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Biomedical subjects

R Turner

Publications and source records attributed to R Turner.

At least 163 records · Page 9Linked to original sources
PubMed1995

The application of quality improvement tools to increase the number of day-only admissions: a rural hospital's experience.

Hospital discharge data were analysed and showed Tamworth Base Hospital as having fewer day-only admissions compared to similar hospitals. A team of ten staff involved in all aspects of day-only patient transactions was selected to analyse work processes associated with the day-only patient system with the aim of increasing the number of day-only admissions. From the application of quality improvement tools, the team was able to make recommendations to increase the work flow and predict resources necessary to increase day-surgery throughput. A revised system allowing for an increase in the number of admissions has been introduced; this has seen a significant increase in the number of people admitted as day-only patients. A telephone survey following discharge of day-surgery patients indicates that standards of care have been maintained and improved.

Ambulatory Surgical Procedures↗
PubMed1995

Quality management: the influence of staff morale on customer focus.

Staff morale can be an indicator of an organization's progress towards developing a customer-focused culture, which is necessary for delivering quality services. While not a new concept, customer focus is the force that drives Quality Management. It is, however, only one of the essential components of quality management. The methodology for assessing staff morale and relating it to customer satisfaction in a large rural hospital is outlined and discussed. Results suggest that staff are willing to respond to the present external customer focus initiative demanded by the New South Wales Health Department, provided management plays its role in creating a work environment conducive to the delivery of satisfying services.

Attitude of Health Personnel↗
PubMed1995

The efficacy of staff training on improving internal customer satisfaction in a rural health setting.

The NSW Health Department is 3 years into its customer satisfaction initiative. North West Health Service, one of the largest rural health districts, was among the first centres to embrace the customer satisfaction philosophy starting with compulsory training of all staff. This paper reports on changes in staff morale (internal satisfaction) as a result of that training. The data suggest that training per se has had minimal effect and argues for management development, particularly regarding leadership, rather than fiscal skills.

Community Health Services↗
PubMed1995

Cultural considerations in the assessment and treatment of religious and spiritual problems.

Scott Peck, a psychiatrist who has written several books on the spiritual dimensions of life, including the best-selling The Road Less Traveled, gave an invited address which drew a standing-room only audience at the 1992 Annual Meeting of the American Psychiatric Association. He pronounced that psychiatrists are "ill-equipped" to deal with either religious/spiritual pathology or health. Continuing to neglect religious/spiritual issues, he claimed, would perpetuate the predicaments that are related to psychiatry's traditional neglect of these issues: "occasional, devastating misdiagnosis; not infrequent mistreatment; an increasingly poor reputation; inadequate research and theory; and a limitation of psychiatrists' own personal development." In recent years, there have been a number of developments that have begun to redress psychiatry's cultural insensitivity to the religious and spiritual dimensions of life. In 1990, the APA Committee on Religion and Psychiatry initiated an APA Position Statement entitled "Guidelines Regarding Possible Conflict Between Psychiatrists' Religious Commitments and Psychiatric Practice." These guidelines emphasized that "psychiatrists should maintain respect for their patient's beliefs ... and not impose their own religious, antireligious, or ideologic systems of beliefs on their patients, nor should they substitute such beliefs or ritual for accepted diagnostic concepts or therapeutic practice." These guidelines reinforce the importance of acknowledging and respecting differences in religious/spiritual beliefs between clinicians and their patients. More recently, the Accreditation Council for Graduate Medical Education published the new "Special Requirements for Residency Training in Psychiatry," which incorporated several changes mandating instruction about gender, ethnicity, sexual orientation, and religious/spiritual beliefs. Finally, the inclusion of "religious or spiritual problem" as a diagnostic category for the first time in the DSM-IV acknowledges that religious and spiritual issues can be the focus of psychiatric consultation and treatment. John McIntyre, MD, former APA President, and Harold Pincus, Director of the APA's Office of Research, observed that this new entry in DSM-IV was "a sign of the profession's growing sensitivity not only to religion but to cultural diversity generally." It is hoped that these developments will increase the accuracy of diagnostic assessments, reduce iatrogenic harm from misdiagnosis, and increase the mental health professional's respect for individual beliefs and values.

