Cardiopulmonary exercise testing provides a predictive tool for early and late outcomes in abdominal aortic aneurysm patients.

INTRODUCTION: The aim of this study was to determine if cardiopulmonary exercise testing (CPET) predicts 30-day and mid-term outcomes when assessing suitability for abdominal aortic aneurysm (AAA) repair. METHODS: Since July 2006 consecutive patients from a single centre identified with a large (≥5.5 cm) AAA were sent for CPET. Follow-up was completed on 1 August 2009. Univariate logistical regression was used to compare CPET parameters with the Detsky score, the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Vascular Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (VPOSSUM) in predicting predefined early and late outcome measures. RESULTS: Full data were available for 102 patients (93% male, median age: 75 years, interquartile range (IQR): 70-80 years, median follow up: 28 months, IQR: 18-33 months). Ventilatory equivalents for oxygen and APACHE II predicted postoperative inotrope requirement (p=0.018 and p=0.019 respectively). The Detsky score predicted the length of stay in the intensive care unit (p=0.008). Mid-term (30-month) survival was predicted by the anaerobic threshold (p=0.02). CONCLUSIONS: CPET provided the only means in this study of predicting both 30-day outcome and 30-month mortality. CPET could therefore become an increasingly important tool in determining the optimum management for AAA patients.

Continuity of care of emergency surgical admissions: impact on SpR training.

INTRODUCTION: Continuity of patient care is an important component of surgical education. This study assesses continuity of care in the current working climate. PATIENTS AND METHODS: Data were collected prospectively on consecutive emergency general surgical admissions during one month. Our SpR rota is a partial shift 24 hour on call with the SpR's own consultant. The SpR is free of commitments the next day following post-take work. The on call general surgery SpR was designated the 'assessor'. Data were analysed according to involvement of the 'assessor' at subsequent stages of the admission--consent, operation, review during admission and review on discharge. Data were also collected defining whether the 'assessor' and operator followed-up the patient. RESULTS: There were 200 admissions; 108 female and 92 male. Overall 23% admissions had the same 'assessor' for all stages of patient care. The 'assessor' dealt with an aspect of patient care in 11% of admissions who underwent an operation and 29% of admissions who were conservatively managed. SpR follow-up of admissions on whom they operated was 70% but only 41% of admissions who were conservatively managed were followed-up by the assessing SpR. CONCLUSION: Complete in-hospital continuity of care was poor, although SpR follow-up of patients on whom they had operated was better. Introduction of shift patterns has reduced continuity of patient care. This will have a negative impact on both surgical training and patient care.

Multi-primer target PCR for rapid identification of bovine DRB3 alleles.

Multi-primer target polymerase chain reaction (MPT-PCR) is a rapid method for the identification of specific BoLA-DRB3 alleles. In a single PCR reaction, the presence of two alleles associated with increased risk, DRB3.2*23 (DRB3*2701-2703, 2705-2707) and decreased risk, DRB3.2*16 (DRB3*1501, 1502), of mastitis in Canadian Holstein can be detected. Two outer primers amplify exon 2 of DRB3. Simultaneously, two inner, allele-specific primers amplify individual alleles. Initially, 40 cows previously typed by PCR-restriction fragment length polymorphism (PCR-RFLP) were genotyped using the multi-primer approach. An additional 30 cows were first genotyped by multi-primer target PCR, then by PCR-RFLP. All animals were correctly identified and there were no false positives. This technique can readily be modified to identify other BoLA alleles of interest.