Perioperative aspirin and coronary artery bypass graft surgery: An updated meta-analysis of randomized controlled trials.

Background: The decision to continue aspirin before elective coronary artery bypass graft surgery remains contentious because of competing thrombotic and bleeding risks. We performed a contemporary systematic review and meta-analysis to compare outcomes between patients undergoing coronary artery bypass grafting who stopped and continued aspirin before surgery.

Methods: PubMed, MEDLINE, and CENTRAL databases were searched from inception to 4 October 2023 for randomized controlled trials comparing patients undergoing coronary artery bypass grafting who continued preoperative aspirin with those who discontinued before surgery.

Effect of Proximal Blood Flow Arrest During Endovascular Thrombectomy (ProFATE): A Multicenter, Blinded-End Point, Randomized Clinical Trial.

Background: The effect of temporary blood flow arrest during endovascular thrombectomy for acute ischemic stroke is uncertain due to the lack of evidence from randomized controlled trials. We aimed to investigate whether temporary blood flow arrest during endovascular thrombectomy using a balloon guide catheter improves intracranial vessel recanalization compared with nonflow arrest.

Methods: The ProFATE trial (Proximal Blood Flow Arrest During Endovascular Thrombectomy) was a multicenter, randomized, participant- and outcome-blinded trial at 4 thrombectomy centers in the United Kingdom.

Establishing patient partners' roles on research teams: a scoping review.

Background: There are a myriad of ways patient partners can enact their roles on research teams. International guidelines emphasize the need for a collaborative approach to determining these roles to try to improve research impact and positive patient partner experience. The aims of this review were to: (1) describe how patient partners' roles as co-researchers in health research are determined; and (2) identify factors that influence how these decisions are made.

Adult-onset dysphagia.

Background: Dysphagia, characterised by a difficulty in swallowing, stems from various causes and is frequently encountered in general practice. The rise in dysphagia in Australia's ageing population necessitates proper management to prevent complications. Recognising and managing dysphagia improves outcomes and quality of life, and reduces secondary complications.

Chronic occupational paronychia secondary to digital pilonidal sinus from dog grooming.

Objectives Pilonidal sinus is a recognized occupational condition sometimes seen in barbers and pet groomers, and it involves most commonly interdigital spaces. We present a previously unreported case of chronic paronychia with two separate digital pilonidal sinuses resulting from multiple embedded hair fragments in the eponychium of a dog groomer, who had been repeatedly treated with antibiotics with no success and ended up to surgical treatment. The objective of this study is to remind readers of this rare but possible occupational disease, particularly among employees working with hair, and to emphasize the importance of preventive measures to prevent its occurrence.

Advancement in predictive biomarkers for gestational diabetes mellitus diagnosis and related outcomes: a scoping review.

Objective: Gestational diabetes mellitus (GDM) is a metabolic disorder associated with adverse maternal and neonatal outcomes. While GDM is diagnosed by oral glucose tolerance testing between 24-28 weeks, earlier prediction of risk of developing GDM via circulating biomarkers has the potential to risk-stratify women and implement targeted risk reduction before adverse obstetric outcomes. This scoping review aims to collate biomarkers associated with GDM development, associated perinatal outcome and medication requirement in GDM.

Pheochromocytoma-induced cardiogenic shock requiring ECMO: cardiovascular recovery prior to surgical resection.

An otherwise healthy woman in her 30s presented with cardiogenic shock and acute pulmonary oedema (APO), subsequently requiring extracorporeal membrane oxygenation (ECMO). A CT scan revealed an adrenal mass that prompted the differential diagnosis of a pheochromocytoma crisis that was later further suggested by raised plasma metanephrines. In the absence of clear guidelines due to the clinical rarity, a decision was made to delay adrenalectomy and stabilise the patient from a cardiac perspective with the view to operate after improvement of cardiac function with adequate alpha and beta blockade.

Elevated cardiac troponin secondary to heterophile antibodies: a case series highlighting an underrecognized differential.

Background: Heterophile antibody presence confounds troponin assay results, causing falsely elevated troponin levels. This rare phenomenon is an important differential to consider when evaluating patients with suspected acute coronary syndrome. We present a case series of three patients with similar clinical presentations where the presence of heterophile antibodies was confirmed.

Locally Delivered Antibiotics in Fracture-Related Infection.

