bluuebunny/crossref_metadata_2025_split huggingface dataset:
LAPAROSCOPIC ANTI‐REFLUX SURGERY IN NEW ZEALAND: A TREND TOWARDS PARTIAL FUNDOPLICATION
Authors: Windsor John A. , Yellapu Srini 
Published: March 2003

Background: The advent of laparoscopic anti‐reflux surgery has generated considerable debate regarding the best technique. The present study was undertaken to determine the trends and current technique in laparoscopic anti‐reflux surgery in New Zealand. Methods: A confidential nationwide postal survey was sent to all general surgeons in New Zealand; it was repeated after a month, and followed up with a telephone prompt, if necessary. Results: Of the 146 questionnaires sent out, 126 were returned (response rate: 86%), and 104 were excluded (no anti‐reflux surgery performed (n = 96); surgeon retired (n = 5); paediatric surgeon (n = 3)). The number of operations performed by the 22 (16%) adult general surgeons who had performed laparoscopic anti‐reflux surgery increased 4.6 times from 1991 to 1997 (474 open and 1218 laparoscopic operations). The median number of cases per surgeon was 30 (range: 5–300). In 1997 there were 208 (60%) total fundoplications (TF) and 135 (40%) partial fundoplications (PF) performed. Variations in the technique of TF included the Nissen–DeMeester (10 surgeons), the Nissen–Rosetti (nine surgeons), division of short gastric vessels (10 surgeons), and routine cruroplasty (14 surgeons). A PF had never been perfomed by six surgeons, was preferred by six surgeons, and four other surgeons were performing it more often. Variations in the technique of PF included posterior (12 surgeons) and anterior (four surgeons) forms. Conclusion: There is significant variation in the technique of laparoscopic anti‐reflux surgery in New Zealand. A TF is preferred by 16 surgeons, but there appears to be a trend towards PF among the more experienced surgeons.
TEACHING ON THE RUN: TEACHING SKILLS FOR SURGICAL TRAINEES
Authors: Crowe Philip , Harris Peter , Ham John 
Published: March 2003

Background: Increasing recognition of the need for training in teaching skills for clinical teachers has coincided with data that registrars and residents conduct much ‘on the job’ teaching as part of their routine work. While attention has been devoted to training consultants, support for the teaching role of the junior staff has been relatively neglected. The aim of the present report is to describe the teaching experiences of surgical registrars and the impact of a registrar teaching workshop. Method: A half‐day programme combining presentation and discussion of surgical teaching with practical skills sessions was designed for surgical registrars at Prince of Wales Hospital. The programme included observation and feedback of brief teaching simulations at the bedside of volunteer patients to newly commenced clinical students, and small group sessions on clinic and operating theatre teaching. A pre‐workshop questionnaire sought information about the registrars’ own teaching, and a survey 3 months after the workshop determined if any changes to teaching practice had occurred. Results: The registrars were generally moderately to very confident with their teaching ability but more than 75% felt that they were more confident after the workshop. Only three of 39 registrars had received any instruction aimed at improving their teaching skills, yet 34/39 had taught either on the ward, in the clinics or in the operating room. Follow‐up after 3 months revealed that most registrars were enjoying their teaching tasks more, and half had increased their teaching since the workshop and began discussing teaching with their surgical colleagues. Conclusions: The present project demonstrates that relatively brief interventions focused on skill development may enhance the confidence and enjoyment of junior clinical teachers and increase the frequency of ‘teaching on the run’.
PERCUTANEOUS ENDOSCOPIC LASER DISCECTOMY
Authors: Boult Maggi , Fraser Robert D. , Jones Nigel , Osti Orso , Dohrmann Peter , Donnelly Peter , Liddell John , Maddern Guy J. 
Published: March 2003

