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PubMedDate not supplied

Children's preoperative coping and its effects on postoperative anxiety and return to normal activity.

A model was tested to assess children's preoperative coping with major orthopedic surgery and how coping is related to two different postoperative outcomes, anxiety and return to normal activities. Ninety children, ages 8 to 17, participated. Data were collected the day before surgery, the second postoperative day, and at 3-, 6-, and 9-month recovery periods. A respecified model was not significantly different from the data (p = .90), indicating a good fit. Children who were older, more anxious, and more internal in locus of control exhibited more vigilant coping. Avoidant coping was associated with less anxiety 2 days postoperatively, and vigilant coping was associated with return to normal activities over the course of recovery.

Activities of Daily Living↗
PubMed1985

Laparoscopic salpingectomy for ectopic pregnancy.

In selective cases operative laparoscopic salpingectomy is an alternative to laparotomy in the surgical treatment of ectopic pregnancy. The obvious advantages of this procedure are decreased morbidity and surgical pain, lower cost, shorter hospitalization and convalescence, and less disability, as well as a cosmetic surgical scar. Because the procedure is so cost-effective, and since the tools are familiar to most gynecologists, we hope it will gain wider utilization. Laparoscopic salpingectomy is not a difficult procedure when the basic principles of surgery are followed. Depending on the fertility desires of the patient and the condition of the opposite tube, this procedure may be preferable to laparotomy. If a complication such as bleeding does occur and fails to respond to cauterization, laparotomy can be done as usual for an ectopic pregnancy.

Adult↗
PubMed2000

The safety and efficacy of laparoscopic live donor nephrectomy: a systematic review.

BACKGROUND: The aim of this systematic review was to compare the safety and efficacy of laparoscopic live donor nephrectomy with the "gold" standard of open live donor nephrectomy. METHODS SEARCH STRATEGY: Three search strategies were devised to enable literature retrieval from the Medline, Current Contents, Embase, and Cochrane Library databases up until, and including, February 2000. STUDY SELECTION: Inclusion of a report was determined on the basis of a predetermined protocol, independent assessment by two reviewers, and a final consensus decision. English language reports were selected and acceptable study designs included randomized-controlled trials, controlled clinical trials, case series, or case reports. Each report was required to provide information on at least one of several safety and efficacy outcomes as detailed in the protocol. DATA COLLECTION AND ANALYSIS: Twenty-five reports met the inclusion criteria. They were tabulated and critically appraised in terms of the methodology and design, sample size, outcomes, and the possible influence of bias, confounding, and chance. RESULTS: High level evidence comparing the safety and efficacy of laparoscopic live donor nephrectomy with open donor nephrectomy was not available at the time of this review. Limited low level evidence suggested that the laparoscopic approach might be advantageous regarding the donor's hospital stay, convalescence, pain, and resumption of employment. CONCLUSIONS: The ASERNIP-S Review Group concluded that the evidence-base for laparoscopic live donor nephrectomy was inadequate to make a safety and efficacy recommendation. Clinical and research recommendations were developed regarding the introduction and current practice of this procedure in Australia.

Australia↗
PubMed2003

Reforming Medicare payment: early effects of the 1997 Balanced Budget Act on postacute care.

The 1997 Balanced Budget Act (BBA) reformed payment for Medicare postacute services. This article examines postacute care use just before and immediately after implementation of the BBA for hospital discharges for five diagnosis-related groups that commonly use postacute care. Changes in treatment patterns were more beneficiaries receiving no postacute care, much less use of home health services both initially and after initial institutional postacute care, and slightly more use of rehabilitation and long-term care hospitals. But no consistent increases in adverse outcomes were observed using logistic regression models. These results demonstrate that financing changes can affect use patterns, that less use does not automatically imply poorer quality, and that the interrelationship of services should be considered when designing reimbursement methodologies.

Budgets↗
PubMed1990

Renal, perirenal, and pararenal abscesses: percutaneous drainage.

The efficacy of percutaneous drainage of renal, perirenal, and pararenal abscesses was assessed in 33 patients. The method eradicated the abscess in 31 patients and was palliative in two patients who were subsequently cured by surgery. Prompt defervescence was attributed to reduction of bacterial flora and institution of appropriate antibiotic treatment based on culture of the aspirate and sensitivity studies of organisms. Antibiotic changes or additions were necessary in 10 of the 33 patients, reflecting a lack of agreement with results of urine and blood cultures. The progress of percutaneous drainage was monitored with computed tomography after diffusion of dilute contrast medium in the abscess cavity. Catheter adjustments (in all patients) or additions (in 11 patients) were made necessary by the presence of demonstrated loculated compartments. Only one major complication (a pyopneumothorax) and four minor complications (bacteremias) were attributed to the percutaneous drainage procedure. The mean time for hospitalization and convalescence was substantially reduced with percutaneous drainage. The method is recommended for initial management of all renal, perirenal, and pararenal abscesses.

Abscess↗
PubMed1999

Endoscopic diverticulotomy for the treatment of Zenker's diverticulum: results in 102 patients with staple-assisted endoscopy.

Endoscopic diverticulotomy for the treatment of Zenker's diverticulum has been reported infrequently in the literature and has engendered considerable controversy. Between March 1992 and September 1996, we attempted to treat 102 patients with endoscopic treatment for pharyngoesophageal diverticula. In 98 patients, the endoscopic surgery was successfully completed. Conversion to open surgery was required in 4 patients (3.92%). One cartridge of staples in 16 patients (16.32%), 2 cartridges in 78 patients (79.59%), and 3 cartridges in 4 patients (4.08%) were used, according to the size of the diverticulum; the median duration of the procedure was 20 minutes (10 to 60 minutes). No postoperative morbidity or mortality was recorded. Oral feeding was started following radiologic control after a median of 2 days; the median hospital stay was 4 days. The median follow-up is 16 months (1 to 45 months). Four patients operated on before the introduction of the modified stapler showed a persistent diverticular pouch: 3 underwent repeat endoscopic operation, and 1 underwent conventional open surgery. All treated patients are asymptomatic. Manometric study performed in 15 patients showed a significant reduction of basal upper esophageal sphincter pressure compared to preoperative data (48.30+/-21.74 versus 29.38+/-5.68 mm Hg; p<.01). We therefore recommend endoscopic diverticulotomy, considering that the procedure is relatively safe and effective, with minimal patient discomfort, and the results are equal to those of the external approach. This procedure offers the advantages of short hospitalization, rapid convalescence, brief operative time, absence of skin incision. predictable resolution of symptoms, and reduced morbidity.

Adult↗
PubMed1996

The place of hysterectomy in the management of benign uterine disease.

The wide variation in hysterectomy rates may reflect professional uncertainty as to the appropriateness of the procedure for managing benign uterine disease. This is thought to be due to diagnostic difficulties and especially to a lack of outcomes data. Many patients experience symptomatic relief after hysterectomy, but the long-term costs and benefits remain uncertain. Alternative treatments are available that spare the uterus and/or ovaries and appear to be as effective as hysterectomy. Vaginal hysterectomy is also associated with significantly reduced hospitalization and convalescent time and a lower rate of post-operative complications compared to abdominal hysterectomy, yet most hysterectomies continue to be performed abdominally. Based on the review, a number of steps are proposed for dealing with the problem of excess hysterectomy rates within a managed care setting.

Endometrium↗