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Registrars

Distribution by Scientific Domains

Medical Sciences	100%

Kinds of Registrars

specialist registrar

Selected Abstracts

Survey of the learning activities of Australasian radiation oncology specialist trainees

JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 6 2008
T Holt
Summary Trainee radiation oncologists must master a substantial body of skills and knowledge to become competent specialists. The resources available to support this are limited. We surveyed the 90 registrars enrolled in the Royal Australian and New Zealand College of Surgeons (RANZCR) radiation oncology training programme to obtain a range of information about their learning activities (with a significant focus on part 1 teaching). Responses were received from 59 registrars (66% of those eligible). Trainees reported spending a median 2.5 h per week (range 0,10 h) in formal teaching activities. With regard to part 1 exam preparation, 83% reported having had physics teaching , the median quality was 5/7; 88% had radiobiology teaching , the median quality was 4/7; 52% had anatomy teaching , the median quality was 3/7. Registrars training within the RANZCR radiation oncologists training programme perceive their own clinical learning environment as generally good; however' 50% of respondents felt that more teaching was needed for part 1 subjects. This compared with only 19% of respondents who felt that more teaching was required for part 2 exam preparation. Innovative solutions, such as centralized web-based teaching, may help to address weaknesses in part 1 teaching. With increasing demands on radiation oncologists and trainees it will be important to monitor learning environments. [source]

A retrospective study of anaesthetic caseload of Specialist Registrars following the introduction of new working patterns in the Wessex region,

ANAESTHESIA, Issue 3 2009
S. Al-Rawi
Summary The impact of implementing the European Working Time Directive (EWTD) and the consequent reduction in hours of work has led to concerns about training. This retrospective study compared total caseload, obstetric caseload, out-of-hours caseload and supervision levels of trainee anaesthetists in one region of the UK (Wessex) before and after the implementation of EWTD compliant rotas. Anaesthetic trainee logbooks submitted at the annual Record of In-Training Assessment were compared between the years 1999 and 2006. The logbook data was divided into two groups, group A (13-h shift) and group B (24-h on-call rota). There was no difference in total caseload, obstetric caseload or supervision. Out-of-hours caseload was greater in group A (p < 0.01). [source]

Training doctors in general practices: A review of the literature

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 5 2006
Karen Larsen
Abstract Objective:,This study was undertaken to assess the evidence of whether new forms of medical training, where substantial training takes place in general practice, will be acceptable to GPs. In particular, we asked the questions: Are GPs willing to act as trainers and supervisors in their practices? Do GPs have the appropriate skills to be trainers? Do practices have the infrastructure and resources to support placements? And, are patients happy to be seen by medical students and General Practice Registrars? Design:,Key Australian and international databases, key Australian journals and key Australian websites were searched for literature on general practice-based training of medical students and General Practice Registrars. Results:,In the international and Australian literature, we found that many GPs consider training medical students and General Practice Registrars to be intrinsically satisfying. They vary in their skills, and most medical schools have made significant investments in training and support activities. Many practices do not have the necessary infrastructure, and investments need to be made if extended placements are to be successful. Many patients are happy to be seen by students and Registrars, but careful thought needs to be given to implementing appropriate models so that students have good learning opportunities, patients are not disadvantaged and general practices can operate efficiently. Conclusion:,The success of this new model of clinical placements is dependent on medical schools having a detailed understanding of the needs and expectations of GPs. [source]

Work force planning: will the aspirations of the present group of Otolaryngology Specialist Registrars meet the need?

CLINICAL OTOLARYNGOLOGY, Issue 6 2005
R.J. Oakley
No abstract is available for this article. [source]

Structured training of ENT Specialist Registrars in the out-patient clinic and theatre

CLINICAL OTOLARYNGOLOGY, Issue 5 2002
A. Drake-Lee
The aims of this paper are to evaluate the training in out-patients and in theatre after the recent changes in SpR training. A postal questionnaire was sent to 191 Specialist Registrars (SpRs) in England and Wales and 57 were returned (30%). There were temporal bone facilities within the hospital for 53 SpRs but only three used them because there were no temporal bones. Surgical training was more satisfactory than out-patient training. Fewer general clinics and more specialized clinics are required, and consultant supervision is still patchy and needs attention. [source]

Validation of emergency physician ultrasound in diagnosing hydronephrosis in ureteric colic

