PubMed Health⌕ Search

Biomedical subjects

D G Fryback

Publications and source records attributed to D G Fryback.

At least 37 records · Page 2Linked to original sources
PubMed1994

Effect of advanced cardiac life-support training in rural, community hospitals.

OBJECTIVES: To define the effectiveness of training personnel in rural, community hospitals in advanced cardiac life support (ACLS) and the changes that result in the process and quality of care to patients with ischemic heart disease that can be attributed to participation by team members in an ACLS course. DESIGN: Case-controlled, retrospective abstraction of hospital records of 869 consecutive patients with ischemic heart disease, who were admitted during the year preceding and the year following the ACLS course. SETTING: Seven rural, community hospitals in Wisconsin. SUBJECTS: Physicians, nurses, and other critical care staff (others). INTERVENTIONS: Training in ACLS using 12 3-hr sessions in an interdisciplinary format by a multidisciplinary faculty. MEASUREMENTS AND MAIN RESULTS: Rates of successful attainment of the terminal behavior objectives by physicians and nurses were 84.0% and 78.8%, respectively. Less than 50% of others achieved a satisfactory level of competence. Performance on an examination of cognitive ability improved significantly for all groups (p < .005 for nurses; p < .05 for physicians). Enhancement of knowledge base and integrative skills occurred in all areas of designated ACLS content. Difficulty remained apparent relative to the pharmacologic effects of epinephrine and atropine. No statistically significant deterioration in didactic knowledge base could be detected 1 to 2 yrs after completion of the ACLS course. Slight deterioration in intubation and defibrillation skills occurred in < 3 months after completion of the course. Substantial costs were encumbered by the hospitals, despite the free training provided to the institutions. After ACLS training had been given, overall mortality rates decreased from 17.4% to 13.4% (p < .05). A pooled estimate of the decrease in the mortality rate was 1.4 +/- 3.8%/quarter. Across the entire spectrum of severity of illness, the probabilities for survival increased at a given severity of illness following completion of the course (p = .06). When extremes of severity of illness were excluded from the analysis, the differences in probability for survival over the midrange of severity were statistically significant (p < .05). CONCLUSIONS: Training directed to the entire team likely to participate in the provision of ACLS in the community hospital favorably affects the overall practice of ACLS and the survival rate of patients with ischemic heart disease.

Aged↗
PubMed1993

Screening for abdominal aortic aneurysm in men ages 60 to 80 years. A cost-effectiveness analysis.

PURPOSE: To evaluate the cost-effectiveness of screening by physical examination or abdominal ultrasonography for abdominal aortic aneurysm (AAA) in men aged 60 to 80 years. DATA SOURCES: A systematic review of the pertinent literature by the Canadian Task Force on the Periodic Health Examination, augmented by an additional computerized search (MEDLINE) and references identified from bibliographies of pertinent articles. Several experts reviewed the data for completeness. STUDY SELECTION: Published English-language studies that present data relevant to screening for abdominal aortic aneurysm. DATA EXTRACTION: Several reviewers determined a range of data and the most probable value for each parameter. DATA SYNTHESIS: A computer spreadsheet model was constructed to simulate the costs and effectiveness of various screening protocols in a cohort of 10,000 men during a period of 20 years. The primary cost-effectiveness measure computed was incremental present-value dollar expenditures for screening and treatment per incremental present-value life-year saved by the screening program. Using the "most probable" values for the simulation parameters, a single screening procedure of abdominal palpation followed by abdominal ultrasound scan for patients with positive screening results is estimated to gain 20 life-years at a cost of $28,741 per life-year. A single ultrasound screen gains 57 life-years at a cost of $41,550 per life-year. A repeated ultrasound screen after 5 years gains 1 additional life-year at a cost of $906,769. CONCLUSIONS: A single screen for AAA by abdominal palpation in men from age 60 to 80 years might be considered cost-effective but of small benefit. A single screen with ultrasonography is at the high end of the cost-per-life-year range that might be considered cost-effective and also is of modest benefit. Repeated screening is not cost-effective.

