Volume 196 Issue 8

While the government’s implementation of the National Bowel Cancer Screening Program remains stalled, Australians are dying unnecessarilyOne in 12 Australians will develop colorectal cancer (CRC), and it is the second most common cause of cancer death. It is one of only three cancers for which organised population screening is recommended, and it is the first to ...

Ian N Olver MD, PhD, FRACP · Graeme P Young MD, FRACP, AGAF

Has the time come to form specialised centres for complex surgical procedures?The article by Speer and colleagues in this issue of the Journal reporting outcomes in patients undergoing pancreatectomy for pancreatic cancer in Victoria in 2002–2003 indicates the poor outcome for this condition on a population basis.1 Consistent with international series are the observations that only ...

Robert T A Padbury MB BS, FRACS, PhD

Closing a regulatory gap to ensure patient safety in all surgical proceduresHealth services are delivered in a variety of settings, including public and private hospitals, day surgeries and practitioner offices. Office-based surgery has been practised safely in the United States for many years,1 and has been embraced by surgical specialties such as otolaryngology,2 vascular surgery,3 ...

F A Hugh Bartholomeusz OAM, MB BS, FRACS

The full content of this article is available by downloading the PDF.

The full content of this article is available by downloading the PDF.

John Cartmill and David Butt discuss how surgery might change with robot-like enhancements to surgeons’ capabilitiesThe advent of the surgical “robot”, exemplified by the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, Calif, USA), brings fresh approaches, possibilities and questions to the field of surgery. Because of their capacity to augment dexterity, strength, coordination and vision, ...

John A Cartmill · David Butt

Wise guidance for winding down from a full workload is at handWhereas surgeons may be perceived by some of their colleagues as arrogant, self-centred and totally lacking in humility and insight, much has been achieved by the Royal Australasian College of Surgeons (RACS) in recent years to influence surgeons’ behaviour through a number of strategies ...

Bruce P Waxman FRACS, FRCS, FACS

To the Editor: We would like to congratulate Geelhoed and de Klerk1 for reporting the expected decreases in emergency department (ED) overcrowding following introduction of the 4-hour rule in Western Australia. Their study highlighted potential adverse effects and inflated demand across hospital systems — specifically, concerns regarding patient safety and junior medical staff training; significantly ...

Biswadev Mitra · Peter A Cameron

To the Editor: We read with interest the article by Geelhoed and de Klerk1 regarding the mortality benefits of a policy that ensures high numbers of patients are admitted to hospital within 4 hours of arrival at an emergency department (ED). The proof of improved performance following service intervention within a complex institution requires careful consideration. ...

Dylan J Toh · Campbell H Thompson · Josephine S Thomas · Jeffrey Faunt

In reply: We thank Mitra and Cameron, and Toh and colleagues for their remarks. Comments from some physicians that the 4-hour rule might increase mortality provided the initial stimulus for us to look at data related to its introduction in Western Australia. Given our results, their hypothesis seems unlikely to be true. Mitra and Cameron point ...

Gary C Geelhoed · Nicholas H de Klerk

To the Editor: Extensive rainfall in Queensland from December 2010 to January 2011 led to much of the state being declared a disaster zone. We report on a cluster of patients requiring hospitalisation with an acute febrile illness after exposure to floodwater in Central Queensland. During the height of the flood emergency, four adults (23–56 years of age) from ...

Hugh Wright · Katie Goot · Benjamin Rogers

To the Editor: The HIV epidemic in Australia is changing. The number of new infections attributed to heterosexual contact has increased, and people from culturally and linguistically diverse (CALD) backgrounds account for a significant proportion of these diagnoses. In the period 2005–2009, 41% of new HIV diagnoses linked to heterosexual transmission were in people from ...

Augustine D Asante · Henrike Körner

To the Editor: Two aspects of developing or renewing medical curricula that were highlighted recently by Goulston and Oates1 deserve further qualification: the dynamic nature of a medical curriculum; and wide consultation with a broad range of academics. Because medical curricula are continually evolving, it is crucial to appoint and support the right people to lead ...

David A Kandiah

The medical profession is ageing in parallel with the wider community, with more Australian doctors working into their 70s. This has implications for workforce planning and raises questions about competence. However, no Australian specialist college has policies relating to the special circumstances of ageing practitioners. Ageing practitioners are affected by a number of age-related ...

George A Skowronski FRCP, FRACP, FCICM · Carmelle Peisah MB BS(Hons), MD, FRANZCP

Objective: To determine whether the introduction of an acute surgical unit (ASU) resulted in a greater proportion of patients with acute cholecystitis receiving definitive surgery on index admission with no adverse change in surgical outcomes.Design, setting and participants: A retrospective study of medical records for patients presenting to Nepean Hospital with ...

Lester Pepingco BMedSc, MB BS(Hons) · Guy D Eslick PhD, FACE, FFPH · Michael R Cox MB BS, FRACS, MS

Objective: To describe the management and outcomes of a population-based cohort of patients with pancreatic cancer in Victoria, Australia.Design, setting and patients: Retrospective study based on questionnaires completed from medical histories of patients diagnosed with pancreatic cancer during 2002–2003 in Victoria who were identified from the Victorian Cancer Registry and followed up ...

