bluuebunny/crossref_metadata_2025_split huggingface dataset:
SE10 THE EDUCATIONAL FRAMEWORK: IN PRACTICE
Authors: Heineman E. , Hamming J. F. , Borelrinkes I. H. 
Published: April 2009

Competency‐based education in the field of medical specialties is attracting a lot of attention.The CanMeds model has been adopted by many colleges in many countries.In the Netherlands the 27 medical specialty colleges have been encouraged to redesign their curricula on the basis of the CanMeds model.A proper framework was lacking and had to be developed. The result is a ‘house’ with a solid foundation ('support by peers’) and 10 different rooms: ‘legislation’, ‘profile of the health worker’, ‘competencies of the health worker’,’ themes’, ‘operalionalised competencies’, ‘assessment’, ‘educational method’, ‘educational activities’, ‘educational material’, ‘and ‘quality control’(educational process, check on legislation, professionalizing trainers and trainees, research of education).This educational framework has been put into practice. It has shown to be a very useful instrument to encourage otherwise not educationally trained medical specialists to embark on the trail of competency‐based curriculum development.The model as employed in the field of surgery will be presented and discussed.
SE17 SURGICAL EDUCATION AND TRAINING: A QUEST FOR EXCELLENCE IN A CHANGING SOCIETY
Authors: Collins J. 
Published: April 2009

In 2008 a leading UK medical correspondent wrote: “the royal colleges must up their game – or die” because of their lack of influence in the debacle over medical training. Surgical education is at a crossroads and the sustained production of surgeons including surgical scientists faces many challenges. It might well be asked how the Royal Australasian College of Surgeons and its partner surgical specialties are responding to the winds of influence blowing their way.The seeds of surgical education must be planted and nurtured in medical school, watered and fertilized after graduation by the Postgraduate Medical Councils and helped to prosper and bloom by the surgical colleges for those who choose surgery as a career. Meaningful and collaborative partnerships are therefore essential for the development of an integrated approach across the continuum of learning.The College has responded to the many factors now influencing training by developing and implementing a new integrated surgical education and training program (SET), new processes and criteria for accreditation for hospital posts for training, more valid and reliable selection and new competency‐based curricula and assessment including workplace‐based assessment. A new and comprehensive foundation surgical skills course has been introduced and new courses implemented to help supervisors.A major challenge surrounds sustaining the delivery of surgical programs and courses. Surgeons are faced with the conflicting priorities of clinical practice, education, research and administration. Research and patient care have become the dominant source of resources and prestige with a decline in the recognition and value of surgical education and teachers. An Academy of Surgical Educators is being developed by the College and its partner specialists to renew and reinvigorate surgical education, equip and support teachers and educational researchers all of which are vital to sustain the future of surgical education and continuing professional development.
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.
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.