bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do surgeons need to look after unwell patients? The role of medical emergency teams
Authors: Wong Kenneth , Levy Richard D. 
Published: September 2005

Background:  Medical emergency teams (MET) have been shown to reduce in‐hospital morbidity and mortality of surgical patients. The present study reviews the experience with the use of MET in the care of critically unwell surgical patients.Methods:  Data were prospectively collected on all patients in a general surgical unit of a tertiary referral centre meeting the criteria for activating a MET over a 6 month period. These data were retrospectively analysed with respect to surgical team and MET involvement in the care of these patients.Results:  Over the 6 month study period, 22 patients qualified for a MET response based on criteria of physiological instability. A MET was activated for 13 of these patients (59%), with the remainder being managed by direct consultation with intensive care and medical staff. Forty‐six per cent of MET activations were outside of normal working hours. Respiratory distress including tachypnoea and desaturation was the most commonly identified physiological abnormality (13 patients), accounting for 62% of MET activations. A MET was activated by a surgical registrar in 46% of cases. Seventy‐seven per cent of MET activations were preceded by at least one registrar level assessment without resolution of the patient's clinical deterioration. The most common MET interventions were supplementation of oxygen therapy and initiation of pharmacotherapy (11 patients). The surgical team complemented the MET response by providing detailed information regarding the patient's surgical condition, premorbid status (13 patients), organized transfer to the operating theatre (three patients), initiated blood transfusions (two patients) and deciding to order abdominal computed tomography (two patients). Urgent surgical decision making was required in 23% of MET activations.Conclusions:  Medical emergency team activations for critically unwell surgical patients are complemented by surgical team involvement in the decision making and management process. The MET may be underutilized in the management of unwell surgical patients.
Surgeon and hospital volume and the management of colorectal cancer patients in Australia
Authors: McGrath Daniel R. , Leong David C. , Gibberd Robert , Armstrong Bruce , Spigelman Allan D. 
Published: September 2005

Background:  The evidence for a relationship between patient outcomes and clinician and hospital volume is increasing. The National Colorectal Cancer Care Survey was undertaken to determine the management patterns in Australia for individuals newly diagnosed with colorectal cancer in a 3 month period in the year 2000.Methods:  All new cases of colorectal cancer registered at each Australian State Cancer Registry were entered into the survey. This generated a questionnaire that was sent to the treating surgeon. Chi‐squared tests and logistic regression analyses were used to determine levels of statistical significance.Results:  Of 2383 surgical questionnaires generated, 2015 (85%) were completed. The majority (58%) of surgeons treated one or two patients with colorectal cancer over the 3 months of the survey. There was variation across surgeon cohorts for preoperative measures including the use of deep vein thrombosis prophylaxis. Patients seen by low volume surgeons were most likely to be given a permanent stoma (P < 0.0001). Patients with rectal cancer who were operated on by high volume surgeons were significantly more likely to receive a colonic pouch (P < 0.0001).Conclusion:  This nationwide population‐based survey of the treatment of colorectal cancer patients suggests that the delivery of care by surgeons (the majority) who treat patients with rectal cancer infrequently should be evaluated.
Factors associated with morbitity in liver hydatid surgery
Authors: Manterola Carlos , Vial Manuel , Pineda Viviana , Sanhueza Antonio , Barroso Manuel 
Published: September 2005

