Biomedical subjects

James F Reed

Publications and source records attributed to James F Reed.

25 records · Page 2Linked to original sources

PubMed2002

Prevalence of mixed infections in the diabetic pedal wound: a perspective based on a national audit.

Foot infections can have disastrous consequences in the life of a diabetic. The treatment of the pedal wound demands a great deal of resources. This retrospective study was formulated to determine the incidence of polymicrobial infections. The National Hospital Discharge Survey was used to gather data regarding cultures from diabetic foot infections. Codes from surgery were used because intraoperative cultures are the most reliable. It was observed that Staphylococcus Aureus is the most frequently responsible inciting organism; regarding polymicrobial infections, Staphylococcus and Streptococcus were the most common combination found. Incidence of anaerobes and gram negatives was low. This information tells a clinician that very broad-spectrum antibiotics would most commonly not be necessary, putting the impetus on the doctors to clinically assess a wound and prescribe the most appropriate antibiotic selection.

Journal Article↗

PubMed2002

Early predictors for lower extremity amputation in a diabetic population: results of a case-controlled study.

Lower extremity amputation is devastating to any person and is a very real complication for a diabetic. Identifying early risk factors is tantamount to saving a limb. This study used the national hospital discharge survey to identify 2206 control patients and 2098 diabetic patients with a lower extremity amputation. These patients were not limited based on gender or race as in previous studies. The results show that nephropathy and retinopathy are early predictors.

Journal Article↗

PubMedDate not supplied

Comparative analysis of risk-adjusted bypass surgery stratification models in a community hospital.

BACKGROUND: Quality improvement in health care, which relies on appropriate strategies to evaluate and compare provider performance, has spawned the propagation of many public report cards or provider profiles for cardiac surgery. These risk-adjusted prediction models allow for the computation of a provider's expected outcome event rate compared with observed outcome events. The aim of this study was to assess the accuracy and reliability of 5 risk-adjusted predictive models for mortality in an independent population of patients in a community hospital who underwent coronary artery bypass graft surgery. METHODS: Five nonproprietary models were selected for evaluation (Parsonnet, Canadian, Cleveland, New York, and the Northern New England). RESULTS: The C-statistic for the 5 models was 0.752, 0.693, 0.748, 0.735, and 0.722 for the Parsonnet, Canadian, Cleveland, New York, and Northern New England models respectively. The H-L c2 calibration statistics were 4.948, P =.763; 1.616, P =.899; 11.96, P =.035; 10.23, P =.249; and c2 = 12.14, P =.145 for the Parsonnet, Canadian, Cleveland, New York, and Northern New England models respectively. CONCLUSIONS: Comparing hospital-specific or surgeon-specific mortality/morbidity rates will remain a challenge. This analysis reaffirms the concept of risk-adjusting outcomes and emphasizes the importance of the risk-adjustment process for CABG surgery in a community hospital.

Aged↗

PubMedDate not supplied

Adrenal gland trauma is associated with high injury severity and mortality.

PURPOSE: To review a statewide experience of adrenal gland trauma (AGT), incidence, demographics, associated injuries, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), mechanisms of injury, and complications, associated with AGT. METHODS: A retrospective analysis of patients admitted to accredited trauma centers in the Commonwealth of Pennsylvania who sustained AGT from January 1, 1989 to December 31, 2000. RESULTS: Adrenal trauma was found in 322 of 210,508 cases (0.15%). There were 76.4% men and 23.6% women. Seventy-one percent of patients had an ISS greater than 20. The overall mortality was 32.6%. The mechanism of injury was blunt in 81.4% of the cases and penetrating in 18.6%. Vehicular accidents constituted 48.8% of the cases. Younger age was associated with male predominance and greater proportion of penetrating injuries. Although exact indications are not known, advanced imaging studies were done in 163 of 322 (50.6%) patients: computed tomography in 133 (41.3%), ultrasound in 26 (8.1%), and angiography in 4 cases (1.2%). Exploratory laparotomy was done in 60 (18.6%), splenectomy in 25 (7.8%), nephrectomy in 14 (4.3%), and adrenalectomy in 8 (2.5%). Penetrating injuries had a 43.8% rate of exploratory laparotomy, whereas it was 12.4% in blunt trauma. Associated injuries included liver injury (57.8%), rib fractures (50.9%), kidney injury (41.3%), and spleen injury (32.9%). Pulmonary complications were most common, followed by infection/sepsis, and cardiovascular. Nearly 45% of patients were discharged home, 17% of patients were discharged to a rehabilitation facility, and 3.4% to nursing homes. CONCLUSIONS: Adrenal gland trauma is a rare and largely coincidental finding diagnosed either during an initial radiologic examination or surgical exploration for other injuries. Surgical exploration was carried out in 21.4% of patients, with adrenalectomy in 2.5% of cases and nephrectomy in 4.3% of cases. Adrenal injury is associated with high injury severity, and with mortality rates up to 5 times higher than non-AGT trauma.

Adolescent↗

PubMedDate not supplied

Improving guideline compliance: assessment of unit-based reminder for monitoring platelet counts post-PCI.

In assessing our institution's vascular access site bleeding complication rate, we found (anecdotally) that for many patients platelet count was not measured according to recommendations of the manufacturer of the predominantly used glycoprotein (GP) IIb/IIIa agents, in either the catheterization recovery unit (CRU) or the coronary care unit (CCU). We hypothesized that a unit-focused effort to remind cardiologists to order platelet counts after percutaneous coronary interventions GP IIb/IIIa would improve compliance. Findings indicated that a greater number of patients had platelet counts drawn after a reminder effort had been implemented. For both the first and second draws, the CCU had a higher pre-reminder rate than the CRU. Post-reminder, the CCU had no significant changes, whereas the CRU showed significant increases in both the first and second draws. For post GP IIb/IIIa platelet measurement, aggregate analysis (CRU and CCU) showed that, of those patients who had platelet counts drawn pre-reminder, only 18.2% met the first guideline and only 17.1% met the second. Post-reminder results showed no significant changes for the first or second draws. We concluded that the practical application of a standard operating procedure can have a secondary beneficial effect despite not meeting the stringent parameters set in prescribing guidelines.

Aged↗

PubMedDate not supplied

Ocular volume change per cardiac cycle.

Ocular pneumoplethysmograph (OPG) tests were performed in 499 employees of an industrial firm. The ocular volume change (OVC), in microliters per cardiac cycle, was calculated from each of OPG tests. In the 195 females, the OVC was 294 +/- 81 microl. In the 304 males, the OVC was 269 +/- 86 microl. The female-male OVC difference was significant, p = 0.001.

Adult↗

PubMedDate not supplied

Adjusted chi-square statistics: application to clustered binary data in primary care.

The frequency of randomized cluster trials is increasing in primary care research. These trials are differentiated by the randomization method, in which a group of individuals is randomly assigned to an intervention as a cluster rather than as individuals. Characteristically, individuals within a cluster tend to be more alike than individuals selected at random. For instance, evaluating the effect of an intervention across medical care providers at an institutional level or at a physician group practice level fits the randomized cluster model. Three examples in this article show how failure to account for the dependence introduced by unit of randomization can affect the analysis of binary data and the conclusions of randomized cluster trials. Greater consideration of the nested nature of patient, physician, and practice data would increase the quality of primary care research.

Chi-Square Distribution↗