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Wilson R, Godwin M, Seguin R, Burrows P, Caulfield P, Toffelmire E, Morton R, White P, Rogerson M, Eisele G, Bont G. End-stage renal disease: factors affecting referral decisions by family physicians in Canada, the United States, and Britain. Am J Kidney Dis 2001; 38:42-8. [PMID: 11431180 DOI: 10.1053/ajkd.2001.25180] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The objective of this study is to determine how patient age, sex, creatinine level, and comorbidity affect referral decisions for the treatment of end-stage renal disease (ESRD) and whether these decisions are affected by physician characteristics in three countries: Canada, the United States, and Britain. A vignette-based questionnaire was mailed to a random sample of family physicians in Ontario, Canada (1,818 physicians); all family physicians in the state of New York (1,814 physicians); and a sample of general practitioners from the south of England (2,228 physicians) in 1996. Physicians were presented with clinical scenarios involving a patient with varying degrees of renal insufficiency and a complicating comorbidity, including angina, diabetes, cancer, mental illness, or socioeconomic circumstances. They were asked to indicate the likelihood of referral. Half the physicians received a questionnaire describing a male patient, and half, a female patient. Mean creatinine levels at which physicians would refer were 260 micromol/L for British physicians, 297 micromol/L for Canadian physicians, and 340 micromol/L for American physicians. No difference in referral rates was found based on the sex of the patient or physician. Sixty-five percent of American and Canadian physicians would refer regardless of patient age, but only 49% of British physicians would do so. Family physicians in the United States, Canada, and Britain function as gatekeepers for patients with ESRD. They are less likely to refer based on increasing severity of comorbid conditions. They also discriminate based on age, but not sex.
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Bakheit AM, Severa S, Cosgrove A, Morton R, Roussounis SH, Doderlein L, Lin JP, Rousso SH. Safety profile and efficacy of botulinum toxin A (Dysport) in children with muscle spasticity. Dev Med Child Neurol 2001; 43:234-8. [PMID: 11305399 DOI: 10.1017/s0012162201000445] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Botulinum toxin A (BTX-A) is widely used in the management of muscle spasticity in children. However, at present the dose of BTX-A for a given patient is selected empirically. The aim of this study is to provide dosage guidelines that are based on risk/benefit assessment. This was a multicentre retrospective study of the safety profile and efficacy of BTX-A in children with chronic muscle spasticity. Data in 758 patients who received a total of 1594 treatments were analysed (mean age 7.2 years; 429 males, 329 females). Spastic cerebral palsy (CP) was the most common diagnosis (94% of the study sample). Of all treatments 7% resulted in adverse events; incidence was related to the total dose rather than the dose calculated on the basis of body weight. The highest incidence of adverse events was observed in patients who received >1000 IU of BTX-A per treatment session. The odds of an adverse event was 5.1 times greater for this group of patients than for those who had 250 IU or less (p<0.001). A good overall response to treatment was reported in 82% and treatment goals were fully or partially achieved in 3% and 94% of participants respectively. More patients in the highest dose group reported functional deterioration. Interestingly, multilevel treatments resulted in a better response than single-level treatments (odds ratio 1.7, 95% CI 1.3 to 2.2,p=0.001).
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Ghosh A, Morton R. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Nebulised epinephrine or corticosteroids in croup. Emerg Med J 2001; 18:119. [PMID: 11300185 PMCID: PMC1725538 DOI: 10.1136/emj.18.2.119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
BACKGROUND The infant with persistent or recurrent wheezing during the first 2 years of life poses a diagnostic dilemma, which can be a source of anxiety to both physicians and parents. A suggested diagnostic approach to the causes of infantile wheezing is outlined. OBJECTIVES 1. To review the physiologic considerations of the infant's airways that predispose to wheezing. 2. To discuss the key physical findings, family history, and risk factors associated with wheezing in infants. 3. To develop a rational approach to the differential diagnosis and management of infantile wheezing. DATA SOURCES The MEDLINE database as well as our clinical experience pertaining to infantile wheezing. CONCLUSIONS This review discusses the diagnostic evaluation and treatment of the wheezing infant. We suggest that infant pulmonary function testing may be used as one diagnostic aid in the workup of the wheezing infant.
