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SUMMARY Two hundred and twenty nine final year medical students were assessed in paediatrics using an objective structured clinical examination (OSCE) and a traditional viva voce examination, and the results were compared with other assessments of the students made during and at the end of the

A family survey was conducted among 909 patients with leukaemia of all types, with the purpose of establishing the incidence of further cases of leukaemia among relatives. Among a total of 41,807 relatives 8,349 were deceased, and the cause of death was objectively confirmed in 5,011. 72 patients had one or more relatives with leukaemia. First degree relatives with leukaemia were much more frequent in families of patients with chronic lymphocytic than in those! of patients with chronic granulocytic leukaemia. The incidence of leukaemia among first degree relatives was established to be 2.8-3.0 times, among more distant relatives about 2.3 times, and overall about 2.5 times that expected. This excess is of the order of that observed in relatives of patients with certain solid tumors. Genetic factors may have accounted for much of the excess incidence in chronic lymphocytic and acute leukaemia, but there was little evidence for a genetic background in chronic granulocytic leukaemia. With the possible exception of one family with muitiple cases, a simple Mendelian mechanism did not appear to be involved in the leukaemia families investigated. It appeared more likely that a polygenic mechanism led to a heightened susceptibility to the disease in these families.

Traditionally we assess students at the end of their 9-week fourth year paediatric training module by means of tutor reports, project marks, multiplechoice questions (MCQ), and viva results. The students are graded as category A (honours potential), B (good average), C (ordinary), D (unsatisfactory), E (very unsatisfactory). Our

The techniques used to examine urine with a view to determining whether or not it is infected vary widely. Although the results produced at any one hospital are usually reproducible and, with experience, interpretable, it is often difficult or impossible to compare accurately these findings with those of any other hospital. This state of affairs is sufficiently disturbing, but there also exists doubt as to whether assessment of pyuria (Stansfeld and Webb, 1953;Stansfeld, 1962) or bacteriuria (Kass, 1956(Kass, , 1957Sanford, Favour, Mao and Harrison, 1956;Pryles, 1960) is better as an indication of infection of urine.These considerations have prompted an investigation into the techniques used to distinguish the presence of a urinary infection and in particular to compare the value of pus cell and bacterial counts and the influence the technique of collection exerts upon them. Selection of PatientsUrine specimens were collected, using several different techniques from two groups of patients.Group I: Infants and children admitted to hospital with conditions other than urinary infection, renal disease or conditions known to affect the cellular or bacterial content of the urine and who were not receiving antibiotic therapy.Group II: Patients whose clinical condition was compatible with a diagnosis of acute urinary infection and from whom the specimen was collected before therapy was undertaken.It is realized that children in Group I were not necessarily 'normal' with respect to their urinary findings, in that they were sick, but it was to distinguish just such children from those who were sick because of a urinary infection that this investigation was primarily undertaken.It is therefore felt that Group I represents a fair control group for comparison with patients suffering from urinary infections.All these specimens were then examined and pus cell and bacterial counts performed on each one. TechniquesIn children of both sexes, who were sufficiently old to be co-operative (usually more than 3 years old) clean specimens of urine were obtained by first thoroughly swabbing the genital skin with an antiseptic solution (aqueous 0 1% chlorhexidine or 1% cetrimide); the child was asked to void urine into a sterile container, and the specimen was immediately refrigerated. At a later stage of the investigation a special sterilized glass tube ( Fig. 1) was used to collect clean specimens from girls, the expanded end of the tube being held over the urethral orifice during micturition; the technique was otherwise as above.In infants and toddlers, those unable or unwilling to co-operate, other techniques were tried. In male infants, after the usual thorough sterilization of the genital skin and glans penis, either a piece of sterilized (autoclaved) Paul's tubing (i in. flat width) with a knot in the distal end or a clean (not necessarily sterile) disposable plastic urine collection bag (Downs) was fixed in position by adhesive plaster. In female infants either a similar plastic bag or another special sterilized glass collector ...

Children who had presented with transient neonatal tyrosinaemia (TNT) were compared with a group of unaffected controls at 7-9 years of age. A comprehensive psychometric assessment revealed significant differences between the groups in adaptive behaviour, psycholinguistic abilities, and speed of learning. In nearly all components of the tests used, higher levels of TNT were associated with lower levels of performance. This study demonstrates that TNT, a condition commonly regarded as benign in the short term, has long-term effects which may be detrimental to the child in school.