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In an attempt to determine the optimum configuration of arteriovenous (A-V) fistulas for haemodialysis, 71 patients were prospectively randomized to undergo either a side-to-side or end-of-vein to side-of-artery A-V fistula. Nine months after operation, the patency rates on dialysis were almost identical in the two groups (79.2 per cent and 78.6 per cent respectively). However, 7 of the 32 side-to-side fistulas developed hyperaemia of the hand, three of which required revisional surgery. Hyperaemia of the hand has not been seen with end-to-side fistulas. In addition, peroperative measurements of fistula flow appeared to have prognostic value with end-to-side but not with side-to-side fistulas. It is suggested that the end-to-side configuration is the one of choice for the formation of A-V fistulas for haemodialysis.

Background-Flexible sigmoidoscopy is a technical skill that has been successfully performed by suitably trained colorectal nurse practitioners in the USA. However, no recognised training course exists for nurse practitioners in the UK. Aims-To design and evaluate a training programme for nurse endoscopists. Methods-A multidisciplinary committee of nurses and clinicians developed a structured programme of study and practice. This involved a staged process of observations, withdrawals, and ultimately, full procedures. Once training had been completed the nurse practitioner was permitted to practice independently. Patients with colorectal symptoms referred for flexible sigmoidoscopy were examined for the final stages of training and independent practice. A prospective evaluation of the training and practice of the first trained nurse flexible sigmoidoscopist was performed. Barium enema, video, clinical follow up, and histology were used to validate the results of the flexible sigmoidoscopies. Results-The training programme required that 35 observations, 35 withdrawals, and 35 supervised full procedures were performed prior to the development of independent practice. Subsequent to the completion of this programme 215 patients have been examined independently by the nurse practitioner. Ninety three per cent of the examinations were judged successful and pathology was identified in 51%. The nurse endoscopist successfully identified all "significant" pathology whereas barium enema failed to identify pathology in 12.5%. There were no complications. Conclusion-With suitable training nurse endosocopists are able to perform flexible sigmoidoscopy safely and eVectively. (Gut 1998;43:711-714) Keywords: nurse endoscopists; flexible sigmoidoscopy There is an increasing demand for diagnostic flexible sigmoidoscopy and the potential introduction of flexible sigmoidoscopy screening for colorectal cancer 1 2 would probably overwhelm the currently available service. If adequate resources were allocated in terms of equipment there would still be insuYcient medically qualified flexible sigmoidoscopists to perform the examinations. One potential solution to this problem is the development of colorectal nurse practitioners trained in flexible sigmoidoscopy. In collaboration with the professional nursing bodies a nationally recognised training scheme has been developed, designed specifically for nurse practitioners wishing to develop the skills necessary to perform flexible sigmoidoscopy. 3The structure of the training programme and the prospective evaluation of the practice of the first UK English Nursing Board recognised nurse practitioner flexible sigmoidoscopist are presented in this paper. MethodsSymptomatic colorectal patients referred for flexible sigmoidoscopies were recruited for the study. The patients were informed that a nurse would be performing the endoscopy and were given the opportunity to decline entry into the study and have a doctor perform the investigation without delay. A consultant endoscopist was appoi...

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