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Biomedical subjects

M Meehan

Publications and source records attributed to M Meehan.

31 records · Page 2Linked to original sources
PubMed1994

Contrasting effects of vecuronium and succinylcholine on the renal microcirculation in rodents.

We assessed the effects of succinylcholine and vecuronium on renal function and on the renal microcirculation in a rodent model. Vecuronium (0.02 mg/kg followed by 0.2 mg.kg-1 x h-1) caused a significant decrease of 16.1% +/- 3.87% in inulin clearance from 0.92 +/- 0.07 to 0.71 +/- 0.05 mL.min-1 x gKW-1 (gram of kidney weight), and a decrease in para-aminohippuric acid clearance by 21.6% +/- 4.69% from 1.58 +/- 0.26 to 1.31 +/- 0.20 mL.min-1 x gKW-1 (P < 0.05), whereas succinylcholine (0.45 mg/kg followed by 2 mg.kg-1 x h-1) altered neither. The effect of these muscle relaxants was also determined on the renal microcirculation in separate experiments using videomicroscopy. Succinylcholine (n = 10; 10(-10) to 10(-6) M) and its parent compound, acetylcholine (n = 10, 10(-10) to 10(-6) M) used as a control, caused a significant vasodilation from baseline diameter in the interlobular, afferent, and efferent arterioles. The vasodilation caused by succinylcholine was significantly less than that observed with acetylcholine. Atropine blocked the response to succinylcholine, indicating the latter has a muscarinic effect. In contrast, vecuronium caused a significant, selective vasoconstriction from baseline diameter in the preglomerular vessels, but not in the postglomerular vessels. The vasoconstriction caused by vecuronium was significantly different than the vasodilation caused by succinylcholine. The preglomerular vasoconstriction observed with vecuronium may contribute to the decrease in renal plasma flow and glomerular filtration rate observed experimentally. The choice of a neuromuscular blocking drug can therefore have the potential to influence renal function by altering the renal microcirculation.

Animals↗
PubMed1994

National pressure ulcer prevalence survey.

In the 1993 survey, the prevalence of pressure ulcers was 11.1% in 177 hospitals. This is higher than the 9.2 prevalence rate Meehan found in 1989. The sacrum, with 38% (n = 2,168) of all reported ulcers, remains the most common site for pressure ulcer occurrence. Non-reactive hyperemia sites, Stage I, were responsible for most reported ulcers, at 46.95% (n = 2,839), while Stage II ulcers comprised 32.66% (n = 1,975). Patients between the ages of 70 and 89 years of age had 54% of the ulcers found. The average number of ulcers per patient was 1.73. Dark-skinned, African-American patients again were found to have the majority of Stage IV ulcers. There were 1,024 ulcers reported in this stage group, and of these, they had 16% (n = 164). Of patients with ulcers, 22% were on some form of air or foam overlay support system; however, standard mattresses and mattress replacements were used for 31% of all patients with pressure ulcers.

Adolescent↗
PubMed1990

Multisite pressure ulcer prevalence survey.

The prevalence of pressure ulcers was 9.2% in the 148 hospitals included in the survey. Fifty-eight percent of ulcers were found in patients between the ages of 70 and 89 years. The sacrum was the most common site of ulcers (38%), but the trochanter had the most Stage IV ulcers. Patients had an average of 1.7 ulcers, and Stage IV ulcers were more common in African-Americans and in hospitals over 500 beds. The most commonly used support system was a purchased overlay, but 20 percent of the patients with ulcers were lying on traditional hospital mattresses.

Bed Occupancy↗
PubMedDate not supplied

Quality improvement in an integrated urban healthcare system: a necessary journey.

Public hospitals and clinics in the United States provide health care for the needs of large numbers of people who are medically indigent, homeless, chronically mentally ill, and suffer medical and social disorders associated with poverty. These "safety-net" healthcare providers traditionally struggle with barriers to providing high-quality, patient-sensitive care, including decaying physical facilities, burdensome bureaucracies, underfunded capital equipment and construction programs, and complex, politically driven budgets and governance. However, these same institutions now must compete for their own Medicaid and Medicare clientele because the private sector is marketing to those patients. They also must continue to provide increasing services to growing numbers of uninsured patients. To accomplish this, these institutions must reinvent themselves as patient-focused, high-quality, cost-effective healthcare providers. The Denver Health system is the public safety-net provider for the city and county of Denver. This large public institution has instituted a multifaceted performance-improvement program. The program includes training employees for patient-focused service, implementing continuous quality-improvement practices, instituting clinical pathways, revising the preexisting ambulatory quality-management program, reengineering key aspects of ambulatory clinic services, and redesigning the hospital-based patient-care services. Major successes have been achieved in some initiatives, but not in all. Many key "lessons learned" may guide others.

Ambulatory Care↗
PubMedDate not supplied

Report on the prevalence of skin ulcers in a home health agency population.

OBJECTIVE: This survey was conducted to assess the presence of skin ulcers within a home health agency population in the United States. DESIGN: This voluntary survey was conducted by 177 home health agencies. A single observation of each patient within the agency's active caseload formed the cohort examined. Patients deemed to be at low risk (Braden Scale score > 19) were eliminated from further evaluation, while those with skin ulcers were evaluated for wound- and caregiver-related factors. Surveys were conducted between March 1, 1996, and December 31, 1997. SETTING: Home health agencies in 19 states throughout the United States, with no restrictions on the type or acuity of the patients served. RESULTS: A total of 21,529 patients were surveyed, with a prevalence of pressure ulcers (inclusive of all stages) of 6.8% (n = 1455). Rates for each agency ranged between 0.5% and 35.7%. The total number of ulcers reported was 2526 (average per patient was 1.7), with 36% (n = 919) found on the sacrum and the buttocks. CONCLUSION: Pressure ulcers were the most frequently reported reason for admission to the agency's caseload. Survey results are similar to rates reported in other segments of the health care industry. However, among the home health care population, the primary caregiver is unlikely to be a health care professional. This survey found that the patient's spouse was the primary caregiver in 30% (n = 437) of the 1450 responses received regarding the relationship of the primary caregiver to the patient.

Bandages↗
PubMedDate not supplied

The application of collaborative benchmarking to the prevention and treatment of pressure ulcers.

In the spring of 1995, 42 hospitals participated in a collaborative benchmarking study on the prevention and treatment of pressure ulcers. The study resulted in the discovery of 54 best practices that, taken together, provide a blueprint for successful actions and processes that can easily be adapted to individual institutional needs. An important finding of this benchmarking study showed that the four hospitals with lowest risk-adjusted, hospital-acquired prevalence rates were the same four hospitals identified as benchmarks in at least four other critical-success factors. During the study, representatives were exposed not only to the practices of care delivered at other hospitals, but also to the rationale, limitations, and success of those practices. This understanding, coupled with the best practices, has helped representatives improve their facilities' pressure ulcer programs.

Humans↗