Getting there.
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Anesthesia, Obstetrical↗
Biomedical subjects
M Morgan
Publications and source records attributed to M Morgan.
The toxicity of busulphan and cyclophosphamide as the preparative regimen for bone marrow transplantation.
The toxicity of the conditioning regimen of high dose busulphan (Bu) (16 mg/kg) and cyclophosphamide (Cy) (120 mg/kg) has been compared to cyclophosphamide (Cy) (120 mg/kg) and fractionated total body irradiation (TBI) 12-14 Gy. Since 1985, 67 patients have received conditioning of Bu and Cy for HLA-identical sibling bone marrow transplants. 166 patients have received Cy and TBI since 1981. Veno-occlusive disease of the liver occurred in 19% in the Bu-Cy group and was fatal in 1/12 cases, but only in 1.3% of Cy-TBI group (P less than 0.0005) and was fatal in 1/2. 30% of evaluable patients developed haemorrhagic cystitis in the Bu-Cy group and 14% in the Cy-TBI group (P = 0.008). A multiple logistic regression analysis demonstrated the preparative regimen as the only significant risk factor for the development of veno-occlusive disease or haemorrhagic cystitis. Interstitial pneumonia was diagnosed in 12/56 evaluable patients (21%) in the Bu-Cy group and was fatal in 75%. It occurred in 39/137 evaluable patients (28%) in the Cy-TBI group with a 54% case mortality. Within the Bu-Cy group, the incidence of veno-occlusive disease and haemorrhagic cystitis was similar in chronic myeloid leukaemia (CML) and acute leukaemia (AL) groups, but there was a significant (P = 0.003) incidence of interstitial pneumonia in the CML group 36% as compared to 7% in the AL group. Preparative regimen and age were significant risk factors in the development of interstitial pneumonia in patients with CML. A flexural and acral rash ranging from pigmentation to severe erosion was noted in the Bu-Cy group, but not in the Cy-TBI group. Thus, veno-occlusive disease, haemorrhagic cystitis and cutaneous changes were more common in patients receiving Bu-Cy. Interstitial pneumonia was more common in patients receiving Bu-Cy for CML than for AL.
Adolescent↗
Adolescent health behaviour and similarity-attraction: friends share smoking habits (really), but much else besides.
Smoking habits and related attitudes were assessed in a sample of 4059 11- to 16-year-olds who also identified their best friends from among their fellow respondents. Subjects' responses were directly collated with those of their friends and indicated a clear covariation of smoking status (controlling for sex and age) as anticipated from previous research in which adolescents have been asked to report on the smoking habits of their friends. Such covariation, however, was not specific to smoking habits, but generalized to related measures of attitude and normative beliefs, alcohol use, health locus of control, school performance, spending habits and socio-economic status. Similarities on these other attributes were much the same, whether or not friends shared each others' smoking habits. It is concluded that these data argue against a simplistic view of unidirectional 'peer group influence' and invite an interpretation of friendship choice based on multiple dimensions of similarity.
Adolescent↗
Audit from preschool developmental surveillance of vision, hearing, and language referrals.
Referrals from preschool medical examinations were followed up for two years to assess attendance rate, waiting time for appointment, appropriateness of the referral, the diagnosis and management of the condition. Altogether 184 children were referrals for ophthalmology, 285 for audiology, and 195 for speech therapy. The median waiting time for an appointment was 46 days in ophthalmology, 175 days in audiology, and 83 days in speech therapy. The poorest attendance rate was identified in speech therapy (75%). Approximately 60% of examined children had a justified referral to ophthalmology and 20% had a clear defect. Over half the children in audiology (55%) had an altered impedance or hearing impairment. Of those with a hearing problem kept under review only half improved spontaneously. In speech therapy 80% of those assessed had a language problem. Many health problems were detected for which parents were unaware or did not use the service. Parental awareness alone will not uncover the sizable level of lingual and sensorial problems in inner city areas. This audit identified specific deficiencies in the provision of services and a number of organisational changes are suggested to improve their effectiveness.
