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Frank Frizelle

Publications and source records attributed to Frank Frizelle.

At least 19 recordsLinked to original sources
PubMed2006

The New Zealand mobile surgical bus service: what is it achieving?

AIM: Equitable access and provision of healthcare is a cornerstone of New Zealand Government health planning. Recent closures of rural hospitals have lead to difficulties with access to surgical services. The mobile surgical service has been developed to help; partly to address this issue as well as to address several other stated goals in the provision of rural heath. This study aims to audit the goals set out for the mobile surgical service and determine if they are been achieved. METHOD: The following outcome measures were assessed: number and type of procedure, length of stay, complications, services for Maori, upskilling for rural staff, social benefits, impact on child health, improved training with telepresence surgery, and the cost. RESULTS: Over the first 2 years (1 March 2002 to 28 February 2004) of service provision, 1901 procedures were undertaken; 57 patients had complications. The most common complication was wound infection, which occurred in 5% of operations. One in 3 treated patients were Maori and 40% of those treated were 15 years of age or younger. The mobile surgical bus service also appears to be meeting its social benefit, upskilling goals, and educational goals. CONCLUSIONS: The provision of specialist services to the rural communities is a difficult problem faced not only in New Zealand. Though still on a trial basis, the mobile surgical service bus appears to be meeting its stated goals to be addressing one of the important goals of the Government health policy: equitable access and provision to surgical care.

Adult↗
PubMed2006

Patients' complaints about doctors in surgical training.

AIM: Research looking at the effect of complaints on senior medical staff has shown that while there is important information to be gained from patient criticisms of medical care, they are often not well received by doctors. There is no information on the effects of complaints on junior medical staff and those undergoing vocational training in New Zealand. The aim of this study is to assess the impact of complaints on trainees in general surgery. METHOD: A questionnaire was devised and sent to all advanced general surgical trainees in New Zealand. There were four sections to the questionnaire covering background, professional life, family life, and personal health. The scale was semantically anchored at not applicable, strongly agree, agree, neither, disagree, and strongly disagree. RESULTS: Following electronic mailings of the questionnaire at three different times, 35 of 58 (60%) questionnaires were returned of which 21 (60%) of the respondents had received at least one major complaint; 10 (29%) indicated they had experienced one complaint; 4 (11%) reported 2 complaints; 3 (9%) had received 3 complaints; and 1 (3%) reported 4 complaints. None of the respondents believed that the complaint had improved their surgical training. Thirty-one (86%) respondents believed that the complaint had made them practice more defensively; 13 (38%) felt that the complaint had a negative effect of future doctor-patient relationships; and 15 (43%) felt a lack of trust with such relationships. Twenty-three (67%) felt decreased enjoyment with their training and 18 (53%) felt the complaint had a negative effect on their family. Twenty-seven (78%) felt depressed over the complaint, with 18 (52%) feeling a lack of support and being alone with the experience. CONCLUSION: Trainees receiving complaints find them difficult to deal with; they incur an emotional cost on the doctor and possible future doctor patient relationships. Thus it is important that trainee doctors receive support and guidance throughout this difficult and stressful event.

Attitude of Health Personnel↗
PubMed2005

Colorectal cancer treated at Christchurch Hospital, New Zealand: a comparison of 1993 and 1998 cohorts.

AIM: To compare clinicopathological variables, management, and outcome of two cohorts of unselected patients treated for colorectal cancer (CRC) at Christchurch Hospital, New Zealand in 1993-94 and 1998-99. METHODS: Retrospective review from hospital discharge codes, oncology referral database, and histology database. Data was stored in a Microsoft Access database. RESULTS: 356 patients in 1993-94 and 317 patients in 1998-99 had a confirmed diagnosis of adenocarcinoma of the colon or rectum. At the minimum follow-up time of 42 months, 54% (40% of CRC) of the 356 patients in the first cohort, and 36% (26% of CRC) of the 317 patients in the second cohort had died. The Kaplan-Meier survival curves showed significant improvement in 1998-99 overall, as well as for Dukes stages A plus B, stage C, and stage D disease. Computed tomography (CT) scan-staging increased from 11.3% to 62.8%. On multivariate analysis, cohort, stage, vascular/lymphatic invasion, and elective surgery were independent prognostic factors for disease-specific mortality. Over the 5 years (1993-94 to 1998-99), surgery by consultant increased from 44% to 82%, adjuvant chemotherapy for Dukes stage C increased from 21% to 45%, and chemotherapy for metastatic disease increased from 2.4% to 23% of stage D and from 2.5% to 36.5% of those patients who developed metastases. CONCLUSION: The improvement in outcome is attributed to more specialised surgery, more frequent CT scan staging, and greater use of chemotherapy.

Adenocarcinoma↗
PubMed2004

Surgeons' experiences of complaints to the Health and Disability Commissioner.

