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M S Litwin

Publications and source records attributed to M S Litwin.

At least 73 records · Page 4Linked to original sources
PubMed1996

Cost-efficient radical prostatectomy with a clinical care path.

PURPOSE: We assessed changes in hospital costs and resource use among patients undergoing radical prostatectomy following implementation of a clinical care path. MATERIALS AND METHODS: A standardized clinical care path for patient management before and after radical prostatectomy was developed and implemented at a large academic medical center in California. All 577 consecutive patients undergoing radical prostatectomy during the 3 years before and 1 year after implementation of the care path were included in the study. Each patient was entered prospectively into a hospital-wide financial data base, which served as the source for observations on hospital costs, hospital charges and length of stay. RESULTS: After implementation of the radical prostatectomy care path hospital costs decreased by 12% ($7,916 versus $6,934, p < 0.001), hospital charges decreased by 20% ($17,005 versus $13,524, p < 0.0001) and length of stay decreased by 28% (5 versus 3.6 days, p < 0.0001). Decreases were noted in all categories of the hospital patient financial profile, except operating room charges. CONCLUSIONS: By standardizing preoperative and postoperative management for patients undergoing radical prostatectomy, significant savings can be achieved over and above existing trends toward shorter hospital stays and lower hospital costs.

Aged↗
PubMed1996

Practice trends of American urologists in the treatment of impotence, incontinence and infertility.

PURPOSE: Trends of urologist practice patterns in evaluating and treating impotence, incontinence and infertility in the United States were assessed. MATERIALS AND METHODS: In July 1995 the executive interviewing branch of the Gallup Organization selected randomly and interviewed by telephone 533 practicing urologists in the United States who had provided urological patient care for more than 20 hours per week, practiced in 1994 and completed a urological residency program. RESULTS: Treatment of male sexual dysfunction and female urinary incontinence comprises a significant portion of the professional activity of United States urologists. However, evaluation and management of male infertility occupy a small portion of the average urological work load. While more than half of United States urologist office clinical laboratories were inspected in 1994, only 2% failed evaluation due to major deficiencies. CONCLUSIONS: Male sexual dysfunction and female urinary incontinence are major areas of urological practice in the United States but male infertility is not. Few United States urologist clinical laboratories failed inspection because of major deficiencies.

Adult↗
PubMed1995

Urology.

The overarching principle throughout the benign prostatic hyperplasia guideline is that patient assessment of symptoms should guide evaluation and therapy. Opinions on prostate cancer run a wide gamut. The treatment of metastatic renal cell carcinoma with immunologic therapies continues to show promise.

Humans↗
PubMed1995

Quality-of-life outcomes in men treated for localized prostate cancer.

OBJECTIVE: To assess health-related quality of life (HRQOL) in men treated for clinically localized prostate cancer. DESIGN: A cross-sectional analysis of HRQOL after treatment with radical prostatectomy, pelvic irradiation, or observation alone for clinically localized prostatic adenocarcinoma, and in age-matched comparison patients. SETTING: A large managed care population in California. SUBJECTS: A total of 528 men, including 214 treated for clinically localized prostate cancer (41 with evidence of metastatic disease were excluded from this analysis) and 273 age-matched, ZIP code-matched comparison patients without prostate cancer. Cancer patients were analyzed in three treatment groups: radical prostatectomy (n = 98), primary pelvic irradiation (n = 56), and observation alone (n = 60). MAIN OUTCOME MEASURES: General HRQOL was measured with the RAND 36-Item Health Survey 1.0. Cancer-specific HRQOL was measured with the CAncer Rehabilitation Evaluation System-Short Form and the Functional Assessment of Cancer Therapy-General form. Disease-targeted quality of life was measured with a new instrument assessing function and bother in three organ systems: sexual, urinary, and bowel. RESULTS: No differences among treatment groups were seen in comparisons of general HRQOL: Significant differences among treatment groups were seen in both function and bother in the prostate-targeted measures of sexual, urinary, and bowel domains. When cancer patients were compared with men of similar age without prostate cancer, differences were seen in the sexual, urinary, and bowel function and bother but not in general HRQOL measures. Although cancer-free men were found not to have full potency or continence, prostate cancer patients treated with surgery or radiation reported significantly worse sexual, urinary, and bowel function than men without cancer. Men who had undergone nerve-sparing prostatectomy did not differ from those who had undergone standard prostatectomy, but the power to detect a difference was low. CONCLUSIONS: Although no differences were seen in general HRQOL, three disease-targeted domains were found to differ significantly among the treatment groups and comparison patients. Even after controlling for the sexual and urinary dysfunction experienced by older men without cancer, those receiving therapeutic interventions for their prostate cancer were found to have poorer disease-targeted HRQOL: We conclude that in addition to general HRQOL, disease-targeted measures must be used to assess outcomes of care in men treated for localized prostate cancer.

