Assessment of ovarian reserve. Ovarian biopsy is not a valid method for the prediction of ovarian reserve.

The evaluation of ovarian reserve, often critical for the elderly infertile woman, is notoriously difficult and inaccurate. The place of ovarian biopsy in this evaluation has been hotly disputed for three decades, but not resolved. To examine the feasibility of ovarian biopsy for this purpose, a project was designed to estimate the total number of oocytes in a human ovary and investigate whether any biopsy regimen is representative of the follicular reserve in an individual. Ovaries removed from patients of reproductive age during operations not involving ovarian pathology were utilized to count the number and type of follicles found in multiple biopsies of 2 and 5 mm and in the whole ovary. Representative results taking into account the total number of follicles found in the whole ovary showed that predicted values based on the biopsies were extremely varied. We concluded that due to the huge variation in the distribution of follicles across the surface of the ovary, there is no place for this procedure in clinical evaluation of reproductive ageing in the individual patient.

Formal education programmes for senior house officers: comparison of experience in three hospital specialties.

This study was designed to compare the attendance rate of senior house officers (SHOs) in three specialties at formal educational events, examine experiences of protected time, use of educational objectives, and perceived barriers to attendance and evaluate differences found in the context of variations in training practice within each specialty. A quantitative questionnaire survey was completed by Trent region SHOs in obstetrics and gynaecology, general medicine, and accident and emergency posts. An independent researcher visited a selection of educational programme events over a two month span, recorded attendances, and administered the questionnaire. Attendance rates ranged from 40.8% of those in obstetrics and gynaecology jobs to 55.4% of those in accident and emergency jobs. The questionnaire findings found that service commitments were a major obstacle to attendance for the majority of those in obstetrics and gynaecology and general medicine jobs, while relatively few of the accident and emergency SHOs specified any barriers. SHOs in accident and emergency jobs had significantly more protected time for education and found educational objectives to be more widely used by senior staff. The findings suggest that the planned integration of formal education programmes with appropriate working pattern systems--in this case full shifts within accident and emergency departments--will result in SHOs receiving a better deal in terms of provision and structure of education.

The work commitments of British general practitioners: a national survey.

Many qualified general practitioners (GPs) are choosing not to become principals. With the current problems in recruitment and retention of GPs, workforce planning for the future of general practice is contingent upon the work commitments of both GP principals and non-principals. A questionnaire survey of 5966 vocationally trained doctors in the UK suggests that shortfalls in the GP workforce will not be alleviated by relying on the non-principal pool increasing their time commitment to general practice work.

Perceptions of flexible training in medicine.

Most flexible trainees believe that their full-time colleagues perceive flexible training as flawed in some way. However, most consultants and full-time trainees actually view flexible trainees and their posts in a positive light.

Staff grade doctors and the consultant ladder: falling off or stepping off?

The majority of the doctors in staff grade posts surveyed had qualified overseas and a substantial proportion were dissatisfied with their posts. Very few doctors had received adequate careers counselling before starting their post and many were concerned at the lack of opportunities for career development.

Low seroconversion for hepatitis C virus (HCV) antibody achieved by universal precautions alone.

Since the cloning of Hepatitis C virus in 1988 positive serology for HCV antibody in haemodialysis populations has been reported at varying rates of 2 to 70%. To date there is no consensus regarding strategies which would curtail spread of HCV in the dialysis unit. In our satellite dialysis programme we implemented Universal Precautions as the sole strategy for containment and HCV monitored closely the outcome of this decisions.

Introducing primary nursing to a satellite dialysis setting in Singapore.

Primary Nursing originated from the University of Minnesota hospitals in the late 1960s. Almost 100 years before, Florence Nightingale defined a "case method" approach to nursing in which she described an individual nurse having responsibility for a given group of patients and dealing with issues relating to health, hygiene and family support.

The similarity between alkaline phosphatase (EC 3.1.3.1) and phytase (EC 3.1.3.8) activities in rat intestine and their importance in phytate-induced zinc deficiency.

1. The activities of alkaline phosphatase (EC 3.1.3.1) and phytase (EC 3.1.3.8) were similarly distributed in the small intestine of rats. Regional differences in activity were reflected by similar differences in the capacity of ligated intestinal segments to hydrolyse phytate in vivo. Activities were greatest in the duodenum and lowest in the terminal ileum. 2. Specific activities of both enzymes were tenfold greater in the brush border fraction of duodenal mucosa compared with entire mucosal homogenates. 3. Brush-border alkaline phosphatase and phytase activities required both magnesium and zinc ions for maximal activity. 4. Zn deficiency induced by feeding a diet low in Zn (0.5 mg Zn/kg) caused similar reductions in activity of both enzymes. 5. Zn deficiency induced by feeding diets marginally adequate in Zn (12 mg/kg) and phytate (10 g/kg) caused reductions in alkaline phosphatase, phytase activities and phytate hydrolysis in vivo. 6. It is suggested that phytase activity is a manifestation of alkaline phosphatase and the significance of this in relation to phytate-induced in Zn deficiency is discussed.

The susceptibility of suckling lambs to zinc toxicity.

1. Suckling lambs maintained for 4 weeks on a milk-substitute diet containing 407 g Toprina yeast/kg dry matter of diet exhibited poor growth, low appetite and extensive renal damage. 2. The batch of yeast used contained 2065 mg zinc/kg. 3. The kidneys of lambs offered a milk diet supplemented with the same Zn content as the yeast-fed diet (32-1 mg Zn/1000 kJ) were similarly affected.