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1.  Effects of Mumps Outbreak in Hospital, Chicago, Illinois, USA, 2006 
Emerging Infectious Diseases  2010;16(3):426-432.
Controlling the outbreak cost 4 times more than a routine prevention program.
In 2006, nearly 6,000 mumps cases were reported in the United States, 795 of which occurred in Illinois. In Chicago, 1 healthcare institution experienced ongoing transmission for 4 weeks. This study examines the outbreak epidemiology and quantifies the financial affect on this organization. This retrospective cohort study was conducted through case and exposure identification, interviews, medical record reviews, and immunologic testing of blood specimens. Nine mumps cases resulted in 339 exposures, 325 (98%) among employees. During initial investigation, 186 (57%) of the exposed employees had evidence of mumps immunity. Physicians made up the largest group of noncompliers (55%) with mumps immunity testing. The cost to the institution was $262,788 or $29,199 per mumps case. The outbreak resulted in substantial staffing and financial challenges for the institution that may have been minimized with readily accessible electronic employee vaccination records and adherence to infection control recommendations.
PMCID: PMC3322003  PMID: 20202417
Mumps; MMR; outbreak; epidemiology; electronic medical records; hospital; Chicago; USA; research
2.  Ohmeda Pulse Oximeters 
Anesthesia Progress  1988;35(4):171.
PMCID: PMC2167954  PMID: 19598701
3.  Pulse Oximetry: Evaluation of Accuracy during Outpatient General Anesthesia for Oral Surgery 
Anesthesia Progress  1988;35(2):53-60.
Pulse oximetry has been shown to be accurate under steady state conditions. In this study, the accuracy of four pulse oximeters are evaluated and compared during outpatient general anesthesia for third molar extractions. The oximeters evaluated are the Nellcor N-100, the Ohmeda 3700, the Novametrix model 500, and the Bird 4400 portable pulse oximeter.
Ultralight general anesthesia for oral surgery presents a unique challenge for respiratory monitoring in that patients are often not intubated and commonly experience periods of hyper- and hypoventilation. Airway obstruction, apnea, and laryngospasm may occur easily and patients often vocalize and move during surgery. Because hypoxemia is the primary cause of morbidity and mortality during anesthesia, an accurate, continuous, and noninvasive monitor of oxygenation is critical to risk management.
Twenty ASA class I and II patients underwent outpatient general anesthesia for third molar removal using nitrous oxide-oxygen, midazolam, fentanyl, and methohexital. Arterial blood samples were obtained at five-minute intervals during anesthesia, as well as any time a desaturation of >5% occurred, for measurement of arterial SaO2 with an IL282 CO-Oximeter. These values were compared with simultaneously recorded saturations observed for each pulse oximeter. A total of 122 arterial samples were obtained over a range of PaO2 from 52-323 mm Hg and observed saturations of 70-100%.
The Bird 4400 portable pulse oximeter proved to be the most accurate and reliably predicted arterial saturation under these conditions (y = 1.03x - 2.8, r = 0.85). The Novametrix model 500 pulse oximeter also demonstrated a high degree of accuracy by linear regression analysis, but displayed the lowest correlation coefficient (spread of data points) overall (y = 0.97x + 2.8, r = 0.80.) The Nellcor N-100 pulse oximeter also proved to be highly accurate. (y = 1.05x - 4.1, r = 0.84.) In contrast, regression analysis of the observed saturations obtained with the Ohmeda 3700 pulse oximeter revealed that this unit significantly underestimated arterial saturation (y = 1.20x - 19.6, r = 0.83.)
This study demonstrates that despite the rigorous conditions imposed by outpatient general anesthesia for oral surgery, three of the pulse oximeters tested were linearly accurate in predicting arterial oxyhemoglobin saturation over the range of 70-100%. The Ohmeda 3700 was found to significantly underestimate arterial saturation.
PMCID: PMC2148593  PMID: 3166346
4.  Reversal Agents in Sedation and Anesthesia: A Review 
Anesthesia Progress  1988;35(2):43-47.
This paper reviews the use of prototypic drugs for reversal of the effects produced by anesthetic and sedative agents. Efficacy and toxicity information is presented for naloxone (as used to reverse opioids), physostigmine (as used for reversal of sedatives), and Flumazenil (a new specific benzodiazepine receptor antagonist). Naloxone is very useful and specific for reversing adverse and life-threatening respiratory depression caused by narcotic drugs and should be used in these situations. Physostigmime has been advocated in incremental doses for reversing sedative effects in patients who are obtunded or depressed after having received benzodiazepines, droperidol, scopolamine, opioids, and phenothiazines. Flumazenil has been shown to readily antagonize the sedative, respiratory depressant, anxiolytic, muscle relaxant, anticonvulsant, amnestic, and anesthetic effects of the benzodiazepines; it appears to have tremendous potential for use in anesthesia, conscious sedation, and emergency medicine when available.
PMCID: PMC2148592  PMID: 3137841
5.  Respiratory Monitoring for Anesthesia and Sedation 
Anesthesia Progress  1987;34(6):228-231.
This article reviews the theory and practice of routine respiratory monitoring during anesthesia and sedation. Oxygen monitoring and capnography methods are reviewed. The current ventilation monitoring system of choice is considered a combination of the pulse oximeter and capnography. Guidelines are provided for monitoring standards.
PMCID: PMC2190035  PMID: 3326430
6.  Recovery Following Sedation with Midazolam or Diazepam Alone or in Combination with Fentanyl for Outpatient Surgery 
Anesthesia Progress  1986;33(5):230-234.
Midazolam is a new water-soluble benzodiazepine with a much shorter pharmacologic half-life than diazepam. Despite this shorter pharmacologic half-life, several reports indicate that patients do not recover more rapidly after sedation with midazolam than with diazepam. The purpose of this study was to compare recovery of patients sedated with either midazolam or diazepam alone or in combination with fentanyl using the digit symbol substitution test (DSST) and Trieger test. Patients were randomly divided into treatment groups and recovery tests were administered to the patients prior to sedation and at 60, 120, and 180 minutes after achieving a standardized sedative endpoint. Patients who received midazolam alone had significantly fewer numbers of correct reponses on the DSST than patients who received midazolam plus fentanyl or diazepam with or without fentanyl. When midazolam was combined with fentanyl there was no significant difference between results obtained on the DSST when compared with either diazepam group. Comparisons between all groups using dots missed or millimeter deviation on the Trieger test showed no statistical difference between any groups. These data indicate that midazolam as a single IV agent has a slightly prolonged recovery phase compared to diazepam. The addition of fentanyl to the sedation regimen allows reduction in the midazolam dose resulting in a recovery time comparable to that of diazepam.
PMCID: PMC2177484  PMID: 3465258

Results 1-6 (6)