Surgical training: an objective assessment of recent changes for a single health board.

The reduction in doctors'' hours and the introduction of specialist training have reduced general surgical training by 60%. This study assessed the implications for a single health board. A questionnaire listing 13 representative operations was sent to 44 trainees and 52 trainers to determine the number of operations a trainee should perform. The total number of operations required for training was compared against the total actually performed across the health board. Operating times for five representative operations were audited prospectively. Trainers and trainees recommended a similar and conservative number of operations. The total number of operations available for training (4913) was 38% less than the number recommended (7946). Trainees required 50-75% more operating time than consultants. To increase the proportion of operations undertaken by trainees from the current 30% to 70% would require an extra 270 theatre days (of pounds 1.3m) yearly. The minimum number of operations required for training must be defined and the proportion of supervised operations undertaken by trainees substantially increased. Service and financial implications will have to be addressed. Action is needed urgently, as the first trainees will become consultants in less than five years.     

Increasing use of private practice by patients in Oxford requiring common elective surgical operations.

A random sample of 6000 people from eight general practices in and around Oxford was studied to ascertain their surgical histories and method of care received. The proportion of operations that were performed privately had increased with time and had a steep gradient according to social class. Different procedures had different likelihoods of being performed privately, but the age and sex of the patient had a non-significant association with private surgery. Adjustment for possible confounding variables using logistic analysis indicated that in the 1980s elective surgery is five times more likely to be performed privately than it was at the institution of the National Health Service.     

Fishing and fertility: a study of a Nova Scotia fishing village.

The relationship between fertility and occupation is compared for: 1) deep-sea fishermen who are away from home as long as 21 days at a time with short rests between; 2) in-shore fishermen who are away at sea most nights; and 3) plant workers in the locality, used as controls. Particular attention was given to the families of fishermen who had done the same job since marriage. The population was old, relatively speaking, due to outmigration of younger people. 73% of the wives were over 30 years of age. Deep-sea fishermen are younger and have higher incomes than in-shore men (42.1 years vs 49.7 and $3544 vs $2900). Among women 15-44 years of age mean number of children for deep-sea fishermen was 3.35; in-shore, 3.60; plant workers, 3.62. Among those whose husbands had held the same job since marriage the variation was greater: deep-sea, 2.54; in-shore, 3.46; plant workers, 3.35. Among women over 45-years-old whose husbands had held the same job since marriage the number of children was 2.61, 3.94, and 4.27, respectively. 33% of plant workers had more children than desired and 66.7% said they had as many as desired. However, 25.9% of in-shore fishermen and 50% of deep-sea fishermen had fewer than desired. Interval between births was similar for all occupational groups (23.5-26.7 months) but the wives of deep-sea fishermen terminated childbearing earlier. Contraception was used only by the younger women, usually coitus interruptus or rhythm. Sterilization may have been important but it was hard to find out whether the 15% of wives who reported operations which made further childbearing impossible intended sterilization. 35.7% of deep-sea fishermens' wives reported such operations, generally women with larger families.     

Caseload or workload? Scoring complexity of operative procedures as a means of analysing workload.

OBJECTIVE--To present a more realistic assessment of surgical workload than that provided by a case count. DESIGN--Prospective study of all the operative procedures performed in one year, classified according to the British United Provident Association''s schedule of procedures and scored by the "intermediate equivalent" value (taking the recommended fee value of an intermediate operation as 1.0) compared with the number of operations performed. SETTING--General surgical unit of Taunton and Somerset Hospital, comparing four consultant surgeons and their teams. PATIENTS--Inpatients and day patients admitted under the care of general surgeons during 1989. MAIN OUTCOME MEASURE--Difference between the apparent workload represented by simple case counting (caseload) and the actual workload represented by calculation of the total "intermediate equivalent" value. RESULTS--The workload assessed in terms of intermediate equivalent values was greater than that suggested by case counting for complex operations (12% v 4%), operations at the district hospital (82% v 74%), and operations performed by consultants (53% v 35%) and was lower for minor operations (20% v 42%), operations at the community hospitals (18% v 26%), and operations performed by surgeons in training grades and clinical assistants (47% v 66%). CONCLUSIONS--The use of the intermediate equivalent values as an indicator of complexity allows a more realistic assessment of the operative workload than a simple case count of the number of different operations and is recommended for comparing workload in different hospitals and departments.     

