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Book part
Publication date: 1 January 2006

William E. Encinosa, Didem M. Bernard and Claudia A. Steiner

Context. The most advanced and fastest growing form of bariatric surgery is laparoscopic gastric bypass. Very little is known about population-based 180-day laparoscopic…

Abstract

Context. The most advanced and fastest growing form of bariatric surgery is laparoscopic gastric bypass. Very little is known about population-based 180-day laparoscopic bypass costs, complication rates, readmission rates, and post-operative care.

Objective. To examine the 6-month costs and outcomes of laparoscopic vs. open bariatric bypass surgery using a national population-based sample.

Design. We use the 1998–2003 Nationwide Inpatient Sample to examine national trends in the rate of laparoscopic bypass. To examine post-operative outcomes, we examine insurance claims for 2,384 bariatric bypass surgeries, at 308 hospitals, among a population of 5.6 million non-elderly people covered by large employers across 49 states in 2001 and 2002. Multivariate logit regression analysis is performed to risk-adjust outcomes.

Main Outcome Measures. 180-day outcomes: 12 complications specific to bariatric surgery and 44 general post-operative conditions, readmission rates, ER rates, and expenditures following bariatric surgery.

Results. Between 1998 and 2003, the national percentage of bariatric bypass surgeries that were laparoscopic grew from 1.5 to 17.1%. There was no significant difference in in-hospital mortality between laparoscopy and open surgery. With the 2001–2002 claims data, we find that of the patients having bypass surgery, men had 48% lower odds of having laparoscopy and that high bariatric volume hospitals were close to four times more likely to use laparoscopy. Laparoscopic bypass, compared with open bypass, had 34% lower odds of a complication during the initial surgical stay, 27% lower odds of a 30-day complication, but no statistically significant difference in 180-day complications. Laparoscopy had 49% higher odds of having the general 44 post-operative conditions, with 45% higher odds of a readmission and 54% higher odds of an ER visit. However, overall, laparoscopy resulted in a 23% lower number of hospital days and 9% lower 180-day expenditures.

Conclusion. The laparoscopic cost-savings during the less invasive initial surgery stay outweigh the increase in post-discharge utilization. Further cost-savings will only emerge from laparoscopy only if its late post-operative complications are reduced. More cost-savings will also emerge as more physicians switch to the use of laparoscopy for bypass surgery.

Details

The Economics of Obesity
Type: Book
ISBN: 978-1-84950-482-9

Book part
Publication date: 28 March 2022

Stephanie N. Wilson

How is medical knowledge produced and what are the implications of that knowledge production for medical practice? Using theoretical ideas on evidence-based medicine…

Abstract

Purpose

How is medical knowledge produced and what are the implications of that knowledge production for medical practice? Using theoretical ideas on evidence-based medicine, standardization in medical research and practice, and biopower, I examine the relationship between medical knowledge and medical practice through the case of pelvic pain care in the US.

Methodology/Approach

Data from ethnographic observations at two medical conferences as well as interviews with healthcare providers inform a critical analysis of the medical discourse.

Findings

The analysis reveals how evidence-based medicine is practiced in the context of medical conditions that lack objective evidence, as well as the unintended consequences of such practices. I provide an alternative approach to medical practice for conditions lacking traditional evidence through presenting outlier cases in the data.

Research Limitations/Implications

In doing so, I make the broad theoretical argument that biomedical paradigms must emerge through the critical process of negative dialectics in order to reach past the limits of standardized medical care.

Originality/Value of Paper

In sociologically analyzing the case of pelvic pain care, I reveal dire limits in the evidence-based approach to medical care for conditions and symptoms that may be deemed medical anomalies, demanding an alternative approach to care for such conditions.

Details

Health and Health Care Inequities, Infectious Diseases and Social Factors
Type: Book
ISBN: 978-1-80117-940-9

Keywords

Article
Publication date: 28 June 2018

Haibo Feng, Yanwu Zhai and Yili Fu

Surgical robot systems have been used in single-port laparoscopy (SPL) surgery to improve patient outcomes. This study aims to develop a vision robot system for SPL…

Abstract

Purpose

Surgical robot systems have been used in single-port laparoscopy (SPL) surgery to improve patient outcomes. This study aims to develop a vision robot system for SPL surgery to effectively improve the visualization of surgical robot systems for relatively complex surgical procedures.

