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R Danzinger

Publications and source records attributed to R Danzinger.

8 recordsLinked to original sources
PubMed1989

[Assessment of the distorted video image of the body by schizophrenic patients].

A method is described using a modified video-image with a continuous image distortion of +/- 45%. By turning a potentiometer-dial the self-estimation of one's own body image can be adjusted. A sample of 108 schizophrenic patients assessed their own body-image as 12% too thin when compared with a matched control group of healthy volunteers (5.8%). This effect of estimating one's body proportions as too thin was shown to be exclusively caused by the female patients. In addition, the schizophrenic patients assessed their faces as significantly thinner than did the controls. The self-estimations made by different diagnostic subgroups of patients according to DSM III and those made on the second and tenth days after admission did not differ significantly. This remarkable tendency to estimate one's own image too thin in female schizophrenics is interpreted as an illusory approximation to an ideal image.

Adult↗
PubMed1986

Assessing surgical risks in a population: patient histories before and after cholecystectomy.

Claims data from the Manitoba Health Services Commission on all health care contacts during the 2 years preceding and the 2 years following gallbladder surgery were used to describe the histories of patients prior to cholecystectomy, and to assess surgical outcomes. The study is unique in focusing on essentially all patients in the population undergoing surgery (whether at large academic centres or small rural hospitals) and in tracking post discharge events (deaths and complications). Many patients presenting for surgery with acute/urgent conditions were previously asymptomatic or at least their gallbladder disease was undiagnosed (27%). Although overall mortality rates were low (0.7%), 26% of the deaths occurred following discharge from the hospital where surgery was performed. In addition, 3.4% of the patients were readmitted to hospital with complications of the gallbladder surgery, 13.5% continued to visit the physician with abdominal symptoms after surgery and 17% presented with psychological problems. Multiple logistic regression is used to estimate the risk of poor surgical outcomes according to a patient's presurgical characteristics. The analysis suggests that most published data are biased towards underestimating the risks associated with cholecystectomy (as well as the risks associated with other common surgical procedures).

Acute Disease↗
PubMed1986

Centralization, certification, and monitoring. Readmissions and complications after surgery.

Research on adverse outcomes following common surgical procedures has suggested the importance of hospital and surgeon variables. Policy directions depend on which factors are important in influencing patient outcomes and what sorts of policies are feasible. Focusing on where a given procedure is performed highlights a concern for centralization; emphasizing who should perform a particular operation implies physician certification. Finally, monitoring involves identifying particular hospitals that appear to have relatively poor (or relatively good) results. This paper analyzes patient, surgeon, and hospital characteristics associated with serious postdischarge complications of hysterectomy, cholecystectomy, and prostatectomy in patients age 25 and over in Manitoba, Canada, following surgery during 1974 through 1976. The three procedures differ markedly in the ease of prediction of the probability of complications and in the predictive importance of patient, hospital, and physician variables. The predictors worked fairly well for cholecystectomy, somewhat less well for hysterectomy, and not well at all for prostatectomy. Hospital variables were not generally important in the multiple logistic regressions. After controlling for case mix and type of surgery, physician surgical experience was found to account for relatively large differences (almost two to one) in the probability of patient complications following cholecystectomy. Cholecystectomy might be a candidate for certification because of the epidemiology of the operation. As of the mid-1970s, a substantial proportion of the cholecystectomies were being performed by physicians with comparatively little ongoing experience with this type of procedure. Moreover, a monitoring perspective identified one hospital with a significantly higher postcholecystectomy complication rate, even after physician experience was taken into account. Both identifying which procedures should be attended to and focusing on problems following surgery are important beyond Manitoba and highly relevant to such American requirements as Peer Review Organizations. Methods of increasing the efficiency of using claims data for quality assurance studies are outlined.

Cholecystectomy↗
PubMed1981

Gallbladder operations: a population-based analysis.

Cholecystectomy is one of the most frequently performed elective surgical procedures, and a major contributor to surgery-associated mortality. The well-documented variation in surgical rates across geographic areas has been attributed not simply to differences in disease prevalence but to factors such as varying rates of clinical and radiologic investigation and use of different indications for surgical treatment. The research uses a large claims-based data bank--the hospital and medical files maintained by the Manitoba Health Services Commission. The study focused first on the incidence of gallbladder operations in Manitoba's six rural and three urban areas. Age-adjusted surgical rates varied across regions from more than 50 operations per 10,000 persons aged 25 and over to less than 42. Such variation was considerably less than that noted earlier for the tonsillectomy/adenoidectomy (T&A) operation. Cholecystectomy and T&A rates were not significantly correlated across regions. Moreover, a region's cholecystectomy rate and its 'supply' of operating physicians (measured by a physician-to-population ratio) were not significantly associated. Because a large number of referrals to surgeons in urban centers take place, an analytical distinction between surgery done within the region and that done outside the region has been made. Some movement of rural patients with more serious conditions to urban hospitals is found. Questions of regionalization of surgery are discussed using 9 years of data on mortality following cholecystectomy and biliary tract surgery.

Adult↗