If you have a burning desire to respond to a paper published in EMJ, why not make use of our ''rapid response'' option? Log on to our web site (www.emjonline. com), find the paper that interests you, and send your response via email by clicking on the ''eLetters option in the box at the top right hand corner. Providing it isn't libellous or obscene, it will be posted within seven days. You can retrieve it by clicking on ''Read eLetters'' on our homepage. The editors will decide as before whether to also publish it in a futher print issue. Are accident and emergency senior house officers getting slower? You sometimes hear people saying that senior house officers (SHOs) in emergency departments are not what they used to be. We studied data collected over a five year period (1996-2001) on the number of patients seen by all SHOs who completed a six month post in our A&E department. The 118 SHOs (62 male and 56 female) worked a full shift rota averaging 52 hours per week. The influence of the sex of the doctor and their future career plan on the number of patients they saw was also assessed. The number of patients seen by each SHO in six months ranged from 1069 to 2659 (mean 1774, SD 346). On average the SHOs working between August 1996 and January 1999 saw 154 more patients than those working between February 1999 and July 2001 (p = 0.015; unpaired t test). Male SHOs saw on average 217.5 patients (range 1121 to 2659) more than female SHOs (range 1069 to 2644) (p = 0.001; unpaired t test). The median number of patients seen by SHOs with a surgical interest was 1831 (interquartile range 1624 to 2024), and by those with a medical one was 1684 (interquartile range 1497 to 1847) (p = 0.042; Mann-Whitney U test). We acknowledge that there have been changes in the delivery of emergency care over the time frame of this study. We did not study the quality of care given by the SHOs and it would be difficult to quantify this. It is possible that the slower SHOs were more thorough but our impression is that some SHOs (male or female) saw a lot of patients with a high standard of care. Our results show that A&E SHOs are seeing fewer patients than they used to. We need to be aware of this and consider the implications for the future of emergency care.
Following ethical approval, we retrospectively reviewed the charts of all patients presenting for surgery at the arthroplasty unit for the period August 2012 to August 2013. The data was compiled using theatre registers and ward admissions. Vitamin D levels are routinely done for patients presenting for elective arthroplasty.
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