Showing papers by "Guy J. Maddern published in 2008"
TL;DR: Skills acquired by simulation-based training seem to be transferable to the operative setting and more studies are required to strengthen the evidence base and to provide the evidence needed to determine the extent to which simulation should become a part of surgical training programs.
Abstract: Objective: To determine whether skills acquired by simulationbased training transfer to the operative setting. Summary Background Data: The fundamental assumption of simulation-based training is that skills acquired in simulated settings are directly transferable to the operating room, yet little evidence has focused on correlating simulated performance with actual surgical performance. Methods: A systematic search strategy was used to retrieve relevant studies. Inclusion of articles was determined using a predetermined protocol, independent assessment by 2 reviewers, and a final consensus decision. Only studies that reported on the use of simulationbased training for surgical skills training, and the transferability of these skills to the operative setting, were included. Results: Ten randomized controlled trials and 1 nonrandomized comparative study were included in this review. In most cases, simulation-based training was in addition to normal training programs. Only 1 study compared simulation-based training with patient-based training. For laparoscopic cholecystectomy and colonoscopy/sigmoidoscopy, participants who received simulation-based training before undergoing patient-based assessment performed better than their counterparts who did not receive previous simulation training, but improvement was not demonstrated for all measured parameters. Conclusions: Skills acquired by simulation-based training seem to be transferable to the operative setting. The studies included in this review were of variable quality and did not use comparable simulation-based training methodologies, which limited the strength of the conclusions. More studies are required to strengthen the evidence base and to provide the evidence needed to determine the extent to which simulation should become a part of surgical training programs. (Ann Surg 2008;248: 166‐179)
559 citations
TL;DR: Although intra-abdominal access could be achieved reliably via oral, anal, or urethral orifices, the optimal access route and method could not be established and risk of peritoneal infection has not been adequately minimized.
Abstract: Objective:Evaluation of models, techniques, outcomes, pitfalls, and applicability to the clinical setting of natural orifice translumenal endoscopic surgery (NOTES) for performing intra-abdominal surgery through a systematic review of the literature.Summary Background Data:NOTES has attracted much r
204 citations
TL;DR: Axiomatic trends were identified, but there was little cohesion between organizations regarding the contents, methods, and definition of a rapid review, and authors suggested restricted research questions and truncated search strategies as methods to limit the time taken to complete a review.
Abstract: Objectives: This review assessed current practice in the preparation of rapid reviews by health technology assessment (HTA) organizations, both internationally and in the Australian context, and evaluated the available peer-reviewed literature pertaining to the methodology used in the preparation of these reviews.Methods: A survey tool was developed and distributed to a total of fifty International Network of Agencies for Health Technology Assessment (INAHTA) members and other selected HTA organizations. Data on a broad range of themes related to the conduct of rapid reviews were collated, discussed narratively, and subjected to simple statistical analysis where appropriate. Systematic searches of the Cochrane Library, EMBASE, MEDLINE, and the Australian Medical Index were undertaken in March 2007 to identify literature pertaining to rapid review methodology. Comparative studies, guidelines, program evaluations, methods studies, commentaries, and surveys were considered for inclusion.Results: Twenty-three surveys were returned (46 percent), with eighteen agencies reporting on thirty-six rapid review products. Axiomatic trends were identified, but there was little cohesion between organizations regarding the contents, methods, and definition of a rapid review. The twelve studies identified by the systematic literature search did not specifically address the methodology underpinning rapid review; rather, many highlighted the complexity of the area. Authors suggested restricted research questions and truncated search strategies as methods to limit the time taken to complete a review.Conclusions: Rather than developing a formalized methodology by which to conduct rapid reviews, agencies should work toward increasing the transparency of the methods used for each review. It is perhaps the appropriate use, not the appropriate methodology, of a rapid review that requires future consideration.
189 citations
TL;DR: 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.
Abstract: Watt A, Cameron A, Sturm L, Lathlean T, Babidge W, Blamey S, Facey K, Hailey D, Norderhaug I and Maddern G
135 citations
TL;DR: An interactive model is available, which can assist vascular surgeons to evaluate the expected outcomes for a particular patient undergoing EVAR, and is useful for counselling and pre-operative decision making.
108 citations
TL;DR: An evaluation of current literature concerning religious beliefs among persons of Jewish, Muslim, and Hindu faiths was undertaken to determine if animal-derived surgical implants are permitted for use in these religions.
