Systematic Review and Meta: Analysis of Aortic Graft Infections following Abdominal Aortic Aneurysm Repair.

Introduction. Aortic graft infection (AGI) is a rare complication following AAA repair and is associated with high morbidity and mortality. Management is variable, and there are no evidence-based guidelines. The aim of this study was to systematically review and analyse management options for AGI. METHODS: Data was collected between July and August 2018. A full HDAS search was conducted on the following databases: MEDLINE, EMBASE, CINAHL, and PUBMED. Meta-analysis was conducted using RevMan 5 software. RESULTS: 1,365 patient outcomes were assessed (10 cohort studies and 12 comparative studies). The most common treatment was in situ replacement of the graft (ISR) followed by extra-anatomical replacement (EAR). Various grafts were used for ISR, such as fresh/cryopreserved allograft, venous graft, and prosthetic grafts. No graft material was shown to be superior. Axillobifemoral graft was the commonest type of EAR used. In the majority of cohort studies, ISR was the main treatment for AGI. There was no significant difference in the overall mortality rate (ISR n = 70/176 vs. EAR n = 70/176 vs. EAR P = 0.87). Graft occlusion rate was significantly lower in the ISR group vs. the EAR group (n = 70/176 vs. EAR n = 70/176 vs. EAR P = 0.87). Graft occlusion rate was significantly lower in the ISR group vs. the EAR group (n = 70/176 vs. EAR n = 70/176 vs. EAR P = 0.87). Graft occlusion rate was significantly lower in the ISR group vs. the EAR group (Discussion. In situ replacement is the preferred method of treatment as it had lower rates of occlusion. Further strong evidence is required, such as a multicentre trial to establish a management pathway for the condition.

Thirty-five months experience of risperidone long-acting injection in a UK psychiatric service including a mirror-image analysis of in-patient care.

OBJECTIVE: To report the use of risperidone long-acting injection (RLAI) in a UK psychiatric service. METHOD: Retrospective case note review of all patients prescribed RLAI over a 35-month period. In the mirror-image analysis patients initiated on RLAI as in-patients had the index admission attributed to previous treatment. RESULTS: Patients prescribed RLAI had significantly higher baseline rates of drug misuse, alcohol misuse, unemployment and forensic markers than control patients prescribed oral antipsychotics. Most patients started RLAI because of poor compliance with oral antipsychotics. Inefficacy accounted for more discontinuations than intolerability. Fifty-eight percent (39/67) of patients were continuing RLAI 12 months after initiation. Mirror-image analysis (n = 74) showed that RLAI was associated with a reduction in the number of admissions (65 vs. 33, P < 0.005) and in total in-patient days (4550 vs. 2188 days, P < 0.005). The mean reduction in in-patient care was 29 days per patient-year of treatment, equivalent to a net financial saving over the acquisition and administration costs of RLAI of pound1172. CONCLUSION: Risperidone long-acting injection was associated with reduced in-patient care and was cost-effective.