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Biomedical subjects

F Harris

Publications and source records attributed to F Harris.

At least 19 recordsLinked to original sources
PubMed1992

Intoxication and injury.

The relationship between alcohol use and injury severity was investigated in trauma patients admitted to a tertiary referral hospital during a 23-month period. Admission blood alcohol levels (BALs) were obtained on 427 trauma patients, who were stratified into three groups: those with no measurable blood alcohol, those within the legal limit of 100 mg/dL, and those over the legal limit or intoxicated. The no-alcohol group had significantly lower injury severity than the other two groups (p less than 0.001). Even when the BAL was well within the legal limit, injuries suffered by those in the alcohol-positive groups were more severe than those in the no-alcohol group. Confirmatory evidence of the effect of alcohol on injury severity was reflected by a 2.3% mortality in alcohol-negative patients compared with a 13.3% death rate in alcohol-positive patients (p less than 0.0001). To assess the potentially confounding effect of alcohol on injury scoring accuracy, we examined the change in Glasgow Coma Scale (GCS) scores following admission. No significant differences were found when admission GCS values were compared with GCS determinations made 24 hours following admission by separate observers. To correct for any potential bias as a tertiary referral center, repeat analysis with exclusion of transferred patients was done with essentially no change in results. Our data revealed a highly significant relationship between alcohol use, degree of injury, and resource consumption.

Adult↗
PubMed1992

An updated study of taconite miners and millers exposed to silica and non-asbestiform amphiboles.

This is the second update of a study of 3,444 taconite miners and millers who were first exposed to taconite, with associated exposures to silica and nonasbestiform amphiboles, in the period 1947 through 1958. Previous analyses of deaths through 1977, and again through 1983, showed no significant excess deaths from any specific causes. The present study continues the follow-up through 1988, adding 14,748 person-years of observation and 261 death certificates for analysis. The population, reduced to 3,431 because of the detection of 13 earlier duplications, has now been observed for 101,055 person-years, with 1,058 deaths and 1,039 death certificates. Death certificates were obtained for 98.2% of those known to be dead. The total number of deaths was significantly fewer than expected. Based on US rates, the standardized mortality ratio (SMR) was 83 (ie, 83% of expected). Based on Minnesota death rates, it was 91. With both US and Minnesota death rates, the SMRs for malignant neoplasms, cancer of the respiratory tract, cancer of the digestive system, heart disease, nonmalignant respiratory disease, and cirrhosis of the liver were all below 100. Slightly elevated SMRs were found for cancer of the colon, cancer of the kidney, and lymphopoietic cancer. These elevations were not statistically significant. Separate analyses were made of total deaths, lung cancer deaths, and kidney cancer deaths in men who had worked with taconite for time periods of less than 1 year, 1-5 years, 5-10 years, and over 10 years, during observation periods less than 10 years, 10-20 years, and over 20 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Dust↗
PubMed1991

The epidemiologic features of nosocomial infections in patients with trauma.

Sepsis is a major cause of morbidity and mortality in patients with trauma. To elucidate factors that might lead to infection, we studied the epidemiologic characteristics of nosocomial infections in our patient population with trauma. During a 3.5-year period, 2496 patients were entered into our hospital trauma registry and cross-matched with hospital infection control surveillance information. Two hundred twenty-nine patients with trauma and nosocomial infections were identified (9.2%), a figure that was nearly twice the nosocomial infection rate for the general hospital population. The majority of those infected were either orthopedic (51%), general surgical (25%), or neurosurgical (13%) patients. The most common sites of first infection were urinary tract (61%) or respiratory system (14%). Patients developing nosocomial infections were significantly older and had a higher Injury Severity Score than those who did not. Injury site was related to risk of infection with injuries of the spine, chest, and extremity showing the most significant relationship. The length of stay as well as hospital charges were significantly related to the occurrence of infectious complications. By determining the patient with trauma at risk for infection, treatment strategies can be designed to minimize septic complications.

Accidents↗
PubMed1991

Evaluation of the rapid CLEARVIEW Chlamydia test for direct detection of chlamydiae from cervical specimens.

