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Purpose: The management of geriatric femoral neck fractures, which includes options like hemiarthroplasty (HA), total hip arthroplasty (THA), and fixation, exhibits regional and healthcare setting variations. However, there is a lack of information on global variations in practice patterns and surgical decision factors for this injury. Methods: Survey data were collected from April 2020 to June 2023 via Orthobullets Case Studies, a global clinical case collaboration platform hosted on a prominent orthopedic educational website. Collaboratively developed standardized polls, based on the best available evidence and a comprehensive, peer-reviewed, evidence-based item list, were used to capture surgeons' treatment preferences worldwide. Subsequent analyses explored preferences within subspecialties and practice settings. Multivariable regression analysis identified associations between subspecialty, practice type, the likelihood of choosing THA, and the preferred femoral fixation method. Results: Our study encompassed 2595 respondents from 76 countries. Notably, 51.5% of participants (n = 1328; 51.5%, 95% CI 49.6–53.4%) leaned towards THA and 44.9% for HA, while 3.6% favoured surgical fixation. Respondents affiliated with academic institutions and large non-university-affiliated hospitals were 1.74 times more likely to favour THA, and arthroplasty specialists exhibited a 1.77-fold preference for THA. There was a 19-fold variation for cemented femoral fixation between the United Kingdom (UK) and USA with the UK favouring cemented fixation. Conclusion: Our study reveals a significant shift towards THA preference for managing geriatric femoral neck fractures, influenced by subspecialty and practice settings. We also observed a pronounced predominance of cement fixation in specific geographic locations. These findings highlight the evolving fracture management landscape, emphasizing the need for standardization and comprehensive understanding across diverse healthcare settings. [ABSTRACT FROM AUTHOR]

Infection with SARS-CoV-2 may trigger a delayed hyperinflammatory illness in children called paediatric multisystem inflammatory syndrome temporally associated with COVID-19 (PIMS-TS). A similar syndrome is increasingly recognised in adults termed multisystem inflammatory syndrome in adults (MIS-A) and may present acutely to medical or surgical specialties with severe symptoms, such as acute abdominal pain or cardiogenic shock. No national guidelines exist in the UK for the management of MIS-A and there is limited evidence to guide treatment plans. We undertook a national Delphi process to elicit opinions from experts in hyperinflammation about the diagnosis and management of MIS-A with the dual aim of improving recognition and producing a management guideline. Colleagues in paediatrics successfully initiated a national consensus management document that facilitated regional multidisciplinary referral and follow-up pathways for children with PIMS-TS, and we propose a similar system be developed for adult patients across the UK. This would facilitate better recognition and treatment of MIS-A across the multiple specialties to which it may present as well as enable follow-up with specialty services post-discharge. [ABSTRACT FROM AUTHOR]

Over the last 20 years, surgical training in the United Kingdom (UK) has changed dramatically. There have been considerable efforts towards creating a programme that delivers the highest standard of training while maintaining patient safety. However, the journey to improve the quality of training has faced several hurdles and challenges. Recruitment processes, junior doctor contracts, flexible working hours and equality and diversity have all been under the spotlight in recent times. These issues, alongside the extended surgical team and the increasingly recognised importance of trainee wellbeing, mean that postgraduate surgical training is extremely topical. Alongside this, as technology has evolved, this has been incorporated into all aspects of training, from recruitment to simulated training opportunities and postgraduate examinations. The coronavirus (COVID-19) pandemic has brought technology and simulation to the forefront in an attempt to compensate for reduced operative exposure and experience, and has transformed the way that we learn and work. In this article, we reflect on the UK surgical trainee experience and discuss areas of success as well as highlighting potential areas for improvement going forward. [ABSTRACT FROM AUTHOR]

Spinal surgery is an interface subspeciality that has developed from two independent specialities: orthopaedics and neurosurgery. As the subspeciality has developed, so has the need for dedicated post-certification training. In this review we discuss the history of UK training, explain the current routes to become a spinal surgeon, including fellowships and the qualifications required for a consultant spine surgeon post. We also discuss how we expect fellowships to change and become accredited, as spinal training evolves and continues to employ contemporary educational evidence. [ABSTRACT FROM AUTHOR]

