bluuebunny/crossref_metadata_2025_split huggingface dataset:
BA01 AUDIT OF WAIKATO REGIONAL BURNS CENTRE: BIOBRANE INFECTION RATES
Authors: Nichols K. G. , Moaveni Z. , Mcewan C. , Alkadhi A. , Mcewan W. , Alkadhi A. 
Published: April 2009

Purpose:   To review the Burns Service within Waikato Regional Burns Unit (WRBU) and specifically the use and infection rates of Biobrane (TM).Methods:   Retrospective audit of hospital database and clinical records from January 2003 to July 2008. Data collection included age, sex, ethnicity, percentage burn, site and thickness of burn, time to transfer to regional burns centre, time to theatre for application of Biobrane, antibiotic or topical silver treatment, re‐admission, total number of operations and overall cost of admission. Biobrane infection, causative organism and treatment.Results:   WRBU admitted 830 patients (236 female and 594 male). A total of 124 patients (37 female and 87 male, average age 15.2 years) required application of Biobrane. Five patients were referred onto National Burns Centre. Mean length of stay 11.4 days (Median 6 days, range 1–68 days), percentage burn 15.6% (range 1–80%), transfer time 5 hours and time to theatre for application of Biobrane 13.5 hours (range 3.5 to >48 hours). Overall infection rate for Biobrane was 19.3% (23 from 119 patients). The main causative organisms were Staphylococcus aureus and Pseudomonas. Statistical analysis did not reveal a statistical significance (p = 0.05) in site, percentage or depth of burn, antibiotic cover or silver dressings and time to theatre for application. Re‐admission was statistically significant for infected Biobrane patients (n = 6, p = 0.04).Conclusion:   Biobrane infection rates of 19.3% in this audit are far higher than has been reported. This discrepancy may be due to the inclusion and exclusion criteria used in clinical trails. Biobrane remains a useful adjunct but the high risk of infection in our population may require stricter guidelines.
BA04 OPERATIVE REQUIREMENTS OF SEVERE BURN PATIENTS: IMPLICATIONS FOR A DISASTER MANAGEMENT PLAN
Authors: Phua Y. S. , She R. W. , Moazzam A. 
Published: April 2009

Purpose:   To determine the operative requirements of patients with severe burns and to develop a disaster management plan for our centre.Methodology:   A retrospective review was undertaken of 46 patients with burns of more than 20% admitted to the Middlemore Hospital National Burn Centre from June 2006 to October 2008. The main outcome measures were length of inpatient stay, number of operative procedures, and total operating time. The impact of burn severity and other clinical factors on these outcome measures was analysed.Results:   The mean length of hospital stay for the 38 survivors was 51.4 days. Overall 197.6 visits to theatre per year were required (79.3 operative procedures and 118.3 changes of dressing per year). This equated to 0.14 operative procedures and 36.7 operating minutes per percentage burn. Operative procedure time was greatest in the first week. Patients with burns more than 50% required a longer length of stay and greater number of operative procedures though had a higher overall mortality. Resource utilization was also higher in older patients and those with airway burns without a improvement in survival.Conclusion:   With the high operative requirements of a major burn, a policy on triage in a mass burn casualty is required. While theatre time for changes of dressing can be eliminated in a disaster setting, theatre time requirements in the first week are largely unaffected. Limited intervention is recommended for burns over 50% in a disaster setting, taking into account age and concomitant injuries.
BA05 A REVIEW OF BLOOD TRANSFUSION PRACTICES IN BURNS PATIENTS ATTENDING THE NATIONAL BURNS CENTRE, NEW ZEALAND
Authors: Guiney A.‐M. , Stapelberg F. H. , She R. W. , Moazzam A. 
Published: April 2009

Purpose:   Blood loss and high rates of transfusion in the intensive care unit and burn centre is an area of ongoing concern. Many studies report that patients receiving red blood cell transfusions in the ICU/burn centre setting are more likely to experience complications.Blood use brings the risk of infection, adverse reaction and immunosuppression and more recently evidence for tumour progression.The purpose of this study was to review blood transfusion practices in burns patients attending the national burn centre over a 2 year period and to assess transfusion policies over this timeframe.Methodology:   A retrospective chart review from 2006 to 2008 was performed. All patients with >10% total body surface area burns who underwent surgery were included in the study. Variables examined were packed red blood cells transfused during and after surgery, preoperative and postoperative haemoglobin and cross‐match to transfusion ratios.Results:   Of the 146 patients reviewed, 79 required multiple transfusions which were administered in the majority of cases via a traditional red blood cell transfusion approach. There was a high cross‐match to transfusion ratio.Conclusion:   A traditional blood transfusion policy is administered in this unit however in those patients that were treated using a more restrictive policy, a lower haemoglobin was well tolerated. There is scope for the implementation of a more restrictive transfusion policy.
BA07P PAEDIATRIC TREADMILL INJURIES IN NSW: AN INCREASING PROBLEM
Authors: Kim L. , Maze D. , Adams S. , Giutronich S. , Holland A. 
Published: April 2009

