Contralateral vesicoureteral reflux after simple and tapered unilateral ureteroneocystostomy revisited.

PURPOSE: We reviewed our experience with contralateral vesicoureteral reflux following unilateral ureteroneocystostomy. MATERIALS AND METHODS: We retrospectively identified 88 children who underwent unilateral ureteroneocystostomy from 1986 through 1995, including standard repair in 69 and tapered repair in 19. Cystoscopy was performed in all cases immediately before repair. RESULTS: Grades IV to V vesicoureteral reflux was identified preoperatively in 34% of the patients, including 13 (19%) and 14 (74%) who underwent standard and tapered repair, respectively. Renal duplication was noted in 24% of the cases, including 18 standard (26%) and 3 tapered (16%) repairs. An abnormal contralateral nonrefluxing ureteral orifice was present in 8 of the 53 standard (15%) and 3 of the 14 (21%) tapered cases. Ipsilateral reflux was corrected in all children undergoing standard repair but it persisted in 4 (21%) in the tapered repair group. Postoperatively contralateral vesicoureteral reflux developed in 1 child (1.4%) in the standard and 1 (5.3%) in the tapered repair group. CONCLUSIONS: Contralateral vesicoureteral reflux is rare and does not appear to be influenced by preoperative reflux grade, a duplicated system or the endoscopic appearance of the ureteral orifice.

Postoperative hospitalization of children undergoing cross-trigonal ureteroneocystostomy.

The hospital records of 145 girls and 41 boys who had undergone ureteroneocystostomy for vesicoureteral reflux were retrospectively reviewed to determine the duration of urethral catheterization and postoperative hospitalization. Children with a complicated urological history or the need for ureteral tapering and stent placement were excluded. The trend in urethral catheter removal was from 2.71 days postoperatively during the first year of the study to 1.18 days during the last year. Postoperative hospitalization decreased from 4 to 2 days. It is now routine practice to remove the urethral catheter on the first postoperative day and discharge the patient from the hospital on the second day. The surgical resolution of reflux was 96%.

Computer technology in institutional foodservice.

A survey research study profiled foodservices and foodservice managers in health care and educational institutions that applied computer technology to their operations. The survey also examined the extent to which computers were applied to management and client service functions. Both the size and the type of institution were found to be significantly related to computer usage. The larger the institution, the greater the extent of indicated usage. Educational institutions used computers more than all types of health care institutions. Mainframe systems (time shared internally or externally) were the predominant computers used. Internal mainframe systems and minicomputers were used significantly more by educational institutions than by health care institutions. The manager most likely to use computers was a man of any age with at least a bachelor's degree who was employed full-time within the institution. He had taken at least six business management courses and had at least some understanding of and ability to apply systems management concepts to his daily management practices. Applications were categorized into five functional areas: menu, purchasing/storage, production, client service, and managerial information. Managerial information applications were most frequently reported by all respondents, with large institutions and elementary/secondary schools reporting the greatest usage for those applications. Several purchase/storage and production applications were significantly related to type or to size or to both, with large institutions and college/university foodservices reporting the greatest usage. Menu precosting was the only significant menu function, and that was significant only relative to institutional type. No client service functions were significantly related to either type or size.

Program evaluation for effective resource management and accountability.

A means of determining the effectiveness of public programs as a basis for justifying resource allocation to these programs is urgently needed. Program evaluation can provide the data base required for program decision-making and modification. A ten-step model for planning and carrying out an evaluation is suggested as a guideline for program personnel who may be assigned to evaluation responsibilities. Nutrition professionals must become aware of the increasing need for evaluation and of the procedures for conducting the evaluation process within programs for which they are responsible. Failure to provide documentation of adequate, on-going evaluation of effectiveness may lead to a loss of resources for the program and, ultimately, to the demise of the nutritional care program.