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Biomedical subjects

M Morgan

Publications and source records attributed to M Morgan.

At least 181 records · Page 10Linked to original sources
PubMed1995

Dysphagia: diagnosis and treatment in Kentucky.

Dysphagia, a disorder of swallowing, is commonly associated with neurological and neuromuscular disorders. Damage to the sensation or muscles of the swallowing mechanism leads to unsafe oral motor or pharyngeal movement patterns, placing a patient at risk for development of aspiration pneumonia. At present, multidisciplinary Dysphagia Teams are being used to improve the diagnosis and treatment of swallowing disorders. A survey including all 112 hospitals in the Commonwealth of Kentucky indicates 33 (29%) presently have such a team, while 42 (38%) offer outpatient dysphagia services. In addition, 56 (50%) of the hospitals indicate they perform modified barium swallows which is an essential test for diagnosing and treating dysphagia. An example of how a Dysphagia Team works in one Kentucky rehabilitation hospital is presented to illustrate how to provide early diagnosis and treatment of these problems.

Barium Sulfate↗
PubMed1995

Petro-Canada Heart Health Program: successful program.

1. The economic impact of cardiovascular disease is significant, requiring 8.3 million annual inpatient days for treatment. Disability accounts for 25% of disability pensions paid by Canada Pension Plan to individuals less than 65 years of age. 2. Management of risk factors provides an opportunity to reduce the likelihood of coronary heart disease (CHD) and to mitigate the effects of non-modifiable risks. 3. There is an increased risk for CHD with elevated cholesterol. The best return on the value of a cholesterol program comes from testing work groups comprised mainly of males and older employees. 4. The goal of promoting and maintaining high levels of physical, mental, and social well being for workers can be achieved through programs such as the cholesterol screening and education programs.

Adolescent↗
PubMed1995

General practitioner registrars' views about a career in general practice.

BACKGROUND: Current low morale in general practice and the fall in the number of general practitioner registrars (trainees) has led to concern about the decline in popularity of general practice as a career. AIM: A study was performed to evaluate the career intentions of general practitioner registrars and the factors underlying their decisions. METHOD: An anonymous postal questionnaire seeking both quantitative and qualitative data was sent to 138 registrars during June 1993. All were registrars at practices in the south west region of England. Outcome measures used were the popularity of different types of general practice work and identification of variables and emergent themes considered important in career choice. RESULTS: A total of 101 registrars returned questionnaires (73%). Of the respondents, 96% expressed an interest in general practice as a career. However, registrars expressed considerable uncertainty about the future of general practice and therefore their career. Continuity of care and a holistic approach were considered valued aspects of work in general practice. Increased workload, increased out-of-hours work and erosion of professional autonomy emerged as negative aspects of a career in general practice. Of the respondents, 91% considered time for leisure activities an important factor when considering future career, 72% would have been glad to do away with 24-hour cover and 99% agreed that general practitioners increasingly fear litigation. CONCLUSION: Although registrars were interested in general practice as a career they had many concerns and expressed uncertainties. The future popularity of general practice is likely to depend on addressing these concerns and on the clarification of the future direction of the profession.

Adult↗
PubMed1994

Effect of HIV infection and tuberculosis on hospitalizations and cost of care for young adults in the United States, 1985 to 1990.

