The impact of routine open nonsuction drainage on fluid accumulation after thyroid surgery: a prospective randomised clinical trial.

Background: Thyroid drains following thyroid surgery are routinely used despite minimal supportive evidence. Our aim in this study is to determine the impact of routine open drainage of the thyroid bed postoperatively on ultrasound-determined fluid accumulation at 24 hours. Methods: We conducted a prospective randomised clinical trial on patients undergoing thyroid surgery. Patients were randomly assigned to a drain group (n = 49) or a no-drain group (n = 44) immediately prior to wound closure. Patients underwent a neck ultrasound on day 1 and day 2 postoperatively. After surgery, we evaluated visual analogue scale pain scores, postoperative analgesic requirements, self-reported scar satisfaction at 6 weeks and complications. Results: There was significantly less mean fluid accumulated in the drain group on both day 1, 16.4 versus 25.1 ml (P-value = 0.005), and day 2, 18.4 versus 25.7 ml (P-value = 0.026), following surgery. We found no significant differences between the groups with regard to length of stay, scar satisfaction, visual analogue scale pain score and analgesic requirements. There were four versus one wound infections in the drain versus no-drain groups. This finding was not statistically significant (P = 0.154). No life-threatening bleeds occurred in either group. Conclusions: Fluid accumulation after thyroid surgery was significantly lessened by drainage. However, this study did not show any clinical benefit associated with this finding in the non-emergent setting. Drains themselves showed a trend indicating that they may augment infection rates. The results of this study suggest that the frequency of acute life-threatening bleeds remains extremely low following abandoning drains. We advocate abandoning routine use of thyroid drains. Trial registration: ISRCTN94715414.

Measuring QoS in an aeronautical opportunistic network architecture with limited access to a satellite communications backhaul

We measure quality of service (QoS) in a wireless network architecture of transoceanic aircraft. A distinguishing characteristic of the network scheme we analyze is that it mixes the concept of Delay Tolerant Networking (DTN) through the exploitation of opportunistic contacts, together with direct satellite access in a limited number of the nodes. We provide a graph sparsification technique for deriving a network model that satisfies the key properties of a real aeronautical opportunistic network while enabling scalable simulation. This reduced model allows us to analyze the impact regarding QoS of introducing Internet-like traffic in the form of outgoing data from passengers. Promoting QoS in DTNs is usually really challenging due to their long delays and scarce resources. The availability of satellite communication links offers a chance to provide an improved degree of service regarding a pure opportunistic approach, and therefore it needs to be properly measured and quantified. Our analysis focuses on several QoS indicators such as delivery time, delivery ratio, and bandwidth allocation fairness. Obtained results show significant improvements in all metric indicators regarding QoS, not usually achievable on the field of DTNs.