Aged↗
PubMed1993

The General Electric-Association of University Radiologists Radiology Research Academic Fellowship (GERRAF). An industry-academic collaboration to improve clinical research in radiology.

The association of GE Medical Systems and the AUR represents a unique collaboration between academic radiology and industry that bears important potential for elevating the quality of clinical research in radiology and developing a cadre of high-quality radiologist researchers for the future. The establishment of the GERRAF is especially timely given the new imperatives of the rapidly changing health care environment, with its emphasis on expenditure reduction. The ultimate goals of GERRAF are to develop research leaders for radiology that will provide guidance for appropriate clinical practice, better train future researchers, and secure the role of radiologists in caring for patients.

Fellowships and Scholarships↗
PubMed1993

Disk-caused nerve compression in patients with acute low-back pain: diagnosis with MR, CT myelography, and plain CT.

Ninety-five patients with acute low-back and radicular pain underwent magnetic resonance (MR) imaging and either plain computed tomography (CT) (n = 32) or CT myelography (n = 63) for diagnosis of herniated nucleus pulposus-caused nerve compression (HNPNC). Patients were followed up for at least 6-12 months. Fifty-six patients underwent surgery, and 39 received conservative treatment. Receiver operating characteristic (ROC) analysis was performed on correlation of results of blinded image reading with "true" diagnoses determined by an expert panel [corrected]. Results in subgroup analysis for ROC curve areas were MR, 0.84, versus plain CT, 0.86; MR, 0.81, versus CT myelography, 0.83; and MR, 0.82, versus findings with both CT techniques, 0.85. Results indicate no statistically significant difference in diagnostic accuracy of HNPNC among the three modalities. Thus, factors of cost, radiation dose, and invasiveness influence selection of modality. On the basis of accuracy findings, the authors suggest that MR should replace CT myelography because of the invasiveness of myelography but that MR should not replace plain CT because plain CT is equally accurate and much less costly.

Acute Disease↗
PubMed1991

Cost-effectiveness of strategies for detecting diabetic retinopathy.

A computer model has been developed to determine cost-effectiveness of screening and treatment for diabetic retinopathy from a societal viewpoint. This model was used to evaluate biannual and annual screening programs using ophthalmoscopy, fundus photography with a "nonmydriatic camera," and photography with a "mydriatic camera." Computations were performed for three subpopulations formed by patients with younger onset diabetes (age at diagnosis less than 30 years) of 5 years or more duration, with older onset diabetes (age at diagnosis greater than or equal to 30 years) who are taking insulin, and with older onset diabetes not taking insulin. Population characteristics are from a well-described southern Wisconsin population where data are available, but the computer model may be specialized to other population. Generally costs of screening programs appear to be recovered by avoided costs of blindness in the population subgroups taking insulin; however, the cost of screening programs generally are not recovered by avoiding costs of blindness in the older onset population subgroup not taking insulin. It was estimated that supplying annual examination with mydriatic fundus photography as a screening program to a cohort of 1,000 diabetics from the younger onset population who have been diagnosed at least 5 years and who are currently not receiving care might save 319 sight years over the lifetime of the cohort. This program will save 62 sight years in an older onset cohort who are taking insulin, and 21 sight years in the older onset population not taking insulin (all benefits are presented as present values computed with an annual discount rate of 5%). Other programs achieve slightly lower savings in each subpopulation.

Adult↗
PubMed1988

The art of medicine: subjective measures as predictors of outcome in stroke and traumatic brain injury.

