bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE PROVISION OF GENERAL SURGICAL SERVICES IN RURAL SOUTH AUSTRALIA: A NEW MODEL FOR RURAL SURGERY
Authors: Bruening M. H. , Maddern G. J. 
Published: January 2008

Background: Rural South Australia (SA), like other rural areas in Australia, faces crisis in the medical workforce. It is also generally assumed that the same applies to rural surgical services but finding evidence to support this is scarce. Methods: All hospitals situated outside the outer metropolitan area of SA were surveyed about surgical services (n= 57). Questions were asked about the frequency of emergency and elective theatre usage and which surgeons provided surgical services. Results: Operating theatre facilities were in active use in 39 of the 57 hospitals studied. At the time of the study there were seven specialist general surgeons resident in rural SA. General practitioners continued to have major input in the provision of surgical services, either by providing the general anaesthetic (34/39) or by performing the surgical procedures (26/39). Conclusions: The Department of Surgery at the University of Adelaide is instituting various measures to counter the rural surgical workforce problem and is developing model that serves either the individual or the two–person surgical practice. Metropolitan teaching hospitals can play an important role in supporting current rural surgeons and can foster an increased commitment to the future of rural general surgery.
RADIATION USE IN THE ORTHOPAEDIC THEATRE: A PROSPECTIVE AUDIT
Authors: Jones David Gwynne , Stoddart Julian 
Published: January 2008

Background: There is concern about the exposure of orthopaedic surgeons to radiation. The aim of this study was to monitor radiation use in theatre to improve practice and to attempt to quantify the radiation dose the orthopaedic surgeon may have received. Methods: A 6–month prospective audit of all procedures performed in the orthopaedic theatre that used fluoroscopy or radiographs was undertaken An anthropomorphic phantom was used to measure scatter and direct–skin doses. Screening times were recorded in subsequent 6–month post at tertiary trauma centre. Results: Fluoroscopy or radiographs were used in 378 procedures. Fluoroscopy was used in 260 procedures with screening time of 124 min at an average of 0.48 min per procedure. Lead aprons were worn in 99% of cases and thyroid guards in 32%. All dosimeter badges were negative. The surgeon'hand was caught in the fluoroscopy beam in 15% of procedures. The phantom recordings ranged from 13 to 210 microGy for skin dose and 0.17‐0.87 microGy for scatter dose. The calculated hand exposure was less than 5% of recommended levels. In the trauma post 210 min of screening was used potentially increasing the hand exposure to one–third of recommended limits. If printer was used to record the image, 58% of intra–operative radiographs would have been avoided. Conclusions: Hand exposure to radiation is the limiting factor in orthopaedics. The extremity limit will only be exceeded if the hands are regularly caught in the beam. Dose‐reduction gloves should be considered for high–risk procedures. A printer can reduce the need for intraoperative plain radiographs.
ADVERSE EVENTS AFTER PROSTATECTOMY IN VICTORIAN PUBLIC HOSPITALS
Authors: Ansari M. Z. , Costello A. J. , Jolley D. J. , Ackland M. J. , Carson N. , Mc donald I. G. 
Published: January 2008

