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S K Plume

Publications and source records attributed to S K Plume.

9 recordsLinked to original sources
PubMed1992

A methodology for QI in the coronary artery bypass grafting procedure involving comparative process analysis.

This report describes an example of applying comparative process analysis to improve surgical procedures. This approach to health care quality improvement relies on combining techniques from the technical disciplines of systems analysis and systems engineering with concepts embodied in the philosophies of total quality management. Coronary artery bypass grafting (CABG) has been examined in a cooperative observational study involving an engineer, cardiac surgeons, perfusionists, nurses, and an anesthesiologist. A baseline process flow for the CABG procedure was developed, against which interinstitutional variations among the five participating medical centers have been identified. On the basis of analysis of the variations, efforts are under way to develop a strategy for incremental continuous improvement in the CABG procedure in each of the five institutions. On the basis of the perceived success of the first phase of the activity, a second phase, wider in scope, has been undertaken.

Coronary Artery Bypass↗
PubMed1992

Multivariate prediction of in-hospital mortality associated with coronary artery bypass graft surgery. Northern New England Cardiovascular Disease Study Group.

BACKGROUND: A prospective regional study was conducted to identify factors associated with in-hospital mortality among patients undergoing isolated coronary artery bypass graft surgery (CABG). A prediction rule was developed and validated based on the data collected. METHODS AND RESULTS: Data from 3,055 patients were collected from five clinical centers between July 1, 1987, and April 15, 1989. Logistic regression analysis was used to predict the risk of in-hospital mortality. A prediction rule was developed on a training set of data and validated on an independent test set. The metric used to assess the performance of the prediction rule was the area under the relative operating characteristic (ROC) curve. Variables used to construct the regression model of in-hospital mortality included age, sex, body surface area, presence of comorbid disease, history of CABG, left ventricular end-diastolic pressure, ejection fraction score, and priority of surgery. The model significantly predicted the occurrence of in-hospital mortality. The area under the ROC curve obtained from the training set of data was 0.74 (perfect, 1.0). The prediction rule performed well when used on a test set of data (area, 0.76). The correlation between observed and expected numbers of deaths was 0.99. CONCLUSIONS: The prediction rule described in this report was developed using regional data, uses only eight variables, has good performance characteristics, and is easily available to clinicians with access to a microcomputer or programmable calculator. This validated multivariate prediction rule would be useful both to calculate the risk of mortality for an individual patient and to contrast observed and expected mortality rates for an institution or a particular clinician.

Aged↗
PubMed1991

A regional prospective study of in-hospital mortality associated with coronary artery bypass grafting. The Northern New England Cardiovascular Disease Study Group.

OBJECTIVE: A prospective regional study was conducted to determine if the observed differences in in-hospital mortality rates associated with coronary artery bypass grafting (CABG) are solely the result of differences in patient case mix. DESIGN-Regional prospective cohort study. Data including patient demographic and historical data, body surface area, cardiac catheterization results, priority of surgery, comorbidity, and status at hospital discharge were collected. This study presents data for 3055 CABG patients between July 1, 1987, and April 15, 1989. SETTING: This study includes data from all surgeons performing cardiothoracic surgery in Maine, New Hampshire, and Vermont; the data were collected from five regional medical centers. PATIENTS: Data were collected from all consecutive isolated CABG surgery patients during the study period. MAIN OUTCOME MEASURES: Crude and adjusted in-hospital mortality rates associated with CABG. MAIN RESULTS: The overall crude in-hospital mortality rate for isolated CABG was 4.3%. The rate varied among centers (range, 3.1% to 6.3%) and among surgeons (range, 1.9% to 9.2%). Predictors of in-hospital mortality included increased age, female gender, small body surface area, greater comorbidity, reoperation, poorer cardiac function as indicated by a lower ejection fraction, increased left ventricular end diastolic pressure and emergent or urgent surgery. After adjusting for the effects of potentially confounding variables, substantial and statistically significant variability was observed among medical centers (P = .021) and among surgeons (P = .025). CONCLUSION: We conclude that the observed differences in in-hospital mortality rates among institutions and among surgeons in northern New England are not solely the result of differences in case mix as described by these variables and may reflect differences in currently unknown aspects of patient care. Understanding this variation requires a detailed understanding of the processes of care.

Adult↗
PubMed1977

Arteriosclerotic femoral artery aneurysms.

Arteriosclerotic aneurysms of the femoral artery are uncommon lesions that occur in elderly men. In 30 patients 36 aneurysms were repaired at the Toronto Western Hospital from January 1965 to June 1977. Half of the patients presented with ischemia and one quarter with an enlarging mass, and one quarter had no symptoms. Two thirds had other aneurysms and one third had suffered from cerebral or myocardial ischemia. The technique of repair changed from reconstructive aneurysmorrhaphy before 1970 to use of an interposition arterial prosthesis thereafter. Minimal groin dissection, internal control of blood flow in the deep femoral artery, and use of an appropriate arterial prosthesis provided excellent results. Surgical repair is recommended for most symptomatic ones when the patient's life expectancy is more than 2 years.

Aged↗
PubMed1977

Thrombosis of Björk-Shiley aortic valve prosthesis: report of three cases.

Thrombotic malfunction of a Björk-Shiley aortic valve prosthesis occurred in three patients 6 to 16 months postoperatively. None of the patients had been taking anticoagulants. Although the presentation was acute, prodromal symptoms could be identified retrospectively in two of the patients. Two patients survived thrombectomy. Postoperative anticoagulant therapy is recommended in patients with these prostheses despite factors that may make such therapy riskier in specific patients. Attention to the character of murmurs and of the closure sound of the prosthetic valve must be part of the routine follow-up. In the emergency situation, when delay must be avoided, catheterization and angiography are unnecessary. The operative approach consists of complete thrombectomy without replacement of the valve or any of its components unless there is obvious periprosthetic leak or prosthetic wear.

Adult↗
PubMed1976

Pharmaco-cholangiography with anticholinergic drugs in the dog.

The effect of atropine and pipenzolate bromide (PB) in different dosage levels was investigated in intravenous cholangiography with 0.6 ml/kg iodipamide infused over 30 minutes in six cholecystectomized dogs (20-36 kg) equipped with Thomas cannulas through which the common bile duct could be cannulated. Doses of 1 mg atropine and 20 mg PB, half the dose given intravenously just prior to the contrast agent and the other half with the iodipamide infusion, had the greatest effect in decreasing the bile flow (atropine-24% at 60, PB-23% at 30 minutes) and increasing the bile iodine concentration (atropine + 16%, PB + 14%). The biliary iodipamide excretion rate was not affected.

Animals↗