EMERGENCY MEDICINE AUSTRALASIA, Issue 3 2007
Stuart Watkins
Abstract Objective:, Patients presenting to the ED with obstructive nephropathies benefit from early detection of hydronephrosis. Out of hours radiological imaging is expensive and disruptive to arrange. Emergency physician ultrasound (EPU) could allow rapid diagnosis and disposition. If accurate it might avert the need for formal radiological imaging, exclude an obstruction and improve patient flow through the ED. Methods:, This was a prospective study of a convenience sample of all adult non-pregnant patients with presumed ureteric colic attending the ED with prior ethics committee approval. An emergency physician or registrar performed a focused ultrasound scan and were blinded to the patient's other management. A computerized tomography scan was also performed for all patients while in the ED or within 24 h of the EPU. The accuracy of EPU detection of hydronephrosis was determined; using computerized tomography scans reported by a senior radiologist as the ,gold-standard'. Results:, Sixty-three patients with suspected ureteric colic were enrolled of whom 57 completed both EPU and computerized tomography imaging. Forty-nine had confirmed nephrolithiasis by computerized tomography with 39 having evidence of hydronephrosis. Overall prevalence of hydronephrosis was 68% (95% confidence interval [CI] 56,79%); compared with computerized tomography, EPU had a sensitivity of 80% (95% CI 65,89%); specificity of 83% (95% CI 61,94%); positive predictive value of 91% (95% CI 75,98%) and negative predictive value of 65% (95% CI 43,83%). The overall accuracy was 81% (95% CI 69,89%). Conclusion:, Although the accuracy of detection of hydronephrosis after focused training in EPU is encouraging, further experience and training might improve the accuracy of EPU and allow its use as a screening tool. [source]

Factors influencing career choices in radiology trainees in Queensland, Australia

JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 2 2010
SW Ip
Summary The aim of this study was to investigate factors influencing career choices in radiology trainees. We distributed a 27-question written survey to all radiology registrars in Queensland. The questions investigated whether radiology was their first specialty choice, career satisfaction, ideal working conditions and attitudes regarding having children during the time of training. Forty-four of 51 surveys were returned (86% participation rate, 73% men, P = 0.048055) with 100% reporting a high job satisfaction; 28% of male registrars compared to 8% of female registrars did extra work outside of training to earn extra money (P = 0.000003), and 17% of female registrars took a leave of absence during their training, while no male registrar did (P = 0.087923). Only one female trainee worked part-time (P = 0.272727). In addition, 58% of female registrars planned a pregnancy (P = 0.731789) before completion of training; 83% of women versus 75% of men had no children (P = 0.329263). Only 5% of trainees agreed that it was easy to arrange part-time training, only 14% stated that it was easy to negotiate flexible work schedules and 7% agreed that it was easy to return to work after a period of absence. ,Time spent with immediate family' was rated the most important lifestyle factor, followed by ,work hours' and ,on-call duty'. The least important factors were ,being away from extended family', ,availability of part-time work' and whether ,work was in a rural location'. Overall job satisfaction is high among radiology trainees. Nevertheless, lifestyle factors, particularly those related to work time, are becoming more important for career decisions. This should be taken into account when designing and structuring radiology training to ensure that it is considered an attractive career choice. [source]

Effects of the European Working Time Directive on anaesthetic training in the United Kingdom

ANAESTHESIA, Issue 8 2004
D. J. Sim
Summary Decreases in the hours worked by trainee anaesthetists are being brought about by both the New Deal for Trainees and the European Working Time Directive. Anticipated improvements in health and safety achieved by a decrease in hours will be at the expense of training time if the amount of night-time work remains constant. This audit examined the effects of a change from a partial to a full shift system on a cohort of trainee anaesthetists working in a large district general hospital in the South-west of England. Logbook and list analyses were performed for two 10-week periods: one before and one after the decrease in hours. An 18% decrease in the number of cases done and an 11% decrease in the number of weekly training lists were found for specialist registrars. A 22% decrease in the number of cases done and a 14% decrease in the number of weekly training lists were found for senior house officers. Furthermore, a decrease of one service list per specialist registrar per week was seen, which will have implications for consultant manpower requirements. [source]

