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Biomedical subjects

M Morgan

Publications and source records attributed to M Morgan.

At least 127 records · Page 7Linked to original sources
PubMed1997

Illness doesn't belong to us.

There has been little research in Britain into the experiences of doctors who are ill. We conducted in-depth interviews with 64 doctors of all grades with a recent illness lasting one month or more. Whether the illness was physical or psychiatric, many expressed the idea that illness is inappropriate for doctors. This idea is a cultural value among doctors which is reinforced by the organization of medical work. It discourages doctors from seeking and obtaining appropriate help when they are ill.

Adaptation, Psychological↗
PubMed1997

Correlates of change in adolescent alcohol consumption in Ireland: implications for understanding influences and enhancing interventions.

Studies of two similar cohorts of students in Ireland in 1984 and 1992 showed a dramatic increase in the consumption of alcohol, especially in the frequency with which students reported being drunk. A comparison of measures obtained at both times showed that there were major changes with regard to beliefs about consequences of alcohol consumption in a direction favorable to consumption as well as increases in the perceived social support for drinking. However, there were no strong indications that changes in problem behavior were associated with the observed increases in drinking patterns. These results are supportive of some explanatory models of initiation to substance use and have associated implications for programs designed to reduce consumption.

Adolescent↗
PubMed1997

Outcomes assessment: a primer.

The routine assessment of outcomes, including clinical and functional outcomes, charges, cost and effectiveness data, and complications of treatment, as well as HRQOL and patient satisfaction, are essential to demonstrate and ensure the quality of care. Secondary to patient-related concerns, outcomes data provide a tool for use by the surgeon in proving (and improving) the quality of care rendered. These tools, as well as surgical input into the development of outcomes indicators, will allow surgeons to practice more effectively in a managed care environment.

Cost-Benefit Analysis↗
PubMed1997

The impact of chronic urticaria on the quality of life.

The impact of chronic urticaria (CU) on the quality of life is undocumented. We assessed quality of life in patients with CU, including patients with associated delayed pressure urticaria (DPU). One hundred and forty-two out-patients completed self-administered questionnaires: a disease-specific, purpose designed questionnaire, and the Nottingham health profile (NHP). Many patients reported problems attributable to their skin condition in facets of everyday life including home management, personal care, recreation and social interaction, mobility, emotional factors, sleep, rest and work. The NHP part I scores showed restriction in the areas of mobility, sleep, energy, and demonstrated pain, social isolation and altered emotional reactions. Part II of the NHP showed that patients experienced difficulties in relation to work, looking after the home, social life, home relationships, sex life, hobbies and holidays. The patients with DPU had significantly more problems with mobility, gardening and choice of clothing than the uncomplicated CU patients. They also suffered more pain, had more problems with work and were more restricted in their hobbies.

Activities of Daily Living↗
PubMed1997

Dermatology quality of life scales--a measure of the impact of skin diseases.

Patient-generated dermatology quality of life scales (DQOLS) were developed to assess the impact of skin conditions on patients' psychosocial state and everyday activities. The items were derived from the self-reported impacts of their skin condition by 50 dermatology out-patients. The resulting 17 psychosocial items and 12 activities items were assigned five-point scales and self-completed by 118 out-patients. Factor analyses grouped the items into four psychosocial subscales (embarrassment, despair, irritableness, distress) and four activities subscales (everyday, summer, social, sexual). Tests of the psychometric properties indicated that the internal consistency of responses was high, with Cronbach's alpha coefficients of 0.92 for the 17 psychosocial items and 0.83 for the 12 activity items. Assessment of reliability based on 41 psoriasis patients attending phototherapy treatment identified good short-term test-retest reliability, with intraclass correlation coefficients of 0.84 for both the psychosocial and activities scales. Construct validity was confirmed by the ability of the scales to identify clinically expected differences and their greater sensitivity to the impacts of skin problems compared with a widely used generic health status measure. The DQOLS thus form a robust measure of patient-perceived impacts. They were quickly self-completed and provide information that complements traditional clinical indicators. These scales should assist in informing treatment decisions by identifying impacts of different skin conditions and variations in responses among social and cultural groups, as well as guiding priorities for services within the specialty.

Acne Vulgaris↗
PubMed1997

Fatalism, current life satisfaction, and risk for HIV infection among gay and bisexual men.