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Abstract
September 2000 saw the publication in the UK of the first National Health Service (NHS) plan for cancer services. The NHS Cancer Plan (Department of Health (DoH), 2000a) may be one of the most fundamental reforms of national cancer care services ever attempted – just as important is the fact that there is much in it for palliative care. It states: ‘All patients should have access to the specialist palliative care advice and services they need. For most patients, these will be provided in their homes, in the community or in hospital. Some will require the specialist facilities of a hospice. Voluntary palliative care services need to be enabled to play their full role in the cancer network, with adequate funding from the NHS’. (DoH, 2000a)
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Deterding RR, Fan LL, Morton R, Hay TC, Langston C. Persistent tachypnea of infancy (PTI)--a new entity. Pediatr Pulmonol 2001; Suppl 23:72-3. [PMID: 11886155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
MESH Headings
- Humans
- Hyperplasia/pathology
- Hyperplasia/physiopathology
- Hyperplasia/therapy
- Infant, Newborn
- Infant, Newborn, Diseases/pathology
- Infant, Newborn, Diseases/physiopathology
- Infant, Newborn, Diseases/therapy
- Lung/pathology
- Lung/physiopathology
- Lung Diseases, Interstitial/pathology
- Lung Diseases, Interstitial/physiopathology
- Lung Diseases, Interstitial/therapy
- Neurosecretory Systems/pathology
- Neurosecretory Systems/physiopathology
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Stirrat SC, Lawson D, Freeland WJ, Morton R. Monitoring Crocodylus porosus populations in the Northern Territory of Australia: a retrospective power analysis. WILDLIFE RESEARCH 2001. [DOI: 10.1071/wr00079] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In the Northern Territory of Australia, populations of the estuarine crocodile
(Crocodylus porosus) have been subject to an annual egg
harvest since the early 1980s. Since 1997, adult and juvenile crocodiles have
also been harvested in some catchments. Annual surveys of crocodile
populations are conducted in order to ensure that the harvest is sustainable.
Boat surveys commenced in 1975 and helicopter surveys commenced in 1989.
Retrospective power analysis was used to determine whether the sampling
program meets the objectives of the Crocodile Management Program for the
Northern Territory. Data collected during boat surveys vary in quality between
river systems. The analysis of pooled data from 7 river systems with a
residual standard deviation of 0.11 indicates that the power of the current
spotlight survey method to detect a decline of 10% per annum in around
4 years is about 0.9. In this time the population would decline by around
33% and would fully recover in 8 years following the removal of the
factor causing the decline. This allows detection of a decline within
one-third, and recovery within two-thirds, of the estimated generation time of
the saltwater crocodile and will allow management actions to be implemented
before the impacts on populations are serious. The data from helicopter and
boat surveys from a 10-year period were compared. Helicopter surveys did not
provide useful management information.
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Eid N, Morton R. Impact of specialty care on cost containment and pulmonary function. Pediatr Pulmonol 2001; Suppl 23:18-9. [PMID: 11886133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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84
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Stabler SP, Morton RL, Winski SL, Allen RH, White CW. Effects of parenteral cysteine and glutathione feeding in a baboon model of severe prematurity. Am J Clin Nutr 2000; 72:1548-57. [PMID: 11101485 DOI: 10.1093/ajcn/72.6.1548] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The availability of cysteine for glutathione synthesis is low in premature infants with respiratory distress. OBJECTIVE The effects of gestational age, oxygen delivery, and cysteine infusion or glutathione infusion, or both, on plasma total cysteine and other methionine metabolites were studied in a baboon model of severe premature birth with respiratory distress. DESIGN Premature baboons were studied as part of the multiinvestigator National Institutes of Health Collaborative Project on Bronchopulmonary Dysplasia. Premature baboons, 125 d (69% of term) or 140 d (78% of term) of gestational age, were maintained in neonatal intensive care units for </=14 d. Parenteral feeding with or without supplemental cysteine and glutathione infusions was given. Plasma total cysteine, methionine, N:-methylglycine, cystathionine, and the other methionine metabolites were monitored by capillary gas chromatography-mass spectrometry. RESULTS Cord blood plasma total cysteine was the lowest in the 125-d-old premature baboons. Plasma total cysteine decreased in the first 3 d after delivery in the 125-d-old (but not in the 140-d-old) premature baboons even when cysteine was infused. Supplementation with glutathione from the first day of life raised plasma total cysteine markedly. Plasma cystathionine increased in all animals after birth but increased 4-fold in 125-d-old animals with glutathione infusion. At 6 and 10 d postdelivery, the arterial-alveolar oxygen gradient was significantly higher in the 125-d-old animals that received glutathione infusions. CONCLUSIONS Glutathione, but not supplemental cysteine, infusions prevented the postdelivery decline in plasma cysteine concentrations in premature baboons. Glutathione infusions resulted in marked elevations of plasma cystathionine concentration.
