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Background: There is concern around projected unmet need in the surgical workforce internationally. Current barriers to medical students pursuing surgical careers include lack of early exposure, low confidence in surgical skills, and perceived lifestyle barriers. This review aimed to examine both the purpose of student surgical interest groups (SIGs) globally, and their effect on metrics representing student surgical career interest. barriers. Methods: MEDLINE, EMBASE, PubMed, and Google Scholar were searched for papers analysing surgical interest group purpose and efficacy. Risk of bias was assessed for survey‐based papers using a 20‐point checklist. Descriptive analysis was performed based on qualitative data. Results: Twenty‐eight papers were included in the analysis including 13 surveys. These were of moderate quality. The analysed SIGs had 100–1000 student members and a diverse range of funding sources. Purpose of SIGs was described by 26 of 28 papers with common themes including promotion of surgical career choice and developing theoretical/practical surgical skills. Common initiatives of SIGs included surgical lectures/teaching and practical skills workshops. Data from 15 papers analysing efficacy of SIGs suggested they positively influenced self‐reported student interest in surgical careers (78.6%) and confidence in surgical knowledge (80%), as well as confidence in practical skills, knowledge about surgical careers/lifestyle, mentorship opportunity, and research involvement. Conclusion: Student SIGs make a unique contribution to early medical student experience through positive effect on promoting surgical careers. They target relevant metrics such as surgical knowledge and confidence that are known to influence surgical career choice in the modern surgical landscape. [ABSTRACT FROM AUTHOR]

Background: Gastrografin (GG) has been shown to accelerate the resolution of adhesive small bowel obstruction (ASBO) and decrease length of stay (LOS) in hospital. Consequently, we instituted a protocol recommending the routine use of GG in patients with ASBO. This study reviews patient outcomes after protocol implementation. Methods: We conducted a retrospective review of all patients with ASBO from January 1997 to December 2007. Data were categorized by admission date and use of GG. The outcomes reviewed were protocol uptake, median LOS in hospital and operative rate. Results were analyzed using the Mann-Whitney U test and the 2-tailed Fisher exact test. Results: There were 710 patients with ASBO overall. Sixteen of 376 (4.3%) patients received GG before institution of the protocol (period 1), whereas 195 of 334 (58.4%) received GG thereafter (period 2). In period 2, use of GG was limited to between 58% and 69% of all potentially eligible patients per year. Fifty-seven of 710 (8%) patients required surgery. In period 1, there were no significant differences in median LOS in hospital (p = 0.29) and operative rate (p = 0.65) between patients who received GG and those who were managed without GG. In period 2, patients receiving GG had a greater median LOS in hospital (3 [range 2-5] v. 2 [range 1-5] d, p = 0.048) but significantly lower operative rates (5.1% v. 12.9%, p = 0.018). Overall, the median LOS decreased over time (period 1: 4 [2-7] d v. period 2: 2 [1-5] d, p = 0.010). The operative rate did not vary substantially between periods (7.7% v. 8.4%, p = 0.42). Conclusion: The introduction of a protocol has increased the proportion of eligible patients receiving GG. However, protocol nonadherence and factors other than GG usage have influenced LOS in hospital and operative rates. Demonstrated benefits from previously published clinical trials have thus not been replicated within our setting. Contexte : Il a ete demontre que la gastrografine (GG) accelere la resorption de l'occlusion de l'intestin grele causee par des adherences (OIGA) et reduit la duree du sejour a l'hopital. Nous avons donc etabli un protocole recommandant l'usage de routine de la GG chez les patients qui ont une OIGA. Cette etude passe en revue les resultats pour les patients apres l'application du protocole. Methodes : Nous avons effectue une analyse retrospective des dossiers de tous les patients qui avaient une OIGA de janvier 1997 a decembre 2007. Les donnees ont ete classees en fonction de la date d'admission et de l'usage de la GG. L'adoption du protocole, la duree mediane du sejour a l'hopital et le taux d'interventions ont constitue les resultats, que nous avons analyses au moyen du test U de Mann-Whitney et de la methode exacte bilaterale de Fisher. Resultats : Au total, 710 patients avaient eu une OIGA. Seize patients sur 376 (4,3 %) avaient recii de la GG avant l'instauration du protocole (periode 1) tandis que 195 sur 334 (58,4 %) avaient recii de la GG par la suite (periode 2). Au cours de la periode 2, l'usage de la GG a ete limite a un total se situant entre 58 % et 69 % des patients qui pouvaient etre admissibles par annee. Cinquante-sept patients sur 710 (8 %) ont du subir une intervention chirurgicale. Au cours de la periode 1, il n'y avait pas de differences significatives aux niveaux de la duree mediane du sejour a l'hopital (p = 0,29) et du taux d'interventions (p = 0,65) entre les patients qui ont recii la GG et ceux qui ont ete traites sans GG. Au cours de la periode 2, la duree mediane du sejour a l'hopital a ete plus longue (3 [intervalle de 2 a 5] c. 2 [intervalle de 1 a 5] j, p = 0,048) chez les patients qui ont recu la GG, mais leurs taux d'interventions ont ete beaucoup moins eleves (5,1 % c. 12,9 %, p = 0,018). Dans l'ensemble, la duree mediane du sejour a l'hopital a diminue avec le temps (periode 1: 4 [2-7] j c. periode 2: 2 [1-5] j, p = 0,010). Le taux d'interventions n'a pas varie considerablement entre les periodes (7,7 % c. 8,4%,p = 0,42). Conclusion : La mise en oeuvre d'un protocole a augmente le pourcentage des patients admissibles qui recoivent de la GG. L'inobservation du protocole et des facteurs autres que l'usage de la GG ont toutefois eu un effet sur la duree du sejour a l'hopital et les taux d'interventions. Les bienfaits demontres a la suite d'essais cliniques publies anterieurement ne se sont pas reproduits dans notre contexte., Gastrografin (GG) has revolutionized the nonoperative management of adhesive small bowel obstruction (ASBO). (1,2) It is a radio-opaque, water-soluble hypertonic liquid contrast agent given orally or via nasogastric (NG) tube [...]

