Search

Background: Pharmacist surgical preadmission review is common in adult healthcare settings, however there is little evidence of this practice in the paediatric setting. This research describes a pilot surgical preadmission pharmacist service in a paediatric hospital. Aim: To evaluate the impact of a surgical preadmission pharmacist service on patient flow and the quality of medication management. Method: A retrospective review (2 months) was conducted to compare an intervention group (1 May 2019–30 June 2019) to historical baseline (1 October 2018–30 November 2018). Children and adolescents (aged 0–18 years) presenting for elective surgery and overnight admission were included. Relevant clinical data and timestamps were extracted from the electronic medical record. Multiple linear regression models were built to examine the difference in outcomes between the control and intervention groups. This project was exempt due to the local policy requirements that constitute research by the Queensland Children's Hospital Human Research Ethics Committee (Reference no: LNR/19/QCHQ/53406). The justification for this exemption was as follows: the study presented no foreseeable risk of patient harm as it involved evaluation of an established standard of clinical care and involved the use of existing collections of records that contain only non‐identifiable patient data. Results: In total, 135 patients were included in the baseline and 96 patients were included in the intervention group. The intervention group had statistically significant lower time to best possible medication history (BPMH) by 47.57 h (95% confidence interval [CI] −53.25 to −41.89, p < 0.001). Time to prescription of home medications was significantly reduced in the intervention group by 5.26 h (95% CI −10.45 to −0.08, p = 0.05). There was no difference in proportion of patients with home medications omitted (71–62%, p = 0.38) or requiring modification (14–12%, p = 0.58) between the two groups. Conclusion: Implementation of a surgical preadmission pharmacist service in our paediatric hospital demonstrated earlier BPMH documentation and prescription of home medications, without negative effects on perioperative patient flow. [ABSTRACT FROM AUTHOR]

Background: Acute limb ischaemia (ALI) is a limb and life‐threatening condition with significant morbidity. There are currently no consensus recommendations for the investigative practices to determine the aetiology of ALI presenting without a known aetiology. We undertook a detailed analysis of all investigations performed to identify an underlying precipitant in those with unexplained ALI and formulated a suggested diagnostic algorithm for the evaluation of unexplained ALI. Methods: ALI cases presenting to a tertiary referral centre over a 3‐year period were reviewed, and known aetiologies, and investigations undertaken to determine the underlying aetiology of unexplained ALI were obtained. Results: Unexplained ALI was found in 27 of 222 patients (12%), of which 21 (78%) had a cause for ALI established after further investigations. Six patients had no cause identified despite extensive work‐up. Most patients with unexplained ALI had a cardioembolic source identified as the underlying cause (62%), and this included atrial fibrillation, infective endocarditis, cardiac myxoma and intra‐cardiac thrombus. Other causes of unexplained ALI were detected by computed tomography (CT) imaging and included newly diagnosed significant atherosclerotic disease (19%), embolism from isolated proximal large vessel thrombus (10%) and metastatic malignancy (10%). There were no cases attributed to inherited thrombophilias, myeloproliferative neoplasms or anti‐phospholipid syndrome. Conclusion: Among patients with unexplained ALI, the majority had a cardioembolic source highlighting the importance of comprehensive cardiac investigations. A subset of patients had alternative causes identified on CT imaging. These data support the use of a collaborative and integrative diagnostic algorithm in the evaluation of unexplained ALI. [ABSTRACT FROM AUTHOR]

