RESUMEN
PURPOSE: The management of the contralateral inguinal canal in children with clinical unilateral inguinal hernia is controversial. Our objective was to systematically review the literature regarding management of the contralateral inguinal canal. METHODS: We searched MEDLINE, EMBASE, and Cochrane databases (1940-2011) using 'hernia' and 'inguinal' and either 'pediatric,' 'infant,' or 'child,' to identify studies of pediatric (age ≤21 years) patients with inguinal hernia. Among clinical unilateral hernia patients, we assessed the number of cases with contralateral patent processus (CPP) and incidence of subsequent clinical metachronous contralateral hernia (MCH). We evaluated three strategies for contralateral management: expectant management, laparoscopic evaluation or pre-operative ultrasound. Pooled estimates of MCH or CPP were generated with random effects by study when heterogeneity was found (I(2) > 50 %, or Cochrane's Q p ≥ 0.10). RESULTS: We identified 2,477 non-duplicated studies, 129 of which met our inclusion criteria and had sufficient information for quantitative analysis. The pooled incidence of MCH after open unilateral repair was 7.3 % (95 % CI 6.5-8.1 %). Laparoscopic examination identified CPP in 30 % (95 % CI 26-34 %). Lower age was associated with higher incidence of CPP (p < 0.01). The incidence of MCH after a negative laparoscopic evaluation was 0.9 % (95 % CI 0.5-1.3 %). Significant heterogeneity was found in studies and pooled estimates should be interpreted with caution. CONCLUSIONS: The literature suggests that laparoscopically identified CPP is a poor indicator of future contralateral hernia. Almost a third of patients will have a CPP, while less than one in 10 will develop MCH when managed expectantly. Performing contralateral hernia repair in patients with CPP results in overtreatment in roughly 2 out of 3 patients.
Asunto(s)
Hernia Inguinal/diagnóstico , Hernia Inguinal/cirugía , Conducto Inguinal/cirugía , Niño , Herniorrafia , Humanos , Laparoscopía , Procedimientos InnecesariosRESUMEN
As medical technology advances at a rapid pace, clinicians become further and further removed from the design of their own technological tools. This is particularly evident with information management. For radiologists, clinical histories, patient reports, and other pertinent information require sophisticated tools for data handling. However, as databases grow more powerful and sophisticated, systems require the expertise of programmers and information technology personnel. The radiologist, the clinician end-user, must maintain involvement in the development of system tools to insure effective information management. Conceptual database modeling is a design method that serves to bridge the gap between the technological aspects of information management and its clinical applications. Conceptual database modeling involves developing information systems in simple language so that anyone can have input into the overall design. This presentation describes conceptual database modeling, using object role modeling, as a means by which end-users (clinicians) may participate in database development.
Asunto(s)
Sistemas de Información Radiológica , Sistemas de Administración de Bases de Datos , Humanos , MamografíaRESUMEN
In response to rising health care costs and changing expectations concerning the quality of health care, information management is becoming increasingly important in the practice of medicine; more specifically, it is beginning to effect significant changes in radiology practice and patient care. Radiologic applications of information management include reporting diagnostic information generated from film interpretation as well as tracking utilization patterns of different imaging modalities and the variability of clinical outcomes, documenting the type of information sought by and provided to clinicians, and evaluating departmental quality standards and performance goals. Conceptual database modeling enables radiologists to understand and participate in the development of information systems, thereby improving the likelihood of successful results. In object-role modeling, groups of relevant objects and roles are identified and used to create elementary facts that form the "building blocks" for information models. The resultant models can easily be communicated, reviewed, and revised, allowing decreased development time and optimizing inclusion of relevant features in the target relational database. Increasing the amount of clinical and management input in the development process may help information systems better meet user needs, become accepted and more often used, and ultimately succeed.