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T R Fulton

Publications and source records attributed to T R Fulton.

13 recordsLinked to original sources
PubMed2001

Exploring a chronic care model in a regional healthcare context.

The episodic acute care model of service delivery that consumes the majority of healthcare funding is inadequate to meet the needs of a society experiencing an increasing burden of chronic illness. This article describes, in a regional Canadian healthcare context, the application and preliminary evaluation of a model of chronic care delivery developed in a managed care environment in the United States. The strategic goals of this model are to empower clients by providing a redesigned service delivery environment that supports self-management; support care providers by developing clinical information systems and decision supports; and align community resources, policies and organization of care to support an informed, activated client and a proactive practice team.

Aged↗
PubMed2000

Effects of 3 analgesic regimens on the perception of pain after removal of femoral artery sheaths.

BACKGROUND: Effective pain management after removal of femoral artery sheaths after percutaneous transluminal coronary angioplasty is highly individualized and requires frequent, accurate assessment and administration of analgesics as needed. OBJECTIVE: To determine which of 3 analgesic regimens is most effective in decreasing patients' perception of pain with the fewest side effects after removal of a femoral artery sheath. SAMPLE: 130 adult who had undergone percutaneous transluminal coronary angioplasty and were in an 8-bed cardiac short-stay unit in a 1400-bed acute care hospital. METHOD: Patients were randomized to receive either intravenous morphine, intravenous fentanyl, subcutaneous lidocaine around the sheath site, or an intravenous placebo before sheath removal. Rescue analgesia (intravenous fentanyl) was made available to all groups. Patients used a visual analog scale to assess pain within 10 minutes before, 1 minute after, and 20 minutes after sheath removal. Pain levels, frequency of side effects, and use of rescue analgesia were compared among groups. RESULTS: Age, sex, number of stents, and frequency of hematomas did not differ significantly among groups. Pain ratings, use of rescue analgesia, and side effects (nausea, vomiting, or vasovagal symptoms) were not significantly different among treatment groups. Ratings of pain were slightly higher immediately after sheath removal in all groups. CONCLUSION: For most patients, removal of femoral artery sheaths and manual compression for hemostasis are relatively pain-free. Pain scores among patients given analgesia with subcutaneous lidocaine, intravenous morphine, or intravenous fentanyl were not significantly different from pain scores among control patients.

Adult↗
PubMed1999

A melanin polyketide synthase (PKS) gene from Nodulisporium sp. that shows homology to the pks1 gene of Colletotrichum lagenarium.

The melanin polyketide synthase (pks) gene of Nodulisporium sp. MF5954 (ATCC74245) was cloned by exploiting its homology to the Colletotrichum lagenarium pks1 gene. Sequence analysis demonstrated that this gene is 70% identical to the C. lagenarium pks1 gene. A gene disruption construct, designed to replace both the ketoacyl synthase and acyl transferase domains with a hygromycin resistance (Hyr) gene, was synthesized, and used to disrupt the Nodulisporium melanin pks1 gene via homologous recombination, resulting in a mel(-) phenotype. Sequence analyses of the gene and of cDNA segments generated by RT-PCR indicate that there are three introns in the 5' half of the gene. The proposed 2159-amino acid product is 72% identical and 78% similar to the 2187-amino acid sequence deduced from the C. lagenarium pks1 gene. This similarity is notable, considering that C. lagenarium is a member of the order Phyllachoales or Sordariales, whereas Nodulisporium is generally believed to be member of the order Xylariales. However, despite the strong resemblance between the amino acid sequences in the acyl transferase domains of the two proteins, only one in five codons are conserved in the DNA sequences that encode this motif. The Nodulisporium sp. pks1 gene sequence and the amino acid sequence deduced from its coding region have been deposited in Genbank under Accession No. AF151533.

Amino Acid Sequence↗
PubMed1996

Nurses' adoption of a patient-controlled analgesia approach.

The value of a patient-controlled analgesia (PCA) approach has been demonstrated in the literature. A group of nurses responsible for implementing a PCA approach in their agencies reported varying levels of success. It was not known how nurses' values, goals, and experiences influenced their innovation adoption behavior, nor was it understood how an organization's contextual factors affected nurses' adoption of the PCA approach. The purpose of this study was to increase the understanding of the factors that influence nurses' adoption of PCA. A total of 13 coinvestigators responsible for the implementation of PCA in their agencies formed a participatory action research group. A phenomenological approach, using staff nurse focus groups, was chosen by the coinvestigators to gather data from their respective agencies. The concept of innovation adoption provided the framework for the study.

Adolescent↗
PubMed1995

rRNA operon restriction derived taxa for Streptomyces (RiDiTS).

A method for grouping Streptomyces strains by fingerprints of their rRNA operons is described. In polyacrylamide gels, multicopy rRNA operon fragments in Streptomyces genomic MseI fingerprints produced intense bands which are well resolved from the less conspicuous low copy fragments interspersed between them. The high intensity multicopy rRNA bands are easily distinguished from the low intensity bands, eliminating the need for Southern blot hybridization to visualize the rRNA fragments. Direct evidence that the high-intensity bands in these polyacrylamide gels originated from rRNA operons was provided by a 'differential' Southern blot technique. We have used this method to assign 98 strains to 11 rRNA fingerprint type groups. This clustering method may be applicable to any prokaryote with a high G+C content genome.

Blotting, Southern↗
PubMed1989

A 12 megabase restriction map at the cystic fibrosis locus.

