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Re: Cardiac surgery in the Pacific islands

机译：回复：太平洋岛屿的心脏外科

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I would like to comment on this paper concerning 'Cardiac surgery in the Pacific Islands'.This excellent and frank analysis of the problems of 'off-shore' cardiac surgery reminds me of my unit's similar involvement in Vanuatu, Fiji and Mauritius 30 odd years ago. Certain crucial issues were recognized early in our experience and might be compared with those mentioned by Davis and his associates.Evaluation of results was controlled by the same criteria that affected our triage of patients for surgery. By and large, 'productive', adult patients were preferred by referrers, regardless of clinical interest or treatment simplicity. Proximity to urban resources was fundamental in long-term (beyond hospital) care such as for clinical review, International Normalised Ratio management and general drug regimes. The latter two needs are highly undesirable. Wound healing problems require expert attention, safe Warfarin management is impossible (as it is with safety and effectiveness in 50% of all patients worldwide) and prophylactic penicillin programmes rarely provide consistent, effective coverage against rheumatic pathology.'Primitive' patients exclude themselves unless their treatment is immediately curative.
机译：我想对这篇有关``太平洋岛屿的心脏外科手术''的文章发表评论。对``离岸''心脏外科手术问题进行的出色而坦率的分析使我想起了我所在单位在瓦努阿图，斐济和毛里求斯30多年的类似经历前。某些关键问题在我们的经验中很早就得到了认可，可以与戴维斯及其同事提到的那些问题进行比较。结果的评估受影响我们手术患者分流的相同标准控制。总体而言，无论临床兴趣或治疗简便性如何，推荐人都首选“生产性”成年患者。靠近城市资源是长期（医院以外）护理的基础，例如临床检查，国际标准化比率管理和一般药物治疗。后两个需求是非常不希望的。伤口愈合问题需要专家的关注，无法进行安全的华法林管理（全球50％的患者都具有安全性和有效性），并且预防性青霉素治疗方案很少能提供一致，有效的风湿病理学治疗。治疗立即可治愈。

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