RESUMEN
AIMS: The aim of this project was to employ interdepartmental and cross district health board collaboration to reach a regional consensus on the management of patients who may benefit from carotid endarterectomy. METHODS: All regional stroke physicians, neurologists, and vascular surgeons met to review relevant literature and local audits and to discuss best management strategies suited to the region. RESULTS: A consensus statement was agreed upon and is presented here along with a summary of the supporting scientific evidence. DISCUSSION: Regional interdisciplinary collaboration proved an effective way to reach a carotid endarterectomy management consensus across a wider geographical area that is served by a single vascular surgery department. This approach could serve as a model for other regional initiatives.
Asunto(s)
Estenosis Carotídea/cirugía , Endarterectomía Carotidea/normas , Accidente Cerebrovascular/prevención & control , Anticoagulantes/uso terapéutico , Puente de Arteria Coronaria , Diagnóstico por Imagen , Femenino , Humanos , Masculino , Nueva Zelanda , Selección de Paciente , Complicaciones Posoperatorias/prevención & controlRESUMEN
OBJECTIVES: To describe the use and outcomes of outpatient antimicrobial therapy (OPAT) for infective endocarditis (IE) within the Canterbury region of New Zealand over an 8 year period. METHODS: All cases of IE admitted to Christchurch Hospital were reviewed. Prospectively collected data from our OPAT service's database and retrospective data from case notes were analysed. RESULTS: There were 213 episodes of IE meeting modified Duke Criteria over this time. Patients received OPAT in 100 episodes. Viridans streptococci were the infecting organism in 34, Staphylococcus aureus in 27, and enterococci in 10. Adverse events were encountered in 27 episodes. Of these, 24 were related to intravenous lines, infusion devices or adverse drug reactions which resolved with change of treatment. There were 3 serious adverse events which were likely to have occurred in hospital. During 12-month follow-up there were 5 further episodes of IE and 2 deaths unlikely to be directly related to the episode of IE. CONCLUSIONS: Despite significant co-morbidities and complications, nearly half of all patients with IE, including those with disease due to S. aureus and enterococci, successfully completed their treatment as outpatients. Continuous infusion devices were successfully used in 32 patients, including 22 with disease due to S. aureus.