Age Factors↗
Are current techniques of inguinal hernia repair optimal? A survey in the United Kingdom.
Data was collected on the techniques currently employed in adult inguinal hernia repair by means of a postal questionnaire to consultants in four Regional Health Authorities in England. Questionnaires were returned by 240 consultants (85%). This identified a considerable range in methods of repair, with a Moloney nylon darn being the sole method used by 35% of consultants, and the Shouldice technique, either alone or in combination with other methods, being used by 20%. Overall, 51% employ a subcuticular suture for skin closure, and traditional skin sutures are used by 31%. There was no association between consultant's date of qualification or subspecialty and type of repair. Consultants qualifying after 1969 are most likely to use a subcuticular suture. Some 14% of all consultants and 19% of those qualifying since 1969 employ a Shouldice procedure and a subcuticular suture.
Adult↗
Natural history determinants of the time constants of the fetal electrocardiogram.
A total of 92 fetuses have been studied during labour using a technique of real-time fetal electrocardiography. This study showed differences in the PR and QRS intervals between male and female infants and also confirmed previous findings of a positive correlation between QRS width and fetal birthweight. The importance of taking natural biological factors into account in the interpretation of the time constants of the FECG is demonstrated.
Birth Weight↗
Consumers' views of the maternity services: implications for change and quality assurance.
The feasibility and usefulness of consumer surveys for quality assurance and planning maternity services were assessed in a postal survey of 1807 women in four health districts representing a range of social and demographic characteristics. A response rate of 79 per cent was achieved. Scope was identified for some reduction in length of stay: 43 per cent of postnatal women wished for a shorter stay than they have actually experienced. The Domino system and a 1-2 days stay were the preferred options (25 and 24 per cent respectively). Six per cent of postnatal women would have preferred a longer stay than experienced and consisted mainly of women with birth complications including caesarean deliveries, women with lack of help at home and Afro-Caribbeans. Schemes to increase continuity of care and make the delivery suite more home-like would be favoured by a large proportion of women. Sixty-five per cent of women regarded continuity of midwifery care and familiarity with the delivering midwife as important. Seventy-five per cent considered a home-like environment in the delivery suite as important, and gave specific suggestions of how this might be achieved. The results show that consumers' surveys are feasible, with a good response rate and range of views expressed by the study population. They can assist in monitoring quality and provide guidance for planning at local and regional levels.
Adult↗
Fair share and economic general welfare. Interview by Robert Campbell.
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Budgets↗
Which route to the future? Developments in the community psychiatric nurse's role.
The community psychiatric nurse's role is undergoing a crucial period of change. If they are to take the development of their role in their own hands, they must determine how they can accommodate the need for professional supervision with their desire for increased autonomy.
Community Health Nursing↗
Regional techniques for postoperative analgesia.
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Analgesia↗
Metabolism of nicotine by hepatocytes.
The profile of nicotine metabolites produced by freshly isolated hepatocytes from rats, hamsters, guinea pigs, mice and humans was investigated after a 30-min exposure to nicotine ([2-14C]pyrrolidine). Large species differences occurred in the extent of nicotine metabolism; these ranged from 95% metabolism in guinea pig hepatocytes to only 30% metabolism in human and rat hepatocytes. The spectrum of metabolites formed also varied widely in different species. In hepatocytes from obese human subjects, nicotine was metabolized most extensively in smokers, least in nonsmokers, and to an intermediate degree in exsmokers, suggesting that cigarette smoking enhances the rate of nicotine metabolism. Pretreatment of all nonhuman species studied with phenobarbital and beta-naphthoflavone and with Aroclor in rats produced distinctive inductive patterns. Phenobarbital pretreatment of nonsmokers for 2 days prior to liver biopsy doubled the extent of nicotine conversion to cotinine by their hepatocytes. Rat and hamster hepatocytes exhibited sex and stereoselectivity differences in nicotine metabolism. Collectively, these studies indicate that hepatocytes offer some advantages over in vivo systems in investigating certain aspects of nicotine metabolism.
