%0 Journal Article
%~ PubMed
%A Begg, Lindy
%A McLaughlin, Patrick
%A Manning, Leon
%A Vicaretti, Mauro
%A Fletcher, John
%A Burns, Joshua
%T A novel approach to mapping load transfer from the plantar surface of the foot to the walls of the total contact cast: a proof of concept study.
%B Journal of Foot and Ankle Research
%D 2012
%C United Kingdom
%I BioMed Central Ltd.
%V 5
%N 1
%P 32
%@ 1757-1146
%X 
%Z FOR Codes: 110399


%0 Book
%A McNeil, Catriona
%A Stacey, Michael
%A Fletcher, John
%A Baker, Ross
%A Chong, Beng
%A Flanagan, Damian
%A Gallus, Alex
%A Gibbs, Harry
%A McLintock, Claire
%A Salem, Hatem
%T Cancer Associated Venous Thromboembolism: Summary of best practice recommendations for Australia & New Zealand
%B 
%D 2012
%C Australia
%I HEMI
%V 
%N 
%P 
%@ 9780957890992
%X 
%Z FOR Codes: 111204


%0 Book Section
%A Fletcher, John
%T Prevention of Venous Thromboembolism in Knee Surgery: Limitations of Aspirin and Mechanical Devices
%B Insall & Scott Surgery of the Knee, Fifth Edition
%D 2012
%C United States
%I Elsevier
%V 
%N 
%P 0
%@ 9781437715033
%X 
%Z FOR Codes: 110323


%0 Book Section
%A Fletcher, John
%T Prevention of venous thromboembolism in varicose vein surgery
%B Twenty Years of Varicose Vein Treatment
%D 2012
%C Italy
%I Edizioni Minerva Medica
%V 
%N 
%P 73-76
%@ 9788877117601
%X 
%Z FOR Codes: 110323


%0 Journal Article
%~ PubMed
%A Lesjak, M
%A Boreland, F
%A Lyle, D
%A Sidford, J
%A Flecknoe-Brown, S
%A Fletcher, J
%T Screening for abdominal aortic aneurysm: does it affect men's quality of life?
%B Australian Journal of Primary Health
%D 2012
%C Australia
%I CSIRO Publishing
%V 18
%N 4
%P 248-288
%@ 1448-7527
%X 
%Z FOR Codes: 110323 110201 111708


%0 Journal Article
%~ PubMed
%A Hitos, Kerry
%A Wain, Gerard V
%A Fletcher, John P
%T Venous thromboembolism following gynaecological surgery for suspected or confirmed malignancy.
%B The Australian and New Zealand Journal of Obstetrics and Gynaecology
%D 2012
%C Australia
%I Wiley-Blackwell Publishing Asia
%V 52
%N 1
%P 23-27
%@ 1479-828X
%X Background:??? Venous thromboembolism (VTE) is a serious complication following gynaecological surgery, with malignancy placing patients at an even greater risk. Aims:??? To review the incidence of VTE following gynaecological surgery for suspected or confirmed malignancy with respect to prophylactic modalities and to assess the incidence and associated risk factors for bleeding complications. Methods:??? A retrospective cohort study was undertaken between 2001 to 2006 on 1363 women undergoing surgery for suspected or confirmed gynaecological malignancy. Data on demographic details, diagnosis, radiotherapy/chemotherapy treatment, operative details, and hospital length of stay (LOS), thromboprophylaxis, in-hospital and 3-month readmission rates for deep vein thrombosis (DVT) and/or pulmonary embolism (PE) were collected. Results:??? Median age was 54???years (IQR 44-66) and hospital LOS 7???days (IQR 5-9). 51.6% had a new malignancy and 33.0% benign disease. All in-hospital VTE events (0.4%; 95% CI 0.2-1.0%) occurred in women with advanced malignancy. VTE rate was 1.5% (95% CI 1.0-2.3%) at 3???months. In-hospital and 3-month non fatal PE occurred in 0.4% (95% CI 0.2-0.9%) and 1.1% (95% CI 0.7-1.8%) respectively, with a fatal PE rate of 0.1% (95% CI 0.04-0.5%). Malignancy (OR 10.3; 95% CI 1.3-80.6; P???=???0.026) and duration of surgery (OR 2.1; 95% CI 1.4-3.2; P???=???0.001) significantly increased bleeding risk. Conclusions:??? In-hospital VTE risk is higher following gynaecological surgery for malignancy than for benign disease, despite the use of thromboprophylaxis. Given the higher non fatal PE rate after discharge and increasing trend towards shorter hospital LOS, extended prophylaxis in these patients should be considered.
%Z FOR Codes: 1102 1112