The CLEARVIEW Chlamydia test (Unipath, Mountain View, Calif.), a 30-min immunoassay, was compared to a standard tissue culture technique for the direct detection of chlamydiae from 677 cervical specimens obtained from 667 patients. For data analysis, 15 specimens were eliminated because of toxicity in the culture and 14 were eliminated because of failure of the extracted specimen to migrate in the CLEARVIEW test, one of the latter group being culture positive. Of the remaining 648 specimens, 40 were culture positive, of which 38 were detected by the CLEARVIEW test, and 12 specimens were positive only by the CLEARVIEW test. Therefore, the CLEARVIEW in comparison with culture was easier to perform, more rapid, and in this low prevalence (6.2%) population had a 95.0% sensitivity, 98.0% specificity, and 76.0% positive and 99.7% negative predictive values.

Adolescent↗
PubMed1991

Features and outcome in meningococcal disease presenting with maculopapular rash.

Sixty nine patients with meningococcal disease some of whom presented with a maculopapular rash were entered in a prospective multicentre study. The clinical and laboratory features of children presenting with maculopapular rashes were compared with those of children presenting with typical haemorrhagic rashes. Of the 69 children 26 (38%) developed maculopapular rashes; nine (13%) had a maculopapular rash only, and the remaining 17 had a mixed maculopapular-purpuric rash. Twelve of the 17 (7%) had less than 12 petechiae. Children with maculopapular rashes had significantly higher platelet counts (median 294 compared with 243 x 10(9)/l), and plasma total haemolytic complement activity (80.5 compared with 65.0 U/ml) and significantly lower Glasgow meningococcal septicaemia prognostic scores (2.5 compared with 5.5) than those with purpuric rashes on admission. There were no significant differences between the groups in mortality, white cell count or absolute neutrophil count on admission, or C reactive protein concentration. Meningococcal disease can present with a maculopapular rash alone but this does not necessarily mean that the disease is less severe.

Complement Hemolytic Activity Assay↗
PubMed1991

Ascertainment of congenital malformations: a comparative study of two systems.

STUDY OBJECTIVE: The aim was to compare the Office of Population Censuses and Surveys (OPCS) notification system for congenital malformation surveillance and the Liverpool Congenital Malformations Registry (LCMR) with respect to efficiency and uniformity of ascertainment, diagnostic accuracy, and overreporting of minor malformations. DESIGN: Manual matching of computer listings was done, using date of birth, sex, birthweight, and health district of residence. Maternal age was used to confirm the match. SETTING: Data were collected in the English health districts of Liverpool, St Helens and Knowsley, Southport and Formby, South Sefton, and Wirral over the years 1980-1985. SUBJECTS: 1959 malformed children notified to OPCS and 2649 notified to LCMR were assessed. MAIN RESULTS: 35.5% of malformed children ascertained by LCMR within seven days of birth were not notified to OPCS; 35.7% of cases reported to OPCS were exclusions from the LCMR protocol as being trivial malformations according to EUROCAT (European Registry of Congenital Anomalies) guidelines. Misclassification was infrequent but in 11.2% of cases the additional malformations present were not notified to OPCS. Conditions readily diagnosed at birth, such as neural tube defects, exomphalos, and facial clefts, were well ascertained by OPCS but others such as oesophageal atresia and Down's syndrome were not. CONCLUSIONS: It is important that national surveillance of congenital malformations should continue. However, several modifications to the present OPCS monitoring system are necessary, including greater standardisation of data collection, the exclusion of trivial and clinically non-significant malformations, and the inclusion of data on therapeutic abortions performed for fetal abnormality. These issues are being addressed by OPCS.

Congenital Abnormalities↗
PubMed1991

A proposal for the measurement of the level of fluctuating background noise used in audiology.

Disturbances of communication in noisy environments may be identified sooner in patients with sensorineural hearing loss when speech audiometry is performed using fluctuating rather than stationary background noises. In the present study, the factors determining the loudness of fluctuating noises were examined using psychoacoustical procedures. The results indicated that loudness of fluctuating noises was best represented by the same percentile loudness N15 or percentile level L15. This is the value that is reached or exceeded in 15% of the analysed measurement time. The percentile level L15 or the percentile loudness N15 may be used to measure the level of noises with identical spectra. However, subjective loudness is approximated only by the percentile loudness N15 if the stationary and the fluctuating noises are spectrally different.

Adult↗
PubMed1990

Hypnosis training enhances communication skills.