Background: A retrospective analysis of data from the Victorian Inpatient Minimum Database (VIMD) was conducted to analyse trends in prostatectomy rates in Victorian public acute‐care hospitals from 1989/90 to 1994/95. The study also sought to identify predictors of adverse events (AE) after prostatectomy, and to compare in‐hospital complications between open prostatectomy and transurethral resection of prostate (TURP). Methods: All patients who had undergone any prostatectomy were identified according to the relevant ICD‐9‐CM procedure codes (60.2–60.4) documented in the VIMD. The main outcome measures, AE, were identified using the ICD‐9‐CM supplementary classification of external cause of injury (E850–858, E870–876, E878–879, E930–949). The variables used as predictors were year of prostatectomy, type of admission (planned, emergency), location of the hospital (rural, metropolitan), type of procedure (TURP, open), and teaching status of the hospital. Crude and adjusted odds ratios (OR) were based on univariate and multivariate logistic regression. Results: The rates of prostatectomies have significantly increased over the 6‐year study period (P for trend < 0.0001). The percentage of AE after prostatectomy increased simultaneously from 6.1 to 12.9% (P < 0.0001). During the same period, the in‐hospital mortality rate after prostatectomy decreased from 1.2 to 0.5%, and length of stay decreased from 10.3 to 6.1 days (Kruskal–Wallis P < 0.0001). The significant predictors of outcome were year of prostatectomy (P for trend < 0.0001), emergency admissions (OR = 1.57; P < 0.0001), metropolitan hospitals (OR = 0.81; P= 0.0003), non‐teaching hospitals (OR = 0.78; P < 0.0001), and open prostatectomy (OR = 1.52; P= 0.04). More in‐hospital complications were associated with open prostatectomy than with TURP. Conclusions: The rise in AE rate after prostatectomy is unlikely to reflect poor quality of care, because in the same period there was a significant decrease in in‐hospital mortality after prostatectomy. A more likely explanation is heightened awareness of AE with a lower threshold for reporting such events. Important factors other than variations in quality of care can result in an increase in AE. Hence the reported increase should be interpreted with caution before attempting to conclude that changes in clinical practice could have a direct impact on these rates.
PAROTID AND SUBMANDIBULAR SIALADENITIS TREATED BY SALIVARY GLAND EXCISION
Authors: Bates Damien , O'Brien Christopher J. , Tikaram Kamille , Painter Dorothy M. 
Published: January 2008

Background: The purpose of the present study was to compare and contrast the clinicopathological features and treatment outcome of chronic sialadenitis involving the parotid and submandibular glands, among patients who were treated by excision of the affected gland. Methods: In a series of 88 patients treated over an 8‐year period, 47 had parotid sialadenitis and 41 had submandibular sialadenitis. In the parotid group, 63% of patients were symptomatic for longer than 6 months compared with 27% in the submandibular group. Calculi were implicated in the disease process in 24% of patients with parotid sialadenitis, compared with 73% of patients with submandibular disease. Results: Patients with parotid sialadenitis had superficial (n= 14) or near‐total parotidectomy (n= 35), while those with submandibular sialadenitis underwent total gland excision. Complications occurred twice as frequently in the parotidectomy group. The rate of temporary facial nerve weakness was 29% after parotidectomy while marginal mandibular nerve dysfunction occurred after 12% of submandibular excisions. Both procedures were highly effective in permanently relieving the symptoms of sialadenitis. Conclusions: Parotid sialadenitis is infrequently associated with stones and tends to run a longer course before surgical intervention is necessary. Submandibular sialadenitis usually presents earlier, is secondary to calculi and requires early intervention.
MULTIPLE LAPAROTOMIES FOR SEVERE INTRA‐ABDOMINAL INFECTION
Authors: Jlffry Bllal A. , Sebastian Mark W. , Amin Tarek , Isbister William H. 
Published: January 2008

Background: Mortality rates for patients with severe peritoneal infection are high. The present study was undertaken in order to examine mortality rates in patients with severe peritoneal infection who were managed by planned re‐laparotomy. Methods: Retrospective analysis of patients presenting at the King Faisal Specialist Hospital and Research Centre between 1992 and 1994 with severe peritoneal infection was undertaken. Results: A total of 52 patients underwent either single (n= 30) or multiple (n= 22) peritoneal lavage, and Acute Physiology and Chronic Health Evaluation (APACHE II) scores and predicted mortality rates were calculated for these patients. The predicted mortality rate for patients undergoing a single washout was 42.4%, actual mortality: 23%. The predicted mortality for patients undergoing multiple washouts was 55.6%, actual mortality: 36.3%. No patient with a predicted mortality of < 30% who underwent multiple washouts died. Of nine patients with a predicted mortality between 31 and 60%, one died (11.1%). For a predicted mortality of 61–80%, five of six patients died (83.3%), and for patients with a predicted mortality of > 80%, two of three died (66.7%). Conclusions: The utilization of planned re‐look laparotomy and peritoneal lavage in patients with severe peritonitis may result in a significant decrease in mortality as predicted by APACHE II scoring.
LAPAROSCOPIC COLECTOMY FOR CANCER: A REVIEW
Authors: Luck Andrew , Hensman Chris , Hewett Peter 
Published: January 2008

