bluuebunny/crossref_metadata_2025_split huggingface dataset:
GS13 SPOT MARKING FOR LAPAROSCOPIC COLECTOMIES
Authors: Smith S. R. , Cao C. 
Published: April 2009

Purpose:   Mechanical Bowel Preparation (MBP) is often used by surgeons for patients undergoing Laparoscopic Colectomy (LC) due to the concern that small lesions normally palpable at open surgery may not be seen at the time of laparoscopic surgery. This study sought to determine whether preoperative marking of the colonic primary at the time of colonoscopy with Spot® could overcome this concern.Methodology:   All patients suitable for a LC had Spot® marking performed at their colonoscopy. One millilitre of Spot® marking was injected submucosally in 3 positions around the circumference of the lumen at least 5 cm distal to the lesion. The first 100 LC performed by the surgeon for lesions were audited for the purpose of this study, and MBP was not used while all patients received preoperative immunonutrition.Results:   Overall mortality was 0%. The anastomotic leak rate was 2% (1 reoperation, 1 low output fistula). Conversion rate was 23%. Spot® marking was successfully identified at laparoscopy in all 100 cases. No cases were converted as a result of failure to identify the marking, however 1 case required an extension in the final incision due to the fact the Spot® marking had been placed proximal to the lesion. Anastomoses were performed “across” the Spot® marking on 3 occasions with no untoward effect.Conclusion:   Spot® marking is a safe and effective way to mark lesions in the colon in order to facilitate LC without the need for MBP.
GS20 *ADVERSE EVENTS IN GENERAL SURGERY
Authors: Kalogeropoulos G. , Watters D. , Brereton S. 
Published: April 2009

Background:   The rate of adverse events occurring in Australian hospitals is reported to be up to 12–17%. Adverse events need to be identified, reported and responded to if the system of health care is to be improved. The purpose of this study was to determine the rate and nature of adverse events (unintentional harm arising as a result of healthcare) in general surgery in the Geelong Hospital.Method:   A review was conducted of adverse events in the hospital incident reporting system (Riskman) and general surgical audits between 2004 and 2008. Adverse events were categorised according to severity (1–4) and the hospital response to these events noted.Results:   There were 888 adverse events arising in 12801 general surgical admissions (6.93%). Their severity assessment codes (SAC) were: catastrophic (0.15%),; major (0.40%),; moderate (2.22%),; and minor (4.30). Some of the complications reported in surgical audits were also adverse events, the major ones being mortality (0.74%), unplanned reoperation (1.27%) and unplanned readmission (1.46%). Identification and tracking of these enabled implementation of system changes. These included a colorectal outcome reporting, PreVENT program (for DVT prophylaxis), review of colonoscopy initiatives, bedside tracheostomy care, and an electronic system to respond to pathology results (TR3).Conclusion:   The adverse event rates occurring in general surgery at the Geelong Hospital were lower than those previously reported in the literature and may reflect a general improvement in the quality of care during the last decade if these rates are applicable to other hospitals. The hospital response to adverse events has resulted in significant sustainable system changes.
HP12 *ACTUAL 5‐YEAR SURVIVORS FOLLOWING OESOPHAGECTOMY AND PREDICTORS OF SURVIVAL
Authors: Hirst J. , Smithers M. , Gotley D. , Martin I. , Thomas J. , Barbour A. 
Published: April 2009

Purpose:   Oesophagectomy remains the mainstay of curative treatment for localised oesophageal cancer. Despite this there is a paucity of data reporting actual 5 year survivors following oesophagectomy. This study was undertaken to identify and characterise actual 5 year survivors who underwent oesophagectomy.Methods:   A prospectively maintained database identified 526 patients who underwent oesophagectomy from 1987 to 2008. Patients were followed for a minimum of 5 years or until death. Clinico‐pathologic factors associated with 5 year disease‐specific survivorship were analysed. Median follow‐up for all patients was 40 months.Results:   Median disease specific survival (DSS) was 32 months. Neoadjuvant therapy was administered to 248/526 (47%). There were 95/526 (18%) actual 5‐year survivors. On multivariate analysis, 5‐year survivors were significantly lower T stage, N stage and less likely to have received blood transfusion compared with patients who died less than 5 years after surgery. There were 76/526 (14%) patients with positive margins and of these 6 patients were 5 year survivors. Amongst 5‐year survivors, 41 (43%) had neoadjuvant therapy. Of the 95 5‐year survivors, 14 (14%) subsequently died of oesophageal cancer. The prognostic factors for DSS after 5 years were dysphagia or odynophagia at presentation. Stage was no longer a prognostic factor after surviving to 5 years.Conclusion:   No single clinico‐pathological variable negated survival to 5 years. Prognostication in 5 year survivors is difficult, but odynophagia and dysphagia at presentation are still active as prognostic factors after 5 years. The majority of 5‐year survivors can be considered cured of oesophageal cancer.
HP14 EVOLVING MANAGEMENT OF HIGH GRADE DYSPLASIA IN BARRETT'S OESOPHAGUS
Authors: Duong C. P. , Smithers M. , Thomas J. , Gotley D. , Martin I. , Barbour A. 
Published: April 2009