Background: The aim of the present paper was to systematically review the literature on percutaneous endoscopic laser discectomy (PELD) with respect to the safety and efficacy of the procedure. Where possible the procedure was compared with open discectomy. Methods: Studies on PELD were identified using MEDLINE (1984 to December 1999), EMBASE (1974 to December 1999) and Current Contents (1993 to Week 1, 2000). A number of search terms were used: PELD; PLDD (percutaneous laser disc decompression); and laser and (spine or lumbar) and (disc* or disk*). The Cochrane Library was searched from 1966 to issue 4, 1999, using the search terms ‘discectomy’ or ‘discotomy’. Live human studies of patients with lumbar disc prolapses for whom surgery was appropriate were included. Cadaver studies were also included. A surgeon and reviewer independently assessed the retrieved articles for their inclusion in the review. Results: Only 12 papers were identified that related to PELD. The level of evidence for safety and efficacy was low; there were no controlled, blinded or randomized studies. The highest level of evidence came from time series studies. No quantitative analysis could be undertaken for the present review. Conclusions: Given the extremely low level of evidence available for this procedure it was recommended that the procedure be regarded as experimental until results are available from a controlled clinical trial, ideally with random allocation to an intervention and control group.
USE OF AN AMBULANCE‐BASED HELICOPTER RETRIEVAL SERVICE
Authors: Wills Vanessa L. , Eno Louise , Walker Christopher , Gani Jonathon S. 
Published: March 2003

Background: John Hunter Hospital is the major trauma centre for a region covering more than 25 000 square kilometres. The helicopter primary retrieval service for trauma is paramedic staffed and protocol driven. The aim of the present study was to assess the overtriage rate created by such protocols, and to assess the benefit to patient outcomes that may be attributable to the service. Methods: The John Hunter Hospital trauma database was used to identify all cases arriving by helicopter in 1996, as well as their demographic details, injury severity score, details of the accident and outcome. An expert panel reviewed the medical records for the 184 primary retrievals. Using a consensus model, estimates of time delay or saving were calculated and likelihood of benefit, no benefit or harm was assessed. Results: A total of 3087 trauma patients were assessed at John Hunter Hospital in 1996, of which 8% arrived by helicopter. Of the primary retrievals, 67.6% had an injury severity score of 9 or less, with only 17.9% having a score of 16 or greater. Twelve patients were discharged from Emergency and 36% were discharged within 48 h. The overall mortality was 5.0%. Twenty‐five per cent of patients were retrieved within 35 km of John Hunter Hospital with minimal attributable benefit. Overall 1.7% of patients were felt to have been potentially harmed, 17.3% to have benefited and 81.0% to have had no attributable benefit related to the helicopter use. Conclusions: Although the majority of retrievals are for minor injuries, the service provides benefit for the region. There is potential for harm, however, where base hospitals are overflown in situations where patients have airway compromise, and where patient transfer is delayed due to helicopter activation. Primary helicopter tasking to trauma cases within 35 km of the major trauma centre is seldom beneficial.
Grasper Trauma During Laparoscopic Cholecystectomy
Authors: Marucci Damian D. , Shakeshaft Anthony J. , Cartmill John A. , Cox Michael R. , Adams Stuart G. , Martin Christopher J. 
Published: March 2003

Background: The present study characterized the histopathological nature of laparoscopic grasper trauma during laparoscopic cholecystectomy in a prospective, blinded trial in order to establish a model for laparoscopic grasper trauma. The null hypothesis that graspers cause no histologically distinct tissue injury was tested.Methods: The gall bladders of 19 patients undergoing laparoscopic cholecystectomy were examined. The area of gall bladder that had been grasped by Debakey laparoscopic forceps was excised (sample), along with an area of gall bladder that had not been grasped (control). Paired specimens were examined by a pathologist (blinded) to identify which was ‘sample’ and which was ‘control’ and to assess for histological markers of crushed tissue injury. The data were analysed by chi‐squared or Fisher’s exact tests.Results: The pathologist was able to identify the sample (gripped) specimen in 13 of the 19 cases. In the remaining six cases the pathologist was unable to determine the specimen that had been gripped due to either absence of damage (four cases), or severe inflammation precluding assessment (two cases). The ability of the pathologist to distinguish the sample from the control specimen was significant (chi‐squared test, P = 0.003). Of the histological markers of crushed tissue injury, focal thinning of the gall bladder wall and epithelial loss were present in significantly more sample (gripped) specimens than control specimens (chi‐squared test, P = 0.0002 and P < 0.0001, respectively).Conclusions: Laparoscopic graspers cause tissue trauma that can be assessed histologically. The current study presents a relevant, reproducible, ethically acceptable human model for assessing the interaction between laparoscopic graspers and soft tissues.
Trauma training in Australia and New Zealand: Results of a survey of advanced surgical trainees
Authors: Thomson B. N. J. , Civil I. D. , Danne P. D. , Deane S. A. , Mcgrath P. J. 
Published: March 2003

