PubMed Health⌕ Search

Biomedical subjects

John Morris

Publications and source records attributed to John Morris.

24 records · Page 2Linked to original sources
PubMed2002

TRISS unexpected survivors: an outdated standard?

BACKGROUND: Performance improvement is an essential component of the trauma center. TRISS methodology has been applied as a national standard against which trauma centers can compare their outcomes. Earlier reviews of TRISS unexpected survivors sustained the classification of unexpected survivor in the vast majority of cases. Our hypothesis was that the level of care that is currently expected has made the TRISS unexpected survivors a statistical phenomenon only. METHODS: Two hundred seventy TRISS unexpected survivors at a Level I trauma center from 1991 to 1995 were reviewed. Each case was reviewed as a blinded abstract by six reviewers (three of whom are directors at other facilities) and classified as clinically unexpected survivor (confirmed TRISS classification) or clinically expected survivor (did not sustain TRISS classification as unexpected survivor). Data are expressed as mean +/- SD. Statistical significance was achieved at p < 0.05. RESULTS: Among the 270 patients categorized by TRISS as unexpected survivors, only 10.7% were corroborated as clinically unexpected survivors by this peer review process and 89.3% were reclassified as clinically expected survivors. Confirmed clinically unexpected survivors were more likely to go directly from the emergency department to the operating room (82 vs. 46%; p < 0.05). Age (32 +/- 12 years vs. 40 +/- 19 years; p < 0.05), Injury Severity Score (46 +/- 20 vs. 32 +/- 14; p < 0.05), Revised Trauma Score (2.46 +/- 1.89 vs. 3.11 +/- 1.21; p < 0.05), probability of survival (0.13 +/- 0.13 vs. 0.24 +/- 0.15; p < 0.05), systolic blood pressure in the emergency department (60 +/- 51 mm Hg vs. 109 +/- 33 mm Hg; p < 0.05), hospital length of stay (39.6 +/- 30.3 days vs. 24.0 +/- 23.0 days; p < 0.05), and intensive care unit length of stay (19.5 +/- 20.6 days vs. 9.6 +/- 10.1 days; p < 0.05) were significantly different comparing confirmed versus unsustained classification as unexpected survivors. CONCLUSION: Only 10.7% of survivors classified as unexpected by TRISS were corroborated as unexpected by a blinded, peer-review process. TRISS needs to be updated for meaningful interpretation; modifications need to be made and coefficients need to be revised.

Adult↗
PubMed2002

Annexin 1-dependent actions of glucocorticoids in the anterior pituitary gland: roles of the N-terminal domain and protein kinase C.

Annexin 1 (ANXA1) is an important mediator of glucocorticoid action in the neuroendocrine system. As the activity of this protein in other systems is modulated by phosphorylation of its N-terminal domain, we have explored the significance of this domain and its phosphorylation status to ANXA1 actions within the pituitary gland, using an established in vitro preparation. Two N-terminal peptides, ANXA1(Ac2-26) and ANXA1(Ac1-50), inhibited forskolin-evoked ACTH and prolactin release; however, they lacked the potency and full efficacy of the parent molecule (ANXA1(1-346)), whereas other shorter N-terminal sequences were without effect. A chimeric protein comprising ANXA1(1-44) and the C-terminal core of ANXA5 (ANXA5(20-320)) also produced a partial inhibition of peptide release. Protein kinase C (PKC) blockade (PKC(19-36)) abolished the inhibitory effects of dexamethasone on forskolin-evoked peptide release and attenuated the antisecretory actions of ANXA1(Ac2-26.) ANXA5, which sequesters PKC in other systems, produced similar effects. PKC(19-36) also blocked the dexamethasone- induced translocation of a serine phosphorylated species of ANXA1 from the cytoplasm to the outer cell surface. These results suggest that 1) the N-terminal domain plays a fundamental role in effecting the inhibitory actions of ANXA1 on pituitary peptide release; 2) PKC-dependent mechanisms are essential for both the cellular exportation and the biological activity of ANXA1; and 3) ANXA1 exported from the cells is serine phosphorylated.

Adrenocorticotropic Hormone↗
PubMed2002

The working patterns and retirement plans of general dental practitioners in a Midlands Health Authority.

INTRODUCTION: With the problems of access to NHS primary dental care services in the last few years attention has focused on manpower considerations for dentistry. MATERIALS AND METHOD: This paper presents the results of a simple survey of general dental practitioners in South Staffordshire. RESULTS: The response rate was 88%. Most dentists (76%) reported working over 30 hours a week. A small number reported working more than 50 hours a week. Woman dentists were more likely to report working fewer than 31 hours a week. Younger male dentists tended to work longer hours than older male dentists, whereas younger women dentists tended to work fewer hours than older women. The reported retirement plans suggested that around 16% of dentists in their 40s and 50s were planning to retire before 60. CONCLUSION: The findings add weight to the view that woman dentists tend to work fewer hours but studies of cohorts are required to examine the impact of premature retirement and the reasons behind this apparent gender difference.

Adult↗
PubMed2002

Identification and evaluation of existing nursing homes quality indicators.

We summarize work done to identify and evaluate existing quality indicators (QIs) for long-term care (LTC) settings. Indicators operationally defined using routinely collected and computerized patient assessments were identified and then aggregated to characterize the performance of the nursing facility over a specific period of time. Of 143 indicators reviewed, only 22 were recommended for use in comparing performance across facilities. Conceptual and technical issues influence the appropriateness of QIs for different audiences.

Aged↗
PubMedDate not supplied

The impact of a normoglycemic management protocol on clinical outcomes in the trauma intensive care unit.

BACKGROUND: The purpose of this study was to determine if protocol-driven normoglycemic management in trauma patients affected glucose control, ventilator-associated pneumonia, surgical-site infection, and inpatient mortality. METHODS: A prospective, consecutive-series, historically controlled study design evaluated protocol-driven normoglycemic management among trauma patients at Vanderbilt University Medical Center. Those mechanically ventilated > or =24 hours and > or =15 years of age were included. A glycemic-control protocol required insulin infusion therapy for glucose >110 mg/dL. Control patients included those who met criteria, were admitted the year preceding protocol implementation, and had hyperglycemia treated at the physician's discretion. RESULTS: Eight hundred eighteen patients met study criteria; 383 were managed without protocol; 435 underwent protocol. The protocol group had lower glucose levels 7 of 14 days measured. After admission, both groups had mean daily glucose levels <150 mg/dL. No difference in pneumonia (31.6% vs 34.5%; p = .413), surgical infection (5.0% vs 5.7%; p = .645) or mortality (12.3% vs 13.1%; p = .722) occurred between groups. If one episode of blood glucose level was > or =150 mg/dL (n = 638; 78.0%), outcomes were worse: higher daily glucose levels for 14 days after admission (p < .001), pneumonia rates (35.9% vs 23.3%; p = .002), and mortality (14.6% vs 6.1%; p = .002). One or more days of glucose > or =150 mg/dL had a 2- to 3-fold increase in the odds of death. Protocol use in these patients was not associated with outcome improvement. CONCLUSIONS: Protocol-driven management decreased glucose levels 7 of 14 days after admission without outcome change. One or more glucose levels > or =150 mg/dL were associated with worse outcome.

Adult↗