Predictors of failure of conservative management of cholecystitis: a systematic review of the literature.

Objectives: While emergency cholecystectomy is the preferred treatment for acute cholecystitis, conservative management can be used as a bridge to definitive surgical management in situations where emergency surgical services are limited. The objective of this systematic review is to identify factors associated with conservative management failure as defined as either failed resolution of symptoms on initial presentation, or the recurrence of symptoms whilst awaiting an elective cholecystectomy. This study aims to allow clinicians to make evidence-based recommendations for conservative versus operative management.

Failure to rescue following oesophagectomy in Australia: a multi-site retrospective study using American College of Surgeons National Surgical Quality Improvement Program.

Background: Failure to rescue (FTR), defined as death after a major complication, is increasingly being used as a surrogate for assessing quality of care following major cancer resection. The aim of this paper is to determine the failure to rescue (FTR) rate after oesophagectomy and explore factors that may contribute to FTR within Australia.

Methods: A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2015 to 2023 at five Australian hospitals was conducted to identify patients who underwent an oesophagectomy.

The Continuing Problem of Expert Evidence in Medical Litigation - A Surgical Perspective with Reference to Daubert.

The tension that exists between the medical and legal professions regarding expert evidence is longstanding. In this article, we will examine some of the issues regarding expert evidence particularly as it relates to matters involving surgeons. Many of the current aspects of the Australian uniform evidence law in relation to expert testimony were based on the Federal Rules of Evidence promulgated in the United States in 1975.

Gastric diverticulum: a contemporary review and update in management.

Background: Gastric diverticula (GD) are the rarest form of gastrointestinal tract diverticulum, with an estimated incidence of 0.013-2.6%.

Presentation of multiple painful subcutaneous nodules: Dercum's disease, a rare variant of lipoma.

A woman in her 50s presented to her general practitioner (GP) with an 8-month history of multiple painful subcutaneous nodules of various sizes in her trunk and limbs. Her previous GP made the clinical diagnosis of lipoma when they presented as non-painful nodules 2 years ago. Initial ultrasound demonstrated multiple lipomata with the largest size in the left upper thighs displaying features of subtle internal vascularity, entirely contained within the subcutaneous layer.

Accuracy and Precision of a Novel Photogate System to Measure Toe Clearance on Stairs.

Toe clearance on stairs is typically measured using optoelectronic systems, though these are often constrained to the laboratory, due to their complex setups. Here we measured stair toe clearance through a novel prototype photogate setup and compared this to optoelectronic measurements. Twelve participants (age 22 ± 3 years) completed 25 stair ascent trials, each on a seven-step staircase.

The Effects of Constraining Head Rotation on Eye and Whole-Body Coordination During Standing Turns at Different Speeds.

A limitation of the ability to rotate the head with respect to the upper body has been associated with turning problems; however, the extent of head constraints on whole-body coordination has not been fully determined. The aim of this study was to limit head on body rotation and observe the effects on whole-body coordination during standing turns at various speeds. Twelve participants completed standing turns at 180°.

Benefits of task-specific movement program on en bloc turning in Parkinson's disease: A randomized controlled trial.

Introduction: En bloc turning highlights a lack of rotational intersegmental coordination, which commonly impacts turning ability in people with Parkinson's disease (PD). Whilst this turning deficit responds fairly well to medical treatment, it may be further mitigated by performing specific exercise training. Thus, the present study aimed to examine the effects of a 4-week exercise program, which focused on task-specific movements (TSM program) on turning ability and clinical outcomes in people with PD.

Bile Duct Injuries as a Result of Cholecystectomy: An Australian Perspective.

Cholecystectomy remains the mainstay treatment for symptomatic gallstones. Despite the evolution of surgical techniques and approaches, bile duct injury represents a significant complication, even in experienced hands. It is associated with significant postoperative morbidity, resource utilisation and costs.

Underlying mechanisms of fall risk on stairs with inconsistent going size.