Background:The success of laparoscopic cholecystectomy in providing patient benefits in the immediate postoperative period has led to laparoscopic techniques being used for many other intra‐abdominal procedures. Colorectal resection for malignancy is one of the more contentious applications of this new technology, because the postoperative benefits are more subtle and the long‐term oncological results are as yet unknown.Methods:A review of the English‐language literature was undertaken in order to collate and analyse all published series where 20 or more laparoscopic colectomies were performed, and where the indication for resection in the majority of cases was adenocarcinoma of the colon.Results:Laparoscopic colectomy for cancer can be performed safely by experienced surgeons, although there is a considerable learning curve for the procedure. The expected benefits of minimal access surgery are provided by laparoscopic colectomy, although to a lesser extent than that seen with other procedures. The oncological safety of the procedure is as yet unproven. It is clear that an equivalent resection can be performed, but not whether this translates to an equivalent recurrence and survival rate. Reports of isolated port‐site recurrences are of concern.Conclusions:Early results of laparoscopic colectomy for cancer are encouraging, although the fate of this procedure rests with the analysis of the large multicentre prospective randomized trials currently under way, particularly with regard to the long‐term recurrence and survival rates.
BACILLUS CALMETTE‐GUERIN (BCG) IMMUNOTHERAPY FOR BLADDER CANCER: REVIEW OF COMPLICATIONS AND THEIR TREATMENT
Authors: Paterson David L. , Patel Anil 
Published: January 2008

Background:Intravesical bacillus Calmette–Guerin (BCG) is widely used in the management of bladder cancer but because it is a living organism, local and disseminated infection may result.Methods:A prospective assessment of complications of this therapy in 200 patients in Queensland was performed. A review of management of complications of intravesical BCG was also carried out.Results:Major side effects were rare. Cystitis was the most common side effect, being seen to some degree in all patients, although only forcing cessation of BCG therapy in two patients. Two patients developed persistent cystitis necessitating institution of isoniazid and rifampicin. Two patients had culture‐proven bladder infection that presented several months after the BCG treatment. These patients also responded to two‐drug antituberculous therapy. While low‐grade fever is very common with this therapy, seven patients (3.5%) had fevers of > 39°C within 48 h of receiving BCG. Fevers may be an indication of severe disseminated mycobacterial infection, which has a high mortality, so it needs to be treated aggressively. Alternatively bacterial sepsis with Gram‐negative bacterial pathogens or a hypersensitivity reaction to BCG may cause this degree of fever, and cannot be rapidly distinguished from fulminant mycobacterial infection. One patient in the present series developed pneumonia attributed to mycobacterial dissemination.Conclusions:The key to appropriate management of complications of BCG therapy is awareness of their possibility, even months or years after the therapy has been given. Appropriate empirical therapy in acute situations and mycobacterial culture in chronic situations can then be performed.
CONSTRUCTION OF CONTINENT CATHETERIZABLE URINARY CONDUIT FROM AN ISOLATED SEGMENT OF COLON
Authors: Sen Sudipta , Ahmed Saeed 
Published: January 2008

Background:Continent urinary diversion may be necessary in range of urological abnormalities. In circumstances where the standard techniques are not possible, alternative innovative techniques may be used.Methods:In female patient with bladder exstrophy, continent diversion was recommended. The appendix was not available, the ureters were not suitable and continent stoma was fashioned from an isolated segment of colon.Results:The stoma proved to be continent, although it was somewhat stenotic. However, clean intermittent catheterization maintained its patency.Conclusions:A continent catheterizable stoma may be constructed from segment of colon. The technique may be considered when other well recognized methods are not feasible.
COMPUTERS IN MEDICAL EDUCATION 2. USE OF A COMPUTER PACKAGE TO SUPPLEMENT THE CLINICAL EXPERIENCE IN A SURGICAL CLERKSHIP: AN OBJECTIVE EVALUATION
Authors: Devitt Peter , Cehic Daniel , Palmer Edward 
Published: January 2008

