3 research outputs found
Outcomes of Revascularization for Peripheral Artery Disease in Aboriginal and Torres Strait Islander Peoples and Non-Indigenous Australians
No full textBackground
Australia's Aboriginal and Torres Strait Islander Peoples are at high risk of peripheral arterial disease (PAD), but outcomes of revascularization are unknown. Revascularization outcomes were compared among Aboriginal and Torres Strait Islander and non-Indigenous Australians.
Methods
A retrospective cohort study was conducted of patients who underwent lower limb revascularization between January 2015 and July 2023. PAD severity was defined using the Rutherford classification and angiographic scoring systems (ANGIO score, Global Limb Anatomic Staging System [GLASS], Trans-Atlantic Inter-Society Consensus). The primary outcome was major adverse limb events (MALE), that is, major amputation or repeat revascularization. The secondary outcomes were major adverse cardiovascular events (MACE), major amputation, and repeat revascularization alone.
Results
A total of 504 patients were included. Fifty-seven (11.3%) were Aboriginal and Torres Strait Islander People, who were more likely to present with chronic limb-threatening ischemia (74% vs. 65%; P = 0.01) and have infrapopliteal disease (GLASS: odds ratio [OR] 1.93, 95% confidence interval 1.15–3.24; P = 0.013; ANGIO score: OR 1.97, 1.18–3.29; P = 0.01) compared to non-Indigenous Australians. Risk of MALE (rate ratio [RR] 1.39; 0.91–2.13; P = 0.126) and repeat revascularization (RR 1.18, 0.74–1.88; P = 0.493) were similar, but Aboriginal and Torres Strait Islander People had a higher risk of major amputation (RR 3.35; 1.66–6.75; P = 0.001) and MACE (RR 1.88, 1.17–3.03; P = 0.009) than non-Indigenous participants. Adjusted analyses suggested the increased risk of major amputation was due to Aboriginal and Torres Strait Islander People presenting with more severe PAD and tissue loss compared to non-Indigenous patients.
Conclusion
Aboriginal and Torres Strait Islander Peoples present with more severe PAD and have greater risk of major amputation. Culturally appropriate programs are needed to raise awareness and promote secondary prevention.Full Tex
Incidence and management of choledocholithiasis on routine intraoperative cholangiogram: a 5‐year tertiary centre experience
No full textBackground: The incidence of choledocholithiasis on routine intraoperative cholangiogram (IOC) during cholecystectomy is approximately 12%. Cholecystectomy without IOC may lead to undiagnosed choledocholithiasis placing patients at risk of complications such as pancreatitis or cholangitis. This study aims to determine the incidence of choledocholithiasis intraoperatively as well as the associated risk factors and the methods of management. Methods: A retrospective observational analysis of all laparoscopic cholecystectomies with IOC at the Gold Coast Hospital and Health Service from 1 January 2016 to 2 December 2021 was carried out. Patient demographics, operative data and cholangiogram findings were collected from electronic medical systems. Results: A total of 3904 cholecystectomies were carried out over the study period. 3520 (90.1%) had an IOC, and 474 (13.4%) had positive IOC findings. 158 (33.3%) of the cases were managed intraoperatively with hyoscine butylbromide with or without intravenous glucagon followed by biliary tree flushing alone, 183 (38.6%) received transcystic bile duct exploration (TCBDE) with a success rate of 83% and 167 (35.2%) received endoscopic retrograde cholangiopancreatography (ERCP). Choledocholithiasis was incidental in 44 (9.28%) patients. Conclusion: Incidental choledocholithiasis during routine IOC is not uncommon. Management predominantly includes intraoperative TCBDE or postoperatively via an ERCP. This study has not found reliable preoperative factors to predict choledocholithiasis based on preoperative clinical, radiological and biochemical factors. A small proportion of patients received preoperative endoscopic intervention, and the decision-making process requires further investigation.No Full Tex
COVID-19 impact on medical education and the future post-pandemic era for medical students
No full textThe COVID-19 global emergency has brought about unexpected changes in the format and quality of undergraduate medical education in a short period of time. The impact of remote delivery on medical students learning, satisfaction, confidence, social relationships, communications and emotional wellbeing has been significant. The lack of direct patient and teacher contact is generating anxiety about their future competence. The ambivalence about urge to help without sufficient clinical skills and the fear of being either infected or becoming an asymptomatic carrier that puts patient safety at risk is of concern to them. Suggestions for enhancing pandemic or global emergency preparedness for the future are made. Strategies to manage the way in which remote learning is delivered need to be implemented as a matter of urgency should social distancing and quarantine regulations keep medical students away from hands-on clinical practice for long periods. Actions to maintain motivation and trust in the medical schools to meet their learning needs now and in the future are warranted