Background:   High grade dysplasia (HGD) in Barrett's oesophagus is a pre‐cancerous condition, where oesophagectomy eliminates the risk of malignancy but can incur significant morbidity. Endoscopic therapies and expectant surveillance have been increasingly adopted. Given that the timing of malignant transformation cannot be predicted, the optimal treatment for HGD is unclear and is evolving. This study aims to evaluate the outcome of a cohort of patients with HGD in Barrett's oesophagus.Methodology:   There were 84 patients with biopsy‐proven HGD treated at our institution between 3/1992 and 12/2008 documented prospectively onto a database. Records were reviewed for patient characteristics, presence of occult cancer, treatment and outcomes including operative mortality and morbidity, and malignant transformation.Results:   The primary treatment was oesophagectomy in 48 patients, endoscopic mucosal resection (EMR)/ablation in 18 and observation in 18. Following oesophagectomy, 19 (40%) had an occult invasive carcinoma. Following endoscopic therapy, (median FU 36 months), 2 patients were diagnosed with cancer requiring resection. In those patients observed, due to co‐morbidity or patient's choice, (median FU 74 months) 9 (50%) developed malignancy leading to resection (6), EMR (1) and radiotherapy (2). Following resection there was 1 death (2%) with 34 patients (62%) having a complication.Conclusion:   Resection of HGD is a curative treatment but post‐operative morbidity is not insignificant. Medium term outcome data for endoscopic therapies is encouraging but patients need long term careful follow‐up. Patients with HGD need to be fully informed of the different treatment options and their limitations.
HP21P HIGH‐FREQUENCY GASTRIC ELECTRICAL STIMULATION FOR THE TREATMENT OF GASTROPARESIS: A META‐ANALYSIS
Authors: O’grady G. , Egbuji J. U. , Du P. , Cheng L. K. , Pullan A. J. , Windsor J. A. 
Published: April 2009

Purpose:   High‐frequency gastric electrical stimulation (GES) is a relatively new treatment for medically‐refractory gastroparesis. There have been a number of clinical studies using a surgically‐implanted stimulator (Enterra, Medtronic, Minneapolis). A meta‐analysis was performed to evaluate the evidence for improved outcome.Methodology:   A literature search of major medical databases was performed for the period January 1992 to August 2008. Studies involving an implanted high‐frequency GES device were included and reported a range of clinical outcomes. Studies of external, temporary and/or low frequency GES were excluded.Results:   Of 13 included studies, 12 lacked controls and only one was blinded and randomized. Following GES, patients reported improvements in total symptom severity score (3/13 studies, mean difference 6.52 [CI: 1.32, 11.73], p = 0.01), vomiting severity score (4/13, 1.45 [CI: 0.99, 1.91], p < 0.0001), nausea severity score (4/13, 1.69 [CI: 1.26, 2.12], p < 0.0001), SF‐36 physical composite score (4/13, 8.05 [CI: 5.01, 11.10], p < 0.0001), SF‐36 mental composite score (4/13, 8.16 [CI: 4.85, 11.47], p < 0.0001), requirement for enteral or parenteral nutrition (8/13, OR 5.53 [CI: 2.75, 11.13], p < 0.001) and 4‐hour gastric emptying (5/13, 12.7% [CI: 9.8, 15.6], p < 0.0001). Weight gain did not reach significance (3/13, 3.68 kg [CI: –0.23, 7.58], p = 0.07). The device removal or reimplantation rate was 8.3%.Conclusion:   Results show substantial benefits for high frequency GES in the treatment of gastroparesis. However, caution is necessary in interpreting the results, primarily due to the limitations of uncontrolled studies. Further controlled studies are required to confirm the benefits of high‐frequency GES.
HP27P META‐ANALYSIS OF GLYCERYL TRINITRATE USE IN ERCP: EFFECTS ON TECHNICAL SUCCESS OF CANNULATION AND RATE OF POST‐ERCP PANCREATITIS
Authors: Maddock L. A. 
Published: April 2009

