ABSTRACT
BACKGROUND: Hashimoto's thyroiditis (HT) is rarely on its own the indication for thyroidectomy. However, surgery in patients with HT will be undertaken when there is malignancy and may be required for pressure symptoms. Therefore, this study aimed to investigate the indications for surgery in HT patients. METHODS: The Monash University Endocrine Surgery Database was analysed from 1994 to 2013 for patients with HT. Patients with HT were compared to a similar group of patients with no HT on histopathology. Patient demographics, indication for surgery, histopathology, gland weight and complications were analysed. RESULTS: A total of 2346 patients underwent total thyroidectomy during the study period. The median age was 55 years. Eleven percent of patients had HT on final pathology (259/2346). HT patients reported more pressure symptoms, 25.5% compared to those with other pathology, 18.9% (P = 0.01). Patients with pressure symptoms had heavier glands, 113 g compared to 85 g in those with other indications for surgery (P = 0.048). Within the HT cohort, the median gland weight was 66 g compared to 93 g in those without HT (P < 0.01). On multivariate analysis, pressure symptoms as an indication for surgery was associated with HT (P < 0.01), but age, gender and gland weight were not associated. In patients operated for pressure with HT as the only pathology, 90% had relief of pressure symptoms. CONCLUSION: Patients with HT were more likely to have pressure symptoms as an indication for surgery independent of gland weights.
Subject(s)
Hashimoto Disease/physiopathology , Hashimoto Disease/surgery , Thyroidectomy/methods , Adult , Aged , Female , Humans , Male , Middle Aged , Pressure , Treatment OutcomeABSTRACT
OBJECTIVE: The present study aims to determine parental and guardian's perceptions of paediatric emergency care and satisfaction with care, waiting times and triage category in a community ED. METHODS: A structured questionnaire was provided to parents or guardians of paediatric patients presenting to emergency. The survey evaluated parent perceptions of waiting time, environment/facilities, professionalism and communication skills of staff and overall satisfaction of care. RESULTS: One hundred and thirty-three completed questionnaires were received from parents of paediatric patients. Responses were overall positive with respect to the multiple domains assessed. Parents generally considered waiting times to be appropriate and consistent with triage categories. Overall satisfaction was not significantly different for varying treatment or waiting times. Patients triaged as semi-urgent were of the opinion that waiting times were less appropriate than urgent, less-urgent or non-urgent patients. CONCLUSION: On the basis of the present study, patient perceptions and overall satisfaction of care does not appear to be primarily influenced by time spent waiting or receiving treatment. Attempts made at the triage process to ensure that semi-urgent patients have reasonable expectations of waiting times might provide an opportunity to improve these patients' expectations and perceptions.
Subject(s)
Child Health Services/standards , Emergency Service, Hospital/standards , Parents , Pediatrics , Personal Satisfaction , Triage/standards , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , Patient Satisfaction , Surveys and Questionnaires , Victoria , Waiting Lists , Young AdultABSTRACT
INTRODUCTION: Infection is a major cause of morbidity and mortality following burn. Early debridement and wound closure minimize the risk of infection. This study aimed to examine the association of surgical modalities with burn wound infection (BWI) rate, graft loss and length of stay (LOS) outcome. METHOD: This study is a retrospective analysis of all patients undergoing surgical intervention at the Royal Perth Hospital between 2004 and 2011. Multivariable regression analyses were used to predict the impact of burn and patient factors on the outcomes. RESULTS: Seven hundred seventy patients were eligible for inclusion with 74.8% males and a mean total body surface area (TBSA) burnt of 7.9% (range 1.0-75). Sixty-seven patients (8.7%) had positive post-operative swabs indicating potential wound infection. Age and TBSA significantly increased the risk of BWI (confirmed by quantitative swab). Positive microbiology was not associated with surgery type. Age, TBSA, diabetes and surgical modalities had significant influence on LOS in hospital. Only TBSA was an independent predictor of graft loss. CONCLUSION: Age, TBSA and diabetes were associated with poorer outcomes after burn. Surgery type was not associated independently with the risk of infection.
