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Biomedical subjects

M Murphy

Publications and source records attributed to M Murphy.

At least 271 records · Page 15Linked to original sources
PubMed1995

Sterilisation as a method of contraception: recent trends in Great Britain and their implications.

Data on patterns and trends in sterilisation in Britain among women, men and couples are presented using life table approaches with data from a national survey, the General Household Survey. Among couples under age 50, sterilisation is the main method of contraception used, with slightly more women than men being sterilised, although this is reversed if only contraceptive sterilisation is considered. Trends in contraception have remained relatively constant in recent decades. Patterns of sterilisation differ following births of different orders. For example, the resort to sterilisation is much quicker after a third birth than after a second. The proportions of men and women who have been sterilised and then formed a subsequent partnership are very small, so the effect of sterilisation in preventing births in such unions is negligible.

Adolescent↗
PubMed1995

Open learning; the managers' and educationalists' perspective.

The development of the internal market within nurse education has led colleges of nursing to review their portfolio of course provision for consumers of health education. As a result of this, education is questioning whether traditional modes of programme delivery are sufficiently versatile to meet the needs of purchasers within the changing nature of health care delivery. This study uses a case study approach to explore nurse managers' and nurse educationalists' feelings and motivations towards the development of open-learning programmes within one college of nursing. The central themes emerging from the literature review of open learning mirror the philosophies underpinning humanistic education theories. These themes led to the development of the theoretical framework against which the data generated from in-depth interviews with managers and educationalists were analysed. The data identified that both managers and educationalists valued open learning as a mode of programme delivery appropriate to their needs. However, both groups confused the concepts of open and distance learning, the latter being firmly supported by nurse managers as it allows staff development without demanding time out of the clinical area. Each group saw benefits in the commercialization of open-learning packages, not purely as a cut-throat enterprise but as a means by which nurse education can protect itself from competition.

Adult↗
PubMed1995

Strategies for immune intervention in visceral leishmaniasis.

Therapeutic intervention remains a major tool for control of visceral leishmaniasis (VL). Studies in murine models of VL have demonstrated the efficacy of various cytokines, either alone or in conjunction with antimony chemotherapy. Here, some basic aspects of the models used to study VL are summarized and the recent data in this field are reviewed. Finally, alternative strategies to harnessing the protective potential of the host immune response, based on augmenting communication between antigen-presenting cells and T cells, are discussed.

Animals↗
PubMed1995

Dietary calcium and lead interact to modify maternal blood pressure, erythropoiesis, and fetal and neonatal growth in rats during pregnancy and lactation.

We studied the effects of dietary calcium and lead exposure on lead toxicity, fetal and neonatal growth, erythropoiesis and blood pressure during pregnancy and lactation in rats. Pregnant Sprague-Dawley rats (n = 43) were randomly assigned to one of six treatment groups of 7-8 rats each. Half of the rats were fed diets of low (0.1%), normal (0.5%) or high (2.5%) calcium as calcium carbonate and exposed to 250 mg/L of lead in their drinking water for the duration of the pregnancy and for 1 wk of lactation. Three control groups were fed the same diets without lead exposure. Pups were studied at 1 d and 1 wk of age. Maternal and fetal blood and organ samples from the groups fed the low calcium diet had the highest lead concentrations, whereas the lowest lead concentrations were found in the groups fed the high calcium diet. Dam and pup hemoglobin concentrations, hematocrits, and body weights and lengths were reduced by lead exposure and by the high calcium diet. The latter also reduced organ iron concentrations and prevented lead-induced increases in free erythrocyte protoporphyrin. Dam systolic blood pressures during the third trimester of gestation were significantly higher in rats exposed to lead and fed the low calcium diet than in rats in the other five treatment groups. The results demonstrate that dietary calcium and lead exposure interact in rats to influence maternal blood pressure, erythropoiesis, and fetal and neonatal growth during pregnancy and lactation.

Animals↗
PubMed1995

Clinical trial of a new lightwand device (Trachlight) to intubate the trachea.

