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Optimising perioperative care for hip and knee arthroplasty in South Africa: a Delphi consensus study. BMC Musculoskelet Disord 2018; 19:140. [PMID: 29743063 PMCID: PMC5944094 DOI: 10.1186/s12891-018-2062-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/26/2018] [Indexed: 12/30/2022] Open
Abstract
Background A structured approach to perioperative patient management based on an enhanced recovery pathway protocol facilitates early recovery and reduces morbidity in high income countries. However, in low- and middle-income countries (LMICs), the feasibility of implementing enhanced recovery pathways and its influence on patient outcomes is scarcely investigated. To inform similar practice in LMICs for total hip and knee arthroplasty, it is necessary to identify potential factors for inclusion in such a programme, appropriate for LMICs. Methods Applying a Delphi method, 33 stakeholders (13 arthroplasty surgeons, 12 anaesthetists and 8 physiotherapists) from 10 state hospitals representing 4 South African provinces identified and prioritised i) risk factors associated with poor outcomes, ii) perioperative interventions to improve outcomes and iii) patient and clinical outcomes necessary to benchmark practice for patients scheduled for primary elective unilateral total hip and knee arthroplasty. Results Thirty of the thirty-three stakeholders completed the 3 months Delphi study. The first round yielded i) 36 suggestions to preoperative risk factors, ii) 14 (preoperative), 18 (intraoperative) and 23 (postoperative) suggestions to best practices for perioperative interventions to improve outcomes and iii) 25 suggestions to important postsurgical outcomes. These items were prioritised by the group in the consecutive rounds and consensus was reached for the top ten priorities for each category. Conclusion The consensus derived risk factors, perioperative interventions and important outcomes will inform the development of a structured, perioperative multidisciplinary enhanced patient care protocol for total hip and knee arthroplasty. It is anticipated that this study will provide the construct necessary for developing pragmatic enhanced care pathways aimed at improving patient outcomes after arthroplasty in LMICs.
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The relationship between pre-operative hypertension and intra-operative haemodynamic changes known to be associated with postoperative morbidity. Anaesthesia 2018. [DOI: 10.1111/anae.14239] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Using therapeutic mammoplasty to extend the role of breast-conserving surgery in women with larger or ptotic breasts. Ann R Coll Surg Engl 2013; 95:192-5. [PMID: 23827290 DOI: 10.1308/003588413x13511609958091] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The equivalence of breast-conserving surgery followed by postoperative radiotherapy against mastectomy is now firmly established in patients with early breast cancer. The results of surgery in large-breasted women can be poor, with radiation-induced fibrosis, chronic pain and poor cosmesis contributing to long-term psychological and physical morbidity. Therapeutic mammoplasty offers an alternative management strategy to both enhance the role of breast-conserving surgery and provide better outcomes. METHODS A retrospective note review was undertaken of all patients undergoing therapeutic mammoplasty for breast malignancy between 2007 and 2011. All cases were performed using a Wise pattern-reduction technique. Histology and pathological outcomes were assessed. Postoperative outcomes reviewed included wound infection, seroma and need for further intervention. RESULTS During the study period, 20 patients underwent therapeutic mammoplasty with a mean follow-up duration of 36 months. The mean weight of the lumpectomy specimen was 330g. The average cancer size was 34mm, with a mean margin clearance of 7mm. There was one episode of wound infection and three of delayed wound healing at the T-junction. One patient required a mastectomy for involved margins. There were no recurrences at the most recent follow-up visit. CONCLUSIONS Therapeutic mammoplasty offers a tailored approach to women with larger breasts and early breast cancers with good cosmetic results and oncological outcomes.
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Ultrasonic dissection versus electrocautery in mastectomy for breast cancer - a meta-analysis. Eur J Surg Oncol 2012; 38:897-901. [PMID: 22704049 DOI: 10.1016/j.ejso.2012.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 05/17/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Electrocautery has advanced the practice of mastectomy but significant morbidity, such as seroma and blood loss, remains a concern. This has led to newer forms of dissection being introduced including the ultrasonic dissection devices, which are thought to reduce tissue damage. The aim of this systematic review was to compare the outcomes after mastectomy using novel ultrasonic dissection or standard electrocautery in published trials. METHODS Medline, Embase, trial registries, conference proceedings and reference lists were searched for comparative trials of ultrasonic dissection versus electrocautery for mastectomy. The primary outcomes were total postoperative drainage, seroma development and intra-operative blood loss. Secondary outcomes were operative time and wound complications. Odds ratios were calculated for categorical outcomes and standardised mean differences for continuous outcomes. RESULTS Six trials were included in the analysis of 287 mastectomies. There was no effect in total postoperative drainage (pooled analysis weight mean difference: -0.21 (95% CI: -0.70-0.29); p = 0.41) or seroma development (pooled analysis odds ratio: 0.77 (95% CIs 0.43-1.37); p = 0.37). Intra-operative blood was slightly less for ultrasonic dissection compared to standard electrocautery (pooled analysis weight mean difference: -1.04 (95% CI: -2.00 to -0.08); p = 0.03). Ultrasonic dissection and standard electrocautery had similar outcomes with regard to operative time and wound complications. CONCLUSION Ultrasonic dissection and standard electrocautery appear to deliver similar results in the mastectomy setting. Further cost-effectiveness analysis may guide surgeon selection in the use of new technologies for mastectomy.