Background:  The purpose of the present paper was to determine the association between clinical evolutionary and laboratory variables with postoperative morbidity in patients surgically treated for liver hydatidosis (LH).Methods:  A case−control nested cohort study was undertaken. Patients were studied and surgically treated in Hospital Regional of Temuco between 1994 and 2001. The morbidity variable registered with a minimum 12‐month follow‐up period was considered in a dichotomous way. The association with clinical, laboratory, evolutionary, and surgical variables was studied. Descriptive statistics, bivariate analysis using χ2 and Fisher's exact test for categorical variables; t‐test, anova, and Kruskal−Wallis for continuous variables; odds ratio calculations, and ordinal and multivariate logistic regression models were applied.Results:  The cohort was composed of 202 patients surgically treated for LH, 112 women (55.5%) and 90 men (44.5%), with an average age of 45.2 years. Average morbidity of the series, with a median follow‐up period of 53 months, was 16.4%. Six variables were significantly associated in the bivariate analysis (age, haematocrit, total leucocyte count, alkaline phosphatase, history of previous surgery for LH and existence of biliary communications), but only two achieved statistical significance in the multivariate model (age and history of previous surgery for LH; P = 0.017 and 0.018; and odds ratio of 1.0 and 4.1, respectively).Conclusions:  In surgical decision making for patients with LH, the history of previous surgery for LH must be considered as a risk factor for postoperative morbidity.
Diagnostic value of routine drain tip culture in primary joint arthroplasty
Authors: Weinrauch Patrick 
Published: September 2005

Background:  Closed suction drainage after joint arthroplasty is common practice in many institutions. The purpose of this study was to determine the correlation between routine drain tip culture and the diagnosis of superficial or deep postoperative wound infection after primary knee and hip replacement.Methods:  Over a 12‐month period, drain tips were retrieved and cultured in all patients who underwent unilateral primary total knee or hip replacement with the use of closed suction drainage. A total of 393 cultures was performed in 387 patients (145 hip replacements, 242 knee replacements). Patients were followed for an average of 8.9 months after surgery to assess for postoperative wound infection.Results:  Three patients had a positive drain tip culture, none of which were diagnosed with superficial or deep infection. Four patients (1%) were diagnosed with deep infection, 16 (4.1%) with superficial infection. No patient with either superficial or deep infection had a positive drain tip culture after their index procedure. The sensitivity of routine drain tip culture for the diagnosis of postoperative infection in primary joint replacement was 0% and specificity was 99.2%.Conclusions:  These data do not support the practice of routine drain tip culture after primary hip or knee replacement for the diagnosis of postoperative infection.
National Breast Cancer Audit: establishing a web‐based data system
Authors: Boult Margaret , Cuncins‐Hearn Astrid , Tyson Sarah , Kollias Jim , Babidge Wendy , Maddern Guy 
Published: September 2005

Background:  An audit of surgical treatment of early breast cancer was introduced nationally in 1999. In August 2002, the Australian Safety and Efficacy Register of New Interventional Procedures − Surgical, under the auspices of the Royal Australasian College of Surgeons, assumed responsibility for managing this audit. This article provides an update of audit activities, now known formally as the National Breast Cancer Audit (NBCA), including a description of the new governance structure and the development of a secure online surgical audit system.Methods:  Major changes have taken place in the design and governance of the NBCA during the last two years. Two committees have been established to oversee the audit. A clinical advisory committee comprises experts from a number of fields including breast surgery, oncology, government, and from peak breast cancer and consumer bodies. A technical advisory committee oversees many of the technical issues that have arisen with the development of an online data entry system. The online system of data entry was developed and launched to surgeons in May 2004.Results:  There are now 28 000 cases of primary breast surgery in the audit. Around 250 surgeons are currently participating, an increase of over 50 surgeons since May 2004. Surgeons can review their data using the online system and compare their own results by generating reports which graph their own results against national aggregate data.Conclusions:  There has been a significant increase in the volume of data received since the launch of the secure online system. The governing committees are working towards creating a clinical audit which will provide an improved data entry system and better reporting for all participating surgeons. The NBCA can also serve as a template on which to base other surgical audits.
Paediatric trauma at an adult trauma centre
Authors: Holland Andrew J. A. , Jackson Alicia M. , Joseph Anthony P. 
Published: September 2005

