Chylothorax is an uncommon complication of oesophagectomy. In a review of 537 oesophageal resections there were 11 cases of chylothorax, an incidence of 2.0 per cent. There was no correlation with site, size, penetration, lymph node status, length or type of tumour but there was a significant correlation between chylothorax and the type of operative procedure carried out. The incidence in 95 transhiatal resections was 10.5 per cent. The incidence following 442 transthoracic procedures was 0.2 per cent (P less than 0.001) with one chylous fistula occurring after a three-stage oesophagectomy. Initial management was conservative with chest drainage and total parenteral nutrition. Thoracotomy and duct ligation was subsequently carried out in three patients and was successful in two. The third patient died. Conservative management alone was successful in four out of eight patients, with closure of the fistula at a median of 35 days (range 14-42 days). Four patients treated conservatively died. Transhiatal oesophagectomy greatly increases the risk of chylothorax, a condition that carries a high mortality rate (46 per cent in this series) whether managed conservatively or by surgical intervention.

Sixty-one patients with gastro-oesophageal reflux refractory to medical therapy were entered into a prospective randomized trial comparing the Rossetti-Hell modification of the Nissen fundoplication (n = 31) with the Angelchik prosthesis (n = 30). Mean age, sex ratio, duration of symptoms, preoperative pH profiles and manometric findings were similar in the two groups. At a mean of 84 (range 64-105) months after closure of the trial 47 patients were available for review, eight had died from unrelated causes and six were lost to follow-up. Of the patients reviewed, 28 consented to endoscopy, 25 to oesophageal 24-h pH assessment and 20 to oesophageal manometry. Both fundoplication and the Angelchik prosthesis provided lasting control of gastro-oesophageal reflux, with 20 and 17 patients respectively maintaining a satisfactory outcome. There were no significant differences in pH profile between the groups but the Angelchik prosthesis had to be removed from three patients.

As the sport coaching profession continues to grow, there is a need to reflect upon and revise the knowledge and competencies coaches should possess to support quality sport experiences. The purpose of this paper is to document the revision process of the National Standards for Sport Coaches (NSSC) which were established to outline professional sport coaching standards in the United States of America (USA). The 3-year revision process involved two separate task forces organized by SHAPE America and several public reviews. The final revision aligns the NSSC with quality coaching frameworks and documents seven core responsibilities of sport coaches. Additionally, the NSSC includes standards meant to provide guidance on what a coach should know (e.g., professional knowledge, interpersonal knowledge, and intrapersonal knowledge), what a coach should be able to do (e.g., expectations of performance and developed competencies), and what common practices occur among coaches (e.g., shared values) to meet each core responsibility. It is hoped that the revised version of the NSSC continues to provide direction for all stakeholders to improve coaching practices within the USA.

This description of a survey is not intended to give a blow-by-blow account of what was found or the significance of the result, since this would only be of any relevance to the medical school in which the survey was conducted. Rather it is intended to give a description of what was done and why it was done, for medical students in other schools who wish to conduct a similar inquiry. The initial indication that a survey was required was the establishment in the medical school of a curriculum review group. It was felt that rather than airing the group's own views, or impressions of what other students' views were, it would be advisable to find out exactly how students felt. To this end the survey was conducted.

No abstract