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Morton R. Special study modules in medical illustration in the undergraduate medical curriculum. THE JOURNAL OF AUDIOVISUAL MEDIA IN MEDICINE 2000; 23:110-2. [PMID: 11070579 DOI: 10.1080/01405110050130865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The General Medical Council's recommendations on undergraduate medical education, published in December 1993 under the title of 'Tomorrow's Doctors', put forward the concept of the Special Study Module (SSM) as part of the medical undergraduate curriculum. This was to have a major impact on medical schools, requiring them to introduce a new element into their teaching and calling for input from departments not normally involved in the delivery of the undergraduate course. The Media Resources Centre in the University of Wales College of Medicine saw the introduction of SSMs as an opportunity to contribute to the education of medical students in ways that had not been possible previously. Several SSMs are now offered by the Centre and involvement in the SSM programme has been an interesting and rewarding experience.
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Jett J, Hatfield A, Bauman M, Hillman S, Soori G, Veeder M, Morton R. Phase II trial of topotecan and paclitaxel (TP) with G-CSF support alternating with etoposide and cisplatin (EC) in previously untreated extensive stage small cell lung cancer (ED-SCLC): A North Central Cancer Treatment Group study. Lung Cancer 2000. [DOI: 10.1016/s0169-5002(00)80168-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Popat SR, Liavaag PG, Morton R, McIvor N, Irish JC, Freeman JL. Epstein Barr virus genome in nasopharyngeal carcinomas from New Zealand. Head Neck 2000; 22:505-8. [PMID: 10897111 DOI: 10.1002/1097-0347(200008)22:5<505::aid-hed10>3.0.co;2-u] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The population in New Zealand is a heterogeneous mix of Caucasians (80%), Maori (9%), and Polynesians (10%). It is believed that the Polynesians are of Chinese descent and may harbor the same high incidence of nasopharyngeal carcinoma (NPC). In addition, it is not known whether the Epstein-Barr virus (EBV) is as closely associated with the development of NPC in Polynesians as it is in those of Chinese origin. METHODS This study reexamines the associative correlation between EBV and NPC with two methods of genetic detection, polymerase chain reaction (PCR) and in-situ hybridization (ISH). In addition, geographic heterogeneity was analyzed to determine whether there are differences in the prevalence of EBV in NPCs among the ethnic mixed populations found in New Zealand. Nasopharyngeal biopsy specimens from 20 patients with NPC and 36 controls were obtained from Auckland. RESULTS With PCR, EBNA-1, a genomic sequence of EBV in NPC samples was able to be detected with 76.5% sensitivity and 96.7% specificity. By use of ISH, EBV was detected in NPC tissue with 82.4% sensitivity and 100% specificity. CONCLUSION There seems to be no geoanthropologic differences in terms of the association of EBV with NPC.
