain a silencing domain. In addition it is unable to cooperate with the repression function of TR or v-erbA in a heterodimer.

Amino Acid Sequence↗
PubMed1994

Lipolysis in burned patients is stimulated by the beta 2-receptor for catecholamines.

OBJECTIVE: To determine if the cardiovascular effects of excessive catecholamines could be selectively blocked in severely burned patients without adversely affecting protein or fat kinetics. DESIGN: Prospective cohort study. SETTING: A large tertiary care referral center in Galveston, Tex. PATIENTS: Sixteen patients with greater than 40% body surface area burns. INTERVENTIONS: Patients were randomly selected to receive propranolol hydrochloride, a nonselective beta 1- and beta 2-blocker, or metoprolol tartrate, a selective beta 1-blocker. MAIN OUTCOME MEASURES: Heart rate; rate-pressure product; rate of appearance of urea, glucose, and leucine; and leucine oxidation were measured before and after selective or nonselective beta-adrenergic blockade. RESULTS: Propranolol and metoprolol caused a significant decrease in heart rate, from a mean (+/- SD) of 143 +/- 15 to 115 +/- 11 and from 147 +/- 17 to 120 +/- 9 beats per minute, respectively, during the 5-day study period. Neither the rate of appearance of urea nor the rate of urea production were significantly altered by propranolol or metoprolol therapy. Only propranolol produced a significant decrease (P < .05) in the rate of appearance of glycerol, from a mean (+/- SD) of 5.54 +/- 0.62 to 3.07 +/- 0.7 mumol/kg per minute. The rate of appearance of leucine, used as an index of total body protein catabolism, was not significantly altered by either beta-blocker. CONCLUSIONS: Selective beta 1-adrenergic blockade did not reduce lipolysis; however, a beta 1- and beta 2-adrenergic blockade significantly reduced lipolysis. Thus, the increased lipolysis, characteristic of severely burned patients, is caused by stimulation of the beta 2-adrenergic receptors for catecholamines.

Adolescent↗
PubMed1994

A complex composed of at least two HeLa nuclear proteins protects preferentially one DNA strand of the simple (gt)n(ga)m containing region of intron 2 in HLA-DRB genes.

Electrophoretic mobility shift assays reveal that HeLa nuclear proteins bind fast and with measurable affinity to target DNAs containing mixed simple repetitive (gt)n(ga)m stretches. Preincubation of the proteins at elevated temperature prevents the formation of the major DNA/protein complex in favour of several distinct assemblies. A similar pattern of retarded bands was observed employing higher salt concentrations in the binding reaction. Thus conformational changes of different proteins appear to influence the complex rather than alternating DNA structures. Separation of the total nuclear extract into a water soluble and an insoluble protein fraction leads to a complete loss of target DNA binding capability of the fractions. The binding capacity is restored by combining the two fractions suggesting that at least two protein components are necessary to form a complex with the target sequence. The proteins can be differentiated into heat sensitive, water soluble and temperature stable, water insoluble, respectively. Furthermore, specifically binding polypeptides are not detectable by Southwestern analyses, probably because the essential components are separated during electrophoresis. DNase I footprint analyses yield four different protein binding regions only on the (gt)n(ga)m harbouring strand. The footprints cover larger portions of the mixed simple repeat in addition to a portion 5' of the (gt)n part. Hence at least two nuclear protein components of unknown biological function have to be present simultaneously to protect preferentially the (gt)n(ga)m-containing strand of intron 2 in HLA-DRB genes.

Base Sequence↗
PubMed1994

DNase I hypersensitive sites far upstream of the rat tryptophan oxygenase gene direct developmentally regulated transcription in livers of transgenic mice.

Expression of the gene coding for tryptophan oxygenase (TO) is switched on in rat liver about two weeks after birth. We identified two clusters of DNaseI hypersensitive (HS) sites in the TO gene upstream region; one near the promoter, the other at a distant upstream location (-8.5 kb). Hypersensitivity of upstream sites was present in adult and in 7 day old rat liver, but absent in kidney. To investigate their role in transcriptional regulation, a reporter gene controlled by both HS site regions was used to generate transgenic mice. In these animals the transgene followed the cell specific and developmental regulation of the endogenous gene: inactive after birth and active in adult liver. Transgenes containing only the promoter proximal HS site were non-functional.

Aging↗
PubMed1994

Malignant rhabdoid tumour of the pineal region.

A 9-month-old male presented to hospital with signs and symptoms of raised intracranial pressure. A CT scan showed obstructive hydrocephalus from a large pineal region mass lesion into which an intratumoral hemorrhage had occurred. A posterior fossa craniectomy and subtotal excision of the mass lesion were performed. By histopathology, the lesion was a malignant rhabdoid tumour (MRT). Despite surgery and chemotherapy, the tumour grew inexorably, and the patient died four months after the initial diagnosis. MRT is a rare and highly invasive neoplasm which infrequently arises from the central nervous system. This is the first documented case of a MRT arising from the pineal region. The clinical, radiographic, and pathological features of the MRT in this patient are presented.

