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Backgrounds: Surgical site infections (SSI) are a significant cause of postoperative morbidity and mortality, contributing to a considerable financial burden on the healthcare system. Insufflation of the open surgical wound with warm, humidified carbon dioxide (CO2) is a novel measure aimed to reduce SSI. The local atmosphere of warm, humidified CO2 within the open surgical wound is proposed to decrease airborne contamination, bacterial growth, desiccation, and heat loss while improving tissue oxygenation and perfusion. This randomized controlled trial evaluates the impact of the HumiGard™ surgical humidification system on the incidence of SSI in patients undergoing open colorectal surgery. Methods: We conducted a multi‐site single‐blinded randomized control trial on patients undergoing elective or emergency laparotomy at a single tertiary Colorectal Surgery service. The primary outcome measure was the incidence of SSI, with secondary outcomes including ICU length of stay (LOS), total LOS and mean core temperature. Results: Patients who received HumiGard™ had a lower incidence of SSI, although this did not reach statistical significance (4.5% for treatment group versus 13.0% for control group; P = 0.092). There was no significant difference in ICU LOS or total LOS between cohorts. The HumiGard™ group had a higher mean core temperature than the control at the end of surgery (P < 0.001). Conclusion: The present study could not confirm that utilization of warm, humidified CO2 with HumiGard™ reduces SSI in open colorectal surgery. Further research is indicated to validate and extend these findings. [ABSTRACT FROM AUTHOR]

A personal narrative of author's experience of surviving stroke is presented

The article offers information related to role of planning fallacy in time management in the operating theatre. It mentions that the planning fallacy include planners focusing on the most optimist scenario for the task rather than using their full experience of how much time similar tasks require. It further discusses the use of the planning fallacy by surgeons.

Canada and Australia share similar cultural origins and current multicultural societies and demographics but there are differences in climate and sporting pursuits. Surgeons and surgeon teachers similarly share many of the same challenges, but the health care and health-care education systems differ in significant ways. The objective of this review is to detail the different postgraduate surgical training programs with a focus on general surgery and how the programs of each country may benefit from appreciating the experiences of the other. The major differences relate to entry requirements, the role of universities in governance of training, mandatory skills courses in early training, the accreditation process, remuneration for surgical teachers and the impact of private practice. Many of the differences are culturally entrenched in their respective medical systems and unlikely to change substantially. Direct entry into specialty training without an internship per se is now firmly established in Canada just as delayed entry after internship is mandated by the Australian Medical Board. Both recognize the importance of establishing goals and objectives, modular curricular and the emerging role of online educational resources and how these may impact on assessments. The Royal Australasian College of Surgeons is unlikely to cede much responsibility to the universities but alternative academic models are emerging. Private health care in the two countries differs, but there are increasing opportunities for training in the private sector in Australia. In spite of the differences, both provide excellent health care and surgical training opportunities in an environment with significant fiscal, technological and societal challenges. [ABSTRACT FROM AUTHOR]

Background: Within surgery the debate about the place of evidence-based medicine (EBM) has focused on the nature and compatibility of EBM with surgical practice with an inevitable polarization of opinion. However, EBM techniques are being embedded into undergraduate medical curricula and surgical training programs across Australia. The Monash University Department of Surgery at Monash Medical Centre implemented a pilot study to explore current knowledge, attitudes and behaviours of practising surgeons towards EBM techniques. Methods: Descriptive survey of surgeons based in a tertiary care environment. Results: The results from the surgeons surveyed suggest that (i) they believe that EBM marginalizes patient involvement in decision-making; (ii) they believe that EBM-generated knowledge is useful and is commonly used in daily clinical decision-making – however, not using EBM does not adversely affect their daily clinical decision-making; (iii) they have high confidence in their own judgement compared with low confidence in clinical practice guidelines and other sources of evidence; and (iv) journal summaries of the latest research related to a subject are the most useful resources in clinical practice above clinical practice guidelines. Conclusion: The importance of incorporating concepts of the ‘culture’ of surgery as an important factor in understanding and developing new ways to mobilize Australian surgeons to adopt EBM into their practice is discussed. [ABSTRACT FROM AUTHOR]

