bluuebunny/crossref_metadata_2025 huggingface dataset:
SE05 GENERATING A MODEL TO EXPLORE DECISION MAKING IN AN ACUTE SURGICAL SETTING
Authors: Rennie S. C. , Vanrij A. , Hall K. , Theis J.‐C.
Published: April 2009

Purpose:   There is no current research in surgery that articulates what constitutes good or poor decisions in acute management of a surgical patient. The aim of this study was to define good and poor decision making to facilitate the teaching, learning and assessment of surgical trainees’ decision making skills.

Methodology:   A qualitative web‐based survey was delivered to global experts in Surgery, Medical Education and Cognitive Research. Half the participants were asked to list features of a good decision, characteristics of a good decision maker and essential factors in developing good decision making skills. The rest of the participants were asked to consider the same areas related to poor decision making. The free text responses were collated and grouped into themes.

Results:   29 (52%) experts responded. The free text comments for good and poor decisions were predominantly the inverse of each other. However some of the features of a poor decision included qualified statements; e.g. timing was important but some respondents felt a poor decision was characterised by being too slow and others by being too fast. The relationship between themes was considered and a model generated to illustrate acute surgical decision making. The model is composed of three major layers –central is the decision process, surrounded by the decision maker and the decision environment. Each of these three layers is compiled of sub layers. From this model a second model was generated to consider how factors important in decision making might interact in real life.

Conclusion:   Understanding decision making is vital for training surgeons. These models enable the factors that constitute decision making to be mapped in detail.
SE08 PROSPECTIVE CONTROLLED STUDY OF THE EFFECTIVENESS OF STRUCTURED TRAINING IN ULTRASOUND GUIDED PERCUTANEOUS BREAST NEEDLE BIOPSY
Authors: Law M. T. , Bennett I. C.
Published: April 2009

Effective training is essential to ensure satisfactory performance in surgeon performed ultrasound (US) guided breast needle biopsies. We aim to determine the efficacy and optimal format of structured training in US breast biopsy.

Method:   Consenting participants of the US for Surgeons Workshop at the General Surgeons Australia 2008 Annual Scientific Meeting were recruited. Theory assessment included a brief pre‐test (control), lecture series then a post‐test. Practical assessment involved US biopsies using turkey phantoms implanted with simulated lesions (olives). Pre‐instructional biopsies were assessed, followed by structured instructions by qualified instructors and concluded with post‐instructional biopsy assessment. Points rewarded for successful biopsies (defined criteria) and deducted for simulated chest wall hits (complications). Previous experience and training in US biopsy were recorded. Pre and post lecture/instructional results were compared and correlation tested using Student's t‐test (significance: p < 0.05).

Results:   14 participants recruited: 93% had none to moderate experience with US biopsies. Theory component: 27.4% improvement over pre‐test (p < 0.001). Practical component: 26% improvement after instruction (p = 0.004); improvement most marked in the group with moderate experience (38%, p = 0.003). No chest wall hit were recorded following instructions.

Conclusion:   Structured workshop is an effective tool in the training of US guided breast biopsy. Both theory & practical components demonstrated similar efficacy and should be considered integral components in training programmes. More importantly formal training may decrease potential complication rate, especially for the less experienced.
SH17 FRACTURE FIXATION THROUGH THE AGES
Authors: Yeoh T. S. , Tan J. S.
Published: April 2009

Throughout the ages, immobilisation has been flagged as a key ingredient for successful fracture management. The means by which this is achieved, however, and the duration of immobilisation have changed greatly, and are examined in this article.

The first man to describe the reduction and immobilisation of fractures was the Ancient Egyptian Imhotep around the time of 3000 BC. He wrote about fixation using wooden splints and bandages for at least two to three months, which undoubtedly successfully treated the fracture, but at the expense of sacrificing soft tissue integrity. The same mistake continued for centuries, with casts being made of widely varying materials including stone, cardboard and linen dipped in egg white, resins and even blood to achieve rigidity. It was not until the early 19th century when the famous military surgeon Seutin popularised the belief that prolonged immobilisation and bed rest was actually detrimental to fracture healing, and he advocated early mobilisation in starch bandages.

This was soon followed, in 1852, by the development of the Plaster of Paris cast as we know it, by Matthysen. He described strips of coarse meshed cotton, rolled in plaster and wet, to allow rapid moulding around a fracture site – a property of great importance on the battlefield.

Whilst operative techniques of fixation have developed and progressed from these times, little has changed in terms of casts. It seems that Paré may have been right after all, when he wrote ‘I dress it, but God cures it’.
SH18 BARBER‐SURGEONS: A DOOMED GUILD OF MASTERS AND MISTERS IN THE MIDDLE AGES
Authors: Bernardi M.‐P. , Watters D.
Published: April 2009

In the Middle Ages, a Papal edict by Innocent III (1215) forbade physicians, mostly clerics, from performing surgical procedures considered ‘contaminating’. The clerics handed over their surgical responsibilities to the barbers, hence the advent of Barber‐Surgeons. Surgery was relegated to the status of a manual trade, acquired by apprenticeship, designed to maintain a monopoly on services provided, but also to ensure standards.

This paper reviews the reasons for the eventual separation of barbers and surgeons across Europe during the thirteenth to eighteenth centuries. The guilds advanced their professions and grew in reputation and influence forming Companies. James VI granted a royal charter for a Barber‐Surgeons Company in Edinburgh (1505) and Henry VIII approved an act of parliament to establish a Barber‐Surgeons’ Company in London (1540).