Background: In March 2020 NHS England issued guidelines recognizing the elective component of cancer surgeries may be 'curtailed', due to staffing and supply shortages during the COVID-19 pandemic. However, it suggested, 'local solutions' should be sought in order to protect the delivery of cancer services. We aimed to compare surgeons' practice for the provision of colorectal (CR) cancer surgery across the United Kingdom (UK), against updated Joint Royal Colleges & ACPGBI guidelines and highlight differences in practice, if any.Method: An online survey was conducted. It examined surgical practice across the UK against current protocols for CR cancer surgeries, during the COVID-19 pandemic.Results: 29 individual responses were received from 23 NHS Trusts across the UK. 23/29 (79%) surgeons ceased or experienced delays in their CR cancer surgeries during the pandemic, with 3/29 (10%) yet to reintroduce these services. 19/26 (73%) surgeons instructed their patients to self-isolate prior to surgery, of which 5/19 (26%) correctly enforced a duration of 14 days. 10/19 (53%) participants adhered to guidelines of performing a CT chest within 24 h of surgery. 10/26 (38%) participants believe their patients are experiencing longer hospital admissions in the COVID-19 setting.Conclusion: This snap shot survey highlights the dramatic variations in CR cancer surgery practice within the UK and inconsistent adherence to protocols. Guidelines will no doubt change as our knowledge of COVID-19 increases both nationally and internationally. It is essential CR surgeons keep up to date with changes in guidance, so uniformity in practice can be maintained. [ABSTRACT FROM AUTHOR]

Introduction: Major Trauma Centres (MTCs) should ideally have all key surgical specialities on site. This may not always be the case since trauma is only one factor influencing speciality location. The implications of this can only be understood when the demands on specific specialities are established and this is not well documented. We investigated surgical speciality demand by quantifying the frequency and urgency of surgical trauma interventions. Patients and methods: Data on adult trauma admissions for a UK MTC were retrieved from the UK Trauma Audit and Research Network for a 2-year period and analysed to establish the frequency and urgency of surgical interventions. Results: Of 1285 trauma patients with an ISS > 15 presenting in the study year period 713 (55.5%) required surgery. Neurosurgical (59.9%) and orthopaedic (55.1%) operations were most frequent. Cardiothoracic, general surgery, plastic surgery and maxillofacial operations were required infrequently. General surgery was commonly needed urgently, 45% within 4 h of MTC arrival. Urgency was also common in interventional radiology and vascular surgery. Cardiothoracic interventions were mainly urgent interventions (thoracotomy 1/3) and less urgent (rib fixation 2/3). Discussion: Neurosurgery and orthopaedic surgery are key on-site trauma specialities and required frequently. General surgery, interventional radiology and cardiothoracic interventions are required less frequently but often urgently. This confirms a need for MTC on-site capability and possibly training to maintain competency in occasional trauma operators, particularly in general surgery. Maxillofacial surgery, ENT and urology are required neither frequently nor urgently and on-site presence may be less critical. Conclusion: Demand for specific surgical specialities was reported in a cohort of UK trauma patients. This confirmed the need for rapid on-site capability in key specialities and highlights possible training requirements for occasional trauma operators in specialities with low frequency but high urgency. [ABSTRACT FROM AUTHOR]

Background: Evidence that Enhanced Recovery After Thoracic Surgery (ERAS) improves clinical outcomes is growing. Following the recent publications of the international ERAS guidelines in Thoracic surgery, the aim of this audit was to capture variation and perceived difficulties to ERAS implementation, thus helping its development at a national level.Methods: We designed an anonymous online survey and distributed it via email to all 36 centres that perform lung lobectomy surgery in the UK and Ireland. It included 38 closed, open and multiple-choice questions on the core elements of ERAS and took an average of 10 min to complete.Results: Eighty-two healthcare professionals from 34 out of 36 centres completed the survey; majority were completed by consultant thoracic surgeons (57%). Smoking cessation support varied and only 37% of individuals implemented the recommended period for fluid fasting; 59% screen patients for malnutrition and 60% do not give preoperative carbohydrate loading. The compliance with nerve sparing techniques when a thoracotomy is performed was poor (22%). 66% of respondents apply suction on intercostal drains and although 91% refer all lobectomies for physiotherapeutic assessment, the physiotherapy adjuncts varied across centres. Perceived barriers to implementation were staffing levels, lack of teamwork/consistency, limited resources over weekend and the reduced access to smoking cessation services.Conclusion: Centres across the UK are working to develop the ERAS pathway. This survey aids this process by providing insight into "real life" ERAS, increasing exposure of staff to the ESTS- ERAS recommendations and identifying barriers to implementation. [ABSTRACT FROM AUTHOR]

