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Biomedical subjects

R W Morris

Publications and source records attributed to R W Morris.

At least 55 records · Page 3Linked to original sources
PubMed1998

Assaults from penetrating trauma in the State of Illinois.

This study was undertaken to evaluate the incidence, epidemiology, and temporal relationships of assaults in the State of Illinois from penetrating trauma presenting to Level I and Level II trauma centers, and to project the impact of these variables on hospital staffing. A retrospective analysis was performed on 4 months of data (7/1/92 to 10/31/92) provided by the Illinois Department of Public Health describing consecutive assaults with firearms or knives presenting to all Level I and Level II trauma facilities in the State of Illinois. Data were analyzed for epidemiological parameters including age, gender, and race. Other variables analyzed included trauma score, Glasgow Coma Scale (GCS) score, ethanol levels, urine toxicology results, and mortality. The data were also analyzed for temporal patterns of hospital presentations with respect to the time of day and day of the week. A total of 1,288 cases of penetrating wounds were analyzed. Of these, 881 (68.4%) resulted from firearms and 407 (31.6%) resulted from stab wounds. Ages of all penetrating trauma victims ranged from less than 1 year to 84 years of age. The mean age for firearm victims was 25.0 +/- 10.8 (SD) years and 30.5 +/- 11.4 years for stabbing victims. Ninety percent of penetrating trauma victims were male and 10% were female. Seventy-two percent of the victims were African-American, 13% Hispanic, 13% Caucasian, and 2% other. Alcohol levels were available for 727 of the 1,288 (56.4%) patients. Of these 727, 433 (59.6%) had measurable levels. The results of drug screens were available for 582 of the 1,288 (45.1%) victims. Of these 582, 208 (35.7%) were positive. Other than alcohol, cocaine was the most frequently detected drug, accounting for 58.4% of the positive drug screens. Firearm victims had significantly lower trauma scores (10.5 v 11.2) and GCS scores (13.2 v 14.3) than stab victims. Significant circadian patterns of penetrating trauma were observed for both types of assaults. For assaults with firearms, the circadian rhythm peaked at 23.1 +/- 0.36 hours. For assaults with knives, the circadian rhythm peaked at 23.7 +/- 0.44 hours. Weekly patterns were not statistically significant for each individual type of assault. However, when the data were pooled, a weekly pattern peaking on Thursday was observed. These patterns of presentation for assaults are a significant finding that may have implications for hospital staff scheduling of trauma center physicians, nurses, technicians, security, social service, and other ancillary staff.

Adolescent↗
PubMed1998

International, multicentre, placebo-controlled study to evaluate the effectiveness of ondansetron vs. metoclopramide in the prevention of post-operative nausea and vomiting.

Ondansetron 4 mg was compared with metoclopramide 10 mg for prevention of post-operative nausea and emesis in in-patients undergoing major gynaecological surgery in this double-blind, randomized, placebo-controlled, multicentre study. A total of 1044 patients received a single intravenous (i.v.) injection of study medication immediately before induction of anaesthesia. Nausea and emesis were assessed over the 24 h post-operative period. Significantly more patients who received ondansetron experienced no emetic episodes (44%) compared with those who received metoclopramide (37%, P = 0.049) or placebo (25%, P < 0.001). No nausea was experienced by significantly more patients who received ondansetron (32%) than with patients who received metoclopramide (24%, P = 0.009) or placebo (16%, P < 0.001). In addition, fewer emetic episodes, less severe nausea and a reduced need for rescue antiemetics were also observed with ondansetron (P < 0.05 vs. metoclopramide and placebo). Metoclopramide and placebo-treated patients were also 1.5 times (95% Cl 1.5-4.2) and 2.5 times (95% Cl 1.1-2.0) more likely, respectively, to experience nausea post-operatively. Overall, ondansetron was the most effective antiemetic in this patient population.

Adolescent↗
PubMed1998

High prevalence of low bone mass in thalassaemia major.

