Current neurosurgical trainees' perception of the European Working Time Directive and shift work.

The introduction of the shift system in response to the European Working Time Directive has had an enormous impact on the running of neurosurgical units in the UK. This study seeks to establish what provisions are currently in place for out of hours cover and what has been the effect of the introduction of shifts in three main areas: patient safety, training and 'work/life balance'. The on-call registrar at each UK neurosurgical unit was contacted by telephone. Data regarding current emergency provision were sought. Registrars who had worked both on-calls and the shift system during their career as a neurosurgical registrar were asked to make a comparison. Data were collected from all 33 UK units. Twenty-two still use a traditional 24-h on-call system. Twenty-one on-call rotas were classed as non-resident although 12/21 of those officially on non-resident rotas were in fact resident whilst on call. Twenty-two registrars had worked both systems as a neurosurgical registrar. Twenty-one (95.45%) felt that traditional on-calls gave better clinical exposure. Twenty-one (95.45%) felt that on-calls allowed the provision of better patient care. Nineteen (86.36%) felt that on-calls were safer. Thirteen (59.09%) reported that they were more tired when doing shift work than on-calls. Fourteen (63.63%) found that the on-call system gives more useful spare time and more time to deal with family commitments. Current neurosurgery registrars feel the shift system is less safe, harmful to training and worse in terms of work/life balance. More than one-third of units are claiming to have non-resident on-call systems in order to appear compliant with EWTD when registrars are in fact resident.

Tuberculosis in Swaziland: a health needs assessment in preparation for a community-based programme.

This study was undertaken to assess the healthcare needs of people with tuberculosis (TB) in the rural district of Lubombo in Swaziland, with a view to improving the delivery of healthcare services. Qualitative and quantitative methodologies were used to describe the knowledge, attitudes and behaviour of TB patients, the epidemiology of TB, and the strengths and weaknesses of the current TB control programme. The incidence of TB is rising rapidly in this rural region of Swaziland. Poor treatment completion rates indicate low levels of knowledge about the importance of compliance with TB treatment among many other factors. If local health services are to cope with future rising demands, then efforts must be made to implement a community-based TB treatment strategy. Key practical steps in establishing such a programme are discussed, and the experience from Lubombo is used to demonstrate the steps in performing a health needs assessment in a developing country.