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Biomedical subjects

C L Morgan

Publications and source records attributed to C L Morgan.

At least 37 records · Page 2Linked to original sources
PubMed1998

Evaluating CPR performance in basic life support: the VIDRAP protocol.

This paper presents the second part of the validated Cardiff test for one rescuer basic life support skills, based on observation of video recording combined with the Recording Resusci Anne printout (VIDRAP). The authors believe that this is a robust evaluation tool which is capable of assessing the potential value to a casualty of a simulated resuscitation. The adoption of a widely accepted test methodology would facilitate comparison of research in different centres, which is not possible at present.

Adult↗
PubMed1998

The demand for hospital services for patients with epilepsy.

PURPOSE: To describe the patterns of inpatient and outpatient hospital care for patients with epilepsy in our health district. METHODS: Routine hospital data for the health district of South Glamorgan (population 408,000) underwent record linkage to identify those records relating to the same patients and to flag those records for patients with epilepsy. This data was analyzed to determine inpatient and outpatient activity by specialty and compared with the nonepileptic population. RESULTS: We identified 2.267 patients representing a prevalence of 0.56%. The average age was 46 years in both male and female patients. This group, which constituted 1.5% of the hospital population, was responsible for 2.8% of all admissions but, because of increased length of stay, utilized 7.3% of all bed days. The total cost of care for this group lies between these two extreme values and is dependent on case severity. The patterns of associated diagnoses differed considerably in three arbitrary age groups (0-18, 19-55, >55 years). CONCLUSIONS: This study quantifies for the first time the level of demand that this subpopulation places on the service as a whole, and begins to illustrate that there may be evidence for cost containment by, for example, a reduction in multiple admissions. The demand for inpatient services is greater than we would have predicted.

Adolescent↗
PubMed1998

The epidemiology and cost of inpatient care for peripheral vascular disease, infection, neuropathy, and ulceration in diabetes.

OBJECTIVE: To describe the epidemiology and costs of the acute care of peripheral vascular disease, infection, neuropathy, and ulceration in a U.K. population with special consideration of those patients with diabetes. RESEARCH DESIGN AND METHODS: Routine data describing inpatient care for a 4-year period were analyzed (financial years 1991/1992 to 1994/1995). These data had undergone record-linkage to draw together records from the same patients, and records of patients with diabetes were flagged. Cost estimates were determined by attributing a diagnosis-related group cost-weight to each record. RESULTS: A total of 4,245 admissions (1.2% of all admissions) had a primary diagnosis of peripheral vascular disease, infection, neuropathy, or ulceration, and 7,379 (2.1%) admissions had these categories recorded in any one of six diagnostic fields. These figures were generated by 3,159 and 4,751 patients, respectively. This represented a range of crude annual incidence of admission of between 1.9 and 2.9 per 1,000 people. Patients with diabetes accounted for 625 (15.4%) of primary admissions, a crude annual incidence of admission of 18.8 per 1,000. The age-standardized relative risk of admission for patients with diabetes to the nondiabetic population was 7.61 for men and 6.85 for women. The length of stay for patients with diabetes was almost twice that of the nondiabetic population (15.5 vs. 8.7 days). The relative risk of hospital mortality (diabetes vs. non-diabetes) was 2.83. Surgical procedures were carried out on 857 patients, 272 (31.2%) with diabetes. This represented an age-standardized relative risk of 31.19. The estimated cost of admissions for primary diagnoses in these categories over 4 years was 6,128,211 pounds ($9,743,855). Patients with diabetes accounted for 1,236,623 pounds ($1,966,230), an excess of 87% attributable to the diabetic state. CONCLUSIONS: Diabetes is confirmed as a significant risk factor for peripheral vascular disease, infection, neuropathy, and ulceration. The severity of these disorders in terms of increased risk of hospital mortality, length of stay, and risk of surgical procedure is also demonstrated for those patients with diabetes.

Communicable Diseases↗
PubMed1998

Reinforcement frequency, but not gender, determines sensitivity to discriminative stimulus effects of morphine.