Anal stenosis: use of an algorithm to provide a tension-free anoplasty

ANZ JOURNAL OF SURGERY, Issue 5 2010
Zeev Duieb
Abstract Background:, Anal stenosis is a debilitating condition that often is iatrogenic in cause. Various surgical procedures to manage this problem have been described. The present study evaluates the use of different anoplasty techniques in a series of 11 patients with anal stenosis. To the best of the authors' knowledge, this is the first study to provide a stepwise algorithm for the anoplasty techniques used. Methods:, A series of 11 patients were evaluated for presenting symptoms, cause of anal stenosis, type of anoplasty used, complications and post-operative success in relieving symptoms. All operations were performed by one surgeon in three hospitals, and were followed up by the same surgeon and by a surgical registrar. Results:, The most common presenting symptoms were constipation and decreasing calibre of stool. The main causes of anal stenosis were previous surgery, neoplasia and fissure. Transverse closure, Y-V and diamond advancement flaps were used in an escalating manner to deal with increasing severity of stenosis. All 11 patients had some level of improvement in symptoms post-operatively. There were no long-term complications. Conclusion:, Anoplasty is a safe and successful option in the treatment of anal stenosis, and this stepwise algorithm takes the guesswork out of choosing the most appropriate procedure for each patient. [source]

Nothing to sneeze at!

ANZ JOURNAL OF SURGERY, Issue 12 2009
A study into intra-operative contamination
Abstract Purpose:, We performed a prospective study of sneezes from orthopaedic registrars to assess the potential for intra-operative contamination from a masked surgeon, and to determine if head position can alter the potential for contamination. Type of Study:, Prospective controlled trial. Methods:, Four orthopaedic registrars from the Gold Coast Hospital each inhaled pepper to precipitate a sneeze. Cultures were taken with and without standard Smith & NephewÔ surgical masks, in positions directly in front and to the sides of a masked registrar. The process was repeated three times for each registrar. A control plate was left exposed to the atmosphere. A control plate and sneeze plate was cultured on blood agar. Three masks were subsequently swabbed to exclude contamination from the masks. Results:, 2/24 (8.33%) of the side with mask cultures returned significant bacterial growths. Also, 1/12 (8.33%) of the front with mask cultures returned significant growths. In addition, 9/12 (75%) of the direct sneezes resulted in significant bacterial counts. The control plate failed to return any growth. Subsequent culture of the exterior of three surgical masks failed to yield significant growth. There was a statistically significant odds ratio of 0.03 comparing the front and side group with the unmasked direct group. There was no statistically significant difference comparing front and side sneeze growth. Conclusions:, While the use of surgical face masks significantly reduces bacterial counts following a sneeze, it fails to eliminate the potential for surgical field contamination completely. The fact that significant bacterial counts can be returned from direct culture through a mask and to the sides of a mask suggests that head position is irrelevant and contamination is possible in any direction. It is, therefore, suggested that, if possible, a sneezing surgeon distances himself/herself as much as possible from the sterile field. We also recommend following a sneeze; surgeons should re-gown and glove, given the risk of contamination of the sterile field. Level of evidence:, Level II. [source]

GS14P ROUTINE USE OF MEDICAL EMERGENCY TEAMS IN MANAGING SURGICAL EMERGENCIES

ANZ JOURNAL OF SURGERY, Issue 2007
H. K. Kim
Introduction Trauma teams and cardiac arrest teams provide an urgent and expert multi-disciplinary response to time critical emergencies. The present study documents the contribution of a medical emergency team (MET) to managing non-trauma surgical emergencies. Materials and Methods Data was prospectively collected over a two year period concerning the contribution of medical emergency teams to the resuscitation of all patients with non-trauma surgical emergencies and altered vital signs in hospital wards. Results Over the study period, the details of 19 patients with surgical emergencies were recorded. 63% of emergencies occurred outside of normal working hours. In 53% of cases, the surgical registrar was off-site or physically unavailable to attend the emergency immediately. In 11% of cases, the medical emergency team was activated prior to the arrival of the surgical registrar. In 26% of cases, the patient was left unattended whilst awaiting arrival of the surgical registrar. The medical emergency team provided resuscitation procedures and arranged urgent investigations in all patients, physically transported the patient to the operating theatre in 16% of patients and prepared for general anaesthetic in the operating theatre in 11% of cases. The surgical registrar complemented the medical emergency team response by liaising with consultant surgeons, anaesthetists and operating theatre staff in all cases. All patients received definitive treatment within 30 minutes of MET response. Conclusion Routine use of medical emergency teams in the initial resuscitation of patients with surgical emergencies expedites definitive management. [source]

Letters to the Editor: Comment on: an anonymous survey of registrar training in the use of Kjelland's forceps in Australia.

