Outpatient non-attendance is a common source of inefficiency in a health service, wasting time and resources and potentially lengthening waiting lists. A prospective audit of plastic surgery outpatient clinics was conducted during the six months from January to June 1997, to determine the clinical and demographic profile of non-attenders. Of 6095 appointments 16% were not kept. Using the demographic information, we changed our follow-up guidelines to reflect risk factors for multiple non-attendances, and a self-referral clinic was introduced to replace routine follow-up for high risk non-attenders. After these changes, a second audit in the same six months of 1998 revealed a non-attendance rate of 11%--i.e. 30% lower than before. Many follow-up appointments are sent inappropriately to patients who do not want further attention. This study, indicating how risk factor analysis can identify a group of patients who are unlikely to attend again after one missed appointment, may be a useful model for the reduction of outpatient non-attendance in other specialties.
In this article, we introduce a complex world of working with qualitative data in multiple languages, modalities and media. We share some of the theoretical considerations that influenced our decisions about when to translate, what and how. We also report some of the multiple possibilities available to the researcher when analysing data in a visual language -in this case, British Sign Languagesharing considerations in choosing one method over another in differing circumstances. Through these discussions we draw attention to how translation issues are both similar and different from working solely with spoken language audio recordings. We then offer suggestions on the reporting and dissemination of results when more than one language is involved and when translation is at the heart of the research. While grounded in empirical Deaf Studies research, the methodological, cultural and theoretical issues raised here concerning translation, representation and 'voice' are applicable across social science disciplines, and particularly where minority communities and unwritten languages are at the heart of research activities.
The postoperative assessment of free flaps is essential to identify and act on signs of incipient flap failure. Where the flap is completely buried, this becomes almost impossible unless part of the flap is exteriorised or an overlying skin window is used. Alternatively, complicated and often impractical monitoring devices have been advocated, but these have failed to gain widespread acceptance. A simpler solution to this problem has been evaluated in a series of patients using colour duplex Doppler imaging. This re-appraisal of a previously reported technique has been facilitated by updated technology in diagnostic radiology. Duplex Doppler imaging was confirmed as an accurate, non-invasive, and inexpensive tool for the postoperative measurement of blood flow within the pedicles of five buried free flaps in four patients undergoing surgery in our unit.
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