bluuebunny/crossref_metadata_2025_split huggingface dataset:
PR09 INFECTION RATES IN IMPLANT BASED BREAST RECONSTRUCTION
Authors: Friederich L. J. , Corrigan E. B. 
Published: April 2007

Infection is a potentially devastating complication of Breast Reconstruction Surgery.We retrospectively reviewed primary implant based breast reconstruction cases over a six year period at a tertiary Plastic Surgery Unit in Perth to determine both infection and explantation rates, as well as patient and operative factors which may contribute to this risk.First and subsequent reconstructive stages were included in the study with the majority of patients having had their second stage procedure. All cases were followed up for a minimum of six months post operatively.185 implants were placed into 88 patients with an overall infection rate of 7.6% and an explantation rate of 4.3%. Most (86%) of these infections occurred following the first staged procedure.Factors which may impart a greater risk of infection included smoking, increased Body Mass Index, shorter duration of wound drains and larger implant size.Multiple antibiotic regimes of varying duration were noted, however there was no significant difference between the infected and non‐infected groups.Of note, documentation was found to be poor, particularly regarding implant and pocket preparation, drain sites and their subsequent daily drainage and time of removal.Formal protocol and/or a dedicated Breast Reconstruction database may prove useful in further audit and surveillance with the aims of identifying and decreasing patient and operative risks.
SE13 ACCURACY, ACCEPTANCE AND COMPLIANCE IN THE USE OF A WEB BASED AUDIT TOOL – RESULTS OF PHASE 1
Authors: Khurana S. , Orford J. , Preen D. , Logan J. , Gera P. , Jackson C. 
Published: April 2007

Background  Patient privacy related concerns are thought to be a major impediment to the use of modern web‐based database systems in clinical audit and multi‐centre research. Most new electronic health record systems are ‘opt out’ models in which all patients are included within the system by default.1Aim  The aim of the first phase of this ‘multi’‐centre study is to assess the level of community acceptance of an ‘opt in’ model in which individual parents are given a choice of having their child’s medical information stored on a customised, highly secure, commercially available web‐based data management system.Materials and methods  Parents/guardians of all children presenting with any of a pre‐determined set of conditions are invited to complete a questionnaire after reading an information leaflet. The questionnaire is designed to correlate community attitudes to web‐bases electronic health records with factors such as expected duration of requirement for health services, availability of mobile phone and internet services, usage of other web based services as well as parental demographics.Results  The recruitment rate of ‘eligible’ parents has been 100% so far. Overall, 64.5% have responded in favour of a web based databank, 17.5% were unsure and 17.5% not in favour of a web based databank. 90% of parents with children requiring ‘medium’ and ‘long’ term follow up were definitely in favour.Conclusions  Greater involvement of patients and clinicians may overcome one of the major impediments in the use of web based audit tools.
SE14 COMPETENCY MODELS AND POLITICALLY MANAGING THE SURGICAL PROFESSIONS
Authors: Canter R. J. 
Published: April 2007

This presentation examines the nature of surgical competency and the drift towards what might be termed “models of competence”, the advantages and disadvantages of such a model, from where has this model arisen, and the concerns the professions frequently sense but have trouble articulating about what is happening.The development of simple checklist competency models arguably arises out of a combination of skill remix, appealing to simple ‘assembly lines’ models of healthcare delivery, and a behaviouralist model of management control. Awareness of the broader political context in which all of this is played out helps to make sense of what is happening as surgery becomes ‘de‐professionalised’ and reduced to a technical activity. The development of simple competency models has the capacity to destroy the very thing it seeks to define so that there is genuine concern that an organisational model of healthcare delivery, so effective in industry, may be inappropriate to a profession.The presentation takes a ‘simple’ surgical case and, as the case unfolds, shows how the ‘technical’ process of clinical surgical decision‐making is actually very complex indeed, so complex that the literature on the subject struggles to define it at all. As one generation of surgeons passes down its skills to the next generation, how are we to define clinical decision‐making and judgement? What are the implications for surgical training? How do we respond to being ‘deprofessionalised’?
SE19 CAN THE TRAINEE OPERATIVE LOGBOOK BE USED AS AN ASSESSMENT TOOL OF THE LEVEL OF SUPERVISION PROVIDED BY TRAINING CENTRES?
Authors: Mcbride C. A. , Beasley S. W. 
Published: April 2007

