Simple analgesics.

A number of drugs are available that act fairly specifically as "mild" analgesics, although this description by no means implies that their clinical effectiveness is limited to the relief of slight pain and trivial disability. They are effective by mouth and their action is mediated peripherally. Among the possible mechanisms of action, the inhibition of prostaglandin synthesis is currently regarded as most likely to be relevant. Some centrally acting drugs of the narcotic analgesic type, such as codeine and dextropropoxyphene are effective orally; they are usable in the same way as other mild analgesics and may be preferable for some types of pain. Many problems arise in the assessment and comparison of mild analgesics, both experimentally and clinically. Subjective assessments may be made on a pain scale by the patient himself, or by a trained observer. Individual variations are all-important, and the limitations of controlled trials need to be remembered. Alternative drugs and mixtures have little advantage over aspirin, but specific drug tolerance, in the long term, varies from patient to patient. Gastric irritation is most likely to occur with aspirin in the presence of chronic dyspepsia or acute precipitating causes such as alchoholic gastritis. Allergy also occurs in some susceptible individuals. The risk of renal damage with phenacetin is increasingly appreciated, and the possibility of hepatic damage from paracetamol is now recognised. Other side-effects and interactions are summarized in the review, and some notes are given on therapeutic and non-therapeutic use.

Mass spectrometry in anesthesia. Problems in using mass spectrometer for monitoring anesthetic gases and vapours.

The use of mass spectrometers for total gas monitoring during anesthesia presents a number of problems which stem from the Cracking Pattern of the gases present, inlet design, viscosity variations, water vapour and machine deterioration. Some of these have been adequately solved, by making mechanical modifications to the inlet system, and by using more complex electronic circuitry to process the signals obtained. Remaining problems, however, still limit accuracy and ease of operation. CO2 measurements are particularly prone to error, especially when sampling halothane-containing gas which leads to significant internal production CO2. A study of the principal sources of error remaining in the machine suggests that the only definitive solution is to develop a microprocessor system which could cope with complex Cracking Patterns and non-linearities, and which would allow complete automation of the calibration procedure.

Career preferences of doctors who qualified in the United Kingdom in 1993 compared with those of doctors qualifying in 1974, 1977, 1980, and 1983.

OBJECTIVE: To report the career preferences of doctors who qualified in the United Kingdom in 1993 and to compare their choices with those of earlier cohorts of qualifiers. DESIGN: Postal questionnaires with structured questions, including questions about choice of future long term career, were sent to doctors a year after qualification. SETTING: United Kingdom. SUBJECTS: All medical qualifiers of 1993, comparing their replies with those from earlier studies of the qualifiers of 1974, 1977, 1980, and 1983. MAIN OUTCOME MEASURES: Choice of future long term career and certainty of choice expressed at the end of the first year after qualification. RESULTS: Questionnaires were sent to 3657 doctors. 2621 (71.7%) replied. Of the 2621 respondents, 70.5% (1849) stated that their first preference was for a career in hospital practice, 25.8% (677) specified general practice, 1.0% (25) specified public health medicine or community health, 1.4% (36) specified careers outside medicine, and 1.3% (34) did not state a choice. By contrast, 44.7% (1416/3168) of the doctors in the 1983 cohort had specified that their first preference was general practice. Among the 1993 qualifiers, general practice was the first career choice of 17.5% of men (227/1297) and 34.0% of women (450/1324). Only 7.4% of men (96/1297) stated that they definitely wanted to enter general practice. Only 7.8% (103/1324) of women qualifiers in 1993 expressed a career preference for surgical specialties. Within hospital practice, comparing 1993 with 1983, choices for the medical specialties and for accident and emergency medicine rose and those for pathology fell. Women were less definite than men about their choice of future long term career. CONCLUSIONS: If the 1993 cohort is typical of the current generation of young doctors, there has been a substantial shift away from general practice as a career choice expressed at the end of the preregistration year. General practice was much more popular among women than men. Few women opted for surgery. The sex imbalance in the percentage of doctors who choose different mainstreams of medical practice seems set to continue.