Background: Vaccination, education and use of long-term antibiotics are recommended in expert guidelines for the prevention of infectious complications after splenectomy. However, studies outside Australia have shown poor adherence to the guidelines. The aim of this study was to determine overall adherence to the guidelines and to ascertain any independent risk factors for poor compliance with the guidelines. Method: A retrospective review of hospital records between 1999 and 2004 was carried out. Results: Indications for splenectomy of the 111 patients in this review included post-trauma (32), haematological (32), cancer surgery (24), iatrogenic (12) and others (11). On multivariable analysis, age was associated with a 28% less likelihood to receive education (odds ratio (OR) 0.72; 95% confidence interval (CI) 0.56–0.92; P = 0.009) and 36% less likelihood to receive long-term antibiotics (OR 0.64; 95% CI 0.52–0.80; P ≤ 0.001). Women were four times more likely to receive education (OR 4.03; 95% CI 1.16–14.0; P = 0.028) and patients who had undergone splenectomy in 2004 were 22 times more likely to have received education compared with those in 1999 (OR 22.53; 95% CI 3.12–162.34; P = 0.002). Conclusions: Education for prevention of sepsis after splenectomy is poorly documented and may be incomplete. Older age and male sex are risk factors in non-adherence to guidelines for prevention of postsplenectomy sepsis. Strategies such as alert cards and information brochures may improve adherence to guidelines particularly in older patients. [ABSTRACT FROM AUTHOR]

Objectives To determine whether earlier clinical intervention by a medical emergency team prompted by clinical instability in a patient could reduce the incidence of and mortality from unexpected cardiac arrest in hospital. Design A non-randomised, population based study before (1996) and after (1999) introduction of the medical emergency team. Setting 300 bed tertiary referral teaching hospital. Participants All patients admitted to the hospital in 1996 (n=19 317) and 1999 (n=22 847). Interventions Medical emergency team (two doctors and one senior intensive care nurse) attended clinically unstable patients immediately with resuscitation drugs, fluid, and equipment. Response activated by the bedside nurse or doctor according to predefined criteria. Main outcome measures Incidence and outcome of unexpected cardiac arrest. Results The incidence of unexpected cardiac arrest was 3.77 per 1000 hospital admissions (73 cases) in 1996 (before intervention) and 2.05 per 1000 admissions (47 cases) in 1999 (after intervention), with mortality being 77% (56 patients) and 55% (26 patients), respectively. After adjustment for case mix the intervention was associated with a 50% reduction in the incidence of unexpected cardiac arrest (odds ratio 0.50, 95% confidence interval 0.35 to 0.73). Conclusions In clinically unstable inpatients early intervention by a medical emergency team significantly reduces the incidence of and mortality from unexpected cardiac arrest in hospital. [ABSTRACT FROM AUTHOR]

The article talks about the need for doctors in Australia be kind towards each other while practicing ISBAR (Identify, Situation, Background, Assessment and Recommendation) for clinical handovers, which would help to improve collegiality among themselves.

The article offers news briefs about medicine. Assessing physical signs such as an altered respiratory rate and presence of carotid bruit may lead to the diagnosis of serious diseases. The number of people with diabetes is estimated to reach up to 380 million by 2025 says the International Diabetes Federation. Using alcohol-based hand rub solution by health workers is effective in reducing methicillin-resistant Staphylococcus aureus and other nonsocomial infections in Australian hospitals.

The article presents several abstracts on medical topics which include the AUTOLOGOUS CELLS - A BOSST FOR THE SPHINCTERS, AVOID FLUID OVERLOAD IN MAJOR ABDOMINAL SURGERY, and FRACTURE RECOVERY IMPAIRED IN COMPENSABLE PATIENTS.

The article offers a look on the medical response of Australia in delivering humanitarian aid for the Indian Ocean disaster in December 2004. The surgeons responded to the disaster by offering medical assistance to the victims. The Royal Australasian College of Surgeons in Melbourne, Victoria showed their support by providing an infrastructure for fellows and trainees with the backing required in future deployments.

The article offers information on the 2015 Asia Pacific Federation of Coloproctogy (APFCP) Congress which was held from October 5 to 7, 2015 in Melbourne, Victoria. Parvez Sheikh, former president from Mumbai, India, challenged the APFCP with his planning for the future of the Federation. The plenary sessions covered topics including colorectal cancer, laparoscopic surgery, and pelvic floor.

The author discusses the importance of recognizing and managing psychological stress when medical students transition to medical practitioners. He explains that the incidence of anxiety and depression amongst interns are reported greater during the intern year based on the survey from the University of Sydney. The author recommends strategies to reduce psychological distress including duty hour reduction, half-day educational interventional programs, and regular internal assessments.

The article presents the author's views on his journey in medical writing and acknowledges people including editor-in-chief John Hall and Hugh Dudley for their contribution to the journal.

The article reports on the advice of Greg Moran and Stephen Duckett from the Grattian Institute to avoid hospitalization in January due to increased hospital-acquired complications induced by the deployment of fresh medical graduates in medical institutions.

The article discusses evolution of cardiac transplantation since its introduction by South African surgeon, Christiaan Barnard in 1967. It states that the transplatation practice has faced moral and ethical question over the past, and mentions that donor organ needed to come from an obviously healthy individual who had suffered some life-ending injury that left the heart unaffected. It notes existence of issues like scarce donor pool, imprecise immunosuppression, and infection.

