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Background: The surgical management of trauma within Australia and New Zealand has recently been undergoing major organizational changes. The aim of the present paper was to evaluate the attitudes and experience of Australian and New Zealand advanced surgical trainees in this changing climate and to identify problems with trauma training. Methods: A survey assessing important areas of trauma management and training was sent to all advanced surgical trainees of the Royal Australasian College of Surgeons. Results: Two hundred and seventy-two of 587 trainees responded (46%). Overall 85% of trainees believed they would be involved in trauma management in the future. The majority of trainees reported low rates of involvement and consultant supervision in trauma resuscitations. Only 32% of general surgical trainees believed that their exposure to major trauma operations was very adequate despite an average of 12.3 trauma operations per year. Seventy per cent of general surgical trainees reported a very adequate level of consultant supervision at trauma operations. In contrast 86% of orthopaedic trainees reported a very adequate exposure to trauma operations with an average of 221 orthopaedic trauma operations per year. Only 46% of orthopaedic trainees reported a very adequate level of consultant supervision at trauma operations. Conclusions: Regional rotations may need to be developed to even out trainees’ experience in trauma management. The low level of supervision in trauma resuscitations and orthopaedic surgical training requires attention. This survey warrants repeating in a prospective manner. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the present study was to determine if interpersonal counselling (IPC) was effective in reducing psychological morbidity after major physical trauma., Methods: One hundred and seventeen subjects were recruited from two major trauma centres and randomized to treatment as usual or IPC in the first 3 months following trauma. Measures of depressive, anxiety and post-traumatic symptoms were taken at baseline, 3 months and 6 months. The Structured Clinical Interview for DSM IV diagnoses was conducted at baseline and at 6 months to assess for psychiatric disorder., Results: Fifty-eight patients completed the study. Only half the patients randomized to IPC completed the therapy. At 6 months the level of depressive, anxiety and post-traumatic symptoms and the prevalence of psychiatric disorder did not differ significantly between the intervention and treatment-as-usual groups. Subjects with a past history of major depression who received IPC had significantly higher levels of depressive symptoms at 6 months., Conclusion: IPC was not effective as a universal intervention to reduce psychiatric morbidity after major physical trauma and may increase morbidity in vulnerable individuals. Patient dropout is likely to be a major problem in universal multi-session preventative interventions.

One hundred and fifty-three patients with haematemesis and melaena were studied retrospectively. The majority were managed in general medical units. Fifty-one per cent had a past history of peptic ulcer and/or bleeding, and only 9% had no identifiable predisposing factors. Endoscopy was the major diagnostic tool, with a diagnostic rate of 85%. Nineteen per cent of patients had no diagnostic investigations performed for varied reasons. The operative rate was 15% overall, with an operative mortality of 17%. The presence of other serious disease states concomitant with the haematemesis and melaena, and the presence of oesophageal varices as the aetiology, were both shown to be associated with statistically worse prognoses. Age of greater than 50 years and transfusion of four or more units of blood were also associated with a worse prognosis. Overall mortality was 14%, comparable to or less than that at several institutions, but more than double that of a Haematemesis and Melaena Unit in another Melbourne hospital [Br. Med. J. 1, 1238-40 (1979)] Patient population should be considered closely when comparing mortalities from different series. It is felt that results could be improved using a combined medical and surgical approach, and a set protocol of management, and that such changes should be monitored via a prospective study.