Establishing local manufacture of PPE for healthcare workers in the time of a global pandemic.

A face shield is a secondary personal protective equipment (PPE) for healthcare workers (HCW). Worn with the appropriate face masks/respirators, it provides short term barrier protection against potentially infectious droplet particles. Coronavirus disease 2019 (COVID-19) caused a spike in demand for PPE, leading to a shortage and risking the safety of HCW. Transport restrictions further challenged the existing PPE supply chain which has been reliant on overseas-based manufacturers. Despite the urgency in demand, PPE must be properly tested for functionality and quality. We describe the establishment of local face shields manufacture in Western Australia to ensure adequate PPE for HCW. Ten thousand face shields for general use (standard) and for ear, nose and throat (ENT) specialist use were produced. Materials and design considerations are described, and the face shields were vigorously tested to the relevant Standards to ensure their effectiveness as a protective barrier, including splash and impact resistance. Comparative testing with traditional and other novel face shields was also undertaken. Therapeutic Goods Administration (TGA) licence was obtained to manufacture and supply the face shields as a Class I medical device. The swiftness of process is a credit to collaboration from industry, academia and healthcare.

Fibrolipomatous hamartoma of the median nerve in the elbow: a case report.

A fibrolipomatous hamartoma-also known as a fibrofatty overgrowth, perineural lipoma, intraneural lipoma, and lipomatous hamartoma-is a rare, benign, congenital lesion most commonly found in the median nerve, usually at the level of the wrist or hand. To our knowledge, no published cases report a hamartoma arising from the median nerve at the level of the elbow. We report a case of a fibrolipomatous hamartoma in a 55-year-old woman that necessitated a surgical intervention because of its size and associated neurologic symptoms.

Comparison of nasendoscopic-assisted cautery versus packing for the treatment of epistaxis.

INTRODUCTION: Epistaxis is one of the commonest ear, nose and throat presentations. We present a study of our unit's management of epistaxis, comparing 48 h of nasal packing with nasendoscopic-guided cautery. METHODS: A search was performed for the diagnosis of epistaxis, according to the (International Statistic Classification of Diseases and Related Health Problems, 10th Revision, Australia Modification) diagnosis code R04.0. Admissions from January 2007 to December 2007 were included. Patients in the first 6 months were treated with 48 h of nasal packing, that is, conventional treatment (CT). In the second half of the year, nasendoscopic cautery (NC) was performed. A retrospective chart review was then performed. RESULTS: Thirty-three patients were included in the analysis with 15 (45.5%) males and 18 (54.5%) females. The median age was 77.5 years (range 21-87). The majority (50%, n= 16) of the epistaxis was idiopathic with an anterior bleed. A quarter (n= 8) were treated with NC and the rest had the CT. The average length of stay in the CT group was 1.55 days and 0.84 days in the NC group (P-value 0.049). There were no complications in the NC group compared with 44% in the CT group (P= 0.005). There was no re-presentation in the NC group. CONCLUSION: We have shown NC for epistaxis to be an effective treatment. In our study, it was associated with a significantly reduced hospital admission, complication rate and with no re-presentations.

Doctor-patient communication: a review.

Effective doctor-patient communication is a central clinical function in building a therapeutic doctor-patient relationship, which is the heart and art of medicine. This is important in the delivery of high-quality health care. Much patient dissatisfaction and many complaints are due to breakdown in the doctor-patient relationship. However, many doctors tend to overestimate their ability in communication. Over the years, much has been published in the literature on this important topic. We review the literature on doctor-patient communication.

Splenic artery aneurysm rupture in pregnancy.

Splenic artery aneurysm (SAA) is the commonest visceral artery aneurysm. It is diagnosed more frequently in younger women, with up to 95% presenting during pregnancy. Rupture is associated with a disproportionately high maternal and fetal mortality. We performed a literature search on the patient and SAA characteristics, clinical presentations, management and outcome of this serious complication. There were 32 patients in total with a mean age of 27.9 years (range 20-38). The mean SAA size was 2.25 cm (range 0.5-4 cm) and from the available data half of the ruptured SAA were 2 cm or less. Only one case (3.1%) was discovered incidentally, whilst the rest (96.9%) were found following rupture. The majority ruptured spontaneously. Most (62%) of the patients underwent SAA ligation and splenectomy. The maternal death rate was 21.9% (n=7), and fetal death rate was 15.6% (n=5). Most cases are not diagnosed until surgery following rupture. Ruptured SAA should be considered in the differential diagnosis of a pregnant patient with severe and unexplained abdominal pain.

Splenic injury in colonoscopy: a review.

INTRODUCTION: Splenic rupture secondary to colonoscopy was first reported in 1974 by Wherry and Zehner. It has an incidence of around 0.00005-0.017%, and a mortality rate of 5%. METHOD: We performed a literature search to identify the demographic profile, risk factors, clinical presentations, diagnosis and management of this rare complication. RESULTS: There were 66 patients (51 females and 14 males), with a median age of 65. The mortality rate was 4.5%. Majority (n=41, 62.1%) occurred in uneventful colonoscopies. Symptoms usually (74%) occurred within 24h, and 55.8% presented within 24h. Majority (93.9%) had some form of work-up done, with blood tests (78.8%) and CT (68.2%) being the most frequent. Laparotomy and splenectomy were done in over half (56.1%) of the patients. Splenic hematoma (47%), laceration (47%) and rupture (33.3%) were the most common findings. CONCLUSION: Splenic injury is an important complication to be aware of as its number will continue to rise with the increasing numbers of colonoscopies being performed for colorectal diseases, and delayed diagnosis may result in adverse outcome for the patient.

Laparoscopic splenic artery aneurysm resection: review of current trends in management.

Splenic artery aneurysm, although rare, is the commonest visceral aneurysm. Its management options have expanded with advances in minimally invasive techniques. In the last decade, the laparoscopic technique has gained popularity owing to its simplicity, safety, and short postoperative course in the experienced hand. We recommend the laparoscopic approach to be considered as the first option in the management of splenic artery aneurysm. It is of particular use in pregnant women where this condition has a high mortality and morbidity.

A modified bowel clamp technique for ischemic preconditioning.

We report an alternative method in the application of bowel clamp for ischemic preconditioning of pedicled flaps. The proposed method minimizes tissue damage and patient discomfort.