Basic surgical training in the era of the European Working Time Directive: what are the problems and solutions?

BACKGROUND AND AIMS: Imposed reductions in working hours will impact significantly on the ability of surgical trainees to achieve competency. The objective of this study was to obtain the opinions of Scottish surgical trainees concerning the training they receive, in order to inform and guide the development of future, high-standard training programmes. METHODS: An anonymous questionnaire was sent to basic surgical trainees on the Edinburgh, Aberdeen and Dundee Basic Surgical Rotations commencing after August 2002. RESULTS: Thirty six questionnaire responses were analysed. Very few of the returned comments were complimentary to the existing training structure; indeed, most comments demonstrated significant trainee disappointment. Despite "regular" exposure to operative sessions, training tutorials and named consultant trainers, the most common concern was a perceived lack of high-quality, structured, operative exposure and responsibility. Textbooks and journals remain the most frequently utilised learning tools, with high-tech systems such as teleconferencing, videos, CD-ROMS, and DVDs being poorly exploited. CONCLUSIONS: Current surgical training is not meeting the expectation of the majority of its trainees. To solve this problem will require extensive revision of attitudes and current educational format. A greater emphasis on the integration of 21st century learning tools in the training programme may help bridge this gap.

The use of a Giardia vaccine as an immunotherapeutic agent in dogs.

Dogs (n = 13), which had failed to be cured of giardiosis following chemotherapeutic measures, were treated with a Giardia vaccine (2-3 injections). Clinical signs resolved between 16 and 42 days postvaccination and cessation of fecal cyst shedding was between 21 and 70 days. Vaccination is a potential method of treating giardiosis in dogs.

Variation in distances among teats of Holstein cows: implications for automated milking.

Distances among teats were measured immediately prior to and immediately following milking in 912 lactations of 506 Holstein cows to assess variation due to age (parity), stage of lactation, year, and observer. Data were used to simulate success or failure to attach by the Gascoigne Melotte robotic milker. Distance between front teats premilking was nearly twice that for rear teats. When attachment of the cluster to an udder with a particular set of teat distances was simulated, excessive distance between front teats was the most frequent cause of attachment failure for third and later parities. For first parity, extremely narrow distance between rear teats was the most frequent cause of predicted attachment failure. Reduction in teat distances because of milking was proportionately much greater for distance between rear teats (45 to 50%) than for other teat distances (25 to 29%). In a study of 10 Holstein cows measured at milking and at 0, 6, 8, and 12 h after milking, distances among teats increased linearly with time elapsed postmilking. Electronic storage of a profile of a cow for teat distance and adjustments for milking interval and stage of lactation can increase chances for successful cluster attachment.

Variation in milk somatic cells of heifers at first calving.

To evaluate variation in milk somatic cells, 24 primiparous cows (paired by calving date) were sampled during the first 75 d of lactation. Milk somatic cell counts were lowest at 9 to 10 wk. For differential cell counts in milk, only percentage of macrophages changed significantly during first 75 d (33% at 1 wk, 25% at 6 wk, and 34% at 11 wk). Epithelial cells were identified and ranged from 11 to 20% of total. For milk somatic cell count, variation between cows within pairs sampled contemporaneously was small (3 to 24%). However, variation between cows was much greater for the differential cell counts (46% of total for lymphocytes and 34% for epithelial cells). Of 1021 quarter foremilk samples, 26 were positive for major pathogens, but 326 were positive for various species. Prevalence of bacteria was significantly higher during first 10 d after calving. Rear quarters had significantly higher bacterial presence: 47% for left rear versus 21% for left front and 37% for right rear versus 24% for right front. Total milk somatic cell count after first calving appears to depend primarily on differences in temporary factors and is not a stable characteristic of individual cows. Proportions of the different somatic cell types in milk may vary consistently by cow in early first lactation.

Relationship between immunoglobulin concentrations in milk and phagocytosis by bovine neutrophils.

