Volume 198 Issue 8

To date, there have been no serious attempts in Australia to introduce public reporting of surgeon performance data. Some audits have shown local trends in surgical outcomes, but feedback from more comprehensive monitoring would benefit clinicians and patients.

Guy J Maddern MB BS, PhD, FRACS

While medical and technical expertise are what might be described as core business for a surgical college, the question of who is to assume responsibility for teaching other, non-technical competencies remains. So far only the colleges have stepped forward, though often in tandem with other stakeholders.

Michael J Hollands 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.

Recent changes in perioperative patient management — including well integrated pre-admission clinics, the “bundle of care” initiative and clinical handover using electronic medical records — mean that surgical patients should have a smooth perioperative journey.

Bruce P Waxman FRACS, FRCS, FACS

One tool that decisionmakers could use to assess whether such interventions are fit for purpose is a comprehensive checklist of evaluative criteria, starting with questions about how well the problem to be addressed by the intervention has been defined.

Ian A Scott FRACP, MHA, MEd · John B Wakefield MPH, FRACMA, FRACGP

Guiding principles in the Australian Open Disclosure Framework consultation draft highlight the important roles that health service organisations can play in closing the “disclosure gap” between expected practice regarding disclosure of medical errors and what is actually being done.

Stuart R McLennan MBHL · Robert D Truog MD

To the Editor: Reducing the time from presentation to cholecystectomy in patients with acute cholecystitis has been shown to benefit patients (eg, by reducing the duration of patient discomfort before surgery) and to be cost-effective.1-3 Benefits have also been shown for performing cholecystectomy during the index admission for gallstone pancreatitis.4 Geelong Hospital (in regional Victoria) introduced daily general surgery emergency theatre sessions in February 2011. We ...

Daniel P McGlade · David A Watters · Douglas A Stupart

To the Editor: Harris and colleagues report failure to obtain reduction in several important risk factor-based intermediate outcomes for vascular disease from their lifestyle intervention in the Health Improvement and Prevention Study (HIPS).1 Using intention-to-treat analysis, if only 117 of 384 participants completed at least two of six group sessions, a positive result could not be expected. We know that interventions for prevention of cardiovascular disease (CVD) ...

James A Dunbar · Edward D Janus · Erkki Vartiainen

In reply: The Health Improvement and Prevention Study (HIPS) and the Greater Green Triangle study are not comparable. HIPS was a cluster randomised controlled trial of a pragmatic intervention that was delivered by general practitioners (through Divisions of General Practice) and was analysed on an intention-to-treat (ITT) basis.1 The Greater Green Triangle study was a pre–post study of patients recruited in GP waiting rooms who ...

Mark F Harris

DMAA was recently banned in Australia and other countries owing to toxicity, lack of health benefits, and concerns about long-term safety and potential for misuse. A trawl of the NSW Poisons Information database confirms the wisdom of the ban and suggests an expanded role for the database in future.

Jared A Brown · Nick A Buckley

Trauma registry data on patients admitted to Sydney hospitals following bicycle or motorcycle accidents reveal the protective effect of wearing a helmet.

Michael M Dinh · Kate Curtis · Rebecca Ivers

To the Editor: Surfboard riding is an iconic pastime in Australia. Injuries to the head and face constitute a considerable proportion of surfing injuries;1-5 26% of acute surfing injuries are to the head and face, and these make up 42% of emergency department presentations by surfers.3 We conducted a retrospective review at our tertiary referral hospital of patients who underwent medical imaging for injuries sustained to ...

Simon J Dimmick · Patrick V Sheehan · Mark Gillett · Suzanne E Anderson

The J-shaped relationship between alcohol consumption and cardiovascular risk has been studied and confirmed in multiple studies. Whether it should influence the formulation of public policy on alcohol consumption is another question.

Peter L Thompson MD, FRACP, FACC

A survey of Royal Australasian College of Surgeons trainees suggests that although many trainees are interested in pursuing part-time surgical training, very few have obtained accredited positions to do so. In a related commentary, the RACS censor-in-chief acknowledges the desire of trainees for flexible training, and describes what the College is doing to help meet this need.

