Implantable cardioverter-defibrillator lead failure and revision following transcutaneous bicaval valve (TricValve®) implantation.

INTRODUCTION: Tricuspid regurgitation is associated with significant morbidity and mortality, and occurs at a higher rate in patients with cardiovascular implantable electronic devices. Percutaneous strategies for managing tricuspid regurgitation are evolving, including the development of bicaval valve implantation which has been successfully used in patients with pacing leads. METHODS AND RESULTS: We present the first documented case of lead failure following TricValve® implantation, a dedicated self-expanding system for bicaval valve implantation, and the first successful lead revision procedure in this setting. CONCLUSION: The case illustrates important considerations in undertaking percutaneous intervention in patients with cardiovascular implantable electronic devices, and their ongoing management.

Outcomes of patients with delayed surveillance colonoscopy.

BACKGROUND: Surveillance colonoscopy has been shown to be an effective tool for prevention of colorectal cancer (CRC) in high-risk populations, if adhered to. AIM: To discover the sequelae of late surveillance in a cohort of patient's overdue for colonoscopy. METHODS: We conducted a retrospective cohort study on all patients from the Bay of Plenty District Health Board region, New Zealand, placed on the colonoscopy surveillance waitlist from 2006 onwards who had their procedure completed between 1 November 2016 and 31 January 2018. Patients with overdue surveillance, defined as done later than 90 days after the recommended due date, were compared with patients who were done either early or on time. RESULTS: A total of 786 patients was recorded as overdue for surveillance colonoscopy and 386 were completed early or on time. The median time overdue was 22 months. Three (0.4%) cases of CRC were found in overdue patients compared with four (1%) cases for those done on time (adjusted P = 0.24). There were 86 (11%) advanced adenomas (AA) in patients overdue compared with 27 (7%) in those not overdue (odds ratio (OR) 1.6; 95% confidence interval (CI) 1.0-2.5; P = 0.04). Surveillance of 180 high-risk post-polypectomy patients identified 2 CRC and 8/43 AA in those overdue compared with no CRC and 9/137 AA (18.6% vs 6.6%; OR 1.79; 95% CI 1.07-2.0; unadjusted P = 0.03) in those done on time. CONCLUSION: While overdue surveillance is not predictive of increased CRC, it is associated with an increase in expected number of AA, particularly in patients having surveillance for previous high-risk polypectomy.

Implementing mobile devices to reduce non-rostered workload for junior doctors.

There is a large body of evidence demonstrating the detrimental effect of long work hours on the performance, mood, and job satisfaction of junior doctors. By extension these effects carry over into the realm of patient safety, compromising the quality of care provision. House officers in the general surgery department of Tauranga Hospital, New Zealand are often required to arrive at work well before their rostered start time of 7.30am to hand write the results of clinical investigations on their patient lists. Baseline measurement demonstrated that each house officer was spending an average of 28 minutes a day of non-rostered time completing this task, increasing to 33 minutes on post-acute days. This quality improvement project trialed the use of a mobile device for accessing clinical results in real-time on surgical ward rounds with the ultimate aim of reducing non-rostered workload by one hour per house officer, per week. A sustainable reduction to a median of 15 minutes non-rostered work per day for each house officer was achieved, translating into 75 minutes less non-rostered work for each house officer every week. Importantly, this result was sustained for more than seven working weeks and spanned a changeover in house officer rotation. Furthermore, the use of the devices was associated with a perceived improvement in the accuracy and timeliness of access to clinical results with no perceived detriment to the speed or flow of the ward round.