Feasibility of a consultant-led, trainee-delivered urgent laparoscopic cholecystectomy service.

BACKGROUND: Urgent laparoscopic cholecystectomy has become the gold standard for the treatment of acute gallstone disease. Since 2005 we have implemented a consultant-delivered urgent surgical service for this condition. In an attempt to increase the capacity of this service, we have recently introduced a new policy of also allowing selected trainee surgeons to perform urgent laparoscopic cholecystectomy with consultant assistance available on request. The purpose of this study was to audit our initial experience of this new service. METHODS: Patients with acute gallstone disease had their surgery performed by a consultant or a trainee operating independently with consultant assistance available only on request. Allocation was based purely on surgeon availability. The clinical outcomes of 50 consecutive trainee and 50 consecutive consultant cases were compared and an attempt made to identify pre-operative predictors of technically-demanding trainee cases requiring consultant intervention. RESULTS: The mean operating time of trainees was significantly longer than consultants (80 +/- 5 mins vs 55 +/- 4 mins, p <0.001) although the conversion rates for trainees (4%) and consultants (2%) were similar. There were no significant differences between the groups with respect to postoperative morbidity. Of the 50 trainee cases, consultant intervention was required in 12 (24%) cases. There were no statistically significant pre-operative predictors of requirement for consultant assistance. CONCLUSIONS: Urgent laparoscopic cholecystectomy may be performed independently by appropriately skilled trainees within a consultant-led service. Although consultant intervention is often not required, the requirement for consultant assistance cannot be easily predicted based on pre-operative data.

The use of supermarket till receipts to determine the fat and energy intake in a UK population.

OBJECTIVES: To validate the use of supermarket receipts as an index of fat and energy intake in a population that buys most of its food from supermarkets. DESIGN: Cross-sectional, prospective dietary survey - feasibility study. SETTING: Households situated within a 20-mile radius of a large (Tesco) supermarket in Leeds. SUBJECTS: Two hundred and fourteen households who spend >or=60% of their food purse in (Tesco and other) supermarkets. RESULTS: Mean daily household purchase of fat, energy and percentage energy from fat contained in food from supermarkets were 185 g, 19.2 MJ and 35.9%. Mean daily household intakes of fat and energy were 190 g and 20.7 MJ, and 35% of energy was derived from fat. Mean household size was 2.4 persons. The association between the amount of fat and energy purchased from supermarkets and the amount of fat and energy consumed by households was strong. 0.90 MJ (95% confidence interval (CI): 0.8-1.0) of energy were consumed for every 1 MJ purchased from supermarkets and 0.76 g (95% CI: 0.64-0.87) of fat were consumed for every 1 g of fat purchased. CONCLUSIONS: The results show a strong association between estimates of the intakes of fat and energy and percentage energy from fat using 4-day food diaries and 28 days of receipts, in populations who buy most of their food from supermarkets. They also show that the fat content of total food purchases from supermarkets is 35.9% energy from fat compared with 33% energy from fat recommended by the Department of Health. This preliminary research indicates the feasibility of and potential for utilising large quantities of readily available data generated from supermarket checkouts in dietary surveys.