ANZ journal of surgery
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ANZ journal of surgery · Jul 2007
Fast-track rehabilitation in elective colorectal surgery patients: a prospective clinical and immunological single-centre study.
Recent clinical data indicate that fast-track surgery (multimodal rehabilitation) leads to shorter postoperative length of hospital stay, faster recovery of gastrointestinal function as well as reduced morbidity and mortality rates. To date, no study has focused on the effects of fast-track surgery on postoperative immune function. This study was initiated to determine whether fast-track rehabilitation results in improved clinical and immunological outcome of patients undergoing colorectal surgery. ⋯ Fast-track rehabilitation after colorectal surgery results in better-preserved cell-mediated immunity when compared with conventional postoperative care. Furthermore, patients undergoing fast-track rehabilitation suffer from less pain and have a faster return of gastrointestinal function in the postoperative course. In addition, postoperative length of hospital stay was significantly shorter in fast-track patients.
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ANZ journal of surgery · Jul 2007
Is informed consent in cardiac surgery and percutaneous coronary intervention achievable?
Medical and legal published work regularly discusses informed consent and patient autonomy before medical interventions. Recent discussions have suggested that Cardiothoracic surgeons' risk adjusted mortality data should be published to facilitate the informed consent process. However, as to which aspects of medicine, procedures and the associated risks patients understand is unknown. It is also unclear how well the medical profession understands the concepts of informed consent and medical negligence. The aims of this study were to evaluate patients undergoing coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI) to assess their understanding of the risks of interventions and baseline level of understanding of medical concepts and to evaluate the medical staff's understanding of medical negligence and informed consent. ⋯ Patients undergoing both CABG and PCI have a poor understanding of their disease, their intervention, and its complications making the attaining of true informed consent difficult, despite their desire to be informed of all risks. PCI patients particularly were highly optimistic regarding the need for reintervention over time, which requires specific attention during the consent process. Medical staff showed a poor knowledge of the concepts of material risk and medical negligence requiring much improved education of both junior doctors and specialists.
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Lipomatous tumours comprise a range of diagnoses. There are controversies regarding the histopathological diagnosis, nomenclature, diagnostic method, surgical management, roles of radiotherapy and the risk of metastasis, local recurrence and dedifferentiation. This study describes our experience with such tumours. ⋯ Large deep lipomatous tumours are uncommon and although they do not tend to metastasize, they not infrequently recur locally. Hence their local treatment to prevent local recurrence is important. Key aspects in achieving a complete, but marginal resection of the deep atypical lipoma and the well-differentiated lipoma-like liposarcoma is accurate preoperative diagnosis with core biopsy and accurate imaging to assess deep unsuspected extensions of the tumour.
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ANZ journal of surgery · Jul 2007
Gastric banding at the Royal Brisbane and Women's Hospital: trials and tribulations of a public service.
The Royal Brisbane and Women's Hospital provides the only gastric banding service for the public to the state of Queensland. Our patients are potentially a different group from the previously reported Australian series with respect to weight, comorbidities and ease of follow up and we therefore present this series of public patient for comparison of medium-term results. ⋯ A banding service for the public is a unique experience. The BMI is greater than in other published series; diverse geographic origin of the patients creates difficulties with review and there are limited surgical resources. The Royal Brisbane and Women's Hospital is leading the way towards a multidisciplinary clinic approach to managing obesity. However, more resources will be required to have an effect on overall public health.
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There has been increasing awareness of the need for monitoring the quality of health care, particularly in the area of surgery. The Cumulative Summation (Cusum) techniques have emerged as a popular tool for performance monitoring in surgery. ⋯ Four parameters need to be set in advance: acceptable outcome rate, unacceptable outcome rate, Type I and Type II error rates. In this article, we review the history, statistical methods and potential applications for the Cusum techniques in the field of surgery and illustrate the two common forms of charting (cumulative failure and Cusum charting) by using unadjusted outcome data from the Geelong Hospital and St Vincent's Hospital cardiac surgery databases.