Search PubMed⌕ Search

Biomedical subjects

B P Simmons

Publications and source records attributed to B P Simmons.

At least 19 recordsLinked to original sources
PubMed1995

Symptoms, functional status, and neuromuscular impairment following carpal tunnel release.

This study examined the resolution of symptoms, functional limitations and neuromuscular impairments following carpal tunnel release. Thirty-five patients were evaluated preoperatively and 6 weeks, 3 months, 6 months, and a mean of 27 months postoperatively. Evaluation consisted of physical examination (performed in a subset of patients) and previously validated questionnaire scales measuring symptoms, functional limitations, and satisfaction. Nocturnal pain, tingling, and numbness improved within 6 weeks after surgery. Weakness and functional status improved more gradually. Grip and pinch strength worsened initially, returned to pre-operative levels after about 3 months, and improved significantly by 24 months. The Tinel and Phalen signs remained positive in two and seven patients, respectively, after 2 years, and two-point discrimination remained abnormal in over half of patients after 2 years. These temporal patterns should be discussed with patients to foster realistic expectations of the response to surgery.

Carpal Tunnel Syndrome↗
PubMed1995

Epidemiologic approaches to quality assessment.

Hospital epidemiologists have an opportunity to apply their skills to hospital quality problems other than infection control. Soon, hospitals will be required to collect and report numerous quality indicators, whose results will require epidemiologic interpretation. For those who choose to make the transition into quality management, careful assessment and planning are needed to succeed.

Epidemiology↗
PubMed1995

Nonunion of the scaphoid in children treated by Herbert screw fixation and bone grafting. A report of five cases.

In children, nonunion of fractures of the waist of the scaphoid is uncommon. Treatment has included bone grafting without internal fixation, bone grafting with Kirschner-wire fixation, and screw fixation without bone grafting. We report the successful use of Herbert screw fixation and iliac-crest bone grafting in five cases, all of which healed without further surgery. At an average follow-up of 3.3 years, the range of motion, grip strength, carpal stability, and radiological appearances were all excellent.

Adolescent↗
PubMed1995

Replacement of "other" joints.

Replacement of larger joints other than the hip and knee has been relatively disappointing and remains in a developmental stage. In the small joints, initial enthusiasm for silicone rubber arthroplasty has diminished in all sites except the MCPs because of the recognition of the high frequency of silicone synovitis. Further research and development is ongoing. This article was intended to facilitate understanding of the choices of operative procedures, the types of available components, and particularly, the specifics of radiographic assessment of the success or failure of these "other" prostheses. We hope this information will be helpful in assessing postoperative radiographs, as "We only see what we look for and we only look for what we know."

Ankle Joint↗
PubMed1993

A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome.

We developed a self-administered questionnaire for the assessment of severity of symptoms and functional status in patients who have carpal tunnel syndrome. The reproducibility, internal consistency, validity, and responsiveness to clinical change of scales for the measurement of severity of symptoms and functional status were evaluated in a clinical study. The scales were highly reproducible (Pearson correlation coefficient, r = 0.91 and 0.93 for severity of symptoms and functional status, respectively) and internally consistent (Cronbach alpha, 0.89 and 0.91 for severity of symptoms and functional status, respectively). Both scales had positive, but modest or weak, correlations with two-point discrimination and Semmes-Weinstein monofilament testing (Spearman coefficient, r = 0.12 to 0.42). In thirty-eight patients who were operated on in 1990 and were evaluated a median of fourteen months postoperatively, the mean symptom-severity score improved from 3.4 points preoperatively to 1.9 points at the latest follow-up examination, while the mean functional-status score improved from 3 to 2 points (5 points is the worst score and 1 point is the best score for each scale). Similar improvement was noted in twenty-six patients who were evaluated before and three months after the operation. We concluded that the scales for the measurement of severity of symptoms and functional status are reproducible, internally consistent, and responsive to clinical change, and that they measure dimensions of outcomes not captured by traditional measurements of impairment of the median nerve. These scales should enhance standardization of measurement of outcomes in studies of treatment for carpal tunnel syndrome.

Adult↗
PubMed1991

Continuous quality improvement. Concepts and applications for physician care.

There has been a growing interest by health care leaders in the continuous quality improvement method of quality management. This method uses measurements of quality "indicators" to initiate and drive organizational changes in a never-ending cycle of continuous improvement. Many discussions of the continuous quality improvement method have emphasized the organizational and attitudinal changes necessary to fully implement the model while deemphasizing the uses of measures of quality to guide improvement. In this article, we emphasize the concepts behind the measurement of quality that underline the continuous quality improvement model and give examples of how these concepts can be immediately applied to guide improvement in the quality of physician care.

Continuity of Patient Care↗
PubMed1991

Environmental versus analytical variability in exposure measurements.

