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Biomedical subjects

M McGuckin

Publications and source records attributed to M McGuckin.

At least 19 recordsLinked to original sources

Indications for and outcomes of cholecystectomy: a comparison of the pre and postlaparoscopic eras.

PURPOSE: Examine changing patient characteristics and surgical outcomes for patients undergoing cholecystectomy at five community hospitals in 1989 and 1993. PROCEDURES: In a retrospective chart review, data were gathered regarding gallstone disease severity, type of admission, patient age, number of comorbidities, American Society of Anesthesiologists (ASA) Physical Status Classification, length of stay, and multiple outcomes of surgery. MAIN FINDINGS: The volume of nonincidental cholecystectomies increased 26%, from 1611 in 1989 to 2031 in 1993. Nearly all of the increase occurred among patients with uncomplicated cholelithiasis and with elective admissions. In 1993, lengths of stay were significantly shorter and percentages of complications were significantly lower for infectious, cardiac, pulmonary, and gastrointestinal complications when controlling for patient case-mix characteristics. There were more major intraoperative complications (unintended wounds or injuries to the common bile duct, bowel, blood vessel(s), or other organs) in 1993. CONCLUSIONS: Different types of patients underwent cholecystectomy in 1993 compared with patients in 1989, which supports the hypothesis of changing thresholds. Statements supporting the safety of cholecystectomy in the laparoscopic era were borne out when controlling for differences in patient characteristics.

Adult

Occlusive dressings: a microbiologic and clinical review.

This review discusses the microbiology of normal skin and wounds and examines the rates of infection reported under both conventional (nonocclusive) dressings and all occlusive dressings, together with cost factors. The overall infection rate under conventional dressings was 7.1% in 1085 wounds, whereas under occlusive dressings on 3047 wounds the rate was 2.6%. In studies in which the two dressing types were directly compared, the respective rates were 7.6% and 3.2%. The reasons for this difference may include both dressing-specific and host-specific factors, and these factors are discussed.

Biological Dressings

Increasing handwashing compliance with more accessible sinks.

The frequency of handwashing in two intensive care units (ICUs) was observed. Handwashing after direct contact with patients or their support equipment was recorded. The ratio of beds to sinks was 1:1 in the medical ICU and 4:1 in the surgical ICU. Surveillance of physicians, nurses, and other personnel demonstrated a greater frequency of handwashing by nurses (63%) compared with physicians (19%) and other personnel (25%). The nurses in the unit with one sink per bed had a significantly greater number of handwashes (76%) than those in the unit with fewer sinks (51%).

Cooperative Behavior

Duration of handwashing in intensive care units: a descriptive study.

The duration of handwashing was studied in two community hospitals (teaching and nonteaching). The duration in seconds of 180 handwashes by health care personnel and 52 handwashes by non-health care personnel were recorded. The mean duration for health care personnel was 8.62 +/- 0.29 SEM; the degree of patient contact did not influence the duration of handwashing. The duration of handwashing was two times longer in health care personnel vs. non-health care personnel (8.62 +/- 0.29 vs. 4.14 +/- 0.42; t = 7.7; p less than 0.001). Comparisons revealed no statistically significant difference in duration between personnel at teaching and nonteaching hospitals or among those in different occupations. The data indicate that the duration of handwashing among health care personnel is below the standard recommended by authorities in hospital infection control. This may be an important factor in the transmission and persistence of nosocomial infection in critical care units. The antimicrobial efficacy of handwashing agents should be reevaluated considering the actual duration of handwashing by health care personnel within the hospital environment or efforts should be made to increase the duration of handwashing.

Hand Disinfection

Airborne contamination of fine-particle nebulizers.

To determine whether bacteria present in ambient air play a role in the contamination of fine-particle reservoir nebulizers, nebulizers were placed in operation in separate hospital locations having qualitatively and quantitatively different bacterial flora in background air. Nebulizers placed in a surgical intensive care unit that had higher numbers of bacteria and a predominance of Gram-negative organisms in background air had a significantly higher incidence of nebulizer contamination (33.0%) than did nebulizers placed in a non-patient-care area that had lower bacterial counts and a predominance of Gram-positive organisms (0%) (P less than .05). The present study indicates that airborne contamination of fine-particle reservoir nebulizers occurs when bacteria present in ambient air enter the nebulizer during its operation.

Aerosols