%0 Conference Proceedings
%A Hitos, Kerry
%A New, Charles
%A McMaster, J
%A Cummine, J
%A Fisher, P
%A Fletcher, John
%A Rogers, J
%A Ng, I
%A Lim, J
%A Cree, A
%A Kam, A
%A Owler, Brian
%A Dandie, Gordon
%A Dexter, M
%T Venous thromboembolism prophylaxis in spinal surgery
%B 25th World Congress of the International Union of Angiology
(IUA)
%D 2012
%C Prague, Czech Republic, July
%I Edizioni Minerva Medica
%V 
%N 
%P 103-104
%@ 9788877116161
%E Roztocil, Karel
%X 
%Z FOR Codes: 110323


%0 Journal Article
%~ PubMed
%A Steele, Mitchell J
%A Fox, John S
%A Fletcher, John P
%A Grigg, Leeanne E
%A Bell, Gordon
%T Clopidogrel dilemma for orthopaedic surgeons.
%B ANZ Journal of Surgery
%D 2011
%C Australia
%I Wiley-Blackwell Publishing Asia
%V 81
%N 11
%P 774-784
%@ 1445-2197
%X Patients medicated with clopidogrel who require orthopaedic surgery present a particular challenge. Whether in an emergency or elective situation the orthopaedic surgeon must balance the risks of ceasing clopidogrel versus the risk of increased bleeding that dual antiplatelet therapy generates.
%Z FOR Codes: 110323 110202


%0 Journal Article
%~ PubMed
%A Fahrtash, Farzan
%A Kairaitis, Lukas
%A Gruenewald, Simon
%A Spicer, Tim
%A Sidrak, Hannah
%A Fletcher, John
%A Allen, Richard
%A Swinnen, Jan
%T Defining a significant stenosis in an autologous radio-cephalic arteriovenous fistula for hemodialysis.
%B Seminars in dialysis
%D 2011
%C United States
%I Wiley-Blackwell Publishing, Inc.
%V 24
%N 2
%P 231-8
%@ 1525-139X
%X The current definition of a significant stenosis in an autologous arteriovenous fistula (aAVF), the percentage narrowing compared with the adjacent "normal" vessel, is inaccurate. We believe a significant stenosis in the aAVF is an absolute minimal luminal diameter determined by the requirements of the hemodialysis pump. To determine what absolute diameter constitutes a hemodynamically significant stenosis in a radio-cephalic autologous arteriovenous fistula (RC aAVF), the minimal luminal diameter of dysfunctional RC aAVF was compared to that of functional RC aAVF using grayscale and color ultrasound. There were 93 fistulas in study group and 77 in control group. The mean minimum luminal diameter in study group was significantly lower than in control group (2.19 vs. 4.71 mm, p 0.001). With a cutoff value of 2.7 mm, there was 90% sensitivity and 80% specificity in distinguishing functional fistula from dysfunctional fistula. The area under the receiver-operator curve was 90% (CI 84-94%), indicating that a 2.7 mm diameter is accurate in discriminating functional from dysfunctional fistulas. An absolute minimal luminal diameter of 2.7 mm, as determined with grayscale and color ultrasound, is a useful cutoff for defining significant stenosis in a RC aAVF.
%Z FOR Codes: 1103 1102


%0 Book
%A Ali Alzahrani, Hasan
%A Hitos, Kerry
%A Fletcher, John
%T The Diabetic Foot
%B 
%D 2011
%C Australia
%I Health Education & Management Innovations
%V 
%N 
%P 
%@ 9780957890978
%X 
%Z FOR Codes: 110306 110321


%0 Journal Article
%~ PubMed
%A Sanderson, Brenton
%A Hitos, Kerry
%A Fletcher, John P
%T Venous thromboembolism following colorectal surgery for suspected or confirmed malignancy.
%B Thrombosis
%D 2011
%C United States
%I Hindawi Publishing Corporation
%V 2011
%N 
%P 828030
%@ 2090-1496
%X Surgery for colorectal cancer conveys a high risk of venous thromboembolism (VTE). The effect of thromboprophylactic regimens of varying duration on the incidence of VTE was assessed in 417 patients undergoing surgery between 2005 and 2009 for colorectal cancer. Low-dose unfractionated heparin (LDUH) was used in 52.7% of patients, low-molecular-weight heparin (LMWH) in 35.3%, and 10.7% received LDUH followed by LMWH. Pharmacological prophylaxis was continued after hospitalisation in 31.6%. Major bleeding occurred in 4% of patients. The 30-day mortality rate was 1.9%. The incidence of symptomatic VTE from hospital admission for surgery to 12 months after was 2.4%. There were no in-hospital VTE events. The majority of events occurred in the three-month period after discharge, but there were VTE events up to 12 months, especially in patients with more advanced cancer and multiple comorbidities.
%Z FOR Codes: 110299