However, within the guilds of Barber‐surgeons existed a pervasive dichotomy, fueled by the surgeons’ growing knowledge of anatomy and development of practical skills. Outside the guilds, Lanfranc of Milan (died 1315), Henri de Mondeville (France 1260–1320), Guy de Chauliac (France 1300–1368) and Vesalius (Padua 1514–1564) held discriminatory views towards Barber‐surgeons, but produced great surgical advances. Ambrois Paré (1510–1590), a French military surgeon, revolutionised the surgery of wounds based on observation, results and practical experience. During the 18th century most guilds dissolved under pressure imposed by their own surgical graduates, including William Cheselden in London.

The Middle Ages was a crucial period in which surgical knowledge evolved far beyond the teachings of Galen. There was no longer any place for Barbers in the Companies of Surgeons.
SH21 ABRAHAM LINCOLN – A MAN OF PATHOLOGICAL STATURE
Authors: Merry C. J. , Ross V. K.
Published: April 2009

Abraham Lincoln, born 1809, died 1865, was the 16th President of the United States. Leading the US through the civil war and the reconstruction and reunion that followed, he is rightly regarded as one of America's greatest presidents.

However, he also provides a fascinating medical mystery, as anyone who has seen his heavy browed gaze will attest. Despite suffering from a number of ailments including frostbitten feet, malaria and smallpox he may also have had syphilis.

It is his stature, standing 1.95 metres that has promoted the argument that he suffered Marfan's syndrome. More recent investigation has proposed that he in fact was a sufferer of Multiple Endocrine Neoplasia.

Despite his longevity, his death shortened by an assasin's bullet, he exhibits a number of signs of the disease.

This presentation will examine the pathology surrounding this great man, in the era of DNA analysis and ask would America have elected him today?
SO10P CRITICAL ASSESSMENT OF PREOPERATIVE AND OPERATIVE RISK FACTORS FOR COMPLICATIONS AFTER CYTOREDUCTIVE SURGERY AND PERIOPERATIVE INTRAPERITONEAL CHEMOTHERAPY FOR PSEUDOMYXOMA PERITONEI
Authors: Yan T. D. , Morris D. L. , Saxena A.
Published: April 2009

Background:   Cytoreductive Surgery (CRS) combined with peri‐operative intraperitoneal chemotherapy (PIC) has demonstrated improved survival in selected patients with pseudomyxoma peritonei (PMP). This treatment modality was associated with relatively high rates of peri‐operative morbidity and mortality in the past. This study evaluates the clinical and treatment‐related risk factors for peri‐operative morbidity and mortality in PMP patients who underwent CRS and PIC.

Methods:   One hundred and thirty‐six consecutive CRS and PIC procedures for PMP were evaluated. The association of twenty‐four clinical and treatment‐related risk factors with grades III and IV/V morbidity were assessed by univariate and multivariate analysis.

Results:   The mortality rate was 4%. The grades III and IV morbidity rates were 21% and 23%, respectively. Multivariate analysis showed 2 significant risk factors for grade IV/V morbidity: ASA > 3 (p = 0.008) and an operation length > 10 hours (p < 0.001).

Conclusions:   Patients with extensive comorbidity who undergo a long cytoreductive procedure are at a particularly high risk of a severe adverse event. Preoperative evaluation of patients is necessary to improve peri‐operative outcome.
SO11P CYTOREDUCTIVE SURGERY AND INTRAPERITONEAL CHEMOTHERAPY FOR PERIOTONEAL MESOTHEMLIOMA
Authors: Zhu J. C. , Yan T. D. , Morris D. L.
Published: April 2009

Purpose:   Peritoneal mesothelioma is a rare malignancy regarded as a preterminal condition with few therapeutic options. The aim of this study is to report the results of 25 patients with diffuse peritoneal mesothelioma treated with cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC).

Methodology:   From 1999 to 2008, the clinical and treatment‐related data of 25 patients with primary peritoneal mesothelioma who underwent CRS and IPC were reviewed from a prospective database. The CRS was performed by using peritonectomy procedures and the IPC was performed using Cisplatin, Mitomycin C at 42 degrees Celsius for 90 minutes by using the Coliseum technique.

Results:   The peri‐operative mortality rate was 4%. The morbidity rates were was 36%, with grade 1 and 2 complications in 9 patients, grade 3 complications in 7 patients and grade 4 complications in 4 patients. The median follow‐up was 15 months (range: 1–89 months). The overall patient median survival after cytoreduction and peri‐operative intraperitoneal chemotherapy was 30 months. The 1‐, 2‐ and 3‐ year actuarial survival was 77%, 61% and 49% respectively. On univariate analyses, the histopathology subtype (p = 0.007) and completeness of cytoreduction (p = 0.013) were identified to be significant prognostic factors for overall patient survival.

Conclusion:   CRS and IPC for diffuse peritoneal mesothelioma can be performed safely with acceptable morbidity and mortality rates. Compared to historical controls, CRS and IPC have demonstrated improved survival in selected patients. The completeness of cytoreduction and histological subtype were demonstrated to be the major determinants of survival.
SO13P META‐ANALYSIS OF IRINOTECAN MOLECULAR TARGETED SECOND LINE CHEMOTHERAPY IN ADVANCED COLORECTAL CANCER
Authors: Weekes J. M. , Ho Y.‐H. , Sabesan S.
Published: April 2009