Culture↗
PubMed1994

Comparison of EPI gradient-echo contrast changes in cat brain caused by respiratory challenges with direct simultaneous evaluation of cerebral oxygenation via a cranial window.

A gradient-echo echo planar imaging (EPI) sequence has been used to generate images of cat brain during respiratory challenges. Direct spectrophotometric measurements have been made simultaneously in order to correlate the changes in oxygen saturation as measured by spectrophotometry with the image intensity changes seen in the gradient-echo images. When blood volume remains approximately constant, as derived from the spectrophotometry data, good correlation is seen between calculated plots made of changes in the transverse relaxation rate, delta R2*, and the oxygen saturation as measured by spectrophotometry for much of the time course of the respiratory challenges of anoxia, apnea and hypercapnia. In some cases, the correlation is poorer during the recovery periods of the apnea and anoxia challenges. Those lower correlations can often be accounted for by changes in blood volume, which also affects the NMR relaxation rate. These results contribute to the understanding of the image intensity changes seen during functional brain imaging studies in humans.

Animals↗
PubMed1994

Effect of cardiac flow on gradient recalled echo images of the canine heart.

The effect of coronary flow on the signal intensity of gradient recalled echo (GRE) MR images of the canine heart was evaluated at 4 T. Using a fully instrumented canine model, hyperfusion (local adenosine infusion) and ischemia (local occlusion) were evaluated while coronary blood flow and venous oxygen tension were monitored. These studies demonstrated an increase in GRE signal intensity with increases in coronary blood flow and venous oxygenation. A local occlusion resulted in a small decrease in signal intensity in the affected area of the heart. The dependence of the signal changes on TE and TR indicated that the effects of high flow were associated with changes in the apparent T2 and T1. Both relaxation effects could reflect changes in tissue blood volume associated with the conditions studied. In addition, the apparent T2 changes were consistent with alterations in total tissue deoxyhemoglobin concentration and the changes in apparent T1 were consistent with inflow effects.

Adenosine↗
PubMed1994

Maps from two interspecific backcross DNA panels available as a community genetic mapping resource.

We established two mouse interspecific backcross DNA panels, one containing 94 N2 animals from the cross (C57BL/6J x Mus spretus)F1 x C57BL/6J, and another from 94 N2 animals from the reciprocal backcross (C57BL/6J x SPRET/Ei)F1 x SPRET/Ei. We prepared large quantities of DNA from most tissues of each animal to create a community resource of interspecific backcross DNA for use by laboratories interested in mapping loci in the mouse. Initial characterization of the genetic maps of both panels has been completed. We used MIT SSLP markers, proviral loci, and several other sequence-defined genes to anchor our maps to other published maps. The BSB panel map (from the backcross to C57BL/6J) contains 215 loci and is anchored by 45 SSLP and 32 gene sequence loci. The BSS panel map (from the backcross to SPRET/Ei) contains 451 loci and is anchored by 49 SSLP loci, 43 proviral loci, and 60 gene sequence loci. To obtain a high density of markers, we used motif-primed PCR to "fingerprint" the panel DNAs. We constructed two maps, each representing one of the two panels. All new loci can be located with a high degree of certainty on the maps at current marker density. Segregation patterns in these data reveal several examples of transmission ratio distortion and permit analysis of the distribution of crossovers on individual chromosomes.

Animals↗
PubMed1994

Analysis of a translational enhancer upstream from the coat protein open reading frame of potato virus S.

Evidence has suggested that the subgenomic RNA of the carlavirus potato virus S is an efficient message for the coat protein, even though evidence suggests it is uncapped at its 5' terminus. We have investigated the effect of the upstream region of the coat protein gene of potato virus S on the level of reporter gene expression in vitro. The region of 101 nucleotides upstream of the coat protein, designated VTE (viral translational enhancer) was found to increase levels of translation in comparison to a synthetic leader when linked to the beta-glucuronidase (GUS) reporter gene in vitro in rabbit reticulocyte and wheat germ lysate. VTE was also able to increase translation of the reporter gene luciferase (LUC) in vitro above the levels obtained for both a synthetic leader and a leader obtained from a plant gene isolated from Arabidopsis thaliana. The level of enhancement was evident with both capped and uncapped transcripts. When the VTE sequence was deleted to 20 nucleotides of the upstream region, thus removing the nucleotide block homologous among carlaviruses, the ability to enhance levels of translation was removed. In vitro translation studies indicated that the translational enhancement activity of VTE was at least partially cap independent. Translation of VTE linked to reporter genes in the presence of cap analogue was relatively unaffected whereas synthetic leader and a plant leader constructs were both more sensitive. In vitro competition analysis revealed that when short RNA transcripts representing the 101 nucleotides of VTE were added in trans to functional VTE leader LUC constructs there was a marked decrease in the level of translation when compared with a synthetic leader added in trans. These results suggest that the upstream region of the coat protein ORF of potato virus S promotes translation in a cap-independent manner that may involve the binding of proteins and/or ribosomes to the 101 nucleotides of the VTE sequence.