%0 Journal Article
%~ PubMed
%A Gibbs, Harry
%A Fletcher, John
%A Blombery, Peter
%A Collins, Renea
%A Wheatley, David
%T Venous thromboembolism prophylaxis guideline implementation is improved by nurse directed feedback and audit.
%B Thrombosis Journal
%D 2011
%C United Kingdom
%I BioMed Central Ltd.
%V 9
%N 1
%P 7
%@ 1477-9560
%X Venous thromboembolism (VTE) is a major health and financial burden. VTE impacts health outcomes in surgical and non-surgical patients. VTE prophylaxis is underutilized, particularly amongst high risk medical patients. We conducted a multicentre clinical audit to determine the extent to which appropriate VTE prophylaxis in acutely ill hospitalized medical patients could be improved via implementation of a multifaceted nurse facilitated educational program.
%Z FOR Codes: 110202


%0 Journal Article
%~ PubMed
%A Lesjak, Margaret S
%A Flecknoe-Brown, Stephen C
%A Sidford, Jan R
%A Payne, Kerryn
%A Fletcher, John P
%A Lyle, David M
%T Evaluation of a mobile screening service for abdominal aortic aneurysm in Broken Hill, a remote regional centre in far western NSW.
%B Australian Journal of Rural Health
%D 2010
%C Australia
%I Wiley-Blackwell Publishing Asia
%V 18
%N 2
%P 72-77
%@ 1440-1584
%X OBJECTIVES: To evaluate the feasibility of a mobile screening service model for abdominal aortic aneurysm (AAA) in a remote population centre in Australia. DESIGN: Screening test evaluation. SETTING: A remote regional centre (population: 20 000) in far western NSW. PARTICIPANTS: Men aged 65-74 years, identified from the Australian Electoral roll. INTERVENTIONS: A mobile screening service using directed ultrasonography, a basic health check and post-screening consultation. MAIN OUTCOME MEASURES: Attendance at the screening program, occurrence of AAA in the target population and effectiveness of screening processes. RESULTS: A total of 516 men without a previous diagnosis of AAA were screened, an estimated response rate of 60%. Of these, 463 (89.7%) had a normal aortic diameter, 28 (5.4%) ectatic and 25 (4.9%) a small, moderate or significant aneurysm. Two men with AAA were recommended for surgery. Feedback from participants indicated that the use of a personalised letter of invitation helped with recruitment, that the screening process was acceptable and the service valued. CONCLUSIONS: It is feasible to organise and operate a mobile AAA screening service from moderate sized rural and remote population centres. This model could be scaled up to provide national coverage for rural and remote residents.
%Z FOR Codes: 111799


%0 Book
%A Fletcher, John
%A Baker, Ross
%A Chang, Beng
%A Fisher, Charles
%A Flanagan, Damian
%A Gallus, Alex
%A Gibbs, Harry
%A McLintock, Claire
%A Matthews, Geoff
%A Salem, Hatem
%A Stacey, Michael
%A Van Rij, Andre
%T Prevention Venous Thromboembolism
%B 
%D 2010
%C Australia
%I Health Education & Management Innovations
%V 
%N 
%P 
%@ 9780957890978
%X 
%Z FOR Codes: 110202


%0 Journal Article
%~ PubMed
%A Fletcher, John P
%T Thromboprophylaxis after surgery (Re: ANZ J. Surg. 2009; 79: 544-7).
%B ANZ Journal of Surgery
%D 2010
%C Australia
%I Wiley-Blackwell Publishing Asia
%V 80
%N 12
%P 951
%@ 1445-2197
%X 
%Z FOR Codes: 1102


%0 Journal Article
%~ PubMed
%A Fiessinger, J N
%A Bounameaux, H
%A Cairols, M A
%A Clement, D L
%A Coccheri, S
%A Fletcher, J P
%A Hoffmann, U
%A Turpie, A G G
%A , ON BEHALF OF THE TAIPAD INVESTIGATORS
%T Thromboxane Antagonism with terutroban in Peripheral Arterial Disease: the TAIPAD study.
%B Journal of Thrombosis and Haemostasis
%D 2010
%C United Kingdom, Unit
%I Wiley-Blackwell Publishing Ltd.
%V 8
%N 11
%P 2369-2376
%@ 1538-7836
%X Summary.??? Background: Terutroban is a selective prostaglandin endoperoxide (TP) receptor antagonist with antithrombotic, antivasoconstrictive and antiatherosclerotic properties and is currently in development for long-term cardiovascular secondary prevention. Objectives: TAIPAD is an international, double-blind, randomized controlled study comparing the effects of five dosages of oral terutroban vs. aspirin and placebo on platelet aggregation in peripheral arterial disease (PAD) patients. Patients/methods: After 10???day''s placebo run-in, included patients (n???=???435; ankle-brachial pressure index, 0.7????????0.1) were randomly allocated to aspirin 75???mg???day(-1) , terutroban 1, 2.5, 5, 10 or 30???mg???day(-1) or placebo. On day 5, the placebo group was reallocated to one of the terutroban groups for the rest of the study (day 83). Ex vivo platelet aggregation induced by the thromboxane analog U46619 (7?????m) was measured 24???h after dosing, as well as platelet aggregation induced by arachidonic acid (AA), collagen and ADP. Results: Terutroban dose-dependently inhibited U46619-induced platelet aggregation at days 5 and 83. At day 5, the inhibition was significant vs. placebo for all terutroban dosages (P???<???0.001). Terutroban (5, 10 and 30???mg???day(-1) ) was at least as effective as aspirin in inhibiting platelet aggregation induced by arachidonic acid (AA), collagen and adenosine diphosphate (ADP). Terutroban was well tolerated, with a safety profile similar to aspirin. Conclusions: In PAD patients, terutroban dose-dependently inhibited platelet aggregation 24???h after dosing, and was at least as effective as aspirin at 5, 10 and 30???mg???day(-1) . Terutroban was well tolerated.
%Z FOR Codes: 110399