Background: The surgical management of trauma within Australia and New Zealand has recently been undergoing major organizational changes. The aim of the present paper was to evaluate the attitudes and experience of Australian and New Zealand advanced surgical trainees in this changing climate and to identify problems with trauma training. Methods: A survey assessing important areas of trauma management and training was sent to all advanced surgical trainees of the Royal Australasian College of Surgeons. Results: Two hundred and seventy‐two of 587 trainees responded (46%). Overall 85% of trainees believed they would be involved in trauma management in the future. The majority of trainees reported low rates of involvement and consultant supervision in trauma resuscitations. Only 32% of general surgical trainees believed that their exposure to major trauma operations was very adequate despite an average of 12.3 trauma operations per year. Seventy per cent of general surgical trainees reported a very adequate level of consultant supervision at trauma operations. In contrast 86% of orthopaedic trainees reported a very adequate exposure to trauma operations with an average of 221 orthopaedic trauma operations per year. Only 46% of orthopaedic trainees reported a very adequate level of consultant supervision at trauma operations. Conclusions: Regional rotations may need to be developed to even out trainees’ experience in trauma management. The low level of supervision in trauma resuscitations and orthopaedic surgical training requires attention. This survey warrants repeating in a prospective manner.
Functioning adrenal tumours in children and adolescents: An institutional experience
Authors: Mishra Anjali , Agarwal Gaurav , Misra Anand Kumar , Agarwal Amit , Mishra Saroj K. 
Published: March 2003

Background: The purpose of the present paper was to carry out an audit of clinicopathological profile and treatment outcome in 13 children with functioning adrenal tumours. Methods: The medical records of 13 children with functioning adrenal tumours who were managed between June 1990 and January 1999 were reviewed. Demographic data, clinical features, biochemical and localization studies, operative details and follow‐up records were studied. Children with neuroblastoma were excluded. Results: The mean age was 7.4 ± 5.3 years. Seven patients had Cushing’s syndrome (CS), two patients had virilizing tumours, three patients had phaeochromocytoma (PCC) and one patient had Conn’s syndrome. All patients (except one child with CS) were treated surgically. Two children with adrenocortical carcinoma (ACCa) died during the perioperative period. Histopathological diagnosis was adrenal cortical adenoma (ACAd) in four patients, ACCa in five patients and PCC in three patients. Two ACCa patients died of metastases at 12 and 14 months, respectively, while the third is alive and well at 30 months. Children with ACAd are alive and well at 91, 56, 32 and 27 months postoperatively. Children with PCC are free of disease (normal urinary metanephrines) at 63, 18 and 8 months after surgery but require antihypertensive drugs in low doses. Conclusion: The outcome of surgery is good in cases of ACAd and PCC. Although outcome is poor in ACCa, surgery remains the mainstay of treatment and offers good palliation.
Breast reconstruction after mastectomy: A survey of general surgeons in Singapore
Authors: Lim Jeremy , Low Sze Chuan , Hoe Michael 
Published: March 2003

