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Biomedical subjects

A T Stein

Publications and source records attributed to A T Stein.

8 recordsLinked to original sources
PubMed2005

Laparoscopy versus laparotomy for benign ovarian tumours.

BACKGROUND: Over the last ten years laparoscopy has become an increasingly common approach for the surgical removal of benign ovarian tumours. There remains uncertainty as to the value of this intervention. This review has been undertaken to assess the available evidence for the benefits and harms of laparoscopic surgery for benign ovarian tumours compared to laparotomy. OBJECTIVES: To determine the efficacy, safety and cost of laparoscopic surgery compared with laparotomy in women with ovarian tumours assumed to be benign. SEARCH STRATEGY: We searched electronic databases, trials registers and reference lists of published trial reports. Review articles were also searched. SELECTION CRITERIA: All randomised controlled trials comparing laparoscopy versus laparotomy for benign ovarian tumours. DATA COLLECTION AND ANALYSIS: Three reviewers independently assessed each study's eligibility and quality and extracted data. MAIN RESULTS: Six randomised controlled trials were identified involving 324 patients. Three subgroups of ovarian tumours were considered: any histological type of benign ovarian tumour, dermoid cysts and endometriomata. Surgical outcomes: The mean duration of surgery was longer in the laparoscopy group compared to the laparotomy group overall (WMD 11.39; 95% CI 0.57 to 22.22). However, heterogeneity was present with substantial inconsistency (I(2)=87%) . The heterogeneity found in these analyses was likely to reflect differences in the patient populations. Adverse effects of surgery: The pooled estimate for febrile morbidity decreased for laparoscopy compared to laparotomy (Peto OR 0.34; 95% CI 0.13 to 0.88). The odds of any adverse effect of surgery (total number of complications - surgical injury and/or post operative complications) were decreased after laparoscopic procedures (Peto OR 0.26; 95% CI 0.12 to 0.55). Short-term recovery: VAS pain scores favoured laparoscopy (WMD -2.36; 95% CI -2.07 to -2.03) andt he odds of being pain free were significantly greater for the laparoscopy group compared to laparotomy (Peto OR 7.35; 95% CI 4.3 to 12.56). Mean length of hospital stay was shorter in the laparoscopy group with reduction 2.79 days (95% CI -2.95 to -2.62) compared to laparotomy. Economic outcomes: There was a significant reduction of US$1045 (95% CI -1361 to -726.97) in the laparoscopy group compared to the laparotomy group in one trial of women with any type of benign ovarian tumour. AUTHORS' CONCLUSIONS: In women undergoing surgery for benign ovarian tumours, laparoscopy is associated with a reduction in the following; febrile morbidity, urinary tract infection, post operative complications, post operative pain, days in hospital and total cost. These findings should be interpreted with caution as only a small number of studies were identified including a total of only 324 women and not all of the important outcomes were reported in each study.

Female↗
PubMed2002

The relevance of continuity of care: a solution for the chaos in the emergency services.

BACKGROUND: In Brazil, there continues to be an excessive use of emergency services by patients with elective medical problems. Those patients who report having a primary care physician are less likely to utilize the emergency department for non-urgent consultations. OBJECTIVE: The objective of this study was to compare patients who have a primary care physician with those who do not in relation to severity of their chief complaint at presentation in the emergency department. METHODS: The study was carried out as a cross-sectional interview-based survey at the Conceição Hospital Emergency Service in Porto Alegre (Brazil). The sample was 553 patients selected through a systematic random sampling, and the response rate was 88%. The data entry and analysis were performed using the software Epi-info, EGRET and SPSS. The analysis included simple statistics to determine the prevalence of the conditions being investigated and the effect of independent variables (regular doctor) in relation to the dependent variable (severity of disease) through logistic regression. RESULTS: The chief complaints were divided up as follows: 15% emergency cases, 46% urgent cases and 39% elective. The chief complaint was defined as urgent or emergency if it exhibited a significantly statistical association with the following independent variables, after being analysed by a logistic regression model: patients who reported having a primary care physician [odds ratio (OR) = 2.98, 95% confidence interval (CI) = 1.84-4.80] and patients who usually go to the emergency room by car (OR = 2.67, 95% CI = 1.75-4.05). CONCLUSION: One strategy to reduce the number of non-urgent consultations at emergency rooms is to establish a close out-patient relationship between patients and physician. There is a need to optimize the health care of patients who have non-urgent problems but still seek the emergency department through strategies at the primary health care level-especially when continuous care is available-and where a comprehensive approach with an emphasis on prevention would stimulate better quality of care at a lower cost.

Brazil↗
PubMed1999

Who in Brazil has a personal doctor?

BACKGROUND: Continued medical care (including having a personal doctor) is regarded as an essential aspect of a good health service. OBJECTIVES: The objectives of the present study were to investigate the reasons for not having a personal doctor, and the satisfaction with the care received by patients with and without a personal doctor. METHODS: We conducted a cross-sectional study with data collected during 20 days over 6 months in the Emergency Service of the Conceição Hospital, the busiest emergency service in Porto Alegre. The subjects were 553 patients selected through systematic random sampling. The main outcome measure was having a personal doctor. Patients who reported usually to see the same doctor and remembered their physician's name were regarded as having a personal doctor. RESULTS: Patients who usually use primary care service represented 23% of the sample, and were four times more likely to have a personal doctor (OR = 3.83, CI 95% = 2.41-6.11). Independent, statistically significant variables associated with having a personal physician were: usually receiving care from a primary health care service (OR = 3.8, CI 95% = 2.39-6.00) and from a physician in the private sector (OR = 2.16, CI 95% = 1.15-4.00). Patients who had a personal doctor reported higher satisfaction with their access to health care. The personal doctors' specialties were: internal medicine (37%), cardiologist (17%), gynaecologist-obstetrician (13%), family physician (8%) and pneumologist (6%). CONCLUSIONS: For patients who attend emergency services in Brazil, primary health care and private medical care provide better access to continuity of patient care. Patients with personal doctors report higher satisfaction with access to consultations.

Adult↗
PubMedDate not supplied

Accuracy of frozen-section analysis in the diagnosis of ovarian tumors: a systematic quantitative review.

A quantitative systematic review was performed to estimate the diagnostic accuracy of frozen sections in ovarian tumors. Studies that compared frozen sections and paraffin sections within subjects for diagnosis of ovarian tumors were included. Fourteen primary studies were analyzed, which included 3 659 women. For benign ovarian vs borderline/malignant tumor cases, the occurrence of a positive frozen-section result for benignity (pooled likelihood ratio [LR], 8.7; 95% confidence interval [CI], 7.3-10.4) and posttest probability for benign diagnosis was 95% (95% CI, 94-96%). A positive frozen-section result for malignant vs benign diagnosis (pooled LR, 303; 95% CI, 101-605) increased the probability of ovarian cancer to 98% (95% CI, 97-99%). In borderline vs benign ovarian tumor cases, a positive frozen-section result (pooled LR, 69; 95% CI, 45-106) increased the probability of borderline tumors to 79% (95% CI, 71-85%). In borderline vs malignant ovarian tumor cases, a positive frozen-section result (pooled LR, 18; 95% CI, 13-26) increased the probability of borderline tumors to 51% (95% CI, 42-60%). We conclude that diagnostic accuracy rates for frozen-section analysis is high for malignant and benign ovarian tumors, but the accuracy rates in borderline tumors remain relatively low.

Cryopreservation↗