Abstract: Objective To determine the acceptability of porcine and bovine surgical implants among persons of Jewish, Muslim, and Hindu faiths whose beliefs prohibit them from consuming porcine and bovine products. Data Sources An evaluation of current literature concerning religious beliefs among persons of Jewish, Muslim, and Hindu faiths was undertaken to determine if animal-derived surgical implants are permitted for use in these religions. Study Selection Because of the limited published literature about this topic, the opinions of religious leaders in Australia were sought. Data Extraction Religious and cultural beliefs can conflict with and limit treatment options, especially in surgery. Approximately 81 porcine and bovine surgical implants are regularly used in Australia. Data Synthesis It is deemed acceptable for members of the Jewish faith to undergo surgery using porcine products. In dire situations and only after all other options have been exhausted, followers of the Muslim faith are permitted to use porcine surgical products. Hindu religious leaders did not accept the use of bovine surgical implants. Conclusions Australia comprises a multicultural society; therefore, it is necessary to consider religious beliefs of all patients. As part of a surgeon's duty of care, the informed consent process should include a discussion about animal-derived surgical implants to avoid religious distress and possible litigation. A greater understanding of religious views would enhance the medical care of persons of Jewish, Muslim, and Hindu faiths.
96 citations
TL;DR: Perioperative morbidity and a positive resection margin had a negative impact on long-term survival in patients following liver resection for colorectal metastases.
77 citations
TL;DR: It is indicated that bioengineered skin substitutes with a dermal component may improve healing outcomes in diabetic foot ulcers and venous leg ulcers, however, better designed trials with longer follow-up periods are needed.
Abstract: This systematic review indicates that bioengineered skin substitutes with a dermal component may improve healing outcomes in diabetic foot ulcers and venous leg ulcers. However, better designed trials with longer follow-up periods are needed.
44 citations
TL;DR: It is proposed that upper airway surgery should not be first line treatment for obstructive sleep apnoea, as it is associated with multiple morbidities, motor vehicle crashes, and reduced health related quality of life.
Abstract: #### Key points
The prevalence of obstructive sleep apnoea in high income countries is estimated to be 20% for mild disease and 6-7% for moderate or severe disease. The condition is associated with multiple morbidities, motor vehicle crashes, and reduced health related quality of life.1 Clinical guidelines recommend continuous positive airway pressure (CPAP) with weight and alcohol management (if indicated) as first line treatment for symptomatic, moderate to severe obstructive sleep apnoea.2 3 Upper airway surgery (such as uvulopalatopharyngoplasty) may also be done, but evidence does not support its use.4 However, use of surgical procedures is widespread and increasing in Australia and elsewhere (such as the Nordic countries).5 6 We propose that upper airway surgery should not be first line treatment for obstructive …
40 citations
TL;DR: By modification of the standard RFA circuit with the addition of a direct electrical current, significantly larger ablations can be produced and it is anticipated this could reduce the rate of local recurrence.
18 citations
TL;DR: The involvement of members of the Royal Australasian College of Surgeons Section of Breast Surgery in Australia and New Zealand in multidisciplinary care teams is explored.
Abstract: Objective: To explore the involvement of members of the Royal Australasian College of Surgeons (RACS) Section of Breast Surgery in Australia and New Zealand in multidisciplinary care (MDC) teams. Design and setting: Questionnaire sent to all full members of the RACS Section of Breast Surgery in December 2006. Participants: 239 of 262 active full members of the RACS Section of Breast Surgery (response rate, 91.2%). Main outcome measures: Surgeons' use of, and the composition and functioning of, MDC teams in public and private practice, and in metropolitan, regional and rural settings. Results: 85% of responding surgeons reported participating in at least one fully established MDC team. Public-sector teams were operationally more consistent and functional than private teams, and rural teams were less well developed than those in metropolitan and regional centres. The six core disciplines recommended by the National Breast Cancer Centre appear to be well represented in most teams. Patients and their general practitioners were not considered to be part of the treatment team by surgeons. Conclusions: MDC is supported by most breast surgeons, but there are deficits in rural areas, and in the private sector relative to the public sector.
TL;DR: Although the positive electrode placement requires further consideration, bimodal electric tissue ablation appears to be safe and behaves in a similar fashion to other thermal therapies such as standard radiofrequency ablation.
TL;DR: 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, and 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.
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.
TL;DR: A nihilistic attitude to the patient with seemingly inoperable liver metastases should be discouraged and improved chemotherapy regimes and other innovative treatments have opened up new options for such patients and may even render conventionally in operable disease resectable.
TL;DR: Surgical audits can be used to assess practice trends and the impact of systematic reviews or clinical guidelines on treatment practice, to identify the disparities in the uptake of evidence, and to promote further research on how to bridge evidence–practice gaps and to overcoming possible barriers for the evidence uptake.
Abstract: Evidence-based medicine (EBM) is an important advance in health care. The Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), the Royal Australasian College of Surgeons, has been at the forefront of promoting EBM in surgery by developing systematic reviews and managing surgical audits. In EBM, uptake of evidence is just as important as establishing the evidence. The prospective, long-term data collection of surgical audits on treatment processes and outcomes often have a high patient and surgeon coverage and make them extremely valuable as a tool for assessing the uptake of evidence. Surgical audits can be used: (i) to assess practice trends and the impact of systematic reviews or clinical guidelines on treatment practice, (ii) to identify the disparities in the uptake of evidence, and (iii) to promote further research on how to bridge evidence-practice gaps and to overcoming possible barriers for the evidence uptake. The information gathered through the audit data assessment on evidence-uptake can be used to improve evidence dissemination and identify possible barriers to the uptake of evidence.