Animals↗
PubMed1994

In vivo characterisation of a translational enhancer upstream from the coat protein open reading frame of potato virus S.

The 101 nucleotide region upstream from the ATG of the potato virus S (PVS) coat protein gene was isolated and the effect of this region on the translation of a downstream open reading frame analysed in vivo. Translation was monitored using the reporter genes B-glucuronidase (GUS) and luciferase (LUC). Translational enhancement was assayed transiently using DNA microprojectile bombardment into both leaf and pollen tissue and also by polyethylene glycol mediated transfection of tobacco protoplasts. In both cases the presence of this region resulted in a 2-3 fold increase in translation when compared to reporter expression with synthetic leader and authentic plant leader constructs. Tobacco plants stability transformed with this PVS 101 nucleotide region and downstream GUS gene gave 4 times the level of translation over synthetic leader GUS control plants.

Base Sequence↗
PubMed1994

Prediction of survival in a hospital-based continuing care unit.

Prediction of survival can be relevant in palliative care in those units with selective admission policies and limited resources, for planning patient management and in discharge planning for those patients expected to go home. In this study, factors most predictive of prognosis were identified. Those factors shown to have no effect on survival included the performance of investigations or procedures, anti-cancer therapy, morphine dose on admission and original admitting ward. Patients admitted primarily for pain control had a significant survival advantage over those patients admitted for palliation of some other symptom. Actual survival correlated well with predicted outcome. Factors most predictive of relative risk of death in a multivariate analysis were dyspnoea, decubitus ulcers, predicted outcome, interventions and a diagnosis of lung cancer. When symptoms alone were analysed, dyspnoea and immobility carried the highest relative risk of death.

Adult↗
PubMed1994

Plasma insulin and lipid levels in untreated obstructive sleep apnoea and snoring; their comparison with matched controls and response to treatment.

Obstructive sleep apnoea (OSA), and snoring are associated with coronary heart disease. To assess whether OSA or snoring may contribute to this by raising fasting lipid or insulin levels, venous fasting total cholesterol, triglyceride, very-low-density lipoprotein, low-density lipoprotein, high-density lipoprotein, and insulin were measured in 15 untreated OSA patients and 18 snorers. Each of these subjects was individually matched to a control of the same sex, age +/- 10%, body index +/- 15%, smoking and drinking habits. This produced study groups which did not differ significantly by any of these criteria. Fasting venous blood samples were collected at 06.30 hours following polysomnography, and analysed blind of the subjects respiratory status. The OSA patients were then treated with nasal continuous positive airway pressure. In 10 of these subjects lipid and insulin levels were repeated after more than three months treatment. Lipid and insulin levels were also remeasured in the controls matched to these 10 subjects. The end points were compared with paired t-tests. There was no difference in any of the end points when the untreated OSA patients and the snorers were compared to their matched controls (P > 0.25 for all comparisons), and none of the indices changed when OSA was corrected with nasal continuous positive airway pressure (P > 0.25 for all comparisons). Patients with obstructive sleep apnoea or snoring do not have significant fasting hyperlipidaemia or hyperinsulinaemia when compared to carefully matched controls. These factors are therefore unlikely to be the cause of the excess cardiovascular mortality experienced by this patient group.

Journal Article↗
PubMed1994

Magnetic resonance imaging functional activation of left frontal cortex during covert word production.

