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Biomedical subjects

D L Sanders

Publications and source records attributed to D L Sanders.

14 recordsLinked to original sources
PubMed2001

The effects on clinician ordering patterns of a computerized decision support system for neuroradiology imaging studies.

OBJECTIVE: To evaluate the impact of computerized ordering guidelines on clinician ordering patterns for neuroradiology imaging studies of the head. DESIGN: A retrospective analysis was performed using a pre-post design. A 9-week control period was followed by an 8-week intervention period. SUBJECTS: All clinicians who placed an order for either an MRI of the brain or a CT of the head on inpatients using a computerized order entry system. METHODS: We designed, implemented, and evaluated a decision support system for the implementation of test ordering guidelines. Changes in ordering patterns were evaluated with a Chi-square analysis. RESULTS: 742 tests were ordered in the pre-intervention period, while 704 studies were ordered after the intervention. A significant change in the distribution of tests ordered resulted from the intervention (p=0.048). Changes trended toward the guideline recommendations for all tests considered. 60% of users receiving a recommendation ordered the suggested study. DISCUSSION: Our intervention successfully influenced clinician ordering patterns. Examination of detailed usage patterns may aid in further quality improvement of both the guidelines and the decision support tool used to implement them.

Brain↗
PubMed2000

Wound healing and collagen thermal damage in 7.5-microsec pulsed CO(2) laser skin incisions.

BACKGROUND AND OBJECTIVE: Wound-healing delays caused by lateral thermal damage to tissue remain a drawback of CO(2) surgical lasers. This study compares the thermal damage and wound-healing properties of a 7.5-micros pulsed CO(2) laser with scalpel and continuous wave (CW) CO(2) laser incisions. STUDY DESIGN/MATERIALS AND METHODS: We created incisions on the dorsal pelts of rats with a 7.5-micros pulsed CO(2) laser at 5-, 10-, or 15-Hz repetition rate, a conventional CW laser, or scalpel. Animals were euthanized at postoperative days 3, 7, 14, 21, and 80. Tissue was harvested and analyzed histologically and for wound tensile strength. In addition, tissue was harvested acutely and analyzed for acute thermal injury lateral to the incisions. RESULTS: Incisions made with the pulsed laser had significantly higher tensile strength and histologic rankings than did CW laser incisions at days 3-21, producing 118 microm of thermal damage to tissue as compared with 333 microm for CW laser. Pulsed laser incisions were not statistically different than scalpel incisions at days 3-14 of healing. Mathematical modeling showed the pulsed laser to produce a wound healing delay of 1.0 day by tensiometry and 1.9 days by histology, compared with 3.2 days by tensiometry and 6.0 days by histology for CW laser. There were no significant differences in wound healing when the pulsed laser was used at repetition rates of 5-15 Hz. CONCLUSIONS: Using a 7.5-micros pulse duration, CO(2) laser incisions healed at a rate similar to scalpel incisions and reduced the wound-healing delay seen with typical surgical CO(2) lasers.

Animals↗
PubMed1999

Analysis of a critical pathway in osteoplastic flap for frontal sinus obliteration.

OBJECTIVES: A critical pathway was applied to patients undergoing osteoplastic flap (OPF) for frontal sinus obliteration to determine whether efficiency could be improved. STUDY DESIGN: A retrospective review of consecutive OPF procedures (n = 51) performed between 1992 and July 1997 was conducted. METHODS: The patient groups were subdivided into those who underwent OPF alone and those who had endoscopic sinus procedures performed in addition to OPF. Comparisons were made between the precritical pathway and post-critical pathway groups, specifically noting operative time, total operating room (OR) time, estimated blood loss (EBL), length of hospital stay, and costs. We used a critical pathway that was developed for endoscopic sinus procedures at our institution through a multidisciplinary team approach. Preoperative evaluation and testing, intraoperative equipment and medications, and postoperative care including follow-up clinic visits were all standardized. An unpaired, two-tailed Student t test was used to evaluate the data. RESULTS: Statistically significant (P<.05) reductions in operative times, total OR time, EBL, and length of hospital stay were observed in the post-critical pathway group who underwent endoscopic sinus procedures as well as OPF. Costs to the OR were reduced 29% and 15% for OPF and for OPF with endoscopic surgery, respectively. Patient costs were reduced 5% and 4% in these groups, respectively. CONCLUSIONS: With implementation of effective critical pathways, significant decreases in length of stay are seen, and cost reductions can be realized through the improved efficiency, shortened OR times, and decreases in redundancy of ordering materials.

Bone Transplantation↗
PubMed1999

Inhibition of subglottic stenosis with mitomycin-C in the canine model.

The objective of this randomized, prospective study was to study the efficacy of topical mitomycin-C in the inhibition of subglottic stenosis in a canine model. Subglottic stenosis was elicited with the carbon dioxide laser in 10 mongrel dogs. Radial incision and serial dilation of the subglottic airway were then carried out. The animals were randomized to receive a topical solution of 1% mitomycin-C to the dilated area for a 5-minute duration or no further treatment. Weekly direct microlaryngoscopy and photodocumentation were performed during the 6-week study. Airway distress developed in 4 of the 5 control dogs, requiring early sacrifice, while all treatment group animals survived the duration of the study (p < or = .006). Morphometric analysis of the subglottic photographs confirmed a greater than 100% increase in the percentage of relative airway at sacrifice in the treatment group (p < or = .049). A statistically significant (p < or = .015) decrease in collagen formation in the subglottic scar of dogs treated with topical mitomycin-C was documented. Mitomycin-C favorably altered the clinical progression of subglottic stenosis, improved quantified airway patency, and reduced the amount of subglottic collagen formation in the canine model.

