Surgery News - May 2008 - (Page 23)

M AY 2 0 0 8 • SURGERY NEWS PRACTICE TRENDS Patients Largely Satisfied With ‘Robotic Telerounding’ BY JOHN R. BELL Else vier Global Medical Ne ws se of televised bedside follow-up in patients who received any of several laparoscopic urologic procedures did not lessen patient safety or patient satisfaction, according to the results of a randomized, controlled, multicenter trial. Thus, hospitals that want to improve access to patients and reduce medical errors through the use of new technology may justifiably consider such “robotic telerounding,” wrote Dr. Lars M. Ellison of the University of California, Davis, and his colleagues (Arch. Surg. 2007;142:1177-81). They disclosed no conflicts of interest. The investigators enrolled 270 adult patients (mean age 54 years) at three U.S. hospitals. Each patient was undergoing one of the following procedures: nephrectomy, U the results of a questionnaire completed 2 weeks after hospital discharge. A slightly larger portion of the telerounding group reported perceiving excellent physician availability, medical information, and physician respect, although the differences were not significant. A slight but also nonsignificant advantage for conventional rounds was seen in the portion of patients rating as excellent the personal attention and resident interactions they experienced. These findings echoed those of a prior study, the authors noted, in which tele- rounding improved patient satisfaction ( J. Am. Coll. Surg. 2004;199:523-30). Dr. Ellison and his colleagues cautioned that the “robust performance of this system may not necessarily be replicated for patients with evolving or slowly resolving medical conditions.” They also noted that telerounding is not an absolute replacement for physical bedside follow-up. In an accompanying commentary, Dr. Jo Buyske, an ACS Fellow and surgeon at Penn Presbyterian Medical Center, Philadelphia, explained that these find- ings emphasize that patients prefer the familiarity of their own physician, even through the intermediary of a video monitor, over an in-person visit from another physician, as demonstrated by a previous study on a smaller group of patients. “We should not be surprised. People have a desire to be known. The robot, acting as an intermediary between the patient and the attending surgeon, maintains that important personal link,” wrote Dr. Buyske, who also is the associate executive director of the American Board of Surgery. PATIENTS PREFER THEIR OWN PHYSICIAN, EVEN THROUGH A VIDEO MONITOR, OVER AN IN-PERSON VISIT FROM ANOTHER PHYSICIAN. partial nephrectomy, nephroureterectomy, retroperitoneal lymph node dissection, partial ureterectomy, or radical prostatectomy. The patients were randomized to receive either conventional bedside follow-up by the attending surgeon (136 patients) or follow-up conducted by the attending surgeon via a bedside device comprising a digital camera, microphone, and video monitor (134 patients). The primary end point was the rate of complications identified by the attending surgeon. Secondary outcomes were length of hospital stay and patient satisfaction with the hospitalization. There were no differences reported in overall, minor, or major complication rates between the two study arms. The standard-rounds group had a rate of 14% for minor complications and 2% for major ones, while the telerounds group had a rate of 13% for minor complications and 4% for major ones. The differences between study arms did not reach statistical significance. There were no false-positive complications identified by either rounding method; nor were there any missed complications. The overall complication rate for the study was 16.3%. The mean length of stay was 2.8 days in both study groups. Patients in both groups were satisfied with the care they received, according to INDEX OF ADVERTISERS Elan Pharmaceuticals Azactam General Scientific Corporation SurgiTel Surgi-Cam KCI InfoV.A.C. Wyeth Pharmaceuticals Inc. TYGACIL 7-8 9 5 23-24 TYGACIL® (tigecycline) Brief Summary See package insert for full Prescribing Information. For further product information and current package insert, please visit www.wyeth.com or call our medical communications department toll-free at 1-800-934-5556. CONTRAINDICATIONS TYGACIL is contraindicated for use in patients who have known hypersensitivity to tigecycline. WARNINGS Anaphylaxis/anaphylactoid reactions have been reported with nearly all antibacterial agents, including tigecycline, and may be life-threatening. Glycylcycline class antibiotics are structurally similar to tetracycline class antibiotics and may have similar adverse effects. TYGACIL should be administered with caution in patients with known hypersensitivity to tetracycline class antibiotics. TYGACIL may cause fetal harm when administered to a pregnant woman. If the patient becomes pregnant while taking tigecycline, the patient should be apprised of the potential hazard to the fetus. Results of animal studies indicate that tigecycline crosses the placenta and is found in fetal tissues. Decreased fetal weights in rats and rabbits (with associated delays in ossification) and fetal loss in rabbits have been observed with tigecycline. (See PRECAUTIONS, Pregnancy.) The use of TYGACIL during tooth development (last half of pregnancy, infancy, and childhood to the age of 8 years) may cause permanent discoloration of the teeth (yellow-gray-brown). Results of studies in rats with TYGACIL have shown bone discoloration. TYGACIL should not be used during tooth development unless other drugs are not likely to be effective or are contraindicated. Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including TYGACIL, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile. C. difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents. If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated. PRECAUTIONS General Caution should be exercised when considering TYGACIL monotherapy in patients with complicated intra-abdominal infections (cIAI) secondary to clinically apparent intestinal perforation. (See ADVERSE REACTIONS.) In Phase 3 cIAI studies (n=1642), 6 patients treated with TYGACIL and 2 patients treated with imipenem/cilastatin presented with intestinal perforations and developed sepsis/septic shock. The 6 patients treated with TYGACIL had higher APACHE II scores (median = 13) vs the 2 patients treated with imipenem/cilastatin (APACHE II scores = 4 and 6). Due to differences in baseline APACHE II scores between treatment groups and small overall numbers, the relationship of this outcome to treatment cannot be established. Glycylcycline class antibiotics are structurally similar to tetracycline class antibiotics and may have similar adverse effects. Such effects may include: photosensitivity, pseudotumor cerebri, and anti-anabolic action (which has led to increased BUN, azotemia, acidosis, and hyperphosphatemia). As with tetracyclines, pancreatitis has been reported with the use of TYGACIL. The safety and efficacy of TYGACIL in patients with hospital acquired pneumonia have not been established. In a study of patients with hospital acquired pneumonia, patients were randomized to receive TYGACIL (100 mg initially, then 50 mg every 12 hours) or a comparator. In addition, patients were allowed to receive specified adjunctive therapies. The sub-group of patients with ventilator-associated pneumonia who received TYGACIL had lower cure rates (47.9% versus 70.1% for the clinically evaluable population) and greater mortality (25/131 [19.1%] versus 15/122 [12.3%]) than the comparator. As with other antibacterial drugs, use of TYGACIL may result in overgrowth of non-susceptible organisms, including fungi. Patients should be carefully monitored during therapy. If superinfection occurs, appropriate measures should be taken. Prescribing TYGACIL in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria. Information for Patients Patients should be counseled that antibacterial drugs including TYGACIL should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold). When TYGACIL is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by TYGACIL or other antibacterial drugs in the future. Diarrhea is a common problem caused by antibiotics which usually ends when the antibiotic is discontinued. Sometimes after starting treatment with antibiotics, patients can develop watery and bloody stools (with or without stomach cramps and fever) even as late as two or more months after having taken the last dose of the antibiotic. If this occurs, patients should contact their physician as soon as possible. Drug Interact http://www.wyeth.com

Table of Contents Feed for the Digital Edition of Surgery News - May 2008

Surgery News - May 2008 Contents New Lung Approach Speeds Extubation Innovative GI Procedures May Improve Diabetes Quality Programs Differ on Risk Data Crystal Ball Medical Modeling Ventricular Valve Taking Stock

Surgery News - May 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.