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L Crist

Publications and source records attributed to L Crist.

4 recordsLinked to original sources
PubMed2002

Persistent post-laparoscopy pneumoperitoneum.

BACKGROUND: Persistent pneumoperitoneum after a laparoscopic operation can represent either residual postoperative pneumoperitoneum or free intraperitoneal gas released from the gastrointestinal tract. This animal study was conducted to better characterize the extent and duration of postoperative pneumoperitoneum as detected by computed tomography (CT). METHODS: Five pigs underwent cholecystectomy, four laparoscopically and one open. All pigs were followed serially with upright chest radiographs and abdominal CT scans beginning immediately postoperatively and continuing daily until resolution of pneumoperitoneum as detected by both imaging modalities. All radiographs and CT scans were reviewed by dedicated radiologists who reported the extent and duration of pneumoperitoneum in a blinded fashion. RESULTS: Pneumoperitoneum resolved on upright chest radiographs in all five pigs by or on postoperative day 1. Serial CT scans demonstrated that the laparoscopic group had either resolution of pneumoperitoneum or minimal persistence of free intraperitoneal gas by postoperative day 2. In contrast, the single pig in the open group had CT evidence of persistent pneumoperitoneum through postoperative day 6. CONCLUSIONS: In the pig model, small pockets of free intraperitoneal gas detected by CT scanning are expected to resolve by postoperative day 2 following laparoscopic surgery. Persistence of pneumoperitoneum beyond this interval is abnormal and may represent a perforated viscus. Whereas a prospective CT imaging study in humans is not ethically feasible, we believe that parallel conclusions between the pig and human may be drawn.

Abdominal Pain↗
PubMedDate not supplied

Outcomes system implementation for subacute care.

The emergence of subacute care, seen as a cost-effective alternative to other, more expensive settings, is an important option for case managers. The current, rapid growth of subacute care, the diversity of subacute programs, the differences in patient types, and the lack of consistent standards to define subacute care illustrate the critical need for the case manager's role in balancing quality and cost. The lack of solid clinical outcomes data for patients treated in subacute care make it difficult for case managers to assess quality. Outcomes data, as a measurable dimension of quality, may include clinical effectiveness measures, associated costs, and patient/family satisfaction. Outcomes data can be used as a tool by the case manager to facilitate the coordination of patient care. Although there is an increased consumer interest in outcomes across all health care modalities, there is limited outcomes research available to document the efficacy of subacute care. As the pressure increases for outcomes data on subacute care by consumers and payers, efforts toward facility implementation of outcomes systems to assess subacute care are growing. The unique challenges to outcomes implementation in a skilled nursing facility-based setting are discussed, and strategies for successful implementation are presented. Basic subacute outcomes implementation issues of organizational support, staff participation, and data collection are reviewed. Ideas for case management involvement with facility implementation are discussed.

Case Management↗