PubMed Health⌕ Search

Biomedical subjects

M M Hickey

Publications and source records attributed to M M Hickey.

15 recordsLinked to original sources
PubMed1998

Capital issues for ORL nurses.

As the 1997 Nurse in Washington Intern for SOHN, I was awed by the quality and quantity of information and experiences shared during the workshop. The three major concerns in healthcare policy on Capitol Hill are cost, quality, and access. Healthcare costs have escalated at tremendous speed, bypassing the growth of the Gross Domestic Product. Medicare is projected to go broke by 2007. The United States population is aging rapidly. The Federal Government must make changes to Medicare and Medicaid legislation or the U.S. Treasury may be consumed. As costs are cut, quality and access must be ensured. These are years of rapid change in healthcare. Nurses face many challenges and have many opportunities to participate in and influence the formation of healthcare policy. Nurses must be armed with information about key players, the processes, and what nursing can contribute to the healthcare system. We need to step up to the plate; we need to be part of the solution.

Health Expenditures↗
PubMed1993

Septicaemia in patients with and without AIDS at Westminster Hospital, London.

The types of organism causing septicaemia in patients with AIDS and without AIDS at Westminster Hospital were examined prospectively over a period of 2 years (1990-1991). Altogether 417 episodes of septicaemia were diagnosed, 148 (35%) of which were in patients with AIDS. Of septicaemias in patients with AIDS, 53 (36%) were caused by mycobacteria. Non-mycobacterial septicaemias were associated with IV access devices in 58 (61%) of patients with AIDS and in 50 (19%) of those without AIDS. Gram-negative organisms were responsible for septicaemia associated with IV access devices in 16 (28%) of 58 patients with AIDS and in 8 (16%) of 50 patients without AIDS. Non-typhoidal Salmonella species or Shigella species caused 13 (31%) of 42 episodes of septicaemia caused by Gram-negative organisms in patients with AIDS. These findings have influenced the strategy for empirical therapy of septicaemia in patients with AIDS at Westminster Hospital.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Northwick Park Infection Consultation Service. Part I. The aims and operation of the service and the general distribution of infection identified by the service between September 1987 and July 1990 [see comment].

The Northwick Park Infection Consultation Service (ICS) is a collaborative service operated by the departments of Medical Microbiology and Infectious Diseases where personnel and skills are combined. Its aim is to improve the availability and effectiveness of consultation for infection-related problems. This paper sets out the framework for establishing an ICS and also details the general distribution of infection identified by the Northwick Park ICS in a study carried out between September 1987 and July 1990. Part II assesses the contribution that the ICS made to the management of infection. One thousand and thirty-eight (1038) patients were seen on the ICS. Seventy-five per cent (776) were judged to be infected and in 691 this was a probable or certain diagnosis. Skin and subcutaneous tissue, respiratory tract, and genito-urinary tract infections accounted for 64% of the total. Eighty-seven per cent of infections required treatment with intravenous antibiotics, 22% were associated with concomitant bacteraemia, and 2.7% of patients died as a direct result of their infection. Sixty-four per cent of consultations were unsolicited and arose from laboratory results or the clinical information on the form accompanying the specimen: over one quarter were initiated before results were available. These infections were no different in either severity or nature from those identified by solicited requests to either department. Fifty-three per cent of consultations had a moderate to high clinical component. The results emphasise the importance of infection in hospitals and highlight the advantages of a collaborative approach from the departments of Medical Microbiology and Infectious Diseases.

Cross Infection↗
PubMed1991

Northwick Park Infection Consultation Service. Part II. Contribution of the service to patient management: an analysis of results between September 1987 and July 1990.

The establishment of Infectious Disease teams combining microbiological and clinical expertise has recently been recommended by a joint working part of the Royal College of Physicians and the Royal College of Pathologists. The Northwick Park Infection Consultation Service (ICS) has been operating on these lines since 1983; details are given in Part I. Part II assesses the contribution that the ICS has made to the management of infection in a study of 1038 patients undertaken between September 1987 and July 1990. The areas of patient diagnosis, treatment, investigation and isolation were examined to assess the appropriateness of the attending doctor's management of infection and the benefits resulting from recommendations made by the ICS. At the time of consultation the correct diagnosis had already been made or considered in 93% of patients, essential investigations needed to confirm or refute the diagnosis performed in 92%, and side-room isolation correctly instituted in 81% of patients requiring it. However, 41% of 776 infected patients were receiving suboptimal treatment: this was significantly more frequent in unsolicited consultations (P less than 0.05). Advice was given following consultation in 893 of 1038 patients (86%) and related to treatment (66%), investigation (41%), diagnosis (30%) and patient isolation (4%). Of 844 patients where receipt of advice could be accurately assessed, it was taken fully in 708 (84%), partly in III (13%), and went unheeded in 25 (3%). Advice on diagnosis or investigation enabled the correct diagnosis to be reached in 30% of consultations and in a further 47 patients (5%), the diagnosis was proposed by the ICS on initial consultation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Metronidazole resistant Bacteroides fragilis infection of a prosthetic hip joint.

A case of infection involving a prosthetic joint in a patient with adult Still's Disease is described. The causative organism was a strain of Bacteroides fragilis which was resistant to metronidazole. The rarity of this occurrence is emphasised. Diagnostic difficulties which arose are described and the problems encountered with therapy discussed.

Administration, Oral↗
PubMedDate not supplied

Parenteral nutrition utilization: evaluation of an educational protocol and consult service.

A two part study was undertaken to evaluate the effectiveness of an educational protocol and consult service on parenteral nutrition (PN) utilization. Forty-one patient admissions were evaluated retrospectively and nine prospectively. Average length of hospital stay and number of days on PN were decreased significantly (p less than .05). Frequency of adverse effects were also decreased significantly (p less than .05). A positive trend toward selection of patients for enteral rather than PN was evidenced. Utilization of already available manpower and financial resources by this modified approach should contribute toward reducing costs and hazards of PN therapy, particularly for smaller hospitals with both limited requirements and resources, as well as for teaching institutions.

Adult↗