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Biomedical subjects

R E Burney

Publications and source records attributed to R E Burney.

At least 19 recordsLinked to original sources
PubMed2002

Ambulatory and admitted laparoscopic cholecystectomy patients have comparable outcomes but different functional health status.

BACKGROUND: Laparoscopic cholecystectomy is frequently an ambulatory procedure, but some patients are best admitted for a brief hospital stay. In this study, we compared the functional health status, symptoms, and outcomes of patients undergoing ambulatory elective laparoscopic cholecystectomy to those with brief hospital admission. The purpose was to assess patient satisfaction and to identify factors that might assist in selecting patients for ambulatory vs short-stay operations. METHODS: A total of 140 patients scheduled for elective cholecystectomy completed the SF-36 health survey and provided additional information regarding symptoms preoperatively, at 2 months, and at 6 months after operation. RESULTS: All patients had symptomatic gallstones; 76 were admitted to the hospital, and 64 were ambulatory. Admitted patients reported more emotional role limitations on preoperative SF-36. They also reported symptoms of depression more often. Patients in both groups were equally relieved of symptoms of pain, nausea, vomiting, and tenderness. Satisfaction with care was similar for both groups; however, at 2 and 6 months, admitted patients continued to report significantly poorer functional health status than ambulatory patients. CONCLUSION: A reliable, reproducible measure of functional health status, such as the SF-36, may be useful for identifying patients who are appropriate for short-stay hospital admission after laparoscopic cholecystectomy as part of a decision process that tries to optimize outcomes while utilizing resources efficiently.

Ambulatory Care↗
PubMed2001

Return to work after inguinal hernia repair.

BACKGROUND: There is much variation in the time when a patient returns to work after inguinal hernia repair. Most surgical research has focused on the type of operation performed, but other factors may be equally or more important. This study attempted to identify these factors. METHODS: We prospectively studied the return to work after inguinal hernia repair in a convenience sample of 235 patients who were operated on by one surgical group. Ninety-three of these subjects, who were working and had complete data, were included in this analysis. Data were gathered through personal interviews, written surveys, and medical record reviews. The main outcome measures were actual and expected return to work. RESULTS: Primary tissue repair was done in 94% of the patients. The mean age was 49 years; 90% were male. The expected return to work was 10 days; the actual mean return to work after operation was 12 days (median, 7 days; range, 2 to 60 days) and was unrelated to preoperative functional status. Bivariate analysis showed that age, educational level, income level, occupation, symptoms of depression, and the expected return to work accounted for 61% of the variation in actual return to work. CONCLUSIONS: Factors other than operative technique, including patient expectations, are strongly associated with return to work after inguinal hernia repair. Depression significantly delayed return to work. More research is needed to understand how expectations are formed and how decisions are made regarding return to work, and whether these can and/or should be influenced by surgeons, employers, or others to promote earlier return to work.

Analysis of Variance↗
PubMed2000

Patient expectations for surgery: are they being met?

BACKGROUND: The purpose of the study was to determine patient expectations for the outcomes of three elective surgical procedures, the extent to which patient expectations for surgery were met, the reasons for unmet expectations, and the factors that might predict unmet expectations. Better understanding of these questions might help identify targeted interventions to better prepare patients for specific health care experiences. METHODS: In a longitudinal, prospective design, a convenience sample of 445 patients (age range, 18 to 86 years) at a general surgery clinic at a major academic medical center was included--177 patients undergoing inguinal hernia repair, 146 undergoing parathyroidectomy, and 122 undergoing cholecystectomy. Patients completed both standardized and newly developed condition-specific health survey instruments. Preoperative interviews were administered, followed by mailed surveys 2 months after surgery. RESULTS: Between 9% and 27% of the respondents reported unmet expectations, with significant variation by condition; reasons included perceived lack of symptom relief, surgical complications, and process of care issues. Patients undergoing parathyroidectomy had a greater probability of unmet expectations. Both feeling prepared for surgery and improved postoperative symptom relief and role functioning reduced the probability of unmet expectations. DISCUSSION: To reduce the level of unmet expectations, patients need to be prepared both for the surgical experience and for what to expect in the recovery phase. This is especially true for complex illnesses such as primary hyperparathyroidism. Innovative educational strategies to ensure adequate preparation for surgery will be needed, and attention will need to be paid to latent, unstated process measures, if unmet expectations are to be reduced.

Academic Medical Centers↗
PubMed1999

Fistula-in-ano after episiotomy.

BACKGROUND: In the past 2 years, we treated three women with fourth-degree lacerations or episiotomy infections presenting with persistent pain and drainage not responding to standard treatment. CASES: These women were referred for evaluation 5 weeks, 3.5 months, and 2 years postpartum. After diagnosing fistula-in-ano, we treated them with fistulotomy and curettage, which resolved the problem. CONCLUSION: When a patient presents with pain or drainage at her episiotomy site, fistula-in-ano should be considered.

