Objective The role of selective decontamination with oral antibiotics(OABs)and mechanical bowel preparation(MBP)prior to elective colorectal surgery is still widely debated.The objective of this study was to compare t...Objective The role of selective decontamination with oral antibiotics(OABs)and mechanical bowel preparation(MBP)prior to elective colorectal surgery is still widely debated.The objective of this study was to compare the outcomes of selective decontamination with neomycin,metronidazole and MBP compared to those of decontamination with MBP alone or with no preparation.Methods Selective decontamination with neomycin and metronidazole combined with bowel preparation was introduced prior to elective colorectal surgery as part of an enhanced recovery after surgery program at Westmead Hospital,a major Australian tertiary referral hospital,between June 2017 and January 2023.Comparisons between short-term outcomes of OAB+MBP and MBP/no preparation were made using prospectively collected data on length of stay(LOS),readmission,mortality within 30 days,anastomotic leakage(AL),surgical site infection(SSI),urinary tract infection,deep venous thrombosis and/or pulmonary embolism,pneumonia,and ileus.Follow-up was limited to hospital stays and subsequent presentations within the health district within thirty days of surgery.The Mann-Whitney U test was used to analyse continuous data,and the chi-square test was used for categorical data.Univariate and multivariate regression modelling was performed to identify risk factors associated with an increased likelihood of SSI and AL.Results Patients with oral neomycin and metronidazole combined with bowel preparation had reduced superficial SSI(2.7%vs.7.6%,p=0.043)and overall complications(32.7%vs.44.6%,p=0.020),particularly Clavien-Dindo 1 complications(7.3%vs.16.5%,p=0.009).However,the differences in AL(2.7%vs.4.5%,p=0.369)and organ/space SSI(1.3%vs.3.7%,p=0.327)were not statistically significant.The median LOS(6 d vs.6 d,p=0.370)was not different between the groups.Conclusion Selective decontamination with neomycin and metronidazole reduces the risk of SSIs and overall complications.There was a trend to toward a lower AL,but this difference was not statistically significant.展开更多
The whirl sign refers to the computed tomography(CT)radiological finding of swirl of the small bowel and adjacent mesenteric soft tissue around the twisted mesenteric vessel.The whirl sign is highly specific for small...The whirl sign refers to the computed tomography(CT)radiological finding of swirl of the small bowel and adjacent mesenteric soft tissue around the twisted mesenteric vessel.The whirl sign is highly specific for small bowel volvulus(SBV)and raises the suspicion of closed loop obstruction.Nearly all patients with whirl signs associated with small bowel obstruction(SBO)require operative intervention,and one study showed that patients with whirl signs are 25 times more likely to need surgery.展开更多
Background:Much has been written about the loss to follow-up in the transition between pediatric and adult Congenital Heart Disease(CHD)care centers.Much less is understood about the loss to follow-up(LTF)after a succ...Background:Much has been written about the loss to follow-up in the transition between pediatric and adult Congenital Heart Disease(CHD)care centers.Much less is understood about the loss to follow-up(LTF)after a successful transition.This is critical too,as patients lost to specialised care are more likely to experience mor-bidity and premature mortality.Aims:To understand the prevalence and reasons for loss to follow-up(LTF)at a large Australian Adult Congenital Heart Disease(ACHD)centre.Methods:Patients with moderate or highly complex CHD and gaps in care of>3 years(defined as LTF)were identified from a comprehensive ACHD data-base.Structured telephone interviews examined current care and barriers to clinic attendance.Results:Overall,407(22%)of ACHD patients(n=1842)were LTF.The mean age at LTF was 31(SD 11.5)years and 54%were male;311(76%)were uncontactable.Compared to adults seen regularly,lost patients were younger,with a greater socio-economic disadvantage,and had less complex CHD(p<0.05 for all).We interviewed 59 patients(14%).The top 3 responses for care absences were“feeling well”(61%),losing track of time(36%),and not needing fol-low-up care(25%).Conclusions:A large proportion of the ACHD population becomes lost to specialised cardiac care,even after a successful transition.This Australian study reports younger age,moderate complexity defects,and socio-economic disadvantage as predictive of loss to follow-up.This study highlights the need for novel approaches to patient-centered service delivery even beyond the age of transition and resources to maintain patient engagement within the ACHD service.展开更多