Career destinations in 1994 of United Kingdom medical graduates of 1983: results of a questionnaire survey.

Cohort studies of doctors' career choices and career progression since the mid-1970s have shown important changes in the medical workforce, in specialist training, and in employment. Examples of these changes are the increasing proportion of women doctors and of doctors who wish to work part time, the emigration patterns of doctors, and the development of vocational training for general practice. Studies enable the effects of longer term changes to be assessed, and sometimes they inform current debate.

Medical manpower two years on.

Medical manpower in Britain, with particular reference to the NHS, was analysed for 1976 and 1977. The output of British medical schools increased. The total of doctors in the NHS rose by 2% between 1975 and 1976 and by 2.4% between 1976 and 1977. The highest and lowest growth rates were in junior and senior hospital staff grades respectively, while the highest growth rate in career grades seemed to be in community medicine and health. The inflow of overseas doctors remained high, though few tended to remain permanently in Britain. Continuous evaluation of the medical manpower position is needed before long-term predictions can confidently be made.

The journey and the arrival.

The present motivation, recruitment and career structure of the specialty of anesthesia in England and Wales in relation to training and the needs of the National Health Service is examined and assessed. Proposals are made for reorganisation and future development.

UK medical school intake and output 1985-99.

Accurate, comprehensive follow up of individual medical students is not currently available. The best aggregate data source is probably the Higher Education Funding Council for England (HEFCE). According to their Medical Return tables, 43 131 students began undergraduate medical studies in the United Kingdom (UK) in the decade 1985-94, and 38 376 doctors qualified from UK medical schools in the decade 1990-99, being 89% of the intake numbers 5 years previously. Continuous monitoring is required to enable medical school intake to be adjusted according to the demand for more doctors.

A follow-up of career preferences.

Of 146 pre-registration house officers in 1972 who answered an enquiry about career preferences, 111 were written to again in 1974. The enquiry yielded 101 comparisons, out of which 65 doctors retained their original first choice of career, 15 opted for their previous second or third choice and 21 gave a completely new first choice. Reappraisal of abilities, additional experience of the new choice of career and additional knowledge of promotion prospects were the commonest reasons given for change of career choice.

A follow-up of the career preferences of Manchester and Sheffield graduates of 1972 and 1973.

Pre-registration house officers who answered enquiries in 1973 and 1974 about career preferences were written to again in 1976. This yielded 205 comparisons, in which 134 (65.5%) doctors retained their original first choice of career, thirty-five (17%) opted for their previous second or third choice and thirty-six (17.5%) gave a completely new choice. The most common reasons for a change in career choice were reappraisal of aptitudes and abilities, altered domestic circumstances, additional knowledge of promotion and career prospects and additional experience of the new choice of career.

Working towards an inclusive curriculum.

The move towards an inclusive model of education presents teachers with the difficulty of differentiating the curriculum for children with speech, language and communication impairments. This paper focuses on the 'WiSaLT Curriculum Appendix'-a tool which can be used by teachers and speech and language therapists to help such children access the mainstream curriculum and to promote improvement in their language and communication skills. As well as highlighting potential areas of difficulty within each attainment target for key stage one, the appendix guides users to specific strategies and activities. Thus the speech and language therapist and teacher can identify which attainment targets might prove problematic for any one child and also have access to ideas which can help.

Future prospects for British graduates and the health service.

What are the prospects, in the National Health Service, for the increasing output of British medical schools? A comparison of the numbers of training and career posts likely to be available in N.H.S. hospitals with the probable requirements of British graduates seeking training suggests that the supply of senior-house-officer and registrar posts will far exceed the demand, so that dependence on overseas doctors is likely to continue. The number of senior-registrar posts should ensure that the present percentage of graduates become consultants, but available consultant posts seem likely to exceed the output of qualified applicants. The only grade for which demand looks likely to exceed supply is the compulsory preregistration grade: in three years' time medical-school output could be greater than the number of approved posts.