Background:   ERCP is a technically challenging procedure. Glyceryl Trinitrate [GTN] has been shown to reduce sphincter of Oddi pressure. Several randomized controlled trials have sought to assess the clinical effect of GTN in ERCP. The objective of this study is to assess in a meta‐analysis the benefit of routine GTN use in ERCP in cannulation success and post‐ERCP pancreatitis.Methods:   A comprehensive literature search was conducted using online databases PubMed, Medline and Cochrane database of randomised controlled trials. Studies included had to be randomised controlled trials of GTN use as in ERCP. The outcomes of interest were cannulation success and/or rate of post‐ERCP pancreatitis.Data Collection and Analysis:   Seven Randomised Controlled Trials were identified. Data was analysed using Cochrane Collaboration Review Manager software. Each study was weighted in accordance with its size and event rate. Outcome of interest from each study and pooled results had Risk Ratio and 95% confidence intervals calculated.Results:   A total of six studies and 1321 patients were analysed for effect on cannulation success. A pooled Risk Ratio of 0.66 [95% CI 0.43–1.01] represents a relative risk reduction of 34%, though not statistically significant. Four studies and a total of 854 patients were analysed for rate of post ERCP pancreatitis. A pooled Risk Ratio of 0.56 [95% CI 0.37–0.85] represents a significant relative risk reduction of 44%.Conclusions:   GTN administration in ERCP reduces the rate of post ERCP pancreatitis and may have a small benefit in cannulation success.
ML01 SURVIVING THE GLOBAL FINANCIAL CRISIS: THE OUTLOOK IS DISTURBING FOR MEDICAL INDEMNITY
Authors: Coman W. 
Published: April 2009

The world is faced with a recession. We can see three disturbing trends: (1) Insurers expect an increase in the number and size of claims, particularly in insurance, such as MI. (2) Investment returns will be lower as a result of lower interest rates and weaker equity markets. (3) All companies face reduced access to funding, as lenders become more reluctant to lend money.To survive these forces, insurers need to be well capitalised and to have effective risk and governance practices in place. No insurers will be immune to the adverse trends listed above. There are some specific issues facing MI insurers: (1) There is emerging evidence that the tort law reforms in MI are being watered down in interpretation, which would cause medical indemnity claims to increase rather than decrease in the future. (2) MI claims are long‐tail in nature, so it is critical that the insurer is strong enough that it will still be around when the claims need to be settled. (3) Because MI claims can be very large, it is important that the MI insurer holds adequate reinsurance, which is the principal way that insurers spread the risk that they take on.By their very nature, insurers are risk takers. However, risk must be properly managed. A good risk management approach forms a useful checklist for anyone seeking review of their insurer: (1) Active and effective underwriting ensures that an appropriate premium is charged for the risk being underwritten. (2) Use of pre‐eminent reinsurers ensures that policyholders can be confident that their claims can be paid.A low‐risk, absolute‐return investment strategy, with minimal exposure to equities, avoids adding risks. 3A strong track record and a listing on the ASX make it easier to raise further capital if so required.
ML03P CLINICAL HANDOVER: A NATIONAL AUDIT OF PRACTICE IN NEW ZEALAND HOSPITALS
Authors: Jenkins B. A. 
Published: April 2009

Purpose:   When the responsibility for care of any patient passes from one doctor to another, there must be a systematic and structured transfer of relevant information. This clinical handover must be performed well to ensure patient safety is protected. The audit's aim was to gain a snapshot of morning handover practice in New Zealand hospitals and to compare this to the inaugural audit of 2007.Method:   An eleven point questionnaire was sent to resident doctors across New Zealand. One questionnaire per handover on a specified date was to be completed and returned. Questions were related to the physical and technical support of handover as well as quality and integrity of the information handed over. This information was analysed and compared to the results of the initial audit.Results:   Seventy–five questionnaires across 16 District Health Boards (DHBs) were returned. In 2007 there were 190 across 18 DHBs. Across the two years, data has been collected for all NZ DHBs bar one. Most questions recorded an improvement overall, with the most dramatic improvement being handovers that were completed without interruptions for non–urgent tasks (9% 2007, 86% 2008).Conclusion:   This snapshot audit shows an overall improvement in the practice of handover. The full results have been tabled to the NZ Resident Doctors’ Association – DHB Memorandum of Understanding (MOU) Collaborative Committee to contribute to developing supporting national guidelines for handover. A further audit is planned for 2009 to continue assessment.
NS02 THE USE OF WW(TM) VENTRICULAR PORT FOR NEUROENDOSCOPY – A NOVEL DEVICE AND TECHNIQUE
Authors: Akil H. , Symons W. , Wickremesekra A. 
Published: April 2009