%0 Journal Article
%~ PubMed
%A Tiwari, Alok
%A Saw, Chong
%A Li, Michelle
%A Mohan, Irwin
%A Daly, Tom
%A Swinnen, John
%A Richardson, Arthur
%A So, Simon
%A Young, Noel
%A Vicaretti, Mauro
%A Fletcher, John
%T Use of inferior vena cava filters in a tertiary referral centre in Australia.
%B ANZ Journal of Surgery
%D 2010
%C Australia
%I Wiley-Blackwell Publishing Asia
%V 80
%N 5
%P 364-367
%@ 1445-2197
%X Introduction: To investigate the use of inferior vena cava (IVC) filters in a tertiary referral centre, looking at indication, types of filters and, with temporary/optional filters, removal rates. Methods: Data was collected from a prospective database of all IVC filters inserted from January 2003 to January 2007. Patients'' records and radiological imaging were all reviewed. Results: 66 patients (40 males) had IVC filters inserted during the study period. The median age of the male patients was 57.5 (21-79) years, and females 56 (24-81). There were 49 (74.2%) temporary/optional filters and 17 (25.8%) permanent filters. The most common indication for filter was a contraindication to anticoagulation for both permanent (64.7%) and temporary/optional filters (77.6%). In the temporary/optional filter group, 38 of 49 (77.6%) patients had documented venous thromboembolism, while in the permanent filter group, this was 14 of 17 (82.4%). Of the optional filters, 22 of 49 (45.8%) have been removed. Conclusion: More than half (54.2%) of temporary/optional filters were not removed and with potential for long-term complications. A protocol has now being instituted for vascular surgeons to authorize the insertion of filters and to then be responsible for ensuring their removal.
%Z FOR Codes: 104


%0 Journal Article
%A Collins, Renea
%A MacLellan, Lorna
%A Gibbs, Harry
%A MacLellan, Donald
%A Fletcher, John
%T Venous Thromboembolism Prophylaxis: The role of the nurse in changing practice and saving lives
%B Australian Journal of Advanced Nursing
%D 2010
%C Australia
%I Australian Nursing Federation
%V 27
%N 3
%P 83-89
%@ 1447-4328
%X 
%Z FOR Codes: 111003


%0 Journal Article
%~ PubMed
%A Swinnen, Jan
%A Chao, Alex
%A Tiwari, Alok
%A Crozier, John
%A Vicaretti, Mauro
%A Fletcher, John
%T Vertical or Transverse Incisions for Access to the Femoral Artery: A Randomized Control Study.
%B Annals of vascular surgery
%D 2010
%C United States
%I Elsevier
%V 24
%N 3
%P 336-41
%@ 1615-5947
%X To look at wound complications with either a transverse or vertical groin incision in vascular surgery.
%Z FOR Codes: 1114 1108


%0 Journal Article
%~ PubMed
%A Gibbs, H
%A Fletcher, J
%A Blombery, P
%A Glennane, A
%A Collins, R
%T Does a dedicated nurse practitioner improve thromboprophylaxis use in acutely ill medical patients in Australia? The methodology for a multicentre VTE Task Force Audit.
%B International Angiology
%D 2009
%C Italy
%I Edizioni Minerva Medica
%V 28
%N 1
%P 73-78
%@ 1827-1839
%X AIM: To determine the extent to which a multifaceted venous thromboembolism (VTE) prophylaxis program, coordinated by a dedicated nurse practitioner, improves the level of appropriate prophylaxis in patients hospitalised with an acute medical illness. METHODS: A multicentre clinical audit was conducted in 16 hospitals across Australia. Approximately 9600 acutely ill medical patients over 18 years of age hospitalised for at least 3 days. A 4-month programme implemented by a VTE Nurse Educator to raise awareness of the risk of VTE, the importance of risk assessment and the appropriate prophylactic management of high-risk medical patients with local VTE prophylaxis audit result feedback. RESULTS: The effect of this programme on the proportion of high-risk medical patients receiving appropriate thromboprophylaxis according to current guidelines. CONCLUSIONS: The VTE Task Force Audit will be the first multicentre clinical audit in Australia to evaluate thromboprophylaxis use in acutely ill medical patients and the effects of employing a nurse educator. Based on published results from clinical audits conducted overseas, it is expected that thromboprophylaxis will be underutilised in these patients. It is hypothesised that an active multifaceted programme will improve the rate of thromboprophylaxis among eligible medical patients through the effective implementation of evidence-based guidelines.
%Z FOR Codes: 110201


