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7th April – Randomized double-blind trial comparing the cosmetic outcome of cutting diathermy versus scalpel for skin incisions
Quote from Deleted user on 7th April 2016, 7:13 pmthe conclusions drawn about pain advantages were dubious on the other hand. there were not enough knowledge recorded of pain regimens to make that association as strong as it was implied in the paper and abstract
the conclusions drawn about pain advantages were dubious on the other hand. there were not enough knowledge recorded of pain regimens to make that association as strong as it was implied in the paper and abstract
Quote from Deleted user on 7th April 2016, 7:13 pmIt improved post op pain but did not make note of the wide variety in pain management between patients
It improved post op pain but did not make note of the wide variety in pain management between patients
Quote from Deleted user on 7th April 2016, 7:13 pmit sort of addresses that in the discussion where it says that the results cannot be extrapolated to cosmetically sensitive areas of the skin, but yeah I agree, potentially some different types of surgery other than abdominal would have produced more valid results?
it sort of addresses that in the discussion where it says that the results cannot be extrapolated to cosmetically sensitive areas of the skin, but yeah I agree, potentially some different types of surgery other than abdominal would have produced more valid results?
Quote from Deleted user on 7th April 2016, 7:14 pmI think good point on the sample size. The authors had two problems, firstly its a single centre study (big trials in surgery normally require multiple centres internationally) and secondly they excluded any scar less than 3cm (that excludes a lot of laprascopic procedures)
I think good point on the sample size. The authors had two problems, firstly its a single centre study (big trials in surgery normally require multiple centres internationally) and secondly they excluded any scar less than 3cm (that excludes a lot of laprascopic procedures)
Quote from Deleted user on 7th April 2016, 7:15 pmthe pain data from a pilot study point of view could be interesting, and if anything the authors could have probably highlighted better that this would be an avenue worth rigorous further exploration
the pain data from a pilot study point of view could be interesting, and if anything the authors could have probably highlighted better that this would be an avenue worth rigorous further exploration
Quote from Deleted user on 7th April 2016, 7:15 pmIf the study is significant with adequate power, but the sample size is still small, it’d be difficult to say if the significant result reflects a true outcome
If the study is significant with adequate power, but the sample size is still small, it’d be difficult to say if the significant result reflects a true outcome
Quote from Deleted user on 7th April 2016, 7:17 pmthey didn’t seem to give a rationale for the exclusion of incisions <3cm. Any possible reasons for this?
they didn’t seem to give a rationale for the exclusion of incisions <3cm. Any possible reasons for this?
Quote from Deleted user on 7th April 2016, 7:17 pmHowever the paper did mention its drawbacks, for e.g. post op pain management being too heterogeneous to be included
However the paper did mention its drawbacks, for e.g. post op pain management being too heterogeneous to be included
Quote from Deleted user on 7th April 2016, 7:18 pmDid anyone else feel that the lack of information of the training grade of the surgeons doing the procedure was significant?
Did anyone else feel that the lack of information of the training grade of the surgeons doing the procedure was significant?
Quote from Deleted user on 7th April 2016, 7:18 pm@ Tomison I was wondering if they were doing it to try and have scars of similar size for a more reliable comparison between the scalpel incision and diathermy but they didn’t seem to have an upper limit?
@ Tomison I was wondering if they were doing it to try and have scars of similar size for a more reliable comparison between the scalpel incision and diathermy but they didn’t seem to have an upper limit?
Quote from Deleted user on 7th April 2016, 7:18 pmThere was also a much higher proportion of laparoscopic procedures within both the diathermy and scalpel incision groups – the data for laparotomy scars is much less reliable given than there are only 15 total patients with laparotomies.
There was also a much higher proportion of laparoscopic procedures within both the diathermy and scalpel incision groups – the data for laparotomy scars is much less reliable given than there are only 15 total patients with laparotomies.
Quote from Deleted user on 7th April 2016, 7:19 pmI was also wondering why they chose 6 months as a follow up point, might have been interesting to see how they compared at different points in recovery
I was also wondering why they chose 6 months as a follow up point, might have been interesting to see how they compared at different points in recovery
Quote from Deleted user on 7th April 2016, 7:21 pmAn upper limit could have improved the study and there would probably have been less variation in scar size
An upper limit could have improved the study and there would probably have been less variation in scar size
Quote from Deleted user on 7th April 2016, 7:22 pmIf they had more follow ups, maybe the drop out rate would have been higher, reducing sample size further?