Purpose  Specialist trainees and the specialty boards of the College of Surgeons expect that levels of supervision will not remain static during training. As training progresses the level of supervision will change, from an assistant role and direct supervision towards independent practice with consultation available as required. The Summary of Operative Experience may provide a de facto measurement of this.Methodology  Assessment of the surgical logbook of an individual trainee to document the changes in the level of supervision that occur during a training term, the factors that influence it, and the degree of variation between posts.Results  Upon arrival at a new institution supervision for most cases is direct. For minor and intermediate surgery that supervision is rapidly relaxed once it has been confirmed the trainee has acquired and demonstrated the required skills. In areas of complex surgery (such as neonatal surgery) there is a clear progression observable over the training period. In the early part of the term the trainee is assisting in complex surgery, with the surgeon supervisor operating. By the end of the term those roles may have reversed, but there are significant variations between posts.Conclusion  It is possible to use the operative logbook as an indicator of the supervision provided by training centres to trainees. This could provide one mechanism to enable specialty boards to confirm that supervision for trainees is appropriate to their needs as they progress through their training. It also allows an indirect measure of the quality of the post for specialty training.
SE20 THE ANATOMY OF COMPLICATIONS IN THE UPPER LIMB
Authors: Luo D. Y. W. , Tai E. , Lim T. S. , Stokes B. , McMenamin P. 
Published: April 2007

Complications in clinical medicine and surgery may arise from an inadequate knowledge of topographical anatomy. Consequently, a thorough understanding and knowledge of topographical anatomy is one of the major pillars in the training of many surgical and medical disciplines. In Western Australia, we have found that even simple procedures done on the ward by junior medical staff can result in a complication due to a lack of understanding of anatomy. For example, procedures such as intravenous cannulation at the wrist may result in superficial radial nerve injuries and debilitating neuromas.The authors, with the support of The Office of Safety and Quality in the Department of Health have put together a teaching DVD which focuses on the applied anatomy of the upper limb, with a focus on procedures involving the peripheral vascular system. This DVD emphasizes vascular and related topographical anatomical features prior to introducing the viewers to procedures like intravenous cannulation, peripheral lines, peripherally inserted central cannulas and central venous lines. It thus raises awareness of possible complications that may arise from these procedures which can be avoided from understanding the anatomy.The amount of topographical anatomy taught in medical school has been reduced compared to 30–50 years ago. This has been necessary to accommodate the increase in knowledge in other pre‐clinical, para‐clinical and clinical sciences. This DVD is a timely reminder of the importance of a sound knowledge of anatomy for those practitioners required to perform invasive procedures. We hope that this will be a prototype for further teaching material produced in collaboration with The Department of Health.
SE03 ANATOMY IN THE VIRTUAL WORLD
Authors: Dobbins C. , Kanhere A. , Maddern G. J. 
Published: April 2007