Background: Breast cancer is the leading malignancy among women in Singapore. In the West as many as 30% of eligible patients undergo some form of reconstruction, but in Singapore breast reconstruction is not often performed. Methods: A postal survey of general surgeons in Singapore (response rate of 46%) was conducted to ascertain the factors influencing their decision to refer for reconstruction and the possible concerns they had about reconstruction. Results: Age, anticipated psychosocial morbidity and the need for adjuvant therapy were the most important factors identified. The survey also found that almost 30% of respondents were unsure of whether reconstruction would mask recurrence. Despite this, almost 80% of respondents felt that reconstruction was worth the effort, but 55% (compared to less than 20% in the West) felt that patients did not want reconstruction despite being advised of its availability. Conclusion: Lack of information and the perception that patients would not want reconstruction may be important reasons for the low emphasis placed on the role of breast reconstruction in post‐mastectomy patients.
Anal incontinence surgery: A small personal experience
Authors: Isbister William H. 
Published: March 2003

Background: The true incidence of faecal incontinence in Saudi Arabia is unknown and probably relatively few patients seek treatment at the present time. In order to assess the types of treatment available and their outcomes, a retrospective audit of patients presenting at King Faisal Specialist Hospital during an 8‐year period has been undertaken. Methods: Charts were examined in order to identify the cause of the incontinence, the severity and duration of the problem, the clinically determined resting and squeeze pressures, the anatomical muscular defect, the surgery performed, the surgical morbidity, the results of surgery and the length of follow up. Results: Thirty patients (average age 36.9 years) were surgically treated for anal incontinence. Thirteen were females. Previous fistula surgery was the commonest cause for incontinence. Nine patients had generalized sphincter weakness. The average duration of symptoms was 71.6 months. Eighteen patients had overlapping sphincter repairs, of whom eight had wounds that became infected and 13 (72%) patients were ‘better’. Two of five patients were ‘better’ following dynamic graciloplasty. Stomata were constructed in 12 patients and six were closed. Surgery reduced mean incontinence scores (Wexner) from 10.4 to 5.0. Conclusion: Overlapping sphincter repair can be safely performed for localized sphincter defects in Saudi Arabia with a high probability of improving continence. In contrast, dynamic graciloplasty is not a suitable operation for patients in this region, where cultural and social habits preclude satisfactory function of the stimulated neosphincter.
Costs of accessing surgical specialists by rural and remote residents
Authors: Rankin Sarah L. , Hughes‐Anderson Wayne , House Anthony K. , Heath Dugal I. , Aitken Robert J. , House Jill 
Published: March 2003

Introduction: Access to surgical specialist services by rural and remote residents in Australia is limited. Little information is available on the cost to rural residents of accessing specialist treatment. The aim of the present study was to define the personal costs incurred by country patients in Western Australia when accessing specialist surgical services in a rural or metropolitan setting. Methods: A random sample of 50 patients who attended a visiting rural surgical service between December 1998 and February 1999 inclusive was recruited. In a structured telephone interview patients were asked 40 non‐clinical questions relating to their recent specialist consultation. The cost of accessing these services was determined from time lost from work, distance and travel expenses. The same formula was then applied to estimate the cost of attending a base metropolitan hospital. The need for an accompanying person was determined from a subset of 16 patients who had transferred to metropolitan specialist consultation in the previous 12 months. Average waiting list times for consultations and common surgical procedures for the visiting service were compared with those for a metropolitan‐based service. Results: An estimated saving of AU$1077 was made per specialist consultation when accessing a local rather than a metropolitan service. Savings were observed in travel time, distance travelled, lost income, provision of an escort and waiting time. Conclusion: The present study shows that the personal costs and difficulties incurred by rural and remote residents when accessing specialist treatment can be reduced if a visiting specialist service is available.
Identification of appropriate assessment criteria to measure older adults’ driving performance in simulated driving
Authors: Lee Hoe C. , Drake Vaile , Cameron Don 
Published: March 2003