Background:  Trauma in children remains the commonest cause of mortality. The majority of injured children who reach hospital survive, indicating that additional more sensitive outcome measures should be utilized to evaluate paediatric trauma care, including morbidity and missed injury rates. Limited contemporary data have been presented reviewing the care of injured children at an adult trauma centre (ATC).Methods:  A review was undertaken of injured children who warranted activation of the trauma team, treated within the emergency department of an ATC (Royal North Shore Hospital) situated in the Lower North Shore area of Sydney. Data were collected prospectively and patients followed through to death or discharge from the ATC or another institution to which they had been transferred.Results:  A total of 93 children were admitted to the ATC between January 1999 and April 2002. Mean age was 9 years 3 months (range 5 weeks−15 years 9 months) and 70% were male. The median injury severity score was 15 (range 1−75) and there were three deaths. Forty‐two children were transferred to a paediatric trauma centre (PTC), including three children who had been transferred to the ATC from another hospital. There was one missed injury and one iatrogenic urethral injury.Conclusions:  The majority of children with trauma were treated safely and appropriately at the ATC. The missed injury rate was < 1% and there were no adverse long‐term sequelae of initial treatment. Three secondary transfers could have been avoided by more appropriate coordination of the initial referral to a PTC.
Evolution of methodological standards in surgical trials
Authors: Ellis Carleen , Hall Jane. L. , Khalil Alizan , Hall John C. 
Published: September 2005

Background:  The Consolidated Standards of Reporting Trials (CONSORT) Statement outlines acceptable ways of performing and reporting clinical trials. The objective of the present study was to identify evolving patterns in the methodological standards of surgical trials.Methods:  Compliance with 12 key standards from the CONSORT statement were evaluated in 490 trials published in either the ANZ Journal of Surgery or the British Journal of Surgery between January 1969 and December 2003.Results:  There has been an irregular but progressive improvement in the methodological standards of published trials. The criteria with the greatest improvement related to estimation of sample size, randomization, concealment of the allocated intervention, baseline comparisons, and the method of expressing outcomes. Compliance rates were <50% for three criteria during the last decade of the review, that is, concealment of the allocated intervention, blindness of assessment, and the method of expressing outcomes.Conclusion:  The results of surgical trials need to be interpreted with care.
Diagnosis and surgical management of popliteal artery entrapment syndrome
Authors: Goh Brian K. P. , Tay Kiang‐Hiong , Tan Seck‐Guan 
Published: September 2005

Background:  The purpose of the present study was to report the authors’ experience of surgically treating eight limbs in six patients for popliteal artery entrapment syndrome (PAES), over a 10‐year period.Methods:  From 1995 to 2004, six patients (eight limbs) underwent surgery for PAES at a single institution. The patients’ data were collected retrospectively from the case records and operative notes.Results:  There were six patients with a mean age of 34 years (range, 27−38 years) at diagnosis and five of them were male. Two patients were found to have bilateral involvement. Both patients had symptoms involving both limbs and underwent bilateral surgery. Intermittent claudication was the most frequent presenting symptom (seven of eight limbs). All the patients had Delaney's type III PAES. Popliteal artery release was performed in all eight limbs and this was combined with a vein patch or a reversed long saphenous vein bypass graft in four limbs because the arteries in these four limbs were diseased or occluded. At a median follow up of 15 months (range, 40 days−9 years), five (seven limbs) of the six patients (eight limbs) were cured of their symptoms. One patient who presented late with rest pain and dusky toes underwent popliteal artery release, endarterectomy and a vein patch repair for an occluded popliteal artery. However, her limb could not be salvaged and her affected limb had to be amputated.Conclusion:  Popliteal artery entrapment syndrome is a rare but important cause of peripheral vascular insufficiency especially in young patients. Early diagnosis and surgical intervention is imperative for good operative outcome and to prevent limb loss.
Use of two‐point discrimination as a nerve repair assessment tool: preliminary report
Authors: Shooter David 
Published: September 2005

