The British journal of surgery
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The technical skill of surgical trainees is not well assessed. This study aimed (1) to compare the reliability of three scoring systems, (2) to compare live and bench formats and (3) to assess construct validity of a test of operative skill. ⋯ This preliminary study suggests that the Objective Structured Assessment of Technical Skill can reliably and validly assess surgical skills. Global ratings are a better method of assessment than task-specific checklists. Bench model simulation gives equivalent results to use of live animals for this test format.
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There has been a marked increase in the number of surgical patients developing Clostridium difficile colitis. The epidemiology, pathogenesis, diagnosis and management of C. difficile infection were reviewed from a surgical perspective. ⋯ Appropriate use of antibiotics, isolation of affected patients and meticulous hygiene measures on the part of staff are vital if the morbidity, mortality and economic consequences of this nosocomial infection are to be minimized.
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The past decade has seen an increase in the use of distal arterial bypass grafts for treating critical lower limb ischaemia. However, this surgical policy is associated with variable results. The aims of this study were to identify factors that affect outcome and to calculate the cost of such surgical interventions. ⋯ The patency rate of femorotibial and peroneal bypass depends on the inflow state, the availability of a venous conduit, the number of calf vessels, the presence of straight flow to the foot and the presence of patent pedal vessels. These factors can help in the selection of patients for femorodistal reconstruction and may explain the wide variation in published results. The low cost of revascularization compared with amputation justifies attempted reconstruction. However, repeated attempts to reconstruct patients with severe distal disease who may benefit more from primary amputation will significantly increase the cost.
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Musculotendinous groin disruption is common in professional sportsmen. Diagnosis is difficult and management complicated by strong desires for early return to sporting activity. The possible role of laparoscopic repair in promoting early recovery was examined. ⋯ Laparoscopic repair appears as effective as conventional repair for sporting injuries, and merits further evaluation as a technique to permit early return to activity.