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2010
Aust N Z J Obstet Gynaecol 2009; 49: 515-51
No abstract is available for this article. [source]

An anonymous survey of registrar training in the use of Kjelland's forceps in Australia

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2009
Marian CHINNOCK
Large series suggest that, when used with appropriate care and skill, rotational deliveries with Kjelland's forceps are a safe and useful procedure. We surveyed obstetric trainees in Australia to assess their experience with, and intentions to use, Kjelland's forceps. The response rate was 65%, and it was uncommon for even senior trainees to have performed more than ten Kjelland's forceps rotations during their training. Ninety-four per cent of final-year trainees stated they did not intend to use Kjelland's forceps in their consultant practice. [source]

Accuracy of computed tomography in the detection of blunt bowel and mesenteric injuries

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2005
C. Elton
Background: There are conflicting views on the accuracy of computed tomography (CT) findings in patients with bowel and mesenteric injuries (BMIs) following blunt abdominal trauma. The aim of the present study was to assess the accuracy of the CT report during a trauma call. Methods: Ninety-eight patients underwent preoperative abdominal spiral CT and subsequent laparotomy following blunt trauma between January 1996 and March 2001 at a level I trauma centre. The immediate results of the scans were reported by the on-call radiology registrar and written in the medical notes by the trauma team leader. Seventy of the 98 preoperative abdominal CT scans were retrieved from the radiology department and reported by two consultant radiologists with a special interest in trauma radiology. Results: The sensitivity and specificity of the 70 expert CT reports were 80 (95 per cent confidence interval (c.i.) 66 to 94) and 78 (95 per cent c.i. 65 to 90) per cent respectively for diagnosing a BMI. The sensitivity and specificity of the immediate CT reports were 93 (95 per cent c.i. 84 to 100) and 71 (95 per cent c.i. 60 to 83) per cent respectively. Conclusion: Spiral CT is highly sensitive for detecting a BMI following blunt abdominal trauma. This sensitivity is maintained when the scan is reported by a radiology registrar. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Cutaneous melanoma: practical usefulness of the American Joint Committee on Cancer staging system

DERMATOLOGIC THERAPY, Issue 6 2005
Arthur J. Sober
ABSTRACT:, The 2002 American Joint Committee on Cancer melanoma staging classification is the first to be based on natural history. Although primarily for hospital tumor registrars, knowledge of the classification is of value to dermatologists in prognosticating for their patients and in selecting candidates for sentinel node biopsy and possible subsequent therapies. [source]

Factors influencing career choices in radiology trainees in Queensland, Australia

Survey of the learning activities of Australasian radiation oncology specialist trainees

Preparing to sit the Royal Australia and New Zealand College of Radiologists Faculty of Radiation Oncology Fellowship Part 2 examination: The value of a workshop including practice and feedback

JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 5 2007
S Bydder
Summary A workshop has been held annually to help prepare candidates to sit the Royal Australia and New Zealand College of Radiologists Part 2 Faculty of Radiation Oncology examination. This study examined the value of such a course and its component parts and assessed attendees' learning environments. We collected detailed information from participants before and after the training workshop in 2005. A specific feature of this workshop included the use of an examination technique feedback form to facilitate the provision of systematic and comprehensive feedback to individual candidates after mock examination. Participants completed course evaluation forms and a learning environment survey. There were 22 candidate participants. The course and its components of this course were perceived very positively , including the examination technique feedback forms and written advice. Only three of the 24 questions regarding the registrars learning environment had less than 80% favourable responses , two of these questions related to workload. The course design described seems reasonably satisfactory in that it included the components ranked most highly by candidates. We also identified a number of variations that may be useful for future workshops. Although learning environments were generally good, we identified a perceived problem with workloads affecting a significant number of registrars. [source]

The relationship between personal breastfeeding experience and the breastfeeding attitudes, knowledge, confidence and effectiveness of Australian GP registrars

