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Biomedical subjects

P McQuillan

Publications and source records attributed to P McQuillan.

9 recordsLinked to original sources
PubMed2004

Hearing Surveillance Chart--a tool for tracking serial audiometry results and predicting future hearing impairment.

High frequency hearing loss is related to noise-induced deafness. We decided to develop a method of recording serial audiogram results that would provide an accessible overview of trends for an individual. Health & Safety Executive (HSE) warning and referral levels for high frequency hearing losses were plotted against age. A third line was added to indicate a level of 'significant' handicap. This graph is inserted in each individual's hearing surveillance record. High frequency hearing loss results are plotted for each ear over time. Someone with known hearing loss but minimal deterioration will exceed the HSE warning level at every review, whereas someone with perfect hearing suffering a significant deterioration may not exceed the warning level initially. The latter should be of more concern to their current employer.

Audiometry↗
PubMed2003

Presentation of diaphragmatic herniae during pregnancy and labour.

We report two cases of pregnancy-related diaphragmatic hernia. Case one was a 36-year-old woman who presented in her ninth pregnancy, after eight vaginal deliveries. Eight months after a stab wound to the chest, she developed persistent vomiting. The diagnosis was made by chest X-ray after a contralateral central line had been inserted for parenteral nutrition. A 6 x 4 cm stab-induce defect in the diaphragm was repaired. Close by was a second healed diaphragmatic stab wound. Case two involved a 32-year-old woman with a history of repaired childhood diaphragmatic hernia. She developed atypical shoulder and precordial chest pain during labour. Delivery was achieved by the vaginal route, ventouse-assisted. Persistent pain and vomiting led to insertion of a nasogastric tube and the diagnosis was made on the subsequent chest X-ray. The omentum was very adherent to the lung and could only be mobilised via a thoracotomy, at which significant air leaks occurred but settled rapidly. The difficulties of diagnosis are discussed along with the embryology, mechanisms and management of this condition.

Journal Article↗
PubMed2001

Creating healthy workplaces in Northern Ireland: evaluation of a lifestyle and physical activity assessment programme.

An observational study was carried out on 2595 Northern Ireland civil servants who attended a workplace lifestyle and physical activity assessment programme involving self-reported lifestyle history, measurement of physiological parameters and a 6 month follow-up postal questionnaire survey. Almost two-thirds of participants did not engage in regular moderate physical activity, with females twice as likely not to than men. Approximately one in six participants were smokers and three-quarters were found to have body fat estimations above the acceptable level, with females much more likely to be obese than men. Aerobic capacity was below average in 17% of participants and was associated with increasing age, smoking in the under 35s and poor physical activity levels. Excessive alcohol intake was found in 8% of all participants, and was more likely in men and smokers. In the follow-up survey, 83% needed to make one or more changes to their lifestyle. Smoking was the most difficult to change, with only 14% remaining abstinent after 6 months. Almost two-thirds were maintaining improved dietary habits and exercise activity, with around one-half moderating alcohol intake and achieving weight reduction. Overall, the average level of non-attempted behaviour change was one in five (19.6%), tried but failed accounted for almost one in three (31.2%) and successful maintenance of positive lifestyle change occurred in one-half (49.2%). Brief lifestyle and physical activity assessment programmes are effective interventions in getting employees to modify their lifestyles. The impact this has on wider organizational issues such as absenteeism and productivity needs further evaluation.

Administrative Personnel↗
PubMed1998

Confidential inquiry into quality of care before admission to intensive care.