This study surveyed 430 men at an urban gay pride celebration to assess fatalism, current life satisfaction, and perceived expected years of life among men who have sex with men. Analyses showed that men who engaged in unprotected anal intercourse outside of exclusive relationships reported a greater fatalistic outlook, were more dissatisfied with life, and perceived a shorter life for themselves than men who practiced only safer sex and men who were in exclusive relationships. Gay men in exclusive relationships scored higher than nonexclusively partnered gay men on the measure of current life satisfaction. These results suggest that efforts to prevent HIV infection among gay men should include building personal self-worth, support of long-term relationships, and future goal orientations.

Adult↗
PubMed1996

Brainiac encodes a novel, putative secreted protein that cooperates with Grk TGF alpha in the genesis of the follicular epithelium.

brainiac (brn) is involved in a number of developmental events. In addition to being required zygotically for segregation of neuroblasts from epidermoblasts, it is essential for a series of critical steps during oogenesis which also depend upon gurken (grk), a TGF alpha homolog. Animals harboring strong mutations of either grk or EGF receptor tyrosine kinase (Egfr) or doubly mutant for brn and weak grk or Egfr mutations produce ovarian follicles with multiple sets of nurse cell-oocyte complexes. These follicles frequently have discontinuities in the follicular epithelium that uncover nurse cells but not the oocyte. Gaps first appear in the germarium, suggesting that some nurse cells lack affinity for invading prefollicular cells. This is the first evidence that grk, in addition to its involvement in the genesis of anterior-posterior and dorsal-ventral polarity, is also required for Egfr-dependent development of the follicular epithelium that surrounds each nurse cell/oocyte cluster to form an egg chamber. We have used restriction fragment length polymorphisms to localize brn to a 10-kb region within a 300-kb stretch of DNA on the X-chromosome, and we have identified the brn gene by means of RNA rescue. brn codes for a putative secreted protein. brn is expressed in germ cells at the time follicle cells first surround the nurse cell-oocyte complex. Our genetic data suggest that brn acts in a parallel, but partially overlapping pathway to the Grk-Egfr signaling pathway. The brn pathway may help to provide specificity to TGF alpha -Egfr function during oogenesis.

Amino Acid Sequence↗
PubMed1996

No transfer of perceptual learning between similar stimuli in the same retinal position.

BACKGROUND: Recent experiments have demonstrated a remarkable amount of specificity in the learning of simple visual tasks in humans, as well as considerable plasticity of receptive fields in the visual cortex of adult monkeys. Here, we tested the specificity of improvement through learning in the performance of human observers on two tasks using almost identical stimuli. RESULTS: Two groups, of six observers each, were trained in two hyperacuity tasks - three-dot bisection and three-dot vernier discrimination. The groups started with different tasks, and switched tasks after one hour of training. Training improved performance significantly, in spite of considerable variability between observers, but improvement did not generalize from one of these tasks to the other. This result indicates that perceptual learning can be extremely stimulus specific, and that deviations from the same standard but in orthogonal directions require completely new training. CONCLUSIONS: Learning is not based on the development of a more exact map of positional information, or on training to fixate or accommodate the eye, but on a better discrimination between the stimuli using one specific stimulus dimension. We also demonstrate that observers differ considerably, not only in their speed of learning, but also in their relative level of performance on the two similar tasks.

Adult↗
PubMed1996

Failure of dialysis access: revise or replace?

Providing adequate long-term dialysis access has become increasingly difficult. In order to evaluate the operative factors associated with early failure of dialysis access, 2337 operations performed in 1124 patients over an 8-year period were retrospectively reviewed. Evaluation of 1306 procedures that eventually failed and required operative revision or repair provided the basis for this study. Access failure occurred in 459 (41%) of the 1124 patients. An average of 2.8 episodes of failure (range 1-13) were observed among this group of patients, occurring after an average of 230 +/- 9 days (mean +/- ++standard error) postoperatively, with the longest interval to failure being 2529 days. The time-to-failure for revision of a preexistent arteriovenous fistula or prosthetic graft (140 +/- 9 days, n = 449) was significantly (P < 0.0001 ANOVA) shorter than for creation of an arteriovenous fistula (272 +/- 21 days, n = 336) or prosthetic graft (299 +/- 19 days, n = 372) at a new site. Procedures performed in octogenarians tended to fail earlier (178 days). Dialysis access failure tends to recur in patients with a history of previous access problems. The time-to-failure was similar for new prosthetic grafts and arteriovenous fistulas, but twice as long compared to revision of a previous access site.

Adolescent↗
PubMed1996

Teaching schoolchildren cardiopulmonary resuscitation.

Forty-one children aged 11-12 years received tuition in cardiopulmonary resuscitation (CPR) and subsequently completed questionnaires to assess their theoretical knowledge and attitudes their likelihood of performing CPR. Although most children scored well on theoretical knowledge, this did not correlate with an assessment of practical ability using training manikins. In particular only one child correctly called for help after the casualty was found to be unresponsive, and none telephoned for an ambulance before starting resuscitation. These omissions have important implications for the teaching of CPR and the resulting effectiveness of community CPR programmes.

Ambulances↗
PubMed1996

Cognitive functioning in premenstrual syndrome.

OBJECTIVE: To evaluate cognitive functioning in women with premenstrual syndrome (PMS) and controls during the follicular and luteal phases of the menstrual cycle. METHODS: Thirty women with PMS and 31 controls were selected on the basis of psychiatric interview and prospective daily diary recordings. Subjects were tested on two occasions, follicular (days 8-10) and luteal (days 24-26), using complex tasks consisting of measures validated previously for the assessment of "executive" frontal-lobe functions. Tests were counterbalanced for order across subjects. RESULTS: The Beck Depression Inventory scores were significantly different between the groups and across time (P < .001). Women with PMS had a mean luteal phase Beck score of 13.3 consistent with mild-to-moderate premenstrual depression. There were no statistically significant score differences in tests for attention, memory, cognitive flexibility, and overall mental agility. The evaluation of our preliminary data with 30 PMS subjects and 31 controls indicated a very small effect size (.02). To detect an effect size this small (if in fact one exists) with a power of .8 would require a sample of more than 1000 subjects per group. CONCLUSION: Our sample of women with PMS failed to demonstrate objective evidence of diminished cognitive performance, despite subjective feelings of inadequacy.

Adult↗
PubMed1996

Localization of impalpable breast lesions--a surgical approach.

The conventional approach to localization of impalpable breast lesions, i.e. employing a hooked wire with either stereotaxis or a perforated plate, has potential disadvantages for the operating surgeon. Often the entry point of the wire lies some distance from the site of projection of the lesion on the skin. The guide-wire should pierce the skin at, or close to, the site of any proposed surgical incision and proceed along the shortest and most direct course towards the lesion. Ideally, the wire should lie within a radial distance of between 1 and 2 cm from its target. A method is described which achieves these objectives and involves both radiological and clinical measurements. A total of 665 guide-wire localized biopsies have been carried out at the above institutions between 1 November 1987 and 31 March 1995 and between 1 January 1994 and 31 March 1996. In only 4% of cases was re-positioning of the wire required. Excision of the radiological lesion was obtained with a single biopsy in 99% of cases. A second or third biopsy was indicated in 0.7% and 0.3% of cases, respectively. Migration of the wire occurred in two patients and no cases of wire transection or pneumothorax were reported. This method of localization facilitates subsequent excision and permits the most appropriate incision consistent with optimal cosmesis.

Breast↗
PubMed1996

Vein graft stenosis: incidence and intervention.

OBJECTIVES: The incidence of vein graft stenosis ranges from 5%-45%. Reported rates appear to be increasing as technological advances make detection easier. The aim of this study was to review our experiences with regard to the incidence of stenosis in infrainguinal bypass grafts and the outcome of intervention for salvage of failing grafts. DESIGN: Retrospective review of graft surveillance records. SETTING: Vascular Studies Unit, Bristol Royal Infirmary. METHODS: A Duplex-based graft surveillance (GS) programme was used from January 1989 to June 1994 to study 275 primary graft procedures in 250 patients with lower limb ischaemia. Patients were scanned at 1 week, 6 weeks and 3, 6, 9 and 12 months postoperatively. RESULTS: One year cumulative limb salvage, patient survival and primary, primary assisted and secondary patencies were 91%, 83%, 67%, 77% and 84% respectively. Duplex scanning detected 85 vein graft stenoses in 59 patients: an incidence of 21.5%. In addition, 64 potentially graft-threatening inflow (14) and outflow (50) problems were detected in the native vessels of 52 patients from clamp damage or progression of disease (POD). Of the 85 graft stenoses, 40 were treated by balloon angioplasty (PTA) and 20 by surgical intervention and 1 patient's symptoms were treated by chemical sympathectomy. Twenty-four patients were not actively treated. Of the 64 grafts affected by POD, 20 were treated by PTA, 15 by surgery, one with anti-coagulation and 28 had no treatment. Comparing patients with non-treated and treated lesions, the respective 12 month cumulative patencies for patients with graft stenoses were 75% and 87.5% as against 86% and 83% for patients with POD (log rank test 0.1). CONCLUSIONS: These results uphold the perceived benefits of a GS programme, although the evidence from the non-treated cases in this series reinforces a need for a large, prospective, randomised trial to confirm the case for GS.

England↗
PubMed1996

Angioscopically-assisted in situ saphenous vein bypass for infrainguinal revascularisation.

OBJECTIVES AND STUDY DESIGN: The diagnostic capability of angioscopy for endoluminal evaluation is established and its superiority over arteriography for completion studies has been confirmed. The therapeutic use of angioscopy in vein graft preparation is more controversial. The aim of this prospective study was to establish whether angioscopic vein preparation confers real benefits over existing techniques. METHODS: Forty-seven patients were randomised to either full angioscopic (ANG) vein preparation (23 patients) or conventional (CON) in situ grafting (19 patients). All patients underwent completion studies with arteriography and angioscopy and postoperatively, entered a Duplex graft surveillance programme. RESULTS: There was a significant difference in the incidence of wound morbidity: 26% in the ANG group as against 63% in the CON group (Fisher's exact test: p = 0.043), but no significant differences with respect to duration of operation, duration of vein graft preparation, length of hospital stay and both 30 day and 12 month secondary cumulative patencies (log rank test: p > 0.5). Completion angioscopy detected eight persistent valve cusps in six patients, all missed at arteriography, but failed to detect arteriovenous fistulae. CONCLUSIONS: Angioscopic preparation reduces wound morbidity and complements arteriography for detecting intraoperative defects. A large, prospective, randomised trial is now warranted to fully evaluate the potential therapeutic role of angioscopy with respect to current vascular practice.

Aged↗
PubMed1996

Angioscopy for quality control of saphenous vein during bypass grafting.

OBJECTIVES: Although autogenous vein is the conduit of choice for infrainguinal bypass grafting, some 20-30% of vein grafts fail during the first year postoperatively. Many of these failed veins are now known to have pre-existing pathological changes. Angioscopy enables intraoperative endoluminal visualisation of veins and can reveal anomalies, some previously unsuspected, despite preoperative Duplex ultrasound mapping and normal external appearances. The aim of this study was to compare angioscopic findings with contemporary histological appearances and with subsequent graft outcome and ultimately, to identify those endoluminal features which might be predictive for failure. METHODS: Angioscopic vein inspection was carried out using Olympus 1.4 and 2.2mm angioscopes in patients undergoing femoropopliteal/distal bypass. Severe disease in the veins of five patients led to preferential use of polytetrafluoroethylene (PTFE) for above-knee bypasses. The remaining 38 videotaped sequences were reviewed by two surgeons and scored using a scale of 0 to 3, based on frequency and distribution of angioscopically detected lesions. These included haemorrhagic mural plaques, flimsy intraluminal strands, webs/bands and mobile/adherent thrombus. Vein harvested at operation was assessed by a pathologist according to the level of pre-existing abnormality. RESULTS: There were significant associations between angioscopy/histology scores and graft survival (chi 2 = 22.00; df:3; p < 0.001; chi 2 = 22.43; df:3; p < 0.001 respectively). There was a significant correlation between angioscopy and histology scores (R8 = 0.725; p < 0.001). CONCLUSIONS: Angioscopy allows immediate identification of the at risk, poor quality vein graft at the time of surgery, without the delays inherent with histological preparation and assessment. Recognition of abnormalities at angioscopy may ultimately improve graft outcome by prospectively eliminating use of poor vein.

Adult↗