MATERNAL & CHILD NUTRITION, Issue 4 2008
Wendy Brodribb
Abstract In conjunction with other health professionals, doctors believe they play an important role in promoting breastfeeding to women. Although many have positive breastfeeding attitudes, significant knowledge deficits often limit their capacity to effectively encourage, support and assist breastfeeding women and their infants. Personal breastfeeding experience (of self or partner) may be the main source of breastfeeding knowledge and skill development and is related to improved knowledge, more positive attitudes and greater confidence. This paper describes the relationship between the cumulative length of personal breastfeeding experience and the breastfeeding knowledge and attitudes of a cohort of Australian general practice (GP) registrars, as well as their confidence and perceived effectiveness assisting breastfeeding women. The Australian Breastfeeding Knowledge and Attitude Questionnaire containing demographic items, a 20-item attitude scale and a 40-item knowledge scale was distributed between February and May 2007 to Australian GP registrars in their final year of training. Participants with more than 52-week cumulative personal (self or partner) breastfeeding experience had the highest mean knowledge score, had more positive attitudes, and were more confident and effective than all other participants. Parents with limited personal experience (,26 weeks) had the poorest breastfeeding attitudes and their knowledge base was similar to participants with no personal experience. Confidence and perceived effectiveness when assisting breastfeeding women rose with increasing cumulative breastfeeding experience. Personal breastfeeding experience per se does not guarantee better breastfeeding knowledge or attitudes although increasing length of experience is related to higher knowledge, attitude, confidence and perceived effectiveness scores. [source]

Using job analysis to identify core and specific competencies: implications for selection and recruitment

MEDICAL EDUCATION, Issue 12 2008
Fiona Patterson
Objective, Modern postgraduate medical training requires both accurate and reliable selection procedures. An essential first step is to conduct detailed job analysis studies. This paper reports data on a series of job analyses to develop a competency model for three secondary care specialties (anaesthesia, obstetrics and gynaecology, and paediatrics). Methods, Three independent job analysis studies were conducted. The content validity of the resulting competency domains was tested using a questionnaire-based study with specialty trainees (specialist registrars [SpRs]) and consultants drawn from the three specialties. Job analysis was carried out in the Yorkshire and the Humber region in the UK. The validation study was administered with additional participants from the West Midlands and Trent regions in the UK. This was an exploratory study. The outcome is a set of competency domains with data on their importance at senior house officer, SpR and consultant grade in each specialty. Results, The study produced a model comprising 14 general competency domains that were common to all the three specialties. However, there were significant between-specialty differences in both definitions of domains and the ratings of importance attached to them. Conclusions, The results indicate that a wide range of attributes beyond clinical knowledge and academic achievement need to be considered in order to ensure doctors train and work within a specialty for which they have a particular aptitude. This has significant implications for developing selection criteria for specialty training. Future research should explore the content validity of these competency domains in other secondary care specialties. [source]

Workplace-based assessment for general practitioners: using stakeholder perception to aid blueprinting of an assessment battery

MEDICAL EDUCATION, Issue 1 2008
Douglas J Murphy
Context, The implementation of an assessment system may be facilitated by stakeholder agreement that appropriate qualities are being tested. This study investigated the extent to which stakeholders perceived 8 assessment formats (multiple-choice questions, objective structured clinical examination, video, significant event analysis, criterion audit, multi-source feedback, case analysis and patient satisfaction questionnaire) as able to assess varying qualities of doctors training in UK general practice. Methods, Educationalists, general practice trainers and registrars completed a blueprinting style of exercise to rate the extent to which each evaluation format was perceived to assess each of 8 competencies derived primarily from the General Medical Council document Good Medical Practice. Results, There were high levels of agreement among stakeholders regarding the perceived qualities tested by the proposed formats (G = 0.82,0.93). Differences were found in participants' perceptions of how well qualities were able to be assessed and in the ability of the respective formats to test each quality. Multi-source feedback (MSF) was expected to assess a wide range of qualities, whereas Probity, Health and Ability to work with colleagues were limited in terms of how well they could be tested by the proposed formats. Discussion, Awareness of the perceptions of stakeholders should facilitate the development and implementation of workplace-based assessment (WPBA) systems. These data shed light on the acceptability of various formats in a way that will inform further investigation of WPBA formats' validity and feasibility, while also providing evidence on which to base educational efforts regarding the value of each format. [source]