Objective:Sudden cardiac death(SCD)and malignant ventricular arrhythmia(VA)are increasingly recognized as important issues for people living with a Fontan circulation,but data are lacking.We sought to characterize the...Objective:Sudden cardiac death(SCD)and malignant ventricular arrhythmia(VA)are increasingly recognized as important issues for people living with a Fontan circulation,but data are lacking.We sought to characterize the cohort who had sudden cardiac death,most likely related to VA and/or documented VA in the Australia and New Zealand Fontan Registry including risk factors and clinical outcomes.Methods:A retrospective cohort study was performed.Inclusion criteria were documented non-sustained ventricular tachycardia,sustained ventricular tachycardia,ventricular fibrillation,resuscitated cardiac arrest or SCD>30 days post-Fontan completion.Results:Of 1611 patients,20(1.2%)had VA;14(1.0%)had VA without SCD and 6(<1%)had SCD(6%of all deaths recorded in Registry;5 of those had documented VA at the time of arrest and 1 was presumed to be VA-associated).The median age at first VA was 20.5(14–32)years,10(50%)were females,and the median age at Fontan operation was 8(4–17)years.On univariable analysis,hypoplastic left heart syndrome(p=0.03)and older age Fontan operation(p<0.001)were associated with VA.Earlier Fontan era(p<0.003),atriopulmonary Fontan(p<0.001),pre-Fontan atrioventricular valve repair(p=0.013)pre-or post-Fontan atrial arrhythmia(p=0.010)were associated with SCD.Patients with VA had a 3 times higher risk of death or heart transplant(HR 3.27(1.19,8.98),p=0.02).Conclusions:A proportion of people living with a Fontan circulation have malignant VA.Routine VA screening in this cohort is essential.More data are needed to aid risk stratification.展开更多
This paper reviews management of obstetric anaemia and the role of intravenous iron for the treatment of obstetric anaemia.Red blood cell transfusions are routinely used for haemoglobin restoration in anaemic women.Th...This paper reviews management of obstetric anaemia and the role of intravenous iron for the treatment of obstetric anaemia.Red blood cell transfusions are routinely used for haemoglobin restoration in anaemic women.The decision for red blood cell transfusion is made on a combination of haemoglobin level and clinical status,and it is suggested that transfusions are not necessary in those who are well compensated or when alternative therapy is available.To reduce the risk,intravenous iron infusion is proposed as a bloodless therapeutic approach.There are a variety of iron preparations.Intravenous iron infusion can reduce the requirement for blood transfusion in hemodynamically stable women with perinatal anaemia,especially in resource-scarce settings.It a cost-effective bloodless approach for the treatment of anaemia than can enhance patient outcomes.According to the literature,when haemoglobin is greater than 90 g/L,blood transfusion is not often required.In perinatal women with anaemia,the decision whether to administer blood or iron is based on patient preferences,haemoglobin levels,clinical symptoms,past and present medical conditions and the clinician’s judgement.Nevertheless,due to the lack of rigid criteria for blood transfusions in the majority of clinical settings,it is considered the default treatment for anaemia in perinatal women.展开更多
2016年澳大利亚胃肠病学会等多家机构组织专家联合撰写并发布了《2016年澳大利亚丙型肝炎病毒(HCV)感染诊治指南》,内容涉及澳大利亚HCV感染的流行现状及管理模式、丙型肝炎病毒(hepatitis C virus,HCV)感染的筛查及诊断、治疗前评估、...2016年澳大利亚胃肠病学会等多家机构组织专家联合撰写并发布了《2016年澳大利亚丙型肝炎病毒(HCV)感染诊治指南》,内容涉及澳大利亚HCV感染的流行现状及管理模式、丙型肝炎病毒(hepatitis C virus,HCV)感染的筛查及诊断、治疗前评估、治疗方案选择、治疗期间监测及治疗后随访等,本文对其中的部分要点进行解读,并着重与《2015年中国丙型肝炎防治指南》、《2016年欧洲肝病学会丙型肝炎治疗指南》、《2015年加拿大肝病学会慢性丙型肝炎管理共识指南》、《2015及2016年美国肝病学会丙型肝炎治疗指南》、《2016年英国HCV感染诊治指南》以及《2016年世界卫生组织丙型肝炎治疗指南》中的相应内容进行比较,以期为临床肝病医生了解各个指南推荐意见的异同、规范HCV感染的临床诊治提供便利。展开更多