Background:  Two‐point discrimination, static and dynamic, has long been used as an assessment tool for tactile gnosis, and to assess recovery after repair of a peripheral nerve. While use of a bent paperclip with a specified intertip distance as the assessment device has been described, no research has been performed on the accuracy of setting this distance by hand and eye alone. The aim of the present study was to demonstrate this accuracy.Methods:  Five orthopaedic registrars, four residents and three clinic nurses performed static and dynamic two‐point discrimination testing on each other. They set the tip distance by hand and eye by bending a paperclip such that the distance between the two ends was their best approximation of 5 mm and then 10 mm. The testing was repeated after 7 days, n = 264 for each tip distance.Results:  Two‐sample t‐tests showed no significant difference (P > 0.53−0.93) between tip distance setting performed by registrars, nurses and residents; while single sample t‐test showed a statistically significant difference (P < 0.0001) between the attempted tip distance and the overall mean tip distance achieved at 5 mm and 10 mm.Conclusion:  Statistical analysis showed that the single sample t‐test could be discarded. Static and dynamic two‐point discrimination testing with a paperclip set by hand and eye is therefore an accurate and reproducible test capable of being administered by both medical and non‐medical staff, and is suitable for inclusion in a peripheral nerve repair testing protocol.
Transfer of intubated patients with traumatic brain injury to Auckland City Hospital
Authors: Lind Christopher R. P. , Heppner Peter A. , Robins Toby M. , Mee Edward W. 
Published: September 2005

Background:  Delays in patient transfer to definitive neurosurgical care after traumatic brain injury are important in determining neurological outcome. The efficiency of interhospital transfer of patients to Auckland City Hospital (ACH) was analysed and compared with international standards.Methods:  The ACH Department of Critical Care Medicine database for the year 2002 was reviewed, with supplementary information obtained from transfer organizations, hospital notes, radiology archives, and operative logbooks.Results:  Thirty‐four adult patients with traumatic brain injury and no special reasons for delayed transfer were transported intubated from other hospitals in the North Island of New Zealand. The median time from injury to arrival at ACH was 6.5 h. It took a median 4.4 h for patients to get from initial computed tomographic imaging to ACH. For those requiring evacuation of haematomas, the mean time from arrival at ACH to the start of the operation was 1.4 h. Only 33% of patients from other metropolitan Auckland hospitals, and none from hospitals outside the city, arrived within 4 h from the time of injury.Conclusion:  Transfer times for brain trauma patients are currently longer than recommended for optimal neurological outcome. Referring hospitals and transfer organizations should review their systems to identify areas for improvement. Direct admission to theatre needs to be expedited within ACH when required. Triage of all trauma patients in metropolitan Auckland with a Glasgow Coma Scale score of less than 14 to ACH would be likely to improve time to treatment. A mobile acute neurosurgical service based in Auckland that would support general surgeons initiating acute decompressive cranial operations would be likely to reduce time to surgery and improve outcomes for patients admitted to hospitals outside Auckland. The development of a mobile acute neurosurgery service which would complete decompressive procedures started by general surgeons would likely improve trauma outcomes for patients injured outside Auckland.
Microsatellite isolation from four avian species comparing two isolation techniques
Authors: GREGORY SEAN M. , QUINN JAMES S. 
Published: September 2005

AbstractMicrosatellites are continuing to increase in popularity for genetic studies. A major drawback, however, is they often need to be isolated de novo. The traditional method (shotgun cloning) generally results in thousands of recombinant clones, which are then screened by Southern hybridization. Results are typically around 2% positive for mammals, but less than 0.4% for birds. Shotgun cloning is therefore generally not an effective method for isolating microsatellites from avian genomes. Several alternative methods have been developed, but the decision as to which method to use is often arbitrary. Here we present results for two microsatellite isolation techniques from four avian species.
Isolation and characterization of highly polymorphic microsatellite loci for the garden tiger mothArctia caja(Lepidoptera: Arctiidae)
Authors: ANDERSON SARAH J. , DAWSON DEBORAH A. , FREELAND JOANNA R. 
Published: September 2005

AbstractA set of microsatellite markers was isolated fromArctia caja, a species that has been declining in UK for several decades. As has been found with other Lepidoptera species, this proved to be a difficult task. Eight enriched libraries identified 103 positive clones, and these yielded only seven polymorphic microsatellites. Allelic diversity ranged from 10 to 23 alleles per locus in a population of 30 individuals. Significant heterozygosity deficits were shown by three of these loci, presumably due to null alleles. The remaining four loci were in Hardy–Weinberg equilibrium and will be used to investigate the population genetic structure ofA. caja.
Development and characterization of novel tetra‐ and dinucleotide microsatellite markers for the French Polynesia black‐lipped pearl oyster, Pinctada margaritifera
Authors: HERBINGER C. M. , SMITH C.‐A. , LANGY S. 
Published: September 2005