Training the ideal hospital doctor: the specialist registrars' perspective

MEDICAL EDUCATION, Issue 10 2001
N Khera
Background When training for junior doctors is being planned, little discussion is focused on what outcomes hospitals are trying to achieve with regard to education/training, i.e. on what makes the ideal hospital doctor. Instead, the primary focus is on the requirements of the syllabi of the Royal Colleges (credentialing) and the requirements of service delivery (job description). Current literature has no qualitative studies of any longitude in which middle-grade doctors are asked about their vision of the ideal hospital doctor, what they feel can be done to help realize this vision, and how they feel about their own training. Methods This study examined data principally collected through a series of semistructured interviews conducted with eight specialist registrars (SpRs), four each from the North Trent and South Thames rotations over a period of 18 months. Additional information was taken from focus groups, interviews with programme directors, and questionnaires. Findings A model was created of the SpRs' perceptions of the key attributes of an ideal hospital doctor and of how these may be achieved in training. Eight broad areas were identified: clinical knowledge and skills; key clinically related generic/non-clinical skills; self-directed learning and medical education; implementing change management; applying strategic and organizational skills in career planning; consultation skills; research; and key personal attributes. Conclusions SpRs are articulate in expressing their own expectations of their training and have considerable insight into the components of good training. Further improvement could be made and will require significant commitment from both trainees and trainers. [source]

Teaching consultation skills: a survey of general practice trainers

MEDICAL EDUCATION, Issue 3 2001
Alison Evans
Background Consultation skills are vitally important in general practice (GP), and now form part of the summative assessment of GP registrars in the UK. GP trainers need to be skilled in teaching consultation skills, and also need the time and resources to ensure that their registrars are competent in consultation skills. Aims To describe the teaching methods used by GP trainers in one deanery, the frequency of teaching of consultation skills, the problems encountered and the training that GP trainers have themselves received both in consultation skills and how to teach them. Method Postal questionnaire survey of all the 164 trainers in the Yorkshire Deanery. Results Replies were received from 129 trainers (response rate 79%) of which 123 could be analysed. Of these trainers, 45 (37%) trainers taught consultation skills fewer than five times a year, 45 (37%) five to 10 times, and 14 (11%) more than 10 times a year. A total of 24 trainers reported problems with teaching consultation skills, most commonly lack of time, technical difficulties, and unreceptive registrars, and 97 (79%) trainers had had some postgraduate training in consultation skills with 112 (91%) reporting some form of teacher training. Conclusion There is considerable variation in the reported frequency of teaching consultation skills, the models used, and the preparation of trainers for teaching, despite a systematic approach to teacher training in the Yorkshire Deanery. [source]

Attitudes to prescription of antiplatelet drugs by diabetes health workers

PRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 8 2007
A Woodward RN, MPhill Diabetes Specialist Nurse
Abstract The aim of this survey was to explore the attitudes to antiplatelet drug use amongst a group of UK diabetes specialist medical and nursing personnel. A postal questionnaire survey was circulated to all consultant diabetologists, specialist registrars in diabetes and diabetes specialist nurses working in the Mersey Deanery area. Seventy-eight questionnaires were sent out, 63 (81%) returned. The perceived use of antiplatelet therapy was significantly higher for type 2 diabetes compared with type 1 diabetes, especially in the absence of complications or cardiovascular risk factors (52% vs 21%, p = 0.0004). Responses were more variable for type 1 diabetes: more nurses than doctors advised antiplatelet drugs in the absence of risk factors (46% vs 5%, p = 0.0002) and in the presence of smoking (79% vs 51%, p = 0.034). Aspirin was first-line choice of antiplatelet drug; clopidogrel was generally used for gastric intolerance and aspirin allergy. We conclude that the combination of limited evidence base and imprecise guidelines is not favouring proper usage of antiplatelet drugs and that more evidence-based didactic guidelines are required. Copyright © 2007 John Wiley & Sons. [source]

Difficult and failed intubation in 3430 obstetric general anaesthetics*

ANAESTHESIA, Issue 11 2009
E. A. Djabatey
Summary A retrospective audit was performed of all obstetric general anaesthetics in our hospital over an 8 year period to determine the incidence of difficult and failed intubation. Data was collected from a number of sources to ensure accuracy. A total of 3430 rapid sequence anaesthetics were given. None of the patients had a failed or oesophageal intubation (95% CI, 0,1:1143). There were 23 difficult intubations (95% CI, 1:238,1:100). This was anticipated in nine cases, requiring awake fibreoptic intubation in three cases. Consultants or specialist registrars were involved in the management of all cases. We attribute the low incidence of airway complications to the above average rate of general anaesthesia in our hospital, senior cover and specialised anaesthetic operating department assistants. [source]