NHS Resolution provides indemnity cover for legal claims against the NHS, assists the NHS with risk management and aims to share lessons from claims in order to improve safety. The study aimed to investigate the financial costs of litigation against English Health Trusts in otolaryngology over a 10-year period, to see if any lessons have been learned and identify trends that may lead to a potential reduction in costs and improve patient safety. A Freedom of Information request was made to NHS Resolution for information regarding claims made to otolaryngology departments over the last 10 years. There was a total of 612 successful claims in the 10-year period between 2008/2009 and 2017/2018 with costs of nearly £87 million. Overall, the costs of litigation have increased dramatically, and the main areas for these successful claims can be identified, but restrictions in the detail of information released allows too little insight for improvements to be made to avoid them in future. This continues to be a major problem for healthcare funding and practice. [ABSTRACT FROM AUTHOR]

In 2007, the first trainee-led surgical research network was founded in the United Kingdom (UK). The West Midlands Research Collaborative was started by a group of enthusiastic adult surgical trainees who saw the benefits of altruistic collaboration to generate high quality, multicenter research. Seeing the success of their research projects, including randomized controlled trials, trainees in other regions and specialties were spurred on to founding their own research collaboratives. The Pediatric Surgical Trainee Research Network was started in 2011 by a group of UK trainees with the aim to promote, facilitate, and encourage trainee-led research in pediatric surgery. This article summarizes the history and evolution of the trainee collaborative surgical research. It examines the challenges which multicenter research entails and the steps the collaboratives have taken to overcome them. We describe some of the projects which have been successfully completed and the benefits that the trainee networks have for patients and surgeons alike. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess the routine surgical practices of consultant gynaecological oncologists (CGOs) in the United Kingdom in their management of primary advanced (FIGO stages III and IV) epithelial ovarian cancer (PAEOC). Methods: The same anonymised questionnaire was sent twice to all consultant gynaecological oncologists (CGOs) working in the UK. The questions enquired about surgical practice of the previous calendar year and the respondents were asked to describe their usual or typical management of patients with PAEOC. Results: 45 of 85 CGOs responded (53%). The mean number of ovarian cancer cases operated on by an individual surgeon was 47 (range 6–100). 6% of the surgeons never perform pelvic lymphadenectomy, and 22% of the surgeons never perform para-aortic lymphadenectomy in the primary surgery (PS) group, compared to 8% and 30% in the neoadjuvant chemotherapy (NAC) group. In the PS group 17% of the respondents perform pelvic lymphadenectomy routinely (80% or more of patients) compared to 11% of the respondents in the NAC group. The rates of bowel surgery and surgery for upper abdominal disease were highly variable. The average operating time per case was less than 3h in 78% of the respondents. Conclusions: The mean operating times, caseload, and types of procedure undertaken in the management of advanced ovarian cancer provide compelling evidence that in many UK cancer centres the surgical goal has not been complete cytoreduction. These data have implications for the centralisation of surgical services, subspecialty training, and the lower survival of UK patients compared to other comparable countries. [Copyright &y& Elsevier]

The article discusses the importance of the optimization of the red blood cell transfusion therapy. It mentions that according to a data analytical study by a group of scientist in Great Britain, there has been vast decline in use of the transfusion therapies for surgery. It also mentions that overuse and wastage of the blood during transfusion should be avoided and delayed administration of blood during life saving events should not be promoted.

