Postgraduate teaching audit by peer review of videotape recordings.

The effectiveness of peer review in postgraduate medical teaching by hospital consultants using videotape recordings of teaching sessions has been assessed. The technique is useful for routine, infrequent and for 'one off' self-tuition. Participants' assessment of the 'clarity of structure' of teaching sessions and 'abilities to self-analyse' did change but 'mannerisms' did not.

Can selection of medical staff be improved?

Selection procedures for medical staff have been reviewed. Much can be learnt from industrial practices, including the adoption of 'person specifications', improved references, structured interviews and training for interviewers. Possible supplementation with personality assessments is discussed. The clinical (and financial) importance of appointing the best candidate increased with the seniority of the post.

Towards better discharge summaries: brevity and structure.

In an investigation of the communication between Hospital and General Practitioners, 99 General Practitioners were asked by means of a postal questionnaire to state the relative importance they attached to the issues of speed of delivery, format, author, and the content of the discharge summaries. The issue of speed of delivery proved to be a central and recurrent theme in the replies received, with a clear demand for increased speed and efficiency in Hospital-General Practitioner communication. In addition, an overwhelming support was revealed for summaries in the form of short prioritised problem lists, as opposed to longer conventional prose accounts. This response proved to be independent of the style of summary being received by the General Practitioners in the study. With a clear need nationally to improve communication with General Practitioners, consideration should be given to adopting prioritised problem lists as a means of upgrading the quality of data sent to General Practitioners.

Aeromedical evacuations in Papua New Guinea--a case for routine oxygen supplementation in developing countries.

Aeromedical evacuations in developing Third World countries lack the technological support available in developed countries. 125 hospital admissions from such flights over a four-month period in Papua New Guinea have been analysed to show the pattern of medical conditions and flight altitudes involved. In general, the overall pattern reflects the range of medical problems seen in many other developing countries. 36 percent of all patients were deemed to be at risk of hypoxia; on flights below an altitude of 8000 feet (2440m.) this proportion was 50 percent. Supplementary oxygen (but not 100% oxygen) given routinely to all patients would benefit many without handicapping the remainder.

Is "benign intracranial hypertension" really benign?

Hypothalamic-hypophyseal insufficiency has been found in seven of eight patients with so-called benign intracranial hypertension, of whom four showed an inadequate adrenal response to stress. The syndrome of benign intracranial hypertension cannot therefore be considered entirely benign and patients should receive full endocrinological assessment and follow up.

Hypopituitarism in normal-pressure hydrocephalus.

Hypothalamic hypopituitarism has been associated with the intermittent intracranial hypertension of "normal-pressure" hydrocephalus. Six patients with this condition were studied endocrinologically; five showed evidence of hypothalamohypophyseal insufficiency, and, though only one needed treatment, all needed continued assessment of their endocrine state during follow-up. Thus, hypothalamohypophyseal dysfunction is more common than might be expected. Tests of anterior pituitary function should be preformed before surgical intervention, as such dysfunction may adversely affect survival and the response to ventricular shunting.

Cimetidine effects on prolactin release and production.

The effect of cimetidine 1600 mg. daily for three months on prolactin and related hormones is reported. Basal prolactin levels rose slightly but not significantly. There was no change in basal thyroid and sex hormone levels nor in the prolactin, gonadotrophin or thyrotrophin responses to releasing hormone stimulation. Since intravenous cimetidine induces a transient hyperprolactinemia it appears that cimetidine may facilitate release of prolactin but has no effect on its synthesis.

Hypopituitarism and artificial ventilation.

Anterior pituitary gland function was assessed in 50 patients maintained for more than 48 h on a mechanical ventilator. Partial hypopituitarism occurred in 7 patients which did not appear to affect survival and proved transient when subsequently re-assessed. These results indicate that the pituitary infarcts previously reported in such patients are not clinically important.