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Objective(s): Life and limb threatening vascular emergencies often present to rural hospitals where only general surgery services are available. It is known that Australian rural general surgical centres encounter 10–20 emergency vascular surgery procedures annually. This study aimed to assess rural general surgeons' confidence managing emergent vascular procedures. Setting, Participants and Design: A survey was distributed to Australian rural general surgeons to determine their confidence (Yes/No) in performing emergent vascular procedures including limb revascularisation, revising arterio‐venous (AV) fistulas, open repair of ruptured abdominal aortic aneurysm (AAA), superior mesenteric artery (SMA)/coeliac embolectomy, limb embolectomy, vascular access catheter insertion and limb amputation (digit, forefoot, below knee and above knee). Confidence level was compared with surgeon demographics and training. Variables were compared using univariate logistic regression. Results: Sixteen per cent (67/410) of all Australian rural general surgeons responded to the survey. Increased age, years since fellowship and training prior to 1995 (when separation of Australian vascular and general surgery occurred) were associated with greater confidence in limb revascularisation, revising AV fistulas, open repair of ruptured AAA, SMA/coeliac embolectomy, and limb embolectomy (p < 0.05). Surgeons who completed >6 months of vascular surgery training were more comfortable with SMA/coeliac embolectomy (49% vs. 17%, p = 0.01) and limb embolectomy (59% vs. 28%, p = 0.02). Confidence in performing limb amputation was similar across surgeon demographics and training (p > 0.05). Conclusion: Recently graduated rural general surgeons do not feel confident in managing vascular emergencies. Additional vascular surgery training should be considered as part of general surgical training and rural general surgical fellowships. [ABSTRACT FROM AUTHOR]

Objective: Language that implies a conclusion not supported by the evidence is common in the medical literature. The hypothesis of the present study was that medical journal publications are more likely to use misleading language for the interpretation of a demonstrated null (i.e. chance or not statistically significant) effect than a demonstrated real (i.e. statistically significant) effect. Methods: This was an observational study of the medical literature with a systematic sampling method. Articles published in The Journal of the American Medical Association, The Lancet and The New England Journal of Medicine over the last two decades were eligible. The language used around the P‐value was assessed for misleadingness (i.e. either suggesting an effect existed when a real effect did not exist or vice versa). Results: There were 228 unique manuscripts examined, containing 400 statements interpreting a P‐value proximate to 0.05. The P‐value was between 0.036 and 0.050 for 303 (75.8%) statements and between 0.050 and 0.064 for 97 (24.3%) statements. Forty‐four (11%) of the statements were misleading. There were 40 (41.2%) false‐positive sentences, implying statistical significance when the P‐value was >0.05, and four (1.3%) false‐negative sentences, implying no statistical significance when the P‐value <0.05 (relative risk 31.2; 95% confidence interval 11.5–85.1; P < 0.0001). The proportion of included manuscripts containing at least one misleading sentence was 16.2% (95% confidence interval 12.0–21.6). Conclusions: Among a random selection of sentences in prestigious journals describing P‐values close to 0.05, 1 in 10 are misleading (n = 44, 11%) and this is more prevalent when the P‐values are above 0.05 compared to below 0.05. Caution is advised for researchers, clinicians and editors to align with the context and purpose of P‐values. [ABSTRACT FROM AUTHOR]