bluuebunny/crossref_metadata_2025_split huggingface dataset:
RS03 VASCULAR SURGERY IN A RURAL PRACTICE – THE CASE FOR
Authors: Vallance S. 
Published: April 2007

Centralisation of principal vascular services to tertiary centres has great merit in enabling adequate specialist numbers to provide an acute service with appropriate support facilities. Demand on this vascular service is expected to increase almost 100% with the aging population over the next 20 years. The demography of the population of New Zealand and Australia is such that providing vascular services only in tertiary centres has great potential to disenfranchise many patients living in rural areas. Unless the overall provision of service is excellent, providing an excellent service for only part of the population is untenable.A purely centralised, regional service will have difficulty providing satisfactory care for elderly infirm patients, with limited mobility, who live in rural areas. General Surgeons with no vascular training, working in provincial or rural hospitals cannot be expected to spend the significant time required to triage patients with possible peripheral vascular disease simply to refer them on to vascular surgeons in distant tertiary centres. Many aspects of vascular surgery, relating both to patient assessments and operative procedures do not require tertiary facilities and have historically been competently performed by general surgeons. There are also occasions when our colleagues in other specialities require urgent interventional support for vascular complications. There remains a need in smaller centres for general surgeons with some vascular training to provide this local service supported by, and supporting, colleagues in tertiary centres.
RS05 CRAFT GROUP AUDIT FOR RURAL SURGEONS
Authors: Watters D. A. K. , Campbell G. , Pennington B. , Richardson G. , Lowe A. , Graham J. 
Published: April 2007

Aims  To establish a prospective audit of surgical outcomes in regional and rural surgical practice and a strategy for recognising and managing outliers identified through audit.Methods  Support Scheme for Rural Specialist Funding (SSRS – Round 6) was obtained. Five major centres: Geelong, Ballarat, Bendigo, Wagga Wagga and Lismore agreed to participate in a prospective audit from September 06 to March 07. Various individual surgeons and smaller centres also offered to provide audits of their individual practice (Broome, Bathurst, Wangaratta, Kalgoorlie, Alice Springs). Five operations were audited: colorectal cancer surgery, breast cancer surgery, thyroidectomy, inguinal hernia repair and laparoscopic cholecystectomy. Indicators included mortality, unplanned re‐operation, anastomotic leak, recurrent laryngeal nerve damage, bile leak, postoperative pain for >2 months requiring analgesia or referral to a pain clinic after hernia repair, and the same indicators as the breast cancer audit. Anonymity of surgeons and patients was maintained.Results  At the time of abstract submission all five major sites had appointed project officers. Each centre is contributing about 40+ cases per month. By early December Geelong had collected thyroids (21), laparoscopic cholecystectomy (78 − 2 conversions), breast cancer (17 − 8 mastectomies), adult inguinal hernia repair (38), colorectal surgery (50 − 13 right hemi, 14 anterior resections).Conclusion  It is hoped that the existence of rural surgery craft group audit will provide indicators to assess the outcomes of any individual surgeon who chooses to contribute and compare their performance.
RS06 INTRODUCTION OF LAPAROSCOPIC RESECTIONAL COLORECTAL SURGERY TO NAIVE HOSPITALS
Authors: Ragg J. , Guest G. D. , Thorne M. , Watters D. , Hurley J. , Crowley S. 
Published: April 2007