Adenocarcinoma↗
PubMed1995

Identification of an endogenous inhibitor of prostatic carcinoma cell growth.

The rate of expansion of primary prostatic carcinoma is comparatively slow, with tumours frequently taking years or decades to reach clinically relevant size. We now report the presence of an endogenous inhibitor, derived from aqueous extracts of human prostate tissue, which blocks prostatic carcinoma cell proliferation in vitro and prevents subcutaneous tumour expansion in vivo. Purification and characterization revealed the inhibitor to be spermine, a polyamine known to be locally abundant in the prostate. These results suggest that endogenous polyamine can negatively regulate the growth of prostatic carcinoma cells at their primary site in vivo and may explain the slow rate of primary tumour expansion in the prostate.

Adenocarcinoma↗
PubMed1995

Practice trends in the diagnosis and management of benign prostatic hyperplasia in the United States.

PURPOSE: The American Urological Association (AUA) first commissioned the Gallup Organization of Princeton, New Jersey to conduct a study to assess urologists' practice patterns in 1992. MATERIALS AND METHODS: In August 1994 a random sample of 514 American urologists was surveyed by the Gallup Organization regarding practice patterns for the diagnosis and management of benign prostatic hyperplasia (BPH). It asked questions regarding the practice patterns of respondents in their diagnosis and management of BPH. RESULTS: The survey revealed that 99% of the respondents were aware of and used the AUA symptom score index, and that 21% of these respondents had altered their diagnosis and management strategies because of its existence. CONCLUSIONS: Therapeutic recommendations of the respondents based upon AUA symptom score index severity parallel the recently announced federal Agency for Health Care Policy and Research BPH practice guidelines.

Adrenergic alpha-Antagonists↗
PubMed1995

Practice trends in the diagnosis and management of prostate cancer in the United States.

PURPOSE: The American Urological Association first commissioned the Gallup Organization of Princeton, New Jersey to conduct a study to assess urologists' practice patterns in 1991. MATERIALS AND METHODS: A random sample of 514 American urologists was surveyed by the Gallup Organization regarding practice patterns used in the staging and treatment of prostate cancer. The third annual survey taken during August 1994 asked questions regarding the practice of respondents in their diagnosis and management of prostatic cancer. RESULTS: The survey revealed that 95% of the respondents would recommend radical prostatectomy for men younger than 70 years with confirmed clinically localized prostate cancer. CONCLUSIONS: In this patient age group, surprisingly, the survey resulted in some interesting facts: 1) 13% regard hormonal manipulation for early stage cancer appropriate, 2) the respondents used extensive numbers of diagnostic staging studies in the new prostate cancer patient with a prostate specific antigen of less than 10 and 3) despite the obvious increased costs, the majority of patients receiving hormone manipulation were being treated with luteinizing hormone-releasing hormone agonists rather than orchiectomy.

Adult↗
PubMed1994

Measuring health related quality of life in men with prostate cancer.

Health related quality of life is one of several end points commonly studied in medical outcomes research. It refers to how well an individual is functioning in life and to his or her own perceptions of well being. Although health related quality of life variables concern subjective phenomena, their measurement is rigorously quantitative and based upon the well defined principles of psychometric research methodology. Health related quality of life data are collected with survey instruments, which may be self-administered or require a trained interviewer. Some are completed at a medical facility, while others are completed independently at home or by telephone. To yield useful information, such instruments must undergo extensive pilot testing and be shown to have sound psychometric properties. This testing determines whether an instrument can produce data that are reliable or reproducible, and valid or meaningful. Health related quality of life instruments typically contain several collections of items, called scales, that apply to particular dimensions of quality of life. These scales contribute to a qualitative profile of the health-related components of the daily life of a subject. General health related quality of life measures include broad issues that concern many types of patients, while disease-targeted measures address issues that are specific to the condition under study. Both are necessary to create a full and rich picture of patient quality of life. The field of health related quality of life research remains in its adolescence. Although several general measures are now well established, many disease targeted domains have been left unexplored. In men treated for prostate cancer, established general and cancer specific health related quality of life instruments may be combined with newly developed measures that assess the prostate related sexual, urinary and bowel domains in terms of degree of dysfunction and level of bother from that dysfunction. With the substantially increased patient role in directing treatment for prostate cancer, the importance of examining health related quality of life outcomes in addition to survival has been underscored. It is the responsibility of the urological community to include health related quality of life when assessing new and established prostate cancer therapies, and when counseling patients.

Attitude to Health↗
PubMed1993

The resource-based relative value scale: methods, results and impacts on urology.

