Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction

Introduction Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction. Methods A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori. Results 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity. Conclusions Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups

AHC interview with Adele Monteser Wardle.

03/16/2008Adele Wardle née Monteser was born on Dec. 10, 1916, in Vienna, Austria. She left Austria in 1939, traveling to Italy and France, where she was arrested in Angoulème as an Enemy Alien. She arrived in the United States in January 1940.Austrian Heritage Collectio

Ghana General Elections:7 December 2016

The Commonwealth Observer Group for the 7 December 2016 General Electionswas present in Ghana from 29 November to 13 December 2016. The Group’sarrival was preceded by an Advance Observer Team which was in the countryfrom 16 November 2016.In carrying out its Terms of Reference, the Group met, among others, with theElectoral Commission (EC) of Ghana, the presidential candidates, politicalparties, civil society, including women and youth groups, the media, the Police,Commonwealth High Commissioners, as well as other citizen and internationalobserver missions.On 4 December 2016 our teams were deployed throughout the ten regions ofGhana to observe the election environment and preparation of the polls, andmet key stakeholders at the regional, district and constituency levels.The campaign was highly competitive and closely contested, and was conductedin a largely peaceful and vibrant manner, with fundamental rights ofcandidates, political parties and supporters largely respected.The media, on the whole, played a prominent and positive role in the campaign,with freedoms of speech and expression respected. Our Group also noted thegrowing influence of social media on the electorate and the campaign.However, we also observed cases of the use of inflammatory language, andbiased reporting.The legal framework provides an adequate basis for the conduct of democraticelections in Ghana, with guarantees for fundamental freedoms of the right tovote, to be elected, freedom of assembly, association, expression andmovement.The Electoral Commission was, on the whole, well prepared for the elections,and administered the electoral process efficiently and professionally. The pollslargely opened on time with election materials available and polling staff,security and party agents present. Pregnant women, the elderly and personswith disability were generally given priority. The poll set up, voting, and thecount, collation and results process, for the most part, followed the prescribedprocedures. The vast majority of voters found their names on the voters’ listsand were able to vote. Few incidents were reported that had a significantimpact on the voting process.Well-conducted elections can be further improved. Our report encouragesundertaking a post-election review of all aspects of the electoral frameworkand administration both internally and with stakeholders, with a view toadopting recommendations and best practice, in particular with regard to thefollowing aspects: the legal framework, voter register, women’s politicalparticipation, administrative and logistical arrangements for the elections,signage for polling stations, vote collation, tabulation and transmission systems,special voting provisions, and communications between the ElectoralCommission and other stakeholders. The reports from citizen and international observers could be used to inform this post-election review. In the context of our Terms of Reference, our Report offers, in a positive spirit, a number of recommendations for consideration to further improve the electoral process in Ghana. Our overall conclusion is that the Ghana General Election as a whole was conducted in a peaceful, credible, transparent andinclusive manner. The Group commends and congratulates the Ghanaianvoters, the Electoral Commission of Ghana and polling staff, civil society, thecitizen observers, the media and the security forces for their respective roles in ensuring the success of the elections

Outcomes of obstructed abdominal wall hernia: results from the UK national small bowel obstruction audit

Abstract Background Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co-morbidity, imaging, operative treatment, and in-hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results NASBO included 2341 patients, of whom 415 (17·7 per cent) had SBO due to hernia. Surgery was performed in 312 (75·2 per cent) of the 415 patients; small bowel resection was required in 198 (63·5 per cent) of these operations. Non-operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32·1 per cent) of 106 patients with an incisional hernia. The in-hospital mortality rate was 9·4 per cent (39 of 415), and was highest in patients with a groin hernia (11·1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16·3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1·05, 95 per cent c.i. 1·01 to 1·10; P = 0·009) and complications (odds ratio 1·05, 95 per cent c.i. 1·02 to 1·09; P = 0·001). Conclusion NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group. </jats:sec