文摘Objective The role of selective decontamination with oral antibiotics(OABs)and mechanical bowel preparation(MBP)prior to elective colorectal surgery is still widely debated.The objective of this study was to compare the outcomes of selective decontamination with neomycin,metronidazole and MBP compared to those of decontamination with MBP alone or with no preparation.Methods Selective decontamination with neomycin and metronidazole combined with bowel preparation was introduced prior to elective colorectal surgery as part of an enhanced recovery after surgery program at Westmead Hospital,a major Australian tertiary referral hospital,between June 2017 and January 2023.Comparisons between short-term outcomes of OAB+MBP and MBP/no preparation were made using prospectively collected data on length of stay(LOS),readmission,mortality within 30 days,anastomotic leakage(AL),surgical site infection(SSI),urinary tract infection,deep venous thrombosis and/or pulmonary embolism,pneumonia,and ileus.Follow-up was limited to hospital stays and subsequent presentations within the health district within thirty days of surgery.The Mann-Whitney U test was used to analyse continuous data,and the chi-square test was used for categorical data.Univariate and multivariate regression modelling was performed to identify risk factors associated with an increased likelihood of SSI and AL.Results Patients with oral neomycin and metronidazole combined with bowel preparation had reduced superficial SSI(2.7%vs.7.6%,p=0.043)and overall complications(32.7%vs.44.6%,p=0.020),particularly Clavien-Dindo 1 complications(7.3%vs.16.5%,p=0.009).However,the differences in AL(2.7%vs.4.5%,p=0.369)and organ/space SSI(1.3%vs.3.7%,p=0.327)were not statistically significant.The median LOS(6 d vs.6 d,p=0.370)was not different between the groups.Conclusion Selective decontamination with neomycin and metronidazole reduces the risk of SSIs and overall complications.There was a trend to toward a lower AL,but this difference was not statistically significant.
文摘The whirl sign refers to the computed tomography(CT)radiological finding of swirl of the small bowel and adjacent mesenteric soft tissue around the twisted mesenteric vessel.The whirl sign is highly specific for small bowel volvulus(SBV)and raises the suspicion of closed loop obstruction.Nearly all patients with whirl signs associated with small bowel obstruction(SBO)require operative intervention,and one study showed that patients with whirl signs are 25 times more likely to need surgery.
文摘Background:Much has been written about the loss to follow-up in the transition between pediatric and adult Congenital Heart Disease(CHD)care centers.Much less is understood about the loss to follow-up(LTF)after a successful transition.This is critical too,as patients lost to specialised care are more likely to experience mor-bidity and premature mortality.Aims:To understand the prevalence and reasons for loss to follow-up(LTF)at a large Australian Adult Congenital Heart Disease(ACHD)centre.Methods:Patients with moderate or highly complex CHD and gaps in care of>3 years(defined as LTF)were identified from a comprehensive ACHD data-base.Structured telephone interviews examined current care and barriers to clinic attendance.Results:Overall,407(22%)of ACHD patients(n=1842)were LTF.The mean age at LTF was 31(SD 11.5)years and 54%were male;311(76%)were uncontactable.Compared to adults seen regularly,lost patients were younger,with a greater socio-economic disadvantage,and had less complex CHD(p<0.05 for all).We interviewed 59 patients(14%).The top 3 responses for care absences were“feeling well”(61%),losing track of time(36%),and not needing fol-low-up care(25%).Conclusions:A large proportion of the ACHD population becomes lost to specialised cardiac care,even after a successful transition.This Australian study reports younger age,moderate complexity defects,and socio-economic disadvantage as predictive of loss to follow-up.This study highlights the need for novel approaches to patient-centered service delivery even beyond the age of transition and resources to maintain patient engagement within the ACHD service.
