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PubMed1994

What constitutes general surgical training? Evidence from the log books of trainees in one district general hospital.

It is accepted wisdom that surgical expertise in the UK is achieved by virtue of long service, and perhaps not enough genuine training. The average age at appointment to consultant posts in general surgery has risen from 37.0 years in 1978 to 38.0 in 1992. This message has reached the politicians who run the Health Service: at the Association of Surgeons in Training Annual General Meeting in September 1991 Mrs Virginia Bottomley said 'A complaint often made to me is that trainees, particularly surgical trainees, in the UK are over-experienced but under-trained'. Training posts acquire a reputation (good or bad) based on word of mouth, pass rate in examinations, and success in placing trainees into higher grades. Little is known about the relationship between training and operative experience. Log books have been introduced as a compulsory requirement for the Clinical Surgery in General and Intercollegiate Specialty Examinations. This report aims to define the operative experience of trainees at a District General Hospital by analysis of data obtained from their log books. This information has been used to calculate trainee workload in terms of intermediate equivalents (IE) and service equivalent value (SEV).

Education, Medical, Graduate↗

PubMed2003

A general dental practice research network: impact of oral health in general dental practice patients.

OBJECTIVE: To measure the subjective impact of oral health in a group of patients attending general dental practices in the North West of England and to investigate the attributes of dentists and practices in order to examine how such attributes might relate to patients' subjective perceptions of oral health. DESIGN: Fifteen general dental practices conducting a simultaneous survey of attending patients and 15 practitioners from these practices providing information about their attitudes to treatment, prevention and various aspects of their surgery. SETTING: General dental OUTCOME MEASURES: Patient subjective impact scores. Relationships between practice and practitioner variables and patients' subjectively perceived oral health. RESULTS: Fifteen practitioners with diverse practice attributes provided data on 718 patients. The mean total oral health impact score was 18.4. Twenty two per cent of patients had experienced pain in the four weeks before the survey and 11% had been unable to chew some foods. Fifty five per cent of the surveyed population had, in the previous year, worried about the appearance of their mouth and 65% had worried about their oral health in general. Dentists' beliefs were related to patient impact scores but practice attributes were not significantly associated with patients' impacts. CONCLUSIONS: Fourteen percent of the differences in patients' subjectively perceived oral health can be attributed to dentist attitudes and attributes. Further research regarding the influence of dentists personality and professional beliefs on patients well-being needs to be undertaken.

Adolescent↗

PubMed1996

Pharmaceutical trials in general practice: the first 100 protocols. An audit by the clinical research ethics committee of the Royal College of General Practitioners.

OBJECTIVE: To assess the outcome of 100 general practice based, multicentre research projects submitted to the ethics committee of the Royal College of General Practitioners by pharmaceutical companies or their agents between 1984 and 1989. DESIGN: Analysis of consecutive submitted protocols for stated objectives, study design, and outcomes; detailed review of committee minutes and correspondence in relation to amendment and approval; assessment of final reports submitted at conclusion of studies. SUBJECTS: 82 finally approved protocols, embracing 34,523 proposed trial subjects and 1195 proposed general practice investigators. MAIN OUTCOME MEASURES: Success at enrolling subjects and investigators; commencement and completion data; validity of final report's assessment of efficacy, safety, tolerability, and acceptability; and method of use and dissemination of findings. RESULTS: 18 studies were not approved and 45 had to be amended. Randomised controlled trials comprised 46 of the original submissions. Remuneration considerations, inadequate information or consent sheets, pregnancy safety, the need to discontinue existing therapy, and suboptimal scientific content were major reasons for rejecting studies or asking for amendments. Of the 82 approved studies 8 were not started. Shortfalls of investigators (of 39%) and trial subjects (of 37%) and an overall 23% withdrawal rate were responsible for a significant incidence of inconclusive results. Within the six year follow up interval, only 19 of the studies had been formally published. CONCLUSIONS: This audit identified substantial ethical concerns in the process of approving multicentre general practice pharmaceutical research.

Clinical Protocols↗

PubMed1998

Screening for anxiety and depression in adult general medical in-patients in a Scottish District General Hospital.

