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The findings of a comparative study of cost awareness amongst particular groups of health service staff are reported. The study is a repeat of that undertaken in 1987 by Fairbrass and Chaffe. The findings are compared to assess how awareness of the cost of anaesthetic drugs, fluids and disposables has changed as a result of the publicity since 1987. Without prior warning, the study group were asked to estimate the cost of twenty-eight items. The results show that their degree of accuracy remains poor. Overall the tendency was to overestimate costs, whilst a small number of expensive items such as volatile agents were consistently underpriced. The results show that, over the last three years, there has been no significant change in the knowledge of cost awareness. At a time when the effective use of scarce resources is being emphasised, a staff programme of continuing cost awareness training is recommended.

From study of gauze dressings produced by the Paul Hartman firm the authors analyse the approaches to their elaboration. It is shown that the use of industrially sterilized gauze dressing-material creates the condition for fruitful work of the surgeon and ensures economy of the gauze. Concrete problems of the production of modern gauze dressing material by Soviet industry are defined.

An inexpensive and reliable fluid-gas exchange system has been developed for vitreous surgery. The system relies on a fish-tank air pump and was compared with the Grieshaber Air System in several laboratory and operating room situations. No significant differences were found between the two systems. Details of the Davis Ocular Air Pump are provided along with a cost analysis.

In the article are considered the main problems of osteosynthesis development in the Russian Soviet Federative Socialist Republic. The most long-term directions of scientific development works in this area are indicated. There is analyzed provision of treatment-and-prophylactic organizations of the Russian Federation with metal constructions, determined the necessity in metal fixing devices. There are formulated propositions on the organization of production of articles for osteosynthesis and creation of educational and production center for training of traumatologists-orthopaedists in modern methods of operative treatment of fractures.

In the majority of centers, orthotopic liver transplantation at any given time involves a team of four: the surgeon and the first, second, and third assistants. As a result, considerable skilled manpower must be available around the clock. Furthermore, the presence of four surgeons and an instrument nurse creates considerable crowding around the operating table. Although various mechanical devices have been occasionally employed by various teams for the purpose of solving these problems, no single instrument has been reported as truly helpful. During the past year, the Iron Intern, a table-mounted surgical robot that replaces up to two of the human assistants during the liver transplantation recipient operation, has been successfully employed at the University of Pittsburgh. The instrument is easy to use and versatile enough to be satisfactory under any circumstances. We believe this device is a real breakthrough in streamlining orthotopic liver transplantation.

This is the third of a series of papers describing the development of costing models for use in the Clinical Information System (CIS) at the Clayton Campus (formerly the Queen Victoria Medical Centre) of the Monash Medical Centre (MMC) in Melbourne. The first two papers in this series described the costing of diagnostic laboratory services and organ imaging services. This paper describes the development of a model for costing operating theatre procedures.

Clearly, custom OR procedure packs can reduce costs, increase efficiency, and increase productivity. Indirect savings in purchasing, transporting material, inventory, and utilization will dramatically add to the benefits of the custom packs. The saving that has the most positive effect, however, is the time made available to deliver perioperative patient care.

In summary, the goal of lowering operating room costs by reducing the number of persons needed for safe performance of operations is an important stimulus to the improvement and refinement of table-fixed retractor systems. Far more important in my view, however, is the need for a convenient system that can reliably replace extra help in emergency situations when a surgical procedure must be performed under less than optimal conditions. As teachers of surgeons, we should introduce table-fixed retractor systems into training programs so that surgeons can be familiar enough with them to use them effectively when necessary. This will not be accomplished unless table-fixed retractors are simple and convenient to set up and readjust.