Dissertations / Theses on the topic 'Surgery Australia'

Tonsillectomy, adenoidectomy and myringotomy are the most common surgical procedures undergone by children. Medical opinion regarding the appropriateness of these procedures remains contentious, and considerable resources have been expended in the formulation and distribution of relevant practice guidelines. The impact of this surgery on the child, community and private and public health resources is considerable, yet there has been little examination of surgery rates and trends, or of the characteristics of children who undergo surgery. This thesis addressed five major questions regarding this surgery in New South Wales, Australia. The first three related to population rates: the level of surgery among NSW children, comparability with international rates, trends over time and the effect of guidelines. Comprehensive hospital data between 1981 and 1999 were analysed. Major findings were a higher myringotomy rate in NSW than reported internationally, the short-term effect of guidelines, and a major shift towards children having surgery at a younger age. The remaining questions asked whether children who had surgery differed from other children in their use of health services prior to surgery, and if so, whether their utilization reverted to the norm following surgery. Matched records of a population cohort of 6239 NSW children, born during January 1990, were extracted from Health Insurance Commission data, and their claims for medical services followed retrospectively from birth to 8 years. Children who had privately funded surgery were found to use more medical services than other children, and, most unexpectedly, this did not change following surgery. The results suggest potential non-clinical factors influencing this excess utilization. This is the first population study to examine health service utilisation by these children and it has identified an important new risk factor for surgery.

Thesis (PhD)--Macquarie University, Macquarie Graduate School of Management, 2001.
Bibliography: leaves 288-310.
Introduction -- Introduction to research problem and methodology -- Study context -- Theoretical framework - Review of the literature -- Study design and methods -- Study sites, surgical procedures, and labour input to surgical production -- New intra-operative artefacts: goals, choices and consequences -- Conclusion.
Surgical technologies since the late 1980s have undergone substantial innovations that have involved ...the adoption of new machines, instruments, and related surgical materials... referred to throughtout this thesis as intra-operative artefacts... typically represents a commitment of substantial financial resources by the hospitals concerned. However, little is documented about the process whereby the decisions are made to adopt new intra-operative artefacts, and no previous research appears to have explored the work-related consequences of new intra-operative artefact adoption within operating theatre services. This thesis explores the reasons why new intra-operative artefacts are adopted, how the decisions are made, who are the participants in the decsion process and what are the expected and actual organisational consequences of new intra-operative artefact adoption.
Electronic reproduction.
xii, 347 leaves, bound :
Mode of access: World Wide Web.
Also available in print form

Health care providers in the United States, United Kingdom and Australia debate the need for expanding the role of podiatrists' to include the surgical care of foot problems. Paradoxically, during a twelve month period from July 1995 to June 1996, Fellows of the Australian College of Podiatric Surgeons (FACPS) performed over 1,500 individual surgical operations on approximately 785 Australians. Few prospective investigations of podiatric surgeon outcomes have been conducted, none of which have taken place in Australia. More particularly, no studies have used valid psychometric instruments to measure the effects of care provided on patients' "health related quality of life". The research contained in this thesis deals with the conceptualisation, development and validation of a new health status instrument: the Foot Health Status Questionnaire. This instrument has been developed with the specific intent of investigating the impact of FACPS on patients' health related quality of life. One hundred and forty-two subjects treated by eleven Fellows for orthopaedic, neurological or integumentary systems diseases of the foot were recruited into a six month long quasi-experimental repeated measures (time series) study. The study identified that the vast majority of subjects (more than 92%) who underwent foot surgery experienced significant improvements' in a range of health related quality of life dimensions and indicated that they would undergo their procedure again. In particular, a MANCOVA analysis demonstrated that subjects' reported reduced levels of foot pain, increased levels of physical function, improved general foot health perception and footwear related quality of life, up to six months after their respective operations. Adverse effects of surgery identified in this study include a significant short-term functional disability for subjects' undergoing orthopaedic correction of foot problems and, in the immediate post operative phase, a significant reduction in social function for all three groups of subjects'. Generic measures of General Health and Vitality, as captured by the Short Form 36 health status instrument, were unaffected by Fellows treatment. This study did not identify any significant short to medium term morbid outcomes. Assessment of patients' satisfaction with surgery one, three and six months postoperatively reflected a general under-reporting of the beneficial effects of foot surgery. These findings support the premise that; specific health related quality of life measures provide significant explanatory power about the outcomes of care compared with the more traditional approach of evaluating patient satisfaction with surgery. In summary, it has been recommended that podiatrists, like other health care professionals, use recognised methods to determine whether their care meets professional standards and to generate evidence to prove that it does. This research contributes to meeting this important public health need.