In 2001, the lifetime risk of developing colorectal cancer (CRC) in Australia was 1 in 17 men and 1 in 26 women. Most patients with CRC undergo surgical resection and then commence adjuvant chemotherapy, except for stage A and some stage B cancers which avoid chemotherapy. Of the 46% of patients that develop recurrent or metastatic CRC, Oxaliplatin and 5‐Fluorouracil combined are the most extensively used first line treatment, with a response in 50–55% of patients. If the cancer progresses, Irinotecan is commenced, with 12–17.1% of patients responding. The aim of this review is to identify advanced CRC molecular markers that predict response to irinotecan in order to recommend treatment options for patients and to reduce morbidity. OvidSP, Proquest, Science Direct, PubMed, the ABS and the NHMRC were searched for literature between 1980 and 2009 on the treatment of advanced CRC with Irinotecan with specific focus on p53, VEGF and á‐B‐crystallin. Results: Phase II and III clinical trials conclude irinotecan improves pain free survival (p = 0.003), quality of life, one year survival, progression free survival (p = 0.030) and overall survival (p = 0.0001) in metastatic CRC. Irinotecan sensitizes p53 wild type, mutant and null cells to Fas‐mediated cell apoptosis in CRC cells (p < 0.001). Wild type p53 cells were more sensitive to irinotecan than mutated p53 (log rank test p = 0.05, p = 0.0004 respectively). Irinotecan has an anti‐VEGF effect inhibiting endothelial cell proliferation, increasing apoptosis and reducing microvascular density which is only limited by the irinotecan toxicity levels. There is currently no information correlating á‐B‐crystallin in CRC and irinotecan.
SO06 ADJUVANT RADIATION SHOULD BE CONSIDERED IN STAGE III MELANOMA
Authors: Burmeister B.
Published: April 2009

Radiation therapy has several roles in the management of stage III melanoma. Perhaps the most controversial is in the post‐operative setting where several retrospective studies and one prospective trial have suggested that radiation therapy results in a reduction in regional recurrence. On the basis of this and the fact that late toxicity is not increased, many cancer centres have adopted the use of radiation therapy in “high risk” patients with large nodes, multiple node involvement and the presence of extracapsular extension.

The benefit of radiation therapy for this indication remains to be proven in a randomised trial and the outcome of the Trans Tasman Radiation Oncology group/Australian and New Zealand Melanoma Trials Group in settling this question is awaited. At the present time the only clear indications for post‐operative radiation therapy are in those patients where the dissection may reveal an inadequate number of dissected nodes, those with positive margins, tumour spill at surgery or where disease has already recurred after a previous dissection. The area which is gaining more interest is the role of radiation therapy in the pre‐operative setting for bulky, tethered or fixed nodal disease where the use of such therapy can not only result in significant reduction in tumour volume, thus aiding resection, but also separate out patients at high risk of metastatic disease where a major operation may be counterproductive to quality of life.

If patients having this approach do develop distant metastases during or shortly after receiving radiation therapy, they may still obtain reasonable palliation with the use of such local therapy.
TN01 A NOVEL SURGICAL TECHNIQUE OF SIMULTANEOUS RAT HEART, THYMUS AND VASCULARISED BONE MARROW TRANSPLANTATION ON THE SAME VASCULAR PEDICLE
Authors: Kubitskiy A. , Bishop A. G.
Published: April 2009

Purpose:   Currently organ transplant patients require life‐long treatment with powerful immunosuppressive drugs to prevent rejection. An alternative is to use either the donor thymus or bone marrow to promote acceptance without requirement for immunosuppression and such approaches have been partially successful. The aim is to combine both donor thymus and vascularised bone marrow transplantation to promote heart transplant acceptance in a rat model where the heart alone is rejected.

Methods:   Combined transplantation of the heart, thymus and sternum bone on the common vascular pedicle was performed between completely MHC matched transplants (Lewis strain donor to Lewis recipient) (n = 5) and completely mismatched (PVG to DA) (n = 3) rats. Transplant survival was checked by manual palpation of the transplanted heart to monitor heart beat.

Results:   All animals survived >120 postoperative days. Heart transplant survive time in syngeneic rats (Lewis to Lewis) was >120 days in all cases. However, in the completely mismatched (PVG to DA) transplants there was no significant difference between the simultaneous transplantation of the heart, thymus and bone marrow (survival times of 6, 7, 10 days), com‐pared with survival of the transplanted heart alone (survival times of 8, 8,9,9,10,11 days).

Conclusion:   The new method of the vascularised heart, thymus and sternum transplantation is surgically successful as demonstrated by the prolonged survival of syngeneic hearts, although this treatment alone did not prolong survival of mismatched hearts. The method provides a model for the manipulation of donor and recipient T cells which could provide a novel approach to inducing transplant acceptance.
TN05 QUALITY ASSESSMENT OF THE ORGAN DONOR RETRIEVAL PROCESS
Authors: Allen R. D. , Azanza M. , Wills T. , Crawford M. , Pleass H. , Verran D.
Published: April 2009

Organ procurement surgery is a nocturnal pursuit with inherent risk of surgical misadventure. A single deceased donor organ procurement service was established in NSW to simplify retrieval of abdominal organs for transplantation in 17 Australian centres. An Organ Retrieval Report Form (ORRF) was created as a communication tool to facilitate identification of systemic problems.

Methods:   The surgical technique was standardised. ORRF were distributed with each kidney, liver, liver lobe and pancreas and returned to a data co‐ordinator. Identified problems were collated and reviewed by medical advisors. Fisher's exact test was used.

Results:   Compliance with ORRF return was 98%. 662 abdominal organs from 229 donors (10.4% DCD) were transplanted in 4 year period from July 2004. 18 organs were deemed unsuitable for transplantation, with 3 for avoidable reasons. Donor surgeons reported an iatrogenic injury to kidney and liver vessels in 7.4% (n = 13) and 4.4% (n = 5) of donors respectively (p = 0.45). The annual rate of donor surgeon recognition of injury increased with time from 5 to 14% (p = 0.067). Transplanting teams reported problems in an additional 23% of donors. Combining donor and retrieval reported data, structural injury occurred in 12.3% of kidneys, no pancreases (p = 0.008) and 4.8% of livers (p = 0.003). The rate of injury did not improve with time.