Administration, Topical↗
PubMed1995

Steam sterilization of laparoscopic instruments.

Because of the intricate internal parts of laparoscopic instruments, questions have been raised about the efficacy of cleaning and sterilization techniques. To assess these risks, hamburger meat was inoculated with high concentrations of vegetative pathogens and packed into laparoscopic cannulas. All openings of the cannulas were sealed during steam sterilization cycles ranging from 3 to 10 min in different experiments; cultures were obtained after cooling. Experiments were then performed using heat-resistant spore forms. Our studies showed that both the standard 10-min cycle and the 3-min "flash" were uniformly successful in killing all pathogenic microorganisms. A 7-min steam sterilization was necessary to kill spores within sealed cannulas. We conclude that a standard 10-min cycle within the steam autoclave provides complete sterilization of laparoscopic instruments; the 3-min "flash" sterilization is appropriate and safe for instruments that have been inadvertently contaminated or dropped during a surgical procedure.

Equipment Contamination↗
PubMed1994

Common bile duct evaluation in the era of laparoscopic cholecystectomy. 1050 cases later.

OBJECTIVE: The authors documented the evolution of common bile duct (CBD) evaluation after the development of laparoscopic cholecystectomy (LC) and CBD exploration. Emphasis was placed on stratification of CBD stone risk so that subgroups could be selected appropriately for no further studies, preoperative endoscopic retrograde cholangiogram (ERC), or intraoperative intervention. METHODS: Data were accumulated by the authors on presentation, findings, and outcomes of 1050 patients who underwent cholecystectomies. Risk stratification was based on the history, ultrasound findings, biochemical derangements, and operative findings. RESULTS: Fifty-seven per cent of patients met criteria to be "no/low" risk for CBD stones (CBD diameter < 5 mm, normal liver enzymes, and no history of acute cholecystitis, jaundice, or pancreatitis); in these patients, cholangiograms were not obtained, and there was no clinical evidence of CBD stones observed in follow-up at 45 months (sensitivity = 100%). As techniques developed for laparoscopic CBD exploration, there was a decreased incidence of open cholecystectomy (p < 0.05) and preoperative ERC (p < 0.05). The rate of operative cholangiogram increased from 13% to 23% during the series (p < 0.01). There were no CBD injuries or late strictures. The only bile leak occurred from a peripheral segmental duct in the gallbladder bed and was resolved with a laparotomy and suture. There were no transfusions. Three retained stones were documented in patients who had false-normal operative cholangiograms. CONCLUSIONS: Criteria were defined that delineate a "no/low" risk group of LC patients for whom operative cholangiograms were not indicated for excluding CBD stones. The routine use of operative cholangiography as a means of preventing CBD injury was not substantiated by this study. The indications for preoperative ERC should continue to decrease as laparoscopic techniques evolve.

Adolescent↗
PubMed1993

Physician hospital organizations: through lawyers' eyes.

A physician hospital organization may be a necessary step in the evolution of health care. However, many important decisions must be made in addressing the competing requirements of hospitals and physicians in the original design of the organization.

Humans↗
PubMed1987

Conditioned saccharin aversions in rats as a result of cutaneous nicotine or intraperitoneal nicotine administered in divided doses.

Nicotine base was used in a conditioned taste aversion (CTA) paradigm to avert male Sprague-Dawley rats to saccharin solution (0.1%, w/v). Experiments investigated different dose routes of nicotine administration and duration of action as determinants in nicotine-induced CTA. In Experiment 1 nicotine was injected intraperitoneally (IP) at doses of 0.5, 1.0, or 3.0 mg/kg 30 min after drinking saccharin solution. Using a two-bottle choice test, no CTA was observed, although all nicotine animals showed obvious symptoms of malaise including seizures in the highest dose group. Experiment 2 showed dose-related CTA when nicotine (10.0, 30.0, or 50.0 mg/kg) was cutaneously applied 30 min following saccharin drinking. Experiment 2B showed that the aversions were due to associative rather than nonassociative factors such as sensitization or enhanced neophobia. In Experiment 3, the following group treatments were begun 30 min after saccharin drinking to distribute identical total nicotine doses over an extended period of time: One IP injection of 2.0 mg/kg nicotine (in a saline vehicle) and four injections of saline solution, three injections of 0.67 mg/kg nicotine and two injections of saline, five injections of 0.40 mg/kg nicotine, or five injections of saline. All injections were spaced 30 min apart. Compared with saline-injected controls, CTA occurred in the rats receiving either three or five injections of nicotine but the group receiving one injection did not differ from the control group. There was no difference in CTA between the groups receiving three or five injections.

Administration, Topical↗
PubMed1986

Saccharin aversions in hamsters as a result of nicotine injections.

Golden Syrian hamsters (males, N = 70) showed dose-related conditioned taste aversion (CTA) when saccharin drinking was followed by delayed nicotine injections. Baseline consisted of measuring amounts consumed after 20 minutes of daily access to tap water. Measures were taken for five days. The hamsters were then conditioned by offering them saccharin solution (0.1%, w/v) for 20 minutes; afterwhich a 30 minute delay was imposed. Subsequent to the delay, groups of 10 animals were treated as follows: nicotine injection (1.0, 3.0, or 9.0 mg/kg, IP), saline injection, lithium chloride injection (2% body weight of a 0.15 M solution), sham injection, or left in their cages as handling/stress controls. Following two recovery days with plain water available for 20 minutes, all animals were tested for CTA by offering them saccharin solution. Dose-related CTA was demonstrated in the nicotine animals as measured by a decrease in saccharin consumption compared to drinking measures obtained from animals injected with saline. Lithium chloride produced the same degree of CTA as 9 mg/kg of nicotine, and the aversions had extinguished in all groups by the third test day.

Animals↗