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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 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 article discusses the strategies developed by the Royal Australasian College of Surgeons (RACS) that would influence surgeons' behaviour in their ageing process. RACS' code of conduct advises surgeons to be aware of the ageing process, refrain from practice if impaired by a physical disability and on retirement provide a smooth handover of patients under their care. It cites the Senior Surgeons Group developed which targets retiring surgeons as they wind down from surgical practice.

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.

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., Method: 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. 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 < or = 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)., Conclusion: 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.

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.