TL;DR: Internal radiotherapy with radiolabelled lipiodol has been used with some success in treatment of HCC, and appears to have a role in treating unresectable tumours.
Abstract: Background: Hepatocellular carcinoma (HCC) is one of the most common solid organ tumours, with approximately 500 000 new cases being reported each year. It has a very high prevalence in Asia, and almost two-thirds of all cases occur in this region. The incidence of this tumour in Australia has nearly doubled in the past decade. Surgical resection is the mainstay of treatment, but only 10–30% of HCC are amenable to surgical resection at the time of diagnosis. The prognosis for patients with unresectable HCC remains dismal. Internal radiotherapy with radiolabelled lipiodol has been used with some success in treatment of HCC. Several studies have validated its usefulness in an adjuvant setting, but it also appears to have a role in treating unresectable tumours.
Methods: Twenty-two patients with proven HCC, not amenable to or having failed surgical treatment, were evaluated for radiolabelled lipiodol treatment. Of these, 10 patients were excluded after initial evaluation and 12 patients underwent treatment. Patients were followed up every 3 months with physical examination, computed tomography scan and α-fetoprotein levels. Overall survival, change in tumour size and α-fetoprotein levels were used to evaluate the efficacy of treatment.
Results: The median overall survival in patients undergoing lipiodol therapy was 15 months. Tumour size was stabilized in most patients and very few side-effects of the treatment were observed.
Conclusion: This study has shown that radiolabelled lipiodol is an effective method for the treatment of unresectable locally advanced HCC.
TL;DR: This current analysis confirms an improvement in survival over time for advanced CRC and this is seen in unselected patients including those over 70 years of age.
TL;DR: Bimodal electric tissue ablation is a novel variation to standard radiofrequency ablation that produces significantly larger ablations by the addition of a direct electrical current and by increasing the surface area in contact with the positive electrode, the risk of tissue injury is reduced.
Abstract: Background: Bimodal electric tissue ablation is a novel variation to standard radiofrequency ablation that produces significantly larger ablations by the addition of a direct electrical current. The negative electrode is attached to the radiofrequency current and the positive electrode is placed nearby. It has been identified that an electrolytic injury can occur at the positive electrode site. It is suggested that by increasing the surface area that is in contact with the positive electrode, the risk of tissue injury is reduced. This hypothesis was tested in a pig model.
Methods: Thirty-six ablations were carried out in the livers of six pigs (six ablations per pig). Two were standard radiofrequency ablation controls and two were carried out with positive electrode attached to a scalpel blade. Two were carried out with positive electrode attached to a grounding pad. After 48 h, liver was harvested and the ablation sizes were compared. Skin biopsies were taken from the scalpel site and one from the pad site and examined histopathologically.
Results: The scalpel blade ablations were significantly larger than controls and the grounding pad ablations (P < 0.001). The grounding pad ablation was significantly larger than controls. The scalpel blade skin site showed full-thickness tissue injury. The grounding pad site appeared microscopically normal.
Conclusion: By increasing the surface area that connects to the positive electrode, significantly larger ablations can be carried out while minimizing the risk of associated tissue injury.
TL;DR: International evidence based guidelines are needed to standardise approaches to reducing risk of infectious disease in women and girls across Europe and Asia.
Abstract: International evidence based guidelines are needed to standardise approaches to reducing risk
TL;DR: This study aims to assess the trend in Australia and New Zealand of BCS use between 1999 and 2006 and to determine pathological factors associated with it.
Abstract: Background: The optimal surgical treatment of early breast cancer in young women is not fully determined, while past reports indicate a trend to the increased use of breast-conserving surgery (BCS). This study aims to assess the trend in Australia and New Zealand of BCS use between 1999 and 2006 and to determine pathological factors associated with it.
Methods: Data on cancer characteristics and surgical procedures in younger patients with early breast cancer reported to the National Breast Cancer Audit have been analysed.
Results: There was little change in the rate of BCS over the last 7 years with an overall rate of 53%. The main factors associated with the use of BCS are low histological grade, absence of extensive intraductal carcinoma (EIC), negative lymph node involvement, unifocal tumour and small tumour size.
Conclusion: Between 1999 and 2006, the use of BCS for early breast cancer treatment in younger women was stable. These results show that surgeons contributing data to the National Breast Cancer Audit appear to use pathological factors that are known to increase the risk of local recurrence after BCS, in selecting mastectomy for younger women.
01 Jan 2008
01 Jan 2008