Publications by authors named "Ian D Civil"

20 Publications

  • Page 1 of 1

A Public Health Approach to Prevent Firearm Related Injuries and Deaths.

Ann Surg 2021 10;274(4):533-543

Department of Surgery, University of Texas Health Science Center, San Antonio, Texas.

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http://dx.doi.org/10.1097/SLA.0000000000005056DOI Listing
October 2021

Research and Publishing in the COVID-19 Pandemic.

Injury 2020 05;51(5):1151

Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds General Infirmary, Leeds, UK; NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK.

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http://dx.doi.org/10.1016/j.injury.2020.04.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244408PMC
May 2020

The future of medical publication as we move towards the second half of the 21 century.

Injury 2020 01;51(1):1-3

Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds General Infirmary, Leeds, UK; NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK. Electronic address:

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http://dx.doi.org/10.1016/j.injury.2019.12.017DOI Listing
January 2020

Timing is everything: Do we need more from our databases?

Injury 2018 09;49(9):1639-1640

Centre for Population Health Sciences, Usher Institute, University of Edinburgh, UK. Electronic address:

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http://dx.doi.org/10.1016/j.injury.2018.08.001DOI Listing
September 2018

Do professional medical colleges serve a function in the 21st century?

Authors:
Ian D Civil

Intern Med J 2017 May;47(5):488-491

Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.

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http://dx.doi.org/10.1111/imj.13409DOI Listing
May 2017

Improved scores for observed teamwork in the clinical environment following a multidisciplinary operating room simulation intervention.

N Z Med J 2016 Aug 5;129(1439):59-67. Epub 2016 Aug 5.

Professor of Anesthesiology, University of Auckland and Anesthesiologist, Auckland City Hospital, Auckland.

Aims: We ran a Multidisciplinary Operating Room Simulation (MORSim) course for 20 complete general surgical teams from two large metropolitan hospitals. Our goal was to improve teamwork and communication in the operating room (OR). We hypothesised that scores for teamwork and communication in the OR would improve back in the workplace following MORSim. We used an extended Behavioural Marker Risk Index (BMRI) to measure teamwork and communication, because a relationship has previously been documented between BMRI scores and surgical patient outcomes.

Methods: Trained observers scored general surgical teams in the OR at the two study hospitals before and after MORSim, using the BMRI.

Results: Analysis of BMRI scores for the 224 general surgical cases before and 213 cases after MORSim showed BMRI scores improved by more than 20% (0.41 v 0.32, p<0.001). Previous research suggests that this improved teamwork score would translate into a clinically important reduction in complications and mortality in surgical patients.

Conclusions: We demonstrated an improvement in scores for teamwork and communication in general surgical ORs following our intervention. These results support the use of simulation-based multidisciplinary team training for OR staff to promote better teamwork and communication, and potentially improve outcomes for general surgical patients.
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August 2016

Resuscitative thoracotomy in penetrating trauma.

World J Surg 2015 Jun;39(6):1343-51

Auckland City Hospital Trauma Services, Park Road Grafton, Auckland, 1023, New Zealand.

The resuscitative thoracotomy (RT) is an important procedure in the management of penetrating trauma. As it is performed only in patients with peri-arrest physiology or overt cardiac arrest, survival is low. Experience is also quite variable depending on volume of penetrating trauma in a particular region. Survival ranges from 0% to as high as 89% depending on patient selection, available resources, and location of RT (operating or emergency rooms). In this article, published guidelines are reviewed as well as outcomes. Technical considerations of RT and well as proper training, personnel, and location are also discussed.
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http://dx.doi.org/10.1007/s00268-014-2829-zDOI Listing
June 2015

So why would my paper be rejected?

Injury 2014 Sep 10;45(9):1285-6. Epub 2014 Jun 10.

Department of Surgery, Division of Acute Care Surgery, University of Texas Health Science Center, Houston, TX, United States.

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http://dx.doi.org/10.1016/j.injury.2014.06.003DOI Listing
September 2014

Appropriate working hours for surgical training according to Australasian trainees.

ANZ J Surg 2012 Apr 17;82(4):225-9. Epub 2012 Jan 17.

Royal Australasian College of Surgeons' Trainees Association, Melbourne, Victoria, Australia.

Background: The demands of surgical training, learning and service delivery compete with the need to minimize fatigue and maintain an acceptable lifestyle. The optimal balance of working hours is uncertain. This study aimed to define the appropriate hours to meet these requirements according to trainees.

