The British journal of surgery
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Left hepatic trisectionectomy (LHT) is a challenging major anatomical hepatectomy with a high complication rate and a worldwide experience that remains limited. The aim of this study was to describe changes in surgical practice over time, to analyse the outcomes of patients undergoing LHT for hepatobiliary malignancy, and to identify factors associated with morbidity and mortality. ⋯ Morbidity, mortality and long-term survival after LHT support its use in selected patients with a significant tumour burden.
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One of the major challenges of competency-based training is defining a score representing a competent performance. The objective of this study was to set pass scores for the Objective Structured Assessment of Technical Skill. ⋯ Consistency in pass-fail status between the various methods builds evidence of validity for the set scores. These methods can be applied and studied across a variety of assessment platforms, helping to increase the use of standard setting for competency-based training.
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Surgery has had low priority in global health planning, so the delivery of surgical care in low- and middle-income countries is often poorly resourced. A recent Lancet Commission on Global Surgery has highlighted the need for change. ⋯ Surgery deserves a higher priority in global health resource allocation. Lessons learned from participation in humanitarian crises should be considered in surgical developments.
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Sleeve gastrectomy is indicated for the treatment of obesity and related co-morbidity including diabetes. The dynamic changes in insulin secretion and sensitivity after sleeve gastrectomy are unknown. ⋯ Sleeve gastrectomy improved insulin sensitivity and reduced insulin secretion within 6 months after surgery. Although there was a correlation between insulin sensitivity and bodyweight, the major driver of the improvement in insulin sensitivity was GLP-1 secretion.