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S R Springman

Publications and source records attributed to S R Springman.

9 recordsLinked to original sources
PubMed1991

The pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters: a prospective study utilizing molecular subtyping.

To delineate the pathogenesis and epidemiology of catheter-related infection with Swan-Ganz pulmonary artery (PA) catheters, a prospective clinical study of hospitalized adult medical and surgical patients was done. Role of catheter material was assessed by randomizing insertions to heparin-bonded PA catheters made of polyvinylchloride or polyurethane. Sources of infection and pathogenesis were studied by culturing skin, the introducer, the PA catheter tip, all hubs, infusate from each lumen, and the extravascular portion of the PA catheter beneath the external protective plastic sleeve. Concordance between isolates from sources and infected catheters was determined by speciation, antibiogram, and for coagulase-negative staphylococci, plasmid profile analysis. Risk factors for infection were determined by stepwise logistic regression. Overall, 65 (22%) of 297 Swan-Ganz catheters showed local infection of the introducer (58 catheters) or the intravascular portion of the PA catheter (20 catheters); only two catheters (0.7%) caused bacteremia. Eighty percent of infected Swan-Ganz catheters (the introducer or PA catheter) showed concordance with organisms cultured from skin of the insertion site, 17% with a contaminated hub and 18% with organisms contaminating the extravascular portion of the PA catheter beneath the sleeve. Isolates from infected PA catheters were most likely to show concordance with concomitantly infected introducers (71%). Cutaneous colonization of the insertion site with greater than 10(2) cfu/10 cm2 (relative risk [RR] 5.5; p less than 0.001), insertion into an internal jugular vein (RR 4.3; p less than 0.01), catheterization greater than 3 days (RR 3.1; p less than 0.01), and insertion in the operating room using less stringent barrier precautions (RR 2.1; p = 0.03) were each associated with a significantly increased risk of catheter-related infection. The risk of bacteremic infection with Swan-Ganz catheters is now low, in the range of 1%, with reasonable care. Swan-Ganz catheters are vulnerable to contamination from multiple sources, but the patient's skin is the single most important source of organisms causing invasive infection, which in most cases involves the introducer rather than the PA catheter. Heavy colonization of the insertion site, percutaneous insertion in the internal jugular vein rather than subclavian vein, catheterization longer than 3 days, and insertion with less stringent barrier precautions significantly increase the risk of catheter-related infection. These findings hold promise for application to management of Swan-Ganz catheters and research in catheter design to reduce the risk of catheter-related infection.

Adolescent↗
PubMed1988

Difficult laryngoscopy and diabetes mellitus.

The incidence of difficult laryngoscopy was determined retrospectively in 40 diabetic patients having pancreas transplantations and in 75 diabetic and 112 nondiabetic patients having kidney transplantations. Diabetes was associated with a significant increase in the proportion of patients having difficult laryngoscopies in patients having renal transplants: 0.027 in patients without diabetes; 0.320 in patients with diabetes. The incidence of difficult laryngoscopy in diabetic recipients of cadaveric kidneys (0.419) was not significantly different from that in diabetic recipients of pancreas transplants (0.40), but significantly higher than that in diabetics given kidneys from living donors (0.187). Although cadaveric recipients were older than recipients of kidneys from living donors (40.8 v. 31.6 years), age at the time of transplantation was not a significant predictor of difficulty in laryngoscopy. Groups were otherwise matched for clinical, morphologic, hematologic, and biochemical indices. Diabetic stiff joint syndrome (SJS), which predisposes a subset of Type I diabetic patients to rapidly progressive microvascular disease and subsequent need for renal and/or pancreas transplantation, may lead to difficult laryngoscopy because of involvement of the atlanto-occipital joint.

Diabetes Mellitus↗
PubMedDate not supplied

Patient safety in outpatient surgery: the viewpoint of the healthcare providers.

The objective of this study is to understand the viewpoint of healthcare providers with regard to patient safety in outpatient surgery settings. Two methods were used to gather data from the healthcare providers: (1) questionnaire with open-ended questions about six predefined stages of the patient care process; (2) survey with closed questions. With the first method, the main quality and safety of care issues concerned communication to patients, coordination of reports and forms, patient and staff time pressures and standards of care. The first two stages of the outpatient surgery process, i.e. patient work-up prior to day of surgery and patient admission and preparation on the day of surgery, yielded many more comments than the other four stages. The results of the structured questionnaire show that, overall, the healthcare providers report high quality of care provided by themselves (98%) and their surgery centre (96%). With regard to patient safety (i.e. cancellations of surgeries, patient safety problems and serious mistakes), there was a clear difference in perceptions reported by the physicians vs. the nurses and other staff. Nurses and other staff were more likely to report patient safety problems than physicians. The combination of qualitative data from the initial questionnaire and the quantitative data from the structured questionnaire provides a rather complete view of the outpatient surgery staff perceptions of quality and safety of care. This research highlights the importance of getting input from the healthcare providers regarding the quality and safety of care rather than relying only on traditional measures about patient outcomes.

Adult↗
PubMedDate not supplied

Computer-assisted continuous infusion for the delivery of target-controlled infusions of propofol during outpatient surgery.

Propofol was administered intravenously using a first-order, three-compartment, computer-controlled infusion pump (CCIP) based on the Ohmeda 9000 syringe pump. The CCIP system produced a target-controlled infusion (TCI) based on the estimated blood concentration (EBC). Twenty-five patients undergoing ambulatory surgery completed the study. The induction EBC was 4.72 +/- 0.28 micrograms/ml, and was achieved rapidly with minimal hemodynamic changes. The emergence EBC was 1.55 +/- 0.21 micrograms/ml, and the discharge EBC was 1.06 +/- 0.22 micrograms/ml. The EBC, together with clinical signs, allowed for predictable inductance and emergence from anesthesia using propofol.

Adolescent↗