Mapping timely access to emergency and essential surgical services: The Malaysian experience.

Background: Surgical conditions form a significant proportion of the global burden of disease. Since the 2015 World Health Assembly resolution A68.15, there is recognition that the provision of essential surgical care is an integral part of universal access to health care.

State-wide outcomes in elective rectal cancer resection: is there a case for centralization in Victoria?

Background: The role of service centralization in rectal cancer surgery is controversial. Recent studies suggest centralization to high-volume centres may improve postoperative mortality. We used a state-wide administrative data set to determine the inpatient mortality for patients undergoing elective rectal cancer surgery and to compare individual hospital volumes.

Short-term outcomes of pancreaticoduodenectomy in the state of Victoria: hospital resources are more important than volume.

Background: Pancreaticoduodenectomy (PD) is a high-risk procedure. Australian hospitals perform a relatively low volume of PD. This study sought to gain an understanding of hospital volume and short-term outcomes of the procedure in the Australian state of Victoria.

Measuring Outcomes of Clinical Care: Victorian Emergency Laparotomy Audit Using Quality Investigator.

Background: The Australian and New Zealand Audit of Surgical Mortality (ANZASM) National Report 2015 found that within the cohort of audited deaths, 85% were emergencies with acute life-threatening conditions, and by far, the most common procedures were laparotomy and colorectal procedures. Emergency laparotomy outcomes have shown improvement through audit and reporting in the UK. The purpose of this study was to determine the outcome of emergency laparotomy in the state of Victoria, Australia.

Systematic review and meta-analysis of hepatic resection versus transarterial chemoembolization for solitary large hepatocellular carcinoma.

Background: Surgical techniques and pre-operative patient evaluation have improved since the initial development of the Barcelona clinic liver cancer staging system. The optimal treatment for solitary hepatocellular carcinoma ≥5 cm remains unclear. The aim of this study was to review the long-term survival outcomes of hepatic resection versus transarterial chemoembolisation (TACE) for solitary large tumours.

Measuring the Burden of Surgical Disease Averted by Emergency and Essential Surgical Care in a District Hospital in Papua New Guinea.

Background: Timely access to emergency and essential surgical care (EESC) and anaesthesia in low- and middle-income countries (LMICs) prevents premature death, minimises lifelong disability and reduces their economic impact on families and communities. Papua New Guinea is one of the poorest countries in the Pacific region, and provides much of its surgical care at a district hospital level. We aimed to evaluate the surgical capacity of a district hospital in PNG and estimate the effectiveness of surgical interventions provided.

How Does Cholecystectomy Influence Recurrence of Idiopathic Acute Pancreatitis?

Background: Idiopathic acute pancreatitis is diagnosed in approximately 10-30 % of cases of acute pancreatitis. While there is evidence to suggest that the cause in many of these patients is microlithiasis, this fact has not been translated into a resource efficient treatment strategy that is proven to reduce recurrence rates. The aim of this study was to examine the value of prophylactic cholecystectomy following an episode of acute pancreatitis in patients with no history of alcohol abuse and no stones found on ultrasound.

Colorectal multidisciplinary meetings: how do they affect the timeliness of treatment?

Background: The aim of this study is to determine whether multidisciplinary team (MDT) meetings alter the length of time to treatment (LOTT) for patients with colorectal cancer.

Methods: We conducted a retrospective audit of all patients with colorectal cancer from the Geelong Hospital (TGH) mandatory colorectal database from 1 January 2006 to 3 February 2011. To be included, patients had to have had elective surgical intervention for primary colorectal adenocarcinoma.

Evaluation of the medium-term outcomes and impact of the Rowan Nicks Scholarship Programme.

Background: Rowan Nicks was a cardiothoracic surgeon in Sydney. He endowed the Rowan Nicks Scholarship Programme of the Royal Australasian College of Surgeons, which was initiated in 1991 to provide opportunities for clinicians from developing countries so that they return to their countries as leaders and teachers. This paper's objective was to evaluate the outcomes and impact of the scholarship on individuals and their communities.

Guy de Chauliac: pre-eminent surgeon of the Middle Ages.

Guy de Chauliac (c1300-1368) trained in Toulouse and the University of Montpellier from where he achieved the highest possible degree of Master of medicine. He undertook fellowships in Bologna (anatomical dissection) and Paris (surgery) and was qualified as a physician not a Barber Surgeon. He took Holy Orders and was appointed as physician to three Avignon-based Popes.

Does an Acute Surgical Model increase the rate of negative appendicectomy or perforated appendicitis?