Conclusions:   The ORRF proved a valuable quality tool. Transplanting centre evaluation served to strengthen of retrieval protocols. The significant disproportion of kidney versus liver donor related injuries, dictated that the senior surgeon remained with the donor until removal of all donor organs rather than retreating to the back table after liver retrieval.
TS11 *ACUTE INTERNAL FIXATION OF PELVIC RING FRACTURES: SAFE AND EFFICIENT
Authors: Enninghorst N. , Toth L. , King K. , Evans J. , Balogh Z.
Published: April 2009

Background:   High energy pelvic ring fractures often occur on polytrauma where staged surgery is recommended. The purpose of this study was to evaluate the safety and efficacy of acute pelvic ORIF which is still controversial.

Methods:   45‐month retrospective review was performed. All high energy trauma patients requiring internal fixation were included. Patients were acute ORIF (<24 hrs) or late ORIF (>24 hrs). Demographics, ISS, pelvic AIS, 24 hrs pack cell transfusions, physiological parameters, time to OT, angiography requirement, LOS and mortality were recorded. Data is presented as mean ± SD or percentages. Statistical significant was at *p < 0.05.

Results:   Forty‐six patients met inclusion criteria, seventeen patients had acute definitive ORIF (5.5 hrs to OT) and twenty‐nine late definitive ORIF (5 days to OT). Demographics, (age: 48 ± 22 years vs. 40 ± 14, gender: 82% vs. 79% males), injury severity (ISS: 30 ± 18 vs. 24.5 ± 13, pelvic AIS: 3.7 ± 1 vs. 3.4 ± 1.1) and 24 hrs transfusion requirements (4.7 ± 5 U vs. 6.6 ± 4 U) were not statistically different between groups. Initial shock parameters were significantly worse in the acute group (*SBP 69.7 ± 17 vs. 108 ± 21, *BD −7.35 ± 4 vs. −4.9 ± 1.5, *Lactate 6.67 ± 7 vs. 2.51 ± 1.3). Angiography was used in 18% (3/17) vs. 21% (6/29) of the cases. All acute ORIF patients survived and one (3%) of the delayed ORIF patients died. The shorter hospital LOS was not significant (25 ± 24 vs. 37 ± 32 days) while the ICU LOS was similar 12/19 patients with 2.9 ± 2.5 days vs. 15/27 patients with 3.7 ± 3.6 days).

Conclusion:   Acute ORIF of unstable pelvic ring fractures could be performed even in severely shocked polytrauma patients. It did not lead to increased ICU LOS and could decrease the hospital LOS.
TS02 IMPROVING THE OSTEOPOROSIS CARE GAP IN ELDERLY PATIENTS FOLLOWING HIP FRACTURES FOR THE ICHIBAN INITIATIVE
Authors: Lai C. C. , Mak J. C. , Shen Q. , O’rourke F. , Chan D. K.
Published: April 2009

Problem:   There are low rates of treatment of osteoporosis following hip fractures in the elderly.

Design:   Controlled before‐after trial of the ortho‐geriatric‐led ‘ICHIBAN’ program. Data were collected by a blinded observer in 2 phases: over the year before and 10‐months following intervention. The data is collected from orthopaedic wards in a large metropolitan hospital.

Improvement Measures:   Rate of measurement: 25‐hydroxyvitamin levels (25‐OHD), thyroid‐stimulating hormone (TSH), and parathyroid hormone (PTH). Prescription of osteoporosis medications (vitamin D, calcium supplements, oral bisphosphonates). Documentation of rationale for non‐prescription.

Conclusion:   Three‐hundred‐and‐fifty‐two patients presented during a period of 22‐months: 202 during 12‐months prior to and 150 in the 10 months following intervention. Investigation of 25‐hydroxyvitamin levels increased from 31.6% to 71.2%, focused tests for secondary osteoporosis (TSH, PTH) from 9.4% to 37.1%, prescription of osteoporosis medications improved from 40.1% to 78.2% for vitamin D, 41.3% to 75.6% for calcium supplements and 34.8% to 53.8% for oral bisphosphonates (p < 0.001). Ninety percent documented rationale for non‐prescription of treatment. A 6‐month follow‐up of the first 60 patients following intervention showed that 51.6% were still on appropriate treatment. The ICHIBAN program has improved delivery of osteoporosis care to appropriate at‐risk patients following hip fracture.
TS03 *THE EFFICACY AND SAFETY OF PROPHYLACTIC VENA CAVA FILTERS AFTER MAJOR TRAUMA
Authors: Batty L. M. , Dowrick A. S. , Bailey M. , Lyon S. M. , Liew S. M.
Published: April 2009

Purpose:   Despite increasing use of vena cava filters (VCFs) for pulmonary embolism (PE) prophylaxis after trauma, there is continued debate regarding their safety and efficacy.

Methods:   Prospectively collected data from The Alfred Hospital's trauma registry were used to identify all major trauma patients admitted between 1/7/2001 and 1/7/2008. These data were matched to data from the Department of Radiology's VCF Database.