AbstractTen microsatellite loci were developed for the black‐lipped pearl oyster Pinctada margaritifera with a magnetic bead enrichment protocol. These tetra‐ and dinucleotide markers were polymorphic, with 10 to 43 alleles observed in 97 individuals from two Tuamotu atoll populations. Most loci revealed significant genic differentiation between the two populations and also exhibited some degree of heterozygote deficiencies, probably due to the presence of null alleles. These loci should be very useful to describe genetic structure, genetic variability and reproductive success in the various aquaculture and wild populations of pearl oyster in French Polynesia.
Development of microsatellite markers in the toxic dinoflagellate Alexandrium catenella (Dinophyceae)
Authors: NAGAI S. , SEKINO M. , MATSUYAMA Y. , ITAKURA S. 
Published: September 2005

AbstractThe outbreak of paralytic shellfish poisoning caused by the toxic dinoflagellate Alexandrium catenella (Dinophyceae) is a worldwide concern from the economic and food hygiene point of view. To assess the dispersal mechanism, a population genetic study using highly polymorphic genetic markers is one of the crucial approaches. We isolated 12 polymorphic microsatellites from this species. These loci provide one class of highly variable genetic marker as the number of alleles ranged from three to 12 and the estimate of gene diversity was from 0.248 to 0.897 across the 12 microsatellites; we consider that these loci have a potential to detail the genetic structure and gene flow among A. catenella populations.
An evaluation of allowing for mismatches as a way to manage genotyping errors in parentage assignment by exclusion
Authors: VANDEPUTTE M. , MAUGER S. , DUPONT‐NIVET M. 
Published: September 2005

AbstractIn parentage assignment by exclusion, using multiple and very polymorphic loci, genotyping errors are a major cause of non‐assignment. Using stochastic simulations, we tested the possibility to allow for mismatches at one or more allele as a way to recover assignment power. This was very efficient provided the set of loci used had a high assignment power (> 99%) and the error rate was not too high (below 3–4%). In these cases, most of the theoretical assignment power could be recovered. We also showed the efficiency of the method in a practical experiment with rainbow trout.
Democracy, Islam and Dialogue: The Case of Turkey
Authors: Kanra Bora 
Published: September 2005

AbstractThe November 2002 general elections in Turkey produced an Islamic-leaning government, supported by one of the biggest majorities, bringing the relationship between Islam and democracy under scrutiny. This paper examines the nature of this relationship and the current political situation in Turkey. It argues that Turkey's long-running aspiration for democratization has now a reasonable chance of success. This argument is supported by the findings of a Q study, conducted in Turkey during the 2002 election campaign, indicating strong support for dialogue, particularly within the Turkish Muslim community. Yet, it will also argue that turning this possibility into a success depends on the implementation of the right deliberative framework. Habermas's discourse theory of democracy provides the essentials for this. However, particularly in the context of a divided society, like Turkey, it has to be complemented with a better emphasis on deliberation as a social learning process, as in Dryzek's theory of discursive democracy.
Lessons Learned, Lessons Forgotten: The Swedish Referendum on EMU of September 2003
Authors: Aylott Nicholas 
Published: September 2005

AbstractSweden's referendum on whether to join EMU produced an emphatic No. The murder of one of the Yes side's leading representatives thus appeared not to have affected the result. Cleavages exposed in the referendum on EU membership nine years previously were even more apparent this time; yet No-voters were also to found across the political, regional and social spectrums. As well as describing the campaign and explaining the outcome, this article focuses on the campaign strategies adopted by parties and other actors. Lessons from previous campaigns had been learned by the opponents of EMU, but largely forgotten by its supporters.