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Bhat S, Chia B, Babidge W, Maddern GJ. Assessing performance in ageing surgeons: systematic review. Br J Surg 2023; 110:1425-1427. [PMID: 37260108 PMCID: PMC10564395 DOI: 10.1093/bjs/znad158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/08/2023] [Accepted: 05/04/2023] [Indexed: 06/02/2023]
Affiliation(s)
- Saiuj Bhat
- Department of Plastic and Reconstructive Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Benjamin Chia
- Department of Plastic and Reconstructive Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Wendy Babidge
- Research, Audit, and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
- Discipline of Surgery, Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Guy J Maddern
- Research, Audit, and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
- Discipline of Surgery, Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
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2
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Gaget V, Inacio MC, Tivey DR, Jorissen RN, Babidge W, Visvanathan R, Maddern GJ. Trends in utilisation of plain X-rays by older Australians (2010-2019). BMC Geriatr 2022; 22:100. [PMID: 35120445 PMCID: PMC8817507 DOI: 10.1186/s12877-022-02786-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/19/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Older Australians are major health service users and early diagnosis is key in the management of their health. Radiological services are an important component of diagnosis and disease management planning in older Australians, but their national utilisation of diagnostic services has never been investigated in Australia. PURPOSE This study aims to evaluate the utilisation of major plain X-rays by Australians ≥ 65 years old. METHODS A population-based epidemiological evaluation and yearly cross-sectional analyses of X-ray examinations per 1,000 Australians aged ≥ 65 years old between 2009 and 2019 were conducted using publicly available Medicare Benefits Schedule and Australian Bureau of Statistics data sources. Age and sex specific incidence rate (IR) of plain X-rays per 1,000 Australians, adjusted incidence rate ratios (IRR) and 95% confidence intervals (CI) were estimated using a negative binomial regression model. RESULTS During the study period, the Australian population over 65 years old increased by 39% while the crude plain X-ray utilisation by this population increased by 63%. Most X-rays were conducted on extremities or the chest. Men used chest radiography more than women, and particularly for lungs, where the incidence increased the most in those ≥ 85 years old. There was an increase in X-rays of extremities and the hip joint between 2009-10 and 2013-14 in people ≥ 85 years old. CONCLUSION The utilisation of plain X-rays of the chest, the gastro-intestinal tract and extremities was high and has increased among older Australians between 2009-10 and 2018-19. Plain X-rays remain a commonly used diagnostic tool for conditions affecting the older population.
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Affiliation(s)
- Virginie Gaget
- Surgical Specialities, University of Adelaide, The Queen Elizabeth Hospital, Woodville, SA, 5011, Australia.
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, 5001, Australia.,UniSA Allied Health and Human Movement, University of South Australia, Adelaide, Australia
| | - David R Tivey
- Royal Australasian College of Surgeons, Adelaide, SA, 5001, Australia
| | - Robert N Jorissen
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, 5001, Australia
| | - Wendy Babidge
- Surgical Specialities, University of Adelaide, The Queen Elizabeth Hospital, Woodville, SA, 5011, Australia.,Royal Australasian College of Surgeons, Adelaide, SA, 5001, Australia
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research With Aged Care Centre (GTRAC), Faculty of Health and Medical Sciences, University of Adelaide, Woodville, SA, 5011, Australia.,Aged & Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Woodville, SA, 5011, Australia
| | - Guy J Maddern
- Surgical Specialities, University of Adelaide, The Queen Elizabeth Hospital, Woodville, SA, 5011, Australia
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3
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Tan L, Tivey D, Kopunic H, Babidge W, Langley S, Maddern G. Part 2: Blockchain technology in health care. ANZ J Surg 2020; 90:2415-2419. [PMID: 33236489 DOI: 10.1111/ans.16455] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/02/2020] [Accepted: 10/31/2020] [Indexed: 11/30/2022]
Abstract
Blockchain technology is one of the many disruptive technologies of the Fourth Industrial Revolution that will irrevocably change the way we live and work. These technologies are well embedded in the areas of global finance, health care and defence, to name a few. This review focuses on the relevance of blockchain technology to health care. Blockchain technology will be the unifying platform for sharing patient data currently inaccessible due to the siloed architecture of legacy software systems, and as a result potentially be the basis for precision or individualized patient treatment. It will also strengthen digital security of sensitive patient data that is presently a lucrative target for cyber criminals. In the current COVID-19 environment, clinicians will rely more on telehealth to reduce person-to-person contact. This service can be delivered by the clinical team with confidence in the veracity of the patient data made accessible through the blockchain platform. Smart contracts written on the blockchain platform will reduce the possibility of international humanitarian aid to low- and middle-income countries being misspent. The pharmaceutical supply chain industry is adopting blockchain technology to ensure supply chain provenance. Similarly, the health insurance industry recognizes how the blockchain ecosystem can improve services to its members and expedite reimbursements to clinicians.
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Affiliation(s)
- Lorwai Tan
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - David Tivey
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia
| | - Helena Kopunic
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Wendy Babidge
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sally Langley
- Plastic and Reconstructive Surgery Department, Christchurch Hospital, Christchurch, New Zealand
| | - Guy Maddern
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia
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4
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Tan L, Tivey D, Kopunic H, Babidge W, Langley S, Maddern G. Part 1: Artificial intelligence technology in surgery. ANZ J Surg 2020; 90:2409-2414. [PMID: 33000556 DOI: 10.1111/ans.16343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/25/2020] [Accepted: 09/14/2020] [Indexed: 12/21/2022]
Abstract
Artificial intelligence (AI) is one of the disruptive technologies of the fourth Industrial Revolution that is changing our work practices. This technology is in use in highly diverse industries including health care, defence, insurance and e-commerce. This review focuses on the relevance of AI to surgery. AI will aid surgeons with diagnostic decision-making, patient selection for surgery as well as improve patient pre- and post-operative care and management. Ethical considerations of AI with respect to patient rights and data privacy are highlighted. A further challenge is how best to present to national regulators a pragmatic way to assess AI as 'software as a medical device'. This relates to the ramifications for the adoption of AI technology in clinical practice, and its subsequent public funding support and reimbursement. It is evident that AI technology has important applications in surgery in the 21st century. The establishment of a key work programme in this area will be important if surgeons are to fully utilize AI in surgery.
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Affiliation(s)
- Lorwai Tan
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - David Tivey
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia
| | - Helena Kopunic
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Wendy Babidge
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sally Langley
- Plastic and Reconstructive Surgery Department, Christchurch Hospital, Christchurch, New Zealand
| | - Guy Maddern
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia
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5
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Vega Vega C, Gostlow HC, Marlow N, Babidge W, Maddern G. Examination of participant preferences in the design and delivery of simulation-based education programmes. BMJ STEL 2020; 6:245-246. [DOI: 10.1136/bmjstel-2019-000476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 11/03/2022]
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6
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Gostlow H, Vega CV, Marlow N, Babidge W, Maddern G. Participant perceptions of the Laparoscopic Simulation Skills Program. ANZ J Surg 2019; 89:1365-1367. [PMID: 31760699 DOI: 10.1111/ans.15411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/16/2019] [Accepted: 07/26/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Hannah Gostlow
- Discipline of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.,Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Camila Vega Vega
- Discipline of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.,Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Nicholas Marlow
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Wendy Babidge
- Discipline of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.,Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Guy Maddern
- Discipline of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.,Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
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7
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Chan JCY, Gupta AK, Stewart S, Babidge W, McCulloch G, Worthington MG, Maddern GJ. "Nobody told me": Communication Issues Affecting Australian Cardiothoracic Surgery Patients. Ann Thorac Surg 2019; 108:1801-1806. [PMID: 31254505 DOI: 10.1016/j.athoracsur.2019.04.116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/05/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Failure of communication can have potentially severe results in cardiothoracic surgery. Previous literature regarding patient safety highlighted communication as a common area for improvement. This study utilized a qualitative approach to analyze a national mortality audit data set to identify and describe communication issues that could potentially contribute to patient mortality following cardiothoracic surgery. METHODS We utilized a peer-reviewed audit of surgical deaths after cardiothoracic surgery in Australian hospitals from 2009 to 2015 via the Australian and New Zealand Audit of Surgical Mortality. Cases were identified with clinical management issues then individual analysis of cases highlighting communication issues was undertaken. A total of 91 reports from surgeons and assessors were analysed using a thematic analytic approach. RESULTS A total of 908 cases of potentially avoidable mortality were identified as being associated with clinical management issues, and communication issues were identified in 91 (10%) of these cases, which served as the basis for this analysis. The study found that failure to achieve shared decision making was the most common theme (n = 38, 41.8%), followed by failure to notify patient deterioration (n = 22, 24.1%), misreporting of patient condition (n = 10, 11.0%) and issues related to informed consent (n = 9, 10.0%). The most frequent communication issues occurred between surgeons and the intensive care unit. CONCLUSIONS Poor communication was identified in patients who died after cardiothoracic surgery. Communication is an important modifiable factor in patient mortality. Efforts to address teamwork and communication have the potential to improve safety and quality of care for patients undergoing cardiothoracic surgery.