Background: Gallstone pancreatitis is a consequence of ampullary obstruction by common bile duct (CBD) calculi. Magnetic resonance cholangiopancreatography (MRCP) has been advocated for routine use to diagnose choledocholithiasis. However, the selective use of MRCP in clinically equivocal situations has not been explored until now. This study examines the diagnostic value of selective MRCP in gallstone pancreatitis. Methods: We conducted a retrospective audit of all presentations of gallstone pancreatitis between January 2001 and December 2007 at Middlemore Hospital, Auckland, New Zealand. Demographic data, clinical presentation, biochemical and radiological findings and outcomes were reviewed. Results: There were 339 cases of gallstone pancreatitis during the study period; 236 patients were women and the mean age was 52 years. Overall, choledocholithiasis was diagnosed in 95 patients. A total of 117 patients underwent MRCP within a median of 4 days of admission, with 15 (13.7%) showing choledocholithiasis. There was no significant difference in time to MRCP between positive and negative groups. Endoscopic retrograde cholangiopancreatography (ERCP)/intraoperative cholangiography (IOC) confirmed 13 of 15 stones within a median of 2.5 days. However, MRCP missed 8 cases of choledocholithiasis subsequently demonstrated on ERCP/IOC, where clinical suspicion remained after a negative MRCP. Its sensitivity was 62% and specificity 98%. The positive likelihood ratio was 6.5 and the negative likelihood ratio was 0.1. In all, 222 patients followed different clinical pathways with 82 CBD stones diagnosed by ERCP/IOC. Conclusion: Selective MRCP is highly specific in gallstone pancreatitis but may not be sensitive enough to exclude choledocholithiasis in this context. Contexte: La pancreatite biliaire est une consequence de l'obstruction de l'ampoule par des calculs du canal choledoque. On a preconise le recours a la cholangiopancreatographie par resonance magnetique (CPRM) comme mesure standard pour diagnostiquer la choledocholelithiase. Toutefois, l'emploi selectif de la CPRM dans des situations cliniquement equivoques n'a fait l'objet d'aucune etude jusqu'a present. La presente etude se penche sur l'utilite diagnostique de la CPRM selective dans la pancreatite biliaire. Methodes: Nous avons effectue un examen retrospectif de tous les cas de pancreatite biliaire repertories entre janvier 2001 et decembre 2007 au Middlemore Hospital d'Auckland, en Nouvelle-Zelande. Nous avons passe en revue les donnees demographiques, les tableaux cliniques, les resultats d'analyses biochimiques et d'epreuves radiologiques, de meme que l'issue chez les patients. Resultats: Nous avons denombre 339 cas de pancreatite biliaire au cours de la periode de l'etude; 236 touchaient des femmes et l'age moyen etait de 52 ans. Globalement, la choledocholelithiase etait le diagnostic chez 95 patients. En tout, 117 patients ont subi une CPRM apres une periode mediane de 4 jours suivant leur admission, 15 d'entre eux (13,7%) presentant des signes de choledocholelithiase. On n'a note aucune difference significative quant a l'intervalle avant la CPRM entre les groupes positifs et negatifs. La cholangiopancreatographie endoscopique retrograde (CPER)/cholangiographie peroperatoire (CPO) ont confirme 13 calculs sur 15 au cours d'une periode mediane de 2,5 jours. Toutefois, la CPRM n'a pas reussi a mettre au jour 8 cas de choledocholelithiase ulterieurement reveles par la CPER/CPO qui continuaient d'eveiller des soupcons cliniques apres une CPRM negative. Sa sensibilite a ete evaluee a 62% et sa specificite a 98%. Le rapport positif probable etait de 6,5 et le rapport negatif probable de 0,1. En tout, 222 patients ont fait l'objet de demarches cliniques differentes et 82 cas de calculs du choledoque ont ete diagnostiques au moyen de la CPER/CPO. Conclusion: La CPRM selective est fortement specifique dans les cas de pancreatite biliaire, mais pourrait ne pas etre suffisamment sensible pour exclure la choledocholelithiase dans ce contexte., Gallstone pancreatitis is a consequence of ampullary obstruction by common bile duct (CBD) calculi. (1) Successful management of gallstone pancreatitis therefore requires accurate diagnosis and, occasionally, removal of CBD stones. [...]