Purpose  Laparoscopic resectional colorectal surgery (LRCS) was introduced to Australia in the early 90’s but gained widespread acceptance only recently. Most published studies demonstrating safety, benefits and acceptable outcomes are from centres with established colorectal units with extensive experience in LRCS. Hospitals looking to introduce this technique realise a long learning curve exists and hence the introduction of LRCS may initially result in a drop in standard of care. It is prudent to ask how and can LRCS be safely introduced to LCRS naïve hospitals.Methods  During introduction of LRCS, surgeons and theatre nurses undertook additional training courses and were encouraged to undertake initial cases with support from a colleague. Clinical pathways were introduced for post operative care.A well established colorectal database was used to prospectively gather data. All LRCS cases during the initial 9 months were included. Comparison is made with non LRCS from the same period, data from the previous year and published studies.Results  95 LRCS cases were studied representing 57% (95/166) of resectional colorectal cases. Of 14 surgeons performing colorectal procedures, 5 undertook LRCS at 2 hospitals previously naïve to LRCS. Favourable results were demonstrated relative to non LRCS performed in the same period compared over major clinical indicators (death, anastomotic leak, return to theatre, unplanned ICU admission, re‐admission). Improvements were observed in length of hospital stay and ICU days.Conclusion  We believe this series demonstrates that LRCS can be rapidly, safely and effectively introduced to a LRCS naïve health service.
RS08 THE NEW ZEALAND MOBILE SURGICAL SERVICE: 5 YEARS ON THE ROAD
Authors: Yule A. G. , Gowland S. 
Published: April 2007

Purpose  Out of the ashes of a radically pruned Health service the “Surgical Bus” (SB) has risen to redress some of the loss of access to surgery suffered by rural New Zealand (NZ). The mobile surgical service has also contributed towards several of the other stated goals of provision of equitable access healthcare to rural NZ. This study examines the performance of the SB over its first 5 years.Methodology  Mobile Surgical Services (MSS) has prospectively collected data on the SB. Assessment has been made of number and type of procedure, length of stay and complications. Services for children, services for Maori, social benefits, upskilling for rural staff, training gains through telepresence surgery and cost were also reviewed.Results  6500 procedures have been performed in the 5 year period 1 March 2002 to 28 February 2007. 6% of patients had complications with 2% having infection.Children (15 yrs of age or younger) made up 40% of patients treated and 26% were Maori. The SB has traveled 50,000 Km/year, has visited 21 rural centres and has had 9 different specialty services contributing. There have been 145 Telepresence sessions undertaken.Conclusion  The SB has significantly improved specialist surgical services to many rural areas in NZ over the last 5 years. This is in line with Government health policy of equitable access.
RS09 TO SPRINT OR TO STROLL THAT IS THE QUESTION. EVOLUTION OF SURGICAL SERVICES IN A REGIONAL CENTRE. A THREE YEAR REVIEW
Authors: Desai D. , Almehdi R. 
Published: April 2007

Purpose  Mackay Base Hospital is a regional hub for the North of Queensland’s Centre.There is a definite demographic growth in this region due to the mining industry. The study aimed to identify if this was reflected by a similar growth in the surgical services’ volume and diversity and to recognise the challenges that face this process.Methodology  Between 2004 and 2006 analysis was done to prospectively collected data banks relevant to both operative and endoscopic procedures. This was compared to other productivity factors like numbers of surgical, anaesthetic and nursing staff respectively. The advent of new technology and utilisation of experience in advanced laparoscopy was also assessed.Results  In spite of a general trend of lack of permanent surgeons &/or other support services, the number of all surgical procedures were either seen to increase(operative) or maintain a high plateau (scopes). There was an increase in incidence of all major cancers in the region, namely Skin, Colon and Breast respectively. There was a statistical inclination toward Laparoscopy mainly for Appendicectomy, Acute cholecystectomy, Bile duct explorations, Fundoplication and selected Colorectal procedures. Trauma surgery reflected a similar pattern of increase though the referrals to tertiary centres remained selective.Conclusion  The application of advanced surgical techniques may be restricted by available resources and local experience, nevertheless perseverance (while reasonably recognising these limitations) gives a long term outcome that is quite encouraging and compatible to other established centres.
SE10 SURGICAL TEAMWORK: SYSTEMIC FUNCTIONAL LINGUISTICS AND THE ANALYSIS OF VERBAL AND NON VERBAL MEANING IN SURGERY
Authors: Cartmill J. , Moore A. , Butt D. , Squire L. 
Published: April 2007