Background:Student teaching of surgery has been devolved from the university in an effort to increase and broaden undergraduate clinical experience. In order to ensure uniformity of learning we have defined learning objectives and provided a computer‐based package to supplement clinical teaching. A study was undertaken to evaluate the place of computer‐based learning in a clinical environment.Methods:Twelve modules were provided for study during a 6‐week attachment. These covered clinical problems related to cardiology, neurosurgery and gastrointestinal haemorrhage. Eighty‐four fourth‐year students undertook a pre‐ and post‐test assessment on these three topics as well as acute abdominal pain. No extra learning material on the latter topic was provided during the attachment.Results:While all students showed significant improvement in performance in the post‐test assessment, those who had access to the computer material performed significantly better than did the controls. Within the topics, students in both groups performed equally well on the post‐test assessment of acute abdominal pain but the control group'performance was significantly lacking on the topic of gastrointestinal haemorrhage, suggesting that the bulk of learning on this subject came from the computer material and little from the clinical attachment.Conclusions:This type of learning resource can be used to supplement the student'clinical experience and at the same time monitor what they learn during clinical clerkships and identify areas of weakness.
THE ANATOMICAL BASIS FOR SEGMENT III CHOLANGIOJEJUNOSTOMY WITH ANALYSIS OF 13 CASES
Authors: Vellar I. D. A. , Banting S. W. , Hardy K. J. 
Published: January 2008

Background:The majority of patients who require palliation for jaundice and pruritus resulting from malignant hilar obstruction are treated by stenting. Stenting is usually achieved from below after performing an endoscopic retrograde cholangiopancreatography. In some cases the rendezvous technique is employed, negotiating the passage through a malignant stricture from above and stenting from below. A minority of cases, such as those who had a previous polyagastrectomy and those in whom attempts at stenting have failed, are considered to be suitable for a Segment III cholangiojejunostomy. We have investigated the anatomical basis for Segment III duct bypass and have critically analysed the results in 13 patients. Ten patients were treated by Segment III duct bypass alone, and three patients had a Segment III duct bypass combined with stenting of the right liver.Methods:The anatomy of the biliary tree was investigated by dissection of 54 normal livers removed at autopsy. Clinical details of the 13 patients who had Section III cholangiojejunostomy were obtained from hospital records and by contacting treating practitioners.Results:In 64.8% of the anatomical dissections, the findings were favourable for a Section III cholangiojejunostomy. In these specimens the Segment III duct bypass would have drained Segments II, III and IV. In 35.2% of the specimens the anatomical disposition was potentially unfavourable, mainly due to the Segment II or IV ducts joining close to the confluence and therefore liable to obstruction by the tumour. In nine of the 54 specimens the true left hepatic duct was less than 6 mm in length, making it unsuitable for a bypass procedure to drain the left hemi liver. Of the 10 patients who were subjected to a palliative Section III cholangiojejunostomy only, there was one postoperative death. Of the nine patients who survived, six obtained excellent palliation of jaundice and pruritus.Conclusions:In carefully selected cases, Section III cholangiojejunostomy achieves excellent palliation in patients with unresectable hilar malignancies that have been unable to be stented pre‐operatively or who have unresectable tumours at the time of laparotomy.
EVALUATION OF THYROID SHIELDS FOR REDUCTION OF RADIATION EXPOSURE TO ORTHOPAEDIC SURGEONS
Authors: Dewey Peter , Incoll Ian 
Published: January 2008

Background:A perceived increase in the incidence of thyroid carcinoma in orthopaedic surgeons prompted an assessment of the use and value of thyroid shields in the operating theatre. Methods: he radiation exposure to the thyroid area of 19 orthopaedic trainees was measured over a 3‐month period, while they were operating. The results were correlated with thyroid function tests and the number of emergency operative cases performed. Results: Thirteen trainees received radiation exposure within the guidelines set for the general population. Two trainees received exposure above this but within the guidelines set for occupational exposure. A thyroid shield reduced radiation exposure of the neck in one trainee by a factor of 13. The availability and usage of thyroid shields was low: only seven out of 13 trainees used shields. Conclusions: A thyroid shield should be worn by orthopaedic surgeons if radiation is used during the operative procedure.
Elements of a Fiscal Politics: Public Choice and Public Finance
Authors: Brennan Geoffrey 
Published: January 2008