Study Type - Therapy (outcomes research) Level of Evidence 2b What's known on the subject? and What does the study add? The use of funnel plots has helped to overcome the limitations and risks of ranking surgical performance. The case for a more widespread application of funnel plots in assessing and reporting performance in surgery has been made. No study has previously published a funnel plot analysis of outcomes for radical cystectomy in England. No Trust, using the final complex model for risk-adjustment, can be confidently said to have a performance worse than the national average for both mortality and re-intervention rates following radical cystectomy. Funnel plots act as a complementary method of validating volume-outcome data by displaying disaggregated outcomes at a provider level and reduce the opportunity for spurious labelling of outliers. OBJECTIVE • To explore whether risk-adjusted funnel plots are a useful adjunct to analyse volume-outcome data and to further facilitate our understanding of institutional performance data by combining funnel-plot methodology with an incremental statistical modelling approach. PATIENTS AND METHODS • Risk-adjusted funnel plots were generated for mortality and re-intervention rates after elective radical cystectomy using administrative data from NHS Hospital Trusts between 2000/01 and 2006/07. Trusts were divided into volume tertiles based on their average annual cystectomy rate. • A funnel plot was produced for each of the following four incremental statistical models: model one (no adjustment), model two (adjusted for patient case mix variables), model three (case mix and 'clustering' of patients) and model four (additional adjustment for institutional structural and process-of-care variables). RESULTS • In the final complex model (model four), no Trusts had abnormally high mortality or re-intervention rates. • Comparison of the funnel plots showed the importance of adjusting for certain confounding factors, such as the surgeon, at the institutional level, before they could be labelled as having truly outlying performance. CONCLUSION • Risk-adjusted funnel plots have a useful role to play as a component of a methodological framework for investigating the volume-outcome relationship at the institutional level. They can act as a complementary method of validating data by displaying disaggregated outcomes at provider level and account for unmeasured confounders, so reducing the opportunity for spurious labelling of outliers. [ABSTRACT FROM AUTHOR]

The author reflects on the Never Events cases in the field of health care and on the Never Events Framework of the National Patient Safety Agency (NPSA). The author explores Never Events reported by NPSA including surgery in wrong locations, in-hospital maternal death, and improper administration of chemotherapy. The author believes that the principle of the framework of NPSA is that if institutions or responsible persons are aware and respond to published guidance, never events would not occur.

The article focuses on the UK Consensus guideline on the treatment for renal cell carcinoma (RCC) to be able to establish the best medical practice and to improve the standard of care for RCC patients in Great Britain. The survey reveals that the reimbursement and cultural differences between countries can affect the national guidance. The bodies producing the guideline reveals on observation as the recommended standard of care after surgery for RCC patients. The use of adjuvant therapy for patients with intermediate or high risk of relapse needs to be referred to a center that offers the medical service.

The article focuses on the efficiency of administering supplemental fluid for colorectal surgery in Great Britain. The meta analysis of randomized controlled trials (RCTs) is used to determine whether the perioperative fluid therapy is effective for patient's recovery after surgery. However, the use of fluid therapy may cause the prolong recovery of bowel function and impair wound healing when used excessively.

Purpose: To study the practice of dacryocystorhinostomy (DCR) surgery by ophthalmologists in the United Kingdom (UK) looking at the evaluation techniques used, surgical variations, and follow-up management of DCR cases. Methods: A mail-shot questionnaire was designed and distributed to every UK consultant ophthalmologist on the specialist register held by the Royal College of Ophthalmologists. The questionnaire consisted of eight questions and an image of a typical DCR candidate so respondents could illustrate details of their surgical incision. The data received was entered into a database and analyzed with the SPSS statistical package. The variation in incisions was divided into various sub-types and quantified accordingly. The chi-square test and analysis of variance (ANOVA) were used to calculate significance, which was set at p < 0.05. Results: A response rate of over 75% was achieved amongst the 800 questionnaires dispatched, almost one-third of which perform DCR surgery. Of these, almost 50% were non-lacrimal specialists. The majority never use the endonasal approach, with 59% never performing preoperative nasal endoscopy. Most respondents use a standard incision 10-15 mm long with routine silicone intubation. Lacrimal specialists tended to remove tubes earlier (week 4 to 8) and suture posterior flaps more often than non-specialists. Significant differences in practice were found between lacrimal and non-lacrimal specialists in most parameters, in addition to differences between members and non-members of the National Oculoplastic Surgery Society. Conclusions: A minimum of 200 DCR surgeons are practicing in the UK where almost 50% are non-lacrimal specialists. Marked variations exist in the perioperative DCR practice. [ABSTRACT FROM AUTHOR]

This article offers an overview about the Quality and Outcomes Framework (QOF). QOF is a voluntary annual reward and incentive program for all general practitioner (GP) surgeries in Great Britain, detailing practice achievement results. It is not about performance management, but about resourcing and rewarding good practice. Part of the 2004 GMS Contract, it was revised in April 2006 for 2006-2007, and is due for a further overhaul in 2008, once the current payment round is over.