Purpose:   The steady growth in popularity of home treadmills during the past decade poses a potential hazard to infants and children. Despite increasing awareness of this problem, treadmill‐related injuries in the paediatric age group continue to be a concern. The aim of the study was to determine if there has been any change in the incidence of treadmill‐related injury in comparison to previous studies.Methodology:   Medical records of all children with treadmill‐related injuries from the two tertiary paediatric hospitals between January 2007 and December 2008 in NSW, Australia were reviewed. Data collected include patient details, events surrounding the mechanism of injury, site of the burn and need for surgical intervention.Results:   A total of 65 children sustained treadmill‐related injuries, 43 of whom were male. There were 17 cases in 2007 and 48 in 2008. The mean age of injury at the time of incident was 3.7 years (range 18 months–14 years). The most common site occurred in fingers/hand (75%) followed by arm/forearms (9%) and torso (8%). 22% required surgical intervention. One patient required two procedures. The most common injury event was when the treadmill was in use by an adult and the child approached unnoticed from behind.Conclusion:   There has been an exponential increase in the incidence of treadmill‐related injuries in NSW, which parallels with a report from Queensland. The data suggest the need for national legislative changes in addition to increased public education to reduce the impact of this mechanism of injury.
CR10 MRI CRITERIA FOR SELECTING PATIENTS FOR PREOPERATIVE RADIOTHERAPY IN RECTAL CANCER
Authors: Bissett I. P. , Shannon D. E. , Bates N. 
Published: April 2009

Purpose:   Preoperative radiotherapy (PRT) reduces the risk of local pelvic recurrence (LR) after rectal cancer surgery but is associated with considerable side‐effects. This study aims to identify the LR rate associated with the present MRI based selection criterion for PRT (tumour threatening the fascia propria on MRI) at Auckland City Hospital (ACH), and to assess the likely influence on LR rates of a regimen using a PRT selection criterion based on a 5 mm clearance of the fascia propria.Methodology:   All patients with rectal cancer treated at ACH from 1997–2005 who had preoperative MRI scans were identified from the National Cancer Registry. Details of demographics, MRI results, treatment and outcome were collated. Long‐term outcomes were obtained from digital records, GPs, patient contact and death‐certificates. All MRIs were re‐reported using the new criterion of 5 mm clearance for the fascia propria.Results:   There were 126 patients eligible patients, 20 were excluded with lack of MRI or follow‐up. 106 patients (mean age 66.5 years, 67% male) were followed‐up for a minimum 2 years (med 3 years). Using the present MRI based ACH criteria for PRT 29 (27%) patients were irradiated. Using a 5 mm tumour free margin 80 (75%) of patients would have been offered PRT. Overall 7 (6.6%) patients developed LR, 6 of these did not receive PRT, 4 of these fulfilled the new criterion and only 2 of these patients had a resection with curative intent.Conclusion:   Selective PRT based on threatened fascia propria involvement on MRI lead to low PRT and LR rates. The use of a 5 mm tumour free lateral margin on MRI would result in three times as many patients receiving PRT and is likely to reduce the local recurrence rate by about 2%.
CR12 *SELF‐EXPANDABLE METALLIC STENT VS SURGERY IN MANAGEMENT OF ACUTE MALIGNANT LARGE BOWEL OBSTRUCTION
Authors: Braun W. V. , Abdool I. S. , Lim A. , Frenkiel B. , White S. I. 
Published: April 2009