文摘Objective:Sudden cardiac death(SCD)and malignant ventricular arrhythmia(VA)are increasingly recognized as important issues for people living with a Fontan circulation,but data are lacking.We sought to characterize the cohort who had sudden cardiac death,most likely related to VA and/or documented VA in the Australia and New Zealand Fontan Registry including risk factors and clinical outcomes.Methods:A retrospective cohort study was performed.Inclusion criteria were documented non-sustained ventricular tachycardia,sustained ventricular tachycardia,ventricular fibrillation,resuscitated cardiac arrest or SCD>30 days post-Fontan completion.Results:Of 1611 patients,20(1.2%)had VA;14(1.0%)had VA without SCD and 6(<1%)had SCD(6%of all deaths recorded in Registry;5 of those had documented VA at the time of arrest and 1 was presumed to be VA-associated).The median age at first VA was 20.5(14–32)years,10(50%)were females,and the median age at Fontan operation was 8(4–17)years.On univariable analysis,hypoplastic left heart syndrome(p=0.03)and older age Fontan operation(p<0.001)were associated with VA.Earlier Fontan era(p<0.003),atriopulmonary Fontan(p<0.001),pre-Fontan atrioventricular valve repair(p=0.013)pre-or post-Fontan atrial arrhythmia(p=0.010)were associated with SCD.Patients with VA had a 3 times higher risk of death or heart transplant(HR 3.27(1.19,8.98),p=0.02).Conclusions:A proportion of people living with a Fontan circulation have malignant VA.Routine VA screening in this cohort is essential.More data are needed to aid risk stratification.
文摘This paper reviews management of obstetric anaemia and the role of intravenous iron for the treatment of obstetric anaemia.Red blood cell transfusions are routinely used for haemoglobin restoration in anaemic women.The decision for red blood cell transfusion is made on a combination of haemoglobin level and clinical status,and it is suggested that transfusions are not necessary in those who are well compensated or when alternative therapy is available.To reduce the risk,intravenous iron infusion is proposed as a bloodless therapeutic approach.There are a variety of iron preparations.Intravenous iron infusion can reduce the requirement for blood transfusion in hemodynamically stable women with perinatal anaemia,especially in resource-scarce settings.It a cost-effective bloodless approach for the treatment of anaemia than can enhance patient outcomes.According to the literature,when haemoglobin is greater than 90 g/L,blood transfusion is not often required.In perinatal women with anaemia,the decision whether to administer blood or iron is based on patient preferences,haemoglobin levels,clinical symptoms,past and present medical conditions and the clinician’s judgement.Nevertheless,due to the lack of rigid criteria for blood transfusions in the majority of clinical settings,it is considered the default treatment for anaemia in perinatal women.
文摘2016年澳大利亚胃肠病学会等多家机构组织专家联合撰写并发布了《2016年澳大利亚丙型肝炎病毒(HCV)感染诊治指南》,内容涉及澳大利亚HCV感染的流行现状及管理模式、丙型肝炎病毒(hepatitis C virus,HCV)感染的筛查及诊断、治疗前评估、治疗方案选择、治疗期间监测及治疗后随访等,本文对其中的部分要点进行解读,并着重与《2015年中国丙型肝炎防治指南》、《2016年欧洲肝病学会丙型肝炎治疗指南》、《2015年加拿大肝病学会慢性丙型肝炎管理共识指南》、《2015及2016年美国肝病学会丙型肝炎治疗指南》、《2016年英国HCV感染诊治指南》以及《2016年世界卫生组织丙型肝炎治疗指南》中的相应内容进行比较,以期为临床肝病医生了解各个指南推荐意见的异同、规范HCV感染的临床诊治提供便利。