AbstractThe object of this paper is to indicate how public choice theory and orthodox normative tax theory may be integrated within a single coherent intellectual framework. Because public choice theory has quite different conceptual foundations from normative tax theory, this is no simple task. A purely positive fiscal theory, that derives tax arrangements as one aspect of the emergent political equilibrium, would leave no logical room for normative tax theory at all: the question as to what the tax system ‘ought to be’ becomes irrelevant, or at least inseparable from the broader question as to the appropriateness of general political institutions. However, if tax arrangements are viewed as part of the political institutional framework, normative tax theory can be admitted ‐ but in a somewhat reformulated way. The paper aims to set out briefly the reformulations required.
Financial Regulation in Australia
Authors: Davis Kevin 
Published: January 2008

AbstractThis paper examines whether a regulatory distinction between banks and other financial institutions, as proposed by the Campbell and Martin Reports, is an appropriate ingredient of financial regulation. Three specific issues relevant to the making of such a distinction are examined. They are entry to the payments mechanism, monetary control, and prudential regulation. In examining each of these three issues the roles of imperfect information and other financial market characteristics are stressed. The paper concludes that while a regulatory distinction between banks and others may be appropriate, the distinctions suggested by the Reports and associated regulatory frameworks are unwarranted.
How Much Do We Know About Wealth Distribution in Australia?
Authors: Nevile J. W. , Warren N. A. 
Published: January 2008

AbstractThis paper surveys what is known about wealth distribution in Australia and concludes that our knowledge is scanty. The most reliable evidence comes from studies using probate returns and with the abolition of estate duties, these studies are becoming out of date. However, it is clear that wealth is very unequally distributed. The top 5 per cent of adult individuals own between 40 and 50 per cent of the wealth. This inequality is not just due to life cycle effects, and there is no strong evidence that wealth distribution has become more equal in Australia in the period since the First World War.
Labour Costs and the Future of the Accord
Authors: Dawkins Peter , Blandy Richard 
Published: January 2008

AbstractThis article concentrates on the wages policy aspects of the Accord. The Statement of the Accord, the National Economic Summit Communique and the Principles for National Wage Cases, are considered in the context of the rationales for wages policy. The apparent early successes of the Accord, followed by signs, such as the emergence of wage drift, that it will eventually break down, are outlined. Long‐term political economy aspects of the Accord are considered, which suggest that it is unlikely to represent a long‐term solution. The growing enthusiasm for decen tralisa tion and deregulation, despite the Hancock Report, is noted, as is the importance of promoting shared objectives at the grass roots level.
Macroeconomic Policy in Australia Since the Sixties
Authors: McDonald Ian M. 
Published: January 2008

AbstractThis article reviews macroeconomic policy in Australia since the 1960s. It is argued that economic thinking by Australian governments progressed from a Keynesian approach to a classical approach in 1975 and then to a Keynesian‐classical synthesis in 1983. To the usual major indicators of macroeconomic performance, unemployment and inflation, the article adds a third indicator, called thrift. Thrift is a measure of how society is allocating its resources between current and future consumption. The record of thrift for Australia since the 1960s is described and evaluated.
Taxation and Policy Change: A Median Voter Model for Australia 1968–69 to 1981–82
Authors: Brennan Geoffrey 
Published: January 2008

AbstractThis article constructs a median voter model of public expenditure levels, which includes as a central piece of the analysis the costs of expenditure increments to voters in various income groups. These marginal cost‐shares or ‘tax‐prices’ are derived from tax data for three separate periods over the larger period under discussion. The levels of spending predicted by the model are compared with the levels of spending that actually prevailed, as a means of checking the median voter model ‐ and in that sense, to investigate the plausibility of one line of reasoning that might be used to explain ‘continuity and change’ from 1968–69 to 1981–82.