Donald E Fry

..It is likely that other infectious agents will emerge as operating room threats. Surgeons must maintain vigilance in avoiding blood exposure and percutaneous injury...

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..This reality makes it necessary for civilian disaster-planning strategies to incorporate an understanding of chemical agents, their effects, and the necessary treatment...

..We propose that excess risk-adjusted, postoperative length of stay (poLOS) is a valid indicator of an adverse outcome...

..A fundamental reorganization will be required if care is to be broadened and sensible economies achieved...

..Data Sources. Claims and abstracted clinical data on patients hospitalized for 5 medical conditions and 3 surgical procedures at 188 Pennsylvania hospitals from July 2000 through June 2003...

..Risk-adjustment equations used in these analyses must contain sufficient clinical detail to ensure accurate measurements of hospital quality...

..The identification of cost-effective hospitals permits objective measurement of excessive surgical costs and development of strategies to improve outcomes and efficiency...

..Control charts have been proposed for the measurement of quality in surgical care...

..Uncomplicated surgical care has highly variable costs. High costs of complications have led payers to deny additional payments even for predictable complications...

..Elective peripheral vascular surgery provides quality outcomes that are of great benefit to patients, but have complications that result in severe morbidity and excessive costs...

..Risk-adjusted outcomes of surgical care are important for quality and cost assessments. Although cardiac surgery is commonly studied, risk-adjusted analysis of excess costs of lung resection has not been pursued...

..Wide ranges of reported hospital death rates led us to hypothesize that survival after elective colon resection would be a legitimate outcomes measure for quality of surgical practice...

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..Surgical site infection (SSI) continues to be a common if often times preventable infection. Considerable patient morbidity and economic cost are the consequences...

..An alternative payment structure, especially for high volume, high cost episodes of care (eg, total knee replacement), is needed to reward high quality care and reduce costs...

..Colon preparation for elective colon resection to reduce surgical site infection (SSI) remains controversial...

..In the past, this concern attracted great attention, but recently, this subject has been given much less attention...

..The actual risk and frequency of operating room transmission remains poorly understood by many surgeons...

..In summary, S. aureus will continue to challenge surgeons as an adaptable pathogen that can defy all of our treatment efforts...

..To determine whether the occurrence of "never events" after major surgical procedures is affected by patient and disease characteristics and by the type of operation performed...

..Surgical infections of interest caused by this pathogen include community-acquired infections, especially of skin and soft tissue; surgical site infections; and nosocomial infections during the post-operative period...

..We herein describe the use of antimicrobial prophylaxis for Medicare patients undergoing major surgery...

..Concerns persist that double-gloving can compromise the dexterity and tactile sensitivity of the surgeon...

..A simulated scenario is analyzed in detail to illustrate the ability of this technique to correctly determine best practices when other approaches fail to do so...

..We need to adopt a culture dedicated to quality control through better information technology and data-driven initiatives to achieve improved clinical outcomes from infectious complications in surgery...

..Perioperative nurses play an important role as the patient's infection control advocate...

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..The evolution of strategies for the prevention of SSI has had the correct use of preventive antibiotics as a crucial component...

..It is concluded that failure to define novel and effective treatments reflects fundamental gaps in our understanding of inflammation and its regulation...

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..This review was undertaken to bring into focus the relevant literature regarding the costs associated with SSI...

..The hypotheses of the study were that concurrent antimicrobial administration affects blood culture yield, prophylactic administration alters the culture result, and repetitive culturing is unnecessary...

..However, there were no surgeons on the committee, and thus questions remained regarding the safety and efficacy of drotrecogin alfa (activated) in surgical patients...

..Surgical patients treated with drotrecogin alfa (activated)showed reduced D-dimer concentrations and a more rapid increase in protein C concentrations during the infusion period...