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Affiliation(s)
- Justin C Y Chan
- Department of Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.
| | - Aashray K Gupta
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Sasha Stewart
- Australian and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, Adelaide, Australia
| | - Wendy Babidge
- Australian and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, Adelaide, Australia
| | - Glenn McCulloch
- Australian and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, Adelaide, Australia
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8
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Tan L, Garrod T, Pleass S, Babidge W, Angus J, Scott DF, Truskett P. Royal Australasian College of Surgeons Scholarship Program evaluation snapshot: success breeds success. ANZ J Surg 2019; 89:146-147. [PMID: 30827049 DOI: 10.1111/ans.14888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/08/2018] [Accepted: 09/02/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Lorwai Tan
- Section of Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Tamsin Garrod
- Section of Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Sue Pleass
- Partnerships Division, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Wendy Babidge
- Section of Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - James Angus
- Honorary, Pharmacology and Therapeutics, The University of Melbourne, Melbourne, Victoria, Australia
| | - David F Scott
- Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Philip Truskett
- Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
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9
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Gostlow H, Marlow N, Thomas MJW, Hewett PJ, Kiermeier A, Babidge W, Altree M, Pena G, Maddern G. Non-technical skills of surgical trainees and experienced surgeons. Br J Surg 2017; 104:777-785. [DOI: 10.1002/bjs.10493] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 12/09/2016] [Accepted: 12/18/2016] [Indexed: 11/10/2022]
Abstract
Abstract
Background
In addition to technical expertise, surgical competence requires effective non-technical skills to ensure patient safety and maintenance of standards. Recently the Royal Australasian College of Surgeons implemented a new Surgical Education and Training (SET) curriculum that incorporated non-technical skills considered essential for a competent surgeon. This study sought to compare the non-technical skills of experienced surgeons who completed their training before the introduction of SET with the non-technical skills of more recent trainees.
Methods
Surgical trainees and experienced surgeons undertook a simulated scenario designed to challenge their non-technical skills. Scenarios were video recorded and participants were assessed using the Non-Technical Skills for Surgeons (NOTSS) scoring system. Participants were divided into subgroups according to years of experience and their NOTSS scores were compared.
Results
For most NOTSS elements, mean scores increased initially, peaking around the time of Fellowship, before decreasing roughly linearly over time. There was a significant downward trend in score with increasing years since being awarded Fellowship for six of the 12 NOTSS elements: considering options (score −0·015 units per year), implementing and reviewing decisions (−0·020 per year), establishing a shared understanding (−0·014 per year), setting and maintaining standards (−0·024 per year), supporting others (−0·031 per year) and coping with pressure (−0·015 per year).
Conclusion
The drop in NOTSS score was unexpected and highlights that even experienced surgeons are not immune to deficiencies in non-technical skills. Consideration should be given to continuing professional development programmes focusing on non-technical skills, regardless of the level of professional experience.
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Affiliation(s)
- H Gostlow
- Division of Surgery, University of Adelaide, Queen Elizabeth Hospital, Woodville, Australia
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
| | - N Marlow
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
| | - M J W Thomas
- Westwood-Thomas Associates, Norton Summit, South Australia, Australia
| | - P J Hewett
- Division of Surgery, University of Adelaide, Queen Elizabeth Hospital, Woodville, Australia
| | - A Kiermeier
- Statistical Process Improvement Consulting and Training, Gumeracha, South Australia, Australia
| | - W Babidge
- Division of Surgery, University of Adelaide, Queen Elizabeth Hospital, Woodville, Australia
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
| | - M Altree
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
| | - G Pena
- Division of Surgery, University of Adelaide, Queen Elizabeth Hospital, Woodville, Australia
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
| | - G Maddern
- Division of Surgery, University of Adelaide, Queen Elizabeth Hospital, Woodville, Australia
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
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10
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Gostlow H, Marlow N, Babidge W, Maddern G. Systematic Review of Voluntary Participation in Simulation-Based Laparoscopic Skills Training: Motivators and Barriers for Surgical Trainee Attendance. J Surg Educ 2017; 74:306-318. [PMID: 27836238 DOI: 10.1016/j.jsurg.2016.10.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/06/2016] [Accepted: 10/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To examine and report on evidence relating to surgical trainees' voluntary participation in simulation-based laparoscopic skills training. Specifically, the underlying motivators, enablers, and barriers faced by surgical trainees with regard to attending training sessions on a regular basis. DESIGN A systematic search of the literature (PubMed; CINAHL; EMBASE; Cochrane Collaboration) was conducted between May and July 2015. Studies were included on whether they reported on surgical trainee attendance at voluntary, simulation-based laparoscopic skills training sessions, in addition to qualitative data regarding participant's perceived barriers and motivators influencing their decision to attend such training. Factors affecting a trainee's motivation were categorized as either intrinsic (internal) or extrinsic (external). RESULTS Two randomised control trials and 7 case series' met our inclusion criteria. Included studies were small and generally poor quality. Overall, voluntary simulation-based laparoscopic skills training was not well attended. Intrinsic motivators included clearly defined personal performance goals and relevance to clinical practice. Extrinsic motivators included clinical responsibilities and available free time, simulator location close to clinical training, and setting obligatory assessments or mandated training sessions. The effect of each of these factors was variable, and largely dependent on the individual trainee. The greatest reported barrier to attending voluntary training was the lack of available free time. CONCLUSION Although data quality is limited, it can be seen that providing unrestricted access to simulator equipment is not effective in motivating surgical trainees to voluntarily participate in simulation-based laparoscopic skills training. To successfully encourage participation, consideration needs to be given to the factors influencing motivation to attend training. Further research, including better designed randomised control trials and large-scale surveys, is required to provide more definitive answers to the degree in which various incentives influence trainees' motivations and actual attendance rates.
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Affiliation(s)
- Hannah Gostlow
- Division of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia; Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - Nicholas Marlow
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - Wendy Babidge
- Division of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia; Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - Guy Maddern
- Division of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia; Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia.
