The effect of povidone iodine on wound sepsis following gastrointestinal surgery was studied in a trial involving 153 patients of whom 72 had their wounds sprayed with povidone iodine dry powder (Disadine DP) and 81 acted as a control group. The infection rate of 9.9 per cent in the patients treated with povidone iodine was significantly lower than that of 24.4 per cent in the control group (P less than 0.05). Bacterial contamination of the wound at the time of operation was shown to be of importance, being associated with a 52 per cent infection rate in the control group. However, spraying of contaminated wounds with povidone iodine reduced the infection rate to the significantly lower level of 11 per cent (P less than 0.05). We conclude that povidone iodine is a safe and effective means of reducing wound sepsis following gastrointestinal surgery.
bandage was applied in the usual way, and was reinforced by four six-inch (15 cm) plaster-of-Paris bandages that were wound round the crepe bandage. Weight-bearing was allowed with the aid of crutches for balance on the third day, and patients were discharged on the fourth day. Physiotherapy was given only to calf muscles and chest. Plaster-of-Paris bandages were removed on the 10th day, and quadriceps exercises were then begun, either at home unaided or in the physiotherapy department.The two groups were comparable (table I). Heavy occupations included mining (two in each group), others were labourers on building sites. All patients in the second group were discharged on the fourth day, as planned. No complications occurred. When questioned, patients in group 2 seemed to have had less discomfort than those who received traditional treatment (group 1). Indeed, five patients in group 2 had previously been managed traditionally after meniscectomy, and they unanimously preferred treatment by adequate splintage and early weight-bearing as being more comfortable and convenient. Operative findings are shown in table II. ResultsThe amounts of effusion fluid, estimated on the 10th postoperative day, were similar in both groups. In group 1 effusions were small in 14 patients, moderate in 19, and large in seven. In group 2 amounts of fluid were small in 13,-moderate in 23, and large in four. The average times before patients could return to work and resume sporting activities were 8-8 ±SD 3-6 weeks and 13-5 ±5-3 weeks respectively in group 1, and 7-7 ±2 6 weeks and 10-5 ±3 0 weeks respectively in group 2. These results were not significantly different (Mann-Whitney U test). Miners and labourers returned to work in 10 weeks (group 1) and 7-20 weeks (group 2). Patients who had undergone a lateral meniscectomy took longer to return to work-9-8 weeks in group 1 and 8 weeks in group 2.The symptoms and results of examination in the two groups when seen as outpatients six months or more after operation were similar. In group 1 two patients had discomfort when playing football, one had a mild effusion six months postoperatively, and one had quadriceps wasting (1 inch; 2-5 cm). One of those in group 2 had discomfort when playing squash, one had a mild effusion eight months after operation, and one who had a degenerative lesion of the anterior horn lacked 300 flexion in the joint. CommentWe suggest that applying an adequate splint and allowing early walking is more convenient and comfortable postoperatively for patients who have undergone routine meniscectomy. In addition, when beds are in short supply the quicker turnover reduces the waiting list, while time is also saved on physiotherapy. None of our patients who were treated in this way had complications, and a persistent effusion was not a problem. Return to work is not delayed, and the time before patients can resume full sporting activities may even be slightly reduced.
As a social theory of organization, it is unsurprising that institutional theory draws upon the profound and ambitious work of the late anthropologist Mary Douglas. One of the foundational concepts of organizational institutionalism, institutional logics, directly draws upon her work. Yet, in recent times, this foundational role has faded from view as institutional theory itself becomes increasingly institutionalized as a vibrant branch of organization studies. This is unfortunate for there is much continuity in current work with that of Douglas, it now being 50 years and 30 years, respectively, since the publication of two of her formative works. The deep analogies that underpin classificatory systems and the processes by which they are sustained remain significant areas under continued investigation by institutional theorists. Thus, in this paper we revisit Douglas' core arguments and their connections to institutional theorizing. We specifically explore her contribution of 'naturalizing analogies' as a way of accounting for the unfolding of change across levels of analysis, extending, modifying and enriching explanations of how institutional change is reified, naturalized and made meaningful. We do this by providing empirical descriptions of meta-organizing analogies and field-level applications. We explain how Douglas' major theoretical works are of considerable relevance for current institutional theorizing. This aids particularly in informing accounts of institutional logics and the movement between individual cognition and collective signification.
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