Background  Recently, the use of 3‐dimensional virtual reality anatomy teaching tools has generated interest. Although they would appear to have the potential to revolutionise the way in which anatomy is taught, further evaluation is required. The aim of this study was to evaluate the use of 3‐dimensional virtual reality as a tool for teaching anatomy to basic surgical trainees.Methods  Basic surgical trainees from The Queen Elizabeth Hospital and Flinders Medical Centre in South Australia were invited to participate in an anatomy teaching session. Liver and pancreas anatomy were the topics covered during the session and these were taught using either standard or virtual reality teaching techniques. Participants were asked to evaluate the two modalities by way of multiple choice examination, pre and post session evaluation forms and commenting on their preferred teaching modality.Results  16 participants were involved in the study. 1 of 16 participants preferred teaching with standard techniques. 14 out of 16 participants found teaching with virtual reality to be either good or very good. The number who thought their knowledge of anatomy had improved with either technique was similar (7 out of 16 with virtual reality, 6 out of 16 with standard techniques). Post teaching session test results showed similar improvements with both teaching modalities.Conclusions  The 3‐dimensional virtual reality teaching method was very well received by participants and is at least as good as standard teaching techniques. The use of 3‐dimensional virtual reality may offer a more interesting and useful option for anatomy instruction.
SE04 BIO‐REALITY SURGICAL TRAINING MODELS
Authors: Murphy D. L. 
Published: April 2007

Purpose  To create valid, re‐vascularized tissue models for surgical training.Method  Re‐established pulsatile flows were created in selectively cannulated arteries of the cadaveric tissues, being developed as training models. Venous flow was also re‐established for some teaching models. Manual pump techniques were used to produce a pulsatile flow through these blood vessels.Results  Selected examples have been developed and used in Advanced Surgical training. Video examples to be displayed include Models for renal, vascular, micro‐vascular and cardiac surgery.Conclusion  The ideal surgical training model needs pulsatile vessel preparations for many training circumstances.A bio‐reality, pulsatile surgical training model has been developed. It has application as a penultimate model for surgical skills training.
SE05 THE PRIVATE HEALTH SECTOR: A POTENTIAL SURGICAL TRAINING GROUND? – A STUDY OF THE PERCEPTIONS OF PATIENTS
Authors: Wun L. P. S. , Wong L. M. , Shaw J. , Heriot A. , Keck J. , Vellar D. 
Published: April 2007

Purpose  The need for more accredited advanced surgical training positions has been identified by the Royal Australasian College of Surgeons. This study aimed to explore the perceptions of a sample of patients on surgical education and training in a private hospital setting.Methodology  This is a prospective study where patients undergoing elective surgery in a private hospital were recruited over a 6‐week period. A Likert Scale questionnaire was used to assess patient perception on choice of private healthcare, the role of the surgical resident in a private hospital and surgical training within a private hospital environment.Results  Sixty‐eight patients were recruited. Choice of surgeon was the most important reason for having private health insurance (59%). Almost all (97%) patients supported surgical training within a private hospital. There was support for a surgical trainee to liaise with the consultant surgeon about their care (95%), to perform minor procedures on the ward (91%) and assist the consultant at surgery (86%). Patients supported options for the trainee to perform part (73.4%), the majority (50.0%) and the entire operation (40.6%) under supervision of the consultant surgeon.Conclusion  A representative group of patients surveyed supported surgical training within a private hospital environment. The increasing demand for surgical training within the public environment necessitates the consideration of additional training resources such as the private healthcare system. It appears that the private health sector could be explored as a potential avenue for provision of surgical education and training.
SE06 DOCTORS AND POWER; OR THE TRUE STORY OF SURGERY TOLD FOR THE VERY FIRST TIME!
Authors: Canter R. J. 
Published: April 2007

This presentation aims to discuss two ideas in particular; the ‘biomedical’ paradigm of evidence based medicine and ‘power’ in the medical encounter, to link them together to examine, and hopefully disturb, some basic assumptions that exist in medical decision‐making. To keep the talk firmly rooted within the bounds of real life, all the ideas will be illustrated by reference to a simple surgical procedure and basic science experiments with a frog.The gold standard for knowledge in medicine are ‘facts’ generated by a randomized,double‐blind controlled trial, so called level 1 evidence. By drawing on the ideas postulated by the philosopher David Hume, the presentation will argue that such ‘facts’ do not fully comply with the requirements of causality, question the appropriateness of such a reductionist biomedical model in a world of complexity, raise questions about their generalisability and illustrate the tendency for the model to marginalize certain types of information.As is often quoted, ‘knowledge is power’ so what power framework can be used to shed light on the medical encounter and the way medical ‘facts’ are used. How do doctors handle their power? Is this a question any of us ask of ourselves? By utilizing various contemporary models of power I hope to show how the ideas put forward by the French philosopher Michel Foucault and the English philosopher Steven Lukes can shed light on how we use our power in the medical encounter, and in turn how establishment power is used to manage the medical profession.
SE08 STUDENTS PERSPECTIVES OF A SURGICAL EDUCATION PROGRAM
Authors: Hillis J. , Dodds A. , Collins J. P. 
Published: April 2007

