ANZ Journal of Surgery最新文献

{"title":"Telehealth after lockdown: evaluating a regional urological telehealth service before and after the pandemic.","authors":"Thomas Neerhut, Kathryn McLeod, Stuart Willder, Benjamin Harrison, Alexander Mills, Richard Grills","doi":"10.1111/ans.19419","DOIUrl":"https://doi.org/10.1111/ans.19419","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic facilitated the rapid uptake of telehealth Australia wide. To date, no studies have analysed patient perceptions of a regional urological telehealth service before and after the pandemic. With over 10 years of experience delivering telehealth to Southwest Victoria, we aim to highlight the benefits, limitations and progress of a regional urological telehealth service.</p><p><strong>Methods: </strong>Regional patients living within Western Victoria who participated in our 2017 survey and continued their urological telehealth consultations throughout 2021-2023 were invited to participate in our 2023 survey. Questions were both short answer and multiple choice. Seventy-eight patients met inclusion criteria, and 42 responses were returned. Data analysis utilized a mixed methods approach.</p><p><strong>Results: </strong>Overall patient perceptions were favourable in 2017 and improved throughout the Pandemic. The greatest improvements were seen within the performance areas: overall satisfaction, technological aspects, comprehension and financial benefits. Following the pandemic, the distance patients were prepared to travel for face-to-face reviews decreased and preferences for telehealth compared to face-to-face consultations increased by almost 20%. However thematic analysis revealed loss of personalized care, technological faults, fixed beliefs and unsuitable appointments as limitations of this model of care.</p><p><strong>Conclusion: </strong>Patients' perspectives of a regional urological telehealth service were overwhelmingly positive highlighting the vital place of urological telehealth in the delivery of equitable urological healthcare to a regional population. Overall, post COVID-19 there were improved patient perceptions of a telehealth service and its role in providing regional patients with the provision of timely, supportive and high-quality urological care.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and face validity testing of pyeloplasty surgical training models.","authors":"Georges Mehawed, JingJing Fan, Emma Lee, Paul Sourial, Laing Goostrey, Matthew Sellwood, Melissa Short, Nicholas Rukin, Rebecca Murray","doi":"10.1111/ans.19373","DOIUrl":"https://doi.org/10.1111/ans.19373","url":null,"abstract":"<p><strong>Background: </strong>There are few realistic and accessible laparoscopic pyeloplasty training models. The aim of this study is to develop a functional training model through user-centered design that depicts the pathological features of pelvicoureteric junction obstruction (PUJO).</p><p><strong>Methods: </strong>Realistic patient-matched anatomical models of the kidney, renal pelvis, and ureter were created based on segmentations of computed tomography (CT) scans of a paediatric patient with PUJO who underwent laparoscopic pyeloplasty. Three training model versions (polyjet, resin, and silicone) were produced, tested, and published. Training model testing was conducted by consultant surgeons (n = 14), training surgeons (n = 5), and medical students (n = 8). Face validity testing was conducted to assess realism and usefulness of training models on a 10-point Likert-type scale. Training model accessibility was assessed using equipment availability and cost to set-up and produce as proxy measures.</p><p><strong>Results: </strong>Participants significantly preferred polyjet and silicone models over resin models for overall rating (6.9 ± 2.3, 7.9 ± 1.1, and 5.0 ± 1.8) respectively; and usefulness in trainees (7.6 ± 2.1, 8.6 ± 0.9, and 5.0 ± 3.1) respectively. While both the polyjet and silicone models were found to be realistic and useful, the silicone model is considered more accessible due to the ready availability of the manufacturing equipment and materials and around 300-fold reduction in cost compared to polyjet.</p><p><strong>Conclusions: </strong>A surgeon-assessed realistic and useful pyeloplasty surgical training model was developed here which enables surgical practice on challenging small anatomical features. The comparatively low cost and accessibility of the silicone model can enable trainees to practice the procedure depicting the realistic pathological features in environments with limited resources.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Needs assessment of surgical skills of interns: a qualitative study in metropolitan Melbourne, Australia.","authors":"Matthew Y Wei, Howard H Y Tang, Debra Nestel, Greg Rumler, Kat Hall, Kate Martin, Vijayaragavan Muralidharan, Michael Hii, Fiona Reid, Shektar Kumta, Krinal Mori, Justin M C Yeung","doi":"10.1111/ans.70046","DOIUrl":"https://doi.org/10.1111/ans.70046","url":null,"abstract":"<p><strong>Introduction: </strong>Upon graduation, newly qualified doctors are expected to manage complex and unwell patients, and adapt their prior learning to navigate an often-nuanced healthcare workplace environment. Surgical rotations can bring a unique set of learning curves and challenges to this already demanding transitional period. The aim of this study was to identify the training needs of medical students and early-career doctors in surgical skills, incorporating viewpoints from all stakeholder groups to provide a holistic insight into the provision of surgical education currently, and how it can be optimized to improve work preparedness.