Purpose  Surgeons rely on teamwork, yet beyond an appreciation that some teams are more enjoyable to work in than others, or more effective, there is little understanding of the myriad complex interactions that make teamwork possible.Techniques of systemic functional linguistics permit objective analysis of behaviour (often subtle or subliminal) that carries meaning; these techniques can be applied to surgical teamwork.Methodology  Linguists came into the operating room initially for unobtrusive note taking and sketching. Increasing familiarity over several months allowed detailed audio visual analysis of surgery. Surgical sequences were recorded and analysed using Elan software. Recurring patterns of meaning were identified and catalogued.Results  The techniques surgeons and their team members use to exchange meaning is made explicit in this study, which brings out the systemic character of the options for meaning available to surgical team members. A grammar, albeit one that encompasses meaning through gesture, touch, body position and gaze, as well as speech, is presented. This grammar captures not only the conventions, rules and consistencies of the surgical ensemble, it also brings out the rhythm, tone, and nuance of the teamwork interactions.Conclusion  It is possible to analyze the subtle nuances of interaction that constitute teamwork during surgery. We hope that this work will help demystify the operating room and make it easier for junior staff to understand what is being “said” while making it possible for more experienced staff to recognize and optimise the teamwork so essential for the realization of a complex modern operation.
SE12 THE RELATIONSHIP BETWEEN BURNOUT AND EMOTIONAL INTELLIGENCE IN AUSTRALIAN SURGEONS AND SURGICAL TRAINEES
Authors: Benson S. , Truskett P. G. , Findlay B. 
Published: April 2007

The current study aimed to explore burnout prevalence rates and to examine the relationship between burnout and emotional intelligence in an Australian surgical population. The sample comprised 126 participants (53 SSTs, 73 Fellows; Mean age = 44.03 years, SD = 13.29).Method  Participants completed a battery of self‐report measures of burnout, emotional intelligence, and social desirability. Measures achieved reliability coefficients between .68 and .89, indicating adequate internal consistency.Results  A series of independent samples t‐tests indicated that burnout levels were significantly higher for the surgical sample than for other normative populations, with 47.6% of the sample reporting high general burnout levels. As predicted, younger surgeons reported significantly higher burnout levels, regardless of career stage. Burnout correlated significantly with early retirement and/or retraining intentions, and was inversely related to overall emotional intelligence levels. A series of regression analyses revealed that emotional control, emotional recognition and expression, and understanding of emotions were significant predictors of burnout. An exploration of gender differences found that females reported slightly higher general burnout levels.Conclusion  A number of implications, limitations, and suggestions for further research were explored. It was concluded that burnout remains a significant problem for the surgical profession, with the potential for considerable personal, psychological, and societal impairment. The development of training interventions and further exploration of the aetiology of burnout was recommended, to ensure that impairment is minimised for individuals vulnerable to developing burnout.
SE02 THE VALIDITY OF AN INTEGRATED CLINICAL SIMULATOR FOR LEARNING LAPAROSCOPIC APPENDICECTOMY
Authors: Windsor J. A. , Loveday B. , Oosthuizen G. , Diener S. 
Published: April 2007

Purpose  Attaining procedural competence requires a combination of specific cognitive and psychomotor skills. The Multimedia Clinical Skills Trainer (MCST, GoVirtual Medical Ltd) is software program that integrates text, anatomy, video and simulation for teaching a range of procedures. The purpose of this study was to determine the face, content and construct validity of MCST for laparoscopic appendicectomy (LA).Methodology  The study was supported by the RACS. Basic surgical trainees (BST) in NZ were recruited and randomized into a control group and an intervention group. The latter received MCST for ad libitum use on their personal computers. Participant received three questionnaires: at the start of the study to determine demographics, at 2 weeks to assess knowledge and problem solving ability, and at four months to assess operative confidence and usefulness of MCST.Results  Fifty‐eight BST’s were randomized. The first questionnaire was returned by 46% of participants, and third questionnaire by 44%. The intervention group scored more highly than the control group in the second questionnaire (14.69/20 vs 13.48/20). This difference was more apparent for first year BST’s (14.93/20 vs 12.13/20, p = 0.04). Operative confidence was similar at four months for the two groups. First year BST’s scored MCST more highly for its usefulness (5.2/7 vs 3.7/7, p = 0.04).Conclusions  MCST has face, content and construct validity for BST’s learning LA, is a useful pre‐learning tool prior to clinical training opportunities, and can be used to measure knowledge and performance.
SE21 THE VALUE OF CLINICAL INDICATORS IN SETTING STANDARDS OR IMPROVING CLINICAL OUTCOMES
Authors: Beasley S. W. 
Published: April 2007

