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Biomedical subjects

D S Morrison

Publications and source records attributed to D S Morrison.

At least 19 recordsLinked to original sources
PubMed2003

What are the most effective ways of improving population health through transport interventions? Evidence from systematic reviews.

STUDY OBJECTIVE: To review systematic review literature that describes the effectiveness of transport interventions in improving population health. METHODS: Systematic review methodology was used to evaluate published and unpublished systematic reviews in any language that described the measured health effects of any mode of transport intervention. MAIN RESULTS: 28 systematic reviews were identified. The highest quality reviews indicate that the most effective transport interventions to improve health are health promotion campaigns (to prevent childhood injuries, to increase bicycle and motorcycle helmet use, and to promote children's car seat and seatbelt use), traffic calming, and specific legislation against drink driving. Driver improvement and education courses are associated with increases in crash involvement and violations. CONCLUSIONS: Systematic reviews are able to provide evidence about effective ways of improving health through transport related interventions and also identify well intentioned but harmful interventions. Valuable additional information may exist in primary studies and systematic reviews have a role in evaluating and synthesising their findings.

Accidents, Traffic↗
PubMed2002

Potential of specialist drug services to deliver hepatitis B vaccination.

The city of Glasgow has a large population of injecting drug users (IDUs) who are likely to be susceptible to acute hepatitis B infection. We evaluated the effectiveness of a hepatitis B vaccination programme delivered at three existing types of services for IDUs. It was found that while uptake rates were generally low, they were higher at services where throughput of patients was lower, where clients had continuing relationships with services and where staff training and confidence were better.

Adult↗
PubMed2001

Changing patterns of hospital admission for asthma, 1981-97.

BACKGROUND: Hospital admission rates for asthma have stopped rising in several countries. The aim of this study was to use linked hospital admission data to explore recent trends in asthma admissions in Scotland. METHODS: Linked Scottish Morbidity Records (SMR1) for asthma (ICD-9 493 and ICD-10 J45-6) from 1981 to 1997 were used to describe rates of first admissions and readmissions by age and sex. As a measure of resource use, annual trends in bed days used were also explored by age and sex. RESULTS: There were 160 039 hospital admissions for asthma by 82 421 individuals in Scotland during the study period. The overall hospital admission rate increased by 122% (from 106.7 to 236.7 per 100 000 population) but this varied by sex, age, and admission type. First admissions rose by 70% from 73.2 per 100 000 in 1986 to 124.8 per 100 000 in 1997 while readmissions fell. Children (<15 years) experienced a decline in overall admissions after 1992 due to falls in both new admissions and readmissions. By 1997 the ratio of female to male admissions was 0.57 in children, but 1.50 above 14 years of age. Mean lengths of stay fell from 10.7 days to 3.7 days between 1981 and 1997 and bed days used showed little change except for a decline after 1992 in children. CONCLUSIONS: After a period of increasing hospitalisation for asthma in Scotland, rates of admission among children have begun to fall but among adults admissions continue to rise.

Adolescent↗
PubMed2001

Prison admission health screening as a measure of health needs.

OBJECTIVE: To assess the validity of routine prison screening admission data for measuring health needs and planning health services. DESIGN: Retrospective descriptive study of routinely collected admission data. SETTING: The largest Scottish men's prison with an annual throughput of around 20,000 men. SUBJECTS: All adult male (> or = 21 years) prisoners admitted during January 1998. RESULTS: Nine hundred and six men were screened in January 1998. Thirty-eight per cent of men entering prison said they currently or had previously used illegal drugs and 22% of all admissions gave a history of intravenous drug use. Six men (0.7%) reported hepatitis C infection and two (0.2%) reported hepatitis B infection. A history of major mental illness was reported by 10% of all prisoners, 7% of drug users and 15% of problem drinkers. Deliberate self-harm was reported by 10% of all prisoners, 9% of drug users and 17% of problem drinkers. CONCLUSION: There is a high prevalence of reported substance misuse and its sequelae and mental illness in prisoners. However, mental illness, substance use and some infectious diseases (such as HIV, hepatitis B and hepatitis C) may be under-reported, possibly because of social stigma or low expectations of treatment in prison. Health screening on admission to prison presents a unique opportunity to identify health needs at an early stage. However, there is a need to improve detection of some stigmatized conditions if individual care and health service planning are to be improved.