Limited evaluation research has been conducted on the effectiveness of mental health services and intervention provided to Indigenous children and young people (C&YP) in care. The primary objective of the study was to examine the difference in functioning and mental health outcomes of C&YP in care at a specialist mental health service for Indigenous and non-Indigenous C&YP. Of the total 259 C&YP included in this study, 38.2% (N = 99) were Indigenous. Two measures were used to examine C&YP's mental health and functioning. Indigenous consumers showed a significantly greater improvement in antisocial behaviour, emotional symptoms, and peer relationships compared to non-Indigenous consumers at discharge from the program. The findings of this study provide support for the program's therapeutic intent to be a culturally supportive tertiary level mental health service for vulnerable C&YP in care. IMPLICATIONS Equivalent outcomes for Indigenous and non-Indigenous consumers provide support for the program's intent to be a culturally supportive and safe tertiary level mental health service for vulnerable children and young people in care. Further research is needed to determine the key components of cultural consultation that are advantageous for consumers, care providers, and their families. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Advanced skull base malignancies are a heterogenous subset of head and neck cancers, and management is often complex. In recent times, there has been a paradigm shift in surgical technique and the advent of novel systemic options. Our goal was to analyse the long‐term outcomes of a single quaternary head and neck and skull base service.A retrospective review of 127 patients with advanced anterior skull base malignancies that were treated at our institution between 1999 and 2015 was performed. Multiple variables were investigated to assess their significance on 5 and 10‐year outcomes.The mean age was 60.9 (± 12.6 SD). Sixty‐four percent were males and 36% were females. Ninety percent of patients had T4 disease. Median survival time was 133 months. The 5‐year overall survival (OS) was 66.2%, disease‐specific survival (DSS) was 74.7%, and recurrence‐free survival (RFS) was 65.0%. The 10‐year OS was 55.1%, DSS was 72.1%, and RFS was 53.4%. Histological type and margin status significantly affected OS & DSS.Surgical management of advanced skull base tumours has evolved over the last few decades at our institution with acceptable survival outcomes and complication rates. Histological diagnosis and margin status are the main predictors of survival. The addition of neoadjuvant systemic agents in current trials may improve outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Peripheral intravenous catheters (PIVCs) are the most commonly used vascular access device in hospitalised patients. Yet PIVCs may be complicated by local or systemic infections leading to increased healthcare costs. Chlorhexidine gluconate (CHG)-impregnated dressings may help reduce PIVC-related infectious complications but have not yet been evaluated. We hypothesise an impregnated CHG transparent dressing, in comparison to standard polyurethane dressing, will be safe, effective and cost-effective in protecting against PIVC-related infectious complications and phlebitis., Methods and Analysis: The ProP trial is a multicentre, superiority, randomised clinical and cost-effectiveness trial with internal pilot, conducted across three centres in Australia and France. Patients (adults and children aged ≥6 years) requiring one PIVC for ≥48 hours are eligible. We will exclude patients with emergent PIVCs, known CHG allergy, skin injury at site of insertion or previous trial enrolment. Patients will be randomised to 3M Tegaderm Antimicrobial IV Advanced Securement dressing or standard care group. For the internal pilot, 300 patients will be enrolled to test protocol feasibility (eligibility, recruitment, retention, protocol fidelity, missing data and satisfaction of participants and staff), primary endpoint for internal pilot, assessed by independent data safety monitoring committee. Clinical outcomes will not be reviewed. Following feasibility assessment, the remaining 2624 (1312 per trial arm) patients will be enrolled following the same methods. The primary endpoint is a composite of catheter-related infectious complications and phlebitis. Recruitment began on 3 May 2023., Ethics and Dissemination: The protocol was approved by Ouest I ethic committee in France and by The Queensland Children's Hospital Human Research Ethics Committee in Australia. The findings will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals., Trial Registration Number: NCT05741866., Competing Interests: Competing interests: CMR’s employer (The University of Queensland or Griffith University) has received unrestricted research grants on her behalf from BD, Cardinal Health, Eloquest and consultancy payments from 3M, BD, BBraun, and ITL Biomedical. AU’s employer (The University of Queensland or Griffith University) has received unrestricted research grants or consultancies on her behalf from BD, 3M, Sterile Care and Medline. NMM— Griffith University and The University of Queensland have received on her behalf investigator-initiated research grants or consultancies from Cardinal Health, 3M, Eloquest, Medline and Becton Dickinson. AC has received unrestricted investigator-initiated research grants, paid to her employer (Griffith University), from Cardinal Health, 3 M and Eloquest. TMK’s employer (The University of Queensland or Griffith University) has received unrestricted research grants on her behalf from BD, and consultancy payments from 3M, BD, BBraun, Medical Specialties Australia, and Smiths Medical. OM, BD and JG received funding for congress attendance, and research funding from Becton Dickinson and 3M. JB’s employer (Griffith University) has received unrestricted research grants on his behalf from BD and Navi Technologies, and consultancy payments from 3M, and BD. COB has no conflicts of interest., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)