Purpose  The Australasian Association of Paediatric Surgeons (AAPS) has collected Clinical Indicator (CI) data from virtually all the paediatric surgical institutions of Australia and New Zealand for the last five years. These CI’s were modified and expanded from the original ACHS/RACS specialty specific CI’s. This study reviews the CI data to determine the extent to which they have set standards or influenced the management of several paediatric surgical conditions.Methodology  Analysis of AAPS CI data for pyloric stenosis, intussusception, appendicectomy and oesophageal atresia collected between 2001–2005 inclusive, and comparison with published outcome data for the same conditions.Results  To date, the data have been accessed only rarely. For some of the CI’s, eg duodenal perforation during pyloromyotomy, the numbers have established a reliable benchmark rate (1.55% of 581 pyloromyotomies), and have already proved useful in the reconfiguration of services. For others, eg leak rate after repair of oesophageal atresia, the small numbers and complexity of confounding variables mean that they are unlikely to have any longterm value or application.Conclusion  Well constructed CI’s provide data that can been useful to improve clinical outcomes. However, regular review is required to identify those that are unlikely to have useful application so they can be removed.
SE09 TRAINING OF FINAL YEAR MEDICAL STUDENTS IN PROCEDURAL SKILLS: IS IT WORTHWHILE?
Authors: Lushkott M. , Bissett I. P. 
Published: April 2007

Purpose  Doctors graduating from medical school are immediately faced with performing many clinical procedures. This study aimed to assess whether the introduction of a new procedural skills course for final year students increased their confidence in performing these skills at qualification.Methods  Students attending the final year procedural skills course were asked to complete a pre‐course, post‐course and end of year questionnaire scoring their confidence and experience in each of the procedures. Fifteen skills were taught in a simulated setting including; instrument handling, suturing, knot tying, local anaesthetic administration, plaster application, rectal examination, male catheterisation, nasogastric tube insertion, arterial blood sampling and lumbar puncture.Results  The questionnaires were completed satisfactorily by 60, 64 and 93 students at the precourse, postcourse and end of year times respectively. There was a significant improvement in confidence for the 15 skills taught at the postcourse and end of year assessments over the precourse values (p < 0.0001 for all). By the end of the year (3–7 months later) there was a significant drop in confidence (p < 0.05) from the postcourse scores in 10 procedures that was not seen in local anaesthetic administration, rectal examination, preparing a sterile workplace, male catheterisation and arterial blood sampling. In these 5 procedures there was a significant increase in experience between the course and end of year.Conclusion  Teaching procedural skills to final year medical students results in increased confidence in these skills at graduation and confidence is maintained best in those with ongoing experience in the procedure.
SH10 TEACHING AND LEARNING ANATOMY IN MELBOURNE OVER 150 YEARS
Authors: Collins J. P. 
Published: April 2007

The teaching of anatomy which began unofficially in Melbourne 150 years ago was formally established with the passing of “An Act for Regulating Schools of Anatomy” in 1862 by the Victorian government. Armed with this Act, the University of Melbourne founded its medical school later that same year.The development of anatomy teaching and the separation of anatomy from pathology one hundred years ago, is a colourful story in which several local personalities played their part. Commencing in an improvised outbuilding of his home, the first professor, George Halford began teaching anatomy in May 1863, the first such course in Australia. He was followed by Allen, Berry, Wood Jones and many others, each of whom was to make their own contribution.The influence of surgeons including George Adlington Syme was paramount from the beginning and frequently the teaching of students only survived through their efforts. It was Wood Jones, who first drew attention to the negative aspects of the preservative formaldehyde and the artificial descriptions of anatomy which resulted. He warned in 1923, that “students will one day have to readjust their ideas, since they deal with the living but it is only now that living anatomy has fully taken its place in anatomy learning, through the use of telescopic views and the newer imaging techniques of the living body.From simple beginnings, this department has evolved into a world leader in innovation and its award wining multi‐media package An@tomedia has brought the teaching and learning of anatomy into a new dawn.
SH11 THE MEDIEVAL ENGLISH CORONER
Authors: Sharp P. A. 
Published: April 2007