Measurements of 8-hr time-weighted average (TWA) exposures are subject to environmental variability and collection and analytical error. Environmental variability can be represented by the geometric standard deviation (GSD) of the lognormally distributed 8-hr TWAs; analytical variability can be represented by the coefficient of variation (CV) of the normally distributed collection and analytical errors. A mathematical expression is derived for the variance of the measured 8-hr TWAs as a function of the GSD of the true daily average exposures and the total CV of the industrial hygiene method used in monitoring. For typical values of the GSD and CV, environmental variability is far more important than analytical variability in determining the variance of the measured 8-hr TWAs. A resulting policy implication is that the Occupational Safety and Health Administration inappropriately focuses on analytical variability when determining compliance with its permissible exposure limits.

Bias↗
PubMed1990

Cefamandole versus cefonicid prophylaxis in cardiovascular surgery: a prospective study.

We randomized 400 patients who were scheduled for an elective cardiovascular operation involving median sternotomy to receive cefamandole nafate or cefonicid in a prospective double-blind study. Three hundred fifty-seven patients were evaluable for prophylactic efficacy. Chest wound and donor site infections and early prosthetic valve endocarditis occurred more frequently with cefonicid (11 patients, 6.3%) than with cefamandole (4 patients, 2.2%) (p = 0.05). Three patients, all in the cefonicid group, required sternal debridement to control postoperative deep wound infections. Twenty-five miscellaneous postoperative infections (urinary tract infection, pneumonia, intravenous site infection, bacteremia, sepsis, Clostridium difficile diarrhea) occurred in 16 patients (9.19%) in the cefonicid group and four in 4 patients (2.19%) in the cefamandole group (p = 0.003). These data indicate that cefamandole is superior to cefonicid in preventing both surgical wound infections and miscellaneous nonsurgical infections after cardiovascular operations.

Cardiac Surgical Procedures↗
PubMed1990

Pediatric herpetic hand infections.

Fourteen cases of pediatric herpetic hand infection were admitted over a 15-year period. Five cases were documented by viral culture, four by Tzanck smear; the remainder were diagnosed on clinical grounds. The natural history of herpetic hand infections is similar in adult and pediatric populations. Adult infections are most frequently found in medical and dental personnel; pediatric infections are most common in children between 5 months and 6 years of age. Whereas adult infections are usually the result of exogenous occupational or sexual exposure, 11 (80%) of 14 pediatric cases exhibited coexistent oral lesions. Treatment in all cases is nonsurgical; resolution is complete within 3 to 4 weeks. Antibiotics are indicated only in the advent of bacterial superinfection.

Child↗
PubMed1990

Risk factors for wound infections after total knee arthroplasty.

Wound infections are an infrequent but serious complication of total knee arthroplasty. Between January 1984 and November 1987, 20 of 243 (8.2%) patients at two affiliated hospitals developed surgical wound infections following 259 total knee arthroplasty procedures performed in clean-air operating rooms. Eighteen (90%) of the patients had deep infections; nine required removal of the prosthesis. A single surgeon (surgeon X) was associated with 18 of the procedures that had subsequent infection (risk ratio (RR) = 9.4, 95% confidence interval (CI) 2.2-39), and an investigation was carried out in an effort to explain the difference in infection rates between surgeon X and other surgeons. In a cohort study, stratified analyses identified a preoperative American Society of Anesthesiologists (ASA) physical status class greater than or equal to 3, surgeon X, and early postoperative use of a continuous passive motion device as risk factors associated with surgical wound infection following total knee arthroplasty procedures. Logistic regression analyses identified being a patient operated on by surgeon X with an ASA class greater than or equal to 3 as the only significant independent risk factor for total knee arthroplasty-associated surgical wound infections (RR = 9.3, 95% CI 2.8-31). The effect due to surgeon X could not be explained by receipt or timeliness of administration of antimicrobial prophylaxis, type of prosthesis inserted, duration of operation, postoperative use of continuous passive motion, or underlying etiology of joint disease. The authors conclude that surgical technique and patient's severity of illness were the primary determinants of surgical wound infection after total knee arthroplasty. This study demonstrates the complexity of epidemiologic investigation of surgical wound infections and the importance of considering patient severity of illness when interpreting surgeon-specific infection rates.

Cohort Studies↗
PubMed1989

Enterobacter sakazakii infections in neonates associated with intrinsic contamination of a powdered infant formula.

We report an outbreak of Enterobacter sakazakii infection and colonization in neonates related to an infant formula contaminated during the manufacturing process. The outbreak occurred in a 20-bed neonatal intensive care unit during a six-week period in 1988, and involved a total of four infants. Three infants had sepsis and three had bloody diarrhea; all patients responded to intravenous antibiotics and recovered without complications. The E sakazakii isolated from the formula had the same plasmid and multilocus enzyme profile as those isolated from patients. This outbreak demonstrates the significance of commercially contaminated formulas and emphasizes the need to limit contamination and multiplication of bacteria in enteral formulas.

Cross Infection↗