Environment, sustainability and health: the learning curve steepens.
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Focus groups are not simply a discussion between people, but are focused interviews exploring interactions between participants. In this paper, Ian Mansell, Glynis Bennett, Ruth Northway, Donna Mead and Laurie Moseley explore the complexities and practicalities of using focus groups in research, with reference to a study of palliative care services.
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Laparoscopic inguinal hernia repair is a new but accepted method of treatment for this common condition. It has several distinct advantages over traditional open types of repair but also has the potential for complications not found with open repair. We have performed over 1700 laparoscopic repairs in our unit and modified the technique over the last 5 years whilst auditing our results. We present a description of the technique and describe the common complications we have experienced and the methods we have employed to reduce these complications.
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PURPOSE: To describe our experience with management of eyes with stage 5 retinopathy of prematurity (ROP). METHODS: Closed vitreoretinal surgery was done on 96 eyes of patients with stage 5 ROP. Lens was sacrificed in all but one eye. Surgery involved an attempt to clear all preretinal tissue and open the peripheral trough all round. In most instances bimanual surgery under viscoelastic was performed. RESULTS: At last follow up, anatomical success (defined as attached posterior pole) was achieved in 22.5% cases. Significant postoperative problems included reproliferation and secondary glaucoma. Only two infants obtained mobile vision. CONCLUSION: Late identification of disease, lack of prior treatment such as laser or cryo, and higher incidence of narrow-narrow funnel configuration were responsible for the poor surgical results noted in this series. The poor surgical and functional results reemphasize the need for prompt screening and management of infants at risk.
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In the interest of our patients and advancement in medicine and with the guarantee by law of the freedom to select methods of treatment, we may and must try out new strategies even in the face of initially unknown risks, side effects, and consequences. Every innovation assumes, however, that the advantages and disadvantages, potential complications, and burden to the patient have been weighed against those of conventional methods. The risks that a pioneer takes must be justified and presented comprehensively and clearly to the patient. Otherwise the threat is posed of civil and criminal accusations of negligence in responsibility or in the obligation to fully inform patients. Patient protection and safety must always be the first priority.
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