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Morton R, Nicholls J, Williams R. The changing role of the medical illustrator. THE JOURNAL OF AUDIOVISUAL MEDIA IN MEDICINE 2000; 23:65-8. [PMID: 10912326 DOI: 10.1080/01405110050010840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The annual meeting of the Australian Institute of Medical and Biological Illustration in Melbourne in November 1998 included keynote addresses from Richard Morton and Robin Williams. Both speakers looked at the future of the medical illustration profession, and in particular the impact of new technology. This matter was also addressed by Joe Nicholls in a presentation given at the Institute of Medical Illustrators' Annual Symposium in Warwick, UK, in September 1998. This paper is a synthesis of the ideas presented by these three speakers and elaborates on common themes in their presentations.
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Dagnone E, Collier C, Pickett W, Ali N, Miller M, Tod D, Morton R. Chest pain with nondiagnostic electrocardiogram in the emergency department: a randomized controlled trial of two cardiac marker regimens. CMAJ 2000; 162:1561-6. [PMID: 10862229 PMCID: PMC1231335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Early detection of acute myocardial infarction (AMI) may save lives. In the emergency setting, it is unclear whether the early use of certain cardiac markers (myoglobin and cardiac troponin I [cTnI]) assists in making appropriate decisions whether to admit or discharge patients with chest pain of possible ischemic cause who have nondiagnostic electrocardiograms (ECGs). We performed a study to determine whether the addition of new cardiac markers in the emergency department results in improved clinical decisions. METHODS A single-blind randomized controlled trial was conducted between June 1997 and June 1998 in a tertiary care emergency department in Kingston, Ont. Of 296 patients aged 30 years or more who presented to the emergency department with chest pain and nondiagnostic ECGs, 146 were randomly assigned to the intervention group (determination of baseline creatine kinase [CK] level, CK MB fraction and cTnI level, and myoglobin level at baseline and at 2 hours) and 150 to the control group (determination of baseline CK level and CK MB fraction). Outcome measures included the rate of admission to the inpatient cardiology service and length of stay in the emergency department. RESULTS Of the 296 patients, 34 (11.5%) received a diagnosis of AMI in the emergency department, and 92 (31.1%) had chest pain of noncardiac cause. Patients in the intervention group were less likely than those in the control group to be admitted to the cardiology service (67 [45.9%] v. 81 [54.0%]). The absolute difference in the proportion (8.1% [95% confidence interval -3.3 to 19.5]), although potentially important clinically, was not statistically significant. The length of stay in the emergency department was essentially the same in the 2 study groups. At 30 days, the proportions of patients with a diagnosis of recurrent angina (58.2% in the intervention group and 58.0% in the control group) and AMI (12.3% and 14.7%) were also similar. INTERPRETATION The optimal cardiac marker panel to be used in the emergency department remains unknown. The addition of serial testing of myoglobin with cTnI confirmation to the standard panel did not substantially change the clinical management or outcomes of patients presenting with chest pain and nondiagnostic ECGs.
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Morton RL, Schroeder HE, Bateman KS, Chrispeels MJ, Armstrong E, Higgins TJ. Bean alpha-amylase inhibitor 1 in transgenic peas (Pisum sativum) provides complete protection from pea weevil (Bruchus pisorum) under field conditions. Proc Natl Acad Sci U S A 2000; 97:3820-5. [PMID: 10759552 PMCID: PMC18100 DOI: 10.1073/pnas.070054597] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2000] [Indexed: 11/18/2022] Open
Abstract
Two alpha-amylase inhibitors, called alphaAI-1 and alphaAI-2, that share 78% amino acid sequence identity and have a differential specificity toward mammalian and insect alpha-amylases are present in different accessions of the common bean (Phaseolus vulgaris). Using greenhouse-grown transgenic peas (Pisum sativum), we have shown previously that expression of alphaAI-1 in pea seeds can provide complete protection against the pea weevil (Bruchus pisorum). Here, we report that alphaAI-1 also protects peas from the weevil under field conditions. The high degree of protection is explained by our finding that alphaAI-1 inhibits pea bruchid alpha-amylase by 80% over a broad pH range (pH 4.5-6.5). alphaAI-2, on the other hand, is a much less effective inhibitor of pea bruchid alpha-amylase, inhibiting the enzyme by only 40%, and only in the pH 4.0-4.5 range. Nevertheless, this inhibitor was still partially effective in protecting field-grown transgenic peas against pea weevils. The primary effect of alphaAI-2 appeared to be a delay in the maturation of the larvae. This contrasts with the effect of alphaAI-1, which results in larval mortality at the first or second instar. These results are discussed in relationship to the use of amylase inhibitors with different specificities to bring about protection of crops from their insect pests or to decrease insect pest populations below the economic injury level.
