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Has the introduction of a nurse practitioner led to reduced training opportunities for junior surgeons?

Purpose. To compare the outcome after open carpal tunnel decompression by specialists versus a nurse practitioner. Methods. Of 1361 cases of open carpel tunnel decompression under local anaesthesia from 1996 to 2008, 807 were performed by specialists (consultant, specialist registrar, or specialty and associate specialist) and 554 by a nurse practitioner (since May 2006). The 2 groups were compared in terms of surgical time, total theatre time, postoperative pain, and patient satisfaction with the service. Results. The mean surgical time was shorter in cases performed by specialists (13 vs. 18 minutes, pConclusion. Specialists and the nurse practitioner achieved comparable outcome after open carpal tunnel decompression.

T nEN years ago Professor Robert C. Binkley surveyed the first "Ten years of Peace Conference history" for the Journal of modern history (I [1929], 607-29). It was an exhaustive and able analysis and presented a definite theory of historiography. What chiefly impressed Mr. Binkley about early writing on the Peace Conference was the melodramatic clash of personalities and principles. He drew interesting parallels between the earlier writing on the subject of war responsibility and the early writing on the Peace Conference and concluded his essay with the warning: If the historians of the Peace Conference profit by the mistakes as well as by the achievements of those who have given their efforts to the study of the outbreak of the war, the question of responsibilities will be kept in the background until the more prosaic study of procedure and drafting has been accomplished and the environment of the Conference will be thought of in terms of social psychology, not in terms of ethics. Instea(l of delicting heroes and villains, they will trace projects and amendmiients; instead of speaking of idealism and justice, they will speak of public opinion. In this way the problem of the Peace Conference can be kept within the reach of sound historical metlho(l.