Serious falls occur frequently on stairs with inconsistent dimensions. Inconsistent smaller goings are thought to reduce user's foot clearances and foot contact lengths since individuals do not detect and alter their behaviour prior to the inconsistency, increasing the risk of a trip, heel-catch or over-step and potential slip on the stairs. So far, these mechanisms for a stair fall remain theoretical only.

Using a stair horizontal-vertical illusion to increase foot clearance over an inconsistently taller stair-riser.

Introduction: Stair falls can be caused by inconsistent stair dimensions. During ascent, inconsistently taller stair risers lead to reduced foot clearances as the inconsistency goes unnoticed. A stair horizontal-vertical illusion increases perceived riser heights and foot clearance and could offset reduced foot clearances over inconsistently taller risers, though this might impact other stair safety measures.

The Effect of Different Turn Speeds on Whole-Body Coordination in Younger and Older Healthy Adults.

Difficulty in turning is prevalent in older adults and results in postural instability and risk of falling. Despite this, the mechanisms of turning problems have yet to be fully determined, and it is unclear if different speeds directly result in altered posture and turning characteristics. The aim of this study was to identify the effects of turning speeds on whole-body coordination and to explore if these can be used to help inform fall prevention programs in older adults.

The next step in optimising the stair horizontal-vertical illusion: Does a perception-action link exist in older adults?

Introduction: Tripping on stairs results from insufficient foot to step edge clearance and can often lead to a fall in older adults. A stair horizontal-vertical illusion is suggested to increase the perceived riser height of a step and increase foot clearance when stepping up. However, this perception-action link has not been empirically determined in older adults.

RACS and its Fellows: a contribution to sustainable healthcare improvement in South East Asia.

The question of whether small non-government organizations with comparatively small budgets can make a substantial contribution to sustainable improvement in health care in low- and middle-income countries is crucial to funding global surgical projects. The Royal Australasian College of Surgeons and its Fellows have partnered with local organizations and clinicians to deliver a wide range of projects in South East Asia. These projects have proved sustainable and have increased healthcare capacity in these nations.

Children With Developmental Coordination Disorder Show Altered Visuomotor Control During Stair Negotiation Associated With Heightened State Anxiety.

Safe stair negotiation is an everyday task that children with developmental coordination disorder (DCD) are commonly thought to struggle with. Yet, there is currently a paucity of research supporting these claims. We investigated the visuomotor control strategies underpinning stair negotiation in children with ( = 18, age = 10.

Management of Boerhaave syndrome in Australasia: a retrospective case series and systematic review of the Australasian literature.

Background: Boerhaave syndrome is a rare and life-threatening condition characterized by a spontaneous transmural tear of the oesophagus. There remains wide variation in the condition's management with non-operative management (NOM) and surgery being the two main treatment strategies. The aim was to review the presentation, management and outcomes for patients treated for Boerhaave syndrome at our institution and to compare these data with that previously reported within the Australasian literature.

Constancy of Preparatory Postural Adjustments for Reaching to Virtual Targets across Different Postural Configurations.

Postural and movement components must be coordinated without significant disturbance to balance when reaching from a standing position. Traditional theories propose that muscle activity prior to movement onset create the mechanics to counteract the internal torques generated by the future limb movement, reducing possible instability via centre of mass (CoM) displacement. However, during goal-directed reach movements executed on a fixed base of support (BoS), preparatory postural adjustments (or pPAs) promote movement of the CoM within the BoS.

Characteristics of Voluntary-induced Stepping Response in Persons with Stroke compared with those of healthy Young and Older Adults.

Background: Impairment of protective steps to recover balance from external perturbation is evident after stroke. Voluntary-induced stepping response (VSR) can be used to practice protective steps by instructing an individual to voluntarily lean their whole body forward until they perceive a loss of balance and automatically induce a step. However, to improve protective stepping performance, detailed characteristics of VSR in healthy persons are required.

Children With Developmental Coordination Disorder Exhibit Greater Stepping Error Despite Similar Gaze Patterns and State Anxiety Levels to Their Typically Developing Peers.

This study examined stepping accuracy, gaze behavior, and state-anxiety in children with ( = 21, age = 10.81, = 1.89) and without ( = 18, age = 11.