OBJECTIVE: To evaluate the effect of human immunodeficiency virus (HIV) infection and tuberculosis on hospitalizations and the cost of care. DESIGN: National Hospital Discharge Survey, a nationally representative survey of discharges from U.S. nonfederal short-stay hospitals, and statewide billing information. PATIENTS: Patients 15 to 44 years of age with a listed diagnosis of HIV infection (n = 418,200) or active tuberculosis (n = 77,700) during 1985-1990. RESULTS: During 1985-1990, hospitalizations related to HIV infection increased sixfold, from 18 to 102 per 100,000 persons; during 1988-1990, hospitalizations related to tuberculosis increased twofold, from 8 to 16 per 100,000 persons. The prevalence of tuberculosis among HIV-infected patients increased from 2.4% in 1985-1988 to 5.1% in 1989-1990 (P = 0.003). The prevalence of HIV infection among patients with tuberculosis increased from 11% in 1985-1988 to 28% in 1989 to 39% in 1990 (P < 0.001). Infection with HIV was more prevalent among patients with extrapulmonary tuberculosis (31%) than among those with pulmonary tuberculosis (18%) (P = 0.01). An increase in the duration of hospital stay was associated with both tuberculosis and HIV infection. From 1985 to 1990, inpatient care costs increased 7.7-fold and 3.2-fold for HIV and tuberculosis hospitalizations, respectively. During this period, HIV and tuberculosis hospitalizations resulted in 5,793,000 and 1,107,900 days of care, respectively, with an estimated direct cost of $5.7 to $7.4 billion and $0.89 to $1.07 billion, respectively. Estimated national costs of inpatient care for HIV infection or tuberculosis or both totaled $6.4 to $8.1 billion, 5% of which was for patients with both HIV infection and tuberculosis. CONCLUSIONS: This is the first study to use a nationally representative sample of hospitals, combined with cost data, to estimate hospitalizations and their costs for HIV and tuberculosis care. Our findings suggest that the convergence of the HIV and tuberculosis epidemics has had an increasing effect on morbidity and the cost of care among young adults in the United States. The increasing prevalence of comorbidity of HIV infection and tuberculosis in inpatients underscores the need for strict infection control of tuberculosis on the part of hospitals, increased attention to prevention, and early identification and treatment of HIV infection, and tuberculosis to reduce morbidity, hospitalizations, and the cost of care.

Adolescent↗
PubMed1994

Effects of hand and age upon abductive and adductive movements: a kinematic analysis.

Older and younger dextral subjects performed targeting movements to left and right with their preferred and nonpreferred hands upon a computer graphics tablet. Kinematic analysis revealed that older subjects produced larger constant errors than younger, paused more, and differed from younger individuals in a number of ways with respect to adductive/abductive asymmetries. The right hand was associated with shorter stroke durations and higher peak velocities, and both shorter times to peak velocity and from peak velocity to zero, suggesting superior ballistic preprogramming by the preferred right hand which was also more accurate. While both hands showed small abductive superiorities in terms of peak velocity and time from peak to zero, the largest directional asymmetries, stroke duration, showed leftward superiorities by both hands. We cannot therefore conclude either that experience with the rightward patterns of writing or that a reported tendency towards mirror-symmetrical movements by the two hands can account for the present results. Rather a right-hemisphere mediation of visually directed movements into left hemispace, along with a left-hemisphere mediation of fast, precise, temporal sequencing may jointly determine observable asymmetries. These may appear as a vector representing the opposing contributions of the two specialized hemispheres.

Adolescent↗
PubMed1994

Use of open standards to implement health maintenance guidelines in a clinical workstation.

We are developing a clinical workstation which integrates access to health maintenance guidelines with access to a computer-based medical record. In order to enhance the portability of such a system, we emphasize the use of open standards which can be used in diverse clinical environments. We discuss the use of relational database and expert system technology to provide both patient-specific and patient-independent access to clinical guidelines. We use the Arden Syntax as the format for a textual library which facilitates the storage of structured medical knowledge.

Artificial Intelligence↗
PubMed1994

The prognosis of patients with alcoholic liver disease. An international randomized, placebo-controlled trial on the effect of malotilate on survival.