Adult↗
PubMed1999

Health status improvement after surgical correction of primary hyperparathyroidism in patients with high and low preoperative calcium levels.

BACKGROUND: We conducted a prospective cohort study to determine whether there are differences in functional health status between patients with low (< 10.9 mg/dL) and high (> or = 10.9 mg/dL) serum calcium levels before surgical correction of primary hyperparathyroidism (HPT) and to compare changes in health status after correction of primary HPT. METHODS: The SF-36 Health Survey, which provides demographic and condition-specific information, was used to obtain information on patients with primary HPT seen in a university hospital endocrine surgery clinic over a 4-year period before operation and again 2 months and 6 months after operation. RESULTS: A total of 155 patients were studied; 86 had calcium levels < 10.9 mg/dL (normal < 10.5 mg/dL) and 69 had serum calcium levels > or = 10.9 mg/dL (range 10.9 to 13.4 mg/dL). One hundred four patients completed 6-month reports, 55 with low calcium levels and 49 with high calcium levels. Both high and low calcium groups showed marked and virtually identical impairment of functional health status. Both groups showed marked improvement in health status at 2 months and additional improvement at 6 months, returning to normal or near normal in 6 of 8 SF-36 domains. CONCLUSIONS: Patients with primary hyperparathyroidism have significant functional health status impairment independent of the level of serum calcium. Dramatic improvement is seen after surgical correction. Referral for surgical treatment of primary HPT should not be delayed until serum calcium is elevated, as recommended in the 1990 National Institutes of Health consensus statement.

Calcium↗
PubMed1998

Surgical correction of primary hyperparathyroidism improves quality of life.

BACKGROUND: The SF-36 health status assessment tool is well suited for measuring the morbidity associated with primary hyperparathyroidism (HPT). The purpose of this study was to test the hypothesis that surgical correction of primary HPT leads to measurable improvement in patient reported functional health status and well-being. METHODS: For the past 4 years patients with primary HPT have been asked to complete the SF-36 and to provide additional demographic and condition-specific information for study before operation. They then completed the SF-36 again by mail 2 months and 6 months after operation. RESULTS: One hundred forty patients entered the study through March 1998; 110 patients completed follow-up at 2 months and 82 at 6 months. Marked impairment compared to population norms occurred before operation in 7 of 8 domains of health status. Substantial improvement occurred in 5 of 8 domains of health status at 2 months and in 6 of 8 domains at 6 months. Statistically significant improvement was demonstrated in limitations caused by physical and emotional role function, social function, bodily pain, and vitality. CONCLUSIONS: Successful operation to correct primary HPT significantly improves patient reported functional health status and quality of life. Most improvement is seen within 2 months, but additional improvement in both physical and mental function is seen at 6 months.

Adult↗
PubMed1998

Measuring health-status improvement after surgery: experience with the SF-36.

The outcomes of care delivery are increasingly being measured and managed by health care providers and clinicians. The authors describe an outcomes monitoring program implemented in one tertiary care center that uses both generic and condition-specific instruments to monitor patient recovery after routine surgery. The SF-36 Health Survey was shown to be a useful tool for measuring changes in functional status and well-being after inguinal hernia repair, cholecystectomy, and parathyroidectomy. Recommendations for its successful adoption in a clinical setting are presented.

Activities of Daily Living↗
PubMed1997

Core outcomes measures for inguinal hernia repair.

BACKGROUND: Demands on the medical profession to develop performance measures and demonstrate cost-effectiveness make it imperative that a uniform approach to the measurement of outcomes for common conditions be adopted. We report here on patient acceptance, response rates, and utility of a new set of core outcomes measures for patients with inguinal hernia (IH), which incorporates patient reporting of outcomes. METHODS: Beginning in March 1994, a convenience sample of patients scheduled for IH repair completed a series of questionnaires addressing a range of patient case mix and outcomes dimensions, including demographics, comorbid conditions, SF-36 health status (Medical Outcomes Study 36-item short-form health survey), and condition-specific questions, expectations, and responses to the surgical experience before and after operation. Surgical data were abstracted from the medical records. RESULTS: One hundred three patients were entered in the study; 63 completed 2-month reports and 44 completed 6-month reports. Acceptance of the study and response rates were excellent. Differences in health status associated with IH have been identified in two SF-36 domains, and changes in function after repair noted in several others, supporting the applicability of this measure. Outcomes may also differ by type of hernia and type of repair performed. CONCLUSIONS: A core outcomes measurement set for IH that encompasses demographics, comorbidities, health status, expectations, utilization, and condition-specific data provides a portrait of patient outcomes that is useful to providers and patients, and combined with cost and satisfaction data, it can be used for benchmarking and improving surgical care.

