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Melbourne, Australia

Ibrahim E.F.,Wexham Park Hospital | Richardson M.D.,Epworth Hospital | Nestel D.,Monash University
Medical Education | Year: 2015

Context: Good preparation for surgical procedures has been linked to better performance and enhanced learning in the operating theatre. Mental imagery is increasingly used to enhance performance in competitive sport and there has been recent interest in applying this in surgery.Objectives: This study aims to identify the mental imagery components of preoperative preparation in orthopaedic trauma surgery and to locate these practices in existing socio-material theory in order to produce a model useful for surgical skills training.Methods: Semi-structured interviews were conducted with nine orthopaedic surgeons. Participants were identified by personal recommendation as regularly performing complex trauma operations to a high standard, and by affiliation to an international instruction course in trauma surgery. Interviews were audio-recorded and transcripts were independently analysed using thematic analysis.Results: Analysis revealed that surgeons interact intensively with multiple colleagues and materials during their preparatory activities. Such interactions stimulate mental imagery in order to build strategy and rehearse procedures, which, in turn, stimulate preparatory interactions. Participants identified the discussion of a preoperative 'plan' as a key engagement tool for training junior surgeons and as a form of currency by which a trainee may increase his or her participation in a procedure.Conclusions: Preoperative preparation can be thought of as a socio-material ontology requiring a surgeon to negotiate imaginal, verbal and physical interactions with people, materials and his or her own mental imagery. Actor-network theory is useful for making sense of these interactions and for allowing surgeons to interrogate their own preparative processes. We recommend supervisors to use a form of preoperative plan as a teaching tool and to encourage trainees to develop their own preparatory skills. The ability of a trainee to demonstrate sound preparation is an indicator of readiness to perform a procedure. © 2015 John Wiley & Sons Ltd.

Whitbourn R.,St. Vincents Hospital | Harding S.A.,Wellington Hospital | Walton A.,Epworth Hospital
EuroIntervention | Year: 2015

Aims: The aim of this study was to test the safety and performance of the Symplicity™ multi-electrode radiofrequency renal denervation system which was designed to reduce procedure time during renal denervation. Methods and results: The multi-electrode radiofrequency renal denervation system feasibility study is a prospective, non-randomised, open label, feasibility study that enrolled 50 subjects with hypertension. The study utilises a new renal denervation catheter which contains an array of four electrodes mounted in a helical configuration at 90 degrees from each other to deliver radiofrequency energy simultaneously to all four renal artery quadrants for 60 seconds. The protocol specified one renal denervation treatment towards the distal end of each main renal artery with radiofrequency energy delivered for 60 seconds per treatment. Total treatment time for both renal arteries was two minutes. The 12-month change in office systolic blood pressure (SBP) and 24-hour SBP was -19.2±25.2 mmHg, p<0.001, and -7.6±20.0 mmHg, p=0.020, respectively. There were three patients with access-site complications, none of which was related to energy delivery; all were treated successfully. No new renal artery stenosis or hypertensive emergencies occurred. Conclusions: The Symplicity multi-electrode radiofrequency renal denervation system was associated with a significant reduction in SBP at 12 months and minimal complications whilst it also reduced procedure time. © Europa Digital & Publishing 2015. All rights reserved.

Perera E.,Epworth Hospital | Sinclair R.,University of Melbourne
Australian Family Physician | Year: 2013

Background: Hyperhidrosis and bromhidrosis are two common conditions, which are troublesome for patients and carry a significant psychosocial burden. Objective: This article details an approach to the assessment and management of hyperhidrosis and bromhidrosis, and outlines current treatment options. Discussion: Hyperhidrosis can be either generalised or focal. Generalised hyperhidrosis may be primary and idiopathic or secondary to systemic disease. Treatment may require oral anticholinergic agents. Focal hyperhidrosis is usually primary and responds to topical measures. Specialist referral for botulinum toxin A, iontophoresis or sympathectomy should be considered for severe cases. Bromhidrosis usually responds to antiperspirants, fragrance and antibacterial agents.

Williams G.,Epworth Hospital | Pallant J.,University of Melbourne | Greenwood K.,RMIT University
Brain Injury | Year: 2010

Primary objectives: The high-level mobility assessment tool (HiMAT) was developed to measure high-level mobility limitations following traumatic brain injury (TBI). Rasch analysis was used in the development to ensure cognitive deficits would have a minimal impact on performance. The main aim of this study was to investigate the dimensionality of the HiMAT using recently developed advanced testing procedures. Research design: Results from the original sample of 103 adults with TBI used to develop the HiMAT were re-analysed using the RUMM2020 program. Revised minimal detectable change (MDC95) scores were also calculated. Main outcomes and results: Rasch analysis of all 13 HiMAT items suggested that the scale was multidimensional, showing a clear separation between the stair and non-stair items. The nine non-stair items of the HiMAT showed good overall fit, excellent internal consistency, with no disordered thresholds or misfitting items, however removal of one item was required to ensure a unidimensional scale. The final 8-item solution showed good model fit (p=0.93), excellent internal consistency (PSI =0.96), no disordered thresholds, no misfitting items and no differential item functioning for age or sex. The revised HiMAT total score is 32 points and the MDC95 was calculated to be ±2 points. Conclusion: The results of this study demonstrate that the revised HiMAT is unidimensional and valid to use in rehabilitation and community settings where there is no access to stairs. © 2010 Informa UK Ltd.

There is no situation in medicine where outcome is so utterly dependent on time than in the treatment of patients with S-T elevation myocardial infarction. This life-threatening situation accounts for 30% of acute coronary syndromes. Prompt myocardial reperfusion saves lives, but health services need to be thoroughly organised to achieve this outcome. Unfortunately, a minority of patients in Australia present within 2h of symptom onset and most patients receive reperfusion 3-4h after. So health professionals begin at a disadvantage. A novel approach to this problem has been to give thrombolysis at first contact with the patient, before admission to hospital. A French study has assessed this practice against the gold standard treatment for S-T elevation myocardial infarction with some very interesting results. The implications of this study now challenge well-entrenched guidelines for the management of patients with this condition. © 2012 Royal Australasian College of Physicians.

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