We prospectively screened for anxiety and depression by administering the HAD scale to consecutive general medical patients admitted to a Scottish District General Hospital (DGH) over a calendar month. Age, gender, and use of psychotropic medications were also recorded. Of 119 patients (49 male) aged 16 to 92 years, "Probable presence of anxiety" was recorded in 23%, and "Probable presence of depression" in 19%. There was no significant difference between male and female patients or between different age groups. Formal psychological management was not available on site. Sixty-seven per cent of patients with "Probable presence of anxiety" and 61% with "Probable presence of depression" received no psychotropic medications. Despite a high prevalence of psychological distress amongst general medical in-patients, anxiety and depression are consistently under-diagnosed and under-treated. Screening for psychological distress, followed, where indicated, by psychological and/or pharmacological intervention, should be a fundamental element of holistic, patient-centred care in general medicine.

Adolescent↗

PubMedDate not supplied

[Advantage of combined spinal, epidural and general anesthesia in comparison to general anesthesia in abdominal surgery].

Type and technique of anesthesia have an important effect on per operative surgical course. The aim of the study was prospective analyses of advantages of combined spinal, epidural and general anesthesia (CSEGA) versus general anesthesia (GA) in abdominal surgery according to: 1. operative course (haemodynamic stability of patients, quality of analgesia, undesirables effects), 2. postoperative course (quality of analgesia, unfavourable effects, temporary abode of patients in intensive care). Using prospective randomized double blind controlled study, we evaluated two groups of patients whom the same type of abdominal surgical intervention was planed and the only difference was the type of technique of anesthesia. First group of patients (n = 34), was treated with CSEGA and second group of patients (n = 33), was treated only with standard (GA). Both groups had intraoperative and 24-hour-long postoperative continued monitoring of blood pressure, central venous pressure, and dieresis. In the 24 hours postoperative period, the following parameters were analyzed: vigilance conditions, motor block level, pain intensity in rest and movement, necessity for a complementary analgesia, side effects and final subjective effect of analgesia. There was important difference in waking up the patients after a general anesthesia--in the first group this period was shorter. In the first 24 hours, patients from the first group didn't get any systemic analgesic, while the patients from the second group needed fractionary application of parenteral analgesics in the period of 4-6 hours. Patients from the first group were also physically faster and easier recovered and they had less respiratory complications and there was not any example of thromboembolsm and the intestine motility was faster re-established. First group of patients spent less time in intensive care (three days) than second group (six days). Final subjective effect of analgesia, according to verbal descriptive scale (VDS) of pain was satisfying with 75% of patients of the first group and 15% of patients of the second group. According to results investigation, advantages of CSEDGA versus GA in abdominal surgery manifold: better hemodynamic stability and perfusion of operative region, decrease of single doses of opioid analgesics, local and general anesthetics followed by the decrease of their side effects, better intensity and longer duration of analgesia, improved total functional capability of patients.

Abdomen↗

PubMed1995

The future of general surgery characterized by general surgical chief residents.

The future of any specialty in medicine depends in large part on the career choices of its trainees. We obtained data from General Surgery Chief Residents who finished their training in 1990 and compared their attitudes to a similar survey conducted by us in 1985. According to those responses, residents in general surgery continue to choose fellowship training at a time when they no longer perceive an oversupply of general surgeons. This has broad implications for the future of general surgery as a specialty that requires significant change in the structure of our residency programs.

Attitude of Health Personnel↗

PubMed1990

Eyelid twitching seizures and generalized tonic-clonic convulsions: a syndrome of idiopathic generalized epilepsy.

This is a report of two neurologically normal patients who had primary generalized seizures consisting of irregular fluttering or twitching movements of the eyelids accompanied by generalized, rhythmic 9- to 15-Hz electroencephalographic discharges as well as infrequent generalized tonic-clonic seizures. This is a syndrome of idiopathic generalized epilepsy that responds to treatment with valproic acid.

Acetazolamide↗

PubMed2006

[The program initiative "general practice" of the Conference of the German Federal Health Ministers. Successes of interventions and possible reasons for the shortage of general practitioners].

The number of general practitioners has clearly decreased over the last 10 years in Germany. The situation is more critical in Eastern Germany compared to Western Germany. The article shows the results of the "program initiative to secure primary care in general practice" of the Conference of the Federal Health Ministers. The authors focus on the situation in Saxony-Anhalt, where they are founders of the Institute of General Medicine at the Universities of Halle-Wittenberg and Magdeburg. They also work as general practitioners.