We demonstrated previously that several parameters of a morphine discrimination were significantly different in female versus male rats, using a fixed ratio (FR)-10 schedule of food reinforcement; however, this schedule produced a significant bias in reinforcement frequency between saline and morphine sessions in males but not in females. To determine whether this schedule-drug-sex interaction caused the sex difference in discriminability of morphine, female and male rats were trained to discriminate 3.0 mg/kg morphine from saline using a variable interval (VI) 15-s/VI 15-s (Phase I), a VI 7.5-s/VI 15-s (Phase II), and a VI 15-s/VI 15-s (Phase III) schedule of food reinforcement on morphine/saline levers, respectively. After a minimum of 40 training sessions in each phase, mean reinforcement rates in morphine sessions were highest, and the ED50 values for morphine discrimination were lowest, in Phase II. Thus, as predicted, the morphine dose-effect curves shifted to the left from Phase I to Phase II, and back to the right from Phase II to III, presumably due to the bias in reinforcement rate between saline and morphine sessions that was induced by manipulating the VI schedule on the morphine lever. However, there were no sex differences in the morphine versus saline reinforcement rate or in discrimination ED50 in any phase, suggesting that the sex difference observed in our initial study was probably due to the bias in reinforcement frequency (towards the saline condition) that occurred only in males under the FR-10 schedule. This study demonstrates the importance of considering group differences in schedule-drug interactions when comparing discriminative stimulus properties of drugs between groups.

Analysis of Variance↗
PubMed1997

Hospital utilization as a function of social deprivation: diabetes vs non-diabetes.

We tested the hypothesis that a relationship between ill health and deprivation exists for patients with diabetes, distinct from that experienced by the non-diabetic population. Age standardized admission and appointment rates and proportion of total activity for patients with and without diabetes were determined by electoral ward and correlated with the Townsend index of social deprivation for the health district of South Glamorgan (population 408,000). Both diabetic (r = 0.78, p < 0.001) and non-diabetic (r = 0.74, p < 0.001) in-patient admissions were positively correlated with social deprivation. This relationship also existed for attended out-patient appointments (r = 0.67, p < 0.001 and r = 0.45, p < 0.01, respectively). The proportion of diabetic to non-diabetic admissions by ward also showed a positive correlation for in-patients (r = 0.47, p < 0.001). This remained true for IDDM (r = 0.23, not significant) and NIDDM (r = 0.62, p < 0.001) diabetes, for admissions for coronary heart disease (r = 0.50, p < 0.001) and cerebrovascular disease (r = 0.29, p < 0.05), elective admissions (r = 0.30, p > 0.05), and emergency admissions (0.46, p < 0.001). Our results suggest that secondary care utilization is positively correlated with social deprivation and that this relationship is stronger in the diabetic population. This may be due to different prevalence rates or increased complications requiring hospital treatment in different social circumstances. Further research is required to examine these factors more closely.

Age Factors↗
PubMed1997

NHS acute sector expenditure for diabetes: the present, future, and excess in-patient cost of care.

We set out to determine the present proportion of in-patient revenue used for the care of diabetes and its related complications and to use these data to determine (1) the trend in future hospital costs for the condition and (2) the excess cost of admissions for diabetic patients over and above that expected had these patients not had diabetes, using a cross-sectional descriptive study in conjunction with a population modelling exercise in a District Health Authority with a resident population of 408 000 people. The crude proportion of admissions for people with diabetes was 7.0% of activity in financial year 1994/5 (of 115929 total in-patient and day case admissions). Patients with diabetes occupied 10.7 % of bed days and had a crude mean length of stay of 10.7 days vs 6.7 days for the non-diabetic group. The proportion of revenue used for their treatment was 8.7 %. This translated locally to 11.9 M. In year 2011 overall cost of in-patient care is predicted to increase by 9.4 %, however, the proportion of revenue used for the care of people with diabetes will increase by 15% because of age-related effects. The excess cost associated with treating diabetes is estimated to be 82% of admissions for the diabetic population, 88% of their bed days, and 86% of expenditure associated with their care. Most of this excess cost is associated with the recognised vascular complications of diabetes. We conclude that the cost of in-patient care for patients with diabetes is notably disproportionate to the population prevalence of diabetes-9 % compared to 1.36% in South Glamorgan-and will increase disproportionately with time. As much of the long-term morbidity is known to be preventable by earlier intervention, strategies should reflect the imperative to reduce the burden of diabetes.

Adolescent↗
PubMed1997

Assessing with CARE: an innovative method of testing the approach and casualty assessment components of basic life support, using video recording.

