Publications by authors named "Francis Morris"
Objectives: Persistent CD4:CD8 ratio inversion (< 1) is associated with mortality in older people. We investigated the interaction of the effects of baseline CD8 count and age at HIV diagnosis on CD4:CD8 ratio recovery with antiretroviral therapy (ART).
Methods: An observational study (1 January 2007 to 31 December 2016) was carried out using routinely collected data from the HIV outpatient services at Imperial College Healthcare NHS Trust, London, UK.
Objectives: Management of anticoagulated patients after head injury is unclear due to lack of robust evidence. This study aimed to determine the adverse outcome rate in these patients and identify risk factors associated with poor outcome.
Design: Multicentre, observational study using routine patient records.
Objectives: It is not currently clear whether all anticoagulated patients with a head injury should receive CT scanning or only those with evidence of traumatic brain injury (eg, loss of consciousness or amnesia). We aimed to determine the cost-effectiveness of CT for all compared with selective CT use for anticoagulated patients with a head injury.
Design: Decision-analysis modelling of data from a multicentre observational study.
Background: The appropriate management of patients with ST-segment elevation myocardial infarction (STEMI) depends on accurate interpretation of the 12-lead ECG by paramedics. Computer interpretation messages on ECGs are often provided, but the effect they exert on paramedics' decision-making is not known. The objective of this study was to assess the feasibility of using an online assessment tool, and collect pilot data, for a definitive trial to determine the effect of computer interpretation messages on paramedics' diagnosis of STEMI.
View Article and Find Full Text PDFObjectives: To estimate the cost-effectiveness of delayed troponin testing for myocardial infarction compared with troponin testing at presentation.
Design: Decision analysis modelling of cost-effectiveness using secondary data sources.
Setting: Acute hospitals in the UK.
Background: Chest pain units (CPUs) provide a system of care for patients with acute chest pain that can improve outcomes while reducing health service costs. The Effectiveness and Safety of Chest Pain Assessment to Prevent Emergency Admissions (ESCAPE) multicentre trial was undertaken to determine whether CPUs could be successfully established throughout the National Health Service (NHS).
Aim: To describe the structure, processes and outcomes of patients managed by CPUs in the ESCAPE Trial.
Objective: Creatine kinase MB isoenzyme (CK-MB) mass and rate of change of CK-MB have been proposed as superior to cardiac troponin measurement for very early exclusion of acute myocardial infarction (AMI). All three markers were examined prospectively in patients presenting to the Emergency Department (ED) for rule out of AMI.
Methods: Consecutive admissions to the ED with undifferentiated chest pain were initially assessed clinically and by electrocardiography.
Background: The chest pain unit (CPU) provides rapid diagnostic assessment for patients with acute, undifferentiated chest pain, using a combination of electrocardiographic (ECG) recording, biochemical markers and provocative cardiac testing. We aimed to identify which elements of a CPU protocol were most diagnostically and prognostically useful.
Methods: The Northern General Hospital CPU uses 2-6 hours of serial ECG/ST segment monitoring, CK-MB(mass) on arrival and at least two hours later, troponin T at least six hours after worst pain and exercise treadmill testing.
Objectives: The chest pain unit (CPU) has been developed to improve care for patients with acute, undifferentiated chest pain. The authors aimed to measure patient and primary care physician (PCP) satisfaction with CPU care and routine care and to determine whether patient satisfaction predicted PCP satisfaction.
Methods: A CPU was established, and 442 days were randomly allocated to either CPU care or routine care.
Objectives: To measure the effectiveness and cost effectiveness of providing care in a chest pain observation unit compared with routine care for patients with acute, undifferentiated chest pain.
Design: Cluster randomised controlled trial, with 442 days randomised to the chest pain observation unit or routine care, and cost effectiveness analysis from a health service costing perspective.
Setting: The emergency department at the Northern General Hospital, Sheffield, United Kingdom.
Objectives: To measure the predictive value and diagnostic performance of clinical features used to diagnose coronary syndromes in patients presenting with acute, undifferentiated chest pain.
Methods: The clinical features of patients presenting to the authors' chest pain unit with acute, undifferentiated chest pain were prospectively recorded on a standard form. Admitted patients were followed up by case note review.