Background:   Management of acute LBO remains challenging. An urgent surgical intervention is often associated with poorer clinical outcome compared to an elective procedure. SEMS as BTS or palliative measure remain controversial and not widely available.Methods:   From 1995 to 2008, retrospective analysis of the patients presenting with an acute malignant LBO to the Tweed and John Flynn Private Hospitals was performed.Results:   SEMS were inserted in 31 patients (median age 74 (46–95), 17 females and 14 males, ratio 1.2:1). 12 were elective and therefore excluded. The remaining 19 had emergency SEMS insertion – 12 as BTS and 7 palliative. LOS was 4.5 days (2–21). Tumour was located in the left colon and the rectum (15) and transverse colon (4). 15 patients experienced complete resolution of LBO. 10 patients from the BTS group had subsequently undergone one‐stage curative resection with good outcome. There were 2 deaths and 2 unsuccessful SEMS placements. Urgent operation was performed in 23 patients (median age 74 (52–89), 10 males and 13 females, ratio 1.3:1): 18 Hartmann's procedures, 3 resections with primary anastomosis and 2 defunctioning colostomies. LOS was 17.7 days (2–59). There was 1 death, 1 ongoing pelvic sepsis, 5 significant wound complications, stoma prolapse, AMI, IHD exacerbation, 2 episodes of AF, 3 UTI, pneumonia and 3 cases of prolonged ileus.Conclusions:   In expert hands SEMS are effective in treatment of LBO. They are associated with an overall better outcome and improved quality of life of patients. Surgery is indicated, where SEMS are unavailable or have failed.
CR13 *EARLY SURVEILLANCE COLONOSCOPY FOR METACHRONOUS COLORECTAL CANCER
Authors: Hollington P. , Tiong L. U. 
Published: April 2009

Introduction:   Colorectal cancer is the 3rd most common cause of cancer deaths in Australia. The Australian NHMRC guideline recommends regular surveillance colonoscopy every 3–5 years after curative surgery. Some studies recently reported disturbing rates of metachronous colorectal cancer occurring early after curative treatment of the index tumour. There are concerns that performing surveillance colonoscopy only 3–5 years after curative surgery may miss a significant proportion of metachronous cancers. This study looks at the rate and timing of metachronous cancer in two institutions, and examines factors which may be associated.Methods:   This is a retrospective audit utilising a database of all patients undergoing surveillance colonoscopy at Flinders Medical Centre and Repatriation General Hospital. Patients were identified using the database, with subsequent case note review. Patients with familial disorders or disease recurrence at anastomotic sites within 12 months were excluded. This audit has been approved by the Ethics and Research Committee of both hospitals.Results:   Colorectal cancers were identified in 569 patients, of whom 15 (2.6%) had metachronous cancers and were included in our study. There were 10 men and 5 women with average age of 74 years. The median time interval to detection of metachronous cancer was 36 months (range 13–202 months). 8 (53%) patients had metachronous cancer identified at between 13–36 months after diagnosis of the primary tumour.Conclusion:   Our study showed that a significant proportion (53%) of patients who had metachronous colorectal cancer presented within 13–36 months. Early surveillance colonoscopy may be warranted to detect earlier stage disease relapse.
CR14 *ANAL INTERSPHINCTERIC NERVE BLOCK PRIOR TO RUBBER BAND LIGATION OF HAEMORRHOIDS. IS IT EFFECTIVE? A RANDOMISED CONTROL TRIAL
Authors: Collins S. J. , Von Papen M. 
Published: April 2009

Purpose:   Significant pain and discomfort are reported by a proportion of patients undergoing rubber band ligation of haemorrhoids. Several nerve blocks have been trialled with varied results. The aim of this study was to determine whether an anal intersphincteric nerve block may reduce post‐operative pain and analgesic requirements in these patients.Methodology:   One hundred sequential patients undergoing rubber band ligation of haemorrhoids were randomised to either an anal intersphincteric nerve block using 0.5% Marcaine with adrenaline or to the control group. The procedures were performed by a single surgeon using the KilRoid (TM) rubber band ligator (Astratech – Sweden). Patients were assessed for pain and analgesic use in the immediate post operative period and at 24 hours. Both the patient and data collector were blinded to whether a nerve block had been administered.Results:   There was no statistically significant difference between the two groups in median post operative pain (3.0 vs. 2.0 p > 0.0.29), median post operative analgesic use (1.6 vs. 3.3 p = 0.62), median pain score at 24 hour (4.14 vs. 4.22 p = 0.9) and median analgesic use at 24 hours (1.0 vs. 1.0 p = 0.13).Conclusions:   There is no benefit from performing an intersphincteric nerve block in patients undergoing rubber band ligation of haemorrhoids.
CR15 *IS SACRAL NERVE STIMULATION A VALID TREATMENT FOR FAECAL INCONTINENCE?
Authors: Lutton N. J. , Patton V. , Lubowski D. Z. 
Published: April 2009

