Postoperative Outcomes After Robotic Versus Abdominal Myomectomy

Background and Objectives:

Differences in postoperative outcomes comparing robotic-assisted laparoscopic myomectomy (RALM) with abdominal myomectomy (AM) have rarely been reported. The objective of this study was to compare surgical, quality-of-life, and residual fibroid outcomes after RALM and AM.

Methods:

Consecutive patients who underwent RALM (n = 16) were compared with AM patients (n = 23) presenting with a uterine size of <20 weeks. Study patients participated in a telephone interview at 6 weeks and underwent a no-cost ultrasonographic examination at 12 weeks after surgery to obtain quality-of-life and residual fibroid outcomes. Medical records were reviewed to obtain surgical outcomes.

Results:

Longer operative times (261.1 minutes vs 124.8 minutes, P < .001) and a 3-fold unfavorable difference in operative efficiency (73.7 g vs 253.0 g of specimen removed per hour, P < .05) were observed with RALM compared with AM. Patients undergoing RALM had shorter lengths of hospital stay (1.5 days vs 2.7 days, P < .001). Reduction of patient symptoms and overall satisfaction were equal. RALM patients were more likely to be back to work within 1 month (85.7% vs 45.0%, P < .05). Residual fibroid volume in the RALM group was 5 times greater than that in the AM group (17.3 cm³ vs 3.4 cm³, P < .05).

Conclusion:

RALM and AM were equally efficacious in improving patient symptoms. Although operative times were significantly longer with RALM, patients had a quicker recovery, demonstrated by shortened lengths of stay and less time before returning to work. However, greater residual fibroid burden was observed with RALM when measured 12 weeks after surgery.     

Patient selection for day surgery

Day surgery is a planned pathway delivered by a multidisciplinary team and is perhaps better described as ‘same day surgery’. In 2000 the NHS set a target of performing 75% of operations as same day surgery but practice varies widely; an assessment of 10 procedures easily performed as same day surgery showed rates varying from 19% to 90% by procedure and the potential day case rate was not being reached for any procedure. There is a move to ‘treat day surgery as the norm’ in an effort to increase rates of day surgery so this article describes patient selection and procedures for day surgery, and discusses techniques which can be employed by anaesthetists and surgeons to achieve the reduced surgical trauma, rapid recovery and minimal complications necessary for successful day surgery.     

Improving evidence‐based practice in rehabilitation: Introducing PsycBITETM

Background: Clinicians face significant obstacles in their access to evidence for the efficacy of different communicative and cognitive treatments after brain impairment. These include the need to search across diverse journals and different clinical conditions to find potential treatments and the lack of easily accessible standards by which to evaluate the methodological rigour of treatment studies once found.

Aims: We aimed to address these issues by developing a freely available, user‐friendly database of all relevant treatment trials for psychologically based disorders that arise from brain impairment.

Methods & Procedures: PsycBITE^TM (http://www.psycbite.com) was developed as an internet‐based database and was officially launched in 2004. Included on PsycBITE^TM are all trials that have been published that evaluate treatment for any communication, cognitive, or psychological disorder arising from any form of acquired brain impairment in children (above the age of 5 years) and adults. PsycBITE^TM also provides a rating for the methodological rigour of each trial using the previously established PEDro scale (Maher, Sherrington, Herbert, Moseley, & Elkins, 2003 Maher, C. G., Sherrington, C., Herbert, R. D., Moseley, A. M. and Elkins, M. 2003. Reliability of the PEDro scale for rating quality of randomized controlled trials.. Physical Therapy, 83: 713–721. [PubMed], [Web of Science ®] , [Google Scholar]) for randomised controlled trials (RCT) and non‐RCT group comparisons. A PsycBITE^TM rating scale for single case experimental studies is still under development. This report overviews the database, its contents, and the methodology by which papers are selected for inclusion.

Outcomes & Results: As of June 2005 there are 1167 treatment studies listed on PsycBITE^TM with prospective searches being conducted on a regular basis. The highest proportion of studies report treatments for communication disorders followed by behavioural problems and memory. Ratings of the randomised controlled trials, group comparisons, and single case studies are available for a proportion of papers and are being updated continuously.

Conclusions: PsycBITE^TM is an invaluable resource for clinicians and researchers interested in an evidence‐based practice approach to treatment. It is a free, fast, and effective way of accessing and evaluating treatments for communicative and cognitive disorders following brain impairment.     