The author discusses the significance of the symposium Lancet Commission on Global Surgery 2030 to the Asia-Pacific region which was launched in January 2014 to improve the access and affordability of surgery. Topics include the vision of the commission for universal access in surgical and anaesthesia care, the involvement of the Royal Australasian College of Surgeons (RACS) in global health in 2015, and RACS support to the symposium.

The article offers information on the perspective of Sir John Monash and his career development. He was born on June 27, 1865 in Melbourne, Victoria, Australia. He gained his degrees at Melbourne University in Arts, Law and Engineering. Monash as 'the outsider who won a war' or 'the Maestro-Australia's greatest citizen general.'

The article offers information on the 56th Annual Surgeons' Meeting (Vic ASM) that was held on October 24-25, 2014 at the Sheraton Melbourne Hotel, Melbourne, Australia. Topics discussed include upcoming Victorian parliamentary elections, a representative group of metropolitan hospitals' surgical directors and Victorian Regional Committee (VRC) members met with key political representatives Health Minister David Davis, Shadow Minister Gavin Jennings and Greens Spokesperson Colleen Hartland.

The article presents the author's views over analysis of complaint letter by several nurses of the Monash University's Department of Surgery over his bullying approach as a Chief of Surgery. Topics discussed include consideration of the issues by author that leads to his approaches for adoption of an anger management; association with psychologist for management of his anger; and illustration of the Royal Australasian College of Surgeons in Melbourne, Victoria campaign for surgeon's behaviour.

The article offers information on connection between intelligence quotient (IQ) and longevity in children. It mention that study conducted by Calvin and his colleagues showed that the persons with high IQ showed lower rates of death from coronary heart disease, stroke, cancer, respiratory disease and digestive diseases. It also mention that the risk of dementia-related mortality and deaths by suicide was reduced by at least one-third in the highest performing quarter of intelligence.

The article examines the potential impact of climate change on human health. Topics discussed include the formal withdrawal of the U.S. from the Paris climate agreement on June 2, 2017, the World Health Organization's publication of a report that outlines how climate change affects the social and environmental determinants of health, and the Australian Medical Association's call for an international cooperation to mitigate climate change.

The article discusses the relevance of the issue of conflict of interest to medical journals. Topics discussed include the International Committee of Medical Journal Editors' (ICMJE) definition of the term conflict of interest, the responsibilities of authors submitting articles to medical periodicals in terms of disclosing conflicts of interest and the ways in which journal editors deal with conflict of interest issues.

The article discusses developments in reducing surgical site infections from 1865 to 2017. University of Glasgow surgery professor Joseph Lister first applied the combination of carbolic acid spray and acid-soaked towels surrounding the incision in 1865. The germ theory of wound infection from the writings of French chemist Louis Pasteur is cited as the basis for Lister's principle. Guidelines for using prophylactic antibiotics are also enumerated.

The article discusses the medical case of a 65-year-old woman admitted with chest pain, with a history of lower back pain on non-steroidal anti-inflammatories. Topics discussed include the patient diagnosed with ischaemic chest pain despite minor electrocardiography (ECG) changes, a dissecting thoracic aortic aneurysm confirmed by a computed tomography and cognitive biases as flaws or distortions in judgment and decision-making.

In this article, the author discusses evolution of medical transcription (MT) over the years with services such as outsourcing, voice recognition (VR) and electronic medical records. Topics discussed include companies employing MTs contracted by large medical consulting practices and hospitals for cost-saving strategies are outsourcing businesses, self-employed MTs whose potential for continuing employment determined by cheaper rates and VR as threat to MTs due to replacement of services.

The author examines the continued use of dietary supplements by consumers despite evidence suggesting their lack of health benefits and potential health risks. He discusses the results of a U.S. study of trends in dietary supplement use from 1999 to 2012 which showed that their use by adults remained stable during the study period. He also explores consumers' possible reasons for continuing to use dietary supplements, including little restriction on their advertising.

The article looks at fact sheets and guide published by public health and public education agencies versus scientific evidence on sleep hygiene. It shares tips in the U.S. Centre for Clinical Interventions publication. It also discusses studies on claims of sleep hygiene education programs and sleep hygiene practices in medical students. It also mentions the association between caffeine consumption and sleep quality.

The author discusses the 2014 RACS Annual Scientific Congress (ASC) held in Singapore on May 2014 which regard to the importance of team management in perioperative care to improve patient outcomes. The author mentions steps to improve perioperative outcomes discussed by Philip James Devereaux at the 2014 conference which include the acknowledgement of the problem, the importance of addressing care fragmentation, and the establishment of perioperative clinical fellowships.

