Biomedical subjects

Mary Ellen Wechter

Publications and source records attributed to Mary Ellen Wechter.

5 recordsLinked to original sources

PubMed2006

Cesarean delivery on maternal request: maternal and neonatal outcomes.

OBJECTIVE: To review systematically the evidence about maternal and infant outcomes of cesarean delivery on maternal request and planned vaginal delivery. DATA SOURCES: We searched MEDLINE, Cochrane Collaboration resources, and Embase and identified 1,406 articles through dual review using a priori inclusion criteria. METHODS OF STUDY SELECTION: We included English language studies published from 1990 to June 2005 that compared the key reference group (cesarean delivery on maternal request or proxies) and planned vaginal delivery. TABULATION, INTEGRATION, AND RESULTS: We identified 54 articles for maternal and infant outcomes. Virtually no studies exist on cesarean delivery on maternal request, so the knowledge base rests on indirect evidence from proxies with unique and significant limitations. Most studies compared outcomes by actual routes of delivery, resulting in variable relevance to planned routes of delivery. Primary cesarean delivery on maternal request and planned vaginal delivery likely differ with respect to individual outcomes; for instance, risks of urinary incontinence and maternal hemorrhage were lower with planned cesarean, whereas the risk of neonatal respiratory morbidity was higher and maternal length of stay was longer with planned cesarean delivery. However, our comprehensive assessment, across many outcomes, suggests no major differences between primary cesarean delivery on maternal request and planned vaginal delivery, but the evidence is too weak to conclude definitively that differences are completely absent. If a woman chooses to have a cesarean delivery in her first delivery, she is more likely to have subsequent deliveries by cesarean. With increasing numbers of cesarean delivery, risks occur with increasing frequency. CONCLUSION: The evidence is significantly limited by its minimal relevance to primary cesarean delivery on maternal request. Future research requires developing consensus about terminology, creating a minimum data set for cesarean delivery on maternal request, improving study design and statistical analyses, attending to major outcomes and their special measurement issues, assessing both short- and long-term outcomes with better measurement strategies, dealing better with confounders, and considering the value or utility of different outcomes.

Cesarean Section↗

PubMed2005

Teaching residents coding and documentation: effectiveness of a problem-oriented approach.

OBJECTIVE: We sought to assess the effectiveness of a problem-oriented approach to teaching residents accurate coding and documentation of ambulatory gynecology visits. STUDY DESIGN: This was a pilot before-and-after study. Nine resident volunteers underwent 4 individual instructional sessions on coding and documentation with a trained faculty member over 6 weeks. Outcomes were assessed by comparing the appropriateness of procedure and diagnostic codes billed in participant continuity clinic prior to and in the 6 to 9 months following the intervention. RESULTS: Following the intervention, participants demonstrated an increase in the accuracy of coding the correct category of the evaluation and management service, an increase in the appropriate use of modifiers, and a decline in undercoding errors. CONCLUSION: Problem-oriented interactive learning appears to be an effective method of teaching residents proper coding and documentation.

Feasibility Studies↗

PubMed2005

Reclosure of the disrupted laparotomy wound: a systematic review.

OBJECTIVE: To review systematically all prospective, randomized trials published in English quantifying the success of reclosure of the disrupted laparotomy wound. DATA SOURCES: The MEDLINE/PubMed, EMBASE, CINAHL, and Cochrane databases were searched from 1966 to 2004. References were hand-searched and their authors contacted to identify all published and unpublished eligible studies. METHODS OF STUDY SELECTION: We included all prospective, randomized trials measuring successful reclosure of disrupted laparotomy wounds in human subjects. Studies with fascial disruption, subfascial abscess, or ongoing contamination were excluded. Of over 2,098 potentially relevant articles, 8 were included, incorporating 348 patients. TABULATION, INTEGRATION, AND RESULTS: Two authors determined study inclusion. One investigator abstracted data, and a second checked for accuracy. The main outcome was successful healing after wound reclosure. Timing of reclosure, utility of antibiotics, and reclosure techniques were also analyzed. Successful healing after reclosure ranged between 81% and 100%. Failed healing included both superficial wound separation and reaccumulation of abscess. No serious morbidity or mortality was reported. Compared with healing by secondary intention, reclosure resulted in faster healing times (16-23 days versus 61-72 days), and in the one study that evaluated it, 6.4 fewer office visits. The optimal timing and technique for reclosure and the utility of antibiotics were inconclusive. CONCLUSION: Reclosure of disrupted laparotomy wounds was successful in over 80% of patients. Failed reclosure resulted in no life-threatening complications. Reclosure of disrupted laparotomy wounds is safe and decreases healing times.

Adult↗

PubMed2004

Vulvar melanoma: a report of 20 cases and review of the literature.

BACKGROUND: Vulvar melanoma is the second most common vulvar malignancy and represents a significant women's health issue. OBJECTIVE: To report experience with 21 cases of vulvar melanoma in 20 patients and to review the literature about the condition. METHODS: Parameters retrospectively reviewed included age at diagnosis, family history of melanoma, location on the vulva, atypical nevi, Breslow depth, ulceration status, histologic pattern, presenting signs and symptoms, and the results of sentinel lymph node biopsy. Molecular characterization of the melanocortin type 1 receptor was performed in 1 patient. RESULTS: A family history of cutaneous melanoma was present in 15% of cases. The mean Breslow depth was 2.8 mm (range, 0.0-11.0 mm). Ten patients successfully underwent sentinel lymph node biopsy, results of which were positive in 2 (20%). Reported for the first time is that one patient had a germline mutation in the melanocortin type 1 receptor. CONCLUSION: Vulvar and cutaneous melanoma behave similarly despite their unique pathogeneses. Sentinel lymph node biopsy can be performed successfully for vulvar melanoma.

Adult↗

PubMed2004

Vulvar melanoma: review of diagnosis, staging, and therapy.

OBJECTIVES: To update, assimilate, and bridge the contemporary literature on vulvar and cutaneous melanoma regarding diagnosis, staging, and therapy to provide a useful clinical reference for managing and counseling for affected patients. MATERIALS AND METHODS: A computerized search for reports in the literature up to June 2003 was carried out using PubMed and MEDLINE databases. Multidisciplinary involvement was used in evaluating the available data and formulating conclusions. RESULTS: More than 300 reports were reviewed. Diagnosis, staging, and therapy aspects of vulvar melanoma are summarized. CONCLUSIONS: Vulvar melanoma represents a subtype of cutaneous melanoma, with similar prognostic and staging factors. The most recent American Joint Committee on Cancer staging system for cutaneous melanoma is applicable to vulvar melanoma. Sentinel lymph node biopsy is reliable for staging the regional lymph node basin for vulvar melanoma. Standardized documentation of clinical and histopathologic parameters is needed to standardize grouping of cases for future comparison studies.

Journal Article↗