Giving information: The importance of context on communicative opportunity for people with traumatic brain injury

This study is one of a series investigating everyday communication skills of people with traumatic brain injury (TBI) using communication partners other than speech pathologists or research assistants. The first of these studies examined telephone conversations where subjects were asked to request specific information during telephone interactions with a range of communication partners. Results indicated that people with TBI were disadvantaged in some of their interactions on the telephone with community agencies and family members during information-seeking interactions, when compared with matched controls. TBI subjects were given less information than matched controls and were also asked for less information. For example, therapists never asked TBI subjects questions to which they didn't already know the answer. This was in contrast to the control interactions, where subjects were asked for novel information. In the current study seven subjects with TBI were compared with seven matched control subjects across two conditions: a community education information-giving session with two schoolboys, and an information-requesting interaction with the researcher. Exchange structure analysis showed that when placed in an information-giving role, TBI subjects gave similar amounts of information as control subjects. TBI subjects used joke telling as an information-giving device, serving a number of communicative functions, which are discussed. There was no significant difference in the amount of information requested or given by TBI and control subjects in the researcher condition; however there were significant qualitative differences in the nature of the requesting. It has been previously emphasized that people with TBI should be evaluated with a number of interlocutors as part of a thorough communication needs assessment (Hartley 1995). Merely varying the interlocutor is not sufficient, however, as the goal of the interaction and the primary speaking roles of participants are also important, and will determine the language choices available to both speakers. Exchange structure analysis is a useful way to delineate these language choices, as it is interpreted in light of the genre of the interaction and the tenor and communicative purpose of the participants.     

Training communication partners of people with traumatic brain injury: A randomised controlled trial

Background: Communication disorders after traumatic brain injury (TBI) are difficult to modify due to the cognitive limitation imposed by frontal lobe damage. As an alternative approach, this paper describes a training programme designed to improve communication partners' responsiveness to people with TBI during routine service inquiries with a community agency. Aims: To evaluate the effectiveness of a training programme aimed at improving the communication of police officers during service encounters with people with TBI. Methods & Procedures: A total of 20 police officers were randomly assigned to two groups (training or control). Prior to the 6‐week training programme, participants with TBI made a routine telephone inquiry to the police officers. Training focused on specific aspects of telephone inquiries previously documented to be aberrant in service encounters of people with TBI. Following the training programme, police subjects received another telephone service inquiry. Service encounters were transcribed and analysed using generic structure potential analysis. Outcome & Results: Comparison of pre‐ and post‐training measures indicated that trained police had learned strategies to successfully establish the nature of the inquiry, provide a clear answer to the inquiry, and ensure appropriate leave taking, resulting in more efficient, focused interactions in the post‐training telephone calls. People with TBI also altered their communication in the post‐training calls, with reduced episodes of unrelated utterances and an increased proportion of the interaction devoted to completing the service encounter. This appeared to be in response to the communicative options they were given. Conclusions: This study demonstrates the efficacy of an approach based on training communication partners rather than people with TBI themselves. Training communication partners led to the provision of appropriate feedback, support, and structure of everyday interactions. Service encounters account for a significant amount of everyday communication exchanges, therefore training service providers has the potential to have a significant impact on the communicative effectiveness of people with TBI.     

Measuring the social interactions of people with traumatic brain injury and their communication partners: The adapted Kagan scales

Background: Considerable attention has been given to the nature of communication impairments of individuals with TBI (Coelho, 2007 Coelho, C. A. 2007. Management of discourse deficits following traumatic brain injury: Progress, caveats, and needs. Seminars in Speech & Language, 28(2): 122–135.  [Google Scholar]; Ylvisaker, Turkstra, & Coelho, 2005 Ylvisaker, M., Turkstra, L. S. and Coelho, C. 2005. Behavioral and social interventions for individuals with traumatic brain injury: A summary of the research with clinical implications. Seminars in Speech & Language, 26: 256–267. [Crossref], [PubMed] , [Google Scholar]). However, there have been few data focusing on the way communication partners deal with the often distressing sequelae of TBI.

Aims: This study reports inter- and intra-rater reliability of the Adapted Measure of Support in Conversation (MSC) and Measure of Participation in Conversation (MPC) for TBI interactions.

Method & Procedures: The MSC and MPC were adapted to reflect theoretical models of cognitive-communication support for people with TBI. A total of 10 casual and 10 purposeful TBI interactions were independently rated by two raters to establish inter-rater reliability and by one rater on two separate occasions to determine intra-rater reliability.

Outcomes & Results: Excellent inter-rater agreement was established on the MSC (ICC?=?0.85–0.97) and the MPC (ICC?=?0.84–0.89). Intra-rater agreement was also strong (MSC: ICC?=?0.80–0.90; MPC: ICC?=?0.81–0.92). Over 90% of all ratings scored within 0.5 on a 9-point scale.

Conclusions: This is the first scale to measure the communication partner during TBI interactions. It shows promise in evaluating communication partner training programmes.