ANZ journal of surgery
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ANZ journal of surgery · Dec 2017
Implementing entrustable professional activities: the yellow brick road towards competency-based training?
We describe implementation of competency-based postgraduate surgical training, using an entrustable professional activities (EPAs) programme. The programme aims to improve patient outcomes by optimizing supervision of surgical trainees, creating opportunities for additional teaching and feedback. The curriculum was designed to maximize feasibility for implementation within a colorectal surgical department. ⋯ There are perceived benefits and problems evident in the EPA model at this early stage of implementation. The programme should result in an increase in the number of formative assessments and feedback opportunities for trainees. The assessment process is familiar to supervisors, which should facilitate implementation of the curriculum. There is concern that supervisors may require further training to ensure the assessment process is objective and reproducible. The EPA programme could make the process of delegating patient care to trainees more transparent, but we have not identified a method of widely disseminating trainee assessment data without the potential to prejudice trainees unfairly.
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ANZ journal of surgery · Dec 2017
Comparative StudyImpact of sex on prognostic host factors in surgical patients with lung cancer.
Lung cancer has markedly poorer survival in men. Recognized important prognostic factors are divided into host, tumour and environmental factors. Traditional staging systems that use only tumour factors to predict prognosis are of limited accuracy. By examining sex-based patterns of disease-specific survival in non-small cell lung cancer patients, we determined the effect of sex on the prognostic value of additional host factors. ⋯ Sex differences in non-small cell lung cancer are important irrespective of age, ethnicity, smoking, performance status and tumour, node and metastasis stage. Epidemiological findings such as these should be translated into research and clinical paradigms to determine the factors that influence the survival disadvantage experienced by men.
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ANZ journal of surgery · Dec 2017
Observational StudyUse of surgical safety checklists in Australian operating theatres: an observational study.
The use of surgical safety checklists (SSC) is an intervention aimed at reducing mortality and morbidity. Although the effectiveness of their use in surgery has been studied extensively, little is known about their practical use in Australian hospitals. The aim of this study was to observe and document the use of SSC in Australia. ⋯ This is the first study of surgical checklist use within Australia. Overall completion was low across the sites included in this study. Compliance data collected from observations differed markedly from reported compliance in medical records.
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ANZ journal of surgery · Dec 2017
ReviewTransoral robotic surgery base of tongue mucosectomy for head and neck cancer of unknown primary.
Head and neck cancer of unknown primary (HNCUP) is a source of diagnostic uncertainty. Patients presenting with cytologically positive neck lumps without a clinically identifiable primary, require extensive investigation including imaging, tonsillectomy, panendoscopy and tissue biopsy. Treatment typically involves neck dissection, wide field radiotherapy and chemotherapy. Transoral robotic surgery (TORS) has emerged as an expanding surgical technique for resecting tumours of the oropharynx. Its role in base of tongue (BOT) mucosectomy for HNCUP can alleviate diagnostic uncertainty and provide an adjunct treatment modality with few complications. ⋯ TORS BOT mucosectomy is an expanding surgical technique with a key role in head and neck surgery. It can be utilized to good effect where head and neck cancer is diagnosed without an identifiable primary. Incorporating robotic surgery in the diagnostic and treatment pathway offers low complication rates, reduced morbidity and improved tumour identification.
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ANZ journal of surgery · Dec 2017
Comparative Study Observational StudyHinchey I and II diverticular abscesses: long-term outcome of conservative treatment.
The management of diverticular disease and its complications are an increasing burden to the health system. The natural history of conservatively managed diverticular abscesses (Hinchey I and II) is poorly described and it remains open to debate whether subsequent sigmoid resection is indicated after conservative management. This observational study compares outcomes of patients treated with conservative management (antibiotics +/- percutaneous drainage) and surgery. ⋯ Recurrence after diverticular abscess is higher after initial conservative treatment (antibiotics +/- percutaneous drainage) compared with surgery, however, patients with recurrent disease can be treated conservatively with similar good outcomes and few patients required further surgery.