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The state Republican Party, which is run by Al Cardenas, a lawyer who has been a close ally of Jeb Bush's for 22 years, turned overnight into a full-fledged operative arm of the Bush effort.
In many ways, his work is reminiscent of that of Edward Bernays, the nephew of Sigmund Freud and father of modern public relations, whose 1928 book, "Propaganda," made a positive case for manipulating public opinion through advertising as the operative arm of psychology.
Of the three remaining patients, two indicated that they would find randomisation to the non-operative arm unacceptable, and one found randomisation to the operative arm unacceptable.
Kim et al 25 employed a previously published parental telephone interview survey of bowel function with investigators blinded to the patient's operative arm.
After application of standard monitoring, operative arm was elevated for two minutes and was then exsanguinated with an Esmarch bandage from distal to proximal.
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Since all the included studies were observational, there remains the possibility of uncontrolled confounding between the two treatment groups and thus, there are concerns regarding the comparability of both operative arms.
The NSABP R-03 trial of pre-operative against post-operative chemo-radiotherapy has shown down-staging, and demonstrated an improvement in the rate of sphincter-preserving operations from 31%to50%0% in the pre-operative arm.
This critique is particularly timely given the drive towards minimally invasive techniques, such as sentinel node biopsy, which aim to reduce the incidence and severity of post-operative arm problems.
The paper highlights the need for methodological rigor in study design, and the careful selection of appropriate, sensitive, reliable and clinically meaningful outcome measures to evaluate the impact of post-operative arm morbidity.
One patient in the randomised non-operative arm was lost to follow-up at 6 and 9 months.
However, these studies are limited by lack of pre-operative arm volume measurement, varying definitions of lymphedema, small sample size, and limited long-term follow-up.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com