The aim of this study was to examine the effect of malotilate on survival in patients with alcoholic liver disease and to determine prognostic variables for survival. Four hundred and seven patients with alcoholic liver diseases, from seven European liver units, entered a randomized placebo-controlled, double-blind trial: 140 patients received malotilate 1500 mg/day, 133 patients received 750 mg/day, and 134 patients received placebo. The patients were included in the study over a period of 3 1/2 years, and the study was closed 1 year after the entry of the last patient. Eighty-four patients died (35, 19, 30 patients in groups 1500 mg/day, 750 mg/day, and placebo, respectively). Survival was slightly better in the 750 mg/day group than in the two other treatment groups, when tested by conventional log-rank tests (p = 0.06). However, a treatment effect was supported by a highly significant (p = 0.006) non-proportionality of the death intensity in patients receiving 750 mg/day against those receiving either 1500 mg/day or placebo. Prognostic variables for survival were evaluated using the multiple Cox regression analysis of clinical and laboratory variables and with or without liver histology variables, as determined at entry into the study. The analysis was stratified for the three treatment regimens. In the analysis including liver histology variables, independent significant prognostic variables were: years of high alcohol intake, prothrombin index, alkaline phosphatases, creatinine, immunoglobulin M, white blood cell count, and liver cell steatosis. In the analysis without liver histology variables, prognostic variables were: years of high alcohol intake, prothrombin index, alkaline phosphatases, creatinine, and immunoglobulin M.

Adult↗
PubMed1994

Age-related motor slowness: simply strategic?

BACKGROUND: While older adults typically exhibit slower hesitant movements, this may simply reflect a preference for a cautious movement strategy, rather than any pathological process. METHOD: To separate strategic preferences from any impairment in the coordination of movement, the present experiment trained older adults to move at the preferred speed of younger adults (and vice versa) in a simple zigzag drawing task on a digitizing tablet which sampled pen position at 200 Hz. Twelve older adults (mean age 69 yrs 8 mo) and 12 young adults (mean age 21 yrs) joined 9 targets 125 mm apart, of either 5, 10 or 20 mm diameter. Once the age groups were matched for movement duration, movement kinematics were examined to determine whether there were differences in the quality or accuracy of their movements. RESULTS: When strategic differences are controlled for, older adults performed the task with comparable overall accuracy, but exhibited greater hesitancy and more submovements. CONCLUSION: The results suggest a decline in motor coordination rather than any simple strategic preference for caution in movement. The hesitancy of movement to some extent parallels that seen in Parkinson's disease.

Adolescent↗
PubMed1994

Metastatic ependymoma manifested by pancytopenia.

We present the case of a 32-year-old white man seen for evaluation of pancytopenia 12 years after thoracolumbar myeloresection of intramedullary ependymoma. Bone marrow examination revealed extensive marrow fibrosis and tumor infiltrate compatible with metastatic ependymoma. Myelophthisic anemia due to metastatic ependymoma, though not previously reported, should be entertained in the differential workup for pancytopenia.

Adult↗
PubMed1994

Pulmonary artery catheterisation.

The introduction of balloon-tipped pulmonary artery flotation catheters revolutionised monitoring of the cardiovascular system and the management of seriously ill patients. Advances in design allow direct measurement of cardiac output and continuous mixed venous oxygen saturation, while intracardiac electrocardiogram monitoring and passage of pacing wires is now possible. The technique of insertion must be meticulous as must the method of obtaining central venous, pulmonary artery, pulmonary artery wedge and pulmonary capillary wedge pressures. Sources of error are highlighted as are methods to avoid and detect them. Correct interpretation of the data is essential for proper patient management and must be taken in light of information obtained by other methods. Complications of insertion are numerous and potentially serious or even lethal. It is mandatory that the information obtained by insertion of a pulmonary artery catheter be used to optimize patient management.

Blood Pressure↗
PubMed1993

Photoanthropometric study of facial growth in Noonan syndrome.

We present a photoanthropometric analysis of 104 individuals with Noonan syndrome. The study contained 53 males and 51 females with an age range of one to 60 years (mean 13.8 years). The results provide an objective evaluation of facial abnormality in Noonan syndrome. Individuals with Noonan syndrome are demonstrated to have an increased mid face height, hypertelorism, retrognathia, a lower nasal bridge and nasal root, a wider mouth, a more prominent upper lip, and apparently lower set ears than normal control individuals. Within the patient group an apparent alteration of facial structure was noted with increasing age, suggesting that remodelling of the characteristic face in Noonan syndrome may occur into adult life.

Adolescent↗