Results:   6,344 major trauma patients were treated during this period with 73.2% male, mean age of 44.2 ± 21.0 SD, 90.2% with a blunt mechanism of injury and mean ISS of 24.3 ± 12.0 SD. Of these patients, 511 (8.1%) received prophylactic VCFs (inserted in absence of PE) at the discretion of the treating clinician. There were 45 PE (0.71%), 2 of which were fatal. Three variables were independently associated with the occurrence of PE in a multivariate logistic regression model: presence of prophylactic VCF (OR 0.28; 95%CI 0.09–0.89); number of injuries to the AIS body region lower limb (OR 1.31; 95%CI 1.17–1.47) and central venous catheterization (OR 1.87; 95%CI 1.88–6.17). Data were available on the VCF database for 429 of the 511 patients with VCFs (84.0%). The mean time to prophylactic VCF insertion was 3.6 ± 0.2 SEM days after admission. The VCF major complication rate was 2.6% (n = 11), including 4 non‐fatal PE. The technical success rate for retrieval was 92.4% (279 retrievals from 302 attempts) and the overall retrieval rate was 65.0% (279 retrievals from 429 placements).

Conclusion:   Prophylactic VCFs are associated with a reduced rate of PE when used in selected major trauma patients. In addition, prophylactic VCFs have a low major complication rate and high rate of technical success for retrieval.
TS08 *SIMPLE AND EFFECTIVE PROGNOSTIC CRITERIA DAMAGE CONTROL PROCEDURES
Authors: Collete silva F. S. , Bardella R. , Garcia D. , Poggetti R. S. , Birolini D. , Rasslan S.
Published: April 2009

To identify patients in whom damage control surgical procedures alone were not sufficient to achieve acceptable mortality rates.

Methods:   Hospital charts of trauma patients from October, 2004 to March, 2007, analyzed by: trauma severity indices, hemoglobin level, pH, PaO2, and bicarbonate level. Kruskal Wallis test and multiple comparison tests based on Z value (p ≤ 0.05).

Results:   37 patients were study. Mean age 34.7 ± 16.3 years (89% male). Blunt trauma was the most frequent (84%). They were divided into three groups according with death: Group I: mortality <24 h (n = 17), Group II: mortality >24 h (n = 5), and Group III: survivors (n = 15).

Prognostic variable by group

RTS I: 4.22 ± 2.39, II 5.22 ± 2.46; III: 7.17 ± 0.85 p = 0.0005. ____ISS I: 35.71 ± 11.05; II: 25.80 ± 11.08; III: 24.87 ± 10.55 p = 0.0268. ____TRISS I: 46.98 ± 35.40 II: 71.20 ± 35.54; III: 90.05 ± 20.56 p = 0.0004____GCS: I: 6.71 ± 4.37; II: 7.60 ± 6.31; III: 12.73 ± 2.81; p = 0.0017____Hemoglobin I 7.44 ± 3.80; II: 9.25 ± 3.54; III: 9.02 ± 3.36 p = 0.7555____pH: I: 6.96 ± 0.09; II: 7.10 ± 0.10; III: 7.15 ± 0.14 p = 0.0425____PaO2: I: 159.33 ± 58.35; II: 140.75 ± 82.40; III: 244.39 ± 92.39 p = 0.0231____Bicarbonate: I: 9.55 ± 0.98; II: 16.70 ± 2.28; III: 15.70 ± 4.32 p = 0.0045

Patients who died <24 h presented higher injury severity scores RTS, ISS, TRISS, Glasgow Coma Scale, and more severe metabolic disturbances than survivors. Among patients who survived at least 24 h, control of bleeding and of metabolic disturbances was effective in 95% of cases (only one death due to hemorrhage).

Conclusion:   severity indices and metabolic changes seem to correlate with the outcome of severe trauma patients subjected to surgical damage control procedures.
TS09 TOWARDS A TRAUMA‐LESS TIMOR‐LESTE: AN EXPLORATION OF HOSPITAL‐BASED TRAUMA CARE IN TIMOR‐LESTE USING THE ‘WHO‐IATSC’ ESSENTIAL TRAUMA CARE GUIDELINES
Authors: Sullivan K. H. , Gillies R. , Zwi A.
Published: April 2009

Purpose:   To describe current management of hospital‐based trauma care in Timor‐Leste from both a national and clinical perspective and evaluate the use of the WHO Essential Trauma Care Guidelines (EsTCG).

Methodology:   Nationwide mixed‐methods study consisting of 3 stages. Stage 1 consisted of 5 in‐depth interviews with Ministry of Health officials. Stage 2 involved quantitative audits of all 6 hospital facilities in Timor‐Leste, supplemented by 25 semi‐structured interviews with administrative and clinical staff involved in trauma care. During Stage 3, results from Stage 2 were presented to participants and findings discussed. Likert scale evaluation of the process was then completed by stage 2 participants to ascertain the value of the EsTCG in Timor‐Leste.

Results:   Interviews revealed that while some elements of a trauma systems approach were present, there was no national coordination. At the hospital level, limited human resources and lack of organized approaches to trauma care severely impacted upon injury management. The audit suggested that while necessary equipment was often present, commonly it was not in working order, and specific weaknesses in capabilities for rehabilitation and blood transfusion were also noted. Participants generally felt that the EsTCG were effective in identifying these deficiencies and possible solutions.