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11
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Vega Vega C, Gostlow H, Marlow N, Babidge W, Maddern G. Recruitment barriers in surgical education research. BMJ Simul Technol Enhanc Learn 2017; 3:34-35. [DOI: 10.1136/bmjstel-2016-000160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2016] [Indexed: 11/03/2022]
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12
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Gupta AK, Stewart SK, Cottell K, McCulloch GAJ, Babidge W, Maddern GJ. Potentially avoidable issues in neurosurgical mortality cases in Australia: identification and improvements. ANZ J Surg 2016; 87:86-91. [DOI: 10.1111/ans.13542] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/14/2016] [Accepted: 02/22/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Aashray K. Gupta
- South Australian Audit of Perioperative Mortality (SAAPM); Royal Australasian College of Surgeons; Adelaide South Australia Australia
| | - Sasha K. Stewart
- South Australian Audit of Perioperative Mortality (SAAPM); Royal Australasian College of Surgeons; Adelaide South Australia Australia
| | - Kimberley Cottell
- South Australian Audit of Perioperative Mortality (SAAPM); Royal Australasian College of Surgeons; Adelaide South Australia Australia
| | - Glenn A. J. McCulloch
- South Australian Audit of Perioperative Mortality (SAAPM); Royal Australasian College of Surgeons; Adelaide South Australia Australia
| | - Wendy Babidge
- University of Adelaide Discipline of Surgery; The Queen Elizabeth Hospital; Adelaide South Australia Australia
- Australian and New Zealand Audit of Surgical Mortality (ANZASM); Royal Australasian College of Surgeons; Adelaide South Australia Australia
| | - Guy J. Maddern
- University of Adelaide Discipline of Surgery; The Queen Elizabeth Hospital; Adelaide South Australia Australia
- Australian and New Zealand Audit of Surgical Mortality (ANZASM); Royal Australasian College of Surgeons; Adelaide South Australia Australia
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13
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Boult M, Babidge W, Pleass S, Scott D. Looking back at the John Mitchell Crouch Fellowship: the most prestigious research award of the Royal Australasian College of Surgeons. ANZ J Surg 2015; 85:705-8. [DOI: 10.1111/ans.13229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Margaret Boult
- Department of Surgery; The Queen Elizabeth Hospital; University of Adelaide; Adelaide South Australia Australia
| | - Wendy Babidge
- Department of Surgery; The Queen Elizabeth Hospital; University of Adelaide; Adelaide South Australia Australia
- Division of Research; Audit and Academic Surgery; Royal Australasian College of Surgeons; North Adelaide South Australia Australia
| | - Susan Pleass
- Division of Research; Audit and Academic Surgery; Royal Australasian College of Surgeons; North Adelaide South Australia Australia
| | - David Scott
- Division of Research; Audit and Academic Surgery; Royal Australasian College of Surgeons; North Adelaide South Australia Australia
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14
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Pena G, Altree M, Field J, Sainsbury D, Babidge W, Hewett P, Maddern G. Nontechnical skills training for the operating room: A prospective study using simulation and didactic workshop. Surgery 2015; 158:300-9. [DOI: 10.1016/j.surg.2015.02.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 02/26/2015] [Accepted: 02/27/2015] [Indexed: 11/27/2022]
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Pena G, Altree M, Field J, Thomas MJW, Hewett P, Babidge W, Maddern GJ. Surgeons' and trainees' perceived self-efficacy in operating theatre non-technical skills. Br J Surg 2015; 102:708-15. [PMID: 25790065 DOI: 10.1002/bjs.9787] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/26/2014] [Accepted: 01/16/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND An important factor that may influence an individual's performance is self-efficacy, a personal judgement of capability to perform a particular task successfully. This prospective study explored newly qualified surgeons' and surgical trainees' self-efficacy in non-technical skills compared with their non-technical skills performance in simulated scenarios. METHODS Participants undertook surgical scenarios challenging non-technical skills in two simulation sessions 6 weeks apart. Some participants attended a non-technical skills workshop between sessions. Participants completed pretraining and post-training surveys about their perceived self-efficacy in non-technical skills, which were analysed and compared with their performance in surgical scenarios in two simulation sessions. Change in performance between sessions was compared with any change in participants' perceived self-efficacy. RESULTS There were 40 participants in all, 17 of whom attended the non-technical skills workshop. There was no significant difference in participants' self-efficacy regarding non-technical skills from the pretraining to the post-training survey. However, there was a tendency for participants with the highest reported self-efficacy to adjust their score downwards after training and for participants with the lowest self-efficacy to adjust their score upwards. Although there was significant improvement in non-technical skills performance from the first to second simulation sessions, a correlation between participants' self-efficacy and performance in scenarios in any of the comparisons was not found. CONCLUSION The results suggest that new surgeons and surgical trainees have poor insight into their non-technical skills. Although it was not possible to correlate participants' self-belief in their abilities directly with their performance in a simulation, in general they became more critical in appraisal of their abilities as a result of the intervention.
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Affiliation(s)
- G Pena
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Australia; University of Adelaide Discipline of Surgery, Queen Elizabeth Hospital, Australia
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Lin D, Pena G, Field J, Altree M, Marlow N, Babidge W, Hewett P, Maddern G. What are the demographic predictors in laparoscopic simulator performance? ANZ J Surg 2015; 86:983-989. [DOI: 10.1111/ans.12992] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Diwei Lin
- The Queen Elizabeth Hospital; University of Adelaide Discipline of Surgery; Adelaide South Australia Australia
| | - Guilherme Pena
- The Queen Elizabeth Hospital; University of Adelaide Discipline of Surgery; Adelaide South Australia Australia
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical; Royal Australasian College of Surgeons; Adelaide South Australia Australia
| | - John Field
- John Field Consulting Pty, Ltd.; Adelaide South Australia Australia
| | - Meryl Altree
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical; Royal Australasian College of Surgeons; Adelaide South Australia Australia
| | - Nicholas Marlow
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical; Royal Australasian College of Surgeons; Adelaide South Australia Australia
| | - Wendy Babidge
- The Queen Elizabeth Hospital; University of Adelaide Discipline of Surgery; Adelaide South Australia Australia
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical; Royal Australasian College of Surgeons; Adelaide South Australia Australia
| | - Peter Hewett
- The Queen Elizabeth Hospital; University of Adelaide Discipline of Surgery; Adelaide South Australia Australia
| | - Guy Maddern
- The Queen Elizabeth Hospital; University of Adelaide Discipline of Surgery; Adelaide South Australia Australia
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical; Royal Australasian College of Surgeons; Adelaide South Australia Australia
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Pena GN, Altree MJ, Field JBF, Babidge W, Maddern GJ. Demand for surgical simulated learning. Supervisors and trainees views: do they align? ANZ J Surg 2014; 83:700-1. [PMID: 24251319 DOI: 10.1111/ans.12283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Raju RS, Guy GS, Field JBF, Kiroff GK, Babidge W, Maddern GJ. Australian and New Zealand Audit of Surgical Mortality: concordance between reported and audited clinical events and delays in management in surgical mortality patients. ANZ J Surg 2014; 84:618-23. [PMID: 24754257 DOI: 10.1111/ans.12642] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Australian and New Zealand Audit of Surgical Mortality (ANZASM) is a nationwide confidential peer review of deaths associated with surgical care. This study assesses the concordance between treating surgeons and peer reviewers in reporting clinical events and delays in management. METHODS This is a retrospective cross-sectional analysis of deaths in 2009 and 2010. Cases that went through the process of submission of details by the surgeon in a structured surgical case form (SCF), first-line assessment (FLA) and a more detailed second-line assessment (SLA) were included. Significant clinical events reported for these patients were categorized and analysed for concordance. RESULTS Of the 11,303 notifications of death to the ANZASM, 6507 (57.6%) were audited and 685 (10.5%) required the entire review process. Nationally, the most significant events were post-operative complications, poor preoperative assessment and delay to surgery or diagnosis. The SCF submissions reported 338 events, as compared with 1009 and 985 events reported through FLA and SLA, respectively (P = 0.01). Treating surgeons and assessors attributed 29-30% of events to factors outside the surgeon's control. Surgeons felt that delay to surgery or diagnosis was a significant event in 6.6% of cases, in contrast to 20% by assessors (P = 0.01). Preoperative management could be improved in 19% of cases according to surgeons, compared with 45 and 36% according to the assessors (P < 0.001). CONCLUSION There is significant discordance between treating surgeons and assessors. This suggests the need for in-depth analysis and possible refinement of the audit process.
