Laparoscopy-assisted vaginal hysterectomy: cost analysis and review of initial experience in a community hospital.

During the past 2 years, an increasing number of gynecologic surgeons have performed laparoscopy-assisted vaginal hysterectomy (LAVH) and laparoscopic hysterectomy (LH). Although these procedures have become more common, they are still considered controversial. Many gynecologists question their cost, safety, efficacy, and indications. We reviewed and analyzed the perioperative and postoperative course of ten patients as well as the total cost. The patients who underwent these procedures were compared with ten matched patients who underwent abdominal hysterectomy for similar indications. Compared with control subjects, patients in the laparoscopic group had a shorter hospitalization stay (2.2 days vs 4.2 days), shorter recovery (2 weeks vs 5 weeks), and 28% fewer complications. Although the LAVH took significantly longer than TAH (3.28 hours vs 1.75 hours), the total hospital costs and charges for both procedures were similar. As technology advances and techniques are modified, the laparoscopic approach should reduce hospital costs and charges significantly. The current results suggest that LAVH may eventually be preferred to the TAH approach by physicians and their patients.

A social historical note on the formal emergence of community psychology.

Recent interviews of 15 eminent community psychologists, 6 of whom attended the founding conference at Swampscott, highlighted some historically significant aspects of community psychology's emergence and provided background information concerning the conference's processes and content. The interview informants described the idealism of the era in the context of societal unrest, the struggle with psychiatrists' control of extant mental health services, and the uncertain role of a community orientation within academic psychology as key social historical factors. The informants identified some of the behind-the-scenes preparations for Swampscott as well as the conference climate and emergent ideology. The report concludes with a note on the historical status of women in the subdiscipline.