Using bovine neutrophils and radio-labelled Staphylococcus aureus, skim milk samples taken at 4 stages of lactation from the 4 mammary quarters of 48 cows were used in an in vitro phagocytosis assay. Immunoglobulin (Ig) isotype concentrations in the milk samples were estimated by use of an ELISA procedure. To determine associations of Ig concentrations with phagocytosis, correlations, simple regressions, and partial regressions were calculated. Simple correlations were computed between each Ig isotype and phagocytosis percentage for each lactation number stage of lactation category. Ranges of these correlations for IgM, IgG1, IgG2, and IgA were 0.33 to 0.60; -0.16 to 0.43; 0.04 to 0.46; and -0.30 to 0.36, respectively. Correlations for concentrations of IgG2 and IgM with percentage of phagocytosis tended to be slightly higher for samples from older cows, in contrast to the correlations calculated for IgA and IgG1. Multiple regression of percentage of phagocytosis calculated simultaneously on concentrations of the 4 Ig isotypes in the sample indicated that IgM, followed by IgG2 and IgA, was most closely associated with phagocytosis. Partial regression calculated on concentration of IgG1 was not significant. Addition of bacteriologic status of the quarter and somatic cell concentration in the milk sample did not increase accuracy of predicting percentage of phagocytosis, compared with use of Ig concentrations alone. These results supported the attribution of unique modes of action to IgM and IgG2 in promoting phagocytosis by neutrophils.

Comparison of single- and multiple-trait selected sires--response of heifer growth.

Body weights and linear body measurements were on 386 heifers whose sires were selected according to two criteria: 1) Yield, selection only on milk yield Predicted Difference from daughters' first lactations; 2) Merit, selection on a combination of milk yield Predicted Difference (all daughters), udder type, and percentage of daughters leaving herd in first lactation. No significant differences existed between Yield and Merit heifers for body weights at various ages through first calving or in heart girth or withers height through 18 mo of age. Heifers born to dams first parity were lighter at birth but were not significantly different from other parties of dam for weight, withers height, or heart girth at later ages. Differential selection for milk yield as in this study did not change body weight of heifers.

Comparison of single and multiple-trait selected sires. Response in mastitis traits.

Estimated somatic cell counts and incidence mastitis were measured on 163 daughters of two groups of bulls selected by two alternative criteria. Yield bulls were selected solely on progeny test for milk in first lactation; Merit bulls were selected by independent culling levels on fat-corrected milk yield, percent daughters culled in first lactation, and udder type conformation of daughters. Daughters of Yield sires exceeded daughters of Merit sires by 685 kg milk in first lactation. Groups did not differ significantly in measures of clinical mastitis or in measures of estimated cell counts of milk. Also, groups did not differ in kilograms milk discarded because of antibiotic treatment for mastitis, in spite of the large difference in total milk yield. Mean milk discarded per lactation completed was 171 kg, representing 64,243, and 207 g for parities one, two, and three.

Three times a day milking during the first half of lactation.

Three milking frequency treatments were compared: twice daily milking; thrice daily milking until milk dropped below 24 kg; thrice daily milking until milk dropped below 31 kg. Three time milking was at least 45 days but no more than 150 days. Cows (12 to 14 per group) were managed alike except for milking frequency. In early lactation, increased milking had little effect. With time the superiority in yields increased such that cows on three times for 150 days were outproducing two time cows by 20%. Cumulative milk yields were greater for the thrice groups than for the twice group by 5% at 56 days, 11 and 8% at 154 days, 11 and 9% at 182 days, and 10% at 280 days. Fat percentage, adjusted for previous lactation fat percentage, averaged .2 to .3% lower for the cows milked three times until 24 kig but only .1% lower for cows milked thrice until 31 kg. Increased yield was primarily from prolonged peak yield and less subsequent decline. Switching from three to two milkings decreased yield 6 to 8% in the 1st wk. However, three time milking had a positive carryover, apparently due to higher starting yield at the point at which they were switched.

Genetic parameters of several measures of milk flow rate and milking time.

Heritabilities and genetic correlations of milking rate, time, and yield were estimated by intrasire regression of daughter on dam for 252 Holstein pairs. Heritabilities were: lactation yield, .51 +/- .11; peak rate, .47 +/- .11; bucket milk yield, .38 +/- .10; average rate, .37 +/- .12; milk yield to .45 kg/min, .19 +/- .12; total time, .17 +/- .12; duration of peak rate, .10 +/- .10; strip time, .08 +/- .15; yield during peak rate, .07 +/- .11; and strip yield, .01 +/- .17. The genetic correlation of peak rate with lactation milk yield was .69 +/- .08, indicating substantial genetic improvement in milking rate by selecting for milk production. The genetic correlation between total milking time and lactation milk yield was .50 +/- .20, indicating an increase in total milking time due to selection for milk. Direct selection for peak rate would provide an opportunity to reduce total milking time.