Practitioner characteristics, diagnostic accuracy metrics and discovering-individual with respect to 637 melanomas documented by 27 general practitioners on the Skin Cancer Audit Research Database.

Background And Objective: Knowledge of accuracy for melanoma diagnosis and melanoma discovering-individual in primary care is limited. We describe general practitioner (GP) characteristics and analyse defined diagnostic accuracy metrics for GPs in the current study comparing this with a previous study for GPs common to both, and we analyse the individual first discovering each melanoma as a lesion of concern.

Methods: The characteristics and diagnostic accuracy of 27 Australasian GPs documenting 637 melanomas on the Skin Cancer Audit Research Database (SCARD) in 2013 were described and analysed.

Developing culturally safe education practices in optometry schools across Australia and Aotearoa New Zealand.

Access to culturally safe health services is a basic human right, however through the lasting effects of colonisation, oppression, and systemic racism, the individual and community health of Indigenous peoples in Australia and Aotearoa New Zealand have been severely impacted. The Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy of the Australian Health Practitioners Regulation Agency, and the Standards of Cultural Competence and Cultural Safety of the Optometrists and Dispensing Opticians Board of New Zealand, recognise the importance of access to safe health care for Aboriginal, Torres Strait Islander and Māori patients, which encompasses both clinical competency and cultural safety. Universities have an ongoing responsibility to ensure their learning and teaching activities result in graduates being able to provide culturally safe practice.

Characteristics, treatment and outcomes of 589 melanoma patients documented by 27 general practitioners on the Skin Cancer Audit Research Database.

Background And Objective: General practitioners manage more melanomas than dermatologists or surgeons in Australia. Previously undescribed, the management and outcomes of melanoma patients treated by multiple Australasian general practitioners are examined.

Methods: The characteristics, management and outcomes of 589 melanoma patients, managed by 27 Australasian general practitioners and documented on the Skin Cancer Audit Research Database (SCARD), were analysed.

Characteristics of 637 melanomas documented by 27 general practitioners on the Skin Cancer Audit Research Database.

Background And Objective: Most melanomas (including melanomas in situ), in Australasia, are treated by general practitioners (GPs). Previously undescribed, the characteristics of a series of melanomas treated by multiple GPs are examined.

Patients And Methods: Six hundred and thirty-seven melanomas treated by 27 Australasian GPs during 2013 and documented on the Skin Cancer Audit Research Database (SCARD) were analysed by anatomical site, subtype, Breslow thickness, diameter, associated naevi and linked adverse outcomes.

How an urban Aboriginal and Torres Strait Islander primary health care service improved access to mental health care.

Introduction: Aboriginal and Torres Strait Islander people experience higher levels of psychological distress and mental ill health than their non-Indigenous counterparts, but underuse mental health services. Interventions are required to address the structural and functional access barriers that cause this underuse. In 2012, the Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care employed a psychologist and a social worker to integrate mental health care into its primary health care services.

Anaesthetic agents for thoracic surgery: what's best?

Purpose Of Review: Pneumonectomy is still associated with a 5% 30-day mortality in a large series involving a variety of anaesthetic agents and techniques.

Recent Findings: As well as the immediate 'anaesthetic' complications of pain, nausea and vomiting and respiratory dysfunction, differences between anaesthetic agents have emerged in systemic inflammation, postoperative cognitive dysfunction, immune suppression and cell signalling after surgery.

Summary: No one anaesthetic agent has emerged as best.

Coronary artery bypass grafting and concomitant excision of chest wall chondrosarcoma.

Coexistence of coronary artery disease and cancer with both requiring surgical treatment at the same time is rare. A 52 year male undergoing elective coronary artery bypass grafting was incidentally discovered to have a large soft tissue mass of variable consistency with cartilaginous elements arising from the right costal margin and adjoining ribs by a broad attachment and protruding into right pleural cavity. Frozen section suggested it to be either a chondrosarcoma or a teratoma.

Efficacy and safety of remifentanil in coronary artery bypass graft surgery: a randomized, double-blind dose comparison study.

Objectives: To compare the efficacy and safety of 3 doses of remifentanil as part of a total intravenous anesthesia technique with low-dose propofol in patients undergoing coronary artery bypass graft (CABG) surgery.

Design: Multicenter, multinational, double-blind, randomized, dose comparison study.

Setting: Nine hospitals in 5 countries.

Lobar volume reduction surgery: a method of increasing the lung cancer resection rate in patients with emphysema.

Background: Guidelines on patient selection for lung cancer resection identify a predicted postoperative forced expiratory volume in 1 second (ppoFEV(1)) of <40% as a predictor of high risk. Experience with lung volume reduction surgery suggests that ppoFEV(1) may be underestimated in those with concomitant emphysema.