Background  The purpose of the undergraduate surgical education program is to prepare students for their internship and eventual vocational practice. It is also an opportunity to sow the seeds of a possible career in surgery.Methods  In order to understand students’ perspective of their surgical program and the various factors which might impact on their learning, and the possibility of their choosing a career in surgery, a structured questionnaire was given to the 2006 cohort of final year medical students at the University of Melbourne.Results  Responses were received from 260 of the 285 students (91%). Bedside teaching, small group tutorials and clinical skills workshops were regarded as the most appropriate methods for learning surgery, with bedside teaching and the operating theatre (when surgeons were willing to teach) considered to provide the greatest learning opportunities. The most significant barriers were lack of anatomy teaching and lack of formal surgical teaching and difficulties accessing surgeons willing to undertaking teaching. 25% did not feel adequately prepared for the surgical components of their internship. 32% were considering a career in surgery and lifestyle factors and poor experience with surgeons were given as some of the reasons for lack of interest in surgery. Increase in anatomy teaching throughout the course, and more bedside and formal teaching were considered the most significant ways to improve the course.Conclusion  Surgical education is at a crossroads and the findings of this study have important messages for preparing the future workforce and will be discussed.
SH01 MY COUSIN ERNEST
Authors: Arnot R. S. 
Published: April 2007

My cousin Ernest was born into an Anglo‐Irish Protestant family on 15 February 1874. My Quaker grandmother was his second cousin. Shackleton did not follow his father into medicine, but went to sea at the age of 16, and accompanied Scott to the Antarctic on the Discovery expedition in 1902. He went on to lead three Antarctic expeditions, and has been hailed as one of the world’s greatest leaders. In all his travels he is acclaimed as never having lost a man, and a fellow explorer once said of him –‘for a dash to the Pole give me Amundsen, but if I am in a devil of a hole and want to get out, give me Shackleton every time’.Recently his techniques of leadership have become widely disseminated in business, the military and many other walks of life and have been described as ‘Shackleton’s Way’. And yet paradoxically, Shackleton never led a group larger than 27 and he failed to reach nearly every goal he ever set.I will also discuss the Endurance expedition of 1914–16, which is one of the most spectacular disasters of all time.
SH02 THE BIRTH OF VASCULAR SURGERY IN AUSTRALIA
Authors: Mellick S. A. 
Published: April 2007

During and after the Napoleonic wars surgeons in Europe, Britain and America ligated peripheral arteries for symptomatic aneurysms. It is not generally known that five surgeons performed similar operations in early colonial Australia.Andrew Gibson ligated the femoral artery in 1827 and William Bland the innominate in 1832 and 1837, all in Sydney. Edward Bedford ligated the carotid artery in Hobart in 1837 having apparently previously ligated one popliteal artery in a patient in 1835 and his other popliteal in 1837. Colin Buchanan of Port Stephens tied the femoral artery of a patient in Stroud in the Hunter Valley in 1847, possibly the first major operation performed under general anaesthesia in Australia; and somewhat later Frederick Milford in Sydney ligated the femoral artery in St Vincent’s Hospital in 1869, again under general anaesthesia.None of these isolated cases was included in an extensive review article in 1847 by G W Norris of Philadelphia, who recorded no less than 118 ligations of the external iliac and femoral arteries between 1796 and 1842, with an overall mortality of 33 (28%). Bland’s operation in 1832 escaped his scrutiny despite its being reported in The Lancet Volume I 1832/3.It is timely that the work of these pioneer ‘vascular’ surgeons and their place in the history of vascular surgery in Australia be acknowledged.
SH03 SLAVERY, SERPENTS, SPELLS & SURGERY: DR ETIENNE RUFZ DE LAVISON IN MARTINIQUE
Authors: Robson K. J. 
Published: April 2007