Conclusion:   The EsTCG were useful in identifying national and clinical weaknesses in trauma care and may provide a framework for trauma system development in the future. However, the local context must be considered before applying recommendations in standard guidelines such as the EsTCG to ensure a “one size fits all” approach does not ensue.
VS06 DIAGNOSTIC IMAGING: ISSUES RELATED TO THE NEXT PHASE OF ACCREDITATION
Authors: Bourke B. M.
Published: April 2009

All diagnostic imaging practices claiming Medicare benefits for items covered by the Radiology Memorandum of Understanding (this includes services provided by vascular surgeons: vascular ultrasound and angiography) need to have registered with one of 4 designated Accreditation Providers and to have achieved Stage 1 accreditation by June 30 this year. The government has recently formed a Consultative Working Group (CWG) to commence proceedings regarding stage 2 of the Accreditation process and I have accepted their nomination to represent both RACS and ANZSVS on this group after seeking approval from the respective Presidents of RACS and ANZSVS. Between the time of submission of this abstract and the presentation of this paper there will have been two teleconferences and one face to face meeting of the CWG in Canberra. An update will be presented.
WS01 THE SWIM (SURGEONS AND WOMEN'S INITIATIVE TO MENTOR) PROGRAM
Authors: Nichevich A. , Ellis C. , Saunders C. M.
Published: April 2009

Background:   There is a notable disparity between female representation in undergraduate medical courses and surgical faculty. The authors investigated the factors that influence female surgeons’ career choices and decisions to pursue academia. Role models and mentors strongly influenced respondent's surgical career choices and progression. Under‐exposure to same‐sex role models and a lack of available mentors in academic surgery were identified as barriers to pursuing academic careers (1).

Aim:   To pilot SWIM as a formal, surgical mentorship program targeting young female surgical trainees in Western Australia from March through November, 2009, with a view to long‐term continuation.

Objectives:   The goals of SWIM are to establish a professional network of female surgeons in WA; mentor and guide female surgical trainees; raise the profile of women in academic surgery; encourage female surgical trainees to participate in health and medical research; increase the number of female academic surgeons within the School of Surgery at the University of Western Australia.

Methods:   Participants briefed and paired; regular, face‐to‐face meetings; relationship driven by the trainee; guest speaker evening; networking breakfast; e‐newsletter; annual research publication award.

Expected Outcomes:   Participation will result in surgical trainees gaining support and career advice whilst building professional networks; mentors gaining personal satisfaction, identifying protégés for future collaboration and broadening their skill sets; the promotion of gender equity and diversity within the UWA School of Surgery.
Role of GABAAreceptors in the physiology and pharmacology of sleep
Authors: Winsky‐Sommerer Raphaëlle
Published: April 2009

Most sedative‐hypnotics used in insomnia treatment target the γ‐aminobutyric acid (GABA)Areceptors. A vast repertoire of GABAAreceptor subtypes has been identified and displays specific electrophysiological and functional properties. GABAA‐mediated inhibition traditionally refers to ‘phasic’ inhibition, arising from synaptic GABAAreceptors which transiently inhibit neurons. However, there is growing evidence that peri‐ or extra‐synaptic GABAAreceptors are continuously activated by low GABA concentrations and mediate a ‘tonic’ conductance. This slower type of signaling appears to play a key role in controlling cell excitability. This review aims at summarizing recent knowledge on GABA transmission, including the emergence of tonic conductance, and highlighting the importance of GABAAreceptor heterogeneity. The mechanism of action of sedative‐hypnotic drugs and their effects on sleep and the electroencephalogram will be reported. Furthermore, studies using genetically engineered mice will be emphasized, providing insights into the role of GABAAreceptors in mechanisms underlying physiological and pharmacological sleep. Finally, we will address the potential of GABAAreceptor pharmacology for the treatment of insomnia.
Evaluating scaling models in biology using hierarchical Bayesian approaches
Authors: Price Charles A. , Ogle Kiona , White Ethan P. , Weitz Joshua S.
Published: April 2009

Theoretical models for allometric relationships between organismal form and function are typically tested by comparing a single predicted relationship with empirical data. Several prominent models, however, predict more than one allometric relationship, and comparisons among alternative models have not taken this into account. Here we evaluate several different scaling models of plant morphology within a hierarchical Bayesian framework that simultaneously fits multiple scaling relationships to three large allometric datasets. The scaling models include: inflexible universal models derived from biophysical assumptions (e.g. elastic similarity or fractal networks), a flexible variation of a fractal network model, and a highly flexible model constrained only by basic algebraic relationships. We demonstrate that variation in intraspecific allometric scaling exponents is inconsistent with the universal models, and that more flexible approaches that allow for biological variability at the species level outperform universal models, even when accounting for relative increases in model complexity.
Influence of plant silicon and sugarcane cultivar on mandibular wear in the stalk borer Eldana saccharina
Authors: Kvedaras Olivia L. , Byrne Marcus J. , Coombes Neil E. , Keeping Malcolm G.
Published: April 2009

1 Silicon can increase the resistance of plants to attack by herbivorous insects. The present study aimed to determine the effect of silicon and cultivar on mandibular wear in larvae of the sugarcane stalk borer Eldana saccharina Walker (Lepidoptera: Pyralidae).

2 Four sugarcane cultivars, resistant (N21, N33) and susceptible (N11, N26) to E. saccharina were grown in a pot trial in silicon deficient river sand, with (Si+) and without (Si−) calcium silicate. Individual third‐instar larvae were confined on the sugarcane stalk at three known feeding sites (leaf bud, root band and internode) and left to feed for 21 days.

3 Eldana saccharina larval heads were mounted on stubs, with the mandibles oriented horizontally and photographed under a scanning electron microscope. Mandibular wear was measured from the digital images using a quantitative method.

4 Although there was a trend for increased wear in larvae that developed on Si+ cane, no significant effect of silicon, cultivar or site on mandibular wear of E. saccharina was shown.