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Affiliation(s)
- Ravish S Raju
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
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Pena G, Altree M, Babidge W, Field J, Hewett P, Maddern G. Mobile Simulation Unit: taking simulation to the surgical trainee. ANZ J Surg 2014; 85:339-43. [DOI: 10.1111/ans.12549] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Guilherme Pena
- Department of Surgery; The Queen Elizabeth Hospital; University of Adelaide; Adelaide South Australia Australia
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical; Royal Australasian College of Surgeons; Adelaide South Australia Australia
| | - Meryl Altree
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical; Royal Australasian College of Surgeons; Adelaide South Australia Australia
| | - Wendy Babidge
- Department of Surgery; The Queen Elizabeth Hospital; University of Adelaide; Adelaide South Australia Australia
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical; Royal Australasian College of Surgeons; Adelaide South Australia Australia
| | - John Field
- John Field Consulting Pty Ltd; Adelaide South Australia Australia
| | - Peter Hewett
- Department of Surgery; The Queen Elizabeth Hospital; University of Adelaide; Adelaide South Australia Australia
| | - Guy Maddern
- Department of Surgery; The Queen Elizabeth Hospital; University of Adelaide; Adelaide South Australia Australia
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical; Royal Australasian College of Surgeons; Adelaide South Australia Australia
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20
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Pena GN, Altree M, Babidge W, Maddern GJ. Surgical simulation training: mobile and anywhere. Med J Aust 2014; 200:180-1. [DOI: 10.5694/mja13.10736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 12/11/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Guilherme N Pena
- Australian Safety and Efficacy Register of New Interventional Procedures — Surgical, Royal Australasian College of Surgeons, Adelaide, SA
| | - Meryl Altree
- Australian Safety and Efficacy Register of New Interventional Procedures — Surgical, Royal Australasian College of Surgeons, Adelaide, SA
| | - Wendy Babidge
- Australian Safety and Efficacy Register of New Interventional Procedures — Surgical, Royal Australasian College of Surgeons, Adelaide, SA
| | - Guy J Maddern
- Australian Safety and Efficacy Register of New Interventional Procedures — Surgical, Royal Australasian College of Surgeons, Adelaide, SA
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA
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Khan MW, Lin D, Marlow N, Altree M, Babidge W, Field J, Hewett P, Maddern G. Laparoscopic skills maintenance: a randomized trial of virtual reality and box trainer simulators. J Surg Educ 2014; 71:79-84. [PMID: 24411428 DOI: 10.1016/j.jsurg.2013.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 05/03/2013] [Accepted: 05/26/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE A number of simulators have been developed to teach surgical trainees the basic skills required to effectively perform laparoscopic surgery; however, consideration needs to be given to how well the skills taught by these simulators are maintained over time. This study compared the maintenance of laparoscopic skills learned using box trainer and virtual reality simulators. DESIGN Participants were randomly allocated to be trained and assessed using either the Society of American Gastrointestinal Endoscopic Surgeons Fundamentals of Laparoscopic Surgery (FLS) simulator or the Surgical Science virtual reality simulator. Once participants achieved a predetermined level of proficiency, they were assessed 1, 3, and 6 months later. At each assessment, participants were given 2 practice attempts and assessed on their third attempt. SETTING The study was conducted through the Simulated Surgical Skills Program that was held at the Royal Australasian College of Surgeons, Adelaide, Australia. RESULTS Overall, 26 participants (13 per group) completed the training and all follow-up assessments. There were no significant differences between simulation-trained cohorts for age, gender, training level, and the number of surgeries previously performed, observed, or assisted. Scores for the FLS-trained participants did not significantly change over the follow-up period. Scores for LapSim-trained participants significantly deteriorated at the first 2 follow-up points (1 and 3 months) (p < 0.050), but returned to be near initial levels by the final follow-up (6 months). CONCLUSIONS This research showed that basic laparoscopic skills learned using the FLS simulator were maintained more consistently than those learned on the LapSim simulator. However, by the final follow-up, both simulator-trained cohorts had skill levels that were not significantly different to those at proficiency after the initial training period.
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Affiliation(s)
- Montaha W Khan
- University of Adelaide, Department of Surgery, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Diwei Lin
- University of Adelaide, Department of Surgery, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Nicholas Marlow
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, Australia
| | - Meryl Altree
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, Australia
| | - Wendy Babidge
- University of Adelaide, Department of Surgery, The Queen Elizabeth Hospital, Adelaide, Australia; Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, Australia
| | - John Field
- John Field Consulting Pty Ltd, Adelaide, Australia
| | - Peter Hewett
- University of Adelaide, Department of Surgery, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Guy Maddern
- University of Adelaide, Department of Surgery, The Queen Elizabeth Hospital, Adelaide, Australia; Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, Australia.
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Marlow N, Altree M, Babidge W, Field J, Hewett P, Maddern GJ. Laparoscopic skills acquisition: a study of simulation and traditional training. ANZ J Surg 2013; 84:976-80. [DOI: 10.1111/ans.12282] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2013] [Indexed: 01/22/2023]
Affiliation(s)
- Nicholas Marlow
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical; Royal Australasian College of Surgeons; Adelaide South Australia Australia
| | - Meryl Altree
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical; Royal Australasian College of Surgeons; Adelaide South Australia Australia
| | - Wendy Babidge
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical; Royal Australasian College of Surgeons; Adelaide South Australia Australia
| | - John Field
- John Field Consulting Pty Ltd; Adelaide South Australia Australia
| | - Peter Hewett
- Discipline of Surgery; University of Adelaide; The Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - Guy J. Maddern
- Discipline of Surgery; University of Adelaide; The Queen Elizabeth Hospital; Adelaide South Australia Australia
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Xafis V, Babidge W, Field J, Altree M, Marlow N, Maddern G. The efficacy of laparoscopic skills training in a Mobile Simulation Unit compared with a fixed site: a comparative study. Surg Endosc 2013; 27:2606-12. [PMID: 23389073 DOI: 10.1007/s00464-013-2798-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 12/31/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Laparoscopic skills development via simulation-based medical education programs has gained support in recent years. However, the impact of training site type on skills acquisition has not been examined. The objective of this research was to determine whether laparoscopic skills training outcomes differ as a result of training in a Mobile Simulation Unit (MSU) compared with fixed simulation laboratories. METHODS An MSU was developed to provide delivery of training. Fixed-site and MSU laparoscopic skills training outcomes data were compared. Fixed-site participants from three Australian states were pooled to create a cohort of 144 participants, which was compared with a cohort derived from pooled MSU participants in one Australian state. Data were sourced from training periods held from October 2009 to December 2010. LapSim and Fundamentals of laparoscopic surgery (FLS) simulators were used at the MSU and fixed sites. Participants self-reported on demographic and experience variables. They trained to a level of competence on one simulator and were assessed on the other simulator, thus producing crossover scores. No participants trained at both site types. RESULTS When FLS-trained participants were assessed on LapSim, those who received MSU training achieved a significantly higher crossover score than their fixed-site counterparts (p < 0.001). Compared with baseline data, MSU LapSim-trained participants assessed on FLS displayed a performance increase of 23.1 %, whereas MSU FLS-trained participants assessed on LapSim demonstrated a 12.4 % increase in performance skills. Participants at fixed sites displayed performance increases of 5.2 and 10.9 %, respectively. CONCLUSIONS Mobile Simulation Unit-delivered laparoscopic simulation training is not inferior to fixed-site training.