</p><p><strong>Methods: </strong>Final-year medical students, interns and clinical educators from five clinical schools affiliated with the University of Melbourne were recruited for semi-structured interviews. Following transcription, multi-phased thematic analysis was performed to identify key themes.</p><p><strong>Results: </strong>Thirty-seven participants were interviewed (18 students, 8 interns and 11 clinical educators). Outside of commonly utilized procedural skills, different emphases were placed on non-technical skills by students and interns, compared to clinical educators. Increased hands-on learning and structured teaching were thought to be key to increasing confidence and work preparedness.</p><p><strong>Conclusion: </strong>This qualitative study interviewed key stakeholders to identify important skills in order to help newly qualified interns to thrive in a surgical rotation. These skills in particular included more supervised hands-on practical teaching. Future studies involving graduates from other medical schools may provide a better understanding of surgical education in the wider Australian context.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fifty years of free tissue transfer: the past, present and future of microsurgical reconstruction.","authors":"Francis D Graziano, Jocelyn Lu, Hani Sbitany, L Scott Levin, G Ian Taylor, Peter J Taub, Peter W Henderson","doi":"10.1111/ans.70032","DOIUrl":"https://doi.org/10.1111/ans.70032","url":null,"abstract":"<p><p>G. Ian Taylor and Rollin Daniel described the first fasciocutaneous vascularized free tissue transfer in 1973 using the groin flap. Over the last 50 years, the field of microsurgery has advanced significantly, with the advent of improved surgical instruments, discovery and description of numerous flaps, and a growing application and indications for free tissue transfer. The aim of this paper is to discuss the origins and major milestones of free tissue transfer reconstruction over the past half-century, providing insights into the evolution of surgical techniques and technological integration. The review culminates in a forward-looking perspective, contemplating future directions and innovations that will shape the ever-evolving field of free autologous tissue transplantation and reconstruction.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early use of non-vitamin K antagonist oral anticoagulants after cardiac surgery compared with warfarin for postoperative atrial fibrillation.","authors":"Shantel Chang, Alexander Lombardo, Ian Smith, Samuel Lawler, Cheng He, Andrie Stroebel","doi":"10.1111/ans.70045","DOIUrl":"https://doi.org/10.1111/ans.70045","url":null,"abstract":"<p><strong>Background: </strong>The introduction of non-vitamin-K-antagonist oral anticoagulants (NOAC) has shifted the landscape of anticoagulation in the setting of atrial fibrillation (AF), as an alternative to warfarin. Despite extensive evidence for NOACs in non-perioperative and non-valvular AF, there remains little consensus on anticoagulation choice for patients with postoperative atrial fibrillation (POAF) after cardiac surgery.</p><p><strong>Methods: </strong>This retrospective, observational study included 2263 patients who underwent cardiac surgery between 1 March 2016 and 13 January 2023 at a tertiary cardiac centre. Patients with pre-existing AF, valvular AF and transcatheter interventions were excluded. Short- and long-term outcomes were compared between patients who received a NOAC and those who received warfarin for POAF. A Cox regression model was constructed to identify independent predictors for time-to-mortality. Subgroup analysis was performed based on the type of surgery, including CABG-only, aortic valve replacement (AVR)-only, and combined surgery cohorts.</p><p><strong>Results: </strong>Of the 2263 patients, 556 (24.5%) developed POAF. Of those who developed POAF, 162 were anticoagulated with warfarin and 65 were anticoagulated with a NOAC, including apixaban, rivaroxaban and dabigatran. There were three cases of permanent stroke in the warfarin group compared with no cases in the NOAC group. All-cause 30-day and one-year readmission rates were similar between groups. The use of NOAC or warfarin did not impact overall survival in the Kaplan-Meier analysis. Subgroup analysis demonstrated similar outcomes in CABG-only, AVR-only and combined surgery groups.</p><p><strong>Conclusions: </strong>Warfarin and NOAC performed similarly in short- and long-term complications, suggesting NOAC as a plausible alternative to warfarin for anticoagulation in POAF.