Curriculum↗

PubMed2006

Prevention of latex allergy among health care workers and in the general population: latex protein content in devices commonly used in hospitals and general practice.

BACKGROUND: In this study the latex protein content in devices commonly used in hospitals and general practice were investigated. The main aim was to acquire information for preventing latex allergy in health care workers and in the general population. METHODS: About 22 different types of medical devices and 23 devices commonly used in general practice were examined evaluating the total allergenic potency by a modified RAST-inhibition assay and quantitative determination of single allergens (Hev b1, Hev b5 and Hev b6.02) by using commercial ELISA kit. RESULTS: A high level of inhibition was found in medical devices, such as elastic bandage (81.57%), tourniquet (74.09%), Foley urinary catheter (68.35%), Penrose drainage (67.25%) and taping (39.6%), and in common devices, such as rubber inner-sole (84.20%), toy balloon (78.62%), latex mattress (74.27%), household rubber gloves (49.10%), working gloves (38.25%), inflatable floating mattress (32.10%). Concentrations of latex extractable proteins and Hev b1, Hev b5 and Hev b6.02 antigens were high in some medical and general devices. CONCLUSIONS: Latex exposure sources were found in hospitals and the home. These findings, though only preliminary and far from conclusive, could enable sensitized persons to avoid risky exposures and prevent allergic reactions. From the point of view of prevention, the time may come when every natural rubber object could be systematically labelled as "containing latex" together with the warning that "this item may cause allergic reactions in sensitized subjects."

Consumer Product Safety↗

PubMed1994

Community and participation for general practice: perceptions of general practitioners and community nurses.

A central theme of health policy has concerned the public's participation in primary health care services, both as individual consumers and collectively as communities. In the U.K. primary care increasingly centres on general practice. This paper reports an exploratory study undertaken with practice teams in inner city Sheffield about community participation. The study design was influenced by a grounded theory approach to data collection and analysis. The main data collected was from interviews of 23 general practitioners, 20 practice nurses, 11 health visitors and 7 district nurses. Concepts of community and participation were explored by interview with these primary care workers. Typologies of community and participation for general practice are presented in the findings, along with associated strategic positions and political tensions. The discussion highlights a number of tensions and issues concerning community participation when primary care is organized around general practice.

Attitude of Health Personnel↗

PubMed1996

General Gaussian Priors for Improved Generalization.

We explore the dependence of performance measures, such as the generalization error and generalization consistency, on the structure and the parametrization of the prior on "rules", instanced here by the noisy linear perceptron. Using a statistical mechanics framework, we show how one may assign values to the parameters of a model for a "rule" on the basis of data instancing the rule. Information about the data, such as input distribution, noise distribution and other "rule" characteristics may be embedded in the form of general Gaussian priors for improving net performance. We examine explicitly two types of general Gaussian priors which are useful in some simple cases. We calculate the optimal values for the parameters of these priors and show their effect in modifying the most probable, MAP, values for the rules. Copyright 1996 Elsevier Science Ltd.

Journal Article↗

PubMedDate not supplied

Anxiolytic and hypnotic use by general hospital inpatients. The impact of psychopathology and general medical conditions.

This study explored the relative impact of general medical conditions and psychopathology on the current and lifetime use of anxiolytic and/or hypnotic drugs by general hospital inpatients. One hundred and five consecutive patients, admitted to an internal medicine department, were assessed by a structured interview about current and lifetime use of anxiolytic and/or hypnotic drugs, and with somatic and psychopathology scales. Eighty percent of patients reported using anxiolytics and/or hypnotics at least once in a lifetime, 62.9% in the last year, 55.2% in the last 3 months, and 42.9% in the last week. Correlations were found between drug use and current levels of anxiety and depression, but not somatic pathology. Psychological suffering appeared to be a major determinant for anxiolytic and/or hypnotic use by patients with general medical conditions. Consumption rates were higher than in the general population, but there was no direct link between somatic morbidity and drug use.

Adolescent↗

PubMed2000

Validity of measures of cognitive processes and general ability for learning and performance on highly complex computerized tutors: is the g factor of intelligence even more general?

Theoretical arguments and analyses from 2 studies provide compelling evidence that computerized measures of information-processing skills and abilities are highly useful supplements to more traditional, paper-based measures of general mental ability for predicting individuals' capacity to learn from and perform on highly challenging, multifaceted tutors. These tutors were designed to emulate learning and performance in complex, real-world settings. Hierarchical confirmatory factor analysis provided evidence that a general, higher order factor model with general ability at the apex could quite adequately and singularly account for the individual-differences data, both traditional and cognitive-process measures. Results are interpreted in light of the utility and generality of human cognitive abilities.