The resuscitation community is now moving towards a set of basic life support guidelines but different countries and training centres have their own individual methods of instruction. It would be advantageous if a universal testing method were available to facilitate intercentre comparison. This could lead to an international course which had been rigorously assessed and evaluated. Taking this as a starting point, the Cardiff Assessment of Response and Evaluation (CARE) was developed. CARE is an innovative assessment technique using video recording for testing the preliminary steps of life support as outlined by the European Resuscitation Council. The assessment was validated by testing 67 members of the public who had been trained in cardiopulmonary resuscitation, 27 shortly after instruction and 40 between 6 and 18 months after instruction. All subjects were tested without prior warning and video recorded for independent scoring by two researchers and a paramedic training officer. Scores were compared using the k correlation which showed a high level of agreement between observers. Video recording and marking using the CARE schedule and guidelines is a reliable method for assessing the preliminary steps in life support.

Cardiopulmonary Resuscitation↗
PubMed1997

Kindler syndrome: a rare cause of desquamative lesions of the gingiva.

Kindler syndrome is a rare syndrome with cutaneous and intraoral manifestations. It has been suggested that there is an overlap between this syndrome and another called Weary syndrome. Only 68 cases of Weary and Kindler syndromes have been reported, with fewer solely attributed to Kindler syndrome. The salient cutaneous features are neonatal bullae, poikiloderma, photosensitivity, and acral atrophy. This article presents the clinical intraoral findings of two siblings of consanguineous descent diagnosed as having Kindler syndrome. Both had an erythematous and erosive appearance of the gingiva; one sibling had poor oral hygiene and a rapidly progressive form of periodontal disease; the other, whose oral hygiene was acceptable, had no detectable bone loss.

Adult↗
PubMed1997

Patterns and costs of hospital care for coronary heart disease related and not related to diabetes.

OBJECTIVE: To describe the epidemiology and costs of coronary heart disease (CHD) requiring hospital admission, with particular reference to diabetes. SETTING: The former South Glamorgan Health Authority, South Wales. METHODS: Routine hospital activity data were record linked and all diabetic and non-diabetic individuals over a four year period (1991-95) were identified. A cost weight was included for each admission based on diagnosis related groups. RESULTS: There were 10,214 patients admitted with a primary diagnostic code for CHD, representing an incidence of 6.3 per 1000 per annum. Including all CHD and non-CHD admissions, these individuals were responsible for 17% of acute inpatient activity. Men had a consistently higher age specific prevalence of CHD than women. The age adjusted relative risk of CHD for patients with diabetes compared with those without was 4.1 for men and 5.5 for women. Patients with diabetes accounted for 16.9% of CHD related admissions and had a fourfold increased probability of undergoing a cardiac procedure. The total cost of CHD was estimated to be 6% of NHS revenue at 1994-95 pay and prices. Patients with diabetes were responsible for 16% of this expenditure. This translated to an estimated NHS acute hospital expenditure for CHD of 1.1 billion pounds per year at 1994-95 pay and prices. CONCLUSIONS: CHD was responsible for a larger proportion of NHS expenditure than had previously been reported. Nearly one in five acute hospital admissions were for patients whose condition included cardiac problems. The relation between diabetes and CHD was particularly evident, and may offer opportunities for disease prevention.

Acute Disease↗
PubMed1997

Epidemiology and costs of acute hospital care for cerebrovascular disease in diabetic and nondiabetic populations.

BACKGROUND AND PURPOSE: Little is known about the pattern of cerebrovascular disease (CVD) for diabetic and nondiabetic patients or about the cost of treatment for CVD in the United Kingdom. The purpose of this study was to extend previous work to describe the epidemiology and cost of acute care of CVD as a frequent comorbidity of diabetes in a UK population (408 000 people). METHODS: Routine data describing inpatient care for a 4-year period were analyzed (financial years 1991/1992 to 1994/1995). These data had undergone record linkage to draw together records from the same patients. Cost estimates were determined by attributing a diagnosis-related group cost weight to each record. Mortality data from an overlapping period were supplied by the Office of Population Censuses and Surveys. RESULTS: There were 11 196 CVD admissions (3.1% of all admissions). Of these, 7351 (66%) were primary diagnoses. These admissions were generated by 5358 patients (3904 primary diagnosis). For people with diabetes, the incidence rate was between 23 and 32.8 per 1000 per year compared with 2.4 to 3.3 per 1000 for the population as a whole, depending on the use of primary and subsidiary codes. The age-adjusted relative risk of stroke in diabetic men versus nondiabetic men was 3.70 (95% confidence interval, 3.53 to 3.88) and in women was 4.35 (95% confidence interval, 4.37 to 4.76). We describe other epidemiological relationships. The cost of CVD is between pounds 1.1 and pounds 1.6 million per 100 000 population-at least pounds 0.7 million per 100 000 for CVD alone. Approximately 15% of this value is related to diabetes, and an estimated 94% of this diabetes-related expenditure is potentially avoidable. CONCLUSIONS: CVD represents a major source of expenditure for health services, and diabetes is confirmed as a major risk factor within this disease group. Differences between diabetic and nondiabetic inpatient patterns of CVD may reflect greater incidence of comorbidities in the former.