The prevention and treatment of fracture-related infections (FRIs) pose significant challenges in orthopaedic trauma care, with current practices predominantly relying on systemic antibiotic administration. However, locally delivered antibiotics achieve substantially higher tissue concentrations and minimise systemic side effects. Whilst extensively researched in periprosthetic joint infections (PJIs), the use of local delivery methods is increasingly prevalent in FRI prevention and treatment.

Clinicians' views on implementing enhanced recovery after surgery: a descriptive qualitative study.

Background: Enhanced recovery after surgery (ERAS) protocols have existed for the past three decades; these protocols may improve patient outcomes and healthcare costs. Yet, ERAS is difficult to implement, and there has been limited focus on processes used to promote ERAS use. Thus, the aim of this study was to identify and describe the barriers and enablers to implementing ERAS.

Effect of introduction of a rapid response system and increasing Medical Emergency Team (MET) activity on mortality over a 20-year period in a paediatric specialist hospital.

Background: Rapid Response Systems are hospital-wide patient-focused systems aiming to improve recognition of acute deterioration in patients and trigger a rapid response aimed at preventing potentially avoidable adverse events such as cardiac arrest and death. In 1994, the Royal Children's Hospital in Brisbane, Australia, was one of the first institutions to adopt a paediatric rapid response system (RRS). The purpose of this study was to investigate the impacts of both introduction of a paediatric RRS and increasing RRS activations (MET dose) on hospital mortality.

The Referrer Matters. Musculoskeletal Surgical Conversion Rates: A Systematic Review With Meta-Analysis.

Background: Efficient musculoskeletal care is important for health services and society. Surgical conversion rates are a common measure of efficiency, yet normal values and the impact of referrer type are unclear. This information could assist musculoskeletal care, service benchmarking and redesign.

Lipoprotein(a) throughout life in women.

Lipoprotein (a) [Lp(a)] is a lipoprotein with multiple deleterious characteristics and is a recognized cardiovascular (CV) risk factor. The pro-atherogenic, pro-thrombotic, and pro-inflammatory features of Lp(a) are associated not only with atherosclerotic vascular disease but also with aortic valve calcification and all-cause mortality. One of the most interesting aspects of Lp(a) is that its level is determined by genetics in more than 90% of cases, with lifestyle habits having very little influence.

Direct oral anticoagulant assay utilization and associated bleeding events: a multi-center cohort study.

Background: There is a lack of evidence regarding direct oral anticoagulant (DOAC) assay plasma concentrations and their association with bleeding events or transfusion requirements. This multicenter study aimed to characterize the use and plasma levels of DOAC assays of anticoagulated patients who present to emergency with a bleeding event and their association with bleeding severity.

Methods: A multicenter retrospective cohort study of consecutive emergency bleeding presentations with a DOAC assay over a five-year period was conducted.

Clinical Snapshot of Group A Streptococcal Isolates from an Australian Tertiary Hospital.

(Group A , GAS) is a human-restricted pathogen that causes a wide range of diseases from pharyngitis and scarlet fever to more severe, invasive infections such as necrotising fasciitis and streptococcal toxic shock syndrome. There has been a global increase in both scarlet fever and invasive infections during the COVID-19 post-pandemic period. The aim of this study was the molecular characterisation of 17 invasive and non-invasive clinical non-1 GAS isolates from an Australian tertiary hospital collected between 2021 and 2022.

An Update on Recent Clinical Trial Data in Bloodstream Infection.

Bloodstream infections (BSIs) remain a significant source of morbidity and mortality globally, exacerbated by an ageing population and rising antimicrobial resistance (AMR). This review offers an updated evaluation of randomized clinical trials (RCTs) in BSI management from 2018 onwards, focusing on the evolving landscape of diagnostics and treatment. New rapid diagnostic technologies and shorter antimicrobial courses have transformed clinical practice, reducing the time to appropriate therapy and hospital stays.

Patients' Ability to Self-Manage Their Surgical Wound to Prevent Wound Complications: A Cross-Sectional Study.

Aims: To provide insights into postdischarge patients' experiences and preferences regarding surgical wound care education at discharge in the Netherlands.

Background: Patient involvement in wound care practices postdischarge is beneficial for the prevention of surgical site infections and has become an essential component in reducing the burden on healthcare systems. Surgical wound care discharge education is crucial to achieve this.