The case for differential capitation fees based on age in British general practice.

A study was performed to assess whether the existing differential capitation fees for general practitioners accurately assess differential workloads. Data from the third morbidity study in general practice were used to compare capitation fees with relative workload in differing age and sex groups. The population mix which determined the payment by capitation for the 143 principals in the study provided the basis for examining the advantage or disadvantage the general practitioner got from the existing system. Capitation fees for the elderly underestimated the increased workload by 21% for those aged 65-74 and by 54% for those aged 75 or over but overestimated the workload for male adults aged up to 65. Nevertheless, 60% of the participating general practitioners were not advantaged or disadvantaged by more than 2.5% of their capitation fees (450 pounds a year for the average practitioner with a list of 2000 patients). Similarly 88% were not advantaged or disadvantaged by more than 5%; none were advantaged or disadvantaged by more than 10%. A three scale capitation fee for the age groups 0-64, 65-74, and 75 or over should be applied in the ratio of 3:5:7 rather than in the present ratio of 3:4:5, but given the present population mix in practices there is no case for differential capitation fees by sex or differential fees for the age group 0-4 years.     

Use and abuse of performance indicators.

An audit was performed by this department after allegations by the regional health authority of low productivity. It was found that the health authority had underestimated the number of operations performed in 1983 by only 5%, but an inexact classification and grading of operations had led to errors in the performance indicators of 19.8% for the "weighted number of operations" and 34.5% for the "number of major operations per consultant." When the throughput of orthopaedic departments in districts was compared by the regional health authority it was found that such errors in performance indicators had been further compounded by the inconsistent use of population data and incorrect data on medical staffing. Medical practitioners and the health authorities are alerted to this amplification of inaccurate data. Other methods for assessing trauma and orthopaedic surgery are proposed, such as a simplification of the Office of Population Censuses and Surveys classification of surgical operations, grading operations based on time spent in the operating theatre, and provision of computer programs to code for diagnosis and operation when writing discharge summaries.     

THE COPPER CONTENT OF THE LIVER OF SOME GAME ANIMALS IN KENYA

The liver copper levels of a number of game animals in Kenya were determined. It was found that the results fell naturally into two fairly distinct groups; for those with simple and those with complex stomachs respectively. The latter, generally speaking, had a higher mean content and a much greater range, with more individual variation. An exception to this was the hippopotamus which appeared to have a much higher content of liver copper than others in the simple stomach group.     

Screening for abdominal aortic aneurysms: single centre randomised controlled trial

Objective To determine whether screening Danish men aged 65 or more for abdominal aortic aneurysms reduces mortality.Design Single centre randomised controlled trial.Setting All five hospitals in Viborg County, Denmark.Participants All 12 639 men born during 1921-33 and living in Viborg County. In 1994 we included men born 1921-9 (64-73 years). We also included men who became 65 during 1995-8.Interventions Men were randomised to the intervention group (screening by abdominal ultrasonography) or control group. Participants with an abdominal aortic aneurysm > 5 cm were referred for surgical evaluation, and those with smaller aneurysms were offered annual scans.Outcome measures Specific mortality due to abdominal aortic aneurysm, overall mortality, and number of planned and emergency operations for abdominal aortic aneurysms.Results 4860 of 6333 men were screened (attendance rate 76.6%). 191 (4.0% of those screened) had abdominal aortic aneurysms. The mean follow-up time was 52 months. The screened group underwent 75% (95% confidence interval 51% to 91%) fewer emergency operations than the control group. Deaths due to abdominal aortic aneurysms occurred in nine patients in the screened group and 27 in the control group. The number needed to screen to save one life was 352. Specific mortality was significantly reduced by 67% (29% to 84%). Mortality due to non-abdominal aortic aneurysms was non-significantly reduced by 8%. The benefits of screening may increase with time.Conclusion Mass screening for abdominal aortic aneurysms in Danish men aged 65 or more reduces mortality.     