Cognition↗

PubMed1997

General practitioner registrars' opinions of general practice training in ophthalmology: a questionnaire survey in the northern region.

PURPOSE: Approximately 6% of general practitioners have worked in ophthalmology but to our knowledge the relevance of this training has not previously been evaluated. METHODS: We sent an anonymous questionnaire to all doctors who had held general practitioner registrar (vocational training) posts in ophthalmology in the Northern Region during a 5-year period (1989-1994). RESULTS: Twenty-six of 48 (54%) questionnaires were returned. Twenty-five of 26 respondents (96%) thought the training was useful, with 22 (91.7%) continuing to use some ophthalmic practical skills and 17 (65.4%) said they had received adequate and relevant clinical exposure. Twenty-one (87.5%) of those in general practice felt that they were more confident with eye problems than their peers and 12 (50%) said their referral patterns differed. Eleven (46%) had provided advice for colleagues. However, 9 (34.6%) commented on the large service commitment and 5 (19%) felt that supervision had been inadequate. Only 9 (34.6%) had received relevant teaching and 18 (69%) thought more was necessary. CONCLUSION: We conclude that general practitioner registrar posts in ophthalmology are useful and rewarding but that there is scope for improvement.

Attitude of Health Personnel↗

PubMed2000

Functional interaction of general transcription initiation factor TFIIE with general chromatin factor SPT16/CDC68.

BACKGROUND: Transcriptional initiation of class II genes is one of the major targets for the regulation of gene expression and is carried out by RNA polymerase II and many auxiliary factors, which include general transcription initiation factors (GTFs). TFIIE, one of the GTFs, functions at the later stage of transcription initiation. As recent studies indicated the possibility that TFIIE may have a role in chromatin transcriptional regulation, we isolated TFIIE-interacting factors which have chromatin-related functions. RESULTS: Using the yeast two-hybrid screening system, we isolated the C-terminal part of the human homologue of Saccharomyces cerevisiae (y) Spt16p/Cdc68p, a general chromatin factor. The C-terminal part of human SPT16/CDC68 directly interacts with TFIIE, and ySpt16p/Cdc68p also interacts with yTFIIE (Tfa1p/Tfa2p), thus indicating the existence of an evolutionarily conserved interaction between TFIIE and SPT16/CDC68. Functional interaction of yTFIIE and ySpt16p/Cdc68p was examined using a conditional yTFIIE-alpha mutant strain. Over-expression of ySpt16p/Cdc68p suppressed the phenotype of cold sensitivity of the yTFIIE-alpha-cs mutant strain, and in vitro binding assays revealed that yTFIIE-alpha-cs mutant protein showed diminished binding affinity to ySpt16p/Cdc68p. CONCLUSIONS: These observations indicate that general transcription initiation factor TFIIE functionally interacts with general chromatin factor SPT16/CDC68, a finding which provides new insight into the involvement of TFIIE in chromatin transcription. This may well lead to a breakthrough in relationships between the transcription initiation process and structural changes in chromatin.

Amino Acid Sequence↗

PubMed2002

General pharmacological profile of the novel muscarinic receptor agonist SNI-2011, a drug for xerostomia in Sjögren's syndrome. 1st communication: effects on general behavior and central nervous system.

A novel muscarinic receptor agonist, SNI-2011 ((+/-)-cis-2-methylspiro[1,3-oxathiolane-5,3'-quinuclidine] monohydrochloride hemihydrate, cevimeline, CAS 153504-70-2), is a candidate therapeutic drug for xerostomia in Sjögren's syndrome. The general pharmacological properties of this drug on general behavior and the central nervous system were investigated in mice, rats and cats. 1. General behavior: When SNI-2011 was administered orally to mice at 100 mg/kg, mydriasis, a decrease of spontaneous motor activity, tremor, convulsions, salivation, abnormal posture, abnormal gait, reduced grip strength and reduced response against external stimulating were observed, and 2 out of 6 animals died. At 10 mg/kg or lower, no particular sign was observed except mydriasis, which appeared to be caused via the peripheral muscarinic acetylcholine receptors. 2. Central nervous system: SNI-2011 had no effect on the motor coordination in mice. Hypothermia was observed in rats and reduced spontaneous motor activity, analgesia and enhanced maximum electroshock-induced convulsions were observed in mice after oral administration of 30 mg/kg SNI-2011. Slight increase in the rate of theta-wave band in the hippocampal EEG of rats and spinal multisynaptic reflexes in cats were observed after intravenous injection of 10 mg/kg SNI-2011. At an oral dose of 10 mg/kg, prolongation of thiopental-induced sleeping time in mice was observed. The prolongation of sleeping time was inhibited by a peripheral muscarinic antagonist. These results suggest that SNI-2011 has muscarinic effects on general behavior and the central nervous system at the doses approximately 10-fold higher than the effective doses needed for saliva secretion.

