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Biomedical subjects

B P Simmons

Publications and source records attributed to B P Simmons.

At least 19 recordsLinked to original sources
PubMed1991

Continuous quality improvement. Concepts and applications for physician care.

There has been a growing interest by health care leaders in the continuous quality improvement method of quality management. This method uses measurements of quality "indicators" to initiate and drive organizational changes in a never-ending cycle of continuous improvement. Many discussions of the continuous quality improvement method have emphasized the organizational and attitudinal changes necessary to fully implement the model while deemphasizing the uses of measures of quality to guide improvement. In this article, we emphasize the concepts behind the measurement of quality that underline the continuous quality improvement model and give examples of how these concepts can be immediately applied to guide improvement in the quality of physician care.

Continuity of Patient Care↗
PubMed1991

Environmental versus analytical variability in exposure measurements.

Measurements of 8-hr time-weighted average (TWA) exposures are subject to environmental variability and collection and analytical error. Environmental variability can be represented by the geometric standard deviation (GSD) of the lognormally distributed 8-hr TWAs; analytical variability can be represented by the coefficient of variation (CV) of the normally distributed collection and analytical errors. A mathematical expression is derived for the variance of the measured 8-hr TWAs as a function of the GSD of the true daily average exposures and the total CV of the industrial hygiene method used in monitoring. For typical values of the GSD and CV, environmental variability is far more important than analytical variability in determining the variance of the measured 8-hr TWAs. A resulting policy implication is that the Occupational Safety and Health Administration inappropriately focuses on analytical variability when determining compliance with its permissible exposure limits.

Bias↗
PubMed1990

Cefamandole versus cefonicid prophylaxis in cardiovascular surgery: a prospective study.

We randomized 400 patients who were scheduled for an elective cardiovascular operation involving median sternotomy to receive cefamandole nafate or cefonicid in a prospective double-blind study. Three hundred fifty-seven patients were evaluable for prophylactic efficacy. Chest wound and donor site infections and early prosthetic valve endocarditis occurred more frequently with cefonicid (11 patients, 6.3%) than with cefamandole (4 patients, 2.2%) (p = 0.05). Three patients, all in the cefonicid group, required sternal debridement to control postoperative deep wound infections. Twenty-five miscellaneous postoperative infections (urinary tract infection, pneumonia, intravenous site infection, bacteremia, sepsis, Clostridium difficile diarrhea) occurred in 16 patients (9.19%) in the cefonicid group and four in 4 patients (2.19%) in the cefamandole group (p = 0.003). These data indicate that cefamandole is superior to cefonicid in preventing both surgical wound infections and miscellaneous nonsurgical infections after cardiovascular operations.

Cardiac Surgical Procedures↗
PubMed1990

Pediatric herpetic hand infections.

Fourteen cases of pediatric herpetic hand infection were admitted over a 15-year period. Five cases were documented by viral culture, four by Tzanck smear; the remainder were diagnosed on clinical grounds. The natural history of herpetic hand infections is similar in adult and pediatric populations. Adult infections are most frequently found in medical and dental personnel; pediatric infections are most common in children between 5 months and 6 years of age. Whereas adult infections are usually the result of exogenous occupational or sexual exposure, 11 (80%) of 14 pediatric cases exhibited coexistent oral lesions. Treatment in all cases is nonsurgical; resolution is complete within 3 to 4 weeks. Antibiotics are indicated only in the advent of bacterial superinfection.

Child↗
PubMed1990

Risk factors for wound infections after total knee arthroplasty.