Adult↗
PubMed1996

Assessment of patient outcomes after operation for primary hyperparathyroidism.

BACKGROUND: We have used the SF-36, an accepted health status assessment tool, in conjunction with condition-specific clinical information, to assess patient-reported health status before and after operation for primary hyperparathyroidism (1 degree HPT). METHODS: Beginning in March, 1994, a convenience sample of patients has been asked to complete the SF-36 and provide additional demographic and condition-specific information for study. The SF-36, which measures eight components of functional status and well-being, is completed in person before operation and again by mail at 2 and 6 months after operation. Clinical and condition-specific data are gathered at the same times. RESULTS: Fifty-nine patients have entered the study; 56 had abnormal parathyroid tissue removed. Patients with 1 degree HPT have lower SF-36 scores in all health domains at baseline than do healthy patients. At 2 months, scale scores for emotional role limitations and bodily pain improved by more than 10 points. At 6 months all eight scale scores showed improvement, seven of eight by 10 points or more. Commensurate improvements in HPT-specific measures were also seen. CONCLUSIONS: Patient-reported measurements of health outcomes after parathyroidectomy for 1 degree HPT show improvement in all aspects of health status 6 months after operation. Most dramatic improvements were reported in reduction of bodily pain and in improved vitality and emotional and physical function. Surgical correction of 1 degree HPT improves patient health status and quality of life.

Adult↗
PubMed1996

A study of preventable trauma mortality in rural Michigan.

OBJECTIVE: To determine the preventable death rate (PDR) and the frequency and types of inappropriate medical care in a large, rural region of Michigan. DESIGN: A prospective study of all deaths caused by injury during a 1-year period. METHODS: Preventability of death and appropriateness of care were determined using a structured implicit review process and expert panel. A second panel was convened to confirm the reliability of the review process. MAIN RESULTS: One hundred fifty-five injury-related deaths underwent panel review. Four deaths (2.6%) were found to be definitely preventable and 16 (10.3%) possibly preventable, for a combined preventable death rate of 12.9%. Sixty-five deaths (41.9%) occurred in the emergency department or hospital; 18 of these (27.7%) were judged to be definitely preventable or possibly preventable. Forty-three episodes of inappropriate care were identified in 27 (17.4%) of the 155 cases reviewed. These occurred primarily in the emergency department and hospital rather than during prehospital care or transfer. CONCLUSIONS: A relatively small percentage of trauma fatalities in rural Michigan could have been prevented by more appropriate or timely medical care. Efforts to improve the care of injured persons in rural Michigan should be directed primarily at the emergency department and inpatient phases of trauma system care.

Accidents, Traffic↗
PubMed1995

Variation in air medical outcomes by crew composition: a two-year follow-up.

STUDY OBJECTIVE: In a previous 1-year retrospective study, we found no differences in outcomes of patients transported by physician/nurse (P/N) and nurse/nurse (N/N) air medical crews. To confirm this finding and to identify any trends in outcome that might be associated with changes in crew composition, we prospectively collected and analyzed 2 additional years of severity and outcome data. DESIGN: Prospective cohort. SETTING: University hospital-based air medical program. RESULTS: Severity measured by APACHE-II, the Revised Trauma Score, and the Therapeutic Intervention Scoring System, and outcomes measured by mortality and the number of ICU and hospital days, were gathered prospectively on all adult air medical patients between July 1, 1990, and June 30, 1992. Patients less than 16 years old or those who were delivered to other hospitals were excluded. Patients were categorized as cardiac, acute trauma, and other. Origin of transfer and transfer times were included in the analysis. In all, 1,169 patients were studied--554 in the first year of the study, 615 in the second. In the first year, there were 185 P/N (33%) and 369 N/N (67%) flights. P/N patients were older (48.8 versus 44.5 years; P = .01) and were more likely to come from a scene (14% versus 5.7%; P = .001), but no differences were found with regard to sex or disease category. Mortality, the Therapeutic Intervention Scoring System, APACHE-II, number of ICU days, and number of hospital days were no different; nor were total flight times or times spent at the hospital or scene. In the second year, 89% of flights were N/N. Differences in age or origin were not observed. Severity levels and outcomes remained unchanged. Between 1987 and 1992, the proportion of cardiac patients decreased, and overall illness severity of transported patients increased. CONCLUSION: Two years of detailed prospective measurement of air medical patient characteristics and outcomes confirmed the initial finding that no significant differences in clinical outcomes could be identified between patients managed by P/N versus N/N crews.

Air Ambulances↗
PubMed1995

Geographic variation in preventable deaths from motor vehicle crashes.