This study was designed to explore new ways of predicting the functional outcomes of stroke and brain injury patients. Upon admission and initial assessment of functional performance, we used an on-line computer program to indicate the most important and subjective judgment items to set rehabilitation goals for patients. The functional performance and discharge outcomes of patients from an inpatient program were measured by using five nonmedical functional items from the patient evaluation conference system (PECS). For stroke patients we most frequently selected motor loss, perceptual/cognitive deficit, spasticity, sensory deficit (PECS medical items), and comprehension (subjective cue). For traumatic brain injury patients, however, we selected motor loss, perceptual/cognitive deficit, spasticity (PECS medical items), communication, and comprehension (subjective cues). Data were statistically analyzed using the Fisher Exact Test. Of the medical function items, a level of independence in the sensory deficit function in stroke patients at admission was associated with a patient achieving independence in ambulation at discharge. Demonstrating a moderate or maximum level of attention, concentration, and realism was positively related to a patient achieving a level of independence in ambulation at discharge. Independence in the function items of behavior and interaction was associated with moderate or maximum levels of comprehension at admission. In traumatic brain injury patients, none of the subjective cues were associated with achieving independence at discharge in any of the functional levels. This paper demonstrates the value of developing a way to assess subjective measures that are based on their ability to predict outcomes. Using such a method, new predictive measures can be developed.

Adolescent↗
PubMed1986

A program for training and feedback about probability estimation for physicians.

Medical decisions are rarely made under conditions of complete certainty. In the past decade there has been a rapid growth of interest in formal methods for optimizing medical decisions under uncertainty. Application of decision-analytic methods requires physicians to make probability estimates about clinical events for which extensive data are not available. This paper describes a computer program to train physicians to be better probability estimators: to make probability estimates that are numerically meaningful for use in formal decision analyses. It is designed to be a stand-alone application requiring about 2 hours of physician time. Use requires an IBM-PC or compatible microcomputer with graphics adaptor and monitor, and 8087 coprocessor.

Computer-Assisted Instruction↗
PubMed1985

A cost-effectiveness analysis of screening for carcinoma of the prostate by digital examination.

While screening for carcinoma of the prostate by digital examination has been promoted as low in cost, safe, and effective, recent reviews have questioned its cost-effectiveness. Critical analysis has been lacking because of limited understanding of the preclinical phase of the disease and because of the absence of pertinent large-cohort data. We conducted a cost-effectiveness analysis of digital examination for prostate cancer using computer simulation of a large-cohort study. The simulation allowed for study of variations in critical assumptions about the disease and the screening procedure and keeps track of outcome descriptors such as total cost of the screening program and total years of life saved over the life of the cohort. Under assumptions favoring demonstrations of benefit from screening, modest increases in life expectancy were found in direct proportion to frequency and increasing costs of screening.

Aged↗
PubMed1984

Skull fracture and the low risk of intracranial sequelae in minor head trauma.

The presence of skull fracture has been associated with a higher risk of intracranial sequelae than if a fracture were not present. This is true for the total population of head-injury patients. However, reanalysis of the patient selection criteria data from two large published series on skull imaging in head trauma revealed that this increased risk factor for intracranial sequelae did not apply to a specific subset of minor-head-trauma patients. The patients in this subset were characterized by the presence of one or more of five "low-yield" criteria: (1) asymptomatic (no complaints), (2) headaches, (3) dizziness, (4) scalp hematoma, and (5) scalp laceration. All other criteria were absent. Results of the reanalysis showed (from a total population of 3031 head-trauma patients) a subset of 1184 patients characterized by these five criteria. In these 1184 minor-head-trauma patients there were 19 fractures, all linear, with none depressed or basilar. There were no intracranial sequelae. This change in the concept of fracture as a risk factor for intracranial sequelae has major implications in the future development of strategies for selecting patients for not having skull films or head computed tomograms.

Brain Injuries↗
PubMed1984

Optimizing work-up of adult hypertensive patients for renal artery stenosis. Observations about hypertensive urography, digital subtraction arteriography, and patient selection.

To optimize the use of digital subtraction arteriography in the evaluation of hypertensive patients, the use of this diagnostic test should be linked to the treatment choice of surgery. To accomplish this, the patient selection criteria for digital arteriography should be the same as those used to select patients for surgical correction of renal artery stenosis with a high likelihood of surgical cure.