AIMS: To investigate details of patient complaints to the Health and Disability Commissioner about surgeons-to identify factors in the patient-surgeon interaction that might make a complaint more likely, and to consider ways of improving the complaints environment. METHODS: A questionnaire was developed asking specific questions about surgeons and their practice, number of complaints since 1996 and specific questions about their last Health and Disability Commissioner complaint. The questionnaire was mailed to surgeons on the mailing lists of the New Zealand Orthopaedic Association and The New Zealand Association of General Surgeons. Anonymous responses were entered into an Microsoft Access database. RESULTS: Responses were received from 280 (86%) of the 325 people contacted. Of these 280 replies, 259 were eligible for analysis. 149 (58%) of these 259 responses were from doctors who had received a complaint. There were 282 complaints, which gives an annual rate of complaints per person (inclusive of all respondents) of 0.16 over the 7 years: 1996 to 2002--but during 2000 to 2002 this rate was 0.34. The peak of complaints was in 2000. Those in mid-career (ie, 10-15 years of practice) and in private practice were at increased risk. Patients who complained were more likely to be female (58%) and in older ages. Respondents presented a very negative impression of their experience of the complaints process. In 91.1% of cases, either no action was taken or the surgeon was not in breach. Only 2.2% of cases were referred for disciplinary proceedings. CONCLUSION: Complaints against surgeons are common. The 'highest-risk surgeon' is a subspeciality general surgeon in private practice. The most likely people to complain are middle-class, white females aged 35-70 years. It would appear likely that the present system does not resolve issues for the patient or the surgeon. Radical changes are needed, and are beginning to occur, in the complaints environment. Especially needed is acceptance and disclosure of harm and error (away from a culture of blame and discipline). Therefore, if medical practitioners are to move with confidence into this more open environment, a more supportive political/media/organisational culture is needed, with a focus on valuing disclosure and learning from mistakes.

Adult↗
PubMed2004

Postoperative follow-up strategies for patients after potentially curative surgery for colorectal cancer at Christchurch Hospital.

AIM: To describe the follow-up patterns of patients with colorectal cancer (CRC) having had surgery with curative intent. METHODS: A retrospective study was undertaken of follow-up patterns in patients who had undergone 'curative' surgery for colorectal cancer at Christchurch Hospital from 1 January 1996 to 31 December 2000. Patients were identified from three sources: the General Surgical Audit Database (Otago system), the hospital clinical Casemix DRG Database, and the Oncology Service database. Patients were included only if they had surgery with curative intent, within the stated period, and had follow-up at Christchurch Hospital. Data extracted included: patient demographics, details of initial surgery, adjuvant therapies, recurrences, and details of follow-up arrangements (including investigations). RESULTS: Of 893 patients coded as having CRC, 284 patients met the inclusion criteria. Patients were excluded for the following reasons: no operation (64), operation before 1996 (18), palliative surgery (345), previous cancer (55), no cancer (32), died within 30 days of surgery (26), follow-up outside of Christchurch region (39), and notes unavailable (30). The median age was 72 (range 28.6-99.9 years). Median follow-up time was 732 days. Most patients (91%) were followed-up by their surgeon. Patients had an average of 2.6 visits to their specialist in the first year of follow-up. Unplanned clinic visits accounted for 8.3% of all clinic visits--resulting in a number of unplanned investigations. During the follow-up period, patients had 112 colonoscopies, 68 CT scans, 8 abdominal ultrasounds, and 7 barium enemas. Recurrence was detected in 58 patients (20.4%); 23 (39.7%) recurrences were detected in the first year of follow-up. Of the 279 patients who had some form of follow-up, 9 asymptomatic patients had recurrent disease (detected as a result of a planned clinic visit) and had a potentially curative procedure for recurrence. CONCLUSIONS: The number of visits per year correlated closely with the earlier findings of Connor et al,4 however the number of investigations carried out was variable and substantially less than had been reported. Follow-up visits have limited value for the detection of asymptomatic potentially curable recurrent disease.

Adult↗
PubMed2004

A systematic review of intraoperative radiotherapy in early breast cancer.

A systematic review was undertaken to assess the safety and efficacy of intraoperative radiotherapy (IORT) in early breast cancer compared with breast conserving surgery with postoperative radiotherapy. Literature databases were searched up to March 2002 inclusive. IORT studies of any design and breast conserving therapy randomised controlled trials with sample sizes greater than 500 patients (with at least one arm of breast conserving therapy (BCT)) and systematic reviews on BCT published since 1992, were included for comparison. Seven unique IORT studies were located; one randomised controlled trial, one study with a concurrent control group and five case series. Minor postoperative complications were reported following IORT. Short-term results were similar for both treatment modalities in terms of local recurrence, disease-free and overall survival. However, the current evidence base is poor, making definitive assessment on IORT very difficult. Further research is required to clarify several issues such as identification of the most appropriate subgroups of patients for IORT, a comparison of the currently available mobile IORT technologies, establishing whether IORT is most appropriate as a boost replacement dose or replacement for all postoperative radiotherapy, the examination of how biological repair processes may differ between the two treatment modalities and determining precisely where local recurrences originate with respect to the original tumour site.

Breast Neoplasms↗
PubMed2003

Liver injury in children: causes, patterns and outcomes.

AIM: To compare the causes, patterns and outcomes of hepatic trauma in children with those in adults. METHODS: A retrospective audit was conducted of a five-year period from 1996 of adults and children admitted to Christchurch Hospital with liver injuries. Details of age, mechanism of injury, injury severity score (ISS), radiological grade of liver injury, operations and mortality were recorded and analysed. RESULTS: There were 93 liver injuries over the five-year period: 22 in children and 71 in adults. The median age of each group was 7 and 29 years respectively. The most common causes of injury in children were bicycle (7/22) and motor vehicle accidents (MVAs) (7/22). The majority (37/71) of adult injuries were caused by MVAs. The median length of hospital stay was significantly shorter in the paediatric group: 4 days (range 1-12) in children vs 9 days (range 0-52) in adults. CONCLUSIONS: Liver trauma in children has a different spectrum of causes, and results in more severe liver injury than in adults. However, children are more likely to have an isolated liver injury that results in a shorter length of stay in hospital. A nationwide paediatric-injury surveillance system might allow better identification of preventable causes of injury.

Accidents, Traffic↗