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Biomedical subjects

Donald E Fry

Publications and source records attributed to Donald E Fry.

25 records · Page 2Linked to original sources
PubMed2002

The economic costs of surgical site infection.

BACKGROUND: Surgical site infections (SSIs) remain common and are a major cause of postoperative morbidity. Less well recognized is the cost of these complications, both in the direct costs of care and also in terms of lost economic productivity when workers are disabled as a result of an infection. This review was undertaken to bring into focus the relevant literature regarding the costs associated with SSI. METHODS: Review of the pertinent English language literature. RESULTS: The estimated costs of SSI vary as a function of locale, type of operation, and the extent (depth) of the infection itself. Superficial SSIs cared for in the National Health Service of the United Kingdom have an estimated cost of less that 400 dollars/case, whereas estimates range into the tens of thousands of dollars per case in the United States for complex infections such as infected joint prostheses or sternal infections following cardiac surgery. The magnitude of the problem is emphasized by a report from Denmark, which shows that the cost of care for surgical site infections consumes 0.5% of the annual hospital budget. CONCLUSION: SSI is morbid and expensive. However, not all SSIs are the same. Reports of economic costs that do not stratify for the depth of the infection or the context in which the infection occurs are potentially misstating the magnitude of these complications.

Cost of Illness↗
PubMed2002

Blood culturing practices in a trauma intensive care unit: does concurrent antibiotic use make a difference?

BACKGROUND: Febrile trauma patients have repeated blood cultures drawn during a prolonged hospitalization. We examined the diagnostic yield of blood cultures in severely injured patients to determine whether concurrent antimicrobial therapy or prophylactic administration of antibiotics affects blood culture growth. We also determined how rapidly growth changed to determine whether total numbers of blood cultures could be decreased. The hypotheses of the study were that concurrent antimicrobial administration affects blood culture yield, prophylactic administration alters the culture result, and repetitive culturing is unnecessary. METHODS: A retrospective chart review of trauma patients with minimum Injury Severity Score of 15 and minimum 5-day intensive care unit length of stay was performed. The dates and results of blood cultures and antibiotic type and administration dates were recorded. "Prophylactic" antibiotics were defined as antibiotics administered on admission to the unit. Computer software was used to match the blood culture date to the period of antimicrobial administration. Categorical data were compared using Fisher's exact test. RESULTS: Two hundred fifty-eight patients met entry criteria, and 208 charts were complete for review. One hundred twenty-nine patients had 347 sets of blood cultures drawn. The positive blood culture rate was 10.8% in patients off antibiotics, and 13.9% in patients on antibiotics (p = 0.68). All prophylactic antibiotics included a beta-lactam. Only 18% of positive blood cultures in patients receiving prophylactic antibiotics were sensitive to beta-lactams as opposed to 59% sensitivity in those who did not receive prophylaxis (p = 0.03). One hundred seventy-six sets of blood cultures were performed after an initial positive culture. Only three patients with an initial positive culture had a second positive culture with a different organism. The mean time to culturing a new organism after initial growth was 19 days. CONCLUSION: Concurrent antimicrobial administration does not alter blood culture yield. Prophylactic administration alters the type of organism cultured. Little new information is gained from repetitive culturing.

Adult↗
PubMed2002

A "health commons" approach to oral health for low-income populations in a rural state.

Oral health needs are urgent in rural states. Creative, broad-based, and collaborative solutions can alleviate these needs. "Health commons" sites are enhanced, community-based, primary care safety net practices that include medical, behavioral, social, public, and oral health services. Successful intervention requires a comprehensive approach, including attention to enhancing dental service capacity, broadening the scope of the dental skills of locally available providers, expanding the pool of dental providers, creating new interdisciplinary teams in enhanced community-based sites, and developing more comprehensive oral health policy. By incorporating oral health services into the health commons primary care model, access for uninsured and underserved populations is increased. A coalition of motivated stakeholders includes community leaders, safety net providers, legislators, insurers, and medical, dental, and public health providers.

Adult↗