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4.
Asia Pac J Clin Oncol ; 19(4): 559-565, 2023 Aug.
Article in English | MEDLINE | ID: mdl-36507563

ABSTRACT

AIM: To compare access to the initial management and overall survival with colorectal cancer for limited English proficient (LEP) patients compared with patients from an English background. METHODS: All newly diagnosed patients from 2017 with colorectal cancer from a single health service with a highly multicultural catchment area and a well-developed and integrated translation and language support (TALS) department were recruited. Time from referral to: biopsy, date seen by a surgeon, oncologist, discussion at a multidisciplinary meeting (MDM), and day of commencement of the first treatment modality, and overall survival were analyzed. RESULTS: One hundred sixty-two patients were analyzed, including 57 LEP patients from 22 countries of birth. Interpreters were present at 687/782 appointments with LEP patients. There were no differences in demographics or cancer staging. There were no differences between English background and LEP patients with regard to times from referral to biopsy (1 vs. 0 days), specialist review (surgical: 4 vs. 6 days, oncological: 45 vs. 57 days), MDM discussion (23 vs. 15 days), or commencement of treatment (32 vs. 28.5 days). There were no differences in treatment for colorectal cancer, although a higher rate of stomas was noted in LEP patients. There was no difference in overall survival between groups. CONCLUSION: Time to critical initial checkpoints and overall survival were similar in LEP and English background patients with colorectal cancer. An integrated TALS department may abrogate the language and cultural barriers that are known to disadvantage LEP patients and may contribute to normalizing care for the culturally and linguistically diverse community.


Subject(s)
Colorectal Neoplasms , Communication Barriers , Humans , Language , Cultural Diversity , Health Services Accessibility , Colorectal Neoplasms/therapy
5.
ANZ J Surg ; 92(10): 2571-2576, 2022 10.
Article in English | MEDLINE | ID: mdl-35642258

ABSTRACT

BACKGROUND: Repeat colonoscopy may be required for tumour localisation. The aim of the study is to explore the clinical settings it was used and benchmark the quality of initial colonoscopy against standardized guidelines for tumour localisation, tattooing and colonoscopy reporting amongst clinicians. METHODS: A retrospective study from 2016 to 2021 has been performed on patients who underwent elective colorectal cancer resections at the Northern Hospital. Patient demographics, colonoscopic and operative details were retrieved from the Bi-National Colorectal Cancer Audit (BCCA) Registry database and hospital medical records. PRIMARY OUTCOMES: changes in operative approach and delays to operation. SECONDARY OUTCOMES: reasons for a repeat colonoscopy and complications from repeat colonoscopy. RESULTS: A total of 339 patients were included in this study. 94 (28.6%) underwent a repeat colonoscopy. Re-scoping rate was 29.6% for surgeons, and 26.2% for non-operating endoscopists. Surgeons had a 5.9% localisation error rate, and non-operating endoscopist 6.95% (p = 0.673). Surgeons did not have a lower rate of repeat colonoscopy (p = 0.462). Repeat endoscopy was associated with a longer time to definitive operation (p < 0.001). No complications were associated with a repeat colonoscopy. CONCLUSION: There was no difference in localisation error rates or repeat colonoscopy amongst surgeons (29.6%) and non-operating endoscopists (26.2%) (p = 0.462). This could be explained by the standardized endoscopy training in Australia governed by a common training board. Lack of tattooing at index colonoscopy and inadequate documentation often led to a repeat endoscopy, which was associated with a longer time to definitive operation. Standardized guidelines in tattooing of lesions and colonoscopy reporting should be implemented.


Subject(s)
Colorectal Neoplasms , Tattooing , Colonoscopy , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/pathology , Colorectal Neoplasms/surgery , Endoscopy, Gastrointestinal , Humans , Retrospective Studies
6.
BMJ Case Rep ; 14(2)2021 Feb 08.
Article in English | MEDLINE | ID: mdl-33558386

ABSTRACT

A 45-year-old man had recurrent presentations with pleuritic chest pain and shortness of breath. Four months prior, he had developed cauda equina syndrome from a spinal epidural abscess in the setting of intravenous drug use, complicated by lasting neurological deficits and a rectal prolapse. On his final presentation, blood cultures taken in the absence of antibiotics grew Enterococcus faecalis from multiple sets. A transoesophageal echocardiogram confirmed tricuspid valve endocarditis. He recovered well post-targeted long-term antibiotics. Endoscopy confirmed a chronic rectal prolapse with multiple ulcers and was hypothesised as the source of bacteraemia. He subsequently underwent perineal rectosigmoidectomy. This uncommon sequela of rectal prolapse highlights several issues, including the management of neurogenic bowel dysfunction following spinal cord injury and the importance of early prolapse recognition and management. Finally, appropriate collection of blood cultures and correct use of echocardiography are critical steps in investigating infective endocarditis.