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is No difference a good outcome? Equity evaluation of the general surgery prioritization tool.","authors":"Douglas Wood, Nohoana Findlay, Alice Hyun Min Kim, Kfyr-Eyal Behar, Anthony Lin","doi":"10.1111/ans.70042","DOIUrl":"https://doi.org/10.1111/ans.70042","url":null,"abstract":"<p><strong>Background: </strong>The general surgery prioritization tool (GSPT) was implemented in 2018 to equitably prioritize non-cancer elective general surgery waitlists. It combines patient-reported Impact On Life (IOL) scores and clinician-reported values for a total score which determines access to the waitlist. In New Zealand there are inequities in surgical access and outcomes, particularly for Māori, and this study evaluates whether the GSPT may contribute.</p><p><strong>Method: </strong>A retrospective review of general surgery prioritization events at Capital & Coast District Health Board, New Zealand, between May 2018 and August 2022 was conducted. The patient-reported IOL score (6-36), total score (0-100), waitlist access, and time to surgery in days were recorded and analyzed for ethnic, age and gender differences.</p><p><strong>Results: </strong>4527 events were included. Median IOL score and total score were 20 and 68. 4231 (90.8%) met the waitlist threshold with a median time to surgery of 99 days. Higher average IOL scores were associated with being female (P = 0.005), Pacific Peoples (P = 0.007) and Other Ethnicity (P = 0.006). The average total score for Māori was 1.13 points higher than Europeans (P = 0.013). There was no evidence of associations between the odds of surgery booking and patient age, ethnicity and gender when adjusted for deprivation and procedure type.</p><p><strong>Conclusion: </strong>This study shows that despite differences in the IOL and total scores across ethnicity, no evidence of difference was found in the odds of surgical booking based on patient ethnicity, age or gender. Amendments to weighting of IOL scores and ethnicity score adjustment could be considered to remedy this.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143475916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"25, 50 & 75 years ago","authors":"Julian A. Smith MBMS, MSurgEd, FRACS","doi":"10.1111/ans.70048","DOIUrl":"10.1111/ans.70048","url":null,"abstract":"&lt;p&gt;&lt;b&gt;Collopy BT, Rodgers L, Woodruff P, Williams J. Early experience with clinical indicators in surgery. ANZ J. Surg. 2000;70:448–51&lt;/b&gt;.&lt;/p&gt;&lt;p&gt;In 1997, a set of 53 clinical indicators developed by the Royal Australasian College of Surgeons (RACS) and the Australian Council on Healthcare Standards (ACHS) Care Evaluation Programme (CEP) was introduced into the ACHS Evaluation and Quality Improvement Programme (EQuIP). The clinical indicators covered 20 different conditions or procedures for eight speciality groups and were designed to act as flags to possible problems in surgical care. The development process took several years and included a literature review, field-testing and revision of the indicators prior to approval by the College Council. In their first year, 155 healthcare organizations (HCO) addressed the indicators and this rose to 210 in 1998. Data were received from all states and both public and private facilities. The collected data for 1997 and 1998 for some of the indicators revealed rates, which were comparable with those reported in the international literature. For example, the rates of bile duct injury in laparoscopic cholecystectomy were 0.7% and 0.53%, respectively; the mortality rates for coronary artery graft surgery were 2.5% and 2.1%, respectively; the mortality rates after elective abdominal aortic aneurysm repair were 2.5% and 3.7%, respectively; and the post-tonsillectomy reactionary haemorrhage rates were 0.9% and 1.3%, respectively. Results for some indicators differed appreciably from other reports, flagging the need for further investigation; for example, the negative histology rates for appendectomy in children were 18.6% and 21.2%, respectively, and the rates for completeness of excision of malignant skin tumours were 90.7% and 90%, respectively. The significance of these figures, however, depends upon validation of the data and their reliability and reproducibility. Because reliability can be finally determined only at the hospital level, they are of limited value for broader comparison. The process of review established for the indicator set has led to refinement of some indicators through improvement of definitions, and to a considerable reduction in the number of indicators to 29 (covering 18 procedures), for the second version of the indicators (which was introduced for use from January 1999). The clinical indicator programme, as it has with other disciplines, hopefully, will provide a stimulus to the modification and improvement of surgical practice. Clinician ownership should enhance the collection of reliable data and hence their usefulness.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Foulds KA, Beasley SW, Moate K. Factors that influence length of stay after appendicectomy in children. ANZ J Surg 2000;70:43–6&lt;/b&gt;.