Multi-organ procurement surgical procedures are undertaken on donors who have consented at the time of their death to donate multiple organs, body parts or tissues. These donors fulfil the criteria for donation by either being certified as brain dead as a result of an injury or via a donation after cardiac death (DCD) pathway. Worldwide multi-organ procurement surgery has made a huge impact in both extending and enhancing the quality of life for recipient patients who have received organs from donors. Perioperative nurses working in surgical teams play a vital role in procuring organs from both paediatric and adult cadaver organ donors. The nature of the surgical procedure used for procuring organs, the urgency of coordinating surgical procurement teams and the removal of organs for urgent transplantation to awaiting recipients is fast paced and technical. The experience has been reported to evoke emotions which traumatically impact on perioperative nurses when assisting in these surgical procedures. There is currently a dearth of research examining the experiences of Australian perioperative nurses assisting within multi-organ procurement surgery.The objective of this study was to describe and gain a greater understanding of the personal experiences nurses encountered as part of their professional roles when involved in these surgical procedures. This thesis presents the substantive theory which has used a grounded theory methodology to describe the experiences of 35 perioperative nurses working within multi-organ procurement surgical teams from metropolitan, regional and rural hospitals in both New South Wales and Western Australia. The qualitative data from in-depth interviews were simultaneously collected and analysed to develop the substantive theory. The study findings draw attention to the complexities that exist for perioperative nurses to participate in these surgical procedures.The basic social psychological problem of hiding behind a mask was found to be a fundamental shared concern that the majority of perioperative nurses in this study faced when participating in multi-organ procurement surgery. The problem of hiding behind a mask was comprised of three stages: being unprepared, being overwhelmed and hiding the burden. The first stage, conceptualised as being unprepared, consisted of not knowing what to expect during the surgical procedure when they lacked prior knowledge and experience and felt unprepared for being exposed to death by operating on a cadaver donor and managing DCD donors within the operating room. Moreover participants were unprepared for witnessing the circumstances of each donor patient in addition to dealing with the grieving family.During the second stage participants described being overwhelmed with fears of facilitating death of the donor when they lacked understanding of the process of brain death diagnosis. They reported being overwhelmed at also having to witness the graphic nature of the procurement process and feeling overwhelmed by their own emotional responses to the donor’s death which they tried to hide and contain from their work colleagues through hiding behind a mask. Lastly the third stage of hiding behind a mask was identified as hiding the burden where participants were forced to contain their own personal beliefs and attitudes towards these surgical procedures whilst undertaking their professional roles. They reported hiding behind a mask when suppressing personal beliefs, hiding an objection to participate, not disclosing their own views or attitudes on death and spiritual ‘afterlife’ beliefs and lastly hiding not being able to cope when participating in these surgical procedures. The majority of the participants in this study articulated that various conditions influenced and directly contributed towards their experiences of hiding behind a mask. Three conditions were identified and these were reported as: work conditions, levels of knowledge and experience and levels of support.In an attempt to overcome the problem of hiding behind a mask, the data revealed that participants had to reach a turning point which was labelled as taking control. The turning point of taking control was described by participants as taking control of their own internal turmoil and rationalising the situation they were placed in whilst also changing their attitudes and thoughts towards their participation in the procedure. Once they had passed through the turning point of taking control participants were able to move beyond this point into the basic social psychological process of finding meaning.The basic social psychological process of finding meaning comprised of three stages: pushing through; preserving self and coming to terms. The first stage of finding meaning was conceptualised as pushing through. For many of the study participants in pushing through they dissociated themselves from their internal feelings and conflicts by focusing on the importance of their role and professional contributions towards the surgical procedure. The second stage of the basic social psychological process of finding meaning was conceptualised as preserving self, this saw participants implement strategies to protect themselves from both the traumatic experiences of procurement surgery and the tragic circumstances of the donors they came in contact with. Three aspects of preserving self were identified: being resilient; nurse self care and seeking personal support. The third and final stage of the basic social psychological process of finding meaning was conceptualised as coming to terms. During this stage participants were able to gain some understanding from their experiences by placing their participation role into perspective, honouring the donation wish and assisting in preserving life for the greater good when focusing on the needs of recipient patients requiring the organs they were assisting to procure. Conditions influencing the basic social psychological process of finding meaning encompassed: work conditions, levels of knowledge and experience and levels of support. Participants articulated these as positive influencing conditions such as a changing work environment, feeling less isolated and being supported by their work organisations.Throughout this thesis pertinent scientific literature has been woven into the research findings to illustrate the relevance of the newly developed theory and to place the substantive theory within the context of other findings and related theories to further support the trustworthiness of the current study data and the newly developed theory. The findings detailed in the substantive theory illustrate new contributions to the knowledge and understanding of the Australian perioperative nurses experiences when undertaking multi-organ procurement surgical procedures which will have relevance both nationally and internationally. The findings have implications and recommendations directed towards perioperative nurses, health services, perioperative organisations, government and policy makers.

