The New Zealand medical journal
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Emergency repair for ruptured aneurysm is associated with a high mortality rate. From our experience of treatment of ruptured abdominal aortic aneurysms (AAA), we evaluated the morbidity and mortality rates, and identified preoperative variables that may be predictive of mortality after emergency repair. ⋯ Selection of patients with ruptured AAAs for emergency repair can be a complex and emotionally charged process. Simple preoperative variables with predictive values have been identified, which may be used to complement the surgeon's own patient selection criteria for emergency repair.
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Trauma is a heterogeneous 'disease' that affects all age groups with varying degrees of severity. While injury severity, time to definitive care, and the quality of care in trauma patients have been quantified, it has been much more difficult to quantify pre-existing health status or 'host factors' in trauma patients and relate them to trauma outcome. Numerous studies have attempted this task, but none have succeeded in producing a simple system to quantify co-morbidities. As a prelude to developing a simple Abbreviated injury scale (AIS)-like score, the incidence of major and minor co-morbidities (and outcomes) in a cohort of admitted trauma patients > or =40 years of age were evaluated. ⋯ Co-morbidities were surprisingly common in trauma patients. Trauma outcome in patients with co-morbidities is difficult to predict and is not well addressed by any of the existing injury scales. The possibility of developing single 'AIS-like' co-morbidity score merits ongoing evaluation. The prevalence of co-morbidities in trauma patients > or =40 years of age suggests that the influence of co-morbidity on outcome should be considered in a much greater cohort than is currently the case.
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Conservative management of isolated blunt splenic injuries has become widely accepted for haemodynamically stable patients, but may be untenable in those with multiple injuries. A retrospective review was performed to evaluate of our cumulative experience with non-operative management of splenic injuries, and to identify the risk factors for operative management. ⋯ Appropriate patient selection is the most important element of non-operative management. Patients with splenic injuries who are haemodynamically stable can be managed non-operatively with acceptable outcome. However, in the presence of concomitant trauma, there is an increasing trend towards operative management.
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To review the Auckland Hospital Outpatient Parenteral Antimicrobial Therapy (OPAT) Service. ⋯ We have found that parenteral antibiotic therapy can be administered safely and successfully in an outpatient setting despite relatively frequent dosing intervals. The majority of complications were minor, and 88% of patients were cured.
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To investigate details of patient complaints to the Health and Disability Commissioner about surgeons-to identify factors in the patient-surgeon interaction that might make a complaint more likely, and to consider ways of improving the complaints environment. ⋯ Complaints against surgeons are common. The 'highest-risk surgeon' is a subspeciality general surgeon in private practice. The most likely people to complain are middle-class, white females aged 35-70 years. It would appear likely that the present system does not resolve issues for the patient or the surgeon. Radical changes are needed, and are beginning to occur, in the complaints environment. Especially needed is acceptance and disclosure of harm and error (away from a culture of blame and discipline). Therefore, if medical practitioners are to move with confidence into this more open environment, a more supportive political/media/organisational culture is needed, with a focus on valuing disclosure and learning from mistakes.