If they had more follow ups, maybe the drop out rate would have been higher, reducing sample size further?
Quote from Deleted user on 7th April 2016, 7:22 pmthe training grade of surgeons is definitely a factor missing, i hadn’t thought of that. Also, doing some very quick reading about the Vancouver scar scale (one of the scales they used to assess the scars in this study) says that it is the most recognised scar assessment for burns; would this be significant in assessing the scars of abdominal surgery ?
the training grade of surgeons is definitely a factor missing, i hadn’t thought of that. Also, doing some very quick reading about the Vancouver scar scale (one of the scales they used to assess the scars in this study) says that it is the most recognised scar assessment for burns; would this be significant in assessing the scars of abdominal surgery ?
Quote from Deleted user on 7th April 2016, 7:22 pmIs the lack of information regarding skin closure significant?
Is the lack of information regarding skin closure significant?
Quote from Deleted user on 7th April 2016, 7:23 pmTo me it seemed a little odd to have predominantly laparoscopic procedures but then exclude wounds < 3cm, as if your looking for the best cosmetic result possible a small wound via a laparoscopic procedure would be the best
To me it seemed a little odd to have predominantly laparoscopic procedures but then exclude wounds < 3cm, as if your looking for the best cosmetic result possible a small wound via a laparoscopic procedure would be the best
Quote from Deleted user on 7th April 2016, 7:24 pmWhat did you make of the patient demographics? I thought it was a good attempt to take into account factors that influence wound healing and spread them equally within the two groups (to an extent; see DM and preop. chemo/radiotherapy). However, going back to the inadequacy of the size of the sample, the number of white people was way more than any other race.
What did you make of the patient demographics? I thought it was a good attempt to take into account factors that influence wound healing and spread them equally within the two groups (to an extent; see DM and preop. chemo/radiotherapy). However, going back to the inadequacy of the size of the sample, the number of white people was way more than any other race.
Quote from Deleted user on 7th April 2016, 7:24 pmI think it is significant Will. Do we know that it was the same surgeon throughout the whole case. If the surgeon was the same for the skin opening but then the closure was his registrar this could alter results
I think it is significant Will. Do we know that it was the same surgeon throughout the whole case. If the surgeon was the same for the skin opening but then the closure was his registrar this could alter results
Quote from Deleted user on 7th April 2016, 7:25 pmone thing i notice d about the sample size was that 9 patients withdrew from the trial, bringing the data set to 57 rather than the 66 they seem to focus on. would this not mean that the study was lacking the original power stated to be needed?
one thing i notice d about the sample size was that 9 patients withdrew from the trial, bringing the data set to 57 rather than the 66 they seem to focus on. would this not mean that the study was lacking the original power stated to be needed?
Quote from Deleted user on 7th April 2016, 7:25 pmAlso on calculation of the sample size, I also found it interesting how their calculation of score was based on a previous study, however that study was only for 37 patients (less than this study) and was not primarily focussed on the cosmetic outcome of the scar (Paper title: Prospective evaluation of vacuum-assisted closure in abdominal compartment syndrome and severe abdominal sepsis.)
Also on calculation of the sample size, I also found it interesting how their calculation of score was based on a previous study, however that study was only for 37 patients (less than this study) and was not primarily focussed on the cosmetic outcome of the scar (Paper title: Prospective evaluation of vacuum-assisted closure in abdominal compartment syndrome and severe abdominal sepsis.)
Quote from Deleted user on 7th April 2016, 7:26 pmDo we also need more information on the techniques and suture types used on the skin closures?
Do we also need more information on the techniques and suture types used on the skin closures?
Quote from Deleted user on 7th April 2016, 7:27 pm@rachel they used staples, but may still need information on technique?
@rachel they used staples, but may still need information on technique?
Quote from Deleted user on 7th April 2016, 7:27 pmthe caucasian population owas higer thatn other groups, but maybe that reflected the chances of keloid formation being higher in other ethnic groups, as well as just a generally higher caucasian population for this centre or this procedure? hard to say
the caucasian population owas higer thatn other groups, but maybe that reflected the chances of keloid formation being higher in other ethnic groups, as well as just a generally higher caucasian population for this centre or this procedure? hard to say
Quote from Deleted user on 7th April 2016, 7:29 pmI think we probably do Rachel. It says all skin incisions were closed with clips, but there is no mention of how the deeper tissues were closed
I think we probably do Rachel. It says all skin incisions were closed with clips, but there is no mention of how the deeper tissues were closed