Includes bibliographical references (leaves 159-213) Shows that IGF-I peptides are effective in diminishing post-surgical catabolism and enhancing adaptive gut hyperplasia in rats recovering from massive small bowel resection.

This research explores why specialists undertake further training in advanced gynaecological surgery, how and why such training pathways develop and how they are regulated. This research advocated for the acceptance of alternative training pathways and shaped postgraduate medical education and workforce planning. Through a mixed-methods approach, this thesis constructs a historical timeline as the foundation for a critical analysis of the professionalization of operative gynaecology and establishes the main reasons for advanced training as the development of surgical competency, recognition, certification, and involvement in academic activities, emphasizing the training unit, surgical case load, a structured curriculum and peer group.

Bibliography: leaves 197-205. Electronic publication; full text available in PDF format; abstract in HTML format. This thesis reports the development, testing, and application of computer programs for simulating Lagrangian-Stochastic particle dispersion in coastal seas, with particular application to tide and storm induced dispersion in South Australian seas. Electronic reproduction.[Australia] :Australian Digital Theses Program,2001.

An analysis of the outcome following cardiac valve surgery and coronary artery bypass grafting performed in the Royal Adelaide Hospital Cardiothoracic Surgical Unit over a 25 year period.
Thesis (M.S.) -- University of Adelaide, Dept. of Surgery, 1993.

