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Introduction: Surgical training is traditionally a public hospital-based practice. At Epworth Private Hospital, Richmond, Victoria, there are three accredited surgical training positions and one fellowship position. We conducted a patient survey to review the patients' perspective of surgical trainees in private hospitals. Methods: Over 6 weeks, 100 patients admitted under the surgical units with full-time surgical registrars were given a survey to complete in two parts on the training of surgeons in private hospitals. Results: Seventy per cent of surveys were returned completed. Ninety per cent of respondents agreed that private hospitals should be involved in surgical training and 85.7% of patients were agreeable to having trainees involved in their operation. Only 1.4% of patients were not in agreement with surgical training in private and 8.6% of patients were neutral in their opinion. Conclusion: Our results clearly show that private hospital patients are generally favourably disposed to the presence and participation of surgical trainees in the private hospital setting.

OBJECTIVES Graves' disease is associated with different human leucocyte antigen (HLA) genes in different populations. This study was designed to examine the HLA class II associations with Graves' disease in Jamaicans. PATIENTS One hundred and six Jamaicans with Graves' disease and 104 controls. DESIGN Oligotyping for HLA-DRB1, DRB3, DQA1 and DQB1 alleles was performed using the polymerase chain reaction sequence specific oligonucleotide probe (PCR-SSOP) technique. RESULTS The frequency of HLA-DRB3 *0101 was increased significantly in the patients compared to controls (38·7% vs. 19·2%; RR = 2·72; Pc

Data from a sample of 82 impaired elderly people and their carers were gathered before (T1) they started to receive support from a home-based care aide service. Several variables were significantly correlated with, but only two were predictive of reported carer distress at T1. Data gathered from a subsample of 45 carers after receiving support for 3 months (T2) showed that reported distress decreased significantly between T1 and T2. The only variable which significantly correlated with, and was predictive of carer distress at T2 was distress at T1. A ladder plot showed great variability in changes in distress with 11 subjects actually reporting increased distress at T2. There was no relationship between initial distress scores and change in distress over time. The implications of these findings are discussed.

During the period 1968 to 1978 a total of 447 patients were treated in the Royal Newcastle Hospital for acute respiratory failure after injury. In 321 patients respiratory failure occurred after thoracic and/or long bone injury. In only 17 of these could a diagnosis of fat embolism syndrome (FES) as a sole cause of respiratory failure be substantiated when strict diagnostic criteria were applied. In a further 15 patients FES may have coexisted with other causes of respiratory failure. The outstanding features of patients with FES were: (I) all were in the younger age groups; (II) all developed respiratory symptoms within 48 hours of admission to hospital; (III) most had multiple limb fractures; (IV) more than half had been transferred from other hospitals; and (V) three were pregnant and had sustained in comparison with the others, less severe long bone injuries.

The construction and validation of a brief instrument for assessing social support in the elderly is described. The Index of Social Support (ISS) has nine items and provides separate measures of a person's perceived availability of support and his or her satisfaction with it. The two scales are shown to have high internal consistencies (coefficient alphas of 0.84 and 0.81) and the score totals discriminated significantly between non-depressed elderly people and elderly people who had suffered a recent onset of depression. Principal components analysis showed that the perceived availability of support subscale provides a single factor accounting for 41% of the variance. Item analysis suggested that perceived availability of friends and good neighbours discriminated better between non-depressed and depressed subjects than items based on feelings of family belongingness or having available someone with whom one could talk frankly.

The properties of four global ratings of life stress were investigated using data from 237 elderly subjects interviewed using the Brown & Harris life event and difficulties schedule. The global ratings had high one-year test-retest reliability and inter-rater reliability agreement. A summary measure of Adversity (based on contextual rating of all events and difficulties) may be reliably derived when a single index of life stress is desired. In the elderly sample Adversity was more closely related to chronic difficulties than to life-events.