Vanessa Simonite

Delayed versus immediate exercises following surgery for breast cancer: a systematic review

SummaryBackgroundSeroma formation, wound healing and fluid drainage are a concern for both surgeons and patients. Excessive fluid production can result in seroma formation, and inadequate drainage of seromas is known to cause infection, pain, discomfort and longer periods of hospitalisation. Postoperative exercises given to maintain movement of the arm are believed to increase the amount of fluid production following surgery. This review aimed to determine whether a program of delayed exercises reduces the risk of seroma formation, fluid loss and hospital stay, without loss of arm movement.MethodA systematic review. RCTs of early versus delayed shoulder mobilisation after surgery in females with breast cancer were included in the review. Outcomes. One or more measurements of shoulder range of motion, wound complications, fluid drainage volumes and incidence of seroma formation. Design. Randomised controlled trials, control group of delayed exercise/mobilisation. Validity assessment was carried out using a data extraction form based on the CONSORT statement. Study characteristics recorded include sample size, intervention, control, period of exercise delay, surgical procedure and conclusions drawn. Data synthesis was carried out using random effects and weighted mean differences to test for heterogeneity and combined effects.Results12 RCTs were included in the review of which 6 were included for meta-analysis. Delaying exercises significantly decreases seroma formation (OR=0.4; 95%CI 0.2–0.5; p=0.00001). No significant differences were found for drainage volume or hospital stay.ConclusionCurrent evidence from RCTs supports the use of a delayed program of arm exercises to reduce seroma formation. Clinical and statistical inconsistencies between studies did not allow any conclusions to be drawn regarding the effects of delayed exercises on fluid drainage, hospital stay and immediate or long term ability to move the arm.

Incidence of and risk factors for perineal trauma: a prospective observational study

BackgroundOur aim was to describe the range of perineal trauma in women with a singleton vaginal birth and estimate the effect of maternal and obstetric characteristics on the incidence of perineal tears.MethodsWe conducted a prospective observational study on all women with a planned singleton vaginal delivery between May and September 2006 in one obstetric unit, three freestanding midwifery-led units and home settings in South East England. Data on maternal and obstetric characteristics were collected prospectively and analysed using univariable and multivariable logistic regression. The outcome measures were incidence of perineal trauma, type of perineal trauma and whether it was sutured or not.ResultsThe proportion of women with an intact perineum at delivery was 9.6% (125/1,302) in nulliparae, and 31.2% (453/1,452) in multiparae, with a higher incidence in the community (freestanding midwifery-led units and home settings). Multivariable analysis showed multiparity (OR 0.52; 95% CI: 0.30–0.90) was associated with reduced odds of obstetric anal sphincter injuries (OASIS), whilst forceps (OR 4.43; 95% CI: 2.02–9.71), longer duration of second stage of labour (OR 1.49; 95% CI: 1.13–1.98), and heavier birthweight (OR 1.001; 95% CI: 1.001–1.001), were associated with increased odds. Adjusted ORs for spontaneous perineal truama were: multiparity (OR 0.42; 95% CI: 0.32–0.56); hospital delivery (OR 1.48; 95% CI: 1.01–2.17); forceps delivery (OR 2.61; 95% CI: 1.22–5.56); longer duration of second stage labour (OR 1.45; 95% CI: 1.28–1.63); and heavier birthweight (OR 1.001; 95% CI: 1.000–1.001).ConclusionsThis large prospective study found no evidence for an association between many factors related to midwifery practice such as use of a birthing pool, digital perineal stretching in the second stage, hands off delivery technique, or maternal birth position with incidence of OASIS or spontaneous perineal trauma. We also found a low overall incidence of OASIS, and fewer second degree tears were sutured in the community than in the hospital settings. This study confirms previous findings of overall high incidence of perineal trauma following vaginal delivery, and a strong association between forceps delivery and perineal trauma.

Class size and student performance: 1984–94

ABSTRACT The literature on class size and student performance is reviewed. Student performance and class size in a large modular course was studied over a period of 10 years, involving over 5,000 modules and 250,000 student grades. The hypothesis that students would perform less well in larger classes was confirmed. A small but highly significant negative relationship between module enrolment and grades was found and students in larger classes stood significantly lower chances of getting good grades. Subject areas varied widely in the strength of the relationship between class size and performance. As class size increased markedly during this period and performance was worse in larger classes it was hypothesised that overall student performance would have declined during the period studies. This hypothesis was not confirmed: overall student performance improved. Possible explanations of this paradox are explored.

Academic Achievement of Mature Students on a Modular Degree Course

Abstract The massive increase in the proportion of mature students in higher education has not been accompanied by adequate quantitative studies of their performance relative to conventional students and of the value added by higher education in relation to their entry qualifications. The limitations of published studies are identified. This paper reports a quantitative study undertaken at Oxford Brookes University on the performance of 1,222 students who graduated in 1994. Student performance was shown to increase with age after taking account of sex, entry qualifications and the type of course studied. Students entering the course in their thirties had three times the chance of gaining a good degree than equivalent students aged twenty and under. This relative performance advantage for mature students was established in their first year of study. Mature students entered with poorer qualifications and so the value added by Oxford Brookes University was shown to be greater for mature students. Practical i...

Multilevel analysis of relationship between entry qualifications and trends in degree classifications in mathematical sciences: 1994–2000

There has been growing concern about the mathematical skills and understanding of undergraduates entering higher education to study mathematical sciences. In spite of this, as in other disciplines, the classifications of degrees awarded in mathematical sciences have risen. The research described here uses statistical analyses of data collected by the Higher Education Statistics Agency to study the relationships between the classifications of degree awards in mathematical sciences from 1994/5 to 1999/2000 and the entry qualifications and other characteristics of the 22,433 graduates with UK domicile who received these awards. The results show that although there have been statistically significant changes in degree classifications during the period covered by the data, in statistical terms, these changes are explained, by the increasingly high grades achieved before entering higher education by students graduating in successive years.