The value of mastectomy flap fixation in reducing fluid drainage and seroma formation in breast cancer patients

<p>Abstract</p> <p>Background</p> <p>Prolonged and excessive drainage of serous fluid and seroma formation constitute the most common complications after mastectomy for breast carcinoma. Seroma formation delays wound healing, increases susceptibility to infection, skin flap necrosis, persistent pain and prolongs convalescence. For this, several techniques have been investigated to improve primary healing and minimize seroma formation.</p> <p>Materials and methods</p> <p>Between June 2009 and July 2010 forty patients with breast carcinoma, scheduled for modified radical mastectomy, were randomly divided into 2 groups, the study group (20) and the control group (20). In the study group; the mastectomy flaps were fixed to the underlying muscles in raws, at various parts of the flap and at the wound edge using fine absorbable sutures. In the control group; the wound was closed in the conventional method at the edges. Closed suction drains were used in both groups. Patients, tumor characteristics and operative related factors were recorded. The amount and color of drained fluid were recorded daily. The drains were removed when the amount become less than 50 cc. The total amount and duration of drained fluid and the formation of seroma were recorded and the results were compared between the two groups.</p> <p>Results</p> <p>In the flap fixation group, the drain was removed in significantly shorter time compared to the control group (p < 0.001). Also, the total amount of fluid drained was significantly lower in the flap fixation group (p < 0.001). The flap fixation group showed a significantly lower frequency of seroma formation compared to the control group, both clinically (p = 0.028) and ultrasonographically (p = 0.047).</p> <p>Conclusions</p> <p>The mastectomy flap fixation technique is a valuable procedure that significantly decreases the incidence of seroma formation, and reduces the duration and amount of drained fluid. However, it should be tried on a much wider scale to prove its validity.</p

Safety in home care: A research protocol for studying medication management

<p>Abstract</p> <p>Background</p> <p>Patient safety is an ongoing global priority, with medication safety considered a prevalent, high-risk area of concern. Yet, we have little understanding of the supports and barriers to safe medication management in the Canadian home care environment. There is a clear need to engage the providers and recipients of care in studying and improving medication safety with collaborative approaches to exploring the nature and safety of medication management in home care.</p> <p>Methods</p> <p>A socio-ecological perspective on health and health systems drives our iterative qualitative study on medication safety with elderly home care clients, family members and other informal caregivers, and home care providers. As we purposively sample across four Canadian provinces: Alberta (AB), Ontario (ON), Quebec (QC) and Nova Scotia (NS), we will collect textual and visual data through home-based interviews, participant-led photo walkabouts of the home, and photo elicitation sessions at clients' kitchen tables. Using successive rounds of interpretive description and human factors engineering analyses, we will generate robust descriptions of managing medication at home within each provincial sample and across the four-province group. We will validate our initial interpretations through photo elicitation focus groups with home care providers in each province to develop a refined description of the phenomenon that can inform future decision-making, quality improvement efforts, and research.</p> <p>Discussion</p> <p>The application of interpretive and human factors lenses to the visual and textual data is expected to yield findings that advance our understanding of the issues, challenges, and risk-mitigating strategies related to medication safety in home care. The images are powerful knowledge translation tools for sharing what we learn with participants, decision makers, other healthcare audiences, and the public. In addition, participants engage in knowledge exchange throughout the study with the use of participatory data collection methods.</p

On the Possibility of a Paratelic Initiation of Organizational Wrongdoing

In terms of reversal theory, both dominant and alternative explanations of the initiation of organizational wrongdoing assume that its perpetrators act in a telic state of mind. This leaves us with explanations that are insufficiently appreciative of the agent’s experience. The human mind can be creative and imaginative, too, and people can fully immerse in their activity. We suggest that the paratelic state of mind is relevant for the phenomenological understanding of the initiation of original, creative, daring courses of action, and that the paratelic state of mind may originate courses of action that social control agents, at a later moment in time, may label as organizational wrongdoing. Our proposal is especially relevant when organizational agents are on a course of exploration, facing uncertainty, complexity, and unavailability of information

Managerialism, organizational commitment and quality of job performances among European university employees

To achieve efficient and effective quality improvement, European universities have gradually adopted organizational strategies, structures, technologies, management instruments, and values that are commonly found in the private business sector. Whereas some studies have shown that such managerialism is beneficial to the quality of job performances of university employees, others have argued that managerialism is largely counterproductive and that it results in lower performances. The latter situation is called a ‘managerialism contradiction’. This paper tests two lines of reasoning underlying a potential contradiction governing the relationship between managerialism and job performances, while using university employee survey data from six European countries (Belgium, Finland, Germany, Netherlands, Sweden, UK). The results tend to support the assumption that managerialism, in these six countries at least, has a positive effect, albeit a modest one, on the quality of performances. The most important conclusion is therefore that there is no managerialism contradiction at work in European universities.