The author reflects on how can surgeons handle the challenge of keeping clear, concise and contemporaneous medical records. He mentions the recommendations from the Victorian Surgical Consultative Council (VSCC) on the documentation standard in medical records, the Standard 1.9 which relates to the use of an integrated clinical record identifying all aspects of patient's care, and the study of Douglas-Moore and colleagues which performed surgical records audit to tackle the said challenge.

The author discusses the content, value and purpose of Regional Annual Scientific Meetings (ASMs) to create a balance between fellowship and science, as ASMs struggle in attracting the interest and attendance of fellows and trainees. He explores the objectives of the ASM by the Royal Australasian College of Surgeons (RACS), which include providing fellows with an update on developments in surgery. He mentions the importance of participation of state representatives on College Council in ASM.

The author comments on various topics related to surgery. He expresses disappointment to leading character of Carol Scott-Conner's short story named Beth Abernathy after refusing a leadership role in a surgical procedure for an elderly man suffering from co-morbidities and ischaemic gut. He stresses the importance of teaching operative techniques to surgical trainees. He adds the impact of sleep deprivation to the surgical performance and professionalism of surgeons.

The author reflects on burnout in surgeons. The author reflects on studies related to burnout in surgeons including one by the American College of Surgeons (ACS) which reveals a strong correlation between working hours and burnout and one by C.M. Balch, J.A. Freischlag and T.D. Shanafelt which showed the importance of self-wellness in coping with burnout. The author adds that burnout outcomes will depend on willingness for trust, teamwork and cultural change.

In this article, the author discusses the contribution of randomized controlled trials on the increased rate of carbon dioxide emissions. It states that the randomized trials were identified as the factors that generate the emissions on an average of 78.4 tonnes. It mentions that the trials teams had produced most of the emissions through their travel, which gained 46%. Meanwhile, the Copenhagen Summit in December 2009 reveals that the government is not yet taking actions on the emissions.

The author discusses importance of the voice of consumers in patient safety and quality, and avenues where patients can express their opinion. Topics include Standard 2 of Australia's National Safety Quality and Health Service Standards that covers consumer partnerships; and avenues for patients to express their opinion including the not-for-profit public online platform Patient Opinion Australia, and the international charity Picker Institute Europe, that focuses on person-centred care.

The author discusses the significance of assessing presence of frailty or the risk of delirium before conducting surgery of elderly people, as of October 2016. He states physiological changes associated with frailty such as unintentional weight loss, and self-reported exhaustion, and mentions findings of a retrospective cohort study inferring link between frailty and poor outcome of operations. He notes association between the presence of frailty and postoperative delirium.

The author discusses the potential harmful effects of the term, pimping, on learning and potential mistreatment and bullying of medical students. He relates various studies of medical students on the potential harms of pimping. The author suggests mentors to be mindful of how to dig the knowledge of medical students by providing thought-provoking questions without the fear of humiliation and subconscious image of horror.

The article dicussses the role of editor of a medical journal as discussed by Richard Horton, editor of the journal "The Lancet." We noted that he had evaluated the first edition of nine general surgery journals in 1996 and found that of the 215 articles, only 7% were randomized trials and 46% case series. He was an advocate to provide better research in surgery.

The author discuses aspects of the adoption of technological innovations in medicine. Topics discussed include the influences of machine learning in the practice of medicine, the several factors which serves as the root of digital revolution such as the massive amount of data, advances in computational processes, and introduction of machine learning, and the association and adoption of wearable and mobile devices with biometric device.

The author discusses aspects of pursuit of happiness. He mentions its reference to the efforts of people in ameliorating the quality of their life and well-being as well as points out its attributes including satisfaction, pleasure and exhilaration. An overview of the study on its impact on morality is also presented.

The author discusses the hand hygiene campaign at hospitals in Australia and New Zealand to reduce the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections. Topics include the introduction of clinical dress code, the elements of the dress code, and a study on contamination found in clinical clothing.

In this article, the author discusses the patient's perceptions of the surgical ward round. It contends that it is not necessarily a problem even medical and nursing staff may perceive the surgical ward round to be intimidating and interrupting for patients. It cites that other institutions may conduct their ward rounds in different fashions. It recommends that each unit conduct its own survey of patient perceptions to maximize patient education and care.

The author reflects on the College Arms, the Coat of Arms of the Royal Australasian College of Surgeons (RACS). He discusses how the College Arms was developed with its origin that dates back to the twelfth century. He features the etymology of the Coat of Arms as well as the process required for a college or society to have a Coat of Arms. The author also cites details about the elements of the Coat of Arms along with its motto.

The author examines the role of clinical prediction rules (CPRs) in medical decision making and transforming evidence-based medicine (EBM) into daily surgical clinical practice. He cites the four distinct phases needed to establish CPRs and explains their clinical accuracy compared to clinical judgement. He also discusses a systematic review which found that CPRs are rarely superior to clinical judgement in terms of diagnosis improvement and diagnostic testing reduction.