In modern anaesthesia practice, regional techniques are preferred to general anaesthesia for many types of surgery, particularly in obstetric care. Improved outcomes have been recorded in UK practice, but the techniques remain underutilised in many parts of the world. With encouragement, training and a regular supply of appropriate needles and local anaesthetic agents, the advantages of regional techniques in the developing world could be realised. [ABSTRACT FROM AUTHOR]

Background--In November 2005, the world's first partial facial transplantation positioned this treatment at the forefront in the development of facial reconstructive techniques. Objective--Because the procedure is dependent on donation of facial tissue, we sought to understand the attitudes and beliefs of the general public and transplant professionals toward this treatment. Methods--This research reports the results of a survey of 170 transplant professionals sampled by means of a questionnaire generated by a focus group of transplant coordinators. Results--We found a high level of support for facial transplantation, with 76% of respondents in favor and none opposed to the procedure in principle. There was a significant association between knowing someone with a disfiguring condition and being in favor of facial transplantation. Areas of concern to this group can be summarized as factors that affect organ retrieval and the impact on the retrieval team and the donor family. Conclusions--Consistency in ranking of item importance provides the basis for development of relevant education materials, team liaison, and care pathways. These findings also validate the use of focus groups in sampling issues of concern to relevant groups as facial transplantation takes its place as a reconstructive option. [ABSTRACT FROM AUTHOR]

Background: Several studies have shown a relationship between surgeon volume and outcomes in colorectal cancer surgery. The aim of this study was to determine the impact of surgeon volume and specialization on primary tumour resection rate, restoration of bowel continuity following rectal cancer resection, anastomotic leakage and perioperative mortality. Methods: The Northern Region Colorectal Cancer Audit Group conducts a population-based audit of patients with colorectal cancer managed by surgeons. This study examined 8219 patients treated between 1998 and 2002. Outcomes were modelled using multivariate logistic regression analysis. Results: Tumour resection was performed in 6949 (93.8 per cent) of 7411 patients. High-volume surgeons with an annual caseload of at least 18.5 (odds ratio (OR) 1.53 (95 per cent confidence interval (c.i.) 1.10 to 2.12); P=0-012) and colorectal specialists (OR 1.42 (95 percent c.i. 1.06 to 1-90); P = 0.018) were more likely to perform elective sphincter-saving rectal surgery. In elective surgery, the risk of perioperative death was lower for high-volume surgeons (OR 0.58 (95 per cent c.i. 0.44 to 0.76); P < 0.001), but this was not the case in emergency surgery. Conclusion: High-volume surgeons had lower perioperative mortality rates for elective surgery, and were more likely to use restorative rectal procedures. [ABSTRACT FROM AUTHOR]

Carotid endarterectomy (CEA) is a proven treatment in the prevention of stroke, but its overall effectiveness is reduced by excessive delays from symptom to surgery. Specifically, delaying surgery in symptomatic patients with 50-99% NASCET stenoses (70-99% ECST) for >12 weeks prevents only eight strokes per 1000 CEAs in the long term. This is a very depressing observation as the 2004 Sentinel Audit observed that only 50% of stroke patients in the UK will have undergone a Duplex scan by 12 weeks. Excessive delays prior to surgery not only undermine professional confidence in the role of CEA, but they effectively mean that while every patient is exposed to the risks of surgery, many may gain little in the way of long-term stroke prevention. Many of the issues debated in this review will only be resolved by a paradigm shift in political emphasis, but surgeons too have a responsibility to recognise and correct important deficiencies within their own practice. [ABSTRACT FROM AUTHOR]