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Diagnosis of vasa previa with endovaginal color Doppler and power Doppler sonography: report of two cases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 1998; 17:393-398. [PMID: 9623479 DOI: 10.7863/jum.1998.17.6.393] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Polychlorinated biphenyls and organochlorine pesticides in EELS (Anguilla anguilla L.) from Welsh rivers. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 1997; 95:127-134. [PMID: 15093481 DOI: 10.1016/s0269-7491(96)00065-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/1995] [Accepted: 05/09/1996] [Indexed: 05/24/2023]
Abstract
Organochlorine concentrations in the muscle tissues of eels at 41 freshwater sites across Wales were surveyed in 1993. Positive but weak relationships were detected between eel age or length and the concentration of some organochlorines. Isomers of HCH were below detection at most sites. Dieldrin was widespread at 10-100 microg kt(-1) wet weight, despite its ban in sheep dip in 1989. Total DDT residue concentrations averaged 73 microg kg(-1). Total PCB burdens expressed as Arochlor 1260, were > 50 microg kg(-1) at 76% of sites and > 100 microg kg(-1) at 46% of sites. The range of concentrations was comparable with other UK data. Rural sites had relatively low levels of PCBs, highest contamination occurring in the lower reaches of industrialised catchments. The inferences for environmental effects are discussed.
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Abstract
A series of experiments is reported during which three subjects were initially classically conditioned to produce visual percepts to a sound only, second-order conditioned to transfer that response to an animal name, and finally taught a "foreign language". The results suggest that semantic generalization occurs whether the semantic relationships are formed either before or after the conditioned response is established.
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Abstract
Repeated pairing of an auditory conditioned stimulus with a weak visual unconditioned stimulus produced extended image sequences and visual responses conditioned to the tone alone. The experiment is set into the context of Pavlov's view of Helmholtz's "unconscious inference" thus providing experimental evidence linking the higher mental process of perception with classical conditioning.
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Hospital-based Social Workers. West J Med 1972. [DOI: 10.1136/bmj.1.5791.50-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Points from Letters: Childhood Autism. West J Med 1970. [DOI: 10.1136/bmj.1.5698.761-i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sex Chromatin. West J Med 1967. [DOI: 10.1136/bmj.1.5537.427-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Points from Letters: Training for General Practice. West J Med 1966. [DOI: 10.1136/bmj.2.5520.1012-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Consultants at the Periphery. West J Med 1966. [DOI: 10.1136/bmj.1.5501.1483-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Putting Things Right. West J Med 1965. [DOI: 10.1136/bmj.1.5441.1073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ingrowing Toenails. West J Med 1964. [DOI: 10.1136/bmj.1.5377.243-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Future of General Practice. West J Med 1963. [DOI: 10.1136/bmj.2.5357.621-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Trends in Child Psychiatry. West J Med 1962. [DOI: 10.1136/bmj.1.5290.1479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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M.R.C.P. (London). West J Med 1962. [DOI: 10.1136/bmj.1.5283.1004-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fathers at Delivery. West J Med 1961. [DOI: 10.1136/bmj.1.5227.744-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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POINTS FROM LETTERS: Effect of Physical Exercise on Alimentary Lipaemia. West J Med 1960. [DOI: 10.1136/bmj.2.5206.1165-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Drugs for the Menopause. West J Med 1960. [DOI: 10.1136/bmj.1.5173.643-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Qualification in Medicine. West J Med 1959. [DOI: 10.1136/bmj.2.5154.758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Unwanted Hypnotics. West J Med 1959. [DOI: 10.1136/bmj.1.5134.1414-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Why are Medical Journals So Dull? West J Med 1958. [DOI: 10.1136/bmj.2.5097.693-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Disease Education by the B.B.C. West J Med 1958. [DOI: 10.1136/bmj.1.5073.769-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Drug Firm Representatives. West J Med 1958. [DOI: 10.1136/bmj.1.5061.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Adult Education for Consultants. West J Med 1955. [DOI: 10.1136/bmj.2.4954.1504-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Drowning. West J Med 1955. [DOI: 10.1136/bmj.2.4935.378-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Care of the Elderly. West J Med 1949. [DOI: 10.1136/bmj.1.4615.1098-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cerebral Aneurysm. West J Med 1948; 2:574. [DOI: 10.1136/bmj.2.4576.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Points from Letters: Negative Health. West J Med 1948. [DOI: 10.1136/bmj.1.4542.176-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Points from Letters: Pruritus Ani as an Allergic Condition. West J Med 1947. [DOI: 10.1136/bmj.1.4512.950-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Basic Salary. West J Med 1947. [DOI: 10.1136/bmj.1.4507.737-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mr. Bevan and Ourselves. West J Med 1946. [DOI: 10.1136/bmj.2.4482.836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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The G.P. and the Health Service Bill. West J Med 1946. [DOI: 10.1136/bmj.1.4452.698-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Artificial Insemination. West J Med 1945. [DOI: 10.1136/bmj.1.4390.277-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mr. Shaw on Doctors. West J Med 1944. [DOI: 10.1136/bmj.2.4376.675-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Some Therapeutic Fallacies. West J Med 1943. [DOI: 10.1136/bmj.2.4324.657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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The B.M.A. and the Beveridge Report. West J Med 1943. [DOI: 10.1136/bmj.1.4286.266-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Desert Sores. West J Med 1942. [DOI: 10.1136/bmj.2.4263.351-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Treatment of Fractured Ribs. West J Med 1942. [DOI: 10.1136/bmj.1.4241.508-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bell's Palsy and Herpes Zoster. West J Med 1941. [DOI: 10.1136/bmj.1.4182.336-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Friedreich's Ataxia. West J Med 1940. [DOI: 10.1136/bmj.1.4126.192-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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