Major Operations on Patients with Poliomyelitic Impairment

Pertinent data on operations (other than orthopedic) carried out in 39 patients who had residual impairment from poliomyelitis were reviewed with a view to appraising what additional operative risk there may be for such patients.For a large proportion of the patients, equipment to aid respiration was needed and a large proportion of the operations were urologic procedures as might be expected in a group with generally restricted physical activity. Also, the occurrence of complications was higher than for an ordinary surgical service. Even so, the experience indicated that residual impairment from poliomyelitis ought not be considered a contraindication even of elective, let alone emergency operations.     

Plasma progesterone profiles,ovulation rate,donor embryo yield and recipient embryo survival in native Saloia sheep in the fall and spring breeding seasons

The response to superovulatory (SOV) and estrus synchronization (ES) treatments and the fertility of donor (n=68) and recipient (n=118) Saloia ewes was evaluated in the fall and spring breeding seasons. The proportion of acyclic ewes at treatment time was significantly higher in the spring than in the fall (42.6% versus 4.0%, P<0.00001). Donors treated with eCG had a significantly higher mean number of follicles over 5mm in diameter in the ovaries at embryo recovery and a significantly lower mean efficiency of recovery than FSH-treated ewes. These negative effects were more pronounced in the fall than in the spring, which resulted in a significantly lower mean number of total and fertilized ova recovered from eCG-treated ewes, compared to FSH donors in the fall, but not in the spring. Season had no significant effect on the ovulation rate and plasma P4 concentrations of recipients treated with a progestagen plus eCG combination. Although the recipient lambing and embryo survival rates were higher in the fall than in the spring the differences were not significant. No significant differences were observed in the ovulation rate or P4 concentrations of recipients that lambed compared to those that did not lamb. These preliminary results show that, in Portugal, response of Saloia ewes to SOV or ES treatments and donor fertility following the SOV treatment were similar in the spring and the fall, which suggests that in the spring acyclic ewes are in moderate anestrus. The effect of season on fertility following embryo transfer should be confirmed in further studies involving a larger number of animals. The semilaparoscopic transfer method reported here allowed lambing and embryo survival rates higher (although not significantly) than a standard surgical approach.     

Strain preference in donor and recipient for production of W-bearing sperm in mixed-sex germline chimeric chickens

To elucidate the strain preference in donor and recipient for the production of W-bearing sperm, mixed-sex germline chimeric chickens were produced. The combination of donor and recipient was White Leghorn (WL) and Barred Plymouth Rock (BPR), and vice versa. Four sets of mixed-sex chimeras that had the male phenotype at sexual maturity were subjected to analysis: group 1, a female WL donor and a male BPR recipient; group 2, a male WL donor and a female BPR recipient; group 3, a female BPR donor and a male WL recipient; group 4, a male BPR donor and a female WL recipient. The mean number of W-bearing sperm detected by in situ hybridization among 10000 sperm observed was 135, 158, 26 and 71 in groups 1, 2, 3 and 4, respectively. The number in group 1 was significantly higher than that of group 3 (P<0.05). And the number in group 2 was significantly higher than those of groups 3 and 4 (P<0.05). It is suggested that the combination of a WL donor and a BPR recipient produced W-bearing sperm more efficiently than the reverse combination.     

Effects of diet on reproductive performance of the Bank vole (Clethrionomys glareolus)