5 This is the first study to accurately and quantitatively measure the mandibular wear of an insect fed on Si+ plants.
Distribution of the first metastatic lymph node in colon cancer and its clinical significance
Authors: Tan K. Y. , Kawamura Y. J. , Mizokami K. , Sasaki J. , Tsujinaka S. , Maeda T. , Nobuki M. , Konishi F.
Published: April 2009

Introduction  The pattern of distribution of lymph node metastasis in resected specimens of colon cancer has been rarely reported in the English literature. The aim of this study was to determine the location of the first metastatic lymph node, giving insight into the drainage pattern of colon cancer lymphatics.

Method  All lymph nodes in the mesentery of the resected specimen were carefully harvested and their precise locations documented. Patients with a single metastatic node in the resected specimen were included in the study.

Results  Ninety‐three patients with only one metastatic lymph node found on histology were studied. The mean number of lymph nodes per specimen was 22.3 (range: 8–72). The patients’ first metastatic node was not directly below the tumour in 48% of cases. The first metastatic node was found in the region either along the feeding vessels (skipping the pericolic nodes) or in the pericolic area outside 5 cm on either side of the tumour edge in 18% of cases. No factors were found to be predictive for lymph node metastasis occurring elsewhere other than in the pericolic region just below the tumour.

Conclusion  Although there has been recent resurgence of interest in using sentinel node biopsy to limit surgical dissection to facilitate minimally access and natural orifice surgery, the present study is a warning that this may compromise oncological clearance. Radical surgery should remain standard practice for colorectal cancer.
Risk factors of rectal cancer local recurrence: population‐based survey and validation of the Swedish rectal cancer registry
Authors: Jörgren F. , Johansson R. , Damber L. , Lindmark G.
Published: April 2009

Aim  Despite advances in rectal cancer treatment, local recurrence (LR) remains a significant problem. To select high‐risk patients for different treatment options aimed at reducing LR, it is essential to identify LR risk factors.

Method  Local recurrence and survival rates of 4153 patients registered 1995–1997 in the Swedish Rectal Cancer Registry were analysed. LR risk factors were analysed by multivariate methods. For LR patients the registry was validated and additional data retrieved.

Results  The 5‐year overall and cancer‐specific survival rates were 45% and 62% respectively. LR was registered in 326 (8%) patients. After R0‐resections for tumours in TNM stages I–III, LR developed in 10% of tumours at 0–5 cm, 8% at 6–10 cm and 6% at 11–15 cm above the anal verge. Preoperative radiotherapy (RT) reduced the LR rate irrespective of height [0–5 cm: OR 0.50 (0.30–0.83), 6–10 cm: OR 0.42 (0.25–0.71), and 11–15 cm: OR 0.29 (0.13–0.64)]. Patients without preoperative RT had significantly higher LR risk after rectal perforation [OR 2.50 (1.48–4.24)], and almost significantly decreased LR risk when rectal washout was performed [OR 0.65 (0.43–1.00)]. Preoperative RT prolonged time to LR but did not significantly influence the survival among LR patients. LR was an isolated tumour manifestation in 103 (39%) patients with validated LR.

Conclusion  Preoperative RT should be considered for rectal cancer also in the upper third of the rectum. Intraoperative perforation should be avoided, and rectal washout is indicated as valuable. Follow‐up for the detection of isolated LR is important. Extended follow up should be considered for patients treated with RT.
Chronic disease trends due to excess body weight in Australia
Authors: Atlantis E. , Lange K. , Wittert G. A.
Published: April 2009

Trends in chronic diseases provide insights into strategies required to improve population health. The authors determined prevalence and multiple‐adjusted population attributable risk (PAR) estimates of chronic diseases because of lifestyle factors among Australian adults between 1989–90 and 2004–5, accounting for demographic factors. Between 1989–90 and 2004–5, prevalence increased for diabetes (3.8–6.0%, P < 0.001) and high cholesterol (11.3–13.9%, P < 0.001), but decreased for high blood pressure (21.4–20.4%, P = 0.003) and cardiovascular disease (CVD, 6.2–5.4%, P < 0.001). Prevalence increased for body mass index (BMI) 25–29.9 (30.3–34.9%, P < 0.001), BMI 30–34.9 (7.4–13.5%, P < 0.001) and BMI 35+ (2.1–5.4%, P < 0.001), but decreased for metabolic equivalent‐hours per week (MET‐hr/week) 0 (36.8–33.1%, P < 0.001) and current smokers (27.6–24.4%, P < 0.001). Diabetes, high cholesterol and high blood pressure burden increased mostly for 60+ years, lowest income quintiles and high BMI (30–34.9 and 35+). Diabetes and CVD burden increased mostly for MET‐hr/week 0. Many chronic disease cases would have been theoretically prevented if adults had no prior exposure to BMI 25–29.9 (PAR 9–17%), BMI 30+ (PAR 1–14%) and MET‐hr/week 0 (PAR 6–14%). Reducing exposure to lifestyle hazards across the lifespan is required for reversing the rising burden of chronic diseases. Decreases in CVD and high blood pressure prevalence were likely due to targeted improvements in health care, indicating that more can and should be done.
REFRAINING AND THE EXTERNAL
Authors: Johns Brandon
Published: April 2009

It is usually taken for granted that the necessary and sufficient conditions for refraining are with respect to mental or behavioral states of agents. Let us call such accounts internalist conceptions of refraining. In this paper, I argue that internalist conditions are insufficient for refraining; and so internalist conceptions of refraining are inadequate. I conclude that a proper account of refraining must contain an externalist condition – i.e., a condition that makes reference to an agent's environment.
THE NATURE OF HOPE
Authors: Meirav Ariel
Published: April 2009

