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At least 253 records · Page 14Linked to original sources
PubMed2001

Nonrandomized comparison of open flank versus laparoscopic nephrectomy in 249 patients with benign renal disease.

OBJECTIVES: We report the results from a nonrandomized comparison of open flank versus laparoscopic nephrectomy in patients with benign renal disease. METHODS: From January 1993 to December 1997, 249 nephrectomies for benign renal disease were performed at our institution. There were 118 patients in the open flank nephrectomy group (median age 58.5, range 8-89 years) and 131 patients in the laparoscopic nephrectomy group (median age 40, range 16-73 years). Clinical parameters such as operative times, blood loss, transfusion rates, conversion and complication rates, start of oral intake, analgesic consumption, duration of hospitalization and convalescence and short-term mortality were compared among both groups. RESULTS: Median operative time in the open flank nephrectomy group was 90 (range 30-240) min and also 90 (range 41-210) min in the laparoscopic nephrectomy group. In the laparoscopy group 8 patients were converted to open surgery (6.1%). There were 27 complications (20.6%) in the laparoscopic nephrectomy group compared to 30 complications (25.4%) in the open flank nephrectomy group. Postoperatively, patients in the laparoscopic nephrectomy group required less morphine sulfate equivalent (12 vs. 20 mg) for pain control and they had a shorter hospital stay (4 vs. 10 days) and convalescence (24 vs. 36 days). The postoperative parameters are given as medians and reached statistically significant differences in favor of laparoscopic nephrectomy. CONCLUSIONS: Laparoscopic nephrectomy results in a significantly briefer postoperative course when compared to open flank nephrectomy. As a matter of fact laparoscopy in urology is still a center-related procedure and even in these centers only a minority of urologists practice laparoscopy. However, in experienced centers the laparoscopic technique should be offered to patients with benign renal disease who are scheduled for elective nephrectomy.

Adolescent↗
PubMed2004

The virtual hospital: treating acute infections in the home by telemedicine.

The growth and aging of the population of Hawaii mandates a need for more effective utilization of hospital beds. One approach is early hospital discharge and outpatient treatment. However, as the acuity of illness increases, satisfactory outcomes of outpatient treatment maybe difficult to achieve. We have utilized telemedicine to closely monitor acutely ill patients with infections, such as community-acquired pneumonia, skin and soft tissue infections, and urinary tract infection, in the home setting. Our treatment paradigm achieved satisfactory outcomes, cost savings, and at the same time resulted in more rapid convalescence than hospitalization.

Acute Disease↗
PubMed2006

Managerial attitude to the implementation of quality management systems in Lithuanian support treatment and nursing hospitals.

BACKGROUND: The regulations of the Quality Management System (QMS) implementation in health care organizations were approved by the Lithuanian Ministry of Health in 1998. Following the above regulations, general managers of health care organizations had to initiate the QMS implementation in hospitals. As no research on the QMS implementation has been carried out in Lithuanian support treatment and nursing hospitals since, the objective of this study is to assess its current stage from a managerial perspective. METHODS: A questionnaire survey of general managers of Lithuanian support treatment and nursing hospitals was carried out in the period of January through March 2005. Majority of the items included in the questionnaire were measured on a seven-point Likert scale. During the survey, a total of 72 questionnaires was distributed, out of which 58 filled-in ones were returned (response rate 80.6 per cent; standard sampling error 0.029 at 95 per cent level of confidence). RESULTS: Quality Management Systems were found operating in 39.7 per cent of support treatment and nursing hospitals and currently under implementation in 46.6 per cent of hospitals (13.7% still do not have it). The mean of the respondents' perceived QMS significance is 5.8 (on a seven-point scale). The most critical issues related to the QMS implementation include procedure development (5.5), lack of financial resources (5.4) and information (5.1), and development of work guidelines (4.6), while improved responsibility and power sharing (5.2), better service quality (5.1) and higher patient satisfaction (5.1) were perceived by the respondents as the key QMS benefits. The level of satisfaction with the QMS among the management of the surveyed hospitals is mediocre (3.6). However it was found to be higher among respondents who were more competent in quality management, were familiar with ISO 9000 standards, and had higher numbers of employees trained in quality management. CONCLUSION: QMSs are perceived to be successfully running in one third of the Lithuanian support treatment and nursing hospitals. Its current implementation stage is dependent on the hospital size - the bigger the hospital the more success it meets in the QMS implementation. As to critical Quality Management (QM) issues, hospitals tend to encounter such major problems as lack of financial resources, information and training, as well as difficulties in procedure development. On the other hand, the key factors that assist to the success of the QMS implementation comprise managerial awareness of the QMS significance and the existence of employee training systems and audit groups in hospitals.

Attitude of Health Personnel↗
PubMed1981

[Epidemiologic significance of different categories of carriers of hepatitis B surface antigen (HBsAg). I. Role of reconvalescent HBsAg-positive viral hepatitis in the spread of infection].

133 convalescents, formerly hospitalized for HBsAG-positive viral hepatitis and discharged still with HBsAG in the blood serum, and 982 persons (665 children and 317 adults) having contacts with the convalescents in families and organized groups have been subjected to many-year complex observation, including epidemiological, clinical and laboratory examinations. As a result, chronic HBsAG carriers with the antigen persisting in their blood for a year or longer have been found to be epidemiologically more dangerous in conditions of inartificial infection. Most often children, especially those with prolonged persistence of HBsAG in the blood accompanied by the development of chronic infectious process in the liver, are the source of hepatitis B infection. Among their contact the greatest number of persons (mostly children) with the manifest form of the infection and with certain signs of hepatitis B can be found. Of these signs, the presence of HBsAG in the blood serum and increased activity of fructose-1-phosphate aldolase are most frequently detected in persons having contacts with HGsaG carriers.

