Treatment and outcomes for indigenous and non-indigenous lung cancer patients in the Top End of the Northern Territory.

BACKGROUND: Lung cancer is the most common cause of cancer-related mortality for both Indigenous and non-Indigenous Australians, and the death rate of lung cancer in Indigenous Australians is increasing. AIMS: To provide a comprehensive description of patterns of lung cancer presentation, diagnosis, treatment and outcomes in Indigenous and non-Indigenous Australians in the Top End of the Northern Territory. METHODS: Retrospective cohort study of adult patients with a new diagnosis of lung cancer in the Top End between January 2010 and December 2014. Unadjusted survival probabilities by indigenous status were calculated. The primary end-point was all-cause mortality. RESULTS: Despite receiving similar diagnostic procedures and treatment, Indigenous Australians with lung cancer have poorer 1- and 5-year survival (25.0% and 9.4% respectively), when compared to non-Indigenous Australians included in the study (42.0% and 16.2% respectively). Indigenous lung cancer patients were more likely to be female (51.6% of indigenous patients were female, compared to 30.5% non-indigenous), be current smokers (61.3% vs 36.9%), have more comorbidities (73.6% vs 52.7%, 24.2% vs 5.3% and 30.8% vs 14.2% for respiratory disease, renal insufficiency and diabetes mellitus respectively), and live in more socio-economically disadvantaged (66.7% vs 14.2%) and very remote areas (66.1% vs 6.8%). They were also more likely to die at home, compared to their non-indigenous counterparts (64.3% vs 26.7%). CONCLUSIONS: Indigenous patients from the Top End diagnosed with lung cancer were more likely to have poorer survival outcomes when compared to non-indigenous people. Potential reasons for the discrepancy in survival need to be addressed urgently.

Acute kidney injury requiring dialysis and in-hospital mortality in patients with chronic kidney disease and non-ST-segment elevation acute coronary syndrome undergoing early vs delayed percutaneous coronary intervention: A nationwide analysis.

BACKGROUND: Chronic kidney disease (CKD) is a well-known risk factor for coronary artery disease and is associated with poor outcomes following an acute coronary syndrome (NSTE-ACS). The optimal timing of an invasive strategy in patients with CKD and NSTE-ACS is unclear. HYPOTHESIS: Timing of PCI in CKD patients will not affect the risk of mortality or incidence of dialysis. METHODS: We queried the National Inpatient Sample database (NIS) to identify cases with NSTEMI and CKD. Patients who underwent percutaneous coronary intervention (PCI) day 0 or 1 vs day 2 or 3 after admission were categorized as early vs delayed PCI, respectively. The primary outcomes of the study were in-hospital mortality and acute kidney injury requiring hemodialysis (AKI-D). The secondary outcomes were length of stay and hospital charges. Baseline characteristics were balanced using propensity score matching (PSM). RESULTS: After PSM, 3708 cases from the delayed PCI group were matched with 3708 cases from the early PCI group. The standardized mean differences between the 2 groups were substantially reduced after PSM. All other recorded variables were balanced between the 2 groups. In the early and delayed PCI groups, the incidence of AKI-D (2.5% vs 2.3%; P = 0.54) and in-hospital mortality (1.9% vs 1.4%; P = 0.12) was similar. Hospital charges and length of stay were higher in the delayed PCI group. CONCLUSIONS: The incidence of AKI-D and in-hospital mortality among patients with CKD and NSTE-ACS were not significantly affected by the timing of PCI. However, delayed PCI added significant cost and length of stay. A prospective randomized study is required to validate this concept.

Right Ventricular and Chest Wall Perforation with Implantable Cardioverter-Defibrillator Lead with Lodgment into the Cutaneous Tissue of the Chest Wall.

Implantable cardioverter-defibrillator (ICD) lead perforation is a rare but serious complication of cardiac device implantation. Subacute (24 h to one month) and delayed (>1 month) presentations of rupture are also rare. Here we report a case of right ventricular perforation by a ventricular ICD lead in a 61-year-old man that was detected four months' postimplantation. The lead was present out from his chest wall and was palpable beneath the skin.

International cooperation and support in environmental remediation - is there any room for improvement?

The challenges faced by states seeking to implement Environmental Remediation works are many. To this end, the International Atomic Energy Agency attempts to provide assistance and guidance to Member States wherever possible. This review article provides a brief overview of these challenges and highlights the international sources of financial and implementation support discussed at an international conference on the topic in Astana, Kazakhstan in 2009. The conference concluded the importance of institutional structures as a pre-requisite for remediation work, recognized privatization as a useful but limited financing tool for remediation and illustrated the need for better coordination between international funding organizations to reduce overlap and optimization of resources to secure the best outcomes.