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Affiliation(s)
- Vicki Xafis
- Research, Audit, and Academic Surgery Division, Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, SA, Australia
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Daruwalla J, Marlow N, Field J, Altree M, Babidge W, Hewett P, Maddern GJ. Effect of fatigue on laparoscopic skills: a comparative historical cohort study. ANZ J Surg 2013; 84:137-42. [PMID: 23351016 DOI: 10.1111/ans.12069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fatigue has been shown to have a negative impact on surgical performance. However, there is a lack of research investigating its effect on laparoscopy, particularly in Australia. This study investigated whether fatigue associated with a surgeon's usual workday led to a measurable drop off in laparoscopic surgical skills as assessed on a laparoscopic simulator. METHODS A comparative study involving two cohorts was undertaken: a study group whose data were collected prospectively was compared to a historical control group. Participants were required to reach a predetermined level of proficiency in each laparoscopic task on either a FLS or LapSim simulator. The participants in the study cohort were re-tested approximately 1 month after completing 10 h of work. The participants in the historical non-fatigued group were re-tested approximately 1 month after reaching proficiency. Comparisons between cohorts were made using a 'decrease in score per day elapsed' value to account for the natural attrition in skills over time and the variability in testing times within and between the two cohorts. RESULTS The decrease in overall score per day elapsed for fatigued participants was significantly greater than for historical non-fatigued participants, irrespective of the simulator type. Fatigue had a greater impact on certain laparoscopic skills, including peg transfer and knot tying. Participants who self-reported higher level of fatigue demonstrated significantly better skills than those who self-reported lower levels. CONCLUSION Overall laparoscopic skill proficiency was reduced in the fatigued participants compared to the historical non-fatigued participants, with certain laparoscopic skills more affected than others.
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Wong THI, Guy G, Babidge W, Maddern GJ. Impact of consultant operative supervision and surgical mortality in Australia. ANZ J Surg 2012; 82:895-901. [DOI: 10.1111/j.1445-2197.2012.06310.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Teresa Hoi Ian Wong
- Discipline of Surgery; University of Adelaide and The Queen Elizabeth Hospital; Adelaide; South Australia; Australia
| | - Gordon Guy
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical; Royal Australasian College of Surgeons; Adelaide; South Australia; Australia
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Maddern G, Smith J, Babidge W, Guy G. Hospital mortality under surgical care. Ann R Coll Surg Engl 2012; 94:66. [PMID: 22524941 DOI: 10.1308/003588412x13171221499900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Maddern GJ, Smith JA, Babidge W, Guy GS. Development of clinical-quality registries in Australia: the way forward. Med J Aust 2011; 195:266. [PMID: 21895591 DOI: 10.5694/mja11.10779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 07/11/2011] [Indexed: 11/17/2022]
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Abstract
Although treatment recommendations have been advocated for all women with early breast cancer regardless of age, it is generally accepted that different treatments are preferred based on the age of the patient. The aim of this study was to assess the pattern of breast cancer surgery after adjusting for other major prognostic factors in relation to patient age. Data on cancer characteristics and surgical procedures in 31,298 patients with early breast cancer reported to the National Breast Cancer Audit between 1999 and 2006 were used for the study. There was a close association between age and surgical treatment pattern after adjusting for other prognostic factors, including tumor size, histologic grade, number of tumors, lymph node positivity, lymphovascular invasion (LVI), and extensive intraduct component. Breast Conserving Surgery (BCS) was highest among women aged <or=40 years (OR = 1.140; 95% CI: 1.004-1.293) compared to women aged 51-70 years (reference group). BCS was lowest in women aged >70 years (OR = 0.498, 95% CI: 0.455-0.545). Significantly more women aged <or=50 years underwent more than one operation for breast conservation (20.4-24.8%) compared with women aged >50 years (11.4-17.0%). Women aged >70 years were more likely to receive no surgical treatment, 3.5% versus 1.0-1.3% in all other age groups (<or=40, 41-50 51-70 years). There is an association between patient age and the type of breast cancer surgery for women in Australia and New Zealand. Women age <or=40 years are more likely to undergo BCS despite having adverse histologic features and have more than one procedure to achieve breast conservation. Older women (>70 years) more commonly undergo mastectomy and are more likely to receive no surgical treatment.
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Affiliation(s)
- Jim Wang
- National Breast Cancer Audit, ASERNIP-S, Royal Australasian College of Surgeons, Stepney
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Watt A, Cameron A, Sturm L, Lathlean T, Babidge W, Blamey S, Facey K, Hailey D, Norderhaug I, Maddern G. Rapid versus full systematic reviews: validity in clinical practice? ANZ J Surg 2008; 78:1037-40. [PMID: 18959712 DOI: 10.1111/j.1445-2197.2008.04730.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Rapid reviews are being produced with greater frequency by health technology assessment (HTA) agencies in response to increased pressure from end-user clinicians and policy-makers for rapid, evidence-based advice on health-care technologies. This comparative study examines the differences in methodologies and essential conclusions between rapid and full reviews on the same topic, with the aim of determining the validity of rapid reviews in the clinical context and making recommendations for their future application. METHODS Rapid reviews were located by Internet searching of international HTA agency websites, with any ambiguities resolved by further communication with the agencies. Comparator full systematic reviews were identified using the University of York Centre for Reviews and Dissemination HTA database. Data on a number of review components were extracted using standardized data extraction tables, then analysed and reported narratively. RESULTS Axiomatic differences between all the rapid and full reviews were identified; however, the essential conclusions of the rapid and full reviews did not differ extensively across the topics. For each of the four topics examined, it was clear that the scope of the rapid reviews was substantially narrower than that of full reviews. The methodology underpinning the rapid reviews was often inadequately described. CONCLUSIONS Rapid reviews do not adhere to any single validated methodology. They frequently provide adequate advice on which to base clinical and policy decisions; however, their scope is limited, which may compromise their appropriateness for evaluating technologies in certain circumstances.
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Affiliation(s)
- Amber Watt
- Australian Safety and Efficacy Register of New Interventional Procedures (ASERNIP-S), Stepney, South Australia, Australia
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Abstract
The Australian Safety and Efficacy Register of New Interventional Procedures--Surgical (ASERNIP-S) came into being 10 years ago to provide health technology assessments specifically tailored towards new surgical techniques and technologies. It was and remains the only organisation in the world to focus on this area of research. Most funding has been provided by the Australian Government Department of Health, and assessments have helped inform the introduction of new surgical techniques into Australia. ASERNIP-S is a project of the Royal Australasian College of Surgeons. The ASERNIP-S program employs a diverse range of methods including systematic reviews, technology overviews, assessments of new and emerging surgical technologies identified by horizon scanning, and audit. Support and guidance for the program is provided by Fellows of the Royal Australasian College of Surgeons. ASERNIP-S works closely with consumers to produce health technology assessments and audits, as well as consumer information to keep patients fully informed of research. Since its inception, the ASERNIP-S program has developed a strong international profile through the production of over 60 reports on evidence-based surgery, surgical technologies and audit. The work undertaken by ASERNIP-S has evolved from assessments of the safety and efficacy of procedures to include guidance on policies and surgical training programs. ASERNIP-S needs to secure funding so that it can continue to play an integral role in the improvement of quality of care both in Australia and internationally.