Laboratory experiments were carried out to test the effect of dietary supplements of fresh sprouted wheat on reproduction of the Bank vole, Clethrionomys glareolus. One hundred and twenty females were divided into three groups at weaning: (a) group NSS (no sprout supplement), (b) group LSS (low sprout supplement) and (c) group HSS (high sprout supplement). Six- to seven-week-old females were paired with fertile males. Both groups on sprout supplement showed a significantly higher incidence of pregnancy in primiparous females (76%) compared with controls (NSS) (46%). Diet had no significant effect on the incidence of pregnancy in multiparous females. Control females had consistently higher mean litter sizes up to and including the fifth litter, compared with experimental females. Primiparous NSS females had the highest mean litter size and the experimental group HSS had the lowest. Differences in mean litter interval between groups were related to litter size (number of sucklings) rather than diet. The number of foetuses in utero had no effect on litter interval. The incidence of post-partum conception was higher in group LSS as compared with groups HSS and NSS. Diet did not affect the mean number of young produced per female in a given time, or the percentage of young surviving to weaning. The results are discussed with reference to their implications regarding habitat suitability of C. glareolus.     

Drinking in different social contexts among white, black, and Hispanic men

This paper describes alcohol use by White, Black, and Hispanic men in eight different social settings. Data were obtained from a multi-stage probability sample of the household population of White, Black, and Hispanic adults aged 18 years and over, residing in the 48 contiguous United States. The response rate was 73 percent for Whites, 76 percent for Blacks, and 72 percent for Hispanics. Results show that Whites go more frequently and drink more frequently than Blacks and Hispanics at restaurants, in clubs or organizational meetings, and in bars. Blacks go more frequently than Whites and Hispanics to public settings such as parks, streets, and parking lots; however, the mean number of drinks consumed in these public places and the proportion of men drinking five or more drinks is higher for Hispanics than for Whites and Blacks. Other places where heavier drinking is common in all three ethnic groups are bars, taverns and cocktail lounges, and parties. In all three ethnic groups, men who are younger and those who are single go more frequently than other men to bars or public places such as streets, parks, and parking lots. Men who are younger and those who are single also have a higher rate of heavy drinking and of drunkenness than other men.     

Significant prolongation of disease-free period gained by oral polysaccharide K (PSK) administration after curative surgical operation of colorectal cancer

Summary To examine the clinical efficacy and the mechanism of action of polysaccharide K (PSK), a proteinbound polysaccharide extracted from a Basidiomycetes fungus, a randomized double-blind trial was performed by administering PSK to 56 patients and a placebo to another group of 55 patients after surgical operations on their colorectal cancers. The rate of patients in remission (or disease-free) was significantly higher in the PSK group than in the placebo group; the difference between both groups was statistically significant atP <0.05 by the logrank test. The survival rate of patients was also significantly (P <0.05) higher in the PSK group than in the control group. The most significant laboratory finding was that polymorphonuclear leukocytes from PSK-treated patients showed remarkable enhancement in their activities, such as random and/or chemotactic locomotion, and phagocytic activity, when compared with those in the control group. In conclusion, PSK was useful as a maintenance therapy for patients after their curative surgical operations for colorectal cancer. The beneficial effects were probably due to the activation of leukocyte functions as one of the many biological-response-modifying (activities induced by PSK).     

Peripheral Retinal Vascular Patterns in Patients with Rhegmatogenous Retinal Detachment in Taiwan

This is an observational study of fluorescein angiography (FA) in consecutive patients with rhegmatogenous retinal detachment (RRD) in Changhua Christian Hospital to investigate the peripheral retinal vascular patterns in those patients. All patients had their age, sex, axial length (AXL), and refraction status (RF) recorded. According to the findings in FA of the peripheral retina, the eyes were divided into 4 groups: in group 1, there was a ramified pattern of peripheral retinal vasculature with gradual tapering; in group 2, there was an abrupt ending of peripheral vasculature with peripheral non-perfusion; in group 3, there was a curving route of peripheral vasculature forming vascular arcades or anastomosis; and in group 4, the same as in group 3, but with one or more wedge-shaped avascular notches. Comparisons of age, sex, AXL, and RF, association of breaks with lattice degeneration and retinal non-perfusion, surgical procedures utilized, and mean numbers of operations were made among the four groups. Of the 73 eyes studied, there were 13 eyes (17.8%) in group 1, 3 eyes (4.1%) in group 2, 40 eyes (54.8%) in group 3 and 17 eyes (23.3%) in group 4. Significant differences in age, AXL and RF, and association of retinal breaks to non-perfusion were noted among the four groups. Patients in group 1 had older ages, while younger ages were noted in groups 3 and 4. Eyes in group 1 had the shortest average AXL and were least myopic in contrast to the eyes in groups 3 and 4. Association of retinal breaks and retinal non-perfusion was significantly higher in groups 2, 3 and 4 than in group 1. In conclusion, peripheral vascular anomalies are common in cases with RRD. Patients with peripheral non-perfusion tend to be younger, with longer axial length and have the breaks associated with retinal non-perfusion.     