Introduction: Identifying potentially modifiable factors leading to patient mortality in cardiothoracic surgery may provide the basis for interventions to improve patient safety. Australia is unique in that all cardiothoracic surgeons participate in a mandatory national surgical audit. All patients who die under the care of a surgeon are referred to the Australian and New Zealand Audit of Surgical Mortality (ANZASM). Surgeons are asked to provide a narrative to patient death and the case is reviewed by independent assessors with case note review if necessary. The aim of this project was to examine the ANZASM database for cardiothoracic mortality and identify possible factors leading to patient mortality. Methods: The ANZASM database was analysed for a seven-year period from February 2009 through December 2015. The surgeons’ narrative and assessors report of all patients who died under the care of a cardiothoracic surgeon were examined. A qualitative analysis using a thematic analysis technique was performed on the data set. Researchers read the surgical narrative and assessor report and common clinical management issues (CMIs) were coded from these extracts and subsequently grouped into a set of common themes. Within these themes, the reports were re-analysed to look in further detail about common factors and subthemes. Specific attention was paid to potentially avoidable themes. This process was repeated for the overall dataset, followed by the most common theme identified (operative technical factors) and again focusing on communication issues, which were identified as prevalent throughout all operative phases. Results: A total of 1440 CMIs were identified in 908 patients in our analysis. The CMIs were grouped into preoperative, intraoperative and postoperative phases. The most common individual CMI was intraoperative technical factors (31.7% of cases) and most CMIs occurred in the postoperative phase. Themes that were identified in the preoperative phase included: decision to operate (18.3%), inadequate assessment (13.1%) and delay to surgery (10.4%). Intraoperative themes comprised technical factors (31.4%), wrong surgical approach (6.6%) and junior surgeon (2.4%). Postoperative themes included inappropriate management (15.9%), delay to recognising complication (3.6%), postoperative bleeding (13.2%), infection (11.6%) and inadequate monitoring (2.6%). Technical factors affecting surgery were made up of unintentional injury to anatomical structures (42% of operative-phase CMIs), perfusion issues related to coronary grafts (15.4%), unaddressed surgical pathology (13%), inadequate myocardial protection (11.2%), air and anastomotic leaks (6.3%), bleeding (13.2%), technical issues with cardiopulmonary bypass (4.2%) and excessive surgery (3.8%). Communication issues identified were broken down into failure of shared decision making (41.8% of communication-related CMIs), failure to notify a patient deterioration (24.1%), misreporting of patient condition (11%) and issues regarding informed consent (10%). Conclusions: This thesis identified many factors leading to cardiothoracic surgical mortality throughout all operative phases. Technical and postoperative factors are the most common issues, however, most mortality results from multifactorial failures spanning the operative phases. National surgical audit is useful in identifying factors and maintaining safety standards for patient care perioperatively. Attention to correcting issues most commonly identified may improve the quality of patient care in cardiothoracic surgery.
Thesis (MPhil) -- University of Adelaide, Adelaide Medical School, 2019

For many general surgical procedures, quality of care does not differ greatly between providers or hospitals. However, the outcomes of complex surgical procedures such as those performed on the liver or pancreas have been shown to vary by hospital, surgeon and their respective volume or experience. This research sought to provide an assessment of the current state of hepatic and pancreas surgery in Australia with identification of potential areas for improvement. A systematic search for studies investigating the determinants of mortality and morbidity for hepatic resection and pancreaticoduodenectomy (PD) was performed. A particular focus on Australian studies revealed gaps in the current available evidence. The first objective was to evaluate the mortality due to hepatic resection in Australia. Publication 1 (Variability of perioperative mortality of hepatic resection in Australia) reflected this aim. Australian Institute of Health and Welfare (AIHW) data was interrogated for hepatic resection. The overall POMR for hepatic resection in Australia was 1.6% with significant interstate variability but without significant variability over time. Publications 2 (Peer review of mortality after pancreaticoduodenectomy in Australia) and 3 (Peer review of mortality after hepatectomy in Australia) used the data collected from the Australian and New Zealand Audit of Surgical Mortality (ANZASM) to examine the factors leading to mortality post hepatic or pancreas resection. This was a unique approach not previously employed to examine the drivers of mortality for a specific procedure. For each patient death following PD or hepatic resection, the ANZASM Assessor’s determination of whether patient care could have been improved was reviewed and summarised using thematic analysis. ANZASM assessors determined that a poor decision to operate contributed to 17% of deaths post PD and 25% of deaths post hepatic resection. Delay in the recognition of serious complication was considered relevant in 21% and 18% of PD and hepatic resection deaths respectively. Multi-disciplinary decision making has been strongly recommended in deciding which patients to offer these complex procedures. Optimal care includes early recognition of complications and enactment of an adequate rescue plan. Finally, mortality data from the Victorian Admitted Episodes Database was interrogated for patients who underwent PD in public hospitals and reported in publication 4 (The short-term outcomes of pancreaticoduodenectomy in the state of Victoria – Hospital resources are more important than volume). Risk adjusted perioperative outcomes were reported and compared for hospital volume and hospital peer group. The overall inpatient mortality for PD in Victoria was 2.7% with a significant difference in mortality between hospital peer groups and not hospital volume. This finding highlights the importance of resource availability in the care of these complex patients. The results seen in this group of studies contribute new evidence into the current status and variability of hepatic and pancreatic surgery in Australia. Furthermore, the two studies investigating the determinants of perioperative mortality provide a new perspective to the current international literature on hepatobiliary surgery.
Thesis (MPhil) -- University of Adelaide, Adelaide Medical School, 2020