%0 Journal Article
%~ PubMed
%A Mohan, I V
%A Swinnen, J
%A Hitos, K
%A Fletcher, J P
%A White, G H
%A Harris, J P
%A Stephen, M S
%A May, J
%T Endovascular Repair of Aortic Transection can be a Durable Treatment Option.
%B European Journal of Vascular and Endovascular Surgery
%D 2009
%C United Kingdom
%I WB Saunders Co. Ltd.
%V 37
%N 1
%P 120-122
%@ 1532-2165
%X 
%Z FOR Codes: 110323 110299


%0 Journal Article
%A Fletcher, John
%T Genesis of medical thromboprophylaxis guidelines in Australia: a need for trnasparency and standardisation in guideline development
%B Medical Journal of Australia
%D 2009
%C Australia
%I Australasian Medical Publishing Company Pty. Ltd
%V 190
%N 
%P 450
%@ 0025-729X
%X 
%Z FOR Codes: 110399


%0 Journal Article
%~ PubMed
%A Fletcher, J P
%A Hugh, T B
%T Managing the risk of perioperative thromboembolism.
%B ANZ Journal of Surgery
%D 2009
%C Australia
%I Wiley-Blackwell Publishing Asia
%V 79
%N 7-8
%P 544-547
%@ 1445-2197
%X 
%Z FOR Codes: 110299


%0 Journal Article
%~ PubMed
%A Burns, J
%A Wegener, C
%A Begg, L
%A Vicaretti, M
%A Fletcher, J
%T Randomized trial of custom orthoses and footwear on foot pain and plantar pressure in diabetic peripheral arterial disease.
%B Diabetic Medicine
%D 2009
%C United Kingdom, Uni
%I Wiley-Blackwell Publishing Ltd.
%V 26
%N 9
%P 893-899
%@ 1464-5491
%X AIM: Custom-made foot orthoses reduce plantar pressure, ulceration and amputation in patients with diabetes mellitus. There is limited evidence of their effect on foot pain. In a randomized, single-blind, sham-controlled trial, the efficacy of custom orthoses on foot pain and plantar pressure in diabetic patients with peripheral arterial disease was investigated. METHODS: Sixty-one participants were randomly assigned to either custom foot orthoses (n = 30) or sham insoles (n = 31). Both groups also received standardized walking footwear. Outcomes included foot pain and function, mean pressure, toe-brachial index, average daily steps, disability, comfort, quality of life, adherence and adverse events. A multivariate predictive model was constructed to explore factors contributing to pain relief during the trial. RESULTS: At 8 weeks, 95% of participants provided follow-up data, adherence was high and there were few adverse events. Foot pain and function scores significantly improved at 8 weeks with both custom orthoses and the sham, but there was no significant difference between groups. Custom orthoses reduced pressure significantly more than the sham. There were no significant differences between groups for toe-brachial index, daily steps, disability, comfort or quality of life. Regression modelling identified inappropriate pre-trial footwear as the strongest predictor of foot pain relief during the trial. CONCLUSIONS: Custom foot orthoses significantly reduced plantar pressure compared with the sham, but there were no significant differences between groups for pain or function. The high-quality walking footwear provided to both groups may explain this finding. Footwear should have greater emphasis as the clinical intervention.
%Z FOR Codes: 1117


%0 Journal Article
%~ PubMed
%A Fletcher, John P
%A Maclellan, Donald
%A Gibbs, Harry
%A Matthews, Geoff
%T Rational thromboprophylaxis in medical inpatients: not quite there yet. Comment.
%B The Medical journal of Australia
%D 2009
%C Australia
%I Australasian Medical Publishing Company
%V 190
%N 7
%P 398-9
%@ 0025-729X
%X 
%Z FOR Codes: 110399


%0 Journal Article
%~ PubMed
%A Hitos, K
%A Fletcher, J P
%T Venous thromboembolism following primary total hip arthroplasty
%B International Angiology
%D 2009
%C Italy
%I Edizioni Minerva Medica
%V 28
%N 3
%P 215-221
%@ 1827-1839
%X AIM: In the absence of thromboprophylaxis, venographically detected deep vein thrombosis (DVT) occurs in approximately 50% of patients undergoing primary total hip arthroplasty. Despite the existence of national and international guidelines, thromboprophylaxis may be underused. METHODS: A retrospective review was performed of the clinical incidence of venous thromboembolism (VTE) and thromboprophylactic practice patterns over a nine year period. Patient baseline characteristics, VTE risk factors, prophylactic modalities (mechanical and pharmacological), operation duration, type of prosthesis and fixation, mode of anesthesia, hospital length of stay (LOS) were analyzed. The main efficacy outcome was DVT and/or pulmonary embolism (PE). The primary safety outcome was major bleeding. RESULTS: In-hospital incidence of VTE was 2.5% and 3.8% up to three months post hospital discharge. Median time to postoperative VTE development in-hospital and after discharge was 6.5 days (IQR: 5.0 to 8.0 days) and 29.0 days (IQR: 19.5 to 38.0 days) respectively. 66.7% (95% CI: 30.0 to 90.3%) of all readmissions for VTE occurred within one month post-operatively. There were no readmissions for VTE in patients discharged on extended pharmacological prophylaxis. CONCLUSIONS: The use of prophylactic protocols was associated with relatively low VTE rates up to three months with minimal bleeding complications. A more intense in-hospital and extended prophylaxis beyond hospitalization is recommended in this high risk group of patients.
%Z FOR Codes: 110201


