Colonoscopy quality of GP endoscopists in three rural hospitals in Queensland, Australia.

BACKGROUND AND OBJECTIVES: Rural general practitioners (GPs) are responsible for delivering primary and secondary care to rural populations in Australia. There is limited literature investigating the performance of GP endoscopists. The aim of this study was to investigate the colonoscopy performance of three GP endoscopists in rural Queensland against current Australian quality indicator (QI) standards. METHOD: A cross sectional study investigated eligible colonoscopies between January 2018 and February 2021 by three GP endoscopists in three rural hospitals in Queensland, Australia. RESULTS: A total of 1674 colonoscopies were investigated. The GP endoscopists demonstrated high QI performance, above the recommended benchmarks. Caecal intubation rate, adenoma detection rate, sessile serrated adenoma/polyp detection rate and clinically significant serrated polyp detection rate were 97.9%, 49.5%, 16% and 14.1% respectively. The major colonoscopy-related complications rate was 0.06%. DISCUSSION: Rural GP endoscopists potentially can deliver safe, high-quality colonoscopy services for rural communities and can have an integral part in facilitating colorectal cancer prevention and treatment in rural communities.

Venous thromboembolism associated with lower limb fractures after trauma: dilemma and management.

BACKGROUND: Trauma patients have the highest risk of developing venous thromboembolism (VTE) among hospitalised patients, with a reported 13-fold greater risk of developing VTE over non-trauma patients. This study examines the incidence of VTE and associated complications in trauma patients with lower limb fractures or injuries. METHODS: We retrospectively analysed 6,227 trauma patients and classified them according to injury severity score (ISS). The minor trauma group (ISS ≤15) contained 5,637 patients and the major trauma group (ISS >15) contained 590 patients. RESULTS: In the minor trauma group, VTE incidence was 1.17 %: 0.67 % were diagnosed with deep vein thrombosis (DVT) and 0.5 % with pulmonary embolism (PE). The readmission rate in the following 3-month period was 11 %, of which 2.8 % were subsequently rediagnosed with VTE. The 30-day mortality rate was 2.2 %. Seven patients died from PE following their initial admission and treatment, and another patient died from PE within three months after discharge. In the major trauma group, the VTE incidence was 6.8 %: 5.1 % with diagnosed with DVT and 1.7 % with PE. The readmission rate during the following three-month period was 6.6 %, of which 5 % were readmitted because of VTE and two cases were readmitted because of DVT. The overall 30-day mortality rate was 9.7 %, but no patients were formally diagnosed with a fatal case of PE. CONCLUSION: This study found that major trauma patients have an approximate six-fold increased risk of developing VTE during admission compared with minor trauma patients (relative risk: 5.79; 95 % confidence interval: 3.94-8.49). Our findings support the use of extended prophylaxis to treat minor trauma patients.

Hormones and gallbladder cancer in women.

Epidemiological evidence suggests that the incidence of gallstone disease and gallbladder cancer is higher in women. We analyzed the literature on estrogen and progesterone receptor expression in gallbladder cancer in women. A systematic search was done using Medline, Embase, and Cochrane Central Register of Controlled Trials for the years 1983-2009. The search terms used included 'gallbladder', 'gallstone', 'oestrogen/estrogen', 'progesterone', 'cancer', 'cholelithiasis', 'hormone,' and 'motility'. Hormone receptor expression in gallbladder cancer was analyzed in 11 studies of which immunohistochemistry was used in 10 and enzyme immunoassay in one study. Sample sizes varied 141. Estrogen and/or progesterone receptor expression was detectable in gallbladder cancer tissue samples in nine studies, whereas four studies failed to confirm these findings. The data on the association of hormone receptor expression to tumor differentiation is contradictory and needs further evaluation.