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Biomedical subjects

M T Morgan

Publications and source records attributed to M T Morgan.

7 recordsLinked to original sources
PubMed1992

Quality assurance in the emergency department: evaluation of the ECG review process.

STUDY OBJECTIVE: To determine whether the review of emergency department ECGs by cardiologists contributes to the quality of patient care. STUDY DESIGN: We retrospectively analyzed ED ECGs and compared interpretations of the treating emergency physicians with those of the reviewing cardiologists. We then evaluated the ED care of patients with potentially significant ECG abnormalities that were not detected by the treating emergency physicians, as well as the care of patients whose ECGs were "flagged" by the reviewing cardiologists as needing follow-up. SETTING: University hospital. PARTICIPANTS: Four hundred consecutive ECGs obtained on ED patients. MEASUREMENTS AND MAIN RESULTS: Thirty-three of the 400 tracings had undetected potentially significant or critical ECG abnormalities; this adversely affected patient care in two cases. These two tracings were not flagged by the reviewing cardiologists. Thirteen ECGs were flagged by the cardiologists; patient care was not altered in any of these cases. CONCLUSION: Review of ED ECGs by cardiologists did not affect patient care at our institution.

Aged↗
PubMed1992

The effect of linkage and population size on inbreeding depression due to mutational load.

Using a stochastic model of a finite population in which there is mutation to partially recessive detrimental alleles at many loci, we study the effects of population size and linkage between the loci on the population mean fitness and inbreeding depression values. Although linkage between the selected loci decreases the amount of inbreeding depression, neither population size nor recombination rate have strong effects on these quantities, unless extremely small values are assumed. We also investigate how partial linkage between the loci that determine fitness affects the invasion of populations by alleles at a modifier locus that controls the selfing rate. In most of the cases studied, the direction of selection on modifiers was consistent with that found in our previous deterministic calculations. However, there was some evidence that linkage between the modifier locus and the selected loci makes outcrossing less likely to evolve; more losses of alleles promoting outcrossing occurred in runs with linkage than in runs with free recombination. We also studied the fate of neutral alleles introduced into populations carrying detrimental mutations. The times to loss of neutral alleles introduced at low frequency were shorter than those predicted for alleles in the absence of selected loci, taking into account the reduction of the effective population size due to inbreeding. Previous studies have been confined to outbreeding populations, and to alleles at frequencies close to one-half, and have found an effect in the opposite direction. It therefore appears that associations between neutral and selected loci may produce effects that differ according to the initial frequencies of the neutral alleles.

Genetic Linkage↗
PubMed1977

The clinical investigation and management of chest pain in an emergency department: quality assessment by criteria mapping.

Criteria Mapping, a recently developed chart review method, was tested for its ability to assess the quality of symptom investigation and management for the presenting complaint of chest pain in an emergency department. A criteria map, which is based on decision making logic and permits use of criteria relevant to individual patients, was used to review the records of 137 patients who were examined for chest pain and subsequently discharged from the emergency department. All 111 patients assessed as receiving adequate process had positive outcomes. Twenty-six charts (19 per cent) were determined to have inadequate process, having failed at least one relevant and critical criterion; 23 of these 26 patients had positive outcomes. Review of the unmet criteria in these 23 charts revealed their uncertain predictive validity regarding immediate risk of death. We conclude that the Criteria Mapping method--the first reported technique for evaluating care for patient problems (as opposed to diagnoses)--provides an effective and feasible means for assessing the quality of symptom investigation and management.

Adult↗
PubMed1977

Selective use of radiography of the skull and cervical spine.

Based on the findings of a five-month study, the authors suggest that physicians should be more discriminating in using radiography of the skull, especially when dealing with patients who are minimally injured. The low incidence of fractures disclosed by radiography in patients with insignificant head injuries is a primary factor in arriving at this recommendation. A lack of correlation between skull fractures, and cerebral injury, and subsequent therapy is another factor. Finally, the prohibitive cost of medical care generally (and radiographs in particular) makes greater selectiveness imperative. Although the number of cervical spine fractures in this study was small, the findings indicate that based on history and physical examination there can and should be increasing selectivity in ordering routine cervical spine series, without increasing the risk of missed fractures.

Cervical Vertebrae↗