The Scottish Royal Colleges: a prospective survey of continuing medical education undertaken by their examiners.

Objective: To measure the amount and nature of Continuing Medical Education (CME) activity undertaken by the examiners of the three Scottish Royal Colleges. The data obtained to be compared with recommendations for formal CME participation published by the medical Royal Colleges and Faculties.

Design: All examiners in active clinical practice prospectively surveyed over a 12 month period by completing a monthly return from a specially designed loose-leaf diary.

Surgery of the rheumatoid elbow.

I suggest that for too long the problem of the rheumatoid elbow, particularly the need for surgical intervention, has been underestimated. Where the latter has been advocated the philosophy has been adopted that synovectomy and debridement with excision of the head of the radius is probably all that is required, or that in the late case excision arthroplasty may yield an adequate result. I suggest that these approaches are no longer tenable.

Identification of a Golgi-associated protein that undergoes mitosis dependent phosphorylation and relocation.

By means of a monoclonal antibody (BH3), we have identified a 57-kD protein (p57) that in interphase is restricted largely to the perinuclear region of the cell. Double label immunofluorescence microscopy suggests localization of p57 to the Golgi complex and associated membranous structures. Protease protection experiments and chemical extractability indicate that p57 is a peripheral membrane protein exposed to the cytoplasm.

[Planning surgical treatment].

The following should be regarded as prerequisites for successful surgical treatment: careful assessment of the local problem and of the patient as a complete individual; a thorough understanding of the biomechanical implications of the disease and of the operations used in its management; a clear definition of the goals of surgery in both the patient's and the surgeon's minds; and very careful planning with regard to the timing and sequence of operations. Other factors of major importance, especially in multijoint reconstructive programmes, are careful patient selection, the early establishment of good doctor/patient rapport, the support of a highly skilled multidisciplinary team of health professionals, and impeccable supervision of the convalescence, especially at the particularly difficult period for the patient following discharge from hospital. Finally, the hospital team must be prepared to offer a permanent service as a readily available advice bureau for family doctors, patients, and their relatives.