%0 Journal Article
%A Fletcher, John
%T When should surgical intervention be considered for patients with intermittent claudication?
%B Medicine Today
%D 2009
%C Australia
%I Medicine Today
%V 10
%N 
%P 72-73
%@ 1443-430X
%X 
%Z FOR Codes: 110323


%0 Journal Article
%~ PubMed
%A Mohan, I V
%A Hitos, K
%A White, G H
%A Harris, J P
%A Stephen, M S
%A May, J
%A Swinnen, J
%A Fletcher, J P
%T Improved Outcomes with Endovascular Stent Grafts for Thoracic Aorta Transections.
%B European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
%D 2008
%C United Kingdom
%I WB Saunders Co. Ltd.
%V 36
%N 2
%P 152-7
%@ 1532-2165
%X To retrospectively assess the outcome of endovascular stent-graft implantation for thoracic aortic transections (ETAT).
%Z FOR Codes: 110323


%0 Journal Article
%~ PubMed
%A Dahl, O E
%A Borris, L C
%A Bergqvist, D
%A Schnack Rasmussen, M
%A Eriksson, B I
%A Kakkar, A K
%A Colwell, C W
%A Caprini, J A
%A Fletcher, J
%A Friedman, R J
%A Lassen, M R
%A Frostick, S P
%A Sakon, M
%A Kwong, L M
%A Kakkar, V V
%A , International Surgical Thrombosis Forum
%T Major joint replacement. A model for antithrombotic drug development: from proof-of-concept to clinical use.
%B International Angiology
%D 2008
%C Italy
%I Edizioni Minerva Medica
%V 27
%N 1
%P 60-67
%@ 0392-9590
%X AIM: Development of antithrombotic compounds has traditionally been performed in patients undergoing total hip and knee replacement surgery. A high number of asymptomatic deep-vein thromboses are radiologically detectable, and bleeding and other adverse events (AE) are easy to observe. However, standardization of study procedures and endpoints in early proof-of-concept studies and late pure clinical endpoint studies has been lacking. This has made comparison between studies difficult, economic analyses speculative and potential benefits of applying the drug regimen in non-selected patients uncertain. In this paper, the International Surgical Thrombosis Forum proposes a strategy for the clinical investigation of new pharmacological agents for the prophylaxis of postoperative thrombotic events. METHODS: First, dose titration safety studies of short duration, in highly selected patients using objective venographic endpoints are recommended. Bleeding should be divided into the quantified volume of surgical bleeding and other adjudicated clinical bleeding events. The number of AE should be described for each dose step and classified according to International Coding of Diagnoses (ICD). Second, a dose confirmatory study of moderate exposure period and sufficient follow-up time is recommended. The exclusion criteria should be restricted to contraindications of the compared drugs and technical procedure. RESULTS: The efficacy, bleeding and AE should be similar to those used in dose-titration studies. In addition, the failure rate of the drug to exert its effect and the net clinical benefit should be calculated. CONCLUSION: Finally, trials with simple clinical endpoints and long follow-up should be conducted to evaluate the potential benefits of the drug-regimen in non-selected populations.
%Z FOR Codes: 110314


%0 Journal Article
%~ PubMed
%A Medbury, H J
%A Tarran, S L S
%A Guiffre, A K
%A Williams, M M Y
%A Lam, T H
%A Vicaretti, M
%A Fletcher, J P
%T Monocytes contribute to the atherosclerotic cap by transformation into fibrocytes.
%B International Angiology
%D 2008
%C Italy
%I Edizioni Minerva Medica
%V 27
%N 2
%P 114-123
%@ 0392-9590
%X AIM: The stability of an atherosclerotic plaque is a key-determining factor in the clinical outcome of cardiovascular disease. In this respect, smooth muscle (SM) alfa actin positive cells play an important role in maintaining plaque stability through formation of a fibrous cap. Recent evidence suggests that circulating progenitors may be a source of these cells. We hypothesized that they may be fibrocytes bone-marrow derived cells that acquire SM-like characteristics, including the expression of SM alfa actin. METHODS: We examined human carotid endarterectomy specimens for the presence of fibrocytes by immunohistochemistry staining for CD34/procollagen I and leukocyte specific protein-1/procollagen I) and examined fibrocyte differentiation in vitro. RESULTS: Fibrocytes were found in regions of plaque growth/healing. They possessed a SM-like spindle shape, produced collagen, and consistent with being fibrocytes they co-localized with transformation growth factor beta, but not serum amyloid P factors, known to promote and inhibit their formation, respectively. While fibrocytes were detected in regions of new growth in 35/40 specimens, only 1/3 of the specimens expressed the SM cell marker calponin, and smoothelin was absent, in these regions. CONCLUSION: Our results demonstrate that fibrocytes contribute to formation of the fibrous cap. With fibrocytes being a monocyte derived cell, we suggest that monocytes may play a more crucial role in the clinical outcome of atherosclerosis than previously realized as they not only contribute directly to plaque instability (through foam cell formation), but also promote plaque stability by transformation into a fibrocyte.
%Z FOR Codes: 110201


