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Comparative Outcomes (comparative + outcome)
Selected AbstractsComparative outcomes of elderly patients undergoing Altemeier procedure versus laparoscopic rectopexy for rectal prolapseASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 1 2010O. De Oliveira Jr Abstract Introduction: We compared outcomes of elderly patients (>70 years) who underwent the Altemeier procedure versus laparoscopic rectopexy for full-thickness rectal prolapse. Materials and Methods: We reviewed our data from a prospective database and the medical records of patients treated at a single institution from 2002 to 2008. Patients who underwent surgery for full-thickness rectal prolapse were evaluated. Results: Sixteen patients underwent laparoscopic rectopexy (median age 82 years; ASA 2.6), and 16 patients underwent the Altemeier procedure (median age 85 years; ASA 2.8). The Altemeier procedure patients had a significantly higher recurrence rate when compared to laparoscopic rectopexy patients (P<0.045). The mean length of follow-up was longer for the Altemeier group (20 months) compared to the laparoscopic rectopexy group (28.5 months; most recurrence (5/6) occurred <1 year. The median length of specimen removed in the Altmeier group was 9.5 cm (6.5,18.5 cm). The majority of patients in both groups had preoperative fecal incontinence. Significantly more Altemeier patients reported worsening perioperative fecal incontinence at 1,3 months (p<0.046). All laparoscopic rectopexy patients underwent general anesthesia while 44% of the Altemeier patients underwent regional anesthesia (p<0.003). One laparoscopic rectopexy patient required reoperation for an incarcerated trocar site hernia. No other major complications occurred in either group. There was no difference in rates of minor complications. Discussion: Compared to the Altemeier procedure, laparoscopic rectopexy for elderly patients with rectal prolapse resulted in a significantly smaller recurrence rate, better perioperative fecal incontinence and an equivalent morbidity rate. [source] Systematic review of post-treatment psychosocial and behaviour change interventions for men with cancerPSYCHO-ONCOLOGY, Issue 3 2010Hannah L. Dale Abstract Objectives: The psychosocial impacts of a cancer diagnosis include reduced quality of life, poorer inter-personal relationships, hopelessness and mental illness. Worse outcomes, including mortality rates have been found for single men with cancer compared with women and partnered men. The aim of this systematic review was to examine the effectiveness of post-treatment psychosocial and behaviour change interventions for adult men with cancer, in order to inform the development of an intervention. A focus on single men was intended. Methods: Ten databases were searched via Ovid and Web of Science. Papers were systematically extracted by title, abstract and full paper according to the inclusion/exclusion criteria. Full papers were assessed by two authors. Inclusion criteria: participants at any stage of a cancer diagnosis, ,50% male and aged 18+; psychosocial and/or behavioural post-treatment interventions, using any format; a one,three level of evidence. Couple/carer/family interventions were excluded. Results: From 9948 studies initially identified, 11 were finally included in the review. They implemented cognitive behaviour therapy, hypnosis or psychoeducational interventions. All studies had some positive results, however, lack of reporting of intervention content and methodological issues limit the findings. No studies intervened with single men, and none provided comparative outcomes for marital status. Conclusions: Effectiveness of interventions was difficult to assess as, while all had benefits, their generalisability was limited due to methodological and reporting limitations. Improved reporting procedures are required to allow for replication. Copyright © 2009 John Wiley & Sons, Ltd. [source] Influence of Polyps on Outcomes After Endoscopic Sinus SurgeryTHE LARYNGOSCOPE, Issue 10 2007Neil Bhattacharyya MD Abstract Objective: To determine clinical and comparative outcomes for endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) with polyposis. Methods: Two cohorts of adult patients with refractory CRS with and without nasal polyps were prospectively studied before and after ESS (minimum follow-up, 12 months) with the Rhinosinusitis Symptom Inventory (RSI). For the non-polyp and polyp cohorts, RSI symptom domains and medical resource utilization were compared in the preoperative and postoperative states. Corresponding effect sizes were computed and compared between cohorts to determine the effect of polyps on prognosis after ESS. Results: A total of 165 non-polyp and 86 polyp patients were enrolled. Polyps were more common in female patients (2:1, P = .025); age (mean, 42.9 years) and follow-up (18.5 months) were similar between groups. Lund scores were significantly higher for polyp patients (13.7, SD 4.8) vs. non-polyp patients (8.1, SD 5.3, P < .001). At baseline, polyp patients reported lower symptom scores for facial, oropharyngeal, and systemic RSI symptom domains (all P < .012); nasal and total symptom domains were similar between groups. Both non-polyp and polyp groups obtained significant symptomatic benefit from ESS with effect sizes for RSI symptom domain improvements ranging from 0.89 to 1.38 and 0.43 to 1.19, respectively (all P < .001). There were no significant differences between groups in symptomatic improvement, excepting oropharyngeal symptoms (better improvement in non-polyp group, P = .024). Non-polyp patients decreased medical resource consumption more significantly than did polyp patients. Conclusions: Both non-polyp and polyp patients derive similar clinically significant symptomatic improvement after ESS. These similarities suggest that polyp patients do not necessarily have a poorer symptomatic outcome after ESS. [source] Fast track surgery: A clinical auditAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2010Jonathan CARTER Background:, Fast track surgery is a concept that utilises a variety of techniques to reduce the surgical stress response, allowing a shortened length of stay, improved outcomes and decreased time to full recovery. Aims:, To evaluate a peri-operative Fast Track Surgical Protocol (FTSP) in patients referred for abdominal surgery. Methods:, All patients undergoing a laparotomy over a 12-month period were entered prospectively on a clinical database. Data were retrospectively analysed. Results:, Over the study period, 72 patients underwent a laparotomy. Average patient age was 54 years and average weight and BMI were 67.2 kg and 26 respectively. Sixty three (88%) patients had a vertical midline incision (VMI). There were no intraoperative blood transfusions. The median length of stay (LOS) was 3.0 days. Thirty eight patients (53%) were discharged on or before post op day 3, seven (10%) of whom were discharged on postoperative day 2. On stepwise regression analysis, the following were found to be independently associated with reduced LOS: able to tolerate early enteral nutrition, good performance status, use of COX inhibitor and transverse incision. In comparison with colleagues at the SGOG not undertaking FTS for their patients, the authors' LOS was lower and the RANZCOG modified Quality Indicators (QI's) did not demonstrate excess morbidity. Conclusions:, Patients undergoing fast track surgery can be discharged from hospital with a reduced LOS, without an increased readmission rate and with comparative outcomes to non-fast tracked patients. [source] Families on the brink: the effectiveness of family support servicesCHILD & FAMILY SOCIAL WORK, Issue 2 2004June Statham ABSTRACT This paper presents findings from a study of the costs and effectiveness of family support services offered to 40 families with a high level of need, in two neighbouring local authorities in North Wales. It describes the level and type of services offered by different agencies in each of the authorities, estimates the costs of these services, and assesses outcomes for the families receiving them after three months. Information is also provided about families' experience of the support they received, and the kind of help they would have liked. Parents' well-being and family functioning were found to improve over the intervention period in both authorities, although only to a limited extent. Improvements were greater among those who were living with partners, and less among families identified by social workers as having financial difficulties or problems with drug or alcohol abuse. Respondents who rated their problems as very severe showed less improvement. The pattern of service provision and the costs involved turned out to be similar in both authorities, so it was not possible to reach conclusions about the relationship between services and outcomes. However, a number of themes emerging from the data are discussed, including the role of day care services in supporting families with young children, the impact of poverty and deprivation on parents' ability to provide good care for their children, and the importance of an interagency response to children's and parents' needs. The article also includes a discussion of problems encountered in undertaking comparative outcomes-based research and cost-effectiveness analyses in the social welfare field. [source] | ||||||||||