Background: Acquired aerodigestive fistula (ADF) are rare, but associated with significant morbidity. Surgery affords the best prospect of cure. We present our experience of the surgical management of ADFs at a specialist unit, highlighting operative techniques, challenges and assess clinical outcomes following intervention. We also illustrate findings of a Hospital Episodes Statistics search for ADFs.
Methods: A prospectively-maintained database was searched to identify all patients diagnosed with an ADF who were managed at our institution. Of 48 patients with an ADF, eight underwent surgical intervention.
Results: Four patients underwent an exploration of the ADF with primary repair of the defect. Two of these patients had proximal ADFs, amenable to repair through a neck incision, and two required a thoracotomy. Two patients suffered fistulae secondary to endoscopic therapy and underwent oesophageal exclusion surgery, with subsequent staged reconstruction. Two patients with previous Tuberculosis had a lung segmentectomy and lobectomy respectively, and a further patient in remission after treatment for lymphoma underwent oesophageal resection with synchronous reconstruction. Three patients suffered a complication, with one post-operative mortality. The remaining seven patients all achieved normal oral alimentation, with no evidence of ADF recurrence at a median follow-up of 32 months.
Conclusions: Surgery to manage ADFs is effective in restoring normal alimentation and alleviates soiling of the airway, with a very low risk of recurrence. Several operative techniques can be utilised dependent on the features of the ADF. Early referral to specialist units is advocated, where the expertise to facilitate the complete management of patients is present, within a multi-disciplinary setting.
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http://dx.doi.org/10.1186/s13019-018-0799-1 | DOI Listing |
The purpose of this study was to identify whether NHS Trusts where discrimination in the delivery of care to patients from the South Asian community had been demonstrated had taken any actions to address the issue over the subsequent year. Freedom of information requests were sent to three trusts which had provided evidence of disparate provision of biologic therapy to patients with Crohn's disease, their associated Clinical Commissioning Groups and Healthwatch organisations to seek evidence whether they had remedied the situation. Requests were also sent to the Care Quality Commission, NHS Improvement and the Equality and Human Rights Commission seeking examples where they had responded to inequitable delivery of care related to ethnicity.
View Article and Find Full Text PDFTasers, a form of police weaponry causing neuromuscular incapacitation and extreme pain, were confirmed in 2010 to be used in New Zealand inpatient mental health units. Their use on patients, or tāngata whai ora (persons seeking wellbeing), raises ethical concerns about harm prevention, moral duties, and human rights in healthcare. The New Zealand healthcare system, grounded in principles and rights, regulates procedures to uphold fundamental rights.
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November 2024
Associate Professor, Monash University Faculty of Law; Deputy Director, Castan Centre for Human Rights Law.
This article analyses qualitative empirical research conducted by this author to gain a deeper understanding of the rationale behind conscientious objection (CO) to voluntary assisted dying (VAD) and its impact on the operation of VAD in Victoria, Australia. It begins by providing an overview of the Australian legal approach to CO in the context of VAD. It then discusses the spectrum of attitudes that exist towards VAD, illuminating some of the nuance and complexity of the individual and institutional approaches.
View Article and Find Full Text PDFJ Law Med
November 2024
Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
The framing of patients making decisions about their medical treatment and care as traditional legal decisions, thresholds and formalities is a means to avoid legal liabilities through a rationalisation of decision-making, autonomy and choice. A credible account for the actual place of patients posits the sovereign power (founded in the works of Carl Schmitt and Giorgio Agamben) of the health care professional deciding the state of exception - a discrete legal space where the authority of health care professionals is both lawful and beyond the law. This reveals that dealing with broadly conceived consent issues with more law, more process and procedure but without addressing the inherent legality assumptions that empower health care professionals will always be flawed.
View Article and Find Full Text PDFPsychooncology
January 2025
Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China.
Objective: Influenced by their life stage and socio-cultural background, young and middle-aged cancer patients in China may experience unique psychological distress. Therefore, this study investigated the severity, problems, and associated factors of psychological distress among young and middle-aged cancer patients.
Methods: We conducted a cross-sectional study on young and middle-aged cancer patients aged 18-59 who were treated at a radiotherapy center from February 2022 to September 2023.
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