%0 Journal Article
%A Flanagan, D
%A MacLellan, D
%A Gibbs, H
%A Baker, R
%A Fletcher, John
%T The insidious hazard of hospitalisation: venous thromboembolism
%B Medicine Today
%D 2008
%C Australia
%I Medicine Today Pty. Ltd
%V 9
%N 
%P 16-26
%@ 1443-430X
%X 
%Z FOR Codes: 110299 110299


%0 Journal Article
%~ PubMed
%A Chong, Beng H
%A Braithwaite, Jeffrey
%A Harris, Mark F
%A Fletcher, John P
%T Venous thromboembolism - a major health and financial burden: how can we do better to prevent this disease?
%B The Medical Journal of Australia
%D 2008
%C Australia
%I Australasian Medical Publishing Company Pty. Ltd.
%V 189
%N 3
%P 134-5
%@ 1326-5377
%X VTE prophylaxis is effective and safe, but grossly underused in Australian hospitals.
%Z FOR Codes: 110202 140208


%0 Journal Article
%~ PubMed
%A Lu, Y
%A Ma, B
%A Guo, R
%A Wang, Y
%A Zhang, J
%A Wu, Y
%A Pang, G
%A Xin, J
%A Ye, W
%A Zou, Y
%A Wang, X
%A Hitos, K
%A Curtin, P
%A Fletcher, J
%T Deep vein thrombosis in trauma: a prospective study of lower limb orthopedic trauma patients in Tianjin Hospital, China.
%B International angiology : a journal of the International Union of Angiology
%D 2007
%C Italy
%I Edizioni Minerva Medica
%V 26
%N 2
%P 165-170
%@ 0392-9590
%X AIM: Pulmonary embolism is a third leading cause of death in trauma patients. The prevalence of deep vein thrombosis (DVT) in Asian countries is considered to be less than in Western countries. Our aim was to establish the rate of DVT in orthopedic trauma patients in Tianjin Hospital, to identify DVT risk factors and to support the use of prophylaxis. METHODS: Patients admitted between November 2003 and October 2004 with recent fracture had data collected prospectively to record type of fracture, mechanism of injury, history of DVT, blood transfusion requirements, operation details, extent of postoperative swelling, use of traction, immobilization, bandaging and patient positioning. Each patient had 3 duplex ultrasound examinations, the first within 24 h of admission. Patients requiring surgery had a second ultrasound within 2 days preoperatively, then 7 days postoperatively. Patients not requiring surgery had second and third ultrasound examinations 5 and 14 days after admission. RESULTS: There were 547 patients, median age 39.6 years (interquartile range: 28-50 years). DVT developed in 12.4% (95% confidence interval: 9.7-15.2%), most occurring with femoral shaft fractures (30.6%), 15.8% occurred with hip fractures, 14.5% with fractures around the knee and 10.8% with fractured tibia and fibula. Over half of DVTs (56.7%) developed within 3 days following injury. CONCLUSION: The incidence of DVT in Chinese orthopedic trauma patients approaches that in Western countries. Guidelines for DVT prophylaxis should be applied in China as in Western countries.
%Z FOR Codes: 111706


%0 Journal Article
%A Yu, Y
%A Ma, B
%A Guo, R
%A Wang, Y
%A Zhang, J
%A Wu, Y
%A Pang, G
%A Xin, J
%A Ye, W
%A Zhou, Y
%A Wang, X
%A Hitos, Kerry (Keriaki)
%A Curtin, P
%A Fletcher, John
%T Deep vein thrombosis risk in orthopaedic traumatic patients
%B Chinese Journal of Orthopaedics
%D 2007
%C China
%I Di-1 Junyi Daxue * Nanfang Yiyuan
%V 27:9
%N 
%P 693-698
%@ 1671-7600
%X 
%Z FOR Codes: 110202 110202


