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Biomedical subjects

J P McMullin

Publications and source records attributed to J P McMullin.

At least 19 recordsLinked to original sources
PubMed2004

Improving patients' safety locally: changing clinician behaviour.

Safety initiatives in hospitals should focus on common health care interventions that when used appropriately can improve important health outcomes, and when used inappropriately or not at all, result in substantial harm. We suggest that errors of omission should be a safety priority. We focus on preventive health care interventions, and describe five steps that can improve patients' safety by changing clinician behaviour. The steps are to: do an environmental scan; understand current behaviour, target behaviour for change (why, what, when, where, and who); adopt effective strategies to change behaviour; and synergise.

Behavior↗
PubMed2002

Clinical estimation of trunk position among mechanically ventilated patients.

OBJECTIVES: Trunk position at 45 degrees from the horizontal is associated with a decreased risk of gastroesophageal aspiration. The objectives of this study were to determine the accuracy of trunk flexion estimates compared to a reference standard measurement, and to determine agreement about trunk flexion among ICU clinicians. DESIGN: Prospective observational study. SETTING: Two university-affiliated medical-surgical ICUs. PATIENTS AND PARTICIPANTS: Thirty-three mechanically ventilated ICU patients, seven residents, two fellows, three intensivists, and twenty-eight bedside nurses. INTERVENTIONS: Prospectively, concurrently, and independently during rounds, one bedside nurse, one resident, one fellow, and one intensivist clinically estimated the trunk flexion of mechanically ventilated patients. To record the reference standard, a trained investigator measured trunk position in the vertical plane using a goniometer. MEASUREMENTS AND RESULTS: We made 438 clinical assessments on 33 patients aged 57.2+/-19.4 (SD) years with an APACHE II score of 27.3+/-9.4. Mean trunk flexion estimates were: nurses 24.3+/-12.3 degrees from the horizontal, residents 20.2+/-13.7, fellows 20.3+/-10.8, and intensivists 21.1+/-13.1 compared to the reference standard measurement 16.2+/-9.0 degrees. The accuracy of trunk flexion estimates was fair to moderate [intraclass correlation for reference standard versus nurses (ICC 0.42), residents (ICC 0.52), fellows (ICC 0.36), and intensivists (ICC 0.55)]. The agreement among different groups of clinicians was moderate. CONCLUSIONS: In mechanically ventilated patients, we found that clinical estimates of trunk position were moderately good, agreement amongst caregivers was moderately good, but that all clinicians tended to overestimate the angle of semirecumbency.

APACHE↗
PubMed1995

Observations of chemical processing in the circumstellar environment.

High resolution interferometer and single-dish observations of young, deeply embedded stellar systems reveal a complex chemistry in the circumstellar environments of low to intermediate mass stars. Depletions of gas-phase molecules, grain mantle evaporation, and shock interactions actively drive chemical processes in different regions around young stars. We present results for two systems, IRAS 05338-0624 and NCG 1333 IRAS 4, to illustrate the behavior found and to examine the physical processes at work.

Astronomical Phenomena↗
PubMed1994

The circumstellar environment of IRAS 05338-0624.

Millimeter continuum and spectral line observations with 10", 30", and 60" resolution are used to characterize the structure and chemistry of the gas around the young, embedded star, IRAS 05338-0624. On arcminute scales, emission from dense gas tracers outline an isolated condensation centered on the IRAS source position. The condensation is characterized by a size of approximately 60", a density of 2 x 10(5) cm-3, and a virial mass of 40 M solar. Interferometric CS J = 2-1 observations show two peaks, one toward the continuum peak and the other toward a position 14" west and 8" south. Single-dish maps of SO, CH3OH, and SiO show pronounced wing emission to the west of the IRAS source, which interferometer observations reveal to be a compact region of outflow activity. CS emission as redshifted and blueshifted velocities reveals a bipolar outflow oriented with a position angle of 45 degrees, while SiO emission appears to be tracing a fast shock interaction region at the CS red-lobe peak, 14" west and 8" south of the IRAS source. Finally, H13CO+ emission traces clumps of quiescent gas toward the IRAS source and adjacent to the blue lobe of the outflow. Column densities and molecular fractional abundances are derived to explore the interaction between the surrounding condensation and the young stellar object. We find evidence for gas phase depletions within the overall condensation in several gas tracers (CO, CS, HCN, SO) but not in the region immediately around the young stellar object. Enhanced abundances of SO, CH3OH, and SiO (by factors of 4, >100, >1000, respectively) are observed in the shocked gas; these enhancements may be explained in terms of a nondissociative shock liberating mantle materials that contain some amount of refractory materials, a moderate velocity dissociative shock in which only minor sputtering of Si occurs, or a shock that impacts surrounding material with a range of speeds.

Astronomy↗
PubMed1988

Renal angiography in potential living related renal donors in Iraq.

Between July 1983 and March 1986, 160 potential living related renal donors underwent renal angiography. One hundred and twenty-eight have (Group 1) and 32 have not (Group 2) become renal donors. The addition of selective renal angiography did not alter the pre-operative arterial prediction made on flush aortography in 102 of 109 renal donors who had both investigations. At surgery, nine of the 13 unexpected arterial findings were in patients who had both forms of angiography. Complications of angiography in 16 patients (11%) included failed groin puncture (two), groin haematoma (eight), haematocoele (one) and loin pain (five). Three patients had renal artery damage detected at surgery, one of which resulted in graft loss. The arterial anatomy demonstrated was similar in 22 of the 23 patients in Group 2 who had flush and selective angiography. One patient (3%) developed a small groin haematoma. Forty-six patients (29%) had multiple renal arteries demonstrated angiographically. This paper highlights the incidence of renal artery damage following selective renal angiography and suggests that flush aortography provides adequate pre-operative information.

Adolescent↗
PubMed1988

Diffuse cavernous hemangioma of the rectosigmoid and low anterior resection using the autostapler.

Over 200 cases of colonic hemangioma have been reported, with more than 50% occurring in the rectosigmoid. These benign vascular neoplasms usually present in childhood, often with life-threatening hemorrhage. Lack of awareness of the condition continues to lead to errors in diagnosis and management, and may contribute to previously reported mortality rates of 50%. We report a case of diffuse cavernous hemangioma of the rectosigmoid in a 10-year-old boy and its treatment by low anterior resection using the end-to-end autostapler.

Anastomosis, Surgical↗
PubMed1984

A case of metastasizing benign pleomorphic adenoma of the parotid.

A 69-year-old man who had a 50-year history of recurrent benign pleomorphic adenomas of the parotid presented with a further recurrence and a skull nodule. Biopsy of the skull nodule was consistent with a metastasis of a benign pleomorphic adenoma.

Adenoma, Pleomorphic↗
PubMed1984

A comparison of two types of vacuum drainage after cholecystectomy.

Following cholecystectomy, 50 patients were randomly allocated for suction drainage by small (2.5 mm) Redivac or large calibre (6 mm) Redivac drains. There were 25 patients in each group. Subhepatic collection was detected by ultrasonic examination in 5 patients on the seventh postoperative day. The smaller drain was used in all of these patients. Of these 5 patients, one developed pulmonary infection, a second had internal bleeding requiring laparotomy, while the remaining 3 were asymptomatic. Subhepatic fluid was not detected in any patient who had the larger drain.

Adult↗