Rat uterus anastomoses in a single and a double layer

The Authors display their results on microsurgical operations in rat's uteri. After having described the instruments and methods used, the surgical techniques and the differences between a single and a double layer suture are discussed. However the formation of intraoperative adherences, which can damage the functional results of the intervention, is studied. And what's more the mean number of live born foetuses is seen as an attainable parameter for future validations.     

克隆水分整合有助胡杨无性系幼株在极端干旱生境下保持更高生存优势

以塔里木河下游的胡杨为对象,研究胡杨母株与其克隆幼株间的克隆水分整合特征及对克隆幼株生理机能的影响.结果表明: 胡杨母株与其克隆幼株间存在明显的以顶向传输为特征的水分整合,母株对克隆幼株的日平均水分整合流量为同区域长势相近的实生幼株通过自身根系日平均获取水量的3倍,克隆幼株因水分整合而能够获取与母株相似且较实生幼株水分来源相对较深层的土壤水,拥有更好的水分获取能力.这使胡杨克隆幼株较实生幼株保持显著更高的叶片水分含量,且黎明前和正午叶水势分别显著增加10.0%和29.7%.更好的水分生理状态使克隆幼株的光合电子传递速率与光适应下实际光化学效率显著高出实生幼株23.4%和11.5%,并能够保持显著更低的光系统Ⅱ过剩激能比例和光抑制风险.这可能让胡杨克隆幼株在极端干旱生境中较实生幼株保持更高的生存优势.     

Interaction between Gammarinema gammari (Nematoda), Microphallus papillorobustus (Trematoda) and their common host Gammarus insensibilis (Amphipoda).

The influence of the nematode Gammarinema gammari on survival, mating success, and fecundity of its host Gammarus insensibilis (Amphipoda) was investigated. The prevalence and the mean intensity of G. gammari were significantly higher in males than in females. There was a positive and significant relationship between the mean number of G. gammari and male body size, suggesting that accumulation of this parasite had no significant effect on the survival of its host. Males that harbored the metacercariae of the trematode Microphallus papillorobustus had a lower number of nematodes than those that did not harbor the trematode. Fecundity was significantly reduced in infected females, and unpaired females tended to be more frequently infected by G. gammari than paired ones. However, we found no evidence for parasite-mediated reduction in male competitiveness because the mean number of G. gammari was not significantly different between paired and unpaired males.     

Elderly patients in a general surgical unit: do they block beds?

In a prospective study of patients aged 65 years and over admitted to a general surgical unit only one patient in 10 remained in hospital for more than a month and fewer than one patient in a hundred became a "bed-blocker." While the over-65s had mean and median durations of stay which were longer than those of younger patients, in almost all cases a prolonged stay in hospital resulted from postoperative morbidity and was not related to social or administrative factors. Only a reduction in the incidence of postoperative morbidity could achieve a significant saving in the number of bed-days occupied by elderly people.     

Rat behavior in a light/dark chamber: place preference task

After a 6-week social isolation (from 22nd to 70th day from birth) male Wistar rats (a sibship, 10 animals), were tested for 20 min in a light/dark box in order to reveal behavioral features of choice of their spatial localization in unknown conditions. Socially deprived rats significantly differed from control animals in longer time of the room choice, higher number of entries of the light section, and higher number of rearings, which was probably explained by their higher anxiety and lack of experience to estimate unexpected stimuli and select a response. The mean level of behavioral activity during exploration of the box defined by the number of elementary operations per minute remained constant and was significantly higher in the socially deprived rats than in the control animals.