Both traditional accounts of hope and some of their recent critics analyze hope exclusively in terms of attitudes that a hoper bears towards a hoped‐for prospect, such as desire and probability assignment. I argue that all of these accounts misidentify cases of despair as cases of hope, and so misconstrue the nature of hope. I show that a more satisfactory view is arrived at by noticing that in addition to the aforementioned attitudes, hope involves a characteristic attitude towards an external factor, on whose operation the hoper takes the prospect's realization to depend causally.
Measles and the spatio‐temporal structure of modern Japan1
Authors: SUZUKI AKIHITO
Published: April 2009

This article explores the spatio‐temporal structure of infectious diseases in modern Japan, using measles mortality data from the late nineteenth and early twentieth centuries. Three aspects of the epidemiology of measles are discussed: the synchronization of epidemic waves, seasonality, and age at infection. These epidemiological analyses are connected to, respectively, regional integration, governmental policy on primary school education, and the number of young children in families. In addition, based on the fact that measles did not become endemic in early modern Edo (Tokyo), this article corrects epidemiologists' misunderstanding about the threshold of endemicity and argues that the critical population size varied substantially according to the societal factors of a given community. In so doing, this article suggests that historians can use measles data as a new biometric index for studying human health and socio‐economic conditions in societies of the past.
The Treasury, Britain's postwar reconstruction, and the industrial intervention of the Bank of England, 1921–91
Authors: CERRETANO VALERIO
Published: April 2009

This article describes how the Trade Facilities Act and the liquidation of certain government‐owned assets spurred the industrial intervention of the Bank of England in the 1920s. What emerges is that the Treasury had a much greater role in the Bank of England's industrial intervention than has been hitherto suggested. This article places the theme of the Bank of England's industrial intervention within broader discussions about Treasury history and Britain's postwar reconstruction, and refines the argument that the original involvement of the Bank of England with industry merely represented an extension of its prewar operations of branch banking and its duties as a central bank.
A Generalisation of the Mean‐Variance Analysis
Authors: Zakamouline Valeri , Koekebakker Steen
Published: April 2009

In this paper we consider a decision maker whose utility function has a kink at the reference point with different functions below and above this reference point. We also suppose that the decision maker generally distorts the objective probabilities. First we show that the expected utility function of this decision maker can be approximated by a function of mean and partial moments of distribution. This ‘mean‐partial moments’ utility generalises not only mean‐variance utility of Tobin and Markowitz, but also mean‐semivariance utility of Markowitz. Then, in the spirit of Arrow and Pratt, we derive an expression for a risk premium when risk is small. Our analysis shows that a decision maker in this framework exhibits three types of aversions: aversion to loss, aversion to uncertainty in gains, and aversion to uncertainty in losses. Finally we present a solution to the optimal capital allocation problem and derive an expression for a portfolio performance measure which generalises the Sharpe and Sortino ratios. We demonstrate that in this framework the decision maker's skewness preferences have first‐order impact on risk measurement even when the risk is small.
Does It Pay to Have the Euro? Italy's Troubled Politics and Financial Markets under the Lira and the Euro*
Authors: Fratzscher Marcel , Stracca Livio
Published: April 2009

There is a broad consensus that the quality of the political system and its institutions are fundamental for a country's prosperity. This paper focuses on Italy's troubled politics over the past 35 years and asks whether the adoption of the euro in 1999 has helped insulate Italy's financial markets from the adverse consequences of its traditionally unstable political system. We find that important political events have exerted a statistically and economically significant effect on Italy's financial markets throughout the 1970s, 1980s and 1990s. The introduction of the euro appears to have indeed played a major role in insulating financial markets from such adverse shocks. The findings of the paper therefore suggest another important economic dimension and channel through which Italy may have been affected by EMU. Our analysis could also be potentially interesting for other countries with weak institutions considering adopting a currency based on stronger institutions.
Why Fiscal Stimulus is Unlikely to Work*
Authors: Hassett Kevin A.
Published: April 2009

This paper reviews the empirical literature on countercyclical policy. It finds that three types of countercyclical policies have been studied in the literature: built‐in stabilizers, temporary policy changes and more permanent policy changes. The literature is decidedly mixed on the effectiveness of temporary changes, but more hopeful concerning the other two.
The extent of marketability and consumer preferences for traditional leafy vegetables – a case study at selected markets in Ghana
Authors: Quaye Wilhemina , Gyasi Osman , Larweh Patience , Johnson Paa‐Nii T. , Obeng‐Aseidu Patrick
Published: April 2009

This paper reports on a survey conducted at two major marketing centres in Ghana; Tamale in the dry savannah zone and Kumasi in the forest zone. One hundred traders were interviewed using a semi‐structured questionnaire and focus groups discussions held on traders’ perceptions and consumer preferences, relative importance and indigenous nutritional knowledge of traditional leafy vegetables (TLVs). The survey established that, with the exception of Xanthosoma mafafa (cocoyam leaves), inter‐market distribution of TLVs is limited because of their perishable nature, narrow utilization base and lack of storage techniques. Socio‐culturally related factors limiting the distribution of TLVs include regional diversity and ethnic differences in the dietary patterns of the Ghanaian populace, inadequate knowledge about the methods of preparations as well as nutritional and medicinal values of TLVs. The most preferred TLVs as reflected in the consumers’ buying behaviour and traders’ perceptions are Xanthosoma mafafa (cocoyam leaves), Corchorus spp.(Ayoyo), Amaranthus spp (Alefu) and Hibicus sabdariffa (Bra). The order of preference in the forest zone is Xanthosoma mafafa (cocoyam leaves) > Corchorus spp.(Ayoyo) > Amaranthus spp (Alefu) > Hibicus sabdariffa (Bra), while the reverse order pertains in the savannah zone.