No abstract

The population-adjusted number of mastoid procedures for Ontario declined from 7.1 cases per 100,000 in 1986 to 4.1 cases per 100,000 in 2006. During this time the number of both modified radical mastoidectomies and revision mastoid surgeries at UHN increased.

Purpose: To retrospectively assess operative supervision for orthopaedic trainees over an 18 week period when trauma and orthopaedic consultants changed their on call working practice from one week on call to a four day/three day block, during a fortnight period. Outcome: The rota changes had important implications on workload and consultant availability to supervise juniors during operation with a positive effect upon training such that trauma surgery supervision rates increased significantly (p,0.001) after the introduction of these new working arrangements. Working life for consultants and ultimately patient care were also felt to improve and consultants' working hours were closer to the European working hours directives.A t present surgical training is at crossroads with recent implementation of the European Working Time Directive (EWTD), the Calman Training scheme, and now modernising medical careers (MMC) (that is, a shorter working week for fewer years) on the one hand and the preservation of the highest British standards in surgical training on the other. Thus new challenges are emerging because of a shorter length of training with fewer opportunities for hands on experience. These changes have affected training and supervision of junior doctors. 1 Before our audit, nine orthopaedic consultants each had been on call for one week at a time where there had been delays in operating (because of routine commitments), disruption to outpatient clinics, and large numbers of patients admitted. This lead to unpredictability of the workload and consultants were finding it difficult to be present for both trauma and their elective commitments. At that time juniors felt that they were not having a high enough level of supervision. This led to the whole structure of the on call trauma take to be rearranged. Driven by the forthcoming European directive to limit working hours, the consultants elected to change their traditional working practice upon the above stated ''4:3'' split-that is, a continuous four day on call commitment in week one and a three day on call commitment in week two.The new rota has meant that consultants are now either on call from Friday to Monday with ''respite leave'' until the following Thursday, or from Monday to Thursday with ''respite leave'' until the following Monday. New to the system is that while on call, the consultants have a commitment to perform or supervise all trauma cases each weekday until 5 pm, and to be present in the theatre suite at weekends to supervise all juniors on call.During the on call and ''respite'' periods, all routine clinics and operating lists were cancelled for the on call firm. This was intended to allow time the on call consultant extra time for the management of trauma patients, and for operative supervision of junior staff.The aim of this study was to assess the effect of the new 4:3 rota on the working practice of consultants and further the impact on supervision of junior staff operating on trauma patients. Additionally, the study aimed to evaluate consul...

SummaryAn elderly woman, two months after chemotherapy for diffuse large B-cell lymphoma, presented with left-sided otalgia, discharge and facial nerve palsy. MRI showed an active left mastoid infection with an ear canal lesion, likely to be a cholesteatoma. However, a biopsy of the mass showed recurrent high-grade lymphoma. Following diagnosis, the patient opted for palliative care within the community and consequently passed away a few weeks later. BACKGROUND

No abstract