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Morton R, Gleason O, Yates W. Psychiatric effects of anabolic steroids after burn injuries. PSYCHOSOMATICS 2000. [PMID: 10665271 DOI: 10.1016/s0033-3182(00)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Morton R, Gleason O, Yates W. Psychiatric effects of anabolic steroids after burn injuries. PSYCHOSOMATICS 2000; 41:66-8. [PMID: 10665271 DOI: 10.1016/s0033-3182(00)71176-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
The term clinical governance, coined in 1998 and referred to in the document A First Class Service: Quality in the New NHS (Department of Health (DoH), 1998), is now central to current healthcare policy (DoH, 1999). However, the concept of clinical governance predates 1998 in that the notion of continuous quality improvement is not new in healthcare delivery. This article addresses four key areas in relation to clinical governance: the meaning of cl inical governance; participants; the process; and the implications for palliative care.
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Morton R. Palliative care. A guide to good care commissioning. NURSING TIMES 1999; 95:53-4. [PMID: 10983084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
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Morton RL, Shoemaker LR, Eid NS. Steroid-refractory neonatal eosinophilic pneumonia responsive to cyclosporin A. Am J Respir Crit Care Med 1999; 160:1019-22. [PMID: 10471634 DOI: 10.1164/ajrccm.160.3.9812086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Idiopathic neonatal eosinophilic pneumonia is extremely rare. We report an infant who presented with tachypnea and interstitial infiltrates on chest radiograph at age 2 wk. Lung biopsy revealed perivascular and interstitial eosinophils. Despite initial improvement, the patient's condition became resistant to corticosteroids, cromolyn, and intravenous gamma globulin. After treatment with cyclosporin A his symptoms resolved.
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Purdy A, Wilson R, Godwin M, Morton R, Toffelmire E. Sex differences in renal transplantation in Canada. JOURNAL OF WOMEN'S HEALTH & GENDER-BASED MEDICINE 1999; 8:631-5. [PMID: 10839649 DOI: 10.1089/jwh.1.1999.8.631] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
To determine if a patient's sex influences access to renal transplantation in Canada, transplant recipient data for first cadaveric unrelated renal transplants were obtained from the Canadian Organ Replacement Register (CORR) for the period 1985-1992. There were 4683 first unrelated cadaveric transplant recipients during this time. Differences in the proportion of men and women registered with CORR who received a renal transplant were analyzed. In Canada between 1985 and 1992, 25% of males 40 years and older on dialysis received renal transplants compared with 18% of females (p < 0.0001, RR 1.54, 95% CI 1.40-1.67). There was no difference in the rates of transplants in males and females who were under 40 years of age. Adjusting for panel-reactive antibody data did not change the significance of the difference in transplant rates between the sexes. In Canada from 1985 to 1992, male patients with end-stage renal disease received proportionately more transplants than females.
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Florakas C, Godwin M, Morton R, Wilson R, Toffelmire E. Body size, not sex, is responsible for differences in type of dialysis. CMAJ 1999; 160:818-9. [PMID: 10189427 PMCID: PMC1230162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
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Morton RL, Kennedy MM. Advice from the experts. Experts address the professional concerns of healthcare executives. HEALTHCARE EXECUTIVE 1999; 14:44-5. [PMID: 10351659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Morton R, Benton S, Bower E, Carroll-Few L, Hankinson J, Lingham S, Onslow D, Rhead S, Wallis S, Walter A. 'Multidisciplinary appraisal of the British Institute for Brain Injured Children, Somerset, UK'. Dev Med Child Neurol 1999; 41:211-2. [PMID: 10210256 DOI: 10.1017/s0012162299220415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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