Biomedical subjects

AG Johnson

Publications and source records attributed to AG Johnson.

3 recordsLinked to original sources

PubMed2000

Mismatch between trainees' subspecialist interest and advertised jobs; worrying implications for upper gastrointestinal trainees

AIMS: The aim of this study was first to assess the primary subspecialist interests of general surgical specialist registrars who were accredited and still looking for a consultant position, or who were within 3 years of their CCST (certificate of completion of surgical training). These interests were then compared with subspecialist interests declared in consultant vacancies advertised in the British Medical Journal over the preceding 16 months. METHODS: All trainees in general surgery holding a national training number in six regions (Mersey, North West, Trent, Yorkshire, Northern, West Midlands) were identified, and those accredited or within 3 years of their CCST (n = 136) were telephoned to ascertain their primary subspecialist interest, whether they had a higher degree and what their desired consultant job would be. The consultant vacancies advertised in the British Medical Journal between 3 January 1998 and 8 May 1999 were assessed according to the required subspecialist interest. RESULTS: Upper gastrointestinal surgery is the second most popular subspecialty (n = 37; 27 per cent of trainees) after colorectal surgery (n = 40; 29 per cent of trainees). However, there were fewer consultant vacancies in upper gastrointestinal surgery (31 of 226; 14 per cent of jobs) than in any of the other three main subspecialist areas of general surgery (colorectal, vascular and breast/endocrine). The ratio of percentage of jobs to percentage of trainees was lowest in upper gastrointestinal surgery (0.50), compared with colorectal (0.77), vascular (0.89) and breast/endocrine (2.23) surgery. CONCLUSIONS: Upper gastrointestinal surgery appears to be the most competitive of the general surgical subspecialties at present, having by far the lowest ratio of jobs to trainees. In addition, 87 per cent of upper gastrointestinal trainees have or are completing a higher degree, and 43 per cent expressed a desire to work in a teaching hospital.

Journal Article↗

PubMed2000

Current practice in the management of acute cholecystitis

AIMS: Several recent papers have advocated emergency cholecystectomy for patients with acute cholecystitis, stating that it is safe, cost effective and leads to less time off work. This study was designed to assess current practice in the management of acute cholecystitis in the UK. METHODS: A postal questionnaire was sent to 357 consultant surgeons who were thought to be involved in a general surgical on-call rota, to ascertain their current management of patients with acute cholecystitis. Replies were received from 250 consultants (70 per cent) of whom 242 (68 per cent) were involved in a general surgical take. Sixteen of these consultants, however, handed their patients with acute cholecystitis on to a different team the following day for further management. RESULTS: Twenty-seven consultants (12 per cent) routinely treat their patients by emergency cholecystectomy whenever possible, with 24 stating that they would do this within 72 h. Limiting factors to this practice were stated to be availability of surgical staff (15), theatre space (nine) and radiological investigations (four). The remaining consultants (n = 199) routinely manage their patients conservatively initially and providing they settle, either (1) book directly for cholecystectomy (n = 94, 47 per cent), (2) reassess as an outpatient (n = 65, 33 per cent), (3) either of above (n = 21; 11 per cent) or (4) refer on to a colleague (n = 19, 10 per cent). The commonest indications for acute cholecystectomy stated by consultants whose initial treatment policy is conservative are spreading peritonitis due to bile leak (93 per cent), empyema (89 per cent), unexpected space on a theatre list (28 per cent) and failure of an acute episode to settle (21 per cent). The laparoscopic method is the commonest for both elective and emergency cholecystectomy, but the percentage of consultants using an open method rises dramatically from 9 per cent in the elective situation to 48 per cent for emergency cholecystectomy. CONCLUSIONS: Despite evidence to support the increased use of emergency cholecystectomy, this practice is routinely carried out by only 12 per cent of consultants. However, of the consultants who treat their patients conservatively, 28 per cent are prepared to undertake emergency cholecystectomy if an unexpected space appears on the theatre list.

Journal Article↗

PubMed2000

Cholecystectomy: does subspecialization alter workload?

AIMS: Cholecystectomy is a common operation. This study reviewed the changes in workload and practice in a teaching hospital over a 4-year period, during which a hepatobiliary subspecialist unit was developed. METHODS: Computerized demographic data, and details of operations and inpatient events were reviewed for all patients undergoing cholecystectomy in a single teaching hospital from 1993 to 1997. For statistical analysis the consultants were grouped into those with a hepatobiliary interest (n = 3) and those with other primary interests (n = 6); and the workload for the first 12 months of the study was compared with that of the last 12-month period. RESULTS: Between April 1993 and April 1997, 1121 cholecystectomies were performed, of which 75 were excluded because they were performed with other simultaneous procedures. Of the remaining operations, 911 involved cholecystectomy alone (mean patient age 52. 9 years), and 135 (12.9 per cent) comprised cholecystectomy with exploration of the common bile duct (ECBD) (mean age 60.1 years). Between the first and last years studied, the rate of ECBD rose significantly from 7.4 to 14.9 per cent (P < 0.01, chi2 test), and the proportion of ECBD procedures being performed by hepatobiliary specialists rose from 31.6 to 52.7 per cent, but this was not statistically significant (P = 0.13). However, for cholecystectomy in the same period the proportion performed by hepatobiliary surgeons rose from 40.4 to 58.5 per cent, representing a highly significant trend (P < 0.001). Following cholecystectomy alone there was a significantly shorter stay associated with patients treated by hepatobiliary surgeons (P = 0.002, F test), although the median postoperative hospital stay was 2 days for both groups of surgeons (interquartile range 1-3 days for hepatobiliary and 1-4 days for non-hepatobiliary surgeons). CONCLUSIONS: Although cholecystectomy is not viewed as a specialist procedure, the trend in this teaching hospital reveals a steady increase in the proportion of cholecystectomies being performed by teams with a biliary interest. The data indicate that this practice is associated with a shorter hospital stay.

Journal Article↗