BACKGROUND: Transillumination of the soft tissue of the neck using a lighted stylet (lightwand) is an effective and safe intubating technique. A newly designed lightwand (Trachlight) incorporates modifications to improve the brightness of the light source as well as flexibility. The goal of this study was to determine the effectiveness and safety of this device in intubating the trachea of elective surgical patients. METHODS: Healthy surgical patients were studied. Patients with known or potential problems with intubation were excluded. During general anesthesia, the tracheas were intubated randomly using either the Trachlight or the laryngoscope. Failure to intubate was defined as lack of successful intubation after three attempts. The duration of each attempt was recorded as the time from insertion of the device into the oropharynx to the time of its removal. The total time to intubation (TTI), an overall measure of the ease of intubation, was defined as the sum of the durations of all (as many as three) intubation attempts. Complications, such as mucosal bleeding, lacerations, dental injury, and sore throat, were recorded. RESULTS: Nine hundred fifty patients (479 in the Trachlight group and 471 in the laryngoscope group) were studied. There was a 1% failure rate with the Trachlight, and 92% of intubations were successful on the first attempt, compared with a 3% failure rate and an 89% success rate on the first attempt with the laryngoscope (P not significant). All failures were followed by successful intubation using the alternate device. The TTI was significantly less with the Trachlight compared with the laryngoscope (15.7 +/- 10.8 vs. 19.6 +/- 23.7 s). For laryngoscopic intubation, the TTI was longer for patients with limited mandibular protrusion and mentohyoid distance, with a larger circumference of the neck, and with a high classification according to Mallampatti et al. However, there was no relation between the TTI and any of the airway parameters for Trachlight. There were significantly fewer traumatic events in the Trachlight group than in the laryngoscope group (10 vs. 37). More patients complained of sore throat in the laryngoscope group than in the Trachlight group (25.3% vs. 17.1%). CONCLUSIONS: In contrast to laryngoscopy, the ease of intubation using the Trachlight does not appear to be influenced by anatomic variations of the upper airway. Intubation occasionally failed with the Trachlight but in all cases was resolved with direct laryngoscopy. The failures of direct laryngoscopy were resolved with Trachlight. Thus the combined technique was 100% successful in intubating the tracheas of all patients.

Adult↗
PubMed1995

Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: a randomized trial of a group cognitive intervention.

OBJECTIVES: This investigation attempted to prevent unipolar depressive episodes in a sample of high school adolescents with an elevated risk of depressive disorder. METHOD: Adolescents at risk for future depressive disorder by virtue of having elevated depressive symptomatology were selected with a two-stage case-finding procedure. The Center for Epidemiologic Studies-Depression Scale (CES-D) was administered to 1,652 students; adolescents with elevated CES-D scores were interviewed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Subjects with current affective diagnoses were referred to nonexperimental services. The remaining 150 consenting subjects were considered at risk for future depression and randomized to either a 15-session cognitive group prevention intervention or an "usual care" control condition. Subjects were reassessed for DSM-III-R diagnostic status after the intervention and at 6- and 12-month follow-up points. RESULTS: Survival analyses indicated a significant 12-month advantage for the prevention program, with affective disorder total incidence rates of 14.5% for the active intervention, versus 25.7% for the control condition. No differences were detected for nonaffective disorders across the study period. CONCLUSION: Depressive disorder can be successfully prevented among adolescents with an elevated future risk.

Adaptation, Psychological↗
PubMed1995

Abnormal body composition and reduced bone mass in growth hormone deficient hypopituitary adults.