Antony G Speer BE, MB BS, FRACP · Vicky J Thursfield BSc, GradDip(ApplStats) · Yvonne Torn-Broers BA(Hons) · Michael Jefford MB BS, PhD, FRACP

Objectives: To determine current colorectal cancer (CRC) screening rates and the level of adherence to screening guidelines at a community level.Setting: A cross-sectional cohort of at-risk people aged 56–88 years randomly selected from the Hunter Community Study (HCS), Australia.Main outcome measures: Proportion ever reporting undertaking any CRC testing; current screening ...

Ryan J Courtney BPsych(Hons) · Christine L Paul PhD · Robert W Sanson-Fisher PhD, MClinPsych · Finlay A Macrae MD, FRACP, FRCP · Mariko L Carey PhD · John R Attia MD, PhD · Mark A McEvoy MClinEpi

Objectives: To identify barriers to and facilitators of colorectal cancer (CRC) screening participation among different cultural subgroups in South Australia, and to describe how these might be shared or be distinct across these groups.Design, participants and setting: Qualitative study using individual interviews in Adelaide, South Australia, between July 2009 and December 2010. ...

Sara Javanparast MD, PhD · Paul R Ward PhD · Stacy M Carter MPH(Hons), PhD · Carlene J Wilson BA(Hons), MBA, PhD

A 46-year-old woman, who had lived in rural Australia as a child, presented with abdominal distension, jaundice and cachexia. Abdominal computed tomography showed extensive cystic disease of the liver, peritoneum, ovaries and uterus; well circumscribed coarsely calcified cysts were visible in the abdomen and pelvis (Figure A). Results of hydatid serological testing were consistent with ...

Melanie C Figtree · Matthew R Watts · Robyn Timmins · Ross Smith · Bernard J Hudson

Clinical record A 33-year-old man with Eisenmenger syndrome due to a congenital ventricular septal defect presented with a 3-week history of headache, blurred vision and expressive dysphasia, and unintentional weight loss of 10% of his body weight. His medications included sitaxsentan sodium (a sulfonamide endothelin-receptor antagonist, recently withdrawn because of hepatotoxicity) for pulmonary arterial hypertension. He ...

Anthony M T Chau MB BS(Hons) · Lileane L Xu · Jacob M Fairhall MB BS, FRACS · Joga Chaganti FRANZCR · Brendan J McMullan BMed(Hons), DTMH, DCH

Learning in the clinical setting is the cornerstone of medical school education, but there are strong imperatives to optimise the ways in which students acquire clinical expertise. Deliberate practice is characterised by attention, concentration, effort and repetition of skills; it is an important tool for developing and maintaining professional expertise. Research has led ...

Jennifer J Conn FRACP, MClinEd, BSc(Hons) · Fiona R Lake MB BS, FRACP, MD · Geoffrey J McColl MB BS, PhD, FRACP · Justin L C Bilszta BSc(Hons), PhD, GradCertUniTeach · Robyn Woodward-Kron BA, MA, PhD

For this two-part series, the MJA interviewed various stakeholders about the length of medical education. This first part focuses on the pathway before vocational training.When Dr Gavin Sandercoe watched one of the first open-heart operations on television as a young child, he knew he wanted to become a surgeon. He got straight into undergraduate medicine ...

Sophie McNamara BA(Hons), GradDip(Journ)

How do decisions change if we can assess risk of “unacceptable badness”?The concept of medical futility has been debated for many years, but a precise definition remains elusive.1-3 This is not surprising given the evolving nature of modern medicine. Progressively more complex decisions are required when considering increasingly sophisticated diagnostic and therapeutic interventions. Providing a ...

Stephen Honeybul FRCS, FRACS · Kwok M Ho FCICM, PhD · Grant R Gillett FRACS, MPhil · Christopher R P Lind FRACS · Susan O’Hanlon MB BS

Nothing!” Jill said. “He didn’t say nothing”, said Warren, as he eased the car into the outside lane. No horns, no fist-pumps, no swearing. Warren was driving considerately. He was not himself. “Yes, but he didn’t exactly paint a rosy picture of what he did say I could do.” Jill put on her sunglasses, then dropped them ...

Philip A Sprott MB BS, FRACS

DID YOU KNOW that the McMurray test has been shown to have a specificity of 86% and a sensitivity of 48% for meniscal injury? This text describes a wide range of such clinical signs and also evaluates them for effectiveness, adding invaluable detail not available in other clinical texts.The three authors, two of whom are ...

Sarah J Abrahamson

CorrectionTypographical error: In “Emergency department overcrowding, mortality and the 4-hour rule in Western Australia” in the 6 February 2012 issue of the Journal (Med J Aust 2012; 196: 122-126), there was a typographical error in Box 1 (page 123). The total number of admissions for 2008–09 was erroneously preceded by the letter “l”. The number of admissions in 2008–09 was ...

Gary C Geelhoed FRACP, FACEM, MD · Nicholas H de Klerk BSc, MSc, PhD

Neurosurgeons need strong technical skills and a capacity for hard work

Sophie McNamara

Dr Adam Wells, fourth-year neurosurgery trainee, Royal Adelaide Hospital, and PhD Candidate, the University of Adelaide

Cate Swannell

Professor Jeffrey Rosenfeld is head of the department of surgery at Monash University and director of the department of neurosurgery at Alfred Hospital

Sophie McNamara

It's a scenario that occurs regularly in Australia's medical practices

Amanda Bryan

Cardiologist Professor Krishna Somers, now based in Perth, has twice had to flee oppressive political regimes: first from South Africa during the apartheid years, and then from Uganda under Idi Amin.

Sophie McNamara