Subject(s)
Endocarditis, Bacterial/diagnosis , Enterococcus faecalis , Epidural Abscess/complications , Epidural Abscess/microbiology , Gram-Positive Bacterial Infections/diagnosis , Rectal Prolapse/complications , Rectal Prolapse/microbiology , Anti-Bacterial Agents/therapeutic use , Bacteremia/diagnosis , Bacteremia/drug therapy , Cauda Equina Syndrome/etiology , Chronic Disease , Colonoscopy , Diagnosis, Differential , Echocardiography, Transesophageal , Endocarditis, Bacterial/drug therapy , Gram-Positive Bacterial Infections/drug therapy , Humans , Male , Middle Aged , Substance Abuse, Intravenous/complications
7.
J Surg Res ; 257: 22-31, 2021 01.
Article in English | MEDLINE | ID: mdl-32818781

ABSTRACT

BACKGROUND: Surgical site infection (SSI) and wound breakdown after emergency laparotomy are common. They incur significant patient morbidity and health care costs. Negative-pressure dressings (NPDs) applied over closed incisions may minimize wound complications. However, its utility in the emergency setting is unknown. Here, we examined whether prophylactic NPD reduces wound complications after emergency laparotomies. METHODS: This is a retrospective review of consecutive emergency laparotomies undertaken at a university hospital from January 2018 to October 2019. Outcomes included the rate of SSI, wound breakdown, hospital-outreach service utilization, wound-related readmissions, and length of stay. Propensity score matched analysis was used to assess bias. RESULTS: A total of 227 emergency laparotomies were reviewed, 70 received NPD and 157 had conventional dressings (controls). SSI was identified in 33 (21.0%) patients from the control group and six (8.6%) from the NPD group (odds ratio 0.35, 95% confidence interval: 0.15-0.85, P = 0.022). Wound breakdown was observed in 21 (13.4%) patients from the control group and three (4.3%) from the NPD group (odds ratio 0.29, 95% confidence interval: 0.09-0.91, P = 0.040). The prophylactic benefit of NPD was most evident in clean-contaminated, contaminated, and dirty wounds. The NPD group had comparatively shorter postoperative stay, less outreach service utilization, and lower rates of wound-related readmissions. Multivariate analysis demonstrated that increasing age, body weight >75 kg, and wound contamination are independent predictors of wound complications, whereas NPD prevented SSI and wound breakdown. CONCLUSIONS: Prophylactic NPD significantly reduced wound complications after emergency laparotomy. This was associated with a substantial health resource saving. This study provides a strong rationale for randomized trials in this area.


Subject(s)
Bandages , Emergency Treatment/methods , Laparotomy/methods , Negative-Pressure Wound Therapy/methods , Surgical Wound Infection/prevention & control , Adult , Aged , Aged, 80 and over , Female , Humans , Length of Stay , Male , Middle Aged , Retrospective Studies , Risk Factors , Surgical Wound , Surgical Wound Infection/epidemiology , Wound Healing
9.
Obstet Gynecol Int ; 2020: 2185290, 2020.
Article in English | MEDLINE | ID: mdl-32547618

ABSTRACT

Midgut volvulus in pregnancy is rare but life-threatening, resulting in high maternal and fetal mortality. This surgical emergency commonly masquerades as symptoms of pregnancy, which together with its low incidence often leads to delay in diagnosis and definitive treatment. Here, we review the last three decades of the literature, discuss the challenges in managing this rare condition, and raise awareness among clinicians to minimise loss of life.

10.
BMJ Case Rep ; 13(5)2020 May 14.
Article in English | MEDLINE | ID: mdl-32414778

ABSTRACT

Midgut volvulus complicating congenital malrotation is a rare but life-threatening condition that can occur in pregnancy. We present a case of intestinal infarction resulting from midgut volvulus in a healthy 32-week pregnant woman who underwent emergency laparotomy and small bowel resection in the setting of fetal death in utero. This case highlights several challenging issues in diagnosing and managing this uncommon condition which leads to increased adverse perinatal outcomes. Prompt investigation and definitive surgical treatment are required when pregnant women present with bilious vomiting and new-onset abdominal or back pain especially beyond the first trimester.


Subject(s)
Digestive System Abnormalities/surgery , Intestinal Volvulus/surgery , Pregnancy Complications/surgery , Adult , Diagnosis, Differential , Female , Fetal Death , Humans , Pregnancy
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