OBJECTIVES: The role of growth hormone in maintaining normal body composition and bone strength in adults has attracted much interest recently. We have assessed body composition and bone mass in GH deficient hypopituitary adults on conventional replacement therapy and compared them with matched controls. DESIGN AND SUBJECTS: A cross-sectional study of 64 growth hormone deficient hypopituitary adults (29 males and 35 females) on conventional replacement therapy and a large number of healthy control subjects matched for age, sex and body mass index (BMI). MEASUREMENTS: Skinfold thicknesses at two sites (triceps and subscapular), waist and hip girth circumferences were assessed by standard methods. Body composition was assessed using total body potassium (TBK), bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DEXA). Bone mineral mass was assessed at the lumbar spine and the total body by DEXA. Not every patient and control participated in every measurement. RESULTS: Obesity was common in the hypopituitary patients; BMI (mean +/- SD) was 27.5 +/- 4.6 kg/m2 and body weight was 111.8 +/- 18.5% of the maximal ideal for height (P < 0.001). The sum of subscapular and triceps skinfolds was significantly higher in hypopituitary patients than in controls (men 46 + 15 vs 37 +/- 14 mm, P < 0.05; women 55 +/- 13 vs 47 +/- 17 mm, P < 0.05). Waist to hip circumference ratio was significantly greater in female hypopituitary patients than in matched controls but was not significantly different in men (men 0.94 +/- 0.07 vs 0.91 +/- 0.07, NS; women 0.84 +/- 0.09 vs 0.77 +/- 0.05, P < 0.001). The difference between patients and controls in the sum of skinfolds and the waist to hip ratio were present in non-obese (BMI < 26 kg/m2) subjects (21 patients and 32 controls). TBK corrected for body weight was significantly lower in hypopituitary patients (n = 44) than in controls (n = 31) (men 43.5 +/- 5.6 vs 50.1 +/- 5.9 mmol/kg, P < 0.003; women: 34.0 +/- 3.2 vs 40.6 +/- 5.3 mmol/kg, P < 0.0001). BIA-derived body water content (corrected for body weight) was significantly lower in hypopituitary patients (n = 56) than in controls (n = 57) (0.492 +/- 0.064 vs 0.545 +/- 0.067 l/kg, P < 0.0004). Percentage body fat derived from all the three methods was significantly higher in hypopituitary patients than in normal controls in both sexes (from TBK: men 34.7 +/- 9.4 vs 28.8 +/- 7.0%, P < 0.05; women 37.8 +/- 8.7 vs 30.4 +/- 9.7%, P < 0.01; from BIA: men 29.3 +/- 8.5 vs 23.2 +/- 8.4%, P < 0.01; women 34.6 +/- 8.1 vs 29.3 +/- 9.1% P < 0.01; and from DEXA: men 24.8 +/- 6.8 vs 20.4 +/- 6.1%, P < 0.05; women 38.9 +/- 7.9 vs 32.5 +/- 9.8%, P < 0.01). There was a significant difference between non-obese patients and controls in BIA-derived percentage fat in both sexes and in TBK-derived percentage fat in females only. Bone mineral density (BMD) of the lumbar spine in the L2-L4 region was lower in hypopituitary patients than in controls (men 1.116 +/- 0.129 vs 1.311 +/- 0.131 g/cm2, P < 0.0001; women 1.001 +/- 0.122 vs 1.131 +/- 0.138 g/cm2, P < 0.001). Spine BMD was also reduced in hypopituitary patients compared to the young adult and age and weight matched reference data. Total body BMD was significantly lower in patients than in controls (men 1.186 +/- 0.102 vs 1.250 +/- 0.080 g/cm2, P < 0.05; women 1.080 +/- 0.077 vs 1.149 +/- 0.073 g/cm2, P < 0.005). CONCLUSIONS: Hypopituitary adults on conventional therapy have abnormal body composition with increased fat content, reduced body water content and reduced bone mineral mass.

Adipose Tissue↗
PubMed1995

Effect of glucocorticoids on serum osteocalcin concentration in horses.

The effects of dexamethasone (0.2 mg/kg of body weight; IV, IM, and PO) and methylprednisolone acetate (120 mg given intra-articularly) on serum osteocalcin and cortisol concentrations were studied in 6 horses. Serum osteocalcin and cortisol concentrations were serially monitored after each treatment. A significant (P < 0.05) decrease in serum osteocalcin and cortisol concentrations was observed from 12 to 24 and 2 to 48 hours, respectively, after IV and IM administrations of dexamethasone. Serum osteocalcin and cortisol concentrations were significantly decreased from 6 to 48 and 3 to 72 hours, respectively, after oral administration. In contrast, a change in serum osteocalcin concentration was not detected after intra-articular administration of methylprednisolone. Oral, IV, or IM treatment with 0.2 mg of dexamethasone/kg caused a decrease in serum osteocalcin concentration in horses.

Animals↗
PubMed1995

Loin pain and haematuria syndrome: a somatoform disorder.

Fifteen patients with the loin pain and haematuria syndrome (LPH) were compared with 10 patients with complicated renal stone disease referred to the same tertiary centre and matched for age, sex and duration of illness. LPH patients had a history of three times more medically unexplained somatic symptoms other than loin pain (p < 0.01) and a higher proportion took analgesics regularly (p < 0.01). The onset of pain was associated with an adverse psychologically important life-event in eight of the LPH patients but in none of the controls (p < 0.02). LPH patients more frequently recalled serious parental illness and disability in childhood (p < 0.001) than controls, and a higher proportion felt responsible for causing or alleviating parental illness or distress (p < 0.05). LPH subjects scored higher in the 'paternal care' dimension of the Parental Bonding Instrument (p < 0.05). No difference was found between LPH patients and controls in terms of current depression and anxiety but both groups exhibited high rates of lifetime depression. LPH patients expressed lower levels of anger and hostility (p < 0.002) than did controls. Our observations suggest that psychological factors are of major importance in the aetiology of LPH, which may represent a type of somatoform pain disorder.