OBJECTIVE: In Michigan, drivers in rural motor vehicle crashes (MVCs) are twice as likely to die as nonrural drivers: this could be due to variation in the quality of acute trauma care. This study tests the hypothesis that the preventable death rate (PDR) is higher and that anatomic injury severity is lower for rural compared to nonrural MVC fatalities. DESIGN: Retrospective cohort study. METHODS: Autopsy results from MVC victims of three rural counties and one nonrural county were reviewed. The time period was 1986-1991. Using the Abbreviated Injury Scale, 1985 version (AIS-85), Injury Severity Scores (ISSs) and Anatomical Profile G scores were calculated. Preventability was determined based on ISSs (< 59) and AIS scores in the head region (< 5). Student's t test and the chi-squared test were used for analysis; a p value of < 0.05 was considered statistically significant. RESULTS: 143 rural and 306 nonrural fatalities were analyzed. The rural PDR was 37.1% and nonrural 48.0% (p < 0.05). ISSs and also G scores were significantly different between rural (54.8; -2.1) and nonrural (50.2; -1.2) areas. CONCLUSION: This study suggests that regional variation in the quality of acute trauma care is not a significant factor in regional variation in MVC mortality.

Accidents, Traffic↗
PubMed1993

Incidence, characteristics, and outcome of spinal cord injury at trauma centers in North America.

Acute spinal cord injury occurred in 2.6% of the 114,510 patients entered into the Major Trauma Outcome Study from 1982 to 1989. The most common causes of spinal cord injury were motor vehicle accidents (40%), falls (20%), and gunshot wounds (13.6%). Almost 80% of patients with spinal cord injury had multiple injuries. Cervical cord injury was seen in 65% of patients with isolated spinal cord injury, but in only 52% of patients with multiple injuries. The hospital mortality rate was 17%, with patients with multiple injuries having a significantly higher mortality rate than patients with isolated spinal cord injury (19.8% vs 6.9%). The TRISS method overpredicted the mortality rate among patients with multiple injuries (450 vs 379), but not among those with isolated injury. A program for better national surveillance and prevention of spinal cord injury is warranted.

Accidents, Traffic↗
PubMed1992

Surgical approach to insulinomas. Assessing the need for preoperative localization.

The purpose of this study was to examine our experience with the diagnosis, surgical approach, and outcomes of surgery for organic hyperinsulinemia in the era of transhepatic venous sampling. During the period from 1978 to 1991, 50 patients were evaluated and treated for hyperinsulinemia at the University of Michigan Medical Center, all of whom underwent preoperative localization. Forty-one patients (82%) had solitary, benign tumors; four (8%) had either multiple tumors or islet cell dysplasia; and five (10%) had metastatic disease. Forty-seven patients underwent laparotomy, and the source of the hyperinsulinemia was found in all patients. In three patients (6%) preoperative localization did not accurately locate the tumor due to technical difficulties with the completion of the studies. Overall, computed tomography localized nine (26%) of 35 tumors. Angiography accurately localized 18 (44%) of 41 tumors. Transhepatic venous sampling localized 34 (94%) of 36 tumors, and was essential to successful surgical treatment in 15 patients. Compared with angiography, transhepatic venous sampling was a more accurate method of localization and should be performed in all patients in whom computed tomography and visceral angiography do not clearly identify the site of disease. Preoperative localization plays a critical role in the surgical treatment of patients with organic hyperinsulinemia and eliminates the need for blind pancreatic resection.

Adult↗
PubMed1992

Rural motor vehicle crash mortality: the role of crash severity and medical resources.

We did a retrospective case control study to examine the relationship between the risk of dying for Michigan motor vehicle crash (MVC) drivers and the type of county (rural/nonrural) of crash occurrence, while adjusting for crash characteristics, age, sex, and the medical resources in the county of crash occurrence. The 1987 Michigan Accident Census was used to obtain data regarding all MVC driver nonsurvivors (733) and a random sample of all surviving drivers (2,483). County of crash occurrence was defined as rural or nonrural. The crash characteristics analyzed were vehicle deformity, seat belt use, and drivability of the vehicle from the scene. Age and sex of the driver were also analyzed. Medical resource characteristics for the county of crash occurrence were measured as the number of resources per square mile for each of the following: ambulances, emergency medical technicians (EMT), acute care hospital beds, and operating rooms, surgeons and emergency physicians. Also considered were the number and level of emergency rooms in the county of crash occurrence along with the maximum level of prehospital care available (basic life support versus advanced life support) in a county. Before adjusting, the relative risk (RR) for rural MVC drivers dying, compared to their nonrural counterparts, was 1.96. Adjustment for crash characteristics, age, and sex (using logistic regression) decreased the RR to 1.51. An attempt to add medical resource variables to the model resulted in high correlation with the rural/nonrural variable, as well as with each other. This multi-collinearity prevented us from providing a simple explanation of the role of medical resource variables as predictors of survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