&lt;/p&gt;&lt;p&gt;The length of hospital stay following appendicectomy in children at Christchurch Hospital has decreased in recent years. The aim of the present study was to identify those factors that contributed to this change. A retr","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"95 3","pages":"286-288"},"PeriodicalIF":1.5,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.70048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Verrucous plaque over leg in a young male.","authors":"K B Meghana, Apoorva Sharma, Debajyoti Chatterjee, Tarun Narang","doi":"10.1111/ans.70029","DOIUrl":"https://doi.org/10.1111/ans.70029","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143475937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financial barriers in urology publishing: an analysis of legitimate and predatory journals.","authors":"Lequang T Vo, David Armany, Simon V Bariol, Sriskanthan Baskaranathan, Tania Hossack, David Ende, Henry H Woo","doi":"10.1111/ans.70019","DOIUrl":"https://doi.org/10.1111/ans.70019","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the Article Processing Charges (APCs) and fee transparency between legitimate and potentially predatory urology journals.</p><p><strong>Methods: </strong>Potentially predatory journals were identified from unsolicited email solicitations sent to an academic urologist between December 2023 and January 2024. APC data were collected from the journals' websites and categorized based on fee transparency: no APC, non-transparent APCs, or transparent APCs. Legitimate journals were identified from the 69 urology journals listed in the Royal Australasian College of Surgeons library. APCs for these journals were similarly collected and analyzed. We conducted a quantitative analysis with Chi-squared testing to compare categorical variables and a Mann-Whitney U-test to assess differences in APC values.</p><p><strong>Results: </strong>A total of 214 potentially predatory journals were identified from 422 emails, originating from 75 different publishers. Solicitations spanned various disciplines, with only 7.35% from urology journals. Among potentially predatory journals, 3.7% claimed to have no APCs, 21.5% lacked fee transparency, and 74.8% disclosed their APCs, with a mean charge of 2272.50 USD (median 2000 USD; range 150-3690 USD). In contrast, legitimate journals had a mean APC of $3244.51 USD (median 3490 USD; range 635-6950 USD), with 11.6% offering publication without APCs.</p><p><strong>Conclusion: </strong>Academic urologists often face unsolicited invitations from predatory journals and encounter high APCs from legitimate journals. This dual challenge complicates researchers' decisions and can hinder access to reputable publication avenues. To alleviate this burden, institutions should consider financial support for researchers, and both publishers and researchers must prioritize transparency and caution in the open-access publishing landscape.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do hormones and surgery improve the health of adults with gender incongruence? A systematic review of patient reported outcomes.","authors":"Kelsey Ireland, Madeleine Hughes, Nicola R Dean","doi":"10.1111/ans.70028","DOIUrl":"https://doi.org/10.1111/ans.70028","url":null,"abstract":"<p><strong>Background: </strong>Gender diverse people in Australia have higher levels of psychological stress, suicidal ideation and suicide attempts and have poorer self-reported health than cisgender people.</p><p><strong>Objectives: </strong>To determine if adults who experience gender incongruence have improved health-related quality of life and mental health with gender affirming treatment (hormone therapy and surgery), compared with no treatment.</p><p><strong>Data sources: </strong>PubMed, Web of Science, Embase and Psych Info.</p><p><strong>Review methods: </strong>A systematic review of peer-reviewed publications in English from January 2010 to October 2022. Studies were included where: participants were treated with gender affirming surgery or hormone therapy for minimum 3 months and; validated patient reported outcome measures of health-related quality of life or mental health were reported. Quality of evidence assessment was undertaken using the Let Evidence Guide Every New Decision evaluation tool.</p><p><strong>Results: </strong>Eighty-one publications were included for analysis. The systematic review indicated that there were significant improvements in the domains of mental illness, gender dysphoria, body image and health-related quality of life following gender affirming medical treatment as measured by a variety of patient reported outcomes. Meta-analysis showed significant improvement in body image (z = 4.47, P < 0.001) and health-related quality of life for psychological (z = 1.99, P = 0.047) and social relationships (z = 3.09, P = 0.002) following gender affirming surgery.</p><p><strong>Conclusions: </strong>There is evidence that hormones and surgery as a collective for adults with gender incongruence has therapeutic value and should be considered for funding within Australia's healthcare systems. The development and implementation of patient-reported outcome tools tailored for purpose (GENDER Q) will facilitate future research.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}