Adult↗
PubMed1995

Use of total quality management sparks staff nurse participation in continuous quality improvement.

To improve patient care outcomes and reduce costs, hospitals are implementing the total quality management (TQM) model that has been successful in other industries. The Division of Nursing at one major medical center has devised a continuous quality improvement plan that incorporates TQM philosophy and methodology. This article describes how the TQM philosophy has evolved as the foundation for quality management at this medical center.

Academic Medical Centers↗
PubMed1995

Continuous quality improvement for peritoneal dialysis patients.

In addition to a significant savings in time, several qualitative factors were impacted positively by this change in practice. Clear guidelines provided a structure that both physicians and nursing supported, thereby improving their relationship. The LPN's role was amended to include the stop-and-start procedure, which enhanced their self-esteem. Having the assistive personnel contribute to the dialysis regimen allowed the RN more latitude in managing patient care and efficient use of time. Because the procedure was now done more efficiently, therapy was initiated without delay. Lastly, patients expressed satisfaction because the nursing staff's own technique and the patient was now being discharged without their own technique and the patient was now being discharged without delay. All RN and LPN staff continue to be trained in the procedure. Cases of peritonitis continue to be investigated with favorable results. Results of this project were shared not only with the staff but also with the management committee of the hospital. Management had embraced the philosophy of continuous QI. The management committee was anxious to see the principles of continuous QI improve efficiency and patient outcomes. Reducing the complexity and decreasing the time required for the procedure maintained quality patient outcomes. Applying the continuous quality monitoring process and tools to the management of one group of chronically ill patients was shown to be an effective means of improving patient care and efficiency as well as of reducing costs.

Academic Medical Centers↗
PubMed1995

Improving the admission process from the emergency department to the critical care areas.

The CCU and CSU successfully established an interdisciplinary QI team. Through the implementation of the QI process the group focused on an indicator that influenced patient satisfaction. QI tools were effectively used to analyze the complex admission process of CCU and CSU patients admitted through the ED. Quality tools were also used to analyze the data over time. The QI process and methodology were effectively implemented to address a complex problem. The results will serve as a foundation for the new process improvement committee focusing on the unstable angina population.

Academic Medical Centers↗
PubMed1995

Managing ascites via the Tenckhoff catheter.

Ascites is a serious and uncomfortable symptom experienced by a significant percentage of cancer patients. The use of the Tenckhoff catheter provides rapid relief of the mechanical effects of ascites. When this technology is used in the hospital or in the home, nurses act to prevent complications and inform patients and families about safety and other issues.

Ascites↗
PubMed1994

Carbonyl-containing bisphosphonate esters as novel antiinflammatory and antiarthritic agents.

A study of the decomposition of the pyrazoline bisphosphonate ester 2 identified 3 as the sole bisphosphonate component. Evaluation in a delayed-type hypersensitivity granuloma model of chronic inflammation in mice (DTH-GRA) showed 3 to be a potent inhibitor of granuloma formation (sc, 10 mg/kg, 45%), but in a murine model of antigen-induced arthritis (AIA), no significant inhibition was observed. As a result, new ketonic bisphosphonate tetraethyl esters were synthesized from vinylidenebisphosphonic acid tetraethyl ester 4 and activated carbonyl compounds in 13-84% yield. 6 significantly inhibited the pathology of both the DTH-GRA (sc, 25 mg/kg, 45%) and AIA models (sc, 25 mg/kg, 55%). Other compounds in the series were not as potent. Our results show that bisphosphonate ester 6 can inhibit the chronic inflammatory response associated with cutaneous granuloma formation and erosive arthritis.

Animals↗
PubMed1994

Identification of a microsatellite instability phenotype in meningiomas.

To better understand the molecular mechanisms responsible for meningioma tumorigenesis we previously utilized subtractive hybridization protocols to identify genes the expression or structure of which is altered in these common brain tumors. Here we show that a CA dinucleotide repeat element present in one complementary DNA isolated by this approach has undergone a contraction in size in a meningioma cell line. Extension of this initial observation has revealed widespread genetic alterations affecting simple repeat sequences in this and other meningiomas. These data indicate that genetic instability may play a previously unrecognized role in the etiology of meningiomas.

Base Sequence↗
PubMed1994

Horizontal root fracture--an unusual complication.

Cystic change at the site of a root fracture is an unusual sequelae. A case report of such an occurrence in a horizontal root fracture involving the apical third of a permanent central incisor in a 22-year-old man is presented and management of these injuries is discussed in brief.

Adult↗