Is four years enough? An audit of post-hepatectomy surveillance for liver metastases.

BACKGROUND: Optimal timing and modality of surveillance post hepatectomy for colorectal cancer liver metastases (CLM) has not been established. Recommendations vary between countries and surgical units. Individual clinicians do not always adhere to guidelines. METHODS: Using a prospectively collected database of consecutive hepatectomy patients at The Queen Elizabeth Hospital in Adelaide, Australia, CLM patients were reviewed for evidence of recurrent disease (20 February 1996-30 June 2018). Timing and modality of disease detection was analysed. Follow up was until 30 June 2020 or death. RESULTS: 244 patients underwent hepatectomy for CLM during the study period. 139 patients (57%) experienced recurrence post initial hepatectomy (mean time 13.2 months; range 0.6-84.7). For all hepatic recurrences (n = 172), majority of disease was detected in the first seven months post hepatectomy (55%) and by four years, 97.7% of recurrent disease was detected. 51 patients underwent curative repeat hepatectomy after recurrence was detected. Nearly all disease was detected via surveillance CT (160/172; 93%); 12 patients presented with clinical symptoms. CONCLUSION: Hepatectomy patients are likely to experience recurrent disease and clinicians must ensure a robust surveillance plan is in place. We recommend a triple-phase CT at 6, 12, 18, 24, 36 and 48 months.

Effectiveness of operative versus expectant management on recovery of nerve palsies in pediatric supracondylar fractures: a systematic review protocol.

OBJECTIVE: The objective of this review is to evaluate the effectiveness of operative versus expectant management on recovery of nerve palsies after pediatric supracondylar fracture of the humerus or after surgery for supracondylar fracture of the humerus. INTRODUCTION: Supracondylar humerus fractures are the most common fracture of the elbow in children. These fractures have a high risk of complications from both the trauma itself and the treatment. Up to 12% of patients will have associated nerve injury, but there is insufficient information regarding the timing of investigation of and intervention in a persistent nerve palsy. This review aims to summarize the evidence and guide clinicians regarding the timing of investigation and/or surgical intervention for persistent nerve palsies after supracondylar humerus fractures in the pediatric population. INCLUSION CRITERIA: This review will include pediatric patients with ipsilateral upper limb nerve palsy after supracondylar fracture of the humerus or after surgery for a supracondylar fracture of the humerus without preexisting nerve palsies. METHODS: A comprehensive database search will be undertaken in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. The trial registers to be searched will include PROSPERO and AllTrials. The search strategy will include the keywords pediatric/paediatric, supracondylar, nerve injury/palsy/palsies, fracture, and humerus. Titles and abstracts will be screened by independent reviewers for suitability against the inclusion criteria, with accepted publications then being assessed in full with data extraction, synthesis, and assessment of methodological quality, using standardized critical appraisal tools from JBI. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019121581.

Influenza vaccination: Uptake and associations in a cross-sectional study of children with special risk medical conditions.

OBJECTIVE: To determine uptake of influenza vaccination in children with special risk medical conditions (SRMC) and to explore associations with vaccination. DESIGN: Cross-sectional study. SETTING/PARTICIPANTS: Parents of children with a SRMC attending either outpatient department clinics or being an inpatient at the Women's and Children's Hospital (WCH), Adelaide, Australia from September 2015 to February 2016 were recruited using convenience sampling. METHODS: Data were collected using a face-to-face survey. Influenza vaccination was verified with providers. Characteristics associated with uptake were explored using univariable and multivariable analyses. RESULTS: There were 410 participants with complete data. Confirmed influenza vaccination at least once in the last two years was 50%, annual uptake was 32.8%. 63.9% of parents were aware of the vaccination recommendation and 57.9% had been recommended by a specialist or general practitioner (GP). Characteristics strongly associated with uptake included: receiving a recommendation from a specialist or GP and having a parent receive the influenza vaccine annually. CONCLUSIONS: Despite a long standing funded program, influenza vaccination uptake in children with SRMC is suboptimal. Parental vaccination behaviour, along with medical practitioner recommendation, particularly specialist recommendation, appear to be key influences in facilitating vaccination. Potential interventions could target the family rather than just the individual child. Understanding the barriers to recommendation from the perspective of general medical practitioners and specialists who treat these children is needed.