Search PubMed⌕ Search

Biomedical subjects

M Morgan

Publications and source records attributed to M Morgan.

At least 37 records · Page 2Linked to original sources
PubMed1996

Postpartum psychiatric disorder: who should be admitted and to which hospital?

OBJECTIVE: To review the question of whether an infant should be admitted to psychiatric services when a severe psychiatric disorder necessitates admission of the mother. METHOD: All available literature on mother-infant joint admission was reviewed and arguments for and against are summarised. RESULTS: Early reports favoured joint admission, then opinions changed, possibly for economic reasons. Recent thinking encompasses research data on (i) longer-term adverse effects of postnatal depression on the children, and (ii) the finding of psychological and psychiatric morbidity in many of the fathers. Joint admission to designated special units is valuable, but such facilities are only cost-efficient and effective if established as part of an appropriate broader plan for managing postpartum, psychiatric disorder. CONCLUSIONS: (1) Further research is needed to answer this question definitively. (2) Services at primary and secondary level require expansion. (3) All services should target the whole family.

Ambulatory Care↗
PubMed1995

Is Bell's palsy a reactivation of varicella zoster virus?

Despite various pointers to an infectious aetiology, the cause of Bell's palsy remains obscure. We examined paired sera from 62 patients with facial palsy and 50 age and sex matched contemporaneous controls. Significantly more patients than controls had IgM antibodies by ELISA to varicella zoster virus (56.5% vs. 20%, P = 0.0001) and herpes simplex virus (41.9% vs. 18%, P = 0.006). Additionally, significantly more patients than controls were positive for CF antibody to varicella zoster virus (14.5% vs. 0%, P = 0.004) but not to herpes simplex or cytomegalovirus. Significantly more controls than patients (54% vs. 25.8%, P = 0.002) had no evidence of antigenic stimulation by any of the herpesvirus group. No significant difference between patients and controls in seropositivity by IgM ELISA to cytomegalovirus. Epstein-Barr virus and IFA for human herpes virus 6 was found. Furthermore, there was no significant difference between the two groups as to evidence of recent infection by the following agents: rubella virus and Borrelia burgdorferi by IgM ELISA, influenza A. influenza B, adenovirus, respiratory syncytial virus, mumps and measles. Mycoplasma pneumoniae, Coxiella burnetii and chlamydia spp. by complement fixation test. The first reported case of clinically and serologically proven Mycoplasma pneumoniae pneumonia associated with Bell's palsy is described. The rate of complete recovery at 6-8 weeks after onset was not significantly different in patients who were given steroids compared to those who were not. Ear related symptoms were the most common, occurring in 12 of 65 cases, but only three (4.6%) had clinical shingles (vesicles in ear).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

The value of pre-discharge Duplex scanning in infrainguinal graft surveillance.

OBJECTIVES: Protocols and criteria for Duplex-based graft surveillance programmes (GS) vary widely as to the optimum regimens for maximising detection of "at risk" grafts. Few centres recommend starting GS before discharge. The aim of this study was to audit our experience with respect to early scanning. SETTING: Vascular Studies Unit, Bristol Royal Infirmary. METHOD: The records of 123 patients entering GS from January 1992 were reviewed. Patients were scanned at 1 week, 6 weeks and 3, 6, 9 and 12 months post-bypass. Haemodynamic criteria used were a peak mean velocity (PMV) less than 45 cm/s and a focal velocity disturbance with a V2/V1 ratio of 1.5 or more. RESULTS: Forty-six abnormalities (37% detection rate) were identified on scans within one week. In all cases, on-table completion studies with either arteriography and/or flow measurements had failed to identify the anomalies subsequently detected by Duplex. At 1 week, six grafts had occluded, 27 had a focal PMV increase (mean V2/V1 ratio: 2.6; range 1.5-4.3), four had low flow velocities, four had arteriovenous fistulae, one contained mobile thrombus, two had retained cusps and two had hamstring entrapment. Of 40 patent, but compromised grafts, 18 warranted immediate investigation. Of the 27 patients with velocity disturbances on Duplex, 25 were simply observed but, eight have since required intervention for definitive stenoses at these sites which, in retrospect, were evident within the first postoperative week. CONCLUSIONS: Pre-discharge scanning is a useful modality for detecting technical problems. Intrinsic graft abnormalities, possibly the sites of future definitive stenoses, have been visualised even at 1 week and once identified, can be more closely scrutinised thereafter. Pre-discharge colour Duplex is recommended as standard practice for quality control after infrainguinal bypass.

Arterial Occlusive Diseases↗
PubMed1995

Clonal structure of invasive Streptococcus pyogenes in Northern Scotland.

We have used molecular techniques to characterize 51 group A streptococci from Scotland and 17 'serious disease' isolates from other countries, in order to establish the clonal structure of invasive Streptococcus pyogenes strains circulating between 1986 and 1993. Strains were grouped by restriction endonuclease analysis, pulsed field gel electrophoresis and ribotyping patterns, and were examined for the presence of alleles of the speA gene by polymerase chain reaction and DNA sequence analysis. Serious and fatal infections in Scotland were caused by several clones. One clone (9 of 51 strains) was M type 1 and possessed the speA gene allele 2. This was the clone previously identified as causing severe infection in the USA. Another clone (5 of 51 strains) was M type 3 and had speA gene allele 3. In view of the clear association of more than one clone with severe, invasive and fatal infections, horizontal gene exchange between genotypes merits further investigation.

Base Sequence↗
PubMed1995

The SF-36 health survey questionnaire: is it suitable for use with older adults?

An Anglicized version of the SF-36, a recently developed generic health status measure, was tested among people aged 65 years and over in hospital outpatient and general practice settings as both a self-completed and interview-administered instrument. The SF-36 was quick to complete, with 84% completed in 10 minutes or less (median time 8 minutes), while the distribution of scores provided further evidence of its sensitivity and validity. As an interview-administered instrument the SF-36 was acceptable among all age groups, although 32% of outpatients and 10% of general-practice patients, consisting predominantly of people aged 75 years and over with poor physical or mental health scores, felt unable to self-complete the questionnaire. In addition, 26% of respondents missed out at least one of the 36 statements, with missing items being significantly related to older age and self-completion. Missing responses were mainly concentrated on a small number of questions whose emphasis on work or vigorous activities meant that they were frequently regarded as not applicable by elderly people. Suggested modifications to these questions for elderly respondents are given. With these changes the SF-36 is regarded as suitable for use as a self-completed questionnaire among the younger age group of elderly people, although some assistance may often be required by people aged 75 years and over and especially those with poor physical or mental health.

Activities of Daily Living↗
PubMed1995

The significance of ethnicity for health promotion: patients' use of anti-hypertensive drugs in inner London.

Afro-Caribbeans are the second largest ethnic minority in the UK and are concentrated in some inner London areas where they comprise over 12% of the population. Standardized mortality ratios for stroke are relatively high among the Afro-Caribbeans, for whom the control of high blood pressure is thus of particular significance. Semi-structured interviews were conducted with matched groups of 'white' and Afro-Caribbean hypertensive patients attending 15 general practices in an inner London area to examine their beliefs and practices regarding the prescribed drugs. Adherence was high among 'white' patients, but less than half the Afro-Caribbeans took the drugs regularly as prescribed with many having poorly controlled blood pressures. Non-adherence was influenced by traditional cultural beliefs and practices which often strengthened concerns about the long-term harmful effects of drugs and provided an alternative resource in terms of herbal remedies. There was also evidence of a cultural gulf and lack of communication between Afro-Caribbean patients and their general practitioners, thus reducing the effectiveness of this preventive strategy.

Adult↗
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↗