Cooley's original description of beta-thalassaemia major included marked bone deformities as a characteristic feature. These were thought to be due to expansion of haemopoiesis attempting to compensate for the congenital anaemia. Regular blood transfusions from infancy prevents these skeletal problems. Nevertheless, symptoms due to bone disease frequently occur in adult patients. Osteoporosis has not previously been reported as a cause of severe morbidity in thalassaemia major. The present study shows a high prevalence of low bone mass among thalassaemia major patients and analyses the predisposing causes. Bone density scans were performed in 82 patients with transfusion-dependent beta thalassaemia. Factors known to be associated with low bone mass such as gender, endocrine disorders and lifestyle activities, together with factors specific to the thalassaemia and its management, were included in a series of univariate analyses to ascertain any significant associations. 42 (51%) of the patients had severely low bone mass and a further 37 (45%) had low bone mass. The three factors showing a statistically significant association with severely low bone mass were male sex, 24/38 (63%) males had severely low bone mass, compared with 18/44 (41%) females, the lack of spontaneous puberty, 22/32 (69%) who required therapeutic induction of pubertal development had severely low bone mass, compared with 19/47 (40%) with spontaneous puberty and diabetes, 8/10 (80%) diabetic patients had severely low bone mass, compared with 23/56 (41%) with normal glucose tolerance. There was no association between the bone mineral density measurements and the haematological characteristics or treatment details of these patients. Severely low and low bone mass are common findings in patients with beta-thalassaemia major despite optimal transfusion and iron chelation. The associated features suggest that the severely low bone mass is due to endocrine abnormalities, in contrast to the haematological causes of bone disease characteristically seen in untreated thalassaemics.

Adult↗
PubMed1998

Marker selection for the transmission/disequilibrium test, in recently admixed populations.

Recent admixture between genetically differentiated populations can result in high levels of association between alleles at loci that are <=10 cM apart. The transmission/disequilibrium test (TDT) proposed by Spielman et al. (1993) can be a powerful test of linkage between disease and marker loci in the presence of association and therefore could be a useful test of linkage in admixed populations. The degree of association between alleles at two loci depends on the differences in allele frequencies, at the two loci, in the founding populations; therefore, the choice of marker is important. For a multiallelic marker, one strategy that may improve the power of the TDT is to group marker alleles within a locus, on the basis of information about the founding populations and the admixed population, thereby collapsing the marker into one with fewer alleles. We have examined the consequences of collapsing a microsatellite into a two-allele marker, when two founding populations are assumed for the admixed population, and have found that if there is random mating in the admixed population, then typically there is a collapsing for which the power of the TDT is greater than that for the original microsatellite marker. A method is presented for finding the optimal collapsing that has minimal dependence on the disease and that uses estimates either of marker allele frequencies in the two founding populations or of marker allele frequencies in the current, admixed population and in one of the founding populations. Furthermore, this optimal collapsing is not always the collapsing with the largest difference in allele frequencies in the founding populations. To demonstrate this strategy, we considered a recent data set, published previously, that provides frequency estimates for 30 microsatellites in 13 populations.

Alleles↗
PubMed1998

Comparison of remifentanil in combination with isoflurane or propofol for short-stay surgical procedures.

There are few data in the literature that describe the use of remifentanil when administered as a component of an inhalation or total i.v. anaesthetic (TIVA) technique. We studied 251 male and female patients, aged 18-75 years, ASA I-II, undergoing inguinal hernia repair, arthroscopic knee surgery or varicose vein surgery of at least 30 min duration without premedication. Patients were randomized to receive a remifentanil loading dose of 1.0 microgram kg-1 followed by a continuous infusion of 0.5 microgram kg-1 min-1 in combination with isoflurane (end-tidal concentration 0.6%), (Group I, n = 115) or propofol (initial infusion rate 9 mg kg-1 h-1 reduced to 6 mg kg-1 h-1 after 10 min), (Group P, n = 118). The remifentanil infusion rate was reduced by 50%, 5 min after tracheal intubation. Intraoperative stresses were treated with a remifentanil bolus (1 microgram kg-1) followed by an increase in the remifentanil infusion rate. At the insertion of the last suture, the remifentanil infusion and concomitant anaesthetic were switched off simultaneously. Times to spontaneous respiration, adequate respiration and tracheal extubation were significantly shorter in group I compared with group P (6.4 min vs 7.6 min, P < 0.01; 7.6 min vs 9.3, P < 0.003; 7.8 min vs 9.5 min, P < 0.015). Overall mean systolic blood pressures during surgery were greater in group P compared with group I (P < 0.05) but the absolute differences were clinically insignificant (4-5 mm Hg).

Adolescent↗
PubMed1998

Characterizing dose-response: I: Critical assessment of the benchmark dose concept.