Adult↗
PubMed2000

Shoulder impingement.

Understanding the pathophysiology and treatment of rotator cuff disorders is the key to understanding all other aspects of shoulder rehabilitation. Impingement rehabilitation focuses on strengthening the humeral head depressors, while ignoring the deltoid and supraspinatus muscles. Later treatment includes specific retraining of scapular balancing muscles. The final phase of treatment includes strengthening the prime humeral movers in positions that avoid further stress to the injured rotator cuff tendons and, last of all, specifically strengthening the supraspinatus muscle.

Biomechanical Phenomena↗
PubMed1997

A randomized trial of misoprostol and oxytocin for induction of labor: safety and efficacy.

OBJECTIVE: To compare the safety and efficacy of misoprostol and oxytocin for induction of labor. METHODS: One hundred thirty women requiring induction of labor were randomized to receive either intravenous oxytocin or 100 micrograms misoprostol, administered intravaginally every 4 hours until labor was established. RESULTS: Compared with women receiving oxytocin, a greater percentage of women in the misoprostol group had Bishop scores of 3 or less (58 versus 38%, P < .05). Nonetheless, the median induction-to-delivery interval was significantly shorter (585 versus 885 minutes, P < .001) in the misoprostol group. Women in the misoprostol group were more likely to deliver vaginally within 24 hours of the start of induction (77 versus 55%, P < .002). Epidural analgesia was used more frequently in women receiving oxytocin than in those receiving misoprostol (73 versus 50%, P = .025). The total percentage of cesarean deliveries was not significantly different, although the percentage of cesarean deliveries for dystocia was lower in the misoprostol group (8 versus 21%, P = .02). Uterine tachysystole was significantly more common (70 versus 11%, P < .001) and hospital charges significantly less with misoprostol. CONCLUSION: Compared with oxytocin for labor induction, misoprostol results in a shorter induction-to-delivery interval, a reduction in the rate of cesarean delivery for dystocia, and a decreased use of epidural analgesia. Uterine tachysystole is significantly more common with the use of misoprostol.

Adult↗
PubMed1997

Non-operative treatment of subacromial impingement syndrome.

We performed a retrospective study of 616 patients (636 shoulders) who had subacromial impingement syndrome to assess the results of non-operative treatment. The diagnosis was made on the basis of a positive impingement sign and the absence of other abnormalities of the shoulder, such as full-thickness tears of the rotator cuff, osteoarthrosis of the acromioclavicular joint, instability of the glenohumeral joint, or adhesive capsulitis. All patients were managed with anti-inflammatory medication and a specific, supervised physical-therapy regimen consisting of isotonic exercises for strengthening of the rotator cuff. The average duration of follow-up was twenty-seven months (range, six to eighty-one months). Over-all, 413 patients (67 per cent) had a satisfactory result. One hundred and seventy-two patients (28 per cent) had no improvement and went on to have an arthroscopic subacromial decompression. Thirty-one patients (5 per cent) had an unsatisfactory result but declined additional treatment. Seventy-four (18 per cent) of the 413 patients who had a successful result had a recurrence of the symptoms during the follow-up period; the symptoms resolved with rest or after resumption of the exercise program. The patients were stratified according to age, the duration of symptoms, and acromial morphology. Patients who were twenty years old or less and those who were forty-one to sixty years old fared better than those who were twenty-one to forty years old. Patients who were more than sixty years old had the poorest results. Sixty-seven (78 per cent) of the eighty-six patients in whom the symptoms had been present for less than four weeks had a satisfactory result, compared with 144 (63 per cent) of the 228 who had had the symptoms for one to six months and with 202 (67 per cent) of the 302 who had had the symptoms for more than six months. Thirty-two (91 per cent) of the thirty-five patients who had a type-I acromion had a successful result, compared with 173 (68 per cent) of the 256 who had a type-II acromion and with 208 (64 per cent) of the 325 who had a type-III acromion. Shoulder dominance, gender, and concomitant tenderness of the acromioclavicular joint did not affect the result significantly (p = 0.084, 0.555, and 0.365, respectively).