Background: A readmission is classified as a patient necessitating readmission to hospital due to a post-operative complication following discharge. An overstay however, is classified as a patient having to stay longer than the planned duration in hospital (not having been discharged in the interim) due to a post-operative complication. This study aims to investigate patient-related factors that predispose to readmission or overstay and thus make recommendations to decrease the likelihood of readmission or overstay. Method: In this retrospective study 312 'day-case nasal procedures', were selected from a total cohort of 4274 ENT patients over a 17-month period. This sub-group was investigated for a range of demographic factors including, age, gender and ethnicity with regards to their relationship to readmission rates and overstay frequency and duration. Results: The rates were 2.88% and 9.62% for readmission and overstay respectively. The total number of days spent in hospital as a result of readmission was 27. Epistaxis was the leading cause for readmission/overstay (28.9%) followed by high levels of post-operative pain preventing them from being discharged (23.7%). All procedures in this study had readmission rates that were below those recommended in the guidelines set by the Royal College of Surgeons of England. Women overstayed significantly longer (t = 1.65, p < 0.05) than men. Conclusions: Suitable candidates for day-case ENT surgery highlighted by this study include healthy individuals between the ages of 20 and 60. Operating in the morning would increase the immediate post-operative recovery time, which may reduce the numbers of patients who complain of high levels of pain at the time of discharge. Procedures such as septorhinoplasty being performed routinely in the ambulatory setting require additional research into more effective methods of pain control. Standards need to be improved so that the causes of overstay and readmission are clearly identifiable in patient records. [ABSTRACT FROM AUTHOR]

Surgery in the United Kingdom has been practiced for nearly 2000 years. It has evolved as a result of the experiences of warfare and the introduction of the scientific basis of surgery. The influence of the 4 surgical royal colleges in setting standards for training and examinations has ensured that new surgeons are equipped for independent practice as consultants. Responsibility for the National Health Service rests with the government, which determines the number of trainee surgeons in the various surgical specialties. Conflicts between service provision and training are highlighted, as are the pressures on academic institutions to meet the demands of clinical surgery. The government's National Health Service plan for England promises a major expansion in undergraduate places and an increase of 7500 consultants in all specialties by 2004. Time will tell if these changes lead to an improvement in surgical services and a reduction in waiting times. [ABSTRACT FROM AUTHOR]

Background: In 1997 a set of 53 clinical indicators developed by the Royal Australasian College of Surgeons (RACS) and the Australian Council on Healthcare Standards (ACHS) Care Evaluation Programme (CEP), was introduced into the ACHS Evaluation and Quality Improvement Programme (EQuIP). The clinical indicators covered 20 different conditions or procedures for eight specialty groups and were designed to act as flags to possible problems in surgical care. Methods: The development process took several years and included a literature review, field testing, and revision of the indicators prior to approval by the College council. In their first year 155 health-care organizations (HCO) addressed the indicators and this rose to 210 in 1998. Data were received from all states and both public and private facilities. Results: The collected data for 1997 and 1998 for some of the indicators revealed rates which were comparable with those reported in the international literature. For example, the rates of bile duct injury in laparoscopic cholecystectomy were 0.7 and 0.53%, respectively; the mortality rates for coronary artery graft surgery were 2.5 and 2.1%, respectively; the mortality rates after elective abdominal aortic aneurysm repair were 2.5 and 3.7%, respectively; and the post-tonsillectomy reactionary haemorrhage rates were 0.9 and 1.3%, respectively. Results for some indicators differed appreciably from other reports, flagging the need for further investigation; for example, the negative histology rates for appendectomy in children were 18.6 and 21.2%, respectively, and the rates for completeness of excision of malignant skin tumours were 90.7 and 90%, respectively. The significance of these figures, however, depends upon validation of the data and their reliability and reproducibility. Because reliability can be finally determined only at the hospital level they are of limited value for broader comparison. Conclusion: The process of review established for the... [ABSTRACT FROM AUTHOR]

