These findings demonstrate that disability is a stronger predictor of depressive symptoms than depressive symptoms are of disability. In addition, the prior existence of a health condition will lead to further deterioration of health conditions and that they often coexist.

Introduction Severe acute pancreatitis (SAP) is a common diagnosis in emergency general surgery and can be a cause of significant morbidity and mortality. A consequence of SAP is thrombus in the splanchnic veins. These thrombi can potentially lead to bowel ischaemia or hepatic failure. However, another complication of SAP is retroperitoneal bleeding. At this time, it is thus unclear if treating patients with splanchnic vein thrombosis in the context of SAP is associated with any outcome benefit. A systematic review might clarify this question. Methods A two fold search strategy (one broad and one precise) looked at all published literature. The review was registered on PROSPERO (ID: CRD42018102705). Medline, EMBASE, PubMed, Cochrane and Web of Science databases were searched and potentially relevant papers were reviewed independently by two researchers. Any disagreement was reviewed by a third independent researcher. Primary outcome was reestablishment of flow in the thrombosed vein versus bleeding complications Results Of 1462 papers assessed, a total of 16 papers were eligible for inclusion. There were no randomised controlled trials, 2 were case series, 5 retrospective single centre reviews and 9 studies case reports. There were a total of 198 patients in these studies of whom 92 (46.6%) received anticoagulation therapy. The rates of recanalization of veins in the treated and non-treated groups was 14% and 11% and bleeding complications were 16% and 5%; respectively. However, the included studies were too heterogeneous to undertake a meta-analysis. Conclusion The systematic review highlights the lack evidence addressing this clinical question. Therefore a randomised controlled trial would be appropriate to undertake.

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BackgroundOral antiseptics reduce nosocomial infections and ventilator-associated pneumonia in critically ill medical and surgical patients intubated for prolonged periods. However, the role of oral antiseptics given before and after planned surgery is not clear. The aim of this systematic review and meta-analysis is to determine the effect of oral antiseptics (chlorhexidine or povidone–iodine) when administered before and after major elective surgery.MethodsSearches were conducted of the MEDLINE, EMBASE and Cochrane databases. The analysis was performed using the random-effects method and the risk ratio (RR) with 95 % confidence interval (CI).ResultsOf 1114 unique identified articles, perioperative chlorhexidine was administered to patients undergoing elective surgery in four studies. This identified 2265 patients undergoing elective cardiac surgery, of whom 1093 (48.3 %) received perioperative chlorhexidine. Postoperative pneumonia and nosocomial infections were observed in 5.3 and 20.2 % who received chlorhexidine compared to 10.4 and 31.3 % who received a control preparation, respectively. Oral perioperative chlorhexidine significantly reduced the risk of postoperative pneumonia (RR = 0.52; 95 % CI 0.39–0.71; p < 0.01) and overall nosocomial infections (RR = 0.65; 95 % CI 0.52–0.81; p < 0.01), with no effect on in-hospital mortality (RR = 1.01; 95 % CI 0.49–2.09; p = 0.98).ConclusionsPerioperative oral chlorhexidine significantly decreases the incidence of nosocomial infection and postoperative pneumonia in patients undergoing elective cardiac surgery. There are no randomised controlled studies of this simple and cheap intervention in patients undergoing elective non-cardiac surgery.Trial RegistrationThis systematic review was registered with the International prospective register of systematic reviews (PROSPERO). The registration number is CRD42015016063.