The office of Coroner is a uniquely English institution. Scotland never had coroners. England exported her Coroner to almost everywhere coloured red in the Victorian atlas. The first mention of the Coroner dates from the reign of Alfred the Great. We have no records of that period.The Coroner, as we know him today, dates from September 1194, during the reign of Richard the Lionheart whose interest in England was as a source of money to help finance his obsession with warfare.Much of today’s English legal structure was born in the last decade of the 12th century. The edict that formally established the Coroners was Article 20 of the “Articles of Eyre” in September 1194. In 1195, Justices of the Peace were established. Ironically, they became the major reason for the decline of the Coroner in later centuries.Coroners originally had to be Knights and men of substance. They were unpaid. Their prime function was to service the Royal Courts of Law, the General Eyre, which circulated slowly around the kingdom. This took so long to return to each county that, unless careful records were kept by the coroners, many cases never came to trial and potential revenue was lost to the Crown.Other activities of the Coroner includes jurisdiction over “treasure troves”, shipwrecks and catches of royal fish: the whale and the sturgeon. Historically, his most important role, the only one to survive until today, was his role in the investigation of sudden death.
SH13 THE COLONIAL GATES OF THE MELBOURNE COLLEGE GARDENS SITE, RACS HEADQUARTERS
Authors: Murphy D. L. 
Published: April 2007

The colonial past history of the College Gardens site in Melbourne was revealed during the excavations and building of the East Wing, Victorian Training and Education Centre (VTEC).Research has revealed a golden history for this site, which we as Fellows of the College should be proud. The College site continues with its original purpose as a place of learning.The choice of this site as the future RACS Headquarters involved decisions by our Founders. The College Museum plans for the site are progressing, enamel signage displaying the College site’s past history is proposed for the Skills Laboratory Forecourt.This permanent display will provide a linkage between the history of this site to the current role of the VTEC, as a place of continuing education. It is fitting therefore that we look through the gates of that time to our future.
SH14 COLONEL (DR.) JOHN PAUL STAPP – CRASH TEST DUMMY, TRAUMA PREVENTION PIONEER & MURPHY’S LAW
Authors: Harden M. P. 
Published: April 2007

Dr John Paul Stapp was not only the “fastest human on earth;” he was also the quickest to stop. In 1954, Dr Stapp attained a then world record land speed of 632 mph (1020 km/h), going from a stand still to a speed faster than a .45 bullet in 5 s on a rocket sled, and then to a dead stop in 1.4 s, all in the name of safety.Stapp pioneered research on the effects of mechanical forces on living tissues during aircraft crashes. Stapp planned a series of tests on humans and set out to develop a harness to hold them. First, he used a dummy to perfect the harness and after 32 sled runs, he was ready to try it out on a human crash test dummy, himself. By 1954, Stapp had volunteered for 29 deceleration and windblast experiments. On his last run he sustained more than 40 g’s. He suffered fractured ribs and wrist, and retinal haemorrhages which left him temporarily blind.Whilst at the Air Force Stapp also began a car‐crash study program to investigate fatalities in auto accidents. From this program, safety recommendations for the car industry were established including fastening seats more securely to the car body, improving bumper design and proving the effectiveness of seat belts. Stapp’s work resulted in the 3‐point restraint system of today’s belts which has saved millions of lives.Stapp is also credited with coining one of the most famous phrases in history. One of his assistants, Capt E. Murphy, rigged a harness incorrectly yielding no data on the forces Stapp was subjected to. After discovering what happened, Stapp observed, “If there are two or more ways to do something and one of those results in a catastrophe, then someone will do it that way.” It has been called “Murphy’s Law” ever since.