ObjectiveTo report the career intentions one year after qualification of doctors who qualified in the United Kingdom (UK) in 1996, and to compare their intentions with those of 1993 qualifiers at the same stage. DesignPostal questionnaires. SettingUnited Kingdom. SubjectsAll doctors who qualified in the UK in 1996. Main outcome measuresChoices of eventual career expressed one year after qualifying. ResultsWe report on detailed choices of long-term careers for all specialties. Only 20% of 1996 respondents chose general practice compared with 25·8% of 1993 respondents. The percentage choosing general practice fell more sharply among women, from 34·0% to 25·2%, than among men, from 17·5% to 14·1%. Choices for surgical specialties rose from 16·9% of 1993 respondents to 21·4% of 1996 respondents. The percentage choosing the surgical specialties rose among women, from 7·8% to 11·6%, compared with a rise among men from 26·1% to 32·2%. The percentage of respondents who definitely or probably intended to pursue a long-term career in the UK was 77·7% compared with 75·7% of 1993 respondents. Most of the home-based respondents who had doubts about practising in the United Kingdom were considering practising abroad. Only 1% made an explicit first choice for a non-medical career. However, in all, 9·4% said that there was a possibility that they might leave medicine. ConclusionThe substantial decline in intentions to enter general practice among newly qualified doctors, seen in the 1993 qualifiers, is continued in the 1996 qualifiers. A shortfall in recruitment of UK-trained doctors to general practice is the likely outcome. The rise in choices for the surgical specialties, particularly among women, may herald a renewed interest in hospital specialist training following the Calman changes. It is worrying that almost a quarter of respondents indicated some doubts about pursuing a medical career in the UK. [ABSTRACT FROM AUTHOR]

Focuses on the surgical workload of hospital doctors in Great Britain. Formulation of plans for undergraduate and postgraduate teaching; Efficacy of surgical staffing changes on the number of operations; Establishment of guide for surgical trainee.

Looks at the results from the Lothian Surgical Audit (LSA) done by general surgeons in Lothian, United Kingdom, which have been a central component for National Health Service (NHS) reforms. The data from LSA used by the Science and Technology Committee of the House of Commons for a report on minimal access surgery; How LSA has been instrumental in changing general surgical practice in the Lothian region; Background; Examples of changed surgical practice; Discussion.

Discusses the abstracts of various studies presented during the 1998 Symposium of Audit on Surgical Practice in Great Britain. Clinical and radiological follow-up study of total meniscectomy in adolescence; Training in carotid endarterectomy; Model for arthroplasty audit in a district general hospital.

Introduction Over the past five years the number of Perioperative medicine for Older People undergoing Surgery (POPS) services in the UK has increased. This expansion has occurred in response to the needs of an older, multimorbid surgical population with drivers for change coming from national reports and audit results. Different models of care have emerged; this study aimed to describe in detail the surgical specialties, components of care and staffing as delivered by current UK POPS services. Methods An electronic ten-question survey was sent to 31 acute NHS trusts, purposively selected from the British Geriatrics Society POPS network and previous survey respondents. Results Responses were received from 23 of 31 trusts (71%) with key results in Table 1. Eighty-three percent of respondents provided a geriatric-consult service, 13% a shared-care model and 4% had ceased their service due to inadequate funding. The surgical specialties covered included; general surgery (18/23), vascular (12/23) and other including urology, trauma, gynaecology (9/23). Team structures varied with 26% of geriatricians working independently and only 23% having dedicated allied health support. Forty-one percent of services were surgically funded, 36% medically funded and 23% from both directorates. No. hospitals Outpatient service Proactive inpatient service Junior doctors POPS nurses >2 specialties covered Consult 19 14/19 12/19 7/19 3/19 5/19 Shared-care 3 3/3 3/3 2/3 3/3 1/3 Conclusions The predominant model of care remains a geriatric-consult service. The evidenced-based ‘shared-care’ model previously only in operation at a large teaching hospital has now been replicated in two smaller hospitals. A previously described model involving patients transitioning from surgical to geriatric medicine teams was not seen in practice in this study. 4 In line with the NHS’ vision of rationalising and scaling innovation, this survey highlights the growing need to establish a standardised POPS model across the UK. [ABSTRACT FROM AUTHOR]

Editorial. Comments on the controversy over the surgical procedures/operation carried out by British nurse Valerie Tomlinson on a patient. Discussion of the terms `operation,' `nurse' and `surgeon'; Hospital's suspension of Tomlinson for operating on a patient; Lessons to be learned from the episode; Need for the medical and nursing professions to examine possibilities for re-stratification.

The article highlights the need for a review in the curriculum as well as in the way of teaching of undergraduate courses running at various medical institutes to cope with the changing surgical practices adopted by the Great Britain National Health Service. It focuses on the advancements procured by the Departments of Surgery and General Practice of the King's College Medical and Dental School in London, England to come up with the challenges.

The article examines the surgical training within the British National Health Service. The author claims that the emergence of innovations to surgery have affected the clinical practice in the service. However, the financial constraints in the training have limited its adoption of innovations. He also claims that the increase in insurance premiums and consumer pressure will likely forced the service to implement quality control upon surgeons.

