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Biomedical subjects

J S McComb

Publications and source records attributed to J S McComb.

2 recordsLinked to original sources

Comparison of tubal surgery with the CO2 laser and the unipolar microelectrode.

The uterine horns of 40 New Zealand White female rabbits were resected and anastomosed to compare microsurgical anastomosis of the horns excised with microscissors, with a laser, and with a microelectrode. The rabbits were divided into four groups. In the first group of ten rabbits, 3 cm of tissue was resected by microscissors from each uterine horn; the cut ends were then anastomosed in one layer with 8-0 Vicryl sutures using the operating microscope. In the second group of ten rabbits, 3 cm of tissue was resected by laser from each uterine horn; the cut ends were then anastomosed in one layer with 8-0 Vicryl. In the third group of ten rabbits, 3 cm of tissue was resected by laser from each uterine horn; the cut ends were then anastomosed by "welding" the tissues with the laser. In the fourth group of ten rabbits, 3 cm of tissue was resected by a microelectrode; the cut ends were then anastomosed in one layer with 8-0 Vicryl sutures using loupe magnification. All the rabbits in the first and fourth groups became pregnant, only four became pregnant in the second group, and none became pregnant in the third group. It is concluded that the CO2 laser beam as used in this study has no place in tubal resection and reconstruction.

Animals↗

Decrease in expenditures and selected nosocomial infections following implementation of an antimicrobial-prescribing improvement program.

OBJECTIVE: To evaluate changes in antimicrobial use and expenditures and the rates of selected nosocomial infections due to resistant organisms associated with implementation of an antimicrobial-prescribing improvement program. DESIGN: Before-after trial comparing 1992 (pre-program), 1993 (a transition year), and 1994 (after full implementation of the program). SETTING AND PARTICIPANTS: Academic medical center, all patients and physicians. INTERVENTION: An antimicrobial-prescribing improvement program with prior approval requirement for use of restricted agents. MAIN OUTCOME MEASURES: Antimicrobial use and expenditures, rates of selected nosocomial infection marker events. RESULTS: Between 1992 and 1994, there were substantial decreases in antimicrobial use, from 158,107 to 137,364 defined daily doses, and in expenditures from $2,486,902 ($24.01 per patient day) to $1,701,522 ($18.49 per patient day). After adjusting for changes in purchase prices and census days, we estimated savings attributable to the program of $279,573 in 1993 and $389,814 in 1994. In addition, we found significant decreases between 1992 and 1994 in the rates of enterococcal bacteremia (.34 vs .16 events per 1,000 patient days; P = .016), selected gram-negative bacteremia (.26 vs .11; P = .015), methicillin-resistant Staphylococcus aureus colonization or infection (.66 vs .20; P < .0001), and Stenotrophomonas colonization or infection (.35 vs .17; P = .019). No significant change occurred in rates of nosocomial candidemia or Clostridium difficile toxin-positive diarrhea. Values for 1993 were intermediate between those of 1992 and 1994. CONCLUSION: Implementation of an antimicrobial-prescribing improvement program was associated with substantial savings in antimicrobial use and expenditures and significant decreases in rates of selected nosocomial infections due to resistant organisms.

Anti-Infective Agents↗