The pecking order.

This paper explores the idea that courtesy and respect between health professionals at each stage of the admission process of a patient to hospital would make life much easier and more pleasant for all staff.

A review of the evidence for and against thromboprophylaxis in total hip replacement.

Deep vein thrombosis (DVT) after an unprotected total hip replacement (THR) is common and this review explores the balance between risks and benefits of thrombo-prophylaxis in protecting patients undergoing THR. A literature search for English publications was conducted on Medline & PubMed. Governance bodies and their guidelines were consulted.

Routine spinal immobilization in trauma patients: what are the advantages and disadvantages?

Routine spinal immobilization for trauma patients has become established in developed countries throughout the world. Cervical spinal injury is, however, relatively rare in trauma patients, and immobilization practice was developed largely without firm supporting evidence. In recent years, published evidence has suggested that spinal immobilization may in some cases be harmful.

MEDCAPS--do they work?

The objectives of this paper are to lay out for wider discussion the potential advantages and disadvantages of active military units providing medical care for the local population through ad hoc clinics (MEDCAPS). The literature on this subject has been reviewed and the personal experience of MEDCAPS by the author and other doctors in Helmand Province 2007/8 is presented. Although in the published literature, MEDCAPS are almost universally regarded as being good for relations between the military and civilians, the reality on the ground is that they potentially risk the lives of both staff and patients.

Advanced Cardiac Resuscitation Evaluation (ACRE): a randomised single-blind controlled trial of peer-led vs. expert-led advanced resuscitation training.

Background: Advanced resuscitation skills training is an important and enjoyable part of medical training, but requires small group instruction to ensure active participation of all students. Increases in student numbers have made this increasingly difficult to achieve.

Methods: A single-blind randomised controlled trial of peer-led vs.

Autotransfusion drains in total knee replacement. Are they alternatives to homologous transfusion?

We prospectively randomised 104 consecutive patients undergoing primary cemented total knee arthroplasty into two groups of 52 patients each, with one group to receive a standard suction drain (Redivac) and the other, an autologous transfusion drain (Bellovac). Randomisation was achieved using the software programme MINIM: , which was set to randomly allocate patients to either of the two groups based on their age, sex and body mass index (BMI). All procedures were performed under pneumatic tourniquet.

Retraining: can do, will do? A practical guide to process and pitfalls.

This article reports the lessons learnt from a period of retraining and from discussion with others who have been involved in a similar process. The conclusions are that retraining should only be undertaken once there is full agreement between all parties involved that it is necessary and feasible. There must also be agreement in advance of the criteria which will constitute successful retraining, and the actions which will be taken to ensure the rapid return of the retrainee to the type of practice which is being offered and has been accepted.

A randomised controlled trial comparing two methods of teaching medical students trauma and orthopaedics: traditional lectures versus the "donut round".

Objective: To assess whether a new form of teaching, the 'donut round', is as good at imparting factual knowledge as interactive lectures in both the short-term and the long-term.

Design: Randomised controlled trial.

Setting: University of Oxford Medical School.

Assessment at the end of training--a necessity nuisance.

If the public are to be assured that surgeons are safe, then there must be some form of competence assessment on which a licence to practice is based. However, the assessment and the licence needs to be both appropriate to the training received by the surgeon and to the requirements of the post they propose to take up. The 'key-concept' described in this paper attempts to address this problem.

Selecting the best from the rest.

The current method for selecting surgeons of the future is neither objective nor relevant to present day needs. An assessment is needed which ranks potential trainees according to aptitude, motivation and diligence, all of which is validated. This task should be a core duty for the Royal Colleges of Surgeons working in close co-operation with surgical specialty associations.

Training teachers--changing practice?

A three-day course was designed to improve the skills of those who provide clinical training to medical students. This long-term follow up of past participants shows a sustained improvement to their skills, especially in terms of involving students in their own learning, and giving them positive feedback.

Randomized trial comparing interferential therapy with motorized lumbar traction and massage in the management of low back pain in a primary care setting.

Study Design: A randomized trial designed to compare interferential therapy with motorized lumbar traction and massage management for low back pain in a primary care setting.

Objective: To measure and compare the outcome of interferential therapy and management by motorized lumbar traction and massage.

Summary Of Background Data: Management of low back pain by interferential therapy and motorized lumbar traction and massage is common in Germany.

Effects of a drug overdose in a television drama on presentations to hospital for self poisoning: time series and questionnaire study.

Objectives: To determine whether a serious paracetamol overdose in the medical television drama Casualty altered the incidence and nature of general hospital presentations for deliberate self poisoning.

Design: Interrupted time series analysis of presentations for self poisoning at accident and emergency departments during three week periods before and after the broadcast. Questionnaire responses collected from self poisoning patients during the same periods.

The role of MRI in the diagnosis of occult hip fractures.

Undisplaced fractures of the hip can occasionally be difficult to diagnose on radiographs. We performed MRI scans on 33 patients who had post-traumatic painful hips but negative radiographs. Forty per cent of the patients had sustained a fractured neck of femur, 15 per cent had sustained an intertrochanteric fracture and 11 per cent had sustained other fractures around the hip; in one patient a tumour was demonstrated.

Loss to follow-up matters.

Survival analysis of joint replacement relies on the assumption that surgical procedures in patients lost to follow-up have the same chance of failing as those in patients who continue to be assessed. Our study questions that assumption. During the 16-year follow-up of 2268 patients who had received total hip replacements 142 (6%) were lost to follow-up.

Pain levels after total hip replacement: their use as endpoints for survival analysis.

We have assessed the relative value of various outcome measures after THR, by the analysis of follow-up data from over 2000 patients. They had been reviewed clinically and radiologically six months after operation, at one year, and then every two years, some for 16 years. At each review their pain level, stiffness and opinion of progress were scored and a radiograph taken.

Thromboprophylaxis and death after total hip replacement.

The recommendation that patients having a total hip replacement should receive pharmacological thromboprophylaxis is based on the belief that fatal pulmonary embolism is common, and that prophylaxis will decrease the death rate. To investigate these assumptions we performed a meta-analysis of all studies on hip replacement which included information about death or fatal pulmonary embolism. A total of 130 000 patients was included.