The author comments on a study which compared the surgical training quality in the U.S. and Great Britain. He highlights the study findings, such as London residents perform more emergency surgery, and that the University of Pennsylvania residents have more elective surgery operating sessions. He then discusses the weaknesses of the study.

The authors comment on a study which explored the differences in surgical training in the health care systems in the U.S. and Great Britain. They describe the surgical training in both countries, including the training duration and pattern. They argue that the study raised more questions on the clinical competency of surgeons from the U.S. and Great Britain.

The article examines the life of Percy Lockhart-Mummery, senior surgeon at Saint Mark's and Northwick Park Hospita in Harrow, Middlesex, England, and his contribution to surgery. A background on the early medical career of Lockhart-Mummery is presented. Among his contributions and achievements are his mastery of abdomino-perineal excision, advocacy for the specialty of coloproctology, founding of the British Empire Cancer Campaign, and his theories of the origin of cancer.

The article offers tips on how general practice (GP) trainees can perform their tasks well in general surgery. It cites the importance of seeing everything in theatre at least once to acquire more insights into what the patients are going through in the community and urges trainees to try to get an idea of their registrar and consultant's timetables early on. It also advises trainees on conducting a ward round, increasing post-operative diet, and doing a per rectum (PR) examination.

The article discusses the possibility of reducing the number of trainees accepted into general surgical training to avoid an oversupply of consultant surgeons, according to the Centre for Workforce Intelligence (CFWI). Topics mentioned include how many trainees Health Education England should keep yearly, the CFWI forecast for surgical training posts by 2029, and the predicted growth of patient demand for general surgery by 2029.

The article focuses on an announcement from Great Britain's Healthcare Commission. In the announcement the commission indicated that surgeons at Papworth Hospital could resume heart transplant surgery. Heart transplant surgery at the hospital had been suspended by the commission until an investigation into a higher than expected mortality rate among heart transplant patients at the hospital was completed. A discussion of the factors which led the commission to allow the continuation of transplants is presented.

Views on the surgical practice in Great Britain. Modification of timely surgical intervention; Management of bleeding peptic ulcers in people aged over 60 years; Fundamental relevance to operator-dependent interventional modalities.

Editorial. Focuses on the changes in surgical training and education in Great Britain. Evolution of ear and nose training (ENT); Regulation of registrar on ENT training; Benefit of the changes in training and education on the medical health.

Provides guidelines on the aid to a safe and healthy surgery in Great Britain. Importance of crime prevention; Elements of the Health and Safety at Work Act of 1974; Details of the Fire Precautions Act of 1971.

Examines the challenges in informed consent in surgical trials in Great Britain. Indications of participants' interest in trials; Concerns on doctor-patient relationship in clinical trials; Assessment on the role physicians to respective patient and vice versa.

The author discusses the influence of the "British Journal of Surgery" (BJS) on the surgical practice in Great Britain as the journal celebrates its 100th anniversary in 2012. He highlights the journal's influence on the management of military injuries and other changes that it brought in surgical practice over 100 years. He also notes how the evolution of surgical journalism placed greater emphasis on meta-analyses, randomized controlled trials, and systematic reviews.

The article offers information about the Independent Practice Committee (IPC) of the Association of Anaesthetists of Great Britain and Ireland (AAGBI). It cites the goals and members of the committee, the number of meetings conducted every year and its representation to the Board of the Federation of Independent Practitioner Organisations. It also explores the achievements made by IPC including the creation of two very useful glossies in the practice of anesthesiology.

The article discusses the developments of various programs for surgical practices. It mentions the efforts being done by The colleges and associations in Great Britain to maintain the training programs and standards of the performances of surgeons. It also announces the plan of the Hospital Authority to decrease the working hours of public doctors. Moreover, it notes the restructuring of training in plastic surgery in Hong Kong.

The article presents a study regarding the contribution of nursing knowledge to the success of day surgery and the increase of surgery undertaken within the United Kingdom Day Surgery Units in Great Britain. The aim of the educational scrutiny was to assess the consideration given to advanced surgical practices. The results of the study are discussed relative to the re-focusing of pre-registration nurse education and modifying clinical roles.