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Affiliation(s)
- Guy Maddern
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide
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Wang J, Boult M, Tyson S, Babidge W, Zorbas H, Kollias J, Roder D, Maddern G. TRENDS IN SURGICAL TREATMENT OF YOUNGER PATIENTS WITH BREAST CANCER IN AUSTRALIA AND NEW ZEALAND. ANZ J Surg 2008; 78:665-9. [DOI: 10.1111/j.1445-2197.2008.04613.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Wang J, Boult M, Roder D, Babidge W, Kollias J, Maddern G. COMMENTARY: HOW SURGICAL AUDITS CAN BE USED TO PROMOTE THE UPDATE OF SURGICAL EVIDENCE. ANZ J Surg 2008; 78:437-8. [DOI: 10.1111/j.1445-2197.2008.04530.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Affiliation(s)
- J Wang
- ASERNIP-S, Royal Australasian College of Surgeons, Stepney, Australia
| | - J Smith
- Royal District Nursing Service of South Australia Inc, Glenside, Australia
| | - W Babidge
- Research, Audit and Academic Surgery Division, Royal Australasian College of Surgeons, Stepney, and Department of Surgery, Adelaide University, Queen Elizabeth Hospital, Woodville, Australia
| | - G Maddern
- ASERNIP-S, Royal Australasian College of Surgeons, Stepney, and Department of Surgery, Adelaide University, Queen Elizabeth Hospital, Woodville, Australia
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Cuncins-Hearn A, Boult M, Babidge W, Zorbas H, Villanueva E, Evans A, Oliver D, Kollias J, Reeve T, Maddern G. National Breast Cancer Audit: ductal carcinoma in situ management in Australia and New Zealand. ANZ J Surg 2007; 77:64-8. [PMID: 17295824 DOI: 10.1111/j.1445-2197.2006.03979.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ductal carcinoma in situ (DCIS) is a significant issue in Australia and New Zealand with rising incidence because of the implementation of mammographic screening. Current information on its natural history is unable to accurately predict progression to invasive cancer. In 2003, the National Breast Cancer Centre in Australia published recommendations for DCIS. In Australia and New Zealand, the National Breast Cancer Audit collects information on DCIS cases. This article will examine these recommendations and provide information from the audit on current DCIS management. METHODS Three thousand six hundred and twenty-nine cases of DCIS were entered by 274 breast surgeons between January 1998 and December 2004. Data items in the National Breast Cancer Audit database that were covered in the National Breast Cancer Centre recommendations were reviewed. Information was available on the following: diagnostic biopsy rates for all cases and mammographically positive cases and rates of breast conserving surgery (BCS), clear margins following BCS, postoperative radiotherapy following BCS for groups at high risk of recurrence as well as axillary procedures and tamoxifen prescription. RESULTS Close adherence was found in diagnostic biopsy, BCS and clear margin rates. Some high-risk groups received radiotherapy, although women with 'close' margins did not in 33% of cases. Axillary procedures were conducted in 23% of cases and most (81%) patients were not prescribed tamoxifen. CONCLUSION There was predominantly close adherence to recommendations with three possible areas of improvement: fewer axillary procedures, an appraisal of radiotherapy practice following BCS and more investigation into tamoxifen prescription practices for DCIS.
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MESH Headings
- Antineoplastic Agents, Hormonal/therapeutic use
- Australia/epidemiology
- Axilla
- Biopsy
- Breast/pathology
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/epidemiology
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/therapy
- Female
- Guideline Adherence
- Humans
- Lymph Node Excision
- Mammography
- Mastectomy, Segmental
- Medical Audit
- Middle Aged
- New Zealand/epidemiology
- Radiotherapy, Adjuvant
- Tamoxifen/therapeutic use
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Affiliation(s)
- Astrid Cuncins-Hearn
- National Breast Cancer Audit, ASERNIP-S, Royal Australasian College of Surgeons, Stepney, South Australia, Australia
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Cuncins-Hearn AV, Boult M, Babidge W, Zorbas H, Villanueva E, Evans A, Oliver D, Kollias J, Reeve T, Maddern G. NATIONAL BREAST CANCER AUDIT: OVERVIEW OF INVASIVE BREAST CANCER MANAGEMENT. ANZ J Surg 2006; 76:745-50. [PMID: 16916399 DOI: 10.1111/j.1445-2197.2006.03846.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The National Breast Cancer Audit is an initiative of the Breast Section of the Royal Australasian College of Surgeons collecting surgical information in early breast cancer. It is managed in conjunction with the Australian Safety and Efficacy Register of New Interventional Procedures - Surgical. An overview of results for invasive breast cancer from January 1999 until December 2004 is presented to provide preliminary data for participating surgeons. METHODS Invasive breast cancer cases were retrieved from the National Breast Cancer Audit database for the 274 participating breast surgeons in Australia and New Zealand. Data for a variety of clinical parameters were analysed to provide an overview of the diagnostic, histological, surgical and adjuvant therapy management issues. RESULTS There were 25,026 cases of invasive breast cancer. Annual percentages of mammographically detected cancers from 1999 to 2004 did not differ significantly. Breast-conserving surgery rates also remained stable at 60%. Margins were involved in 5% of patients; an additional 9% had final margins of less than 1 mm. Radiotherapy followed breast-conserving surgery in most cases (86%). Patients undergoing mastectomy with large tumours (>5 cm) underwent radiotherapy in 71% of cases. When at least four lymph nodes were positive, radiotherapy followed mastectomy in the majority (75%) of cases. The most frequently carried out axillary procedure was a level 2 dissection. Chemotherapy was received by 78% of oestrogen receptor negative, axillary node positive, postmenopausal patients. Tamoxifen was used in the majority (83%) of oestrogen receptor positive cases. CONCLUSION Surgeons contributing their invasive breast cancer data show a high quality of treatment. Some further improvement may be possibly related to excision margins and tamoxifen prescription for oestrogen receptor negative cancers. Chemotherapy prescription might also warrant further investigation.
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Affiliation(s)
- Astrid V Cuncins-Hearn
- National Breast Cancer Audit, ASERNIP-S, Royal Australasian College of Surgeons, Stepney, SA
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Boult M, Babidge W, Maddern G, Barnes M, Fitridge R. Predictors of Success Following Endovascular Aneurysm Repair: Mid-term Results. Eur J Vasc Endovasc Surg 2006; 31:123-9. [PMID: 16202630 DOI: 10.1016/j.ejvs.2005.08.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Accepted: 08/07/2005] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Australian cases of endovascular aneurysm repair (EVAR) performed between 1999 and 2001 have been evaluated to determine the mid-term (6 months to 5 years) safety and efficacy of the procedure. This study looks at predictors of success, based on mid-term follow-up data. DESIGN OF STUDY This study uses results obtained from a prospective semi-voluntary register (audit) of Australian data obtained from surgeons in the private and public sector. RESULTS Peri-operative mortality for patients enrolled in the audit was 1.8%. Ninety-three percent of procedures were technically successful (890/961). Nearly 13% of patients have had re-interventions (mostly endoluminal) at follow-up. Analysis of audit data shows that the likelihood of experiencing post-operative complications or requiring additional procedures increases with ASA rating, increasing age, large pre-operative aneurysm size, aneurysm angle >45 degrees and number of co-morbid conditions diagnosed. CONCLUSIONS This study confirms satisfactory mid-term results in a, national rather than unit specific, setting. Predictors of clinical failure or need for re-intervention include large aneurysm size, neck angulation >or=45 degrees and short infrarenal neck.
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Affiliation(s)
- M Boult
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Stepney, SA, Australia
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Abstract
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.
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Affiliation(s)
- Margaret Boult
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical, Royal Australasian College of Surgeons, Stepney and Department of Surgery, University of Adelaide, Adelaide, South Australia, Australia
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Tooher R, Middleton P, Pham C, Fitridge R, Rowe S, Babidge W, Maddern G. A systematic review of strategies to improve prophylaxis for venous thromboembolism in hospitals. Ann Surg 2005; 241:397-415. [PMID: 15729062 PMCID: PMC1356978 DOI: 10.1097/01.sla.0000154120.96169.99] [Citation(s) in RCA: 220] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the effectiveness of different strategies for increasing the uptake of prophylaxis for venous thromboembolism (VTE) in hospitalized patients through a systematic review of the literature. METHODS Literature databases and the Internet were searched from 1996 to May 2003. Studies of strategies to improve VTE prophylaxis practice were included. Studies where no policy or guideline was implemented or where the focus of the study was not VTE prevention were excluded. RESULTS Thirty studies were included. The quality of the available evidence was average with the majority of studies being uncontrolled before and after design and thus limited by the historical nature of much of the available data. Adherence to guidelines and the provision of adequate prophylaxis were poor in studies which relied on passive dissemination of guidelines. In general, the use of multiple strategies was more effective than a single strategy used in isolation. The most effective strategies incorporated a system for reminding clinicians to assess patients for VTE risk, either electronic decision-support systems or paper-based reminders, and used audit and feedback to facilitate the iterative refinement of the intervention. There were no studies adequately powered to demonstrate a reduction in rates of VTE. Insufficient evidence was available to make useful comparisons of strategies in terms of costs and resource utilization. CONCLUSIONS Passive dissemination of guidelines is unlikely to improve VTE prophylaxis practice. A number of active strategies used together, which incorporate some method for reminding clinicians to assess patients for DVT risk and assisting the selection of appropriate prophylaxis, are likely to result in the achievement of optimal outcomes.