Methods: Anatomical lobectomy was performed in 29 patients with a resectable lung cancer within a poorly perfused, hyperinflated emphysematous lobe identified by radionuclide perfusion scintigraphy and computed tomographic scanning.

Introducing ropivacaine into a department's epidural analgesic practice. Improving acute pain service practice.

The results of introducing a new licensed local anaesthetic drug, ropivacaine, into routine practice were evaluated by measuring the efficacy and adverse effects of patient controlled epidural analgesia (PCEA), using ropivacaine 2 mg/ml (R), or the mixtures in current use: fentanyl 5 (micrograms/ml with bupivacaine 1 mg/ml (BF5) and fentanyl 10 (micrograms/ml) with bupivacaine 1 mg/ml (BF10). All patients were nursed on general wards after surgery. For two months, 102 consecutive patients were studied.

Breath interval as a measure of dynamic opioid effect.

We measured breath interval to characterize the time course of opioid effect in anaesthetized patients breathing spontaneously during knee replacement surgery with concurrent regional nerve blockade. Breath interval was recorded before and after a single dose of fentanyl 0.75 microgram kg-1 i.

Remifentanil and tramadol.

The lack of analgesic efficacy limits tramadol as a sole agent to treat severe pain after surgery. However, it has a relative lack of respiratory depressant and constipating effects compared with morphine and codeine, and does not share the propensity of nonsteroidal anti-inflammatory drugs to provoke asthma, gastrointestinal mucosal damage and renal impairment. It may well have a place in the management of pain after surgery, in combination with another drug, such as paracetamol, or after control of the worst of pain after surgery by a regional local anaesthetic technique.

Toward the paperless hospital?

This report describes an ethnographic study of document use by anaesthetists. In doing so, it focuses on the role of the preoperative risk assessment form as used in anaesthetic practice at a cardiothoracic hospital, and considers what would be the advantages and disadvantages of shifting the paper into the electronic form. Evidence from this case study is used to comment on how the practical use of documents by medical professionals can be fundamentally at odds with how the organization at large would like to use them.

Remifentanil and pulmonary extraction during and after cardiac anesthesia.

We measured the apparent blood clearance and pulmonary extraction ratio of remifentanil in 10 adult patients undergoing elective myocardial revascularization for the first time with hypothermic cardiopulmonary bypass (CPB). Patients received continuous infusions of remifentanil 1.0, 1.

Co-induction of anaesthesia: the cardiac patient.

Cardiac patients pose special problems to the anaesthetist because of their underlying disease and the nature of the corrective surgery. Information about new methods of induction of anaesthesia obtained in fit patients may not be applicable directly to patients with heart disease. More suitable are patients undergoing cardioversion.

Enoximone and warming after hypothermic cardiopulmonary bypass.

In a randomized, controlled study of 24 patients undergoing myocardial revascularization, we found that enoximone 0.5 mg kg-1 i.v.

Convective warming after hypothermic cardiopulmonary bypass.

In a randomized, controlled study, we found that convective warming after hypothermic cardiopulmonary bypass did not accelerate the rate of warming of the body core or the time to tracheal extubation. The relationship between body core and shell temperature, however, was affected. In all patients inadequate time spent rewarming on cardiopulmonary bypass prolonged body core warming time and time to tracheal extubation.

Efficacy of continuous intercostal bupivacaine for pain relief after thoracotomy.

We studied 20 patients undergoing thoracotomy, in a double-blind, placebo-controlled crossover trial of intercostal bupivacaine. Bupivacaine 0.25% was infused at 5 ml h-1 through each of two catheters placed in the intercostal space at operation.

Pulse oximeter probes. A comparison between finger, nose, ear and forehead probes under conditions of poor perfusion.

The performances of 10 pulse oximeters using finger probes were compared with the same pulse oximeters using alternative probes (eight finger probes, two nose probes and a forehead probe) in poorly perfused patients. All readings were then compared with directly measured arterial blood oxygen saturations. The mean difference (bias, 'accuracy'), standard deviation (precision) and 'drop out' rate for each pulse oximeter combination was determined.

A comparison of the performance of 20 pulse oximeters under conditions of poor perfusion.

The performance of 20 pulse oximeters with finger probes was evaluated by comparison of their readings with directly measured arterial blood oxygen saturations. The samples were taken from patients who had undergone cardiac surgery under hypothermic cardiopulmonary bypass and had poor peripheral perfusion. The mean difference (bias, accuracy), standard deviation (precision) and drop-out rate for each pulse oximeter was determined.