Mesenteric ischaemia may result from a wide range of pathological processes, each possessing unique clinical features, diagnostic difficulties, management strategies and outcome. Regardless of aetiology, prognosis depends crucially on rapid diagnosis and institution of treatment to prevent, or at least to minimize, bowel infarction. Progress in understanding the pathophysiology of mesenteric ischaemia has led to novel methods of treatment, so that in some circumstances therapy may be purely medical. More often surgery is required and is frequently life saving. Percutaneous transcatheter techniques are increasingly employed in both diagnosis and treatment. Close cooperation between radiologists, physicians and surgeons is therefore necessary if clinical outcome is to be optimized. This paper reviews the modern interdisciplinary management of mesenteric ischaemia in the light of recent advances.

BackgroundAccess to appropriate, affordable, acceptable and comprehensive primary health care (PHC) is critical for improving the health of Indigenous populations. Whilst appropriate infrastructure, sufficient funding and knowledgeable health care professionals are crucial, these elements alone will not lead to the provision of appropriate care for all Indigenous people. This systematic literature review synthesised international evidence on the factors that enable or inhibit the implementation of interventions aimed at improving chronic disease care for Indigenous people.MethodsA systematic review using Medical Literature Analysis and Retrieval System Online (MEDLINE) (PubMed platform), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Excerpta Medica Database (EMBASE), ATSIHealth, Australian Indigenous HealthInfoNet via Informit Online and Primary Health Care Research and Information Service (PHCRIS) databases was undertaken. Studies were included if they described an intervention for one or more of six chronic conditions that was delivered in a primary health care setting in Australia, New Zealand, Canada or the United States. Attitudes, beliefs, expectations, understandings and knowledge of patients, their families, Indigenous communities, providers and policy makers were of interest. Published and unpublished qualitative and quantitative studies from 1998 to 2013 were considered. Qualitative findings were pooled using a meta-aggregative approach, and quantitative data were presented as a narrative summary.ResultsTwenty three studies were included. Meta-aggregation of qualitative data revealed five synthesised findings, related to issues within the design and planning phase of interventions, the chronic disease workforce, partnerships between service providers and patients, clinical care pathways and patient access to services. The available quantitative data supported the qualitative findings. Three key features of enablers and barriers emerged from the findings: (1) they are not fixed concepts but can be positively or negatively influenced, (2) the degree to which the work of an intervention can influence an enabler or barrier varies depending on their source and (3) they are inter-related whereby a change in one may effect a change in another.ConclusionsFuture interventions should consider the findings of this review as it provides an evidence-base that contributes to the successful design, implementation and sustainability of chronic disease interventions in primary health care settings intended for Indigenous people.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0261-x) contains supplementary material, which is available to authorized users.

Radiological placement is consistently more reliable than surgical placement. There are fewer placement complications and fewer catheter infections overall.

No abstract

Objectives: To assess differences in the rates of angiography and subsequent revascularisation for Aboriginal and non‐Aboriginal South Australians who presented with an acute coronary syndrome (ACS); to explore the reasons for any observed differences. Design: Analysis of administrative data with logistic regression modelling to assess the relationship between Aboriginal status and the decision to undertake diagnostic angiography. A detailed medical record review of Aboriginal admissions was subsequently undertaken. Setting: Emergency ACS admissions to SA cardiac catheterisation hospitals, 2007–2012. Participants: 13 701 admissions of patients with an ACS, including 274 Aboriginal patients (2.1%). Major outcome measures: Rates of coronary angiography and revascularisation; documentation of justification for non‐invasive management. Results: After adjustment for age, comorbidities and remoteness, Aboriginal patients presenting with an ACS were significantly less likely than non‐Aboriginal patients to undergo angiography (odds ratio [OR], 0.4; 95% CI, 0.3–0.5; P < 0.001). There was no significant difference in the rates of revascularisation for Aboriginal and non‐Aboriginal patients who had undergone angiography. Reasons for Aboriginal patients not undergoing angiography included symptoms being deemed non‐cardiac (16%), non‐invasive test performed (8%), and discharge against medical advice (11%); the reasons were unclear for 36% of Aboriginal patients. Conclusions: After controlling for age and other factors, the rate of coronary angiography was lower among Aboriginal patients with an ACS in SA. The reasons for this disparity are complex, including patient‐related factors and their preferences, as well as the appropriateness of the intervention. Improved consideration of the hospital experience of Aboriginal patients must be a priority for reducing health care disparities.