We present a critical assessment of the benchmark dose (BMD) method introduced by Crump as an alternative method for setting a characteristic dose level for toxicant risk assessment. The no-observed-adverse-effect-level (NOAEL) method has been criticized because it does not use all of the data and because the characteristic dose level obtained depends on the dose levels and the statistical precision (sample sizes) of the study design. Defining the BMD in terms of a confidence bound on a point estimate results in a characteristic dose that also varies with the statistical precision and still depends on the study dose levels. Indiscriminate choice of benchmark response level may result in a BMD that reflects little about the dose-response behavior available from using all of the data. Another concern is that the definition of the BMD for the quantal response case is different for the continuous response case. Specifically, defining the BMD for continuous data using a ratio of increased effect divided by the background response results in an arbitrary dependence on the natural background for the endpoint being studied, making comparison among endpoints less meaningful and standards more arbitrary. We define a modified benchmark dose as a point estimate using the ratio of increased effect divided by the full adverse response range which enables consistent placement of the benchmark response level and provides a BMD with a more consistent relationship to the dose-response curve shape.

Animals↗
PubMed1997

Randomised trial of oral and intravenous methylprednisolone in acute relapses of multiple sclerosis.

BACKGROUND: An intravenous rather than oral course of methylprednisolone is often prescribed for treating acute relapses in multiple sclerosis (MS) despite the lack of evidence to support this route of administration. Our double-blind placebo-controlled randomised trial was designed to compare the efficacy of commonly used intravenous and oral steroid regimens in promoting recovery from acute relapses in MS. METHODS: 42 patients with clinically definite relapse in MS received oral, and 38 intravenous, methylprednisolone. Clinical measurements at entry and at 1 week, 4 weeks, 12 weeks, and 24 weeks included Kurtzke's expanded disability status scale (EDSS), Hauser's Ambulatory Index, and an arm-function index. The primary outcome criterion was a difference between the two treatment groups of one or more EDSS grades at 4 weeks. FINDINGS: There were no significant differences between the two groups at any stage of the study in any measurement taken: the mean difference in EDSS at 4 weeks (adjusted for baseline level) was 0.07 grades more in those taking oral steroids (95% CI -0.46 to 0.60). The most optimistic outcome for intravenous therapy is an average benefit of less than half a grade improvement on EDSS over oral treatment. INTERPRETATION: Since our study did not show any clear advantage of the intravenous regime we conclude that it is preferable to prescribe oral rather than intravenous steroids for acute relapses in MS for reasons of patient convenience, safety, and cost.

Administration, Oral↗
PubMed1997

Alterations in the reproductive patterns of female mice exposed to xenobiotics.

Chemicals, by virtue of their varied interactions with biological molecules, are expected to differ in the way they may alter female reproduction. Reproductive toxicity may reflect effects either on the female germ cells or on various maternal processes such as ovulation, implantation, pregnancy, and parturition. In either case, the ultimate manifestation of chemical toxicity on female reproduction is a decrease in the number of normal young born. Very little information is available on the effects of chemicals that are nonhormonal in nature on the long-term ability of treated females to produce offspring. This report presents the results of long-term female total reproductive capacity (TRC) tests on 29 chemicals, including pharmaceuticals, pesticides, and alkylating and industrial agents. For each chemical, the minimum test involved an evaluation of the maximum tolerated dose administered as a single intraperitoneal injection. Females were single-pair mated with an untreated male for most of the female's reproductive life span (a minimum of 347 days posttreatment) and scored for the number of live births produced during this period. Confirmatory dominant lethal experiments or histological examinations for numbers of small follicles were carried out when mutagenic effects or cytotoxicity, respectively, were suspected as the basis for reduced fertility. Of the 29 chemicals studied, 17 had reproductive effects which may be grouped into one of three classes: (1) those that reduced the total number of young and litters per female, (2) those that reduced the total number of young but not of litters, and (3) those that had no significant effect on the total number of young produced but reduced the size of the first and/or second litters. The TRC provides a capacity for detecting a range of toxic insults upon female reproduction. Many of the chemicals were indeed shown to affect the reproductive performance of females through mutagenic and/or cytotoxic effects on follicles. In some cases, however, no causative mechanism could be identified for the observed reduction in reproductive performance. Nevertheless, with this report the number of chemicals tested by this TRC procedure has been quadrupled and the categories of chemicals tested have been substantially broadened.

Alkylating Agents↗
PubMed1997

Incidence of endocrine complications and clinical disease severity related to genotype analysis and iron overload in patients with beta-thalassaemia.

The incidence of endocrine dysfunction in relation to the detailed genotype of beta-thalassaemia is investigated in this study. In addition, the association of genotype to specific clinical features of beta-thalassaemia is examined, together with the relationship between serum ferritin levels and endocrine complications. Ninety-seven patients were included, all with transfusion dependent beta-thalassaemia. Patients were divided into 2 categories; group 1 consisted of patients with a beta0/beta0 genotype with or without a concomitant alpha-globin gene deletion as well as patients with beta0/beta+ or beta+/beta+ genotype and normal alpha-globin chain synthesis. Group 2 included patients with beta+/beta+ or beta+/beta0 genotype and one alpha-globin chain deletion and those with a moderate amount of beta-globin chain synthesis (beta++) and normal alpha-globin chain synthesis. The results showed that group 1 patients were more likely to have severe clinical disease (p=0.005). Sixty-four patients (66%) had at least 1 endocrine disorder and 39 (40%) had multiple endocrinopathies; the most common abnormality was hypogonadotrophic hypogonadism (HH). There was a significant association between patients with group 1 genotypes and the presence of HH and impaired glucose tolerance or diabetes. A positive correlation was demonstrated between serum ferritin concentrations and the presence of thyroid or parathyroid dysfunction.

Adolescent↗
PubMed1997

Aspirin use in middle-aged men with cardiovascular disease: are opportunities being missed?

BACKGROUND: Since the 1980s, clinical trial evidence has supported aspirin use in the secondary prevention of cardiovascular disease (CVD). AIM: To explore aspirin use among British men with known CVD in a population-based study. METHOD: Longitudinal study (British Regional Heart Study), in which subjects have been followed up for cardiovascular morbidity and mortality since 1978-1980. Aspirin use was assessed by questionnaires to study participants in November 1992 (Q92); cardiovascular diagnoses are based on general practice notifications to October 1992. A total of 5751 men aged 52-73 years (87% of survivors) completed questions on aspirin use. RESULTS: Overall, 547 men (9.5%) were taking aspirin daily, of whom 321 (59%) had documented CVD. Among men with pre-existing disease, 153 out of 345 (44%) men with myocardial infarction, 42 out of 109 (39%) with stroke, and 75 out of 247 (29%) with angina were taking aspirin daily. Among men with angina (54% versus 26%) or myocardial infarction (59% versus 42%), those who had undergone coronary artery bypass surgery (CABG) or angioplasty were more likely to be receiving aspirin. Higher rates of aspirin use were also found in those whose last major event occurred after January 1990 (47% versus 34%). There was no association between aspirin use and social class or region of residence. CONCLUSION: Despite strong evidence of its effectiveness, many patients with established CVD were not receiving aspirin. Daily aspirin treatment was less likely in men with less recent major CVD events and in those who had not received invasive treatment.

Aged↗
PubMed1996

Frequency and relationships of clinical chemistry and liver and kidney histopathology findings in 13-week toxicity studies in rats.

The relative sensitivities of eight commonly used clinical chemistry end points and histopathology to detect potential toxic effects in liver and kidney were evaluated for a series of 61 13-week rat toxicity studies conducted for the National Toxicology Program. The data consisted of 1-,2- to 3-, and 13 week clinical chemistry measurements and 13-week histopathological assessments of liver and kidney. Except for serum alkaline phosphatase, treatment-related alterations of individual clinical chemistry variables occurred in 20-48% of the studies, depending on the analyte, sampling time, and sex. Liver and kidney lesions were reported for 31% and 41% of the studies respectively. There was an association between treatment-related increases in alanine aminotransferase (ALT) and sorbitol dehydrogenase (SDH) activities and histopathological changes in the liver. SDH activity had greater positive and negative predictive values than similar changes in ALT; by week 1 in females and weeks 2-3 in both sexes. SDH predicted morphological hepatic change at study termination with 75% or better accuracy. If increases in activities of both enzymes occurred simultaneously, however, terminal histopathological changes could be predicted, in both sexes, with 75% accuracy by week 1, increasing to 100% by weeks 2-3. There also was an association between treatment-related increases in urea nitrogen (UN) and creatinine (Cre) concentrations and morphological kidney change. Cre concentration had greater positive predictive values than similar changes in UN; by weeks 2-3 in males and week 13 in both sexes. Cre predicted morphological renal change at study termination with 56% or better accuracy. UN concentration was associated and predictive of morphological kidney change only in females at week 13. Depending on time point and sex, serum alkaline phosphatase activity increased in 5-22% of the studies. Increases in total bile acid concentration occurred in 33-48% of the studies. Because both tests are used as markers of cholestasis, this marked discrepancy was unexpected. Treatment-related decreases in alkaline phosphatase activity occurred, however, in 39-56% of the studies; serum alkaline phosphatase may be more useful as an indicator of decreased food intake (decreased activity) than of cholestasis (increased activity). In summary, treatment-related alterations of clinical chemistry and histopathology occurred frequently in this series of toxicity studies in rats. Changes in the chemistry end points also occurred frequently at interim time points, indicating that clinical chemistry evaluations can be useful for detecting potential treatment effects throughout a study. This observation is important, since histopathological evaluations are limited to animal termination and not useful for detecting transient responses or the onset of treatment-related effects.

Alanine Transaminase↗
PubMed1996

Nuchal translucency measurement: training of potential examiners.

The aim of this study was to assess a training regimen for nuchal translucency measurement by transabdominal (TAS) and transvaginal sonography (TVS). After initial instruction regarding the criteria for correct nuchal translucency measurement, trainees (A and B) and an experienced examiner (C) performed nuchal translucency measurements on fetuses of 10-13 weeks' gestation, and the trainees' ability to obtain a measurement, repeatability and levels of agreement were assessed. In addition, a further experienced examiner (D) performed nuchal translucency measurements to validate the training regimen. Examiner C obtained nuchal translucency measurements in 94% by TAS, 93% by TVS and 100% by a combination of both scan modes. The repeatability coefficient was 0.40 mm and 0.24 mm for TAS and TVS, respectively. Trainees A and B were considered trained after 80 and 100 scans with TAS and TVS, respectively. They were considered trained when they could consistently obtain measurements that were of comparable repeatability and comparable levels of agreement with those of examiner C. The trainees' difficulties with TAS were in achieving satisfactory repeatability and levels of agreement, but with TVS it was ability in obtaining a measurement. We propose the training methods, standards and criteria used in this study as the basis for training sonographers in nuchal translucency measurements.

Chromosome Aberrations↗
PubMed1996

Nuchal translucency measurements: frequency distribution and changes with gestation in a general population.

OBJECTIVE: To investigate nuchal translucency variation with crown-rump length (CRL) in the first trimester in normal fetuses. DESIGN: A prospective observational study. SETTING: Department of obstetrics in a London teaching hospital. PARTICIPANTS: One thousand seven hundred and seven pregnant women (1685 singleton and 22 twin pregnancies) with chromosomally normal fetuses between 9+zero and 14+6 weeks of gestation were recruited sequentially from a dating scan clinic. Nuchal translucency was measured in 94.9% by transabdominal sonography (TAS) and by transvaginal sonography (TVS) if difficulty was encountered with TAS (5.1%). Nuchal translucency measurement was repeated in 136 fetuses: the first scan between between 9+zero-11+6 weeks and the second over 12 weeks of gestation. RESULTS: Of this general population, 4.2% had a nuchal translucency (NT) measurement > or = 2.5 mm, but this proportion varied significantly between gestational age groups (P = 0.011). The repeatability coefficients for NT measurements were 0.44 mm and 0.23 mm for TAS and TVS, respectively. The cross-sectional data demonstrate an increase in nuchal translucency measurement between 9 and 12 weeks of gestation and then a decrease at 13-14 weeks. This relation is best modelled using the quadratic equation: log10 (NT) = -1.03 + (0.0314 x CRL) - (2.20 x 10(-4) x CRL2). Longitudinal data confirmed an increase of nuchal translucency measurements with increasing gestation. CONCLUSION: Nuchal translucency measurements increase significantly with increasing gestation. The use of a single threshold nuchal translucency measurement throughout the first trimester is inappropriate. We propose reference ranges of nuchal translucency measurements with gestation, aiming to improve the performance of nuchal translucency screening for chromosomal abnormalities.

Cross-Sectional Studies↗
PubMed1996

Cigarette smoking in British men and selection for coronary artery bypass surgery.

OBJECTIVE: To examine the relation between smoking status, clinical need, and likelihood of coronary artery bypass grafting in middle aged men. DESIGN: A prospective study of cardiovascular disease in British men aged 40 to 59 years, screened in 1978-80 and followed until December 1991. SUBJECTS AND SETTING: 7735 men drawn from one general practice in each of 24 British towns. MAIN OUTCOME MEASURE: Coronary artery bypass graft surgery. RESULTS: Of the 3185 current smokers, 38 (1.03/1000/year) underwent coronary artery bypass surgery compared with 47 of 2715 (1.45/1000/year) ex-smokers, and 19 of 1817 (0.85/1000/year) never-smokers. Ex-smokers had a lower incidence of major ischaemic heart disease during follow up than current smokers. After adjustment for incidence of ischaemic heart disease during follow up, the hazard ratio of coronary artery bypass surgery for ex-smokers compared with smokers was 1.52 (95% confidence interval 0.99 to 2.34). Ex-smokers were more likely at screening to recall a doctor diagnosis of ischaemic heart disease than smokers (7.1% v 5.3%), but among those who recalled a doctor diagnosis, smokers were less likely to undergo coronary artery bypass surgery than ex-smokers (9.4% v 3.5%, P = 0.026). By 1992, men defined as smokers at screening were no less likely than ex-smokers to have been referred to a cardiologist (18.5% v 18.8%), nor to report having undergone coronary angiography less frequently than ex-smokers (12.7% v 11.4%). CONCLUSION: Even allowing for the strong relation between coronary artery bypass surgery and clinical need, continuing smokers were less likely to undergo coronary artery bypass surgery than ex-smokers. A complex interplay exists between the men's experience of heart disease, the decision to stop smoking, and the willingness of doctors to consider coronary artery bypass surgery.

Adult↗
PubMed1996

The use of a load cell for continuous cardiotomy reservoir level measurement during cardiopulmonary bypass.

We have examined the use of a 6 kg strain-gauge load cell for the purpose of continuous measurement of cardiotomy reservoir volume during cardiopulmonary bypass. It performed reliably and reproducibly and was found to be simple to interface to an anaesthesia monitor. The resolution of the cell was +/- 15 ml and the bias and limits of agreement for a series of 221 measurements were +15 ml and 175 ml, respectively. A continuously available digital level signal can present significant advantages to the perfusionist. The signal can be presented remotely in the form of a bar graph or a digital display, or can be interfaced to an intelligent alarm system which can be triggered on the basis of "time to expected reservoir exhaustion' rather than absolute reservoir level. The alarm state can also be conveyed in spoken form using speech synthesis. Finally, when recorded by an automatic record keeping system, the reservoir level constitutes an important addition to the perfusion record.

Cardiac Volume↗
PubMed1996

Response times to visual and auditory alarms during anaesthesia.

OBJECTIVE: To measure and compare the response times to audibly or visually presented alarms in the operating theatre. METHODS: The time taken by anaesthetists to cancel randomly generated visual and audible false alarms was measured during maintenance of routine anaesthesia. Alarms were generated and times recorded by a laptop computer on the anaesthetic machine. The visual signal was a 15 mm diameter red light positioned next to the physiological monitor mounted on top of the machine. The audible alarm was a Sonalert buzzer of the type incorporated into many medical devices. RESULTS: Nineteen anaesthetists provided a total of seventy-two hours of data (887 alarm events). The response times to visual alarms was significantly longer than to audible alarms (P = 0.001 Mann Whitney U test). [Table: see text] CONCLUSIONS: The ability of anaesthetists to appreciate changes in patient physiology may be limited by delays in noticing information presented by monitors. The rapid response to the vast majority of alarms indicates a high level of vigilance among the anaesthetists studied. However, this study suggests that it is safer to rely on audible rather than visual alarms when time-critical information such as oxygenation, heart beat and ventilator disconnection is concerned. Visual alarms would appear to be more appropriate for conveying less urgent information.

Anesthesiology↗
PubMed1996

An evaluation of the Constant-Murley shoulder assessment.

We have analysed the Constant-Murley (1987) assessment for 25 patients with shoulder pathology. We found the score easy to use, with low inter- and intraobserver errors, but sufficiently imprecise in repeated measurements to give concern in its use for clinical follow-up of patients. We have calculated 95% confidence limits for a single assessment to be within 16 to 20 points in most cases. In addition, we found that all our subjects with instability as their main problem scored within five points of the maximum; this suggests that the scoring method may need to be revised for use on these patients.

Confidence Intervals↗