Design/methodology/approach

In this paper, a new master-slave magnetic anchoring vision robotic system for SPL surgery was proposed. A lighting distribution analysis for the imaging unit of the vision robot was carried out to guarantee illumination uniformity in the workspace during SPL surgery. Moreover, cleaning force for the lens of the camera was measured to assess safety for an abdominal wall, and performance assessment of the system was performed.

Findings

Extensive experimental results for illumination, control, cleaning force and functionality test have indicated that the proposed system has an excellent performance in providing the visual feedback.

Originality/value

The main contribution of this paper lies in the development of a magnetic anchoring vision robot system that successfully improves the ability of cleaning the lens and avoiding the blind area in a field of view.

Details

Industrial Robot: An International Journal, vol. 45 no. 4
Type: Research Article
ISSN: 0143-991X

Keywords

Book part
Publication date: 28 May 2019

Léa Kiwan and Nathalie Lazaric

Members of an organization facing change often struggle to adapt and may create new routines. Drawing on insights from a case study of bariatric robotic surgery, the…

Abstract

Members of an organization facing change often struggle to adapt and may create new routines. Drawing on insights from a case study of bariatric robotic surgery, the authors illustrate how a new ecology of space transforms the ostensive and performative aspect of a routine during the introduction of a new technological artifact. The authors discuss two types of space: experimental and reflective. The authors show that the reflective space through debriefings enables practitioners to discuss the new patterns of interdependent actions. Practitioners explore the different aspects of the performative struggle with new artifacts and try to integrate new actions and delineate the boundaries of this change during experimental performances. The findings of this study throw light on the role of the reflective space in addition to the experimental space in routine change, and suggest that socio-material ensembles can produce opportunities for reshaping routines.

Details

Routine Dynamics in Action: Replication and Transformation
Type: Book
ISBN: 978-1-78756-585-2

Keywords

Article
Publication date: 11 June 2018

Robert Shapiro, Rose Laignel, Caitlin Kowcheck, Valerie White and Mahreen Hashmi

Previous studies indicate adherence to pre-operative antibiotic prophylaxis guidelines has been inadequate. The purpose of this paper is to determine adherence rates to…

Abstract

Purpose

Previous studies indicate adherence to pre-operative antibiotic prophylaxis guidelines has been inadequate. The purpose of this paper is to determine adherence rates to current perioperative antibiotic prophylaxis guidelines in gynecologic surgery at a tertiary care, academic institution. As a secondary outcome, improving guidelines after physician re-education were analyzed.

Design/methodology/approach

A retrospective chart review (2,463 patients) was completed. The authors determined if patients received perioperative antibiotic prophylaxis in accordance with current guidelines from the America College of Obstetricians and Gynecologists. Data were obtained before and after physician tutorials. Quality control was implemented by making guideline failures transparent. Statistical analysis used Fisher’s exact and agreement tests.

Findings

In total, 23 percent of patients received antibiotics not indicated across all procedures. This decreased to 9 percent after physician re-education and outcome transparency (p<0.0001). Laparoscopy was the procedure with the lowest guideline compliance prior to education. The compliance improved from 52 to 92 percent (p<0.0001) after re-education.

Practical implications

Gynecologic surgeons overuse antibiotics for surgical prophylaxis. Physician re-education and transparency were shown to enhance compliance.

Originality/value

Educational tutorials are an effective strategy for encouraging physicians to improve outcomes, which, in turn, allows the healthcare system a non-punitive way to monitor quality and mitigate cost.

Details

International Journal of Health Care Quality Assurance, vol. 31 no. 5
Type: Research Article
ISSN: 0952-6862

Keywords

Content available
Book part
Publication date: 28 May 2019

Abstract

Details

Routine Dynamics in Action: Replication and Transformation
Type: Book
ISBN: 978-1-78756-585-2

Article
Publication date: 29 July 2022

Parniyan Khalili, Omid Asbaghi, Ladan Aghakhani, Cain C.T. Clark and Neda Haghighat

This study aims, a systematic review and meta-analysis, to evaluate the effects of folic acid (folate) on patients with depression.

