ANZ journal of surgery
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ANZ journal of surgery · Sep 2020
Time to surgery and transfer-associated mortality for hip fractures in Western Australia.
Transfer time for patients with fractured hips is a significant problem in Australia. Current guidelines support operative management of hip fractures within 48 h with delays to surgery resulting in worse outcomes. The aim of study is to evaluate transfer times and delays and their effect on outcomes. ⋯ Increased time to surgery was associated with increased mortality rates. Transfer delays from a peripheral hospital had a significant bearing on time to surgery. Transfer, regardless of time to surgery, is associated with increased mortality. Early transfer to a referral hospital or bypass of the peripheral hospital is recommended.
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ANZ journal of surgery · Sep 2020
ReviewColorectal peritoneal metastases: pathogenesis, diagnosis and treatment options - an evidence-based update.
Peritoneal metastases confer the worst survival among all sites in patients with metastatic colorectal cancer. They develop largely through transcoelomic spread, with a sequence of events that allow cells to first detach from primary tumours, survive in the peritoneal environment, attach to the peritoneal surface of organs and migrate into the submesothelial space to create a microenvironment conducive to metastatic growth. Diagnostic challenges have previously hindered early identification of peritoneal metastases. ⋯ While peritoneal recurrence can be reliably predicted from high-risk features in primary tumours such as a perforated cancer, ovarian metastases or T4a cancers, the use of prophylactic second look surgery with HIPEC or adjuvant HIPEC failed to demonstrate any survival benefit in high-risk cases in recent clinical trials, raising further questions about the efficacy of HIPEC. With high failure rates from systemic chemotherapy in unresectable disease, novel surgical techniques such as pressurized intraperitoneal aerolized chemotherapy are being investigated in clinical trials worldwide. Further collaborative research is needed to explore newer avenues of treatment for this poor prognostic cohort.
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ANZ journal of surgery · Jun 2020
Basic study on improvement of plastic drape adhesion for surgery: effect of adhesive layer thickness on drape detachment from wound edge.
Plastic drapes are used in surgery for a wide range of purposes, but currently marketed drapes often become detached from the wound edge during surgery. The purpose of this study was to determine the appropriate adhesive layer thickness for optimal peel and shear strength and the smallest peeled area to improve surgical drape wound adhesion. ⋯ It is possible to control the peeling of plastic drapes during surgery by limiting the peeled area at the time of cutting. Three-hundred micrometres is the suitable adhesive layer thickness to minimize the peeled area at cutting.
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ANZ journal of surgery · Jun 2020
Evaluation of communication to general practitioners when opioid-naïve post-surgical patients are discharged from hospital on opioids.
To address the opioid crisis, much work has focused on minimizing opioid supply to surgical patients upon hospital discharge. Research is limited regarding handover to primary care providers. The aim of this study was to evaluate the communication of post-operative opioid prescribing information provided by hospitals to general practitioners (GPs). ⋯ When opioid-naive patients are discharged from hospital on opioids, communication from hospitals to GPs is poor. Future interventions should focus on strategies to improve this.