Sets out the principles of craniofacial surgery and how they have been utilised to form the Australian Craniofacial Unit. Progress of the organisation is mapped over twenty one years using selected published papers in which the author has in some way contributed to the development of teaching, research and service in craniofacial surgery. Papers are grouped so as to show the progress made in the areas of trauma, the craniosynostoses, rare craniofacial clefts, frontal ethmoidal meningoencephaloceles, craniofacial tumours, as well as research and development.
Thesis (M.D.) -- University of Adelaide, Dept. of Surgery, 1999

Includes bibliographical references.
2 v. :
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Sets out the principles of craniofacial surgery and how they have been utilised to form the Australian Craniofacial Unit. Progress of the organisation is mapped over twenty one years using selected published papers in which the author has in some way contributed to the development of teaching, research and service in craniofacial surgery. Papers are grouped so as to show the progress made in the areas of trauma, the craniosynostoses, rare craniofacial clefts, frontal ethmoidal meningoencephaloceles, craniofacial tumours, as well as research and development.
Thesis (M.D.)--University of Adelaide, Dept. of Surgery, 1999

"October 2004"
Includes bibliographical references (leaves 313-337)
x, 337 leaves : ill. (col.), maps (col.) ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 2004

xxiii, 222 leaves : ill., plates ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Shows that IGF-I peptides are effective in diminishing post-surgical catabolism and enhancing adaptive gut hyperplasia in rats recovering from massive small bowel resection.
Thesis (Ph.D.)--University of Adelaide, Dept. of Animal Science, 1992

Selection of trainees for surgical training is widely acknowledged to be both complex and important. Doctors embarking on surgical careers expend considerable time and resources in training, as do those responsible for facilitating their learning. The aim of surgical training is to prepare surgeons to be competent, effective, ethical practitioners in unsupervised clinical practice as consultant surgeons (Carroll, Kennedy, Traynor & Gallagher, 2009; Elfenbein, Sippel, McDonald, Watson, Scarborough & Migaly, 2015). The aim of selection must be to admit those who are most likely to succeed in surgical training and beyond. Admitting candidates who are inadequately suited to surgical training can result in trainees who unduly struggle or are unable to satisfy training requirements, and may ultimately jeopardise patient safety. In contrast, not accepting candidates who are well-suited to surgical training may be unfair to both candidates and communities that miss out on skillful surgeons. These aspects are among those that make selection to surgical training an extremely ‘highstakes’ activity. Those responsible for selection grapple with assessing candidates’ current skills and attributes, and with ascertaining their likely future performance. Limitations of, and tensions between interacting elements—human agency, requirement specifications, instruments, processes, influences—in selection to surgical training, mean that the long-term outcomes of selection can never be assured. This study identifies principal elements in selection to surgical training, discusses influences on, and interrelationships between the elements, and reviews connections between selection and surgical training assessments. This study has appraised the current instruments used for selection into the Royal Australasian College of Surgeons’ (RACS) General Surgery (GS) training program in Australia and New Zealand, to establish their effectiveness in predicting trainees’ performance in assessments during the first two years of training. Data were considered for selection and assessment items for trainees for three yearly cohorts, selected in 2008, 2009, and 2010. The study compared the performance of trainees in three selection instruments—a structured CV, a structured referee report, and a multi-station interview—to their performance in three examinations and three work-based assessments. Firstly, Pearson product-moment correlations were calculated to examine the extent of relationships within each set of variables to determine intra-relationships of the selection items, of the examination items, and of the work-based assessment items. Secondly, Pearson productmoment correlations were conducted to determine degrees of association between selection items and performance in each of the subsequent assessment items. Thirdly, multiple regression analysis was conducted to determine the extent to which trainees’ scores in the selection items (independent variables) predicted scores in each of the assessments during training (dependent variables). The model fit and strength was assessed using the analysis of variance (ANOVA) step within the regression analysis. The relative strength of the associations between dependent variables and the independent variables were assessed using regression coefficients. The findings of this study have shown that performance in RACS GS selection partially predicts performance in assessments during training. In general, candidates’ performance varied across each of the selection items, performance in all examinations was highly consistent and performance in major end of term work-based assessments was also consistent. Most correlations between performance in selection and performance in assessments during training were positive, with the exception that performance in the CV was usually inversely correlated with subsequent assessments. The referee reports and total selection scores were predictive of performance in the major end of term work-based assessments. This study reviewed many factors that affect selection processes and outcomes. Several of these—such as the role of procedural justice, identification of desired attributes of trainees, and the validity, reliability, fairness, and acceptability of selection instruments and protocols— implicitly framed RACS GS selection. However, to maximise the effectiveness of selection instruments and protocols, these and other relevant influences could be explicitly defined for the local context. The findings regarding the predictive capacity of the selection instruments— particularly for the referee reports and the interviews—differ from some other studies, but highlight that the implementation and content of selection instruments are key aspects affecting their performance. Combining scores from multiple instruments reduces the influence of any individual selection instrument. Overall, with the possible exception of the CV, the study has shown that the RACS GS selection tools are performing moderately well. However, the RACS GS selection instruments and processes could be modified to maximise their effectiveness and new, emerging selection activities could be considered.

