A toolkit for trainer appraisal and development.

All GPs are required to undergo formal revalidation and appraisal. Revalidation and re-accreditation assess past performance with a view to licensing future activity. GP trainers have additional responsibilities for delivering high quality education to tomorrow's doctors beyond those of a GP. In order to fulfill this role trainers are required to attend re-accreditation courses by their local educational establishments and will have different needs to those of their doctor role. Course organizers have responsibilities that include the organisation and assurance of quality of the training provided by their scheme. Although there are no absolute definitions of good quality teaching, it is widely accepted that proxy measures for both consulting and teaching are important and definable. In the case of teaching registrars, these include provision for welcoming, inducting and informing new registrars, assessing their needs, and providing a climate in which they can flourish, as well as actually teaching them. This toolkit explores a system of appraisal designed to help trainers achieve these tasks efficiently, using structured feedback from registrars as well as the trainers' own reports as a basis for discussion during an appraisal interview. It contains some hints for interviewers and comments on the likely issues to emerge, as well as the basic tools needed to conduct the process. The toolkit can be adapted for local use. It has been well received by the trainers, and refined in the light of their feedback.

[Early amniocentesis between the 12th-14th week of pregnancy. Clinical experiences with 1,100 cases]. / Die Frühamniozentese zwischen der 12.-14. SSW. Klinische Erfahrungen bei 1100 Fällen.

Information is presented on 1100 early amniocenteses between the 12th and 14th week of gestation, performed at the Evangelisches Krankenhaus Oberhausen over a two year period. In all cases, a sufficient amount of amniotic fluid was obtained. In 99.7%, the cytogenetic diagnosis was successful. In 2.6% (29 patients), an aberrant karyotype was found. The time of cultivation was in the same range as can be observed in standard amniocentesis. The AFP-median measurements correlate with other studies. The spontaneous abortion rate was 0.3%. We conclude, that early amniocentesis can be performed safely and successfully by an experienced surgeon between the 12th to 14th week of gestation.

The impact of livestock-farming on welsh streams: the development and testing of a rapid biological method for use in the assessment and control of organic pollution from farms.

Organic wastes from intensive agriculture are a major cause of surface-water pollution in Great Britain. There are a large number of possible sources for such pollution, and there is a need to target the efforts of pollution-control authorities to the worst-affected parts of catchments. This paper describes the development of a rapid method for the identification of polluted streams based upon the macro-invertebrate fauna. An indicator key was developed by TWINSPAN classification of data from benthic sampling at 55 sites in West Wales. The key requires assessment of the abundance of four macroinvertebrate taxa and of the extent of 'sewage-fungus' growth, all of which can be determined by examination in the field. The key can separate sites into three groups representing different levels of pollution impact as indicated by differences in biotic indices and chemical data. The system was tested successfully at a further 146 sites in West Wales resulting in the notification of 49 farms to the pollution-control authorities. Non-biologists were able to use the key efficiently after a short period of training. A further test involving 51 sites in Devon indicated that the technique may be adaptable to other parts of Great Britain. It is envisaged that indicator systems designed to suit local fauna may have a major role in a pro-active strategy developed to combat pollution from farms because they have potential advantages over more complex biological methods currently in use.

Prenatal diagnosis of monosomy 18 and ring chromosome 18 mosaicism.

The case of monosomy 18/ring chromosome 18 mosaicism which was detected prenatally by amniocentesis is presented. The pregnancy was terminated in week 18. Autopsy showed complex malformation of the fetus consisting of cebocephaly, hypotelorism, microphthalmia, severe defects of brain development, and arrest of placental maturation.

Pseudomonas cepacia 2,2-dialkylglycine decarboxylase. Sequence and expression in Escherichia coli of structural and repressor genes.

A 3969-base pair PstI-PstI fragment of Pseudomonas cepacia DNA containing the gene for the pyridoxal 5'-phosphate dependent 2,2-dialkylglycine decarboxylase (pyruvate) (EC 4.1.1.64) was cloned in Escherichia coli. The insert was sequenced by the dideoxy method using nested deletions from both ends, revealing a central 1302-base pair region that codes for the decarboxylase subunit. The recombinant enzyme was expressed in E. coli, purified to homogeneity, and sequenced at the amino terminus. Also, a cofactor-labeled active site peptide was sequenced. The carboxyl terminus of the deduced amino acid sequence is homologous with the carboxyl terminus of mammalian ornithine aminotransferase; the active site sequence is similar to the active site sequences of several other aminotransferases. No homologies with known decarboxylase sequences could be found. Expression of the decarboxylase gene is negatively controlled by a 687-nucleotide sequence upstream of and diverging from the structural gene. Expression is induced by S-isovaline, 2-methylalanine, and D-2-aminobutanoic acid, but not by glycine, D- or L-alanine, L-2-aminobutanoic acid, R-isovaline, or other alkyl amino acids.

Survey of general practitioners' opinions on the role of radiology in patients with low back pain.

Ninety general practitioners responded to a questionnaire about the role of radiology in patients with low back pain. Their clinical indications for requesting radiographs were mostly in agreement with the opinions of radiologists, but nearly 80% requested investigations for their own or patients' reassurance. Understanding of the terms used by radiologists was good, although 25% thought that acute disc prolapse could be demonstrated on plain films. Previous training in radiology did not seem to influence knowledge. When general practitioners understood radiological terms they had clear therapeutic and specialist referral preferences. Poorly understood terms and those with which they were familiar but unclear about the implications for management were also identified.

Bladder complications in patients receiving cyclophosphamide for systemic lupus erythematosus or rheumatoid arthritis.

The bladder complications of 54 patients treated with oral cyclophosphamide for systemic lupus erythematosus (43) or rheumatoid arthritis (11) were reviewed. During an observation period of 241 patient years, we saw seven cases of acute hemorrhagic cystitis and two cases of transitional cell carcinoma of the bladder. Bladder carcinoma was identified 28 and 60 months after withdrawal of the drug and resulted in the death of one patient. The late-occurring serious toxicities of cyclophosphamide should limit the use of the drug in the treatment of nonmalignant inflammatory rheumatic conditions.