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Results for “Unnecessary Procedures”

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At least 19 recordsLinked to original sources
PubMed1998

Out-of-hospital intravenous access: unnecessary procedures and excessive cost.

OBJECTIVE: To evaluate the concordance with criteria developed by the study investigators and supply costs associated with placement of i.v. lines and saline locks by paramedics in the out-of-hospital setting. METHODS: This was a retrospective consecutive case series at an urban base hospital. Patients were treated by paramedics using one base hospital for medical control during December 1995. Base hospital written records and taped patient calls were reviewed to determine actual i.v. access method used by paramedics, chief complaint, and whether fluid administration was ordered. Indicated method of i.v. access was determined for each patient based on predetermined criteria developed by the investigators. i.v. access methods were ranked by cost of supplies as follows: i.v. line (i.v.) > saline lock (SL) > no i.v. line (No i.v.). An assignment of concordant treatment was made when actual = indicated method, discordant-overtreatment when actual > indicated, and discordant-undertreatment when actual < indicated. RESULTS: 452 patients were treated via radio by the base hospital during the study period. 380 of 452 (84%) received an i.v.. 28 of 380 (7%) received fluid resuscitation in the field. 166 of 452 (37%) received concordant treatment; 253 (56%) discordant-overtreatment; and 33 (7%) discordant-undertreatment. Pediatric patients (< or =14 years of age) were more likely to be undertreated as compared with adults, 33% vs 3% (p < 0.001). Patients who had medical chief complaints were more likely to receive discordant-overtreatment as compared with patients who had trauma chief complaints, 61% vs 32% (p < 0.001). 73% of chest pain patients received discordant-overtreatment. Based on these data, the yearly cost of supplies used in i.v. access discordant-overtreatment was $13,735 for this base hospital and $560,000 for the Los Angeles County emergency medical services (EMS) system. 91% of the excess supply cost is due to patients' receiving an i.v. instead of a SL. CONCLUSION: Based on study criteria for utilization of i.v. lines vs SLs in the field, paramedics and base hospital personnel often provide discordant-overtreatment of patients by placement of an i.v. when a SL or No i.v. would suffice, resulting in unnecessary costs for EMS systems.

Adolescent↗
PubMedDate not supplied

Bone marrow examination in small cell carcinoma of the bronchus: an unnecessary procedure?

One hundred and thirty-seven patients with small cell carcinoma of the bronchus underwent bone marrow trephine and/or aspirate examination as part of their clinical staging. Twenty-four patients (17.5 per cent) were found to have malignant marrow infiltration. In no case was this an isolated finding of metastatic disease, indeed most patients had gross metastatic spread to liver and/or bone. Marrow infiltration has not been shown to be a major prognostic factor in response to chemotherapy or survival in previous studies. We recommend that this staging procedure be discontinued in routine clinical practice, and instead be confined to specific indications in clinical trials.

Bone Marrow Examination↗
PubMed1995

Chest wall resection for Ewing's sarcoma of the rib: an unnecessary procedure. 1988. Updated in 1995.

Approximately 10% of all cases of Ewing's sarcoma arise from a rib. Conventional management has included chest wall resection (3 or more ribs) and radiation therapy. These forms of therapy have led to complications such as scoliosis and local deformity. The addition of radiation therapy can result in damage to the lung and adjacent viscera and also potentiate pulmonary restrictive disease. Between 1971 and 1978, 9 patients were treated with surgery, radiation therapy, and combination chemotherapy (three- or four-drug regimen). Only 2 patients (22%) survive. Since 1979, 14 patients were entered into a new protocol consisting of sequential induction chemotherapy, followed by delayed surgical resection whenever feasible. Three patients had complete resection of their primary lesion at onset. Initially, 7 patients had either biopsy (N = 4) or incomplete chest wall resection N = 3). All 4 patients with biopsy only at diagnosis had excellent responses to induction chemotherapy, allowing delayed resection of the involved rib without chest wall resection. Overall, 12 of 14 patients (86%) treated since 1979 survive, with only 2 receiving radiation therapy for residual disease in the primary rib site.

Bone Neoplasms↗
PubMed1988

Chest wall resection for Ewing's sarcoma of the rib: an unnecessary procedure.