We hypothesized that attending a brief, introductory hypnosis training workshop enhances communication skills. We speculated that attending such a programme would enable residents in a Family Medicine training programme to identify the psycho-social concerns of their patients more rapidly. To test the hypothesis five residents were videotaped interviewing a standardized patient before and after attending a hypnosis workshop. A blinded observer reviewed the tapes. The observer counted the number of comments made by the residents on their patient's non-verbal behaviour and the time required to confront the patient's primary concern. The residents made more comments on their patient's non-verbal communication after training than before, and more than the controls. They also shortened the time until they addressed the primary concern. This difference was not statistically significant. There was however a strong negative correlation (r = -0.92) between the number of these comments made and the time required to unveil the patient's hidden agenda. An increased awareness of non-verbal cues, achieved through hypnosis training, appears to help reveal a patient's hidden agenda. The implications of these findings are discussed.

Canada↗
PubMed1989

Practical evaluation of trauma deaths.

The TRISS method of auditing trauma deaths necessitates audit of patients with minor injuries who die of their underlying medical problems. Using an anatomic definition of injury as a criterion for audit, as suggested by Wesson et al. at the Hospital for Sick Children in Toronto, excludes patients with minor injuries but necessitates audit of patients who expired due to systems problems rather than in-hospital patient care. We propose combining the TRISS and Toronto methods in order to identify the deaths truly appropriate for detailed review of hospital care. Fifty-four trauma deaths over a 22-month period were audited and categorized as frankly preventable, potentially salvageable, or nonpreventable. Considering only in-hospital care, the deaths designated as potentially salvageable by audit were likely to be identified by both TRISS and Toronto, while deaths targeted by only one system were more likely to be nonpreventable by audit. The predictive value of this combination of methods (84.6%) was better than Toronto (52.4%) or TRISS (54.5%) using audit results as the standard for comparison. This simple computerized method may serve as a practical and inexpensive method of targeting deaths for in-depth review.

Adolescent↗
PubMed1989

Cost-analysis of neonatal intensive and special care.

In the present economic climate and with increasing expenditure on neonatal intensive care, there has been a demand for economic evaluation and justification of neonatal intensive care programmes. This study assesses the inhospital costs of neonatal intensive care. Fixed and variable costs were calculated for services and uses of an Intensive/Special Care Nursery for the year 1985 and corrected to 1987 Australian dollar equivalents. Establishing a new neonatal intensive care unit of 43 costs in an existing hospital with available floor space including operating costs for a year were estimated in Australian dollars for 1987 at $6,408,000. Daily costs per baby for each were $1282 ventilator, $481 intensive, $293 transitional and $287 recovery, respectively. The cost per survivor managed in the Intensive/Special Care Nursery in 1985 showed the expected inverse relationship to birthweight being $2400 for greater than 2500 g, $4050 for 2000-2500 g, $9200 for 1500-1999 g, $23,900 for 1000-1499 g and $63,450 for less than 1000 g. Further analysis for extremely low birthweight infants managed in 1986 and 1987 demonstrated costs per survivor of $128,400 for infants less than 800 g birthweight and $43,950 for those 800-999 g. This methodology might serve as a basis for further accounting and cost-evaluation exercises.

Birth Weight↗
PubMed1988

Predicting hospital charges for trauma care.

Diagnosis related groups (DRGs) have sharply decreased the amount of compensation hospitals can expect for providing trauma care. A total of 637 patients admitted for acute traumatic injuries between Oct 1, 1985, and July 30, 1986, had their DRG classifications, Injury Severity Scores, trauma scores, and ages compared with hospital charges in an attempt to identify factors that could be used to accurately predict hospital charges. The best prediction of charges was obtained when DRG assignment was combined with Injury Severity Scores and age. When the equation obtained by this approach was applied to a separate population of 301 patients, the average difference between the actual charge and that predicted was $38 and would have led to a 33-fold decrease in money lost by the hospital. Altering the DRG payment schedule as proposed would allow hospitals to be fairly compensated for the care of trauma patients.

Adolescent↗
PubMed1988

The Liverpool Congenital Malformations Registry.

Data collection and validation for the Liverpool Congenital Malformations Registry (LCMR) are described. Founded in 1960, the LCMR increased its area of surveillance in 1979 to include five health districts in Liverpool and its environs with approximately 20,000 births per annum. The LCMR is now one of the members of the European Congenital Anomalies Register (EUROCAT). Multiple sources of ascertainment are employed, the most useful of these being OPCS notifications, hospital discharge letters and data from specialised paediatric units. In spite of several difficulties encountered in data collection the data base is an invaluable tool both for routine monitoring of prevalence rates and as a starting point for epidemiological research.

Congenital Abnormalities↗