We studied the effect of the addition of the bacteriostatic agent, netilmycin, to cefotiam treatment as prophylactic antibiotics against infection for grade III open tibial fractures. From 45 eligible cases, assigned randomly to a control group that receive only cefotiam, and the treatment group that receive netilmycin in addition to cefotiam. We observed that the clearing of infection occurred earlier in the cefotiam /netilmycin group. We found that 3 day administration of cefotiam netilmycin is superior to 3 day administration of cefotiam only. It is equivalent to 5 day treatment with cefotiam alone.
orthopaedic

BACKGROUND: Skin cancer is the most prevalent cancer by organ type and referral accuracy is vital for diagnosis and management. The British Association of Dermatologists (BAD) and literature highlight the importance of accurate skin lesion examination, diagnosis and educationally-relevant studies. METHODS: We undertook a review of the relevant literature, a national audit of skin lesion description standards and a study of speciality training influences on these descriptions. Questionnaires (n=200), with pictures of a circular and an oval lesion, were distributed to UK dermatology/plastic surgery consultants and speciality trainees (ST), general practitioners (GP), and medical students (MS). The following variables were analysed against a pre-defined 95% inclusion accuracy standard: site, shape, size, skin/colour, and presence of associated scars. RESULTS: There were 250 lesion descriptions provided by 125 consultants, STs, GPs, and MSs. Inclusion accuracy was greatest for consultants over STs (80% vs. 68%; P<0.001), GPs (57%) and MSs (46%) (P<0.0001), for STs over GPs (P<0.010) and MSs (P<0.0001) and for GPs over MSs (P<0.010), all falling below audit standard. Size description accuracy sub-analysis according to circular/oval dimensions was as follows: consultants (94%), GPs (80%), STs (73%), MSs (37%), with the most common error implying a quadrilateral shape (66%). Addressing BAD guidelines and published requirements for more empirical performance data to improve teaching methods, we performed a national audit and studied skin lesion descriptions. To improve diagnostic and referral accuracy for patients, healthcare professionals must strive towards accuracy (a circle is not a square). CONCLUSIONS: We provide supportive evidence that increased speciality training improves this process and propose that greater focus is placed on such training early on during medical training, and maintained throughout clinical practice.
Cicatrix ; Clinical Audit ; Consultants ; Delivery of Health Care ; Diagnosis ; Education* ; General Practitioners ; Humans ; Referral and Consultation ; Skin Neoplasms ; Skin* ; Students, Medical ; Surgery, Plastic ; Teaching ; Surveys and Questionnaires