Methods: All Australian and New Zealand surgical trainees were surveyed. Roster structures, weekly working hours and weekly 'sleep loss hours' (<8 per night) because of 24-h calls were defined. These work practices were then correlated with sufficiency of training time, time for study, fatigue and its impacts, and work-life balance preferences. Multivariate and univariate analyses were performed.

Results: The response rate was 55.3% with responders representative of the total trainee body. Trainees who worked median 60 h/week (interquartile range: 55-65) considered their work hours to be appropriate for 'technical' and 'non-technical' training needs compared with 55 h/week (interquartile range: 50-60) regarded as appropriate for study/research needs. Working ≥65 h/week, or accruing ≥5.5 weekly 'sleep loss hours', was associated with increased fatigue, reduced ability to study, more frequent dozing while driving and impaired concentration at work. Trainees who considered they had an appropriate work-life balance worked median 55 h/week.

Conclusions: Approximately, 60 h/week proved an appropriate balance of working hours for surgical training, although study and lifestyle demands are better met at around 55 h/week. Sleep loss is an important determinant of fatigue and its impacts, and work hours should not be considered in isolation.
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http://dx.doi.org/10.1111/j.1445-2197.2011.05992.xDOI Listing
April 2012

Working hours and roster structures of surgical trainees in Australia and New Zealand.

ANZ J Surg 2010 Dec 12;80(12):890-5. Epub 2010 Oct 12.

Royal Australasian College of Surgeons, Melbourne, Victoria, Australia.

Background: The working hours of surgical trainees are a subject of international debate. Excessive working hours are fatiguing, and compromise performance, learning and work-life balance. However, reducing hours can impact on continuity of care, training experience and service provision. This study defines the current working hours of Australasian trainees, to inform the working hours debate in our regions.

Methods: An online survey was conducted of all current Australasian trainees. Questions determined hours spent at work (AW) and off-site on-call (OC) per week, and roster structures were evaluated by training year, specialty and location.

Results: The response rate was 55.3%. Trainees averaged 61.4 ± 11.7 h/week AW, with 5% working ≥80 h. OC shifts were worked by 73.5%, for an average of 27.8 ± 14.3 h/week. Trainees of all levels worked similar hours (P= 0.10); however, neurosurgical trainees worked longer hours than most other specialties (P < 0.01). Tertiary centre rotations involved longer AW hours (P= 0.01) and rural rotations more OC (P < 0.001). Long days (>12 h) were worked by 86%; median frequency 1:4.4 days; median duration 15 h. OC shifts of 24-h duration were worked by 75%; median frequency 1:4.2 days; median sleep: 5-7 h/shift; median uninterrupted sleep: 3-5 h/shift.

Conclusions: This study has quantified the working hours and roster structures of Australasian surgical trainees. By international standards, Australasian trainee working hours are around average. However, some rosters demand long hours and/or induce chronic sleep loss, placing some trainees at risk of fatigue. Ongoing efforts are needed to promote safe rostering practices.
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http://dx.doi.org/10.1111/j.1445-2197.2010.05528.xDOI Listing
December 2010

Surgical education, training and continuing professional development: crystal ball gazing.

Authors:
Ian D Civil

ANZ J Surg 2009 Mar;79(3):214-6

Royal Australasian College of Surgeons, Spring Street, Melbourne, Victoria, Australia.

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http://dx.doi.org/10.1111/j.1445-2197.2008.04843.xDOI Listing
March 2009

Surgical education and training in Australia and New Zealand.

World J Surg 2008 Oct;32(10):2138-44

Royal Australasian College of Surgeons, College of Surgeons Gardens, Spring Street, Melbourne, Victoria 3000, Australia.

Surgical education for medical students in Australia and New Zealand is provided by 19 universities in Australia and 2 in New Zealand. One surgical college is responsible for managing the education, training, assessment, and professional development programs for surgeons throughout both countries. The specialist surgical associations and societies act as agents of the college in the delivery of these programs, the extent of which varies among specialties. Historically, surgical training was divided into basic and specialist components with selection required for each part. In response to a number of factors, a new surgical education and training program has been developed. The new program incorporates a single merit-based national selection directly into the candidate's specialty of choice. The existing curriculum for each of the nine specialties has been remodeled to a competence-based format in line with the competence required to undertake the essential roles of a surgeon. New standards and criteria have been produced for accreditation of health care facilities used for training. A new basic surgical skills education and training course has been developed, with simulation playing an increasing role in all courses. Trainees' progress is assessed by workplace-based assessment and formal examinations, including an exit examination. The sustained production of sufficient competent surgeons to meet societal needs encompasses many challenges including the recruitment of appropriate graduates and the availability of adequate educational and clinical resources to train them. Competence-based training is an attractive educational philosophy, but its implementation has brought its own set of issues, many of which have yet to be resolved.
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http://dx.doi.org/10.1007/s00268-008-9680-zDOI Listing
October 2008

A new surgical education and training programme.