Purpose:   Sacral nerve stimulation (SNS) is a promising new modality to treat faecal incontinence. This study was designed to examine patient satisfaction with the procedure and relate this to changes in quality of life (QoL) and incontinence scores.Methodology:   Twenty‐eight patients underwent insertion of a permanent stimulator after temporary stimulation had achieved a good result. Faecal incontinence QoL data, incontinence scores (scale 0–24) and baseline anorectal physiology measurements were recorded prospectively in a database, together with a postoperative survey and repeat physiological investigations.Results:   Twenty‐four patients (86%) completed the survey. The median age of patients at the time of SNS insertion was 62 yrs (range 47–83) and median follow‐up was 10 months (2–50 m). The mean St Mark's incontinence scores were 16.9 pre‐operatively and 10.6 post‐operatively (p < 0.001). Faecal incontinence quality of life (FIQL) measurements showed statistically significant improvements across all domains (lifestyle p = 0.02, coping p < 0.01, depression p = 0.01 and embarrassment p < 0.01). Mean patient satisfaction was 6.8 (visual analogue scale of 0–10). This score showed statistically significant correlations with both incontinence scores and three out of four FIQL domains. No correlation was seen with duration of treatment and patient satisfaction.Conclusion:   SNS is a valid procedure for faecal incontinence as demonstrated by significant improvements in incontinence scores, FIQL measurements and these improvements are closely correlated to patient satisfaction with the procedure.
CR02 AUSTRALASIAN LAPAROSCOPIC COLON CANCER STUDY (ALCCAS): LOWER POSTOPERATIVE COMPLICATION RATES BENEFIT ELDERLY PATIENTS
Authors: Allardyce R. A. , Bagshaw P. F. , Frizelle F. A. , Hewett P. J. , C. M. F.  , Rieger N. A. 
Published: April 2009

Purpose:   We report the age‐related peri‐operative morbidity findings of the Australia and New Zealand prospective randomised controlled trial (RCT) comparing laparoscopic (LCR) and open (OCR) surgical treatments of right‐ and left‐sided, potentially curable, colon cancer.Methods:   Between January 1998 and April 2005, 601 eligible patients were recruited by 33 surgeons from 31 Australian and New Zealand centres. Complications were analyzed by an independent reviewer. Their severity was classified as; mild, moderate or severe and their relatedness to surgery as; not, probably not, possibly or definitely.Results:   294 patients had LCR and 298 had OCR. 266 patients were < 70 and 326 ≥70 years (mean = 70.3 ± 11 years). There were 43 (14.6%) conversions from LCR to OCR, of which 35 (81%) had a complication. The numbers of surgical (p = 0.003) and medical (p = 0.043) complications were reduced in completed LCR operations when compared with OCR. These differences were attributable to significantly lower numbers of complications in patients ≥70 years (surgical, p = 0.002; medical, p = 0.043). Likewise, the numbers of individuals experiencing any complication favoured LCR treatment (p = 0.001) and specifically those ≥70 years (p = 0.004).Conclusion:   Treatment choices for colon cancer depend upon survival and tumour recurrence, short‐term outcomes, costs and quality of life measures. If LCR is proven safe and affordable, our results suggest that patients ≥70 years with potentially curable colon cancer be rigorously investigated preoperatively to avoid conversions and then considered for LCR.
CR20P ANASTOMOTIC LEAKAGE AFTER RESECTION OF COLORECTAL CANCER GENERATES PRODIGIOUS USE OF HOSPITAL RESOURCES
Authors: Chapuis P. H. , Sinclair G. , Dent O. F. , Frye J. N. , Bokey L. E. 
Published: April 2009

Objective:   The aim of this study was to determine the demand for hospital resources generated by anastomotic leakage, including surgical, medical, imaging, pathology, and other allied health consultations or services and length of postoperative hospital stay.Patients and Methods:   Data were obtained from a comprehensive, prospective hospital registry of all resections for colorectal cancer from January 1995 to December 2004 and from retrospective review of patients’ notes.Results:   Forty‐one patients with a leak spent 92 days in intensive care, required 129 days of total parenteral nutrition, 69 days of enteric feeding and 41 days on ventilation and had a median postoperative hospital stay of 28 days (range 11–104). These patients required 24 re‐operations and 2,273 separate medical consultations or allied services.Conclusion:   Anastomotic leakage generates a very considerable demand for hospital resources and diverts these resources from the hospital population at large.
CR21P COMPLEX ANAL FISTULAS: PLUG OR FLAP?
Authors: Muhlmann M. D. , Hayes J. , Merrie A. , Parry B. , Bissett I. 
Published: April 2009

