Recent trends in utilization of procedures in otolaryngology-head and neck surgery.

The development of minimally invasive techniques and increasing performance of surgery in outpatient settings have had a major influence on otolaryngology-head and neck surgery (OLHNS), but little is known about the extent to which these forces have affected the overall distribution and total rate of performance of OLHNS procedures. The aims of this study were to determine whether there has been a change in the total number of people undergoing OLHNS procedures between 1989 and 1992 in Maryland and to identify those procedures for which there has been a significant change in utilization. Data were obtained on 171,579 patients undergoing OLHNS procedures between 1989 and 1992 in Maryland's nonfederal, acute care hospitals, hospital-based outpatient centers, and freestanding multispecialty surgical centers.

Does preoperative stoma marking and education by the enterostomal therapist affect outcome?

Introduction: It is generally accepted that preoperative patient education and skin marking for a stoma location are important in avoiding stoma complications. At our institution, enterostomal therapists are available to educate and mark patients before their surgery. However, for various reasons, not all patients who had an elective stoma created, had preoperative skin marking or instructions on stoma care.

Atherosclerotic disease in patients undergoing cataract extraction. A nationwide case-control study. The Cataract Patient Outcomes Research Team.

Objective: To evaluate the association between cataract extraction and atherosclerosis and its complications.

Design: A nationwide case-control study.

Setting And Participants: Using a 5% random sample of all Medicare beneficiaries, we analyzed Medicare claims data on 60803 persons 65 years of age and older who underwent cataract extraction in 1986 or 1987 and a control group of 63765 persons matched to the cases for age, race, sex, ZIP code, and reason for Medicare entitlement.

Risk factors for retinal detachment after cataract surgery. A population-based case-control study.

Purpose: Previous analyses of Medicare claims data, as well as clinical series, have suggested that performance of neodymium:YAG (Nd:YAG) laser posterior capsulotomy after extracapsular cataract surgery increases significantly the risk of retinal detachment. However, methodologic problems with previous research limit the strength of conclusions that can be drawn from these earlier studies. This study was designed to resolve those methodological limitations while using a population-based approach for assessment of the independent association between the performance of Nd:YAG laser posterior capsulotomy and pseudophakic retinal detachment.

Postoperative management of cataract surgery patients by ophthalmologists and optometrists.

Objectives: To assess the frequency and content of post-operative examinations by ophthalmologists and optometrists for cataract surgery patients without operative complications and to assess the referral patterns of optometrists when complications are identified.

Design: In 1992 we conducted a survey of randomly selected members of the American Academy of Ophthalmology and American Optometric Association. Responses were obtained from 538 (82%) of 655 eligible ophthalmologists and 130 (84%) of 154 eligible optometrists.

Practice guidelines. What are internists looking for?

To determine features of the presentation of clinical practice guidelines that may enhance their use by internists, we conducted a cross-sectional survey to which 1,513 (60%) of 2,513 eligible internists responded. Endorsements by respected colleagues and by major organizations were identified as very important by 72% and 69% of respondents, respectively. Respondents preferred short pamphlets and manuals summarizing a number of guidelines and felt that concise recommendations (86%), synopsis of supporting evidence (85%), and quantification of benefit (77%) were important in guideline presentation.

Reproducibility and responsiveness of the VF-14. An index of functional impairment in patients with cataracts.

Objectives: To assess the test-retest reliability and responsiveness of the VF-14, which is an index of functional impairment in patient with cataracts.

Design: Observational longitudinal study. Patients were enrolled prior to undergoing their first cataract surgery between July 15 and December 15, 1991, and they were followed up for 1 year after surgery.

The "battering syndrome": prevalence and clinical characteristics of domestic violence in primary care internal medicine practices.

Objectives: To determine the prevalence of domestic violence among female patients and to identify clinical characteristics that are associated with current domestic violence.

Design: Cross-sectional, self-administered, anonymous survey.

Setting: 4 community-based, primary care internal medicine practices.

Preoperative functional expectations and postoperative outcomes among patients undergoing first eye cataract surgery.

Objective: To describe the relationship between patients' preoperative expectations regarding the outcome of cataract surgery and actual postoperative experience.

Methods: A longitudinal study of 772 patients undergoing first eye cataract surgery recruited from 75 ophthalmology practices in three metropolitan areas was conducted. Prior to surgery and approximately 4 months after surgery, a detailed interview was conducted that included general and vision-specific health status measures (including the Visual Function 12-Item Scale [VF-12]), patient-reported level of trouble and satisfaction with vision, and questions addressing patients' preoperative expectations regarding the outcomes of surgery.

Do ophthalmologists, anesthesiologists, and internists agree about preoperative testing in healthy patients undergoing cataract surgery?

To assess variation in reported use of preoperative medical tests in patients undergoing cataract surgery and to identify factors that influence test use by different physician groups we performed a national survey of ophthalmologists, anesthesiologists, and internists. Participants included randomly selected members of American professional societies who provided care to one or more patients undergoing cataract surgery in 1991. Responses were obtained from 538 (82%) of 655 eligible ophthalmologists, 109 (76%) of 143 anesthesiologists, and 54 (44%) of 122 internists.

Cataract surgical techniques. Preferences and underlying beliefs.