%0 Journal Article
%~ PubMed
%A Hitos, K
%A Cannon, M
%A Cannon, S
%A Garth, S
%A Fletcher, J P
%T Effect of leg exercises on popliteal venous blood flow during prolonged immobility of seated subjects: implications for prevention of travel-related deep vein thrombosis.
%B Journal of thrombosis and haemostasis : JTH
%D 2007
%C United States, UK.
%I Wiley-Blackwell Publishing Ltd.
%V 5
%N 9
%P 1890-1895
%@ 1538-7933
%X Background: Venous stasis is an important contributing factor in the development of travel-related deep vein thrombosis. This study examined factors affecting popliteal venous blood flow in order to determine the most effective exercise regimen to prevent venous stasis. Methods: Twenty-one healthy subjects were randomly assigned to various activities over a 9-week period. Subjects remained seated throughout the investigation and 3660 duplex ultrasound examinations were performed by a single examiner using a SonoSite 180 Plus handheld ultrasound. Baseline popliteal vein blood flow velocity, cross-sectional area and volume flow in subjects sitting motionless were assessed in the first 3 weeks.The remaining 6 weeks involved subjects performing airline-recommended activities, foot exercises, foot exercises against moderate resistance and foot exercises against increased resistance in order to determine the most beneficial method for enhancing popliteal venous flow. Sitting with feet not touching the floor and the effect of sleeping were also assessed. Results: The median age of the subjects was 22 years (range: 18-25.5 years), height 171 cm (162.5-180.5 cm) and body mass index 25.3 kg m(-2) (23.2-26.3 kg m(-2)). Blood volume flow in the popliteal vein was reduced by almost 40% with immobility of seated subjects and by almost 2-fold when sitting motionless with feet not touching the floor. Foot exercises against increased resistance positively enhanced volume flow (P < 0.0001). Conclusion: Leg exercise regimens enhanced popliteal venous flow during prolonged immobility of seated subjects, reinforcing the importance of regular leg movement to prevent venous stasis during prolonged sitting, such as in long-distance travel.
%Z FOR Codes: 111602


%0 Journal Article
%~ PubMed
%A Wright, B
%A Vicaretti, M
%A Schwaiger, N
%A Wu, J
%A Trickett, R
%A Morrissey, L
%A Rohanizadeh, R
%A Fletcher, J
%A Maitz, P
%A Harris, M
%T Laser-assisted end-to-end BioWeld anastomosis in an ovine model.
%B Lasers in Surgery and Medicine
%D 2007
%C USA
%I John Wiley & Sons, Inc
%V 39
%N 8
%P 667-673
%@ 0196-8092
%X The BioWeld tube, an albumin-based exovascular stent, has been used for microsurgical anastomoses and compared to conventional sutures. The study presented investigated the potential of the BioWeld tube for vascular anastomosis in larger vessels. Laser-assisted BioWeld anastomoses were compared to conventional-sutured anatomoses of the carotid artery of Merino-x ewes. The BioWeld procedure resulted in 100% survival and 100% patency at 1 and 6 week post-operative periods, with no noticeable foreign body response. Sutured animals showed 100% survival and patency. The ischemic time for BioWeld anastomosis averaged 15 minutes compared with 10 minutes for sutures. This study indicates that the BioWeld tube is an easy to use anastomotic technique with equivalent success rates and comparable anastomotic times.
%Z FOR Codes: 110323


%0 Journal Article
%~ PubMed
%A MacLellan, Donald G
%A Fletcher, John P
%T Mechanical compression in the prophylaxis of venous thromboembolism.
%B ANZ journal of surgery
%D 2007
%C Australia
%I Blackwell Publishing Asia
%V 77
%N 6
%P 418-423
%@ 1445-1433
%X Venous thromboembolism (VTE) is an important cause of morbidity and mortality in a substantial number of the Australian community. There exists a considerable range of potential prophylactic measures aimed at reducing the risk of VTE. These antithrombotic regimens include pharmacological interventions and mechanical techniques to counteract venous stasis including graduated compression stockings and intermittent pneumatic compression (IPC) devices. This review particularly concentrates on evidence for the use of mechanical prophylaxis and the interrelationship with pharmacological methods of VTE prophylaxis. Mechanical and pharmacological methods of VTE prophylaxis are both effective and when used in combination have synergistic effects. Although there are a number of different IPC systems, little evidence is available at present that differentiates these on the basis of VTE prevention. Compliance and patient acceptance of IPC as a preventative measure has improved with miniaturization and device weight reduction. IPC should be used according to recommended guidelines. In moderate-risk patients when pharmacological prophylaxis is contraindicated, IPC can be used as an alternative. High-risk patients should receive both mechanical and pharmacological prophylaxis to reduce their relative risk. Until further evidence becomes available, the specific type of IPC unit chosen will generally be determined by ease of use, availability and cost.
%Z FOR Codes:


%0 Journal Article
%~ PubMed
%A Fletcher, John P
%T The surgical workload already within the hospital.
%B ANZ journal of surgery
%D 2007
%C Australia
%I Blackwell Publishing Asia
%V 77
%N 5
%P 312
%@ 1445-1433
%X 
%Z FOR Codes: