Participation of Surgical Residents in Operations: Challenging a Common Classification

Background

One important form of surgical training for residents is their participation in actual operations, for instance as an assistant or supervised surgeon. The aim of this study was to explore what participation in operations entails and how it might be described and analyzed.

Methods

A qualitative study was undertaken in a major teaching hospital in London. A total of 122 general surgical operations were observed. A subsample of 14 laparoscopic cholecystectomies involving one or more residents was analyzed in detail. Audio and video recordings of eight operations were transcribed and analyzed linguistically.

Results

The degree of participation of trainees frequently shifted as the operation progressed to the next stage. Participation also varied within each stage. When trainees operated under supervision, the supervisors constantly adjusted their degree of control over the resident’s operative maneuvers.

Conclusions

Classifications such as “assistant” and “supervised surgeon” describing a trainee’s overall participation in an operation potentially misrepresent the varying involvement of resident and supervisor. Video recordings provide a useful alternative for documenting and analyzing actual participation in operations.     

Different risk profiles for hip fractures and distal forearm fractures: A prospective study

In a prospective cohort of elderly persons, aged 70 years and over, we examined risk indicators for which data could be easily obtained, to construct risk profiles for hip fractures and distal forearm fractures. Participants lived independently, in apartment houses for the elderly or in homes for the elderly. At baseline, information was obtained in 2578 subjects on age, gender, residence, mobility and the frequency of going outdoors. Mobility was measured using a walking score ranging from 1 (not able to walk independently) to 3 (able to walk independently for a fair distance). During the study period (median duration 3.5 years, maximum 4 years) 106 participants sustained a hip fracture and 60 participants suffered a distal forearm fracture. Women compared with men, adjusted for age, had a higher risk of hip fracture (adjusted relative risk (RR)=2.4, 95% confidence interval (CI) 1.3–4.3) and distal forearm fracture (RR=3.7, 95% CI 1.5–9.2). Age, adjusted for gender, was related to hip fractures only: the relative risk of fracture for those in the highest age category (>85 years) was 9.5 (95% CI 4.3–21.2) compared with those in the lowest age category (70–75 years). Moderately impaired walking ability compared with normal walking ability, adjusted for age and gender, was associated with a higher risk of hip fracture (RR=1.8, 95% CI 1.2–2.7) but with a lower risk of distal forearm fracture (RR=0.4, 95% CI 0.2–0.8). The outdoor score, adjusted for age and gender, was associated with distal forearm fractures only: going outdoors less than once a week, compared with three times or more, was associated with a lower risk of fractures (RR=0.3, 95% CI 0.1–0.9). In those living in homes for the elderly the risk of hip fracture was higher compared with those living independently (RR=2.4, 95% CI 1.4–4.2), adjusted for age and gender. Risk profiles were constructed using stepwise Cox's proportional-hazards regression. The risk profile predicted probabilites of sustaining a hip fracture in a 4-year period ranging from 0.4% to 25.9%, and of distal forearm fractures ranging from 0.2% to 4.5%, depending on the subject's characteristics as defined by the risk indicators. We conclude that easily obtainable risk indicators can be used in the prediction of fractures and can discriminate among fracture types.     

紫外分光光度法测定复方酮康唑软膏中酮康唑和氧氟沙星的含量

目的：建立复方酮康唑软膏的含量测定方法。方法：用双波长分光光度法测定酮康唑的含量，用单波长法测定氧氟沙星的含量。结果：两被测组分的平均回收率和相对标准偏差分别为酮康唑１００．３３％和０．３２％；氧氟沙星１００．８５％和０．２７％。结论：方法简便、准确，可用于复方酮康唑软膏的质量控制。     

金属硫蛋白对大鼠肝脏线粒体氧自由基损伤的保护作用

目的：研究金属硫蛋白（ＭＴ）对氧自由基损伤线粒体的保护作用以探讨其细胞保护机制。方法：采用ＦｅＳＯ４／抗坏血酸自由基发生系统直接损伤线粒体，测定Ｃａ（２＋）－Ｍｇ（２＋）－ＡＴＰａｓｅ活性和Ｃａ（２＋）摄入的变化。结果：ＭＴ能够直接拮抗氧自由基对线粒体Ｃａ（２＋）－Ｍｇ（２＋）－ＡＴＰａｓｅ活性和Ｃａ（２＋）摄入的抑制作用（Ｐ＜０．０１）。结论：ＭＴ对氧自由基损伤线粒体有明显保护作用，ＭＴ对细胞器线粒体的保护作用可能是细胞保护机制之一。     

Are earlier birth weights different from current ones?

A sample was taken from non-pathological Caucasian births in Amsterdam from 1972 until 1982. The methods replicated as closely as possible those applied by Kloosterman to births from 1931 until 1967 for the Amsterdam Growth Curves. Birth weight percentiles and confidence intervals were determined non-parametrically in groups distinguished by sex, order of birth and duration of pregnancy. The correlations among the weekly means and the extreme percentiles were tested from the 36th to the 43th pregnancy week. We found a strong correlation (r = 0.983) between our sample and the Amsterdam Growth Curves. The means in the latter sample exceeded ours by 48.5 grammes which equals the estimated clerical error of the birth weights of 50 grammes. There is no strong evidence that the birth weights have changed much in the Caucasian part of the Amsterdam population.     

Brain biopsy in the diagnosis of cerebral mycosis fungoides

A case of cerebral mycosis fungoides co-existing with progressive multifocal leucoencephalopathy presented with dementia. Brain biopsy established the diagnosis of mycosis fungoides after cerebrospinal fluid examinations and computerised tomographic scanning of the brain produced non-specific abnormalities.