Rachel E McDonald BSc · Amy E Jeeves MB BS, BMedSci(Hons), FRACS(Plast) · Carolyn E Vasey MB BS, BMedSci · Deborah M Wright BMedSc, MB ChB · Gregory O’Grady BHB, MB ChB, PhD

Establishing part-time surgical training posts may be difficult, but evidence suggests it is possible and increasingly necessaryThe study by McDonald and colleagues confirms previous reports in Australia and elsewhere that there is a significant difference between the number of trainees who are undertaking some of their surgical training part-time and those who would be interested in doing so.1 It cannot be denied that doctors entering a ...

Simon A Williams MB BS, FRACS, FAOrthA

This study suggests that recent media reports and public concern about concussion sustained during sport are valid, as the frequency of hospitalisation for concussed players in Victoria increased significantly between 2002–03 and 2010–11, with substantial associated economic costs.

Caroline F Finch BSc(Hons), MSc, PhD, · Angela J Clapperton M(Counsel), GradDipEdPsych, BSc(Behav) · Paul McCrory MB BS, PhD, FRACP

Objective: To assess the current frequency of sunburn, a preventable risk factor for skin cancer, among Queensland adults.Design and setting: Cross-sectional population-based surveys of 16 473 residents aged ≥ 18 years across Queensland in 2009 and 2010.Main outcome measures: Proportion of the adult population reporting sunburn (skin reddening lasting 12 hours or more) during the previous weekend, by age, sex and other risk factors.Results: ...

Adèle C Green MB BS, PhD, FAAPHM · Louise Marquart BSc, BEcon, BAppSc(Hons) · Susan L Clemens BA, MPH · Catherine M Harper BSc, MPH · Peter K O’Rourke BSc(Hons), BA(Hons), PhD

A 14-year study of patients with M. ulcerans disease treated with surgery alone in a Victorian hospital found that the disease recurred in about a third of patients, with recurrence most often associated with immunosuppression or positive histological margins on excised lesions.

Daniel P O’Brien MB BS, FRACP · Aaron Walton MD, FRACP · Andrew J Hughes MB BS, FRACP · N Deborah Friedman MB BS, FRACP, MD · Anthony McDonald MB BS, FRACS · Peter Callan MB BS, FRACS · Richard Rhadon MB BS, FRACS · Ian Holten MB BS, FRACS · Eugene Athan MB BS, FRACP, MPH

The nematode Angiostrongylus cantonensis has spread down the eastern coast of Australia over recent decades. A healthy 21-year-old man developed life-threatening eosinophilic meningoencephalitis following ingestion of a slug in Sydney. We describe the first case of this severity in which the patient survived.Clinical recordA 21-year-old man presented with a 3-day history of insomnia and paraesthesia affecting his lower limbs bilaterally. He had no associated headache, ...

Nicholas F Blair BSc, MB BS · Carolyn F Orr MRCP, FRACP, PhD · Anthony P Delaney MB BS, MSc, FCICM · Geoffrey K Herkes MB BS, PhD, FRACP

Antibiotics should be continued unchanged when a paradoxical reaction occurs in M. ulcerans infection, but adding steroids can diminish skin loss and systemic symptoms.

Janine M Trevillyan MB BS, FRACP · Paul D R Johnson MB BS, PhD, FRACP

Open disclosure (OD) after adverse health care events is the subject of a national standard that has been implemented in state health policy documents, and is included in the Medical Board of Australia’s code of conduct for doctors. Nevertheless, doctors have been slow to embrace the practice of OD. There is a strong ethical case for implementing OD in the primary interests of ...

Angus J F Finlay · Cameron L Stewart BEc, LLB(Hons), PhD · Malcolm Parker MB BS, MLitt, MD

The authors outline the development of obstetric training and simulation in 18th and 19th century London, and describe the historical obstetric simulators on display in Australia.

Harry Owen MB ChB, MD · Damian J McDonald BA, MA

There is evidence that GPs who work fewer hours practise better medicine and have greater job satisfaction than their full-time colleagues. So how are practices incorporating the growing part-time workforce?

Annabel McGilvray

Yoga, poetry, music and general practice combine to make Dr Arjun von Caemmerer one chilled-out medical man. He talks about how he strives for balance in everything he does, from caring for his patients, to making his visual poetry.

Cate Swannell