Purpose:   Rectal mucosal advancement flaps (RMAF) and fistula plugs (FP) are techniques used to manage complex anal fistulas. The purpose of this study was to review and compare the results of these methods of repair.Methodology:   A retrospective review of all complex anal fistulas treated, by either a RMAF or a FP, at Auckland City Hospital from 2004 to 2008. Comparisons were made in terms of successful healing rates, time to failure and the use of MRI.Results:   Overall, 70 operations were performed on 55 patients (55.7% male). The mean age was 44.9 years. 21 patients (30%) had had at least 1 previous unsuccessful repair. Indications for repair included 57 high cryptoglandular anal (81%), 4 Crohn's anal (6%), 7 rectovaginal (10%), 1 rectourethral (1%) and 1 pouch‐vaginal fistula (1%). All patients were followed up with a mean of 4.5 months. 48 RMAF's (69% of total) were performed with 16 successful repairs (33%). 22 FP's (31% of total) were performed with 7 successful repairs (32%, p = 0.9). In failed repairs, there was no difference in terms of mean time to failure (RMAF 4.8 months vs. FP 4.1 months, p = 0.62). MRI was performed in 21 patients (37%) before the repair. The success rate in these patients was 20%.Conclusion:   The results of treatment of complex anal fistulas are disappointing. The choice of operation of either a RMAF or a FP did not alter the poor healing rates of about one third of patients in each group.
CR25P FAILURE TO ATTEND FOLLOW UP APPOINTMENTS IN PATIENTS WITH COLORECTAL CANCER – HOW COMMONLY DOES IT OCCUR AND WHY?
Authors: Shimokawa K. , Shedda S. , Pem A. , Jones I. , Gibbs P. 
Published: April 2009

Introduction:   Follow up after curative resection for colorectal cancer has been demonstrated to improve survival and failure to attend (FTA) may compromise patient outcomes. The incidences of FTA and the causes have not been documented.Methods:   Patients were identified from a prospective clinical database and a hospital based appointment system. FTA follow up was defined as non‐attendance of at least one appointment, within 5 years post operatively. A phone interview was used to evaluate the cause. Patients from a non‐English speaking background (NESB) were contacted with interpreters.Results:   From January 2003 to May 2008 622 patients with stage I‐III cancer were identified, including 202 from a NESB. 125 non‐attendees were identified. 61 patients (70%) were contacted from 87 surviving patients. 26 could not be located and 38 patients were deceased. Of the 61 patients studied, 32(52%) were male. The mean age was 68 years (range 33, 102). 14 patients (23%) were from a NESB. Each non‐attendant averaged 16 appointments, and 1.7 failed attendances. A median of > 13 months elapsed from diagnosis to 1st missed appointment. The main reasons for non attendance were: unaware of the appointment (n = 21), inconvenience due to time or travel (n = 14), poor health (n = 10), long waiting times (n = 8), forgetting (n = 6) and other (n = 2). Age, sex and number of booked appointments were not associated with non‐attendance.Conclusion:   Failure to attend follow‐up appointments is common. Overall, access to follow up was prevented by structural factors more than disease/patient factors. A common reason for non‐attendance was that patients were unaware of the appointment. Opportunities for significantly improving attendance include a reminder system.
CR26P LAPAROSCOPIC HYBRID RECTAL RESECTION FOR RECTAL CANCER
Authors: Shedda S. M. , Hayes I. , Jones I. T. , Hastie I. , Gibbs P. 
Published: April 2009

Introduction:   Laparoscopic anterior resection for rectal cancer remains controversial due to the possibility of a positive circumferential margin with the laparoscopic approach. The “hybrid procedure” has been performed with laparoscopic colonic mobilization but rectal dissection is through a Pfannenstiel incision.Methods:   Data from a prospective single institution rectal cancer database was used to compare hybrid, converted and open anterior resections for mid and low rectal cancer from February 2003 to August 2008.Results:   There were 253 patients found. There were 66 (26%) hybrid (H), 5 (2%) converted (C) and 182 (72%) open (O) cases. The median follow up all 3 groups was similar. 30 (h), 28 (C), 34 (O) months. The median length of stay (days) was shorter in the (H) group. [6.5 (H), 10 (C), 9 (O), p = 0.001. There was a trend to a higher ASA score, age, median BMI, more wound infections and higher stage in the (O) group. The circumferential margin was involved in 6 (O) group compared with 0 in H) or (C) group (p = 0.5). There were no significant differences in local recurrences [1.1% (O) vs. 1.5% (H&C)] or T stage. There was no difference in neoadjuvant radiation, (48 (26%) (O), 20 (30%) (H), 1 (20%), p = 0.9. The median lymph node count was 11 in each group. The 2 year overall survival was the same both groups, 90% (H), 89% (O) 100% (C) (p = 0.65) as was the progression free survival 76% (H), 64%(O), 80% (C), (p = 0.32).Conclusion:   The hybrid procedure results in improved short term outcomes for patients with rectal cancer compared to open cases. The hybrid approach did not compromise circumferential margins or lymph node yield, and has no effect in short term progression free or overall survival.