Adult↗
PubMed1985

Percutaneous approach to nephrolithiasis.

Percutaneous techniques were successful in removing stones from 101 (92%) of 110 kidneys attempted. Ultrasonic lithotripsy was used on 80 kidneys in 74 patients with stones 5-38 mm in diameter. The most common complication was incomplete disintegration with retained stone fragments. Twenty patients were treated by direct stone extraction, either by a stone basket or forceps. The average hospitalization for percutaneous stone removal of 10 days was not significantly different from that for open nephrolithotomy. However, patients undergoing percutaneous stone removal had only a 3-10 day convalescence after hospital discharge before returning to normal activity.

Adolescent↗
PubMedDate not supplied

[The role of video-laparoscopy in the management of ovarian swellings].

METHODS: Personal experience in videolaparoscopic treatment of 42 ovarian masses during the period September 1991-December 1995 is reported. Seven patients have been operated in emergency, 35 in election. Resection of the masses has been performed by two methods: dissection and electrocoagulation, generally preferred in benign functional cysts; resection by stapler (endo GIA). RESULTS: In 5 of the patients operated in emergency an hemoperitoneum was found because of the rupture of ovarian cyst; in the other two cases, respectively, a necrotic benign cyst twisted on the adnexal axis and a dermoid cyst twisted and necrotic too were found. In the 35 patients operated in election, 33 benign cysts, 1 serous cystoadenoma 1 granulosa tumour were observed. Postoperative course was always excellent, with no painful symptomatology and hospital-stay and convalescence extremely reduced (dismission from hospital approx two days after the operation). CONCLUSIONS: The different aspects which must be evaluated before choosing mini-invasive treatment are discussed. An accurate preoperative study especially by sonography and serous hormonal dosage (in particular CA 125), besides good surgical experience of the operator, are fundamental requisites in order to minimize risks of this procedure and guarantee excellent results.

Adolescent↗
PubMedDate not supplied

Percutaneous nephrostolithotomy vs open surgery for renal calculi. A comparative study.

To evaluate the impact of the percutaneous removal of renal calculi we compared 41 patients who had undergone open renal surgery to 88 patients who had a one- or two-stage percutaneous nephrostolithotomy for symptomatic urolithiasis. The two groups were similar with regard to stone size, stone location, treatment success, and complication rates. However, for patients with calculi 2.5 cm or smaller in diameter, the percutaneous procedure resulted in lower postoperative morbidity, more rapid convalescence, less hospital cost, and greater patient satisfaction. For patients with calculi larger than 2.5 cm in diameter, the percutaneous approach was slightly more expensive than open surgery but resulted in a markedly shortened convalescent period. In our experience, percutaneous nephrostolithotomy performed in a single stage under assisted local anesthesia was the most efficacious and least expensive of the percutaneous approaches.

Adult↗
PubMed2003

Impact of socioeconomic status in etiology and management of urinary stone disease.

INTRODUCTION: The diverse manifestations of urolithiasis provide a very interesting epidemiological study from the standpoints of geography, socioeconomic status, nutrition and culture. Stone disease not only affects the patient, but also the national economy, as the disease is prevalent in the productive age group. There has been a continuous search for the cost-effectiveness of different treatment modalities not only to treat the patient but also to prevent its recurrence. MATERIALS AND METHODS: The various socioeconomic and dietary factors playing roles in the etiology of urinary calculi in the stone-prevalent areas of the world were analyzed. The impact of urinary tract stone disease on the socioeconomic infrastructure of the patient and national economy was studied. A cost-effectiveness analysis vis-à-vis the safety and efficacy of various treatment modalities in both developed and developing countries was done. RESULTS: The standard of living and level of nutrition have directly influenced the process of urolithiasis amongst the communities of the world. A low socioeconomic status has been linked to endemic bladder calculi seen in many poor countries with people subsisting on a deficient diet. The incidence of upper urinary tract calculi increases with prosperity and more nutritious diets. Replacement of open surgery with minimally invasive techniques (ESWL, PCNL, URS) for treating stones in the urinary tract has greatly reduced the patients' morbidity and mortality and the period of hospitalization and convalescence. This change in treatment has also led to less days of absence from work and could minimize the loss to national economy. Minimally invasive surgery is more cost effective in developed countries because of the short hospital stay. However, in developing countries open surgery still appears to be cost-effective in certain subset of the patients. CONCLUSIONS: There is a need for proper health care and a medical insurance system to take care of the financial burden, especially in developing countries, of a disease with a high magnitude of recurrence and morbidity. The need and type of medical treatment should be appraised continually to accommodate advances in techniques of stone removal. Lastly, the quest for etiology, cost-effective treatment and prevention still continues and even today we cannot stay better than Frère Jacques, 'I have removed the stone, it is up to God to cure the patient'.

Cost-Benefit Analysis↗
PubMedDate not supplied

[The organization of the rehabilitation of infectious disease patients in multiple hospital overcrowding].

The Bagram Rehabilitation Centre was deployed to meet the requirements in equal postinfectious management of patients. Its organic structure was as following: command, 8 companies, aid post and supply units. Each company had in its structure 6 combined-arms officers and warrant officers. Rehabilitation measures included protection regimen with a two-hour after-dinner rest, 5 meals a day, therapeutic physical training, vitamin therapy, psychotherapy and occupational therapy. Convalescents were discharged from the Centre after a complete rehabilitation of their performance and combat capabilities.

Afghanistan↗