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Affiliation(s)
- Rebecca Tooher
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, South Australia, Australia
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Boult M, Babidge W, Maddern G, Fitridge R. Endoluminal Repair of Abdominal Aortic Aneurysm—Contemporary Australian Experience. Eur J Vasc Endovasc Surg 2004; 28:36-40. [PMID: 15177229 DOI: 10.1016/j.ejvs.2004.03.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE An audit was established in November 1999 by the Australian Government Department of Health and Ageing to determine the mid- to long-term safety and efficacy of endoluminal graft repair (ELG) of abdominal aortic aneurysm (AAA). The audit has been undertaken by the Australian Safety and Efficacy Register for New Interventional Procedures-Surgical (ASERNIP-S). This study reviews contemporary Australian practice, based on audit data supplied to ASERNIP-S. DESIGN OF STUDY This study is a prospective voluntary register (audit) of Australian data obtained from the private and public sector. Data were collected for ELG repairs performed between 1 November 1999 and 16 May 2001. Follow-up is continuing. Results. Seventy-nine vascular surgeons have contributed data on 950 patients (816 male, 134 female, of median age 75.5 (range 36-94)). The mean aneurysm size was 57.5 mm (+/-10.2) and 44% of procedures were performed on aneurysms less than 55 mm in diameter. Fifty four percent of patients were considered suitable for open repair. Most ELG procedures were performed in an angiography or endovascular suite, under general anaesthetic using an open technique via the femoral arteries. Perioperative mortality was 1.7%, mostly from cardiac causes. Prior to discharge 7.2% of patients experienced an endoleak and 18.6% had systemic complications. The average length of stay was 7.4 days (median 5 days). Unsuccessful exclusion of the aneurysm occurred in 6.7% of cases. CONCLUSIONS Endovascular repair of AAAs is a well accepted procedure and is performed by the majority of vascular surgeons in Australia. Australian surgeons are taking a rather aggressive approach to the management of aortic aneurysms, particularly in the moderate to higher risk patient groups. Mortality rates are low, given the elderly population in question and morbidity rates acceptable. ASERNIP-S is continuing to collect follow-up data for this patient cohort.
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Affiliation(s)
- M Boult
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, North Adelaide, SA, Australia
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Affiliation(s)
- R Tooher
- ASERNIP-S, Royal Australasian College of Surgeons, Adelaide, South Australia
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Abstract
The Australian Safety and Efficacy Register for New Interventional Procedures - Surgical (ASERNIP-S) undertakes horizon scanning, systematic reviews and audits. By disseminating information derived from these processes, ASERNIP-S aims to improve the quality of health care. In the present article, we discuss some of the legal and ethical issues surrounding the collection of identified data for the purposes of audit. The individual's right to privacy is considered as well as the benefits of improving the quality of surgical health care.
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Affiliation(s)
- Maggi Boult
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical, Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
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Boult M, Babidge W, Anderson J, Denton M, Fitridge R, Harris J, Lawrence-Brown M, May J, Myerstt K, Maddern G. Australian audit for the endoluminal repair of abdominal aortic aneurysm: the first 12 months. ANZ J Surg 2002; 72:190-5. [PMID: 12071450 DOI: 10.1046/j.1445-2197.2002.02356.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The Australian Safety and Efficacy Register for New Interventional Procedures - Surgical (ASERNIP-S) was contracted by the Commonwealth Department of Health and Aged Care to audit the procedure of endoluminal repair of abdominal aortic aneurysm. The purpose of the audit was to examine the safety and efficacy of the endoluminal graft (ELG) and, where possible, compare it to the open procedure. The first 12 months of data collection has now been completed. An overview of these results and some of the problems associated with the establishment of this audit are given. METHODS The administrative infrastructure to support the audit is based at the ASERNIP-S office in Adelaide. To achieve high compliance rates, regular contact was maintained with surgeons. A reference group of senior vascular surgeons was established to provide expert support to the audit. RESULTS By December 2000, ASERNIP-S had collected data on approximately 85% of privately performed ELG procedures during the first year of the audit. The early mortality rate was 1.3% in the endoluminal group compared to 2.6% in the open group. The rate of procedural complications was 15% in both groups, but the percentage of systemic complications was higher following the open repair. Aneurysm size and the number of pre-existing conditions had a statistically significant relationship to the variation in the number of complications for ELG patients. CONCLUSIONS Good compliance has been obtained from vascular surgeons for submission of the operative data sets. ASERNIP-S aims to follow this group of patients closely to assess the medium to long-term durability of this procedure.
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Affiliation(s)
- Maggi Boult
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical Royal Australasian College of Surgeons, North Adelaide, South Australia.
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Abstract
BACKGROUND Ultrasound-assisted lipoplasty (UAL) has been associated with particular types of complications and uncertain long-term effects arising from interactions between ultrasonic energy and living tissue. The present review seeks to address these issues. METHODS Search strategy Three search strategies were devised to retrieve literature from Medline, Current Contents, Embase and Cochrane Library databases up until April 2000. Study selection Inclusion of papers was largely determined using a predetermined protocol. English language papers were selected. Acceptable study designs included randomized controlled trials, controlled clinical trials, case series or case reports. Data collection and analysis Thirty-six papers met the inclusion criteria. They were tabulated and critically appraised in terms of methodology and design, outcomes, and the possible influence of bias, confounding and chance. Other papers were also included to provide background material. RESULTS There was little high-level evidence available comparing UAL and suction-assisted lipoplasty (SAL), with no conclusive evidence that UAL has a safety benefit, although low-quality evidence suggests that UAL is associated with reduced surgeon fatigue as well as increased operating times, slower aspiration rates and an increased learning curve. There is inadequate evidence to determine whether the theoretical potential for DNA damage from ultrasound is realized in the clinical setting. CONCLUSIONS The evidence base for UAL is inadequate to determine the procedure's safety and efficacy. The potential for DNA damage must be investigated with appropriate in vivo animal models. Recommendations for the safe use of UAL are discussed.
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Affiliation(s)
- R Cooter
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australian College of Surgeons, North Adelaide
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Babidge W, Maddern G. Evidence-based surgery at ASERNIP-S. Can this improve quality in surgical practice? Australian Safety and Efficacy Register of New Interventional Procedures-Surgical. J Qual Clin Pract 2000; 20:164-6. [PMID: 11207956 DOI: 10.1046/j.1440-1762.2000.00380.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S) project has been established to form a register of new surgical procedures which have been assessed for their safety and efficacy. The ASERNIP-S project systematically reviews the evidence and produces recommendations on the future use of surgical procedures in clinical practice. Further data may be collected to provide information on the outcomes of procedures in use in Australia. Horizon Scanning of new and emerging techniques and technologies complements the ASERNIP-S process. This research identifies procedures that will impact on clinical practice in the near future. Dissemination of information from ASERNIP-S assessments, both locally and internationally, is important for quality improvement. The ultimate aim is for appropriate changes in practice to ensure the highest quality of Australian healthcare.