Anesthetics, Intravenous↗

PubMed2004

Positive self-assessed general health in patients with medical problems. A qualitative study from general practice.

BACKGROUND: Patient and doctor do not always agree on the status of the patient's health. By underestimating the patient's strong sides, the doctor may be contributing to disempowerment and bypassing knowledge needed for adequate medical diagnosis and management. OBJECTIVE: To understand how our patients with medical problems assess their general health as good. DESIGN AND SETTING: Qualitative observational study based on audiotaped material from general practice consultations in authors' practices (Norway and Denmark). The patients were asked to rate their current state of health on a scale ranging from zero to 100, and then to explain their score. SUBJECTS: From 41 consecutive consultations we compiled a purposeful sample of 12 patients who reported positive self-assessed general health although medical problems were present. The 7 women and 5 men were aged between 43 and 96 years, and had been diagnosed with musculoskeletal disorders, heart disease, cancer, depression, headache or severe menopausal symptoms. MAIN OUTCOME MEASURES: Salutogenesis, represented by the authors' Health Resource/Risk Balance Model, and Antonovsky's Sense of Coherence (SOC) concept comprised the theoretical framework. Transcripts from audiotaped consultations were used for qualitative text condensation analysis, inspired by Giorgi's phenomenological method. Analysis was theory-driven, applying comprehensibility, manageability and meaningfulness as entries to elaborate patients' accounts of positive health. RESULTS: Patients' answers demonstrated how a feeling of logical reasoning related to symptom perception could provide comfort and sometimes lead to advantageous coping strategies. Personal and social resources were mentioned as essential means for tolerating and managing the burden of disease. Even fairly extensive endeavours could be experienced as worthwhile when sometimes providing relief, even only temporarily. CONCLUSIONS: Patients' accounts of general health can challenge the traditional medical views on assessment of health and disease.

Adult↗

PubMed1953

Studies on the generalized Shwartzman reaction. IV. Prevention of the local and generalized Shwartzman reactions with heparin.

In order to explore the hypothesis that the occurrence of thrombosis of small blood vessels is an essential stage in the development of the local and generalized Shwartzman reactions, the effect of heparin was studied. Aqueous heparin, administered intravenously, and "depot" heparin, injected subcutaneously, prevented completely the occurrence of the local and generalized Shwartzman phenomena. The amounts of heparin required for protection were similar to the amounts required to produce sustained incoagulability of the blood of rabbits for a period of at least 4 hours. The local and generalized Shwartzman reactions were prevented when heparin was given at the time of provocation, but not when heparin was administered during the period of preparation. Heparin prevented the development of bilateral cortical necrosis of the kidneys following a single intravenous injection of meningococcal toxin in rabbits previously treated with cortisone or thorotrast. Hemorrhagic necrosis of the skin which follows an intradermal injection of toxin in thorotrast-treated rabbits was also prevented by heparin. Provocation of the dermal Shwartzman reaction with glycogen, saline suspension of rabbit liver, and human serum was prevented by treatment with heparin. Heparin itself, in the preparations and dosages used, had no consistent effect on either white blood cell or platelet counts. Heparin had no effect on the occurrence of polymorphonuclear leukopenia which follows an intravenous injection of meningococcal toxin. Treatment with heparin did not interfere with the lethal effect of single, large doses of meningococcus toxin. In animals in which bilateral cortical necrosis of the kidneys was prevented by heparin, occlusion of the glomerular capillaries by "fibrinoid" material did not occur. These observations support the concept that vascular occlusion plays an essential role in the development of the local and generalized Shwartzman reactions.

Animals↗