CRP is a useful negative predictive test for the development of anastomotic leakage following colorectal surgery.

More rigorous study designs and the use of objective outcome measures are needed to ascertain the true effectiveness of RaT programmes. Future research should focus on determining the impact of RaT programmes on learning achievement at the level of medical students.

Sleeve gastrectomy (SG) is a commonly performed bariatric procedure. Weight regain following SG is a significant issue. Yet the defining, reporting and understanding of this phenomenon remains largely neglected. Systematic review was performed to locate articles reporting the definition, rate and/or cause of weight regain in patients at least 2 years post-SG. A range of definitions employed to describe weight regain were identified in the literature. Rates of regain ranged from 5.7 % at 2 years to 75.6 % at 6 years. Proposed causes of weight regain included initial sleeve size, sleeve dilation, increased ghrelin levels, inadequate follow-up support and maladaptive lifestyle behaviours. Bariatric literature would benefit from standardising definitions used to report weight regain and its rate in clinical series. Larger prospective studies are required to further understand mechanisms of weight regain following SG.

SummaryThe use of intra-operative Doppler oesophageal probes provides continuous monitoring of cardiac output. This enables optimisation of intravascular volume and tissue perfusion in major abdominal surgery, which is thought to reduce postoperative complications and shorten hospital stay. Medline and EMBASE were searched using the standard methodology of the Cochrane collaboration for trials that compared oesophageal Doppler monitoring with conventional clinical parameters for fluid replacement in patients undergoing major elective abdominal surgery. Data from randomised controlled trials were entered and analysed in Meta-view in REV-MAN 4.2 (Nordic, Denmark). We included five studies that recruited 420 patients undergoing major abdominal surgery who were randomly allocated to receive either intravenous fluid treatment guided by monitoring ventricular filling using oesophageal Doppler monitor or fluid administration according to conventional parameters. Pooled analysis showed a reduced hospital stay in the intervention group. Overall, there were fewer complications and ICU admissions, and less requirement for inotropes in the intervention group. Return of normal gastro-intestinal function was also significantly faster in the intervention group. Oesophageal Doppler use for monitoring and optimisation of flow-related haemodynamic variables improves short-term outcome in patients undergoing major abdominal surgery.

Increased rates of nodal examination are associated with a significantly lower 5-year mortality for Stage II and III colonic cancer, but this survival advantage appears to be minimal after the 16-node mark. The lymph node ratio has been validated as a powerful predictor of survival in Stage III cancer. Our results support the current practice of harvesting and examining as many nodes as possible during attempted curative resection.

Implementing evidence-based peri-operative care into practice is challenging. Barriers to multimodal recovery pathways should be addressed.

Background: Standardized perioperative care within an Enhanced Recovery After Surgery (ERAS) programme aims to reduce postoperative morbidity and length of hospital stay (LOS). This study evaluated the effect of ERAS in patients undergoing elective, primary total hip and knee arthroplasty (THA and TKA) in a New Zealand public hospital. Methods: Data collected prospectively on patients who had undergone THA and TKA in an ERAS programme (ERAS: August-December 2013) were compared to a retrospective cohort of patients managed in a traditional perioperative care environment (control: JuneAugust 2012). The Breakthrough Series Model for Improvement provided a framework to implement components of the ERAS protocol. The primary outcome was median LOS. Secondary outcomes included 30-day readmission rates, complications and cost. Results: There were 206 patients who met the eligibility criteria (106 ERAS, 100 control). There were no significant differences in baseline characteristics. After the implementation of ERAS, median LOS was reduced by 1 day (5 control versus 4 ERAS; P < 0.001). Shortterm complications were similar (P = 0.372) as were readmission rates (P = 0.258). Cost analysis identified ERAS patients to have reduced cost overall. Conclusions: ERAS in THA and TKA has been shown to be safe and effective in improving recovery through shorter hospital stay.

Breast cancer in Kijabe is an advanced-stage disease, comprised mainly of poorly differentiated cancers that are less likely to be hormone sensitive (across all stages of disease). ER/PR testing of all those affected by breast cancer should be supported as a global priority in cancer control. International and inter-African research collaborations are needed to allow genetic detailing of tumours in indigenous Africans to assess possible racial heterogeneity in the biology of breast cancer.