Approximately 10% of all cases of Ewing's sarcoma arise from a rib. Conventional management has included chest wall resection (3 or more ribs) and radiation therapy. These forms of therapy have led to complications such as scoliosis and local deformity. The addition of radiation therapy can result in damage to the lung and adjacent viscera and also potentiate pulmonary restrictive disease. Between 1971 and 1978, 9 patients were treated with surgery, radiation therapy, and combination chemotherapy (three- or four-drug regimen). Only 2 patients (22%) survive. Since 1979, 14 patients were entered into a new protocol consisting of sequential induction chemotherapy, followed by delayed surgical resection whenever feasible. Three patients had complete resection of their primary lesion at onset. Initially, 7 patients had either biopsy (N = 4) or incomplete chest wall resection N = 3). All 4 patients with biopsy only at diagnosis had excellent responses to induction chemotherapy, allowing delayed resection of the involved rib without chest wall resection. Overall, 12 of 14 patients (86%) treated since 1979 survive, with only 2 receiving radiation therapy for residual disease in the primary rib site.

Adolescent↗
PubMedDate not supplied

Use of ultrasonography to avoid an unnecessary procedure in the prehospital combat environment: a case report.

The role of ultrasonography in the prehospital combat setting has become a useful tool for triage, diagnosis, and treatment. Recent literature has demonstrated that ultrasonography has a greater sensitivity and specificity than clinical examination and plain radiography for pneumothorax detection in trauma patients, particularly small pneumothoraces. This becomes especially critical in austere and remote environments. Although many pneumothoraces are initially considered non-life-threatening, austere and combat environments possess additional risks of limited supplies, multiple casualties, and prolonged evacuation times that may potentially increase the morbidity of these injuries. This case report discusses the role of ultrasonography in pneumothorax detection in the prehospital combat environment.

Adult↗
PubMedDate not supplied

Extended lymph-node dissection in gastric cancer: standard, selective or unnecessary procedure?

The effectiveness of extended lymph-node dissection for patients with gastric cancer still remains unclear because favorable results reported by Japanese and some Western observational studies could not be confirmed by two recent European randomized trials. Because the surgeon's experience with extended node dissection and the node preservation of spleen and pancreas are predominant factors influencing survival, more data from well-designed and conducted randomized trials considering these variables are needed to establish whether extensive lymphadenectomy improves survival in gastric cancer patients.

Hepatectomy↗
PubMed1998

[Breast cancer: axillary dissection--or an unnecessary procedure?].

The status of the axillary lymph nodes is one of the most important prognostic factors in breast cancer. The presence or absence of metastatic lymph nodes is of primordial importance for the choice of adjuvant therapy. Early diagnosis of breast cancer, a result of widespread use of screening mammography, has increased considerably the number of detected in situ cancer and small invasive cancer without involved lymph nodes. Up to now there exists no conclusive study concerning the curative value of axillary dissection. In contrast, the complications of this procedure, especially in the long run, are non-negligible, creating controversy over its use. In situ carcinoma is no longer considered an indication for axillary dissection, nor is micro-invasive cancer (< or = 2 mm). In absence of accurate imaging and valid alternatives to exploratory surgery, new less traumatising procedures are currently under investigation: axillary fat aspiration with endoscopic axillary surgery, or the sentinel lymph node biopsy which is enlarged in case of a positive histology to a full axillary dissection. This approach will permit in the near future a reduction of morbidity to a strict minimum due to surgical treatment in the node-negative patient.

Axilla↗
PubMedDate not supplied

Thresholds for significant decrease in hemodialysis access blood flow.

During hemodialysis access surveillance, referral for evaluation and correction of stenosis is based upon determination that a significant decrease in blood flow (Q) has occurred. However, criteria for determining when a decrease is statistically significant have not yet been established. In this study we established such criteria by analyzing Q variation with the glucose pump test (GPT). We took nine Q measurements in each of 25 patients (18 grafts, 7 fistulas) during three dialysis sessions within a 2-week period (predialysis and during hours 1 and 3). We determined thresholds that define a significant percentage decrease in Q (deltaQ) for various p values. In order to confirm the general applicability of these thresholds, we computed the average within-patient Q variation during the three sessions (computed as a coefficient of variation and referred to as short-term variation). We then determined the relative influences of biological (true) variation and analytical error on short-term variation. We found that deltaQ must be > 33% to be significant at p < 0.05, whereas the threshold is > 17% for p < 0.20. Measuring Q at uniform versus different times during the sessions did not significantly reduce these thresholds. We also found that biological variation was nearly as large as short-term Q variation, whereas analytical error contributed minimally to short-term variation. In conclusion, this study defines thresholds for a significant deltaQ that have wide application in determining access referral for evaluation and correction of stenosis. Selection of a particular threshold should consider the relative importance of avoiding thrombosis versus avoiding unnecessary procedures. If avoiding unnecessary procedures is a priority, then we recommend a threshold of > 33%. These thresholds apply to other methods of measuring Q, provided analytical error is significantly less than biological variation.

Arteriovenous Shunt, Surgical↗