Effects of the European Working Time Directive on anaesthetic training in the United Kingdom

Revising the surgical registrar on-call roster

ANZ JOURNAL OF SURGERY, Issue 7-8 2010
A. Peter Wysocki
Abstract Background:, The work hours of junior doctors have been in the spotlight since the mid-1980s. Rostering and the structure of surgical units aim to balance quality and continuity of patient care with reasonable working hours. Methods:, Actual hours worked during two 12-week surgical registrar rosters were compared. Compliance of each roster with fatigue recommendations was assessed with Fatigue Audit InterDyne (FAID, InterDynamics Pty Ltd, Adelaide, Australia) software. Workload was determined from an electronic prospective surgical audit. Impact of the roster change was discussed with consultants and registrars. The traditional roster started on 16 July 2007 and the fatigue-friendly roster on 14 July 2008. Results:, The total number of hours worked reduced by 11% (from 5085.17 h in 2007 to 4530.85 h in 2008). Fatigue was eliminated (from 133.25 h in 2007 to 0 h in 2008). Over the 12-month period, the operative workload for the Department of General Surgery increased by 18%. FAID compliance improved from 67.3 to 91.2%. Consultant and registrar satisfaction with the new roster was high. Conclusions:, Safe working hours have been achieved for surgical registrars by restructuring the surgical units and implementing a new on-call rota without a perceived effect on patient care. [source]

Acute Surgical Unit: a new model of care

ANZ JOURNAL OF SURGERY, Issue 6 2010
Michael R. Cox
Abstract The traditional on-call system for the management of acute general surgical admissions is inefficient and outdated. A new model, Acute Surgical Unit (ASU), was developed at Nepean Hospital in 2006. The ASU is a consultant-driven, independent unit that manages all acute general surgical admissions. The team has the same make up 7 days a week and functions the same every day, including weekends and public holidays. The consultant does a 24-h period of on-call, from 7 pm to 7 pm. They are on remote call from 7 pm to 7 am and are in the hospital from 7 am to 7 pm with their sole responsibility being to the ASU. The ASU has a day team with two registrars, two residents and a nurse practitioner. All patients are admitted and stay in the ASU until discharge or transfer to other units. Handover of the patients at the end of each day is facilitated by a comprehensive ASU database. The implementation of the ASU at Nepean Hospital has improved the timing of assessment by the surgical unit. There has been significant improvement in the timing of operative management, with an increased number and proportion of cases being done during daylight hours, with an associated reduction in the proportion of cases performed afterhours. There is greater trainee supervision with regard to patient assessment, management and operative procedures. There has been an improvement in the consultants' work conditions. The ASU provides an excellent training opportunity for surgical trainees, residents and interns in the assessment and management of acute surgical conditions. [source]

Nothing to sneeze at!

The harassment and stalking of plastic surgeons by their patients in Australasia

ANZ JOURNAL OF SURGERY, Issue 7-8 2009
Stephen Allnutt
Abstract Medical professionals come into direct contact with the public. The relationships are often personal. The aim of the survey is to examine the prevalence of harassment of plastic surgeons by their patients. Survey questionnaires were mailed to all plastic surgeons listed in the 1999 Australasian Society of Aesthetic Plastic Surgery List of Members. A very wide definition of harassment was then provided and information in regard to the nature of the harassment was obtained. This was a descriptive survey of plastic surgeons' experiences of harassment by patients in Australia and New Zealand. More than half of the plastic surgeons in Australia and New Zealand who responded to the questionnaire reported having been a victim of harassment at some point of their careers. One quarter had been harassed in the previous year. Over 20% of cases met the legal criteria for stalking. These estimates are in excess of those reported in the other studies of the general community. Harassment persisted in the majority of cases for at least a month and in a third of cases for up to 5 years. The recognition of psychiatric disorder, particularly personality dysfunction, prior to embarking on surgery may limit the likelihood of harassment by difficult patients. Formal teaching may be helpful to surgical registrars and consultants. Expert intervention could assist in reducing clinician anxiety. [source]