Brain Neoplasms↗
PubMed1994

Patterns of weight growth in aboriginal children on Queensland communities.

We have used data from existing health records to study the birthweights and percentage weights for age (%W/A) of children in five Aboriginal communities in Queensland. The data are from cohorts of children born in the 1950s-80s at Cherbourg, the 1960s-80s at Yarrabah and the 1970s-80s in Woorabinda, Palm Island and Doomadgee. Birthweights have not changed significantly in any of the communities and generally remain below the international level. The weights for 1 and 5 year old children have improved significantly at Cherbourg and Palm Island, but have dropped significantly at Doomadgee. The overall pattern is for children on remote communities to have a lower %W/A and less improvement in %W/A than those closer to population centres. Other workers have found the same pattern elsewhere. These patterns of growth are probably not directly related to the level of general health services, but rather to other facilities available and attitudes of mothers to child care. The results also show that Aboriginal children can reach international levels of %W/A, so the poor growth in many communities is potentially preventable.

Body Weight↗
PubMed1994

A thyroid hormone receptor-dependent glucocorticoid induction.

Glucocorticoid and thyroid hormones exert their effects in many body tissues by binding to their respective receptors. The search for possible cross-talking mechanisms in overlapping target cells led to the discovery of synergism between a thyroid hormone receptor-binding site and a cryptic glucocorticoid-responsive element. Glucocorticoid responsiveness could only be detected in the presence of thyroid hormone and its receptor. This synergism requires the glucocorticoid receptor (GR) DNA-binding domain and is mediated by the transactivation domains. We found that synergism also occurs when the thyroid hormone receptor is replaced by the retinoic acid receptor or the GR is replaced by the progesterone receptor. Synergism is qualitatively independent of the type of thyroid hormone receptor-binding site and promoter. In several combinations of promoter and response elements, including a retinoic acid response element, T3 induction was only seen in the presence of the cryptic glucocorticoid-responsive element, GR, and glucocorticoids.

Animals↗
PubMed1994

Legal limitations in the practice of the primary health care nurse.

In this article the legal limitations in the practice of the primary health care nurse in the Republic of South Africa, having direct implications for the achievement of the goal: "Health for all by the year 2000", are explored and described. The questions which had to be answered by means of the research are in relation to the nature and scope of the limitations obstructing the practice of the primary health care nurse. A legislative (document) analysis was performed and limitations in the legislation confirmed. It is recommended that an empirical investigation be done to verify the results after which amendments and clarification of the legislation may be requested.

Community Health Nursing↗
PubMed1994

Legal limitations in primary health care nursing practice in South Africa (Part 2).

This is the second of two articles on the limitations in the practice of the nurse functioning in the primary health care field. An exploratory descriptive study was done within the context of the Republic of South Africa. Medical practitioners and nurses were asked by means of interviews of their experiences of the role of the nurse in primary health care services. The findings were verified by means of a content analysis of health legislation. Arising from this recommendations were made to address legal and other limitations in the practice of the nurse working in a primary health care setting. It was further recommended that a model for accountability for health professions be developed.

Attitude of Health Personnel↗
PubMed1994

The views of primary health care practitioners regarding legal limitations influencing the practice of primary health care nurses in South Africa.

An exploratory descriptive study was performed within the South African context to determine the legal limitations which influence the practice of the registered primary health care nurse. Primary health care medical practitioners and nurses were interviewed to ascertain their views on these limitations. The results confirmed various limitations that need to be rectified by means of the amendment/deregulation of selected legislation. It is also recommended that a model for professional accountability, suitable for the South African health care delivery system, be developed.

Attitude of Health Personnel↗
PubMed1994

Human endothelial cells suppress prothrombin activation in nonanticoagulated whole blood in vitro.

Human endothelial cells cultivated on polystyrene microcarrier beads were used to study endothelial anticoagulant activity in vitro. Spontaneous whole blood coagulation was inhibited by endothelial cells on microcarriers at a surface to volume ratio of 16 cm2/ml blood. Thrombin activity generated in nonanticoagulated whole blood during 1 hour and assessed by its fibrinogen clotting effect was reduced by 87% in the presence of endothelial cells. Consistent with this observation, prothrombin fragment1+2, fibrinopeptide A, and thrombin-antithrombin III-complex release during the same period of time were inhibited by 81%, 47%, and 88%, respectively. Immunoblotting analysis of cell-free supernatants derived from the same samples demonstrated that prothrombin activation was strongly suppressed in the presence of endothelial cells. Furthermore, the incubation of nonanticoagulated whole blood with endothelialized beads for only 5 minutes after venipuncture was sufficient to prevent subsequent prothrombin activation in the cell-free supernatants of the same whole blood sample after centrifugation. These findings suggest that interruption of the coagulation cascade is probably one major mechanism of endothelial anticoagulant activity in vivo.

Antithrombin III↗