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Babidge W, Millard S, Roediger W. Sulfides impair short chain fatty acid beta-oxidation at acyl-CoA dehydrogenase level in colonocytes: implications for ulcerative colitis. Mol Cell Biochem 1998; 181:117-24. [PMID: 9562248 DOI: 10.1023/a:1006838231432] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The disease process of ulcerative colitis (UC) is associated with a block in beta-oxidation of short chain fatty acid in colonic epithelial cells which can be reproduced by exposure of cells to sulfides. The aim of the current work was to assess the level in the beta-oxidation pathway at which sulfides might be inhibitory in human colonocytes. Isolated human colonocytes from cases without colitis (n = 12) were exposed to sulfide (1.5 mM) in the presence or absence of exogenous CoA and ATP. Short chain acyl-CoA esters were measured by a high performance liquid chromatographic assay. 14CO2 generation was measured from [1-14C]butyrate and [6-14C]glucose. 14CO2 from butyrate was significantly reduced (p < 0.001) by sulfide. When colonocytes were incubated with hydrogen sulfide in the presence of CoA and ATP, butyryl-CoA concentration was increased (p < 0.01), while crotonyl-CoA (p < 0.01) and acetyl-CoA (p < 0.01) concentrations were decreased. These results show that sulfides inhibit short chain acyl-CoA dehydrogenase. As oxidation of n-butyrate governs the epithelial barrier function of colonocytes the functional activity of short chain acyl-CoA dehydrogenase may be critical in maintaining colonic mucosal integrity. Maintaining the functional activity of dehydrogenases could be an important determinant in the expression of ulcerative colitis.
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Affiliation(s)
- W Babidge
- University of Adelaide, Department of Surgery, The Queen Elizabeth Hospital, Australia
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Abstract
It has been proposed that the reduction in n-butyrate oxidation by colonic epithelial cells observed in ulcerative colitis may be related to exposure to reduced forms of sulfur derived from dissimilatory sulfate reduction by luminal microflora. This study aims to compare stool sulfide concentrations in control and colitic subjects. Control subjects had significant colorectal disease excluded by virtue of their selection. Patients with ulcerative colitis were stratified by disease extent and activity, and by salicylate drug use. Stool sulfide was measured using a direct spectrophotometric method on NaOH (free sulfide) and zinc acetate (total sulfide) stool slurries. Fifteen control and 19 colitic subjects were studied. There was no significant difference in stool sulfide between control and colitic patients (free sulfide, control = 0.52 (0.17), colitic = 0.45 (0.10), t = 0.36, P = 0.71, total sulfide, control = 1.33 (0.21), colitic = 0.96 (0.15), t = 1.44, P = 0.16). Disease extent or activity did not significantly influence stool sulfide. These results do not support a primary etiologic role for luminal sulfide in ulcerative colitis.
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Affiliation(s)
- J Moore
- University of Adelaide, Department of Surgery, The Queen Elizabeth Hospital, Woodville, Australia
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Affiliation(s)
- W E Roediger
- Colorectal Unit, University of Adelaide, Queen Elizabeth Hospital, SA, Australia
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Abstract
A role for colonic sulfide in the pathogenesis and treatment of ulcerative colitis (UC) has emerged based on biochemical, microbiological, nutritional, toxicological, epidemiological, and therapeutic evidence. Metabolism of isolated colonic epithelial cells has indicated that the bacterial short-chain fatty acid n-butyrate maintains the epithelial barrier and that sulfides can inhibit oxidation of n-butyrate analogous to that observed in active UC. Sulfur for fermentation in the colon is essential for n-butyrate formation and sulfidogenesis aids disposal of colonic hydrogen produced by bacteria. The numbers of sulfate-reducing bacteria and sulfidogenesis is greater in UC than control cases. Sulfide is mainly detoxified by methylation in colonic epithelial cells and circulating red blood cells. The enzyme activity of sulfide methylation is higher in red blood cells of UC patients than control cases. Patients with UC ingest more protein and thereby sulfur amino acids than control subjects. Removing foods rich in sulfur amino acids (milk, eggs, cheese) has proven therapeutic benefits in UC. 5-Amino salicylic acid reduces fermentative production of hydrogen sulfide by colonic bacteria, and aminoglycosides, which inhibit sulfate-reducing bacteria, are of therapeutic benefit in active UC. Methyl-donating agents are a category of drugs of potential therapeutic use in UC. A correlation between sulfide production and mucosal immune responses in UC needs to be undertaken. Control of sulfidogenesis and sulfide detoxification may be important in the disease process of UC, although whether their roles is in an initiating or promoting capacity has yet to be determined.
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Affiliation(s)
- W E Roediger
- Colorectal Unit, University of Adelaide, Queen Elizabeth Hospital, Australia
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Abstract
A role for colonic sulfide in the pathogenesis and treatment of ulcerative colitis (UC) has emerged based on biochemical, microbiological, nutritional, toxicological, epidemiological, and therapeutic evidence. Metabolism of isolated colonic epithelial cells has indicated that the bacterial short-chain fatty acid n-butyrate maintains the epithelial barrier and that sulfides can inhibit oxidation of n-butyrate analogous to that observed in active UC. Sulfur for fermentation in the colon is essential for n-butyrate formation and sulfidogenesis aids disposal of colonic hydrogen produced by bacteria. The numbers of sulfate-reducing bacteria and sulfidogenesis is greater in UC than control cases. Sulfide is mainly detoxified by methylation in colonic epithelial cells and circulating red blood cells. The enzyme activity of sulfide methylation is higher in red blood cells of UC patients than control cases. Patients with UC ingest more protein and thereby sulfur amino acids than control subjects. Removing foods rich in sulfur amino acids (milk, eggs, cheese) has proven therapeutic benefits in UC. 5-Amino salicylic acid reduces fermentative production of hydrogen sulfide by colonic bacteria, and aminoglycosides, which inhibit sulfate-reducing bacteria, are of therapeutic benefit in active UC. Methyl-donating agents are a category of drugs of potential therapeutic use in UC. A correlation between sulfide production and mucosal immune responses in UC needs to be undertaken. Control of sulfidogenesis and sulfide detoxification may be important in the disease process of UC, although whether their roles is in an initiating or promoting capacity has yet to be determined.
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Affiliation(s)
- W E Roediger
- Colorectal Unit, University of Adelaide, Queen Elizabeth Hospital, Australia
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Abstract
BACKGROUND It has been proposed that the diminished n-butyrate oxidation observed in ulcerative colitis may be the result of sulphide induced inhibition of short chain acyl-coenzyme A (acyl-CoA) dehydrogenase activity. AIM To examine the acyl-CoA ester profiles in isolated rat colonic epithelial cells treated in vitro with sodium hydrogen sulphide (NaHS). METHODS Isolated rat colonic epithelial cell suspensions were incubated for 10 minutes in the presence of [1-14C] n-butyrate (5 mM), with and without NaHS (1.5 mM). Incubations were carried out both in the presence and the absence of exogenous CoA and ATP. Metabolic performance was assessed by 14CO2 production and by acyl-CoA ester production measured by HPLC with ultraviolet detection. RESULTS Results are given as mean (SEM). For colonocytes incubated in the presence of exogenous CoA and ATP, treatment with NaHS significantly diminished 14CO2 production (control 0.97 (0.06) mumol/g dry weight cells/min, treated 0.26 (0.09) mumol/g dry weight cells/min, p = 0.0019), was associated with an increase in butyryl-CoA concentrations in the final reaction mixture at 10 minutes (control 2.55 (0.28) mumol/g dry weight cells, treated 3.32 (0.32) mumol/g dry weight cells, p = 0.002), and a reduction in crotonyl-CoA concentrations (control 0.274 (0.02) mumol/g dry weight cells, treated 0.120 (0.04) mumol/g dry weight cells, p = 0.008). The mean concentration of acetyl-CoA in the reaction mixture at 10 minutes was not significantly different between control and sulphide treated incubations. There were no significant differences in acyl-CoA ester profiles observed when cells were incubated in the absence of exogenous CoA and ATP. CONCLUSIONS These results support the view that sulphides inhibit n-butyrate oxidation in colonic epithelial cells by inhibiting short chain acyl dehydrogenation of activated fatty acids.
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Affiliation(s)
- J W Moore
- University of Adelaide, Department of Surgery, Queen Elizabeth Hospital, Woodville, Australia
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