Objectives: Determine if patient satisfaction is greater after delivering postoperative care via telemedicine following minimally invasive gynecologic surgery. Materials and Methods: University-based outpatient clinic; Randomized controlled trial (Canadian Task Force classification I). Females between 18 and 60 years of age scheduled to undergo laparoscopic hysterectomy or laparoscopic excision of endometriosis were invited to participate. Eligible patients were randomized to receive postoperative care either through a traditional office visit or via telemedicine. PSQ-18 satisfaction surveys were performed by phone after the visit. Results: Forty-one patients were analyzed out of which 25 were in the office group and 16 in the telemedicine group. Groups were homogenous to age (41.4 vs. 43.3 p. 48), body mass index (31.9 vs. 30.6 P = 0.52), distance in miles from home (12.7 vs. 12.4 P = 0.92), and parity ( P = 0.51). PSQ-18 questionnaire was scored and each category was compared between the office and telemedicine groups. When comparing medians (interquartile range), the general satisfaction and time spent with doctor categories were significantly higher in the telemedicine group (4.0 [4.0, 4.5] vs. 4.5 [4.5, 5.0] P = 0.05), (4.0 [4.0, 4.5] vs. 4.5 [4.0, 5.0] P = 0.05). The remainder of the categories analyzed were not different between groups Technical Quality (4.0 [3.8, 4.5] vs. 4.5 [3.9, 5.0] P = 0.13), Interpersonal Manner (4.0 [4.0, 4.5] vs. 4.5 [4.0, 5.0] P = 0.34), Communication (4.5 [4.0, 4.5] vs. 4.5 [4.3, 5.0] P = 0.21), Accessibility and Convenience (4.0 [3.5, 4.5] v 4.0 [3.6, 4.5] P = 0.84). A chart review was performed, examining the first 30 days after surgery. One (4%) patient in the office group went to the ER after postoperative visit, and 0 in the telemedicine group ( P = 0.42). Conclusion: Postoperative care via telemedicine after gynecologic surgery results in higher patient satisfaction.
We present a case of three multifocal synchronous ipsilateral clear cell, papillary type 1 and papillary type 2 renal cell carcinoma (RCC), with papillary type 2 RCC appearing bilaterally. With review of the literature, it was determined that multifocal synchronous RCC subtypes and bilateral renal tumors are both rare in occurrence.
Acute pancreatitis among the pediatric population can result from genetic disorders, anatomic anomalies, gallstones, trauma, and medications; trauma and idiopathic causes being the most common. Although chronic pancreatitis presents with increased severe long-term complications, acute pancreatitis presents with its share of complications such as fistulas, pseudocysts, and venous abnormalities. With an increase in hospitalization rates of acute pancreatitis among the pediatric population, the importance of understanding rare complications and how to further recognize these complications can aid in the diagnosis, medical management, and intervention necessary to optimize a patient's outcome. Our patient presented with a rare complication of splenic vein thrombosis (SVT), which is a complication that can also be observed in adults with acute pancreatitis. SVTs are uncommon in both the adult and pediatric populations, and they have received little attention or research in the pediatric population. We report a case that will highlight a rare case of SVT presenting in a pediatric patient with acute necrotizing gallstone pancreatitis.
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