A critical evaluation of the electronic surgical logbook

Background  

The Association of Surgeons of Great Britain and Ireland (ASGBI) devised the electronic surgical logbook (version 2.4) for higher trainees in General Surgery enabling trainees to compile a uniform data set of their operative and training experience. This is in use by higher surgical trainees (HST) in the United Kingdom. This logbook permits trainees to submit data centrally into a Regional Analysis Database (RAD). With the implementation of the European Working Time Directive (EWTD) there is need for reliable data to assess the effects of the directive on training. In order to draw meaningful conclusions from the database the quality of data needs to be validated. We critically analysed the RAD in the Yorkshire region for a one-year period.     

Development of the New Lung Allocation System in the United States

This article reviews the development of the new U.S. lung allocation system that took effect in spring 2005. In 1998, the Health Resources and Services Administration of the U.S. Department of Health and Human Services published the Organ Procurement and Transplantation Network (OPTN) Final Rule. Under the rule, which became effective in 2000, the OPTN had to demonstrate that existing allocation policies met certain conditions or change the policies to meet a range of criteria, including broader geographic sharing of organs, reducing the use of waiting time as an allocation criterion and creating equitable organ allocation systems using objective medical criteria and medical urgency to allocate donor organs for transplant. This mandate resulted in reviews of all organ allocation policies, and led to the creation of the Lung Allocation Subcommittee of the OPTN Thoracic Organ Transplantation Committee. This paper reviews the deliberations of the Subcommittee in identifying priorities for a new lung allocation system, the analyses undertaken by the OPTN and the Scientific Registry for Transplant Recipients and the evolution of a new lung allocation system that ranks candidates for lungs based on a Lung Allocation Score, incorporating waiting list and posttransplant survival probabilities.     

Report of the Ad Hoc Committee on Risk Factors for Coronary Artery Bypass Surgery

The Society of Thoracic Surgeons remains greatly concerned about the use of raw mortality data as the sole measure to determine quality of care following coronary artery bypass surgery. Use of such data without consideration of risk factors that are predictors of hospital mortality and of other indices of quality of care is inappropriate and misleading and may adversely affect the care of the high-risk cardiac surgical patient. The Society is committed to the principle of providing the public with accurate information regarding the conduct of coronary artery surgery. However, it believes that the data provided by HCFA do not provide this information and should not be used as the sole index of quality of care following coronary artery bypass surgery.     

Metabolism of the bay-region diol-epoxide of chrysene to a triol-epoxide and the enzyme-catalysed conjugation of these epoxides with glutathione

Metabolic activation of chrysene in mouse skin appears to involver-1,t-2-dihydroxy-t-3,4-oxy-1,2,3,4-tetrahydrochrysene (anti-chrysene-1,2-diol 3, 4-oxide) and 9-hydroxy-r-1,t-2-dihydroxy-t-3, 4-oxy-1,2, 3, 4-tetrahydrochrysene (anti-9-OH-chrysene-1, 2-diol 3,4-oxide). The enzyme-catalysed conjugation of these epoxideswith [³⁵S]glutathione has been studied in experiments in whichthe glutathione conjugates were separated by h.p.l.c. and examinedby fluorescence spectrophotometry. Both anti-chrysene-1, 2-diol3, 4-oxide and anti-9-OH-chrysene-1, 2-diol 3, 4-oxide formedconjugates nonenzymically and both were shown to be substratesfor rat liver glutathione transferases. When anti-chrysene-1,2-diol 3, 4-oxide was incubated with [³⁵S]glutathione and arat liver microsomal metabolizing system, glutathione conjugateswith h.p.l.c. and fluorescence spectral characteristics identicalto those of conjugates formed from both anti-chrysene-1, 2-diol3,4-oxide and anti-9-OH-chrysene-1, 2-diol 3, 4-oxide were detected.This finding provides evidence that anti-chrysene-1, 2-diol3, 4-oxide can be further metabolized to the triolepoxide, anti-9-OH-chrysene-1,2-diol 3, 4-oxide by rat liver microsomal systems.