Clinical outcomes of subtotal cholecystectomy performed for difficult cholecystectomy

Background: Laparoscopic cholecystectomy (LC) has been recognized as the new "gold standard" for the treatment of symptomatic gallstone disease. In order to prevent serious bile duct and vascular injuries, conversion is advocated for unclear anatomy at the Calot’s. Our aim was to assess the safety and effectiveness of laparoscopic subtotal cholecystectomy (LSC) in difficult cholecystectomy in order to reduce the incidence of bile duct injury and conversion rates.Methods: An analysis of retrospectively collected data of 452 patients who underwent LC was done at our Hospital during the period of January 2010 to December 2013. In few cases of difficult GB when Calot’s could not be dissected, laparoscopic retrograde cholecystectomy (LRC) was attempted and if that failed we adopted the technique of LSC.Results: A total of 452 patients were included. The median age was 48 years. All the 452 patients were posted for LC. Of the 452 patients, 404 patients underwent LC and the remaining 48 patients had difficult GB. Among the 48 patients having a difficult GB, 44 cases underwent LSC (3 cases underwent LSC Type-1 and 41 cases underwent LSC Type-2) and the remaining 4 cases underwent conversion to open cholecystectomy. The mean operative time was 130mins and median post op stay was 2 days.Conclusions: In our technique of LSC the conversion rates were <1% with no bile duct injury and believe that it is feasible and safe for operating on difficult GB’s.

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Accreditation of predoctoral dental education: clinical outcomes assessment

Journal of Dental Education ◽

10.1002/j.0022-0337.1991.55.11.tb02592.x ◽

1991 ◽

Vol 55 (11) ◽

pp. 729-734

Author(s):

MA Boyd ◽

IC Bennett ◽

KC Bentley

Keyword(s):

Clinical Outcomes ◽

Dental Education ◽

Outcomes Assessment ◽

Clinical Outcomes Assessment

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Selecting Skills To Teach Communication Partners: Where Do I Start?

Perspectives on Augmentative and Alternative Communication ◽

10.1044/aac21.4.127 ◽

2012 ◽

Vol 21 (4) ◽

pp. 127-135 ◽

Cited By ~ 6

Author(s):

Cathy Binger ◽

Jennifer Kent-Walsh

Keyword(s):

Clinical Outcomes ◽

Intervention Program ◽

Communication Partners ◽

Multiple Challenges

Abstract Clinicians and researchers long have recognized that teaching communication partners how to provide AAC supports is essential to AAC success. One way to improve clinical outcomes is to select appropriate skills to teach communication partners. Although this sometimes seems like it should be a straightforward component of any intervention program, deciding which skills to teach partners can present multiple challenges. In this article, we will troubleshoot common issues and discuss how to select skills systematically, resulting in the desired effects for both communication partners and clients.

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Linguistic Interactions: A Therapeutic Consideration for Adults With Aphasia

Perspectives on Augmentative and Alternative Communication ◽

10.1044/aac17.3.93 ◽

2008 ◽

Vol 17 (3) ◽

pp. 93-98

Author(s):

Lynn E. Fox

Keyword(s):

Clinical Outcomes ◽

Social Contexts ◽

Interaction Models ◽

Social Communities ◽

Wernicke's Aphasia ◽

Communication Challenges ◽

Therapeutic Consideration ◽

Patterns Of Interaction ◽

Structural Language

Abstract Linguistic interaction models suggest that interrelationships arise between structural language components and between structural and pragmatic components when language is used in social contexts. The linguist, David Crystal (1986, 1987), has proposed that these relationships are central, not peripheral, to achieving desired clinical outcomes. For individuals with severe communication challenges, erratic or unpredictable relationships between structural and pragmatic components can result in atypical patterns of interaction between them and members of their social communities, which may create a perception of disablement. This paper presents a case study of a woman with fluent, Wernicke's aphasia that illustrates how attention to patterns of linguistic interaction may enhance AAC intervention for adults with aphasia.

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The Complexity of Health Disparities: More Than Just Black–White Differences

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2020_persp-20-00199 ◽

2021 ◽

pp. 1-10

Author(s):

Charles Ellis ◽

Molly Jacobs

Keyword(s):

Health Disparities ◽

Clinical Outcomes ◽

The United States ◽

Careful Examination ◽

White Americans ◽

Speech Language Pathology ◽

Death Rates ◽

The Social ◽

Health Related ◽

Language Pathology

Health disparities have once again moved to the forefront of America's consciousness with the recent significant observation of dramatically higher death rates among African Americans with COVID-19 when compared to White Americans. Health disparities have a long history in the United States, yet little consideration has been given to their impact on the clinical outcomes in the rehabilitative health professions such as speech-language pathology/audiology (SLP/A). Consequently, it is unclear how the absence of a careful examination of health disparities in fields like SLP/A impacts the clinical outcomes desired or achieved. The purpose of this tutorial is to examine the issue of health disparities in relationship to SLP/A. This tutorial includes operational definitions related to health disparities and a review of the social determinants of health that are the underlying cause of such disparities. The tutorial concludes with a discussion of potential directions for the study of health disparities in SLP/A to identify strategies to close the disparity gap in health-related outcomes that currently exists.

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Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd20.4.121 ◽

2011 ◽

Vol 20 (4) ◽

pp. 121-123

Author(s):

Jeri A. Logemann

Keyword(s):

Decision Making ◽

Patient Care ◽

Clinical Outcomes ◽

Clinical Judgment ◽

Clinical Decision Making ◽

Evidence Based Practice ◽

Clinical Decision ◽

Evidence Based ◽

Clinical Method ◽

Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

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