To characterize the intraoperative procedures employed by cataract surgeons in the United States and the beliefs underlying the practices, a standardized questionnaire was sent to a systematic random sample of members of the American Academy of Ophthalmology in 1992. Of 667 surveyed ophthalmologists, 550 completed the questionnaire (response rate, 82.5%).

Comparison of generic versus disease-specific measures of functional impairment in patients with cataract.

The increased demand for health status measures in evaluating medical interventions has increased the importance of clarifying when to use generic versus disease-specific health status measures. The authors compared the performance of a well known generic health status measure, the Sickness Impact Profile (SIP), and a disease-specific measure of functional impairment related to vision (the VF-14) in detecting functional impairment in 426 cataract patients before and at 12 months after first eye cataract surgery. Using analysis of covariance models, the associations were assessed between the SIP and VF-14 and four criterion variables--patient ratings of trouble and satisfaction with their vision and overall health, and best corrected visual acuity--after controlling for patient age and medical comorbidities.

Blood flow in colon anastomotic stricture formation.

Purpose: The influence of both blood flow and anastomotic technique on the development of anastomotic stricture formation was studied using a dog model.

Methods: Fifty-three dogs underwent distal colocolonic anastomosis with either an EEA (U.S.

Variation in ophthalmic testing prior to cataract surgery. Results of a national survey of optometrists. Cataract Patient Outcome Research Team.

Objective: To assess variation in optometrists' use of ophthalmic tests in the evaluation of patients being considered for cataract surgery who have no history of other eye disease.

Design/participants: National survey of a systematic sample of practicing members of the American Optometric Association (St Louis, Mo), who had referred at least one patient to an ophthalmologist for consideration of cataract surgery in 1991.

Results: Ninety-two of 130 eligible responding optometrists reported that they routinely performed preoperative testing on patients being considered for cataract surgery.

Comparison of the rating scale and the standard gamble in measuring patient preferences for outcomes of gallstone disease.

To estimate patient preferences for gallstone-related treatments and outcomes, and assess how preferences vary by patient characteristics and scaling technique, the authors randomly assigned 40 patients without gallstones to interviews based on a rating scale (n = 22) and a standard gamble (n = 18). The patients assigned preference values (possible values 0 to 1) to open cholecystectomy (mean 0.45 by rating scale, 0.

Variation in ophthalmic testing before cataract surgery. Results of a national survey of ophthalmologists.

Little information is available either for the clinical value of many ophthalmic tests performed preoperatively in the evaluation of patients for cataract surgery or for variation in ophthalmologists' use of such tests. To assess variation in ophthalmologists' use of ophthalmic tests, we conducted a national survey of American Academy of Ophthalmology members. Thirty-three percent, 17%, 37%, and 19% of the respondents reported that they "frequently" or "always" perform glare testing, contrast sensitivity testing, potential acuity measurement, and specular microscopy, respectively, in patients being considered for cataract surgery who have no history of eye disease other than cataract.

Internists' attitudes about clinical practice guidelines.

Objective: To assess internists' familiarity with, confidence in, and attitudes about practice guidelines issued by various organizations.

Design: Cross-sectional, self-administered survey.

Participants: Questionnaires were mailed to a stratified random sample of 2600 members of the American College of Physicians (ACP) in 1992.

National study of cataract surgery outcomes. Variation in 4-month postoperative outcomes as reflected in multiple outcome measures.

Background: Although ophthalmologists have long recognized that visual acuity alone is an inadequate measure of visual impairment, the need for and outcomes of cataract surgery historically have been assessed in terms of visual acuity.

Purpose: To examine the relation among different cataract surgery outcome measures, including a 14-item instrument designed to measure functional impairment caused by cataract (the VF-14), at 4 months after cataract surgery.

Methods: The authors performed a longitudinal study of 552 patients undergoing first eye cataract surgery by 1 of 75 ophthalmologists practicing in Columbus, Ohio, St.

The VF-14. An index of functional impairment in patients with cataract.

Objective: To describe the development and the performance of a brief questionnaire designed to measure functional impairment caused by cataract (the VF-14).

Design: Observational cross-sectional study. Patients were recruited between July 15 and December 15, 1991.

Surgical rates and operative mortality for open and laparoscopic cholecystectomy in Maryland.

Background: Since 1989, laparoscopic cholecystectomy has been widely adopted as a treatment for gallstone disease. We analyzed the association between the introduction of this procedure and three variables: the rate at which cholecystectomy was performed in Maryland, the characteristics of patients undergoing cholecystectomy in routine clinical practice, and operative mortality.

Methods And Results: We used 1985-1992 hospital-discharge data from all 54 acute care hospitals in Maryland, to identify open and laparoscopic cholecystectomies, characteristics of patients undergoing these procedures, and deaths occurring during hospitalizations in which these procedures were performed.

Efficacy of immune globulin in preventing complications of bone marrow transplantation: a meta-analysis.

To assess the efficacy of immune globulin in preventing CMV infection, interstitial pneumonia, GVHD and death after BMT, we reviewed and synthesized data from 12 published studies (with 1282 patients) in which immune globulin was used prophylactically in BMT patients, controls were included and clinical outcomes were assessed. Data synthesis indicates that immune globulin significantly reduces fatal CMV infection (odds ratio (OR) 0.47, 95% confidence interval (CI) 0.