We have constructed a physical map of the chromosomal region containing the cystic fibrosis locus using seven DNA markers and pulsed-field gel electrophoresis methods. The map includes cleavage sites for 8 rare-cutting restriction enzymes and spans over 12 megabases (Mb) of DNA, with one unlinked probe covering an additional 5 Mb. To our knowledge, this is the largest segment of human DNA which has been restriction-mapped to date. We can identify thirteen putative HTF islands spaced at intervals of 0.3-3.2 Mb. The region between loci D7S8 and MET, where the CF gene lies, includes 1.4-1.9 Mb of DNA.

Blotting, Southern↗
PubMed1989

Cystic fibrosis: diagnostic testing and the search for the gene.

Cystic fibrosis (CF) is a lethal genetic disorder inherited as an autosomal recessive at a frequency of about 1/2000 in Caucasian populations. A DNA marker genetically linked to CF was identified through a collaborative effort by random screening with a collection of RFLP markers on a set of CF families. The marker (CRI-L917) was mapped to chromosome 7. Construction of a genetic linkage map spanning the entire chromosome has led to the identification of a subset of 11 markers close to and flanking the CF locus. Using techniques of pulsed-field gel electrophoresis, which allow very large DNA fragments to be separated, we used seven probes to generate a long-range restriction map covering 12 million base pairs surrounding the CF locus. Information from the map is being used to isolate new probes closer to the CF gene. Methods being developed will allow candidate genes to be tested for their ability to correct defects in ion transport in cultured CF cells.

Chromosome Mapping↗
PubMed1988

Studies on locus expansion, library representation, and chromosome walking using an efficient method to screen cosmid libraries.

We have developed an efficient screening method to search for clones in cosmid libraries prepared from human genomic DNA. Genomic, cDNA, and cosmid probes have been used to isolate homologous cosmids from human chromosomes 7, 10, 16, 17 and X as part of a search for polymorphic nucleotide sequences. This method has been successfully applied to chromosome walking experiments at the interstitial retinol-binding protein locus on chromosome 10, and may be a useful tool for investigating representation of cloned sequences in cosmid libraries. Our library was prepared in the vector c2RB (Bates and Swift, 1983), but the method is applicable to any cosmid cloning system in which the inserted DNA can be separated from the vector by restriction enzyme digestion. A cosmid library containing five human genome equivalents can be rapidly screened using three to four Southern hybridization filters. This results in substantial labor saving, particularly when screening genomes of high complexity with many different probes. Another advantage of the system is that it allows for the long-term storage of the cosmids so that they can be screened whenever necessary. As a consequence, cosmid screening can be made a routine laboratory procedure.

Blotting, Southern↗
PubMed1980

Neuropathology of phenylacetate poisoning in rats: an experimental model of phenylketonuria.

Results of this investigation indicate that the suckling rat treated with phenylacetate should be a useful new model for studying the pathogenesis of phenylketonuria and neuronal development. Both cerebellar and retinal neurons of postnatally treated rats are vulnerable to the adverse effects of phenylacetate. Morphological changes observed in the cerebellum, retina, and optic nerve of treated animals during the fourth to twenty-first days of life consist of regional reduction in the size of cerebellar vermis lobules IV, V, VIa, and IX, 35 to 40% reduction in thickness of the molecular layer, accumulation of cerebellar external granular cells and retinal neuroblastic cells, fewer parallel fibers in the cerebellar cortex, and fewer myelinated axons in the optic nerve.

Animals↗
PubMedDate not supplied

Biochemical indices of neuronal development in experimental phenylketonuria: high affinity transport systems and gangliosides.

High affinity transport systems and gangliosides were assessed in an animal model of experimental phenylketonuria, namely the rat injected with phenylacetate during the first 21 days of life. The velocity of synaptosomal high affinity uptake of [3H]-choline, [14C]-gamma-aminobutyric acid (GABA), and [14C]-glutamic acid served as a measure of the relative density of uptake sites of these specific types of terminals. A reduction of cholinergic (25-37%) and GABAergic (23-45%) functioning terminals was produced by phenylacetate in the hippocampal, occipital, and frontal cortices from 40- to 55- and 80- to 95-day-old rats. In contrast, glutamatergic terminals in these same areas of the cerebrum from animals of both ages were not affected. This selection effect of phenylacetate on synaptic junctions is discussed. Cerebral ganglioside content was reduced approximately 40% in experimental hyperphenylalaninemia induced with p-chlorophenylalanine and L-phenylalanine. A similar decrease was observed in the rat exposed to phenylacetate but not in the animal injected with phenylpyruvate. Short-term exposure to phenylacetate did not alter the capacity of the very young rat to utilize glucosamine for the biosynthesis and incorporation of sialic acid into gangliosides. The large decrease in cerebral ganglioside concentration and the significantly smaller percentage distribution of GM1, observed in the 19-day-old chronically exposed to phenylacetate, are apparently associated with deficient neuronal development.

Animals↗
PubMedDate not supplied

Patient requirements for nursing care: the development of an instrument.

The determination of nursing staff mix is a challenge for many health care agencies. Staff mix decisions have historically been based on workload measurement information, the type of patient care unit and on a subjective or intuitive basis. Weighted task lists (workload measurement systems) do not comprehensively consider the skill and knowledge level required to meet patient care needs. This project describes the development of an instrument that considers patient's nursing care needs as a determinant of nursing staff mix. Recommendations for the use of the tool are identified.

Clinical Competence↗