Acute Disease↗
PubMed1996

Effectiveness of the BBC's 999 training roadshows on cardiopulmonary resuscitation: video performance of cohort of unforewarned participants at home six months afterwards.

OBJECTIVE: To examine the competence of a cohort trained in cardiopulmonary resuscitation by the BBC's 999 training roadshows. DESIGN: Descriptive cohort study applying an innovative testing procedure to a nationwide systematic sample. The test sample received an unsolicited home visit and without warning were required to perform cardiopulmonary resuscitation on a manikin while being videoed. The videos were then analysed for effectiveness and safety using the new test. SETTING: Nine cities and surrounding areas in the United Kingdom. SUBJECTS: 280 people aged between 11 and 72. RESULTS: Thirty three (12%) trainees were able to perform effective cardiopulmonary resuscitation, but of these 14 (5%) performed one or more elements in a way that was deemed to be potentially injurious. Thus only 19 (7%) trainees were able at six months to provide safe cardiopulmonary resuscitation. In addition, large numbers of subjects failed to shout for help, effectively assess the status of the patient, or alert an ambulance. Significantly better performances were recorded by those under 45 years old (31 (14%) v 2 (4%) gave effective performances respectively, P < 0.05), those who had attended a subsequent cardiopulmonary resuscitation course (8 (40%) v 25 (10%) gave effective performances respectively, P < 0.0001), and those confident in their initial ability (26 (20%) v 7 (6%) gave effective performances respectively, P < 0.005). Females were significantly less likely than males to perform procedures in a harmful way (117 (62%) v 10 (12%) performed safely respectively, P < 0.005). CONCLUSION: Television is an effective means of generating large training cohorts. Volunteers will cooperate with unsolicited testing in their home, such testing being a realistic simulation of the stress and lack of forewarning that would surround a real event. Under such conditions the performance of cardiopulmonary resuscitation was disappointing. However, retraining greatly improves performance.

Adolescent↗
PubMed1996

Odors as cues for the recall of words unrelated to odor.

The effectiveness of an ambient odor as a retrieval cue for words unrelated to odor was investigated. After incidental learning of 40 adjectives, 40 participants were tested for recall during three unannounced recall phases (15 min., 48 hr., and 5 days). Participants in two control conditions learned with no odor present and either had no odor present during any recall phase or only during recall after 5 days. Participants in two conditions learned with an odor present and either had the odor present during recall only after 5 days or during recall both after 15 min. and after 5 days. Analyses indicated that, while participants in the control conditions recalled significantly less during each succeeding recall phase, recall by participants in the two experimental conditions did not decrease significantly. Recall by participants in the two experimental conditions was significantly higher during recall after 5 days (when the odor was reintroduced) than either control group. The addition of a salient cue during learning and retrieval facilitated recall more than the presence of constant environmental cues.

Adult↗
PubMed1996

Immunosensors: technology and opportunities in laboratory medicine.

An immunosensor is a device comprising an antigen or antibody species coupled to a signal transducer, which detects the binding of the complementary species. An indirect immunosensor uses a separate labeled species that is detected after binding by, e.g., fluorescence or luminescence (i.e., a heterogeneous immunoassay). A direct device detects the binding by a change in potential difference, current, resistance, mass, heat, or optical properties (i.e., a homogeneous immunoassay). Although indirect sensors may encounter fewer problems due to nonspecific binding effects, the direct sensors are capable of real-time monitoring of the antigen-antibody reaction. A wide range of molecules can be detected with detection limits ranging between 10(-9) and 10(-13) mol/L. However, there are only a few successful commercial applications of direct immunosensors, these being of the optical type. This review describes the principles underlying the technologies, their merits, limitations, and applications.

Biosensing Techniques↗