Purpose:   Peel‐away sheaths are widely used to facilitate the intracranial/intraventricular introduction of neuro‐endoscopes. They can be very cumbersome and can cause minor bleeding from the split edges of the sheath. We report on our experience of a WW(TM) ventricular port that we developed at Wellington Hospital.Methodology:   The stainless‐steel port is made to fit the 6 mm and 3 mm rigid and flexible neuro‐endoscopes. The port has an outer sheath and inner introducer with a central open channel at length from 1 to 7 cm. The proximal end has a fine adjustable stabilizing screw hat that sits on the outer table of the skull at the margins of the Burr hole. The port is inserted through a Burr hole to tap the ventricle and when cerebrospinal fluid is exiting the central channel, the introducer can be withdrawn and the neuro‐endoscope passed into the ventricle.Results:   We have been using this port for the past 4 years for 32 selected cases (25 ETVs, 4 arachnoid cysts, 2 colloid cysts and 1 septum pellucidum fenestration), and have not experienced device related complications. The port has the advantages of atraumatic insertion, stability on the skull, fine adjustability of length, repetitive withdrawal/insertion of the neuro‐endoscope through the port and a central channel for CSF tapping.Conclusion:   In our experience this novel ventricular port has proven to be a useful adjunctive device for neuro‐endoscopic procedure, and has the potential to be incorporated with image guidance techniques and as well as other intracranial procedures.
PR16 A PROSPECTIVE BLINDED RANDOMIZED CONTROLLED TRIAL OF COMMERCIAL VACUUM DRESSINGS VERSUS NON‐MECHANICAL TOPICAL NEGATIVE PRESSURE DRESSING FOR DAY SURGERY LOWER LEG SPLIT THICKNESS SKIN GRAFTS
Authors: Mcardle B. , Stradwick L. , Frank C. 
Published: April 2009

Purpose:   To show that ambulatory non‐mechanical negative pressure dressing results in equivalent graft take and survival compared with commercially available mechanical vacuum dressings.Methodology:   Twenty‐four patients, both males and female, between 18 and 95 years of age in the Australian population requiring skin grafting of the lower limb from July 2008 were randomized consecutively into commercial vacuum assisted ambulatory dressing group, KCI Freedom VAC, [VAC] and non‐mechanical topical negative pressure dressing group using 14 gauge drain [Belovac]. Patients were discharged on the same day of surgery and reviewed at 5 or 6 days post‐operatively. Both groups were treated equally in all other facets of care. The dressings remained intact until outpatient review. A photo of the graft was taken upon removal of the dressing. Graft take/survival was measured from these photographs by an experienced plastic surgeon blinded to treatment group.Results:   Graft take was found to be equivalent in both groups. All twelve patients in the VAC group were judged to have >95% graft take at five/six days post‐op. In the Belovac group all twelve were judged to have >95% graft take at 5/6 days. The cost for VAC group was $AUD413.50/478.50 [5/6 days] compared to $AUD55.93 for the Belovac dressing group.Conclusion:   We conclude that non‐mechanical topical negative pressure dressings are equally effective as commercially available VAC dressings in for the treatment of lower limb skin grafts. We recommend that non‐mechanical topical negative pressure dressing is an acceptable, cheap and safe alternative to commercially available dressings for day surgery patient.
PR28P ABDOMINAL WALL MORBIDITY FOLLOWING TRAM BREAST RECONSTRUCTION
Authors: Anesti K. D. , Avery G. , Armstrong J. R. , Tan S. 
Published: April 2009

