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Biomedical subjects

R P Cole

Publications and source records attributed to R P Cole.

At least 19 recordsLinked to original sources
PubMed2006

Towards performance measurement in reconstructive surgery: a multicentre pilot study of free and pedicled flap procedures.

OBJECTIVES: To pilot the acceptability and feasibility of clinical audit in free and pedicled flap reconstruction. To establish a baseline flap failure rate in participating units, so that a sample size calculation could be performed for future national audit. METHODS: A proforma was piloted over a 3-month period in four participating units, during which time data on 93 reconstructive procedures involving free and pedicled flaps was collected. The patients included those where large transfers of tissue were required such as for coverage of grade IIIb compound tibial fractures and breast reconstruction after mastectomy, and also smaller flap transfers such as after skin cancer excision. RESULTS: The proforma was found to be acceptable to clinicians and the feasibility of the data collection process was established. Overall there was a total flap survival of 89% and secondary operations to the donor or recipient sites were required in 11% of patients. CONCLUSIONS: This study demonstrates the feasibility of comparative audit for free and pedicled flap procedures using the methods proposed. Based on the incidence of flap failure observed in this pilot study, at least 18 months of prospective data collection on consecutive patients is required to fulfil the statistical requirements of comparative audit. The establishment of a routinely collected minimum dataset is proposed as one means of meeting these requirements.

Adolescent↗
PubMed2004

Dynamic external fixation for complex intraarticular phalangeal fractures.

Intraarticular phalangeal fractures are difficult to treat. The advantages of using dynamic external fixation devices include distraction of impacted fracture fragments and reduction in joint stiffness by allowing early joint mobilization. Previous reports have concentrated on pilon fractures and dorsal fracture dislocations affecting the proximal interphalangeal joint. We report our experience using a dynamic external spring fixator in the management of 15 patients with a variety of fracture patterns affecting the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints. In three cases the device spanned two adjacent joints. Long-term follow-up has shown excellent range of joint movement and no major complications. We consider that this device is an effective tool in the management of a range on complex intraarticular phalangeal fractures.

Adult↗
PubMed2001

Basal cell carcinomata in port wine stains.

The development of basal cell carcinoma (BCC) in a port wine stain is rare and the aetiology of these malignancies in this situation is the subject of some debate. Early treatment of port wine stains with ionising radiation has been implicated in the development of BCC. The use of the argon laser has not been implicated. We present four cases of BCC in port wine stains, one previously treated with an argon laser, and discuss the possible aetiological factors.

Adult↗
PubMed2000

Functional recovery in cancer rehabilitation.

OBJECTIVE: To assess the impact of inpatient rehabilitation on the motor and cognitive functional status of cancer patients, and to determine whether cancer diagnosis, rehabilitation impairment, physician-determined rehabilitation goals, and active cytotoxic treatment affect the magnitude of functional improvement. DESIGN AND SETTING: A retrospective, case series of patients with an oncology diagnosis undergoing inpatient rehabilitation at a rehabilitation hospital. PARTICIPANTS: A sample of 200 patients admitted for rehabilitation services due to disability resulting from impairments caused by cancer or its treatment. INTERVENTION: Comprehensive multidisciplinary inpatient rehabilitation. OUTCOME MEASURES: Function status was measured using the motor and cognitive measures of the Functional Independence Measure. RESULTS: All patients made significant gains in motor function regardless of diagnostic group, rehabilitation impairment group, rehabilitation goal group, and cytotoxic treatment status. The magnitude of motor function gain was not equivalent across all impairments and rehabilitation goals. Significant gains in cognitive function were made by all patients except those with intracranial neoplasms, central nervous system dysfunction, and palliative rehabilitation goals. CONCLUSION: Inpatient rehabilitation can improve both motor and cognitive function in patients with disability resulting from impairments caused by cancer or its treatment.

Activities of Daily Living↗
PubMed2000

MRI scan diagnosis of trilucent breast implant rupture.

The authors present the case report of a patient who had undergone a latissimus dorsi breast reconstruction plus Trilucent implant. This patient later presented with discomfort in the breast and an MRI scan diagnosed rupture of the implant and also revealed a fluid level within the implant. These findings were confirmed at exploration and were found to be caused by separation of the contents into a serous layer and a lipid layer.

Breast Implants↗
PubMed1999

The selection of patients for breast reduction: should health commissions have a say?

Selective or restrictive access policies operate for breast reduction, despite proven benefits. The rationale for these policies, in particular the requirement of psychiatric assessment prior to a plastic surgical consultation, as an aid to patient selection by the health commission, was examined in 57 general practice referrals to a plastic surgical unit. In 22 cases, these policies deterred the patient or GP from pursuing the referral further. Sixteen cases were funded by the health commission directly, 16 patients required psychiatric or orthopaedic referrals, and three patients were refused funding outright. The decision to fund, reject or refer to a non-plastic-surgical specialist was not statistically related to the patients' symptoms. Non-plastic-surgical assessment resulted in referral for a plastic surgical opinion in 15 of 16 patients. We conclude that these selective policies are unsatisfactory, since patient management is not related to symptoms and the use of non-plastic-surgical opinions by the health commission as an aid to rationing is of little benefit.

Contract Services↗
PubMed1999

Osteoporosis management: physicians' recommendations and womens' compliance following osteoporosis testing.

Physicians use several pharmaceutical agents (e.g., hormone replacement therapy [HRT], calcitonin, bisphosphonates, calcium, and vitamin D) to manage osteoporosis. However, relatively little research has examined how physicians employ these agents in osteoporosis management. Additionally, researchers have not examined compliance with these treatments following the measurement of bone mass. Using a mail survey, we examined physicians' recommendation of, and women's compliance with, osteoporosis treatment modalities (stratified by fracture risk at the femoral neck and age) following bone mass measurement. We found that physicians recommended non-HRT treatment more often than HRT treatment to women with an increased risk of fracture, and women's acceptance of recommended treatments was relatively high following the measurement of bone mass.

Absorptiometry, Photon↗