Abstract

Purpose

This study aims, a systematic review and meta-analysis, to evaluate the effects of folic acid (folate) on patients with depression.

Design/methodology/approach

Related articles were found by searching PubMed, SCOPUS, Web of science and Cochrane’s Library, from inception to January 2022. Weighted mean differences (WMD) were pooled using a random-effects model. Heterogeneity, sensitivity analysis and publication bias were reported using standard methods.

Findings

Pooled analysis of six randomized controlled trials revealed that folic acid supplementation decreased the depression score in the Beck Depression Inventory (WMD: −3.9; 95% CI: −5.3 to −2.4, p < 0.001) compared with control group, without heterogeneity (I2 = 0.0%, p = 1.000). It also lowered the depression score in the Hamilton (HAM) Depression Inventory (WMD: −3.5 mg/dL; 95% CI: −4.6 to −2.4, p < 0.001) compared with control group, with moderate heterogeneity (I2 = 71.8%, p = 0.007). Moreover, subgroup analysis showed that the folic acid supplementation reduced HAM in all subgroups. Meta-regression analysis demonstrated that there is no evidence of a significant linear relationship between dose and duration of folic acid supplementation and changes in HAM. Also, based on the non-linear dose response, no evidence of a relationship between dose and duration of folic acid supplementation and changes in HAM was found.

Originality/value

Folic acid supplementation could possibly have an effect on lowering depression in patients. However, the clinical trials thus far are insufficient for clinical guidelines and practice.

Details

Nutrition & Food Science , vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 0034-6659

Keywords

Article
Publication date: 6 July 2015

Thomas Hoholm

– The purpose of this paper is to develop the case for studying non-interaction in networks, particularly instances of intentional avoidance of interaction.

Abstract

Purpose

The purpose of this paper is to develop the case for studying non-interaction in networks, particularly instances of intentional avoidance of interaction.

Design/methodology/approach

The paper is based on the analysis of instances of interaction avoidance across four case studies in medical technology development, food product development, food distribution network change, and regional innovation in construction.

Findings

Some answers are provided to the questions of why and how actors may seek to avoid interaction. Five modes of interaction avoidance are identified and outlined. Within these modes, interaction avoidance took place in order to protect knowledge, enforce progress, economise in business networks, avoid wasting resources, and maintain opportunities respectively. This list is not seen to be exhaustive of the theme, and further studies are encouraged.

Originality/value

Few inter-organisational network studies have dealt explicitly with interaction avoidance or non-interaction.

Details

IMP Journal, vol. 9 no. 2
Type: Research Article
ISSN: 2059-1403

Keywords

Article
Publication date: 1 October 2001

Ivo A.M.J. Broeders and Jelle Ruurda

The introduction of laparoscopy in surgery offered clear advantages to patients. Surgeons, however, had to deal with various types of problems inherent to the essential…

1468

Abstract

The introduction of laparoscopy in surgery offered clear advantages to patients. Surgeons, however, had to deal with various types of problems inherent to the essential differences in surgical approach. One of these problems, reduced dexterity, was solved at the end of the previous decade by the introduction of robotic surgery systems. Discusses the backgrounds for development of the Intuitive Surgical “Da Vinci” systems and gives an overview of current status and functionality.

Details

Industrial Robot: An International Journal, vol. 28 no. 5
Type: Research Article
ISSN: 0143-991X

Keywords

Article
Publication date: 1 February 2003

M. Cenk Çavuşoğlu, Winthrop Williams, Frank Tendick and S. Shankar Sastry

Robotic telesurgery is a promising application of robotics to medicine, aiming to enhance the dexterity and sensation of regular and minimally invasive surgery through…

1479

Abstract

Robotic telesurgery is a promising application of robotics to medicine, aiming to enhance the dexterity and sensation of regular and minimally invasive surgery through using millimeter‐scale robotic manipulators under the control of the surgeon. In this paper, the telesurgical system will be introduced with discussion of kinematic and control issues and presentation of in vitro experimental evaluation results.

Details

Industrial Robot: An International Journal, vol. 30 no. 1
Type: Research Article
ISSN: 0143-991X

Keywords

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