Martinique, an island in the archipelago of the Lesser Antilles, and today a d???rtement of France, was throughout the 19th century a much‐feared outpost of the French empire. “This is a region”, wrote one early commentator, “where the land is shaken by earthquakes, the towns turned upside down by hurricanes, the air poisoned by yellow fever, and the different social classes in a perpetual state of hostility”. The healthcare needs of Martinique?s diverse population were shouldered by a small mix of military surgeons, civilian doctors and local healers.In 1804, Etienne Rufz de Lavison was born to Creole nobility in St Pierre, Martinique’s thriving, cosmopolitan former capital. Sent to mainland France at the age of 13, Rufz studied medicine in Paris before returning to St Pierre, where he spent 20 years as a clinician, scientist and prolific historian. A man of astonishing intellectual curiosity, with a self‐confessed ‘mania for writing’, Dr Rufz’s publications encompass local surgical techniques, the yellow fever epidemics, snake bites, plantation and slave health, ethnology, island flora, and the effects of climate. An innovative practitioner, he was a pioneer of anaesthesia on the island. Dr Rufz was also a leader in health politics; he inaugurated Martinique’s public hygiene campaigns, led the vaccination committee, established the colony’s first psychiatric hospital, and became mayor of St Pierre.The quintessential Renaissance man, Dr Rufz upheld the belief that good medical practice requires an understanding not only of disease, but of history, people and the natural world. The story of his life and work offers a vivid portrait of early colonial medicine and surgery.
SH04 BASIL KILVINGTON–SURGICAL SCIENTIST
Authors: Masterton J. P. 
Published: April 2007

Basil Kilvington, son of the Rev. James Kilvington, was born in Hartlepool in the North of England on August 6th. 1877. His schooling began in Greenock but in 1888, when he was eleven, the family migrated to Victoria where he attended Camberwell Anglican Boys’ Grammar School which had been founded just two years earlier. He must have been a bright and capable student because in 1893, when barely sixteen, he matriculated in the Faculty of Medicine of Melbourne University and graduated M.B., B.S. in 1898 at aged 21.He became a resident medical officer at the Royal Melbourne Hospital but retained an interest in teaching and research as a tutor at Trinity College. His academic leaning is reflected in his being awarded M.D. in 1901 and M.S. in 1902. Thereafter he had a distinguished career as both a surgeon and researcher particularly in the field of neurology and nerve regeneration.When he died in 1947 aged 70 the obituaries by Sir Albert Coates and others all bear fulsome testimony to a remarkable man. Above all he was a thinker and a man of great compassion and gentleness both in his surgical technique as well as his dealings with his fellow man. He was one of the College’s Founding Fathers and perhaps deserves better recognition.
SH05 IMAGES OF FREYBERG
Authors: Beasley A. W. 
Published: April 2007

Bernard Freyberg was brought to New Zealand as a two‐year old boy, educated in Wellington, distinguished himself as a swimmer, began a career as a dentist, then sailed to England. He arrived in time to become part of the Royal Naval Division at the outbreak of the 1914–18 war, won his first DSO at Gallipoli, and his VC in France the following year. He became friendly with J M Barrie, who was his best man when he married in 1922.In the 1939–45 war he commanded the NZ forces in the Middle East and Gallipoli, and was then appointed governor‐general of NZ, his term being extended to six years. This paper traces his career with reference to his portraiture.