Management of obstetric emergencies and trauma (MOET): regional questionnaire survey of obstetric practice among career obstetricians in the United Kingdom.

Across specialties in the UK concern exists that the shortened training time, combined with the restriction on hours of work, will result in trainees being short of the necessary depth and breadth of experience for independent practice at the end of their defined training period. In terms of risk management, it is recognised that high reliability organisations anticipate the worst and equip themselves to deal with it at all levels in the organisation. Alternative methods of assessment and training need to be utilised, including models and scenario teaching.

A comparison of bilateral vs. unilateral total knee arthroplasty mobilised using a flexion regime.

Fifty six consecutive, primary simultaneous bilateral total knee arthroplasties were prospectively compared to 172 consecutive, primary unilateral total knee arthroplasties. Outcome measures included length of stay, analgesic and blood requirement as well as range of movement and functional scores. All procedures were performed by a single surgeon using a uniform technique, including a postoperative flexion regime.

Hypophosphatemia following self-treatment for anorexia nervosa.

Unlabelled: Hypophosphatemia is recognized as a serious complication of hospital treatment for patients with anorexia nervosa but may also occur prior to medical intervention.

Method: This paper reports a case of severe hypophosphatemia in a patient who consumed large quantities of carbohydrates following a period of dietary restraint.

Discussion: The possible mechanisms underlying the hypophosphatemia in this case are discussed and its management is described.

Multiple cutaneous plasmacytomas following an autologous peripheral stem cell transplant.

We describe the unusual development of multiple cutaneous plasmacytomas following treatment of IgA lambda myeloma with myeloablative therapy and a peripheral blood stem cell autograft. Cutaneous metastatic spread was evident despite bone marrow remission. Treatment with an autograft may have contributed to the cutaneous relapse.

The importance of providing good patient information.

Having recognised the importance of looking at health care provision from the patient's perspective, a district general hospital's acute pain service revised its policy on providing patient information by involving patients in the development process. The service went on to achieve the Government's mark of excellence in public service, the Charter Mark.

Spontaneous sequence duplication within an open reading frame of the pneumococcal type 3 capsule locus causes high-frequency phase variation.

The molecular genetic basis of high-frequency serotype 3 capsule phase variation in Streptococcus pneumoniae (the pneumococcus) was investigated. Pneumococci were grown in sorbarod biofilms at 34 degrees C to mimic nasopharyngeal carriage. Different type 3 pneumococci commonly associated with invasive disease generated apparently random tandem duplications of 11-239 bp segments within the cap3A gene of the type 3 capsule locus.

Diarrhea and gallbladder hydrops in an immunocompetent child with Cryptosporidium infection.

We report a case of an immunocompetent child who developed gallbladder hydrops during a concurrent diarrheal illness caused by Cryptosporidium parvum. Hepatobiliary disease and chronic cryptosporidial diarrhea is an accepted association in adults with HIV infection but has only once previously been reported in a child, also with HIV.

Flexion vs. extension: a comparison of post-operative total knee arthroplasty mobilisation regimes.

We report a prospective trial comparing the effectiveness of a post-operative flexion regime versus a standard extension regime on the early outcome of total knee arthroplasty. A total of 160 knees were allocated to two separate post-operative mobilisation regimes: a static flexion regime or an active extension regime. Patients were implanted with either an IBII or 913 total knee replacement systems.

Atypical lipoma of the tongue.

We report an atypical lipoma arising in the tongue of a 43-year-old man who presented with an indolent dorsal lingual swelling. Atypical lipomas contain multivacoulated lipoblasts, which distinguishes them from benign lipomas. The superficial location in this case distinguishes this tumour from well-differentiated liposarcoma, which is biologically similar in lacking the propensity for metastasis.

What, when and how to back up your data.

This article defines and describes the process of backing up data files, which should be undertaken by anyone who routinely uses a computer. The important points to be considered when developing a backup strategy are explained and a résumé given of the backup devices currently available.

An evaluation of the reproducibility of landmark identification using scanned cephalometric images.

Objective: A method of cephalometric analysis is described in which cephalometric x-rays were scanned using a flat-bed scanner and transparency hood. Then the image was displayed on a computer monitor for point identification and subsequent cephalometric analysis using dedicated software. The reproducibility of point identification using this method was compared with two other, commonly used, methods.

A straightforward method of assessing the accuracy of implantation of knee prostheses.

Accurate component placement in knee replacement surgery is important. The precision with which the implants are placed directly affects patient outcome as implant position and alignment influence stability, durability and patellar tracking. The ability to measure the accuracy of implantation of knee replacement components is valuable in assessing not only ones own technique but also in evaluating new instruments or implants and in teaching.

Anticoagulant therapy and referral form. Haemostasis and Thrombosis Task Force of the British Committee for Standards in Haematology.

Many hospitals use the recommendations contained in the British Committee for Standards in Haematology anticoagulant guideline documents to develop local protocols for anticoagulant management. A combined anticoagulant treatment chart and referral form has been produced to help incorporate the recently updated recommendations for oral anticoagulation into day-to-day practice.

Treatment of a patient with a deep leg ulcer using Biatain Adhesive.

This article looks at the use of Biatain Adhesive, a new foam dressing from Coloplast which is manufactured by incorporating 3D polymer structures within the central pad. It is now available on the Drug Tariff. The article discusses the treatment of exuding wounds and highlights the benefits of Biatain Adhesive by focusing on the case of an 84-year-old woman who had a history of long-standing leg ulcers where previous dressings had failed to promote healing.

Circumcision using bipolar diathermy scissors: a simple, safe and acceptable new technique.

Background: Circumcision may be performed by a variety of techniques. Postoperative haemorrhage is a recognised complication of the procedure.

Method: A method of circumcision using bipolar diathermy scissors is described.

A new inherited interstitial deletion of the distal long arm of chromosome 4.

A 12-year-old boy showed mild dysmorphic features, late presentation of learning difficulties and behaviour problems, obesity, breast hypertrophy and bilateral slipped capital femoral epiphysis. His mother also has mild dysmorphic features, obesity, and a similar history of late presentation of learning difficulties and behaviour problems. Cytogenetic analysis demonstrated an inherited distal long arm deletion of one chromosome 4.

The Falconª Eccentric Coronary Balloon Angioplasty Catheter: A Randomized Safety and Efficacy Study.

Percutaneous coronary angioplasty (PTCA) is usually performed using concentric shaped balloon catheters with the guidewire passing through the center of the shaft. The Falconª balloon catheter features a guide wire lumen on the outside of the balloon so that an eccentric balloon catheter profile is obtained concentrating the dilating force on the wire supported side, allowing lower inflation pressures and potentially causing less vessel injury. The aim of this study was to evaluate the safety and efficacy of this new balloon catheter in patients with stable and unstable angina.

Basic computing for dental practitioners: 5. Practice management systems.

This article examines the specialist software that is commercially available to assist the running of a dental practice. Generically termed 'practice management systems' (PMSs), these programs are designed to help perform many of the clerical, administrative and accounting tasks traditionally carried out manually, in a shorter time and with greater accuracy. PMSs have benefited considerably from advances in computer technology, particularly the increased speed of processors and graphic displays, to the point that they have become a viable alternative to an appointments diary and clinical records.