Background:   The lower abdominal wall provides ideal autogenous tissue for breast reconstruction. Pedicled TRAM flap is associated with significant flap complication rates and donor site morbidity especially in bilateral reconstruction. Free TRAM flap, muscle sparing free TRAM and DIEP flaps have been used to reduce abdominal wall weakness.Aim:   To document abdominal wall function following breast reconstruction using pedicled TRAM, muscle sparing free TRAM, and DIEP flaps.Methods:   Consecutive patients who underwent breast reconstruction with pedicled TRAM, muscle sparing free TRAM or DIEP flaps were culled from our prospective breast reconstruction database 2004–2007. Each reconstructive technique used was favoured exclusively by individual surgeons within our unit. Patient demographics, the type/timing of reconstruction, and flap and donor site complications were recorded. Abdominal wall function was assessed pre‐operatively and at 6 and 12 months post‐operatively using the Lacote evaluation test. DASH and patient questionnaires were administrated to assess the effect of surgery on daily activities and patient satisfaction.Results:   s34 pedicled TRAM flaps were performed in 29 (24 unilateral, 5 bilateral) patients. There were 38 muscle sparing free TRAM flaps in 29 (20 unilateral, 9 bilateral) patients and 7 DIEP flaps in 7 patients. Abdominal wall function and complications will be presented.
PR30P DELIVERY OF ACUTE PLASTIC SURGICAL SERVICES IN A TERTIARY CENTRE
Authors: Usmar S. J. , She R. W. , Smith K. 
Published: April 2009

Purpose:   To (1) assess the accuracy with which acute plastic surgical caseload is predicted; (2) identify key factors which influence operating times; and (3) determine whether services are delivered in a timely manner.Methodology:   Data was collected prospectively for 200 patients presenting acutely to the Auckland Regional Plastic, Reconstructive and Hand Surgery Unit between 26 November and 22 December 2008. Recorded variables included procedure type, predicted and actual theatre time, level of surgeon and anaesthetist experience and triage category.Results:   Of the 200 patients enrolled in the study, 9 were excluded due to incomplete data. Average time spent in the operating theatre was 81 minutes. This was over‐estimated on the pre‐operative booking form by 17% (R = 0.65, p < 0.001). The intra‐operative time was significantly longer when the procedure was performed by a consultant surgeon compared to a trainee (mean = 115 min versus 76 min, p < 0.001) or when regional anaesthesia was used (median = 116 min versus 72 min, p = 0.02). Intra‐operative time was not affected by anaesthetist seniority (p = 0.18). The procedure was correctly identified on the pre‐operative booking form in 75% of cases. Only 59% of cases were performed within their allotted triage time.Conclusion:   Acute Plastic Surgical Services were not delivered in a timely manner for a significant number of patients. This occurred despite a consistent over‐estimation of theatre time requirements. Methods for improving service efficiency need to be investigated, with a view to reducing the social and economic cost of delays.
PR33P GIANT NON‐MELANOMATOUS SKIN CANCERS: THE CONSEQUENCE OF NEGLECT
Authors: Moore E. C. , Tulloch S. J. 
Published: April 2009

Giant non‐melanomatous skin cancers (GNMSCs) are extremely rare and slow growing. They are grossly disfiguring and present unique management dilemmas.We examined five cases of these unusual tumours and present a literature review of the risk factors inherent in epidemiology, patient demographics and the clinico‐histopathological characteristics.Five patients with GNMSCs admitted to the Alfred and Dandenong Plastics Surgery Departments over a ten year period were reviewed.GNMSCs are more frequent on the scalp in men. Lower socioeconomic status and infrequent medical review are also characteristic of these tumours. Histology can be unusually varied with aggressive features in keeping with their higher metastatic potential.Health promotion by means of vigilant surveillance and prompt specialist referral could prevent extensive surgical efforts later in the course of disease.
PR34P HEAD AND NECK FREE FLAP RECONSTRUCTION IN THE ELDERLY POPULATION – WAIKATO EXPERIENCE
Authors: Neary F. A. , Moaveni Z. 
Published: April 2009

The main indication for free flap reconstruction in the head and neck is malignancy. As the world's population ages, we will be presented with more elderly patients with head and neck cancers requiring free flap reconstruction.However, the older population does have a significantly higher incidence of multisystem disease which can cause some concern when considering a potentially long and complex surgical procedure. Do these co‐morbidities translate into actual risk regarding flap success and post‐operative mortality?This presentation reviews our ten year experience with microvascular reconstruction in the elderly at Waikato Hospital, New Zealand. A synopsis of key considerations in improving success rates in this type of surgery will also be offered.