Results of a clinical care pathway for radical prostatectomy patients in an open hospital - multiphysician system

OBJECTIVES: The object of this study was to evaluate the results of a comprehensive clinical care pathway (CCP) aimed at reducing the length of hospitalization and overall cost for patients undergoing radical prostatectomy in a setting including both academic and private physicians. METHODS: The clinical records of 1,129 consecutive patients who underwent radical prostatectomy by 24 urologists between July 1, 1990, and December 31, 1996, were reviewed. The factors considered were length of stay, morbidity and mortality, readmission rates, and average cost. The CCP was implemented on January 1, 1994. Its scope was to minimize preoperative evaluation, eliminate the preoperative hospital stay, standardize postoperative care and provide intensive patient education. RESULTS: The average length of stay decreased significantly after implementation of the CCP (8.1 vs. 4.9 days, p = 0.0001). In 1990, there was a large difference in length of stay between academic and private physicians (8.3 vs. 12.6 days) (p = 0. 02) but by 1 year after implementation of the CCP there was virtually no difference (4.69 vs. 4.71 days) (p > 0.05). Complication rates were similar before and after implementation of the CCP. Using the average 1993 cost/case as the baseline preCCP figure, the average cost of radical prostatectomy decreased by 16% in 1994 and by 22% in 1995. CONCLUSIONS: It is possible to successfully implement a CCP in a multi-physician system to reduce length of stay and cost of radical prostatectomy without subjecting the patient to a greater risk of complication.     

Solitary Neurofibromas in and around the ear

Three cases of solitary Neurofibromas in and around the ear are reported.     

Lyndiol (1 mg)--evaluation of a new low dose oral contraceptive

The combined oral contraceptive (OC) has become one of the most effective methods of controlling India's staggering population growth. Even the less literate of Indian women have accepted the combined OC with considerable enthusiasm, because they understand that it is a method with a 100% guarantee. As progestogen sensitivity is much more marked than sensitivity to estrogens in India, indicated by the incidence of chloasma and amenorrhea, a trial of a new low dose OC was conducted at the Family Planning Welfare Center of Medical College, Calcutta, India. Lyndiol, 1 mg (ethinylestradiol .05 mg and lynestrenol 1 mg) has low progestogen potency. The trial was initiated in July 1973 and has involved 90 patients over 375 cycles. The patients were selected from married women attending the Family Planning Welfare Center for contraceptive advice. The amount of menstrual flow was unaltered in 81 cases and in 10% of cases there was a reduction of flow as compared with pretreatment menstruation. This compared very favorably with highly progestogenic contraceptives that show a reduction of menstrual flow in over 50% of patients. Only 2 patients complained of breakthrough bleeding or spotting in early cycles. 9 patients (10%) complained of nausea and vomiting in early cycles; 5 patients complained of failure of a withdrawal bleeding in early cycles. Some weight gain was observed in 16 patients (17.7%); 4 patients noted a weight loss. Only 6 patients complained of a headache and 5 of breast engorgement. In this study, 6 patients (6.6%) showed a mean rise of systolic blood pressure of 10 mm and a diastolic pressure of 4 mm. The major risk associated with estrogen/progestogen combination is thromboembolism. In India its incidence is rather low. This trial with Lyndiol 1 mg corroborates this since no thromboembolic occurrences were noted. In sum, Lyndiol (1 mg) is an ideal OC, which is available for Indian mothers with a minimum of side effects.     

Juvenile angiofibroma: review of a case series and role of embolization

Here 15 cases of advanced Juvenile angiofibroma are presented. Advantages of wide tumour exposure and preoperative embolization are discussed.     

Post traumatic laryngeal incompetence

Self-inflicted laryngeal injuries are rare. This is a case of attempted suicide with a knife. The patient was brought into A&E and initial attempts at repair of the laryngo-skeletal structures were performed Later it became evident that the patient had an insensate hypofunctioning larynx. We present a technique aimed at rehabilitating the poorly functioning, incompetent larynx without the necessity for a permanent tracheostomy or laryngectomy. A single surgical procedure combining a cricopharyngeal myotomy, an anterior hyoid suspension and vocal fold angmentations was performed in an attempt to avoid a laryngectomy in non-malignant pathology. The long-term results of this surgery would need to be subjected to further evaluation.