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1.
Am J Cardiol ; 124(7): 1085-1090, 2019 10 01.
Article in English | MEDLINE | ID: mdl-31353006

ABSTRACT

Limited data exist regarding transcatheter aortic valve implantation (TAVI) in nonagenarians. This study evaluates the short- and mid-term outcomes of nonagenarians after TAVI. Between 2008 and 2017, all patients who underwent TAVI in 2 centers in Australia were prospectively included in a registry and followed-up for 5 years. Outcomes were based on VARC-2 criteria. Additionally, the patient's reliance on daily living support at 1 year was evaluated. Of the 588 patients, 71 (12.1%) were ≥90 years old (mean age 92.2 ± 2 vs 83.2 ± 6 years in <90-year-old patients), with a median STS-PROM score of 5.7 (vs 3.9 in <90-year-old patients, odds ratio [OR] 1.07, 95% confidence interval 1.01 to 1.13, p = 0.02) and a median clinical frailty score of 4 (vs 4 <90-year-old patients, OR 0.88, p = 0.44). Mortality was 0% in ≥90-year-old patients at 30 days (vs 1.4% in <90-year-old patients; p = 0.82) and 12% at 1 year (vs 7.4%, in <90-year-old patients; hazard ratio 1.64, p = 0.20). There were no significant differences in periprocedural complications and mortality at 5 years between the 2 groups. At 1 year, nonagenarians were significantly more likely to live in an aged-care facility compared with <90-year-old patients (25% vs 16%, OR 5.99, 95% confidence interval 2.62 to 13.67, p <0.001). In conclusion, carefully selected nonagenarians have excellent short- and mid-term outcomes post-TAVI and should therefore not be refused based on age alone. Nevertheless, the significantly higher rate of transfer to an aged-care facility highlights the importance of a more refined frailty assessment before TAVI than the currently widely used clinical frailty score.


Subject(s)
Aortic Valve Stenosis/mortality , Aortic Valve Stenosis/surgery , Postoperative Complications/epidemiology , Transcatheter Aortic Valve Replacement/adverse effects , Age Factors , Aged , Aged, 80 and over , Aortic Valve Stenosis/complications , Australia , Cohort Studies , Female , Hospital Mortality , Humans , Male , Patient Selection , Survival Rate , Transcatheter Aortic Valve Replacement/instrumentation , Treatment Outcome
2.
Emerg Med Australas ; 29(3): 330-335, 2017 Jun.
Article in English | MEDLINE | ID: mdl-28393486

ABSTRACT

OBJECTIVE: The objective of the study was to identify any differences between emergency physicians and emergency trainees and paediatricians and paediatric trainees in performing paediatric lumbar punctures (LPs). METHODS: Anonymous cross-sectional electronic survey was distributed to emergency physicians, emergency trainees, paediatricians and paediatric trainees within three hospitals of a single public health network. There were four standardised clinical scenarios (neonate, infant, young child and adolescent), with accompanying questions relating to neurological evaluation and imaging prior to LP, the use of written consent forms and parental presence during the procedure. RESULTS: Paediatricians and paediatric trainees have greater confidence performing LP on neonates and infants, while emergency physicians and emergency trainees are more confident in older children. The only differences in self-reported neurological examination prior to LP was paediatricians and paediatric trainees being more likely to perform fundoscopy than were emergency physicians and emergency trainees in infants (21% vs 8%, P = 0.03) and young children (44% vs 16%, P < 0.001). Less than half of both groups of doctors would obtain written consent for paediatric LPs. Emergency physicians and emergency trainees were much more likely to encourage parents to remain in the room during the procedure than their paediatric counterparts (95% vs 37%, P < 0.0001). CONCLUSION: Paediatricians and paediatric trainees are more likely to be confident in performing LP in very young children than are emergency physicians and emergency trainees. They are more likely to perform fundoscopy prior to the procedure, but are much less likely to encourage parental presence during the LP.


Subject(s)
Emergency Medicine/standards , Pediatrics/standards , Physicians/psychology , Self Efficacy , Spinal Puncture/methods , Adolescent , Child, Preschool , Clinical Competence/standards , Clinical Competence/statistics & numerical data , Cross-Sectional Studies , Emergency Medicine/statistics & numerical data , Emergency Service, Hospital/organization & administration , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Infant , Infant, Newborn , Male , Pediatrics/statistics & numerical data , Spinal Puncture/standards , Spinal Puncture/statistics & numerical data , Surveys and Questionnaires , Victoria
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