This study investigated a laboratory‐based driving simulator and identified assessment criteria for its use as an off‐road screening tool for older adult drivers. The driving performance of 53 volunteer older adults was assessed by the driving simulator and gauged by age‐specific assessment criteria. The assessment criteria used in this study were cognitive functions required in making decisions based on past driving experience and ever‐changing driving conditions. The Cronbach alpha confirmed internal consistency of the scales that comprised the measures of driving performance. Pearson coefficient showed some assessment criteria were significantly correlated with age of participants (−0.59 <
r
< 0.49). The multivariate analysis of variance revealed that there was an overall score difference in driving performance between two age groupings: senior drivers and advanced age senior drivers. The younger the age of the participants, the better they performed in driving as defined by the assessment criteria. The findings of this study do not deviate from the literature supporting the evidence that driving ability declines with age. It was established that if appropriate assessment criteria are chosen, driving simulators can differentiate between levels of older adults’ driving skills.
Through the Glass Darkly: Towards Options for Training, Examination and Continuing Education
Authors: Adler Robert 
Published: March 2003

The Royal Australian and New Zealand College of Psychiatrists is a Fellowship of Psychiatrists working together with and for the general community to achieve the best attainable quality of psychiatric care and mental health [ 1 ]. Since its incorporation as the Australian and New Zealand College of Psychiatrists in 1963 over 2000 psychiatrists have become fellows of the College, most by successfully completing the training and examinations process, either in its present form or in an earlier incarnation. The basic framework for the training and examination of psychiatrists in Australia and New Zealand was set down over 30 years ago. It has been modified substantially over the years as training expanded from a three-year membership to a five-year fellowship program. The current system has served us well, producing psychiatrists who compare favourably with their peers anywhere in the world and who have made significant contributions to knowledge in the field. The current review of training, examination and continuing education is not a criticism of past training and examination. Rather, it is an opportunity to consider whether present practices are the most appropriate to equip future psychiatrists to meet the needs and expectations of the community.
The Monash Gender Dysphoria Clinic: Opportunities and challenges
Authors: Damodaran Saji S. , Kennedy Trudy 
Published: March 2003

Objective: The paper describes the origin, and establishment of a gender dysphoria clinic at Monash Medical Centre, Melbourne. It aims at describing the various components of the service, especially the triadic notions of assessment, real life experience and surgery for gender identity disorders. Conclusion: This is a unique service offered by a public psychiatric service, and the viability of the service depends upon new resources and renewed interest from psychiatrists. Besides clinical services, the clinic offers enormous research, teaching and training opportunities.
New Roles for Old: The Role of The Psychiatrist in The Interdisciplinary Team
Authors: Rosen Alan 
Published: March 2003

Objectives: The contributions of the psychiatrist to the interdisciplinary team are described, along with the opportunities for, and barriers to, effective teamwork. Conclusions: Australasian health and medical training systems still provide perverse incentives deterring psychiatrists from becoming full members of interdisciplinary teams. Sources of potential role conflict should be resolved, and advantages of teamwork support, division of labour, cross-fertilisation and hybrid vigour should be realised. Truly essential and desirable roles for psychiatrists in interdisciplinary teams could be developed and strengthened by further training.
The Financial and Service Provision Implications of a New Eating Disorders Service in a Paediatric Hospital
Authors: McDermott Brett , Gullick Karen , Forbes David 
Published: March 2003

Objective: To report the burden of care and financial cost of a new Eating Disorders service within a paediatric teaching hospital. Method: A 39-month period before and after the inception of a child and adolescent Eating Disorders service was studied. Medical records were analysed to compare the burden of care, including number of admissions and bed-days, during the comparison period. The financial implications of the new service were also investigated. Results: The number of individuals referred, assessed and offered treatment was significantly greater following the inception of the ED Team. The number of admissions and total bed-days utilised significantly increased. The burden of care was shifted to the medical ward. The overall service cost increased by 108% from baseline. However, the cost per-admission and per-inpatient decreased by 40% and 48% respectively. Conclusions: There are compelling psychological and medical arguments why children and adolescents with Eating Disorders warrant a coordinated team approach. The inception of such a team is likely to create significant financial economies. However, the overall hospital burden of care will significantly rise.