Animals↗
The future course of AIDS in the United States.
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Acquired Immunodeficiency Syndrome↗
Conducting a matched-pairs historical cohort study with a computer-based ambulatory medical record system.
We describe techniques for using the Computer-Stored Ambulatory Record (COSTAR) at the Massachusetts General Hospital to conduct a historical cohort study of the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on blood pressure control. A query language was used to identify patients satisfying clinical and data-availability criteria, to match these patients with clinically similar patients not exposed to NSAIDs, and to collect data from the COSTAR records of both groups of patients to determine any differences in outcome. We analyzed over 30,000 patient records to select 90 pairs of patients used in the study. This approach to clinical research uses data collected for purpose of patient care and so does not require the separate recording of patient data for clinical research. Using computer-based medical record systems with a query language allows selection and matching of patients using detailed demographic and clinical criteria. The ability to conduct such studies is an advantage of computer-based medical record systems over the paper record system.
Ambulatory Care↗
Contrasting effects of centromedial and basolateral amygdaloid lesions on stress-related responses in the rat.
The effects of lesions in the centromedial and basolateral amygdala were examined using three different tests sensitive to the following stress-related responses: exploratory behavior, pain reactivity, and immune responses. The most clear-cut results were found with exploratory behavior. Rats with lesions of the centromedial amygdala tended to explore a radial-arm maze more quickly and entered more novel arms of the maze than controls. Those with lesions of the basolateral amygdala were generally too hesitant to explore at all. No significant differences were found between groups on measurements of natural killer cell activity. In tests of pain perception, rats in the control group displayed an analgesic response on the hot plate following an injection of the anxiogenic drug, RO 15-1788, whereas rats with centromedial lesions tended to exhibit a blunted response. These findings provide modest support for the view that the central and lateral regions of the amygdala play complementary roles in aversively motivated behaviors and in stress-related response patterns.
Amygdala↗
Database management for a gynecologic oncology service.
With the ready availability of powerful desktop computers, the ability to manage large clinical databases has become practical. A computer can enhance the capability of a gynecologic oncology service to catalog, recall, and analyze data about patients, tumors, and therapies. While commercially available database packages can be used for this purpose, we have developed a custom database for tracking the clinical activity of a busy gynecologic oncology service. The system catalogs data about patients, admissions, tumors, and therapeutic modalities and uses this information to generate several useful reports. The reports are used for daily patient care, fellow and resident case statistics, and clinical research. What is unique about the system is that it is optimized for ease of use. The development of this tumor registry, its user friendliness, and advantages over a manual recordkeeping system are described. Unlike other tumor registries, our system is utilized on a daily basis for patient care. Therefore, the data being entered have an immediate usefulness in addition to being simultaneously added to the tumor register for retrospective clinical research. One may hypothesize that it would be useful if all gynecologic oncology services used a common computerized tumor registry that could allow for the sharing of information on a national or global scale.
Database Management Systems↗
Do health care needs of indigent Mexican-American, black, and white adolescents differ?
Few studies have addressed the specific health care needs of Mexican-American adolescents. This 2-year study assessed the routine health care needs and incidence of chronic illness among 279 Mexican-American, 233 white, and 333 black indigent adolescents enrolled in a vocational training program. Mexican-Americans were more likely to have a positive purified protein derivative tuberculin test and acne/eczema requiring treatment. Blacks were more likely to have incomplete immunizations and thyroid disorders, while whites were more likely to have musculoskeletal conditions and require family planning services and psychiatric intervention for mental health disorders. Although no difference in incidence of chronic illness was noted, our data suggests that routine health care needs may differ among indigent Mexican-American, white, and black adolescents.
Adolescent↗
Massive histamine release in a patient with systemic mastocytosis.
We have measured plasma histamine concentrations, systemic vascular resistance, cardiac output and arterial pressure during laparotomy in a patient with systemic mastocytosis. The patient developed vasodilation and hypotension during surgery, associated with a massive increase in plasma histamine concentration.
Anesthesia, General↗