Increased concern for rising health care costs in the United States has led to the passage of legislation to reform physician payment for Medicare services based on resource inputs. In January 1992 the Health Care Financing Administration began implementing the new law, which replaces the existing Medicare system of physician payment with a fee schedule based on the resource-based relative value scale (RBRVS). We summarize the methods and data used to derive the RBRVS for urology. A national random sample of 115 practicing urologists completed structured telephone surveys to provide ratings of physician time and work required before, during and after most frequently performed urological services. Subsequent survey cycles with urologists provided further refinement. Urologists then participated in a cross-specialty physician panel to link services from all specialties onto a common scale. This common scale was adjusted for geographic differences in practice overhead costs and malpractice insurance premiums. A monetary conversion factor, determined by the Health Care Financing Administration, was then applied to convert the RBRVS into a Medicare fee schedule. The merits and demerits of the scientific process used to develop and maintain the relative value scale are extensive. While statistically valid and reproducible, the study results have been altered in the political arena. The results and impacts of the new Medicare payment system on urology will be significant, although it is not yet clear how urological practice will be affected. Although faring better than most surgical specialties, urologists stand to lose approximately 8% of their Medicare income when the new fee schedule is fully implemented. There will be relative gains for evaluation and management services and losses for most invasive procedures.

Fee Schedules↗
PubMed1993

Why do sicker patients cost more? A charge-based analysis of patients undergoing prostatectomy.

Hospitals are reimbursed a greater amount for Medicare patients undergoing prostate surgery who have comorbid and complicating conditions than for patients without these conditions, since the former have been shown to have higher hospital costs and charges. We attempted to determine whether the higher hospital charges are due to duration of hospital stay and/or intensity of services. We analyzed hospital discharge data from 799 patients undergoing radical or transurethral prostatectomy during a 3-year period (1988 to 1991) at 2 major teaching hospitals by examining length of stay (duration), charges per hospital day (intensity) and total charges per stay. Mean lengths of stay were significantly longer for sicker versus healthier patients undergoing radical prostatectomy (7.4 versus 6.8 days at hospital 1 and 8.9 versus 7.8 days at hospital 2, p < 0.05) and transurethral prostatectomy (3.5 versus 2.8 days at hospital 1 and 3.5 versus 2.5 days at hospital 2, p < 0.05). Total hospital charges were significantly higher for sicker versus healthier patients undergoing radical prostatectomy ($14,557 versus $13,357 at hospital 1 and $17,864 versus $16,080 at hospital 2, p < 0.05) and transurethral prostatectomy ($6,446 versus $5,012 at hospital 1 and $5,468 versus $3,710 at hospital 2, p < 0.05). However, sicker and healthier patients had similar charges per day for radical prostatectomy ($1,959 versus $1,961 at hospital 1 and $2,006 versus $2,073 at hospital 2, p not significant) and for transurethral prostatectomy ($1.839 versus $1,800 at hospital 1 and $1.544 versus $1,488 at hospital 2, p not significant). On specified hospital days the charges per day for room/nursing, medical/surgical supplies, laboratory services and pharmacy services were similar for patients with and without comorbid conditions. Patients who are more ill at admission remain hospitalized longer after prostatectomy. However, they do not receive more intense care during their stays. For these procedures duration and not intensity appears to be the primary determinant of higher hospital charges for sicker patients.

Comorbidity↗
PubMed1992

Ode to Joy.

Explore the source record for details and available documents.

Aged↗
PubMed1992

Extracorporeal shock-wave lithotripsy and ursodiol versus ursodiol alone in the treatment of gallstones.

The efficacy and occurrence of adverse effects after two forms of treatment were compared in 111 patients with biliary colic and radiolucent gallstones in this prospective, nonrandomized study. Fifty-four patients received extracorporeal shock-wave lithotripsy (ESL) plus ursodiol, and 57 patients received ursodiol alone. Among patients with a single stone (5-20 mm in size), no patient treated with ursodiol alone had a stone-free gallbladder at 6 or 12 months after treatment; of those treated with ESL plus ursodiol, 15 of 24 patients (63%) had a stone-free gallbladder at 6 months and 17 of 20 patients (85%) at 12 months. For patients with multiple stones (with an aggregate diameter of less than or equal to 30 mm), the incidence of a stone-free gallbladder was 2 of 43 patients (5%) at 6 months and 8 of 35 patients (23%) at 12 months in the ursodiol treatment group. In the ESL plus ursodiol group, the incidence of a stone-free gallbladder was 7 of 22 patients (32%) at 6 months and 9 of 20 patients (45%) at 12 months. Two patients in the ESL plus ursodiol group (4%) and 13 patients in the ursodiol group (24%) underwent cholecystectomy. Both patients in the ESL plus ursodiol therapy and 4 patients in the ursodiol group had emergency cholecystectomies because of acute cholecystitis. The remaining 9 patients in the ursodiol group had elective cholecystectomies. In this nonrandomized, prospective study, ESL plus ursodiol treatment produced stone-free gallbladders at a faster rate than ursodiol alone in patients with either single or multiple gallstones.

Analgesia↗