Wound infections are an infrequent but serious complication of total knee arthroplasty. Between January 1984 and November 1987, 20 of 243 (8.2%) patients at two affiliated hospitals developed surgical wound infections following 259 total knee arthroplasty procedures performed in clean-air operating rooms. Eighteen (90%) of the patients had deep infections; nine required removal of the prosthesis. A single surgeon (surgeon X) was associated with 18 of the procedures that had subsequent infection (risk ratio (RR) = 9.4, 95% confidence interval (CI) 2.2-39), and an investigation was carried out in an effort to explain the difference in infection rates between surgeon X and other surgeons. In a cohort study, stratified analyses identified a preoperative American Society of Anesthesiologists (ASA) physical status class greater than or equal to 3, surgeon X, and early postoperative use of a continuous passive motion device as risk factors associated with surgical wound infection following total knee arthroplasty procedures. Logistic regression analyses identified being a patient operated on by surgeon X with an ASA class greater than or equal to 3 as the only significant independent risk factor for total knee arthroplasty-associated surgical wound infections (RR = 9.3, 95% CI 2.8-31). The effect due to surgeon X could not be explained by receipt or timeliness of administration of antimicrobial prophylaxis, type of prosthesis inserted, duration of operation, postoperative use of continuous passive motion, or underlying etiology of joint disease. The authors conclude that surgical technique and patient's severity of illness were the primary determinants of surgical wound infection after total knee arthroplasty. This study demonstrates the complexity of epidemiologic investigation of surgical wound infections and the importance of considering patient severity of illness when interpreting surgeon-specific infection rates.

Cohort Studies↗
PubMed1989

Enterobacter sakazakii infections in neonates associated with intrinsic contamination of a powdered infant formula.

We report an outbreak of Enterobacter sakazakii infection and colonization in neonates related to an infant formula contaminated during the manufacturing process. The outbreak occurred in a 20-bed neonatal intensive care unit during a six-week period in 1988, and involved a total of four infants. Three infants had sepsis and three had bloody diarrhea; all patients responded to intravenous antibiotics and recovered without complications. The E sakazakii isolated from the formula had the same plasmid and multilocus enzyme profile as those isolated from patients. This outbreak demonstrates the significance of commercially contaminated formulas and emphasizes the need to limit contamination and multiplication of bacteria in enteral formulas.

Cross Infection↗
PubMed1989

Juvenile rheumatoid arthritis.

Juvenile rheumatoid arthritis affects approximately 60,000 to 250,000 children in the United States and is the most common connective tissue disease occurring during childhood. This article discusses the signs, symptoms, and general management of the disease, including surgical techniques.

Arthritis, Juvenile↗
PubMed1988

Hand and wrist injuries in children.

Hand and wrist injuries in children have steadily increased over the past decade as athletic participation by both boys and girls at an earlier age has been encouraged by parents and coaches. This article will cover the spectrum of hand and wrist injuries in children including ligamentous, tendinous, and bony injuries, as well as the increasing incidence of stress-related injuries in the upper extremities.

Athletic Injuries↗
PubMed1987

Subcondylar fossa reconstruction for malunion of fractures of the proximal phalanx in children.

Subcondylar fractures of the proximal or middle phalanx occur at the neck of the phalanx, usually as a result of a crush injury, and almost exclusively in the pediatric age group. The distal fragment rotates dorsally and the degree of displacement may be misjudged if a true lateral radiograph is not obtained. If malunion occurs, there is a block to flexion. Subcondylar fossa reconstruction by removal of bone through a palmar approach removes this bony block. Three patients are presented in whom this procedure allowed an average increase in flexion of 41.7 degrees.

Adolescent↗
PubMed1987

Treatment of traumatic arthritis in children.

Although alternatives do exist for the treatment of traumatic arthritis in children, all efforts should be directed to treat the initial condition to avoid its progression to arthritis. Once arthritis is established, then follow the axiom, "treat patients, not x-rays." If despite all attempts at conservative treatment, a surgical option is necessary, then attention must be given to potential future growth, joint stability, and alignment, pain relief, and anticipated postoperative range of motion. All cases must be individualized because, unfortunately, none of the alternatives available is capable of guaranteeing a "normal" end result.

Adolescent↗
PubMed1986

Incomplete carpal coalition.

Congenital coalition between the lunate and triquetrum is a common anomaly that may have several different radiographic appearances. We report seven patients with partial coalition and rounded radiolucencies in the subarticular region of both bones. The most likely cause of this combination of findings is abnormal differentiation of the joint space and remnants of misplaced synovial tissue that formed during the disorganized process of joint development.

Adult↗
PubMed1985

Symptomatic carpal coalition.

The carpus is initially a cartilaginous structure that subsequently demarcates into separate carpal bones. Failure of differentiation of parts results in carpal coalition, the most common of which occurs between the lunate and triquetrum. Lunate-triquetral coalitions can be subdivided into four types according to the degree of union. Four types are identified. A case report of type I is presented that responded to a lunate-triquetral fusion.

Adolescent↗