ANZ J Surg 2007 Jul;77(7):497-501

Royal Australasian College of Surgeons, Melbourne, Victoria, Australia.

Educating and training tomorrow's surgeons has evolved to become a sophisticated and expensive exercise involving a wide range of learning methods, opportunities and stakeholders. Several factors influence this process, prompting those who provide such programmes to identify these important considerations and develop and implement appropriate responses. The Royal Australasian College of Surgeons embarked on this course of action in 2005, the outcome of which is the new Surgical Education and Training programme with the first intake to be selected in 2007 and commence training in 2008. The new programme is competency based and shorter than any designed previously. Implicitly, it recognizes in the curriculum and assessment development and processes, the nine roles and their underpinning competencies identified as essential for a surgeon. It is an evolution of the previous programme retaining that which has been found to be satisfactory. There will be one episode of selection directly into the candidate's specialty of choice and those accepted will progress in an integrated and seamless fashion, provided they meet the clinical and educational requirements of each year. The curriculum and assessment in the basic sciences include both generic and specially aligned components from the commencement of training in each of the nine surgical specialties. Born of necessity and developed through extensive research, discussion and consensus, the implementation of this programme will involve many challenges, particularly during the transition period. Through cooperation, commitment and partnerships, a more efficient and better outcome will be achieved for trainees, their trainers and their patients.
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http://dx.doi.org/10.1111/j.1445-2197.2007.04171.xDOI Listing
July 2007

Acquired jejuno-ileal diverticular disease: a diagnostic and management challenge.

ANZ J Surg 2003 Aug;73(8):584-9

Department of Surgery, Auckland Hospital, Auckland, New Zealand.

Background: Acquired jejuno-ileal diverticular disease (JID), a result of abnormalities in the smooth muscle or myenteric plexus of the small bowel, is less rare than was once believed. Approximately 1.3% of the population has JID, of whom approximately 10% present with life-threatening complications such as inflammation, perforation, bleeding, obstruction and malabsorption. Jejuno-ileal diverticular disease can be diagnostically and therapeutically challenging, and complications are often diagnosed only at laparotomy, while the best management is not agreed on in the literature. To increase the awareness of this condition and its complications, the Auckland Hospital's experience of JID was reviewed.

Methods: Retrospective review was carried out of the audit data and the discharge coding records of Auckland Public Hospital for the 5 year period leading to November 2001.

Results: Nine cases with a variety of presentations were found. Those cases are described and a literature review of JID is provided.

Conclusion: Jejuno-ileal diverticular disease should be included in the differential diagnosis when dealing with surgical emergencies in the elderly presenting with features of bowel perforation, obstruction or bleeding.
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http://dx.doi.org/10.1046/j.1445-2197.2003.02709.xDOI Listing
August 2003

Comparing measures of injury severity for use with large databases.

J Trauma 2002 Aug;53(2):326-32

Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand.

Background: After recent debate about the best measure of anatomic injury severity, this study aimed to compare four measures based on Abbreviated Injury Scale scores derived using ICDMAP-90-the Modified Anatomic Profile (ICD/mAP), Anatomic Profile Score (ICD/APS), Injury Severity Score (ICD/ISS), and New Injury Severity Score (ICD/NISS)-with the International Classification of Diseases-based Injury Severity Score (ICISS).

Methods: Data were selected from New Zealand public hospital discharges from 1989 to 1998. There were 349,409 patients in the dataset, of whom 3,871 had died. Models were compared in terms of their discrimination and calibration using logistic regression. Age was included as a covariate.

Results: The ICISS and ICD/mAP were the best performing measures. Adding age significantly improved the discrimination and calibration of almost all the models.

Conclusion: The ICISS is a viable alternative to ICDMAP-based measures for coding anatomic injury severity on large datasets.
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http://dx.doi.org/10.1097/00005373-200208000-00023DOI Listing
August 2002

Unilateral pringle manoeuvre and packing for haemostasis in severe liver trauma.

Injury 2002 Apr;33(3):278-82

Department of Surgery, Auckland Hospital, Private Bag 92012, Auckland, New Zealand.

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http://dx.doi.org/10.1016/s0020-1383(01)00093-6DOI Listing
April 2002
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