OBJECTIVE: To examine the prevalence, nature, causes, and consequences of suboptimal care before admission to intensive care units, and to suggest possible solutions. DESIGN: Prospective confidential inquiry on the basis of structured interviews and questionnaires. SETTING: A large district general hospital and a teaching hospital. SUBJECTS: A cohort of 100 consecutive adult emergency admissions, 50 in each centre. MAIN OUTCOME MEASURES: Opinions of two external assessors on quality of care especially recognition, investigation, monitoring, and management of abnormalities of airway, breathing, and circulation, and oxygen therapy and monitoring. RESULTS: Assessors agreed that 20 patients were well managed (group 1) and 54 patients received suboptimal care (group 2). Assessors disagreed on quality of management of 26 patients (group 3). The casemix and severity of illness, defined by the acute physiology and chronic health evaluation (APACHE II) score, were similar between centres and the three groups. In groups 1, 2, and 3 intensive care mortalities were 5 (25%), 26 (48%), and 6 (23%) respectively (P=0.04) (group 1 versus group 2, P=0.07). Hospital mortalities were 7 (35%), 30 (56%), and 8 (31%) (P=0.07) and standardised hospital mortality ratios (95% confidence intervals) were 1.23 (0.49 to 2.54), 1.4 (0.94 to 2.0), and 1.26 (0.54 to 2.48) respectively. Admission to intensive care was considered late in 37 (69%) patients in group 2. Overall, a minimum of 4.5% and a maximum of 41% of admissions were considered potentially avoidable. Suboptimal care contributed to morbidity or mortality in most instances. The main causes of suboptimal care were failure of organisation, lack of knowledge, failure to appreciate clinical urgency, lack of supervision, and failure to seek advice. CONCLUSIONS: The management of airway, breathing, and circulation, and oxygen therapy and monitoring in severely ill patients before admission to intensive care units may frequently be suboptimal. Major consequences may include increased morbidity and mortality and requirement for intensive care. Possible solutions include improved teaching, establishment of medical emergency teams, and widespread debate on the structure and process of acute care.

Adult↗
PubMed1998

Laboratory simulation of splashes and spills of organophosphate insecticides on chemically protective gloves used in agriculture.

Agricultural workers rely on chemically protective gloves for protection from dermal exposure to insecticides. In Australia the most widely used gloves are manufactured from polyvinyl chloride or nitrile butadiene rubber. During insecticide application splashes and spills frequently occur on the external surfaces of gloves which may compromise the integrity of the membrane. Interaction of two organophosphate insecticides, chlorpyrifos (Lorsban 500 EC(R)) and diazinon (Jetdip(R)), with glove surfaces was investigated in laboratory conditions. The external surface of gloves was treated with concentrated insecticides for one minute and diluted and concentrated insecticides for 24, 36 and 48 hours and later examined by environmental scanning electron microscopy. Two classes of defects, cavities and convexities, were evident in the polyvinyl chloride gloves following all treatments, whereas cracking was significant in the nitrile butadiene rubber gloves after 24 hours. In addition, X-ray energy-dispersive microanalysis was used to evaluate chemical changes on the glove surfaces. Phosphorus and sulfur were useful indicators for organophosphate retention over specific time frames. Results corroborated the need for more robust chemically protective gloves to be developed for routine agricultural use.

Agricultural Workers' Diseases↗
PubMed1995

Contractile effects of diaspirin cross-linked hemoglobin (DCLHb) on isolated porcine blood vessels.

The effects of diaspirin cross-linked hemoglobin (DCLHb) on vascular tone were examined in arterial and venous rings isolated from mesenteric, renal, femoral, and pulmonary blood vessels. Rings were placed in organ baths at optimal passive tension in Krebs' solution (37 degrees C) and aerated with a mixture of 95% O2/5% CO2. Vessels were treated with increasing concentrations of DCLHb or an iso-osmotic serum albumin solution. All artery and vein rings contracted in the presence of DCLHb. With the exception of the pulmonary vein, the magnitude of the tension increase with DCLHb was greater in the arteries than in the veins. Removal of the endothelium by scraping or the addition of a nitric oxide synthase inhibitor blocked the DCLHb-induced contraction in the pulmonary artery and vein. DCLHb also significantly reduced basal cyclic guanosine-3-5'-monophosphate in the pulmonary vein. These studies suggest that the constrictor activity of DCLHb is due primarily to inhibition of basal nitric oxide-induced relaxation of the vascular smooth muscle.

Acetylcholine↗
PubMed1993

Comparison of thoracic electrical bioimpedance and thermodilution for the measurement of cardiac index in patients with severe sepsis.

Cardiac index was measured using thoracic bioimpedance (CIbi) and thermodilution (CItd) in 19 patients with proven sepsis, undergoing artificial ventilation of the lungs. There was a poor correlation between the techniques (r = 0.36, 242 data sets, regression line CIbi = 0.16 CItd + 2.56 litre min-1 m-2). The overall bias (CItd-CIbi) was 1.69 litre min-1 m-2 with limits of agreement (precision) of +4.17 to -0.79 litre min-1 m-2. In individual patients the bias was from -0.46 to 4.56 litre min-1 m-2 with the limits of agreement from +/- 0.29 to +/- 2.55 litre min-1 m-2 around the bias values. The two techniques cannot be used interchangeably in this group of patients.

Bacterial Infections↗