Introduction: The clinical outcomes from suspected appendicitis depend on balancing the rate of negative appendicectomy (NA) with perforated appendicitis (PA). An Acute Surgical Model (ASM) was introduced at Geelong Hospital (GH) in 2011 involving a dedicated emergency general surgery theatre list every business day giving greater access to theatre for general surgeons. The aim of this study was to evaluate the effect of the ASM at GH on the management of appendicitis, in particular the NA and PA rates.

Making decisions in emergency surgery.

Background: Good decision making is essential in surgery. In an emergency, the time for decision making is often short, and the information available is incomplete. The way experienced surgeons make decisions is often not well understood, and therefore is difficult to teach to trainees.

Clinical decision making: how surgeons do it.

Clinical decision making is a core competency of surgical practice. It involves two distinct types of mental process best considered as the ends of a continuum, ranging from intuitive and subconscious to analytical and conscious. In practice, individual decisions are usually reached by a combination of each, according to the complexity of the situation and the experience/expertise of the surgeon.

Reducing errors in emergency surgery.

Background: Errors are to be expected in health care. Adverse events occur in around 10% of surgical patients and may be even more common in emergency surgery. There is little formal teaching on surgical error in surgical education and training programmes despite their frequency.

Medical student participation in a surgical outpatient clinic: a randomized controlled trial.

Background: To determine the patient, doctor and student perceptions with different styles of student participation in a surgical outpatient clinic.

Methods: A randomized controlled trial was conducted in surgical outpatients. Participants included patients scheduled to see one of four specialist general surgeons, the surgeons themselves and third-year medical students undertaking their general surgery rotation at the Geelong Hospital.

Three phases of the Pacific Islands Project (1995-2010).

The Pacific Islands Project (PIP), funded by AusAid and managed by the Royal Australasian College of Surgeons (RACS), has progressed through three phases from 1995 to 2010. During this time, it has sent over 520 teams to 11 Pacific Island Countries, providing over 60,000 consultations and some 16,000 procedures. In addition to this delivery of specialist medical and surgical services that were not previously available in-country, the project has contributed as a partner in capacity building with the Fiji School of Medicine and Ministries of Health of the individual nations.

Monitoring performance in thyroidectomy: cumulative sum analysis of outcomes.

Background: Cumulative sum (CUSUM) analysis gives visual feedback on performance. It requires agreed benchmarks to compare binary outcomes. This process has not previously been applied to thyroidectomy.

How do patients aged 85 and older fare with abdominal surgery?

Objectives: To review the outcomes of patients aged 85 and older after abdominal surgery in terms of mortality, morbidity, and change in residential status and to analyze factors predicting such outcomes.

Design: Retrospective clinical cohort study.

Setting: A tertiary regional hospital in Victoria, Australia.

Training in the private sector: what works and how do we increase opportunities?

In Australia 61% of elective surgery takes place in private hospitals where current opportunities for surgical education and training (SET) are limited. The situation will shortly be compounded because of the large increase in local medical graduates, many of whom will aspire to be surgeons. How and where to train these extra surgeons to meet the expanding needs of the community must be addressed.

Surgery in developing countries.

Object: Frontoethmoidal meningoencephaloceles (MECs) are a relatively common abnormality in southeast Asia, with disastrous consequences for the sufferer. In Cambodia, a lack of skilled neuro-and craniofacial surgeons, and the cost of surgery limit the possibilities for appropriate treatment of patients with these lesions. The authors developed a low-cost humanitarian program with the goals of treating frontoethmoidal MECs, ensuring careful postoperative follow-up, and teaching Khmer surgeons how to treat these malformations.

Loch ness, special operations executive and the first surgeon in paradise: Robert Kenneth Wilson (26.1.1899-6.6.1969).

Lieutenant Colonel Robert Kenneth Wilson (1899-1969) was a surgeon who fought in both world wars and joined the Special Operations Executive parachuting behind enemy lines into Holland, France and Borneo, the last mission being with Australian forces (Semut II). He was an expert on firearms and gave opinion on ballistics at the Old Bailey during the 1930s. He also wrote a definitive text on automatic pistols with editions published in 1943 and 1975.

Thyroid surgery in the tropics.

In the tropics thyroid surgery is carried out either by general surgeons or ear, nose and throat surgeons and there are few places with a subspecialist endocrine or head and neck surgeon. The aim of this review is to determine the pattern of thyroid pathology, surgery and surgical outcomes in the tropics. A review of thyroid surgery in tropical regions was carried out based on published articles in English in Medline (1965-2004).