Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Oct 2011
ReviewThe role of carbohydrate drinks in pre-operative nutrition for elective colorectal surgery.
Traditionally, patients have been fasted from midnight on the night before elective surgery. With the advent of the enhanced recovery programme for elective colorectal surgery, there has been a major change in established practice with patients able to continue with clear fluids up to two hours prior to surgery and solids up to six hours prior to surgery. It has been suggested that nutritional supplements in the immediate pre-operative period enhance post-operative recovery. The aim of this review was therefore critically to appraise the evidence available regarding the use of pre-operative carbohydrate (CHO) supplements for elective colorectal surgery. ⋯ The use of CHO drinks pre-operatively in colorectal surgery is both safe and effective. There is no increased risk of aspiration and it results in a shorter hospital stay, a quicker return of bowel function and less loss of muscle mass. On the basis of this evidence, the use of pre-operative CHO drinks should be standard in elective colorectal patients. Further research is nevertheless required for those with diabetes mellitus.
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Ann R Coll Surg Engl · Jul 2011
ReviewThe use and effectiveness of cadaveric workshops in higher surgical training: a systematic review.
The aim of this systematic review is to describe the use of cadavers in postgraduate surgical training, to determine the effect of cadaveric training sessions on surgical trainees' technical skills performance and to determine how trainees perceive the use of cadaveric workshops as a training tool. ⋯ Evidence for the effectiveness of cadaveric workshops in surgical training is currently limited. In particular, there is little research into how these workshops improve the performance of surgical trainees during subsequent live surgery. However, both trainees and assessors hold them in high regard and feel they help to improve operative skills. Further research into the role of cadaveric workshops is required.
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Ann R Coll Surg Engl · Jul 2011
ReviewThe use and effectiveness of cadaveric workshops in higher surgical training: a systematic review.
The aim of this systematic review is to describe the use of cadavers in postgraduate surgical training, to determine the effect of cadaveric training sessions on surgical trainees' technical skills performance and to determine how trainees perceive the use of cadaveric workshops as a training tool. ⋯ Evidence for the effectiveness of cadaveric workshops in surgical training is currently limited. In particular, there is little research into how these workshops improve the performance of surgical trainees during subsequent live surgery. However, both trainees and assessors hold them in high regard and feel they help to improve operative skills. Further research into the role of cadaveric workshops is required.
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Ann R Coll Surg Engl · Mar 2008
Review Case ReportsExtensor tendon injury to the index and middle finger secondary to Kirschner wire insertion for a distal radial fracture.
We describe a case with the highly unusual complication of attritional ruptures to both the extensor tendons to the index and middle finger following Kirschner wire placements for a distal radial fracture. This particular complication has never been previously described in the literature. We also review the literature, identifying certain techniques in the management of distal radial fractures with Kirschner wires which are considered to increase the risk of tendonous or neurovascular injury. Finally, recommendations are made that should reduce the complications of iatrogenic soft tissue injury associated with this very common procedure.
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The surgical profession, more than any other medical specialty, is constantly in the limelight. Frequently, concerns are expressed about our colleagues. The concerns may be personality clashes rather than failure in behaviour or performance. ⋯ New proposals to modify the GMC procedures will reduce the standard of proof to one of 'balance of probabilities'. The surgical profession should be accountable to its patients and colleagues. Will our Royal College rise to the challenge to establish itself as the bulwark of the surgical profession?