Research Doctorate - Doctor of Philosophy (PhD)
Sea level rise is undoubtedly one of the most threatening consequences of climate change. The impact of sea level rise will be strongly felt in northern Australian coastal regions, where a rapid rising of sea levels is causing an increase in the frequency and severity of storm surge events. This dissertation investigates two main objectives: (1) the short-term local sea level variability associated with tropical cyclones, and (2) the long-term regional sea level variability and trends for the northern coasts of Australia. This study uses 21 years of sea level observations from multiple satellite altimetry missions (e.g., TOPEX/Poseidon, Jason-1, and Jason-2) and 14 tide gauges. First, it focuses on the analysis of the Non-Tidal Sea Level component of Sea Level Anomalies (SLAs), which theoretically only contains the storm surge level, and is constructed by removing the mean sea surface and ocean tides from sea level observations. The SLAs are analysed using the Power Spectral Density method to explore the tidal features in the study area. This concludes that the pointwise response method provides better ocean tidal corrections than the global tidal models, which were available at the time of this study, due to the complexity of the study area. Then, a multivariate regression (MR) model is used to predict sea level variations using both altimetry and tide gauge data. The modelled solution provides sea level predictions at the times of interest, which can be used to monitor extreme sea level events. To overcome the drawback that the MR model cannot model the non-linear variations, a new method has been developed to investigate non-linear components of sea level through the rebuilding the model using a state-of-the-art Multivariate Adaptive Regression Spline (MARS). The comparison results show that MARS can, in general, explain 62% of sea level variance while MR only accounts for 45% of the variance, suggesting an improved sea level prediction from MARS. Comparison results also indicate that the cyclone-induced surge peaks predicted by the MARS model agree well with those observed at independent validating tide gauges. Finally, to achieve the second objective, sea level observations from both datasets are used to characterise sea level trends and interannual variability over the study region. The results show that the interannual sea level fingerprint in the northern Australian coastline is closely related to El Niño Southern Oscillation (ENSO) and Madden-Julian Oscillation (MJO) events. The rate of sea level rise (6.3 ± 0.4 mm/yr) estimated from tide gauges is slightly higher than (6.1 ± 0.3 mm/yr) from altimetry in the period of 1993-2013, which varies with the length of the time interval. This study also provides a novel framework for examining the significance of sea level trends by applying the non-parametric Mann-Kendall test, which is of significance in interpreting sea level trends. Recommendations for further research are to improve the altimetry sea level measurement close to the coastline using re-tracking techniques and to investigate the potential capability of monitoring coastal sea level from new satellite altimetry data, such as Jason-CS, Jason-3, CryoSat and Saral/AltiKa. An improved understanding of sea level rise and storm surges will be helpful in evaluating the coastal flooding scenario in the high flooding risk regions.