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Objectives: Preoperative anaemia is common in patients with colorectal cancer and increasingly optimised prior to surgery. Comparably little attention is given to the prevalence and consequences of postoperative anaemia. We aimed to investigate the frequency and short- or long-term impact of anaemia at discharge following colorectal cancer resection. Methods: A dedicated, prospectively populated database of elective laparoscopic colorectal cancer procedures undertaken with curative intent within a fully implemented ERAS protocol was utilised. The primary endpoint was anaemia at time of discharge (haemoglobin (Hb) < 120 g/L for women and < 135 g/L for men). Patient demographics, tumour characteristics, operative details and postoperative outcomes were captured. Median follow-up was 61 months with overall survival calculated with the Kaplan-Meier log rank method and Cox proportional hazard regression based on anaemia at time of hospital discharge. Results: A total of 532 patients with median 61-month follow-up were included. 46.4% were anaemic preoperatively (cohort mean Hb 129.4 g/L ± 18.7). Median surgical blood loss was 100 mL (IQR 0–200 mL). Upon discharge, most patients were anaemic (76.6%, Hb 116.3 g/L ± 14, mean 19 g/L ± 11 below lower limit of normal, p < 0.001). 16.7% experienced postoperative complications which were associated with lower discharge Hb (112 g/L ± 12 vs. 117 g/L ± 14, p = 0.001). Patients discharged anaemic had longer hospital stays (7 [5–11] vs. 6 [5–8], p = 0.037). Anaemia at discharge was independently associated with reduced overall survival (82% vs. 70%, p = 0.018; HR 1.6 (95% CI 1.04–2.5), p = 0.034). Conclusion: Anaemia at time of discharge following elective laparoscopic colorectal cancer surgery and ERAS care is common with associated negative impacts upon short-term clinical outcomes and long-term overall survival. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic techniques in colorectal surgery have been widely utilised due to short-term patient benefits but conversion to open surgery is associated with adverse short- and long-term patient outcomes. The aim of this study was to investigate the influence of dual specialist operating on the conversion rate and patient outcomes following laparoscopic colorectal surgery.Methods: A prospectively populated colorectal cancer surgery database was reviewed. Cases were grouped into single or dual consultant procedures. Cluster analysis and odds ratio (OR) were used to identify risk factors for conversion. Primary outcome measures were conversion to open and five year overall survival (OS) calculated using the Kaplan-Meier log-rank method.Results: 750 patients underwent laparoscopic colorectal cancer resection between 2002 and 2015 (median age 73, 319 (42.5%) female, 282 (37.6%) rectal malignancies, 135 patients (18%) had two consultants). The single surgeon conversion rate was 20.4% compared to 5.5% for dual operating (OR 4.4, 95% CI 1.87-10.2, p < 0.001). There were no demographic or tumour differences between the laparoscopic/converted and number of surgeon groups. Two-step cluster analysis identified cluster I (lower risk) 406 patients, 8% converted and cluster II (higher risk) 261 patients, conversion rate 30%. Median follow-up was 48 months (range 0-168). Five-year OS was significantly inferior for both converted and single surgeon cases (63% vs. 77%, p < 0.001 and 61% vs. 70%, p = 0.033, respectively).Conclusion: In selected colorectal cancer patients operated by fully trained laparoscopic surgeons, we observed a reduction in conversion with associated long-term survival benefit from dual operating specialists. [ABSTRACT FROM AUTHOR]

Purpose: In adult animals, ventilation with variable tidal volume and rate improves lung mechanics, arterial oxygenation and ventilation compared to a monotonously controlled ventilation pattern. We assessed the physiological consequences of variable ventilation in the immature lung. Methods: Lambs delivered at 129 days (term = 150 days) were euthanised ( n = 9) or anaesthetised, tracheostomised and suctioned prior to prophylactic intra-tracheal surfactant instillation (Curosurf, 100 mg/kg) and commencement of controlled ventilation (50 breaths/min, tidal volume 7.7 ± 0.8 mL/kg). Volume history was standardised at 20 min with two sustained (3 s) inflations to 30 cmHO followed immediately by measurement of baseline dynamic lung mechanics (FlexiVent™, Scireq, Canada). Ventilation was continued according to prior randomisation (variable or conventional ventilation). For variable ventilation ( n = 9), breath-to-breath tidal volume and respiratory rate varied but intra-breath minute volume (MV) and average tidal volume were equivalent to the conventional ventilation group with fixed tidal volume and rate ( n = 7). Lung mechanics and gas exchange were measured at intervals. Lambs were euthanised at 2 h. Inflammatory cell counts and protein from bronchoalveolar lavage fluid and lung tissue cytokine mRNA were quantified. Results: At study completion, PaCO ( p = 0.026) and mean airway pressure ( p = 0.002) were lower and pH ( p = 0.047), ventilation efficiency index ( p = 0.021) and dynamic compliance were higher ( p = 0.003) in lambs on variable rather than conventional ventilation. However, oxygenation indices and post-mortem static compliances were not different between groups. Conclusion: Variable ventilation improves ventilation efficiency and in vivo lung compliance in the preterm lung, but unlike adult models, had no effect on arterial oxygenation. [ABSTRACT FROM AUTHOR]

This study examined sociodemographic and clinical characteristics of treatment completers ( N = 114) and non-completers ( N = 136) at a child and adolescent community mental health clinic. Results indicated that children who completed treatment significantly differ from those who prematurely drop out of treatment. Non-completers presented with considerably more impairment in functioning and psychiatric symptoms, and their caregiver reported experiencing significantly more parenting stress and depressive symptoms. Results suggest that mental health treatment is not readily provided to the most difficult to reach and most at-risk youth and their families. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine if specificity exists between three factors of parenting stress (i.e., parental distress, parent–child (PC) dysfunctional interactions, and difficult child) and childhood internalizing and externalizing symptoms. The incremental validity of parenting stress beyond parental psychopathology was also examined. The sample was drawn from families of children aged 5–17 ( N = 300), who sought treatment for their child from a community mental health clinic. Results indicated that the PC dysfunctional interactions factor showed specificity to internalizing symptoms when controlling for parental psychopathology. Parental distress did not show specificity or incremental validity and the difficult child factor was associated with both internalizing and externalizing symptoms when controlling for parental psychopathology. The influence of age, gender, and ethnicity on these associations is also presented, and findings are discussed in terms of how the results add to understanding the specific relations between parenting stress and child and adolescent symptoms. [ABSTRACT FROM AUTHOR]

To assess the effectiveness of a community mental health center outpatient adolescent treatment program, outcome measures were completed by the parents of 50 consecutively admitted adolescent patients who were evaluated and treated with one of three therapy modalities. Their results were compared to outcome measures of 29 non-treated adolescent control subjects. Also, self-report outcome measures were completed by 30 treatment subjects. The results demonstrated a significant positive change in the study group following treatment as compared with the control group. Each of the treatment modalities used with the study group was associated with improvement. The staffing referral mechanism used to determine the particular treatment modality for each patient was shown to be consistently and appropriately implemented. [ABSTRACT FROM AUTHOR]

Examines the effectiveness of mental health center treatments for mentally-ill children. Use of the Child Behavior Checklist (CBCL); Improvement in problem behaviors of children; Effectiveness of the program for seriously disturbed patients; Observation of a positive behavior change among psychotherapy-only subjects.

Focuses on the genetics consultation on psychiatrically hospitalized school-age children. Biochemical disorders as the common class of genetic disease contributing to psychiatric problems; Review case reports which underscore the impact that chromosomal disarrangements has on psychiatric inpatients.