Adult↗
PubMed1983

An evaluation of multiple trauma severity indices created by different index development strategies.

Evaluation of the effectiveness of emergency trauma care systems is complicated by the need to adjust for the widely variable case mix found in trauma patient populations. Several strategies have been advanced to construct the severity indices that can control for these population differences. This article describes a validity and reliability comparison of trauma severity indices developed under three different approaches: 1) use of a multi-attribute utility (MAU) model; 2) an actuarial approach relying on empirical data bases; and 3) an "ad hoc" approach. Seven criteria were identified to serve as standards of comparison for four different indices. The study's findings indicate that the index developed using the MAU theory approach associates most closely with physician judgments of trauma severity. When correlated with a morbidity outcome measure, the MAU-based index shows higher levels of agreement than the other indices. The index development approach based on the principles of MAU theory has several advantages and it appears to be a powerful tool in the creation of effective severity indices.

Actuarial Analysis↗
PubMed1982

Hypertensive urogram: a nondiscriminatory test for renovascular hypertension.

Evidence has accumulated from clinical experience that the hypertensive urogram is not a satisfactory screening test for differentiating hypertension due to renal artery stenosis from essential hypertension. This is contrary to the conclusion reached in the report of the Cooperative Study published in 1972. The present investigation was done to: (1) reassess the value of the hypertensive urogram on the basis of experience at a single institution and (2) to reassess the validity of the Cooperative Study conclusions. In 197 patients operated on at the University of Michigan for renal artery stenosis during 1961-1977, the true-positive rate for hypertensive urography for prediction of surgical cure or improvement was 60.2%. In 131 patients undergoing hypertensive urography in 1977, the incidence of positive examinations in screening was 0.8%. The chance for a favorable surgical outcome in hypertensive patients having positive hypertensive urograms is now calculated as 24%, rather than 50% as stated in the Cooperative Study. Reanalysis of the Cooperative Study data also shows that the false-negative rate for screening is at least 21.8%, rather than 1.7%. A screening strategy fo choosing patients for renal arteriography and surgery on the basis of clinical factors and excluding urography is presented.

Adolescent↗
PubMed1980

Incidental appendectomy in the elderly? No.

This study examines the appropriateness of incidental appendectomy in the elderly. By examining the incidences of appendicitis and incidental appendectomy in 1977 in Wisconsin's elderly, this study calculated the chances that a citizen undergoing incidental appendectomy would have required otherwise an operation for appendicitis in his remaining lifetime. The 1977 incidences of appendicitis procedures and incidental appendectomy in citizens greater than or equal to 65 years were 0.78 and 1.59 per 1,000 population at risk. During 1977, 3.73 persons were spared an appendicitis operation in their remaining lifetimes because 3.82 incidental procedures were performed. This represents over 100 incidental procedures to avoid a single case of appendicitis. At a 1977-78 mortality rate of 3.5% for appendicitis in patients greater than or equal to 65 years, nearly 3,000 incidental procedures must be performed to save a life which would be lost to appendicitis otherwise. We doubt that incidental appendectomy in the elderly can be performed to better this threshold of risk. Therefore, we believe that incidental appendectomy is not indicated in the elderly, since it would appear that the risk of incidental appendectomy would outweigh its potential benefits.

Aged↗
PubMed1979

A second look at the utility of radiographic skull examination for trauma.

A prospective study tested the hypothesis of Bell and Loop (1971) that 21 high yield findings are significantly associated with the presence of a skull fracture and can be used to decide which patients need skull radiography. In our study, 17 fractures were detected in 594 patients who had skull radiography because of trauma to the head. Six of these fractures occurred in children who had none of the 21 Bell and Loop high yield findings. These six patients were asymptomatic except for superficial injury at the site of trauma. Had the Bell and Loop criteria been used to decide which patients had skull radiography, 35% (all in children) of the fractures would have gone undetected. Thus, in our study population, the Bell and Loop high yield findings were not satisfactory criteria for the decision about obtaining skull films in children.

Adolescent↗