Adolescent↗
PubMed1995

The relationship between subacromial space pressure, blood pressure, and visual clarity during arthroscopic subacromial decompression.

Twenty-two consecutive patients with subacromial impingement syndrome underwent arthroscopic subacromial decompression. Measurements of the subacromial space pressure and the blood pressure were recorded along with the clarity of the visual field. The clarity of the visual field was objectively determined based on the pressure at which bleeding was observed from trabecular bone or the soft tissue capillaries. A direct correlation was found between systolic blood pressure (SBP), subacromial space pressure (SASP), and the clarity of the visual field. On average, maintaining a pressure difference (SBP-SASP) of 49 mm Hg or less prevented bleeding and permitted good visualization. With a greater differential, significant bleeding occurred. Furthermore, the use of relative hypotensive anesthesia permits lower irrigation pressures and significantly reduces the risk of fluid extravasation into the subcutaneous tissues of the shoulder.

Acromion↗
PubMed1990

The use of magnetic resonance imaging in the diagnosis of rotator cuff tears.

One hundred consecutive patients with symptoms of chronic subacromial impingement syndrome were evaluated by both arthrography and magnetic resonance imaging (MRI) techniques. By comparing intermediate and T2 weighted images, the ability to identify the normal and abnormal anatomy of the rotator cuff with the MRI was excellent. All 51 patients with arthrogram-proven rotator cuff tears had abnormal MRI scans (100% sensitivity). However, six of the 49 patients with normal arthrograms had abnormal MRI scans (88% specificity). At arthroscopy, four of these patients were found to have moderate to severe partial thickness rotator cuff tears. These findings indicate that in patients with longstanding subacromial impingement syndrome the MRI has an exceptionally high sensitivity for damage to the rotator cuff.

Arthrography↗
PubMed1989

MRI demonstration of radiographically occult fractures: what have we been missing?

During the course of MRI examinations of the knee for possible internal derangement, the hip for avascular necrosis, and the shoulder for rotator cuff tears, we have encountered many examples of unsuspected fractures of the tibial plateau, femoral condyles, pelvis, hip and proximal humerus. These fractures were either radiographically inapparent or demonstrated very subtle abnormalities that were missed on prospective interpretation. In addition, a large number of patients have been found to demonstrate evidence of intraosseous trabecular disruption, or edema and hemorrhage of medullary bone, or stress type injuries, all of which are radiographically occult. The clinical significance of these osseous abnormalities varies and is dependent upon the degree of injury. It is believed that an awareness of these osseous abnormalities will improve the accuracy of MRI interpretation, will heighten an appreciation of the subtle radiographic abnormalities that may be present, and will improve patient evaluation and management.

Adult↗
PubMed1988

Glenoid bone-grafting in total shoulder arthroplasty.

Abnormal glenoid architecture resulting from loss of bone usually is listed among the contraindications to total shoulder arthroplasty using an unconstrained prosthesis. However, in a series of 463 consecutive replacement procedures that were performed between 1973 and 1985, in only two patients did the lack of bone make the implantation of a glenoid component impossible. Of the remaining sixty-five shoulders that had an abnormal glenoid, twenty were successfully treated with a large, internally fixed bone graft or grafts and forty-five, with smaller bone grafts that were not internally fixed. Nineteen of the twenty shoulders that had a large graft or grafts were followed for two years or more (average, 4.4 years). The clinical results were judged to be excellent in sixteen and satisfactory in one, and the desired limited goals were obtained in two. Two fixation screws broke and one screw was worn by contact with the humeral component. None of the glenoid components clinically loosened or migrated, and no patient has needed further surgical treatment. Although bone-grafting was necessary in only twenty (4.3 per cent) of the 463 replacement procedures, this procedure provided sufficient osseous support to allow implantation of a component in a severely damaged glenoid.

Adult↗