Six normal volunteers underwent 4-T functional magnetic resonance imaging while performing a covert letter fluency task. An echo planar imaging sequence was utilized to detect activation based on deoxyhemoglobin contrast. All 6 subjects showed consistent activation in the frontal operculum and premotor and primary motor cortices. Activation was also detected in the supramarginal gyrus and the posterior part of the superior temporal gyrus. These results show that magnetic resonance functional neuroimaging can be used to investigate cerebral activity noninvasively during performance of complex cognitive tasks.

Adult↗
PubMed1994

Spaceflight results in reduced mRNA levels for tissue-specific proteins in the musculoskeletal system.

The purpose of the present study in growing rats was to investigate the effects of short-term spaceflight on gene expression in bone and muscle and on cortical bone histomorphometry. Two experiments were carried out; Physiological Systems Experiments 1 and 2 were 4- and 10-day flights, respectively. Radial bone growth in the humerus was unchanged during the 4-day flight and decreased during the 10-day flight. Expression of mRNA for glyceraldehyde-3-phosphate dehydrogenase was unchanged in biceps, calvarial periosteum, and long-bone periosteum after spaceflight. Similarly, no changes in ribosomal RNA levels were observed in long-bone or calvarial periosteum after spaceflight. In contrast, spaceflight decreased steady-state mRNA levels for actin in muscle (4-day flight). Osteocalcin (both spaceflights) and the prepro-alpha 2[I] chain of type I precollagen (10-day flight) mRNA levels were decreased in long-bone and calvarial periosteum after spaceflight. These results indicate that the effects of spaceflight on the musculoskeletal system include decreased expression of some muscle- and bone-specific genes as well as decreased bone formation. Interestingly, detectable reductions in gene expression for bone matrix proteins preceded histological evidence for decreased bone formation.

Actins↗
PubMed1994

An audit of morphine prescribing in a specialist cancer hospital.

The object of this study was to assess the quantity and quality of morphine prescribing in a specialist cancer hospital. An audit of prescription charts of all patients was performed using palliative care unit recommendations as the standard. The major weaknesses identified in morphine prescription were a lack of provision of breakthrough doses, the use of 'as required' (prn) oral morphine in the absence of regular oral morphine, and the lack of reference in the unit guidelines to co-prescription of aperients, antiemetics and night sedation. These deficiencies were targeted in an education programme and the survey was repeated to complete the audit cycle. Although some improvement in prescribing practice was shown, persistent problems have illustrated the need for an ongoing hospital-wide education programme.

Analgesics↗
PubMed1994

Costimulation of cutaneous T-cell lymphoma cells by interleukin-7 and interleukin-2: potential autocrine or paracrine effectors in the Sézary syndrome.

PURPOSE: To examine interleukin-7 (IL7)- and interleukin-2 (IL2)-induced proliferation of Sézary lymphoma cells and to consider if an autocrine or paracrine growth-stimulatory circuit involving IL7 exists in the Sézary syndrome (SS). MATERIALS AND METHODS: Fresh Sézary lymphoma cells were maintained in short-term culture in the presence of cytokines, and growth was measured by incorporation of (3H)-thymidine (TdR). Expression of IL7 and IL7 and IL2 receptors (IL7-R and IL2-R, respectively) was assessed by polymerase chain amplification of first-strand complementary DNA (RT-PCR), by affinity cross-linking of radioactive iodine-125-IL7, and by dual-color fluorescence-activated cell analysis. IL-7 production was measured by immunoassay. RESULTS: Sézary lymphoma cells from seven patients showed synergistic (five of seven) or additive (two of seven) proliferation when cultured in the presence of IL2 and IL7, as compared with culture with either cytokine alone. Two patients with evidence of synergistic stimulation of [3H]-TdR incorporation showed IL7-R gene expression by RT-PCR and IL7 affinity cross-linking. Incubation of all seven patients' cells with IL7 induced coexpression to varying degrees of IL7-R and IL2-R. Sézary lymphoma cells from at least three of five patients studied expressed IL7 mRNA, and skin from three of five patients studied, as well as normal skin, expressed IL7 mRNA by RT-PCR. CONCLUSION: Sézary lymphoma cells respond by proliferation to IL7 plus IL2, and in some instances produce IL7. Therapeutic maneuvers should be pursued to take advantage of this potential autocrine or paracrine growth-stimulatory mechanism.

Cell Division↗